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TO TH$ STAT& .AND OOUNTY TALC AS8z88Q>R.
$T. LIIOIZ C70UNTY.1~'IAjtIDA:
This is ~ deelarstion of Domidls and (~6enship is the Stets of PSo~ids tbst I am ~ this day in
aa~rdance, sad in conformity with Chapter 2~, 8sstion 2lEE.17, P7orida 3tatates.
I was lor:nerly a kcal resident of ._._.. ~ ~, ~ ~wTe ..
(~s~ 4)
end I resided at_-__ ~~+~---1~*--,~d~..~ __.._. --.-----------------. However, I ba-ve changed my domidle
(StsMt and N~bw)
:~ wau ssaia i-u.'~. ~:'L' ~'~ g Mna ~~ =~~~~ ^t ~ ~t8*L` r! P4n+.i.ia ei.,~- 1.~.h dev n~
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Ho~enber
1r'1'. PIEIaC=
19 dG sad I reside at._ 414 Etil Dr. _____.~~---
[8ltwt a~ Namb~)~
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------ - -----~ti', Florida,
coal
and this statement is to be taken as my decLration of citir~enahip, actual legal residence and domicile in
the '3tate of Florida.
io~i ~~ of ~ to new~domid~voremue o! Loee.~a~o~a~~t ad e~v1~>~s at
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~~. LUCIE COUNTY, rlu,, .;A
STe IACiIE
I FURTHER CERTIFY that I will register at my local address when the reQiatration books reopen,
ana wm~ily with ail other re~airement$ of a le~ai rmideat of this $tat€.
I FURTHER CERTIFY that I have na intention to return to my former domicile, and I intend to remain
in_~-----2'T~__PIE~4Z.__~----------------------~, -~~_LIISZ~____-----------------___County. Florida,
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permanently.
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cro be e:«ntea i~ anD>k.a ana orlsaul m.a ..stzti c~aic cc eomrt, aaa aust~e.a ..ith ra: s.as.or)
before me this------_5t~ay os
A. D. 19.41
BG.-!Q s~i•o~~ ce., mane nt~, rig.