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D I . f D STo1LUC!1 Cc.u~", ~U. h.
ac earction 0 omlCI e ul10 \-Itizens 'p
TO TIlE STATE AND COUNTY TAX ASSESSOR,
J ame~ E. \'.'ard
ST. LUCIE
COUNTY, FLORIDA: '.
'l"hia !.I my declaration of Domicile and Citizenahip in the State of Florida that I am filing this day in
accordance, ADd in conformity with Chapter 222, SectJ.)n 2.."2.17, Florida Statutes.
I was t\)nn~r\y a legal reaid"nt. cf..______CRAB___ORCHARD._______._._.___u_.___..'__, ,WEST..,Y.IRGlNll_______.
(Cit)') (Stat6)
..ond 1 re3ided at____.., _____.,.._____________._.._.______.______________..,__..._.____.,...,... Howe-~er, I have changed my domicile
(Street aDd Numo..r)
to and am and have been a bona fide reaid~Ht of the Sta~ of FlOlida since_,___24, th __ ,.. ______..__ day of
.__.___l'.~~~_~IT_.____,___._______,___.___, 19.Ql_., ana I reside aL__,2.,Q~LO.ranga...Ay.enwL--..- ._________.....____..._____..
{Street and Number)
.____.____.F.ort..ri~rc.e......____u__,_.~_ __.m_._' __,__.___St...- Lul" i 9.._______....___________.___....__COunty, Florirla,
(City)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the State of Florida.
(lnaert here any pertinent facta, luc:h .. IIIJ. of property or buaiDeu. or nlinquiahment of employment at
former domien.. removal of family to new domlc:U.. purehu. 01 home, etc.)
9~989
FI~ES jN~ ~\~COROEO
I~!q--~~OK, ~
196; I~AR -9 AM 9: 28
ROGER POITRAS, CLERK
ST. LUCIE CCU~HY, fLO~IJA .:-,,\\.-":",
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I FURTHER CERTIFY that I will regiAter at my local addl"El8l' when the reri-~tr&tion books reopen,
and comply with all other requ.iamenta ot a legal resident of th1a State. ,
I FURTHER CERTIFY that I hav~ no intention to return to my former domicile, and I intend to romain
in.Jort Pi_~r~~,
permanently.
__~t..-...w.dL_________County, Florida,
L~ OA'-'~~ & ~~__,___.__
~L.WV_"':- (Name)
James E. War-d
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