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TO THE STATE AND COUNTY TAX It-SSESSOR.
St. Iaeie ccx,NTM, aORIDI~
This is my dederation of Domicile end CMlao~aldp In tM 3taN of Florida that 1 am filing thb day In eooordanoe and
in conformity with CMpter 2~4, Section 2Y1.17, Florida SRatul~s.
1 was formerly a Ipal resident of____-- El~iart -----------=--r---_-----. ---Indiana «-----_-
tn~yl peMl
and 1 resided at 311 Mi>ndsor Street ____, ~~er, I-haw durpsd my domldle
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{i1r.N and PM~b.r)
to and am and have been a bona fide resident of tM State of Florida sinos__~__-_~ _____________________ day of
October _____, t9____"~+snd 1 reside at ___ 141 Bonita Court L-Port
------------------------------------ ~ .nd t~neb.d
_-- St. _Lucis~_Fort Pierce - ~__ St~_Luci°--____-- ca,my, Florida,
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and this statement is to be taken as my dedaration of dtirenship, actual kRal resldenoe and domicile in the State of Florida.
(IroaA Mra any partYnnt facb, suds a ula of propa~y w bwkw~. a nllnquWinwM of a+nploymarM at tonnar donddla, ."
nnnoval of fondly fo new donddla, pncAaw d tanw a1t-1
Applying forbo>neatead
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FILED: AND RECORD -~~-: ~ ~ ~.: =~:. -
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19b1 JAN I I AM I I: 26 - -. ~ ;.. ~-. ~. ~: •
ROGER POITRAS, ClE ," ~~ ,,~''••~~~~ :~' - •
Si. LUCIE COUNtY lQ ~p^ ~= ~',-; -••••-'`.•~` -
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1 FURTHER CERTIFY that 1 will register at my local address when the regiltration books reopen, and comply with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
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_ - St. Lucie ___ County, Florida,
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Sworn to and subxribed before me this__________ u_____day of ____ J~~~____________________, 19_ 62
___ Roger PQitras,~lsrk___________
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ROG€R POITR~IERK CIRCUIT COURT Notary Public
BY -- - -~,-- -~-,-,----- ~ •------------ - D.C. My Commission expires--------------------------
(rn M .:.sMd V ~Ysna ad arlei.d IW ~rM~ elark CYei CarA, a~ ~M. ~raU Ta: AwwM
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