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Declaration gfT.lii~~T~~~~~tize~:hip
TO THE STATE AND COUNTY TAX ASSESSOR,
$L • L1iC1 a COUNTY, FLORIDA:
This is my declaration of Domicile and Citizsnshlp in tM Sta» of Florida that 1 am filirp this day in acoordanca and
In conformity with Chapter 222, Sactioit 222.17, Florida Statutes.
1 wss formerly a legal resident of_______S~Ii.Y.h_P181Af1ll.1S~-------------, ---I'L@!l_s1_8r31.@Y______
Rny) Aaai
and 1 resided at ___~~~-~-GT-~L-w~ ------------------------------. However, t hsve charged my domkile
b and sm and have been a bona fide resident of the State of Florida since----__U!th __________________ day of
June ---------------------, 19----61and 1 reside at _____1U2O ~ Chipol8_Rd._____--
-----------------------
ah.« ~.a tine..)
Ft,P~erce StaLucie __ county, Florida,
and this statement is b be taken as my declaraYwn of citizenship, actual legal residence and domicile in the Stats of Florida.
(Ime,t Mn any partinant faLtt, wd~ as <ak of popNty a businasa, a ralinqui~trnant of amploymant at tom»r danicila,
ranavd of taenity to naw don+itib. PwthaN of hort'a. NtJ
Establishing residency
1t-18`)6
At~O RE~~~g ~C
fem. .
~ JAN ~5 PM ~ 43
1962 S, ~t~lK
.... OVER pp1 NRy. F~ORIOA
~,, ^,j:
{ : f:. / ~.
..... ~.
1 FURTHER CERTIFY that 1 will register at my local address when the registration books reopen, and comply with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that 1 have no intention to return b my former domicile, and I intend to remain in
_ Fart Pierce. -- - - - _-, - -- - ---St.Lucie- --- - ---- county, Florida,
(City)
permanently.
Robert N. Kerb"an")
Sworn to and subscribed before me this ____ _ _1~ `_ ,~ d of =~'.:-----_-___-.-_ January___ _ _ __ -, lq_ 62
:~,. - : , .
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-RUG PUITRA$ - - - - - -_ ~'-- ~.'- r . ;~•~~; ~:~ :: =- ----- - - --------- - - - - - - -
R ITRAS, CORK CI UIT COURT •! ~ :'; ~ ,= a = Notary Public
~G ~ ` `-
4 '~
~~ L' --- --- -- --- -------- O C~ • 1 ~My Commission expires . - --- -- - ----- ---
Ra w axKVM~ is ~licar. a•d «iaiad t/a%~~ri~ cM.k Circrit ca•.b awJ ~lica» wYr ia: Awar«)
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