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TO THE STATE AND COUNTY TAX ASSESSOR, -
3t. L•~~i s _ceuNTY, FLORIDA: .
This is my decluatbn of pomidle and Citi~anship to the Sta» of Florida that 1 am filing this day in aooordana and
in conformity with Chap»r ZZ2, Section 4ZZ.17, Florida Status.
msrly a legal resident af------=--~~------- ~-----------------. ---~i0~-------------
1 wss for _
_-• However. 1 haw charged my domidle
and 1 resided at ------I~tr- ~---- ~ ~~ ------------------------
{snr+.e
________ day of
band am and Mw been a bona fide resident of the Sta» of Florida' sinoe___------~~--------
. _ n Marv _, 19_2-, and I rosids at_~--].x.07 ~ ~-~T~~~o----
---------- County, Horida,
------------F..~.Pier --------- -- r
and this statement is to be taken as my declaration of dtianship, actual kyal rosklanoe and domicile in the Sta» of FlorWa.
fK1y MKt1 M i~ Of pfOpMfy Of 61M11MM. Or ~ ~ ~~ M tOf.1Mf d0111k1M,
pmt Inn ~1f1 Pwtl..~.M ; :. .
nmwal d iweMy to ruw dowldM. Pw~~ d ham. McJ - F'''.~+•`""'~,; ~.
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s Grade = w' ~ . ~~.~'- . ,- .
Eatering Larr7 Burke in Fir t _ ~ = ~n
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•i,,~ I ~ JAN 26 ' AM B: 48
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~''~,•,,, ~E ro•• . ~T. L
lopl address when the reRistrstion books reopen, and comply with all
1 FURTHER CERTIFY that t will register at my
other requirements of a legal cesidsnt of this Sta».
I FURTHER CERTIFY that I haw rw intention b return b my former domicile, and I intend b remain in
------_~Y.~+11li~l--------- County, Fbrida,
--~--------~js+a~.lT.4l~---------------------• ---------
permanerNly. : - - v
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