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~eclaration ot Dotnicils a~d ~ Citisenship . T~
TO TNE STATE ANO COUNTY TAX ASSESSOR, 132513 ,
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Thit is my deduatiqi of Oanicile ~nd Citir~nship in th~ SI~N of florida that 1~m filinq thi~ day tn ~ooordana a~d ;
M oonformlly with ChaptN 22~, S~..'tlon 22~.17, Floride Statuhs. ~ . }
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1 w~s formKly a Ipsl r~std~nt of Qpnws~Le,_ New YQrlc
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~ a~d 1~~dsd ~t 12~~~eet I~ake Ro~d . Haw~vK 1 h~w charq~d my domtdl~
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~ - 14th
b a~d am a~d haw b~en a bona fide rosld~nt of ths Stab of Florid~ ii~ day of
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~ Deo. , 19 64, ro,~ 4004 Oleandar Ave.
(Strost and Nun~)
MRT MERCE, tAMlt LUCN tOUNTY, RARIOA
and this Natement i: to be take~ as my dsclaration of c(tizenship, sctual lepal ~esideno~ ~nd domkll~ in th~ Sht~ af Horida.
. ' prua~t hsre aoy pertinent facts, wd~ as sale of propa-ty or bu:i~s, or rolinquishrnsnt~of ~rnploym~M .
~t formsr domid~s, removal of family to new domkile, purchass of homs, ~tc.) .
Eetabl~ihing reeidency
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~ 1965 JAN 14 aM _ . =
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ROGER POITRAS. Cl.ERK r : - ~ _ =
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St. lUC1E COUNTY. f•.,.>>~~'• s;
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~ 1 RJRTHER CHtTIFY thit I will oompiy with atl ofh~r nquinm~nts of a fpal nsid~nt o#-M~b ShN.
i I HIRTHER CERTIFY that 1 hsve no intentio~n b return to my formsr domic~Is, ~nd 1 intend to ~enwln In FORT
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? PIERC~ 5~,11AR'L'tJeIE,C~OUNTY, FLORIDA, psrmsnently. - -
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s S~worn a.nd wbsaibsd b.for• m. ~his - 14th d,y ~ January ~ l9~
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~r ~~'~'K D.C. M~? Qommission ~xpir~s ;
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