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Declaration ot Do~nicile and Cit~ze~ship
TQ 'fHE STATE ~4ND COUNTY 7AX ASSESSOR,
51. LUCIE COUN'CY, FLORIDA: !1~ ~ ~ ~
This is my dectaration of Domicile and Citize~ship in the State of Florida that t am filing this day in accordance and
in conform+ty with Chapter 222, Section 222.17, Florida Statules.
I was formerly a Icgal resident of H111CICSt H~~~~1tS______ ~'~irvland
(City) ~State)
and i resided at ___5811 St, Clair Drive . Nowe~e~ 1 heve changed my domitjle
(5lreet and Number)
to and am and have been a bona fide resident of the State of Flarida since l~tb _ _ day of
October 65 169 Bstis x I.ant
. _ _ - 19.__ - and I reside af - - - -
(Strect and Number)
F{!RT PtERCE, SAINt WCIE COUNTY, FLORIDA
,1. ~ , .
and this statement is to be taken as my declaration of citizenship, actual legal res+dence and domititp'i+~'l~.State;ofi
Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment~bf;.e nt .
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at formar domicile, removal of family to new domicile, purchase of home, etc.) '
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~BRING TWO CZ) CHILDREN IN PUBLIC SCHOOL.S
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.
Joan Sherrie Goveart 14 qrs.
Ronald Edw~,rd Gaveart 6 yrs. ~~a" R~C~;'RDEO
V~-~
O ~ K
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ST. ~U~j ' r.',;; ~~C~;K
~ COU~JTY,
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I FURTHER CERTIFY that ! will comply with ail other requirements of a legal resident of this State.
I FUR7HER CERTlFY tt~ar ! have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanentiy.
~
(Name)j,piS Ix~11e Goveart
;~`'~~~~~.:::;,~r,i
~ ~'c~~;: r" ~ 169 Es,tia Lane, Ft. Pi~zce P la.
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:
~ ' ~ ; ~ • 'r (Address)
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•_.~iiior~,tb,.~p~! 3vbscribed before me this llth day of - ~t ,
. , ~ ~ t9_. 6~
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~ r~+w0alk~~bITRAS
I ~ cntcui T -
Notary Public
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~Y D.C. My Cpmmiss~on expires
(Ta be extc~ited in dupJi~cata and ori~ina! ~ilacl with Clerk Circuif Court, snd duplica» with Ta~c Asses+~or.)
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