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DeGlarati~o~ Ot Donnicile a~d CitEzenship ~
TO TNE STATE AND GCUNTY TAX ASSESSOR. 15o~si
51. ! U~IE COUNTY, fIORIDA:
This is my declaration of Oomicife a~d Citizenship in the State of Flori~a that 1 am filing this day in atowdante a~d
~n conformity with Chapter 22~, Sectio~ 222.17, Florida Statutes.
CULPBPPER YS VA.
1 was formarly a leyal ~esident of
(City) (State)
Warren's Restaurant
and 1 resided at _ However 1 have c.hanged my domicjle
~ (Street and Number)
to and am and have been a bona fide resident of the State of Florida since 6tli day of
December 66 338 Baraclaugh St.
_ _ _ _ , 19 anci 1 reside at „
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citi2enship, actual legal reside~ce and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
ENTERIrG TWO (2) CHILDRETi IN PUBLIC SCHOOLS
CHERYL LYN BROWI~ ( 7) ST ~E~ AND RECORDED
ECOfAlj ~UNTY,
l~pC WADE TNCMAS BROWI~ ( 6~ RlFI~pLA.
,s ~
s aFe
150 IQ : 06
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CIERK CIRCUIT COURT
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I FURTHER CERTIFlf that 1 witl comply with all other requirements of a lega) resident of this State. i
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I FURTHER CERTIFY that 1 have no intention to return to my former domiti~e, and I inten~ to remain in FORT ~
_ ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. €
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(Name ~
1_,,,ui~u~r:~~:• MARLON KAY BROWN ~
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~ " _ 8th December - 66 `
~ . ~o ~ ~ - • 19 . '
' ~k a~lck~s~bscribed before me this day ot . ~
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CUI UitT Notary Public ~
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gy D.C. My ~ommission expires ;
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(To be sxecuted duplicate snd original ~iled with Gerk Circuit Court, and duplisste with Tax Assessor.) ~
° R 160 PACE 4'11 ~
BOOK
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