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Declaratlon ot Domtcit~ a~d Citize~ship
TO TNE STATE AND COUNTY TAX ASSESSOR. ~6330i
51, IUCIE GOUNTY, FIORIDA:
Yhis is my declaration of Dornicile and Giti:enship in the State of Florida that 1 am filinq this day i~ eccwdanos and
~n conform;ty with Chaprer 2~2, Sect;on 22~.17, Florids Statutes.
I was forme~ly a legal resident of ` G~nr g• i
(City) (Stero)
i
~
and I resided at ~ l~ Chat i l lOn Ro ad However 1 have changed my domicale ~
(Street and Number)
!
to and am and heve been a bona fide ~esident of the Stats of Florida since 20th day of ~
~
- , -.july , 19.~2, and I reside at 1143 Fernindina
(Street and Number)
FORT PIE~CE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be take~ as my declaration of citizenship, actual legal retidence and domicile in fhe State of Ho~ida,
(Insert here any peninent facts, such as sale of property o~ busineu, or ~elinquishm~nt of employment
at former domicile, ~emoval of family to new domicile, purthase of home, etc.)
1
Establishing residence and Mill apply for bomestead ~
FILED AND RECORDED
ST. l.I:C~E COUN7Y. F~A•
H:.^Or^ •J~Flr1ED
~ f.63301
'fi8 J~V 5 P~ 2' 2S
i= •'L~i'~7%•~ ~
CLERK CIRCUIT COUR7
' 1 RIRTHER CERTIFY that I will aomply with all other requirement: of a leyal resident of this State.
; 1 FURTHER CERTIFY that 1 have no intention to retum to my former domi4le, and 1 intend to ~emain in FORT f
F -
PIERCE, SAtNT LUCiE COUNTY, FLORIOA, permanently. ~
~ ;
' :i.::~~~/',',; ~f A
- f(Name)
' ~ ~ ,john W. Allquiet
_ ~ ~ _ _
~ , ' .
~ . ~ _ (Address)
- ~ ~l~
_ C,~~••'' ~ ti~~ _
- re?~}~'subsuibed before me this Sth day of Jan~~ary 19 68 .
,,..r .
ROGE~ fORRAS
, CIRCUR COURT Notary Public ~
~ gY °`'`"'4'~ ~ D.C. My Commission expires
f
.
_ ;
Ro b! ~x~aM~d in dvpliub and oei~iewl ~ with CIKlc Grarif Courf, and dupliuh witb Tax Aswasr.) i
; aoox169 ~z764 ~
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