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Oeclaratlon ot Oomicll• and Cltlsenship 163i351 ~
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TO TNE STATE AND COUNTY TAX ASSESSOR.
Si. lUC1E ~OUNTY, FLORIDA:
This is my declaration of Oomicile and Citi:enship in the State of Florida that i sm filinq this day in aacardanoe and ~
in oonformiy with Chapter 222, Settio~ ~2~,17, Flotida Statuta.
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1 was formerly a lega) resident of Oa~1~II I1 ~^~S ~
(Gi1y) (Stah)
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and 1 resided at ` 9249 SOUth SprOat . However 1 have chanqsd my domicile }
~ (St~eet and Number) -
to and am and have been a bana fide resident of the State of Florida sinoe h day of
_Au~ust , 19 6? , and I ~eside at 217 ~arden Avenue ~
(Street and Numbsr) E
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FORT MERCE, S/1fNT WCIE COUNTY, RORIDA ~
and this statement is to be taken as my declaration of cititenship, actual leqal residence and ~omitils in the State of Horida. ~
(Insert here any pe~tinent facts, such aa aate of property or buaineu, or relinquishment of employment ~
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st former domicile, removal of family to r?ew domicile, purchase of homa, etc.) t
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Sold home and business in Illinois and
xish to applq for hosestead eae~ption
F~~EO AND RECORDED
ST, ~(/~~E COUNTY. F~A,
, REC~o~~3~1Eo
'ss JAN 9 AM II: 01p,~-~~
~,/p. A~',°"~
, rp~ r R ?-vliR~S
CLERK ciRCUrT COURT
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r 1 FURTHER CEitTIFY that 1 will oomply with all other requirements of a le~a) residsnt of this State.
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I fURTHER CERTIFY that I have no intention to retum to my former domi4le, and 1 intend to remai~ in FORT
PtHtCE, SAtNT LUCIE COUNTY, FLORlDA, pe~manently. -
~.,~.s.C C .iY L
~ (Name) Mts.Arthur A~lattsoa
(Catherine)
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(Address)
Swc~tM~to•+~nd subsuibed before me this 9th day of Janugr~v ,~9_~,g
. ~oc~ roinus
' .;CLERK CIRCbtT'COIJRT Notary Public
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6y~-- ~ ' - O.C. My Commission expires
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~To ~ ix~crhd in dup{ieN~ am! oritiinal Hbd wflh Ct~k Cirarif Cou~t, and duplicato with Tax As~uwr.)
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