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Declaratio~ ot Damicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR, j
S~. LUCIE COUNTY, FIORIDA:
This is my deciaration of ~omiciie and Citizenship in the State of Florids that 1 am filiny this day in acoordance snd
in conformiry with Chapte~ 222, Section 222.17, Florida Statutes.
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I was forme~ly a leqal reside~t of ~130 .
(C~y) (State)
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and 1 resided at xonte 9 Hoz T A . However I have chsnged my domitile ~
(Street ar~d Number) 3
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ro and am and have bee~ a bona fide ~esident of the State of Florida sinoe Nov~ember - day of ~
_ , 19~_, and I reside at 72~' T~ling I~ing 8,oad
(Street and I~umber)
FORT PIERCE, SAINT LUCIE COUNTY, FIORIDA
and this statement is to be taken as my decla~ation of citizenship, actual lega) residente and domicile in the State of Ho~ida.
(Insen here any pertinent fads, such as sale of property or busineu, or relinquishme~t of employme~t
at fo~mer domicile, ~emovsl of fsmily to new aomicile, purchase of home, etc.)
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~ Filing for ho.estead ezemgrtion
FILEO ~~lD RECORDED
LUC~E ~OU'vTY. FL~.
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'70 t~pR 12 PN 12 : 0 ~ ~
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'^~::,'~T ~OU~T ~
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i FURTHER CERTIFlf that I will comply with all other reqviremenri of a leqal'resideM of this State. ~
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1 FURTHER CERTIFY that 1 have no intention fo return fo my former domicjle, and i intend to remain in FBRT
WERCE, SAtNT LUCIE COUNTY-,-FLOR{DA;-permaner~tly. - - - ~
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(Name) g~bert B. 1[urphy ~
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(Address) ~
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$~eras~;to ~and suburibed before me this 12 day of ~r~ , 19~. ±
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_ .~p'~E' ~,~~T~:~ .
, =~G~t~CiRCUl~',COU~tT Notary Pubtic
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B~; _ r D.C. My Commission expires
Stirc~',.y,,~=t:
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(To b~ ixicuted in duplicate and ori~inal filed with GKk C~rwif Court, ~nd duptiat~ with Tax Ass~s~ora
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