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~ O~aluatlo~ ot Domiall~ and CitlsMShlp
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TO THE STATE AND COUNTY TAX ASSESSOR; ,
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Sl. LUCIE COUNTY, FLORIDA:
This is my decle~ation of Oomicile and CitisMihip in th~ Stat~ of Floiid~ that 1 am filirq thit d~y in aooorda~ and
oo~formity with Chapter ~2Z, Ssttion 222.17, Florid~ Statut~s. ~
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I was form~rly s Ipal reside~t of ~ t-~-
~ (Cty) (Stah)
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and 1 resided at /~/~~'~7 S~ . Hovwver I have tharped my domitjle
(StrNt and Number)
to and am and have been a bons fide ms'ident of N~e Stsro of florida sinoe wf' S~A day of.
_ ~ , 191Q, and 1 roside at T7PA7/SC/P S~ .
(Streft s~d Number)
FORT ~I~CE. SAINT LtlCI~ COUNTY, RORIDA .
and this statement is to be taken as my daclaration of citizenship, actual le~al residenos and domicile in the State of Horida.
(Insen here any perti~ent facts, such a: sale of property or business, or ~elinquishment of employment
at former domicile, removal of family ta new domicile, purchase of home, etc.)
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1 FURTHER CERTIFY fhat I will oomply with ~II othK r~quirwr~ntt of a(pai r~td~nt of this State.
I FURTHER CERTIFY that I have no intention te return to my former domlCile, and 1 intend to ~emain in FORT
P~ERCE, SAINT LUCIE COUNTY, FLORIDA, p~~man~ntly. . D/9Y~ D ,B. JPo c~i e, SR .
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~ FIL~D ANO RECORDEti' -
ST. LUCIE COUNTY. FLA.'
R~CORD VERIFlED .
~ 19`?'27' '
'TO AUG I~ pM 2: 38
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ROvrR ~0lTRAS 7C~
Sworn ro and subat~~e~o~~~hrsOUR~~~ day of 19~~ .
•'~~~i1N~~j~,.-~,~ . .
4a,b~~
y~'f . Notary Public
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8y • • ' ` D.C. My Commisslo~+ .xpi~
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R. • .wr «yiwal tN~i wMh u«k araiM c.~?, a~i ~lie.~. wiM~ T.ac a......a
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