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D~cla~ation ot Domicll~ a~d Citts~ship
- ~
TO THE STATE AND ~OUNTY TAX ASSESSOR,
~031~7'
51. LUCIE COUNTY, FIORIDA:
This is my declarotion of Qomicile and Citisenship in ths State of Florida that 1~m filin~ this day in aooord~no~ a~d
in oonformity with Chapter 22?, Sectio~ 222.17, Floride Statute=.
1 was fo~me~ly a legal ?esident of ~~Z-d~'4 ` _
(Ciy) (St~t~)
and 1 resided at - . Howevat 1 have cha~psc! my domiale
(St~eet and Number)
ro a~d am and have been a bo~a fide msident of the State of Florida sinoe 7/ ay of
, 19~0 and t resids at ~ a~
(Street and Numbe~)
FORT PI~CE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citize~ship, attual le~al residenos and domitile in the State of Horfda.
(I~sert here s~y peNinent 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.)
G~ _ .
s~~U1bC1E ~
~~OUiMTIr f~
C~ERII
C RCUIT CalRT
RECORO Y[RIFIEO~,~c.
~ ~ I I 12 06 PM'Ti
2Q316~ .
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~ I FURTHER CfRTIFY that 1 will oomply with all other ~equirerrwntt of a Ipal resldent of this Stah.
3
~ I FURTHER CERTIfY that I have no intention to retum to my former domicjle, and 1 intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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SwRrn to and wbxribed before me this day of C ~ 19~~
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~ =.~y::'~ :~1~1Ta~01~T Notary Public
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6~t v' ~ ~ ~ D.C. My Gommission expires
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~ ~Re ~ in duplicah ~nd o~ieal Al~d wiM~ C1KIc qro~N Carrt, and ~upliah wilb Tax A~o~J
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