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O~alaration ot Oomiaii~ a~d Chis~nsltip
TO THE STATE AND COUNTY TAX ASSESSOR,
51. lUC1E ~OUNTY, FLORIDA:
This is my decluation of Oomicil• and Citiunthip in th~ Stats of Florida that 1 am filin~ this day in aooordano~ ~nd
in conformity with Chapter 222, Section 222.17~ Florid~ St~tutet.
1 was formerly a 1e9a1 resident of 111lford Conn.
(Ciry) (State)
arxl 1 ~esided ar ~62 Bridgeport AVe. Hcwever 1 have chan~ed my domicjle
(Street and Numbe~)
b and am and have been a bons fide resident of ths State of Florida :inoe 218 t dey of
April _ ,~9 70, and ~ r~ide ar 2720 No. Fed. H~y; Ft. Pierce, Fla.
(Street ~nd Number) 33450
fORT PI~tCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residenoe a~d domiale in ths Stats of Horida.
(Insert here any pertinent fact:, such as sale of propery ar bu:ineu, or mlinqui~?ment of employm~nt
at former domicile, removal of family ro new domicile, pu~sse of Fw~r~e, etc.)
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` I FURTHER CHtTIFY that I will oomply witfi all otFier nquirameMs of a leqal resid~nt of this State.
I FURTHER CERTIFY that I have no intention b retum to my former domit,ite, and 1 intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently. ~ Q ~
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ffiICHAF.~ T CH S8.
• ~ (Name)
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~ '~.:•••',••-.~4~~~'% 2720 No. Fed. Hwy, Ft. Pierce,
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~ ; Q:~= ~ (Addreu) Florida, 33450
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~ ~~a~.s~s#ibed before me this 18th dsy of January ~q 71
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•./~pt i`~1tAS .
~ CLERK CIRCUfT CQURT Notary Public
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gy D.G. My Commission expires
ae b. .x.cw.a M~pNu~. .nd ..i~ie~sl fil.a ,~ili~ c,.ek ci~a~ c,owf, .~a aup{k.~. w~i~ T.x A~....o.a
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