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Declaratio~ ot Don~icil• and Citi:eRShip ~
211830
TO THE STATE ANO COUNTY TAX ASSESSOR,
' S1. CUClE COUNTY, FIORIDA: - ~
This is my declaration of Oomicile and Citize~ship in the State of Florida that 1 am filing th;s day in aowrdance and }
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~n tonformity with Chapte~ 222, Settion 224.17, Flo~ids Statutes. "
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1 was formerly a legal ~esidcnt of _ ~~~-.C ~
(City) (Stats)
and 1 ~esided at _---i~~~- However 1 have chanqed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 'Z day of
_~~Y_ , 19~L, and I resida at z l'Z ~
_ (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORlDA _ .
and this slatement is to be taken as my declaratio~ of citizenship, actual legal residenoe and domicile in the State of Florida. ~
(Insert here any pe~tinent facts, such as sale of property or busineu, or relinquishment of employment
at former domicile, removal of ~amily to new domicile, purthase of home, ett.)
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2~1830
f,~EO •NO aECOaoEo
51 IUC~E COUMTY FlA •
RO~~p PO1tRAS
clEaK c~~cu1T couRT
RECORO VEA~FtEO~ _
~ ~ 3 59 PI~'~ ~
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_
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I FURTHER CERTIFY that 1 will comply with all other requiremenh of~ alaQal resident
o~this State.
I FURTHER CERTlFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCiF COUNTY, FlORFOAtpe~manently. _
C~,~.~ ~~i~..~~=
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; ~ , i1 tt:1::: - (NarrlC) .
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- - ,2 C~i...-~
' (Address)
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Sworn tq.-5n'Q ~ubsuibed before me this day of , 19~.
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ROGER rO1TRAS ~
CIRCUIT OURT Notary Public
o~l.c.-L. ~
By D.C. My Commission expires
(To b~ ~x~cut~d ie duplieah and oriyinal fil~d with Cl~rlc Gnvif Court, and duplieal~ witb Tau Aa~aer.)
- - ~a~~ 193 2~~~