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Deciaration ot Do~nicile and Cttizenshlp ~
TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. LUCIE COUNTY, FLORIDA: ~~5~~~ ~
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in actordance and
~n conformiry with Chapter 222, Section 422.17, Florida Statutes.
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I was 'formerly a legal resident of _ - ~C~Gl~1~ -
(City) ( ate) ~
and I ~esided at _~.3 _ - However I have cha~ged my domicjle
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(Street and Number~
to and am and have been a bona fide resident of the State of Florida since day of
-_,,Y11.C . 2_.~_ _ - 19~_/__, and I reside at _ 1..~ ~O ~ ~ T----
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~eet and IVumber)
PORT PIERCE, SAINT LUCIE COUNTY, fLORIDA ~
and this statement is to be taken as my declaration of citizenship, attual legal residence and domicile in the State of Florida. ~
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(Inser~ here any pertinent 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.)
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oscoK~ER /
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~ I FURTHER CERTIFY that I will comply ~vith ali other requirements of a leya) resident of ihis State.
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~ 1 FURTHER CERTIFY that I have no intention to return to my former domiule, and I intend to remain in FORT
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PIERCE, SAINT LUCIE COllNTY, FIORIDA, permanently.
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~ . Shirley J Reele~
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_ ' . y;~:~ ` Address)
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- , Swom to and subscribed before me this ~ day of , 19~~
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~ER POITRAS
- C K CIRCUIT COURT Notary Public
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By D.C. My Commission expires
(To b~ sxecut~d in duplicate and originsl filed with U~rk Grcuit Court, and duplicate with Tax Ass~s:or.)
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