HomeMy WebLinkAbout1097 ~
Qeci~.~ ~~i~ ~ a~ ~~or ~ ~~~td ~5~i~.~~:~~~~ ~~i~ .
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~ u'i lit: STATI: nnu cUUN~'Y 1~n~ nss~~:ssoii, 26'?'39'~ '
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st .Lucie _ _ c.o~:r~~~Y, ~~~.o~z~un: ~ ~
Tliis is tnp dcclaratiun ~r no,»;~~i~ ;?iid Citizcn.hi~~ in thr Statc of rloricta that 1:un filin~; this day iii ~
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;~c~or~iance, and in confonnity ~vith Scrtion ~~2.17; ~l~rida Statutes.
I was formcrly a Icgai resiclrnt of Q~~~~'~~_ , and I
~ (c~ir) sw~e)
n~sidcd at 1,~ .~D Howcver, 1 have changcd my domicile to
($t~eet and Number) _
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;snd am and havc bccn a bon.i fide residcnt of thc Statc of rlorida since day ot'
now
_ , 19~,~and 1/residc at 2r_~ 4~
_ _ . (s««~ ~a h~ .
~`~jf . St . Lucie County, rlorida,
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and this statement is to be taken as my dedaration of citi~e~iship, act~~at legal residence and doiiiicile in the State
of Florida. '
(insert here any pertinrnt facts, such as sala of property or business, or relirtqoishrnent of employment at forme~
domicile~ removal of tarnily to ne~v domicilc, purchase ot home, etc_)
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CLERI(' ~~~~fTRAS
Rf~pRn y`k~~~~o COUAT
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26~39~ . ff
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; I FURTHER CERTIFY that I wil! rcgister at my local address when the rcgistration books reopen, and
; comply with all other requirements of a legai resident of this State. . ~
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~ I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
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; ~~~j~ p o ~ ~ S* , Lucie , County, ~ `
` Fiorida, pcrmancntiy,.. cc~~r~ .
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~~;v ~ '#C~G (lrsme) - j{
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i r7- r 1 . ' (AddtCSS) ~ ~.~~5~ ~i
- ~,,,j;_{' "l~'~ s~ . _ : . ;
voni;tqaqd ~iiii's~rihe;~l.b~forc me this day ot
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' ,'~~'G:~~;F~e~C~'_ , A.D. 19-73 . ~
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ROGCR POITRAS, CLERK CIRCUIT COUR ~
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(Tu be eteculeJ in Jup(irrte anJ ~~in.d t~l~d ~crth l'lerk Citcui! Cuutl. ~ud duplir~lr ~~~(h '1'a~ Assesu~r) ! '
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