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~~I~rtt~art uf ~untitile ~ f~'tti~en~~ip ~2~3s
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To the State and County Tax Assessor, ;
1~ COUNTIf, FLORIDA ~
3't. Lucie
This is my Declaration of Domicile and Citizenship in the State of Ftorida that ! am filing this day in actord-
ance, and in confo~mity with Section 222.17, ~ionda Statutes, as ama~ded by Chaptar 2684b, ta~a of 195].
t was formerly a lega! resident of..__. Y41'jC_T4W.0~'11~______________________ ._.__pBOO~Bj~Y~a__-___
c~ti s~.h
and I resided at ---------1~~__Ql~_45~._~r'YlY~_-_-------___Y4?IC_~~5.-----_------A~lj~LB._Al~.
s+...~ .na Nwnb.. s.ca rN ,~e sin.
However, I have changed my Domicile to and am and have been a bona fide resident of the Siate of Florida
since ---91---- day of -OCtO~?~'---------- 19._.~:~, and I reside at
334b2 Lucie
----------~~__~~YIIShil'@__T~8G5-----------P~Y'L__a4t.__L13CLB------------ -----------i'1~D Coun Florida,
sh.e~ ~d N~,~. r~
and this statement is to be taken as my Declaration of Citizenship, actual legat residence and domicile in the
State of Florida. (Insert here any pertihent facts, such as sale of property o~ business, or relinquishment of
employment at former domicile, removal of family to new domicile, purchase of home, etc.)
Owa home at abave Part Sit. Lucle addrees; have aold bueiaess ia
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Fennsylvania; have retired to live ln Flarida
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1 Further Certify that I will register at my local address when the registration books reopen, and comply
with all other requirements of a iegal resident of this State.
I Further Certify that 1 have no intention to return to my former domicile, and 1 intend to remain in
Port 8t. Lucie . S't. Lncie
r_ ~ County, Florida, permanently.
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~ Name - Wif~
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d FIIED AND RECORDEO
' Sworn to and subscribed before me this __,f day aT.LUCtE.C4UNtlf FLA. ~
~ ROCER "r0i?RAS
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i s~ 1~ I~I 9 sz AN'73
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; Notary._ u61i1pr^t~her Official taking Acknowledgment
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: ~ ' C~nRntissiolf egpires
~ e j ~lOTARIf PUSLIC. ST,".TE oi FlOR~DA at ~RRGE
~ ~ 1NY CQN.MIS;i1;iN EXP:}:iS JU'1. 21. 1917
° ~ Bondea Bp Areenc~n Ba,.~.is Insur~nce C~
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