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Decia~a~ion of D~?r~ic~le ~nd Citiz~nship
269209
"1'O Tli[: STATI: AND COUN7'Y "fAX ASSI=SSOR,
St.Lucie ~
COUN~'Y, 1=LORIDA: ;
• • ~ ;
TI~i. i~ mv declaration of Uanticile and Citi~enship in the State of
Fiorida th:~t 1 am liling this day in ~
~
accorciancc, and in conformity with Section 2'_'2.17, Floricla Statutcs. `
I was to~ly ;i Icgal resident of ~ , and I
~ (C~ r) (state) :
r~sidcd at ~~~_.L_~6~ ~ . However, I have ch ged domi 'le to t
~ (S reet anJ Numbet) ,
and am and have bcen a bona fiicie residcnt of the State of Florida since ay of s
now n ~ ~
-?__;x , I 9 a 1 /residr at L y? --s ~i4~
(Street snd Numberj ~
^ S t. Luc ie County, Fiorida, ;
(City •
I
and this statement is to be taken as m~~ declaration of citizensl~ip, act~~al legal residence and domicile in the State ~
of Fiorida. ~
;
,
(Inseri hcre any prrtinent facts, such u sale ot ptoperty or t+usiness, or relioquishment of employment at fo~mer ~
domicile. temoval ot family to new domicile, purchau ot hom~, ctt.) (
Entering children in school;~~. Homestead Exemption: L_J ~
/r L/ _ . , i ?J ~ ~
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I FURTHER CERT[FY that I~vill register at my local address when the registration books reopen, and
camply with all other requirements of a legal resident of this State.
I F RTHER CERTIFY that I have no intcntion to return to my former domicile, and 1 intend to remain in
, St. Lucie - County,
(cstr) ' `
~ Fiorida, pe anently. r.~~ w N~ e Y?~ ~ e~~ ; n~ ~ ~
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~~,~.•.f~7i.~~~~r~• (Name) ~
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~ v ~ • 1. C ~ I~~ ~.tr~ ; 2 ~ ^
, ` •~`v.tA I.'J ~/tS. • ~ LC 1
C)~ Ft~~~ , ' '~1 r <.~~i (Ad ess) .
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Sv~i o.1~`~``{Q aod sub'se~i~e~ beforc. me thi; o~ day of
- ° ~ Q ~ 73
, ~ ~`~i~1'Qt~. A.n. i9----
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~,'%1~O~R•~; :~ft~S; CLCRK CIitCUIT COURT
•-~-'-~T-r-E+ f-1r ~ .r'
~ "4 .~~'••...,~~~r.,•.~,- <
. "'J' . ~ ~ ~
-~Y - - <--j''~ -l~~+~:t/V 0 R
epu y C]_e ~ODlc~~ F~Gc ~
('io he eaeculed m dupli.~le .~nd urigir~.d 1 d wilh l Ir~t, Circuit ('nurl. -rnd Ju~.li:rtr v~~Ih "fat Assess~.t)