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Decto~otion of pomicife ond C~tizenship
TO THE 3'1'ATE AND COUN'l'Y 'TAR AS3I~:SSOR.
St . Lucia CpUpTy~ gi,pgIDp ;
This is mY declantion oi Domicile aAd Citise~abip in tbe State of Fiorida thst I am Alina thi~ d~y ~n
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•aordance. and in conformiqr with Chapter 22Z, Section 222.1T. F7orida Ststutes. :
H~nolulu ~?W~i ~
I waa fornaerly a le~a1 reaident of._._.______...... -
(Stat~) ~
caar~ ~
and I resided at_ 2115. Fern St Iiow~ver. I have chan~d mY domicile ~
(Stnst ~nd Nnmb~:) ~
to and am and hsve ~een a bona Rde reaident o! the State oi Florida siAOe__...4~.--•-- ~Y af ~
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10 Abner Itoai P. . .
--Autust---.-----.._._.__________....._., 19~.. and I reside ai_. ~
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P~rt St. Lucie St. Lucie __.:_.._....County. Florida, ~
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(Ciqr)
and thia atatement ~ to be taken ss a?Y declars?tion oi citisenship. actusl 1a~s1 residence and domicile in ~
the State of Florida. t
(In~ert ber~ W pertiuwL taets. auh u~sl~ oi~ ~yroparty or Dwineu. or raiupy4~a~a?t a~ ~mD1oY~t ~t ~
lorma domieil~. t+~o*al ot i~mtb to n~w doo~kll~. vnxi~a~ at laaa, ~Re.l ~
See attachei c~rreapon~ience • ~
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I F'L)RTHEFt CEBTIFY that I will re~ister at any local sddr~eaa when ti~e re~i~ration booka reopen,
and comply aritb all other requirementa oi a lepcal residet~t ot tbia -State.
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I FUI~THEx CEBTIF'Y tbat I hsve ao int~-.~tion to raturn to my former domicfle, and I intend to remain
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~ Port St. Luci~ ~ St c'e '
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~ pet:.~anently. ~ F~rin S. Usui
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(Nam~)
P.C. Lox 633 Fort Pieres;° i?ioivi~a 33450 ' ~
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Sworn to and aubecribed beiors me thia__L____dsY oi ..~'~~~;~.t:f;~,,~~.~ =;:E j
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- • -Notas~ lie &at~ at Lrp _ c,: :.,~`ft f~r;'.s=F` ~.,,f
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N~ARY Pi)BUC STA?E 4F MI ~ t~~•~"-'r' - y
~iy Commiaaion expirea... ---.jq~ ssourt~ f~;;~~;~~; ~ . ~
: 13 o7~r -~,,,,,H,d„'-i~•~ c ~
(To b~ e:~ent~d b dnollast~ ~d srtsin~l dMd w[ta A~elt Circoit Cerrl. at~ dtivliat~~ wRl ~Tas A~~or) ~
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