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TO Tl[E CLERK OFTt1E CIRCUIT COUttT.
ST. L UC i E CpU~y~ ~,ORIDA: .
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Thb ia my declaration oI Domicile and Citize~ahip in the State ot Flonda that I ara Ciling this day in accordance, and in
eontocmity wieh Section ~2.17, Florida Statutes.
I~ru tarmerl a legat re~ident ot ~ c~! ~ ~'Sr~ ~k-, ~ Y`^~-- and I
. '7 1CU71 ' lStat~) ~
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rtsided at c~ i~ c~-- Ho~rever. I~ave changed my domicile to ~
(Stre~t ud Num~r) ~
aad un and have been a bona Cde reaide~t ot tAe Sute ot Fbrida ~ince ~ 9- G~' day of
19_.. and 1 reside at ~ d 7 ~~u/J
~ f't}t 2L L- ~ 7-~ ~ ST . L UC I Ese~.e.sa ev~meu~
co~,~cr. Fbrid~.
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and this stntement u to be talcen as my declaration o[ citizea~hip. actual legai reaidence and domicile in the Siate ot Fbridn.
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IF FOR THE PURPOSE OF ENROIIING If FOR HOME57EA0 PURPOSES~
CNIIOREN IN SCHOOL~ P~EASE STATE P~EASE CHECK;
THEIR NAM~S:
FIlEO AMD itECORDEC
ST.IUC~E COUMTY flI
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T~ i S DO~~ I C! LE I 5 TO ESTAaL i SF~ ThAT r~~Y DtiUG~:TE~, SA~aDRA G I LL NANLOR
; W;-!0 RESIDES W~TH t~1~ ~S~ AND HAS BEEN A RESIDEyT OF TH~S COUNTY
! SINCE.HER 81RTFi 0~ 9/24/50. .
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E I FURTHER CERTIFY that I will register at mq local address w hen the registration books reopen, and comply with all
other cequirements ot s legel resident of this State.
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~ I FURTHE;~ CERTIFY that I hsve ao intention to return to my former domicile, and I intend to remain in
' $ T. ~ U C I E • County,
(Cit~) . _
~ Flarida, Qetmanen~i;. ' ~
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= Sw•orn to and subscribed betore me this _ (T ~ir ~ ~ ~'--2 ~ e%, ~/C~2c j
~ day oI
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_ - . A.D.19~ .
';i R P01 TRAS,~ LERK OF C IRCUI T_ COU2T
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ST. LUC i E COUNtY, 'FLUR t UA •
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PUTY IERK 1~
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