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TO Tlf~ C[.ERK OF TIIE ClRCUTT COUItT. ~v~ ~j~
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S7. t-UC 1 E Qpv~y. ~,p~p~; -
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'1'Ab b my declaration o~ Domictl~ and Cit~cnahip i~ the St~t~ ot Fb+rida that ~ am C?1ing thu day ia accocd~nee. aad tn
toata~nity with Section 2~.1T, F'laida Slatut~s.
i ~ra ta~m~rt a kgal ~eaide~t o~ ~~c)/e~~/~/~ ~ ~~'/ji'/~1~i tad I
~q~y~ ~s~.a~
tealded at ~E 2
T~ 15~~~ _~~vtvee. t have ehaaged m~r domieile to
Ww~t ~d NYa0K1
aad aas aad Mve beea a boaa Gde resideat ot tt~ Stat~ o! Fbrida aiaa ~•ei'L ,T /9~ . a,r ot ;
,1~~, aad I resid~ at ~~D y~l/.'~~ A~P~~'~ ~i¢iE'.~~ lfJi~
~ IStrMt ~ N~a~b~rl r
~~~QG~-" ~ ST. lUC 1 E Cou4cr,Ftoriea.
lC1t~!
aad thla statement is to be taken u mr deda~atioa o[ citiun~hip. actual kgal re~ideeca and domicile ia tAe Stato oi Ftorid~.
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Ii FOR THE PURPOSE OF ENROIIING Ii FOR HOHEStEAO PURPOSES~
CHILOREN IN SCNOOL~ PIEASE STATE PLEASE CHECK: ~
THEIR NAMES2
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f LEO ~1N0 REC~ROED
S~. LUCIE COUN f1A. -
ROCER POITRA8
C! f.RK C!RCUIT C
vP~IF1E~
APR 13 3 n3 PN'~
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I FUEtTNER CERTIFY that I w~l register at my local addsess when the rcgistration books reopen. and comply with zll_ s
! other tcquirement~ oi a lcgal resident ot thu State. - ' .
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~ I FURTHEIt CERTIFY tl?at I Asve ao intcntion to return to my former domicile. and I intend to remain in
~ • $T . L U C t E ~ Countr. -
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~ Florids, pcrmancati~.
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_ Sworn to ~nd substribcd bcioro mo thi+ day ot ~,~,.,P[~,~~..~
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~ . A.D,19!~~~ .
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e ROGER P01 TR/1S, CLE:RFC OF C IRCUI T COUZT ~ ~ ~
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~ ST. LUCIE COUNTY, FLORtUA ~ ~
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