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~~,:'Thls is s~ dsdsration e[ Damie~e and 4~aenship is the Stab d 1:7orida that I ~l thb d~ k aooordanos. and k.
- _ ooatermif,T wkh Section P~t.1T.1:7orida Statutes. ,
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I was f mer a kcal resident d~ j.Q~.__
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reaia.a at S. S E l l OA N ~ e T 5 a _ Sowe.es.Ih.w ehaaS.a aomieliato
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_ and am and have been a bona tde resident d the Stab d Florida since ~ _ ~ ST' - daj d
'Tw e . i!__L..t.. and I reside at ~`!"T ~ 1~5 ~S ~.A r.7 tJ ~e urE
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and this statement is to be taken as ~ declaration d dtisenship, actual legal residence and domicile is the State d Florida.
IF FOR THE PURPOSE Oi ENROLLING IF FOR HOMESTEAD-PURPOSES,
CNILOREN IN SCHOOt.,~P~EASE STATE PLEASE CHECK:
THEIR NAMESS y~
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I F[JBTIiER (~RTg'Y that I w~11 register at m~ loin address when the registration boob reopen. and oomph with aD
other req~emeats d a kgal resident d this State.
€ I 1`'I1A1'~ C~TII~R the I have m intention to return to my former domieik, and I iIItead to remain in
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sworn to and subsa,'bed before me this ~ ~ daj d c~. _
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