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~ec~arat~c~n ot D~e~icile ~nt! Cifti~ensttip .1 ~~.1 ~3~15 -
TO THE STATE RND LOUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
in~s is i~iy cieciaraliuri oi iiutiii~iie nriu ~..iiiZCiiSi}j~7 ir, iiiC .Si.3t~z af (Ic~rid-a ihai ! am f~Iittt~ =~2t~ ~:~y in L~~~rd~r.LQ ~n~ t
in conformity with Chapter 222, Section 222.17, Florida Statutes.
Bran~ 65 NAV Y~,~k
I was formeriy a iegai resident oi - - - - ~
(City) (State)
?2 SU1188t, TI`21~1, However I have chan ed m domiGile
and I resi~ed at - - - - - - ~ 9 Y
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 3____ day of
s
Marah IGC t2'!9 ~.re..„e v ~
- - - - - ~
- - - - - , 19-'__ _ , and I reside at Li---------
(Street and Number)
FORT PlERCE, SAINT LUCIE COUNTV, FLORIDA 4
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and this statement is to be taken as my declaration of citizenship, aciual legal residence and domicile in the State of Florida. i
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
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3 F~lL~~ AND RECC} p~~ ~
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Fatablishing residence
'66 JAN 6 • ' ~
II.S2 ;
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- 7 ~ ROGE?? ~-r;~~:;. CLERK ~ ~
. ~T. LUCI~ COU~~lTY, ~
F~OF2tDA
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I FURTHER CERTIFY that I wili comply with all other requirements of a legal resident of this State. ~
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} I FURTHER CERTIFY that I have no intention to return to r.~y former domi~ile, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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; ' ~ .l • ~ G~~~~-lG~-C.,' I
k ~J,: ~ ' • , (Name)
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_ , , James Calhoun
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Sworn to and subscribed before me this 6 day of - Jan~~ , 19 66 .
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ROGER POiTRAS
C RK CIRCU! COURT Notary Public
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' gy D.C. My Commission expires j
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fTo (=e executed in dupticate anci originai filed with Clerk Circuit Court, and duplicate with Tax Asssssor.) ~
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soox ~35 4fi~