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t~eclaratton o~P C?erhicile and Citiaeen~t~lp ~
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA: ~
This is my declaration of Oomicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a lega! resident of -
(City) (State)
5342 SQringdale
and I resided at _ However I have chenged my domiCile
(Sireet and Number)
b and am and have been a bona fide resident of the State of Florida since __.___211d day of
Febr~iar 66 612 Bmil
- y - - , 19--- - , and ! reside at __T-
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA .
and this statement is to be taken as my declaration o~ citizenship, actual legal residence and domicile in the State of Florida.
y
(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.)
~ntering child in school ~
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~ r _ ~ - 66 ~E6 =9 PM
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. . - - ROGCR F~; ? ~:NS. CI.ERK
Y ~ SZ. LUClE COUNTY,
•~:c..'.t'~~~~ FLORIDA
~
` I FURTHER CERTIFY that I will comply with all other requirements of a lega) resident of this State.
~
F
~ I FURTHER CERTIFY that I have no intention to return fo my former domi~ile, and I intend to remain in FORT
C
~ PIERCE, SAINT_ LUCIE COUNTY, FLORIDA, permanently.
~ _ ' '6~T•.6~ ~ . "
~ . -.`,'jtt~,~f~~i~~j~~~~' ~ a
( - :~''`~l;~ t.'.:.:' 0~~;~, (Name)
I - ~
i` ' S . .
_ _ James D. Boschard ,
` ' ` ' ~ '.r • ~ ~ . ~ .
~ \ ,~~i r i r •v~.:" ~Addf@$5~
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~'•i;.`` ~rr~?~~d~1d wbsuibed before me this 9th day of - Fe~.t
.~~al^y , ~q 66 ,
`~~1tli1~11ti1111~ .
, . ~
ROGER POITRAS
C RK ClRCUIT COURT Notary Public
' gy ~L-~-~-- D.C. ~My Commission expires
(To be executed in duplic~fie and original filad with Clerk Circuit Gourt, and dupliute with Tax Assessor.)
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