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D~claration ot Do~nicile and Citisenship
TO THE STATE AN~ COUNTY TAX ASSESSOR. 163i93
Sl. lUC1E ~OUNTY, FtORIDA:
This is my declaratior+ of Domicile and Citiisnship in the Stats of Fio?ida thst i am filing this dsy in acoordance and
~n rnnfo~mity with Ghapter 222, Sectio~ ~Z2,17. Florida Ststutes. ;
~
1 was formerly a legal ~esident of LBUSlq_g !~C]ii ¢an
(City) (Stsro)
{
and I resided at ~ 319 _ Chi130Q ~ti'eet However 1 have changed my donnic,ile ~
(Sireet and Number) j
22nd ~
to and am and have been a bona fide resident of the State of Florida since dsy of !
i
~ s
---i~o~~£ ~ , 19 S~ and I reside at 924 Bluef ish Court~ So 25th ct r et ~
(Street and Number) i
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA ~ ~
and this ststement is to be taken as my declaration of cit+Zenship, ectual Isgal reaidente and domitile in the Stete of Norida.
(Inse~t he~e any pertinent facts, such es sale of property or business, or relinquiahment of employment
at former domicile, removal of family to naw domicilc, purchsse of home, etc.)
~ i
Entering 2 children in school
_
F~~~~ AND RECORDEO
ST, LUCIE COUNTy FLA.
RF CORO VERIFIEp
'6e JAN 2 p js3193 .
J~ Z : 33 .
CLE~j~:,i:•-- S j~Ot''~ .
''~7=Ts?~
RK C~RCUrT COURT
I FURTHER CERTIFY tbat I will comply with all other requi~ements of a le~al resident of this State.
.
I fURTHER CERTIFY that I have no intention b retum to my former domic,ile, and I intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, FLORIDA, permane~tly.
,
~ (Name)
~ - . . = Norma Fletcher ( Mrs. Thomas )
~
' ~ ~ • (Address)
, • y ~ .
V
:~~It~r~~~'.'.
Sworn to and subxribed before me this 2nd day of .ISnaury ~q~$.,
. ,
ROGER l~OITRAS .
CIRCIJq COURT Notary Pubtic
~.~..c.. ~.,~.4.~
g O.C. My Ctsmmiuion expires
lTo b~ uacuhd in dupticat~ and ai~i~al Fil+d wifl~ ~I~eic qe~p~i~ Co~~, aed duplieata wilb Tax Assp~or.)
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