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Declaration of Doeniciie and CitizQnship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the Stato of Florida that I am filing this day in aoordanrA and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of CO~ington
(c;ty)
and 1 resided at
Rt. 3
(Street and Number)
vA
(state)
However 1 have changed my domiGle
to and am and have been a bona fide resident of the State of Florida since Aug. 30 day of
19 60 , and I reside at
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
929 Amberjact Court
(Street and Number)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent facts, such as sale of props:: ry or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
placing children in public school
Paye
Carla/and Ricky Alan Thompson
FILED AND RECORDED
ST. LUCIE COUNTY. FLA.
EZ=:COr~O VER11'IEO
182436
'69 SEP 2 AM II: 23
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f 0 ~E R ~•OITR:+S
CLERK CIRCUIT COURT
•
1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~.
(Na Audrey S Thompson
-,»
~.:1: ~ ~ tri'~,. ..~, ;; .~ :y (address)
. - ry r:
;!,', 1
,'. ~`Q
l~r~'fi~fnd' du~ltribed before me this 2nd day of Sente~ber , 19-b9
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fit: +~~,+6.,-`_ .
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A%R!'~.~1KflA~ _ __
CLERK CIRCUIT COURT
gy D.C.
Notary Public
My Commission expires
Qo be executed in duplicate and original filed with Clerk Cirwit Court, end duplicate with Tax Assessor.)
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