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Declaration of Domicile and Citizenship
TO THE S~ATE AND COUNTY TAX ASSESSOR,
n. R:
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8
404
::>T.., U,JClR:OUNTY, FLORIDA:
\ T. LUCIE ClilJNTr\ FLA,
This is my declaration of Domici~ and Citizensh:p in the S:<Ile of Florida that I am filing thi. day in accordllnce,
and in conformity with Chapter 222. Section 222.17, Florida Statutes,
(Cily)
ARKA~;S^S
(SI.le)
I was formerly a le~al resident of
HUGHES
and I resided at
However, I have changed my domicile
(StrHI .nd Nvmb.,)
to and am and have been a bona fide resident of the State of Florida since 10th
, (To Flant City) March 5th, '961 to
Jmu:.'.ry . 19 ~O ,and I re~ide is: 1811 S. 37th ~t..
(St'Hl .nd Numb.,)
day of
Ft Pierce
Fort Pierce
St. Lucie
County, Florida,
(City)
and this statement is to be take" as my declllrlltion of citizenship, actual leg!II residence and domicile in the State
of Florida,
(lrue,l he,. any pertinenl I.CII, wch .. ..Ie 01 properly or b<nine.., 01 relinqvilh~nt of employ"""l .1 forme, domicile.
remo".' of f.mily 10 new cY.>micile, purch... of home, .IC,)
Entering three children in public school.
1- Doy~e Gene Coots
2- Nancy Marie Coots
)_ Carl Coots, Jr.
9(1243 "
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RGGEr\ POITRAS. Cl[f.K
Sl.lUClf. CIlUHl1. flORIO~
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen. and 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 domicile. and I intend to remain in - -- - --
.E.or_t pJ..erce .--.-
_ _ _ $t. Luci~
County, Florida.
(City)
permanently.
1}L~_f:-__~. , e~t:r
(N.me)
Leo Coots
(Ad,-flOU)
. "
Sworn to and subscribed before me this_ 18th-- day of e,;..... -- A.pri~-:. ".~-":_=-'~~;I.:"'<' ,19. 61
_..___.______n' /~ cv.iI;,~-, _'.L~/!~,
ROGER POiTRAS, ClE-RK (IReliii-couRT-- -- / ~-'-'''~of~~;'' --i \' '~ .. .-
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By __ _. ' -- 'n ___ __ ___ __ .. , _.. .... _ _ u .... D.C. My Commission expire5 '- ", '.l._~., :.LY#?,_. :>....;,
. ,Jt ~ .. 4 ......
(To bo executed ift d",liut. ....eI o,itIi....1 filed witt, CIorI< ~i(Cuit C.."", ....d d~IIu..' ~.,~~. ~_).
...CD, Fi. "I!:"CE