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Declaration ot Dort~icile and Citizenship
1482''~'4
TO TNE STATE AND COUNTY TAX ASSESSOR, '
Si . !UClE COUNTY, FLORlDA: ~
This is my dectarotion of Domicile and Citizenship in the State of Florida that 1 am filing this day in aooordancs a~d
im m~formity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of Corinth _ Mississippi
(Ciy) (State)
and 1 resided at ~ _ Rau te 6 _~~„~ever I have changed my domicate
(Street and Number) -
to and am and have been a bona fide tesident of the State of florida since ~ 3~' day of
August 66 Rural Route 3 Box 490-B
- , 19 , and 1 reside at
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actuai fegal residence and domicile in the State of Ho~ida.
(Insert here ar~y 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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~
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Bntering Marsha Fay Baswell in bth Grade .
" 6harlett Basweli in lst Grade r1L~0
ANp RFC
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1 FURTHER CERTiFY that t wilt oomply with all other requirementa of a lega! resident of this State.
I FURTHER CERTIFY that I have no intention to retum to my former domicjle, a~d I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ . . ~
;k;' (Name)
. : " : t:-
• ~ - Herman W. Baswell
_ , s.~ ~
~i - (Address)
; t ~;,~;~Y:,~..~~i -
_ . ":;~~i,; ~::~t 9
,~,~~b a~~ubscribed before me this day of SQptember 19 66
. .
ROCiER PORRAS
ClRCUlT COURT Notary Public
BY D.C. My Commission expires
Ro b~ ~x~cw~d ie duplicab and oripinal fif~d with CIKIc Circuit Court, and dupliu» with Tax Ass~or.)
a oK154 261
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