HomeMy WebLinkAbout1814 16457'g . )
Declaration ot Domicile and Citize~ship
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TO THE STATE AND COUNTY TAX ASSESSOR, ~
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51. LUCIE COUNTY, FLORIDA: ~
This is my declaration of Domicile and Citizenship i~ the State ut Flo~ ida that I am filing this day in accordance and ~
~n conformity with Chapter 222, Section 222.17, Florida Statutes. ~
FRBDRICK MD. ~
I was formerly a legal resident of _ _ - - - - ;
~C~ty) (State) ~
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BRADDICK HSIGHTS '
and 1 resided at _ . - - - - - - - - - - - . . . Hov.?-rer I have changed my domi~ile i
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(Street and Number) L
30 =
to and am and have been a bona fide resident of the State of Florida sinc~ _ _ _ day of '
z
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Ma y 215 01ivc dve. '
19_~7 and I reside at - - - - - '
(Street and Number) ~
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FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile ~n the State of Florida_ ;
(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, purci~ase of home, etc.)
FILING FOR HOMBSTEAD PURP06ES
FILEp AND RECORD~O~
ST. LUCIE COUNTY. FI.A."
f:" ^.'~~n ~rri?tF'~[}
~ '68 fE6 19 PM 4:531s4~~g
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` ~-o:;~-?: ~o# ~ r~:.;
~ CLERK CIRCUIT COUR i
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I FURTHER CERTIfY that I will comply with all other requirements of a legal resident of this State.
1 FURTHER CERTIFY that I have no intention to return io my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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• (Name)
BASIL D. B. COFFMArT
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~ ~ - - • (Addressl
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~ y ~ 19 Peb. , 1968
~ . Sworn t+o prc'1-~ubscribed before me this , day of - • ;
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ttOGER POI S - ~
~ CLE(tK RC T OURT Notary Public ~
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~ gy U.C. My Commission expires
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~ (To bs executed i duplicate snd ori~insl filed with Uwk Ci~cuit Cour1, and dupliute with Tax Assessor.)
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~ BooK i70 ~ 1809
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