HomeMy WebLinkAbout2530 y~
Declaration ot Domicile ~~d Citizenship
TO THE STATE AND ~OUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FIORIDA: ~~+V~g
This is my declaration of Domicile a~d Citizenship in the State of Florida Ihat 1 am filing this day in actordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerl a I Guilford N. Y.
Y e9a1 resident of - - - -
(City) (State)
I,ake Road
and 1 resided as _ _ _ _ _ _ . Howeve~ 1 have changed my domiCile
(Street and Number)
to and am and have been a bona fide ~esident of the State of Florida since ~CtOb@r 15 day of
~9?l__, and I reside at -__13~3 Bayahore Drive
(Street and Number)
FORT PlERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pe~tinent 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.)
hoaeatead ~
CI~RK C R~~t_
.RECORO VEPI#Ifp~,~...,.
MAR ta• Il: o~ ~.M
~ 226349
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$ 1 FURTHER CERTIFY that I will comply with all other requirements of a lega) resident of this State.
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~ I FURTiiER CERTIFY that 1 have no intention to retum to my former domic,ile, and I intend to remain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ ( t~
~ .i ~-Q~ ~ w,
~ (Name)
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~ ~ Rolland M. Purd~
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_ ,~j~~ (Address)
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Sworn to si~~l-subscribed before me this 28 day of ~~TCh ~ 19 72
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_ . RQ¢Elt • ~OiiTRAS
~ 4E~ ~IRtt1JIT COU Notary Public
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By ~.C. My Commission expires
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(To b~ ~x~cwsd in dupliut~ and oripieal fil«f with CINk G~wit Cour1, and duplicst~ with Tax Ass~s~or.)
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e~4 aooK 20U ~E~529
No. 13 A
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