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O~I~ratlon ot Domicii• and Citts~nship 1~Z6$
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TO TIIE STATE MID COUNTY T/1X ASSESSOR, '
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n. ~ucie couHnr. aoRio~: ~ . `
Thls is my dsclarstlo~ of Domidl~ and Clti~nship in th~ Stat~ of Florida M?~t 1 un filinq thi~ day 1~ ~ooordana and
i~ aonformity witfi Chaph? 4ZZ, S~ction 222.17, Hortd~ Statura. .
1 was formKly a Ipal rosident of ~ug] ae ' Geor~3 ~
. ~ (CitY) (Stat~)
and 1 hsid~d ~t _ 609 Wes t Ward St~~ t~, . HowwK 1 haw dunp~d my domidl~ ~
(Stntt and Numbsr) .
b and am ~nd h~w bs~n ~ bona fid~ ~idsnt of the St~ts of Florida sinoe lSth
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~~n4zr.! ti 19_b.5-, and 1 rsslde at 25
a~ Numb~r)
1'ORT MERil. S~AINT LUCIE COUNTY, RORIDA
a+~d this staternent is to be taksn as my dedantion of dti~sn=hip, actval iegd retidenos ~nd domidle in th~ SfaN of Horida. i
p~usrt here any pertinent facts, such as sale of property or buiins:s, or rolinqui~raent'of emptoym~nt ~
at formar domicile, removsl of family to nsw domicile, purchase of 1+orr~e, etc.)
~ntering Msr~ Blizabeth Hsrper in the llth grzde.
. _ ~~~~11~17~+n~ ~a~1.V0?
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A~ RECORQED . , ~ .
IN ' t..Beoo~dr.-eQI~ •d •
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1965 fEB -9 PM 2: OT . - ~ _ - . : N ~ .
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ROGEk PAI7RAS t~.ERK o;:
St. LIkIE ~~UNtY. ~L1RlAA ~ ~ ••:::'.~'S•' ~
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rw.r. . . a ~ ~ : . _ . . .r
' i RJRTHER CERTIFY that 1 will oomply wMh ell otfi~r nquinm~Ms of a Ip~l n~Id~M o~ thb Stah.
1 FURTHER CERTIFY th~t 1 hsw rw Intention to rotum to my former domidl~, ~md I int~nd to rem~in in FORT
PIERCE, SAINT LUCiE COUNTY, FLORIDA, permansnNy. .
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GU t 7 ...c,,,, , (N )
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~ ' - " ~ David J Ha per
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f'•,,`~,c~C..~b~ind wbx~ibsd b~fon m. thts 9tb ~y ~ Februarl? y 19 6S
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. ROaER fOiTRA: •
. GRqMTi C~URT Not~,y publk .
~ D.C. My C,omrN~ion ~xpl~
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. R• •a~•~w.r i~ d~pac.r..~a «ioM:~ fH.~a wi1~ a.~lc araiN c.w~, .aa ~M~M. wIM~ Toc A....~a
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