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O~claration ot Domicil• a~d Cit~~~sh p
TO tHE STATE AND ~OUNTY TAX A?SSESSOR,
St. LUCIE COUNTY, FLORIDA:
Thi: is m`y detlaration of Oomicile and Gitizenship i~ the Stats of Norida th~t 1 am filinq this d~y in aooordancs a~d
in oonformiy with Chapter 222, Saction 424.17, Florida Statutes.
Beth Page , z. i. a. Y.
1 was formKly a Ipal rosident of
(City) (Sta») .
end ~ roslded ar 3 8osart I,ane . However ~ haw chan~ed my domW~s
(Street and Number)
to and ~m and have been a bona fide rosident of the State of Florida sinoe SR~.fi.~~~+er 1 day of
, 19 68, a~d i roside at 758 7i0~ee St?eet
(Street a~d Number)
PORT M~, SAINT LtIC1E COUNTY, lLORIDA
a~d this statsment is b be taken as my dedaration of ati~enship, actval lagal residenas and domicile in the State of Horida.
pnsert here any peMinent facta, such as sale of property or business, or relinquithment of employment
at former domicils, rarnoval of family to new domicile, purchase of hort~e, etc.)
Eetabl~ehing residency t'or hoseetead ezesptioa
,
~ FIl~EO ANp REC4R~~D .
ST. L~C 1E COUNTY. DLA:
R~ Q~~~~
1
~ 9 PM 2' 6
'69 JAN ~
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; R~G POITRAs ~
~ ~~ER IRCUIT COURT
i
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1 FURTHER CHtTIFY thaf 1 will oomply wHh all other requiromsnts of a Is~al r~ldent of this State. ~
I fURTHER CERTIFY that I have no intention to retum to my former domiCile, and I intend to remain in FORT
P(ERCE.. SAINT UKIE COUNTIf, FLORIDA, permsnently.
. ;~i
. -
, : . . ) Rud ph . Jaeper
~-~s'-
~ - ~ .
- ~ : : • : (Address)
- : ~ ' . . 9th danuary t9 69
e~.subscribed befo~e me this - day of , •
•'r., : . ~
. ~ r~
ROG~ 'O~TRIIS
QRK CiRWR COURT Notary Public
By • O.C. My Gommisiwn e~cpires
(T~ i» ~oaaiNd ~ dvpWcat~ and o~ieal fiMd wi1M Clwic Cirsrif Co~rf, and dupfi~M~ wilh Tax As~a~x,l
„ ao~K1?5 ~A~ ,71y f
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