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Declaration of ~Ie ~ip
ST.lUCIE CO'*TY. FLA. '
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TO THE STAn ANO COUNiY TAX AME$SQlt~
St.L~1e
COUNTY, f\OItOAa
Thil II my c:IedA,etton of DomIcile and CJtlzent,htp in tho St~ of Rotlde tnet I em fiUng thk dey In eccorc:tence,
.nd in conf,)ffftity with ChepIiII 222, SectIon 222,17. AoridII StaMel.
I WM torm.rly . Iogarre&ident of __________~!:.~~___ _________ -----------., ________9_~.r.&!~___
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and I ,esided .L__. _______.217__Clave1Aud.b,e.----------,---.. Howewr, I hlw ~ my domicU.
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to end am .nd hive been . bona fide ,..!dent of the Stete of florida alnce______ ----lOtA------------OIy of
___, _ ___ -_JulJ_____ ___H_n__ ___, 19__..6l, .nd I reside at - .-.la24-I.o~)4.tb....JI~----------
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-.Fort- P1er-eI-----H-- ____ -______ -----------. -._-----------Sh-Lv.e-1-e---------- County, Florida,
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and thll It.tement Is to b6 t.ken .1 my ded.r.tion of dtimnshlp. actual legal residence end domicil. In the State
of Florida. '
(1__ .... .., ,.,...... fKl'a, IUCh .. .. of proplII1y Of ~ Of tllIfI~ ',"J.leiIA of ..,...,1....11 .. -- ......,
~ of fMllty to _ ..... ~ of ..... etc.)
Entering Roland D. Johnson in Dan McCarty High School
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I FURTHE" CERTIFY that I will regia'" at my locol eddr... when the registration boob reopen, end comply with
all other MqUlremenb of e I~I ,..\dent of thll Sta".
I FURTHER CER~IFY that I NYe no intention to return to my former domicile, and I Intend to remain In____.__
.__ ______!..~~,_~~_~!'~_'! _____ __________ _ _ _ ___ ~1!!~~~A!_______n__------, - County, Florida,
1CJIot)
permanently.
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Mrs.Corb1n~eOD
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2g~ August 61
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., '., t' ~,;;'Il' 0'" ""fi " ,: . S 01 f'lorlda at ar,.,..
, .~: J' , ..." , ....l .... :, , notary t'uo:.c, \a.c '-0 15 1964
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