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Declaration of Domicile and
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10 THE SlATE ANO COUNTY TAX ASSESSOR,
Citizenship .
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St. J..ucia.. - COUNTY, FlOR;OA
This is my dtK:la'atior. of Domicile and Gtil:cr.ship '" the $.tat. of Florida th"t : an) fd'r>9 this day in .ccordaoce,
IInd in conformity with Chapter 222, 5eoction 222,17, Florida Sta1ute>.
I was form-erly a 11')g<1: r(tSident of
Randolph
New YQr.k
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tCIly)
and I relided at
70 Jamestown Street
($trONi and Po..nnbe<)
However, I have (:".~ my domicil~
to and am Ilnd have been a bona fide resid.nt ot th~ State of Florida since
9th
day. of
September
,1961 ,and I reside ar
725 South _7th Street.
($,,", .rod 1'j......lMr)
Fort Bi&rce
(oty)
St.. Lucie __ .
County, Florida,
arid this s,,,tement i~ to be tllken u my de'd&r.tion of citizenship, actual legal residence and domiciie in the Stahl
of Florida,
O.....ri her. ony perti...nl fo<n, .v,h .. ..ht 01 pr~fty Of t:....!,,"'. <>r '.,,"Cluj..........., ~ trmp~! 01 10"''''' lkomicile,
fo""",.1 of lomil'l 10 _ domkllo, pvrm... qf ,-, .'c.)
Entering Donna Lou Razey in the 9th Grade of
Public School
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ROGER_ PO\~'. ~.;). ' .
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I FURTHER CERTIFY that I will re9ister al my local adcres~ when Ih~ registration boob reopP.n, /lnd ,omply with
all other requireme'\ts of II legal resident of this State_
FURTHER CERTIFY that I have no intentiem ro r<:turr. to r.1Y former dornide, and I inlend to refnain in
Fort Fierc('
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,)". LUC_..O
County, Fiorid5,
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