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Declaration of Domici1e and Citizenship -
;
TO THE STATE ANU COUNTY 'TAX ASSESSOR, ~ ~
,~r0
St'. L ucie COUNTY, FLORIDA:
. f
This is my declaration of Domicile and Citizcnship in th~ State of Florida that [ am filing this day in
accorclance. and in conformity with 5ection 222.17, Florida Statut~~s.
I was formerly a legal resident of ~~V ,'V ~W ~~M
'r er and I
(aer) « ~
resided at ~~?~r l h~s~l~' ~oQ~,L Flrn . Nowever, I have changed my domicile to ~
(Stre~t and Numbet)
and am and have bc~n a bona fide n.~sid~nt of the State of Florida since day of
) p/a., fo rtsiat~ ~o~%r~~•, y,,.y par~H s' rtfWry to ~~be
ND~lm~Otr 19~ and 1~ vSA f'o"' ~y ~REher's eve.s~w~ AJII6N~rl~t,
~ 1 ~$ltttl aAd NY111btf~ '
QT !~A~~~i ~%G w~ArI wS ff. ,"~I'~ fT. Lulil ~ fT - L t.tli~ COUnty, ~Otida,
(Ciir)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Inseti hers aoy pettioent fxts, such as sak ot p~opertr or busineu. oe re~lrWui~hment ot employment st tormer
domicile, removal ot tamilr to new Jomic~le, purchase oi home. etc.)
~ COKN~y w~s pr~v~o.~r/y ~r~u1 ~is/~•r 6y ~
/~tf~ojln~t s~ ~a~ ih .ff. L~.~i~
~~r l.Il~'/'!d W. I/~~1~»a«n.~. in ~~i~ J.1»....~~ oF /~f7~, ~~)e
n,y tatntr , / ~
~tt~itra~toy ~%oa~,it.~~i aas~ ~i Ti~tNt~i~~ ~as fi ~t~l aa~ /'<<ord~./
` O aJ~ /~17t7 GMI~ ~lA/'1 ~/7! nGt.r,~~r' i
by ~/OKr ~r ~ict o., ~ ~ ~
~9G 9d7. " Stls».~ A~On4 9a~o.-s. ~dA~ dj ~LI~.~ ~!l~4ru~/on I'loQ~s
J ?
„0 R .Book ~~6, ~ye ~3S .
~~j/S ~lC~ai'a ~~v.~ N~eln SNL~r,i yl~/ /n M'/ Or?v~ Hl1~+rt ~Pl~iNl!
~ l ~ NA1 ~~~cl~
hA?l a~GIaI~I n-~AJ~r~~r S/~~t n,Y f~r ~`i!~ J.~Pc ~ r~.~ ~oN
~ ~ ~~jS~~~ ~~D~~~cA rt.fii/t.,,~e ~r, N?~/
' Qnd 1 /n~~P«~C~ ~q QS Lt y~f • ` .
~ ~ J !Y)T~H ~lOn Of ~'16{/q~L~In ~~tq
` vt~ti r~9 h~- a N~l ~htr~~y rt a ffr~~r~r.N~ n?y J
t fl,~ rts~.~tN~e ~ulal .by r„~ at cr ~r. st
u°c
FcouNTrFi°~.
RG~~F. r7~TRAS
CIER!c ~.+:,;;~~t COURT,~~~
~ Rfc~Q~ vr~.~~;F-~__..._,.
~
,1~ 13 9 Zo AH'15
- ~9~Q20
1 FURTHFR CERTI[=Y that I wi~l rcgister at my loral address when the registration books reopen, and
comply with ail othcr rcquiremc~~ts of a le~al rrsideni of this State.
~ I FURTHER CERTIFY that I have no intcnti~n to return to my former domicile, and I intend to remain in .
,
~ ~O r 7 L u~ ~ e . ~7. L U l i l , County,
~ Florida, permancntly. «'~r~ ~
~
. PAv~ A. INTrM~N~
~
~ (Name)
~ WtTH THE U.S. AGM~D FORCES ) C~ AL `~El~ W. ~NTE~y~JN~
~ AT RHEIN-MAIN AS, GERMANY ) (wedress)
~
CrIR Box ~36 Z
~ Sworn to and subscribcd bcfore mc this day of
~ T ~~~S~aFF F ~H! yoR~ Dy633
~ `J u A.D ~o~ pfS`.~3iAiFD A '~o '
~ . l ~ ~ n O
~ f! r; - ~l~h
A
~ tL C• ."i . a$ y
~ HARD 9. Rii~~LC~~ ~I{~fn{'~~J~iAf~ ~'<<° Q ~ rn
Judp~ Advocafe, 253-5&6849 . . . = . G k
~ ss, ~ 1~.: . e: P~w. b00~1 Pa~,r
~[~~im~id~c4~iresr ~ f;., . . s .:c _
~3 ~
ti i~~'.'.~~ IItL ~r~.:~~i
l S1A:iS CT ARi. 136
~ ~ (To be eaecuted in duplicale anJ ori~iarl filyd with Cle ~c ' Cor(INand ~ e writh T~x Asacswrl ~
~aa~R Bas~,
~ - ~ - ~ ~
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