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aeclaration ot Domicile and Citizenship 1~8084
TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FIORiDA:
This is my declaration of Domicile and Gitizenship in the State of Florida that 1 am filing this day in accordance and
~n confo~miy with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of Germantown_ _ Ohio _
(Ciy) (State)
and 1 resided at 79~3_ G~~m~~Qw~Road Flowever I have d~anged my domitile
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Florida since ___~8th day of
June ~q 66_, and 1 reside at 3402 Abbott
(Street and Number)
fORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicite, purchase of home, etc.)
Entering Sandra hickell in the 8th grade
" Karen in the Sth grade
" Billy in the 2nd grade
FII.E~ AN 'CY. ~l.A~
C ~N~D~D
gT, E~~~O v~Rl~1ED
~r 31 ~ 9 ' 09
~ ~~s ~ 145~84
~ : t `•~;~R~~ T
~ ;:o ~ ' ` U1T C~~R
CLE~;~ CIR~
I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
1 FURTHER CERTIFY that 1 have no intention to return to my former domiule, and I intend to remain in FORT
PIERCE, SAINT;~UCIE COUNTY, FLURIDA, permanently.
~;:~i~u::i:;,; '
..3'U~J~it....~
:i~' - . : (Name)
_ _ Betty Nickell ~
- . . -
~ y ~
~ ''l' - . ~ k - (Address)
L~ , .~t~ -
Siivorn ~to and subscribed before me this 31 day of AuguSt ~ 19 66
ROGER POITRAS
CIRCUIT COURT Notary Public
By `i"~''~`'~ D.C. My ~ommission expires
(To bs sxecvtad in dupliute snd original Rled with Cl~rk Circuit Cour~, and duplicst~ with Tax Ass~sfor.)
BooK 153 556 .
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