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Oeclaration of Domicile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR, 1450~
S~. LU~IF COUNTY, FlOR1~A:
This is my decfaration of Domiule and Citizenship in the State of Florida that I am filing this day in sooprdante a~d
in confo~mity with Chapter 222, Section 222.17, florida Statutes.
1 was formerly a legal resident of = Ok1aW8ha Pla.
(Ciy) (Stab)
and I resided at _Rt. 2 HOX 129 ~~„~ever I have changed my domi~ite
(Street and Numbe~j
to and am and have been a bona fide resident of the State of Florida since 13th _ day of
August 66 901 Grandvier~? Blvd.
, 19~^, and 1 ~eside at
{Street ar?d Number)
FORT ~IERCE, 3AINT LUCIE COUNTY, RORIDA ~
and this stAtement is to be taken as my declaration of citizenship, actual legal residenca and domicile in the State of Horida.
(Inse~t here any peNineni facts, such as sale of p~operty or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Filing for homestead purposes and entering children in Public Schools.
P'~LLY L. BROSIER (12)
1rqLLY L. BROSIBR (10) . F~~EO
HOLLY L. BROSISR ( 9) sr• tUC1E ~ REC~R~~p
BRADY S. BROSIER ( 7) RECORD
V
R~Ep~,q.
GRADY S. BROSIBR (6)
~~s
i4 P~ ~ ~ 2s
8020
i~~~f_r? r'OtTi?,~S
GLERK CIRCUfT CpURT
1 FURTHER C~RTIFY that 1 will comply with al) other ~equirements of a lega) resident of this State.
1 FURTHER CERTIFY that I have no intentio~ to return to my former domicjte, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_ .
` e, i.. C J, ,'/i
-U A, ~ (Name)
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~ . . r-~.o ~ r - : . GLBNN F . BROS IBR
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~ W , " ~ ~ ' ' ...t ~ ' (Address)
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~ ~ ~.~~''•~.......•••'o•'~`~~ 26th
~ b?ugust 66
"~%_1 J~ ~~vo~~,~'and subscribed before me this day of , ~q
.
ROGER pp
CIERK CUIT T Notary Public
BY D.C. My Commission expires
(To b~ ~x~cut~d i duplicat~ and ori~Insl fil~d wiih Cl~lc Grarif Cour~, snd dvplicat~ with tax A~s~or.)
Bo K 153 445
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