Declaration Of Domicile - Miami-Dade County

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DECLARATION OF DOMICILE
TO THE STATE OF FLORIDA AND
COUNTY OF MIAMI-DADE:
This is my Declaration of Domicile in the State of Florida that
I am filing this day in accordance, and in conformity with
Section 222.17, Florida Statutes.
I,__________________________________ was formerly a legal resident of ______________________
Print Name
City
____________, and I resided at ___________________________________, however, I have changed my
State
Street Address
Domicile to and have been a bona fide resident of the State of Florida since the____day of________,_____.
I now reside at _____________________________________,_________________________________.
Street Address
City
Miami-Dade County, Florida, and this statement is to be taken as my declaration of actual legal residence and
permanent domicile in this State and County to the exclusion of all others, and I will comply with all
requirements of legal residents of Florida.
I understand that as a legal resident of Florida: I must purchase Florida license plates for motor vehicles, if any,
owned by me, and/or my spouse; if I vote, I must vote in the precinct of my legal domicile and that my estate will
be probated in the Florida Courts.
I was born in the U.S.A.: Yes____ No____Place of birth:__________________________________________
Naturalized citizen - Where:___________________ Date: _______________ No.______________________
Lawful Permanent Resident: Date: _____________ No. __________________________________________
________________________________________
Signature
________________________________________
Print Name
_______________________________________________
(Mailing Address)
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
Sworn to and subscribed before me this _______ day of ________________________, _______.
_______________________________________________
Notary Public State of Florida at Large/or Deputy C lerk
_______________________________________________
Print, Type or Stamp name of notary
Type of I.D. Produced #
__________________________________________________.
Penalty for perjury: up to five (5) years in State Prison and $5,000 fine (F.S. 837.02)
CLK/CT 578 REV. 12/07
Clerk's web address:

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