Declaration Of Domicile Form - Florida printable pdf download

DECLARATION OF DOMICILE

To the Clerk of the Circuit Court [County Comptroller] ___________________ County, Florida.

This is my declaration of domicile in the State of ___________________, that I am filing this day in accordance and in

conformity with Section 222.17 Florida Statutes.

FOR DOMICILIARIES OF THE STATE OF FLORIDA:

I hereby declare that I reside in and maintain a place of abode at ________________________, ______________________,

(street and number)

(city)

in _____________________ County, Florida , which place of abode I recognize and intend to maintain as my permanent home

and, if I maintain another place or places of abode in some other state or states, I hereby declare that my above-described

residence and abode in the State of Florida constitutes my predominant and principal home, and I intend to continue it

permanently as such. I am, at the time of making this declaration, a bona fide resident of the State of Florida residing at

_________________________, ______________________, in ___________________ County, Florida. I

(street and number)

(city)

formerly resided at _______________________, ____________________ County, ____________________, and the place

(city)

(state)

or places where I maintain another or other place or places of abode are as follows:

(Here list street address, city, county and state of any other place or places of abode.)

___________________________________

(print name)

(signature)

Sworn to and subscribed before me this _______ day of ____________, _____ by ___________________________ who is

personally known to me or who has produced ________________________ as identification and who did/did not take an oath.

My commission expires

Notary Public

FOR DOMICILIARIES OF STATES OTHER THAN THE STATE OF FLORIDA.

I hereby declare that my domicile is in the State of __________________ and that I intend to permanently continue and

maintain my domicile in such state. At the time of making this declaration I am a bona fide resident of the State of

_____________________. My place of abode within the State of Florida, if any, is as follows:

(Here list street address, city, and county of place of abode in Florida.) (Person making declaration may also include such

other and further facts with reference to any acts done or performed by such person which such person desires or intends not to

be construed as evidencing any intention to establish his domicile within the State of Florida.)

___________________________________

__________________________________________

(print name)

(signature)

Sworn to and subscribed before me this _______ day of ____________, _____ by ___________________________ who is

personally known to me or who has produced _________________________ as identification and who did/did not take an

oath.

My commission expires

Notary Public

CL-0575-1112

Declaration Of Domicile Form - Florida