Broward

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Declaration of Domicile

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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.

1. I hereby declare that I am a bona fide resident of the State of Florida, and reside in and maintain a place of abode at:

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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 have been a bona fide resident of the State of Florida since

2. I formerly resided at:

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Zip Code *

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

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City *

State *

Zip Code *

I intend to permanently continue and maintain domicile in the State of

I intend to be or become domiciled in the State of Florida.

Optional: Also residing at this address:

Created by AIPSS