DECLAR ATIO N O F DOM I CI LE TO TH E STATE O …

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PLEASE USE TAB OR MOUSE. DECLAR atio N O F DOM I CI LE. TO TH E STATE O F FLOR I DA AND. COUNTY O F M I AM I -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 , 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_____________________, 20_____. I now reside at ________________________________________ ________________, _____________________________.

CLK/CT 578 Rev. 08/16 Clerk's web address: www.miami-dadeclerk.com DECLAR ATIO N O F DOM I CI LE

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