DECLARATION OF DOMICILE TO THE STATE ... - …

1 DECLARATION OF DOMICILETO THE STATE OF florida AND county OF miami - dade :This is my DECLARATION of DOMICILE in the STATE of florida thatI am filing this day in accordance, and in conformity withSection , florida ,_____ was formerly a legal resident of _____Print Name City_____, and I resided at _____, however, I have changed my STATE Street AddressDomicile to and have been a bona fide resident of the STATE of florida since the____day of_____, now reside at _____,_____. Street Address CityMiami- dade county , florida , and this statement is to be taken as my DECLARATION of actual legal residence andpermanent DOMICILE in this STATE and county to the exclusion of all others, and I will comply with all requirements of legal residents of 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 willbe probated in the florida was born in the : Yes____ No____Place of birth:_____Naturalized citizen - Where:_____ Date: _____ Permanent Resident: Date: _____ No.

2 _____ _____ Signature _____ Print Name _____ (Mailing Address) STATE OF florida county OF miami -DADES worn to and subscribed before me this _____ day of _____, Public STATE of florida at Large/or Deputy Clerk_____ Print, Type or Stamp name of notaryType of Produced # _____. Penalty for perjury: up to five (5) years in STATE Prison and $5,000 fine ( ) CLK/CT 578 REV. 12/07 Clerk's web address.