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.