Fillable Printable Delaration of Domicile - Florida
Fillable Printable Delaration of Domicile - Florida
Delaration of Domicile - Florida
DECLARATION OF DOMICILE
This is my Declaration of Domicile in the State of Florida that I am filing this
day in accordance and in conformi ty with Section 222.17, Florida Statutes.
FOR DOMICI LES OF THE STATE OF FLORIDA
I hereby declare that I was formerly a legal re sident of, and I resided at:
(1)
________________________ __________ ___ _______________ ________ _____ ___ _________________ _
Street Address City State Country
however, I have changed my domicile to, and have been a bona fide resident of the State of Florida since the
(2)
______ day of ______ _________, __ ____. I now reside at:
Date Month Year
(3)
_________________ ___________ _____ ______________________ __________ _ , Broward County, Florida.
Street Address City ZIP Code
This statement is to be taken as my declaration of actual legal residence and permanent domicile in this State and Country to the exclusion of all
others and I will comply with all requirements of legal residents of Florida. I understand that as a legal resident of Florida, I am subject to
intangible taxes, I must pu rchas e Florid a license plates for mot o r ve hicles, owned b y me and /o r m y spouse, a nd ca rr y a ll statut o ril y required m otor
vehicle insurance. If I vote, I must vote in the precinct of my legal domicile and I understand that my estate will be probated in the Florida Courts.
OPTIONAL SECTION: Also living with me at this address are:
(4)
Signature:__________________________ Signature:_________________________________
(5)
Print Name:______________________________ Print Name:________________________________
State of Florida
County of Broward
Sworn to (or affirmed) and subscribed before me this
___ day of ____________, _____.
Personally Known ___ OR Produced _______ _________________ __ as Identification.
Signature of Notarizing or Attesting Official ______ ___________________________ __
(seal)
FOR DOMICI LES OF STATES OTHER THA N 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 that
such person desires or intends not to be construed as evidencing any intention to establish his domicile within the State of Florida.)
State of Florida
County of Broward
Sworn to (or affirmed) and subscribed before me this
____ day of _____________, _____.
Personally Known ___ OR Produced _______ ______ ____ ___ ________ as Identification.
Signature of Notarizing or Attesting Official ________________________
(seal)
404-23 Revised 11/29/12
DECL ARATION OF DOMICILE INSTRUCTIONS
All information must be legible.
Husband and wife, domestic partners, or others who cohabit may sign the same form.
The Declaration of Domicile form must be notarized. Notary services are available in our office, or you may use a
Notary Public of your choice. The fee for our Notary service is $10.00 p er document, in addition to the standard
recording charges. Please note that all persons who signed the document must appear before the notary.
Have your identification available. You need to have current government-issued pi cture identification in order for
this office to notarize your signature, such as a driver’s license, a state identification card, or passport.
COMPLETING THE FORM:
Line
(1)
Fill in the last address of where you lived before you moved to your current address
Line
(2)
Fill in the date you moved to the State of Florida.
Line
(3)
Fill in your current address.
Line
(4)
Sign
Line
(5)
Clearly and legibly PRINT the name that you signed.
GETTING YOUR DOCUMENT RECORDED:
You may record thru the mail or in person. If you record thru the mail, your document must be notarized before
you send it to us. Notary Service is available only in person. The fees are $10.00 per do cument (notary
acknowledgement) for each person signing and the signors must have a legal form of identification and appear in
person.
Mail to:
Records Taxes and Treasury Divi si on
RECORDING SECTION
115 S. Andrews Ave – Room 114
Fort Lauderda le, FL 33301
Include a self-addressed, postage paid envelope for the return of the document after processing
The recording fee is $10.00 for a one-page document
Make check or money order payable to: BOARD OF COUNTY COMMISSIONERS (do not send cash)
If you want a certified copy of recorded document in addition to the recorded original we will send you, add
$3.00 ($1.00 per page for the copy fee and $2.00 to certify) to your payment for each certified copy requested. A
certified copy is optional.
In person:
County Records offices are located at the Governmental Center and are open Monday through Friday (except
holidays) from 7:30 am to 5:00 pm. If you’re planning on coming in person, be sure to check our Broward County
Records Division page under Important Information.
STREET ADDRESS:
Governmental Center, Recording - Room 114
115 South Andrews A v enue
Fort Lauderda le, Florida 33301
