Declaration Of Domicile

This space is for recorder use only. DECLARATION OF DOMICILE To the Clerk of the Circuit Court and County Comptroller of BAY County, Florida. 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. FOR DOMICILIARIES OF THE STATE OF FLORIDA: I hereby declare that I reside in and maintain a place of abode at: ¹ , , Florida _ (street and number) (city and county) 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 abovedescribed residence and abode in the State of Florida constitutes my predominant and principal home, and I intend to continue it permanently as such. I am, at the time of making this declaration , a bona fide resident of the State of Florida residing at: ² , , Florida (street and number) (city and county) ³ I formerly resided at: , (street and number) (city, county and state) And the place or places where I maintain another or other place or places of abode are as follows: (Here list street address, city, county, and state of any other place or places of abode.) , (street and number) (city, county and state) (Signature of Affiant) (Print Name) (Signature of Affiant) (Print Name) Sworn to and subscribed before me this ________ day of __________________________________, 20________. Personally Known or Produced Identification (Signature of Notary Public) Type of Identification Produced:______________________ (SEAL) FOR DOMICILIARIES OF STATE OTHER THAN 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: (Below list street address, city, and county of place of abode in Florida.) , , Florida (street and number) (city and county) (Person making declaration may also include such other and further facts with reference to any acts done or performed by such person which such person desires or intends not be to construed as evidencing any intention to establish his/her domicile within the State of Florida.) (Signature of Affiant) (Print Name) (Signature of Affiant) (Print Name) Sworn to and subscribed before me this __________ day of _________________________________, 20______. Personally Known or Produced Identification (Signature of Notary Public) Type of Identification Produced:______________________ (SEAL) THIS IS NOT AN APPLICATION FOR HOMESTEAD EXEMPTION American LegalNet, Inc. www.FormsWorkflow.com FLORIDA STATUTE 222.17 Manifesting and evidencing domicile in Florida.-(1) Any person who shall have established a domicile in this state may manifest and evidence the same by filing in the office of the clerk of the circuit court for the county in which the said person shall reside, a sworn statement showing that he or she resides in and maintains a place of abode in that county which he or she recognizes and intends to maintain as his or her permanent home. (2) Any person who shall have established a domicile in the State of Florida, but who shall maintain another place or places of abode in some other state or states, may manifest and evidence his or her domicile in this state by filing in the office of the clerk of the circuit court for the county in which he or she resides, a sworn statement that his or her place of abode in Florida constitutes his or her predominant and principal home, and that he or she intends to continue it permanently as such. (3) Such sworn statement shall contain, in addition to the foregoing, a declaration that the person making the same is, at the time of making such statement, a bona fide resident of the state, and shall set forth therein his or her place of residence within the state, the city, county and state wherein he or she formerly resided, and the place or places, if any, where he or she maintains another or other place or places of abode. (4) Any person who shall have been or who shall be domiciled in a state other than the State of Florida, and who has or who may have a place of abode within the State of Florida, or who has or may do or perform other acts within the State of Florida, which independently of the actual intention of such person respecting his or her domicile might be taken to indicate that such person is or may intend to be or become domiciled in the State of Florida, and if such person desires to maintain or continue his or her domicile in such state other than the State of Florida, the person may manifest and evidence his or her permanent domicile and intention to permanently maintain and continue his or her domicile in such state other than the State of Florida, by filing in the office of the clerk of the circuit court in any county in the State of Florida in which the person may have a place of abode or in which the person may have done or performed such acts which independently may indicate that he or she is or may intend to be or become domiciled in the State of Florida, a sworn statement that the person's domicile is in such state other than the State of Florida, as the case may be, naming such state where he or she is domiciled and stating that he or she intends to permanently continue and maintain his or her domicile in such other state so named in said sworn statement. Such sworn statement shall also contain a declaration that the person making the same is at the time of the making of such statement a bona fide resident of such state other than the State of Florida, and shall set forth therein his or her place of abode within the State of Florida, if any. Such sworn statement may contain such other and further facts with reference to any acts done or performed by such person which such person desires or intends not to be construed as evidencing any intention to establish his or her domicile within the State of Florida. (5) The sworn statement permitted by this section shall be signed under oath before an official authorized to take affidavits. Upon the filing of such declaration with the clerk of the circuit court, it shall be the duty of the clerk in whose office such declaration is filed to record the same in a book to be provided for that purpose. For the performance of the