OR_F_Declaration of Domicile R081820 Page 1 of 1
Declaration of Domicile
To the Clerk & Comptroller of Pasco 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:
____________________________________________________________
(street and number)
____________________________________________________________ , Florida
(city, zip code, 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 above-
described 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:
____________________________________________________________
(street and number)
____________________________________________________________ , Florida
(city, zip code, and county)
I formerly resided at:
____________________________________________________________
(street and number)
____________________________________________________________ ,
(city, zip code, and county)
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, state and zip code of any other place or places of abode.)
__________________________________________________________
_____________________________ _____________________________________________
Affiant Signature
STATE OF FLORIDA
COUNTY OF PASCO
SWORN TO (or affirmed) and subscribed before me by means of ____ physical presence or ____
online notarization, this ______ day of ___________________, by _________________________.
_________________________________________
Signature of Notary/Deputy Clerk
_________________________________________
Print/stamp commissioned name/Notary Public/Commission #
Personally Known or Produced Identification
(Check One)
Type of ID: ________________________________________
