declaration of domicile - declaration de domicile

DECLARATION OF DOMICILE - DECLARATION DE DOMICILE
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
Ceci est ma Déclaration de Domicile dans l’état de la Floride que je remplis aujourd’hui en accord
et en conformité avec la section 222.17 des Statuts de la Floride
FOR DOMICILES OF THE STATE OF FLORIDA
(POUR LES DOMICILES DE L’ETAT DE LA FLORIDE)
I hereby declare I was formerly a legal resident of, and resided at:
Je déclare que j’étais auparavant un résident légal de ____________ , et J’habitais à
(1)
_______________________________________________________________________________________________
Street Address (Numéro et nom de la rue)
City (Ville)
State (Etat) Zip Code (Code Postal)
Country (Pays)
However, I have changed my domicile to, and have been a bona fide resident of the State of Florida since the
Cependant, j’ai changé de domicile et je vis en Floride depuis:
(2)
________ day of _________________, ________.
Date (Jour)
(3)
Month (Mois)
I now reside at (Maintenant j’habite à):
Year (Année)
_________________________________________________________________________________, Broward County, Florida
Street Address (Numéro et nom de la rue)
City (Ville)
State (Etat) Zip Code (Code Postal)
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; 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 purchase Florida license plates for motor vehicles, owned by me and/or my spouse, and
carry all statutorily required motor 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.
Also living with me at this address (Habite(nt) aussi avec moi à cette adresse)
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
(4)
Signature (Signature):_________________________________________Signature: (Signature) ___________________________________________
(5)
Print Name (Ecrivez votre nom en majuscule):____________________ Print Name (Ecrivez votre nom en majuscule)_________________________
Sworn to (or affirmed) and subscribed before me this (Jurez et signez devant moi) ___________ day of _________________, ________
Date (Jour)
Month (Mois)
Year (Année)
Personally Known (Personne connue) _____________________ or Produced (ou Témoin) _______________________as Identification (comme évidence
d’identité).
Signature of Notarizing or Attesting Official (Signature du Notaire ou de l’officier attestant) _____________________________________________
(seal) (sceau)
FOR DOMICILES OF STATES OTHER THAN THE STATE OF FLORIDA - DOMICILES POUR LES ETATS AUTRES QUE LA FLORIDE
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.
Je déclare que mon domicile est dans l’état de __________ et j’ai l’intention d’y habiter en permanence. Au moment ou je fais cette déclaration je réside
légalement dans l’état de ___________.En Floride je séjourne à l’adresse suivante: ___________________________________________
_________________________________________________________________________________________________________________________
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.
Sworn to (or affirmed) and subscribed before me this (Jurez et signez devant moi) Date (Jour)____day of Month (Mois) ___________,Year (Année)_________
Personally Known (Personne connue) ________ or Produced (ou Témoin) __________________ as Identification (comme évidence d’identité)
Signature of Notarizing or Attesting Official (Signature du Notaire ou de l’officier attestant) _____________________________________________
(seal) (sceau)
404-23 Revised English and Spanish 2.14.2012