DECLARATION OF DOMICILE To the Clerk of the Circuit Court (County Controller) Manatee 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) ___________________________________, ______________________, Manatee County, Florida, which place of abode I recognize and (city) (zip code) 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 _________________________________________, _______________________, ____________________, Manatee County, Florida. (street and number) (city) (zip code) I formerly resided at __________________________, ____________________ County, _________________________________ (city) (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) __________________________________________________ (Print Name) ____________________________________________ (Print Name) ___________________________________________________ (Signature) ____________________________________________ (Signature) Sworn to and subscribed before me this ______________ day of _________________________, A.D. 20 _______. Angelina M. Colonneso, Clerk Ad Interim of the Circuit Court, Manatee County By: ________________________________________________ Signature and Title of Notarizing or Attesting Official 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: (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 which such person desires or intends not to be construed as evidencing any intention to establish his domicile within the State of Florida) __________________________________________ (signature) Sworn to and subscribed before me this ____________ day of _______________________________, A.D. 20 ________. ____________________________________________________ Signature and Title of Notarizing or Attesting Official THIS IS NOT AN APPLICATION FOR HOMESTEAD EXEMPTION. To apply for Homestead Exemption you must go to the Property Appraiser, 915 4th Ave. W., Bradenton. American LegalNet, Inc. www.FormsWorkFlow.com