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DECLARATION OF DOMICILE
To the Clerk of the Circuit Court (County Comptroller) of Collier 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 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 and county)
I formerly resided at:
(street and number)
(city, county and state)
and the pl