You can obtain a Declaration of Domicile form at the Records, Taxes and Treasury Division, Broward County Governmental Center Room 114, 115 S. Andrews Ave. This required me to fill out AZ DOT form 960143 for a specialty plate.The Declaration of Domicile form must be notarized. Notary services are available in our office, or you may use a Notary Public of your choice. An affidavit of domicile is a legal document that verifies the primary place of residency of someone after their death. How Do I Fill Out an Affidavit of Domicile? Fort Lauderdale Office. 300 SE 2nd Street Suite 600, Fort Lauderdale, FL 33301. Spouses who live in different states can avoid paying unnecessary state taxes.