IN THE CIRCUIT COURT FOR FLORIDA IN RE: ESTATE OF COUNTY, PROBATE DIVISION File No. Deceased. Division DISPOSITION OF PERSONAL PROPERTY WITHOUT ADMINISTRATION (9 erified 6 tatement) Applicant, 1. Applicant, whose address is is of , who died at , Decedent's last known address was , and, if known, whose age at the time of death was [ ] Decedent left no will. [ ] Decedent's will was deposited with the clerk on 2. minors are: NAME ADDRESS RELATIONSHIP YEAR OF BIRTH [if Minor] , . . , a resident of on . , alleges: So far as is known, the names of the beneficiaries of decedent's estate and of the decedent's surviving spouse, if any, their addresses and relationships to decedent, and the years ofbirth of any who are Bar Form No. P-2.0100 - 1 of 3 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com 3. The estate of decedentconsists only of personal property exempt from the claims of creditors under Florida Statutes Section 732.402 and the Constitution of Florida, and non-exempt personal property the value of which does not exceed the sum of the amount of preferred funeral expenses and reasonable and necessary medical and hospital expenses of the last 60 days of decedent's last illness, all being described as follows: EXEMPT: Description Value NON-EXEMPT: Description Value Preferred funeral expenses [statement or receipt attached]: Services by Amount Paid or Due Bar Form No. P-2.0100 - 2 of 3 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com Medical and hospital expenses for last 60 days of last illness [statement or receipt attached]: Services by Type of Service Amount Paid or Due Other debts of decedent: Creditor Goods or Services [How incurred] Amount Applicant requests that the Court issue a letter or other writing under the seal of the Court authorizing payment, transfer, or disposition of the property to: Name Property Amount or Value Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true,to the best of my knowledge and belief. (Signature of Applicant) (Name of Applicant) _______________________________________ (Address) Statement made before: Deputy Clerk , . Telephone: [Print or Type Names Under All Signature Lines] Bar Form No. P-2.0100 - 3 of 3 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com