IN THE CIRCUIT COURT FOR FLORIDA IN RE: ESTATE OF COUNTY, PROBATE DIVISION File No. Division Deceased. CAVEAT BY INTERESTED PERSON 1. The interest of the caveator is , of___________________________________________deceased, whose last known residence address is , the last four digits of whose social security number, if known, are , and who died on or about , , whose year of birth, if known, is . 2. Caveator's name, mailing address, and residence address are: . 3. Caveator, a non-resident of the state of Florida, who is not represented by an attorney , County, Florida, whose admitted to practice in Florida, hereby designates who (is)(is not) a member of The Florida Bar, a resident of mailing address is and whose residence address is as caveator's agent for the service of notice and consents that service of notice on the agent shall bind the caveator. [delete paragraph 3 if not applicable] Caveator requests that the court not admit a will of the decedent to probate or appoint a personal representative without formal notice on caveator or his or her designated agent, and that caveator be given such additional notice as the Florida Probate Rules require. 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. Signed on this ________ day of __________________________, ________. Caveator Bar Form No. P-1.0310 -1 of 2 © Florida Lawyers Support Services, Inc. January 1, 2016 American LegalNet, Inc. www.FormsWorkFlow.com ACCEPTANCE I CERTIFY that I am a resident of County, Florida, and my mailing and residence addresses are indicated above. I hereby accept the foregoing designation as Resident Agent. Signed on this ________ day of __________________________, ________. Resident Agent [Print or Type Names Under All Signatures Lines] Bar Form No. P-1.0310 -2 of 2 © Florida Lawyers Support Services, Inc. January 1, 2016 American LegalNet, Inc. www.FormsWorkFlow.com