IN THE CIRCUIT COURT FOR FLORIDA IN RE: ESTATE OF COUNTY, PROBATE DIVISION File No. Division Deceased. OATH OF PERSONAL REPRESENTATIVE AND DESIGNATION AND ACCEPTANCE OF RESIDENT AGENT STATE OF FLORIDA COUNTY OF I, (Affiant), state under oath that: 1. I am qualified within the provisions of Florida Statutes Sections 733.302, 733.303 and 733.304 to serve as personal representative of the estate of , deceased. 2. I will faithfully administer the estate of the decedent according to law. 3. My place of residence is and my post office address is . 4. I hereby designate , is who (is not) a member of The Florida Bar, who is a resident of County, Florida, whose place ofof residence) is (place residence and whose post office address is as my agent for the service of process or notice in any action against me, either in my representative capacity, or personally, if the personal action accrued in the administration of the estate. Affiant Sworn to and subscribed to before me on Affiant, who is personally known to me or who produced (yes or no) , (type of identification) , by as identification. Notary Public State of Florida (Affix Notarial Seal) ACCEPTANCE I CERTIFY that I am a permanent resident of , County, Florida, and my residence address is is as indicated above. I hereby accept the foregoing designation as Resident Agent. (residence) addressas indicated above. Signed on , . Resident Agent Bar Form No. P-3.0600 © Florida Lawyers Support Services, Inc. January 1, 2016 [Print or Type Names Under All Signatures Lines] American LegalNet, Inc. www.FormsWorkFlow.com