IN THE CIRCUIT COURT FOR FLORIDA IN RE: ESTATE OF File No. Division Deceased. COUNTY, PROBATE DIVISION ELECTION TO TAKE ELECTIVE SHARE The undersigned is the surviving spouse of died on , , domiciled in , deceased, who County, Florida. 1. The undersigned hereby elects to take an elective share in the decedent's estate. 2. This election is filed within the earlier of 6 months of the date of service of a copy of the Notice of Administration on the surviving spouse or 2 years after the date of the decedent's death, or within the time allowed by the court. 3. The address of the surviving spouse is and the name and address of the attorney for the undersigned, if any, are set forth below. 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 _________________________, ________. Surviving Spouse Attorney for Surviving Spouse Email Addresses: ________________________________________ ________________________________________ Florida Bar No. ___________________________ ________________________________________ ________________________________________ (address) Telephone:______________________________ [Print or Type Names Under All Signature Lines] Bar Form No. P-4.0540 - 1 of 2 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com I CERTIFY that a copy of the foregoing Election to Take Elective Share has been served in the manner of formal notice on: ____________________________________ Attorney Bar Form No. P-4.0540 - 2 of 2 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com