IN THE CIRCUIT COURT FOR FLORIDA IN RE: ESTATE OF File No. Division Deceased. COUNTY, PROBATE DIVISION ORDER DETERMINING HOMESTEAD STATUS OF REAL PROPERTY (Testate ­ Devised, Heirs, No Spouse or Minor Child ­ Exempt From Claims) On the petition of for an order determining homestead status of real property (the "Property"), all interested persons having been served proper notice of the petition and hearing, or having waived notice thereof, the court finds that: 1. The decedent died testate and was domiciled in County, Florida; 2 3. 4. petition; it is ADJUDGED that the following described Property: The decedent was not survived by a spouse or minor child; Decedent's homestead was devised to one or more heirs of the decedent; At the time of death, the decedent owned and resided on the Property described in the Bar Form No. P-4.0466 - 1 of 2 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com constituted the homestead of the decedent within the meaning of Section 4 of Article X of the Constitution of the State of Florida. ADJUDGED FURTHER that, as of the decedent's date of death, the Property was validly devised to and the constitutional exemption from the claims of decedent's creditors inured to the following persons: NAME ADDRESS RELATIONSHIP SHARE ADJUDGED FURTHER that the personal representative is authorized and directed to surrender all of the Property which may be in the possession or control of the personal representative to the persons named above, and the personal representative shall have no further responsibility with respect to it. ORDERED on , . Circuit Judge Bar Form No. P-4.0466 - 2 of 2 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com