IN THE CIRCUIT COURT FOR FLORIDA IN RE: ESTATE OF COUNTY, PROBATE DIVISION File No. Division Deceased. ORDER DETERMINING HOMESTEAD STATUS OF REAL PROPERTY (Intestate ­ Heirs, No Spouse or Lineal Descendant ­ 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 intestate and was domiciled in County, Florida; 2. 3. 4. The decedent was not survived by a spouse; The decedent was not survived by a descendant; The decedent was survived by the following heirs at law: 5. At the time of death, the decedent owned and resided on the Property described in the petition; it is ADJUDGED that the following-described Property: Bar Form No. P-4.0458 - 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 title to the Property descended, as of the decedent's date of death, and the constitutional exemption from claims of the decedent's creditors inured to the following heirs of the decedent: 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 said heirs, and the personal representative shall have no further responsibility with respect to it. ORDERED on , . Circuit Judge Bar Form No. P-4.0458 - 2 of 2 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com