IN THE CIRCUIT COURT FOR FLORIDA IN RE: ESTATE OF COUNTY, PROBATE DIVISION File No. Deceased. Division PETITION TO DETERMINE EXEMPT PROPERTY Petitioner, alleges: 1. is the in Florida. 2. NAME The names and addresses of the persons and the years of birth of any who are minors who ADDRESS RELATIONSHIP YEAR OF BIRTH [IF MINOR] are entitled by law to the exempt property are: Petitioner, whose address is of the decedent who, on the date of death, was domiciled , 3. 4. are as follows: This petition is filed within the time permitted by Florida Statutes Section 732.402(6). Petitioner alleges that the exempt property and the basis on which it is claimed to be exempt BASIS OF EXEMPTION DESCRIPTION OF PROPERTY Bar Form No. P-4.0200 - 1 of 2 � Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com 5. 6. 7. NAME Pursuant to the provisions of Section 732.402, the exempt property of the decedent remains None of the claimed exempt property has been specifically or demonstratively devised by The only persons other than petitioner having an interest in this proceeding and their ADDRESS subject to any perfected security interests. decedent's will to anyone other than the persons specified in paragraph 2. respective addresses are: Petitioner requests that an order be entered determining the persons entitled to the above-described property as exempt property under Section 732.402 of the Florida Probate Code and authorizing and directing the personal representative to deliver the exempt property to the persons entitled to receive the same. 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 ______________________, _________. Petitioner Attorney for Petitioner Email Addresses: Florida Bar No. (address) Telephone: I CERTIFY that a copy hereof has been furnished to: by , on , . Attorney Bar Form No. P-4.0200 - 2 of 2 � Florida Lawyers Support Services, Inc. January 1, 2017 [Print or Type Names Under All Signature Lines] American LegalNet, Inc. www.FormsWorkFlow.com