IN THE CIRCUIT COURT FOR FLORIDA IN RE: ESTATE OF COUNTY, PROBATE DIVISION File No. Division Deceased. PETITION TO DETERMINE HOMESTEAD STATUS OF REAL PROPERTY (Intestate ­ No Spouse or Descendants) Petitioner, 1. The decedent, , , domiciled in , alleges: , County, Florida, died intestate on and was not survived by a spouse or lineal descendants. 2. At the time of decedent's death, the decedent owned and resided on the following described contiguous parcel of real property (the "Property"): Bar Form No. P-4.0415 - 1 of 3 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com 3. The name of the decedent's heirs at law having an interest in the decedent's estate and their respective relationships to the decedent are: NAME RELATIONSHIP YEAR OF BIRTH (Minor heir) 4. The Property constituted the homestead of the decedent within the meaning of Section 4 of Article X of the Constitution of the State of Florida, and petitioner believes that upon decedent's death, title to the Property descended to and the constitutional exemption from claims of decedent's creditors inured to: 5. The only persons, other than petitioner, having an interest in this proceeding, including unpaid creditors, and their respective addresses are: Petitioner requests that an order be entered determining that the Property constituted the exempt homestead of the decedent, title to which, upon decedent's death, descended and the constitutional exemption from claims inured as set forth in paragraph 4; directing the personal representative to surrender possession of the Property; and directing that the personal representative shall have no further responsibility with respect to the Property. 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. Bar Form No. P-4.0415 - 2 of 3 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com 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 [Print or Type Names Under All Signature Lines] Bar Form No. P-4.0415 - 3 of 3 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com