RE: ESTATE OF ____________________________________ Deceased FILE NO.:__________________________ DISPOSITION OF PERSONAL PROPERTY WITHOUT ADMINISTRATION VERIFIED STATEMENT The Petitioner, _______________________________________________________________________, allege that ___________________________________________________________________, a resident of Broward County, whose last four numbers of the Social Security Number were___________________, and whose last known address was _________________________________________________________________ __________________________________________________________________________________and died on ______________________________________. _______ Death Certificate attached _______ Decedent's Will (was) (was not) deposited with the Clerk on ____________________________. The property of the decedent, which must be transferred, consists only of personal property; the entire value of exempt property and the amount of the preferred funeral expenses and reasonable and necessary medical and hospital expenses of the last 60 days of the decedent's life. These assets are: (please supply information to be used in the transfer of these assets.) Give names of bank, transfer agent, or company handling the asset(s). Asset Description Complete Address Dollar Value/Amount _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Funeral or burial expenses (attach statement and/or receipt) Services By Complete Address Amount Paid or Due _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Last illness expenses (statement and/or paid receipt attached): Services By Complete Address Amount Paid or Due _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Petitioner requests payment or distribution to: Name Complete Address Asset Value _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ I know of no other assets in the decedent's name alone except: _____________________________________________________________________________________ I also acknowledge that neither the application, nor the granting of this request for Disposition of Personal Property, in any way, relieves me or this Estate of the possible obligation of filing a State and Federal Tax Return. 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. Date:_________________________________ _____________________________________ SIGNATURE OF PETITIONER _____________________________________ NAME OF PETITIONER (PLEASE PRINT) _____________________________________ ADDRESS _____________________________________ RELATIONSHIP TO THE DECEDENT _____________________________________ CITY STATE ZIP CODE _____________________________________ TELEPHONE NUMBER OF PETITIONER American LegalNet, Inc. www.FormsWorkFlow.com OTHER KNOWN SURVIVING SONS/DAUGHTERS; HEIRS OF THE DECEDENT: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ OTHER KNOWN SURVIVING BROTHERS/SISTERS; HEIRS OF THE DECEDENT: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ OTHER KNOWN SURVIVING HEIRS OF THE DECEDENT, OTHER THAN THE ABOVE: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 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. Date:___________________________ _______________________________________ SIGNATURE OF PETITIONER ____________________________ __________________________________ __________________________________ ADDRESS OF PETITIONER __________________________________ RELATIONSHIP TO DECEDENT American LegalNet, Inc. www.FormsWorkFlow.com WAIVER AND CONSENT FORM RE: ESTATE OF ____________________________________________________________, deceased. I, ________________________________________________, residing at _________________________ (Name of Interested Party) (Address) _____________________________________________________________________________________ (Address) and my relation to the deceased is ________________________________________. I hereby waive all my rights, title and interest to the assets of the Estate in favor of _____________________________________________________________________________________ (Claimant's Name) to enable her/him to (pay the expenses) (receiver the proceeds) of the Estate of the above named decedent.