Betty Strifler Clerk of the Circuit Court Citrus County 110 North Apopka Avenue, Room 101, Inverness, Florida 34450-4299 - Telephone: (352) 341-6425 Our office may be able to assist you in this matter if: 1. The decedent was a Citrus County resident. 2. Amount to be received does not exceed preferred funeral expenses and reasonable and necessary medical and hospital expenses of the last 60 days of the last illness. If this applies, please provide our office with the following: 1. Certified copy of the Death Certificate 2. Original Will or Affidavit of Surviving Heirs (On the Affidavit please be sure to include yourself where applicable) 3. Copy of paid funeral bill 4. Copy of receipt from funeral home showing who paid 5. Medical bills (paid and still owing) 6. Description and value of the asset(s) to be transferred 7. Checks, stocks, savings accounts, checking accounts, etc….copies of these documents Be sure to complete in full “Requested payment or distribution to” on page 3 of Disposition Form. Include Name, address, description of property including account Nos. and the amount or value. Enclosed please find a Disposition of Personal Property Without Administration form. Complete this form in full, have your signature notarized or sign the in presence of a Deputy Clerk, and return along with the filing fee of $116.00. If you have further questions regarding this matter please contact our office at (352) 341-6425 or 6418. Sincerely, BETTY STRIFLER CLERK OF THE CIRCUIT COURT By: ______________________________________ Deputy Clerk \\Isshare\shared\Courts\Website\Website Forms\Dispoform- Probate 072008.doc updated 7/2007 American LegalNet, Inc. www.FormsWorkflow.com IN THE CIRCUIT COURT FOR CITRUS COUNTY FLORIDA IN RE: ESTATE OF PROBATE DIVISION FILE NUMBER_______________ DIVISION ___________________ DISPOSITION OF PERSONAL PROPERTY WITHOUT ADMINISTRATION Verified Statement Petitioner,________________________________________________, alleges: 1. Petitioner, whose address is ______________________________________ _______________________________________________________________ and whose social security number is ___________________is the___________ of____________________________ who died at _______________________ on the ______ day of ______________, ______, a resident of_______________ whose last known address was _______________________________________ and, if known, whose age was __________ and whose social security number is ______________________. ( ) The decedent left no will ( ) The decedent’s will was deposited with the Clerk on ___________________. 2. So far as is known, the names of the beneficiaries of the decedent’s estate and of the decedent’s surviving spouse, if any, their address, their relationship to the decedent, and the ages of any who are minors are: NAME ADDRESS RELATIONSHIP AGE (Birth Date if Minor) 3. The estate of decedent consists only of personal property exempt from the claims of creditors under the Constitution of Florida, and non-exempt personal property the value of which does not exceed the sum of the amount of preferred funeral expenses and reasonable and necessary medical and hospital expenses of the last 60 days of the decedent’s last illness, all being described as follows: Exempt: Description Value \\Isshare\shared\Courts\Website\Website Forms\Dispoform- Probate 072008.doc updated 7/2007 American LegalNet, Inc. www.FormsWorkflow.com Non-Exempt: Description Value 4. Preferred funeral expenses (statement and paid receipt attached): Services by Amount Paid or Due 5. Medical and hospital expenses for last 60 days of last illness (statement or receipt attached): Services by Type of Service Amount Paid or Due \\Isshare\shared\Courts\Website\Website Forms\Dispoform- Probate 072008.doc updated 7/2007 American LegalNet, Inc. www.FormsWorkflow.com Other debts of the decedent: Creditor Goods or Services (How Incurred) Amount 6. Requested payment or distribution to: Name and Address Description of Property Amount or Value I know of no other assets or debts of the decedent except:___________________ _________________________________________________________________ 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. I FURTHER CERTIFY that I have paid those preferred expenses as shown herein that are not being distributed directly to the suppliers of said services by this order. _________________________ Signature of Petitioner Statement made before: _________________________ Name of Petitioner _______________________________ Deputy Clerk _________________________ Address _________________________ ______________________, 20__ _________________________ _________________________ Telephone \\Isshare\shared\Courts\Website\Website Forms\Dispoform- Probate 072008.doc updated 7/2007 American LegalNet, Inc. www.FormsWorkflow.com