Lydia Gardner Clerk of the Circuit and County Courts Orange County • Florida Probate/Mental Health Division Dear Sir or Madam: Please find the attached copy of the Verified Statement for Disposition of Personal Property without Administration. Please complete this form, have it notarized and sealed, and return it to the Clerk of the Court Probate Mental Health Division P.O. Box 4994 Orlando, Fl 32802-4994 We will begin processing your Disposition of Personal Property without Administration upon receipt of the following documents: 1. Completed and notarized (with notary seal) Verified Statement. 2. Copies of funeral bill or receipt showing funeral expenses have been paid in full by the person petitioning. Or copy of funeral bill showing balance due, if applicable. 3. Copy of the assets. (i.e. copy bank statement, insurance policy, stock certificate, check, vehicle registration and blue book value). 4. Copy of the death certificate showing decedent’s residence is in Orange County. 5. Original Will must be filed, if applicable. **********ALL COPIES WILL BE RETAINED BY THE CLERK********** The fee to file a Disposition of Personal Property without Administration is $231.00 plus $6.00 for each Authorization prepared by the clerk for each fiduciary that needs to release assets. Fees are payable by cash, money order or cashier’s check. No personal checks accepted. Checks will only be accepted from an attorney’s office. Money orders or cashier’s check should be made payable to Lydia Gardner, Orange County Clerk of the Court. You may pay with a credit card when presented at our office for a convenience fee of $3.99. All credit cards are accepted except Visa. For further information you may contact our office at (407) 836-2000. LYDIA GARDNER Clerk of the Courts American LegalNet, Inc. www.FormsWorkFlow.com IN THE CIRCUIT COURT OF THE NINTH JUDICIAL CIRCUIT, IN AND FOR ORANGE COUNTY, FLORIDA IN RE: ESTATE OF CASE NO. 48-________-CP-________-O _____________________________________ DECEASED VERIFIED STATEMENT FOR DISPOSITION OF PERSONAL PROPERTY WITHOUT ADMINISTRATION 1. The petitioner, _______________________________________________________________, alleges: _____________________________________________________________, whose last known address was _______________________________________________________________________________, and whose social security number is _____________________________________________________, died on ____________________________________________________________________________. 2. ( ( ) The decedent left no Will. ) Decedent’s Will was deposited with the Clerk on the ______ day of ________________, _______. 3. The estate consist only of personal property exempt under Section 734.402 of the Florida Statutes, personal property exempt from the claims of creditors under the constitution of the State of Florida and preferred funeral expenses as described below: Address Description of Asset(s) Value 4. Funeral and/or burial expense (statement or receipt attached): Services by Address Amount Paid or Due _______________________________________________________________________________________ _______________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com 5. Payment or distribution is to be made to: Name Address Property/Asset Amount 6. Petitioner knows of no other assets of the decedents except for: ______________________________________________________________________________________. 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. ___________________________________ Claimant Signature __________________________________________ Address __________________________________________ Telephone Number __________________________________________ Relationship to decedent __________________________________________ Date Statement obtained by: _______________________________________ Deputy Clerk/Notary Public STATE OF _________________ COUNTY OF _______________ Sworn to (or affirmed) and subscribed before me this _____ day of _____________________, _________, by __________________________________________. (seal) ____________________________________________ Notary Public Personally Known __________ My commission expires:________________________________ Or Produced Identification __________ Type of Identification Produced ______________________________. American LegalNet, Inc. www.FormsWorkFlow.com