In the Sixth Judicial Court in and for Pinellas County, Florida PROBATE DIVISION IN RE: ESTATE OF REF No. (Clerk provides this number when filed) Disposition of Personal Property without Administration Petitioner alleges: 1.Petitioner, whose name is , whose address is (full street address, city, state & zip) , and whose relationship to the decedent is . Decedent, whose name is , who died at (location of death) on (date of death) was a resident of (county and state) address was (full street address, city, state and zip) , and whose age, if known, was and whose Social Security number is (last 4 digits only) . 2.Check one of the following: [ ] The decedent left no will [ ] The decedent's will was deposited with the Clerk on, 20 . 3.Chapter 732 of the Florida Statutes identifies heirs of a decedent (beneficiaries) as: spouse, children (naturalor legally adopted), grandchildren (natural or legally adopted), parents, siblings, nieces and nephews, grandparents,aunts and uncles.List all known names of the beneficiaries of decedent's estate and of the decedent's surviving spouse, if any, their addresses and rela NAME ADDRESS RELATIONSHIP Birth Date (if a Minor) Dispo Petition pg. 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com 4.The estate of decedent consists only of personal property exempt from the claims of creditors under theConstitution of Florida, and non-exempt personal property the value of which does not exceed the sum of theamount of preferred funeral expenses and reasonable and necessary medical and hospital expenses of the last 60days of the decedent's last illness, all being described as follows: EXEMPT property includes: (a) Household furniture, furnishings, and appliances up to a value of $20,000 . (b) Two (2) motor vehicles (c) All qualified tuition programs , including, but not limited to, the Florida Prepaid College Trust Fund. (d) Other personal property (including cash) up to a value of $1,000. Item: Description (for vehicles, include make, model, year, color and VIN#) Value Total of above: NON - EXEMPT includes any personal property (an asset other than real estate) that is not listed above as exempt. Include the balance of an item Dispo Petition pg. 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Medical and hospital expenses for last 60 days of last illness (statements and receipts showing who paid and how much must be attached. DO NOT include services paid by Medicaid, Insurance, HMO, etc. ): Services by Type of Service Amount Paid Amount Due Total: Requested distribution: Use this space to indicate which heir/interested person on page 1 is to receive each of the above assets. Exempt property may only be distributed to a surviving spouse. If there is no surviving spouse, it may only go to a child of the decedent. Name Pro perty Amount or Value By signing below I am affirming, under penalties of perjury, that I have read the foregoing and the facts alleged are true, to the best of my knowledge and belief. (Signature of Petitioner) (Address of Petitioner) (City, State, Zip) (Telephone) (Date Signed) If the clerk may contact you by email on this matter only, please check here and print your email address: @ Dispo Petition pg.3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Consent to Distribution In Re: The Estate of: Reference # I, (name of beneficiary), as (relationship) of the decedent, do agree to the disbursement of assets as listed in the petition of (name of petitioner). 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. (Signature of Affiant) (Address of Affiant) (Printed name of Affiant) (City, State, Zip) (Telephone) (Date Signed) Consent American LegalNet, Inc. www.FormsWorkFlow.com