AOC- 860 Rev. 6-12 Page 1 of 1 Doc. Code: AFPFE COM M O NW E A LT H O F K E lex et justitia Case No. ____________________ Court _______________________ District/Probate County ______________________ NT U C KY Commonwealth of Kentucky Court of Justice www.courts.ky.gov KRS 23A.200; 24A.170; 24A.185; 61.315; 64.012; 172.180 RT OF JUS TI AFFIDAVIT FOR PROBATE FEE EXEMPTION AND ORDER I, the undersigned Affiant, hereby swear and affirm that I am submitting the estate of: ___________________________ _______________________________________________. [ ] a person whose spouse or surviving children are eligible for state death gratuity death benefits(the estate of any police officer, sheriff, deputy sheriff, corrections employee with the power of a peace officer pursuant to KRS 196.037, any metropolitan or urban-county correctional officer with the power of a peace officer pursuant to KRS 446.010, any jailer or deputy jailer, any auxiliary police officer appointed pursuant to KRS 95.445, or any citation or safety officer appointed pursuant to KRS 83A.087 and 83A.088, firefighter, or member of the Kentucky National Guard on state active duty pursuant to KRS 38.030, or a member of a state National Guard or a Reserve component on federal active duty under Title 10 or Title 32 of the United States Code who names Kentucky as home of record for military purposes, whose death occurs on or after July 1, 2002, as a direct result of an act in the line of duty). OR [ ] a regular member of the United States Armed Forces who names Kentucky as home of record for military purposes, whose death occurred as a direct result of an act in the line of duty. Accordingly the estate is exempt from all probate fees, including but not limited to those established by the Supreme Court of Kentucky pursuant to KRS 23A.200 and 24A.170, or imposed under KRS 24A.185, 64.012, and 172.180. Submitted this _____ day of __________________, 2_____. ____________________________________ Affiant/Petitioner's Name (Please Print) C Subscribed and sworn before me by petitioner on _________________________________, 2_______. My commission expires _____________________. _____________________________________________________ Name/Title Clerk: If this form is filed with a petition to probate an estate, collect no filing fees and present to the judge for signature. ORDER IT HEREBY ORDERED [ ] that the above-styled estate is exempt from all probate fees pursuant to KRS 61.315. [ ] that the above-styled estate is not exempt from all probate fees. The petitioner is hereby directed to pay the appropriate fees to the office of the Circuit Clerk within 30 days of this order. SO ORDERED this _____ day of _______________ 2____. ___________________________________________ Judge Distribution: File Petitioner County Clerk American LegalNet, Inc. www.FormsWorkFlow.com CO U E ______________________________________ Affiant/Petitioner's Signature