Disposition Of Personal Property Without Administration Verified Statement

IN THE CIRCUIT COURT FOR POLK COUNTY, FLORIDA PROBATE DIVISION IN RE: ESTATE OF File No Deceased. Division: Probate DISPOSITION OF PERSONAL PROPERTY WITHOUT ADMINISTRATION Verified Statement Applicant, 1. Applicant, whose address is of on Florida, whose last address was known, whose age was The decedent left no will. The decedent's will was deposited with the clerk on . and whose date of birth was , who died at a resident of Polk County, , and, if . , alleges: is 2. So far as is known, the names of the beneficiaries of decedent's estate and of the decedent's surviving spouse, if any, their addresses and relationships to decedent, and the dates of birth of any who are minors are: NAME ADDRESS RELATIONSHIP BIRTH DATE (if minor) Bar Form No. P-2.0100- 1 of 3 Disposition American LegalNet, Inc. www.FormsWorkFlow.com 3. The estate of decedent consists only of personal property exempt from the claims of creditors under Section 732.402 of the Florida Probate Code and 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: DESCRIPTION EXEMPT: VALUE DESCRIPTION NON-EXEMPT: VALUE Preferred funeral expenses (statement or receipt attached): Services by Amount Paid or Due Bar Form No. P-20100-2 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Medical and hospital expenses for the last 60 days of last illness (statement or receipt attached): Services by Type of service Amount Paid or Due Other debts of decedent: Creditor Goods or Services (How incurred) Amount Applicant requests that the Court issue a letter or other writing under the seal of the Court authorizing payment, transfer, or disposition of the property to: Name Property Amount Under the 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 Applicant) Statement made before: (Name of Applicant) ___________________________________ CLERK/NOTARY (Address) Telephone: (Print or Type Names Under All Signature Lines) Bar Form No. P-2.0100-3 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com