Disposition Of Personal Property Without Administration Verified Statement

IN THE CIRCUIT COURT, FIRST JUDICIAL CIRCUIT IN AND FOR OKALOOSA COUNTY, FLORIDA, PROBATE DIVISION IN RE: Estate of: CASE NO. ______CP __________ ________________________________ Deceased 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 (decedent) ( relationship) died at _______________________, on _____________________, a resident of Okaloosa County, Florida, 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 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 AGE (Birth date if minor) ______________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________ _________ ______________________ ______________________ ____________ ____________ _________ _________ ______________________ ____________ _________ Disposition of Personal Property without Administration Rev. 9/10 American LegalNet, Inc. www.FormsWorkFlow.com 3. The estate of the decedent consists only of personal property exempt under the provisions of Section 732.402 of the Florida Probate Code; 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: DESCRIPTION VALUE EXEMPT: List - Automobiles used by the deceased or members of the deceased's immediate family. Household furniture and furnishings. Florida prepaid college tuition and other items of personal property not to exceed $1,000 in value. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ NON EXEMPT: List - All other items of personal property owned by the deceased and their estimated value. Include the balance of items as stocks, bonds & accounts, name of institution, account number and other items of the deceased. PLEASE LIST COMPLETE NAME AND ADDRESS OF BANKING INSTITUTION. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Preferred funeral expenses (statement or receipt attached): Amount Services by Paid or Due _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Medical and hospital expenses for last 60 days of last illness: (statement or receipt attached): Services by Type of Service Paid or Due _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Disposition of Personal Property without Administration Rev. 9/10 American LegalNet, Inc. www.FormsWorkFlow.com Other debts of decedent: Creditor Goods or Services (How incurred) Amount _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Requested payment or distribution to: Name 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. ___________________________________________ (Signature of Petitioner) ___________________________________________ (Print Name of Petitioner) ___________________________________________ (Street Address) ___________________________________________________ (City, State, Zip Code) ___________________________________________________ (Telephone) Sworn and subscribed to before me this ______ day of _____________________________, 20___ is personally known or __produced identification. Type of Identification produced ___________________. Statement made before: _______________________________ (Deputy Clerk or Notary) My commission expires: Disposition of Personal Property without Administration Rev. 9/10 American LegalNet, Inc. www.FormsWorkFlow.com