Disposition Of Personal Property Without Administration Verified Statement

Clerk of the County Court Recorder of Deeds Clerk and Accountant of the Board of County Commissioners Custodian of County Funds County Auditor Our office may be able to assist you in this matter if: 1.The decedent was a Citrus County resident.2.The value of the funds to be distributed does not exceed preferred funeral expenses and/ormedical and hospital expenses paid by the petitioner during the last 60 days of the last illness. If this applies, please provide our office with the following: 1.Certified copy of the Death Certificate2.Original Will or Affidavit of Surviving Heirs(On the Affidavit please be sure to include yourself where applicable)3.Copy of paid funeral bill4.Copy of receipt from funeral home showing who paid5.Medical bills (paid and still owing)6.Description and value of the asset(s) to be transferred7. Include name, address, description of property including accounts number(s) and the amount or value. Enclosed please find a Disposition of Personal Property without Administration form. Complete this form in full, have your signature notarized or sign the in presence of a Deputy Clerk, and return along with the filing fee of $231.00. If you have further questions regarding this matter please contact our office at (352) 341-6425 or 6418. Sincerely, ANGELA VICK Clerk of the Circuit Court and Comptroller By: Deputy Clerk ANGELA VICK CLERK OF THE CIRCUIT COURT AND COMPTROLLER CITRUS COUNTY, FLORIDA American LegalNet, Inc. IN THE CIRCUIT COURT FOR CITRUS COUNTY FLORIDA IN RE: ESTATE OF PROBATE DIVISION FILE NUMBER DIVISION 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 died at on the day of , , a resident of whose last known address was and, if known, whose age was and whose social security number is . ( ) The decedent left no will . 2. surviving spouse, if any, their address, their relationship to the decedent, and the ages of any who are minors are: NAME ADDRESS RELATIONSHIP AGE (Birth Date if Minor) 3. The estate of decedent consists only of 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 Exempt: Description Account Number(s) Value American LegalNet, Inc. Non-Exempt: Description Account Number(s) Value 4. Preferred funeral expenses (statement and paid receipt attached): Services by Amount Paid or Due 5. Medical and hospital expenses for last 60 days of last illness (statement or receipt attached): Services by Type of Service Amount Paid or Due Other debts of the decedent: Creditor Goods or Services (How Incurred) Amount 6. Requested payment or distribution to: Name and Address Description of Property Acct Number(s) 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. I FURTHER CERTIFY that I have paid those preferred expenses as shown herein that are not being distributed directly to the suppliers of said services by this order. Signature of Petitioner Name of Petitioner Address Telephone Statement made before: Deputy Clerk , 20 American LegalNet, Inc.