Fill and Sign the Caveat Form

IN THE CIRCUIT COURT FOR ______________________ COUNTY, FLORIDA PROBATE DIVISION IN RE: ESTATE OF __________________________ DECEASED. File No. _______________ Division _______________ CAVEAT BY CREDITOR 1. The interest of the caveator is that of a creditor of _________________________ , deceased, whose last known residence address is __________________________________________________________________ , whose social security number, if known, is _________________ , whose date of birth, if known is ________________ , ___________ , and who died on or about __________________ , ___________ . 2. Caveator’s name, mailing address and residence address are: ______________________________________________________________________ _____________________________________________________________________ . 3. Caveator, a non-resident of the state of Florida who is not represented by an attorney admitted to practice in Florida, hereby designates ____________________ , who (is) (is not) a member of The Florida Bar, a resident of _______________ , Florida, whose mailing address is ____________________________________________ and whose (residence) (office) address is ______________________________________ _________________________________ as caveator’s agent for the service of notice and consents that service of notice on the agent shall bind the Caveator. [delete paragraph 3 if not applicable] Caveator request that the clerk notify the Caveator in writing of the date of issuance of letter of administration and of the names and addresses of the personal representative and his or her designated agent, and that caveator be given such additional notice as the Florida Probate Rules require. 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. Bar Form No. P-1.0300 Page 1 of 2 Revised January 1, 2011 Signed on ________________________, _____________ ______________________________________ Caveator ______________________________________ Printed or Typed Name ACCEPTANCE I CERTIFY that I am a resident of ________________________ County, Florida, and my (residence) (office) address is indicated above. I hereby accept the foregoing designation as Resident Agent. Signed on _________________________, ______________ _____________________________________ Resident Agent _____________________________________ Printed or Typed Name Bar Form No. P-1.0300 Page 2 of 2 Revised January 1, 2011