CERTIFICATE OF TRUST
UPON OATH, IT IS HEREBY CERTIFIED that:
Name: _________________________________________________________________
Social Security Number: ___________________________________________________
Name: _________________________________________________________________
Social Security Number: ___________________________________________________
is/are entitled to the use and occupancy as to an equitable life estate in the real property under the
terms of the:
Name of Trust: ___________________________________________________________
Dated: ___________________________
and therefore hold sufficient title to claim a Homestead Exemption in compliance with Section
196.041(2), Florida Statutes; and Rule 12D-7.011, Florida Administrative Code, on the property
set forth below:
Property Identification #: ______________________________________________________
Property Address: ______________________________________________________
City: ______________________________ Zip: ______________.
_______________________________________________
S
IGNATURE OF TRUSTEE
_______________________________________________
PRINTED NAME OF TRUSTEE
State of _____________________
County of ___________________
The foregoing instrument was acknowledged befo
re me this _____ day of ____________________, 202__, by
_________________________________________________, who is personally known by me or produced
_________________________________________________ as identification, and who did take an oath.
_________________________________________
(SEAL) Notary Public
_________________________________________
Print Name
