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O Rule 69G-20.0021, F.A.C. Page 1 of 3 FLORIDA UNCLAIMED PROPERTY ESTATE AFFIDAVIT SECTION D: Agreement and Affidavit of Beneficiaries Claim Number: EACH beneficiary (whether an heir at law or devisee) has completed and personally signed this Estate Affidavit, AGREEING to the following division of the unclaimed property described in Section A on page one of this Estate Affidavit, EVEN IF the beneficiary consents to receive a zero-dollar ($0.00) distribution. 1. Printed Name.

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