Form 16.

[Caption]

PETITION FOR AWARD OF STATUTORY ALLOWANCES

The decedent, __________, is survived by the persons named below who constitute the surviving spouse, if any, and all of the decedent's minor children, if any.

Name of surviving spouse: ____________________.

Children:

Name of Child Sex Age Name of Guardian

_______________________ ____ ____ _____________________

_______________________ ____ ____ _____________________

The surviving spouse, who was living with the decedent at thetime of the decedent's death, is entitled to the award of the following items of household furniture, furnishings, appliances, implements and equipment which are reasonably necessary for the use and occupancy of the family dwelling by the surviving spouse and minor children, if any:

HOUSEHOLD FURNITURE AND EQUIPMENT

[Itemizing is required only to the extent necessary to distinguish the selected items from other household furniture and equipment, if any, of the decedent's estate.]

Among the items of personal property of the estate of the decedent are those described below, which the undersigned surviving spouse of the decedent (or the undersigned guardian of the decedent's minor children) have selected to be assigned to and vested in the surviving spouse and minor children of the decedent as provided by law. Each item of property has the value stated opposite its description.

ITEMIZED DESCRIPTION OF PROPERTY

Description Value

__________________________ $ ________

__________________________ $ ________

__________________________ $ ________

The surviving spouse and minor children of the decedent are entitled to be awarded sustenance for a period of two months after the death of the decedent as follows:

THEREFORE, petitioner requests that this court enter an order assigning to and vesting in the surviving spouse and minorchildren of the decedent the personal property described above, to which they are respectively entitled under the provisions of Ark. Code Ann. 28-39-101 through 28-39-104.

______________________________

[Capacity of Petitioner]

[Affidavit]

Reporter's Notes to Form 16: See Ark. Code Ann. 28-39-101 - 28-39-104. The total value under "Itemized Description of Property" is limited to $1,000 as against creditors and $2,000 as against distributees. If minor children are not the children of the surviving spouse, the petition should be revised to reflect that the allowance vests in the surviving spouse to the extent of one-half thereof, and the remainder vests in the decedent's minor children in equal shares. Award for sustenance for period of two months after death of decedent shall be a reasonable amount, not exceeding $500 in the aggregate. Ark. Code Ann. 28-39-101(c). Beneath the signature line, the capacity of the petitioner should be identified (e.g., as the personal representative, the surviving spouse, or the guardian of minor children). If the petitioner is the guardian of minor children, the language in parentheses should be substituted for the language immediately preceding it.