Revised 09/2018 1 of 3 473.090.1 (1) RSMo APPLICATION FOR REFUSALS Fees of $ 103.50 due Add all parties: applicant and decedent Need c opy of death certificate with decedent222s SS# & address Need SS# and birthdate of Applicant Need documentation in support of asset(s) trying to collect (ie car title, bank statement) Minor222s Refusal should contain the following: Need date of death of decedent Need domicile address of decedent Need relationship of applicant to minor Need name(s) of minor children Need documentation supporting relationship of applicant to minor (ie birth certificate, certified copy of letters of guardian or conservator) Need a statement that decedent left an estate, the value of which, l ess liens and encumbrances, is not greater in amount than is allowed by law as exempt property and maintenance of the unmarried minor children for one year from death of decedent Need description and value of the property Need to be signed and dated by applicant under oath and affirmation or notarized American LegalNet, Inc. www.FormsWorkFlow.com Revised 09/2018 2 of 3 473.090.1 (1) RSMo TWENTY SECOND JUDICIAL CIRCUIT Probate Division Case Number: In the Estate of , Deceased. (Date File Stamp) Application of Unmarried Minor Child(ren) for Refusal of Letters (No Surviving Spouse or Nonapplicant Children) The applicant states that applicant is the natural parent conservator of the estate court appointed guardian custodian of , unmarried minor child(ren) of the decedent who died on , residing at , survived by the above named minor child(ren), no surviving spouse and no other unmarried minor children. Decedent left property, in this State, the value of which, less liens and encumbrances, is not greater in amount than that is allowed by law as exempt property and maintenance of said unmarried minor child(ren) for one year after the death of decedent, which said estate consists solely of the property described and of the value as follows: Description of Property Value See Appendix A. Total $ Wherefore, applicant prays that the court order that no letters be granted on said estate unless on the application of creditors or other interested parties, the existence of other or further property is shown. The applicant swears that the matters set forth above are true and correct to the best knowledge and belief of the applicant, subject to the penalties of making a false affidavit or declaration. Date: Signature of Attorney for Applicant Signature of Applicant (Name/Bar Number/Address/Telephone/Fax/E-Mail) (Name/Address/Telephone) American LegalNet, Inc. www.FormsWorkFlow.com Revised 09/2018 3 of 3 473.090.1 (1) RSMo Appendix A Decedent: Case Number: Description of Property Value Real Property Personal Property TOTAL: $ American LegalNet, Inc. www.FormsWorkFlow.com