COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : CIRCUIT COURT OF CLAY COUNTY, MISSOURI JUDICIAL SUBPOENA Plaintiff(s) PROBATE DIVISION -against- : No.__________________ : Matter of _______________________________________, deceased. : APPLICATION FOR EXEMPT PROPERTY Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(Sec. .474.250 RSMo.) .... ..... I, ________________________________________, state that I am the surviving spouse of _______________________________________, deceased, who died on the _______ day of THE PEOPLE OF THE STATE OF NEW YORK ____________________, 20______ and, that among the assets of the estate of said decedent, as shown in the inventory and appraisement thereof, is the following exempt property: (Attach additional page if necessary) TO GREETINGS: WHEREFORE, I request that the Personal Representative of said estate be authorized and WE COMMAND YOU, that all business and excuses being laid aside, you and as provided by law. directed to transfer to me the property aforesaid, as my absolute property, each of you attend before , the Honorable at the Court located AND REPRESENTATIONS IN THIS DOCUMENT ARE MADE at County of THE STATEMENTS in room on the day of , 20 , at noon, and at any recessed UNDER, OATH AND ARE TRUE AND CORRECT TOo'clockBEST OF MY KNOWLEDGE AND THE in the or adjourned date, to testify and give evidence as a witness in this action on the part of the BELIEF. I UNDERSTAND THEY ARE MADE SUBJECT TO THE PENALTIES OF MAKING A FALSE AFFIDAVIT OR DECLARATION. Signature Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Address result of your failure to comply. Phone Witness, Honorable Court in County, , one of the Justices of the day of , 20 ORDER FOR EXEMPT PROPERTY (Attorney must sign above and type name below) Now on this _____ day of _____________________________, 20_____, the application for the exempt property filed herein is considered and the Court finds that the applicant is the surviving spouse of said deceased and is, therefore, entitled to the exempt property described in the above application Attorney(s) for under the provisions of Sec.474.250 RSMo. WHEREFORE, IT IS ORDERED AND ADJUDGED that said surviving spouse is hereby allowed said property as _____ absolute property, Office and P.O. Address the Personal Representative as provided by law, and is hereby authorized and directed to transfer and set over said property accordingly. Form 532-D Revised 3/17/2003 Telephone No.: JUDGE Facsimile No.: E-Mail Address: Page 1 of 1 Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com