IN THE ELEVENTH JUDICIAL CIRCUIT STATE OF MISSOURI PROBATE DIVISION ST. CHARLES IN THE MATTER OF ___________________________________________________ Deceased #___________________________________ AFFIDAVIT AS TO DEATH AND APPLICATION FOR PROBATE OF WILL __________________________________________________________________, being first duly sworn, depose(d) and say(s) that _____________________________________________________________ who resided at _________________________________________________________________________ in the St. Charles County, (street address) (city) Missouri, died on the _____________________ day of __________________________________, _____________, at ________________________________________________________________. That said decedent left __________ instrument(s) in writing, dated _______________________________, purporting to be his/her last will and testament and ____________ codicil(s) to said last will and testament. That the subscribing witnesses to said instrument(s), given herein on the date of the execution of said instrument(s), are: WHEREFORE, your petitioner prays that after said instrument(s) have/has been duly proved that the same be admitted to probate and recorded as the last Will and Testament of said decedent. The foregoing is made under oath and affirmation and its representations are true and correct to the best knowledge and belief of the undersigned, subject to the penalties for making a false affidavit or declaration. _________________________________________________ Petitioner _________________________________________________ Address Phone No PROB014 American LegalNet, Inc. www.FormsWorkFlow.com