IN THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI - PROBATE DIVISION AT IN THE ESTATE OF ESTATE NUMBER , Deceased. APPLICATION FOR LETTERS OF ADMINISTRATION (Sec. 473.017 RSMO) Now come(s) and on oath deceased, age, state(s) that years, sex, , died on intestate, whose last residence was City State and whose domicile was County Street Address . That the value of deceased’s estate is: State Personal property $ ; Real property $ . (If deceased not domiciled in Missouri, state following: Value of personal property located in Jackson County, Missouri is $ and of real property in be subject to administration in Missouri is $ , Missouri which may .) That the names, relationships to the decedent, and residence addresses of the surviving spouse and heirs, with an indication of those believed by applicant(s), to be mentally incapacitated, and the birth dates of those who are minors, and, so far as is known to applicant(s), the names and addresses of the conservators of those who are minors or disabled, are as listed in Appendix A attached hereto and incorporated herein by this reference. Form 10030 That this application is made for (supervised) (independent) administration. * That residing at has been designated as resident agent for service of process within the state of Missouri. (Designation is attached hereto.) That applicant (s) to decedent is (is) (are) entitled to administer said estate because (his) (her) (their) relationship . (state other facts which entitle applicant to appointment) That if letters are issued, applicant(s) will make a perfect inventory of the estate, pay all the debts, if any, as far as the assets will extend and the law directs, and account for and distribute or pay all assets which come into 1 2001 © American LegalNet, Inc. (his) (her) (their) possession and perform all things required by law touching the administration. WHEREFORE, applicant(s) pray(s) that Letters of Administration be granted on the above named decedent’s estate. The undersigned swears that the matters set forth in the foregoing application are true and correct according to the undersigned's best knowledge and belief, subject to penalty for making a false affidavit or declaration. Applicant: Address: Telephone Number: ( ) . Applicant: Address: Telephone Number: ( ) . ATTORNEY FOR ESTATE; (Give firm name and name of individual attorney who will represent the firm.) MO Bar No. Address: Telephone Number ( ) .Fax Number ( ) . E-Mail Address NOTE: Personal representative and/or attorney must notify clerk if it is learned that the application is incomplete or incorrect. 2 2001 © American LegalNet, Inc. ESTATE NUMBER APPENDIX A NAME (Including Conservators) RELATIONSHIP BIRTH DATE (If Minor) (Surviving spouse - RESIDENCE ADDRESS (Zip Code Required) state if none) (Attach sheet for additional names or information) APPENDIX B The undersigned persons entitled to administer the estate hereby renounce our right to administer the estate and request that letters of administration be issued to whose address(es) (is) (are) 3 2001 © American LegalNet, Inc. . SIGNATURE RELATIONSHIP RESIDENCE AND ZIP CODE 4 2001 © American LegalNet, Inc.