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 state(s) that deceased, age, y ears, sex, , died on intestate, whose last residence was City County State Street Address and whose domicile was . That the value of deceaseds 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 , Missouri which may be subject to administration in Missouri is $ .) 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 attac Ahed 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) (is) (are) entitled to administer said estate because (his) (her) (their) relationshipto decedent is . (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, asfar as the assets will extend and the law directs, and account for and distribute or pay all assets which come into 1 >>>> 2(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 decedents estate. The undersigned swears that the matters set forth in the foregoing application are true and correct according to the undersigneds 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 BNo. ar Address: Telephone Number ( ) .F ax 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 >>>> 3 ESTATE NUMBER APPENDIX A NAME RELATIONSHIP BIRTH DATE RESIDENCE ADDRESS (Including Conservators) (If Minor) (Zip Code Required) (Surviving spouse - 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 estateand request that letters of administration be issued to whose address(es) (is) (are) 3 >>>> 4 . SIGNATURE RELATIONSHIP RESIDENCE AND ZIP CODE 4