IN THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI - PROBATE DIVISION AT IN THE ESTATE OF ESTATE NUMBER , Deceased. APPLICATION FOR LETTERS TESTAMENTARY APPLICATION FOR LETTERS OF ADMINISTRATION WITH WILL ANNEXED (Sec. 473.017, RSMO) Now comes and on oat h states that deceased,age years, sex , died testate, whose last residence was , and whose domicile was . (County and State) That the personal representative named in the will (is) (are) NAME: RESIDENCE: That the value of deceaseds estate is: Personal Property $ . Real property, $ (If deceased not domiciled in Missouri: value of tangible personal property located in County, Missouri is $ and of real property in Missouri which may be subject to administration in Missouri is $ ). That applicant believes there (are) (are not) heirs whose names and addresses are unknown to applicant. That the names, relationships to the decedent, and residence addresses of the surviving spouse, heirs and devisees, legatees and lineal descendants of devisees who were relatives of and predeceased the testator, if any, with an indication of those believed by the applicant to be of unsound mind and the birth dates of those who are minors, and, so far as is know to the applicant, the names and addresses of the guardians of any minor or incompetent devisees, legatees or heirs, including the surviving spouse, and all contingent beneficiaries of any testamentary trust,and their relationship, are set forth in Appendix A attached hereto. Form 10070 Page 1 of 4 7/29/96 >>>> 2 That this application is made for (supervised) (independent) administration. * That , a Missouri resident, has been designatedas resident agent for service of process within the state of Missouri and the designation and acceptance is attached hereto That the refusal to qualify by a named personal representative and/or the renunciation of the right to administer are set forth in Appendix B attached hereto. That if letters are issued, the applicant will make a perfect inventory of the estate, pay the debits and legacies, if any, as far as the assets extend and the law directs and account for and distribute or pay all assets which come into the possession of the personal representative, and perform all things required by law touching the administration of the estate. WHEREFORE, applicant prays that letters. (Testamentary) (administration w/w/a) be granted to applicant. Applicant requests Notice of Letters be published in . 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. ( ) (Application) (Address) (Telephone) ( ) (Application) (Address) (Telephone) ATTORNEY FOR ESTATE: (Give firm name and name of individual attorney who will represent the firm: ar No. MO BADDRESS: / Telephone: ( ) zip FAX NUMBER: ( ) E-MAIL ADDRESS: * Use if applicable Form 10070 Page 2 of 4 7/29/96>>>> 3 APPENDIX A IN THE ESTATE OF ESTATE NUMBER NAME* RELATIONSHIP ITEM OF BIRTH DATE RESIDENCE ADDRESS (Including guardians) WILL (If Minor) (Give Zip Code) (Surviving Spouse - State if none.) NOTE: If no unmarried minor children, then so state under NAME . List below heirs at law NOT mentioned in Will; show relationship to the decedent and to any deceased persons through whom they inherit: NAME RELATIONSHIP RESIDENCE ADDRESS (Birth Date If Minor) (Street & Zip) (Attach additional sheets if necessary) Form 10070 Page 3 of 4 7/29/96>>>> 4 APPENDIX B IN THE ESTATE OF ESTATE NUMBER REFUSAL TO QUALIFY BY NAMED PERSONAL REPRESENTATIVE I, the undersigned, being the named personal representative of said will, refuse to qualify. (SIGNATURE) RENUNCIATION OF RIGHT TO ADMINISTER The undersigned persons entitled to administer the estate of hereby renounce our right to administer the estate and request that letters be issued to whose address is . SIGNATURE RELATIONSHIP RESIDENCE WITH ZIP CODE Form 10070 Page 4 of 4 4/21/87