IN THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI - PROBATE DIVISION AT IN THE ESTATE OF ESTATE NUMBER , Deceased. APPLICATION OF CREDITOR FOR REFUSAL OF LETTERS ( Sec. 473.090, RSMo) The undersigned applicant states that the above decedent died on , domiciled in Jackson County, Missouri, and residing at in , Missouri, leaving surviving no spouse or unmarried minor children; that after giving credit for all payments and offsets to which the estate is entitled there is now due and owing applicant, as a creditor of the estate of said for: (state nature of debt) decedent, the sum of $ and that the entire estate of the decedent does not exceed $15,000 and consists solely of personal property and of value as set forth in Appendix A attached hereto. Applicant further states that if this application is granted, applicant will pay the debts of decedent so far as the assets thereof will permit, in the order of preference established by law, and will distribute the balance of said estate, if any, to the persons entitled thereto under the law. WHEREFORE, applicant prays an order that no letters be granted on said estate, unless on the application of creditors or other parties interested, the existence of other or further property is shown. The undersigned swears that the matters set forth above are true and correct to the best knowledge and belief of the undersigned, subject to the penalties of making a false affidavit or declaration. APPLICANT: ADDRESS: / zip TELEPHONE NUMBER: ( ATTORNEY: ) MO BAR No ADDRESS: / zip TELEPHONE NUMBER: ( FAX NUMBER: ( ) ) E-MAIL ADDRESS: Page 1 of 2 2001 © American LegalNet, Inc. ESTATE NUMBER APPENDIX A PERSONAL PROPERTY VALUE $ $ TOTAL Form 10500 Page 2 of 2 6/19/96 2001 © American LegalNet, Inc.