IN THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI - PROBATE DIVISION AT IN THE ESTATE OF ESTATE NUMBER , Deceased. APPLICATION OF SPOUSE FOR REFUSAL OF LETTERS (Sec. 473.090 RSMO) The undersigned applicant states that applicant is the surviving spouse of the above named decedent, who died domiciled in Jackson County, Missouri, and residing at Missouri, survived by applicant and *unmarried minor children, leaving an estate in this state, the value of which, less liens and encumbrances, is not greater in amount than is allowed by the law as exempt property and for maintenance of applicant and said unmarried minor children for one year after the death of said decedent, which said estate consists solely of the real and personal property described and of value as set forth in Appendix A attached hereto. . The aggregate value of all such property is $ 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 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. Dated: . APPLICANT: ADDRESS: TELEPHONE NO.: ( ATTORNEY: ) MO BAR No ADDRESS: TELEPHONE NO.: ( FAX NO.: ( ) ) E-MAIL ADDRESS: *NOTE to applicant: Attach names of unmarried minor children, their birthdates and the name and address of the person having their custody.) Form 10517 APPENDIX A 2001 © American LegalNet, Inc.