IN THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI - PROBATE DIVISION AT IN THE ESTATE OF ESTATE NUMBER , Deceased. APPLICATION OF SURVIVING SPOUSE FOR EXEMPT PROPERTY ALLOWANCE (Sec. 474.250, RSMo) The undersigned applicant states that applicant is the surviving spouse of the above named decedent, andthat among the assets of the estate of said decedent, as shown by the inventory heretofore filed, is the followingdescribed property which is exempt property. WHEREFORE, applicant prays that the personal representative of said estate be authorized and directed totransfer and set over to applicant the property aforesaid, as the absolute property of the said surviving spouse, asprovided by law. The undersigned swears that the matters set forth above are true and correct to the best knowledge and beliefof the undersigned, subject to the penalties of making false affidavit or declaration. Dated: . Surviving Spouse: Address: Attorney: MO BAR No Address: / Telephone Number: ( ) Fax Number: ( ) E-Mail Address: Form 10640