IN THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI - PROBATE DIVISION AT IN THE ESTATE OF ESTATE NUMBER , Deceased. STATEMENT OF ACCOUNT (Sec. 473.840) The undersigned independent personal representative submits the following as a complete accounting of all receipts and disbursements of the probate assets of the above-named decedent: ASSETS PER INVENTORY OR LAST SETTLEMENT 2. Furniture, Household Goods, Wearing Apparel $ 3. Corporation Stocks 4. Mortgages, Bonds, Notes 5. Cash, Bank and Savings & Loan Accounts Insurance Policies 6. All Other Personal Property TOTAL $ Year DETAILS OF TRANSACTION Received/ Paid Out/ Mo./Day Debit Credit Page 1 of 2 >>>> 2 Year DETAILS OF TRANSACTION Received/ Paid Out/ Mo./Day Debit Credit TOTAL$ BALANCE $ THE ABOVE BALANCE CONSISTS OF THE FOLLOWING: 2. Furniture, Household Goods, Wearing Apparel $ 3. Corporation Stocks 4. Mortgages, Bonds, Notes 5. Cash, Bank and Savings & Loan Accounts Insurance Policies 6. All Other Personal Property TOTAL$ All claims, expenses of administration and taxes have been paid, in full, except the following, together with an explanation why said items have not been fully paid: The independent personal representative will distribute the remaining probate assets in accordance with the following schedule of proposed distribution, unless objection to the proposed distribution is filed in court within twenty (20) days after the filing of the foregoing statement of account. Form 10606(a) Page 2 of 2 7/24/96