IN THE PROBATE DIVISION, CIRCUIT COURT, ST. LOUIS COUNTY, MISSOURI In the matter of ________________________________________________________________ Decedent No. _____________________ AFFIDAVIT FOR COLLECTION OF SMALL ESTATE Comes now _______________________________________________________________, being duly sworn on oath and states that ________________________________________________________, whose domicile and last (Deceased Person) residence address was __________________________________________________________________________, Address City State Zip Code St. Louis County, Missouri, died on ______________________ ; that the entire estate, less liens and encumbrances, does not exceed $40,000.00; that no application for letters testamentary or letters of administration or for refusal of letters is pending or has been granted; that all unpaid debts, claims or demands against the decedent's estate and all estate taxes due, if any, on the property transfers involved, have been or will be paid except that any liability by the affiant for the payment of unpaid claims or demands shall be limited to the value of the property received; and that thirty days have elapsed since the death of the decedent. The decedent left no will. The decedent left a will dated the ___________________________. Said will has been or will be admitted to probate by a separate Application for Probate of Will within the limitation periods specified in Section 473.050 RSMo. Affiant further states that the following are the NAMES, ADDRESSES, and RELATIONSHIPS to the decedent of the persons entitled to the property of the decedent, after payment of any unpaid debts, claims or expenses of this proceeding, and pursuant to the laws of descent and distribution of the State of Missouri, or pursuant to the last will and testament of the decedent: HEIRS/LEGATEES OR DEVISEES: RELATIONSHIP NAME _________________ _________________ _________________ _________________ RESIDENCE ADDRESS _________________________ _________________________ _________________________ TO DECEDENT ________________ ________________ ________________ % BIRTHDATE IF MINOR_ _____ _________________ _____ _________________ _____ _________________ _____ _____ ________________ _________________________ ________________ _________________________ _________________ _________________ Rev. 09/2013 For Court's Use Only: KAETW - With Will KAETD - Without Will American LegalNet, Inc. www.FormsWorkFlow.com Affiant further states that the following is an itemized description and valuation of the property of the decedent, and the names and addresses of the persons having possession thereof: DESCRIPTION OF PROPERTY ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ TOTAL Subscribed and sworn to before me this ________ day of ________________, ________. _____________________________________________ Affiant's Signature VALUE ________________ ________________ ________________ ________________ ________________ ________________ ________________ ________________ ________________ NAME AND ADDRESS OF PERSON IN POSSESSION ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ _____________________________________________ Affiant's Name (Typed) (Seal) _____________________________________________ Street Address ________________________________________________ Notary Public Notary Commission expires: _________________________ _____________________________________________ City State Zip Code _____________________________________________ Telephone No. _____________________________________________ Attorney's Signature _____________________________________________ Attorney's Name (Typed) MBE# _____________________________________________ Street Address _____________________________________________ City Publish Notice of Affidavit in: Missouri Lawyers Media (St. Louis Countian) St. Louis County Legal Ledger St. Louis Post Dispatch State Zip Code _____________________________________________ Telephone and Fax Number ___________________________________________________ E-mail Address American LegalNet, Inc. www.FormsWorkFlow.com