IN THE PROBATE DIVISION, CIRCUIT COURT, ST. LOUIS COUNTY, MISSOURI Estate of ________________________________________________________________ Decedent No. ________________ Bond $ _____________ CORPORATE SURETY BOND (Creditor's Refusal) _________________________________________________________________________________________________ as principal(s) and __________________________________________________________________________________ as surety are held and firmly bound to the State of Missouri in the full and just sum of $ _________________________ for the payment of which we bind ourselves, our heirs, our personal representatives and assigns, jointly and severally. The condition of the bond is that if _____________________________________________________________________, creditor of the decedent, shall pay the debts of decedent so far as the assets of the estate will permit in the order of their preference, and distribute the balance of the property of decedent, if any, to the person or persons entitled thereto under the law, then the above bond is void, otherwise to remain in full force; liability of the surety to terminate unless proceedings against it are instituted within two years after the bond is filed. IN WITNESS WHEREOF, we have hereunto subscribed our names this _________ day of ____________________ , __________. ______________________________________________ Principal's Signature ___________________________________________ Principal's Signature ______________________________________________ Street Address ___________________________________________ Street Address ______________________________________________ City State Zip Code ___________________________________________ City State Zip Code Approved this _______ day of ___________________, ________. JOAN M. GILMER, CIRCUIT CLERK Probate Division, Circuit Court St. Louis County, Missouri ______________________________________________ Surety By: __________________________________________ Deputy Clerk By: _______________________________________ Attorney in fact (Surety Seal) For Court's Use Only: KOAB ­ Order Approving Bond American LegalNet, Inc. www.FormsWorkFlow.com ACKNOWLEDGMENT OF PRINCIPAL STATE OF _________________________ } } SS. COUNTY OF _______________________ } Now on this _______ day of ___________________________________ , _______, personally appeared before me in the State aforesaid __________________________________________________________________________________ _____________________________________________________________ to me personally known as the person(s) described in and who executed the foregoing bond as principal(s) and acknowledge(s) that he/she executed the same as his/her free act and deed for the uses and purposes therein mentioned. IN TESTIMONY WHEREOF, I hereto sign my name and affix my seal at office in the state of _____________________ , this _______ day of ____________________________ , _______. (Notary Seal) Notary Commission expires: _____________________________________________ Notary Public ACKNOWLEDGMENT OF CORPORATE SURETY STATE OF _________________________ } } SS. COUNTY OF _______________________ } Now on this _______ day of ___________________________________ , _______, personally appeared before me in the state aforesaid __________________________________________________________________________________ , Attorney in fact, to me personally known as the person described in and who executed the foregoing bond on behalf of _________________________________________________________________________________________________ (surety) and acknowledged that he/she executed the same as his/her free act and deed for the uses and purposes therein mentioned. IN TESTIMONY WHEREOF, I hereto sign my name and affix my seal at office in the state of _____________________ , this _______ day of ____________________________ , _______. (Notary Seal) Notary Commission expires: _____________________________________________ Notary Public American LegalNet, Inc. www.FormsWorkFlow.com