IN THE PROBATE DIVISION, CIRCUIT COURT, ST. LOUIS COUNTY, MISSOURI In the matter of ____________________________________________ Minor No.__________________________ PETITION FOR APPOINTMENT OF A CONSERVATOR OF MINOR Come(s) now _______________________________________________________________________________ (use full name(s) of person(s) requesting conservatorship) of full age, and state that he / she / they wish to be appointed as conservator(s) of the following child who is domiciled in St. Louis County Other ____________________________________________________________________ (list county where domiciled) Full Name of Child _____________________________________________ Date of Birth _____________________ Present residence and post office address: ________________________________________________________________ Most recent addresses for the three (3) years prior to the filing of this petition*: 1. ______________________________________________________________________________________________ 2. ______________________________________________________________________________________________ 3. ______________________________________________________________________________________________ *If unknown, please provide an explanation as to the efforts made to ascertain them. NOTE: A copy of the birth certificate for the minor must be submitted. The nature, extent and estimated value of the minor's assets located in St. Louis County, State of Missouri, and any assets located outside the State of Missouri as far as is known to petitioner(s) is set forth in Exhibit A attached hereto and incorporated herein by this reference. The minor is a qualified beneficiary of a trust for which the purpose is: ________________________________________________________________________________________________. The name(s) and address(es) of the trustee(s) is / are set forth in Exhibit B attached hereto and incorporated herein by this reference. The reasons why the appointment of a conservator(s) is sought are: ________________________________________________________________________________________________. If the proposed conservator(s) is / are a non-resident of Missouri, attached hereto and incorporated herein by this reference as Exhibit C is the proposed conservator(s) designation of resident agent and the agent's consent to act. CCPR013 For Court's Use Only: 1 KALCN - Ptn Appt Conservator Minor American LegalNet, Inc. www.FormsWorkFlow.com Parent's Waiver of Right to Be Appointed Conservator attached hereto and incorporated herein by this reference as Exhibit D. Minor is over the age of 14 and files his / her Selection of Conservator by Minor and Waiver of Service which is attached and incorporated herein by this reference as Exhibit E. The following information is set forth in Exhibit B attached hereto and incorporated herein by this reference: The names and addresses of the minor's parents; and if one or both of them are deceased, their date of death; The minor is married and the name and address of the spouse; The minor has living children and their names, ages and addresses; The minor has a guardian and/or conservator appointed in this state or any other state and their name and address; The name and address of the person having custody of the minor; The names and addresses of any others that the petitioner(s) is / are guardian(s) and/or conservator(s). WHEREFORE, petitioner(s) pray(s) that ________________________________________________, the __________________________________ of said minor be appointed conservator(s) of the estate of said minor, under supervision of the court, and requests that letters of conservatorship issue to the above named person(s). _______________________________________________________ Petitioner's Signature _______________________________________________________ Petitioner's Name (Typed) _______________________________________________________ Street Address _______________________________________________________ City State Zip Code _______________________________________________________ Telephone Number including Area Code ________________________________________________________ Petitioner's Signature ________________________________________________________ Petitioner's Name (Typed) ________________________________________________________ Street Address ________________________________________________________ City State Zip Code ________________________________________________________ Telephone Number including Area Code _______________________________________________________ Attorney's Signature _______________________________________________________ Attorney's Name (Typed) _______________________________________________________ Street Address _______________________________________________________ City State Zip Code _______________________________________________________ Telephone Number including Area Code _______________________________________________________ Missouri Bar Number ________________________________________________________ Attorney's Signature ________________________________________________________ Attorney's Name (Typed) ________________________________________________________ Street Address ________________________________________________________ City State Zip Code ________________________________________________________ Telephone Number including Area Code ________________________________________________________ Missouri Bar Number CCPR013 2 American LegalNet, Inc. www.FormsWorkFlow.com