IN THE PROBATE DIVISION, CIRCUIT COURT, ST. LOUIS COUNTY, MISSOURI In the matter of No. Minor 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 address: How long has the minor lived at this address? Years and months. The reasons why the appointment of a conservator(s) is sought are: Petitioner(s) other than the minor222s spouse, parents, children and siblings over the age of 18, are required to submit at their own expense to a background screening and a credit history investigation. Missouri Caregiver Background Screening form must be completed for petitioner(s) and anyone over 18 living in the household. It must submitted to the Missouri State Highway Patrol and Department of Mental Health at the addresses listed on the form. https://www.mshp.dps.missouri.gov/MSHPWeb/Publications/Forms/documents/MO300-1590s.pdf Birth Certificate - Copy of minor222s birth certificate must be submitted. Exhibit A 226 Financial Statement List the nature, extent and estimated value of the minor222s assets located in or the major part thereof is 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). Exhibit B 226 Minor 226 Interested Parties List information regarding minor222s parents; spouse; living children; the person having custody or who claims to have custody of the minor; any guardian or conservator appointed in Missouri or any other state; any other persons petitioner is already guardian and/or conservator; and trust information. Exhibit C 226 Minor - Consent to Appointment Consent of the proposed conservator(s) to act if appointed. If co-conservators asking to be appointed, this form required for all proposed conservators. Exhibit D 226 Designation of Resident Agent and Acceptance of Appointment of Resident Agent 226 The proposed conservator(s) designation of resident agent and the agent222s consent to act if the proposed conservator(s) is/are a non-resident of Missouri. CCPR013-W Rev. 08/2018 American LegalNet, Inc. www.FormsWorkFlow.com Exhibit E - Selection of Conservator by Minor and Waiver of Service 226 When minor is over the age of 14 he/she must complete the Selection of Conservator by Minor and Waiver of Service. Exhibit F - Parent222s Waiver of Right to Be Appointed Conservator - If only one parent is being appointed as conservator, the Parent222s Waiver of Right to Be Appointed Conservator must be completed by the remaining parent. 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). Petitioner222s Signature Petitioner222s Signature Petitioner222s Name (Typed) Petitioner222s Name (Typed) Street Address Street Address City State Zip Code City State Zip Code Telephone Number including Area Code Telephone Number including Area Code Attorney222s Signature Attorney222s Signature Attorney222s Name (Typed) Attorney222s Name (Typed) Street Address Street Address City State Zip Code City State Zip Code Telephone Number including Area Code Telephone Number including Area Code Missouri Bar Number Missouri Bar Number CCPR013-W Rev. 08/2018 American LegalNet, Inc. www.FormsWorkFlow.com