MISSOURI CIRCUIT COURT, TWENTY-SECOND JUDICIAL CIRCUIT PROBATE DIVISION, CITY OF ST. LOUIS In the matter of 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, so far as the assets of the estate will permit, the debts of the decedent in the order of their preference, and distribute the balance, if any, to the person or persons entitled to such balance 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 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 Principal's Signature Principal's Signature Street Address Street Address City State Zip Code City State Zip Code Surety By: Attorney-in-fact (Surety Seal) American LegalNet, Inc. www.FormsWorkFlow.com ACKNOWLEDGMENT OF PRINCIPAL STATE OF COUNTY OF Now on this in the state aforesaid day of } } } , , personally appeared before me , to me personally known as the person(s) described in and who executed the foregoing bond as principal(s) and acknowledge(s) that 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 , executed the same as Notary Public (Notary Seal) Notary Commission expires: ACKNOWLEDGMENT OF CORPORATE SURETY STATE OF COUNTY OF Now on this in the state aforesaid day of } } } , , personally appeared before me , 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 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 , executed the same as Notary Public (Notary Seal) Notary Commission expires: American LegalNet, Inc. www.FormsWorkFlow.com