MISSOURI CIRCUIT COURT, TWENTY-SECOND JUDICIAL CIRCUIT PROBATE DIVISION, CITY OF ST. LOUIS ESTATE OF ___________________________________________________ No. _________________________ DESIGNATION OF AGENT FOR SERVICE OF PROCESS AND RECEIPT OF NOTICE Come(s) now _______________________________________________________________, a non-resident of the State of Missouri, or a corporation organized under the laws of another state or country, and designates the following resident of the State of Missouri as Agent for the service of all process on and the receipt of notice by such non-resident or foreign corporation, and further states that the following is the name, address and signature of the Agent: ________________________________ Name of Agent _____________________________________ Signature of Agent ________________________________ Residence ________________________________ City State Zip Code *This designation revokes the designation of agent for service of process and receipt of notice of the following:_________________________________________________________________________ Agent’s Name and Residence The foregoing is made under oath or affirmation and its representations are true and correct to the best knowledge and belief of the undersigned, subject to the penalties of making a false affidavit or declaration. Dated this _________ day of __________________________, ______. ________________________________ Signature of Applicant for Letters *STRIKE WHERE INAPPLICABLE American LegalNet, Inc. www.FormsWorkflow.com