MISSOURI CIRCUIT COURT, TWENTY-SECOND JUDICIAL CIRCUIT PROBATE DIVISION, ST. LOUIS CITY No. ________________ Estate of REPORT IN LIEU OF SETTLEMENT Comes now _________________________________________________ and states that __________ has not collected, received or disbursed any money, property or assets of any kind whatsoever, for, or on account of said estate, since the date of ____________________ herein, and prays that this report be accepted and received by the Court as and for an annual settlement as such Personal Representative. The foregoing is made under oath or affirmation and its representations are true and correct to the best of affiant’s knowledge and belief, subject to the penalties of making a false affidavit or declaration. _________________________________ Signature of Attorney for Applicant _________________________________ Name of Attorney for Applicant (Typed) _________________________________ Address _________________________________ City State Zip Code _________________________________ Telephone No. ________________________________ Signature of Applicant ________________________________ Name of Applicant (Typed) ________________________________ Address ________________________________ City State Zip Code ________________________________ Telephone No. MBE # American LegalNet, Inc. www.FormsWorkflow.com