MISSOURI CIRCUIT COURT, TWENTY-SECOND JUDICIAL CIRCUIT PROBATE DIVISION, CITY OF ST. LOUIS In the estate of ____________________________________________ No. _________________________ Deceased/Disabled/Minor SETTLEMENT Following is a settlement of the accounts of the undersigned Personal Representative/Conservator for the period commencing on the ______________________ day of __________________, ____, and ending on the _________________________ day of ____________________, ____. DATE VOUCHER DETAILS OF TRANSACTION NO. BALANCE OF PERSONAL PROPERTY ONLY PER INVENTORY OR LAST SETTLEMENT: RECEIPTS DISBURSEMENTS American LegalNet, Inc. www.FormsWorkFlow.com DATE VOUCHER NO. DETAILS OF TRANSACTION RECEIPTS DISBURSEMENTS American LegalNet, Inc. www.FormsWorkFlow.com DATE VOUCHER NO. DETAILS OF TRANSACTION RECEIPTS DISBURSEMENTS American LegalNet, Inc. www.FormsWorkFlow.com DATE VOUCHER NO. DETAILS OF TRANSACTION RECEIPTS DISBURSEMENTS American LegalNet, Inc. www.FormsWorkFlow.com DATE VOUCHER NO. DETAILS OF TRANSACTION RECEIPTS DISBURSEMENTS American LegalNet, Inc. www.FormsWorkFlow.com DATE VOUCHER NO. DETAILS OF TRANSACTION RECEIPTS DISBURSEMENTS American LegalNet, Inc. www.FormsWorkFlow.com DATE VOUCHER NO. DETAILS OF TRANSACTION RECEIPTS DISBURSEMENTS American LegalNet, Inc. www.FormsWorkFlow.com DATE VOUCHER NO. DETAILS OF TRANSACTION RECEIPTS DISBURSEMENTS American LegalNet, Inc. www.FormsWorkFlow.com DATE VOUCHER NO. DETAILS OF TRANSACTION RECEIPTS DISBURSEMENTS American LegalNet, Inc. www.FormsWorkFlow.com DATE VOUCHER NO. DETAILS OF TRANSACTION RECEIPTS DISBURSEMENTS American LegalNet, Inc. www.FormsWorkFlow.com DATE VOUCHER NO. DETAILS OF TRANSACTION RECEIPTS DISBURSEMENTS American LegalNet, Inc. www.FormsWorkFlow.com DATE VOUCHER NO. DETAILS OF TRANSACTION RECEIPTS DISBURSEMENTS American LegalNet, Inc. www.FormsWorkFlow.com DATE VOUCHER NO. DETAILS OF TRANSACTION RECEIPTS DISBURSEMENTS American LegalNet, Inc. www.FormsWorkFlow.com DATE VOUCHER NO. DETAILS OF TRANSACTION RECEIPTS DISBURSEMENTS American LegalNet, Inc. www.FormsWorkFlow.com DATE VOUCHER NO. DETAILS OF TRANSACTION RECEIPTS DISBURSEMENTS American LegalNet, Inc. www.FormsWorkFlow.com DATE VOUCHER NO. DETAILS OF TRANSACTION RECEIPTS DISBURSEMENTS TOTALS BALANCE American LegalNet, Inc. www.FormsWorkFlow.com ITEMIZATION 1. CORPORATE STOCKS: Name ________________________ ________________________ ________________________ ________________________ ________________________ ________________________ No. of Shares ____________ ____________ ____________ ____________ ____________ ____________ $_________________ STOCKS TOTAL CASH VALUE 2. BANK ACCOUNTS, INSURANCE POLICIES Name ________________ ________________ ________________ ________________ Policy/Account No. Value _________________ $____________ _________________ $____________ _________________ $____________ _________________ $____________ ________________ _________________ $____________ ________________ _________________ $____________ ACCOUNT/POLICY TOTAL VALUE $_________________ American LegalNet, Inc. www.FormsWorkFlow.com ALL PERSONAL PROPERTY INCLUDING VEHICLES: Year Make Model __________ __________ __________ __________ __________ __________ Description ____________________ ____________________ ____________________ VIN No ________________ ________________ ________________ ________________ ________________ ________________ Value $_________ $_________ $_________ $_________ $_________ $_________ Value $__________ $__________ $__________ _____ __________ _____ __________ _____ __________ _____ __________ _____ __________ _____ __________ Name ____________ ____________ ____________ TOTAL VALUE $_________________ MORTGAGES, BONDS, NOTES, OTHER EVIDENCES OF DEBT: Name ______________ ______________ ______________ ______________ ______________ ______________ Description _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ Value $_____________ $_____________ $_____________ $_____________ $_____________ $_____________ $_________________ American LegalNet, Inc. www.FormsWorkFlow.com TOTAL VALUE RECAPITULATION Furniture, household goods, wearing apparel Corporate stocks, per schedule attached Mortgages, bonds, notes, other evidences of debt, Per schedule attached Bank accounts, insurance policies payable to personal representative, per schedule attached All personal property, including proportionate share In any partnership Total Value Personal Property $_______________________________ $_______________________________ $_______________________________ $_______________________________ $_______________________________ $_______________________________ NOTE: If any category does not remain exactly as inventoried, but is changed by any transaction reported herein, such category must be itemized on an attached schedule (i.e., bank accounts, corporate stocks sold, distributed or received by stock split, etc.) The personal representative(s)/conservator(s) of this estate state(s) that the foregoing is made under oath or affirmation and its representations are true and correct to the best of ____________________ knowledge and belief, subject to the penalties of making a false affidavit or declaration. Signed this ________ day of ________________, ______. ________________________________________ Attorney's Signature ________________________________________ Attorney's Name (Typed) and MBE # ________________________________________ Street Address ________________________________________ City State Zip Code ________________________________________ Telephone No. ________________________________________ E-Mail Address ________________________________________ Current Address of Protectee ________________________________________ City State Zip Code _____________________________________ Pers. Rep./Conservator's Signature _____________________________________ Pers. Rep./Conservator's Name (Typed) _____________________________________ Street Address _____________________________________ City State Zip Code _____________________________________ Pers. Rep./Conservator's Signature ____________________________________ Pers. Rep./Conservator's Name (Typed) _____________________________________ Street Address _____________________________________ City State Zip Code REQUIREMENTS Each settlement filed shall state period for which it is made, and among other things, shall contain a just and true account of all asst