CIRCUIT COURT OF JEFFERSON COUNTY, MISSOURI PROBATE DIVISION No. Matter of (First , deceased. Last) Middle APPLICATION FOR LETTERS *TESTAMENTARY *OF ADMINISTRATION WITH WILL ANNEXED I, _________________________________________, state to the Court: That the deceased, whose last residence address was ____________________________, and whose domicile was _______________________________________________; died testate on _____________________; birth date ____________________; age ______ years and sex_____. The probable value of the deceased’s estate is: Real Property $__________________and, Personal Property _____________________. That the names, relationships to the decedent, and resident addresses of the surviving spouse, heirs, devisees, legatees and lineal descendants of devisees who were relatives of and predeceased the testator, with an indication of those believed by the applicant___ to be of unsound mind and the birth dates of those who are minors and, so far as is known to the applicant___, the names and addresses of the Guardians/Conservators of those who are minors or incapacitated/disabled are as follows: NAME Name Include Spouse, Children, Parents, Lineal Descendants, Guardians/Conservators, Trustees RELATIONSHIP Relationship (thru whom) *Surviving Spouse *Trustee BIRTH DATE Birth Date (if under 18) RESIDENCE (Complete Address) HEIRS AT LAW WHO ARE NOT BENEFICIARIES UNDER THE WILL That the applicant___ believe___ there are no heirs whose names and addresses are unknown to applicant___, except as stated above. *Please state if any Form 519-D Revised 7/16/2007 Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com All beneficiaries survived the deceased by more that 120 hours, except as stated above; *PLEASE STATE IF NONE: That if Letters are issued, applicant___ will make a complete inventory of the estate, pay all debts, if any, as far as the assets will extend and the law directs, account for and pay out or distribute all assets which come into applicant’s possession and, perform all things required by law concerning the administration and that application is made for **SUPERVISED - **INDEPENDENT Administration. Wherefore, applicant___ requests___ that Letters of Testamentary be granted on the above named decedent’s estate. THE STATEMENTS AND REPRESENTATIONS IN THIS DOCUMENT ARE MADE UNDER OATH AND ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THEY ARE MADE SUBJECT TO THE PENALTIES OF MAKING A FALSE AFFIDAVIT OR DECLARATION. Applicant Applicant Address Address Phone No. Phone No. Attorney for estate: REQUIRES A SIGNATURE Address Register No, Phone No. RENUNCIATION OF RIGHT TO ADMINISTER We, the undersigned entitled to administer the estate of , deceased, hereby renounce our right to administer the estate of said deceased, also, consent to **SUPERVISED - INDEPENDENT administration and request that Letters of Administration be issued to , whose address **is - **are . SIGNATURE RELATIONSHIP RESIDENCE NOTE: Personal Representative must file an amended application if he learns that this one is incomplete or incorrect. ** strike if inapplicable Form 519-D Revised 7/16/2007 Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com