CIRCUIT COURT OF CLAY COUNTY, MISSOURI PROBATE DIVISION Matter of __________________________________, Minor No. APPLICATION FOR APPOINTMENT OF *GUARDIAN *AND *CONSERVATOR The Applicant, states to the Court that: 1. __________________________________ whose birth date is ____________ and whose domicile is ________________________________________________________________________, needs a *Guardian *and *Conservator ___________________________________ and is the owner of property with the estimated value of: Real Property $______________________ (inside the state of Missouri), $______________________, (outside the state of Missouri) and Personal Property $______________________. *Guardian *and *Conservator 2. The appointment of a ___________________________________ is sought because: 3. The name and address of the trustee(s) for the minor is: 4. The purpose of the trust where the minor is a qualified beneficiary is: 5. The names and addresses of the parents and grandparents are: FATHER: MOTHER: PATERNAL GRANDPARENTS: MATERNAL GRANDPARENTS: 6. The name and address of the spouse of the Minor, if any, is: 7. The above Minor is in the custody of _________________________________________ whose address is Form 100-M, Revised 9/19/2011 Page 1 of 3 * Strike if inapplicable American LegalNet, Inc. www.FormsWorkFlow.com 8. The above Minor has no guardian or conservator except as follows: Name and Address: 9. There are no other custody proceedings relating to the Minor, except (Give style of case) *Guardianship *and *Conservatorship WHEREFORE, the applicant requests that Letters of ________________________________________ of the Estate of __________________________________ be issued to __________________________________, and that the matter be supervised by the Court. 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’s Signature Address Phone: Date Relationship to the Minor: SELECTION OF *GUARDIAN *AND *CONSERVATOR BY MINOR __________________________________, the within named Minor, over 14 years of age, hereby request that *Guardian *and *Conservator __________________________________ be appointed as my ___________________________________. Signature Age Address WAIVER OF RIGHT TO BE APPOINTED *GUARDIAN *AND *CONSERVATOR I, __________________________________, the Mother of __________________________________, *Guardian *and *Conservator Minor, hereby waive any rights that I may have, to be appointed ___________________________________ of said Minor, and request the appointment of __________________________________. Signature of Mother Address Subscribed and sworn to before me this ________ day of _________________________, 20_____ Notary commission expires: Notary Public Form 100-M, Revised 9/19/2011 Page 2 of 3 * Strike if inapplicable American LegalNet, Inc. www.FormsWorkFlow.com WAIVER OF RIGHT TO BE APPOINTED *GUARDIAN *AND *CONSERVATOR I, __________________________________, the Father of __________________________________, *Guardian *and *Conservator Minor, hereby waive any rights that I may have, to be appointed ___________________________________ of said Minor, and request the appointment of __________________________________. Signature of Father Address Subscribed and sworn to before me this ________ day of _________________________, 20_____ Notary commission expires: Notary Public Attorney Bar No. (Signature Required) Phone No. Address Form 100-M, Revised 9/19/2011 Page 3 of 3 * Strike if inapplicable American LegalNet, Inc. www.FormsWorkFlow.com