COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : CIRCUIT COURT OF CLAY COUNTY, MISSOURI JUDICIAL SUBPOENA Plaintiff(s) PROBATE DIVISION -against- : No.__________________ : Matter of _______________________________________, deceased. : (first) (middle) (last) Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . .APPLICATION .FOR .DETERMINATION OF HEIRSHIP ............... .... ....... (473.663 RSMo.) The undersigned applicant, THE PEOPLE OF THE STATE OF NEW YORK _______________________________________, represents TO and states to the Court: 1. That _________________________________, age __________, died on GREETINGS: _____________________________________, domiciled in ______________________, and residing at WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before __________________________________________________________; , the Honorable at the Court located at County of 2. That no administration has been commenced on decedent’s estate in this state nor has in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witnessofferedaction on the in this state; any Will of the decedent been in this for probate part of the 3. That the names, ages, residence addresses and, relationship to the decedent of the heirs, so far as known or can with reasonable diligence be ascertained are: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. NAME Witness, Honorable Court in County, AGE ADDRESS RELATIONSHIP , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Form 572-D Revised 3/17/2003 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : : Index No. Calendar No. : 4. That the names and residence addresses of the persons claiming any interest in the JUDICIAL SUBPOENA Plaintiff(s) property through an heir, so far as known or can with reasonable diligence be -against: ascertained are: NAME : AGE : ADDRESS RELATIONSHIP Defendant(s) : ...................................................... THE PEOPLE OF THE STATE OF NEW YORK TO GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before the Honorable Court 5. And the attached hereto at the as Schedule “A” is a list of all property and its net , marked, located at County of value, owned by the decedent, at at time of death, to the best knowledge of this in room , on the day of , 20 , the o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the applicant. WHEREFORE, applicant requests that the Court order that a hearing be held on this application Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on with notice to all subpoena was issued for a maximum penalty of $50 RSMo.damages sustained as a whose behalf this interested parties as provided in Section 473.663 and all And, that the Court result of your failure to comply. then determines the heirs of the decedent at the time of death. Court in Witness, Honorable , one of the Justices of the THE STATEMENTS AND REPRESENTATIONS IN THIS DOCUMENT ARE MADE County, day of , 20 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. sign above and type name below) (Attorney must _________________ Date Attorney(s) for ________________________________________ Signature of Applicant Office and P.O. Address Attorney for applicant________________________________________ Bar #_________ Telephone No.: Address___________________________________________________ Phone #_______ Facsimile No.: Form 572-D Revised 3/17/2003 E-Mail Address: Mobile Tel. No.: Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com