CIRCUIT COURT OF CLAY COUNTY, MISSOURI PROBATE DIVISION No. CV2_____________________ Matter of APPLICATION FOR PERMISSION TO PROCEED WITHOUT A DEPOSIT ON COSTS Pursuant to Section 514.040 RSMo., and Rule 77.03 of the Missouri Supreme Court, applicant requests permission of this Court to file without making a deposit on costs and in support thereof submits the attached affidavit. Applicant further states that *she/he does not have funds available to pay said deposit on costs in this matter and still be able to provide basic essentials for *herself/himself and the following dependents: THE STATEMENTS AND REPRESENTATIONS IN THIS DOCUMENT ARE MADE UNDER OATH AND ARE TRUE AND CORRECT TO MY BEST KNOWLEDGE AND BELIEF. I UNDERSTAND THEY ARE MADE SUBJECT TO THE PENALTIES OF MAKING A FALSE AFFIDAVIT OR DECLARATION. Applicant *strike if inapplicable Form 234 Revised 3/30/2011 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com