IN THE CIRCUIT COURT OF _____________________________ COUNTY, MISSOURI Case Number: Probate Division In the Estate of _________________________________, Deceased. (Date File Stamp) Application of Creditor for Refusal of Letters The applicant states that the decedent birth date was ______________________________, died on _______________________________, residing at ___________________________________________ __________________________________________________________, leaving no surviving spouse or unmarried minor children; that after giving credit for all payments and offsets to which the estate is entitled there is now due and owing applicant, as a creditor of decedent, the sum of $_____________, for (state nature of debt):________________________________________________________________. The entire estate of decedent does not exceed the value of $15,000.00 and consists solely of personal property described and of a value as follows: Description of Property Value ___________________ Total $ See Appendix A. Applicant further states that if this application is granted, applicant will pay the debts of decedent so far as the assets thereof will permit, in the order of preference established by law, and will distribute the balance of said estate, if any, to the persons entitled thereto under the law. Wherefore, applicant prays the court order no letters be granted on said estate unless on the application of creditors or other parties interested the existence of other or further property is shown. The applicant swears that the matters set forth above are true and correct to the best knowledge and belief of the applicant, subject to the penalties of making a false affidavit or declaration. Date: _________________________________ ______________________________________ Signature of Attorney for Applicant _________________________________ Signature of Applicant _______________________________________ _________________________________ _______________________________________ _________________________________ _______________________________________ _________________________________ (Name/Bar Number/Address/Telephone) (Name/Address/Telephone) OSCA (10-98) PR23 552 1 of 2 473.090.1 (2) RSMo American LegalNet, Inc. www.FormsWorkflow.com Appendix A Decedent: Case Number: Description of Property Value Personal Property TOTAL: ___________ OSCA (10-98) PR23 552 2 of 2 473.090.1 (2) RSMo American LegalNet, Inc. www.FormsWorkflow.com