COURT TY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. : Index No. IN THE CIRCUIT COURT OF _____________________________ COUNTY, MISSOURI : Calendar No. Probate Division: Plaintiff(s) -against- Case:Number: JUDICIAL SUBPOENA : In the Estate of _______________________________________, Deceased. : (Date File Stamp) : Certificate of Clerk Defendant(s) : ............................................... (Small Estate) I, the undersigned official of the Probate Division of the Circuit Court of the County and State aforesaid, certify that the attached affidavit has been duly filed with this court and sets forth the names and addresses of the persons entitled to the described property of the decedent under the facts in the affidavit. OPLE OF THE STATE OF NEW YORK The will of the decedent was duly admitted to probate on __________________________. No will of the decedent has been admitted to probate prior to the signing of this certificate. Notice to creditors to file their claims was published. INGS: The bond of distributees has been filed and approved by the court. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before The court has dispensed with the filing of a bond of distributees. , orable at the Court located at of , on theIn Testimony Whereof, I, Clerk of the Probate Division have signed my name and affixed the seal of the said court day of , 20 , at o'clock in the noon, and at any recessed rned date, to testify and give evidence as a witness in this action on the part of the on _______________________________. Division Clerk ________________________________ By: _________________________________________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to y on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a your failure to comply. Certification Witness, Honorable County, day of I, the undersigned official of the Probate Division of the Circuit Court of the , one of the Justices of the County and State aforesaid, do certify that the above and foregoing are true and correct , 20 copies of the original Affidavit and Certificate made under Section 473.097, RSMo, and on file in my office. Witness my hand and seal of Court on: ____________________________ (Attorney must sign above and type name below) Division Clerk _________________________________ By: __________________________________________ Attorney(s) for NOTE: This affidavit and certificate authorizes the affiant to collect the property of the decedent, described in the affidavit, for the purpose of paying debts and distributing assets. The affiant shall distribute the remaining property to such Office and P.O. Address persons identified in the affidavit who are entitled to receive the specific items of personal property, as described in the affidavit, and have any evidence of such property transferred to such persons. To the extent necessary to facilitate distribution, the affiant may liquidate all or part of decedent’s property. File in Recorder’s Office if real property is involved. Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: OSCA (10-98) PR15 558 1 of 1 American LegalNet, Inc. www.USCourtForms.com Sec. 473.097 RSMo