CIRCUIT COURT OF CLAY COUNTY, MISSOURI PROBATE DIVISION Estate No. CV2____________________ Matter of__________________________________________, Deceased NOTICE OF FILING OF STATEMENT OF ACCOUNT SETTLEMENT AND SCHEDULE OF PROPOSED DISTRIBUTION You are hereby notified that the undersigned independent personal representative will file the attached statement of account, containing a schedule of proposed distribution of the assets of the estate, in the Probate Division of the Circuit Court of Clay County, Missouri, at 11 S. Water, Liberty, Missouri on _________________________. If no objections to the statement of account or schedule of distribution are filed within twenty (20) days after the filing thereof, the undersigned independent personal representative will distribute in accordance with the schedule of proposed distribution contained in the statement of account. If no proceeding is commenced in the Court within six (6) months after the filing of the statement of account, each independent personal representative is thereby discharged from further claim of demand by any interest person. Copies of the original and any supplementary and corrected inventories and all settlements filed in the Court are attached hereto. Personal Representative Address Telephone Attorney Address Telephone ACKNOWLEDGMENT OF SERVICE OF NOTICE Receipt of the above notice is hereby acknowledged. Date Heir Devisee (Instructions for publication refer to 473.840 RSMo.) Form 605-I Revised 3/17/2003 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com CIRCUIT COURT OF CLAY COUNTY, MISSOURI PROBATE DIVISION PROOF OF MAILING OF NOTICE OF FILING OF STATEMENT OF ACCOUNT AND OTHER DOCUMENTS The undersigned hereby states that a copy of the notice as the same appears on the reverse side hereof, together with a copy of the Statement of Account, omitting vouchers, copies of the original and, any supplementary and corrected inventories and all settlements filed in the Court, was mailed by the undersigned on , by ordinary mail, according to law to: NAME ADDRESS 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. Independent Personal Representative_____ Form 605-I Revised 3/17/2003 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com