CIRCUIT COURT OF CLAY COUNTY, MISSOURI PROBATE DIVISION No. Matter of , disabled and now deceased. PETITION FOR APPROVAL OF FINAL SETTLEMENT AND FOR ORDER CLOSING ESTATE, ASSETS EXHAUSTED As Conservator of the above estate I hereby state to the Court that died on _____. That this estate is in proper condition to close; that all assets have been applied to the payment of debts and expenses and are exhausted and, that there are no assets to be distributed. WHEREFORE, I request that the Final Settlement be approved, that this estate be closed and that I, and the surety on my bond be released from further liability on said bond. 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. Dated: Conservator ORDER APPROVING SETTLEMENT AND CLOSING ESTATE ASSETS EXHAUSTED Now on this ________ day of ___________________________, 20_____, finds that , died on _____ and the Final Settlement and petition to close the estate was filed by the Conservator. The Court finds that there are no assets for distribution and the petition should be granted. WHEREFORE, it is ordered that the Final Settlement is approved, the estate closed and, further liability of the principal and surety on the bond is terminated. Clerk/Judge Form 369-A Revised 3/14/2003 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com