Statement As To Death And Delivery Of Purported Will To Court
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Statement As To Death And Delivery Of Purported Will To Court Form. This is a Missouri form and can be use in 7th Circuit (Clay County) Local Circuit Courts.
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Tags: Statement As To Death And Delivery Of Purported Will To Court, 501-D, Missouri Local Circuit Courts, 7th Circuit (Clay County)
CIRCUIT COURT OF CLAY COUNTY, MISSOURI
PROBATE DIVISION
No.
Matter of
, Deceased.
STATEMENT AS TO DEATH AND DELIVERY OF PURPORTED WILL TO COURT
, states that
, age
, who resided at
died on the
day of
, 20
, at
.
That said, decedent left an instrument in writing as *his - * her purported Will, dated the
_______ day of _____________________________, 20______, which is hereby delivered to the
Probate division of the Circuit Court of Clay County, Missouri in accordance with Section 473.043
RSMo.
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.
Date:_______________
(Signature)_____________________________________________
Custodian of Purported Will
_____________________________________________
Address
_____________________________________________
Phone:_______________________________________
Attorney Register No.____________________________
*strike if inapplicable
Form 501-D
Revised 4/13/2005
Page 1 of 1
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