Statement Of Death
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Statement Of Death Form. This is a Missouri form and can be use in 7th Circuit (Clay County) Local Circuit Courts.
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Tags: Statement Of Death, 372-A, Missouri Local Circuit Courts, 7th Circuit (Clay County)
COURT
COUNTY . .
. . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
:
:
Index No.
Calendar No.
:
CIRCUIT COURT OF CLAY COUNTY, MISSOURI
JUDICIAL SUBPOENA
Plaintiff(s)
PROBATE DIVISION
-against-
:
:
No.__________________
:
Matter of _______________________________________., incapacitated now
Defendant(s)
:
. . . . . . . . . . . . . .deceased. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..........
THE PEOPLE OF THE STATE OF NEW YORKSTATEMENT OF DEATH
TO
, states that,
age
, died on
GREETINGS:
, 20
.
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
THE STATEMENTS AND REPRESENTATIONS IN THIS DOCUMENT
or adjourned date, to testify and give evidence as a witness in this action on the part of the
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.
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
Date:____________________
Court in
Witness, Honorable
County,
, one of the Justices of the
day of
Signature
, 20
Address
(Attorney must sign above and type name below)
Phone
Attorney(s) for
Office and P.O. Address
Form 372-A
Revised 3/19/2003
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile
Page 1 of 1 Tel. No.:
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