IN THE CIRCUIT COURT OF COUNTY, MISSOURI Probate Division Case Number: In the Estate of , Deceased. (Date File Stamp) Application of Creditor for Refusal of Letters The applicant states that the decedent died on residing at , leaving no surviving spouse or unmarried minor children; that after giving credit for all payments and offsets to which the estate is entitled there is now due and owing applicanas a t, creditor of decedent, the sum of $ , for (state nature of debt): . The entire estate of decedent does not exceed the value of $15,000.00 and consists solely of personal property described and of a value as follows: Description of Property Value See Appendix A. Total $ Applicant further states that if this applicatioisng ranted, applicant will pay the debts of decedent so far as the assets thereof will permit, in the ordepr reofference established by law, and will distribute the balance of said estate, if any, to the persons entitled thereto under the law. Wherefore, applicant prays the court order no letters be granted on said estate unless on the application of creditors or other parties interested the existence of other or further property is shown. The applicant swears thatthe matters set forth abe arove true and correct to the best knowledge and belief of the applicant, subjectto the penalties of making a false affidavit or declaration. Date: Signature of Attorney for Applicant Signature of Applicant (Name/Bar Number/Address/Telephone) (Name/Address/Telephone) OSCA (10-98) PR23 1 of 2 473.090.1 (2) RSMo >>>> 2 Appendix A Decedent: Case Number: Description of Property Value Personal Property TOTAL: OSCA (10-98) PR23 2 of 2 473.090.1 (2) RSMo