IN THE CIRCUIT COURT OF COUNTY, MISSOURI Probate Division Case Number: In the Estate of , Deceased. (Date File Stamp) Application of Surviving Spouse for Refusal of Letters The applicant, surviving spouse of the dceedent, states that decedent died on residing at , survived by applicant and unmarried minor child(ren), leaving an estate in this state, the value of which, less liens and encumbrances, is not greate r in amount than is allowed by the law as exempt property and maintenance of applicant and unmarried minor child(ren) for one year after the death of decedent. The estate consists solely of th e property described and of value as follows: Description of Property Value See Appendix A. Total $ Unmarried minor child(ren) of the decedent whore is) (anot the child(ren) of the applicant is(are) as follows: Name of Child Date of Birth Name/Address of Custodian Wherefore, applicant prays the court order that no letters be granted on said estate unless on the application of creditors or other interested par tithese ex, istence of other or further property is shown. The applicant swears that the matters set forth abe arove true and correct to the best knowledge and belief of the applicant, subject to 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 (8-02) PR33 1 of 2 473.090.1 (1) RSMo>>>> 2 Appendix A Decedent: Case Number: Description of Property Value Real Property Personal Property TOTAL: $ OSCA (8-02) PR33 2 of 2 473.090.1 (1) RSMo