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Probate

OSCA (04-17) PR10 1 of 1 630.130.6, 632.415.2 RSMo IN THE _______ JUDICIAL CIRCUIT, ________________________ COUNTY, MISSOURI Probate Division For the Month __________________ of Year __________ (Date File Stamp) Attorney Name and Address: Tax ID Number or Social Security Number: * Filing/Hearing Type Mental Health Alcohol & Drug (A) 96 Hr.(E) 96 Hour (B) 21 Day(F) 30 Day (C) 90 Day(G) 90 Day (D) 1 Year (H) 180 Day (I) ECT Statement of Reimbursable Attorney Fees Sections 630.130.6 and 632.415.2 RSMo Case Number Filing Date and Hearing Date Filing/Hearing Type * Total Hours Total To Be Reimbursed Grand Total $ I certify the above amounts charged for attorney fees pursuant to sections 630.130 and 632.415, RSMo, are true and accurate and have not been previously paid by the state of Missouri. Attorney’s Signature (Required) Date Judge’s or Clerk’s Signature (Required) Date Mail original completed form to: Missouri Department of Mental Health, P.O. Box 687, Jefferson City, MO 65102

PR 10 Statement of Reimbursable Attorney Fees

OSCA (10-98) PR23 1 of2 473.090.1 (2) RSMo 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 afte r giving credit for all payments a nd offsets to which the estate is entitled there is now due and owing applicant, as a creditor of decedent, the sum of $ , for (state nature of debt): . The entire estate of decedent does not exceed th e 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 application is granted, applicant will pay the debts of decedent so far as the assets thereof will permit, in the order of preference established by law, and will distribute the balance of said estate, if any, to th e persons entitled thereto under the law. Wherefore, applicant prays the court order no letters be grante d on said estate unless on the application of creditors or other pa rties interested the existence of other or further property is shown. The applicant swears that the matters set forth above are 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 (10-98) PR23 2 of2 473.090.1 (2) RSMo Appendix A Decedent: Case Number: Description of Property Value Personal Property TOTAL:

PR 23 Application of Creditor for Refusal of Letters

OSCA (8-02) PR25 1 of 2 473.090.1 (1) RSMo IN THE CIRCUIT COURT OF COUNTY, MISSOURI Probate Division Case Number: In the Estate of , Deceased. (Date File Stamp) Application of Unmarried Minor Child(ren) for Refusal of Letters (No Surviving Spouse or Nonapplicant Children) The applicant states that applicant is the natural parent conservator of the estate court appointed guardian custodian of , unmarried minor child(ren) of the decedent who di ed on , residing at , survived by the above named minor child(ren), no surviving spouse and no other unmarried minor children.Decedent left property, in this State, the value of which, less liens and encumbrances, is not greater in amount than that is allowed by law as exempt property and maintenance of said unmarried minor child(ren) for one year after the death of decedent, which said estate consists solely of the property described and of the value as follows: Description of Property Value See Appendix A. Total$ Wherefore, applicant prays that the court order that no letters be granted on said estate unless on the application of creditors or other interested parties, the existence of other or further property is shown. The applicant swears that the matters set forth above are 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/Tel ephone) (Name/Address/Telephone) OSCA (8-02) PR25 2 of 2 473.090.1 (1) RSMo Appendix A Decedent: Case Number: Description of Property Value Real Property Personal Property TOTAL:$

PR 25 Application of Unmarried Minor Children for Refusal of Letters

OSCA (8-02) PR30 1of2 473.090 RSMo IN THE CIRCUIT COURT OF COUNTY, MISSOURI Probate Division Case Number: In the Estate of , Deceased. (Date File Stamp) Application to Amend Order Refusing Letters (Surviving Spouse/Unmarried Minor Child(ren)/Creditor) Applicant, , surviving spouse on behalf of , unmarried minor child(ren) creditor of the decedent, first being duly sworn, states that on an order(s) of this court was entered refusing letters on the estate of said decedent, which estate was then repr esented by applicant to cons ist of property of value described in the previous order(s).Applicant further states that thereafter additional assets of said estate were discovered consisting of: Description of Property Value See Appendix A. Total$ (for spouses and unmarried minors) The total value of all property, including pr operty described in the previous order(s), less liens and encumbrances, is not gr eater in amount than that to which the applicant, as surviving spouse and/or the unmarried minor child(ren) of decedent is(are) entitled by law as exempt property and the allowance under Section 474.260, RSMo. (for creditors) The entire estate of decedent does not exceed the value of $15,000.00. Wherefore , applicant prays the court to amend its previous order(s) refusing letters on said estate by listing and including therein the said assets discovered after the entry thereof. The applicant swears that the matters set forth above ar e true and correct to the best knowledge and belief of the applicant, subject to the penalties of making a false affidavit or declaration. Date: Signature of Attorney for Applicant Signature of Applicant (Name/Bar Number/Address/Tel ephone) (Name/Address/Telephone) OSCA (8-02) PR30 2 of 2 473.090 RSMo Appendix A Decedent: Case Number: Description of Property Value Real Property Personal Property TOTAL:$

PR 30 Application to Amend Order Refusing Letters

OSCA (8-02) PR33 1of2 473.090.1 (1) RSMo 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 de cedent, 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 who is(a re) not 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 sa id estate unless on the application of creditors or other in terested parties, the existence of other or further property is shown. The applicant swears that the matters set forth above are 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/Tele phone) (Name/Address/Telephone) OSCA (8-02) PR33 2 of 2 473.090.1 (1) RSMo Appendix A Decedent: Case Number: Description of Property Value Real Property Personal Property TOTAL:$

PR 33 Application of Surviving Spouse for Refusal of Letters

OSCA (10-98) PR75 1of1 474.190, RSMo IN THE CIRCUIT COURT OF COUNTY, MISSOURI Probate Division Case Number: In the Estate of , Deceased. (Date File Stamp) Election of Surviving Spouse I, , surviving spouse of , decedent, elect to take my legal sh are in the estate of decedent. I renounce all provisions in the will of decedent inconsistent herewith. Dated: Surviving Spouse: Acknowledgment On , before me, a Notary Public, personally appeared the person described in and who executed the foregoing instrume nt, and acknowledged that he/she executed the same as his/her free act and deed. In Witness Whereof , I have hereunto set my hand and affixed my seal at my office the day and year last above written. Notary Public: County of: State of: Notary commission expires:

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