Statement As To Death And Presentment Of Instrument In Writing For Probate {10050}

IN THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI - PROBATE DIVISION AT IN THE ESTATE OF ESTATE NUMBER , Deceased. STATEMENT AS TO DEATH AND PRESENTMENT OF INSTRUMENT IN WRITING FOR PROBATE The undersigned states that the above named decedent, who resided at died on (street address - city - state - zip code) at That the surviving spouse of decedent is (if none, so state) whose address is That said decedent left * * * That said instrument dated 474.337, RSMO. That said instrument dated 474.337, RSMO. That the subscribing witnesses to instrument dated are * . instruments (s) in writing, dated is is not self-proved, per Sec. is is not self-proved, per Sec. . . That the subscribing witnesses to instrument dated are . been duly proved, that an order be WHEREFORE, your petitioner prays that after said instrument (s) h entered admitting the same to probate and recorded as the Last Will and Testament of said decedent. * Strike out inapplicable statement. Page 1 of 2 2001 © American LegalNet, Inc. The undersigned swears that the matters set forth are true and correct to the best knowledge and belief of the undersigned, subject to the penalties of making a false affidavit or declaration. Date: . PETITIONER: ADDRESS: TELEPHONE NUMBER: ( ) . / zip ATTORNEY FOR ESTATE; (Give firm name and name of individual attorney who will represent the firm.) MO Bar No. ADDRESS: TELEPHONE NUMBER ( E-MAIL ADDRESS ) . FAX NUMBER ( ) / zip Form 10050 Page 2 of 2 7/29/96 2001 © American LegalNet, Inc.