ࡱ> =?<@ ubjbjFF $,,,u2222222F ,6 $Ff 4 /111111$fRvU2L " LLU22 +jL2 2 /L/22 Z pO$ b /0,.l.FF2222.2L At UUFF FF MISSOURI CIRCUIT COURT, TWENTY-SECOND JUDICIAL CIRCUIT PROBATE DIVISION, CITY OF ST. LOUIS AFFIDAVIT FOR COLLECTION OF SMALL ESTATE STATE OF MISSOURI } SS CITY OF ST. LOUIS } In the matter of:  No. ___________________ Come(s) now ________________________________, being duly sworn on oath and state(s) that __________________________________________________, whose domicile and last residence address was Deceased ________________________________________________________, in the City of St. Louis, State of Missouri Address City State Zip died on the day of , ; that the entire estate, less liens, debts and encumbrances, does not exceed $40,000.00; that no application for letters testamentary or letters of administration or for refusal of letters is pending or has been granted; that all unpaid debts, claims or demands against the decedents estate and all estate taxes due, if any, on the property transfers involved, have been or will be paid except that any liability by the affiant for the payment of unpaid claims or demands shall be limited to the value of the property received; and that thirty days have elapsed since the death of decedent.  FORMCHECKBOX  That decedent has left no will.  FORMCHECKBOX  That decedent left a will dated the day of , . Affiant further states that the following are the NAMES, ADDRESSES, and RELATIONSHIPS to the decedent of the persons entitled to the property of the decedent  FORMCHECKBOX  pursuant to the laws of descent and distribution of the State of Missouri, or  FORMCHECKBOX  pursuant to the last will and testament of the decedent: HEIRS/LEGATEES OR DEVISEES: RELATIONSHIP BIRTHDATE NAME RESIDENCE ADDRESS TO DECEDENT IF MINOR Affiant further states that the following is an itemized description and valuation of the property of the decedent, and the names and addresses of the persons having possession thereof: NAME AND ADDRESS OF DESCRIPTION OF PROPERTY VALUE PERSON IN POSSESSION TOTAL Subscribed and sworn to before me this _________________________________ Affiants Signature , day of , . Affiants Name (Typed) (Seal) Street Address Notary Public City State Zip Code Notary Commission expires: Telephone Number Attorneys Signature Attorneys Name (Typed) MBE # Street Address City State Zip Code Telephone Number %GHIZ\ ( ) * + 7 ; X - 0 Y ³~nbVJbbbh kkCJOJQJ^JhyCJOJQJ^JhEDTCJOJQJ^JhEDThA>*CJOJQJ^Jhy>*CJOJQJ^J0jhEDThACJOJQJU^JmHnHuhEDThACJOJQJ^JhEDTh}CJOJQJ^JhEDTh}5CJOJQJ^Jh&5CJOJQJ^JaJhA5CJOJQJ^JaJh}5CJOJQJ^JaJ7[\) * + Z I W dgdIdgdndgdEDTgd}$a$gd}uY  H I W X Y g h i j w ƹƑƑqqqbhEDThEDTCJOJQJ^JhEDThI>*CJOJQJ^JjthEDThICJUhEDThICJOJQJ^JjhEDThICJUhEDThICJjhEDThICJUhEDThnCJOJQJ^JhEDThA>*CJOJQJ^JhEDTCJOJQJ^JhEDThACJOJQJ^J""$R! ʻ黜ʌʌʌʌʜʌʌʀqqqhEDTh?tCJOJQJ^JhEDTCJOJQJ^JhEDThI>*CJOJQJ^JhEDThsCJOJQJ^Jj\hEDThEDTCJUhEDThEDTCJOJQJ^JhEDThICJOJQJ^JjhEDThEDTCJUhEDThEDTCJjhEDThEDTCJU'RndgdIgd}gdI $da$gdIdgdEDTIfijBpqgds^gdEDT^gd?t #$EFGHRYefnw-n@ABy7m@sٽ宽xh 0hs>*CJOJQJ^Jhs>*CJOJQJ^JhEDT>*CJOJQJ^Jh?tCJOJQJ^JhEDThEDTCJOJQJ^JhEDTCJOJQJ^Jh 0h 0>*CJOJQJ^Jh 0CJOJQJ^JhEDTh?tCJOJQJ^JhsCJOJQJ^J+9deBu^gds^gd?t stuhEDTh}CJOJQJ^JhEDThsCJOJQJ^J":p}/ =!"#$%tDeCheck4tDeCheck4tDeCheck4tDeCheck4<@< NormalCJ_HmH sH tH DAD Default Paragraph FontViV  Table Normal :V 44 la (k(No List u,7[\)*+ZIWRnI f   i j B p q 9 d e Bw000@0@0@0@0@0@00000000x00000000000 000x00000000000000 00 000x00x0000000x0x0000000000000x0 0 0 0 0 0 0 0 080 0 0 00Y  su u uXhuG$G$G$G$8@(  HB  C DB S  ?ut yX  y y" y " y" y  y" yW  yW  yD[  y" y" y yD"QQ==QQw     ZZFFYYw h *urn:schemas-microsoft-com:office:smarttagsCity0http://www.5iamas-microsoft-com:office:smarttagsi *urn:schemas-microsoft-com:office:smarttagsState0http://www.5iamas-microsoft-com:office:smarttagsV*urn:schemas-microsoft-com:office:smarttagsplacehttp://www.5iantlavalamp.com/        8Xww%GHIIZZ(7X"$!$ G tw8Xw (al=V88^8`o(. ^`hH.  L ^ `LhH.   ^ `hH. xx^x`hH. HLH^H`LhH. ^`hH. ^`hH. L^`LhH. (aB          fI 0EDTOn` kkn?t&}Ays@XX#CCXXuP@UnknownGz Times New Roman5Symbol3& z Arial"hvfxf#(M (M "r4dnn3QH+ ?}MISSOURI CIRCUIT COURTbyrketreriddlegs Oh+'0  , H T ` lxMISSOURI CIRCUIT COURTISS byrketreCIRyrkyrk Normal.dotR riddlegstR3ddMicrosoft Word 10.0@G@WKo@mO$@hWO$(M ՜.+,0$ hp  %Office of State Courts AdministratorMIn MISSOURI CIRCUIT COURT Title  !"#$%&'()*+-./012356789:;>Root Entry FpO$@Data 1Table>WordDocument$,SummaryInformation(,DocumentSummaryInformation84CompObjj  FMicrosoft Word Document MSWordDocWord.Document.89q