Missouri > Local Circuit Courts > 7th Circuit (Clay County) > Probate > General
Annual Or Final Settlement (Green Paper Required) 219 - Missouri
| Annual Or Final Settlement (Green Paper Required) Form. This is a Missouri form and can be used in General Probate 7th Circuit (Clay County) Local Circuit Courts . |
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**Must be submitted on green paper CIRCUIT COURT OF CLAY COUNTY, MISSOURI PROBATE DIVISION No. Matter of , __ Deceased__ Disabled __ Minor__ Personal Representative__ Conservator . SETTLEMENT AnnualFinal The following settlement is a just and true accounting from ___________, 20___ to and including________, 20___ ASSETS PER INVENTORY OR LAST SETTLEMENT 1. Furniture, household goods, wearing apparel________________ ___________ ___ 2. Corporation stocks_____________________________________ ___________ ___ 3. Mortgages, bonds, notes________________________________ ___________ ___ 4. Cash, Bank and Savings & Loan Accounts__________________ ___________ ___ Insurance Policies____________________________________ ___________ ___ 5. All other personal property_____________________________ ___________ ___ TOTAL Year Voucher Mo. Day DETAILS OF TRANSACTION No. Received/Credit Paid Out/Debit Dollars Cts Dollars Cts. Form 219 Page 1 of 2 Revised 3/14/2003 <<<<<<<<<********>>>>>>>>>>>>> 2 Year Voucher Mo. Day DETAILS OF TR ANS ACTION No. Rec eived/Credit Paid Out/Debit Dollars Cts Dollars Cts. Totals Balance THE ABOVE BALA NCE CONSIST S OF THE FOLLOWI NG: 1. Furniture, household goods, wearing apparel________________ ___________ ___ 2. Corporation stocks_____________________________________ ___________ ___ 3. Mortgages, bonds, notes_________ _______________________ ___________ ___ 4. Cash, Bank and Savings & Loan Accounts__________________ ___________ ___ Insurance Policies_____ _______________________________ ___________ ___ 5. All other personal property_____________________________ ___________ ___ TOTAL THE STATEMENTS AND REPRESENTA TIONS IN THIS DOCUMENT ARE MADE UNDER OATH AND ARE TRUE AND CORRE CT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERST AND THEY AR E MADE SUBJE CT TO THE PENAL ITIES OF MAKING A FALSE AFFID AVIT OR DECLAR ATION. S ig nature S ig nature: Personal Re presen tative Co-Personal Repr esentative---Co-Conserv ator Addres s : Addres s : Phone Phone: Attorney: Bar Number: Addres s Phone Number: SETTLEMENT APPROVE D Date:_________________________________ JUDGE CLERK Form 219 Pag e 2 of 2 Re vis ed 3/14/2003
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