IN THE PROBATE DIVISION, CIRCUIT COURT, ST. LOUIS COUNTY, MISSOURI In the estate of _______________________________________ No. _______________________ _______________ SETTLEMENT_____________________________ Balance of personal property only Date Voucher Receipts Disbursements No. Per Inventory or Last Statement: <<<<<<<<<********>>>>>>>>>>>>> 2 RECAPITULATION Furniture, household goods, wearing apparel $ ___________________ Corporate Stocks $ ___________________ Mortgages, bonds, notes, other evidences of debt $ ___________________ Bank accounts, insurance policies payable to personal representative $ ___________________ All other personal property, including proportionate share in any partnership $ ___________________ Total Value Personal Property $ ___________________ Note: If any category does not remain exactly as inventoried, but is changed by any transaction reported herein, such category must be itemized on an attached schedule (i.e., bank accounts, corporate stocks sold, distributed or received by stock split, etc.) The foregoing is made under oath or affirmation and its representations are true and correct to the best of my knowledge and belief, subject to the penalties of making a false affidavit or declaration. Signed this _____ day of _______________, 20_____. ____________________________________________ _____________________________________________ Attorneys Signature Pers. Rep./Consvr. Signature ____________________________________________ _____________________________________________ Attorneys Name (Typed) Pers. Rep./Consvr. Name (Typed) ____________________________________________ ______________________ _______________________ Street Address Street Address ____________________________________________ _____________________________________________ City State Zip Code City State Zip Code ____________________________________________ _____________________________________________ Telephone No. Telephone No. ____________________________________________ _____________________________________ ________ Missouri Bar Number Pers. Rep./Consvr. Signature _____________________________________________ Pers.Rep./Consvr. Name (Typed) _____________________________________________ Street Address ____________ _________________________________ City State Zip Code _____________________________________________ Telephone No. REQUIREMENTS Each settlement filed shall state period for which it is made and, among other things, shall contain a just and true account of all assets collected, the date when collected, from whom collected and on what account collected. Also, the date and amount of each expenditure or distribution must be supported by proper vouchers or receipts executed by the person to whom the disbursement was made.