IN THE PROBATE DIVISION, CIRCUIT COURT, ST. LOUIS COUNTY, MISSOURI
In the estate of
_______________________________________ No. _______________________
_______________SETTLEMENT_____________________________
Date Voucher Balance of personal property only Receipts Disbursements
No. Per Inventory or Last Statement:
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 0.00
$ ___________________
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_____.
____________________________________________ _____________________________________________
Attorney’s Signature Pers. Rep./Consvr. Signature
____________________________________________ _____________________________________________
Attorney’s 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.