Fillable Printable Blank Statement of Account
Fillable Printable Blank Statement of Account
Blank Statement of Account
Form 606 D I Page 1 of 4
Revised 05/11/2010
CIRCUIT COURT OF ST. CHARLES, MISSOURI
PROBATE DIVISION
No.
Matter of ,
Deceased
Personal Representative________________________________________
STATEMENT OF ACCOUNT
Personal Representative – U nsup ervised Administration
The following statement of account is a just and true accounting from _____________20___ to and including
___________, 20______.
SETTLEMENT
ASSETS PER INVENTORY
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
Mo. Day
DETAILS OF TRANSACTION
Voucher
No.
Received/Credit
Paid Out/Debit
Dollars
Cts
Dollars
Cts.
Form 606 D I Page 2 of 4
Revised 05/11/2010
Year
Mo. Day
DETAILS OF TRANSACTION
Voucher
No.
Received/Credit
Paid Out/Debit
Dollars
Cts
Dollars
Cts.
Form 606 D I Page 3 of 4
Revised 05/11/2010
Year
Mo. Day
DETAILS OF TRANSACTION
Voucher
No.
Received/Credit
Paid
Out/Debit
Dollars
Cts
Dollars
Cts.
Totals
Balance
THE ABOVE BALANCE CONSISTS OF THE FOLLOWING:
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 undersig ned Personal Rep resentative ________ state ________:
That the foregoing settlement contains a just and true accounting, omitting vouchers, of all receipts and
disbu rsements of the probate assets comin g into the possession of the Person al Rep resentative;
That all claims, expenses of administration and taxes have been paid, in full, excep t the following, together with an
explanation of why said items have not been fully paid:
That th e Personal Rep resentative_____ will d istribute the remaining probate assets in accordance with the following
schedule unless objection to the proposed distribution is filed in Court with twenty (20) days after the filing of this Statement
of Account:
SCHEDULE OF PROPOSED DISTRIBUTION
DISTRIBUTEE
REL ATIONSHIP OR
ARTICLES OF WILL
FRACTIONAL
INTEREST
PERSONAL PROPERTY TO WHICH
EACH DISTRIBUTEE IS ENTITLED
Real Pr
operty described in the Inventory filed with the Court
HEIR or DEVISEE
REL ATIONSHIP OR
ARTICLES OF WILL
INTEREST
The undersigned Personal Representative _____ further state_____:
That Notice of Grant of Letters, as requ i red by Sec. 473.033 RSMo., including a paragraph statin g that Letters
authorizing independent administration, in the form required by Sec. 473.783 RSMo., w as duly given, and the first publication
of such Notice occurred more than six (6) months before the filing of this Statement of Account.
That Notice was gi ven in the manner provided by Sec. 472.100.2 (2) RSMo., at least twenty-nine (29) days prior to the
filing of the Statement of Account which notice stated that: (a) The Personal Representative would file the Statement of
Account on the date certain or as continued by the Court; (b) Objections to th e Schedule of Proposed Distribution shall be
filed with the Court within twenty (20) days after the filing of the Statement of Account and; (c) The notice was published once
a week fo r four consecutive weeks, the last publication at least seven d ays p rior to the date specified therein for filing of the
Statement of Account.
That copies of the Statement of Ac count, copies of the original and any supplementary and corrected Inventories and
all Settlements filed in the Court and , a notice w ere mailed together by ordinar y mail to each interested part y, such notice
stating that the Statement of Account would be filed in the Court on a date stated in the notice and, that if no objections were
filed in the Court within twenty (20) days after the filing of the Statement of Account, the Personal Representative would
distribute in accordance with the Schedule of Proposed Distribution contained in the Statement of Account.
That the mailed Notice further stated that if no proceed ing is commenced in the Court w ithin 6 months after filin g of
the Statement of Ac count, the Personal Representative would be discharged from further claim or demand by any interested
party.
THE ST ATEMENTS AND REPRESENTATIONS IN THIS DOCUMENT ARE MADE UNDER OATH AND ARE TRUE AND
CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THEY ARE MADE SUBJECT TO THE
PENALTIES OF MAKING A FALSE AFFIDAVIT OR DECLARATION.
Signature Signature:
Personal Representativ e Co-Personal Representative
Form 606 D I Page 4 of 4
Revised 05/11/2010
A
ddress:
Address:
Phone Phone:
Attorney:
Bar Number:
Address
Phone Number:
