Free CCP 0345 - Illinois

2641 Claim IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS

(Rev. 11/19/03) CCP 0345 A

Estate of

______________________________________

}

ORDER

No. _____________________________ Docket __________________________ Page ___________________________

_______________, _______ Allowed for $____________ Class __________________ _________________________
Judge

CLAIM
1. Claimant _______________________________________________________________________ has a claim for (name) $ ____________________________________ against this estate. 2. The nature of the claim*

Atty. No.:_________________ Firm Name: ________________________________________ Atty. for Claimant: _________________________________ Address: ___________________________________________ City/State/Zip:______________________________________ Telephone: _________________________________________

_________________________________________________
Address: ___________________________________________ City/State/Zip: ______________________________________ Telephone: _________________________________________

*When the claim is based upon a written instrument, a copy of the instrument must be attached. When the claim is based on tort, so state. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS

Doc. ____________________ Page ________________ No. _____________________ ________________, __________
Mailing and delivery of copy of claim waived

__________________________________________________ IN THE CIRCUIT COURT OF COOK COUNTY County Department Estate of
Representative Attorney for Representative

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__________________, ________
I

-

Probate Division

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________________________________________________
(certify) (state on oath)

that on

____________________________, _________ a copy

__________________________________________________
of this claim was (mailed) (mailed by ordinary mail) Representative

__________________________________________________

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CLAIM

(delivered in person) to

_______________________________________________ ___________________________________________
Attorney for Representative

and to

_________________________________________________________ ________________________________________________ Claimant
Attorney or Agent for claimant (Agent's statement must be notarized) Signed and sworn to before me

______________________________________, _________ Amount of Claim $ _______________________________ ___________________________________________________
Notary Public

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_________________, _________
I consent to the allowance of this claim for $ as a claim of the _________________ class.

________________

Set for hearing _____________________, _________

__________________________________________________
Representative Attorney for Representative

at ______________ m. in Room ___________________

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Date of letters

_____________________________, _________

RICHARD J. DALEY CENTER Chicago, Illinois 60602

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Unless the representative or his/her attorney waives in writing the mailing or delivery of a copy of the claim or consents in writing to the allowance of the claim, the claimant shall cause a copy of the claim to be mailed or delivered to the representative and to his/her attorney of record, if any, and shall file proof of such mailing or delivery within 10 days after the filing of the claim.

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(Rev. 11/19/03) CCP 0345 B