Free CIRCUIT COURT OF THE FOURTEENTH JUDICIAL CIRCUIT - Illinois

CIRCUIT COURT OF THE FOURTEENTH JUDICIAL CIRCUIT ROCK ISLAND COUNTY, ILLINOIS
ESTATE OF _________________________________________ No.__________________

ESTATE CLAIM-CONTRACT 1. Claimant, _______________________________ of ________________________________
(name) _________________________________________________, has (city, state, zip) (address)

a claim for $______________against

the estate, which is just and unpaid after allowing all just credits, deductions and set-offs. 2. The nature of the claim is (based upon a written instrument a copy must be attached): _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Date:___________________________________ (month, day, year) ____________________________________

Signature of Claimant ____________________________________________________________________________________________________________

AFFIDAVIT ______________________________________on oath states that the allegations in this claim are true. Signed and sworn to before me_______________________________________, 20_____. (SEAL) _____________________________________
Notary Public ____________________________________________________________________________________________________________

Name:__________________________________________________ Attorney for Claimant:____________________________________ Address: ________________________________________________ ________________________________________________ Telephone:______________________________________________

ESTATE CLAIM CONTRACT
REVISED 7/15/05

FORM NO. P-45

APPEARANCE-WAIVER OF SERVICE-CONSENT I, ___________________________________of the Estate of _____________________________ Deceased, hereby enter my appearance in the matter of the within claim, waive service of process and consent to the allowance of it for the sum of $____________as of the _______________________Class. Date:____________________________________ __________________________________________
SIGNATURE OF REPRESENTATIVE OR HIS ATTY ____________________________________________________________________________________________________________

PROOF OF SERVICE The undersigned has this day delivered or mailed a true copy of this claim (by ordinary mail) (by registered mail, return receipt attached) together with a true copy of each written instrument upon which the claim is predicted to the legal representative of the estate and to his attorney of record. Date:_________________________________ _______________________________________
Claimant

By

___________________________________

Subscribed and sworn to before me this _______day of _____________________, 20________ (SEAL) ___________________________________
NOTARY PUBLIC ____________________________________________________________________________________________________________

ALLOWANCE OF CLAIM This claim allowed by Court in the sum of $_____________ as of ___________________Class Date:_______________________________________ ENTER:________________________________
Judge

See Docket Entry ______________________________________________________________________________________