STATE OF SOUTH CAROLINA COUNTY OF: IN THE MATTER OF:
) ) ) ) ) )
IN THE PROBATE COURT NOTICE OF DISALLOWANCE OF CLAIM CASE NUMBER:
TO: Name: Address:
The undersigned, as the Personal Representative(s)/Conservator(s) appointed to administer this estate, disallows $ of your claim for $ presented on . Your claim was disallowed for the following reason(s):
Failure to protest this disallowance of your claim, (that is, failing to file your petition for its allowance (form #373PC) in the Probate Court and failing to commence a proceeding on the claim within thirty days after the mailing of this Notice of Disallowance of Claim), shall result in your claim or the disallowed portion of your claim being forever barred. Executed this day of Signature: Name: Address: E-mail: Telephone (O): (H): , 20 .
FORM #372PC (2/2004) 62-3-806, 62-5-428