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NOTICE OF CLAIM
(Filed Pursuant to 20 Pa.C.S. ยง 3532)
COURT OF COMMON PLEAS OF COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION
ESTATE OF No.
, DECEASED
To the Clerk of the Orphans' Court Division: Enter the claim of
(Claimant)
in the , against the above entitled Estate.
amount of $
The Decedent, who resided at
(Street Address)
, died on
(Date of Death)
. Written notice of
said claim was given to
(Personal Representative or his/her counsel)
at
(Address)
on
(Date)
.
(Claimant)
(Street Address)
(City, State, Zip) (Claimant's Counsel) (Supreme Court I.D. No.)
(Address)
(Telephone)
Form OC-07 rev. 10.13.06