Free Statement of Claims - District of Columbia

Superior Court of the District of Columbia
PROBATE DIVISION
ADMINISTRATION NO. ________________________S.E.

______________________________________________________
Name of Decedent

STATEMENT OF CLAIMS
The Notice to Creditors and all interested persons has been duly published in _______________________________________ as shown by the attached Affidavit Publication; the time of filing has expired; funeral expenses in the amount $__________________________ have been paid; and all creditors now known to undersigned, including contingent and disputed claims, are as follows:
Name of Creditor Nature of Claim Amount

the of of the

I do solemnly declare and affirm under penalty of law that the contents of the foregoing document are true and correct to the best of my knowledge, information and belief. __________________________________________ Personal Representative