Free Petition for Claimant for Determination of Claim - District of Columbia

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SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION IN RE: _____________________________________ An Adult Intervention Proceeding No.________________

PETITION OF CLAIMANT FOR DETERMINATION OF CLAIM 1. A statement of claim was filed on___________________________________ by the undersigned who seeks payment of______________________________________ for the following described consideration:______________________________________ ________________________________________________________________________ _______________________________________________________________________. 2. Conservator has [ ] allowed claim but has not paid claim [ ] not denied claim and sixty days have passed since claim deemed presented [ ] denied claim 3. Claimant seeks the following relief with respect to the claim. [ ] an order allowing the claim which the conservator must address no later than the next accounting [ ] an order directing the conservator to pay the claim by a date certain [ ] an order directing the conservator to perform specified acts listed below [ ] an order directing the conservator to allow security from the estate [ ] an order allowing an attachment or garnishment [ ] other (describe)_________________________________________________ _________________________________________________________________ _________________________ Attorney for Claimant
Form PD-1878A/Sep. 89

__________________________ Claimant

CERTIFICATE OF SERVICE I hereby certify that on the ____ day of ____________________, 20 ______, a copy of the foregoing ______________________________ was served by first class mail, postage prepaid, upon the following parties to the above captioned case and persons granted permission to participate pursuant to SCR-PD 303 and persons who requested notice pursuant to SCR-PD 304. __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________

____________________________________________ Signature

Form PD-1878B/Sep. 89