Free SUPERIOR COURT OF THE DISTRICT OF COLUMBIA - District of Columbia

SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION Estate of Trust of Adm. No. TR. No.

CLAIM AGAINST DECEDENT'S ESTATE and/or REVOCABLE TRUST The claimant named below certifies that (check the applicable box[es]) The claimant makes claim for_______________________________________. The claimant makes claim for costs of administration of the settlor decedent's estate in the amount of________________for____________________________. The claimant makes claim for the expenses of the settlor decedent's funeral and disposal of remains in the amount of____________________________________. The claimant makes claim for the homestead allowance, or a portion thereof in the amount of_____________ ,as provided by D.C. Code § 19-101.02. The claimant makes claim for the exempt property allowance, or a portion thereof in the amount of______________ , as provided by D.C. Code § 19-101.03. The claimant makes claim for the family allowance, or a portion thereof in the amount of______________, as provided by D. C. Code § 19-101.04. On behalf of the claimant named below, 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 and belief. Decedent died on ______________________ and was a resident of ________________ _________________________ _____________________________ Signature of claimant or person authorized to make verification on behalf of Claimant

Name of Claimant ________________________ Address _____________________________________ _____________________________________

All claims presented to the Register of Wills must be accompanied by check or money order in the amount of $ 5.00. I hereby certify that I have delivered or mailed, return receipt requested, a copy hereof to the personal representative of the estate of______________________________________and/or___________________________ _____________________trustee of the revocable trust of________________________this_________day of___________, 200_. _________________ Claimant For Register of Wills Use Only Date Filed: By______________________ Deputy Register of Wills