MATT MELUCCI CLERK OF THE CIRCUIT COURT THIRD JUDICIAL CIRCUIT
Filing Fees for Estate Claims 1. 2. 3. 4. When the amount of the claim is less than $150.00.............$0 When the amount claimed is $150.00 - $499.99.................$25.00 When the amount claimed is $500.00 - $9,999.99...............$40.00 When the amount claimed is in excess of $10,000.00..........$60.00
Please remit payment to:
Clerk of the Circuit Court 155 N. Main St., Suite 120 Attn: Probate Edwardsville, IL 62025
IN THE CIRCUIT COURT FOR THE THIRD JUDICIAL CIRCUIT MADISON COUNTY, ILLINOIS
Claimant:______________________ Address:_______________________ _______________________ In Re: The Estate of________________________, Deceased. Claim __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Case #____________ Amount of Claim ______________ ______________ ______________ ______________
______________________________, being duly sworn, on oath says that the Estate of:______________________________, deceased, is indebted to ______________________________________, in the sum of ______________. After allowing all just credits, deduction and set offs; that the same is just and unpaid on this _______ day of _________________, 20____. That attached hereto and made a part of this affidavit is a true and correct itemized statement of said account or a true and correct copy of original promissory note, showing all endorsements thereon.
________________________________ Claimant
Subscribed and sworn to before me this ________ day of ______________________, 20____.
____________________________________ (Seal) Notary Public - Clerk