COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address):
TELEPHONE AND FAX NOS.:
Index No. Calendar No.
FOR COURT USE ONLY
ATTORNEY FOR (Name):
: : : :
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:
ESTATE OF (Name):
Defendant(s) : ......................................................
You must file this claim with the court clerk at the court address above before the LATER of (a) four months after the date letters (authority to act for the estate) were first issued to the personal representative, or (b) sixty days after the date the Notice of TO Administration was given to the creditor, if notice was given as provided in Probate Code section 9051. You must also mail or deliver a copy of this claim to the personal representative and his or her attorney. A proof of service is on the reverse. WARNING: Your claim will in most instances be invalid if you do not properly complete this form, file it on time with the court, and mail or deliver a copy to the personal representative and his or her attorney. 1. Total amount of the claim: $ 2. Claimant (name): WE COMMAND YOU, that all business and excuses being laid aside, an individual a. at the Court an individual b. the Honorable or entity doing business under the fictitious name of (specify):
THE PEOPLE OF THE STATE OF NEW YORK
you and each of you attend before ,
located at County of c. in room a partnership. Theon the signing has authority to sign on behalf of the partnership. the , person day of , 20 , at o'clock in noon, and at any recessed d. or adjourned date, to person signing has authority as sign on behalfthis action on the part of the a corporation. The testify and give evidence to a witness in of the corporation.
e. other (specify): 3. Address of claimant (specify): 4. Claimant is
Your the creditorcomply a person acting on behalf of creditor (statecontempt of court and will make you liable to failure to with this subpoena is punishable as a reason): the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.
Claimant is the personal representative the attorney for the personal representative. 5. Witness, Honorable , one of the Justices of the 6. I am authorized to make this claim which is just and due or may become due. All payments on or offsets to the claim have been Court in County, day of reverse , 20 credited. Facts supporting the claim are on attached. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date:
. . . . . . . . . . . . . . . . . . . . . . .
(TYPE OR PRINT NAME AND TITLE)
(Attorney must sign above and type name below)
(SIGNATURE OF CLAIMANT)
INSTRUCTIONS TO CLAIMANT
A. On the reverse, itemize the claim and show the date the service was rendered or the debt incurred. Describe the item or service in Attorney(s) for detail, and indicate the amount claimed for each item. Do not include debts incurred after the date of death, except funeral claims. B. If the claim is not due or contingent, or the amount is not yet ascertainable, state the facts supporting the claim. C. If the claim is secured by a note or other written instrument, the original or a copy must be attached (state why original is unavailable.) If secured by mortgage, deed of trust, or other lien on property that is of record, it is sufficient to describe the security and refer to the date or volume and page, and county where recorded. (See Prob. Code, § 9152.) P.O. Address Office and D. Mail or take this original claim to the court clerk's office for filing. If mailed, use certified mail, with return receipt requested. E. Mail or deliver a copy to the personal representative and his or her attorney. Complete the Proof of Mailing or Personal Delivery on the reverse. F. The personal representative or his or her attorney will notify you when yourTelephone No.: or rejected. claim is allowed G. Claims against the estate by the personal representative and the attorney for the personal representative must be filed within the Facsimile No.: claim period allowed in Probate Code section 9100. See the notice box above. E-Mail Address: (Continued on reverse)
Form Approved by the Judicial Council of California DE-172 [Rev. January 1, 1998] Mandatory Form [1/1/2000]
Mobile Tel. No.: CREDITOR'S CLAIM
Probate Code, §§ 9000 et seq., 9153
American LegalNet, Inc. www.USCourtForms.com
ESTATE OF (Name): DECEDENT
FACTS SUPPORTING THE CREDITOR'S CLAIM
Date of item See attachment (if space is insufficient) Item and supporting facts Amount claimed
TO PERSONAL REPRESENTATIVE
(Be sure to mail or take the original to the court clerk's office for filing) 1. I am the creditor or a person acting on behalf of the creditor. At the time of mailing or delivery I was at least 18 years of age. 2. My residence or business address is (specify): 3. I mailed or personally delivered a copy of this Creditor's Claim to the personal representative as follows (check either a or b below): Mail. I am a resident of or employed in the county where the mailing occurred. a. (1) I enclosed a copy in an envelope AND deposited the sealed envelope with the United States Postal Service with the postage fully prepaid. (a) placed the envelope for collection and mailing on the date and at the place shown in items below following (b) our ordinary business practices. I am readily familiar with this business' practice for collecting and processing correspondence for mailing. On the same day that correspondence is placed for collection and mailing, it is deposited in the ordinary course of business with the United States Postal Service in a sealed envelope with postage fully prepaid. (2) The envelope was addressed and mailed first-class as follows: (a) Name of personal representative served: (b) Address on envelope: (c) Date of mailing: (d) Place of mailing (city and state): b. Personal delivery. I personally delivered a copy of the claim to the personal representative as follows: (1) Name of personal representative served: (2) Address where delivered: (3) Date delivered: (4) Time delivered: I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date:
. . . . . . . . . . . . . . . . . . . . . . .
(TYPE OR PRINT NAME OF CLAIMANT) DE-172 [Rev. January 1,1998] (SIGNATURE OF CLAIMANT)