Free Connie-B.wpt - North Dakota

ND PROBATE CODE FORM 20

8/13/04

WRITTEN STATEMENT OF CLAIM AGAINST ESTATE DELIVERED OR MAILED TO PERSONAL REPRESENTATIVE OR FILED WITH COURT. (N.D.C.C. . 30.1-1904).

Name, Address, and Telephone No. of Attorney

Space below for use of District Court only Probate No. _______________

Attorney ___________________ for:

IN THE DISTRICT COURT OF __________________________________ COUNTY, STATE OF NORTH DAKOTA In the Matter of the Estate of ________________________________________________________________, Deceased.

CLAIM AGAINST ESTATE
_____________________________________________________________________, creditor of the estate of ___________________________________________________________, deceased, hereby states that said estate is indebted to said creditor in the amount of $_____________________ for:

Dated this _____________________________ day of __________________________________, ____________.

____________________________________________ Claimant ____________________________________________ Address