Statement Of Claim (Probate)

STATEMENT OF CLAIM IN THE CIRCUIT COURT FOR ___________________ COUNTY, FLORIDA PROBATE DIVISION IN RE: ESTATE OF FILE NO. _________________________________ DIVISION ________________________________ DECEASED. STATEMENT OF CLAIM BY ________________________________________________________________ The undersigned hereby presents for filing against the above estate this statement of claim and alleges: 1. The basis for the claim is ______________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 2. The name and address of the claimant are __________________________________________________ _______________________________________________________________________________________ and the name and address of the claimant's attorney, if any, are as set forth below. 3. The amount of the claim is $_____________________________________________________________ which amount is now due, or, if not due, will become due on __________________________, __________. 4. The claim (is) (is not) contingent or unliquidated. If contingent or unliquidated, the nature of the uncertainty is ___________________________________________________________________________ _______________________________________________________________________________________ 5. The claim (is) (is not) secured. If secured, the security consists of _______________________________ _______________________________________________________________________________________ Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of my knowledge and belief. Signed on _____________________________________, __________. ___________________________________ Attorney for Claimant Florida Bar No. ______________________ ___________________________________ ___________________________________ ___________________________________ Telephone: __________________________ ___________________________________ Claimant Copy mailed to attorney for the Personal Representative on __________________________________, __________. CLERK OF THE CIRCUIT COURT By: _______________________________ MUST BE FILED IN DUPLICATE statement of claim American LegalNet, Inc. www.FormsWorkFlow.com