Statement Of Creditors Claim (Mandatory) {371ES}

STATE OF SOUTH CAROLINA COUNTY OF _____________________________ IN THE MATTER OF: ________________________________________ (Decedent) Decedent's Date of Death (if known): Decedent's Last Mailing Address: ) ) ) ) ) ) ) IN THE PROBATE COURT STATEMENT OF CREDITOR'S CLAIM CASE NUMBER: _____________________________________ Creditor: Address: Telephone: Email: Original Creditor: Address (if different from above) Claim Amount Due: Account Number: Other Reference Number: Basis of claim (Ex: Contract, Services Rendered for decedent, etc): $ Date claim will become due (if not already due) Nature of uncertainty as to the claim, if any (i.e. contingent claim, amount of claim, due date): Description of security as to the claim, if any (Ex: Collateral for the debt) Signature: Printed Name: Title: Date: INSTRUCTIONS: Claims MUST be filed with the Probate Court of the county in which the Decedent's Estate is under administration and may be delivered or mailed to the fiduciary appointed to administer the Estate (see SCPC 62-3-803, 62-3-804, and 62-3-806). No claim against a Decedent's estate may be presented or legal action commenced against a Decedent's Estate prior to the appointment of a Personal Representative to administer the Decedent's Estate (except see SCPC 62-3-804(1)(b)). Satisfaction or withdrawal of claim (FORM 325) MUST be filed once claim is resolved. FORM #371ES (1/2016) 62-3-104, 62-3-803, 62-3-804, 62-3-806 American LegalNet, Inc. www.FormsWorkFlow.com