Claim On Estate {P1-PR-021}

IN THE CIRCUIT FOR THE SIXTEENTH JUDICIAL CIRCUIT KANE COUNTY, ILLINOIS Case No. IN THE MATTER OF THE ESTATE OF (DECEDENT): Name Address City, State, Zip Date of Death File Stamp CLAIM ON ESTATE Claimant: Address: City, State, Zip: Description of Claim: The claimant makes a claim against the Estate of CERTIFICATE I certify that on a copy of this claim was mailed by certified or registered mail to: delivered in person for the amount shown. mailed first class Attorney/Agent for Claimant/Claimant The $ Administrator Executor CONSENT Attorney for Estate gives his consent to the Allowance of the claim for the amount of , cost of filing to be charged to the estate. Administrator/Executor/Attorney ORDER Allowed for $ Class Found paid and satisfied and dismissed for the amount of $ Disallowed. . . Entered: Date Judge Under penalties as provided by law pursuant to 735 ILCS 5/1-109, the undersigned certifies that the statements set forth in this petition are true and correct, except as to matters stated to be on information and belief and as to such matters the undersigned certifies that he/she verily believes the same to be true. Attorney/Pro Se: Atty. Registration No.: Address: City, State, Zip: Telephone No.: Attorney E-mail: P1-PR-021 (12/15) American LegalNet, Inc. www.FormsWorkFlow.com