Statement Of Claim (Probate)

: : Index No. Calendar No. IN THE CIRCUIT COURT OF THE : SECOND JUDICIAL SUBPOENA JUDICIAL CIRCUIT, Plaintiff(s) IN AND FOR LEON COUNTY, FLORIDA -against: : RE: ESTATE OF: : FILE NO:_____________ _________________________________/ Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . Deceased . . . . . . . . . . . . . . . . . . . . . . . . ........ THE PEOPLE OF THE STATE OF NEW YORK TO STATEMENT OF CLAIM The undersigned hereby presents for filing against the above estate this statement of claim and alleges: GREETINGS: 1. The basis for the claim is _________________________________________________________________ _____________________________________________________________________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before the Honorable at the Court _____________________________________________________________________________________. , located at County of 2. The name and address of the claimant are: ___________________________________________________ in room , on the day of , 20 , at o'clock in the noon, and at any recessed _____________________________________________________________________________________ or adjourned date, to testify and give evidence as a witness in this action on the part of the _____________________________________________________________________________________. 3. The amount of the claim is $_______________________________________________________________ Your failure to complyis nowthis subpoenadue, will become duecontempt of court and will make you liable to which amount with due, or, if not is punishable as a on ___________________________, 20___. the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a 4. The comply. result of your failure to claim (is)(is not) contingent or unliquidated. If contingent or unliquidated, the nature of the Uncertainly is __________________________________________________________________________ Witness, _____________________________________________________________________________________. Honorable , one of the Justices of the Court in County, day of , 20 5. _____________________________________________________________________________________. (Attorney must sign above and type name below) Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best The claim (is) (is not) secured. If secured, the security consists of _________________________________ of my knowledge and belief. Attorney(s) for Signed on _____________________________________, 20____. _________________________________________ Attorney for Claimant Florida Bar No. ___________________________ ________________________________________ ________________________________________ Telephone: ______________________________ Revised 1/6/03 Office and P.O. Address Claimant ________________________________________ Copy mailed to attorney for the Personal Telephone No.: on ______________________, 20__ . Representative Facsimile No.: By: _______________________________________ E-Mail Address: Mobile Tel. Deputy Clerk No.: American LegalNet, Inc. www.USCourtForms.com