IN THE CIRCUIT COURT OF THE TWENTY-SECOND JUDICIAL CIRCUIT McHENRY COUNTY, ILLINOIS Probate Division Estate of ) ) ) ) ) _______________________________________ Deceased Case Number_____________________________ CLAIM AGAINST ESTATE 1. Claimant _____________________________________________________, has a claim for $_________ against this Estate, which is just and unpaid after allowing all credits, deductions and set-offs. 2. The nature of the claim is ____________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ________________________________________ (Claimant) AFFIDAVIT ______________________________________________ on oath states that the allegations in this claim are true. ________________________________________ ________________________________________ Signed and sworn to before me this ________ day of ____________________,20___ ________________________________________ Notary Public ORDER Allowed for $______________________ and costs. Class ____________________ _________________________________,20___ _______________________________________ Judge ________________________________________ Name_____________________________________ Attorney for________________________________ Address___________________________________ City, State Zip______________________________ Telephone_________________________________ PR-CLA1: Revised 12/01/06 Estate of Deceased American LegalNet, Inc. www.FormsWorkflow.com