In The Circuit Court For The Seventh Judicial Circuit of Illinois Sangamon County, Springfield, Illinois IN THE ESTATE OF: (Deceased) } of (Name) Case Number: ESTATE CLAIM CONTRACT 1. Claimant, (Name) , (Address) (City/State/Zip) has a Claim for $ deductions and setoffs. against the Estate, which is just and unpaid after allowing all just credits, 2. The nature of the Claims (if the Claim is based upon a written instrument a copy must be attached): Date Signature of Claimant AFFIDAVIT on oath states that the allegations in this Claim are true. Date Notary Public Name: Attorney for: Address: City/State/Zip: Area Code/Telephone: Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com APPEARANCE WAIVER OF SERVICE CONSENT I, of the Estate of deceased, hereby enter my Appearance in the matter of the within Claim, waive service of process and consent as of the to the allowance of it in the sum of $ Class. Date Signature of Representative or his PROOF OF SERVICE The undersigned has this day delivered or mailed a true copy of this Claim (by Regular Mail) (by Registered Mail, Return Receipt attached) together with a true copy of each written instrument upon which the Claim is predicated to the Legal Representative of the Estate and to his Attorney of record. Date (SEAL) Claimant Subscribed and sworn to before me this date: Notary Public ALLOWANCE OF CLAIM The Claim allowed by Court in the sum of $ as of Class. Date Judge See Docket Entry Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com