DE-503 (Rev. 7-1-08) STATE OF MAINE COUNTY PROBATE COURT DOCKET NO. Estate of CLAIM AGAINST ESTATE1 Deceased 1.Residence and date of death of decedent if known:2.Name of claimant:3.Address of claimant:4.Amount claimed:5.Basis for claim (Explain or attach evidence):6.Date claim will become due if not yet due:7.Nature of any uncertainty about claim:8.Security for claim (Describe in detail, including recording information, if any): American LegalNet, Inc. www.FormsWorkFlow.com DE-503 (Rev. 7-1-08) Page 2 of 2 I make this claim pursuant to 18-A MRSA 247 3-804 and ask that it be honored according to law. Dated Claimant or Attorney or Authorized Representative Name, address, telephone number and Maine Bar Registration Number of claimant's attorney, if any. Decisions by personal representative: Allowed Disallowed Partially allowed in the amount of $ Notice of decision mailed to claimant on Dated Personal Representative or Attorney and Attorney222s Maine Bar Registration Number Name, address and telephone number of personal representative's attorney, if any NOTICE TO CLAIMANT AND WARNING 18-A MRSA 247 3-806 YOUR CLAIM IS TREATED AS ALLOWED IF THE PERSONAL REPRESENTATIVE HAS NOT MAILED OR DELIVERED TO YOU A SIGNED NOTICE OF DISALLOWANCE OR PARTIAL ALLOWANCE WITHIN 60 DAYS AFTER THE TIME FOR ORIGINAL PRESENTATION OF CLAIMS HAS EXPIRED. THEREAFTER, IT MAY BE DISALLOWED ONLY UPON NOTICE TO YOU. IF THE PERSONAL REPRESENTATIVE MAILS OR DELIVERS NOTICE IN A TIMELY MANNER, YOUR CLAIM IS BARRED TO THE EXTENT HE HAS DISALLOWED IT UNLESS, WITHIN 60 DAYS AFTER HE MAILS OR DELIVERS SUCH NOTICE TO YOU, YOU FILE A PETITION FOR ALLOWANCE IN THIS COURT OR COMMENCE A PROCEEDING AGAINST THE PERSONAL REPRESENTATIVE. THIS FORM IS NOT A PETITION FOR ALLOWANCE, and FILING THIS FORM IN COURT WILL NOT PRESERVE YOUR RIGHTS AGAINST A PERSONAL REPRESENTATIVE WHO HAS DISALLOWED YOUR CLAIM IN WHOLE OR IN PART. 1 To preserve a claim against an estate, a written claim must be delivered or mailed to the personal representative or filed in court in a timely manner. If filed in the court, it is suggested that the claimant deliver or mail a copy of the filed claim to the personal representative. MARP American LegalNet, Inc. www.FormsWorkFlow.com