ESTATE CLAIM STATE OF ALABAMA ) CASE NO. COUNTY OF BALDWIN ) Personally appeared before me (Notary) a Notary Public, in and for said State and County who, upon oath deposes and says (Claimant) that Exhibit A, hereto attached, and now referred to, is a correct statement of the claim which asserts and files against the (Claimant) estate of , deceased (Name of Deceased) for Dollars, (Amount of Claim) that the affiant has a personal knowledge of the correctness of said claim; that the amount claimed is justly due from the estate of , (Name of Deceased) deceased to (Claimant) after allowing all property credits, and now constitutes a subsisting demand for $ Dollars, and that affiant is duly authorized to make this affidavit. (Claimant) Subscribed and sworn to before me, this day of 19 . Notary Public American LegalNet, Inc. www.USCourtForms.com