Name of Person Filing Document: Your Mailing Address Your City, State, Zip Code: Your Telephone Number: Attorney Bar No. & Representing: SUPERIOR COURT OF ARIZONA PINAL COUNTY In the Matter of Estate of ) ) ) ) ) ________________________________) [ ] an Adult or [ ] a Minor, deceased 1. My name and address are: PB 2_____________________ CLAIM AGAINST AN ESTATE [570] __________________________________________________ __________________________________________________ __________________________________________________ 2. The Estate is indebted to me in the amount of $______________________________________. 3. The basis of may claim is: ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ NOTE: Complete number 4 or 5 only if either applies to your claim. 4. The claim is not yet due. It will become due on (date): ________________________________ 5. The claim is secured by the following property (describe): _______________________________ _____________________________________________________________________________ _____________________________________________________________________________ 6. I am mailing a copy of the Claim Against an Estate to the Personal Representative, if one has been appointed. DATED: Signature Print Name Superior Court of Arizona in Pinal County July 9, 2009 ALL RIGHTS RESRVED PB Filing a Claim Against Estate Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com