SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION _________ NRT _________ __________ ADM _________ Trust of ________________________________ Settlor Estate of ________________________________ Deceased CLAIM AGAINST REVOCABLE TRUST The claimant named below certifies that [ [ ] The claimant makes claim for _____________________________________________________ ] The claimant makes claim for costs of administration of the settlor decedent's estate in the amount of $_________________ for ___________________________________________________ _________________________________________________________________________________ [ [ [ [ [ ] The claimant makes claim for the expenses of the settlor decedent's funeral and disposal of ] The claimant makes claim for the homestead allowance or a portion thereof in the amount of ] The claimant makes claim for the family allowance, or a portion thereof in the amount of ] The claimant makes claim for the exempt property allowance, or a portion thereof in the amount ] This claim is also a claim against the settlor decedent's estate, estate number _______ ADM remains in the amount of $___________________________________. $________________________, as provided by D.C. Code, sec. 19-101.02. $________________________, as provided by D.C. Code, sec. 19-101-04. of $______________________, as provided by D.C. Code, sec. 19-101.03. ______. (Note that two claim forms must be filed.) Decedent died on ___________________and was a resident of ______________________________. (date of death) On behalf of the claimant named below, I do solemnly declare and affirm under penalty of law that the contents of the foregoing document are true and correct to the best of my knowledge, information, and belief. ___________________________________ Typed Name _____________________________________ Signature of claimant or person authorized to make verification on behalf of claimant ___________________________________ Address (actual address/not Post Office Box) August 2010 ­ 601.10.v1 American LegalNet, Inc. www.FormsWorkFlow.com ___________________________________ ___________________________________ ___________________________________ Telephone number E-mail Address ___________________________________ Bar Number (if filer is an attorney) ___________________________________ I hereby certify that I have delivered or mailed, return receipt requested, a copy hereof to _________________________________________________ , Trustee of the revocable trust of ________________________________________________, this ________ day of _________________________, 20____. _______________________________ Claimant All claims presented to the Register of Wills must be accompanied by check or money order in the amount of $5.00, payable to the "Register of Wills." August 2010 ­ 601.10.v1 American LegalNet, Inc. www.FormsWorkFlow.com