SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION ADM Estate of Funeral expenses, not exceeding $1,500.00. Fiduciary and attorney222s fees, not exceeding $1,000.00. Homestead allowance, not exceeding $15,000.00. Family allowance, not exceeding $15,000.00. Exempt property, not exceeding $10,000.00. Reasonable and necessary medical and hospital expenses of the last illness of the decedent, including compensation of persons attending the decedent. Rent in arrears for which an attachment might be levied by law. Judgments and decrees of courts in the District of Columbia. Other just claims. 6. The petition is being filed because the claim or unbarred judgment has not been rejected but December 2010 226 109b.10.v1 American LegalNet, Inc. www.FormsWorkFlow.com VERIFICATION 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. Signature CERTIFICATE OF SERVICE I hereby certify that on the day of , 20, I have mailed copies of the foregoing petition, postage prepaid, by first class mail, to the following interested persons (list name and address of all interested persons): Signature December 2010 226 109b.10.v1 American LegalNet, Inc. www.FormsWorkFlow.com SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION ADM Estate of Deceased ORDER Upon consideration of the Petition for Payment of Claim Pursuant to D.C. Code, sec. 20-909(a), filed herein by , and any response thereto, it is hereby, by the Court, this day of , 20, ORDERED 1. That the petition be Granted Denied 2. That JUDGE Cc: (list names and addresses of all interested persons, including yourself) December 2010 226 109b.10.v1 American LegalNet, Inc. www.FormsWorkFlow.com