SUPERIOR COURT OF THE DISTRICT OF COLUMBIA I-I PROBATE DIVISION IN RE: Intervention Proceeding No. An Adult PETITION OF CLAIMANT FOR DETERMINATION OF CLAIM 1. A statement of claim was filed on by the undersigned who seeks payment of for the following described consideration: 2. Conservator has allowed claim but has not paid claim not denied claim and sixty days have passed since claim deemed presented denied claim 3. Claimant seeks the following relief with respect to the claim. an order allowing the claim which the conservator must address no later than the next accounting an order directing the conservator to pay the claim by a date certain an order directing the conservator to perform specified acts listed below an order directing the conservator to allow security from the estate an order allowing an attachment or garnishment other (describe) Attorney for Claimant Claimant Form PD-1878A/Sep. 89 2002 © American LegalNet, Inc. CERTIFICATE OF SERVICE 1 hereby certify that on the day of , ,a copy of the foregoing was served by first class mail, postage prepaid, upon the following parties to the above captioned case and persons granted permission to participate pursuant to SCR-PD 303 and persons who requested notice pursuant to SCR-PD 304. Signature Form PD -1878B/Sep. 89 2002 © American LegalNet, Inc.