IN THE CIRCUIT COURT FOR FLORIDA IN RE: ESTATE OF COUNTY, PROBATE DIVISION File No.__________________ Division ___________________ Deceased. PERSONAL REPRESENTATIVE'S PROOF OF CLAIM (Debts to Be Paid) The undersigned, as personal representative of the above estate, intends to pay the following debts of the decedent: 1. Name of creditor: Address: Basis of claim: Security: Contingent Unliquidated Matured Unmatured [Check the above which apply] Amount: 2. Name of creditor: Address: Basis of claim: Security: Contingent Unliquidated Matured Amount: Unmatured [Check the above which apply] 3. Name of creditor: Address: Basis of claim: Security: Contingent Unliquidated Matured Amount: Unmatured [Check the above which apply] Bar Form No. P-3.1002 - 1 of 2 © Florida Lawyers Support Services, Inc. Revised January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com Any objection to a claim listed as to be paid shall be filed no later than 4 months from first publication of the notice to creditors or 30 days from the date of filing of the proof of claim, whichever occurs later. Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of my knowledge and belief. Signed on this _______ day of __________________________, ________. Attorney for Personal Representative Email Addresses: _______________________________________ Florida Bar No. Personal Representative (address) Telephone: I certify that a copy hereof has been furnished to by on , . Attorney for Personal Representative [Print or Type Names Under All Signature Lines] Bar Form No. P-3.1002 - 2 of 2 © Florida Lawyers Support Services, Inc. Revised January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com