CIRCUIT COURT OF THE FOUR TEENTH JUDICIAL CIRCUIT ROCK ISLAND COUNTY, ILLINOIS ESTATE OF _________________________________________ No.__________________ ESTATE CLAIM-CONTRACT 1. Claimant, _______________________________ of _______________________________ _ (name) (address) _________________________________________________,has a cl aim for $______________against (city, state, zip) the estate, which is just and unpaid after allowing all just credits, deductions and set-offs. 2. The nature of the claim is (based upon a written instrument a copy must be attached): _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Date:___________________________________ ____________ ________________________ (month, day, year) Signature of Claimant ________________________________________________________________________ ____________________________________ AFFIDAVIT ______________________________________on oath states that the allegations in this claim are true. Signed and sworn to before me_______________________________________, 20_____. (SEAL) _____________________________________ Notary Public ________________________________________________________________________ ____________________________________ Name:__________________________________________________ Attorney for Claimant:____________________________________ Address: ________________________________________________ ________________________________________________ Telephone:______________________________________________ ESTATE CLAIM CONTRACT FORM NO. P-45 REVISED 7/15/05 American LegalNet, Inc. www.USCourtForms.com>>>> 2 APPEARANCE-WAIVER OF SERVICE-CONSENT I, ___________________________________of the Estate of _____________________________ Deceased, hereby enter my appearance in the matter of the within claim, waive service of process and consent to the allowance of it for the sum of $____________as of the _______________________Class. Date:____________________________________ _________________________ _________________ SIGNATURE OF REPRESENTATIVE OR HIS ATTY ________________________________________________________________________ ____________________________________ PROOF OF SERVICE The undersigned has this day delivered or mailed a true copy of this claim (by ordinary mail) (by registered mail, return receipt attached) together with a true copy of each written instrument upon which the claim is predicted to the legal representative of the estate and to his attorney of record. Date:_________________________________ ________________ _______________________ Claimant By ___________________________________ Subscribed and sworn to before me this _______day of _____________________, 20________ (SEAL) ___________________________________ NOTARY PUBLIC ________________________________________________________________________ ____________________________________ ALLOWANCE OF CLAIM This claim allowed by Court in the sum of $_____________ as of ___________________Class Date:_______________________________________ ENTER:________________________________ Judge See Docket Entry ______________________________________________________________________________________ American LegalNet, Inc. www.USCourtForms.com