IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT County, Illinois, In Probate } } } } Estate of No. } } } CLAIM - CONTRACT 1. Claimant (name and address) has a claim for $ against this estate, which is just and unpaid after allowing all just credits, deductions and set-offs. 2. The nature of the claim is Claimant AFFIDAVIT on oath states that the allegations in this claim are true. ORDER Allowed for $___________________________and costs, Signed and sworn to before me Class__________________________________________ __________ , _________ . ____________________________________ , _________ ______________________________________________ Judge Notary public Name Attorney for Address City Telephone American LegalNet, Inc. www.FormsWorkFlow.com Mailing and delivery of copy of claim waived. Note: If claim is based upon a written instrument, a copy must be attached. ______________________________ , __________. Attorney for Estate Executor Administrator Guardian Conservator I I consent to allowance of this claim for that on (certify) (state on oath) , . $ as a costs to be charged to the estate. class claim, a copy of this claim was , . (delivered in person) (mailed) Attorney for estate Executor Administrator Guardian Conservator (mailed by registered mail, return receipt requested) to Date of letters . , . Set for hearing , . (guardian) (conservator) (Attorney) (non-attorney) [Non-attorney statement must be notarized] Signed and sworn to before me at , (Notary Public) , Claim date (executor) (administrator) and to his attorney of record. . m., room . NOTE: Unless the legal representative or his attorney waives mailing and delivery, or consents to the allowance of the claim, a copy of the claim MUST be mailed or delivered to the legal representative AND to his attorney. If the claim is against the estate of a decedent and is filed on or before the claim date, the copy may be mailed by ordinary mail. If the copy is mailed after the claim date, or if the claim is against the estate of a minor or incompetent, the mailing MUST be by registered mail, return receipt requested. See Ill. Rev. Stat., ch.3, § 195. American LegalNet, Inc. www.FormsWorkFlow.com