Approved, SCAO JIS CODE: NDC STATE OF MICHIGAN PROBATE COURT COUNTY OF Estate of TO: Claimant name and address FILE NO. NOTICE OF DISALLOWANCE OF CLAIM Your written statement of claim dated in whole. in part as to for $ is disallowed . The entire claim portion of the claim that has been disallowed will be forever barred unless you start a civil action by filing a complaint against the fiduciary. Your complaint must be filed with the appropriate district, circuit, or probate court not later than 63 days after the mailing or delivery of this notice. Date Signature of attorney Name of attorney (type or print) Address City, state, zip Telephone no. Bar no. Signature of fiduciary Name of fiduciary (type or print) Address City, state, zip Telephone no. PROOF OF SERVICE I certify that on Date I served a copy of this notice on the claimant by delivering it personally to the claimant. first-class mail at the address stated above. I declare under the penalties of perjury that this proof of service has been examined by me and that its contents are true to the best of my information, knowledge, and belief. Date Signature of fiduciary/attorney USE NOTE: If this form is being filed in the circuit court family division, please enter the court name and county in the upper left-hand corner of the form. Do not write below this line - For court use only PC 580 (9/10) NOTICE OF DISALLOWANCE OF CLAIM American LegalNet, Inc. www.FormsWorkFlow.com MCL 700.3806, MCL 700.5429, MCL 700.7611