1 2 3 4 5 6 7 8 9 10 11 12 13 14 1768 IN THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE IN THE MATTER OF THE ESTATE OF _______________________________ Deceased. _______________________________/ Case No.:______________ Dept. No.: PR GENERAL CLAIM 15 16 17 18 19 20 21 22 Claim of ______________________, _________________________________________ Name Address The undersigned creditor of the above-named deceased presents this claim against the deceased, a sworn statement 1 of which is attached below. ________________________________________________________________________ $______________ ______________________________________________________________________ ______________________________________________________________________ 23 24 25 26 27 28 1 ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Please refer to NRS 147.070 et. seq. 1 American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 STATE OF NEVADA COUNTY OF WASHOE ) ) SS. ) The undersigned, being duly sworn, says: that he/she is the ______________ 4 5 6 7 8 9 10 11 12 13 14 15 16 17 creditor named herein and who makes the foregoing claim against the Estate of _____________, deceased, that the amount of said claim, to wit: the sum of __________ Dollars, is justly due to said claimant, that no payments have been made which are not credited, and there are no offsets to the knowledge of this affiant; that affiant has personal knowledge of all the facts of said claim. _______________________ Signature of affiant SUBSCRIBED AND SWORN to before me This _____ day of _______________, 20__. ______________________________________ Notary Public The within claim is _________________ for $________ this ____ day of ________, 20__. 18 19 (approved) (disapproved) _____________________________ 20 21 22 23 24 25 26 27 28 Personal Representative of the Estate Allowed and approved for $____________ this ____ day of ________, 20__. _____________________________ DISTRICT JUDGE 2 American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 4 5 6 7 8 9 10 SECOND JUDICIAL DISTRICT COURT COUNTY OF WASHOE, STATE OF NEVADA AFFIRMATION Pursuant to NRS 239B.030 The undersigned does hereby affirm that the preceding document, (Title of Document) filed in case number: Document does not contain the social security number of any person 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 -ORDocument contains the social security number of a person as required by: A specific state or federal law, to wit: ______________________________________________________ (State specific state or federal law) -orFor the administration of a public program -orFor an application for a federal or state grant -orConfidential Family Court Information Sheet (NRS 125.130, NRS 125.230 and NRS 125B.055) Date: (Signature) (Print Name) 27 28 (Attorney for) American LegalNet, Inc. www.FormsWorkFlow.com