VERIFIED CLAIM AGAINST ESTATE (T.C.A. § 30-2-307 et.seq.) ALL CLAIMS MUST BE FILED WITH THE CLERK WITHIN THE TIME SPECIFIED BY LAW. $11.00 Filing Fee Required for each Claim Fee Must Be Paid by Claimant All Claims must be filed with the Clerk of the Court in triplicate. When any claim is due on an open account, an itemized statement of the account shall be filed; when evidenced by written instrument, a copy shall be attached; and when due by judgment or decree, a copy certified by the Clerk of the Court rendering same shall be filed. Every claim must be verified by the affidavit of the creditor. Mail to: Probate Court, 140 Adams, Room 124, Memphis, TN 38103 SHELBY COUNTY, TENNESSEE _________________________________________ Creditor _________________________________________ Address _________________________________________ City, State, Zip Phone Date Items and Nature of Claim CLAIM AGAINST ESTATE OF ______________________________ Deceased Docket No: ____________________ Amount Credits Unpaid Balance TOTAL SHELBY COUNTY, TENNESSEE The undersigned makes oath that the above claim is a correct, just and valid obligation of the Estate of ______________________________, Deceased, that neither the undersigned, nor any other person has received payment therefor, in whole or in part, except as is credited above, and no security has been received therefor, except as above stated. This _______ day of ___________________, 20_____. ____________________________________ Creditor's Signature Sworn to and subscribed before me this ______ day of __________________, 20______. _____________________________________ Attorney for Creditor ____________________________________ Address _____________________________________ Notary Public American LegalNet, Inc. www.USCourtForms.com