$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 open account, an itemized statement of the account shall be filed/ when evidenced by a written instrument, such instrument, or a copy attested by the Clerk of the Court as a true copy of same, shall be filed; 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. VERIFIED CLAIM AGAINST ESTATE STATE OF TENNESSEE, COUNTY OF WILLIAMSON ________________________________________ Creditor CLAIM AGAINST ESTATE OF: ________________________________________ Address _______________________________ Deceased ________________________________________ City State Zip Docket No.______________________ Date Items and Nature of Claim Amount Credits Unpaid Balance TOTAL STATE OF TENNESSEE, WILLIAMSON COUNTY. I (or we) make 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 in my or our behalf has received payment therefore, in whole or in part, except as is credited above, and no security has been received therefore, except as above stated. This _____ day of ______________________, 20_____. __________________________ Creditor’s Signature Sworn to and subscribed before me this ______ day of _________________________, 20_____. NOTARY PUBLIC/CLERK Commission Expires: ____________ American LegalNet, Inc. www.USCourtForms.com