PR-1819, 11/12 Claim Against Estate (Informal Administration and Formal Administration) Chapter 859, 247766.55, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF THE ESTATE OF Name Amended Claim Against Estate Informal Administration Formal Administration Case No. UNDER OATH I STATE: 1. The name and address of the claimant is: Name Address [Street, City, State, Zip] Phone Number 2. The nature and amount of this claim is: (If claim is based on a written document, attach a complete copy.) See attached Nature of Claim Amount of Claim $ TOTAL $ 3. This amount is due. not yet due and will or may become due on [Date] . 4. No payments were made on this claim which is not credited, and there were no offsets except: 5. If the decedent was survived by a spouse, the classification of the obligation under 247766.55(2), Wis. Stats., is as follows: A. Support obligation owed spouse or child. B. Obligation incurred in the interest of the marriage. C. Obligation incurred prior to marriage or prior to January 1, 1986. D. Tort. E. Other: State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: Claimant Name Printed or Typed Address Telephone Number Form completed by: (Name) Date Address Telephone Number Bar Number (If any) NOTE: A statutory filing fee of $3.00 shall accompany each claim filed. American LegalNet, Inc. www.FormsWorkFlow.com