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Claim Against Estate 171P-21a - Illinois
| Claim Against Estate Form. This is a Illinois form and can be used in General Probate Lake Local County . |
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IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS ESTATE OF ) ) ) ) _____________________________________________ ) ) Case No. ________________________ CLAIM AGAINST ESTATE Now comes _______________________________________, under penalties of perjury as provided under Section 1-109 of the Code of Civil Procedure, stating: 1. Claimant, _____________________________________ (Print/Type Name) has a claim for $ ____________________ against this Estate, which is just and unpaid after allowing all just credits, deductions and set-offs. 2. The nature of the claim is as follows: ____________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ________________________________________________ Print Claimant Address City Zip ______________________________________ Claimant Signature NOTE: If claim is based upon a written instrument, a copy must be attached. I, _____________________________________, Certify State on Oath that on ____________________, 20____ a copy of this claim was mailed by registered mail, return receipt requested ordinary mail to Executor Administrator Guardian and to ____________________________________ located at ____________________ Print Name Print Address ______________________________________________________________________________________________________________________ _________________________________________ Signature Attorney Non-Attorney Prepared by: Name: ____________________________________________ Attorney's Name: ____________________________________ Address: __________________________________________ City: ______________________________ State: __________ Phone: ______________________Zip Code: _____________ Fax: ______________________________________________ ARDC #: ___________________________________________ NOTE: Unless the legal representative or his/her attorney waives mailing and delivery, or consents to the allowance of the claim, a copy of the claim MUST be mailed or delivered to the legal representative AND to his/her attorney. If the claim is against the estate or a decedent and is filed on or before the claim date, the copy may be mailed by ordinary mail. If the copy is mailed after the claim date, or if the claim is against the estate of a disabled person, the mailing MUST be by registered mail return receipt requested. 171P-21a (Rev. 12/11) American LegalNet, Inc. www.FormsWorkFlow.com
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