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Claim CCP 0345 - Illinois

Claim Form. This is a Illinois form and can be used in Probate Cook Local County .
 Fillable pdf Last Modified 1/28/2014

Print Form Clear Form 2641 Claim IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS (Rev. 09/06/13) CCP 0345 A Estate of No. _________________________________________ _____________________________________________ Deceased CLAIM 1. Claimant _______________________________________________________________________ has a claim for (name) $ ____________________________________ against this estate. 2. The nature of the claim* Atty. No.:_________________ Firm Name: ________________________________________ Atty. for Claimant: _________________________________ Address: ___________________________________________ City/State/Zip:______________________________________ Telephone: _________________________________________ _________________________________________________ Address: ___________________________________________ City/State/Zip: ______________________________________ Telephone: _________________________________________ *When the claim is based upon a written instrument, a copy of the instrument must be attached. When the claim is based on tort, so state. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Doc. ____________________ Page ________________ No. _____________________ ________________, __________ Mailing and delivery of copy of claim waived __________________________________________________ IN THE CIRCUIT COURT OF COOK COUNTY County Department Estate of Representative Attorney for Representative =============================================== __________________, ________ I - Probate Division ========================================= ________________________________________________ (certify) (state on oath) a copy that on ____________________________, _________ __________________________________________________ of this claim was (mailed) (mailed by ordinary mail) Representative __________________________________________________ ======================== ======================= CLAIM (delivered in person) to _______________________________________________ ___________________________________________ Attorney for Representative and to _________________________________________________________ ________________________________________________ Claimant Attorney or Agent for claimant (Agent's statement must be notarized) Signed and sworn to before me ______________________________________, _________ Amount of Claim $ _______________________________ ___________________________________________________ Notary Public ============================================ ===================================== _________________, _________ I consent to the allowance of this claim for $ as a claim of the _________________ class. ________________ Set for hearing _____________________, _________ __________________________________________________ Representative Attorney for Representative at ______________ m. in Room ___________________ ============================= ============================= Date of letters _____________________________, _________ RICHARD J. DALEY CENTER Chicago, Illinois 60602 =============================== ============================== Unless the representative or his/her attorney waives in writing the mailing or delivery of a copy of the claim or consents in writing to the allowance of the claim, the claimant shall cause a copy of the claim to be mailed or delivered to the representative and to his/her attorney of record, if any, and shall file proof of such mailing or delivery within 10 days after the filing of the claim. ============================================= (Rev. 09/06/13) CCP 0345 B
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