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Claim On Contract - Illinois
| Claim On Contract Form. This is a Illinois form and can be used in General Dekalb Local County . |
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IN THE CIRCUIT COURT FOR THE TWENTY-THIRD JUDICIAL CIRCUIT DEKALB COUNTY, ILLINOIS In the matter of the ESTATE OF: ____________________________________________ ) ) ) ) Case No. ______________________________________ CLAIM ON CONTRACT CLAIMANT: Name: Address: City/State/Zip: AMOUNT OF CLAIM $ Mailing and Delivery of Copy of Claim Waived By: [ ] Executor [ ] Administrator [ ] Guardian [ ] Conservator [ ] Attorney for Estate Date: See 755 ILCS 5-18-1 et. seq. I certify that on the date set forth below that a copy of this Claim was: [ ] Delivered in Person [ ] Mailed by Registered Mail [ ] Mailed by Ordinary Mail TO: [ ] Executor [ ] Administrator [ ] Guardian [ ] Conservator AND: Attorney for Estate Signed:___________________________________________ Attorney or Agent for Claimant Date:_______________ CONSENT I consent to Allowance of the Claim and Cost of Filing Be Charged to the Estate. Date:_______________ Amount: $ Class: Signed:__________________________________________ [] [] [] Executor Guardian Attorney for Estate [] [] Administrator Conservator (Attach separate sheet for more information.) ORDER Date: ___________________ [ ] All for $_____________ Class _______________ ___________________________ Judge ORDER Date:____________________ [ ] Found paid and satisfied. [ ] Dismissed. _________________________ Judge The within named Claimant makes claim against the Estate for the amount shown and for reason stated in the space below and on oath says he/she is the Claimant; he/she has knowledge of the facts relating to the claim; the statements are true; the claim is just and unpaid after allowing all just credits, deductions and set offs. Date:______________ _________________________________ Claimant or Representative of Claimant (If Representative, must state office held) Signed and sworn to before me ________________________, 20_______. ________________________________ (Clerk of Court - Notary) Attorney for Claimant: Address: City/State/Zip: Telephone: ITEMIZED STATEMENT OF CLAIMS WHEN CLAIM IS BASED UPON A WRITTEN INSTRUMENT, A COPY OF THE INSTRUMENT MUST BE ATTACHED. (White - Circuit Clerk; Yellow Atty of Record of Estate; Pink Administrator/Executor of Estate; Goldenrod - Claimant) Claim on Contract\SC000009.SMA Rev.: 11/16/2012 American LegalNet, Inc. www.FormsWorkFlow.com
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