Written Statement Of Claim {PE 34}

Form PE34 STATE OF VERMONT PROBATE DIVISION Unit Docket No._____________________ SUPERIOR COURT In re ESTATE OF Decedent WRITTEN STATEMENT OF CLAIM DIRECTIONS: In the space below, state your claim against the estate. Your statement must include a description of the claim, the amount claimed and a description of the security for your claim, if any. You must attach documentation of your claim. Description of Claim Amount Owed $ $ Use additional sheets if necessary. Security for Claim, if any Documentation Attached? Y/N Y Y N N Dated Signature Name Printed Address Phone Number ( ) Email Address You must deliver or mail your claim to the Fiduciary (Administrator or Executor) of the Estate and you must file a copy with the Court. Name of Fiduciary Fiduciary's Address Name and Address of Court SML 11/12 American LegalNet, Inc. www.FormsWorkFlow.com