Claim {CCP 0345}

CLAIM [signature of Claimant] [address] [city/state/zip] [telephone] 1. þ Claimant has a claim for [name] þ $ against this estate.2. The nature of the claim** þ When the claim is based upon a written instrument, a copy of the instrument must be attached. When the claim is based ontort, so state. Dorothy Brown, Clerk of the Circuit Court of Cook CountyPage 1 of 2CCP-0345A (Rev. 10/1/2018) Case No. Calendar Estate of IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT 226 PROBATE DIVISION Attorney Number Name þ Firm Name þ Attorneys for þ Address þ City/State/Zip þ Telephone þ Email þ 2641 CCP 0345A (Rev. 08/25/2017) þ Case No. 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 Hearing has been scheduled on þ at M in Room , [date] [time]Richard J. Daley Center, 50 W. Washington Street, Chicago, Illinois 60602. I certify that on a copy of this claim was [date] þ (mailed) þ (delivered in person)to [representative] and to . [attorney for representative] [signature of attorney for Claimant or agent for Claimant] Signed and sworn to before me by the agent for Claimant on þ , 20 þ . [signature of Notary Public] On , I hereby waive mailing and delivery of the copy of the claim. [date] [signature of representative or attorney for representative] On , I consent to the allowance of this claim in the amount of [date]$ þ as a class claim against the estate. [amount of claim allowed] þ [class of claim] þ [signature of representative or attorney for representative] Dorothy Brown, Clerk of the Circuit Court of Cook CountyPage 2 of 2CCP-0345B (Rev. 10/1/2018) CERTIFICATE OF SERVICE HEARING ON CLAIM SCHEDULED WAIVER OF SERVICE CONSENT TO CLAIM