Form Prob001 - Claim Against Estate
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STATE OF MISSOURI
)
) ss.
COUNTY OF ST. CHARLES
)
IN THE CIRCUIT COURT OF ST. CHARLES COUNTY, MISSOURI
PROBATE DIVISION
IN THE MATTER OF
________________________________________________________________
#_________________________
Deceased
Ward/Protectee
Minor
CLAIM AGAINST ESTATE
_________________________________________, for_______________________________________ (Claimant), being duly sworn,
states on oath that there is due claimant from the estate of ____________________________________________________________,
Deceased/Ward/Protectee/Minor, the sum of $______________________ on the account of ______________________________________
__________________________________________________.
(describe nature of claim)
An itemized statement of such claim showing dates and amount is *as follows/attached:
The claimant holds security for claim as follows: ____________________________________________________________________.
(if not state; otherwise describe)
Claimant states that to the best of h___ knowledge and belief __he has given credit to such estate for all payments and offsets to which
it is entitled and that the balance claimed as above stated is justly due. The foregoing is made under oath and affirmation and its representations
are true and correct to the best knowledge and belief of the undersigned, subject to the penalties for making a false affidavit or declaration.
_____________________________________________________________________________________________________________
CLAIMANT'S SIGNATURE
ADDRESS
PHONE NUMBER
_____________________________________________________________________________________________________________
ATTORNEY'S SIGNATURE
ADDRESS
PHONE NUMBER
CERTIFICATE OF SERVICE
(By Claimant)
I hereby certify that the foregoing claim was served on the Personal Representative/Guardian/Conservator and/or his attorney of record
by: (please check one)
________ delivering a copy thereof in person
________ ordinary mail
________ registered/certified mail
_________ service by sheriff
_______________________________________________
SIGNATURE OF CLAIMANT
WAIVER OF SERVICE AND/OR CONSENT
(By Personal Representative) (Please check one)
________ Service of all notices is waived.
________Consent for immediate hearing is given.
________ Consent is given to judgment allowing claim for $____________
The foregoing is made under oath and affirmation and its representations are true and correct to the best knowledge and belief of the
undersigned, subject to the penalties for making a false aaffidavit or declaration.
_______________________________________________
SIGNATURE OR PERSONAL REPRESENTATIVE
ORDER APPROVING CLAIM
Claim allowed on ________________________________, 20___, in the amount of $_____________________________and placed
in Class ________.
_______________________________________________
CLAIM BOOK________ PAGE________.
JUDGE OF CIRCUIT COURT, PROBATE DIVISION
PROB001
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