Missouri Claim Against Estate (probate) by vam16455

VIEWS: 42 PAGES: 2

									          IN THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI - PROBATE DIVISION

                                             AT

IN THE ESTATE OF                                                                        ESTATE NUMBER

                                             ,
Deceased.                       Protectee.


                                           CLAIM AGAINST ESTATE
                                         (Sec. 473.360 and 475.205 RSMo)

        The undersigned states that claimant is                                                                       of

                                                      Street in State of                                        and is a

(corporation) (partnership) (individual) and that there is due claimant from this estate the sum of $

                        on account of

                                                                                                                .
                                                 (describe nature of claim)

        An itemized statement of claim showing dates and amounts is attached hereto and incorporated herein by
this reference as Exhibit A.

        The claimant holds security for said claim as follows:

                                                                                                                        .
                                        (If none, so state; otherwise describe.)

        Affiant states affiant is (claimant) (agent) (attorney) (officer) for claimant and that claimant has given credit
to said estate for payments and offsets to which it is entitled and that the balance claimed as above stated is justly
due.

       The undersigned swears that the matters set forth in the foregoing pleading are true and correct
according to the undersigned's best knowledge and belief and subject to penalty for making a false affidavit or
declaration.

        Dated:

                                                                  Affiant:


                                                                  Address:




                                                        Page 1 of 2
*      Service of all notice is waived:

*      Consent for immediate hearing is given:

*      Consent is given to judgment allowing claim for $                                       (If signed, strike any
       part not agreed to.)

*      Strike words not applicable.


                                                              Personal Representative                   Conservator



Date of first publication:                                                                      . Claim allowed on

                                    , in the amount of $                             and placed in Class
.


                                                      Judge                                          Commissioner



                             INSTRUCTIONS AS TO CLAIMS AGAINST ESTATE

For instructions as to making claims against estate, see Sec. 473.360 RSMO, et seq. as to decedent's estates and Sec.
475.205 et seq. as to conservatorship estates.




Form 10140                                          Page 2 of 2                                            7/29/96

								
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