2. The nature and amount of this claim is: If claim is based on a written document, attach a complete copy




Yüklə 18.34 Kb.
tarix17.04.2016
ölçüsü18.34 Kb.


STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY

For Official Use



IN THE MATTER OF THE ESTATE OF

     


 Amended


Claim Against Estate

 Informal Administration

 Formal Administration



     


Case No.      


UNDER OATH I STATE:

1. The name and address of the claimant is:

Name      

Address [Street, City, State, Zip]      

Phone Number      
2. The nature and amount of this claim is: (If claim is based on a written document, attach a complete copy.)  See attached

Nature of Claim

Amount of Claim

     

$     




TOTAL

$     

3. This amount is  due.

 not yet due and will or may become due on (date)       .
4. No payments were made on this claim which is not credited, and there were no offsets except:

     
5. If the decedent was survived by a spouse, the classification of the obligation under §766.55(2), Wisconsin Statutes is as follows:

 A. Support obligation owed spouse or child.

 B. Obligation incurred in the interest of the marriage.

 C. Obligation incurred prior to marriage or prior to January 1, 1986.

 D. Tort.

 E. Other:      



State of      

County of      

Subscribed and sworn to before me on      




Notary Public/Court Official

     

Name Printed or Typed

My commission/term expires:      









Claimant or Claimant’s Representative

     

Name Printed or Typed




     

Address

     
     

Telephone Number

Form completed by: (Name)

     


     

Date

Address

     








Telephone Number

     


Bar Number (If any)

     








Note: A statutory filing fee of $3.00 shall accompany each claim filed.


PR-1819, 11/12 Claim Against Estate (Informal Administration and Formal Administration) Chapter 859, §766.55, Wisconsin Statutes

This form shall not be modified. It may be supplemented with additional material.




Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur ©azrefs.org 2016
rəhbərliyinə müraciət

    Ana səhifə