2641 Claim IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
(Rev. 11/19/03) CCP 0345 A
Estate of
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ORDER
No. _____________________________ Docket __________________________ Page ___________________________
_______________, _______ Allowed for $____________ Class __________________ _________________________
Judge
CLAIM
1. Claimant _______________________________________________________________________ has a claim for (name) $ ____________________________________ against this estate. 2. The nature of the claim*
Atty. No.:_________________ Firm Name: ________________________________________ Atty. for Claimant: _________________________________ Address: ___________________________________________ City/State/Zip:______________________________________ Telephone: _________________________________________
_________________________________________________
Address: ___________________________________________ City/State/Zip: ______________________________________ Telephone: _________________________________________
*When the claim is based upon a written instrument, a copy of the instrument must be attached. When the claim is based on tort, so state. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
Doc. ____________________ Page ________________ No. _____________________ ________________, __________
Mailing and delivery of copy of claim waived
__________________________________________________ IN THE CIRCUIT COURT OF COOK COUNTY County Department Estate of
Representative Attorney for Representative
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__________________, ________
I
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Probate Division
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________________________________________________
(certify) (state on oath)
that on
____________________________, _________ a copy
__________________________________________________
of this claim was (mailed) (mailed by ordinary mail) Representative
__________________________________________________
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CLAIM
(delivered in person) to
_______________________________________________ ___________________________________________
Attorney for Representative
and to
_________________________________________________________ ________________________________________________ Claimant
Attorney or Agent for claimant (Agent's statement must be notarized) Signed and sworn to before me
______________________________________, _________ Amount of Claim $ _______________________________ ___________________________________________________
Notary Public
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_________________, _________
I consent to the allowance of this claim for $ as a claim of the _________________ class.
________________
Set for hearing _____________________, _________
__________________________________________________
Representative Attorney for Representative
at ______________ m. in Room ___________________
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Date of letters
_____________________________, _________
RICHARD J. DALEY CENTER Chicago, Illinois 60602
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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 representative and to his/her attorney of record, if any, and shall file proof of such mailing or delivery within 10 days after the filing of the claim.
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(Rev. 11/19/03) CCP 0345 B