Fill and Sign the California Creditor Claim Form

––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– – ––––– – ––––– ––––– – ––––– ––––– – ––––– – ––––– ––––– – – ––– – DE- 174 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address): FORCOURTUSEONLY TELEPHONE NO.: FAX NO.: ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE BRANCH NAME: ESTATE OF (Name): DECEDEN T ALLOWANCE OR REJECTION O F CREDITO R'S CLAIM CASE NUMBER: NOTE: Attach a copy of the creditor's claim. If allowance or rejection by the court is not required, do not include any pages attached to the creditor claim form. PERSONAL REPRESENTATIVE'S ALLOWANCE OR REJECTIO N 1. Name of creditor (specify): 2. The claim was filed on (date): 3. Date of first issuance of letters: 4. Date of Notice of Administration: 5. Date of decedent's death: 6. Estimated value of estate: $ 7. Total amount of the claim: $ 8 . Claim is allowed for: $ Claim is rejected for: $9 . (The court must approve certain claims before they are paid.) (A creditor has three months to act on a rejected claim. See box below.) 1 0. Notice of allowance or rejection given on (date): 1 1 . The personal representative is authorized to administer the estate under the Independent Administration of Estates Act. Dat e: (TYPE OR PRINT NAME) (SIGNATURE OF PERSONAL REPRESENTATIVE) REJECTED CLAIMS: From the date notice of rejection is given, the creditor must act on the rejected claim (e.g., file a lawsuit) as follows: a. Claim due: within three months after the notice of rejection. b. Claim not due: within three months after the claim becomes due. COURT'S APPROVAL OR REJECTION 1 2 . Approved for: $ 1 3 . Rejected for: $ Dat e: SIGNATURE OF JUD GE COMMISSIONE R 14. Number of pages attached: SIGNATURE FOLLOWS LAST ATTACHMENT (Proof of Service on reverse) Form Adopted for Mandatory Use Judicial Council of California DE-174 [Rev. January 1, 2000] ALLOWANCE OR REJECTION OF CREDITOR'S CLAIM (Probate) Probate Code § 9000 et seq. 9250- 9256,9353electronic form ã 1999 WWW.LawCA.co m Law Publishers ––––– ––––– – – ––––– ––––– ––––– ––––– – – – – ––––– ––––– ––––– ––––– ––––– ––––– –––––––––– ––––– ––––– ––––– ––––– ––––– –––––ESTATE OF (Name): CASE NUMBER: DECEDEN T PROOF OF MAILIN G PERSO NAL DELIVERY TO CREDITO R 1. At the time of mailing or personal delivery 1 was at least 18 years of age and not a party to this proceeding. 2. My residence or business address is (specify): 3. I mailed or personally delivered a copy of the Allowance or Rejection of Creditor's Claim as follows (complete either a or b): a . Mail. I am a resident of or employed in the county where the mailing occurred. (1) I enclosed a copy in an envelope AND ( a )( b ) deposited the sealed envelope with the United States Postal Service with the postage fully prepaid. placed the envelope for collection and mailing on the date and at the place shown in items below following our ordinary business practices. I am readily familiar with this business's practice for collecting and processing correspondence for mailing. On the same day that correspondence is placed for collection and mailing, it is deposited in the ordinary course of business with the United States Postal Service in a sealed envelope with postage fully prepaid. (2) The envelope was addressed and mailed first-class as follows: (a) Name of creditor served: (b) Address on envelope: (c) Date of mailing: (d) Place of mailing (city and state): b . Personal delivery. I personally delivered a copy to the creditor as follows: (1) Name of creditor served: (2) Address where delivered: (3) Date delivered: (4) Time delivered: I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Dat e: (TYPE OR PRINT NAME OF DECLARANT) (SIGNATURE OF DECLARANT) DE-174 [Rev. January 1, 2000] ALLOWANCE OR REJECTION O F CREDITO R'S CLAIM (Probate) Page twoelectronic form ã 1999 WWW.LawCA.co m Law Publishers