Fill and Sign the Claim Against Form

NO. _____________ IN RE: THE ESTATE OF ___________________________, DECEASED IN THE PROBATE COURT NUMBER ____________ (____) OF HARRIS COUNTY, TEXAS SWORN STATEMENT SUPPORTING CLAIM AGAINST ESTATE TO: CLERK OF SAID COURT; and/or TO: INDEPENDENT EXECUTOR OF SAID ESTATE A. I, ______________________________________________, hereafter called "AFFIANT," do solemnly swear that the foregoing and attached claim against the above numbered and styled estate, amounting to the sum of $____________________________, is a just claim, and that all legal offsets, payments and credits known to AFFIANT have been allowed, and that the sum herein claimed is justly due. B. CLAIMANT is: ____________________________________________________ CLAIMANT's address is: _____________________________________________ C. ___ 1. This claim is founded on a written instrument or account, a true copy of which is attached as "EXHIBIT A," incorporated herein by reference; or, ______2. This claim is NOT founded on a written instrument or account and the facts upon which the claim is founded are as follows: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ D. ____ 1. AFFIANT is the owner and holder of the above claim and has personal knowledge of the facts herein contained; and all statements herein are within my personal knowledge and are true and correct; or, ______ 2. The AFFIANT is NOT the owner of said claim, but is a duly authorized officer, agent or representative, to-wit:_____________________________________________________; and I have made diligent inquiry and examination of this claim and I believe the claim is just and that all legal offsets, payments, and credits made known to this AFFIANT have been allowed. E. AFFIANT files this Claim in behalf of the above named CLAIMANT and prays that same be timely approved in accordance with applicable provisions of the Texas Probate Code; and CLAIMANT requests that said claim be classified as a CLASS ______ CLAIM pursuant to § 322, Texas Probate Code, and given preferential treatment. [Class 1 - funeral and last sickness expenses - $15,000 limit; Class 2 - Administration and safekeeping expenses; Class 3 - secured claims, including tax liens; Class 4 - special Texas liens and taxes; Class 5 - confinement costs; Class 6 - state medical benefits; Class 7 - all other claims.] ____________________________________ AFFIANT'S SIGNATURE ABOVE Print name:_______________________________ Address:_________________________________ __________________________________________ Phone:____________________________________ SWORN TO and SUBSCRIBED BEFORE ME by the above named AFFIANT on this the _____ day of _______________________________________, 20____. __________________________________________ NOTARY PUBLIC for STATE OF TEXAS Print name:______________________________ Date commission expires:_________________ Mailed by certified mail, return receipt requested to:___________________________________________ CMRRR #_________________, on ____________________________, 20___. Filed with clerk of court on ____________________________, 20___. NO. _____________ IN RE: THE ESTATE OF ___________________________, DECEASED IN THE PROBATE COURT NUMBER ____________ (____) OF HARRIS COUNTY, TEXAS EXECUTOR'S APPROVAL OR DENIAL OF CLAIM AGAINST ESTATE TO: CLERK OF SAID COURT; and/or TO: CLAIMANT ,___________________________________ Re: CLAIM for $___________________ filed by __________________________________. On ___________________________, 20___, the above claim for $______________________ was filed ________ with the County Clerk and/or was filed ________ with the (Independent Executor)(Administrator). __________ The CLAIM IS APPROVED IN THE TOTAL AMOUNT STATED. __________ The CLAIM IS REJECTED BECAUSE OF THE FOLLOWING DEFECTS IN THE CLAIM FORM OR EXHIBITS AS SUBMITTED (§ § 301, 302, 304): _______________________________________________________________________ __________ The CLAIM IS TOTALLY REJECTED BECAUSE THE CLAIM IS BARRED BY TEXAS' STATUTE OF LIMITATION. __________ The CLAIM IS TOTALLY REJECTED BECAUSE: ______________________________________________________________ __________ The CLAIM IS PARTIALLY APPROVED IN THE FOLLOWING AMOUNT ONLY: $_________________________; AND, REJECTED AS TO THE BALANCE. REASON:_____________________________________________________________ __________ The CLAIM IS CLASSIFIED AS A CLASS _____ CLAIM IN THE AMOUNT OF $________________ AND CLASS ______ CLAIM FOR THE BALANCE. A copy of this approval/rejection action has been delivered to CLAIMANT as below indicated. Dated this _______ day of _____________________________, 20____. The Estate of ______________________________________, Deceased By:____________________________________________ Independent Executor/Administrator CMRRR#______________ to _________________________ Date: Personally served on ________________________________ Date: