Fill and Sign the Claims Against Estate Form

IN THE _____________________________________ (Name of Court, e.g., Probate) COURT OF ____________________________________ (County), ______________________________________________ (State) IN THE MATTER OF THE ESTATE OF ______________________________________________ (Name of Decedent), DECEASED CAUSE NO. ___________________ In consideration of $________________________, paid to __________________________________________________ (Name of Creditor) , of ________________________________________________________________________ ________________________________________________________________________ __________________________________ ( street address, city, county, state, zip code) , by ________________________________________________ ( Name of Administrator) , Administrator of the estate of _______________________________________________ (Name of Decedent), deceased, the undersigned _________________________________ ____________________________ (Name of Creditor) releases and discharges the estate and the Administrator, and/or heirs-at-law of said Decedent from any and all claims that _____________________________________________________ (Name of Creditor) has or might have against the estate of the Decedent. WITNESS my signature on this the _____________________________________ (date). ____________________________________ Signature of Creditor STATE OF ___________________________________________ COUNTY OF ________________________________ Personally appeared before me, the undersigned authority in and for the said County and State, on this ____ day of _________________________________, 20____, within my jurisdiction, the within - named ______________________________________ (Name of Creditor) , who acknowledged that he executed the above and foregoing instrument. ____________________________________ NOTARY PUBLIC My Commission Expires: ______________________ Note: (Form of acknowledgement/oath will vary from state to state)