Fill and Sign the Note to Personal Representative Form

DE-174 FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF ESTATE OF DECEDENT CASE NUMBER: ALLOWANCE OR REJECTION OF CREDITOR’S CLAIM Attach a copy of the creditor’s claim to this form. If approval or rejection by the court is not required, do not include any pages attached to the creditor's claim. PERSONAL REPRESENTATIVE’S ALLOWANCE OR REJECTION (The court must approve certain claims before they are paid.) (A creditor has 90 days to act on a rejected claim. * See box below.) Notice of allowance or rejection given on (date): The personal representative is authorized to administer th e estate under the Independent Administration of Estates Act. Date: (SIGNATURE OF PERSONAL REPRESENTATIVE) (TYPE OR PRINT NAME OF PERSONAL REPRESENTATIVE) NOTICE TO CREDITOR ON REJECTED CLAIM Claim due: within 90 days * after the notice of rejection. Claim not due: within 90 days* after the claim becomes due. COURT’S APPROVAL OR REJECTION 12. Approved for: $ 13. Rejected for: $ Date: Number of pages attached: SIGNATURE FOLLOWS LAST ATTACHMENT (Proof of Mailing or Personal Delivery on reverse) Form Adopted for Mandatory Use Judicial Council of California DE-174 [Rev. January 1, 2009] ALLOWANCE OR REJECTIO N OF CREDITOR’S CLAIM (Probate—Decedents’ Estates) Total amount of the claim: $ Claim is allowed for: $ Claim is rejected for: $ Probate Code § 9000 et seq.,9250–9256, 9353 (Name): ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FAX NO. (Optional): TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): Page 1 of 2 SIGNATURE OF JUDICIAL OFFICER STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: From the date that notice of re jection is given, you must act on the reject ed claim (e.g., file a lawsuit) as follows: 1. 2. 3.4. 5. 6. 7. 8.9. 10. 11. Name of creditor (specify): The claim was filed on (date): Date of first issuance of letters: Date of Notice of Administration : Date of decedent’s death: Estimated value of estate: $ 14. NOTE TO PERSONAL REPRESENTATIVE The 90-day period mentioned above may not apply to your clai m because some claims are not treated as creditors' claims or are subject to special statutes of limi tations, or for other legal reasons. You should consult with an attorney if you have any questions about or are unsure of your righ ts and obligations concerning your claim. * 1. 2. PROOF OF MAILING At the time of mailing or personal delivery I was at least 18 years of age and not a party to this proceeding. My residence or business address is (specify): I mailed or personally de livered a copy of the Allowance or Rejection of Creditor's Claim as follows (complete either a or b) : Mail. I am a resident of or employed in the county where the mailing occurred. a. The envelope was addressed and mailed first-class as follows: b. Date delivered: Time delivered: I declare under penalty of perjury under the laws of the St ate of California that the foregoing is true and correct. Date: (SIGNATURE OF DECLARANT) DE-174 [Rev. January 1, 2009] ALLOWANCE OR REJECTION OF CREDITOR’S CLAIM (Probate—Decedents’ Estates) Page 2 of 2 ESTATE OF CASE NUMBER: DECEDENT deposited the sealed envelope with the Un ited 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 t he 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 envel ope with postage fully prepaid. (TYPE OR PRINT NAME OF DECLARANT) PERSONAL DELIVERY TO CREDITOR Date of mailing: Place of mailing (city and state): Personal delivery. I personally delivered a copy to the creditor as follows: Name of creditor served: Address where delivered: (Name): DE-174 (a) (b) (a) (b) (1) (2) I enclosed a copy in an envelope AND 1. 2. 3. Name of creditor served:Address on envelope: (c) (d) (1) (2) (3) (4)