Fill and Sign the Written Statement of Claim Vermont Form

STATE OF VERMONT PROBATE COURT DISTRICT OF ____________ In Re the Estate of: ) DOCKET No. __________ ) __________________ ) , Deceased ) ) ) LATE OF ) ) __________________ . ) ) ) WRITTEN STATEMENT OF CLAIM Directions: Describe in the space provided below your claim against the above-named estate. The statement must include the basis for the claim, the amount claimed, and a written description of the claim. You must attach a copy of any documentation. If the claim is not yet due, you must specify the date it will be due. If the claim is contingent or unliquidated, the nature of the uncertainty must be described. If the claim is secured, you must describe the security. You must file this claim by delivering or mailing it to the executor or administrator of the estate and filing a duplicate with the register of the Probate Court. Name and Address of Administrator ______________________________ Address of Probate Court ________________________________________ ________________________________________                         Name ________________________________________ Address ________________________________________             ________________________________________                         ________________________________________                         Date: ____________ Signed: ______________________ , Petitioner Print Name: ______________________________ Address: ________________________________________ Telephone: (       ) _______________ Telephone (       )