MARVIN MANDEL, Governor                                   129

CLAIMANT, AND THE AMOUNT CLAIMED. IF THE CLAIM IS NOT
YET DUE, THE DATE WHEN IT WILL BECOME DUE SHALL BE
STATED. IF THE CLAIM IS CONTINGENT, THE NATURE OF THE
CONTINGENCY SHALL BE STATED. IF THE CLAIM IS SECURED,
THE SECURITY SHALL BE DESCRIBED. THE FAILURE OF THE
CLAIMANT TO COMPLY WITH THE PROVISIONS OF THIS SECTION OR

WITH THE REASONABLE REQUESTS OF THE PERSONAL

REPRESENTATIVE FOR ADDITIONAL INFORMATION MAY BE A BASIS
FOR DISALLOWANCE OF A CLAIM IN THE DISCRETION OF THE
COURT.

(C) FILING WITH REGISTER.

THE CLAIMANT MAY FILE A VERIFIED WRITTEN STATEMENT
OF THE CLAIM, SUBSTANTIALLY IN THE FORM CONTAINED IN THIS
SUBSECTION, WITH THE REGISTER AND DELIVER OR MAIL A COPY
OF THE STATEMENT TO THE PERSONAL REPRESENTATIVE.

CLAIM AGAINST ESTATE OF DECEDENT.

THE BELOW-NAMED CREDITOR CERTIFIES THAT THERE IS DUE

AND OWING BY.........., DECEASED, IN ACCORDANCE WITH THE

STATEMENT OF ACCOUNT ATTACHED AS A PART OF THIS STATEMENT

THE SUM OF..........,TOGETHER WITH INTEREST AT THE RATE

OF.......FROM........UNTIL PAID, AND THAT THE ACCOUNT IS

CORRECT AS STATED AND IS UNPAID.

ON BEHALF OF THE BELOW-NAMED CREDITOR, I DO SOLEMNLY
DECLARE AND AFFIRM UNDER THE PENALTIES OF PERJURY THAT
THE INFORMATION AND REPRESENTATIONS MADE IN THE CLAIM,
AND THE ACCOUNT ARE TRUE AND CORRECT ACCORDING TO MY
KNOWLEDGE, INFORMATION, AND BELIEF.

(NAME OF CREDITOR)

(SIGNATURE OF CREDITOR OR
PERSON AUTHORIZED TO MAKE
VERIFICATION ON BEHALF OF
CREDITOR)

(D) COMMENCEMENT OF SUIT.

WHEN A CAUSE SURVIVES DEATH, THE CLAIMANT IS NOT
REQUIRED TO FILE A CLAIM UNDER SUBSECTIONS (E) OR (C).
HE MAY COMMENCE AN ACTION AGAINST THE ESTATE OR AGAINST A
PERSON TO WHOM PROPERTY HAS BEEN DISTRIBUTED, BUT THE
COMMENCEMENT OF THE ACTION MUST OCCUR WITHIN THE TIME
LIMITED FOR THE FILING OF CLAIMS.

(E) WHERE INSURANCE EXISTS.

NOTWITHSTANDING THE OTHER PROVISIONS OF THIS