DE-172 - Creditor's Claim

Summary

Creditor's Claim

Text

Form ID: DE-172
Title: Creditor's Claim
Effective Date: 1998-01-01
Mandatory Form: yes
Info Page: https://selfhelp.courts.ca.gov/jcc-form/DE-172
Primary Download URL: https://www.courts.ca.gov/documents/de172.pdf
Form Detail Page:
Creditor's Claim
(DE-172)
Those to whom a deceased person owes money or other property (creditors) use this to make a claim against the estate.  Also explains how to fill out the claim, when and how to file it, and what may happen if it is not filed on time.
Get form DE-172
Effective: January 1, 1998
Go to
How-to instructions for Probate
PDF Text:
You must file this claim with the court clerk at the court address above before the LATER of (a) four months after the date letters  
(authority to act for the estate) were first issued to the personal representative, or (b) sixty days after the date the Notice of 
Administration was given to the creditor, if notice was given as provided in Probate Code section 9051. You must also mail or deliver a 
copy of this claim to the personal representative and his or her attorney.  A proof of service is on the reverse.   
WARNING:  Your claim will in most instances be invalid if you do not properly complete this form, file it on time with the court, and mail 
or deliver a copy to the personal representative and his or her attorney.
a.
b.
c.
d.
e.
Claimant is
5.
Claims against the estate by the personal representative and the attorney for the personal representative must be filed within the  
claim period allowed in Probate Code section 9100.  See the notice box above. 
I am authorized to make this claim which is just and due or may become due.  All payments on or offsets to the claim have been 
credited. Facts supporting the claim are
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
INSTRUCTIONS TO CLAIMANT
On the reverse, itemize the claim and show the date the service was rendered or the debt incurred. Describe the item or service in 
detail, and indicate the amount claimed for each item. Do not include debts incurred after the date of death, except funeral claims.
If the claim is not due or contingent, or the amount is not yet ascertainable, state the facts supporting the claim.
If the claim is secured by a note or other written instrument, the original or a copy must be attached (state why original is 
unavailable.) If secured by mortgage, deed of trust, or other lien on property that is of record, it is sufficient to describe the security 
and refer to the date or volume and page, and county where recorded.  (See Prob. Code, § 9152.)
Mail or take this original claim to the court clerk's office for filing. If mailed, use certified mail, with return receipt requested.
The personal representative or his or her attorney will notify you when your claim is allowed or rejected.
Probate Code, §§ 9000 et seq., 9153Form Approved by the    
Judicial Council of California 
 DE-172 [Rev. January 1, 1998]
 DE-172
Mail or deliver a copy to the personal representative and his or her attorney. Complete the Proof of Mailing or Personal Delivery on 
the reverse.   
                                                                                                                        (state reason):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
DECEDENT
ESTATE OF (Name):
FOR COURT USE ONLY
CASE NUMBER:
CREDITOR'S CLAIM
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address): TELEPHONE AND FAX NOS.:
      ATTORNEY FOR (Name):
2.
1. Total amount of the claim:  $
Claimant (name):
                                                                                                        (specify):
(specify):
an individual
an individual or entity doing business under the fictitious name of 
a partnership. The person signing has authority to sign on behalf of the partnership.
a corporation. The person signing has authority to sign on behalf of the corporation.
other 
3. Address of claimant (specify):
4. the creditor a person acting on behalf of creditor 
6.
Claimant is the personal representative the attorney for the personal representative.
on reverse attached.
(SIGNATURE OF CLAIMANT)
A.
B.
C.
D.
E.
F.
G.
Date:
(TYPE OR PRINT NAME AND TITLE)
CREDITOR'S CLAIM 
(Probate)
(Continued on reverse)

FACTS SUPPORTING THE CREDITOR'S CLAIM
Amount claimedDate of item
PROOF OF
(Be sure to mail or take the original to the court clerk's office for filing)
I am the creditor or a person acting on behalf of the creditor.  At the time of mailing or delivery I was at least 18 years of age.
I mailed or personally delivered a copy of this Creditor's Claim to the personal representative as follows (check either a or b below):
a.
b.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
CREDITOR'S CLAIM 
(Probate)
DE-172 [Rev. January 1,1998]
Item and supporting facts
(a)
The envelope was addressed and mailed first-class as follows:
I enclosed a copy in an envelope AND
(b)
$
My residence or business address is (specify):
CASE NUMBER:ESTATE OF (Name):
DECEDENT
See attachment (if space is insufficient)
3.
2.
1.
(1)
Mail.  I am a resident of or employed in the county where the mailing occurred.
deposited  the sealed envelope with the United 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' practice for collecting and 
processing correspondence for mailing. On the 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 
envelope with postage fully prepaid.
(2)
(b)
(a)
(d)
(c)
Name of personal representative served:
Address on envelope:
Place of mailing (city and state):
Personal delivery. I personally delivered a copy of the claim to the personal representative as follows:
(4)
(1)
(3)
(2)
Name of personal representative served:
Address where delivered:
Time delivered:
(SIGNATURE OF CLAIMANT)
MAILING PERSONAL DELIVERY 
TOTAL: 
Date:
(TYPE OR PRINT NAME OF CLAIMANT)
Page two
Date of mailing:
Date of mailing:
TO PERSONAL REPRESENTATIVE

Retrieval chunks

• #1

  Form ID: DE-172 Title: Creditor's Claim Effective Date: 1998-01-01 Mandatory Form: yes Info Page: https://selfhelp.courts.ca.gov/jcc-form/DE-172 Primary Download URL: https://www.courts.ca.gov/documents/de172.pdf Form Detail Page: Creditor's Claim (DE-172) Those to whom a deceased person owes money or other p…

• #2

  unavailable.) If secured by mortgage, deed of trust, or other lien on property that is of record, it is sufficient to describe the security and refer to the date or volume and page, and county where recorded. (See Prob. Code, § 9152.) Mail or take this original claim to the court clerk's office for filing. If maile…

• #3

  I enclosed a copy in an envelope AND (b) $ My residence or business address is (specify): CASE NUMBER:ESTATE OF (Name): DECEDENT See attachment (if space is insufficient) 3. 2. 1. (1) Mail. I am a resident of or employed in the county where the mailing occurred. deposited the sealed envelope with the Uni…