CHAPTER 175, Public Acts 1939
STATE OF TENNESSEE
COUNTY OF JEFFERSON
CLAIM AGAINST ESTATE OF
___________________________ ________________________
Deceased Creditor
CREDITOR ADDRESS: DATE CLAIM DUE:
___________________________ ________________________
___________________________ UNPAID BALANCE:
___________________________ ________________________
Quantity Items and Nature of Claim Amount of Claim Credits:
______________________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
STATE OF TENNESSEE
COUNTY OF JEFFERSON
Comes ____________________________, who being duly sworn, makes oath that the attached claim is a
correct, just and valid obligation of the estate of ____________________________; that neither the claimant nor
any other person on his/her behalf has received payment thereof, in whole or in part, except such as credited thereon
and that no security therefore has been received except as therein stated.
____________________________
Sworn to and subscribed before me,
This _______ day of _____________, 20___.
_____________________________________
Notary Public
My Commission Expires: ________________
