Revised 09/2018
5 East Pin
e Street
P.O. Box 743
Georgetown, DE 19947
Phone: (302) 855-7875
Fax: (302) 853-5871
Register of Wills
Name of decedent
Name of claimant
Address of claimant
Amount of claim
Basis of claim (attach copy of any written obligation signed by decedent, if available)
Date obligation became due or, if not yet due, state date on which obligation becomes due
If obligation is contingent or unliquidated, so state and explain
State whether claim is secured or unsecured and, if secured, describe security
State whether claim is being filed within time set forth in 12 Del. C. Sec. 2102
Claimant Signature
$5.00 for first page, any additional pages are $1.00 per page