NOTICE OF DISALLOWANCE OF CLAIM

JIS CODE:  NDC

FILE NO.

Approved, SCAO

STATE OF MICHIGAN
PROBATE COURT
COUNTY OF

Estate of

TO:

Claimant name and address

Your written statement of claim dated

for $

           is disallowed

   in whole.

     in part as to

  entire claim      portion of the claim that has been disallowed

The
will be forever barred unless you start a civil
action by filing a complaint against the fiduciary.  Your complaint must be filed with the appropriate district, circuit, or probate court
not later than 63 days after the mailing or delivery of this notice.

    .

Date

Address

Signature of attorney

Signature of fiduciary

Name of attorney (type or print)

Bar no.

Name of fiduciary (type or print)

Address

City, state, zip

Telephone no.

City, state, zip

Telephone no.

PROOF OF SERVICE

I certify that on

Date

I served a copy of this notice on the claimant by

first-class mail at the address stated above.

delivering it personally to the claimant.

I declare under the penalties of perjury that this proof of service has been examined by me and that its contents are true to the
best of my information, knowledge, and belief.

Date

Signature of fiduciary/attorney

USE NOTE: If this form is being filed in the circuit court family division, please enter the court name and county in the upper left-hand corner of the form.

Do not write below this line - For court use only

PC 580   (9/10)   NOTICE OF DISALLOWANCE OF CLAIM

MCL 700.3806, MCL 700.5429,  MCL 700.7611