Creditor Matters: Estate of JULIO MADRID Print

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                                                                                                                                                                                                               DE-172
ATI'ORNEY 0R PARTY WITHOUT ATI'ORNEY (Name,                      slate bar number,   and address):     TELEPHONE AND FAX NOS;
                                                                                                                                                                       FOR COURT USE ONLY
Jason A. Fetchik State Bar No. 227832                                                                  (626) 914-7809
Driskell,           Gordon &          Fetchik,     LLP                                                  (626)335-7091
180 N. Glendora Ave., Suite 201                                                                                                                                          F       I

Glendora,                CA 91 741                                                                                                                           SUPERbREOUDRT
                                                                                                                                                        COUNTY OF SAN BERNARDINO
                                                                                                                                                         SAN BERNARDINO DISTRICT
                                                                                                                                         -




        ATFORNEY FOR        (Name):        Per|a Arauio
                                                                                                                                                                        NOV               1 9 2021
SUPERIOR COURT OF CALIFORNIA, COUNTY OF San Bernadino                                                                                                         ,



 STREET ADDRESS:247 W. Third Street
    MAILING ADDRESS:                                                                                                                                          I
                                                                                                                                              By
cm AND ZIP cooe:San                                      CA 92415                                                                                                                                w
                                       Bernadine.
          BRANCH NAMEzJustice Center/ Probate Division
                                                                                                                                             Kay M                       aWOWI

                                                                                                                                                                                                        Depl m,

ESTATE OF (Name):
Julio          Pablo Madrid aka               Julio P.    Madrid
                                                                                                                          DECEDENT
                                                                                                                                             CASE NUMBER:
                                                         CREDITOR'S CLAIM                                                                    pR0332100247

               this claim With the court clerk at the court address above before the LATER of (a) four months
                                                                                                                   after the date letters
    ou must fi1e
 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.      proof of service is on the reverse.A
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.
1.        Total      amount      of the claim: $ 12,589.24

          Claimant (name): Perla Araujo
2.

          a-

          b.
                 E
                 E         an individual
                           an   individual or entity doing           business under the fictitious               name   of (specify):



          c.     E
                 E         a partnership. The person signing has authority
                           a corporation. The person signing has authority
                                                                                                     to sign
                                                                                                     to sign
                                                                                                               on behalf of the partnership.
                                                                                                               on behalf of the corporation.


3-
          d.

          e.
                 E         other (specify):
          Address 0f Claimant                  (SPeC'TY): c/o Driskell,     Gordon & Fetchik LLP

4.        Claimant         is                 the creditor    E       a person acting on behalf of creditor (state reason):




9’91
          E          Claimant         is   D       the personal representative              E        the attorney for the personal representative.




I
           |   am   authorized to            make
           credited. Facts supporting the claim are
                                                    this claim     which   is

                                                                                 E
                                                                                just
                                                                                         on reverse

        declare under penalty of perjury under the laws of the State of California that the foregoing
                                                                                                           E
                                                                                       and due or may become due. All payments on or
                                                                                                          attached_
                                                                                                                                              is       true   and
                                                                                                                                                                  offsets to the claim


                                                                                                                                                                       correct.
                                                                                                                                                                                                       have been




Date:               i/    ///z,        ,

 Perla'Araujo                                                                                                      }          (   @42 j      é     Z
                                                                                                                                                         é
                                                                                                                                                         G A URE O C                 |    ANT)
                                     (TYPE   OR PRINT NAME AND TITLE)
                                                                                     INSTRUCTIONS TO CLAIMANT
A-             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        each item. Do not include debts incurred after the date of death, except funeral claims.
                                                                           for

               If the claim is not due or contingent,  or the amount   is not yet ascertainable, state the facts supporting the claim.
B.
C.             If the claim is secured by a note or other written
                                                                    instrument, the original or a copy must be attached (state why original is
                                                                                                                     it is sufficient to describe the security
               unavailable.) If secured by mortgage, deed of trust. or other lien on property that is of record,
    ’




               and refer to the date or volume and page, and county where recorded. (See Prob. Code, § 9152.)
                                                                                                                    with return receipt requested.
D.             Mail or take this original claim to the court clerk's office for filing. If mailed, use certified mail,
                                a         the personal  representative   and  his or her  attorney. Complete  the Proof    of Mailing or Personal Delivery on
    E.         Mail or  deliver   copy t0
               the reverse.
 F.            The personal  representative or his or her attorney will notify you when your claim is allowed or rejected.
                                                                                                             representative must be                                                                          within the
               Claims against the estate by the personal representative and the attorney for the personal
                                                                                                                                                                                                     filed
 G.
               claim period allowed in Probate  Code   section 9100.   See  the notice box above.
                                                                      (Continued on reverse)
           Form Approved by the                                                                CREDITOR'S CLAIM                                                                          Probate Code. §§ 9000 at seq., 9153

        Judlclal Council of Callfomla
    DE-172 [Rem January         1,   1998]
                                                                                                        (Probate)
                                                              \I                                                                       \r
 ESTATE OF         (Name):                                                                                                         CASE NUMBER:

                                    JUY‘O          P0b\o Hadnd                                                        DECEDENT         ?ROSB’UOOZH'?
                                                                   FACTS SUPPORTING THE CREDITOR'S CLAIM

      Date of item
                                                                      E      See attachment         (if   space
                                                                                       Item and supporting facts
                                                                                                                     is insufficient)
                                                                                                                                                                          Amount claimed
                                                                                                                                                                                    12,589.24
11/2/2021                            Funeral, Cemetery, and burial costs




                                                                                                                                                                 TOTAL:   $   n. .53‘]       .ZLl

                     PROOF               OFE           MAILING: PERSONAL DELIVERY                                        To PERSONAL REPRESENTATIVE
                                  (Be sure to mail or take the original to the court clerk's office for filing)
1.    |am the creditor or a person acting on behalf of the creditor. At the time of mai|ing or delivery was at least 18 years                   I                              of age.

2.    My residence or business address is (specify): 180 N. Glendora Ave.. Suite 201. Glendora. CA 91741
           mailed or personally delivered a copy of                    this Creditor’s     Claim to the personal representative as follows (check eithera orb below):
3.    |




      a.
               E   Mail.        I   am   a resident of or employed
                                                    in an envelope AND
                                                                               in   the county where the mai|ing occurred.

                    (1)    |




                           (a)

                           (b)
                                    E
                               enclosed a copy


                                    E       deposited the sealed envelope with the United States Postal Service with the postage fully prepaid.
                                            placed the envelope for collection and mai|ing on the date and at the place shown in items below following
                                            our ordinary business practices. am readi|y familiar with this business‘ practice for collecting and
                                                                                            l




                                            processing correspondence for mai|ing. On the same day that correspondence is placed for collection and
                                            mai|ing,     it   is   deposited   in   the ordinary course of business with the United States Postal Service                          in   a sealed

                                            envelope with postage              fully   prepaid.

                    (2)    The envelope was addressed and mailed                           first-class     as follows:
                           (a)       Name    of personal representative served: Irene G. Madrid

                           (b)       Address on envelope: c/o Albrektson & Shumate, LLP 1801 Orange Tree Ln, Ste 230 Redlands,                                                CA   92374
                           (C)       Date of mai|ing:              \l/‘s/u
                                                                      and                          CA
          b.   D           (d)       Place of mai|ing
                    Personal delivery.
                    (1)    Name
                                                   |
                                                              (city         state):   Glendora,
                                                       personally delivered a copy of the claim to the personal representative as follows:
                                         of personal representative served:

                    (2)    Address where delivered:
                    (3)        Date of mai|ing:

                    (4)    Time       delivered:
                                                                                         foregoing                                           true       and   correct.
     declare under penalty of perjury under the laws of the State of California that the
                                                                                                                                        is
 I




 Date:         \l/{S/Z‘
 Samantha DeVries
                          (TYPE

 DE-172 [Rev. January 1,1998]
                                    0R PRINT NAME 0F CLAIMANT)
                                                                                         CREDITOR'S CLXlM
                                                                                                             ’
                                                                                                                            .




                                                                                                                                                         fl
                                                                                                                                             (SIGNAyORE 0F cfinMANT)
                                                                                                                                                                   [Ma
                                                                                                                                                                                           Page two

                                                                                                  (Probate)
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