HomeMy WebLinkAbout05-11-07
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CLA1M AGfiTNST DFCEDENT'S ESTATE
The Claim=t certifies lPal there is due =d owing by the ~-s..J.a.k O?
I hDlf\a.O /Yl. lock- deceased.
In accordance ~NiLh the attached statement of CCCUll.Llt, L.~e su..,rn of S) 3, it, 1, 79
together will-J. interest at the rate of from
until ocid.
...
On behalf of the clatnant, I do solernnly declare and affirm under the penalties
of perjury that the Information end representations made herein are true cmd correct
of L~e best .:)f my k..l."l.ovvledge, informctio:1 and belief.
(Signature 0_ Cloi_rncmt or pArs n
authorized to make verJicctJ.on
on behalf of creditor)
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IN THE STATE OF Pennsylvania
COUNTY OF Cumberland
IN RE: The Estate of
Thomas M Zock~ Deceased
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PRO~~1r~~f9T 21-2007-0319
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STATEMENT OF CLAIM
The undersigned~ being duly sworn~ deposes and states that:
1. TSYS Total Debt management~ Inc.~ whose address is Post Office Box 6700~
Norcross~ Georgia 30'091-6700~ is the attorney-in-fact for Barclays Bank Delaware
(hereinafter "Claimant")~ whose Account Number is 5140217997756275 ~ and as attorney-
in- fact is authorized to submit this Statement of Claim on its behalf.
2. Claimant is the holder of a claim against the Estate of Thomas M Zock
deceased~ the basis of which is the unpaid balance of charges incurred or authorized by the
deceased or on behalf of the deceased in the total amount of $3869. 79 ~ as of the date of
the death of the deceased.
3. The said sum is now justly due this Claimant; and the claim is not contingent or
unliquidated.
4. No payment has been made thereon~ and there are no offsets against the same~
and the same is not secured by judgment or mortgage upon or expressly charged on the real
estate of the deceased or any part thereof.
This ~L\~
day of
MARY D. COLBERT
NoI8Iy Public, DeKalb County, GeonIII
My Convnission Expires Noverriber 18,'lOO8
Sworn to and subscribed before me this
~dayov4p~ ,2007
~L~CP!W
~p\'. L
TSYS Total Debt Management~ Inc.
As attorney-in-fact for Claimant
Cde6\yOQ\'~
Lestellia Joyner
TSYS Probate Representative
Copy mailed to attorney for Representative or to
Representative~ if not represented by attorney.
~ 2007
czhv-
this day of
TSYS Probate Representative
, 2007