HomeMy WebLinkAbout05-21-07
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May.t.2007
Register of Wills
1 Court House Square
Carlisle, P A 17013
To whom it May Concern
Enclosed please find an itemized statement and a claim form to be used to file an claim
against the estate of Mary Zeigler. Mrs. Zeigler incurred these charges while a resident
in our facility, West Shore Health & Rehab Center.
If you should need additional information or have questions regarding this please feel
Free to contact me at 877-823-8375 ext 2270 Monday thru Friday from 8:00 to 5:00 PM
Central Time.
Sincerely,
Rita Donnelly
Healthcare Collector
Golden Ventures
P.O. Box 180970
Ft. Smith, AR 72918
RDC
Encl:
CC: Client's File #78899
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P.O. Box 180970
Fort Smith, AR 72918
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Claim Against Decedent's Estate
Estate of: Mary Zeigler
Case# 21-20070299
The undersigned hereby presents for filing against the above estate, this statement
of claim and alleges:
Golden Ventures/dba West Shore Health & Rehab Cfllter
P.O. Box 180970 Fort Smith, AR 72918
The basis of claim is: See Attached
The amount of the claim is $1,835.37
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Under penalties of perjury, I declare that I have read the foregoing and~e facts g
alleged are true to the best of my knowledge and belief. G. Si ~
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I swear this statement is correct
Subscribed and sworn to before me
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TWYLA LENSING
Sebastian County
My Commisslon Expires
June 17,2015
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Golden Ventures
P.O. Box 180970
Fort Smith, AR 72918
www.goldenven.com