Loading...
HomeMy WebLinkAbout05-23-07 NOTICE OF CLAIM COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF MARGUERITE ANTONUCCI, DECEASED No. 2007-234 To the Clerk of the Orphans' Court Division: Kindly enter the claim of Claremont Nursing and Rehabilitation Center in the amount of $15,485.72 against the above-referenced Estate in accordance with the invoices attached hereto. This claim is a priority claim under 20 Pa. C.S. 93392(3) for the value of nursing services performed for the Decedent within six months of the date of death. The Decedent, who resided at Claremont Nursing and Rehabilitation Center, 1000 Claremont Road, Carlisle, Pennsylvania, died on November 16, 2006. Written notice of said claim was given to Robert Pomeroy, Administrator of the above- referenced Estate at 413 Amherst Drive, Apt. D, Harrisburg, Pennsylvania 17109 on May 22, 2007. Claimant: Claremont Nursing and Rehabilitation Center 1000 Claremont Road Carlisle, P A 17013 ScL- Steven M. Montresor Attorney No. 74244 Latsha Davis Yohe & McKenna, P.c. 1700 Bent Creek Boulevard, Suite 140 Mechanicsburg, P A 17050 (717)620-2424 Date: '), :1;1. Jar) 7 --J -1..,--- (-) f"'.' W .) : I " :!..~ ..--.~ (...) o \ ,i 115664 \/' May. 15. 2007 10:41AM CLAREMONT BUSINESS OFFICE No. 4326 P. 7 Claremont N~sing & Reha 1000 Clarem~t DrIve Carlisle PA~7013 e G tI 54 PIlXlIl PAI"Ieml 55 IiSl' AIIOlM" DUE as 57 .. 1I8lN0'81WE "',,"~ '!<;'t~11 ,1 m<.":' ~:..'ii<;"'","'''1' :,.',< r- " :~~~;;;?~;f~;#~~,*,~~~\~:~~i!!~~~':i!~~~f ~~~~R~ ,,~.'12 ~"\"'~,~,\~;ir..':'" <If.cr,;''ll,, ....., ".1~1' ... .. -"'." '....1.. .~ ,. '."CT'"'''''''' .~;1tif,'~'!;;;f,~~;.i,~!i~;i~~j{;;~i~~1~;Vfi;i~' 81 GAOUI' /cAME 112 lNSlIW<<Ji GIlllIP 1<<). j ~p~, g.~~~9t..:~~.;i~leh1~Ji~~~ '" 01 'I'.~~4.01~21~5 9 "'''''''''''~''~~~''.,'~''""...~""v.'';w,-."<\,!,,,.-..., "',"".". "....."w '"t".",..-...".... .., ~ "'...'.......l..- ....~.. A ;,{:t~i.v:~\:.' i;r;r.:;~"J:;;;.:-l.!I:..~Eirn'~ ~i~\; ... ~':n7.:;tli\"-"lil' . .~~ ~ !: 'T~I .. 'I' :-,,~~}.f.&r. L~~'~~\::H .~~i::,j;!~..p<<~~~~;~ff~~.i:'~;~;\~~~::.;:.~./i:i:~ri ,~~'i ;~~.h~!t~:.it~h;.:;:i:.(~j:i.l,;~.~~s~.i~~t ~~'i::fi'lk.~J.:~;I\:l:t! . ':'. ......~. ..",.... ..:.'tr',:':&~'___H ~V""i'r'r-":l1....' ..~INO: .,j ~~\". :=I.. "'~'"1"""1 .....~~c::'\~.\:.,~..~.-:'"...::,I~..}..... ....~~.(.~.:. '...~:.:: .~.. . .:...::...,.'..~..,\..:...<....1'.:' C It TRIA'N&Nf AlmtClIIIrA~ COOES Ie Pll'\.OYIIl ~TIOH . ... ....::l. ,.'\:'~ :~r~: I~~.':: '.t''7TC~~~'" 'Tj"ooK~.e.:: :1' .~'..~, ..J.. '~(~..r.f:C('. "',~.,~. ~'.....".~,;.J.~1." ' ; ':'.': It Y:".~~M>:'l~ ot;:\\"!1 ~:iJ:;i.; .;.\:~~...'''m~l.... A ~~... .~"v. ,.it.":"~!"'.' ..~~~I:~~~!f.~t~~:~;.~~' iY.:i~l;:i.;~~;~~~.~~jlr~:~;;~i..:.\<.t~l':.:.::: ;l)'~:\{~~~:.?~t~~~.\..~:\:~ ';,' .:: :::':I,::';::~':', ::/~'.~':i, t, .:.\.,..i:.~:.l.\.:. I ~~. .a..... ~~~'ri-~ ~~l. .. , ''l>l'!Ol.~.,!'' ,.:r:."')o~~~.~tf':~"l(i.~ .J.:.\1i~.it.~'*'~J~...~~~I.r.~.:.i.~..~':;t?:~~~....:.:':.-:'~:~,.!1,......,f ';"'!" (:~:;...,..:.);'.;,.~~',~~':',>.~t+:~,..: o:.~\I!:'I ,......:'~ . 'cr'1"'. '...' .,w:li't....,... . ,..:.~. ~ ;,.Mlt...l-;' ...,;f", :~,.,,~, . .:' ,,,...ry..., ,'.,.. .. . ".' , ., .., c 78 14D K:e;NNETH R . b . b a b .. 1W'.AAXa :Aool_ ~,. 0... NO. ~ PIn8cl an R8e)U1Cl1'GW May. 15. 2007 10:42AM CLAREMONT BUSINESS OFFICE No. 4326 P. 8 Claremont Nu:..f. Bing & Reha I 1000 Clare~~t Drive Car l1s le fA 17013 8 fBI,TAXNO 717 243-20'31 I 2 . ,', ',' :'" ...... " . !', I "-:::" ~i:'. .~ ( ,:' $1 I'IIQYqR t(O. c Sf .:<:': '.~/ ':, ~ /:': ::' ~'}.':~.~?~':!:~:::~'~~:.:::~:}~:'~::?~.~i~~~!~~~rl~ ,1t'!;'IVi' :;i, ;~:: \J.j.:;~!~:,. .1'~~!:.~:?~rr; ~M{~~*("~f~rr:'!;'ji)!; .:: ~:.. 't1~: :~. ;~;: :t~:jp. ';~ ~~~~~~ ~~:~~f:~:~~~.;~:~ ":~:: \ ~ Marguer te ~. ~. .1. 'f'" ", ': .. . ..!th~'(l'': .li.;~"',~""" '''tf.'i>T'~I-t)..I'IKIoff~l~' ~ ft ~tgj~t'c~"'':-'.N~~'}~I!~~''''''1''-::'~''Jf.~..nl~'!r''~'',~ 't~1- ~ , "'I.r..... , 1\;:1- ,......~. I~" .. u,.... '."~' ,,: :,' ',I t' \~ . ,-; '\,', '. t,.,,:.,.M ...... "..~ ,..... ..... .":" ::~ ::!".~ ~ .;:'t~~) ~...1:~ ~..:"..t:'.~.~'1:.::.~~4~~;~ft~:';"f~~~i~~~~~~( '. : Kt ~f.;~J'~~(:f;)!m~~~:r#~~;~~'~f;~~1; .rt.l;~l~i:'~.: '~:~~t.\:,. ~:."ri! J~:.~f.~'!-::,:;(~~::: ": :; 1:~ . :" ,:~:! 'f, ;::. ~~ : ~'~~~ :!~.~~!.~~~f1':~:.i~'.":j;~:~:~:.:::':';.;:Y . 61 'UGJIIED'8 *ME Antonucci $1 GA:l\P tWII! 82 IN!lIlANCi GROUP 110 A C' lIIlN4nt91T' .wJHClRllATION CCXlD III1llC A'l1III'LCIYIR NAIll lIlI &lIPl.CMIllDCAT1QN c A 71 IKV,_ PIInlI4 on ~ "-*' OOAlOl'lJO_ a b . b ~,~~~: a b :i;~n:s~.;\:~ :,:,:(;:':;\:?\::': ;.;~.~r:\~:.:~';::::; ~/}r~:':' :"'/:'0~j~,~1'~:;~~ ~;:XX'; J-"'~OII'R11_API'I"'llI'l1l11IUAlllAIlE_A'.IIII'_. . ~ IIIIWWl May. 15. 2007 10:43AM CLAREMONT BUSINESS OFFICE No. 4326 P. 9 ; . MAnEHI' AlIttClRItAllON CICDlil!I A; ", ci I I 'i<R';;t".~I;: '~'::t;;~:l;i\'J;~.' ~rli':;;!:.r.:f_~Wl<~)1"~~Im" .:;~r'''','1>., {iiio~t. ~~-..h""Jf..'f.~~~ . ,. . ~~~~. ';;': ,. .. .. j. ~...~..l ,".....,:~.". . e!.\~'i!.~ . ,",.."..~:~~~ . .f,~.~~. &0 PAYIIl Meel 56 PIWR PAYloISlITS 15 EST. AIlCIUNT M . ,:':" : . i I :.~~ ~~'fI1'~*,~A~~~:F~~~~~m ~~~~~/lh:~ ::\1\f.ij( ;.~r:~~;~~'J,~[~' . . i ; ",::; :''.J '~~:'J~'~~~7.t.~,~.l;';"I~::'I(;~'2'!:1l ~!~ '."'~il' ..,. . ;.."1: :':(I''':'i.i'!.'I.tri'~M~ ' ~:ll,'~!M:lo '.r~:!~'J:.~~:t~I!:~~'H').'\'~ .. '~1.~'~~' 'l~ :::,;.~: ~ :'~:h~~~iP~~~~~~~~;~1~ff 81 ClIlOOP IWoIE 1II2 INSUIWlCEGIOIP NI) c Ie ~LOeA1JClH i A ; ~W~X~~:Mj;~~~~f;F~1~!!t~~~~H;~~j\ if:Ji ;'~~~~l$!M?~~:i.~{:t.:$;~;p~~~:~,i~~i~{iX:r{~r; K\1W<<~:[.i~ i'i~~';~ii\~~':~;h;:~;r,s~~:.~::i.\ :'<":-1:<"~':.<';':::\";::.::.~...~.,:i~':i:;'. "':':!:~;':~:fi.~:!i~~~!Ni@t!~~~/f;..:~.t; B c 71 1M I&WlIaI ':395660 10/26/06 10/11/06 readmit skilled DISCHARGE NON-CERT )i!,~~"~I;~: a b a b a b ,......"... ,",\:":,,,' ..~, '.,.. .t. ". " '..~: .<...:..'r;::l:.":..'\',::.~..:~'.:.';:':'):,:,:':::,,~,::',:,~;': .\... ,:~~I:'\:~~'::':l':~l~\; ~L~~~~~1:~~~~'-l''i;~i~;~,"1'~~t~'3~~~''#'~'',~''~1:1:~~1~~O}~;.~ , ~~~~~,'\~'H~"':~?~"\':::"'''''~~~~~~':'\'.1~~~,.: ".. Olllll>~ $1'M'tIC CIlI ~1e<I PII'* '.,.,'IltEc:iIIII'lIa_0ll7lll_""'-YlOme....JID_II@liAI'IIlfIlllICJll. May. 15. 2007 10:44AM CLAREMONT BUSINESS OFFICE No. 4326 P. 10 Claremont Nu~sing & Rehab 2 1000 Clare~~~"t Drive ,Carl isle PA, :7013 717 243-20 1 fWIIi ::~':7' ~ '. '~:."'\ =.:::N', t' ',' '. S1 GIlCUPNAIE 12 INSllIIANCE GAllUP NO A ;.a,.~f~~W~l~~f~~~ ~~!JJ~1~ft;;:~i~f.ft/.~:\~.::'~,1~~~~:::;:\;i '~.: \:~~~.~~:::~::.:.' ::':. ':~~:;'i;:}f~~~'~;.i:~.~t~~;~!~~~~01!~)f 8 Oi .. DlPLOYfIIl.OCA11CN A ,0 . IlIMNIK8 :'~'i ~rl:j'(S)i(' I b I b . b .. MOM-lAG APl'FlOYlDOMl NO.~ ."1IIdIIll0l'l~"_ 00 ~;'"::.~~:~;~'-J::{'~\':~.:'~':: ~',i"':':::;;:{ 6 ":'~<'~.~\':~ '.:~:.';: ~:':. '; ;~; ~:~:.; ,'::::'::: ::. \',~,~ :0' ~ ..:'. . ';,; ~~ :' '~<:';\/ iII..,. "','...".... ''',..".. .... ".,,'," ..021. :s:~2"',0!1... ''';:.l.:~'..~'''~;,',,< ';";" ":" ON ,.,'" "..:"......,;!...~.. ...' I CIIl1PI'1NI~CIl1lll...~'LVTO'Il4SIfU._M'~ AI'AIlTIlDlIIOI' . May. 15. 200710:44AM CLAREMONT BUSINESS OFFICE No.4326 P. 11 Clar6mont NMfsing & 1000 Clar.~~t Road Carlisle PA~7013 7 2 0 1~ A' Ii o &1 PIIOVI&lNQ. 5' PRIORP~'f1ttENT8 61 . . ..._......?:lll'...,l.l1(~'\:~....y-'c..\('m.:I...... Medicare Part A 395660 .' I 1 i::",~':.-~j:~\~{.i;:~~~~;[;~:*'lf.4'f~,it:. '~~'~"""i~t''''~1'''':''''.'~'''~'H''_\ \"'!'~J1!j.i1,lll'.""U'~'!II' 04.,....'..1'"'1. '~I.& '''''-'''I~''A' '~tl"\-:"~"...- '...'" ,r:;."J"'''~r.""p::''~''r''''''i'~''':)>; 'J..."i'......"....'f.";\.-':'.... ,..,~. ,T.,fo)....'.(_,O: C"'~'J'i1'_,.fiIf.i.~:'Ili"~I"Io.,.. . . :ot',..!4"AAi".: '.k""!Ji.;"""'1I ~'" ~ . " 't~"" .-ox_.. I ,). :t..'!(,i~~L'~," >.~'''".,,,\..;.,'''!'.'V;'H.'' ''''..~.. . \ ~~~~\\f.,~' . f~":~~:JI~t-:,.::It " ,d' . .~. . ..... ~~.... .~.. I' ~~...;l":'L.JI.'. ~r~r;~~..j~"':~.~:Jk~~;.;~J~.:.:a.:;..~~lv. '.' '. .\. ..... ""'~'" .....,\~~~ y!",t,(( . j ,"1-,( ~:' l~:\,I'~'o}I,:;~~,!'j:~,,~15@'~~~~~~ i i l!~~: ::r!i~~:~i~llff.~;~<'ff"*J.6:.~~J.~~Qo: 11 L'l1IllUJIl NAIl& 52 INStIlWlOf GIlOUP ICI. ~ ~ . 1HSIIlIiD1*Ui .,JII. /Ill ClIlRr., 8SlHIC..1D NO. .,~~i~!t~~~c;~(l,~M.~~f..~~~~~t! 0'".''.''''''''''' ,;. ...3..~~~~~.l ~l,~~"\~~~"r4.~~..,~:::H,.,..,i..,. ~ . :: 'ililloi.~ .... Uii.Uer: '. . .. ., . ~JW:,"1f"", . W . '~1'Ii ~.("tii;j.;;-..;;!;'!;..>'f'l; . ,'~.' -...... ..~l~~.... 'W .....,.~"......Ui ......... . .... ..~"""...._:"'.."". Ill:-:'r' -"':J...OO\"......\'( I'''':' . '~""':"!r\.'''''''(!'o'' . '":/1:''' :.~.,...,... ..;,;....""".'-~' '111.. ...,.....,~". , '~).x~~(\~~.;;~.t.,):-~~....~t;:'J'~.'1.:~:~,Y,': );!1t.~.;'S~'1'~'A:l?~~.1,;~"'I't~,..~~r. . '~J:&~ ~~. J :r.I~!U::~~~~\!~'f;~;"!:'.~;r.~.Jf.'i,.::~~l1i, ~"';.'~ l'~~' "_.:!f ::,.;:,.-l1:J:~~~1'~~1. .~j~:ik:~: A .. TIlrA'MHl' AlItHOIIllA'IKJ( COllIS c iI. lJli BRCMFlHA114 .. EIdI'l.O'tIII LOC411ON i A ! l"-~' .IW.'~;l;';."""JY;;~~,.. .t;1.,1:i.~~~'.w.~.;;:\)r:.,.. . "'., "'~"'~I"" ~~'. ;~"'~W....'I;;'=>...'.-':\"''''''f.l'.~K,~'~;},.I!'''. :t...;..",,:....";...~".,~.::':,.>'.i.~;'..,'i,~~lI",.' ~".'<-'~".'.:,' "':Ii:.:": ,. ;,...., ., ., '..'i,;;:~....!:.i..;::"'.."'7:l...:.': 'i'^: ~ ;~:-~~': ~~~L'~'!rlr-:~~~f!h~,,'. ~\Il~~,^.1'I . . ~:~~ . . ~1ti~$-,:~,M\:i"'4l~.,'~~I~~!i~L\i~;)~,',~'t1r.~~.,~(:; ~,;,.':1i~"'*~.~.:\~~~~'!..-I.~ .:,~~~.,~:~~:!,,~J!\.~,J-:i!~:.~.~~!.; ~~,"'~ ,', ,;.,'..~, ~,.:\::.!.\:;~~..:;i~~:~'l'1~.~~~~:~";f~.~i~~l:~::t I . . ..'"..... .... .:. "~" ." ....';;1;..., ..."'fro.:..... 't... . ". .... _.. .... .,;W~..: ....,. :M.m < ""....... "I'''" if.. c'.n.,,,,,,,,,,,,:,. -''''~''''~''.'' ,'.....,.." .....,..... . .., ''',:: '.'. , ., , " .. :.' ., '... '.1 .-;:...~~..... t" ,......,. "Nt'lr'l, C 78 4;~~~i;i_: ", '. ~ . b a b . b MD KENNETH R:- NONCE J etIlIrtM CIIlIlIICATIOHlI CIIl1G IlRUetAPft.YT01lI8....JIID.IM IMIlIA '1,\:W{~~:::{:;:;'~[lHii:i;::};i\~!,g{(\;;:i1}:;2:T:)}.f\;}{:~!.~., .' May. 15. 2007 10:45AM CLAREMONT BUSINESS OFFICE No. 4326 P. 12 Claremont ~Sing & 1000 Clar$~: t Road Carlisle PA 7013 7 40- '08 aeha a FEll TAX 1<<]. 14 lIIIl11ClATE 54 IlfltOR PAYIIENl'8 55 1!81'. AMOUHI' DUE sa i ~ :~.\l~.;it~~~;.t.:;~~.;:}{~~tMp~"J " '-'..'..w "... L... ... . m'" .' ..... ., ..,... ~~, ~L..... ,_&'.t:__ ",.!W.<tL!.ll.~ ~...~. \:'~~':1i1I' ,-,'..4., ;~'''I f"~~ '..I';"f'~." .~ ~<: 't~' ,W ~~.~I!~~, '::~i :'f'~!'!~;~ is) #.';;~:,;.,i;":<(';;(r.!il',~ ::'.;~:'\)!:~i!f\r!~,~;~~~7~~~r;~~ 12 NUIWICE 8IIOUI' NO A 11lIiA11/!NI' AImIOIIIZAmN IXllIIiI ..Ill; .. PII'l.ClVEANANE IIlIIMI'lOYIII LCCA.11Oll ~~r;t:;Xi~lii~~;~t~~;K.~~~~.*l~~.j~~i'~jl~~ti~ ~\~ ,:~~~,~;~:~~~!;!~;)~\~~~~~~~~~~~~17,(;~~f,!W:'~~~~ ~~ifJ,~~f;i?;{}~~I~i;;;)) l~rh ~!',i;:;. \"~!~!;;~::;;'i>; \';':;:;:';:,::~::~:'~~;,.'~;';1}i~'.$~~\~~;~~;~:0.~~ : , c " _ lllNO-. TO 08/12/06 TO 08/16/06 READMIT DAY44~9/25/06 eI'llr1llllQn~"-" . b I b U,~P.h'ta..jo,. a b : ... IlEUAIIQ . 395660 390058 395660 ~6/30/0G 08/12/1216 08/16/06 lJOlM. ,::;, ....) ....:.: .;~:..":: :.~,\. ..~:'('?::)::':''':';.:~'~';:<'::~:(~:~':'>,..3'\;:.~, f;:fi:\ ..:;: 't. ..l;;\};'::il;~"':r};~~. NONCE .,v..,; .,.',..;....,. '" ':-"'." . '..,.', \ ,.." '.'.. ", ;. .. " '. ":"'~' . ".'03Y 1'1:::I.~Lll17"'~ .... ''A' :.:..~ :'...~~... '.;.:\:"':"'.:'~:."":'" ....~::... i'::." ~J.'(: 1: ....: ~':l.' :,;,' '~.,1. .1.::. .,..~.;;f."~~~~ .,~....r:~ 1c:&r.Fr llIlil:llllRa..-IlII'IMIi lII'IRli .u;oLYlDllliI ____ ..'WHPIlIIO. May. 15. 2007 10:46AM CLAREMONT BUSINESS OFFICE No, 4326 p, 13 Claremont ..J>>rs ing << .Reh 1000 clarelnt Road Carlisle P .17013 .. - , 214: 10 ""ViR 5' PIIlMlEJil'lO. .""~' 1,~.\.9<!,t~.i~,~1i,~~.A""~"'!M"'''''P'''''''''J'~lC\ _,~~~9 ~ ~.?~'O);'''''''''~-''1Il ~ ~~,\(i~"~'~1.1 '~~..~',;!. . ":i;,~~.":;;';~~I"'Il ~ . :>:~,,~. artl~"'Q . ~~~& .1I"lai\."i.:.1tg..,ot,..tt:\,IQ ~~. ..... o;p:;.tiitS,.,.'/ III ",...;'< 'I.:. '''~~'''''II~''''''''''.''\''~o,,,,t.'to "", '.r'';!' ~ ~i','1'li,:.I!J:.l!ti~""'S: "",;},~~ ~~~~':~,v.~{~,Z:~:j::.,~r*~.;.~;..~~.~ , ,. '....r." -~r~'r'''J''.''''.~'"'''. \e~'.'",o:..i "'p...~~." ~..::'...t~''''\.".~., .;f~~}iT J;~t~~~,;;.: ~(~t.:~~~~~~~,a 51 IIINPI&ll'S/WlIE .PIIL to <lERl'..88N.1tC 'ONO ~~n;~~~~~~~1l;'M~~~~J~~'-~ 1.\' ~_"._ ,.1', . . ~~f.!Il!'!~..;\t~!l'" r...ij,~~ '. '. "".,..",.M~~~~...M....~. . lill: I II GROUP NAIll B2 lN8lJIWICl! GllOUP In 204012159A A ..'.1~'~~~~~~~~~~1~! ~~~i~t~m~4~~~&J.~t~f~:~f(~:~ :;t~~:it.r~~t~~~~~~~~rt~~~r~iT~l B c .., ~ ALmlOIIZA11ON ccces If QFLOYEfIl.OC.A11OH j, 'J.:::}',::",.=\"II'rb~~)~.\i=~')~~~~~.w~I~:W...'fI+~~v. '/.I:'!': :TCt:~"'\'I:~:~~~k-~~ ~~y~;:''''''&t'~'t.,it':-~'$}o..ii).;.'',l~ ''''.s.~Jt:::.''':\'t,''''':r'ilI:'''';l~'':\ 1"'.'t....'~u~1.~:i. :.:r'1;:":I.'l:.' ~\:I"" ". ,:v:::,.~:~..,: ,n'.: "'ll':>';\ r.."..........:i.r;::i.-r.~:J~JI1'..~...(~ t.rt~.:i~~~t!&.;1e~$!T~':~~~~~~~;~. .: . . ~. ~~m,~"i1~~ft\P~:'~~t~:J:.:~~~~~~~~~;;~~~:~~!~~" ii4..~~!~~ii1~~~~~~I~f.1~i:'.:~~~i1f(~~~}~.;!~~:~~~! ;;.::~~.:t\'f :';:~"~f ~'~\~~~~~r~~~~~~~!i~~~~b~~ 8 C 78 .. IlIMAIll;S 395660 390058 I MD KENNETH R b ~ I b a b , :W~~t~.~:iH~};~~}:::;~~V~,::ij:~1;;~tr;if:M~~~~:~J5:q~~.;~i~~*f.f. >>PAGYEDOUB PIlIUlI ~ ~ """ Ma y. 15. 2007 1 0 : 48 AM CLAREMONT BUSINESS OFFICE No. 4326 P. 14 'J''' Claremont ~81ng & Reba 1000 Clareli9)t Road Carllsle PAtl7013 54 PRIOII PAYMENTI N EST. AAtO\It.iT DUE 58 J ~:;t~;~t~;;~~~:~~~~*~~~"?~~~" I' ~(:"~~:;':'~~..~""~'7I!1..o1jI~ :r.._'\'MI+'_.'..'::.r."..,.....,,~+ ....'....;.. ~........./...oI;....j .H.Kit::r..v:.~.t~", ~1;.0;. .. '~~j~1t~~~i~ii~;J~ ,.~1:~~~rt.t;l~.:tf.~t,::f~)r~ j i ~'i~~1!/t ~\~$;.~~&t~:fi~~~~~~~~ . ..,;..~:.I,('~."J9,}y.;~~~::t~~~,.,:,..... I .PIII. II CERT -S8N-1i1C -roNO. 11 GACIlPIWotE .ING~GAOUPNO. 1 206012159A A il\i3':.4i' .~l'AI~tJC;1'~.,;,'i~~~Y".1;'l:~".,,:i;I.... "'~"1'?4t,n.l<'''''''''''''''''''''' .,." "l<-'" "'.. .....,......--..".wle*~;I:{:w~~ "~. :f.f!~~~~'fi:M.;.fr!f.i..~1~~t;,~tt~ '~;~~~~.;1t~~l;f:i~~:ff,~~t~~1:~~!~~.~i .:l;~,;~.: ~;;,~~~l::~..I:;V..~f.r;!~~;i~ft~~!!i~:~ I a II s.tR.O'ISl LOC:I.1ICIl ~ ~~~~~~~~;t~~!l'~~;~u~+~~~~~Jm::' .~~~-:it'~~:f.~"~~~~1f'~~:,1l~;J.r::~~.':i~:::~i~:;;::;:~f'~;:!4;;~;;~;.'r~~.:~.;:~~~JC'~.mr;;~ff: I . :&l~fJl~~~trlt.'~..~'iS~~~.~I~~r:~~r ,:~:::.:~~~~:..t(~,~ " iI"'i .~1.i~~.~~'.~ ~..;'rI~~;':!' c.'n~":t\t.::;,'!.,m,:\"":,,,,, """",," ,",. ":':"~..:.f~:..,,..,,;s..,1I..~.~~It'~.:II.(.;...!':.lt C 18 MO K~TH R I b I b . ~ 393031 05/04. 06/30/06 08/12/06 );:;~~~~ oJ -- * PIiIIlI4l CItI Jl8c';ClIClI'IIPIr COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF MARGUERITE ANTONUCCI, DECEASED No. 2007-234 CERTIFICATE OF SERVICE The undersigned hereby certifies that on this date a true and correct copy of the foregoing Notice of Claim was served via Certified Mail, Return Receipt Requested and First-Class United States mail, postage prepaid, upon the following: Robert Pomeroy, Administrator 413 Amherst Drive, Apt. D Harrisburg, Pennsylvania 17109 Dated: 5". d? /C4; 80 Steven M. Montresor 115664