HomeMy WebLinkAbout08-20-07
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
INRE:
ESTATE OF ROBERT WECH
) ORPHANS' COURT DIVISION
) No. 2107-0716
PROOF OF CLAIM
To the Clerk of Orphans' Court Division:
1. Index and make proper entry in your official records of the claim of Shipp ens burg Health Care
Center c/o Capozzi & Associates, P.c., Attn: Andrew R. Eisemann, Esq., 2933 North Front Street,
Harrisburg, P A 17110 as a nursing facility against the Estate of the above-named Decedent in the amount of
$9,902.25, plus interest.
2. At least part of this claim should be paid as a priority claim under 20 Pa.C.S.A. 93392(3)
(Classification and Order of Payment) for Decedent's last three months of costs of medical and nursing services.
The Decedent resided at Shippensburg Health Care Center, 121 Walnut Bottom Road, Shippensburg, PA
17257-9005 and died on June 9,2007. An Invoice is attached hereto as Exhibit A.
3. Claimant delivered notice of this Claim by first-class mail on August 16,2007 to Patricia Wech,
Decedent's sister, at 714 Range End Road, Dillsburg, P A 17019 and to the attorney for the Estate, Peter Russo,
3800 Market Street, Camp Hill, P A 17011.
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Claimant's Address:
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Shippensburg Health Care Center
c/o Capozzi and Associates, P.C.
2933 N. Front Street
Harrisburg, P A 17110
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Respectfully submitted,
Dated: trJr-!o7
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Attorney ill 211
2933 North Front Street
Harrisburg, P A 17110
(717) 233-4101
Attorney for Claimant
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STATEMENT
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SHIPPENSBURG HEALTH CARE CTR
(--' 121 WALNUT BOnOM RD
SHIPPENSBURG, PA 17257
Facility Phone: 717-530-8300
Resident: ROBERT WECH
Statement Date: 03/29/07
ROBERT WECH
20 CIRCLE DRIVE
l MECHANICSBURG, PA 17011
Date Service Through Qty Description Amount
Charaes
03/01/07 01/24/07 01/31/07 8 Room Charges 1,520.00
03/01/07 02/01/07 02/28/07 28 Room Charges 5,320.00
03/16/07 03/01/07 03/16/07 16 Room Charges 3,040.00
Sub Total 9,880.00
Bala nce 9,880.00
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'Ancillarv/Other Charaes
03/01/07 02/19/07 02/19/07 1 Barber & Beauty 8.25
02120/07 02/20/07 02/20/07 1 CABLE 7.00
03/16/07 03/16/07 03/16/07 1 CABLE 7.00
Sub Total 22.25
Balance as of: 03/29/07 9,902.25
Total Amount Due 9,902.25
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EXHIBIT
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A
1
Page
CERTIFICATE OF SERVICE
I do hereby certify that on this 16th day of August, 2007, I caused a true and correct copy
of the foregoing Proof of Claim to be served via first class mail, postage prepaid, addressed as
follows:
Patricia Wech
714 Range End Road
Dillsburg, P A 17109
Peter Russo, Esquire
3800 Market Street
Camp Hill, PA 17011
CAPOZZI AND ASSOCIATES, P.C.
By:
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Attorney I 7 1
2933 North Front Street
Harrisburg, P A 17110
(717) 233-4101
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Attorney for Claimant