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HomeMy WebLinkAbout05-19-08 NOTICE OF STATEMENT OF CLAIM BY CREDITOR BEFORE THE REGISTER OF WILLS, COUNTY OF Cumberland ORPHANS COURT , PENNSYLVANIA IN RE: ESTATE OF Avron Bailyson DECEASED FILE NO. 21070731 STATEMENT OF CLAIM The undersigned hereby presents for filing against the above estate this statement of claim and alleges: 1. The basis for the claim is to collect debt 2. The name and address of the claimant are: PharMerica Corporation, 3625 Queen Palm Drive, Tampa, FL 33619 3. The amount of the claim is: $283.79 which is now due for prescription expenses. 4. The claim is not contingent or unliquidated. 5. The claim is not secured. 6. All legal offsets, payments and credits have been applied Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of my knowledge and behalf. Signed on this L day of ( () C;o ':"", :.D .-D i::rO , ~l~; tB ::_F) ;< C) C) C)-'l-j c--= ::D .0--1 ::>c" Imant Jennifer AlienI Senior Collection Associate FOR PHARMERICA CORPORIATION COPY TO: r...::. = = c:::o :::J:: ):J>o -< \.0 -0 :x. N .. Clerk, Orphans' Court CD ~pporting documentation attached. ]Supporting documentation NOT attached. ~ M )I( W- I-'- v.o -l ...., -c Q lie to~, ..... ... IV -I 0:::;:0 -r. H ::E: c:::o lie W. ~.... ....... ....... ...... ::I> 1-1 ""'1:1 :::t: I 1"'1 Q 0:;::, Q Q -I r- f"\"'l :o:l II '" -..t -..t ...... ...... 1"'1 r- ""CI I r- ....... ....... ...... ...... :z 1"'1 r- c:.. 1"'1 0:::;:0 I"I"l Q Q Q ~I 1"'1 Q ::1:)0 w Q") -C CO CO CO :::t: ...... :::t: Q 1"'1 ""CI "'" -I :E> ::t: :J:> c:::o "... 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Q Q 0-. ~~ (,'1 C Ul 00 o ::z ::z Q'") on ::z ::z -l % -i ::z o:n on :I> CI :I> Q'") O<.-lQ r-Mr- ,., ..... -1 v.. -1 '"l:l ::o::l ::D ERICA ~II~ ,llli May 9, ,2008 Cumberland County Orphans Court Probate Division 1 Courthouse Square 1 st floor Carlisle, PA 17013 o c~o <~:o )-0 iIO , ); :;; -:-n < ."} =,;c- .;. /',," Re: 21070731 Avrom Bailynson Qo ~.,d " :ss [J --j ~. Ref No. Deceased: Dear Orphans' Court: Please find enclosed Statement of Claim regarding the estate above. We greatly appreciate if you will provide us a stamped copy of the claim using the copy attached. A self-addressed stamped envelope has been provided for your convenience. Thanking you in advance for your assistance. re~Jr ~ J ifer J. Allen Senior Collections Associate PharMerica 3625 Queen Palm Drive Tampa, FL 33619 5713-03633 1-877-975-2273 XT 6486 p....,;, c= = = ::x > -< \.0 -0 :Jl': ~ Q)