HomeMy WebLinkAbout09-29-08c
In the estate of:
EUGENE ROZENBURGH
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Date: 9/18/08
Estate No: 21-08-0559
Date of Death: ~1 i ~ ~ ~ s
CLAIM AGAINST DECEDENT'S ESTATE
The Claimant certifies that there is due and owing by the EUGENE ROZENBURGH
deceased,
in accordance with. the attached statement of account the sum of $ 2 0 7.6 3
together with interest at the rate of from
until paid.
On behalf of the claimant I do solemnly declare and affirm under the penalties
of perjury that the information and representations made herein are true and correct
of the best of my knowledge, information and belief.
CHASE BANK USA, N.A.
Name of Claimant
Re: Kohl's Dept. Store
Address of Claimant
Mark E. Bennett, Agent
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Signature of Claimant or p~ `-~'
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authorized to make verificatigri;~ ~ _:
on behalf of creditor ~- ` ; ; ~?
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9441 LBJ Freeway ~" f;
Lock Box 30
Dallas, TX 75243
Address
972-644-6360
Phone Number
FILED:
Phone Number
THIS FORM MAY BE FILED WITH THE ORPHANS COURT UPON PAYMENT OF A
FILING FEE OF $10.00. A COPY MUST ALSO BE SENT TO THE PERSONAL
REPRESENTATIVE.
J-~
PROBATE COURT
Cumberland County, State of Pennsylvania
Eugene Rozenburgh, Deceased
Case #21-08-0559
Proof of Mailinct
I mailed the creditors claim to the fiduciary (and attorney, if applicable) as
follows:
I deposited. a copy/copies of the claim witYi the United States Postal Service in
a sealed envelope with the postage fully pre-paid. I used first-class mail. I
am employed in the county where the mailing occurred. The envelope(s) was/were
addressed and mailed as follows:
Mrs. Lillian Rozenburgh
c/o Keene Jabbour, Esq.
701 Washington St.
Easton, PA 18042
Date of Mailing: ~ z.~Q~
County of Mailing: Dallas, Texas
I declare under penalty of perjury that the foregoing is true and correct.
Date: ~~~ D~'
Mark E. Bennett, Agent for
Kohl's/Chase Bank USA,N.A.
P.O. Box 741026
Dallas, TX 75374
..
SC8820/1 06/27/2008 ROHL'S ACCOUNT STATUS DISPLAY 06/27/2008 12:46 ID: PAS2
Acct'": 0446184228 52 Cycle: 22 Bi : 06/22/2008 Due: 07/17/2008 MVC: N VIP: N
St/Lc: 90 601 CBS - DECEASED Op: 04/11/2006 Closed: 06/24/2 008 Ins: N
Namel: EUGENE ROZENBURGH Home: 717 691 - 3501 Pull:
Name2: Busl: - AScr: 433 04/08
f
Addr 635 E PINE STS Srce: I 00000001 Emp: NScr: 786 04/06
R JJJ N C/S Rstr: 33 05/08
MAHANOY CITY PA 179482822 AdChg: 06/12/2008
Instr: PRMENT RECEIVED DC DOD IS 4-16-08
ACTEAS: N Pymnt H: 32NM2NLNM2N---FNF------- Dun H: 321021010210000 100000000
MKC: Y Last Stmnt Curr Stmnt Auths Last Reage:
Prv Bal: 228.46 257.63 Avl Credit: 92.37
Pur/Adv: Disputes
Returns: Last Pymnt: 50.00 03/18/2008
Fee/Int: 29.17 Cr Lmt E 300 06/23/2008
Cr/Dr -50.00 Limit Ext
Pymnts MVC Pur Dbt Cde: N
Cls__Bal: 257.63 ____ __207_63 _ _ T207.63 Issued Cards Cnt Sts Issue date