HomeMy WebLinkAbout12-10-09gc~ ~~,den
November 30, 2009
Register of Wills
Room 102
1 Courthouse Square
Carlisle, PA 17013
To whom it May Concern:
Enclosed please find an itemized statement and a claim form to be used to file a
claim against the estate of Robert Buffington. Mr. Buffington incurred these
charges while a resident in our living center Golden Livingcenter, Camp Hill -
West Shore LP. Enclosed please find a check for the amount of $10.00 for the
courts filing fee.
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 Central Time.
Sincerely,
Rita Donnelly ~
Health Care Collections _
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Golden Living Center
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P.O. Box 180970 -~
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CC: Client's File #94660
P.O. Box 180970
Fort Smith, AR 72918
;~~~' Phone: 479-201-2000
www. goldenliving, com
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Claim Against Decedent's Estate
ESTATE OF: Robert Buffington
Case# 21-2009-0866
The undersigned hereby presents for filing against the above estate this statement of claim
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eges:
Golden Living /Camp Hill -West Shore LP
PO BOX 180970
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Fort Smith, AR. 72918-0970 a
The basis of claim is: SEE ATTACHED: ~ ~ ~ "- ` ~'
The amount of the claim is $ 1972
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Under penalties of perjury, I declare that I have read the foregoing, and the facts ~ ~~
est of my knowledge and belief
alleged are true to
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Signed ON: November 30, 2009
Glen Tankersley, Collections Manag ~''
I SWEAR THIS STATEMENT IS CORRECT
Subscribed and sworn to before me u~,1
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On ~b d 0 =* ~~ "~ M1'04Ap NSSI~OIVN~LI'Y
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Sebastl~ ~~~,
Notary Public
My Commission Expires ~~ ~ p~
P.O. Box 180970
Fort Smith, AR 72918
Phone: 479-201-2000
www.goldenliving.com
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Golden Living Center
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P.O. Box 180970
w ~ . ~ . Fort Smith, AR 72918
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11/~ ~~ Itemi
zed Resident Statement