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HomeMy WebLinkAbout05-24-10Jt~.a. ~®d Stl ~~ ~:_~ c:~ ~I ~~ - ['.._ C.a ~,LI ~ ~ 'E_ U^' c- ~.~ _ .r ~.... ~-~ (!P C::7 a4 CI~~J N ~'"~ ~ I e ti •. A .. ~ ~Z ~ ~ N ~ O !~ e-1 O .-C O ~ ~ ~ V a M M M ^~ ~ ~ O '"U ~~ e-1 ~ ~ ~ c~ ~ ~ ~ C~ N ~ V v ~ V ~ ~ O V 0 r '^- i w. ~y .. M M O~ N Louis J. Capozzi, Jr., Esquire* Daniel K. Natirboff, Esquire Donald R. Reavey, Esquire Cram I. Adler, Esquire** Bruce G. Baron, Esquire Andrew R. Eisemann, Esquire Michael M. Jerominski, Esquire Dawn L. Richards, Esquire Timothy Ziegler, Reimb. Analyst Karen L. Fisher, Paralegal Keyoung J. Gill, Paralegal * (Licensed in PA, NJ and MD) ** (Licensed in PA and NJ) ~, ' ~~ ~~~s ~ x >s§, May 21, 2010 Register of Wills Cumberland County Courthouse One Courthouse Street, Room 102 Carlisle, PA 17013-3387 Re: Estate of Pearl E. Juliana Orphans' Court No.: 2010-00290 Our Matter No.: 1787-09 Dear Mr. Jacobs: i~ 2933 North Front Street Harrisburg, PA 17110 Telephone: (717) 233-4101 Facsimile: (717) 233-4103 www. capozziassoci ates. com Mid-Penn Abstract Company Charter Settlement Company Telephone: (717) 234-3289 Facsimile: (717) 234-1670 Enclosed for filing with your office please find an original and one copy of a Proof of Claim with regard to the above-referenced matter. Also enclosed is a check in the amount of $10.00 representing the filing fee. Please return the extra time-stamped copy back to me in the enclosed self-addressed, stamped envelope so that I may have a copy for our file. Thank you in advance for your assistance. Please call me if there are any questions concerning this filing. Yours truly, ~~ Keyoung Gill Enclosures cc: Carolyn Burke (w/encl.) n -~ .., .. ~ .' -~ r r j _ ~J ,,,. ~.- ~ ~~ ~ -- i Ca IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: ESTATE OF PEARL E. JULIANA To the Clerk of Orphans' Court Division: ORPHANS' COURT DIVISION No. 2010-00290 PROOF OF CLAIM 1. Index and make proper entry in your official records of the claim of The Jewish Home of Greater Harrisburg, Inc., c/o Capozzi & Associates, P.C., Attn: Andrew R. Eisemann, Esquire, 2933 North Front Street, Harrisburg, PA 17110 as a nursing facility against the Estate of the above-named Decedent in the amount of $49,392.89. 2. This entire claim should be paid as a priority claim under 20 Pa.C.S.A. §3392(3) (Classification and Order of Payment) for Decedent's last six months of costs of medical and nursing services. The Decedent was admitted to The Jewish Home of Greater Hamsburg, 4000-4004 Linglestown Road, Harrisburg, PA 17112 on May 28, 2009 and died on October 2, 2009. An Invoice is attached hereto as Exhibit A. to: 3. Claimant delivered notice of this Claim by first-class mail and certified mail on May 21, 2010, Patricia Smith, Executrix Emily Hoffman, Esquire ~ 8131 Somerset Street 105 N. Front Street ~ ~ c:~ _ Q Hummelstown PA 17036 P. O. Box 11475 ~-~ ~ n ~ ~: ~,i --`~ _I Harrisburg, PA 17108-1475 ~~' ~ rn v r- =: =-,_= Claimant's Address: The Jewish Home of Greater Harrisburg, Inca--~, ~;; `-~ ~ ~ `~ c/o Capozzi & Associates, P.C. -} © .: ~~ Attn: Michael M. Jerominski, Esquire ~ ~ ~ `.-:j ` , , 2933 North Front Street _ _ ~=` ~-~ Harrisburg, PA 17110 Date: May 21, 2010 emann, Esquire Attorney .: 87441 Capozzi & fates, P.C. 2933 North Front Street Harrisburg, PA 17110 (717) 233-4101 Attorney for Claimant Jewish Home of Greater Harrisburg 4000 Linglestown Rd Harrisburg, PA 17112 (717) fi57-0700 STATEMENT Resident: Juliana, Pearl (1204) Location: - Statement Date: 12/1/2009 ALL TRANSACTIONS PROCESSED AFTER Nov 30, 2009 WILL APPEAR ON YOUR NEXT STATEMENT Patricia Smith 8131 Somerset Street Humrneistown, PA 1703fi PLEASE DETACH AND RETURN WITH YOUR PAYMENT Amount Due $49,392.89 Amount Enclosed $ Jewish Home of Greater Harrisburg 4000 Linglestown Rd Harrisburg, PA 17112 1717) fi57-0700 ffect ve Date Description BALANCE FORWARD 8/29/2009 Pharmacy 1111!2008 delete security deposit BALANCE DUE Units Unit Amount 1 $1.95 Amount $5fi,385.94 X1.95 549, 392.89 Resident: Juliana, Pearl (1204} Location: - Statement Date: 12!112009 PAYMENT DUE UPON RECEIPT 1F YOU HAVE ANY QUESTIONS REGARDING YOUR BILL CALL MINNIE AT (717)657-0700 EXT. 8405 Exhibit A