HomeMy WebLinkAbout06-25-10STATE OF Pertniilylvanla
PROBATE COURT STATEMENT AND PROOF OF CLAIM 21-10.0306
Cumbefiallnd CIDUNTY
CIRCUIT COURT - FANNLY DMSION
Estate of Mkhasl D. Noble 831 W Loather St Car11sN PA 17013
I. Fifth Thlyd Bank of E I wbmil the foibwirp dawn against the estate for the sun set rorth.l
Credi6ors name Address
#1861647121 ~ S 19,811.35
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There is now due on the claim, above all legal set-offs, the sum of: ~
I i ia,+s r r.av I
I declare that this claim has been examined by a and that its contents are true to the best of my information, knowledge and belief.
Jana 21, 2010
Attorney Siprmtue ~
MARGARET JONES laimarq Sip
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Name (typo or print) •
1830 E. Paris MD-RSCB3E
Address Addra.s
Grand Rapids, MI 48648 ~I
800.652-2202
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City. state. zip ,
eiephone no. City, state. zip Tsbphons
`1. Describe nature of claim or attach statem t. Attach copy of receipt or other evidence of payment if submitted by assignee. i
Claims must be presented either personally
2 or by mail to the fidudary on or before the last day for presentment of claims.
.
This claim may also be filed with the probate art (see reverse side for proof of service).
PLEASE SEE OTHER SIDE
Do not write below this line - For court use only ~,
AACL 700.3tt04;MSA 27.139M;MICL700.5429; t~SA27.1 rN29.
PC 579 (7100) sTATEMENr Ar'n PROOF OF CW M i MCL 700.7505;MSA 27.17505; ArCR 5.307 O
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PROOF OF SERVICE
AHOY ~~ Romin~r 156 8. Hanover 8t CarNsN, PA 17013
I SeNed Upon EXEC $tNifi I~teibia 3~ 1 tianM saa: ~~a~
Name
tidudary, a cePy of tltis statement and proof of claim on 8J'21N0 by ordlrWtry mail,
Dab State manner and address of senrbe
I declare under penalties of pery'ury that this proof of service has been examined by me and that its contents are true to the
best of my infonnation, knowledge, and belief.
08/21110
Date
ACKNOWLEQt3MENT OF SERVICE
Service of the attached statement and proof of claim is acknowledged.
Date
~igmtiure