HomeMy WebLinkAbout10-08-10gc ~I,den
Claim Against Decedent's Estate
ESTATE OF: Hilda Shotsberger Case# 21-10-0559
The undersigned hereby presents for tiling against the above estate this statement of claim and alleges:
Golden Livingcenter- WEST SHORE PITTSBURGH LLC
PO BOX 180970
Fort Smith, AR. 72918-0970
The basis of claim is: SEE ATTACHED:
The amount of the claim Is 34753.54
NOTE- If there is insurance pending on this account and the insurance fails to pay then amount will
become due privately
Under penalties of perjury, I declare that I have read the foregoing, and the face alleged are true to the
best of my knowledge and belief.
Signed ON: September 29, 2010
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n Tankersley, ollections Manage
I SWEAR THIS STATEMENT IS CORRECT
Subscribed and sworn to before me
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Notary Publ'
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P.o. Box 180970
Fort Smith, AR 72918
Phone: 479-201-2000
Toll-Free: 877-823 -8375
wvwv.goldenlnring.com
gc>Iden
Irving
September 29, 2010
Register of Wills
1 Courthouse Square
Room 102
Carlisle, PA 17013
To whom it May Concern:
Enclosed please find a claim form to be used to file a claim against the estate of
Hilda Shotsberger. Mrs. Shotsberger incurred these charges while a resident in
our living center Golden Living center WEST SHORE PITTSBURGH LLC.
Enclosed please find a check for the amount of $10.00 for the courts filing fees.
If you should need additional information or have questions regarding this please
feel free to contact me at 877-823-8375 ext 2271 Monday thru Friday from 8:00
to 4:00 Central Time.
Sincerely,
Andrew Galvan
Health Care Collections
Golden Living Center
P.O. Box 180970
Ft. Smith, AR 72918 ~o c ~~';
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CC: Client's File # 99004 J
P.o. Box 7sos7o
Fort Smith, AR 72918
Phone: 479-207-2000
Toll-Free: 877-823-8375
www.goldenliving.com
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