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NOTICE OF CLAIM
(Filed Pursuant to 20 Pa.C.S. § 3532)
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COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF WILLIAM BAKSA, JR.
No. 21-11-0418
To the Clerk of the Orphans' Court Division:
DECEASED
Enter the claim of Phillips & Cohen Associates, Ltd. on behalf of US Bank National ,Association) in the
(Claimant) N e ~!~ i«.~, , i~c,.~ c~c~ ~~.; v ~ c r~;,
amount of $ 4989.96 ,against the above entitled Estate.
The Decedent, who resided at CAMP HILL, PA 17011
died on 03/07/2011
(Street Address)
Written notice of
(Date of Death)
said claim was given to Jaclyn Baksa
(Personal Representative or his~her counsel)
at _ 978 Katie Circle Royesford PA 19468
on July 15, 2011 (Address)
,~
(Date)
( ~,y
002 Justison Street _
(Street Address)
Wilmington, DE 19802
(city, state, zip)
(Claimant's Counsel) (Supreme Court L D. No.)
(Address)
(Telephone)
Form CaC-07 rev. J0.13.06
STATE OF PA STATEMENT AND PROOF OF FILE NO:
PROBATE COURT CLAIM 21-11-0418
CUMBERLAND COUNTY
ESTATE OF WILLIAM BAKSA JR
Cumberland County Register Of Wills
One Courthouse Square, Room 102
Carlisle. PA 17013
Phillips & Cohen Associates, Ltd., located at 1002 Justison Street, Wilmington, Delaware 19801
on behalf of US Bank National Association ND dba Elan Financial Services submit the
following claim against the estate for the sum set forth.
DESCRIPTION ___ _ VALUE ___
Account #: XXX_XXXXXXXXX9413 __ _
Amount Due: _ _ _ $4,989.96
CA File #: 17945134
There is now due on the claim, including applicable legal set-offs, the $4,989.5-
sum of
Notice to interested parties: This is a claim for services rendered and/or goods provided. This
claim will be allowed unless notice of an objection by an interested person is delivered c-r mailed
to the court, personal representative and creditor at below address.
I declare that this claim has been examined by a representative of Phillips & Cohen Associates,
Ltd., and that its contents are true to the best of my information, knowledge and belief'.
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Author ed Signature
Elizabeth Hansen
Phillips & Cohen Associates, Ltd.
The Creditor's Rights & Bankruptcy Group
A Division of Phillips & Cohen Associates, Ltd.
1002 Justison Street
Wilmington, Delaware 19801
Telephone: (866) 342-4270
Fee $10 SASE-USE SPECIAL FORM, Write Check Ta CUMBERL06
PROOF OF SERVICE OF CLAIM
I served upon the Estate of WILLIAM BAKSA JR, a copy of this claim on 07/15/2011 via
United States Postal Service to:
Jaclyn Baksa
978 Katie Circle
Royesford, PA 19468
I served upon the Estate of WILLIAM BAKSA JR , a copy of this claim on 07/ 15/2011 via
United States Postal Service to:
Cumberland County Register Of Wills
One Courthouse Square, Room 102
Carlisle, PA 17013
It is declared that this claim has been examined by a representative of Phillips & Cohen
Associates, Ltd. and that its contents are true to the best of our information, knowledge, and
belief.
07/ 15/2011 ~ __
Date Sig ure
Eli abeth Hansen
ACCEPTANCE OF SERVICE
Service of the attached claim is accepted.
Date
Signature
The following account summary is provided:
SUMMARY OF ACCOUNT
1. ACCOUNT NUMBER: XXXXXXXXXXXX9413
2. NAME IN WHICH CARD ISSUED: WILLIAM BAKSA JR
3. PRIMARY CARD HOLDER(S): WILLIAM BAKSA JR
4. OPEN DATE: N/A
5. CREDIT LIMIT: $ N/A
6. FINAL BALANCE: $4,989.96
7. PRIMARY USE OF CARD: Purchases
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