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HomeMy WebLinkAbout08-22-11NOTICE OF CLAIM (Filed Pursuant to 20 Pa.C.S. § 3532) / COURT OF COMMON PLEAS OF ( -1~/j? ~~a~ COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF /~ I~l~~ J No. a l `~/ 0 -©$30 To the Clerk of the Orphans' Court Division: _~ Enter the claim of ~ 1 ~_ ~ , J IaimantJ amount of $_ ~ ~ s~, ~ ~ ,against the above entitled Estate. The Decedent, who resided. at said claim was given to at Ur1-G i in the ~A-- ~ ~o (Street Address) died on _ (1~% /l -l0 .Written notice of (Date of Death) su ©~,~c~ a~-~n~, m ~'Cha~I ~nsrs (Personal Representapve or his/her counsel) On --= ~ 1i ~ P I S M ZQ ~ O (Address (Date) DECEASED (ClannantJ - ~ ~'~ 10 ~~~~e.,1~ (Street Address) (/ ~Pl cyi~ Q I'~- l `~Qo2~' (City, State, Zip) (Claimant's Counsel) (Address) (Supreme CourtLD. No.) ~~ ~ ..._ ~.`r (Telephone) _ ~ -~ C` i ~- ~,, ` ~_ i _J~ ,... _ `. __. .' Forrn OC-07 rev. 10.13.06 - ~ "~ ~; C.: 'T? /. ~~ r_