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STATEMENT OF CLAIlVI
STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND
ESTATE OF: KEVIN COHICK ESTATE#: 165002
This claim is being filed on behalf of The Bureaus Inc., 1717 Central Street, Evanston, IL
60204.
The nature of the claim is for the HSBC/Orchard Bank account number
#5440455027928749. This account was established on June 3, 2005 and said balance has
accrued since that date. The balance due on the account is $1,484.73.
The balance has accrued since the accounts inception and said balance represents
an accumulation of charges as posted to the account number described above.
I declare or affirm that I have read this current and I w or believe its
representations are true and complete.
a Sch li Agent
SIMM Ass fate
800 Pencader ive
Newark, Delaware 19702
STATE OF DELAWARE, New Castle COUNTY,
SUBSCRIBED AND SWORN TO before me this 20th day of December, 2011.
To me known and known to me to be the same person described in and who executed the
foregoing instrument and she duly acknowledged to me that she executed the same.
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Notary Public: Stacy Mozher
Expiration Date: January 24, 2013
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