HomeMy WebLinkAbout01-23-12IN RE: ESTATE OF
JAMES B WATSON
STATE OF Pennsylvania
IN THE REGISTER OF WILLS
CUMBERLAND COUNTY
CASE#: 21-I 1-1054
STATEMENT OF CLAIM
American Infosource as agent for Health Management
~ ~ ,~~,,,,:,,.,,~ hereby presents for filing against the above
estate this statement of claim in the amount of ~ $1,132.00 _
2. The basis for the claim is account number
ilnknnwn
which was open on
3. The name and address Of the Claimant IS American Infosource as agent for Health Management Associates
P.O. BOX 248894, Oklahoma City, OK 73124
4. This claim IS NOT contingent
5. This claim IS NOT secured
6. The last payment made on the account was $ $39,099.21 on Unknown
~. Please Send payments t0 American Infosource as agent for Health Management Associates
P.O. BOX 248894,
Oklahoma City, OK 73124
1-877-817-2554
Please write the above account number on your check.
Under penalties of perjury, [declare that I have read the foregoing, and the facts alleged are true, to the
best of my knowledge and belief.
Executed this 17 day of .Tanuarv 2012
American Infosource as agent for Health Management Associates
Claimant Name: _ Jon McCleskey
Claimant Signature:
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8589503889
CASE #:21-11-1054
IN RE ESTATE OF: JAMES B WATSON
AFFIDAVIT OF ACCOUNT
The undersigned, being first duly sworn deposes and states the follows:
1. Your Affiant is authorized by the Claimant as its Authorized Representative to make this
Affidavit.
2. Your Affiant has reviewed the account records of the Claimant with respect to the
decedent. Your Affiant is familiar with these records and accounts and reviews them as a
regular part of his/her duties.
3. The Decedent purchased merchandise and/or services in the amount of $ $1,132.00
evidenced by account number.
Further your afiant sayeth not
sy: GAL
One of its Authorized Representatives
Printed Name:
Jon McCleskey
American Infosource as agent for Health Management Associates
P.O. BOX 248894 Oklahoma City, OK 73124
Subscribed and sworn before me 1-877-817-2554
8589503889
American Infosource as agent for Health Management Associates