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In the Estate of: Estate No./Docket No.21-2012-0276
Mary Morrison 5/16/12
CLAIM AGAINST DECEDENT'S ESTATE
The claimant certifies that there is due and owing by the decedent in accordance with the
attached statement of account or other basis for the claim, the sum of $ 20,609.55. I
solemnly affirm under the penalties of perjury that the contents of the foregoing claim
are true to the best of my knowledge, information and belief.
Susquehanna Bank
Name of Claimant
Beverly Quigley, Collector II
PO Box 639
Maugansville, MD 21767
1-888-722-7270~x 27228
Telephone Flumber
CERTIFICATE OF SERVICE
I herby certify that on this 16`h Day of May
I delivered / _X_ mailed, first class postage prep a copy of the f eg<
to the Personal Representative- Theresa Brady 22912 ~en,,I,?riv~¢'IjeA
Instructions:
1. This form may be filed with the Register of Wills upon payment of the filing fee provided
by law. A copy must also be sent to the personal representative by t}le claimant.
2. If a claim is not yet due, indicate the date when it will become due. l:f a claim is contingent,
indicate the nature of the contingency. If a claim is secured, describe the security.
RW 1128
2008
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