HomeMy WebLinkAbout10-01-12NOTICE OF CLAIM
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF MARLIN W. KEMPER, DECEASED
No. 21-11-646
To the Clerk of the Orphans' Court Division:
Kindly enter the claim of Claremont Nursing and Rehabilitation Center in the amount of
$14,395.70 against the above-captioned Estate. This claim is a priority claim under 20 Pa.C.S.A.
§3392(3) for the value of nursing facility services within six months of the date of death. The
Decedent, who resided at 1932 Kent Drive, Camp Hill, PA 17011, died on April 29, 2011.
Written notice of said claim was given to Julie M. Kemper, Executrix for the estate of Marlin W.
Kemper, 46 Argali Lane, Mechanicsburg, PA 17055 on September 28, 2012.
Claimant: Claremont Nursing and Rehabilitation Center
1000 Claremont Rd.
Carlisle, PA 17013
Respectfully Submitted,
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Latsha Davis & McKenna, P.C.
Steven M. Montresor
Attorney No. 74244
1700 Bent Creek Boulevard, Suite 140
Mechanicsburg, PA 17050
Phone: (717) 620-2424
Fax: (717) 620-2444
smontresor@ldylaw.com
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ExxisiT A
July Charge Pmt
August 2010 9 Medicare A stay
September 2010 31 Medicare A stay
October 2010 30 Medicare A stay
October 2010 30 Medicare A stay
November 2010 1 250 250.00
December 2010 30 7500 7,500.00
January 2010 31 7750 1,259.30
February 2011 31 7905 -
March 2011 28 MA Pending
April 2011 31 MA Pending
2011 29 MA Pending
Due
- $250/day
- $250/day
6,490.70 $250/day
7,905.00 $255/day
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF MARLIN W. KEMPER, DECEASED
No. 21-11-646
CERTIFICATE OF SERVICE
The undersigned hereby certifies that on this date a true and correct copy of the foregoing
Notice of Claim was served via Certified Mail, Return Receipt Requested and First-Class United
States mail, postage prepaid, upon the following:
Julie M. Kemper
46 Argali Lane
Mechanicsburg, PA 17055
Dated: (~dr{" - ~v~°2
Steven M. Montresor
175909v1