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A Tradition of Excellence
DATE: May 8, 2�}3 ,
ESTATE NO.: 9'-1" �� ' 'Z-��
DATE OF DEATH: October 17, 2011
IN THE ESTATE OF Richard B. Miller Sr.
CLAIM AGAINST DECEDENT'S ESTATE
The Claimant certifies that there is due and owing by Richard B. Miller Sr., deceased, the
sum of$ 9,203.32 together plus fees of$ 200.00 and daily interest at the rate of 196532 % per
diem for a total amount owed of $ 9,403.32 as of May 8, 2013. Additionally, there will be
outstanding interest and other possible fees associated with this obligation, after the date of this
letter.
On behalf of the claimant, I do declare and affirm under the penalties of perjury that the
above information and representations made herein are true and correct to the best of my
knowledge, information and belief.
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Orrstown Bank r�i ' �., ::.�' , �.,
2695 Philadelphia Ave. r �' ;=; � �_�Y
Chambersburg, PA 17201 .- . �
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CERTIFICATE OF SERVICE � a �� �����
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I hereby certify that on `� '�
, 2013, I, of , did
serve a copy of the Claim Against Decedent's Estate, by first class U.S. mail, postage prepaid, to
the party listed below, as follows:
Cumberland County Clerk of Courts
1 Courthouse Square
Carlisle, Pa. 17013
2695 Philadelphia Avenue• Chambersburg, PA 17201 �//>
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