HomeMy WebLinkAbout06-24-13 CREDITOR'S CLAIM FORM
ATTORNEY OR CREDITOR WITHOUT ATTORNEY(Name and Address): TELEPHONE NO FOR COURTUSE ONLY
888-7154315 RECORDED OFFICE OF
WELLS FARGO BANK REGISTER OF VflLLS
P.O.BOX 29482
PHOENIX,AZ 85038 1013 JUN 29 Fn 3 95
ATTORNEY FOR(Nann):
CLERK OF
STREETADDRESS: Cumberland Register of Wilts ORPHANS' COURT
MAILING ADDRESS: 1 Courthouse Square
CITY AND ZIP CODE: Carlisle,PA 17013 CUMBERLAND CO,. PA
BRANCH NAME: Probate Division s
NAME:
Beverly J Kauffman
DECEDENT
CREDITOR'S CLAIM CASE NUMBER:
(for administration proceedings filed after June 30, 1988) 21-13-0277
You must file this claim with the court clerk at the court address above before the LATER of(a)four months after the date letters
(authority to act for the estate)were first issued to the personal representative,or(b)thirty days after the Notice of Administration was
given to the creditor, if notice was given as provided in Probate Code section 9051. Mail or deliver a copy of this claim to the personal
representative. A proof of service is on the reverse.
1. Total amount of the claim: $74,667.31
2. Claimant(name): Wells Fargo Bank,PO Box 53476,Phoenix,AZ 85072
a. ❑ an individual.
b, ❑ an individual or entity doing business under the fictitious name of(specify):
c. ❑ a partnership. The person signing has authority to sign on behalf of the partnership.
d, ® a corporation. The person signing has authority to sign on behalf of the corporation.
e. ❑ other(specify): ��� f
3. Address of claimant{specify): •fr t_
Wells Fargo Bank /rte
P.O.BOX 29482
Phoenix,AZ 85038
4. Claimant is ®the creditor ❑a person acting on behalf of creditor(state reason):
5. ❑Claimant is ❑the personal representative ❑the attorney for the personal representative.
(Claims against the estate by the personal representative and the attorney for the personal representative must be
filed within the claim period allowed in Probate Code section 9100. Seethe notice box above.)
6. 1 am authorized to make this claim which is just and due or may become due. All payments on or offsets to the claim
have been credited. Facts supporting the claim are ❑on reverse ®attached.
I declare under penalty of perjury that this creditor's claim is true and correct.
Date: 61,410
Eva Torero,AVPr_Loan Administration\lana.,.ger
(TYPEORPRI TNAMEANOTITE) ISIUNATUREOPCI.AIMAN'IT
INSTRUCTIONS TO CLAIMANT
A. On the reverse,itemize the claim and show the date the service Was rendered or the debt incurred. Describe the item or
service in detail,and indicate the amount claimed for each item. DD not include debts incurred after the date of death,except
funeral claims.
B. If the claim is not due or contingent,or the amount is not yet ascenainahic,state the facts supporting the claim.
C. If the claim is secured by a note or other written instrument,the original or a copy must be attached(state why original is
unavailable). Ir secured by mortgage.deed of trust.or other lien on property that is of record,it is sufficient to describe the
security and refer to the date or volume and page,and county where recorded. (See Probate Code section 9152.)
D. Mail or take this original claim to the court clerk's office for filing. If mailed,use certified mail,with return receipt requested.
E. Mail or deliver a copy to the personal representative. Complete the Proof of Mailing or Personal Delivery on the reverse.
F. The personal representative will notify you when your claim is allowed or rejected.
(Continued on reverse)
NAME: CASF„NUM6ER:
Beveriy.i Kauffman 21-13-0277
DECEDENT
FACTS SUPPORTING THE CREDITOR'S CLAIM
® See attachment(if space is insufficient)
Item and Supporting Facts
Date of Item Amount Claimed
2115113 xxxx-xxxx-xxxx-6151 (DN122937792) S74,66731
TOTAL $74,667.31
PROOF OF ®MAILING PERSONAL DELIVERY TO PERSONAL REPRESENTATIVE
(Be sure to mail or take the original to the court clerk's office for filing}
1. 1 am the creditor or a person acting on behalf of the creditor. At the time of mailing or delivery I was m least 18 years ofage,
2. My msidenee or business address is(specifv):
Wells Fargo Bank
P.O.BOX 29482
Phoenix,A7 85038 `
3. 1 mailed or delivered a copy of this Creditor's Claim to the personal representative as follows(check either a or b below):
a. ®First Class A1ail. )deposited a copy of the claim with the United States Postal Service,in a scaled envelope with postage
fully prepaid. I used first-class mail. I am a resident of or employed in the county where the mailing occurred.
The envelope was addressed and mailed as follows:
(1) Name of personal representative served: Roger Irwin
(2) Address on envelope: C/o Sheri S Heckman
60 w Pomfret ST
Carlisle,PA 17013
(3) Date of mailing: �12(/1stat
�
(4) Place of mailing(city and e): Phoenix,AZ
b, ❑ Personal delivery. I personally delivered a copy of the claim to the personal representative as follows:
(1) Name of personal representative served:
(2) Address where delivered:
(3) Date delivered:
(4) Time delivered:
i declare under enalty of perjury that the foregoing is true and correct.
Date:
�
Eva Norero.AVP,Loan Administration tNansger
(TYPE OR PRINT NAME AND TITLE) (910VATURE OF CLAIMANT)
CREDITOR'S CLAIM
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