HomeMy WebLinkAbout08-29-13 ,
NOTICE OF CLAIM � s �- ;,;
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(Filed Pursuant to 20 Pa.C.S. § 3532) � --
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COURT OF COMMON PLEAS OF �" �" � � ' '
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Cumberland `' ` ` ��
COUNTY, PENNSYLVA�IA
ORPHANS' COURT DIVISION �� r- ' '-"' � '
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ESTATE OF Rena Burk , DECEASED
No. 21-2013-799
To the Clerk of the Orphans' Court Division:
Enter the claim of Country Meadows Associates d/b/a Country Meadows of West Shore in the
(c[atmanr)
amount of$ 45,647.62 , against the above entitled Estate.
The Decedent, who resided at 4837 East Trindle Rd, Mechanicsburg, PA 17050-3680
(Street Address)
, died on June 1, 2013 . Written notice of
(Date ofDeath)
sa�d claim was given to Craig A. Diehl, Esq.
(Personal Representative or his/her counsel)
at 3464 Trindle Rd Camp Hill, PA 17011-4436
(Address)
on June 10, 2013
(Dare)
Vincent J. Mizak, Sr VP Fin,Acctg, Info Srv �
(Claimant)
830 Cherry Drive
(Street Address)
Hershey, PA 17033-2007
G. Michael Leader, III 23915 �cr�,srare,z�p�
(ClaimanYs Counsel) (Supreme Court LD.No.)
G.M. Leader Family Corp
(Address) Via First Class Certified US Mail
830 Cherry Drive, Hershey, PA 17033-2007 Return Receipt Nbr:7010 0290 0000 9177 8410
717-533-2474 Ext. 10126
(Telephone) �
Form OC-07 rev. 10.13.06
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COUNTRY MEADOWS
R E T I R E M E N T C O M M U N I T I E S
June 10.3013
Via First Class Reqular US Mail and Certified Mail#7012 2210 0002 3478 4052
Crai�A. Diehl, Esq.
3464 "rrindle Rd
Camp Hill, PA 1701 I-4�36
Re: Rena Burl:
Dear Atty. Diehl:
First and foremost, please accept my belated condolences on the death of Ms. Burk. We appreciated and valued
havin�Rena as a resident in our Mechanicsbur�facility since her November 201 1 move in.
I ��ould also ask for your understandinQ of our need to comply with existing laws and regulations govemin�the
required verbiage for filing a claim���ith an cstate for monies due. The verbia�e that follows is that�vhich is
required.
This letter serves as notiee uiider 20 Pa. GS.A.�3384 of Cotuttr}�Nlendox�s Associntes's daim agninst tlre Estnle of Rem�
Burk in dre nmount of$4i,647.62 plus acerui�te inlerest at tlre higl�esl rale permissible«t law,anv nccrui�rn lale jees for
„oods an�l serrices ca:su�ned b��h9s. Burk during her stni'nt Conn/rl',M1lenrtox�s of{b'est Shore,nnd cnsts of co!lection.
1 have included a summary of services provided that comprises the current amount due. If y�ou have already made
pa��ment, please disregard this letter. If you are makinQ a payinent, please make the check payable to Country
Meado�vs Associates and use the enclosed self-addressed, postage paid envelope. If y�ou have an}� questions or desire
additional infonnation,please contact me at 717.533.2474, extension 10217 or e-mail at
viT�izak@countrymeadows.com.Thank you in advance for your attention to this matter.
Si ce ely.
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Vinc nt . izal:
Senior VP-Finance, ccountin�and Info Services
CC: Via ReQular Mail.
Fnclosures �
Country Meadows Home Office PHONE: 717.533.2474 � FAX; 717.533.6202
830 Cherry Drive � Hershey, PA 17033 www.countrymeadows.com
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COUNTRY MEADOWS
R E T I R E M E N T C O M M U N I T I E S
Country Meadows of West Shore IV
Rena Burk's Open Account Analysis
June 10, 2013
Services Date Billed Amount Due
Room and Board June 2012 through May 8,2013 $ 42,627.76
Supplemental Nutrients May 2013 22.85
Beautician June 2012 through May 2013 514.50
Misc.-Meals Out 2012:Aug,Oct, Nov/2013:Jan,Mar,Apr 78.58
Misc.-Late Charge June 2012 through May 2013 2,419.93
Less: Meals Credit May 7 and May 8,2013 (16.00)
Grand Total Due $ 45,647.62
1 declare and a�rm that fhe information and representations made in the above claim
and the account are true and correct according to my know/edge,information and belief.
k�l� �0 �U l�►
Vince . " ak
Senior VP-Finance Acco nting and Information Services Date
Country Meadows Home Office PHONE: 717.533.2474 I FAX: 717.533.6202
830 Cherry Drive � Hershey, PA 17033 www.countrymeadows.com
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■ Complete items 1,2,and 3.Also complete A. i ature i
item 4 if Restricted Delivery is desired. Agent !
■ Print your name and address on the reverse � ❑Addressee
so that we can return the Card to you. Recei d by(Printed NameJ C. Date of Delive
■ Attach this card to the back of the mailpiece, �' ;
or on the front it space permits. G (�"' ;
1. Article Addressed to: D. is delivery address different from item 1? I Yes
If YES,enter delivery address below: ❑No
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Craig A. Diehl, Esq.
3464 Trindle Rd
Camp Hiil, PA 17011-4436
3. Service Type
�I Certified Mail ❑Express Mail '
❑Regis�fered 6�Retum Receipt for Merchandise �
❑Insured Mail ❑C.O.D. ;
4. Restricted Delivery?{Extra Fee) ❑Yes �
2. ArticleNumber 7012 221� aoo2 3478 4�52 #
(Transfer from service label) �
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PS Form 3811,February 2004 Domestic Return Receipt 1o2bs5-o2-M-15ao�
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� Postage $
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� Retum Receipt Fee P Heme rk
� SEndorsement Required)
� Restricted Delivery Fee
(Endorsement Required)
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� Total Postage 8�Fees �
f11
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Sent To
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O or PO Box No.
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