HomeMy WebLinkAbout09-09-13 D
Capital BlueCross
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Cumberland County Courthouse " c `"' 17" ro
Register of Wills v
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1 Courthouse Sq., 1st Floor
Carlisle, PA 17013-3387
Re: Estate of Steven R. Smith
Estate No.: 21-13-0807
Dear Sir or Madam:
In accordance with my telephone conversation with your offices, this letter serves as a
formal claim against the Estate of Steven R. Smith in the amount of$380.00 plus interests and
costs. Please time-stamp the copy of this letter and return it to me in the enclosed, self-addressed
stamped envelope. Enclosed please find our check in the amount of$10.00, representing the fee
to file this claim. By copy of this letter we are notifying the executors and attorney for the Estate
of this claim.
7331. If you have any questions or concerns, please do not hesitate to contact me at(717) 541-
Very truly yours,
Ki berly A. Meals
Senior Paralegal
/mtf
cc: Michael R. Smith, Sr., Executor
Michael L. Bangs, Esquire
Brenda Woods, Collections Specialist
Health care benefit programs issued or administered by Capital BlueCross and/or its subsidiaries. Capital Advantage Insurance Company®, Capital Advantage Assurance
Company®and Keystone Health Plan®Central. Independent licensees of the BlueCross BlueShield Association.Communications issued by Capital BlueCross in its capacity
as administrator of programs and provider relations for all companies.
0-60(7/2012) H a r r i s b u rg , PA 17177 • www . capbIuecross . com
RECEIPT FOR PAYMENT
GLENDA FARNER STRASBAUGH Receipt Date : 9/09/2013
Cumberland County - Register Of Wills Receipt Time : 15 : 57 : 39
One Courthouse Sguare Receipt No. : 1075503
Carlisle, PA 17613
SMITH STEVEN R
Estate File No. : 2013-00807
Paid By Remarks : CAPITAL BLUE CROSS
HMW
---------- Receipt Distribution --------- --------- ------
Fee/Tax Description Payment Amount Payee Name
CLAIM AGAINST EST 10 . 00 CUMBERLAND COUNTY GENERAL FUN
Check# 180939 $10 . 00
Total Received. . . . . . . . . $10 . 00