HomeMy WebLinkAbout09-25-13 IN RE: ESTATE OF JANE L. LEVAN : IN THE COURT OF COMMON PLEAS
Late of the Borough of Carlisle,County of s OF CUMBERLAND COUNTY, PA
Cumberland and Commonwealth of Pennsylvania, : ORPHANS' COURT DIVISION
deceased NO: R/ /0! 0 -3 Q
AFFIDAVIT OF SERVICE j j j
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF NORTHUMBERLAND
WILLIAM R. SWINEHART, ESQUIRE, being duly swom according to law, deposes and
says that he served a true and correct copy of NOTICE OF FILING ACCOUNT, by placing the
same in the United States Mail, return receipt requested, postage pre-paid, at Sunbury,
Pennsylvania, on September 9, 2013 and was received by the Department of Public Welfare on
September 11, 2013, addressed as follows:
Department of Public Welfare
Bureau of Program Integrity
Division of Third Party Liability
Recovery Section
P.O. Box 8486
Harrisburg, PA 17105-8486
A true and correct copy of the return receipt card is attached hereto as Exhibit "A".
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William R. Swinchart, Esquires =o t, °
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Sworn to and subscribed o_n ' Y
before me this 12th <:> X
day of September; 2013. yam, rn a
COMMONWEALTH OF PENNSYLVANIA
t _ Notarial Seal
Debra A.Moyer, Notary Public
Notary Public dty of Sunbury, Northumberland County
My Commission Expires APr6 2-0, 2017
MEMSM PENMLVAMA ASSO UQH of RUIME$
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lta ilriONIMET7 1' i I
.Y�O DELIVERY
■ Complete items t,2,and 3.Also complete A. signature
item 4 if Restricted Delivery is desired. M Agent
Print your name and address on the reverse X Addressee
so that we can return the cad to you, g, t Date of oelNa y
R attach this card to the back of the mallplOce, D�$ 12 Z df ti
or on the front If space permits.
D. IS delkeryaddresdffferent immitem t4 ❑Yes
t. Article AddYes+>ed to: If YES,enter delivery address below: 0 No
Department of Public Welfare
Bureau of Program Integrity
Division of Third Party Liability
Recovery Section
P.O. Box 8486 3. service type
Harrisburg, PA 17105-8486 C3 ed Mall E3 F"PISS Mell
Registered 0 Return Receipt for Merchandise
.. _.. insured Mall 0 C.0.0,
4. ResMeted Delivery?95drs Fes) 0 Yes
2. (rMsW om ?009 2820 0000 8100 7248
{Tiansterttom eeMCel
JPS Form 361'1,February;2004, DomesebReturnReceipt � 7o25ssaz•rn•tsaol
Exhibit "A "
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