HomeMy WebLinkAbout09-24-13 �
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NOTICE OF CLAIM z '
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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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�(JM b�I�l'�1►� COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF I ' �Ct( I /�1�- �UCJI Sd� _, DECEASED
No. a � -r3 -�� �
To the Clerk of the Orphans' Court Division: �
�C�P/1'�`<02
Enter the claim of�t�f 2�v�7-�CCOJ�+ a/1ctYelne��t Selec:�-lylecPrcal ��in the
(c[ntmanr)
amount of$ a ,D�O�W , against the above entitled Estate.
The Decedent,who resided at J��a m��ketS-F {ap-J- I �'lir,,� {f,l I ��0. /7a� �
(SlreetAddress)
, died on �/3 U�/3 - Written notice of
(Date ofDealH)
said claim was given to m Q���n �n Z�-
(Persona[RepresentaHve or his/he epun elJ
at �DOa-- lY1A r��� Sf- �-f- / �'G �.D � ��l � �-70//
p �j (Address)
Ol] //( ��
(�ate)
(C�ant)
�O�J �USFlrunf ��'-- S u 1� �. Sb�`-
(Strer,!AddressJ
�c:�,..� �1-1 ! ��_ 1701 (
�cay,srae�,z;p� doS
�l7-Z.i�,3
(C[aimanPs CounselJ (Supreme Court l.D.No.)
(Address)
(TelephoneJ
Form OG07 reu !0.l3.06 �
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SSH CAMP HIL� SSH CAMP HILL 476 0013943-01
503 NORTH 21;;T STREET PO BOX 642369 5535 0111
CAMP HILL PA 170112288PITTSBURGH PA 15264
888-868-1103 251885943 032113 043013
1'11305257A 20 NORTH 12TH STREET
COULSON MARTHA M LEMOYNE PA 17043
05231937 F 03211319 3 4 16 20
COULSON MARTHA M
20 NORTH 12TH STREET 37 20039 00080 400
APT 117
LEMOYNE PA 17043
0120 ROOM & BOARD 1390 . 37 40 5561480
0250 PHARMACY GENERAL 1051 $78550
0258 PHARMACY IV SOLUTIONS 491 850900
0270 MED/SUR SUPPLIES GENERAL 2332 l�i19773
0300 LABORATORY GENERAL 102 1:359291
0320 RADIOLOGY DIAGNOSTIC GENE 7 311269
0350 CT SCAN GENERAL 1 353925
0381 BLOOD PACKED RED CELLS 2 L08432
03$6 BLOOD-OTHER COMPONENTS 2 204828
0410 RESPIRATORY SERVICES GENE 1561 9007189
0420 PHYSICAL THERAPY 14 L35331
0430 OCCUPATIONAL THERAPY GENE 12 L19620
0440 SPEECH PATHLOGOY GENERAL 7 L20803
0730 EKG/ECG GENERAL 1 21590
0731 HOLTER MONITOR 40 968000
0921 PERIPHERAL VASCULAR LAB 1 84262
0942 EDUCATION/TRAINING/DIETAR 14 33798
0001 1 1 051213 21'739041
1346248333
HIGHMARK FREEDOM BLUE HMO Y Y 1657
MCR SHADOW NS 392039 Y Y 392039
COULSON MARTHA M 18 FER102107560001 01998215
COULSON MARTHA M 18 171305257A
6382461
518 . 84Y 262 Y 428 . 31Y 482 .42N V46 . 11 253 . 6 Y V55 . 1 560 . 1 Y 599 . 0 N
9 276 . 3 N 453 . 82N 112 . 0 N 512 . 89Y 276 . 0 N 785 . 50N 496 Y 428 . 0 Y 416 . 8 Y
518 . 81 207 207
1790786499 1GC30374
96 . 72 032113 96 . 6 032113 99 . 04 040813 COHEN HOWARD
1790786499 1GC30374
97 . 41 032613 COHEN HOWARD
MCR SHADOW NS B3282EOOOOOX
PO BOX 890122
CAMP HILL PA 17089-0122
POST DATE: 5/12/13 476 0013943 Elec Billed * REPRINT *
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