HomeMy WebLinkAbout09-13-13 i
IN RE: ESTATE OF JANE L. LEVAN : IN THE COURT OF COMMON PLEAS
Late of the Borough of Carlisle,County of : OF CUMBERLAND CtJUNTY, PA
Cumberland and Cammonwealth ofPennsylvania, : ORPF{ANS' COURT DTVISION
deceased : NO: �7�_��/�C,�
AFFIDAVIT O�SERVICE
COMMONWEALTH dF PENNSYLVANIA .
. SS.
COUN7"Y OF NORTHLJMBERLAND .
WILLIAM R. SWINEHART, ESQUIRE, being duly sworn according to law, deposes and
says that he served a krue and conect capy of N(7TICE C7F FILING ACCC>tJNT, by placing the
same in #he United States Mail, return receipt requested, postage pre-paid, ai Sunbury,
Pennsylvania, an Septernber 9, 2013 and was received by the Department c�f Public Welfare on
September I l, 2413, addressed as foliows:
Department of Public Welfare
Bureau of Program Integrity
Division of Third Party Liability
Recovery Section
P.O. Box 8486
Harrisburg, PA 17105-8486
A Yrue and correct copy of the return receipt oazd is attached hereto as Exhibit"A".
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William R. Swinehart, Esc�uire
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Sworn to and subscribed r" _`� '
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before me this 12'h s�' -r_- ` _-
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day of Scptember, 2013. _ - -� �
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Notary Public J✓� y
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7. nrt�e a�ctr�ed eo: a. ro a�«yedc�s�s anror«n nom roem y� ❑re�
n r6s,erRer aelWay etldeas below: O Mo
I}epartment af Public Weifare
Bureau of Program Integrity
Division of Third Party Liability
Recovery Section
P.O.Box 8486 3. serv�ce rype
Harrisburg, PA 17105-84$6 ����� p�B°'M°'�
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Exhibit "A "