HomeMy WebLinkAbout07-11-14 STATE OF PA STATEMENT AND PROOF OF FILE NO:
PROBATE COURT CLAIM 21-14-0023
CUMBERLAND COUNTY
ESTATE OF DIANE OCONNOR
Cumberland County Register of Wills One Courthouse Square, Room 102
Carlisle, PA 17013
Phillips & Cohen Associates, Ltd., located at 1002 Justison Street, Wilmington, Delaware 19801
on behalf of Carlisle Regional Medical Center submit the following claim against the estate for
the sum set forth.
DESCRIPTION VALUE
Account #: XXXXXXXXXXXX6174
Amount Due: $1,184.00
PCA File#: 19769909
There is now due on the claim, including applicable legal set-offs, the $1,184.00
sum of:
Notice to interested parties: This is a claim for services rendered and/or goods provided. This
claim will be allowed unless notice of an objection by an interested person is delivered or mailed
to the court, personal representative and creditor at below address.
I declare that this claim has been examined by a representative of Phillips & Cohen Associates,
Ltd., and that its contents are true to the best of my information, knowledge and belief.
Authorized Signature
Madeleine Daley
Phillips & Cohen Associates, Ltd. n 3 f
The Creditor's Rights & Bankruptcy Group
A Division of Phillips & Cohen Associates, Ltd.
1002 Justison Street C_%='-3
Wilmington, Delaware 19801
QC
Telephone: (866) 342-4270 =; S�
PROOF OF SERVICE OF CLAIM
I served upon the Estate of DIANE OCONNOR, a copy of this claim on 06/26/2014 via United
States Postal Service to:
Athony L DeLuca Esq.
P.O. Box 358 _
Boiling Springs, PA 17007
I served upon the Estate of DIANE OCONNOR, a copy of this claim on 06/26/2014 via United
States Postal Service to:
Cumberland County Register of Wills
One Courthouse Square, Room 102
Carlisle, PA 17013
It is declared that this claim has been examined by a representative of Phillips & Cohen
Associates, Ltd. and that its contents are true to the best of our information, knowledge, and
belief.
06/26/2014
Date Si ature
Madeleine Daley
ACCEPTANCE OF SERVICE
Service of the attached claim is accepted.
Date Signature
The following account summary is provided:
SUMMARY OF ACCOUNT
1. ACCOUNT NUMBER: XXXXXXXXXXXX6174
2. NAME N WHICH SERVICES WERE PROVIDED: DIANE OCONNOR
3. OPEN DATE: 11/30/2013
4. REGARDING: Carlisle Regional Medical Center
5. FINAL BALANCE: $1,184.00
6. PRIMARY: Medical
NOTICE OF CLAIM
(Filed Pursuant to 20 Pa.C.S. § 3532)
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF DIANE OCONNOR DECEASED
No. 21-14-0023
To the Clerk of the Orphans' Court Division:
Enter the claim of Phillips & Cohen Associates, Ltd. on behalf of Carlisle Regional Medical Cet\h<
(Claimant)
amount of$ 1,184.00 , against the above entitled Estate.
The Decedent, who resided at 700 WALNUT BOTTOM RD CARLISLE, PA 17013
(Street Address)
died on 01/02/2014 Written notice of
(Date ofDeath)
said claim was given to Athony L DeLuca Esq. -- --
(Personal Representative or his/her counsel)
at P.O. Box 358 Boiling Springs PA 17007
on 06/26/2014 (Address)
(Date)
4(Clmt)
1002 Iustison Street
(Street Address)
Wilmington,DE 19801
(City,State,Zip)
(Claimants Counsel) (Supreme Court LD.No.)
(Address)
(Telephone)
Form OC-07 rev.10.13.06
t
,A A
6
aGcp rp
)U). 'ti
tP N
4!
::ul
Wl
f'k
- Ca
'r
Y
a,
��Ga
n� cO in