HomeMy WebLinkAbout07-11-14 STATE OF PA STATEMENT AND PROOF OF FILE NO:
PROBATE COURT CLAIM 21-14-0213
CUMBERLAND COUNTY
ESTATE OF ALICE HEBERLIG
Cumberland Countv Re¢ister 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#: XXXXXXXXXXXX5533,7716,1342
Amount Due: $2,370.67
CA File#: 19769420,19769439,19769939
There is now due on the claim, including applicable legal set-offs, the 52,370.67
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
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Authorized Signature Co
Madeleine Dale K= t- r
Phillips & Cohen Associates,Ltd.
The Creditor's Rights & Bankruptcy Group
A Division of Phillips & Cohen Associates, Ltd. ='
1002 Justison Street
Wilmington, Delaware 19801 °
Telephone: (866) 342-4270
Fee S 10
PROOF OF SERVICE OF CLAIM
I served upon the Estate of ALICE HEBERLIG, a copy of this claim on 06/26/2014 via United
States Postal Service to:
Kelly M Shields
154 Gbnod69A:,ny1 M06 to �S+ - — - - --
Newville, PA 17241
I served upon the Estate of ALICE HEBERLIG, 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 info ation, knowledge, and
belief.
06/26/2014
Date Si ature
Madeleine Daley
ACCEPTANCE OF SERVICE
Service of the attached claim is accepted.
Date Signature
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The following account summary is provided:
SUMMARY OF ACCOUNT
1. ACCOUNT NUMBER: XXXXX`•{}{} XXXX5533,7716,1342
2. NAME IN WHICH SERVICES WERE PROVIDED: ALICE HEBERLIG V
3. OPEN DATE: 11/19/2013
4. REGARDING: Carlisle Regional Medical Center
5. FINAL BALANCE: $2,370.67
6. PRIMARY: Medical
NOTICE OF CLAIM
(Filed Pursuant to 20 Pa.C.S. § 3532)
COURT OF COMMON PLEAS OF
CUMBERLAND
COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF ALICE HEB.ERLIG
No. 21-14-0213 DECEASED
To the Clerk of the Orphans' Court Division:
Enter the claim of Phillips & Cohen Associates, Ltd. on behalf of Carlisle Regional Medical C
amount of$ 2,370.67 (claimant)
g � i�the
, against the above entitled Estate.
The Decedent, who resided at 154 CME NEWVILLE, PA 17241
, died on 01/13/2014 (Street Address)
said claim was iven to Kelly M Shields Written notice of
(Date oJDeath)
at 154 CME7 C'onae�oe� Mpj'tC FS� (Personal Representative or his/her counsel)
ewv111e PA 17241
on 06/26/2014 (A -- -- — - — -_ --
(Date)
(Claima [)
1002 Justison Street
(Street Address)
Wilmington, DE 19801
(Ciry,State,Zip)
(Clnimant's Counsed) (Supreme Court1.D.No)
(Address)
(Telephone)
Form OC-07 rev. 10.13.06
Last Name First Name PCA Account No. Balance Last 4 numbers of account
HEBERLIG ALICE 19769420 $1,184.Cp5533
HEBERLIG ALICE 19769439 $139.22 7716
HEBERLIG ALICE 19769939 $1,047.451342
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