HomeMy WebLinkAbout07-11-14 NOTICE OF CLAIM
(Filed Pursuant to 20 Pa.C.S. § 3532)
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF JAMES ERB DECEASED
No. 21-14-0007
To the Clerk of the Orphans' Court Division:
Enter the claim of Phillips & Cohen Associates,Ltd. on behalf of Carlisle Regional Medical C41 the
2,548.72 (Claimant)
amount of$ , against the above entitled Estate.
The Decedent, who resided at 7 LARYMN LANE MT HOLLY SPRG, PA 17065
(Street Address)
died on 12/09/2013 Written notice of
(Date of Death)
said claim was given to Mark F Bayley Esq. & Gary L Erb Jr - -
(Personal Representative or his/her counsel)
at 17 W South St Carlisle PA 17013 & 662 Walnut Bottom Rd Shippensburg PA 17257
(Address)
on 06/26/2014
(Date)
41m. [)
1002 Jusrison Street
(Street Address)
Wilmington,DE 19801
(City,State,Zip)
(Claimant's Counsel) (Supreme Court LD.No.) r.,y
(Address) C
r71 r..
(Telephone) C)C~ '�
C.J1 "T1
Form OC-07 rev.10.13,06
STATE OF PA STATEMENT AND PROOF OF FILE NO:
PROBATE COURT CLAIM 21-14-0007
CUMBERLAND COUNTY
ESTATE OF JAMES ERB
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#: XXXXXXXXXXXX5030
Amount Due: $2,548.72
PCA File#: 19769415
There is now due on the claim, including applicable legal set-offs, the $2,548.72
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.
Qwi��U_Q p
Authorized Signature
Madeleine Daley
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$10
PROOF OF SERVICE OF CLAIM
I served upon the Estate of JAMES ERB, a copy of this claim on 06/26/2014 via United States
Postal Service to:
Mark F Bayley Esq.
17 W South St —
Carlisle,PA 17013
Gary L Erb Jr
662 Walnut Bottom Rd
Shippensburg, PA 17257
I served upon the Estate of JAMES ERB, 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 inf ation, knowledge, and
belief.
06/26/2014
Date 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: XXXXXXXXXXXX5030
2. NAME IN WHICH SERVICES WERE PROVIDED: JAMES ERB
3. OPEN DATE: 11/12/2013
4. REGARDING: Carlisle Regional Medical Center
5. FINAL BALANCE: $2,548.72
6. PRIMARY: Medical