HomeMy WebLinkAbout07-11-14 (2) STATE OF PA STATEMENT AND PROOF OF FILE NO:
PROBATE COURT CLAIM 21-14-165
CUMBERLAND COUNTY
ESTATE OF KIMBERLY MENTZER
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#: �;XXXXXX����X4993
Amount Due: $1,263.30
PCA File#: 19769411
(
There is now due on the claim, including applicable legal set-offs, the $1,263.30
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.
�
thorized Signature
Madeleine Daley
'yl
��
Phillips & Cohen Associates, Ltd. ���,. � ��;-,
The Creditor's Rights & Bankruptcy Group ���- �-�- -�;'"�
A Division of Phillips & Cohen Associates, Ltd. �� .� ; .- �, -;,
1002 Justison Street "'�` �1 � �"
Q�, „� ` c,.:
Wilmington, Delaware 19801 c�c.:�- � � -,-;
Telephone: (866) 342-4270 ��� c,.a :=� �„
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PROOF OF SERVICE OF CLAIM
I served upon the Estate of KIMBERLY MENTZER, a copy of this claim on 06/26/2014 via
United States Postal Service to:
Sue E Gilbert _
430 Cedar Rd
New Oxford, PA 17350
I served upon the Estate of KIMBERLY MENTZER, 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.
, .__
.��,
1
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. ACCOLTNT NUMBER: ���XX����X�;XX��4993
2. NAME iN WHICH SERVICES WERE PROVIDED: KIMBERLY MENTZER
3. OPEN DATE: 11/12/2013
4. REGARDING: Carlisle Regional Medical Center
5. FINAL BALANCE: $1,263.30
6. PRIMARY: Medical
NOTICE OF CLAIM
(Filed Pursuant to 20 Pa.C.S. § 3532)
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY,PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF �MBERLY MENTZER , DECEASED
No. 21-14-165
To the Clerk of the Orphans' Court Division:
Enter the claim of Phillips & Cohen Associates, Ltd. on behalf of Carlisle Regional Medical Cen�he
(Claimant)
amount of$ 1,263.30 , against the above entitled Estate.
The Decedent, who resided at 132 N PITT ST CARLISLE,PA 17013
(Street Address)
, died on 02/OS/2014 . Written notice of
('Date of Death)
said claim was given to Sue E Gilbert
(Personal Representative or his/her counsel)
at 430 Cedar Rd New Oxford PA 17350
(Address)
on 06/26/2014
(Date) ° �
(C[a ant)
1002 Justison Street
(Street Address)
Wilmington, DE 19801
�crty,scare,zip>
(Claimant's Counsel) (Supreme Court LD.No.)
(Address)
(Telephone)
Form OC-07 rev. 10.l3.06