HomeMy WebLinkAbout07-11-14 STATE OF PA STATEMENT AND PROOF OF FILE NO:
PROBATE COURT CLAIM 21-14-239
CUMBERLAND COUNTY
ESTATE OF BARBARA A VANCE
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#: 8213,6178,1058,8824,9764,0957
Amount Due: $3,736.63
PCA File #:
19769397,19769545,19769918,19769400,19769403,19770816
There is now due on the claim, including applicable legal set-offs,the $3,736.63
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 c s are true to the best of my information,knowledge and belief
CD
Ant orized Signature
f'r7 C. rn T.
Madeleine Daley --
���.;-. r_
Phillips & Cohen Associates,Ltd. ° c?
rs "T)
The Creditor's Rights & Bankruptcy Group C
A Division of Phillips & Cohen Associates, Ltd. yv'-' ��p
1002 Justison Street c.l
Wilmington,Delaware 19801
Telephone: (866) 342-4270
F=$10
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PROOF OF SERVICE OF CLAIM
I served upon the Estate of BARBARA A VANCE,a copy of this claim on 06/26/2014 via
United States Postal Service to:
Stephen D Tiley Esq.
5 South Hanover St
Carlisle, PA 17013
I served upon the Estate of BARBARA A VANCE, 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, I,td. and that its contents are true to the best of our information,knowledge,and
belief.
06/26/2014 .7
Date Signature
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: 8213,6178,1058, ,8824,9764,0957
2. NAME IN WHICH SERVICES WERE PROVIDED: BARBARA A VANCE
3. OPEN DATE: 01/09/2014
4. REGARDING: Carlisle Regional Medical Center
5. FINAL BALANCE: $3,736.63
6. PRIMARY: Medical
NOTICE OF CLAIM
(Filed Pursuant to 20 Pa.C.S. § 3532)
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF BARBARA A VANCE DECEASED
No. 21-14-239
To the Clerk of the Orphans' Court Division:
Phillips&Cohen Associates,Ltd. on behalf of Carlisle Regional Medical C�kk,,�
Enter the claim of P g ISIS the
(Claimant)
amount of$ 3,736.63 , against the above entitled Estate.
The Decedent,who resided at PO BOX 118 PLAINFIELD,PA 17081
(Streetdddress)
died on 03/05/2014 Written notice of
(Dste of Death)
said claim was given to Stephen D Tiley Esq.
(Personal Representative or his/her counsel)
at 5 South Hanover St Carlisle PA 17013
(Address)
on 06/26/2014
(Date)
(C imam)
1002 Justison Street
(Street Address)
Wilmington,DE 19801
1`00,State,Zip)
(Claimants Counsel) (Supreme Coact ID.No.)
(Address)
(Telephone)
Form OC-07 rev.10.13.06
Last Name First Name PCA Account No. Balance Last 4 numbers of account
VANCE BARBARA/ 19769397 $126.90 8213
VANCE BARBARA/ 19769545 $304.36 6178
VANCE BARBARA 1 19769918 $654.53 1058
VANCE BARBARA) 19769400 $45.53 8824
VANCE BARBARA! 19769403 $2,359.08 9764
VANCE BARBARA/ 19770816 $246.23 OD57 _
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