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HomeMy WebLinkAbout08-11-14 c'� NOTICE OF CLAIM �� =,-�, r�; ;� ��, �� ,-;,,- ��r ��' COURT OF COMMON PLEAS OF � .- �. : - _ CUMBERLAND COUNTY, PENNSYLVANIA �,� ;' - : ORPHANS' COURT DIVISION �r' � :, _�_, �`�; `�.' Y�"_ �;-� ESTATE OF PAULINE B. KING, DECEASED � -p-- `"� No. 21-14-661 �`�` T� To the Clerk of the Orphans' Court Division: Kindly enter the claim of Messiah Lifeways in the amount of$38,377.09 against the above-captioned Estate. The Decedent, who resided at 100 Mt. Allen Drive, Mechanicsburg, Pennsylvania 17055, died on May 21, 2014. This claim is a priority claim under 20 Pa.C.S. §3392(3) for nursing facility services rendered within six (6) months of the date of death. Written notice of said claim was given to Samuel L. Andes, Esq., 525 North 12th Street, P.O. Box 168, Lemoyne, PA 17043, counsel for the Estate of Pauline B. King on August 8, 2014. Claimant: Messiah Lifeways 100 Mt. Allen Road Mechanicsburg, PA 17055 Respectfully Submitted, Latsha Davis & McKenna, P.C. Date: �� �� ��� Steven M. Montresor Attorney No. 74244 1700 Bent Creek Boulevard, Suite 140 Mechanicsburg, PA 17050 Phone: (717) 620-2424 Fax: (717) 620-2444 smontre sor@ldylaw.com 448410v1 j , _�,,, .••- .,I��,., :1;: "���_ i�t.,,�ti�, �... , M E S S I A H �� �. �� ��,� �����r .�...�..�.. ���� �....�. �r,.� Form PB-01 � � �� M�SSIAH YII�AGE 100 ML ALLEN DR.,MECHANICSBURG,PA ti�oss =RESIDEN:T# �UNIT ` ` 'ST'MT.IDATE 111220 062 D 09/5�12013 RESID'ENT S .: _ DANIEL KING Mrs. PAULINE B. KING 524 PARK AVENUE NEW CUMBERLANO, PA 170T0 TOTALAkIOUNT,DUE: 7 622.00 , '; DAT��DUE, . :.;! 07/31/2d14 S . . DATE DESCRIPTION RATE ::��� CHARGES ,' ,CREDIT$ 'BALANCE_ Balance Forward ,., , _ . , ,��g- :,:,,,,.:,, . . .:. . . . . . ,:: ; , ...,._. �_:___g38,265.55 . .•.ry.:i�;il°i""si itii@lS31i::`!FSt d9t1 fi 8(n(p p 0„cH:.,i::i �:l:1. n1 t�irt�{!if{+f( `{ . . .C N 5..,=t.s;7f F�( {Jpgp3 �� i$�� . `�i { t� .i .t�.ti�..e a g � @ �. .,.,,r.. s:::�;s::•�:^i�;yi!� �yt!1 .. �.l;,::::�.�.�;�}.,a,�NttNt�{�gE t_� ya�.�,3.!€a31..�,..i.. .�... f.1 :3!: �� �� ��3, €.y� (gq i�I1 t!.1�1 . ( {7}{ ,3; 3SS:{:,;•r:;an:i; 1 .1.�,...t��.�f�; t sf {t: �.,t�. ::3:;:;::�l�i�t'tf � ,?:i� �;h.,..,,�;;..�.;::�A:: k4 ��r�p,��;:r;-.:�r,:�h'..�F 2�t7�iiii�` j a.�y���.�. .}.�I..t?, p 1 { ��f �: tl�! �::��(���:p� 1���--}��3� �•� y q��t.�3f�f��,��� �y��ttqI �� 1.. �t,;�.. .�::.�x{Z,i.{.i��'l�'�IX!4��.�1����,�,i7it�„?h.t?,,.�:���Nt�F�:�t'kIUL'�I:IE��Y��.�:1,1�.s�...�i.:.�..�...�...S.�H�'l�Sltli�t�ll�fU'�5������i?!�ifLq�l�ir�:��S�f�f(aki���I�f�t����i�,�tIN�E.M.S.,.,��,.�i,�r.�:l!l1I�:�tl{I�l:U�3S�3!�.^;U.�.�.��1;������I����fi�ii��.::��ni:::i�H�H�HI�tA�I�i��flt�tlpi����.��;�. o�J3�t2o14 PAYMENT RECEIVED -THANK YOU!!! 38 265.55 0.00 fiM•ul'�«....a,......;«..z���:::::�:_..-ir...,t� ... �..�.�. .. p.�.... �...]f jtl t t l` . .. �t:�'r ."iuu���:�: ...� r�i �....,..,-�..:,.... ...t--� � 1. t!•:�:t;�.:....q......�..�;_. �, i.�i: 11,t I, 9��, .�� �,�. _s,}t; t( q( 3i atjc;I1>>���!,L�r 7i�i�E((�(�ili!j�y (3�}{ i��`r1E;��':`ii�i;`'� (`{�" :�s;:i<!'; ��j ! 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'������:��:�'�.i����;i�.�h�:� ��ft����f��������I�€{iiCl r,1������i 0�►75/20�4 OXYGEN 01101•01/31 �17.5Q 15 62.50 077.5Q ......._,7.� .�. �-.:.';v'j'r�ii-'-i......�.,,.y........ ..... .,.��..,r_I.._..,r r E�a�a3u�»:f:::e� i C'I Eltiitl�EtEl�£� tl�v i y� r� '� '� `�' "i i�4E'p.R�,_r-.wer!��.�., i�Qf��,:;`���� �► ;,�����..�����,�I.i�l�`���a�s�i�����!�(I��.��II�Is�<<;,�,�t�;��,��.�;���° '� � ��i�'�?� :;� �,� ����E,��.�iiiii�5 .��. .�`."'��� . �.,������TiA: ��i5n����..�..�ulif�,"#�s�.',������t�C11!{,.r�t1�f,�".l..._,I....,....C����t��.'�.t',.`a.��.,� o�l�s►2o�4 BARBERIBEAUTY SHOP , . , .,,, 57.00 1.00 57.00 5 209,.50 i S��f:�rs;iH`%; ;�:`3 z{� . � . i . : :N.i { �? 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E I:i.I� �i E i�� �!�t�:'II.?������it I�I�' F`�fi�l.� �� ... ..__:... o1I3�12o�a pXYGEN 01,131-01131. ,_ ,_ .,,. „: 17.50 1.00 17.50 7 61.7;00 ,, . } , , y � j . .. <3<E�,!1��t�:�,.�;��.��:�.< <j�ti ,;., �0��'{�Q�A4��{ ,i� � .': r. �i� �Cj' ,�I t ,��a;�I((�E;(I((`!{3 i',!'�•�(�z�E I((i{ u� ?�ii'1 �� �n� �� tE �4����i i�����7`�� �}�� ( � tl�i�:.!�:>,€,S:�a�!�I E `,iI• �.i_.,...._.i...,-,.,�.�.,,._„.i_..�:>�� ��.,�i,��,��?��f•71j�11!bi+6���a19p.itl,�flttflilt'lI�I�IE�I�?�':�?i:d}�i�4�l��l��i��!I��#li���,anlr�fi��e��t!��tl��l31�ii,18>i.?ri';�WIFlMi(t�l�r���i�'et ,L:i::r::,:��I!1�(!Ir�EI�I�7�� �.r.'�� 1'..`i� RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TpTAL AMOUNT DUE 111220 7,4s7.oa 165.00 o.oa o.00 o.00 $7,sz2.00 RESIDENT NAME MrS. PAUUNE B. KING FamPB-01 Please make check payable to Messiah Lifeways at Messlah Village. A 1°/a flnanCe Charge may be assessed on accounts for which payment has not been received by the due date. Thank rou have any questions or concerns about your bill,please address them directly to Fiscal Services at 790-8220. Thank Yc � _. . �� ... ' .. �=... ,..~ ,` ._ ..,. �. :iti � M E S S I A H �'�'��� �u� EE�'� �� � .��.����...��. �r .� �. �� Form PB-01 � � at I�ESSlAH VIl1,AGE 100 MT.ALLEN DR.,MECHANIC56URG,PA ��055 `:RESIDENT# UNIT 'STMT. DATE 171220 Ofi2 D 09/30/2013 .:, f:..,.':. . ��RESIDENT S ;;:' , ;; DANIEL KING Mrs. PAULINE B. KING 524 PARK AVENUE NEW CUMBERLAND, PA 17070 TQTALAMOUNT DUE '!7 523.8g ':�: RqTE:DUE ' 07/31/2014 S DATE DESCRIPTIQN RATE, ,';�n�, ;CHARGE3 ' CREDITS BALANC.E . Balance Forvvard 7,622.00 ::,�:.:�:,,.,n,.�....:...:. .......... . .,�,,,., .. .,.:,:,:_-:::,:::::_,.. .,.,. , ,... _ ! 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' f .�. . .. � ± ;.;�'ij;5"� �� i 'p'�S i Lnfi}. t!�?o!Iy,::;�=�:��.:;:,.�.:.i'�'fl ! d-;�n�:?d:,,,:�I�:::;:�;�!:•;,�. ,� �I , �� ,Y,���.�������il f������I��N�iil�:���������������.��1�!���I�E��iry+��I�I��IIUE��:►�_�� Ir�l9�u�l��1;�►�t�- �ia�€;���;���,�����l�;la�,I:!►?:��,iE�3,�uu�iau�«��;;s,=�;�, i..�i.r..il.���!`lilvil�,{.I�i�t����.i1,.M .� n. .� ...I ..�... .� .... 1 �NI �F�i {fi nu � fu i 7�f 1 f S 02►28�20�4 RM/ BRD - NURSING - SEMI-PVT 02/03-02/ 310.04 26.00 8,060.00 16 692.49 ,.i,,,., �••; :.::,:.�,.��....�..,_...,............�. .r .��� u t� 1t �: � � try' �Iyrytr.pµ7y{ yy��'Yq�f vC',a @t r �'„,., :,: ,. �,, ;€,� +�� _ �y`j �p p S`�jS j1]i,�f'CI�'i����riiE'Rill=�li!a����:��N �����IiE��' (�,# q� s+3 i�t���`•.jt:�iji+j"i ii��!�j..�., ��, �.� �.i.�,.,,���m�����4'.�.�»,���a,-����1911���9��!�tt'!�!,#.t��i��i..�.��t�._�.1.,.�.,I.Ip.�.�Gi�bit1�11�ION��tllli`I� �f��F!1��3�.,.���,.1.!�a,�i .R1l�IRI�Ef�f�E��l!Fl�ii!�.�?S�f,�:��r �;n,i:„��l�itT�!'u3GXl ....i .,... .�, �. I_, ozlzs�2o�a AIR MATTRESS 02/03-02/28 5.00 26.00. 130.00 , ,.,,:._,_,:....__._,._:, a:1T 277.49 :..�s:.�.n��„u.�,,.,�w . ..,..._,......._. ,...,� .,.._..,�_.n.�.iN t b D�g+"9'LL!'n�.s�.�rz:u:Ei"=;u��:iiu•r {t 's il 41!1�qH;lt��ylU�l�� `j '"i' yi{Fi ,i� p ! `e .� i�yp� � N 1 C {�i i . �... k.l;:N.,l�.. ;n...i�I i;,... h}�}i(I€ .�,9:1 � +f q i � jp :ti �.Iii .��: � ��i3,ii1��7ts ={:`:�+�3-S :���`�"� (�' (�E 3€'�1�::1s,-I`�•�:�G e��I� SE k�F t1 � I�!�IE�'(s�i .�+;'�i� 1� ����'�If�� . t �j g t1Y4f'�!. . ..� ...�� ����E!��.. ..f :ii":i.x .��� �€ ���I��,U.�Ui,.l.I�.}i�..,�.,„��.�I�Il;3�� Gilil�l�i��tl a t. ...� a.. :,ii�:�......i�..�fi.... ��(..t�{���fSi��l��}���E.1.1.{!3._1v.,_'.._.,.l,,.,„�,+. �.R�. «.�:,.�,..,����,.,�,� ��: __..1 �...._.... .,._..,.,.i-..t.....�.uu.Isl.l�)i:Eh i�3o ��� �#: � RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 dVER 120 TOTAL AMOUNT DUE 111220 9,801.89 7,457.00 165.00 0.00 0.00 a17,523.89 RES{DENT NAME Mr'S. PAULlNE B. KING FormP&0� Please make check payable to Messiah Lifeways at Messiah Village. A 19�o finance charge may be assessed on accounts for which payment has not been received by the due date. Thank rou have any questions or concerns about your bill,please address them directly to Fiscal Services at 790-8220. Thank Yc ! ..:, ,_._ , .. .:,,, dl 3� 3� �f�..:III ' ;�'���� �� .'��. I � L:... � M E S S I A N �:,.:� �� �`�'�- �� ��n� .�.,.�:.��F� �� �.��_ � Fam PB-Ot � � at M ESSlAH Yl LLAGE 100 MT.ALLEN DR.,MECHANICSBURG,PA i�o55 RESIDENT'# ' UNIT` STMT: DATE 111220 062 D 09/30/2013 -: RESIDENT S ;.:: DANIEL KING Mrs. PAULINE B. KING 524 PARK AVENUE NEW CUMBERLAND, PA 17070 TC?TALAMOUNT`DUE ' $28 366.79 ;:' DATE;;DUE. : .. .' 07/31/2014 � DATE DESCRIPTION RATE ; ���� . 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KING FormP&01 Please make check payable to Messiah Lifeways at Messiah Village. A 1%finance charge may be assessed on accounts far which payment has not been received by the due date. Thank rou have any questfons or concerns about your bill, please address them directly to Fiscal Services at 790-8220. Thank Yc ,: , 4 .; -:<: ,si.,. �::,"r� � ,' "��� �i. i.�� i, ,�� � . .{3 {'...., fi: � M E S S 1 A H ,�.,� �� .�.,��, ��� ��,� .,�._��.. �� .�_.�. �; Fortn P&01 � � at NIESSIAH �'lL1AGE 100 MT.ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT.�i`• UNIT S1TMT. DATE 191220 062 D 09/30/2013 '"`�RESIDENT S DANIEL KING Mrs. PAULINE B. KING 524 PARK AVENUE NEW CUMBERLAND, PA 17070 TQTALAMOUNT�DUE 38 377.09 ' DATE;;DUE,;: 07/31/2014 � ,� Da�rs!: ,. DATE DESCRIPTION . RAT�. �n�� CHARGES CREDIT3 BALANCE. 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R G .4.J .....:.......�.,n...,..,..c,.,�..,,�.��,.�,,,�.,.�.��,.,.,,.,.......,..............,...».....�...._....,R�..,,....��.�,,,..�,►��if�ti�l�i�,llll�l�f=���1�,�,���:.l,�.1.�.�.�...}.... .s.......................��1[ .,.11l.��fi.,ll�ltll..=�1„=I�Iltill�tll��,� (= I,.,:,r �....,.�, ...:,>>.�,��.��,.i��,�i.�i�E1,,.�.,.���lr,; RESIDENT# CURRENT OVER 30 QVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 911Z20 2,$35.00 7,175.34 14,707.90 9,801.89 T,757.40 �38,377.09 RESIDENT NAME Mrs. PAULINE B. KING FormP&01 Please make check payable to Messiah Lifeways at Messiah Village. A 1%finance charge may be assessed on accounts for which payment has not been received by the due date. Thank �ou have any questions or concerns about your bil1,please address them directly to Fiscal Services at 790-8220. Thank Yc COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF PAULINE B. K1NG, DECEASED No. 21-14-661 CERTIFICATE OF SERVICE The undersigned hereby certifies that on this date a true and correct copy of the foregoing Notice of Claim was served via Certified Mail, Return Receipt Requested and First-Class United States mail, postage prepaid, upon the following: Samuel L. Andes, Esquire 525 North 12th Street P.O. Box 168 Lemoyne, PA 17043 Dated: �� �' �fl�`� Steven M. Montresor 448410v1