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HomeMy WebLinkAbout12-11-14 NOTICE OF CLAIM COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF REBA V. WISE, DECEASED , No. 21-14-131 C1> c © rn rn o s To the Clerk of the Orphans' Court Division: !:x 2 n rn rn Kindly enter the claim of Messiah Lifeways in the amount of$7,577.71 faga�i�lsz the G <3above-captioned Estate. The Decedent, who formerly resided at 100 Mt. Allen'Ove�C) Mechanicsburg, Pennsylvania 17055, died on January 26, 2014. This claim is a general unsecured claim under 20 Pa.C.S. §3392(6) for nursing facility services. Written ndtice ofjid i-- rn claim was given to John R. Elliott, Esq. of Anstine& Sparler at 117 East Mark�f Street, Ywic, PA 17401, counsel for the Estate of Reba V. Wise on December 9, 2014. 4 Claimant: Messiah Lifeways 100 Mt. Allen Road Mechanicsburg, PA 17055 Respectfully Submitted, Latsha Davis & McKenna, P.C. Date: I c1 l0 a ( a01q Cr Steven M. Montresor Attorney No. 74244 1700 Bent Creek Boulevard, Suite 140 Mechanicsburg, PA 17050 Phone: (717) 620-2424 Fax: (717) 620-2444 smontresor@ldylaw.com 488231v1 h MESSIAH V "1"'1&IF 1-JL. Iii.; Form PB-01 Ifeways at MESSIAH VILLAGE 100 MT ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT#J UNIT -STMT DATE 81103 021 W 00/00/0000 RESIDENT(S) GLENDA HEIGES REBA V. WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 [TOTAL AMOUNT DUE -F— $3,834.71 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE ----------------------- - -- ------------- ...................................... ....................... --------------------- ------------------ ...................... DATE DESCRIPTION RATE Days/ CHARGES CREDITS BALANCE. Units Balance Forward 973.57 11117/11 PAYMENT RECEIVED -THANK YOUM 97*3.57 0..00 MEDICAREPMT-A!�t 1 8 UR-A N C 8::: :11820.50,�i:; 820.60 ............ Nursipg q;rp ........................ .......... 0:11HU.,t�1,villi: jai 1 V11.T 'PHON E S. N 4.00 ' 14.0 11/01/11 DAILY PHONE CHARGE (WAGNER) 1. 0 3,834.71 L I Page I RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 81103 14.21 0.00 3,820.50 0.00 0.00 $3,834.71 RESIDENT NAME REBA V. WISE Forth PS-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. If you have any questions or concerns about your bill,please address them directly to Fiscal Services at 790-8220. MESSIAH v4 I ii Form PB-01 Ifeways at MESSIAH VILLAGE 100 MT ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENTT—F UNIT STMT. DATE 811.03 021 W RESIDENT(S) GLENDA HEIGES REBA V. WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTALAMOUNT DUE $9,777.71 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE $ --------------------------- -------- ------------------- -------------- ------------------ -------------- - T- M . AMQW Rl� ITT DATE DESCRIPTION RATE Days4 U01ts CHARGES CREDITS BALANCE Balance Forward 3,834.71 03131/12 MEDICARE 0A kT A CO-INSURANCE 5,943 00 9,771.71 Please make sure to allow adequate time for your payment to be received in our office by Page 1 12/31/14.Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTALAMOUNT DUE 81103 9,763.50 0.00 0.00 0.00 14.21 $9,777.71 RESIDENT NAM E REBA V. WISE WFoArmPS-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. If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. MESSIAH )t4 •...,I �li, .le.•'iSir' til::• I;ga' .:ita,,..?!:_._tl„ Si1g.;:d' .Sa.,..il.,.. `tlur or Fm P"I if y L ew. wa s at MESSIAH VILLAGE 100 MT.ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT# UNIT —STMT. DATE 81103 021 W 1113012011 1 . RESIDENT(S) GLENDA HEIGES REBA V. WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTALAMOUNT DUE $9,677.71.. DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE ...............----............1—------ ................... ..............---....... ......... ................ ............. DATE DESCRIPTION RATE Days/ CHARGES CREDITS BALANCE Units Balance Forward 9,777.71 06120/12 PAYMENT RECEIVED -THANK YOU111 100.00 9,677.71 Please make sure to allow adequate time for your payment to be received in our office by Page 1 12/31/14.Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER f0 OVER 90 OVER 120 TOTALAMOUNT DUE 81103 0.00 0.00 0.00 9,677.71 0.00 $9,677.71 otm P8-0i RESIDENT NAME REBA V. WISE NF/A 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. If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. VON&- MESSIAHi„•.,�I' =". i`;,.-t,I, Ii4,<, iuu�:' .a1�...;It�...�:;.. {��':.,. ..lil_.�_.., I;, t4 Form P"I Lifeways at MESSIAH VILLAGE 100 MT ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT# UNIT STMT. DATE 81103 021 W 11/30/2011 RESIDENT(S) GLENDA HEIGES REBA V. WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTAL AMOUNT DUE $9, 77.71 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE ............................................................................................. ------------------------------ ................................ ----AMQVNT.REMIT7ED- DATE DESCRIPTION RATE Dayal CHARGES CREDITS BALANCE Units Balance Forward 9,677.71 07120/12 PAYMENT RECEIVED„- THANK YOU!,!!, 100.00 9,577.71 Please make sure to allow adequate time for your payment to be received in our office by Page I 12/31114.Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 1 81103 0.00 0.00 0.00 0.00 9,677.71 $9,577.71 RESIDENT NAME REBA V. WISE N/A Form PB 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. If you have any questions or concerns about your bill,please address them directly to Fiscal Services at 790-8220. MESSIAH dv t4 Form PB-01 Lifeways at MESSIAH VILLAGE 100 MT ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT#--F UNIT STMT. DATE 81103 021 W 11/3012011 RESQENT(S) GLENDA HEIGES REBA V. WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTAL AMOUNT DUE $9,477.71 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE $ ................................................................................................... --------------------------------------------------- ------_--------A MQ X V T__ REMj_I_.T DATE DESCRIPTION RATE Days/ :CHARGES 'CREDITS -BALANCE Das Balance Forward 9,577.71 08/20112 PAYMENT RECEIVED THANK YOU!!!f 100.00 9,477..71 Please make sure to allow adequate time for your payment to be received in our office by Page 1 12/31/14. Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 81103 9,447.71 0.00 0.00 0.00 30.00 $9,477.71 RESIDENT NAME REBA V. WISE Fwm PB-01N/A Please make check payable to Messiah Lifeways at Messiah Village. A 11%finance charge may be assessed on accounts for which payment has not been received by the due date. If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. MESSIAH V4 Form PB-01 if y L ewa- s at MESSIAH VILLAGE 100 MT.ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT# UNIT STMT DATE 81103 021 W 11130/2011 RESIDENT S .GLENDA HEIGES REBA V.WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTAL AMOUNT DUE $9,377.71 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE $ ------------------ -.-.-...... REMITTED_ DATE DESCRIPTION RATE Days/Units CHARGES CREDITS BALANCE Balance Forward9,477.71 09/20112 PAYMENT RECEIVED - THANK YOU!!, 100.00 9 377.71 Please make sure to allow adequate time for your payment to be received in our office by Page 1 12/31/14. Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTALAMOUNT DUE 81103 0.00 9,377.71 0.00 0.00 0.00 $9,377.71 RESIDENT NAME REBA V. WISE Form PB 01 N!A .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. If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. MESSIAH t4 Farm PB-Ot Al Lifeways at MESSIAH VILLAGE 100 MT.ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT#--F UNIT STMT, DATE 81103 021 W 11/30/2011 RESIDENT(S) GLENDA HEIGES REBA V. WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTALAMOUNT DUE $9,277.71 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE $ .................................................................. ... - - --.....................----------------- --------AMQVNTREMLTTI=R. DATE DESCRIPTION RATE Days/ CHARGES CREDITS BALANCE UniBalance Forward 9,377.71 10/22112 PAYMENT RECEIVED -THANK YOUM 100.00 9,277.71 Please make sure to allow adequate time for your payment to be received in our office by Page 1 12/31114. Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 81103 0.00 0.00 9,277.71 0.00 0.00 $9,277.71 ForRESIDENT NAME REBA V. WISE N/A PB°' 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. If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. MESSIAH Form PS-01 Lifeways at MESSIAH VILLAGE 100 MT.ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT# UNIT =MT. DATE 81103 021 W 1113012011 RESIDENT(S) GLENDA HEIGES REBA V.WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTALAMOUNT DUE 177.71 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE $ ''. -...................... ..... ........................... --------------------------------- -------- .............--................................ DATE DESCRIPTION RATE Units ays/ CHARGES CREDITS BALANCE units Balance Forward 9,277.71 11120/12 PAYMENT RECEIVED -THANK YOUM 100.00 9,177.71 Please make sure to allow adequate time for your payment to be received in our office by Page i 12/31/14.Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 81103 0.00 0.00 0.00 9,177.71 0.00 $9,177.71 Form PB-01 RESIDENT NAME REBA V. WISE NIA 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. If you have any questions or concerns about your bill,please address them directly to Fiscal Services at 790-8220. ; )t4 MESSIAH V Form PS-01 Lifeways at MESSIAH VILLAGE 100 MT ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENTIT UNIT :1-STMT DATE 81103 021 W 11/30/2011 RESIDENT(S) GLENDA HEIGES REBA V. WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17060 TOTALAMOUNTIDUE $9,077.71 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE $ ....................................................-I ............ --------- .................. ------------------------------------- ------- DATE DESCRIPTION RATE Dan/ CHARGES CREDITS BALANCE Units Balance Forward 9,177.71 12120112 PAYMENT RECEIVED - THANK YOUM 100.00 9,077.71 Please make sure to allow adequate time for your payment to be received in our office by Page I 12/31/14.Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 81103 0.00 0.00 0.00 0.00 9,077.71 $9,077.71 Form RESIDENT NAME REBA V. WISE NIA PB-0t 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. If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. MESSIAH Form P"l Lif eways at MESSIAH VILLAGE 100 MI ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT# UNIT -STMT DATE 81103 021 W 11/30/2011 RESIDENT.S GLENDA HEIGES REBA V. WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTIALAMOUNT DUE .$8,977.71 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE $ ...........................................................I..............................................................................................................AMOUNT REMITTED. DATE DESCRIPTION RATE Days/ CHARGES CREDITS BALANCE Units Balance Forward 9,077.71 01122/13 PAYMENT RECEIVED - THANK YOU 111 100.00 8,977.71 Please make sure to allow adequate time for your payment to be received in our office by Page 1 12131/14.Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 81103 8,977.71 0.00 0.00 0.00 0.00 $8,977.71 RESIDENT NAME REBA V. WISE Form PO-01N/A Please make check payable to Messiah Lifeways at Messiah Village. A 1%finance charge may be assessed on accounts for which payment has not been received by the due date. If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. i .,i"'X**4 ESSIAH sl.,.. FanL Form PM1 Lifeways � at MESSIAH VILLAGE 100 MT.ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT#--T UNIT STMT, DATE 81103 021 W 11/30/2011 RESIDENT($) GLENDA HEIGES REBA V.WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTALAMOUNT DUE $8,077. DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE �- ...........................-..... ... ----......-----------------.------•-------------- ----.....------------..................... --------------- DATE ---------- ADATE DESCRIPTION RATECHARGES CREDITS BALANCE DaXs! Units Balance Forward 8,977.71 100.00 8,877.71 THANK 02120►13 P RECEIVED - NK YOU!!! Please make sure to allow adequate time for your payment to be received in our office by Page a 12131114.Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTALAMOUNT DUE 81103 0.00 8,877.71 0.00 0.00 0.00 $8,877.71 RESIDENT NAME REBA V. WISE WA Pe-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. If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. MESSIAH t4 Form P9-01 Lifeways at MESSIAH VILLAGE 100 MT ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT# UNIT _STMT DATE 81103 021 W 11130/2011 RESIDENT(S) GLENDA HEIGES REBA V. WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTALAMOUNT DUE $8,777.71 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE AMOUNT REMITTED ............................. ---------------------------- ...................... ........... ........ ------------------------- DATE DESCRIPTION ..RATE Days/ CHARGES CREDITS BALANCE Units Balance Forward 8,877.71 03120/13 PAYMENT RECEIVED -THANK YOUM 10.0.00 8,.777.71 Please make sure to allow adequate time for your payment to be received in our office by' Page 1 12131/14. Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 81103 0.00 0.00 8,777.71 0.00 0.00 $877771 Form PM1 RESIDENT NAME REBA V. WISE N/A 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. If you have any questions or concerns about your bill,please address them directly to Fiscal Services at 790-8220. MESSIAH t Form P8-04 4 Lifeways " at MESSIAH VILLAGE 100 MT ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT# UNIT STMT DATE 81103 021 W 11130/2011 RESIDENT(S)-- GLENDA HEIGES REBA V. WISE . 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTALAMOUNT DUE $8,677.7 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE $ ................ ......................................... .............................................................................................AMQQN-T.REMITTED. DATE DESCRIPTION RATE Da's, CHARGES CREDITS BALANCE U61ts Balance Forward 8,777.71 04/22/13 PAYMENT RECEIVED - THANK' YOU111 100.00 8,677.71 Please make sure to allow adequate time for your payment to be received in our office by Page 1 12131/14. Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 81103 8,577.71 0.00 0.00 100.00 0.00 $8,677.71 RESIDENT NAME REBA V. WISE WFoArrh Pe-0I 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. If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. ��'�II {i` fl' .lit. I r `;t: ?+ ..;'�...Tt �4:a. r' .Cl-J,K. )t4MESSIAH I.,.,�. k,;� kkN.�, klkiik ,,. .,- ,. ,,: Form PB-0t Lifeways at MESSIAH VILLAGE 100 MT.ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT# UNIT STMT. DATE 81103 021 W 11/30/2011 RESIDENT(S) GLENDA HEIGES REBA V.WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTALAMOUNT DUE $8,577.71 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE $ ........ . .. .. . .. ............. . --- --- - . - AMQIINT,REMIT7E4- DATE DESCRIPTION RATE U�t CHARGES CREDITS BALANCE. Balance Forward 8,677.71 05126113 PAYMENT RECEIVED - THANK YOUM 100.00 8,577.71 Please make sure to allow adequate time for your payment to be received in our office by Page 1 12131114.Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTALAMOUNT DUE 81103 0.00 8,577.71 0.00 0.00 0.00 $8,577.71 Form RESIDENT NAME REBA V.WISE N/A PBOt 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. If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. E; :i ;;. .. . MESSIAH 1;,,° � ���.�;� :' . ., ii, ,, � ,{ ; • :1,„:il tib. 4'� ilN-. i i.. !lir!r rti.._,''�.,..m.. °i:tt:P' li....�Fo Ilio Form PB-0t if y ewa s at MESSIAH VILLAGE 100 MT.ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT# UNIT STMT DATE 81103 021 W 11/30/2011 RESIDENT(S) GLENDA HEIGES REBA V. WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTALAMOUNT DUE $8,477.71 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE $ -------- ................................................. ...................................... .......................................AM-0UNT.REMITTED- DATE DESCRIPTION RATE Days Units CHARGES CREDITS BALANCE Balance Forward 8,577.71 06120113 PAYMENT RECEIVED - THANK YOU!!! 100.00 8,477.71 Please make sure to allow adequate time for your payment to be received in our office by Page 1 12131/14.Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTALAMOUNT DUE 81103 0.00 0.00 8,477.71 0.00 0.00 $8,477.71 Form RESIDENT NAME REBA V. WISE NIA Pa-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. If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790=8220. MESSIAH .f.. fj. Form PB-01 Lif eways at MESSIAH VILLAGE 100 MT.ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT# UNIT STMT. DATE 81103 021 W 11/30/2011 RESIDENT(S) GLENDA HEIGES REBA V. WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTALAMOUNT DUE $8,377.71 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE $ ................................................................... ----- ..... -....AMOUNT Rt?MITTED_ DATE DESCRIPTION RATE Days! CHARGES CREDITS BALANCE Units Balance Forward 8,477.71 07122/13 PAYMENT RECEIVED -THANK YOU!!! 100.00 8,377.71 Please make sure to allow adequate time for your payment to be received in our office by Page 1 12131/14. Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTALAMOUNT DUE 81103 0.00 0.00 0.00 8,377.71 0.00 $8,377.71 RESIDENT NAME REBA V. WISE Form PB-0, 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. If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. MESSIAH � =` �i ; ,,; Lif :you..S' �l�t, l[r"Ili• 'US:. ''tir':;:`� ,A�..,.'i4-.«.... ,�IgAHv� .J�L.-ill.. -0t4 Form PB-07� at MESSIAH VILLAGE 100 MT.ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENTET UNIT STMT. DATE 81103 021 W 11/3012011 RESIDENT(S) GLENDA HEIGES REBA V. WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTALAMOUNT DUE $8,277.71 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE $ ----------------------------------------------------------------------------------------- ---------------------------------- AMOUNT-REMITTER. DATE DESCRIPTION RATE Units CHARGES CREDITS BALANCE Balance Forward 8,377.71 08/20/13 PAYMENT RECEIVED -THANK YOUIII 100.00 8,277.71 Please make sure to allow adequate time for your payment to be received in our office by Page 1 12131114. Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 81103 0.00 0.00 0.00 0.00 8,277.71 $8,277.71 RESIDENT NAME REBAV. WISE Form PBOt NlA Please make check payable to Messiah Lifeways at Messiah Village. A 1%finance charge may be assessed on accounts for which payment has not been received by the due date. if you have any questions or concerns about your bill,please address them directly to Fiscal Services at 790-8220. MESSIAH33$ L Form PS-01 fy e www a s at MESSIAH VILLAGE 100 MT,ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT# UNIT STMT. DATE 81103 021 W 11/3012011 — I- RESIDENT(S) GLENDA HEIGES, REBA V. WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTAL AMOUNT DUE 177.71 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE ............­­......... .......................Days/...........................___-----_...,.WQUXX.REMITTED DATE DESCRIPTION —RATE Units CHARGES CREDITS BALANCE Balance Forward 09120113 PAYMENT RECEIVED -THANK YOU!!! 1 90, .0 O ' 8,177.71 Please make sure to allow adequate time for your payment to be received in our office by Page 1 12131/14.Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 81103 0.00 0.00 0.00 0.00 8,177.71 $8,177.71 Form PB-01 RESIDENT NAME REBA V. WISE N/A 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. If you have any questions or concerns about your bill,please address them directly to Fiscal Services at 790-8220. `,,"II •E:. `�,,•�i jai i�.,.:ii: �#,: :;tf',.:.r �;.....,..: �, �% tk MESSIAH Form PB-0t if y L, ewa s at MESSIAH VILLAGE 100 MT.ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT# UNIT STMT. DATE 81103 021 W 11130/2011 RESIDENT(S) GLENDA HEIGES REBA V. WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTALAMOUNT DUE $8,077.71 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE $ AMOVNT RENlITEb- ......................................... ........... ---.....--------- - - --..... .. ...-.---.--...------'-'----------- -------.-.......,....-.....-- - - - ------ -.. DATE DESCRIPTIONRATE Days/Units CHARGES CREDITS BALANCE Balance Forward 8,177.71 10120/13 PAYMENT RECEIVED -THANK YOUM 100.00 8,077.71 Please make sure to allow adequate time for your payment to be received in our office by Page 1 12/31/14.Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTALAMOUNT DUE 81103 0.00 0.00 0.00 0.00 8,077.71 $8,077.71 RESIDENT NAME REBA V. WISE Form PB-01 NIA 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. If you have any questions or concerns about your bill,please address them directly to Fiscal Services at 790-8220. q: MESSIAH t4 if y Form P8.01 at MESSIAH VILLAGE 100 MT ALLEN DR,,MECHANICSBURG,PA 17055 RESIDENT# UNIT STMT. DATE 81103 021 W 11/30/2011 RESIDENT.S GLENDA HEIGES REBA V. WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTALAMOUNT DUE 977.71 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE .................................................................- ....... . ... ------- ...... ............. .......... ------ ............. DATE DESCRIPTION RATE Day-Ws CHARGES CREDITS BALANCE Unit BalanceForward8,077.71 11/20/13 PAYMENT RECEIVED -THANK Y6U!!l 100.06 77977J1' Please make sure to allow adequate time for your payment to be received in our office by Page I 12/31/14.Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER&0 OVER 90 OVER 120 TOTAi.AMOUNT DUE 81103 0.00 0.00 0.00 0.00 7,977.71 $7,977.71 RESIDENT NAME REBA V. WISE Form NIA PB-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. If you have any questions or concerns about your bill,please address them directly to Fiscal Services at 790-8220. t4 0i.MESSiAH Form PM1 Lifeways at MESSIAH VILLAGE 100 MT.ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT—#7 UNIT STMT. DATE 81103 021 W 11/30/2091 RESIDENT(S) GLENDA HEIGES REBA V. WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTAL AMOUNT DUE $7 $77,71 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE $ -....-.. --------------------------------...-.--AMOUNT REMITTER. DATE DESCRIPTION RATE Units CHARGES CREDITS BALANCE Balance Forward 7,977.71 12120/13 PAYMENT RECEIVED -THANK YOUILI 100.00 7,877.71 Please make sure to allow adequate time for your payment to be received in our office by Page 1 12/31/14. Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 81103 0.00 0.00 0.00 0.00 7,877.71 $7,877.71 RESIDENT NAME REBA V. WISE Form PB-01 NIA 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. If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. 3. 4� ifl- A- TL MESSIAH Form PB41 Lif eways at MESSIAH VILLAGE 100 MI ALLEN DR.,MECHANICSBURG, PA 17055 RESIDENT#::[:: UNIT STMT DATE 81103 021 W 11/30/2011 RESIDENT(S) GLENDA HEIGES REBA V. WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTALAMOUNT;DUE $7,777.71:::::j DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE AMOUNT REMITTED ------------------------ ................ .... --------------------------------------------------------------------- ............................ DATE DESCRIPTION RATE Days/ CHARGES CREDITS BALANCE Units Balance Forward 7,877.71 01/21/1. 4 PAYMENT RECEIVED -THANK YOUIII 100.99 7,777.71 Please make sure to allow adequate time for your payment to be received in our office by Page 1 12131114.Any payments received after the due date will be considered late and will not be reflected on your next statement RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 81103 0.00 0.00 0.00 0.00 7,777.71 $7,777.71 RESIDENT NAME REBA V. WISE Form FIB-01WA 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. If you have any questions or concerns about your bill,please address them directly to Fiscal Services at 790-82,20. MESSIAH11 v4 Form PS-01 Lifeways at MESSIAH VILLAGE 100 MT ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT# UNIT STMT DATE 81103 021 W 11/30/2011 RESIDENT(S) GLENDA HEIGES REBA V. WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 ToTALAmbUNTDUE 677.71 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE $ --------------------....... ....... ------- ------------------- ---AMOQN-T-RF,.MIT.TED. DATE DESCRIPTIONDayst RATE CHARGES CREDITS BALANCE Balance Forward 7,77711 02120/14 PAYMENT RECEIVED -THANK YOU!!! 100*.00 7,677.71 Please make sure to allow adequate time for your payment to be received in our office by Page 1 12/31/14.Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER 50 OVER 90 OVER 120 TOTAL AMOUNT DUE 81103 0.00 0.00 0.00 0.00 7,677.71 $7,677.71 RESIDENT NAME REBA V. WISE WA PS-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. If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. NpW t4 if y 0 Form PS-01 L ewa s at MESSIAH VILLAGE 100 MT.ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT# UNIT STMT. DATE 81103 021 W 11130/2011 RESIDENT(S) GLENDA HEIGES REBA V. WISE 1280 GOOD HOPE ROAD MECHANICSBURG, PA 17050 TOTAL AMOUNT DUE $7,577.71 DETACH AND RETURN THIS PORTION 1MTH YOUR REMITTANCE $ AMOUNT REMITTED DATE DESCRIPTION RATE Days/ CHARGES CREDITS BALANCE Units Balance Forward 7,677.71 03127114 PAYMENT RECEIVED THANK YOUII:I 100.00 7,577.71 Please make sure to allow adequate time for your payment to be received in our office by Page 1. 12131114.Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 81103 0.00 0.00 0.00 0.00 7,577.71 $7,577.71 RESIDENT NAME REBA V. WISE NIA PB-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. If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF REBA V. WISE,DECEASED No. 21-14-131 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: John R. Elliott, Esq. Anstine & Sparler 117 East Market Street York, PA 17401 Dated: I �Z 00t a.0k Steven M. Montresor 488231v1 LATSHA DAVIS & McKENNA ATTORNEYS AT LAW PLEASE REPLY TO: Mechanicsburg WRITER'S E-MAIL: mfournier@ldylaw.com December 9, 2014 Clerk of Orphans' Court 1 Courthouse Square Suite 102 Carlisle, PA 17013 Re: Estate of Reba V. Wise, Deceased Cumberland County Estate No. 21-14-131 Our File No:: 651-14 Dear Sir/Madam: Enclosed please find an original and one (1) copy a Notice of Claim for filing in the above-referenced matter. Also enclosed is a check in the amount of$10.00 for the required filing fee. Please date stamp the copy and return it to our office in the enclosed self-addressed, stamped envelope.. Thank you for your attention to this matter. If you have any questions or concerns, please do not hesitate to contact our office. Sincerely, Michelle L. Fournier Paralegal Enclosures cc: John R. Elliott, Esq. (w/enc.) Rebecca Rose, Manager of Revenue and Billing (w/enc.) 1700 Bent Creek Boulevard, Suite 140 • Mechanicsburg,PA 17050 •(717)620-2424•FAX(717)620-2444 350 Eagleview Boulevard, Suite 100 •Exton, PA 19341 • (610)524-8454•FAX(610)524-9383 3000 Atrium Way, Suite 251 •Mt.Laurel,NJ 08054• (856)231-5351 •FAX(856)231-5341 Maryland Telephone: (410)727-2810 488229v1