HomeMy WebLinkAbout02-09-15 dd e n Enhancing lives through
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Claim Against Decedent's Estate
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ESTATE OF: Cora Baney c>� cA
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The undersigned hereby presents for filing against the above estate this statement of air"�ii anallegi*
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Golden Livingcenter—West Shore
PO BOX 180970
Fort Smith,AR. 72918-0970
The basis of claim is: Nursing Home Care
Estate Claim#-21-2015-0014
The amount of the claim is:$2908.43
NOTE-If there is insurance pending on this account and the insurance fails to pay then amount will
become due privately.
Under penalties of perjury, I declare that I have read the foregoing,and the facts alleged are true to the
best of my knowledge and belief. Enclosed is the$10.00 filing fee.
Signed On: February 4, 2015
Shyra Shelton, Collections Specialist
I SWEAR THIS STATEMENT IS CORRECT
Subscribed and sworn to before me�
ITA MY COMMOn EXPIRESeb
Yea., li�
Notary Public
My Commission Expires zz
www,golden iiving,corn
PO Box 180970
Fort Smith, AR 72918 • Phone: 877-367-1716 • Fax: 479-478-2625
golden
living®
February 4, 2015
Cumberland County Register of Wills
One Courthouse Square Rm 102
Carlisle, PA 17013
Re: Estate of: Cora Baney File No: 21-2015-0014
---Dea.r.Clerk:. .
Enclosed please find a $10.00 check and form to file a claim against the estate of
Cora Baney. Cora Baney incurred these charges while a patient at the Golden
Living Center—West Shore.
I have enclosed a self addressed, stamped envelope. Will you please return filing
receipt back to me?
If you should need additional information or have questions regarding this claim,
please contact me at 877-367-1716 ext 2214 Monday thru Thurs from 8:00 am to
4:30 pm Central Time.
Thank you very much!
Regards,
Shyra Shelton
Recovery Specialist II
Golden'Living Center
P.O. Box 180970
Ft. Smith, AR 72918
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Enclosures71
CC: Cora Baney
71
Client File #: 128889 - C:) "'
PO Box 180970 Fort Smith, AR 72918
877-367-1716 Fax: 479-478-2624 9 www.GoidenLiving.com
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