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NOTICE OF CLAIM ' = r N ° ;
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(Filed Pursuant to 20 Pa.C.S. § 3532) ' ; ,:,
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COURT OF COMMON PLEAS OF � G, o
CUMBERLAND COUNTY, PENNSYLVANIA N -'-'
ORPHANS' COURT DNISION
ESTATE OF Nancy Witmer , DECEASED
No. 2014-01213
To the Clerk of the Orphans' Court Division:
Enter the claim of Fox Subacute at Mechanicsburg in the
�cra�man��
amount of$ 14,138.18 , against the above entitled Estate.
The Decedent, who resided at 453 Meadows Road, Newville, PA 17241
(Sh-eet Address)
, died on December 16, 2014 . Written notice of
(Date of Dea[h)
said ciaim was given to Robert G. Frey, Esquire
(Personal Representative or his/her counsel)
at 5 South Hanover Street Carlisle PA 17013
(Address)
on August 4, 2015
(Date)
Fox Subacute at Mechanicsburg
(Claimant,l
120 S. Filbert Street
(Street Address)
Mechanicsburg, PA 17055
Joseph F. Murray, Esq. 31699 �crry,srate,z;p�
(Claimant's Counsel) (Supreme Court L D.No.)
251 Stenton Avenue
(Address)
Plymouth Meeting, PA 19462
484-342-4153
(Telephone)
Form OG07 rev. 10.13.06 �
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Invoice
FOX SUBACUTE AT iNvoicE No. Au�2o�s
IYI C V nl�i1V I V�a V RV COVERED PERIOD NOV-DEC 2014
120 FILBERT STREET PATIENT CONTROL# 298
MECHANICSBURG, PA 17055
Phone: (215)343-2700 TERMS 30 DAYS
'Bus.Office (610)862-0623
08(Q4/2015
Patient Name PLEASE REMIT TO
NANCY WITMER FOX SUBACUTE AT MECHANICSBURG
CIO JUDY WITMER 120 FILBERT ST
7176 OAKVILLE ROAD iATTN;JOE MURRAY ADMINISTRATOR
SHIPPENSBURG,PA 17257 ',MECHANICSBURG PA 17055
Days : Rates ' DESCRIPTION UNIT I��tICE AMOUNT'
9 $925.00 PRNATE PAY $925.00 $8,325.00
NOV 22-30,2014
5 $925.00 PRNATE PAY $925.00 $4,625.00
DEC 01-052014
COPAY $200.00
OGl"24-31,2014
. COPAY $988.18
NOV 01-30,2014
SUBTOTAL $14,138.18
TAX
FREIGHT
TOTAL $14,138.18
Questions concerning this Invoice? MAKE ALL CHECKS PAYABLE TO:
Call: Roni FOX SUBACUTE AT MECHANICSBURG
610-862-0623 ATTN:JOE MURRAY ADMINISTRATOR
120'riL'e3ERT ST
MECHANICSBURG PA 17055