HomeMy WebLinkAbout09-14-05
A I;lfOH'd. SCAO
STATE Pennsylvania
PROBATE COURT
COUNTY OF CUMBERLAND
JOC CODE: SPC
FILE NO.
STATEMENT AND PROOF OF CLAIM
Estate of
EUGENE KEEFE JR
GENERAL MOTORS ACCEPTANCE CORPORATION PO BOX 7041 TROY, MI 48007-7041
.,Creditor's name Address
submit the following claim against the estate for the sum set forth. *
DESCRIPTION VALUE
DESCEDENT WAS INDEBTED TO GENERAL MOTORS ACCEPTANCE CORPORA nON
PURSUANT TO AN INSTALLMENT SALE CONTRACT ENTERED IN ON 04/22/2005
GMAC REFERENCE #
GMAC ACCOUNT NO.020-9026-8 I 537
BALANCE DUE AT AS OF DATE OF DEATH $6796.84
There is now due on the claim, above all legal set-offs, the sum of:
$6796.84
Attorney signature
Date
I declare that this claim has been examined by me aud that its contents are to e best of my information, knowledge and
belief.
Name (type or print)
Bar no.
Claima
GM P
Add ess
TROY. MI 48007-7041
City, state. zip
Address
City. state. zip
Telephone no.
*1.
",'fclellhone no.
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Describe nature of claim or attach statement. Attach copy of receipt or other evidence of pa:ymentifi~mitted8l assign:~'e~~
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2. Claims must be presented either personall~' or by mail to the fiduciary on or before the last day of pre-s~~lent;j claims~ t~3
This claim may also be filed with the probate court r- I" i !:~'j
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Do not write below this line - For court LIse only
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PC 17 (9/88) STATEMENT AND PROOF OF CLAIM
V
"CI.700.4HH..\ISA 27.5488..\1('1. 700.712:\ISA 27.5712.\KR 5.706
I PROOF OF SERVICE OF CLAIM I
I serve upon
Name
fiduciary, a copy of this claim on
Date
by
State manner and address of" sen'ice
I declare that this proof of service has been examined by me and that its contents are true to the best of my [nformation, knowledge.
and belief.
Date
Signature
I ACCEPTANCE OF SERVICE I
Service of the attached claim is accepted.
Date
Signature
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