HomeMy WebLinkAbout11-01-05
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COMMONWEAL TH OF PENNSYL VANIA
Deceased.
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COURT OF COMMON PLEAS ,
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ORPHANS' COURT DIVISION -; 1:2 c;
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IN RE: The Estate of
L-I...);, (. '-113 C. f3 u? pv;u r'3/L
TO: CLERK OF THE ORPHANS' COURT DIVISION
NOTICE OF CLAIM PURSUANT TO ~3532)
OF THE PROBATE. ESTATES AND FIDUCIARIES CODE
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1. Claimant's Name:
2.
Claimant's Address:
G I 5>r c" /-'7 ;<f;c...) ~~.
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ft1lE;ct/;<l.N; -,,/J~~f~\. 44.
3. Claimant's Telephone No.: ( 71? ) ~ L./ / - (~) t' <?'
4. Claimant is the owner and holder of a claim against the above titled estate in the amd
of$ 515U a.a.- I
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5. The facts upon which this claim is based are as follows: Yk -"J K.
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6.
Decedent's Last Known Address: g/ S- U//u05o t/2 /L 0/ C ,~
7.
Decedent's Date of Death:
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8.
The claim referenced herein arose prior to the death of the decedent on or about:
9. The claim is secured by:
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The undersigned hereby verifies that the statements made in this Notice of Claim are true aq.d
correct to the best of his/her knowledge, information and belief. The undersigned understaqds
that any false statements herein are made subject to penalties of 18 Pa. C.S. ~4904 relating tf>
unsworn falsification to authorities.
Dated: L?(<<'TOO~~ ~,20D..r
SERVICE OF CLAIM
~"cLt:~ 6/~ F
Claimant -
Written notice of the herein referenced claim was given to the personal representative ofthe
estate and/or his counsel as stated below by U.S. Mail, First Class, postage prepaid:
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Name
Title
90" e C' l'/d('&JL~T/~ ~7"".
Address
/7,c/'C.-51Y~(/ ,_ ~.;9 /70 J' ? -~/(o
City, State, Zip/ _
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Date NotictMailed
Ref:c: \a-r&tforms\estates\Claim. wpd
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