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IN THE STATE OF Pennsylvania
COUNTY OF Cumberland
'0"'''': i.,
(.~D t jj !: 04
IN RE: The Estate of
Robert Silver, Deceased
I
PROBATE FIt;p. NO.. 21-05!-0597
STATEMENT OF CLAIM
The undersigned, being duly sworn, deposes and states that:
1. TSYS Total Debt management, Inc., whose address is Post Office Box 6700,
Norcross, Georgia 30091-6700, is the attorney-in-fact for EXXONMOBIL
(hereinafter "Claimant"), whose Account Number is 7302897743602459 , and as attorney-
in- fact is authorized to submit this Statement of Claim on its behalf.
2. Claimant is the holder of a claim against the Estate of Robert Silver
deceased, the basis of which is the unpaid balance of charges incurred or authorized by the
deceased or on behalf of the deceased in the total amount of $378.22 , as of the date of
the death of the deceased.
3. The said sum is now justly due this Claimant; and the claim is not contingent or
unliquidated.
4. No payment has been made thereon, and there are no offsets against the same,
and the same is not secured by judgment or mortgage upon or expressly charged on the real
estate of the deceased or any part thereof.
lzih
day of
tlbuerr~
,2005
This
OPHEUA J. SPEAR
NOTARY PUBUC
DeKalb County
State of GeorgIa 007
My Comm. Expires May 8. 2
TSYS Total Debt Management, Inc.
As attorneJj 'n-fact for Claimant
Sworn to and subscribed before me this
~ day of NO\lWltr ( , 2005
e Representative
Copy mailed to attorney for Representative or to
Representative, if not represented by attorney.
U~\H~.
Nota PUblic
~
~~Qo/)
this day of
TSYS Probate Representative
,2005