HomeMy WebLinkAbout12-27-05
IN THE STATE OF Pennsylvania
COUNTY OF Cumberland
IN RE: The Estate of
Margaret L Bear, Deceased
PROBATE FILE NO. 21-05-00359
STATEMENT OF CLAIM
u
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 W ALMART
(hereinafter "Claimant"), whose Account Number is 6032203130578205 , 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 Margaret L Bear
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 $3818.42 , 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.
This
IsH-I
day of
(\LM' J~
,2005
MVRf, DR1NDl.E
F:uf-}!!C
G\'!inn0:~ Ceorqia
~"Y Co~~'::.n:ssl()n Expin3s July .31 st 2009
TSYS Total Debt Management, Inc.
As attorney-in-fact for Claimant
~
By:
Nyla J~ s
TSYS Ptoba e Representative
Copy mailed to attorney for Representative or to
Representative, if not represented by attorney.
Sworn to and subscribed before me this
J..51....day of7)~cp,-y}ber ,2005
:& r) I
./Ja- ~/l.L"Y)~
Notary Public
this day of
TSYS Probate Representative
,2005
~1/