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HomeMy WebLinkAbout07-03-06 Neo Financial Systems, Inc. 140 Sprint Dr. Blountville, Tn. 37617 ,800-295-3884 Ext. 2407 " ~ ~IL 01 W Lll./V :t C_b'u.fLt 1tuL.-ta12- ~ /J /LfL C~u.l.t:tu. fll- I 70 13 , , [ I (~ ' Current Balance: it /03</-,' /7 t-~~; Kob1A.t: tJ~ ) Proof Of Claim against Estate I . J2-+-;) /1? LddX tCJ~1'tJ-; 4.i..A~;T:t (7~~ Pit J70/3 ~ creditor:(!.t2d~ h~~)v,~[~ C~t]lJL ) Date of Service: 9 -I (P '- 0 S- ) ) ) ) Case No.: ~ J - c52(Xk - 0/ '11 Name:~ Address; R4.J:L 1531 '70 '7 f: I .~f/ /) j/Yi"U/.!V(, , \\\\\\\111//1///111 ",\ cS C S IIII ,'~~l;.. . C. '/ ~ "'-~. ........... 0 '>... ~ y/ .... /' ~ 2 .... STATE ". "^ S ~;' OF . ~ ~ ~ TENNESSEE ~ ~ ~ .z :" NOTARY .... ~ ~ S ~n ". PUBLIC .: J...... 2 ~v..;c.. .... ..... ~ $' ,//7/~ ........... O..;:} ", IllllllGrON C \\,\\" 1/" 11111 \ \ \ \ \ \ DECEASED. 02-g.-QG Date: &r r20 ~ oG {1~uOJ)v'rVL- fa.1./ho..vL otary P~llC My Jt;;2!f "'pire Dewanna Palmer Legal Forwarding Assistant Please file a claim against the listed estate. - 1 \./'-. Account:51986134 Window: Disp:4500 REQUESTING INFO Name:DOUGHERTY J ROBERT Rp: Adr:18 WHITSHIRE EAST Poe: Adr: Adr: Cty:CARLISLE Cty: St:PA Zip:17013 St: Zip: C1t:H85803 CARLISLE REGIONAL MEDICAL CENTER Lst:01/10/06 Srv:09/16/05 Ltrs:3 Time:137 Ssn:_ Ssn: Time:NONE Cont:O ___251 Cbr:N Ph:717 258 0906 Rp Ph:717-240-0632 Poe Ph: Pay: 0.00 Born:07/27/1932 Sa1: Org: I Lg1:1 I Freq: I Cane: I Cof:N CARLISLE 7531707 Atmps:16 _ Worked:2 1134.17 Ba1: 1034.17 Int: 0.00 06/20/06 PAGE 001 HEALTH MANAGEMENT ASSOCIATES DA17 COlD: 858 CARLISLE REGIONAL MED CENTER AS OF 06/19/06 PATIENT: DOUGHERTY, J ROBERT F/C: F PIT: 0 DSC CODE: 01 AlC: 7531707 ADMISSION: 09/16/05 DISCHARGE: 09/16/05 CHG DATE DPT REV BAT# HCPC M1M2 CHGCD DESCRIPTION QTY AMOUNT 09/16/05429351 8 70491 70491 CT NECK W/CONTRAST 1 1,134.17 TOTAL CHARGES 1,134.17 TOTAL: CASH> 100.00- ADJUSTMENTS> 0.00 BALANCE> 1,034.17 SELECT: REV= * DEPT= * CHGCD= * DATE/MDCY= * TO/MDCY= * CMD:1 =DAR,2=P A T,4=SUMMAR Y,5= TOP, 6=END, 7=RETURN,8=BACKWARD, 12=UPD,ENTER=FORWA RD ;. . { l' .l1ilS IS AN AITEMPT TO COLLECT A DEBT. ANY INFORMA nON OBTAINED WILL BE USED FOR THAT PURPOSE