On January 14, 2021 a
Medical Assistance Clearance
was filed
for Decree of Descent
in the District Court of Carlton County.
Preview
09-PR-21-78
Filed in District Court
State of Minnesota
1/29/2021 2:26 PM
CERTIFICATE OF CLEARANCE FOR
MEDICAL ASSISTANCE CLAIMS
1) The County Agency issues this Certificate of Clearance for Medical Assistance
Claims in connection with the proceedings in the Estate of Gary Cooper Bell,
a/k/a Gary C. Bell and Gary Bell, Case No. 09-PR-21—78 for a Decree of
Descent now pending in the Carlton County, Minnesota, District Court.
2) There is.a.trike one) claim for recovery of medical assistance arising
under Minn- : . Statutes. Section 2568.15, as amended, against the decedent
named in the application for this Certificate and identified in the Estate of Gary
Cooper Bell, a/k/a Gary C. Bell and Gary Bell and Case No. 09-PR—21-78 .
Amount
Decedent's Name Date of Birth Social Security # of Claim
Gary
Gary
Cooper
C. Bell
Bell,
and
a/k/a
Gary
4-; O
Bell November 12, 1946 See Confidential
Information Form
3) There
under -strike
Minn, ta Statutes
one) claim
Section
of the
for recovery of medical
2568.15,
decedent
as
named
amended.
in the
assistance arising
against the following
for this
predeceased spouse(s) application
Certificate.
Predeceased Amount
Spouse's Name Date of Birth Social Security # of Claim
N ,A a? O
Dated: m/ 25AM By
Title:
«flaw
Qflmf
,
Carlton County Public Health and Human
Services
14 N. 11‘“ Street
P. O. Box 660
Cloquet, MN 55720
(218) 879-4511
IF A CLAIM APPEARS, CONTACT THE COUNTY AGENCY TO ARRANGE FOR
PAYMENT AND SATISFACTION OF THE CLAIM.
788741
Document Filed Date
January 29, 2021
Case Filing Date
January 14, 2021
Category
Decree of Descent
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09-PR-21-78 Filed in District Court State of Minnesota 1/29/2021 2:26 PM CERTIFICATE OF CLEARANCE FOR MEDICAL ASSISTANCE CLAIMS 1) The County Agency issues this Certificate of Clearance for Medical Assistance Claims in connection with the proceedings in the Estate of Gary Cooper Bell, a/k/a Gary C. Bell and Gary Bell, Case No. 09-PR-21—78 for a Decree of Descent now pending in the Carlton County, Minnesota, District Court. 2) There is.a.trike one) claim for recovery of medical assistance arising under Minn- : . Statutes. Section 2568.15, as amended, against the decedent named in the application for this Certificate and identified in the Estate of Gary Cooper Bell, a/k/a Gary C. Bell and Gary Bell and Case No. 09-PR—21-78 . Amount Decedent's Name Date of Birth Social Security # of Claim Gary Gary Cooper C. Bell Bell, and a/k/a Gary 4-; O Bell November 12, 1946 See Confidential Information Form 3) There under -strike Minn, ta Statutes one) claim Section of the for recovery of medical 2568.15, decedent as named amended. in the assistance arising against the following for this predeceased spouse(s) application Certificate. Predeceased Amount Spouse's Name Date of Birth Social Security # of Claim N ,A a? O Dated: m/ 25AM By Title: «flaw Qflmf , Carlton County Public Health and Human Services 14 N. 11‘“ Street P. O. Box 660 Cloquet, MN 55720 (218) 879-4511 IF A CLAIM APPEARS, CONTACT THE COUNTY AGENCY TO ARRANGE FOR PAYMENT AND SATISFACTION OF THE CLAIM. 788741