Document for MARTHA M HUMBIRD DECEASED (E-CASE)

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                                Electronically Filed - CASS - March 05, 2024 - 03:56 PM
                 MISSOURI DEPARTMENT OF SOCIAL SERVICES
                                                                                                         24CA-PR00060
                 MO HEALTHNET DIVISION
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                 ESTATE NOTICE
1. DECEDENT NAME                                                        2. MO HEALTHNET PARTICIPANT NUMBER (IF KNOWN)

           MARTHA
            spencer E.M.
  Billie L.LEROY         HUMBIRD
                      HUMBIRD
3. DATE OF BIRTH                                4. DATE OF DEATH                               5. SOCIAL SECURITY NUMBER

         OCTOBER20,
     NOVEMBER
  01/10/1937     11, 1961
                     1966                           SEPTEMBER
                                                   JANUARY
                                                 11/14/2020     12, 2023
                                                            9, 2024                             493-80-8381
                                                                                               497-34-5096
6. SURVIVING SPOUSE                     LEROY E. HUMBIRD
  X YES         ✔ NO          NO SURVIVING
                                        (DECEASEDSOUSEAS OF 1/9/2024)
                       Name: ______________________________________________________________

7. CHILDREN UNDER AGE 21 IN HOME                                        8. IS THERE A BLIND OR DISABLED DEPENDENT IN THE HOME

     YES        ✔ NO                                                       YES      ✔ NO
9. COUNTY OF ESTATE FILING                      10. DATE ESTATE FILED                          11. BALANCE OF ASSETS

   Clay
  Cass          Cass                            Pending
                                                03/15/2021                                       $400,000
                                                                                               Less than $5,000
12. ATTORNEY NAME

  Terence M. O’Malley
13. STREET ADDRESS, CITY, STATE, ZIP CODE

  1050 W Blue Ridge Blvd, Kansas City, MO 64114
14. TELEPHONE NUMBER                                                    15. FAX NUMBER
                                                                           Text
  (816) 730-9888                                                          terence@omalleylawkc.com
16. EXECUTOR, PERSONAL REPRESENTATIVE, OR CONSERVATOR NAME

  To be named:
     Crystal M.Thomas
                Regan Spencer
17. STREET ADDRESS, CITY, STATE, ZIP CODE

  26105 East 267th St., Harrisonville, MO 64071

18. SIGNATURE                                                                                              19. DATE

     Terence M. O’Malley                                                                                       02/16/2024
                                                                                                             03/16/2021



            FAX: (573) 526-1162

Mail:       Department of Social Services
            MO HealthNet Division
            ATTN: Cost Recovery Unit
            PO Box 6500
            Jefferson City, MO 65102-6500

            TELEPHONE: (573) 751-2005

            EMAIL: MHD.COSTRECOVERY@dss.mo.gov


FOR MO HEALTHNET DIVISION USE ONLY

      Decedent was a MO HealthNet Participant. Case will be reviewed to determine if referral to be made to Attorney General Office for filing
      claim.


      Decedent was not a MO HealthNet Participant. Waiver issued on: _______________________________

MO HEALTHNET DIVISION SIGNATURE                                                                            DATE



MO 886-4354 ( -1 )