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IN THE COURT OF COMMON PLEAS OF THE JUDICIAL
OFFICES OF PENNSYLVANIA
CUMBERLAND COUNTY BRANCH
ORPHANS COURT DIVISION
Estate of Frank Toth, late of Shippensburg, Pennsylvania, deceased March 26, 2007
Pennsylvania File # 21-07-0497
FIRST AND FINAL ACCOUNT OF ~
ORRSTOWN BANK, SHIPPENSBURG, PA =~~ ~ ~ '; . -
EXECUTOR ~ n ~
DATE OF LAST WILL AND TESTAMENT: November 7, 2006 .~
:r; ~ _ _,
m
DATE OF DEATH OF FRANK TOTH: March 26, 2007 -~~ O -~ ~_ >
DATE OF LETTERS TESTAMENTARY: May 18, 2007 ~_.~C ~
ACCOUNT STATED FOR THE PERIOD: May 9, 2007 to May 15, 2008 '~ ~ .~ -'
DATE OF ADVERTISING LETTERS TESTAMENTARY: ~ O -
NEWS-CHRONICLE January 1, 8 & 15, 2008 ~p
CUMBERLAND LAW JOURNAL January 4, 11, 18, 2008
Purpose of Account: Orrstown Bank, Shippensburg, Pennsylvania, Executor, offers this Account to acquaint
interested parties with the transactions that have occurred during their administration of the Estate. The Account
also indicates the proposed distribution of the Estate.
It is important that the Account be carefully examined. Requests for additional information or questions or
objections can be discussed with:
Daniel K. Baer, Trust Officer
Orrstown Bank
77 East King Street
Shippensburg, PA 17257
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SUMMARY OF ACCOUNT
FIDUCIARY ACQUISITION VALUE
PAGE
PRINCIPAL
RECEIPTS 1 $380, 744.77
DISBURSEMENTS 1 & 2 -$115,978.36
GAIN/LOSS ON SALES 2 -$7 352.73
PRINCIPAL BALANCE ON HAND 2 $257,413.68
INCOME
RECEIPTS 2 $8,140.55
INCOME BALANCE ON HAND 2 $8,140.55
COMBINED BALANCE ON HAND $265 554.23
PROPOSED DISTRIBUTIONS 3 $265 554 23
PRINCIPAL RECEIPTS
05/22/2007 CONTRIBUTION RECEIVED-CHECK FROM CONOCOPHILLIPS 5246.00
05/22/2007 CONTRIBUTION RECEIVED -PROCEEDS FROM CLOSED ORRSTOWN BANK CHECKING ACCOUNT #501840 $2,825.00
06!04!2007 CONTRIBUTION RECEIVED -CHECK FROM CONOCOPHILLIPS 5246 00
06/07/2007 CONTRIBUTION RECEIVED-CHECK FROM CONOCOPHILLIPS $410.00
06!12/2007 DIVIDEND RECEIVED FROM COMPUTERSHARE / GM $2.50
07/03/2007 CONTRIBUTION RECEIVED - PPBL DIVIDEND @ $0.3050 $122.00
07/24/2007 CONTRIBUTION RECEIVED -PROCEEDS OF SALE OF 200 SHARES PPL $9.674 00
7 CONTRIBUTION RECEIVED-PROCEEDS OF SALE OF 446.440! SHS. OCCIDENTAL PETROLEUM $24,338.03
08!20!200
08!20/2007 CONTRIBUTION RECEIVED-PROCEEDS OF SALE OF 300 SHS. CONOCOPHILLIPS $23,626.77
00 7 CONTRIBUTION RECEIVED - 10% DOWNPAVMENT RECEIVE[ FROM TROY WISER ON REAL ESTATE $10,600.00
0 8/2 012 TRIBUTION RECEIVED - 10 % DOWNPAYMENT RECEIV E[ FROM KONRAD 8 SUELLEN STRAWMYRE ON REAL ESTATE $7,600.00
08/20/2007
09/13/2007 CON
10 % DOWNPAYMENT RECEIVED ON 08/20!07 FROM BUYERS ON 1 EAST BURD STREET REAL ESTATE -37600.00
10/16/2007 SECURITY DEPOSIT PAID PRIOR TO SETTLEMENT BY TROY WISER; 29-29 1/2 NORTH EARL ST -510,600.00
10!30/2007 CONTRIBUTION RECEIVED-CHECK FROM PERSHING (ACCT #4N2-250732-1) $1,488.40
11/15/2007 CONTRIBUTION RECEIVED -CHECK FROM COMMUNITY BANKERS INS. AGENCY FOR "PREMIUM RETURN" $772.86
11!2012007 CONTRIBUTION RECEIVED -DIVIDEND CHECK FROM CONOCOPHILLIPS $410.00
12!12/2007 CONTRIBUTION RECEIVED -CHECK FROM GM (GOMPUTERSHARE, INC.) $2.50
01/30/2008 CHECK RECEIVED FROM THE COMMONWEALTH OF PA FOR UNCLAIMED PROPERTY (CLAIM #99962321) $25.00
05102!2008 CONTRIBIITION RECEIVED -CHECK FROM COMMONWEALTH OF PA $5.181.03
SUBSEQUENT PRINCIPAL RECEIPTS:
0 510 912 00 7 DEPOSIT 1 SHARES MCCLAYS MILL RD LAND SHBG PA $27,000.00
05/092007 DEPOSIT 1 SHARES 1 EAST SURD STREET, SHIPPENSBURG. PA $85,000.00
05/09/2007 DEPOSIT 1 SHARES 29-29 1/2 NORTH EARL ST., SHIPPENSBURG, PA $115.000.00
051092007 DEPOSIT 32846.03 SHARES FEDERATED MONEY MARKET FUND 851-PRINCIPAL $32.846.03
09/26!2007 DEP 200 SHS OCCIDENTAL PETE CORP DEL COM 59.662.00
09/2712007 DEP 120.9652 SHS DAIMLERCHRYSLER AG ORD $9,769.75
11/28!2007 DEP 200 SHS @ DOD VALUE P P 8 L RES INC COM $7.946.00
11/28/2007 DEP 10 SHS @ DOD VALUE GENERAL MTRS CORP COM $319.65
11/29/2007 DEP 300 SHS @ DOD VALUE CONOCOPHILLIPS COM $20,850.00
01!02/2008 DEP 75 SHS KLM ROYAL DUTCH AIR $2,98125
TOTAL PRINCIPAL RECEIPTS $380,744.77
DISBURSEMENTS OF PRINCIPAL
05/16/2007 BALHARA INTERNAL MED ASSOC PC BALANCE DUE FOR FRANK TOTH -561.59
0 511 712 0 0 7 BOROUGH OF SHIPPENSBURG FRANK TOTH ESTATE -$425.57
0 511 7 /2 0 07 BOROUGH OF SHIPPENSBURG FRANK TOTH ESTATE -$132.25
05/17/2007 PENELEC FRANK TOTH ESTATE -$17.62
05/18!2007 REGISTER OF WILLS. CUMBERLAND COUNTY PROBATE FEES -$380 00
06/14/2007 PENELEC FRANK TOTH ESTATE -$5 15
06!14!2007 FRY 8 BRANNAC OPHTHALMOLOGY ASSOC. FRANK TOTH / ID'. 4320 -$12.42
06!26/2007 REGISTER OF WILLS, CUMBERLAND COUNTY FRANK TOTH /FILE #21-07-0497 -534,637.74
07/06!2007 PENELEC FINAL BALANCE DUE FOR THE FRANK TOTH EST -$4.81
07/11/2007 MARGARET STEFANOWICZ REIMBURSEMENT FOR FINAL 8 FUNERAL -$2,018.14
07!11/2007 MIKE BLACK CONSTRUCTION, LLC BALANCE DUE FOR FRANK TOTH ESTATE -$126.00
0 711 8/2 0 0 7 REVERSE SOCIAL SECURITY BENEFITS RECEIVED AFTER DATE OF DEATH -5434.00
07/20!2007 BOROUGH OF SHIPPENSBURG RENTAL APPLICATION FEE FOR THE -$64.00
07/20/2007 U.S. DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE -$434.00
07!31/2007 WELLS FARGO BANK, N.A. INDEMNITY BOND FEE TO REPLACE -5191.00
08/03!2007 MILLVILIE MUTUAL INSURANCE PREMIUM FOR -$321.00
08/0712007 PENELEC FRANK TOTH ESTATE -$8.96
0 810 812 0 0 7 DEL 1 SHS/PAR MCCLAYS MILL ROAD PROPERTY DELIVERED TO EMMA TOTH AS JTWROS -$27.000.00
08/10/2007 REGISTER OF WILLS. CUMBERLAND COUNTY FIVE SHORT CERTIFICATES FOR TOTH ESTATE -520.00
08/17/2007 COMPUTERSHARE SURETY BOND FEE -$20.00
08/202007 MELLON INVESTOR SERVICES FRANK TOTH ESTATE -$312.72
DISBURSEMENTS OF PRINCIPAL (CONTINUED)
08/21/2007 CARL E. OCKER, AUCTIONEER ADVERTISING FEES FOR FRANK TOTH ESTATE -$711.50
08/21/2007 CARL E. OCKER, AUCTIONEER COMMISSION ON 2 E BURD STREET RE SALE & -$5,460.00
08/29/2007 REGISTER OF WILLS, CUMBERLAND COUNTY 5 SHORT CERTIFICATES -$20.00
09/05/2007 SAFECO INSURANCE CO. OF AMERICA SURETY BOND FEE TO REPLACE 61 SHARES -$98.34
0 911 3 /2 00 7 PRORATED REAL ESTATE TAXES 1 EAST BURD STREET. SHIPPENSBURG, PA -$1,512.10
09/13/2007 1 % REAL ESTATE TRANSFER TAX 1 EAST SURD STREET, SHIPPENSBURG. PA -$760.00
09/13/2007 NOTARY FEE 1 EAST BURD STREET, SHIPPENSBURG. PA -$5.00
09/13/2007 FINAL WATER. SEWER. TRASH BILL 1 EAST BURD STREET, SHIPPENSBURG. PA -$287.27
09/14/2007 PENELEC FRANK TOTH -$17.59
10/05/2007 PENELEC FRANK TOTH -$9.04
10/12/2007 MELLON INVESTOR SERVICES LOST INSTRUMENT BOND TO REPLACE 500 -$645.90
10112/2007 MELLON INVESTOR SERVICES LOST INSTRUMENT BOND TO REPLACE 300 -5462.17
10/16/2007 1 % TRANSFER TAX 29-29 112 NORTH EARL ST _. SHIPPENSBURG, PA -$1,060.00
10/16/2007 PRORATED REAL ESTATE TAXES -$827.56
10/16/2007 FINAL WATERISEWER BILL -$1.022.17
11/20/2007 CITIBANK BOND PREMIUM AND PROCESSING FEE TO -$104.00
1 112 0/2 0 0 7 REGISTER OF W LLS, CUMBERLAND COUNTY 3 SHORT CERTIFICATES -$12.00
1 212 112 00 7 REGISTER OF WILLS, CUMBERLAND COUNTY ADDITIONAL PROBATE FEE -$50.00
12!21/2007 REGISTER OF WILLS, CUMBERLAND COUNTY FILING FEE FOR PENNSYLVANIA INHERITANCE -515.00
03!13/2008 CUMBERLAND LAW JOURNAL ADVERTISING FOR THE FRANK TOTH ESTATE -$75.00
04/11/2008 THE NEWS-CHRONICLE CO. ADVERTISING LETTER TESTAMENTARY -$104 75
RESERVED:
ORRSTOWN BANK, EXECUTOR FEE -$21,092.00
JOEL ZULUNGER, ATTORNEY FEE -$14,500 00
FILING FEES -$500 00
TOTAL DISBURSEMENTS OF PRINCIPAL -$L15 978.36
PRINCIPAL GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS
PRINCIPAL PROCEEDSIACOUISITION VALUE GAINILOSS
09/13/2007 SOLD PROPERTY-1 EAST BURD ST., SHIPPENSBURG $76.000.00/$85,000.00 -$9,000.00
09/27!2007 SOLD 120.9652 SHS @ $92.72 DAIMLERCHRYSLER AG $11,201.43/$9.769.75 $1,431.68
1 0/1 612 0 0 7 SOLD 1 REAL ESTATE 29 291/2 N.. EARL ST., SHIPPENSB URG $106,000 001$115.000.00 -$9,000.00
12/05/2007 SOLD 300 @ 79.63 CONOCOPHILLIPS $23,868.63/$20,850 00 $3.018.63
12/05!2007 SOLD 10 @ 29.83 GENERAL MOTORS CORP $278.29!$319.65 -$41.36
12/05!2007 SOLD 200 @ 69 26 OCCIDENTAL PETROLEUM CORP $13,831.78!$9,662.00 $4,169.78
01/02/2008 SOLD 200 SHS @ $51.95 PP&L RES. INC $10,390.84/$7,946.00 $2,444.84
0 111 4/2 0 0 8 SOLD 75 @ 35 KLM ROYAL DUTCH AIR $2,604.95/$2,981.25 -$376.30
TOTAL GAINIIOSS $7 3b_2.73
PRINCIPAL BALANCE ON HAND
FEDERATED MONEY MARKET FUND $2.57 413,68
INCOME RECEIPTS
FEDERATED MONEY MARKET FUND
05/09/2007 DEPOSIT 269.01 SHARES FED MONEY MARKET FUND $269 01
06/01/2007-5/112008 DIVIDENDS RECEIVED $7,338.20
06/07/2007 MISC. DIVIDENDS RECEIVED FOR F. TOTH ACCT #2057 $37.70
09!1012007 DIVIDEND RECEIVED FROM COMPUTERSHARE / GM $2.50
09/10/2007 DIVIDEND RECEIVED FROM CONOCOPHILLIPS $246.00
10/11/2007 DIVIDEND RECEIVED-PPL $61.00
01/02/2008 DIVIDEND RECEIVED FROM PPL $61.00
01/03/2008 DIVIDEND RECEIVED KLM ROYAL DUTCH AIR $83.52
01/14!2008 DIVIDEND RECEIVED KLM ROYAL DUTCH AIR $41.62
X8,140.55
INCOME BALANCE ON HAND $8 140x55
PROPOSED DISTRIBUTION TO BENEFICIARIES
SHIPPENSBURG PRESBYTERIAN CHURCH $50,000.00
SHIPPENSBURG, PA 17257
TOTH SANDOR
1184 BUDAPEST, XVIII
LAKATOS, U. 32/B I/4, HUNGARY
TOTAL PROPOSED DISTRIBUTIONS
$215,554.23
$265, 554.23
3
VERIFICATION
Orrstown Bank, by Daniel K. Baer, Trust Officer, Executor of the Will of
FRANK TOTH, Deceased, hereby declares under oath that it has fully and faithfully
discharged the duties of its office; that the foregoing First and Final Account is true and
correct and fully discloses all significant transactions occurring during the accounting
period, that all known claims against the Estate have been paid in full, that, to it's
knowledge, there are no claims outstanding against the Estate; that all taxes presently due
from the Estate have been paid; and that the grant of Letters Testamentary and the first
complete advertisement thereof occurred more than four months before the tiling of the
foregoing First and Final Account.
ORRSTOWN AN K, EXECUTOR
(BY DANIEL K. BAER, T`RUS'T OFFICER)
DATED: ~ ~f ~~
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DECEDENT'S ESTATE ~ "c~ ~"~~ ~ ~ "'
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COURT OF COMMON PLEAS OF ' '~' ~'~
CUMBERLAND COUNTY, PENNSYLVANIA ._~.~ -~ ~•:~ ~-~
ORPHANS' COURT DIVISION ~,.
This form may be used in all cases involving the Audit of the Account of a Decedent's Estate. If
space is insufficient, riders naay be attached. Attach the spouse's election, if any; the papers
required under items 8-19 inclusive; and any instrument pertinent to the adjudication.
No. 21-07-0497
DECEASED
PETITION FOR ADJUDICATION /
STATEMENT OF PROPOSED DISTRIBUTION
PURSUANT TO Pa. O.C. Rule 6.9
ESTATE OF FRANK TOTH
INCL UDE ATTACHMENTS AT THE BACK OF THIS FORM.
Name of Counsel: JOEL R. ZULLINGER, ESQUIRE
Supreme Court [.D. No.: 17516
Name of Law Firm: ZULL[NGER/DAVIS LAW OFFICE
Address: 14 NORTH MA[N STREET, SUITE 200, CHAMBERSBURG, PA 17201
Telephone: 717-264-6029
Fax: 717-264-1884
Form OC-0! rer. !0.13.06
Page 1 of 10
t
i
Estate of FRANK TOTH ,Deceased
1. Name(s) and address(es) of Petitioner(s):
A%ame: ORRSTOWN BANK, EXEC.
Andress: 77 EAST KING STREET
SHIPPENSBURG, PA 17257
Identify any executors or administrators who have not joined in the Petition for
Adjudication and Statement of Proposed Distribution and state reason:
Is this the first accounting by this fiduciary? ..................... ®Yes ~ No
If not, identify prior accountings, the accounting periods covered, and the date of
adjudication of the prior accounting.
2. Decedent died on 3/26/07
Q Letters Testamentary or ~ Letters of Administration were granted to Petitioner(s) on
5/18/07
Date of Will (rf applicable): 1 1 ~~~~~
Date(s) of Codicil(s) (rf applicable):
Date of probate (if different from date Letters granted):
Was a bond required? DYes ®No If yes, state amount:
Are proofs of advertising of the grant of Letters attached? ......... ~ Yes ~ No
Dates of advertising of the grant of Letters: 1 / 1 /08: 1 /4/08: 1 /8/08: 1 /1 1 /08: 1 /15/08:
1 / 18/08
Form OG01 rev. 10.13.06
Page 2 of 10
Estate of FRANK TOTH
Deceased
3. Was decedent survived by a spouse? ............................. Yes ~ No
If yes, name of the surviving spouse: EMMA C. WENTZEL
4. Has the surviving spouse filed to take an elective share? ............. Yes ~ No
(See Section 2201 et sue. of the Probate, Estates and Fiduciaries Code)
If yes, date of election:
5. In the case of an intestacy, state the names of the decedent's surviving children or
surviving issue of deceased children (if none, so state):
NONE
6. Did decedent marry after execution of Will or Codicil(s)? ........... ~ Yes ~ No
Were any children born to decedent after execution of
Will or Codicil(s)? ........................................... ~ Yes ~ No
If yes, give names and dates of birth:
Nanae:
Date of Birth:
7. If required by the Medical Assistance Estate Recovery Act,
62 P.S. § 1412, was a request for a statement of claim sent to
the Department of Public Welfare? .............................. Yes ~ No
FormOGOI rer. /0.!3.06
Page 3 of 10
Estate of FRANK TOTH
Deceased
Written notice of the Audit as required by Pa. O.C. Rules 6.3, 6.7 and 6.8 has been or will be
given to all parties in interest listed in item 9 below, all unpaid creditors and all claimants
listed in item 10 below. In addition, notice of any questions requiring Adjudication as
discussed in item 14 below has been or will be given to all persons affected thereby.
A. If Notice has been given, attach a copy of the Notice as well as a list of the names
and addresses of the parties receiving such Notice.
B. [f Notice is yet to be given, a copy of the Notice as well as a list of the names and
addresses of the parties receiving such Notice shall be submitted at the Audit
together with a statement executed by a Petitioner or counsel certifying that such
notice has been given.
C. If any person entitled to Notice is not sui juris (e.g., minors or incapacitated
persons), Notice of the Audit has been or will be given to the appropriate
representative on such party's behalf as required by Pa. O.C. Rule 5.2.
D. If any charitable interest is involved, Notice of the Audit has been or will also be
given to the Attorney General as required under Pa. O.C. Rule 5.5. In addition, the
Attorney General's clearance certificate (or proof of service of Notice and a copy
of such Notice) must be submitted herewith or at the Audit.
9. List all parties (charitable and non-charitable) of whom Petitioner(s) has/have notice or
knowledge, having or claiming any interest in the estate as beneficiaries under the Will or
Codicil(s) or as intestate heirs if there is a complete or partial intestacy:
A. State each party's relationship to the decedent and the nature of each party's
interest(s):
Name and Address of Each Parry in /merest ~ Relationship and Comments, rf any ~ /merest
SH[PPENSBURG NONE $50,000 BEQUEST
PRESBYTERIAN CHURCH
SHIPPENSBURG, PA 17257
TOTHSANDOR BROTHER
1 184 BUDAPEST, XVIII
LAKATOS U. 32/B I/4
HUNGARY
100% ESTATE
RESIDUE
FormOC-0/ rev. !0./3.06 Page 4 of 10
Estate of FRANK TOTH
Deceased
B. Identify each party who is not sui juris (e.g., minors or incapacitated persons).
For each such party, give date of birth, the name of each Guardian and how each
Guardian was appointed. If no Guardian has been appointed, identify the next of
kin of such party, giving the name, address and relationship of each.
C. State why a Petition for Guardian/Trustee Ad Litem has or has not been filed for
this Audit (see Pa. O.C. Rule 12.4).
D. If distribution is to be made to the personal representative of a deceased party,
state date of death, date and place of grant of Letters and type of Letters granted.
corm oc-o~ re.•. gyn. t3.n6 Page 5 of 10
Estate of FRANK TOTH ,Deceased
10. Other than the claim for the family exemption, list the names of all known claimants and
the amount of their claims and state whether each claim is admitted.
Name and Address of Each Claimant Anrovnt of Claim Claim
Admined? Will Claim
Be Paid In
Ful!?
Yes ~ Yes
~No No
Yes ~ Yes
~No ~ No
Yes ~ Yes
~No ~ No
Yes ~ Yes
~No ~ No
[f the estate is insolvent, attach a schedule setting forth the order of preference under
20 Pa.C.S. § 3392 and the proposed payments.
11. Was family exemption claimed? ................................ Yes ~No
Was family exemption allowed? ................................ Yes No
Family exemption claimant's name and relationship:
Name:
Relationship:
Forrn OC-0/ rer. l0.13.06 Page 6 of l 0
Estate of FRANK TOTH
Deceased
12. The amount of Pennsylvania Transfer Inheritance Tax and additional Pennsylvania Estate
Tax paid, the date(s) of payment(s), and the interest(s) upon which paid, are as follows:
Dare Payment Interest
6/26/07
34,637.74
l3. On the date of death, was the decedent a fiduciary
(personal representative, trustee, guardian, agent under power
of attorney) or surety on the bond of a fiduciary? ................... ~ Yes No
If yes, provide the name of the estate, indicate whether an account has been filed and
confirmed absolutely and all awards performed, or, in the alternative, how the
decedent's estate will be discharged for the decedent's fiduciary administration of the
estate.
14. A. Describe in detail any questions requiring adjudication and state the position of the
Petitioner(s) as to each question:
B. Has notice of the question requiring adjudication been given
to the parties identified in Paragraph 9 above? .................. ~ Yes ~ No
I5. [f Petitioner(s) has/have knowledge that a share has been assigned, renounced, disclaimed
or attached, provide a copy of the assignment, renunciation, disclaimer or attachment,
together with any relevant supporting documentation.
Form OGO/ rev. !0.13.06 Page 7 of 10
Estate of FRANK TOTH
Deceased
16. Had the decedent been adjudicated an incapacitated person? .......... Yes ~ No
If yes, attach a copy of the Order if available; otherwise state the Court, term, number,
date, and name of Hearing Judge.
17. A. List or attach a separate list of additional receipts and disbursements since the closing
date of the Account.
B. Has notice of the additional receipts and disbursements been
given to the parties identified in Paragraph 9 above? ............. Yes ~ No
18. If a reserve is requested, state amount and purpose.
Amo:inr: 36,092.00
Pt"p°Se: ATTORNEY AND EXECUTOR FEES; FILING FEES
If a reserve is requested for counsel fees, has notice of the
amount of fees to be paid from the reserve been given to the
parties in interest? ........................................ Yes No
If so, attach a copy of the notice.
19. [s the Court being asked to direct
the filing of a Schedule of Distribution? .......................... Yes ~No
As to real estate only? ........................................ Yes No
FormOC-0/ rer. /0.!3.06
Page 8 of 10
Estate of FRANK TOTH
Deceased
Wherefore, your Petitioner(s) ask(s) that distribution be awarded to the parties entitled
and suggest(s) that the distributive shares of income and principal (residuary shares being stated
in proportions, not amounts) are as follows:
A. Income:
Proposed Distributee(s)
TOTH SANDOR
B. Principal:
Proposed Distrib~rtee(s)
SHIPPENSBURG PRESBYTERIAN CHURCH
TOTHSANDOR
AmoanliProportion
8,140.55
AmoundProporiron
50,000.00
207,413.68
Submitted By:
(All petitioners must sign.
Add additional lines if necessary):
me of P itione : O WN BANK, EXEC.
r
Name of Petitioner: r
Form OG01 rev. 10.13.06 Page 9 of 10
Estate of FRANK TOTH
Verification of Petitioner
(Verification must be by at least one petitioner.)
The undersigned hereby verifies * [tha hei l,e
of the above-named name of corporation ORRSTOWN BANK
Deceased
and] that the facts set
forth in the foregoing Petition for Adjudication /Statement of Proposed Distribution which are
within the personal knowledge of the Petitioner are true, and as to facts based on the information
of others, the Petitioner, after diligent inquiry, believes them to be true; and that any false
statements herein are made subject to the penalties of 18 Pa. C.S. § 4904 (relating to unsworn
falsification to authorities).
/'
igna eti ner
* Corporate petitioners must complete bracketed information.
is axle TRUST OFFICER
Certification of Counsel
The undersigned counsel hereby certifies that the foregoing Petition for Adjudication/
Statement of Proposed Distribution is a true and accurate reproduction of the form Petition
authorized by the Supreme Court, and that no changes to the form have been made beyond the
responses herein. r ~ ~. ,q~-` f
Signature f Counsel for Petitioner
Form OGOI rev. /0. /3.06 Page 10 of 10