HomeMy WebLinkAbout09-17-09 ~-~7c~
Date - ~p ,~~~ Z p D ~
To the Register of Wills: ~`
I, Cathy A. Cohill, born on September 29, 1961, Social Security Number 173-56-9663,
residing at 231 Frost Road, Gardners, PA 17324, do hereby do a disclaimer and am not
receiving any money from the Certificate of Deposit, Account Number 017-2992270
from my deceased father, Robert J. Yinger, Social Security Number 179-30-4032, whose
residence was 7 Village Lane, Newville, PA 17241.
MY name has been taken off the Certificate, and all money goes to my mother, Shirley A.
Yinger, Social Security Number 177-30-8101, who resides at 7 Village Lane, Newville,
PA 17241.
I am enclosing a copy of the original Certificate with the three names listed, and a new
revised Certificate with only my mother's name listed which shows my name is no longer
on the Certificate.
In witness whereof the parties here to have hereunto set their hands and seals the day and
year above written.
C~athy~A. C~ohill /~ p n (~
C v Q • l~~X.
Shirley A. Yinger
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~_~ a ooG Witnessed and Notarized by
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MY CommNNM ~E ,h+n !1, 7111
oUh1tHU OF GVLLLG i IUD ~,.
AND TAXPAYER SERVICES
SEP T 7 200fJ J,
DEPARTMENT OF REVENUE
1ARRISBUHG DISTRICT OFFICE
Certificate of Deposit Receipt
This receipt is issued to:
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Member Number:
Account Number.~-
IRA Number.
:-~-
RBYS.DIGER
SHIRLEY R YINGER
('D TUV-r
7 VILLAGE LANE
;NEWVILLE PA 17291
F&M Trust
PO BOX 6010
Chatnbersburg, PA
{717) 264-6116
17201
Amount
Date Opened
Term
Maturity Date "'1'"t-=
Interest Rate R.q.
Annual Percentage Yield
The account evidenced by this receipt is subject to and Earths explained in the terms and conditions contained in the account
agreement and account disclosures. The account ie Not Negotiable and Not Transferable. Only the items checked apply.
1X Flzed Iatereat hate 1 Variable IntetYSt Rate
1X Additions Permitted
1X Automatkauy Renewable I Single Maturity (not automatically renewable) 1 Callable 1 Nodtt Account
Interest will be:
1 mailed to the owner(s).
I added to principal (compounded).
1 paid to DD Account account No.
1
*~* DDITIONS ONIY PFRMrTTFD AT hnrrtRITY M7r+rertn ca00
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Certificate of Deposit Receipt
This receipt is issued to:
~SHIRLEY R YINGER
7 VILLAGE LN
:NEWVILLE PA 17291
Member Number:
Account Number. ~j~ ~'fQ
IRA Number:
Amoant s i v o o a ~,,~
Date Opened / i I S d
Term
Maturity Date 5 O
Interest Rate 3. ~
` Annual Percentage Yield _ ~/ DO ~
F6M Trust
PO BOX 6010
Chambersburg, PA 17201
(717} 269-6116
The accoum evidenced by this receipt is subject to and further explained in the terms and conditions contained in the account
agreemem and account disclosures. The account is Not Negotiable affi Not Transferable. Only the items checked apply.
® Fixed Interest Rate ^ Variable Interest Rate
® Additlona ]Permitted
QI Autom~lly Renewable ^ S1n~e Maturity (sot automatically recewable) ^ Callable ^
Notice Account
Interest will be:
^ mailed to the owner(s).
® added to principal (compounded).
^ paid to DD Ac . un account No.
**ADDrTrONS ONLY PFrzMrTTFp AT rpmr7Rrmt hrNrnrm csnn
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