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Home My WebLink About11-05-09 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF SIERRA C. ZEIGLER, A Minor N0. 2009-00659 AFFIDAVIT OF COMPLIANCE WITH DECREE DATED AUGUST 1Q. 2009 I, MICHAEL L. BANGS, Esquire, hereby affirm as follows: 1. Pursuant to the Decree of August 10, 2009, I caused a restricted account to be opened in the name of Sierra C. Zeigler with Fulton Financial Corporation in the amount of $57,824.20. The restriction on the account is in accordance with the August 10, 2009 Order whereby Sierra Zeigler shall not have access to those funds until she reaches majority, except as authorized by prior Order of Court. Attached hereto and marked as Exhibit A is a true and correct copy of the certificate of deposit with Fulton Financial Corporation. ~, MICHAEL L. BANGS SWORN TO AND SUBSG~tIBED BEFO E T IS ~-(C DAY OF , 2009. Q i~Ci O i-'n C> C OTARY P I '-'' cn ~ ~ vN3tii,!!W'"Ty~~3~ri V~~ r'i..cvcY~aY~~v:.i~~~•. ~ ~1a1 Seal ~ W VYctidy K Ste, No~ry Public ....~ .. Lar~r A1ren TVrp-, +~eAand ~Y ~ W Apy Commisaios~ E~lres May 10, X11 f' S`1 '" '..~ ~ <~ ~? ~' ~:i ~ C.~' ~'. _.. -~i i ='~ •-- r~t't E~rBiT ~` ~~N~ LISTENING i5 JUST THE BEGINNING.'" Fuhon Bank, NA CERTIFICATE OF DEPOSIT TERMS AND CONDITIONS -SUMMARY Certificate of Deposit Type: 12 Month CD Variable Rate Renewed CD #: Account No.: 022-0327482 Principal Amount: S 57,824.20 Registered Holder Name(s) and Address: SIERRA C. ZEIGLER COURT ORDERED HELD 08/10/2009 66 CHERRY LANE CARLISLE PA 17015 Issue Date: 11/02/2009 Maturity Date: 11/02/2010 Interest Rate: 1.5400 % Annual Percentage Yield: 1.55 Interest Distribution Method: Deposit to Account Savings Checking X Add to Principal Issue Check Mlnlmum Balance: $2,500.00 Frequency of Payment: Annually from Issue Date Tax ID Number(s): 200-74-7929 X Individual(s) Sole Proprietor Partnership Corporation Lodge/Similar Org. Bus. Trust Ltd. Liability Co. ^ Combined Statement -Transaction Account Number The Issuing Bank (the "Bank") acknowledges receipt, as of the Issue Date set forth above, of the above-described deposit (subject to collection of any funds not paid in cash), in accordance with the above Summazy, the accompanying Important Information About Your Certificate of Deposit (the "Important Information"), and (except for a Certificate of Deposit that is an Individual Retirement Account) the attached Rules, including the Arbitration Agreement. Issuing Bank:_ Fulton Bank. N.A. - ~~-~^ch Name: West Shore Office By: Authorized Si lure I/We have receive copy of the abov Summary, the accompanying Important Information, and (except for a Certificate of Deposit vtdual Retirement Account) the attached Rules, including the Arbitration Agreement, and I/We agree, on behalf of all Registered Holders, to the terms and conditions thereof. Individuals & Non-Individuals: Sole Proprietorships: Signature (primary) Narne /Title Signature Signature (secondary) Name /Title Signature Signature (secondary) Name /Title Signature Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding. You must cross out item 2 above if you have been notified by the IRS that you aze currently subject to backup withholding because of underreporting interest or dividends on your tax return. Signature (Primary Individual) Title (ifNon-Individual) Date FBCDSum.rpt 0312008 DIStrIWalOt1: CIFlDeposi[Of Pape 1 of 2 L • CIPAecount-Opening Checklist Date 11/02/2009 Bank # 1057 Department/Branch West Shore Office Employce name Type of account 12 Month CD Account number 022-0327482 Name (I) SIERRA C. ZEIGLER,_ Variable Rate Name (2) COURT ORDERED Ii~LD 08110!2009 EXISTING CUSTOMER #1 _ YcS - /Jthe customer is not known by the employee performing the trnnsacrion request, the customers identificntion must be requested. CUSTOMER ALPHA KEY: CUSTOMER ACCOUNT NUMBER: EXISTING CUSTOMER #2 _ YGS -ljthe customer is no( knorvn by the employee performing the transoctian request, she customers identifirntion must he requested. CUSTOMER ALPHA KEY: CUSTOMER ACCOUNT NUMBER: Date of birth (I) 03/19/1994 Date of birth (2) Address (Individuals -residential address/Businesses or Organizafions -principal place of business) (P.O. Boxes are not sufficient) bb CHERRY LANE CARLISt,E PA 17015 Taxpayer identification number (1) 200-74-7929 Taxpayer identification number (2) Pot entities that do not ye[ have a taxpayer identificaton number (TM), require the customer to have applied for a T1N and obtain a copy of [he application or other verification before opening the accounts. nnr1IMFNTC RFr ~Fn nN ' I ndivi dwl (1) SewsM f it irdividual is nm a61e to pte>auee the regaccd verification documem [i Type oClD __, ^ Type of lD f I Slate of issuance and ID numbers ^ State of issuance ud ID mtmbers __. tl Issue date ^ Issue date _-- ,~ ___ 8xpinlion dale - ^ Expiredon date _ Indivi dua I (?) Sewtd form if individual is not abk to produce the required vttiacatan document CI Type of ID ^ Type of ID ~-_ Slate of issuance and ID nunrhers ^ State of issuance sled ID numbers _ .___ Il Isune date _ ^ Issue date L I Expiration date 0 Expiration date _ _ nnr11MFNTC RFI 7Fn nN - Nnn-inelivi.(n.l I noel Fnfifiwa Corplration Partnership Cenificd Copy of Corponle Resclution ^ Partnership CertiEcation and Authorization Articles of Incorporation ^ Partnership Agreement (it vvriuen agreement exists) Dale of recording--- _, . Date of agreement- SUIe of recording_____ ^ Fictitious Name Registration (itapplicable) Date of registration State or County LL,C (Limited Liability Company) Tnuls Il LLC Certificate and Authorization ^ Trust Certifcate and Authorisation (Busilxss Trust) I i. Registntion or filing with the chartering state Date of recording_._ ^ Trust Agreement or Indrnture (Personal 1'rus[) State of recording---__ Date of agreement _ Estates Unincorporated Associations Origitul certificate of letters testamentary or levers of administre6on ^ Unincorporated Association Resolution Date of issuance _ ^ Bylaws, Charter or Organization Documents State or County Non-Individual Legal Entities PreseMirg Higher Risk Non-Individual Legal Entities Presenting Higher Risk Additional Information nn hrdividual Additional Information on Individual Nanre Name Address Address ___ TIN _--_ _. TP! Date of birth Date of birth Type of I D __ Type of ID State of issuatce and lD numbers Stale of issuance and ID numbers Issue date Issue date 8xpimtibn date Expiretion date Non-Uoeumen[arv Verircation .t. In certain circumstances it may notbe possible [o obtain photo identification. In these instances a minimum of"two types of the following items maybe used [o verify identity: Individual (I)/Business entity Independent verification through tmsted third party, credit bureaus or public databases (Example - ChexSyslems) .. Contacting [he customer via telephone or mail f l Verifying references with other financial institutions i I Obtaining financial statements, paystubs, W-2's and/or tax returns Obtaining utility statements (Isxample -electric, gas or water) as a secondary means of verifying an address is Public records of ownershipof the borrower's principal residence The above checked items were used to verify the identity of the applicant. Processor Name Date Individual (2) LI Independent verification through frosted third party, credit bureaus or public databases (Example - ChexSystems) I I Contacting the customer via telephone or mail Verifying references with other financial institutions I I Obtaining financial statements, paystubs, W-2's and/or tax realms f I Obtaining utility statements (Exailple -electric, gas or water) as a secondary ttuans of verifying an address I I Public records of ownership of the borrower's principal residence The above checked items were used to verify the identity of the applicant. Processor Name Date ChexSvs[ems Verification (1) No records No inquiries SS issuance Existing customer (2) No records No inquiries SS issuance Existing customer EeCDSum.rpl oai2oos Distribution: CIF/Depositor Page 2 or 2