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STATE OF Pennsylvania
IN RE: ESTATE OF IN THE REGISTER OF WILLS
CHAD E BANJAK CUMBERLAND COUNTY
CASE#: 21-09-1152
STATEMENT OF CLAIM
1. Bank of America hereby presents for filing against the above estate this statement of claim
in the amount of $ $3,165.17 .
The basis for the claim is account number 4264296753368106 which was opened on
6/8/2004 .
2. The tax identification number of the claimant is sto33tasa .
3. The name and address of the claimant is BANK OF AMERICA FIA CARD SERVICES NA
DES-014-02-03, Estate Department, 1000 Samoset Drive, WILMINGTON, DE 19884
4. This claim IS NOT contingent.
5. This claim IS NOT secured.
6. The last payment made on the account was $ $597.22 on 12/3/2009 .
7. Please send payments to Bank of America DES-014-02-03, Estate Department, 1000 Samoset Drive,
WILMINGTON, DE 19884 .Please write the above account
number on your check.
Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true,
to the best of my knowledge and belief.
Executed this ~ day of February .2010
BANK OF AMERICA FIA CARD SERVICES NA
Claimant Name: Crai mi h
Claimant Signature:
State of Oklahoma County of Oklahoma
1N WITNESS WHEREOF, I have set my hand and notarial seal this
2 day February , 2010
O a ~:M
Notary Public
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CASE ;~'1-09-1152
IN )tE ESTATE OF: CHAT) E BANJAK
AFFIDAVIT OF ACCOUNT
The undersigned, being first duly sworn deposes and states the follows:
1. Your Affiant is authorized by the Claimant as its Authorized Representative to
make this Affidavit.
2. Your Affiant has reviewed the account records of the Claimant with respect to
the decedent. Your Affiant is familiar with these records and accounts and
reviews them as a regular part ofhis/her duties.
3. The Decedent purchased merchandise in the amount of $ $3,165.17
evidenced by account number 4264296753368106
Further your affiant sayeth not
Bank of America
By:
One of its Au t ed Rep
Printed Name: Craig Smith
BANK OF AMERICA FIA CARD SERVICES NA
DES-014-02-03, Estate Department, 1000 Samoset Drive,
WILMINGTON, DE 19884
1-877-767-9383
Subscribed and sworn before me
This 2 /~., of February 2010
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Public