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Home My WebLink About08-21-12Z:\Est\MIS`,"cAfoos.Carol - AFFIDAVIT 8-20-2012.wpd IN RE: ESTATE OF CAROL DIANE IN THE COURT OF COMMON PLEAS McAF00S OF CUMBERLAND, PENNSYLVANIA LATE OF MECHANICSBURG CLERK OF ORPHANS' COURT BOROUGH, CUMBERLAND COUNTY, PENNSYLVANIA FILE N0. 21-12-0323 AFFIDAVIT REGARDING COMPLIANCE WITH OR1d~R C ~ ~~; .~~ ~-~ ,_.. , COMMON~~EALTH OF PENNSYL~IANIA r- ~- ; ~ ~,, . -. COUNTY OF CUMBERLAND ~~ -t~ ~ --,--; AIv1D NOW THIS, ~:;~~~-~ day of August, 2012, D~r'd H. ~Storn~~e~' ~.n ~ .~ r- counsel for Petitioner in the above-captioned matter, being duly sworn make the following affidavit regarding compliance with the Order :~f Court of June 6, 2012: 1 Guardian received redemption checks from American Funds payable to Leauna Marie Oliver and Richard L. Pivovarnik as Guardian, as follows: $1,874.73 and $1,256.95. 2. Guardian received redemption checks from American Equity Investment Life Insurance Company payable to Leauna Marie Oliver and Richard L. Pivovarnik as Guardian, for $16,983.86. 3. On August 10, 2012, Guardian deposited at Members 1st Federa=. Credit Union the aforesaid checks and purchased a certificate of deposit in the name of Leauna Marie Oliver, c/o Richal:d L. Pivovarnik as Guardian, totaling $20, 115.54 . A copy of the cel~~tificate application and receipt of the deposit is attached as Exh; bit `~A" . 4 Guardian received redemption checks from American Equity Invest~.ent Life Insurance Company payable to Leauna Marie Oliver and Richard L. Pivovarnik as Guardian, for $25,642.36. -1- i,y~ ~ ifJ 5-, On August 10, 2012, Guardian deposited at Members 1St Federa~_ Credit Union the aforesaid check and purchased a certif._cate of deposit in the name of Leauna Marie Oliver, c/o Richard L. Pivovarnik as Guardian, totaling $25, 642.36. A copy of the certificate application and receipt of the deposit is attached as Exhibit "B". 6. Guardian received redemption checks from American Funds payable to Mary Jane Oliver and Richard L. Pivovarnik as Guardian, as follows: $1,874.76 and $1,256.91. 7. Guardian received redemption checks from American Equity Investi~lent Life Insurance Company payable to Mary Jane Oliver and Richar~.~ L. Pivovarnik as Guardian, for $16, 983.87. 8. On August 10, 2012, Guardian deposited at Members 1St Federa Credit Union the aforesaid checks and purchased a certificate of deposit in the name of Mary Jane Oliver, c/o Richard L. Pivovarnik as Guardian, totaling $20,115.54. A copy of the certificate application and receipt of the deposit is attached as Exhibit "C". 9. Guardian received redemption checks from American Equity Investrr~.ent Life Insurance Company payable to Mary Jane Oliver and Richard L. Pivovarnik as Guardian, for $25,642.36. 1~~. On August 10, 2012, Guardian deposited at Members 1St Federal Credit Union the aforesaid check and purchased a certif~_cate of deposit in the name of Mary Jane Oliver, c/o Richar,_~ L. Pivovarnik as Guardian, totaling $25, 642.36. A copy of -2- the certificate application and receipt of the deposit is attached as Exhibit "D". 11 Counsel for the Petitioner is awaiting the additional checks before creating certificates in accordance with the Order of Court of June 6, 2012. 1~ . Counsel for Petitioner will file an additional Affidavit certifying compliance with this order upon completion of the final transf~:rs . B Subscribed and sworn to before me this ~x'~~ day o f -~ ~~ ~ 2 012 . -~ :- °'1Clotary Public COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL JENNIFER A. MEARKLE, Notary Public Ne~~~ Cumberland Boro. Cumberland Co. 111y Commission Expires July 7, 2016 -3- F. St • MEMBERS Ise FEDERAL CREDIT UNION 5000 Louise Drive Mechanicsburg, PA 17055 (800)283-2328 EXHIBIT "A" CERTIFICATE APPLICATION AND RECEIPT I/We hereby apply for a Members 1St Certificate in the amount and term listed below. Maturity Date: 11 / 10 / 2 013 Please Print: Account #: 0 0 0 0 4 7 3 2 9 8 Member Name: LEA[TNA M OLI VER SSN: 2 0 8 - 8 4 - 3 417 Street: 1010 FR.ANRLIN ST Extra Address: C/O RICHARD L PIVOVARNIR City: CARLISLE State: PA Zip Code: 17013 JOINT OWNERS !X Deposit Amount: $ 2 0 , 115 , 54 ~] Transfer Amount $ From Account: Share ID: CERTIFICATE DETAILS Certificate Type Minimum Original Deposit Annual Dividend Share ID Amount Amount Percenta e Yield Rate is MoxTx CERT $500.00 $20, 115.54 1.010$ 1. 000 0041 Dividends Payment Method: By: To Share Tb: Account Number: Share ID: ~IC1/A/1/~ ~/VOUf)?~•/k SI~~/aG Fu Member's Signature: LfB1"~ "^~ o~„~a, h~"' 2 Date: 08/10/2012 This is to certify that the above named person(s) is (are) the owners} of a Certificate account at Members 1 SI Federal Credit Union. The Certificate is in accordance with the terms of the Membership and Account Agreement and the Credit Union's current Truth-in- Savings Rate and Fee Schedule which shall accompany the receipt of deposit for this Certificate and is incorporated by this reference. ~~ r N~t~~:K~r. ~~~ ~r~r`r r:rrvt.t~~t North Middleton 1711 Spring Road Carlisle PA 17013 Inquiries Call: Acct XXXXXXX298 Eff: 08/10/12 Tlr: 0670 717-258-5504 OLIVER,LEAUNA M Date: 08/10/12 Time: 7:19pm Deposit to 15 MONTH CERT 0041 Prev Bal: 0.00 Maturity date: 11/10/13 Amount: 20,115.54 New eal: 20,115.54 geq; #827116 Check Received 1,874.73 Check Received 1,256.95 Check Received 16,983.86 ~` Authorized by ID Soures: `_..] Drv Lic ~_ SigCard [,4 Known (_] Other VISA Balance Transfer 1.90 APR NO balance transfer fews. Ask an assoeiate for more details. For current rates visit our website at www.memberslst.org Ncun 5000 Louise Drive P.O. Box 40 Mechanicsburg, PA 17055 (800)283-2328, (717)697-5312 TDD Members 1st Federal Credit Union 8/10/2012 Share and IRA Certificates, Dividend Rates and APY's Share Certificates IRA Certificates r~~.,~~ } . • The right choice for the long term ~~ scan Funds Norfolk VA 23501-2560 RICHARD L PIVOVARNIK 1010 FRANKLIN STREET CARLISLE PA 17013 I~~rlll~r~lllrrr~~rllr~ll~lr~lrl Check and Transaction Cont~rmation July 2, 2012 Shareholder CS&T CUST IRA CAROL MCAFOOS/DEC'D LEAUNA M OLIVER/GENE RICHARD L PIVOVARNIK/GDN 603 E KELLER ST MECHANICSBURG PA 17055-3426 Rep name I.A.NGr1N Transactions SMALLCAP WORLD FUND-A Fund number 35 Account number 86825785 Dividends {reinvest) and capital gains (reinvest) shares this Trade date Description Dollar amount Share price transaction Share balance ..~.j.~.~.2.I..i.~.........~~~r(~~~~i~ ~~~i ~A-~Y---D-i--~.t.~.i..gli.,~.i.~.N .........................._ .~..j.~.~.~.~..:.~~.--.......~.~.~..~.~..........--~~-~--~--...........:.5.0.:.~.~.~.............. A check is attached to this statement You may reinvest this redemption into any of the American Funds within 90 days without paying a sales charge. If, however, you redeemed $5,000 or more from a fund and account within the previous 30 da ys, you may not reinvest $5,000 or more into that fund and account, for details on our purchase block policy, please see the fund's prospectus. This checAr is made payab/e to you as requested. For more account information ^ Call yourfinancial adviser ^ Automated information and services Website - americanfunds.com American FundsLine~- 800/325-3590 ^ Personal assistance - 8 a.m. to 8 p.m. Eastern time M - F Shareholder Services - 800/421-4225 Redemption check SMALLCAP WORLD FUND-A American Funds' ............................................................................................................................_....._.................._............~.f_ZM;~;o.. July 2, 2012 Account number 86825785 Check numbeE 71090436 PAY "ONE THOUSAND EfGHT HUNDRED SEVENTY FOUR AND 73!100 DOLLARS " it, 874.73 TO THE ORDER OF LEAUNA M OLIVER RICHARD L PIVOVARNIK/GDN CARLISLE PA 17013 'Neib Fargo Bank 333 Suu~h Grand AvErx>e Lo: Arx~eles, CA'.10011 Authorized offrcer l~'0 7 LO 90 ~, 3 6~~' ~: L 2 L000 2 48~: 4 6000 ? 6 ~, 3 4i~' ~~ • ~ 'The right choice for the long. term' .~~'~ican Funds Norfolk VA 23501-2560 RICHARD L PIVOVARNIK 1010 FRANKLIN STREET CARLISLE PA 17013 I~rrlll~~~lllrr~~~~ll~rllrl~~l~) Check and Transactior~t Conf~rmat~on July 2, 2012 Shareholder CB&T CUST IRA CAROL MCAFOOS/DEC'D LEAUNA M OLIVER/GENE RICHARD L PIVOVARNIK/GDN 603 E KELLER ST MECHANICSBURG PA 17055-3426 Rep name I.ANGAN Transactions EUROPACIFiC GROWTH FUND-A Fund number 16 Account number 86825785 Dividends (reinvest) and capital gains (reinvest) shares this Trade date Description Dollar amount Share price transaction Share balance ...... ..~.~.~.o.~ ~..j.2........_~_~N ~.~.i.~..~.A.RY....~.i.$.,~.~.~ ~.U... -o N~ .........................:..§..i.~ .2 ~.e....9 ~..........~.~.~.. ~.~.----...................-~----~ _~~~~~:~91-.~~~-----.........................---............. A check is attached to this statement You may reinvest this redemption into any of the American funds within 90 days without paying a sales charge. If, however, you redeemed 55,000 or more from a fund and account within the previous 30 days, you may not reinvest 55,000 or more into that fund and account. For details on our purchase block policy, please see the fund's prospectus. This chec~f is made payab/s to you as requested. For more account Information • Call your financial adviser ^ Automated information and services Website - americanfunds.com American FundsLine®- 800/325-3590 ^ Personal assistance - 8 a.m. to 8 p.m. Eastern time M - F Shareholder Services - 800/421-4225 Redempt~ori check EUROPACIFIC GROWTH FUND•A American Funds' ~ ..............................................r......................._..... July 2, 2012 t t-24rt2to Account number 88825785 Check number 71090085 PAY 'ONE THOUSAND T'WO HUNDRED FIFTY SIX ANO 95/100 DOLLARS' !1, 258.95 TO THE ORDER OF LEAUNA M DELVER RICHARD L PIVOVARNIK/GDN CARLISLE PA 17013 'N~h Farrp 3.~nk 333 Sough Grind avenue In: Mgeles, ra wort Authorized officer I-'0 ? LO 9008 Sli' ~: 1 2 X000 2 ~,8~: ~, 6000 ? 6 ~, 3 ~,ll' 11'560092 L53011' ~:073903354~: L9340411' THE ORIGINAL DOCUMENT HAS A WHITE REFLECTIVE WATERMARK ON THE BACK. HOLD AT AN ANGLE TO SEE THE MARK WHEN CHECKING THE ENDORSEMENTS. AMERICAN EQUITY INVESTMENT LIFE INS. CO. VENDOR 000000264165 CHECK NO. 5600921530 DESCRIPTION NET AMOUNT DB: Death Clear 21938 CR: Death Claim Pay 21703 16,983.86 DEATH CLAIM TAXABLE INCOME $5,569.58 FED WITHHLDNG $0.00 STATE WITHHLDNG $0.00 SUNDRY: 01-264165 07-20-12 NSKA CHECK TOTAL 16,983.86 t -~- St • MEMBERS 1s~ FEDERALCREDft UNfON 5000 Louise Drive Mechanicsburg, PA 17055 (800)283-2328 EXHIBIT "B" CERTIFICATE APPLICATION AND RECEIPT I/We hereby apply for a Members I g` Certificate in the amount and term listed below Please Print: Member Name: LSAIINA M OLIVI3R Street: 1010 FRANKLIN ST E Maturity Date: 11 / 10 / 2 013 Account #: 0000473298 SSN: 208-84-3417 xtra Address. C/O RICHARD L PIVOVARNIR City: CARLISLE State: PA Zip Code: 17013 JniNT nWNFRC Last: First: MI: Suffix: I Street: Ci State: Zi Code: Extra Address: Date Of Birth: - - / - - / - - - _ SSN: - - Last: First: MI: Suffix: 2 Street: Ci State: Zi Code: Extra Address: Date Of Birth: - - / - - / _ _ _ _ SSN: - - Last: First: MI: Suffix: 3 Street: Ci State: Zi Code: Extra Address: Date Of Birth: - - / - - / - - _ _ SSN: - - Last: First: MI: Suffix: 4 Street: Cit State: Zi Code: Extra Address: Date Of Birth: - - / - - / - - _ _ ~ SSN: - Deposit Amount: $ 2 5, 6 4 2 .3 6 n Transfer Amount $ From Account: Share ID: CERTIFICATE DETAILS Certificate Type Minimum Original Deposit Annual Dividend Share ID Amount Amount Percenta e Yield Rate is Morrra CERT $500.00 $25, 642 .36 1.010$ 1.000 0040 Dividends Payment Method: By: To Share To: Account Number: Share ID: ~~~+~~ ~ivorfrtwx S~CNi~c Fe ~. Member's Signature: [~f~0 ^~ ~`~.rn, n~tioN Date: 08/10/2012 This is to certify that the above named person(s) is (are) the owner(s) of a Certificate account at Members 1 s` Federal Credit Union. The Certificate is in accordance with the terms of the Membership and Account Agreement and the Credit Union's current Truth-in- Savings Rate and Fee Schedule which shall accompany the receipt of deposit for this Certificate and is incorporated by this reference. ~~ ,. rf~rs~x~r.c~r~r<r~r`r~ un~'tc5rt North Middleton 1711 Spring Road Carlisle PA 17013 Inquiries Call: Acct XXXXXXX298 Eff: 08/10/12 Tlr: 0670 717-258-5504 OLIVER,LEAUNA M Date: 08/10/12 Time: 6:19pm Deposit to 15 MONTH CERT 0040 Prev eel: 0.00 Maturity date: 11/10/13 Amount: 25,642.36 New Bal: 25,642.36 5eq: #796117 Check Received 25,642.36 Authorized by ID Source: ^ Drv Lic ^ SigCard Known ^ Other VZSA Balance Transfer 1.90~a APR NO balance transfer foes. Ask an associate for mare details. LEAUNA M OLIVER ..~ Members 1st Federal Credit Union 8/10/2012 Share and iRA Certificates, Dividend Rates and APY's wcun 5000 Louise Drive P.O. Box 40 Mechanicsburg, PA 17055 (800)283-2328, (717)697-5312 TDD Share Certificates IRA Certificates ,_,~.. `~ 4 ~'r~"`-~ John Hancock Life Insurance Company (U.S.A) Annuity Service Office P.O. Box 9505 Portsmouth, N H 03802-9505 MNA-000117 RICHARD L. PIVOVARNIK FBO:LEAUNA M. OLIVER, MINOR 603 E. KELLER STREET MECHANICSBURG PA 17055 :::~:: 1~1': ~`E'~t'~..~: ~~ ~: ...... .... . Carol D. Mcafoos 2751601 Carol D. Mcafoos .;. 07/03/2012 525,642.36 0102455180 Gross Amount Surrender Charges Admin Fee & Other Charges Rider Fee Federal Withholding State Withholding MVA Amount State Premium Tax Bonus Enhancement Reversal Check Amount Separate confirm statement wil! be mailed. If you have any questions please call our Service Department at 877„1HF-FORM (877-543-3676) any business day between 8 AM to 6 PM EST. Citibank, o.iawara On. Pann'a Way, Naw GsU., DE 19720 82-20/311 525,652.83 50.00 so.00 S 10.47 So.00 so.oo so.oo s0.00 s0.00 525,642.36 0102455180 ,lohn Hancock Life Insurance Company (U.S.A) DA~'l~ AIi~4Uk1`..~': . .::::~:.~ y~ . Ofl0312012 ~•'"'"""23,H4238 .. not valid aka~t 190 d~ys_ . i~a~~. ~ Twentjt Five ThvusanaF Six N~ndred Fvrty~ Twv arfd 3B/.10tI Doilar~ ~ . TU THE;`- ; RICHARQ L. PIVOVARNIK , ~ . . ORDER t7P1 - . . ,;. . FBt,;LEAUNA M. OLIVER, MINOR . 803 ~ KELLER STREET MECHANICSBURG PAi 170~R Contract # 27S180f auiborisad aiprtatur• 11.0 LO 24 5 5 L80u• i:03 L 100 209: 3866984 211• ~` SC MEMBERS 1't FEDERAL CREDIT UNION 5000 Louise Drive Mechanicsburg, PA 17055 (800)283-2328 EXHIBIT "C" CERTIFICATE APPLICATION AND RECEIPT I/We hereby apply for a Members lg` Certificate in the amount and term listed below. Please Print: Member Name: MARY JANE OLIVER Street: 1010 FRANKLIN ST Maturity Date: I 1 / 10 / 2 013 Account #: 0000473289 SSN: 182-82-6357 Extra Address: C/O RICHARD L PIVOVARNIR City: CAFRLILSLE State: PA Zip Code: 17013 JniNT (1W1V~RC Last: First: MI: Suffix: 1 Street: Ci State: Zi Code: Extra Address: Date Of Birth: - - / - - / - - - - SSN: - - Last: First: MI: Suffix: 2 Street: Ci State: Zi Code: Extra Address: Date Of Birth: - - / - - / - - - - SSN: - - Last: First: MI: Suffix: 3 Street: City: State: Zi Code: Extra Address: Date Of Birth: - - / - - / - - - - SSN: - - Last: First: MI: Suffix: ~ Street: Cit State: Zi Code: Extra Address: Date Of Birth: - - / - - / - - - - SSN: - - X] Deposit Amount: $ 2 0 , 115.5 4 (] Transfer Amount $ From Account: Share ID: CERTiFiCATF' nFTAri.~ Certificate Type Minimum Amount Original Deposit Amount Annual Percents e Yield Dividend Share ID Rate is Morrrx CERT $500.00 $20,115.54 1.010 1.000 0041 Dividends Payment Method: By: To Share To: Account Number: Share ID: ~rclf~IMQn~O~f~Pn/y SiG~,~~Fi,~ Member's Signature: '"~Y~'"° ~~"'c'`~'''~"'0Q Date: 08/10/2012 This is to certify that the above named person(s) is (are) the owner(s) of a Certificate account at Members 1 S` Federal Credit Union. The Certificate is in accordance with the terms of the Membership and Account Agreement and the Credit Union's current Truth-in- Savings Rate and Fee Schedule which shall accompany the receipt of deposit for this Certificate and is incorporated by this reference. 7 }.~ ~~~~ f ~~ North Middleton 1711 Spring Road Carlisle PA 17013 . Inquiries Call: Acct XXXXXXX289 Eff: 08/10/12 Tlr: 0670 717-258-5504 OLIVER,biARY J Date: 08/10/12 Time: 5:56pm Depasit to 15 MONTH CERT 0040 Prev Bal: 0.00 Maturity date: I1/10/13 Amount: 25,642.36 New Bal: 25,642.36 Seq: #787361 Deposit to 15 MONTH CERT 0041 Prev Bal: 0.00 Maturity date: 11/10/13 Amount: 20,115.54 ~"' New Bal: 20,115.54 Seq: #787363 Check Received 25,642.36 Check Received 16,983.87Y Check Received 1,874.76 Check Received 1,256.91 Authorized by ID Source: Drv Lic SigCard Known Other VISA Balance Transfer 1.905 APR NO balance transfer fees. Ask an associate for more details. MARY JANE OLIVER 1 Members 1st Federal Credit Union Share and IRA Certificates, Dividend Rates and APY's w wr M rr tr`rr n/'wa1 r it ww rrn ~w.~.r N~UA 8/10/2012 5000 Louise Drive P.O, Box 40 Mechanicsburg, PA 17055 {800)283-2328, (717)697-5312 TOD Share Certificates IRA Certificates I-' 56009 2 L 5 29~-' ~:0 ? 390 3 3 54~: L9 3404--' THE ORIGINAL DOCUMENT HAS A WHITE REFLECTIVE WATERMARK ON THE BACK. HOLD AT AN ANGLE TO SEE THE MARK WHEN CHECKINQ THE ENDORSEMENTS. AMERICAN EQUITY INVESTMENT LIFE INS. CO. VENDOR 000000264165 CHECK N4. 5600921529 e r '~ The right choice for the long term'' . ~ ~ ~~~an Fi~~ds ~~ Norfolk VA 23501-2560 Shareholder RICHARD L PIVOVARNIK 1010 FRANKLIN STREET CARLISLE PA 17013 I~r~lll~~rlllrr~„~Ilrrllrl~~l~l CB&T CUST IRA CAROL MCAFOOS/DEC'D MARY JANE OLIVER/GENE RICHARD L PIVOVARNIK/GDN 603 E KELLER ST MECHANICSBURG PA 17055-3426 Rep name LANG.AN Transactions SMALLCAP WORLD FUND-A Fund number 35 Account number 86825769 Dividends ~reinvest- and capital gains (reinvest) shares this Trade date Description Dollar amount Share price transaction Share balance A check is attached to this statement You may reinvest this redemption into any of the American funds within 90 days without paying a sales charge. H, however, you redeemed x5,000 or more from a fund and account within the previous 30 days, you ma y not reinvest SS,OOiD or more into that fund and account. For details on our purchase block policy, please see the /end's prospectus. For more account information ^ Call your financialxdviser ^ Automated information and services Website - americanfunds.com American FundsLine®- 800/325-3590 ^ Personal assistance - 8 a.m. to 8 p.m. Eastern time M - F This checAr is made payab/s to you as requested. Shareholder Services - 800/421-4225 American Funds' Redemption checl~ July 2, 2012 Account number AB826769 PAY. " ONE THOUSAND EIGHT HUNOREO SEVENTY FOUR AN0 761100 DOLLARS TO THE ORDER OF MARY JANE OLIVER RICHARD L PIVOVARNIK/GDN CARLISLE PA 17013 ~Nelh largo Dank 333 South Grand Avr~r,e I os Mgelr!s, CA !~1g 11 Authorized officer SMALLCAP WORLD: EUND• A ,~-z~„z,o Check number 7109a43~ • ;i1.874.7D 11'0 ? ~0 90 ~, 3 511' ~: ~ 2 1000 2 48~: ~, 6000 ? 6 4 3 411' The right choice for the long terms ~~~.~an Flund~`~ Norfolk VA 23501-2560 RICHARD L PIVOVARNIK 1010 FRANKLIN STREET CARLISLE PA 17013 I~~~III~~~lll~~~r~~ll~~ll~l~~l~l Check and Transact~ori Confirmation July 2, 2012 Shareholder CB&T CUST IRA CAROL MCAFOOS/DEC'D MARY JANE OLIVER/GENE RICHARD L PIVOVARNIK/GDN 603 E KELLER ST MECHANICSBURG PA 17055-3426 Rep name LANGAN Transactions EUROPACIFIC GROWTH FUND-A Fund number 16 Account number 86825769 Dividends (reinvest- and capital gains (reinvest) Shares this Trade date Description Dollar amount Share price transaction Share balance ..~~. j.~.~.j..i.~.........~~~N~.~.i..~..t.A.RY....~.i..$.~.~.~.~.U.,~.~.~.~ .........................~.~..j.~.~~.~....9.i..........~.~.~...a~.............---........_...__._:.~.~.:.g..i.~................................................. . A check is attached to this statement You may reinvest this redemption into any of fhe American funds within 90 days without paying a sales charge. If, however, you redeemed X5,000 ormore from a fund and account within the previous 30 days, you may not reinvest$5,000 or more into that fund and account For details on oui purchase black policy, please see the fund's prospectus. For more account information ^ Call yaurfinancial adviser ^ Automated information and services Website - americanfunds.com American FundsLine®- 800/325-3590 ^ Personal assistance - 8 a.m. to 8 p.m. Eastern time M - F This checAr is made payab/s to you as requested. Shareholder Services - 800/421-4225 ---------------------------------------------------------------------------- American Funds' Redemption checl~ July 2, 2012 Account number 86826769 PAY ' ONE THOUSAND TWO HUNDRED FIFTY SiX ANO 911100 DOLLARS " TO THE ORDER OF MARY JANE SLIVER RICHARD L PIV~VARNIK/GDN CARLISLE PA 17013 Weill Fargo Bank :133 Snuth Grand A+~enue Ins Angeles, CA x(1011 EUROPACIFIC GROWTH. FUND•A Check number 71090084 11-24/1210 #1,258.91 Authorized officer i-'0 ? LO 9008 4++' ~: L 1? 1000 2 ~,8~: ~, 6000 ? 6 4 3 4i+' r' y tr, St s MEMBERS ls~ FEDERAL CREDIT UNION 5000 Louise Drive Mechanicsburg, PA 17055 (800)283-2328 EXHIBIT "D" CERTIFICATE APPLICATION AND RECEIPT I/We hereby apply for a Members IS` Certificate in the amount and term listed below. Maturity Date: 11/10/2013 Please Print: Account #: 0000473289 Member Name: MARY JANE OLIVER SSN: 182 - 82 - 6357 Street: 1010 FRANKLIN ST Extra Address: C/O RICHARD L PIVOVARNIR City: CAFRLILSLE State: PA Zip Code: 17013 ,inINT nWNFR4 Last: First: MI: Suffix: 1 Street: Ci State: Zi Code: Extra Address: Date Of Birth: - - / - - / - - - - SSN: - - Last: First: MI: Suffix: 2 Street: Ci State: Zi Code: Extra Address: Date Of B firth: - - / - - / - - - - SSN: - - Last: First: MI: Suffix: 3 Street: Ci State: Zi Code: Extra Address: Date Of Birth: - - / - - / - - - - SSN: - - Last: First: MI: Suffix: 4 Street: Ci State: Zi Code: Extra Address: Date Of Birth: - - / - - / - - - - SSN: - - (] Deposit Amount: $ 25, 642 .36 (-] Transfer Amount $ From Account: Share ID: CF.RTIFiCATF, DF:TAiLS Certificate Type Minimum Amount Original Deposit Amount Annual Percenta e Yield Dividend Rate Share ID 15 Mo1QTx CERT $500.00 $25, 642 .36 1.010$ 1.000$ 0040 Dividends Payment Method: By: To Share To: Account Number: Share ID: Rt c y9o~ OrvaAP~rt S ~ cN r o c Fa ti Member's Signature: M~'~J°A'''~~"'~R~ "'~a2 Date: 08/10/2012 This is to certify that the above named person(s) is (are) the owner(s) of a Certificate account at Members l~` Federal Credit Union. The Certificate is in accordance with the terms of the Membership and Account Agreement and the Credit Union's current Truth-in- Savings Rate and Fee Schedule which shalt accompany the receipt of deposit for this Certificate and is incorporated by this reference. `~ tyg 4 ~~~~~ 14~ r~~anHrt.~r.c,r~r~tirr' u~rtgN North tdiddleton 1711 Spring Road Carlisle PA 17013 Inquiries C311: Acct XXXXXXX289 Eff: 08/10/12 Tlr: 0670 Authorized by Deposit to 15 MOlITH CERT 0040 Prev Bal: 0.00 Maturity date: 11/10/13 Amount: 25,642.36 ~'" New Bal: 25,642.36 Seq: #787361 Deposit to 15 tdONTH CERT 0041 Prev Bal: Maturity date: Amount: Nex Bal: Seq: Check Received Check Received Check Received Check Received ID Source: ~.~_~ Drv Lic ~_~_.~ SigCard (,_ I Kno•,~n (.! Other 717-258-5504 OLIVER,biARY J Date: 08/10/12 Time: 5:56pm 0.00 11/10/23 20,115.54 20,115.54 #787363 25,642.36 16,983.87 1,874.76 1,256.91 VISA Balance Transfer 1.90 APR NO balance transfer fees. Aak an associate for more details. MARY JAb1E OLIVER r `r • Share Certificates Members 1st Federal Credit Union Share and IRA Certificates Dividend Rates and APY's IRA Certificates 8/10/2012 $500 $500 1.40 % 1.39 $10000 $10000 1.50 % 1.49 $50000 $50000 1.50 % 1.49 $75000 _ $75000 1.50 % 1.49 $500 $500 1.06 % 1.05 $10000 $10000 1.15 % 1.14 $50000 $50000 1.15 % 1.14 $75000 $75000 1.15 % 0 1.14 0 3~~'QI'Ik $500 $500 0.75 % 0.75 $10000 $10000 0.85 % 0.85 °!o $50000 $50000 0.85 % 0.85 $75000 $75000 0.85 % 0 0.85 0 q~` AArr.,: ~.~~- VY!'~Y~v $500 $500 0.55 % 0.55 $10000 $10000 0.65 % 0.65 °r6 $50000 $50000 0.65 % 0.65 $75000 $75000 0.65 % 0.65 $500 $500 0.50 % 0.50 $10000 $10000 0.60 % 0.60 $50000 $50000 0.60 % 0.60 $75000 $75000 0.60 % 0 0.60 0 $500 $500 0.45 % 0.45 $10000 $10000 0.55 % 0.55 $50000 $50000 0.55 % 0.55 $75000 $75000 0.55 % 0.55 $500 $500 0.30 % 0.30 $10000 $10000 0.40 % 0.40 $50000 $50000 0.40 % 0.40 $75000 $75000 0.40 % 0.40 $500 $500 $50000 $50000 $75000 $75000 $500 $500 $50000 $50000 $75000 $75000 `Paid at Maturity "Coverdell Education Savings accounts available ~' ' i ~~ Jahn Hancock Life Insurance Company (U.S.A) Annuity Service OfAce P.O. Box 9505 Portsmouth, NH 03802-9505 M NA-00011 i RICHARD L PIVOVARNIK FBO:MARY JANE OLIVER, MINOR 603 E. KELLER STREET MECNANICSBURG PA 17055 ~:: ~~:'E'~t~: . '~A1 Carol D. Mcafoos 2751601 Carol D. Mcafoos :;: A. 07/03/2012 525,642.36 0102455181 Gross Amount 525,652.83 Surrender Charges 60.00 Admin Fee 8~ Other Charges 50.00 Rider Fee 610.47 Federal Withholding 50.00 State Withholding 60.00 MVA Amount 50.00 State Premium Tax 50.00 Bonus Enhancement Reversal 50.00 Check Amount 525,642.36 Separate confirm statement will be mailed. If you have any questions please call our Service Department at 877-JHF-FORM (877-543-3676 any business day between 8 AM to 6 PM EST. ~` C'ibtrank, DNawsn Ong P~nn't Way, New Gttl~, DE 18720 62-20!911 0102455181 John Hancock Ufe Insurance Company (lJ.S.A} . : _:. ,,, .. •.Q~i~. '~~•Y~•.~~fQ~i~~'. :' 07/03/2012 - ~~~,.,~23;H4Z:3~. ' ' . ~ -' a~ •- E not vsNd; sR~t 180 dsy~r- i , . , Twen~ F~~ Thou$ana~. 3I~. Hund~e`~ Forty,.: Twa, and 38/ i0~ t7oltars~° . ., = . ra THE,: - RICHARD t. PfVOVARNIK? ,. ~ = ~° _. OROER oF' ._~ ~, a. . FRd. M,4RY.~JAN~ OUVER MINOfi~ ~=- ', , - - . .. - .- ~, . 603 E. KELLER STREET - MECHANICSBURCI<F~C f70S~ ~, Contract # 2731801 authoriitl tiptutun 11'0 LO 2.55 L8 L11• ~:03 ~ X00 209i: 3B6698~, 211•