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HomeMy WebLinkAbout11-19-12 Z:\ESt\MIS\9cAfoos.Ca rot - AFFIDAVIT 11-6-2012. wpd IN RE: ESTATE OF CAROL DIANE IN THE COUF:T OF COMMON PLEAS McAF00S OF CUMBERLAND, PF~AjNSYLVA~N'SA z-, LATE OF MECHANICSBURG CLERK OF OF;PHANS'C~URT ~~' ~-`,{rj BOROUGH, CUMBERLAND zl-o~~ ~,=~~ c. COUNTY, PENNSYLVANIA FILE N0. 21-12-03~'~ - ~„-. ?: 's' ~o : ; -' Z7 ~' -~ AFFIDAVIT REGARDING COMPLIANCE WITH OVER -~ =-''`n COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND ACD NOW THI5, ~p~ day of November, 2012, David H. Stone, counsel for Petitioner in the above-captioned matter, being duly sworn make the following affidavit regarding compliance with the Order of Court of June 6, 2012: 1. Guardian received redemption checks from Jackson Nationc.l Life Annuity #1007189784 payable to Leauna Marie Oliver and Richard L. Pivovarnik as Guardian, for $42,091.92. 2. On August 27, 2012, Guardian deposited at Members 1st Federal Credit Union the aforesaid cheek and purchased a certificate of deposit in the name of Leauna Marie Oliver, c/o Richard L. Pivovarnik as Guardian, totaling $42,091.92. A copy of the certificate application and receipt of tYie deposit is attached as Exh_'bit "A". ~. On or about August 28, 2012, Guardian completed IRA Direct Transfer Instructions to cause the decedent's IRA at MML Investor Services, Inc. to be transferred to a beneficiary IRA in the nave of Leauna M. Oliver. The amount of the decedent's IRA transferred and deposited was $25,477.08. A copy of the transfer instru~:tions are attached as Exhibit "B". -1- 4. Guardian received redemption cheeks from Jackson National Life Annuity #1007189784 payable to Mary Jane Oliver and Richard L. Pivovarnik as Guardian, in the amount of $92,091.94. 5. On August 27, 2012, Guardian deposited at Members 1st Federal Credit Union the aforesaid check and purchased a certificate of deposit in the name of M<sry Jane Oliver, c/o Richard L. Pivovarnik as Guardian, totaling $42,091.99. A copy of the certificate application and receipt of tl~e deposit is attached as Exhibit "C". 6. On or about August 28, 2012, Guardian completed IRA Direct Transfer Instructions to cause the decedent's IRA at MML Investor Services, Inc. to be transferred to a beneficiary IRA in the name of Mary J. Oliver. The amount of the decedent's IRA transferred and deposited was $25,474.56. P, copy of the transfer instructions are attached as Exhibit "D". 7. The above referenced accounts, together with those accounts referenced in the Affidavit filed with the Court on August 20, 2012, represent all of the accounts payable to Leauna Marie Oliver and Mary Jane Oliver, by Order of Cou f June h; 2 012 . /~-~ By: ` D D QUIRE Subscribed and sw~o~r,n to before me this --(cam- day o f n/UVYm~gl 2 012 . _---~%J,. Y ,,.~~~ COMMONWEALTH OFPENIJSYLVANIA ,~~~ ~6 NOTARIAL SEAL ary Public JENNIFER A. MEARKLE, Notary Public New Cumberland Boro.Cumhedand Co. My Commission Expires July 7, 2016 -2- St • MEMBERS i" PED6R~LCREpR UNION 5000 Louise Drive Mechanicsburg, PA 17055 (800)283-2328 ERHIBTT "An CERTIFICATE APPLICATION AND RECEIPT I/We hereby apply for a Members 1"Certificate in the amount and term listed below. Maturity Date: 08/26/2017 Please Print: Account #: 0000473298 Member Name: LBAIINA M OLIVSR SSN: 208-84-3417 Sheet: 1010 FRANKLIN ST Extra Address: C/O RICHARD L PIVOVARNIR City: CARLI3LR State: PA Zip Code: 17013 .il7INT (1 W NF RC I Last: First: MI: Suffix: Sheet: Ci State: Zi Code: Extra Address: Date Of Birth: - - / _ _ / _ _ _ _ SSN: 2 Last: First: MI: Suffix: Street: Ci State: Zi Code: Extra Address: Date Of Birth: - _ / _ _ / _ _ _ _ SSN: 3 Last: First: MI: Suffix: Street Ci State: Zi Code: Extra Address: Date Of Birth: - - / - _ / _ _ _ _ SSN: 4 Last: First: ML• Suffix: Street: Cit State: Zi Code: Exha Address: Date Of Birth: - - / _ _ / _ _ _ _ SSN: J Deposit Amount: $ 42, 091.92 [ ] Transfer Amount $ CERTIFiCATF. nr.Terr.c From Account: Share ID: Certificate Type Minimum Original Deposit Amoral Dividend Share ID Amount Amount Percents a Yield Rate 60 MONTa CBRT $500.00 $42, 091.92 1.500$ 1.490$ 0042 Dividends Payment Method: By: To Share To: Account Number: Member's Signature: ~~ Y ~--r Share ID: Date: 08/27/2012 This is to certify that the above named person(s) is (aze) the owner(s) of a Certificate account at Members 1" Federal Credit Union. The Certificate is in accordance with the terms of the Membership and Account Agreement and 1:he Credit Union's current Truth-in- Savings Rate and Fee Schedule which shall accompany the receipt of deposit for this Certificate anal is incorporated by this reference. ~- IRA DIRECT TRANSFER INSTRUCTIONS (FORM 2325) Please Print or Type TO: MML Investor Services Inc Current IRA or ORP Fiduciary EXEIIBIT ^B^ D COPY JAV-607615 Account Number at Current Institutlon PO Box 8089, Boston, MA 02266 Mailing Address of Current IRA or ORP Fiduciary Please liquidate and transfer fhe amount Indicated below from the IRA or qualified retirement plan (ORP) you sire maintaining on my behalf to the IRA I have established at my credit union (named in the Identifying Information section of this form). Distdbute the post-70%. required minimum distribution (RMD) or death benefit RMD for the current year (if any) pdor to making the transfer. Make the check for the direct transfer payable as follows: Name of Credit Union, FIB/O IRA Ownar'a Name. Note on the check that It Is for deposit to account number 475157 al the credit union. Attach the check to a copy of this form and send it to the credit union at the address provided below. My credit union can only accept a check to implement this transfer, so please don't send it in any other form. Source of Transfer Into Traditional IRA 0 Traditional IRA' ^ Traditional qualified retirement plan (QRP)' Source of Transfer Into Roth IRA ^ Roth IRA' ^ Traditional IRA ^ Designated Roth account of a QRP' 'Check if Aoolicable ^ Traditional qualified retirement plan (QRP)' Q I am the beneficiary of the distdbuting IRA or QRP. The receiving IRA is subject to the death benefit RMD m.les, and the odginal owner or participant was: Carol McAfoos IDENTIFYING INFORMATION Leauna M Oliver MEMBERS iST FCU IRA Owner's Name (First, Initial, Last) 208-843417 - Social Secudty Number IRA Suffix 27815 CUID (Credit Union will complete) Credit Union Name PO BOX 40 Credit Union Mailing Address MECHANICSBURG PA 17055 City, State, Zip (717)697-1161 Phone Number DEBORAH SMOLUK Contact Person at Credit Union ------- AMOUNT AND TIMING OF TRANSFER Liquidate the current investment and transfer the proceeds as follows. Check one box in each column. Amount to Transfer: Make this Transfer: ^ 1.$ ^ 1. On ^x 2. The entire amount in m account and close Date (MM/DDfYYYY) Y [] 2. Immediately. my account. ^ 3. At maturity of the investment. ---- CREDIT UNION'S SIGNATURE The credit union named above agrees to act as successor trustee or custodian and accept the transfer described above for deposit to the IRA established on behalf of the IRA owner named above. X Credit Union Representative's Signature Date (MM/DD/YYYY) IRA OWNER'S SIGNATURE I have established an IRA with the cretlit union named above. I authorize the curtent fiduciary of my IRA or ORP to liquidate the above descdbed portion of my interest in the plan and send the proceeds to my credit union as directed on this form. (The IRA owner should check vrith the IRA or QRP fiduciary that currently has the funds to determine whether a signature guarantee is required.) X IRA Owna/s Signature Date (MM/DD/YYYY) © 2009 Ascensus, Inc., Midtlleton, W I Stock #90028 2325 (Doc Code 25) (Rev. 17!2009) ~J D 10 O Wa~ dJ W h mr I~ vo 0 p ~ 0 ~~ ~ ~~ E v1 ~ ~ 4 ~ ~' ~ L ~ ~~ w ~ ~ ~ ~ N !~ C s~~ C _\~ LL W 2 D ~Q pq6 `~ C ^ r V 0 1: V H 7 LL E LL St m MEMBERS 1" PED6RALCREDR UMON 5000 Louise Drive Mechanicsburg, PA 17055 (800)283-2328 ERHIBTT nC.n CERTIFICATE APPLICATION AND RECEIPT I/We hereby apply for a Members 1"Certificate in the amount and term listed below. Mahvity Date: 08/26/2017 Please Print: Account #: 0000473289 Member Name: NARY JANB OLIVER SSN: 182-82-6357 Sheet: 1010 PRANRLIN 3T Extra Address: C/O RICHARD L PIVOVARNIR City: CARL28LS State: PA Zip Code: 17013 .InINT nWNGRS I Last: First: MI: Suffix: Street: Ci State: Zi Code: Extra Address: Date Of Birth: --/--/____ SSN: 2 Last: First: MI: Suffix: Street: Ci State: Zi Code: Extra Address: Date Of Birth: _ _ / _ _ / _ _ _ _ SSN: - - 3 Last: Fitst: MI: Suffix: Street: Ci State: Zi Code: Extra Address: Date Of Birth: _ _ / _ _ / _ _ _ _ SSN: 4 Last: Fvs[: MI: Suffix: Street: Cit : State: Zi Code: Extra Address: Date Of Birth: - - / _ _ / _ _ _ _ SSN: !~ Deposit Amount: $ 42, 091.94 [~ Transfer Amount $ CF.RTiFI(`eTR 71RTAri e From Account: Share ID: Certificate Type Minimum Original Deposit Annual Dividend Share ID Amount Amount Percents a Yield Rate 60 MONT1i CHRT $500.00 $42, 091.94 1. SOOk 1.490$ 0042 Dividends Payment Method: By: To Share To: Account Number: Member's Signature: Ic./f~.l~ Shaze ID: Dale: 08/27/2012 This is to certify that the above named person(s) is (aze) the owner(s) of a Certificate account at Members I" 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. ~ IRA DIRECT TRANSFER INSTRUCTIONS (FORM 2325) Please Prlnt or Type TO: MML Investor Services Inc Current IRA or ORP Fiduciary PO Box 8089, Boston, MA 02266 Mailing Address of Current IRA or ORI EXfIIBIT "Dn r ® COPY JAV-607616 Account Number at Current InsliWtion Phave establ shed ffi my credflhunlon (natm dl Inithe denUfying Informal on sect oan of tlhlsnform) I Disbibute the post 70Garequigred min maum distdbution (RMD) or death benefit RMD for the current year (If any) pdor to making Ne transfer. Make the check for the direct transfer payable as follows: Noma of Credit Union, F/B/O IRA Owner's Name. Note on the check Ihat Il fs for deposit to account number 475152 at the credit union. Attach the check to a copy of this form and send it to the credit union at the address provided below. My credit union can only accept a check to implement this transfer, so please don't send It in any other form. Source of Transfer Into Traditional IRA Source of Transfer Into Roth IRA ~ Traditional IRA' ^ Roth IRA" ^ Traditional qualified retirement plan (QRP)• ^ Traditional IRA ^ Designated Roth account. of a QRP• 'Check if Aoolleable ^ Traditional qualified retirement plan (QRP)• I am the beneficiary of the disldbuting IRA or ORP. The receiving IRA is subJed to the death benefit RMD rtlles, and the odginal owner or participant was: Carol McAfoos Mary J Oliver IRA Owners Neme (First, Initial, Last) 182-82-6357 Social Security Number IRA Suffix 27815 CUID (Credit Union will complete) MEMBERS 1ST FCU Credit Union Name PO BOX 40 Credit Union Melling Address MECHANICSBURG PA 17055 City, State, Zip (717)697-1161 Phone Number DEBORAH SMOLUK Contact Person at Credit Union Liquidate the current investment and transfer the proceeds as follows. Check one box in each column. Amount to Transfer: ^ 1.$ 2. The entire amount in my account and close my account. Make this Transfer: ^ 1. On Date (MM/DDfYYI'Y) Q 2. Immediately. ^ 3. At maturity of the investment. The credit union named above agrees to act as successor trustee or custodian and accept the transfer descdbed above for deposit to the IRA established on behalf of the IRA owner named above. X Credit Union Representative's Signature Date (MM/DD/YYYY) I have established an IRA with the credit union named above I authorize the cunent fiduciary of my IRA or ORP to liquidate the above described portion of my interest in the plan and send the proceeds to my credit union as directed on this form. (The IRA owner should check with the IRA or ORP fiduciary that cunently has the Tunds to determine whether a signature guarantee is required.) X IRA Owners Signature Date (MM/DD/YYVY) ©2009 Ascensus, Inc., Middleton, WI Stock r180026 2325 (Doc Cotle 25) (Rev. 12J2009) -. a a m a m 0 9 A a 8 a b_ m 7 C! m u r r A 3 3 !~ I N I m t N f i o m ~ h T a s a C _a ~I e ,, a a a P s Y W _D ~'