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HomeMy WebLinkAbout02-03-15 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: Estate of Orphan's Court Madison J. Perry, Deceased Register of Wills File# 2013-01039 PROOF OF ACCOUNT Attached hereto are documents evidencing the opening of the account and deposit of funds per Court Order. METZGER, WICKERSHAM, KNAUSS & ERB, P.C. By Edward E. Knauss, IV, Esquire Attorney ID No. 19199 2321 Paxton Church Road Harrisburg, PA 17110 Phone (717) 238-8187 Attorney for Petitioner Chris P. Perry, Administrator of the Estate of Madison J. Perry, Deceased m T1 C-) � rTl LJ ►-. r- rn ct� 571274.1 V ti f r METZGER SINCE 1888 2321 Paxton Church Road P.O.Box 69200 Harrisburg,PA 17106-9200 717-238-8187 Fax:717-234-9478 www.mwke.com Lancaster Pottsville 717-431-0138 570-581-8172 January 29, 2015 Shippensburg Wilkes-Barre 717-530-7515 570-825-7500 York 717-843-0502 Orrstown Bank Lurgan Avenue Office 121 Lurgan Avenue Shippensburg, PA 17257 RE: .Account Number 702002863 Dear Ms. Ashley L. Nevling: Enclosed for your reference is a letter of January 20; 2015 from Karyelle Kruppenbacher and a copy of the account information. At this time I am enclosing our firm's check for$4,589.37 along with a savings deposit slip for deposit into the restricted account in the name of Elisa Jai Perry. This is being deposited in accordance with the court order; a copy of which we have sent to you. Very truly yours, . METZGER, WICKERSHAM, KNAUSS & ERB, P.C. Edward E. Knauss, IV EEK/jcb . Enclosures. cc: Chris Perry (w/enclosures) Edward E.Knauss,IV*t° Clark-DeVere t Andrea M.Cohick Zachary D.Campbell Steven R.Tregea° lot Amy E.BauccioCatherine N.ReevesLauren R.Nichols "Board Certfied Civil Trial Specialist 571779.1 'Certified Workers'Compensation Specialist (S AA V # N G'S CASH -1503 �( 313 2 d t S!HECK_R DATE QZ Vt(�{(,( � C TOTTALAA FROM FRO M^ f.9 - DEPOS(IS :AY P(OT GE'A4'�11LAf?LE IA9MEDIAT.iNI fHDF7Alh�At. OTHER SIDE -- TOTAL 153 7SIGN HERE FOR CASH RECEIVED(IP REQUIRED) LESS CASH RECEIVED . omsTOWNBANK (} Q A AadwonGfF�wuonce b t is 500 &,-,0 L 25,: ?02 0028630 ' METZGER WICKERSHAM . 76245 ORRSTOWN BANK 76245 60078-205927 01/27/2015 4589.37 4589.37 0.00 EEK 005606 76245 METZGER WICKERSHAM MIS PENN BANK 60-880-313 0°�7�T2o15 ATTORNEYS - AT- LAW P.O. BOX 59200 (866)6HAPPEN WWW.MIDPENNBANK.COM HARRISBURG, PA 17106-9200 AMOUNT PH. 717-238-8187 4589.37 $ fi PAY Four thousand five hundred eighty-nine and thirty-seven/100************************************************** 8 TO THE B ORDER ORRSTOWN BANK OF: - r AUTHORIZED SIGNATURE H I120 ?6 .24511'f,i:03 L30BIB0 ?i: 12006 L01-1 2110 METZGER WICKERSHAM 76245 ORRSTO WN BANK 76245 60078-205927 01/27/2015 4589.37 . 4589.37 0.00 EEK CHECKS UNLIMITED•0 PARCHMENT TO REORDER:1-80D-667-2439 0 www.ChecksUnlimited.com f -1►► III�IIIIII��II�I���IIIIIIII�f�IIIIIII�IIIIIIIIIIIIIIIIffIIIIIIIIIfIIIfIII�IIIIIIIII�IIIII�IfIIIIIIfIfIIIfIINIIfIIIII�IIIIIIIIIIIIIIIIfIIIIIIIII�IIIIIIIIIf8111fIIIIIfINIINIIIIIIIIIII�NIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII CIF## PBA2693 drrstown Bank ACCOUNT Lurgan Avenue Office NUMBER 702002863 121 Lurgan Ave Shippensburg, PA 17257 ACCOUNT OWNERIS)NAME&ADDRESS (717) 530-3530 Elisa Jai Perry BR: 2 Court Order File #2013-01039 415 South Penn Street OWNERSHIP OF ACCOUNT-PERSONAL PURPOSE Shippensburg PA 17257 INDIVIDUAL ❑ ❑ JOINT-WITH SURVIVORSHIP(and not as tenants in common) ❑ JOINT-NO SURVIVORSHIP(as tenants in common) ❑ TRUST-SEPARATE AGREEMENT: ❑ REVOCABLE TRUST DESIGNATION AS DEFINED IN THIS AGREEMENT Name and Address of Beneficiaries: ® NEW ❑ EXISTING TYPE OF ❑ CHECKING KI SAVINGS ACCOUNT ❑ MONEY MARKET ❑ CERTIFICATE OF DEPOSIT ❑ NOW ❑ I This is your(check one): Statement Savings ReSubmitlt• N © Permanent ❑ Temporary account agreement. Combine: N Number of signatures required for withdrawal 1 Eyewire: FACSIMILE SIGNATURE(S)ALLOWED? ❑ YES ® NO OWNERSHIP OF ACCOUNT-BUSINESS PURPOSE I❑ SOLE PROPRIETORSHIP IX ❑ CORPORATION: ❑ FOR PROFIT ❑ NOT FOR PROFIT SIGNATURE(S) -The undersigned certifies the accuracy of the information helshe ❑ PARTNERSHIP has provided and acknowledges receipt of a completed copy of this form. The ❑ undersigned authorizes the financial institution to verify credit and employment history andlor have a credit reporting agency prepare a credit report on the BUSINESS: undersigned,as individuals.The undersigned also acknowledge the receipt of a copy COUNTY&STATE and agree to the terms of the following agreementfs)ander disclosure(s): OF ORGANIZATION: AUTHORIZATION DATED: © Terms &Conditions ® Truth in Savings ® Funds Availability ® Electronic Fund Transfers 1�4 Privacy ❑ Substitute Checks DATE OPENED 01/15/15 By Ashley L Nevlinc Common Features ❑ INITIAL DEPOSIT S ❑ CASH ❑ CHECK ❑ HOME TELEPHONE# (717) 218-4954 !t)' [X BUSINESS PHONE# Elisa Jai Perry DRIVER'S LICENSE# I.D, # D.O.B. 04/10/12 E-MAIL EMPLOYERMinor (2): MOTHER'S MAIDEN NAME X Name and address of someone who will always know your location: I.D. # D,O.B. BACKUP WITHHOLDING CERTIFICATIONS (3). [X J TIN: 855-97-3174 ® TAXPAYER I.D. NUMBER - The Taxpayer Identification Number shown I.D. # D.O.B, above(TIN)is my correct taxpayer identification number. ��{{ ® BACKUP WITHHOLDING - I am not subject to backup withholding either IX because I have not been notified that I am subject to backup withholding as a result of a (4) failure to report all interest or dividends,or the Internal Revenue Service has notified me that I am no longer subject to backup withholding. ❑ EXEMPT RECIPIENTS - I am an exempt recipient under the Internal Revenue I.D. # D.O.B. Service Regulations. ❑Authorized Signer(individual Accounts Only) SIGNATURE: I certify under penalties of perjury the statements checked in this IX section and that I am a U.S. citizen or other U.S. person (as defined in the instructions} X (Date) I.D.# D.O.B. Signature Card-PA - MPSC-LAZ-PA 10/1/2009 Bankers Systems Wolters Kluwer Financial Services©1992,2009 Page 1 of t OR-RSTOWN BANK A Tradition of Excellence January 20, 2015 Edward E. Knause, IV, Esq. P.O. Box 69200 Harrisburg, PA 17106-9200 RE: Madison J. Perry Register of Wills File#2013-01039 Mr: Knause, This letter is to confirm the account for Elisa J. Perry was opened and restricted on January 15, 2015. The account will remain in a restricted state until the child has reached 18 years old. Per the family's request, I have enclosed all account opening paperwork. Should you need any additional information or have any questions, please feel free to contact me. Sincerely, Karye le Krup n acher Branch Executive Officer II Orrstown Bank—Lurgan Avenue Ph. 717-530-2511 NMLS#561798 1.888.ORRSTOWN www.orrstown.com