HomeMy WebLinkAbout96-00461
Register of Wills of Clllllb".. 1/lIId County, Pennsylvania
PETITION FOR GRANT OF LETTERS
110 _QL1 - q In - 4:LaJ
[,1.11.01 S'I'EPIIEN II. IIAMIYI'DN
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!Joclill~(,CUIlI)'rJo "(}7./1/1.6~77
PAMELA A. IIAMlyrON
POIllIOnOt(s). who is/.lIo 18 vo.1FS 01"90 or ordor. O1pply(ius) 10f
(COMPLETE 'A' or 'B' BELOW)
D A Pro bale and OrJ"1 ollellcls To~l.lmcnta'y .1nd .lVer ttlJt PC!llloner(s) 15/.1fO the o.ccul r 1 X n.uned in tho 1.151 Will of
tho Docedont. dalod and COdICil(s) dalod
Stale relovant circumsl.lnccs. e g. renunciation. de.llh 01 oJeculor, ole.
E1cept as follows. Decodenl did nol marry. was nol divorced. and did not havo OJ child born or adopted aller Ollcculion of tho documents
oUered lor probate; was nol the victim of a killing and W.1S nevor adjudicated incompetent.
[]] B. Grant 01 Lellers 01 Administralion
let .1.; db," c.t a; pendente hte; durante absentia; durante minoritateJ
Petitioner(s) aller a proper search has/have ascertained that Decedent lelt no Wilt and was survived by the lollowing spouse (if any) and
heirs:
Name
JULIA L. HAMPTON
WILLIAM II. HAMPTON
PAMELA A. HAMPTON
Aelationshi
MOTHER
FATHER
SISTER
Residence
22 Cornoll Dr., Cam Hill, PA
P.O. Box 572, Lock Havon, PA
1110 Rodman Rd., Endicott, NY
17011
177/.5
13760
(COMPLETE IN ALL CASES:) Allach addllional sheels If necessary
Decedent was domiciled at death in Cumber land
County. Pennsylvania with hislher lasl family
orprincipalresidence.l 819 Brian Drivo, East Ponnsboro
(list street. number. and municipality)
Decedent, then ~years 01 age. died 0/./26 , 19~. al Hampdon Twp.
(location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl All personal property
III not domiciled in PAl Personal property In Pennsylvania
Of not domiciled in PAl Personal property In County
Value 01 real estate In Pennsylvania
$
$
$
$
35,000.00
situated as follows:
Wherefore. Petitioner(s) respectfully requesds) the probate of the last WIll and Codicil{s) presented with this Petition and the grant of
letters in the a ro riate form 10 the undersi ncd:
i nat re
T ed or tinted narTlC' and residence
PAMELA A. HANPTON
1110 RODMAN ROAD . ENDICOTT. NY 13760
- .
PU!p.1red by lh~ Pennsylv.nI. B.r Auocl'llon
Copyrlghl Ie) 1996 form sollwlreonly CPSystems, Inc.
1.5 -11..17 --I (')
Form RW..1 (1991l
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'96 $1' 0 /1.\1 :01
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Oath of Personal Representative
Commonwllllh 01 Pennsylvania
County 01 Cumber land
The Petitionens) above-n3mod swoar{,) or a!fiuds) th.lt tho statements in tho forogoing Potltion ilfU true
and cOllect 10 the besl 01 the knowledge and boliel 01 Pellt,onells) and th.t..s pelson.tloPlesent.llve(s) 01
the Decedent. Petitionel(s) will well and tluty admini'to~rr~
Sworn to or atllrmed and subscubed .-
belolO me this 1 OTH.:tay 01
-
JUNE 19 96
l - - /\.1l
I ',; I t Jjm(ffl'~~
For the Rogister {j
MA Y C. LEWIS
No.
~1 - 96 - 461
Deceased
Estate 01 STEPHEN II. HAMPTON
Secial Seculity No' 207 -M.- 6577 Date 01 Death, 01./26/96
, 19~. in consldOlation
JUNE 1~
AND NOW,
of the Petition on the reverse side hereon. satisfactory proof having been presented belore me.
IT IS DECREED that LeUOIS 0 Testamontary []] 01 Adminisuation
(c.t.a.: d.b.n,c.t.a.: pendente lite; durante absentia: durante minoritate)
are hereby granted to
PAMELA A. HAMPTON
In the above estate and thai the instrument{s) dOlled
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
leners. . . . . . . ,
$
70,00
7Jl.
(
Short Certilicate(.). . (6.), $
Renunciation. , . $
Allidavits ( $
Ed,a Pag.. ( ), $
Cod~il. , $
Bond
JCP Fee , $
Inventory. $
Other. . $
18,00
10,00
Attorney' STEVEN J. SCHIFFMAN
I D. No' 251.88
SERRI\TELLI, 501IFEM/IN, BRC/.'lN &
Addlc" CALHOON. PC
20~0 LINGLESTOIIN RD., SUITE 106
HARRISBURG, PA 17110-9483
15,00
<;,00
Telephone' 717/51.0-9170
TOTAL. , ' $ 118,00
P,ep.l,ed by Ihl PenMY1'IlnI. 0., "'ssocl.l1on Copyllghl(cl199ti 101m soll.UIe' OMIt' CPSt'ste'ms.lnc.
Mailed letters and order to attorney on 6-13-96.
room RW.' (19'1t)
21 - 96 - 46'
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BOND
REGISTER OF WILl,S OF CUNBERLAND COUNT\'
BOND AND SURETY FOR PERSONAL REPRESENTATIVE
KNOW ALL BY iH2S11PlU!!I!NTS, That Pamela A, Hampton
1110 Rodman Road, Endicott NY 13760
as pnnc.paJ(s) And
Wpg~prn ~IJrpty ~nmr~ny. p n Rnv ~n77 c~Qt.x F~ll~. SD 57117-5077
l.l.urClY (.ur.Ii..) .r. held and firmly bound unto Ihe Commonwealth of Pennsylvania in Ihesum or
SeVentY-ThOusand doll&l' ($70,000. O~ to be paid to the Commonwealth. for which payment we
do bind oUtlclves, jointly and severally, our helll, execUlot!, administrators and ~uccessor~, the
condition of Ihls obllsation belne that If
PA~LA A. H~V.PTOM
as (Slale fiduciary capacity)
Adminilitratr1x
of the eSlale of
STlPHEM W, HAMPTON
, decol.lrd,
or any of them. shall ....ell and lIuly administer the UtAle accordina to law, lhen this obliCalion ShAll
b, void &I to lhe PllIOnal rapn..ntatlve or rep.<<entarives who shall \0 adminisler the eslate and his
or their lurety or surelfe.s; but olherwile il shall remAin in full force.
Sicn~d and sealed Ihis
Imending to be lelally bound hereby.
7th dayor June
.19 96
. each
OM 06-07-96 BEFORE ME PERSONALLY (~al)
CAME CHARLES A HAHN, TO ME KNONN &
KMOWN TO ME TO BE THE INDIVIDUAL
DESCRIBED IN. (S.al)
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21 - 96 - 461
Register of Wills of C1.Il'IllI,;IUANIJ County, Pennsylvania
RENUNCIA TION
Estate of
STEPHEN \~, HAMPTON
No.
21 - 96 - 461
also known as
, Deceased
The undersigned.
MOTHER
01
(Relatlonshlpl ICapacltvl
the above Decedent, hereby renouncefsl the fight to administer the estate and tespcctf'.Jlly If:Qut:5i1SI mal
Letters of J\dministration
be Issued to PAMELA A, HAMPTON
Witness
1'-'-'1
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hand thiS
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davof
'111,""1-
I
1996
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IS,gnaturel .
22 Cornell Dr~ve
Camp Hill, PA 17011
IAddreSSI
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Sworn to 01 af1lrmed and subscnbed
before me thiS 1:3 C/.. dav 01
"t'if1..t I , 19 c:i'/
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I f.. It. (~,;.V ~ ,j, "_'r( t,"' (e
Notarv Public .
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Mv CommIsSion E.pores: '
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NOTE: ~enunclIlIIClns eJll!CuleO UUI"hJ.! ,,,.. Otl,c~ ,.1 ~'IW"'Ij' '."
\..o.J.lIs Me required In 50nld C:>..III'~!> 1u u~ IH...I,HllttcJ
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."...., ,. .... . '"~ ...-.., Notarl~1 ~e~otarv Public
Debm A. Evangel'S. h'n Coun\V
Susquohanna Twp.. Daup' I 7 2000
My Commission E,plres Mav .
RW-13 (Rv.d 9/92)
Register of Wills of CUMImHl/IND
County, Pennsylvania
RENUNCIA liON
EaUII of
alaa known U
STEPHEN \~, HAMP'rON
No.
? 1 - 96 - ~61
. DlClued
Thl undlrslglllCl.
FATHER
(Rllationshlp) (capacity)
of
1lI1 above Dlcodln~ hareby renounca(s) thl
L I.2f Administration
IUers ... ISsuia III
rlqht 1Il .dmlnlstor thl Istatl and rllpectful!y ,.quIII(S) 1lIa1
PAMELA A, HAMPTON
i I ' I 'J1
WITNESS :1' ,r" III; l I(thandthll ,<,
)
dayol ji/., ,
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(Signature) , .
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Swam to or affirmed and subscribed
belor. m. this ~S dey
01 fMcr . . 111..!iL
~~~
Notary Public ,I I
My Commission expires: I fit) '14
(S;gnalln and till 01 Nolai\' ot ollW ollldal
qualillodlll ad",",,", oaN. ShoWdallor
Ujlital;on or Nowy', """",_,
NOlE: Renunciations executed outsldlth. Office 01 Raglst.r 01 Wins
In some countill are required III be notarized.
F...._...
Proparod br 1111 ponnsytvanlalllt AuociuOIIIDlII
CERTIFICATION OF NOTICE UNDER RULF. 5,61al
Name of Decedent: ESTATE OF STEPIIF.N W, HAMPTON
Date of Death: April 26. 1996
will No,
Admin, No,
1996-00461
To the Register:
I certify that notice of beneficial interest required by Rule
5.6(a) of the orphans' Court Rules was served on or maili~!lt, the
following beneficiaries of the above-captioned estate on Pi q~ :
Name Address
william W. Hampton. p,O, Box 572. Lock Haven. PA 17745
Julia L, Hampton. 22 Cornell Drive. Camp Hill. PA 17011
Notice has now been give to all persons entitled thereto under Rule
5.6(a) except: n!~
Date: (,./ :?q(;
. . /~ !~I:c/~- .'
- Signature'
I ,
steven J. Schiffman. Esa.
Name
2040 Linglestown Rd., #106
Harrisbura. PA 17110-9483
Address
Capacity:
17171 540-9170
Telephone No.
Personal Representative
--X- counsel f~~ersonal R~.
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS
Co..nl, CUMIlERI.AND
If APPlICADLCl5URVlVINO SPOUSE'S NAME ILAS' ,rll4SI APt[) ~I{)[JL I. ItllllAL I ~iOt:I"L !i[CUIUT, UU...U[ll
",001._ 1(1-941
Co"~e~tt.~ ~~\ ~,~rM'l1~~'"1A
".n",5Hfi[,h.~rolzo.""",
l)[C(OUH"S 'lAMe (LAST. fIRST. AND -"IOOl[ IwllAl i
HAMPTON, STI':I'HEN II.
:.OCIAl !i(cun!TY "UMoeR
207.1,1,.&577
oAtcor QUltl
01./2&/1996
nAil (H lllllllt
IOIlIJAfL~,O' mAIHArlUII.
'f It ~1'UU~"l
f'OVllll fCI~ll.l!..ULn.A'!'!!jJ}_
FILE NUMOER
.., (It
, -,/
COUln H:OO[ " "
{}(Cl:Dl tiT 'j COMI'l[ 1 [ AlJlllll'i',
HI 'J IlR IAll DR I VI,:
1.:NOI.A, I'A I 7025
(I
.' 'nCIHCll,Il[l1t
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'IN
'wlJllrn
AI..40UNl Flre!:1 I' : ~ ,',rr "j';!UuctIOlj':'.i
0.00
o 5.
2 8.
ROnl.llndcr Rl.lurrl
(lor d.lIO!i 01 di',jlll plior 10 12-13-B21
Federal ESlillt> I dl Rclurn Required
Totill Numbcl (.1 $:110 Depaslt Boxes
2. SupplonlC'IlI.11 Aolurn
41. Fuluro InUHC51 Comprorf\lse
(la, dale5 01 do,'lh "lto, 12,12,821
06. Decedent Died Testate D 7. Decedent M.lintained a liVIng Trust
(AItach co 01 Will) IAltach a copy 01 T,u,,1
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD DE DIRECTED TO:
C .. 0
H I L
E " 0
C I, C
K I~., K
5
C
C ')
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1)'1/10/1 ,)',(,
X 1. Ouginal Return
4. limited Estate
NAME
Sn:VEN J. SCHIFFMAN
TelEPHONE tlUMDER
CO~PL(lE ~AJlIIjG ADDRESS
SERRAn:I.l.I, SCHIFFMAN, BROIllI I. CALHOON
2080 L1NCLESTOIIN RD., SUl'm ;>01
HARRISllURC PA 17110.91,83
(1) None
(2) None
(3) None
(4) None
(5) 71.71&.01
(6) 1.8,521.58
(7) None
(81
(91
23,533.7&
1/11,1.'17. ',9
21,,838.57
95,399.02
95.399.02
0.00
3,011..99
6,772.39
9,787.38
&,971,.75
0.00
2,812.&3
0.00
. ___Z-, B 12. (0},
,~'''.lilje'$ol pe'Jury, I deClare thai I have eumlned thiS rei urn. mClvd'"9 ",(companying 5ch(.'dulc~ ..nd ~Iah:n\(.'f\ts "11\1 10 the L\.'sl 01 "'y . no...k'lJ.J"" 'J 1.,.".'1.11...111.0"
, j...d (ompl~ll', I de(lam lhal all leal utate hn been reporled ..Ilrl.oe nlar"'l vAlue Declaration at prep.UN alhl'rlhan the pt.>r..ondl 'l-'plC~l'fll,)IIWI' ",1 .....d ()Il OIllmlo,malloll 01
. I""parer hit<;,ny .nO>htcdge.
717 51,0.9170
1. Real Esl,'le ISchedule Al
2. SIock5 and Bonds (Schedule BI
3. Cl05ely Held SlocklPartnership Inlore" (Schedule CI
4. Mortgages and Notes Receivable (Schedule 0)
5. Cash. Bank Deposits & Miscellaneous Personal Property {Sch El
6. Joinlly Owned P'operty (Schedule FI
7. T13nsle" (Schodule OJ (Schedule LI
8. Total Gross AS'iets (total Lines 1.71
9. Funeral Expenses, Administrative Costs. Mtscellanl:!OUS
Expensl:!s (Schedule H)
10. Debts. Mortgage liabihtles, liens (Schedule I)
11. Tolal DeductIons (tolallines 9 & 10)
12. Net Value of Estate (line 8 minus line 11)
13, Chmilable and Governmental Bequests (Schedule Jl
14. Net Value Subject to Tax (line 12 minus line 13)
15. Spous.1 T13nsfe" (for dales 01 dealh ailer 6,30.941
See Instruclions lor Applicable Percentage on page 2.
(Include values from Schedule K or Schedule M.)
16. Amounl 01 Une 14 taxable at 6'/, rate
llnclude values from Schedule K or Schedule M 1
17. Amounlof line 14 taxable at 15'/, rale
{Include values horn Schedule K or Schedule M.l
18. P,incipalt.u due (Add tax from line 15. 16 and 17.)
19,Credits/Sp Poverty Plior Payments Discount
+ &,62&.01 + 31,8.71,
20. Utine 19 is greater than line 18. onter the dlllerence on line 20. This is the OVERPAYMENT.
~ 0 Check here It you are requestln a retund 01 your ovel ayment
21. If line 18 is greater than line 19. entel the difference on line 21. This is the TAX DUE.
A. Enter the interest on the balance due on lina 2tA.
B. Enler ,he tolal 01 Line 21 and 21A on Line 210 This i5,he OALANCE DUE.
Make Check pa able to: Re Ister 01 Wills, A enl
. . DE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH · ·
(10)
1,301,.81
(11)
(12)-'
(13)
(14)
(15)
0.00 X
:
(16)
50,21,9.78 X .06:
(17)
1,5,11,9.21, X .15:
(18)
Inlcrest
(19)
(20)
(21)
( 21A)
( 210)
PAMELA A. HAMPTON
1110 RODMAN ROAD
ENOicotf,' 'NY"' .i:i76.0.'.....'....'....'......"..'
SERRATELLI, SCHIFFMAN, IlROIIN [, CALHOON
o LINCLESTOIIN RD., SU ITE 201
HARRis'BURG:' pii" i 'iiio':gl;s:i.....'...,..."....,
DATE
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DATE
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Form (Rev.7.'HI
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f,CI #48011994 provides lor the reduction 01 the tax rates Imposed on the net value 01 transfers 10 or lor
",<, use 01 the spouse, The rates as prescribed by the statute will be:
.:J '. (.03) will be applicable lor estates 01 decedents dying on or alter 7/1/94 and belore 1/1/96
. 2' I, (,02) will be applicable lor estates of decedents dying on or alter 1/1/96 and belore 1/1/97
.1 "I, (.01) will be applicable for estates 01 decedents dying on or alter 1/1/97 and belore 1/1/98
. Spousal translers occurring on or alter 1/1/98 will be exempt Irom Inheritance tax.
PLEASE ANSWER THE FOllOWING QUESTIONS
BY PLACING A MARK (X) IN THE APPROPRIATE BLOCKS.
YES NO
1. Did decedent make a transfer and:
3. retain the use or income 01 the property transferred,. . .
x
b. retain the right to designate who shall use the property transhmed or its income. . . . . . .
x
c. retain a revorsionary interest; or . . . . , . .
x
d. receive the promise for life of either payments. benefits or care? .
x
:' II death occurred on or before December 12, 1982, did decedent within two years preceding death
!fansfor property without receiving adequate consideration? II death occurred alter December 12,
1982. did decedent uansfs, property within one year 01 death without receiving adequate
consideration? . . . . , , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
x
J. Did decedent own an 'in trust for' bank account at his or her dealh? . . . . , . . . . . , . . . . . . . . . . . . . , . . .
x
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
Copyrlghtlc) 1994 fOlmsollwlf.onlyCPS)'stlms.Inc:.
Form 1500 IRev.l.941
"" I~OftEX. (2.811
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCEllANEOUS
PERSONAL PROPERTY
PIO.1S0 PriOI 01 1 e
FilE NUMBER
CO"~N'\l\~~~~~~~Mhl'ANI'
tc r ATE OF
. IEPH~:N II. HAMPTON
5511 207."".6577
0/,/26/1996
must bo dlsclosod on Schodulo F)
VALUE A T DATE
OF DEATH
753.00
\f.Up,o .rt
rEM
l,uMBER
1
DESCRIPTION
Household Personalty
(500 Attached Appraisal)
Coin Collection
(See Attached Appraisal)
The Patriot News
(Refund)
Bell Atlantic
(Rofund)
Rayovac
(Refund)
Motorist's Mutual Insurance Company
(Refund)
Commonwealth of Pennsylvania
(Final Salary)
Commonwealth of Pennsylvania
(Accrued Vacation and Sick Leavo)
Pamela A. Hampton
(Reimbursements for Direct Debits from decedent's account
after date of death for telephone, coble, sewer/trash and
condo fees)
Automobile
(See Attached Total Loss Valuation)
5,206.00
1,7,116.50
2
27,00
3
16.72
/,
2.50
5
75.09
6
1,601.05
7
16,516.55
8
/,01.60
9
10
TOTAL (AI.o .ntor on lino 5, R.capitulation)
(Mach add~ional B 112" xl'. .h.ots ~ more spac. is n..d.d.)
Cr:P)IIl)hl (e) '99"'o,mloll~I" onty CPSYllemt.lnc.
S 71,716.01
Form 1500 Sehl!'dule E (Re"4. 2.87)
Queensize water bed, complete
B pc sectional sofa
3 bar stools
5 pc breakfast set:.
Table lamps
Capri 19" color TV
RCA 19" color TV
TV stand
Kenmore vacuum
Stereo speakers
Sony cassette deck
Sharp VCR
Microwave oven
Coffee table
End tables
Entertainment center
Clock radio
Reel iner
Misc. pots ,pans , dishes.
Metal shelf
Ironing board & iron
4 pc fireplace set
Barbell set
b ta te of Stephen W. IIi1mpton
1I0llsehold goods
f'
S\50.UO' k"jj' .'." {-fi: 'j
75.00
.-24~OO /I: n.tll. ".:11' frni 'J- r;.
,.'
.-75.00 Il~ fill'" _,IiI ~,."I; r..'j
20.00
7~.OO . '.' .' '. ."",
n;-:OO I:, jfHP' .,,/( r r f.
5.00
25.00 ., c"
-25~OO'-f,..f""" ~.rlU h'" ..t, ..
50.00
90.00
25.00
10.00 ,)1
20.00 ,I.
'90-;00 Ir' fl.,- j.~ ~,h. _ I, II.... ~/(:' (I,'
10.00
-25--;"00- /li'J,j;- .~,,114' {-'r '>~ /tJ-,I(l
small appl iances 25.00
10.00
l~~gg /1, ,. ,At ..~,,,., "'" ,c. . /.1 <C.
_~",.oO
$919.00
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page -4-
4 19B4 Hint sets $ 8.00
4 19B5 ~lint sets 8.00
2 19B7 Mint sets 6.00
4 1968 Mint sets B.OO
6 1969 Hint sets 12.00
3 1971 ~Ii nt sets 4.00
1 1972 IIi nt set 1.00
2 !9B3 Prestige sets 100.00
1 1984 Prestige set 20.00
1 19B6 Prestige set 20.00
1 19B7 Prestige set 15.00
1 19BB Prestige set 19.00
1 19B9 Prestige set 20.00
1 1990 Prestige set 20.00
1 1991 Prestige set 40.00
1 1992 Prestige set 40.00
1 1993 Prestige set 45.00
1 1994 Prestige set 45.00
1 1953 ~Iint set 150.00
22 Kennedy I Dollars 15.00
3 S.B.A.l Dollars 4.00
5 Bicentennial First Day Covers 5.00
B Bicentennial medals B.OO
page -5-
7 Pewter medals $ 7.00
13 \4allh' :fluartel~s 10.00
2B 1995 Penny rolls I9.00
1 19fiO Roll of nickels 2.50
1 1964 Roll " " 3.00
1 1963 Roll " 2.50
1 1961D Roll " 2.50
1 1962 Roll " 3.00
1 1950 Roll " 23.00
1 1959D Roll " 2.50
1 1953 Roll " 3.50
35 1942 Rolls " 14.00
1 1960 Roll " 2.50
1 1963 Roll " 2.50
1 1959 Roll " 2.50
1 1946 Roll " 7.00
1 1963 Roll " 2.50
1 1961 Roll " 2.50
1 1960 Roll " 2.5D
1 1960D Roll " 2.50
1 1964 Roll " 3.00
lOB 195BD Pennies 11.00
74 Roosevelt dimes silver 22.DO
page -fi-
35 1964-I9B9 Kennedy Halves
5 1878 Dollars
1 I955 Cyprus 5 piece proof set
I I967 Ton9a 4 piece" "
I 1972 Gibraltar 25 New Pence
1 1962 Suriname ~ pc proof set
I I964 Malowi 4 " " "
3 1966 Bhutan 4 pc " "
1 1966 Gambia 6 pc " "
1 1955 Caribbean Terr 7 pc proof set
1 1964 South Arabia 4 pc proof set
1 1964 Zambia 3 pc proof set
2 1971 Silver clad Ike Dollars
51 Ike Dollars
26 Ike Dollars, silver clad
1 196B Sudan 6 pc proof set
1 1969 Sudan B pc proof set
1 1971 "" " "
2 1967 Sudann 6 pc proof set
3 1B92 Dollars
1 1B93 Dollar
1 1B94 "
1 1B97 "
".,.~:s;. .....,', ~";:~,,,
$ 50.00
225.00
5.00
12.00
B.OO
6.00
4.00
21.00
B.OO
10.00
4.00
5.00
10.00
75.00
91.00
4.00
5.00
5.00
10.00
27.00
54.00
15.00
B.OO
page -7-
1 IB96 Dollar $ 8.00
1 1891 Dollar B.OO
1 1B9B Dollar B.OO
2 IB99 Dollars 16.00
3 1900 Dollars 24.0D
2 I901 Dollars 22.00
2 1902 16.00
1 1903 Dollar IO.OO
2 1904 IB.OO
1 1904. une 45.00
1 19005 Dollar 9.00
1 1B90 Dollar B.OO
1 18B9 Dollar B.OO
1 1BB4 Dollar 8.00
1 IB57 FE Penny 14.00
6 Indian Heads 6.00
1 1947 ? Dollar 13.00
1 195B ! Dollar 3.00
1 1946 I Dollar B.OO
1 1945 I Dollar 11.00
3 1942. unc I Dollar fi4.00
1 1939 ! Dollar 12.00
1 193BD I Dollar 12.00
4 1921 I Dollars 160.00
t
page -8-
2 19195 ! Dollar $28.00
2 1919D I Dollars 28.00
1 1919 I Dollar 12.00
4 1918D I llo11ars 24.00
1 19175 I It 18.00
1 1917 I It 7.00
1 1916D I II 10.00
1 1949 I It 2.00
1 1961 Quqrter 1.00
2 195B II 2.00
2 1949D II 2.00
1 1936 II 2.00
1 1932 II 3.DO
1 1917D Nickel 5.00
1 1915 II 6.00
8 1913 It 24.00
1 IB80 I. H. Penny 2.00
1 IB68 II It 20.00
1 IB65 II II 5.00
1 IB64 II It 5.00
2 18fi3 II " 8.00
2 1860 II It 12.00
1 IB59 It It 7.00
\
page -10-
1 1928 Quarter $ 3.00
1 IB34 Dime 12.00
1 1912 Dime 1.00
1 IB52 Gold one dollar 110.00
1 191BD Nickel 4.00
1 1857 Penny 10.00
1 IB5B Penny 10.00
1 IB04 Half-cent 13.00
1 IBI0 lIalf-cent 30.00
1 IB42 Large cent 10.00
1 19130 Penny 1.50
1 1922 Grant Half-dollar 50.00
, 1921 Alabama Half-dollar 55.00
.
1 IB42 Dollar 100.00
1 IB91 Dollar 10.00
'/ Peace Doll a rs 49.00
5 Barber Half-dollars 30.00
1 IB53 lIalf-do11ar 13.00
1 1836 " " 350.00
1 IB34 " " 20.00
1 1932S Quarter 25.00
1 19320 " 30.00
1 1918S Nickel 3.00
1 19315 " 2.50
page -11-
1 190B Quarter
1 190BS Quarter
1 1917 "
1 IB64 2 cent piece
1 IB73 Nickel
1 1932S Quarter
1 1853 Dime
1 IB5B Quarter
14 J.H. Pennies
19 Large i-cent pieces
1 1976S Proof set
1 1974S II It
1 19B15 II It
1 1976D Mint set
1 196B Proof set
2 1971 Mint sets
2 1972 II "
2 196B It "
1 1990" "
2 19B8" "
2 1989" "
1 19B5 " "
1 1993" "
1 1979 Proof set
$ 2.00
fi.OO
fi.OO
5.00
9.00
25.00
6.00
10.00
14.00
190.00
7.00
6.00
7.00
4.00
4.00
6.00
5.00
8.00
4.00
6.00
6.00
3.00
7.00
5.00
page -12-
1 1977 Proof set $ 4.00
1 19B7 II II 4.00
1 19B3 II II 4.00
IB Seated dimes 90.00
3 Barber dimes 15.00
14 I~ercury dimes 28.00
27 Buffalo neickels 15.00
53 Nercury dimes BO.OO
1 IB69 3-cent piece 5.00
1 IB45 Ha If-dlme 5.00
1 IB42 Penny B.OO
1 1835 lcent 22.00
3 Proof pennies 3.00
3 I.H. pennies 3.00
47 ~l. L. Halves 141.00
1 IB77 Dime 5.00
400 Mercury dimes 120.00
1 IBBl 0 Dollar 14.00
1 19BIS Proof dollar 3.50
1 1934A 5-dollar silver cert. 7.00
1 1990 Proof set 6.00
22 ~Iash. quarters 17.00
6 l'lisc. foreign coins 10.00
1 IB59 penny 7.00
",....:../.
-,,"-,~~r".
page -13-
14 Proof Jefferson nickels HO.OO
6 Proof Hooseve 1t d i Illes 5.00
43 Buffalo nickels 10.00
2 1992 P&U Mint sets 20.00
1 1991 P & 0 Mint set 8.00
29 5. L. Quarters 22.00
50 Barber quarters 50.00
40 Wash. qua rters 30.00
2B Misc. foreign coins 5.00
1 185B Penny 10.00
1 IB65 Penny 4.00
1 IB65 3 cent piece 7.00
1 IB53 i dime 6.00
2 IB6B Nickels IB.OO
1 IB74 Nickel 9.00
1 19035 Half GOllar 8.00
6 Franklin; Dollars 18.00
5 1893 Columbian Halves 45.0D
1 19235 Monroe Doctrine Half 35.00
1 1873 Dollar 75.00
1 1991 Mt. Rushmore Dollar. 25.00
1 1991 U50 Dollar 15.00
26 5. L. dimes 15.00
6 5t Canadian silver 6.00
2 One Dollar. 12.00
page -\li-
1 1996 Silver Dollar 6.00
2 1992\~ Columbus 5-dollar Gold 130.00
1 1905 Lewis & Clark Gold Dollar 400.00
3 1953 W. C. Half-dollar IB.OO
1 IBB5 Penny 4.00
5 1921 Alabama Centennial 2x2 550.00
1 IB94 0 Dollar 30.00
1 18BO 0 It 9.00
1 IB79 0 It 9.00
1 IB45 Half-dollar IB.OO
1 IB44 It 16.00
1 IB97 Quarter 4.00
1 1900 It 3.00
4 l'~ercury dimes 5.00
1 1911 Dime 20.00
1 1912 D Dime 20.00
1 1903 Dime 20.00
1 IB13 Half-dollar 27.00
40 Jefferson nickels 15.00
2B Wooden nickels 5.00
2 1921 Peace Dollars 50.00
5 Franklin Halves 15.00
1 1900 Lafayette Dollar 250.00
1 1900 0 lIalf-dollar 5.00
1 1920D fi.OO
page -15-
1 1899 Half-dollar $ 4.00
1 1840 0 Half-dollar 14.00
1 IB09 It It 30.00
1 1932 Quarter 2.00
1 1932 D Quarter 30.00
1 1932 5 It 2B.00
1 1920 It 10.00
1 IB54 It 7.00
1 IB75 20e piece 40.00
12 Mercury dimes 72.00
1 IBB2 V Nickel 7.00
1 IB68 Penny 20.00
1 IB5B It 12.00
1 IB76 It IB.OO
1 IBOl It 10.00
1 1794 It 55.00
1 1832 Half-cent 28.00
1 1925 Dollar M5 64 100.00
35 Anthony Dollars 55.00
10 Ike It 15.00
1 1927 D Dollar 13.00
2 1921 D Morgan Dollars 14.00
4 1921 5 It It 28.00
3 IBB5 Dollars 24.00
3 Morgan Dollars - 1899 O. 1900 O.
1901 0 30.00
page -16-
2 1887 -0-5 $25.00
2 1884 -D-S 23.00
65 Morgan Dollars 585.00
21 Peace " 170.00
1 1905 Dollar 8.00
20 Franklin l1alves 30.00
71 W. t. l1a I ves 22S.00
20 Kennedy l1alves 15.00
7B Buffalo Nickels 20.00
19 Roosevelt dimes fi.OO
8 Silver 3~ pieces 100.00
19 Nickel 3~ " 115.00
1 IB30 Half-dime 14.00
5 5. L. . " 30.00
1 1869 Nickel 9.00
49 Liberty nalckels 75.00
6 Large cents 60.00
62 I.IL pennies 50.00
1 1864 2, piece 6.00
1 1865 U " 6.00
166 Wash. quarters 125.00
29 Norgan dollars 260.00
4 Peace " 32.00
5 Barber l1a I ves 40.00
3 Barber quarters 10.00
page -18-
2 19B7 Proof sete $ 8.00
1 1990 II II 10.00
1 1973 II II 5.00
2 1972 II II 3.00
1 1971 II II 3.00
1 1970 II II 8.00
1 1969 II II 4.00
1 1957 " " 12.00
1 195B II II 15.00
1 1959 II II 13.00
2 1960 II II 20.00
1 1975 II II 6.00
2 1961 Mint sets 22.00
1 1977 P.& D. Mint set 5.00
1 197B P. & D. II II 5.00
1 1959 Proof set 13.00
4 Lincoln penny books 1941-1990 20.00
500 Lincoln pennies 10.00
IB 1964 Proof dimes 18.00
5 1961 Quarters 15.00
7 1962 II 21.00
9 1963 " 27.00
1 1962 Half-dollar 4.00
page -20-
1 1976 2$ bill $ 2.50
3 IB99 1$ silver certif'~frte 45.00
1 1917 1$ bill IB.OO
1 1901 5$ bill 8.00
1 1934 100$ bill 110.00
1 1934 5$ silver cert. 6.00
2 1934 10$ bill 24.00
1 1950 10$ bill 22.00
3 1934 10$ bill s 72.00
1 1934 50$ bill 60.00
1 IB93 Nickel PF64 180.00
1 1921 S Morgan dollar M563 30.00
1 1955 Half-dollar f1563 10.00
1 IB92 Nickel PF64 IBO.OO
1 1909S v.d.b. Penny MS62 600.00
1 1909S Penny 35.00
1 1926 Oregon Trail ldoll ar M563 90.00
1 1910 Penny M564 20.00
2 1945 Mexico 21 Peso 150.00
1 1919 Mexico 2 Peso 60.00
3 IB57 California 90ld I 300.0D
2 1B52 " " " 200.00
33 Hlscellaneous tokens 15.00
page -21-
7 lYBB Prestige sets
13 Canadian 5$ coins
10 Mexican 1 peso coins
1526 Jefferson nickels
29 Pewter medals
B Bicentennial medals
IB First Day covers
BB Rolls of pennies ,mixed dates Llneolns
675 Wheat pennies
1 IB96 Nickel
1 IB99 Quarter
1 1901 It
1 Partial book Lincoln pennies
1 1964 5$ bill
3 Partial books of Canadian halves
2 Partial books of Can. Large cents
2 II It It It Sma 11 It
2 It It It It Nickels
1 It It It It Type collection
2 It It It It 5 cent silver
1 It It II It Dollars
3 Canada mint sets
$140.00
BO.OO
15.00
310.00
29.00
16.00
36.00
100.00
15.00
1.00
1.00
1.00
5.00
6.00
30.0D
20.00
10.00
10.00
100.00
30.00
25.00
12.00
page -22-
1 1985 Canada Natioal Parks dollar $ 5.00
2 19B7 It Dct Davis Dollar 10.00
1 19B4 It Toronto " 5.00
1 19B3 It Edmonton It 5.00
1 1979 It Jubilee It 5.00
3 1979 It Gri ffon " 15.0D
1 1986 It Vancouver It 5.00
2 1973 It R.C.M.P. It 10.00
2 1971 It B. C. It 10.00
1 1972 It Dollar 5.00
12 Canadian Proof sets 65.00
32 It It Nickels 5.00
42 II Dimes 11.00
42 It Qua rters 27.00
23 It Proof pennies 5.00
1 1913 Canada Large cent 25.00
54 " Nickels 2.00
300 It pennies 4.00
20B " Nickels B.OO
24 It Large cents 15.00
22 It Loons 16.00
454 It Dimes 33.00
23 It Half-dollars B.OO
325 " Qua rters 60.00
34 Misc. Newfoundland coins 13.00
"J(.
page -24-
2 Nepal proof sets
2 Latvia coins
1 1976 Seychelles proof set
1 1973 Panama II It
1 1972 Gibraltar 25-new pence
1 Lot foreign coins
1 19B3 Vatican set
1 1970 Panama 5-balboas
37 Mexican Una Onza
1 1966 British mint set
1 1970 " proof set
1973 Barbados II "
1 1974 Trinidad II II B coins
$ 6.00
4.00
7.00
10.00
4.00
17.00
7.00
6.00
111.00
7.00
8.00
10.00
12.00
7.00
10.00
20.00
10.00
6.00
5.00
4.00
15.00
9.00
2.00
5.00
5.00
1 1971
"
"
" 7 coins
1 1972 Panama 20-balboas proof
2 1973. " "
1 1974" " "
2 1971 Bahamas proof set
2 1973 Liberia " "
1 1974 Bahamas " "
3 1780 Allstria Maria Theresa
3 1971-73 Bahamas 2$ proof
1 1974 Bahamas 5$
1 1974 Philllpines l.peso
1 1974 Paraguay Kinrad Adenauer
page -26
1 1967 Canadian mint set $100.00
1 1967 II 2 coin Expo 67 5.00
1 1971 B. C. Silver dollar 5.00
22 1972-B5 Canadian mint sets 44.00
40 Canadian silver dollars 200.00
14 It Olympic 10$ 70.00
14 It It 5$ 70.00
57 It Hint sets 2B5.00
14 It 1 and 2 dollar bills 30.00
21 3 ent plcces
24 ! dimes
1 I dime. 1872 I~S61
7 Shield nickels
B Liberty nickcls
1 Liberty nickel, IB93 BU
72 Horgan Dollars
1 Mor9an Dollar.1BB9 e.c.
2 Bust dimes
12 Seated dimes
7 Barber dimes
12 Mercury dimes
B Roosevelt dimes
4 Seated Quarters
6 Barber Quarters
9 Standing Liberty Quarters
6 Washington Quarters
2 Walker I Dollars
1 Morgan Dollar
2 Franklin I Dollars
19 Roosevelt dimes
19 W.L. I Dollars, culls
22 Kennedy! Dollars, clad
18 Barber I Dollars. culls
20 Barber I Dollars. culls
20 Barbcr I Dollars. culls
pagc -3-
$170.00
230.00
125.00
70.00
32.0D
32.0D
500.00
300.00
40.00
140.00
30.00
36.00
16.00
40.00
36.00
B5.00
20.00
14.00
8.00
8.00
3B.00
3B.00
20.00
50.00
55.00
55.00
page -4-
11 W.L. I Dollars. culls
20 Barber I Dollars, culls
1 tube Buffalo & Shield nickels, culls
36 Jefferson niclels BU fi2-83
20 1959D une. Quarters
70 Silver Quarters
4B Mercury dimes
50 19640 une. dimes
37 Jefferson nickels
3 Rolls 1960 unc. dimes
1 Roll 1963 unc. dimes
20 silver dimes
42 Barber dimes
46 Wheat pennies
26 Indian Head pennies
50 Lincoln pennies
1 1954 mint set
1 1964 mint set
1 Coin type set
1 1926 Oregon Trail I Dollar
1 1926 21 Dollar Gold Suusqui
1 1926 5esqui l Dollar
1 1925 Vancouver l Dollar
1 1925 Stone Mountain I Dollar
1 1925 Lexington! Dollar
.~-. ---^~...-_...
$ 20.00
55.00
10.00
5.00
30.0D
42.00
15.00
25.00
4.00
75.00
25.00
6.00
21.00
25.00
26.00
1.00
75.00
7.00
10.00
fi5.00
200.00
36.00
175.00
21.00
45.00
page-5-
1 1925 Cal ifornia Half-dollar $60.00
1 1924 HU9uenot It It 60.00
1 1923 S Monroe It It 22.00
1 1922 Grant II It 50.00
1 1921 Missouri II It 130.00
1 1921 Alabama 2x2 It It 100.00
1 1921 It II It 60.00
1 1920 Pilgrim It It 4D.00
1 192D tlaine It It 50.00
1 191B Illinois It It 50.00
4 1993 Columbian It It 24.00
1 1900 Lafayette Dollar 190.00
1 190B S 20 dollar gold 500.00
1 1900 It It 450.00
1 1947 D&S BTW Half-dollar 25.00
1 1949 It It II It 125.00
1 1951 It It II It BO.OO
15 Liberty dollars 95.00
3 Tokens 5.00
1 197fi Bicentennial coin 7.00
1 1956 Wash. quarter 3.00
1 1925 Lexin9ton Half-dollar 45.00
1 1901 Pan-American token 5.00
2 1951-51 BTW set 30.00
:~:~'::-_:l_~~:rn1:~""~-~~~~:~~~~'~;'>"""<"'-'W"''"'~"'';''.-'-
pa!le -fi-
1 1936 Arkansas Half-dollar $ 55.00
1 1936 ~loses Cleveland Hal f 15.00
1 1936 Vit'9inia 5esqui. II lOD . 00
1 1935-36 5 Arkansas Half-dollar 100.00
1 1936 Set Texas Half-dollars 160.00
1 1927 Vennont II II 80.00
1 18B5 10$ 90ld 175.00
1 IBB2 10$ II 175.00
1 1915 21$ II 175.00
1 1B93 5$ II 175.00
1 IB74 1$ II 200.00
1 IB54 1$ II 225.00
1 IB56 1$ II 200.00
1 IB52 1$ " 200.00
1 IB92 Austria 20-F 65.00
1 1974 Bahamas 100$ gold 55.00
1 1973 Columbia lOOO-peso 43.00
1 1969 Mint set 3.00
1 1970 II " B.OO
1 1971 II " 2.00
1 1972 II II 2.00
1 1973 II " fi.OO
1 1974 " II 4.00
1 1975 II II 4.00
pilgC -7-
1 1976 r~lnt 5ct $4.00
1 1971 " II 9.00
2 1956 " II BO.OO
i 1957 " " 65.00
1 195B " II 55.00
1 1959 " " 10.00
1 1960 " " 9.00
1 1961 " " 9.00
1 1962 " " 6.00
1 1963 " " 6.00
1 1964 " It 6.00
1 1965 " " 2.50
1 196B " " 2.00
1 19B9 II " 2.00
1 1990 " " 3.00
1 197B " " 4.00
2 1982 " " B.OO
1 1994 " " 7.00
1 1979 " " 4.00
2 19BO " " 8.00
1 19B1 " " 9.00
1 1993 " II 6.00
1 19B4 " " 2.00
1 1985 " " 2.00
1 19B6 0.00
page -8-
1 19B7 Mint set $4.00
1 19BO It It 4.00
2 1979 S. B. A. Dollar souvenir set 5.00
1 1966 Special mint set 3.00
1 18Bl Dollar 9.00
1 19BO Denver mint set 2.00
1 bicentennial silver set 15.00
1 1956 Proof set 23.00
1 1957 It It 9.00
1 1958 It It 13.00
1 1959 It It 10.00
1 1960 It It 9.DO
1 1961 It It 6.00
1 1962 It II 6.00
1 1963 It It 6.00
1 1964 It It 6.00
1 1968 It It 3.00
1 1969 It It 3.00
1 1970 It It 7.00
1 1971 It It 2.00
1 1972 It II 2.00
1 1973 It It 4.00
1 1974 It It 4.00
1 1975 It It 5.00
1 1976 It It 5.00
IJ~ge -9-
1 1917 Proof set $3.00
1 1978 II II 4.00
2 1979 It II B.OO
1 19BO II It 3.00
1 1981 II II 4.00
1 1982 II II 2.00
1 19B3 II " 4.00
1 1984 II " 7.00
1 19B5 II II 4.00
1 1986 II II 14.00
1 19B7 II II 3.00
1 19B8 It II 5.00
1 1989 " II 4.00
1 1990 " II B.OO
1 1991 It II 15.00
1 1992 " II 14.00
1 1993 " II 15.00
1 1994 II " 13.00
1 1995 II It 13.00
1 1992 Silver proof set 14.00
1 1993 II II II 25.00
6 1921 0 Mor9an dollars 45.00
54 1921-1935 Morgan dollars 50.00
1 1973 Dollar 3.00
3 IB93 Columbian Halh-dollars 15.00
3 B.T.W. lIalf-dollars 1946
7 1952 W.C. II
1 19B2 D Wash. II
35 1941-47 W.L. It
42 194B-63 Franklin Half-dollars
3 1963 It II
6 1965 It II
2 IB77 S Trade Dollar
72 IB7B-1921 II
5 1944-45 dimes
40 1946-B7 II
2 IB58-75 S Quarters
43 Wash. quarters silver
1 1917 II
59 1956-BB It clad & silver
7 IB09 Half-dollars
23 W.L. II
II
11 1944-92 pennies
4 IB64 2-cent piece
4 1863 3-cent nickels
6 IBB3 NoCents
10 1913 Nickels
32 193B nickels
1 1910 Dime
19 1937-44 Dimes
IJage -10-
$18.00
42.00
10.00
140.00
16B.00
12.00
6.00
110.00
650.00
3.00
12.00
25.00
35.00
12.00
30.00
175.00
35.00
6.00
20.00
15.00
18.00
10.00
5.00
2.00
6.00
\
,
_. _. _ .~... 4., ._._
pa!le _11-
44 1909-43 pennies $22.00
24 !.11. " 24.00
4 F .E- tt 52.00
1 IB25 Half-cent 22.00
1 IB35 " 28.00
1 IB07 I-cent 13.00
6 Large cents 18.00
2 IB54-55 I-cent braided hair 14.00
3 IB82 ee Dollars 150.00
2 IBB3 cc tt 100.00
5 IBB4 ce " 250.00
1 IBB5 ce tt 175.0D
5 1971-75 Proof dollars 15.00
1 IB7B Dollar M563 24.00
1 IB79 0 tt ~1560 28.00
1 1879 S II N563 23.00
1 IB80 tt 1\565 500.00
1 IBBl 0 tt 1~5fi3 25.00
1 IB81 0 II M560 13.00
4 IBB2 0 tt 11563 200.00
2 1884 0 tt MS63 40.00
1 18B7 tt MS63 20.0D
1 18B7 tt N564 30.00
1 IBB7 tt M565 80.00
1 IBB9 tt M5fi4 31.00
,......
page -12-
1 1921 D Morgan dollar M563 $20.00
1 1923D It It Ms64 165.00
1 1925 It liS64 34.00
1 1926 S It ~1563 70.00
1 1927 D It M563 160.00
1 1931 D Dime tlS65 15.00
1 1944 D \0 MS66 F.B. 20.00
1 1941 S \0 lIoS65 16.00
1 195B D Half-dollar MS65 14.00
1 1952 It \0 M565 75.00
1 1964 D It \0 3.00
1 1945 0 It \0 ~1564 34.00
1 1936 S Nickel HS65 20.00
1 1936 " MS65 20.00
1 193B D It M565 19.00
1 1941 " PR64 20.00
1 1934 Dan. Boone Half M563 65.0D
1 IB53 Halh-cent M562 200.00
1 1936 Long Island Half M563 50.00
1 1935 5 San Diego \0 H564 50.00
1 18B6 Dime H5fiO 75.00
1 190B Half-dollar 55.00
2 Eisenhower dollars 22.00
2 Korea \0 26.00
~ U50 \0 36.00
t.
~~ D~~
AUTOMOBILE TOTAL lOSS REPORT
()'I I ~~ I
LOSS Dill
~ 3-~9~O~U
Claim H~mIICI
C.~ <;;"'J'<..< ..p- I7~Y")
Yehlele Loelllon
05" I 0'3 I q",
\ Inspeellon Dale
ISlW'f- .d-.,,~
! Vehicle oWner
9~'1i D19 ~ij1i9 t::. SOO'3? 39
Vehicle V.IK
I crtOlIIsion [J COl11llnlhunslve
\
N/fI
,
tleense Plate Number
[J Theft [J PO
[J Firo
VIle 0 Loss
Color /1-<.
U <=69 \ Drive \ I Interior Exleriel
Year
S~lal Paint
M'~o G At:vM 100<<1 I ~ \ ~la\1le 0 TI'IO Tone
o OIhar (describe)
I Engln.
Model U ] Body l C/ J B'tlas 0 DillOl 0 Rol.ry o ProPIIlll
117'1"'0I# Style Cylindel1 2 3 ~ 5 6 B 12 Sila
I
Edillonl\ /5 ) Mil..ge I: //(,(P() I I ~mlllllon o S-Ip o Hp o 3-.p
I 4-lp Auto 0 3-sp Auto
,. CO ION
. I~~ 0
Oi ~
AbOve AvO. AVln!oe Below AVV.
! EXTER~
Ole' 0 1st Tow
AboVI A\'Q. AVlnlge Below AVV. $
,
I
I
PoWIll' I Equipment
~~nd.
~~rlkes
~ ~tnring
o Pwr WindoWS
o Pwr Locks
o ClIlis. Cntll
g.-Ti1t Whlel
o Rem 011 Mi_
. 0 Pwr Antenne
C-"O!5 (sIBBl
,0 Ijlj
Driveable.!.....,.;".
[J VeS ~ No
Slorega Apprlllt. 5alvege Value Salvaga Bids Invlled
S @/S 100y S 0 Yes 0 No
S..tll "Idlo
o powlr 0 AM
~kct 0 AMIHI
o Bench ~MIFM 5,""0
o Split ,a-;'M · Tape
o Luthlr 0 TIp. Only
o Vinyl 0 Compact Disc
.J<rClolh 0 CB
o V.lour 0 Olx Sorn~
o Other (do sol 0 Olher ~lo'c)
Roof Options
o Vinyl
o Sun Men
o Sun Elce
o T-Top
o Other (desel
Bumper Option?
o Rell Slip
o Chromo Slop
o Tubuler
o Other Idesc)
~CSI\',1 ~II'
Whllelll
o Alum
o SpoU
DWire
o Win! ClP
o Rlllye
o Other Idml
WindOW Options
o Sliding Sido
o Slid,,".! Rell
o OIher (<lese)
om III
~"O.lrast
o Digital lost
o Allnn System
J2(f.ntld GIllS
o LI!t'16
o 01111 WhlGls
o />JJ, FU91 Tank
o Bid COYQ'
o Bed Liner
o Cln'plr Sl1all
SEE REVERSE SlOE
O~06 l~~ Ll~ IVA zt:Cl 96:tO!~o
\
l
VEHICLE INSPECTION CHECKLIST
PAINT
~~orago for YaIr of clr
o Orlgl".,
o ~ nollcnblo tlllW'
o $1 ishl tiding
o Modorllo fading
o COmplDIDly oxld/ZDd
RECONDITIONING NEEDED TO MAKE AVERAClE
t{JTE; Separlle Estimate ReQul~d in PAJ
Collision Repolr $
Pllnl Cost $
Interior
Rust Rep.Dlr
Mlsc:olllneous Mechllllcll
$
$
$
1$
$Zl.W
O "..I.... ....,--,
r.lln '-II .,..
Olller
I Tolll Rocondlllonlng Cosls
o L1V:;:
Mil......
L..I nwnr
o ROCDnt ropllnt
OlJIIIly: 0 Good
o fllr
o Pocr
EVALUATION
NAOA BOlJ( (1.01 AIldill,ns &. lltduc:ti'tlll $ SIsn.ao
INTelIIO/\
l3'Averlge tar yellt: of CIr
o No visible Weir 01 ~mege
o Noeds c/ellllng
[J'fhows minor Wilt
o Creckld dish
o Tom hOldllner
o Worn carpels
o HOIVY wear (le.-s. etcJ
o Abasive weir
o Recent Inlerlor Wllrk
Elpllln
REO BOOK (If Nem."rl
$ :5"1 O.CO
Additional Source (If NecelBlry)
$
$
Addillollll Source (If Necessaryl
'~rll.',
Avrnoo of Abow 01 NttOl..yt
Condition & Titus (+) or H
Subloto'
Other 11;.,1.. 1lt~..1 i7Iol, '",OL. 'rn't
Deduclibl. (If ~,IIC1bI!l _ .JtJO .0 U
INET PAY
$ 5\ ~o,c:O
$ - SO,uo
$ .:5"10-0 .co
$ gOCD,CJO
$ - ~ 0(2, ,00
1$ 5~06.o~
MECHANICAL
o Rmnl Work
COMMENTS
lEapltln In Commentsl
/l)A.M
!:tJ :s..c c
o New Plrll
(" 50,00
./~."" ""'/'/
(flll-S.c:o
~S.a:l TIn
:2S": al -....,,<
... , '31..s-.(Z) ,uth.)
lU!.,I..ft In CDmmemJJ
o Melntenlnce racords: 0 VOS 0 No
,.., ft.__._._
U nc,"alpu
,.., u__ ,.., .'_
U fO:l W nu
I I
~c ,t'<,-"" ~t'l1<a d""/~6/r.
o Maraoe lor yeer or cer
TIRES
Rf ....:L/32
LF 9 132
-
RR-f:.../32
LA U /32
-
S~.rt_/32
BRANO
(,,t'~ ~
TYPE
SIZE
/9S/t~;//1/
o Prnmium
HA."IOLEI\' :
')4'.1:' ,.,., frr' X~... ~ r
Oslo
OF/(j319c
o Stlnd.rd
o Reclps
to@]
~c Sll\".1 ~ II'
Ol06 :~~ ~;: IV.' ~C'CI Q~ ro'rn
!'>09[)( . IIZ-1I111
cO"I1.~n~~~w.WJ,WhYAHIA
SCHEDULE F
JOINTLY-OWNED PROPERTY
-
E~r.\TEOF
'IEPHEN II. HAMPTON 5SI1 207-"'.-6577 0/,/26/1996
"lnt lenont(.):
FILE NUMBER
NAME
PAM~:LA A. HAMPTON
AODRESS
1110 RODMAN ROAD
END Icorr , NY 13760
RELATIONSHIP TO OECEDENT
SISTER
Il
JULIA L. HAMPTON
22 CORNELL DRIVE
CAMP HILL, PA 17011
MOTHER
c.
:alnlly-owned properly:
LETTER DATE
ITEM FOR MADE DESCRIPTION OF PROPERTY TOTAL VALUE DECO'S DOLLAR VALUE OF
MSER JOINT OF ASSET .,\ INT. ECEDENT INTEREST
TENANT JOINT
1 A 0/,/08/93 819 Brian Drive 6!. ,000. 00 50.00y. 32,000.00
Enola, PA 17025
2 A 09/12/94 ~e Montgomery Funds 26,294.11 50.00y. 13 ,11.7.06
3 02/20/86 Acct. 111305627
A P5ECU 6.60 33.00y. 2.18
Acct. 112207",.6577
It B 11/15/76 PSECU 1.88.33 50.00y. 2It/t.17
Acct. 00207446577
5 B 02/01/84 PSECU 179.02 50.00y. 89.51
Acct. 01207446577
6 B 02/20/86 P5ECU 2,753,1,0 50.00y. 1,376.70
Acct. 0021183286
7 8 OS/23/89 Dreyfus Family of Funds 3,323.91 50.00y. 1,661. 96
Acct. 0762-0400289575
TOTAL (Also enler on line 6, Recapitulalion) ~ 1,8,521. 58
~w
(If more space IS needed, Insert additional sheels 0' same slle.)
COr)lll)ht fc) 1994 form .ollw.,. only CPSy.terns, Inc:.
\.
FOtm 1500 SChedule F (Rev. IZ-811)
APPRAISAL OF REAL PROPERTY
LOCATED AT:
819 Brian orive
Record Book E 30 Page 165
Enola
FOR:
Eotolt.C o! Stephan Halr.ptOn
c/o Steve Schi!(~an
;2040 Lingleot.own RCi\d. \lbg. 1't, 11110-')110
AS OF:
June 22. 1996
BY:
GEORGE R. ULSIt
fOtlt\UAt _101~llOOlIClVI""'" ~"".'" I"I'~"";"'" - \.IOO..L'MOOt
'dIo'hl 9606171
Juno' 2~, 19~1(,
Estatu of Stepholll Har:;ptof;
c/o Stcv~ Sch1f!~an
Z040 Lin91esto~n ROda
lIarr1sburq, P'\ 17110~~H7C
Cear Stovo:
E'ursuant to i'our request, ',"0 have prep.uect .1n appraisal report of the
properti' c.1Ptioned in the "Su:nrr,a.ry of Salient features" ....hich
follow:! ,
The accompanj'i:1g report is based on a site lnSpeCtlon or irnprov8r.lents,
investigation of the subject nelghborhcoa area of influence, and a review
o! sales and cost data for 51rnl:ar propertles,
Th15 appraisal has been maae ~ith particular attention paid to applicable
value-ir.fluer.clng eCCi:~G:r..l.'; ;:endltl(,n~ Car.d has lJeer. precessed in acc.Jrdallce
~ith nationally recoqni=cd appraisal quidelines,
The value conclusion" stated herein arc as of tne effective date as
stated in the body of the appraisal, and contingent upon the
certification and limiting conditions attached,
Please do not hestitate to contact me or any of my staf! if we can be of
additional service to you.
Pe.5pectfully,
4:.~ /??c/~
Georqe R. t.'15h
RL 000409 L
AB 048723 L
R & L APPRAISAL ASSOCIATES
fQlm OM - '10TAl2OO:l tar ~"'lWflIi' WUI Whl'n C11 LI~. tt _ 1.eoo.~I..AMCOf
5lot;tcIAJJ:m
l~Ot!l(I4-l"'n
C~,
, Cllllrtl
5131e
Z9CO~
Ce~~s T,xl
M~Refeltl'(e
S.l:ePrce
O.te!jf s.u
eimoweJ/Cllert
lerdef
SiZe (Squ.reFeelJ
Pril:e~fSQua:eFocl
l{j(,tQn
''''
CQr4:lCn
Tcl.1lRooms
et>1rooms
a.",
"; Ar~~el
Oa:e(;IAw~dVoliJe
FNI bLmte cf VJ:\It
SUMMARY OF SALIENT FEATURES
~l~' Er.",. ~n'"''
r~l' ';,-,1(1 :::;; I. ie,';. i ..1;'- ..
Er.CJ:d
~i...::.ri~r ~ <i:;J
!-;..
. '0~ ~
,: ~ i:;':
::ct A....adab~e
$"/.
,,/1"1
:UA
Esta~e of stepl".ar. Ha~.ptor.
lor/..
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S 55.9';
S"ourban/A....
:0 '{ed::,!,.
Averdge
5
,
GE:..RGE R. e:':ii
Oti:;:/:.,:
S t:4, 000
fcun SSO- "TOil.l 2COOfcI Wn.)J\\s. "{<I.:wI sc.iue tyll.1 rrW!, n: - 1.SCG.ALA!.lODt
INDIVIDUAL CONDOMINIUM UNIT APPRAISAL REPORT
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CordbJtl ollhl> t.rol. .y;.r~L1:,,"n. r~ru~ f'lftJta_ ,,'\I.!;!, c.I tl.tlS:r;J;l.cn Itmc.:1e:f.1}m-cJoJl'lla:iCll. aJ.J:lCl\tl I~,'~l'" l~t~lX e~t;. r'lc~f1 ~f~,S, t!: 1 I
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INDIVIDUAL CONDOMINIUM UNIT APPRAISAL REPORT
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To plq,t11t m..~","ll( ;.tiJi~1 y,J PM,,)!: tt..! W.r::e\ "''\l..::,.,.ttl1r~ t,~')1'1 a;;"X\ ~)'",jtt
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illY I SUe,;ECT 1 cc.V:H~E.E t.: c':....a:v.:~!?.~ ;
AtUtUJM 819 Bran on.ve \173 t~e l.c1r,(> -1::<:0 br;.<1:-. :"n':p.
PtolfCltl.1.T.eWc,lWOod vlllaoe 1~;t.'5t.HOCcj ':~:~2J~ :~;est'.J:)cd '.'111it1t!
PrcantiiloS~tll'Cl I IS.\l'"~ Pro."c!. :!OIl:':".t" ?r':'~f'I~~
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. .lbo;t Gr~ i lclal Mrf'l'.s fl.\1h$ i Tc.!al B"n~ B.ths ; Tc.lal B~ms Bth$
t;Roorneol,irt t!:o ~ "I~ ~.. "'-~::
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Ba!.tmer.! &f~j \lIe Ba.5e~,en~ \liO 8a5e:7.e!"'.~ ~ :lJ Ea5~::-,en':.
Rocms Beklw Glaje
fur<'o""Ulit/ ; ;,vera'. ';..ve,.q. ';,"'"'' ,';,,';era'e
H..n;Cool.o] lIeH ,,,,,.p 'Heac ,""" ,; HeaC P.c.O )'HeaC Fu.~P
EriTlii E'<"" ",ms !TMrc.o "..d' ':hcco' ',:r.d' or.':c.' ;:"0, :':h"".' ;:r.d.
C.S'""" : car Fad . Ca: Fad ' Car ,," : Co: ?ac
Balccny. PtiO, \ ~at.10 \ l'atlC, . ~. JC':: ?at:c :' i Pa~lO
h."".,.)., I Fireplace ':;or.. ,nreolaoe ''',r,e
;:;:;<~.. 'p'O C', D"e '.40 _".C"" ) ,,0 '" "".0'''0.' :,;.
Il.A~-,,"lll ... - I ,;))1 '.' - I ,. - I
Mij!oleoj~'tiPfl~e tlel '9 \: -r tiel \t' il 1It1 2.3"
"Ce."". . Glos. 92.,i1 " 4,,,1 Glos, ~'I ",:c (;M' 2.3 lI'!
Cemmenl."S".Comp."'" t"''''''l'''"",,,'''....Ct.,,",'."tto ot'" "",,"....m uc'"'''' ,<',.,,"", '" I Oh. "les. Wl cr,
ad,u,t...n'". coc.C1"r. a "n" of v..le" f" cl,e ,uo1CCC. :he ,.,q1CCC " If. ,....,." :OhdlC"'.
ar.d 5UOf;0rts a. 'la..''';'~ t.:::,.J.lr:lr; tr:.~ ."._ :;,;:r~..OI. ..,. t~,e '!'5t.a~-.~:~:-"
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ItlOICATEO VALUE. BY SAlE.S CQUPARlScrl APPROACH
1I10ICATEDVALUE9Y UlCOUEAPPROACH (~A~~~ItJ
lIl0ICATEO VAlUE BY CO~T APPROACH 1~ll.lCh' .lal.ca!,~,
TM a;.\.H.II!olll$ ml1e '.L'o IS' ~l,ibj~d loJ l:l! let \liS ~~rta;n~ or,<,;.t:tr-;r.) I,;l cc.r.~~...m b:eJ tt~;\
Ccrd\.'~'W-'" .h"n' ".. ... ".,,,,,, ,..",,"". ....> ,"""",. ,- .... '.'..10 ",CI."'C .:: " C..'
.,':.ta,:he~' Jdd(.r.Ja,
lIUlR"''''...." :r.e ;.,ld "'c.cc...",,,. ;M"';:' ~.l." ,",,",.,;;.. "." ".C" ",.., to', .,,1'" ,,,' ',:.'
. """.ol .""..'C.... :,.. o."C ;,cc",ca"O ,o,j ".:C",. ;,,,,,,,,. ... .... ,"",,,Ced ,n cr." nce,nor..
. n. p1t1'C" ~ '" "pI""." ..,"'",,. rr.""'''''~ '''' ". ow.,"". L.. "'I'" el ".; "'^'. ''''' 10'" "0" ,,,,,,... .,,'" ",,,."" "."7-"
. ." '~'''l """.",. ". .>1" ...e ;.",,,,,,,,,,,-,,,.,,, ",."H""" ..,.>: ,",m 4'''......1..'' I". ,"'6 ,R..", '" ;
I lWEI ESTIUm THE .,",ET mULAI DEfilED. Of THE RUL PROPERty THAT IS THE SUBJECTCf THIS RERilRUS Of .,,' (
(WHICH IS THE DATE OJ..lUSPEC.TlCIll 1110 THE EJFECTlVE DATE O~ THIS REPORT'l TO BE S ') 01 , ,~, ': ~
APPIUISER. !:..P ,.:yr: ? ',:: ~t) /. . ,/ /' SuPE"GORY ",..\sEAlOtlL Ylf REOUiAECI
f~!I::.:w_~~,a:C';'-;'~l~-'(f~e(,-- ~.~.'. ---~-
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~1'u!,l~F'Ir.11C31:.""
~h'"
BUILDING AREA ADDENDUM
~.~..t\,ll\M G~t,,!.e__Q[_!Jtr,pl1l1n_lkltfllllQn
t1fl'!'ti A ~m ..:. '"uX_:_;~~Un;:.r_~.,Y::'~
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h~r~,.__~!c:j.~ :.:.;
itt, i'i.
Jl.isl._~'l-::'~
GlOSS lIvlnlj Area (GlA) _...---J.L.~..i 5.1
Gtass BU11~lno At" (GBA) 1 ~ 44 51
AJ~U 5l;J.lltfoolot}:
6.l.l.tiT.t.1 0 .1 ~\,f(ja""
le-.eJl 1. 144 .1 .2Q\ ~ fiB'
le.eJ2 0 ., -1\cl "fA
It.el3 0 .1 --2' \;1 lie:.
G.u~ (J " --9' l;t GS:'
Clfll!1 0 " ---1:\ c;f ,,!,\
Area DImensions Type 01 Ate. Level
Mw.;remtr:lo helol At.. l~ Slo:r.r.l G~~ Cll'tr 0,. 1'0 Ttm
,-
~ x ...ll.:.Q.Q. x -L.QQ . 1.014.00
.- =; - - -
---1.:..9.Q x 3Z. SO X ~ . :.'c' . 130.C-0
.-_. --. "
x x . = =
-. - -- ..- -
X X . = =
..- -- ,-
X X . =
- - -- -- _.
X X . ... = =
- - -..
X X .
- - , - - ..~. ....
X X .
,-. -
X X - . ~
-- -- - -- -. ,-
X X .
,n .-
X X . ~
X X . ;';;::,
- .n
X X .
- no -- .-- -
X X .
X X .
r,'rntlC- 'lOT1.l2COOICl'\'''n1O'''''~m~...~etr~ IIl.1r.'lOJe.t:( -1.eoo.ALA~100E
Gcncral Tcxl AddcndulII
E.ct,' e::clt !.", "eer. "..lte" ,":et.. '" 'J.c..'.;,.... ....,j It. r.c" co,." .':en "rooter
1rlte:p:I~t..Hh>n~, fG\illd ,'::r~'.(;li t. .,_~~l ln~'l.:-:^>l~; .n Uif' .'>(.':;cf,'j,lri'r':,)u;et.
:;~n':I' l!vt!:i' plCpcn,' CM,'t <=c:q: 'I 1(' tc "l'H..',I~" ;';'~rq"lL~I.;.e .~.ll'J:'. ~:'.~ .jFPr...~l)C fr.USt
'~u.e 'he ba,t O..'labln ..le. Inr ccop.r"on ..",l.ble Irc= 'ha =.rtot .eoren tho,
:r('!.t:l ;'l~"'u~tOl~, ur,,1'~n.;r.t..ll'J 5t'H,:J.HU~ .H)d ;)"lcjt,:a,(J!: t:,'1tLw;lst.ed vI tho protlJ~~lCn"~
,11;Pl'11:..11 'H':\';'-~.;lt.un tt"H ':r...~, "'I'i;..',:,,~: .tJ ,lU.~..lt(G l.I.tr.. ;r;~ !;.:st P,Ht IJ! tne-
.-.u~J"r.~i...n. .s d(!~.qrl"<l t.:... c~.Il~!i' .~,l'll,:' ';:.rr:r,c;, tu a~: "'FP:<il~,1l r~pr",rt:), 7t,e Sl,!c.:CflQ
part d 'h" ,'dd,,,,,,,,,, " 01"" ,,,,,..t :c "'.1'11:,' H." "'I"tt.nq ;,1 cor'_"..nt, c.c.t ','p'e.II,'
:~qUl:~J bj' l'~rld,~:.., to ~"LH::r i::;i;~!Ct~, (j~ ~1,1" .-;r~f;:-i"':'s,}l proce~s.
The p:c:ic'nce of UfH:';-fO:rl.'.Al.:'EHY::E Fal':': ::Z:':J:',\7L:; 'J: P.A:J.C'N GAS r.ols net beer.
aet~n~,lt.eJ. I: urn -;: RIOt:'::; ~~A;:' ~.$ ;J:f:5('..~, ti.e appra':'~e1.J :r.an;~':. '/a.i,ue ::lay be
advur~uly ~f(ectoa.
Ex.lC~ 'Ii''' \'a;~'.' ~n::HJ:,H':';"r. :.1('::':::-:, c'-,~:q r.ut De Getcr:;-,!nea. Ar.j' .:.n!ormolt.:.on s::ateo
or. the ilpprai:SJl ~.lS P10Vhlell l:.y uw l:i.5P(!ct..o.. ~'here tt.u i.,.5l.dat!o:; ....a:; vi"icle, ..:It
b:,' tht! a....r.er c.r .1gont c! the mone:.' ~'::ere U~e .:.n~:d.;lat.:.\~r. ....as cc.r.cealcd.
AlIa: 'he .ales ."e Ole."" tr..r.soetlon, un;".. ocr,.r.... r.ct.a. .h. ..ttl.rr.ent date
l.!. to IlC l;or,s:dt-rc(] ttj(: ,j;,::", ':: ~t",l: s..~" 'J.. ,1:".:1 .';11 .:.!> sr.c..." cr. the ::-:ar.:et grid date
5 c.::t-i, c..1"; , :..: "t'-I:!,l!\ tel ...:r."H.! '~_:;:l..I~t <.:.:' 3 :>t.:ar.;J:, !_1 5(;tt~e.:i :Jate. 7h.:.s:.~ done to
9......0 a-.f: lbl..:lCr If,ere ,;~:;-,p...t>t(; ..;-.!ur::-,,,t~c;-. ...r. :r~~ c~n~;'(jere:J cc~:paraQ.i.e sa~es.
'oure. of ,.Iorc..cicr. 01 'n. s.!o. ..ne.ally I,s, the .PP'.,se.. Caca ean.. .h. tat.
e.'M; cent. In. H.form.tlen fro::l tM followlnq 'oorees; CE::TP.AL PWN MUL7;-LIST,
1.:CI/THLr S.Ee REPOR.S. COUR.HOUSE RECOHDS. :'SSESS~:ENT5 P.ECCP.DS. E:':.ERIOR ::ISPEC7101: Of
'rHE SUDJECr PROPERTY, TELEPHO::r. WTEHV:EA'S ;"':7H HE';l. ESTATE AGEI:rS, ':i-::H:fI..S, 1\::0
eUrERS. OR PRIVA.E SALES REPeR.!::G AGE::CIES. Ir.forr.,atlcn i. 01..," V.n!ied oy t.o
l~: sources, and most usuall~,. by three (3J sou.::ces. i.'her. the Source i.5 listed as
":::SPEC7:0r:" your appral.ser .....105 p~r~c'r.alll' ;.nspCct~:j the preper::,'.
Il.atlllq .y..ems .bbre\'iatlons us.a H. tn,s r"pcrt .r. .s 101100'5: Tt,. ff:.. l.ae:
denote. the fuel u.ed - 0 " 0:1, G . G.s, E . El.c'.:e. C . Co.l, . . ,ccd, .nd 0 .
:luel File:.
.h. naxt serl.. inct:eoc.d th. typo cl ".OC: BE 0 Ba..oo.rct, f.A 0 fc,e.d .arc. :'ir,
H~B8 = Hot Wa~Q: Basebc3:a, ::5 = Cast rr~~ Easeboar~, ST:~ = Stea~ iraa...ator or
cor....ector), Uii .. Hot: I\'ate: ;Rao...atcr or CCr.....1CtCZ..), P';D .. Radiant ;heat.:.r.q elemen:'5
cor.cc,lleJ H. the ce.:..l.:.r.g ::Jr t:"Cr5;.
Alr Condaion: CW. a C.ner.l Air, .all . BullC ,. w.ll unit.. Jee.Olon.uy. che
suoJ.ct ar eoc.paraol. h.v. .peci.l, h:gh.r .1!icl.r.C, o.atlr.q s,.tems: HEA. PUMP. .
!o:eect warm air hoat'r.g .ystem .ICh a ccnvenc,cnal oactup he.tlng sy.tem lu.ually
electrlc, could be oil or gas) and cen::ral alt ccnditlcning.
C,EC. HEA':' PUHf '" ":'eClthet::-ta: Hen:' Pl..a:ip ~~e~ cOnstdnt :.e::-:perature ~ro~m:l ....ci::er in
he,lt.:.r.g .'lna coollr.q. Tlu:. 5i'~terr. reqUlte5 t-.;C,l ',.'e:b an:J ':'5 e;.;:reir.elj' eUlc:.ent.
SESS a SUpploc..nC.l Elaecrlc Sto'a90 S;.st.c.. .hB S;"Com ne... largo quancitl.. of
.ac.r during oH-pe.t hcurs ..,0 us.. 'n" neat.o .ac.. oo::r,g p.a. nou... Suo'C.""'1
sav;nqs result !rc~ reduc~d electrlc rate5 !ro~ the :o~al electrlc co::':pan~'.
.he use of the terc.. Superlor/;n!.r,or IS ocnsld.r.d a, a ::I,d :io. range bet.e.n 'no
~ore standard GOOd, Average, ralr, etc., etc.
It .. "..urr.ed, unl... nO'ed Ir. 'h., '"pun, 'hot n.e "ccl, P:"'.b:ng, neat,ng.
ol"o'"e.l .nd Olr eond'C10n,ng 'ystem. ..lls, sepcle 'ant. o. oes'pccl .re In
.0Cisloetory op.r.t,ng ccndlticn, Chat tho bUIldIng " structura:ly .eund ar.d [r.. o!
tor~.:.te Infestation and !r~~ ot ::er~lte jamage.
n.e <1pP:..,isor SlH;;gcsts 'tat bUj:er.s, :enje::s and ?t!":er l..teres'ted part..:.es Cbtali,
Certl!iCdtlcns frc~ prc~er:~ q~d~~t:ea prc!ess...cnol:s for 'the.:.r p:ctQc:.:.~n.
"'ore r.dS r.ot boen a tal. ,.,,, cr. Ct .,ur':",' oocpl.'eo or. 'ho ,uIlJ.e, propony 'h.,
would oonflrm ., d"r.y .ny "r.crcaenmor.,., .asem"r.ts 0' .... ,e"rlec:.r.. or. cr .ga'r..t
U,o s"Il;." prcperty. At the tI::.. ot th. :n.paetlon 01 'ne subJect onlo.s r.o'"a '"
the .ppr.,sal r.po,t, nuno cf n.. 1 Com. .".nCoen.a .n tn,s par..,ap" .or. '....,"1,.
ncticp'q or upp.Hent. j~f~ .JHHia":'Sd: .:.~ :r.a~h' ..;;,)ri~~:l~::::,:: :~.e ':'::t:::i.'l :;~l~ ;'::~,'jent ~:
ha"n~ r.c .!I"c' or. tho C....II t;p'eal ".. cl cn. 'CL;oc, as ..Ieo. :r. tn" r.porc.
:1 ,'n;' o! th..e ItOC" are P1..en" tr,. f... ::.."., ';a;uo ., ct.C.",Ir..d br cr,,, r.port
m~y te advor~cli' a!!ectoLl.
R & l A;pra;s,}/ ASSOCI.res Gtcrgt R lJiS~ LJ:'::la S G1a=-(
felm U,OO_ '10TAl2CCOla WlrUj"l'~~a.us..'1:'I\n~,. .Ibmc,je, n;;-I'&","C.:'LAI.lODf
'.
MULTI-PURPOSE SUPPLEMENTAL ADDENDUM
FOR FEDERALLY RELATED TRANSACTIONS
h t L ,l.W"'~ ,l.'.",^l~.} 1$\)"" 'JI\" Lnll j '..',:,
6clll,,!~C"~:!J.:~ ,~~ "_ '.~ '::c"!!.,II:' H,j~ 1.'
.1\I'J!,lfl~HH\
u1 t.:. ;.,
I.'" lo' ~ ; ;,
.:. t':.
, !, _:: ~.,'"
(.
: ,,; ~ L. :
. .~t. ii,
'"I" ~
_.',.1-~_~:' .._',
H.~ '.'~~;,P~li";Y ~"t.,..rr,l~JJ ;'Jrn.l~~ l~! ftil';.!.J, fo.t~t:tj lr".~I'.lt.~j,....1:> Jf'~r;"(J t... "\l"~ lt~ oIj~:",~tl ",~f1 J t;.lt,tf"rt ft~J 11.1 CI.I'r:;.t, ...~:lttiP, t~ilt;i
J;rj.L"'~ ~1.t...aJ~,\'l,J thi'\.arnfl(~ Lt ~'t 11'71 ~ C.~....\t l:lhl,n:e tL!~I.s:"rlIH)jC), tt, G~(~ 1.11tl! CCrl'.,!;I...ft cl C~!I~!l;j (GCC) t~ ~.(.t l;.llhrtt
:'~.r(,;....n \OlS\ t~ FI'~I~!lI.J:'Ill~~1 C"!i../~":''llr\lCi .v..J!,'Y' ft~:lI fO.tYfOl'
this Mulll.PUlpO" Supplemental Addendum Is lor un with any appraisal. Only Iholl
.tllements which hnll bllln checked by lhl IPP.IIIII. apply 10 Ihl properly bllng apprllud.
o PURPOSE & FUNCTION OF APPRAISAL
The ~~l....~e el L"~ ,"iAl~.\l61iJ ~:tnJ:e tt~ mJ:lel \'.tllt do Ut ~\.~;~l po~tltj as je!~ ~:~l\ The IJI"l:I"l'itll~ JW.tUI ~ 10 ~w t.~ ~cle.nameJ
le~l ., eli~.l:ofl]lhe 1~t.,td ~''':Ie:~ l~ll!:rJ.nj ~...:~.,;'>t~ ,r.1 '" .lle~Ia..., reLteJl;l"M;t(;n
U. EXTENT OF APPRAISAL PROCESS
11"'- Jj.~,u."U 11 ~~ en !tie 1I"!\Ilfl'.a!ll"n gJ:~:e:1 t.; ltt a;.'pl~ll:crn PIoLIC Ie(.C!j~. ,,:~tr 1Y.r:~~j ~lolm. ....~~l"rl cf ttt Mli~l plo~tt; 11)J
~ljt'~Qltwj. ;nl !lelctJ;n (;1 tem~J:.l:.'e 1.v.~ .,,{M It'. s~t.jett rr..i:~.tt il:e.1 The (;Il)n.\l ~~I~e cll~ (,,~~:t~its ~ ~An I'lL'lt Oatl Sco,;l(t sectiOn
clltt m'>>I,el O'~ oWlYJ l'It,L"~ sc\:!tt ol (cl1,"I.):I;;",' ,...~~ The (illi::'.\! SCllrte 6 ple~~~ejIJSl The ~jjtm a."d dJll ale tcnsde:eJ retx;it
\',rtn (Cr:a:l"1 do,;lre31qn U\ ~M~!tie S01l1~e ~mej mc~11eil..J!."'! h.l$ L~n II}(J O.tl t.e~tJlc toe ur:e!..ltll! AU n::l tltillJei1 rlthe lepot! /'K;I
\l~J.Ii a ~:t.6Iilr l~t IJ::oe tC!'l;I:J~o:.r,
Tt,-P.e~ro.j~Cl.(jnCC)I",t~eJt:'i :.:,\:')t,d:~ ,Ir.::! ;:,,,~~t '::l:',..l'.~(,!; ::o>:...~::,.
s~;~tr:;er:ed b; I~ .t;.j:~.l.~(~ ~...ItJ]! d l~ k;.<.1i ~.lil.tl
Ptl.~cJl Je~~~.I;n 11 b~J IA lie eS:il':l.t~j~e-;:fl~ IJy. ",I ~ ~~t.I~(1 ~'IC~<f:tt F~~,,:~~..t. a."I1I.;l e':tllUi C<'P!Cl.tiCn, ~ pt:.t:1. ~ s~~~c.v,
a~t~~J II t.t.e Ja,I!.S-IIle;,"rt 1;1 ,IntI aJ.~;'\j.l in esl,m.tl"l1l ~ ~~e u::.!.lIt a;.~.I.L~~r ~ili IMJ.;;rl ~m.:;r~ J~...ItJjt (;;1 t."tl.xal ma:~~l ll'~
~,"I.;''''i'-.17- ~ t.MJ co, p.;.l .\"t1V1 c~::!~l ,}.'\~',~ti d ~~~ ~,~~ &.-UCJ ~S~U{:':~'''' ~,~e .~~'1I:.;m ~~\ "lllT,.r",eJ ~,q-t~.<!~
Tr.o! ~~t',!'l jI,,~e:t, j~ i..o:! J tI 0I.'\.1:t.i "t ~.m1;~1 I.M~l-i."~~t J s~~ l.t.':'~j I!).:.t~.:e~.c-J l:,t ;:-.:;;rr.t ..~~!CJ(~ 111'1..01 tCrll,':t!e::lli;i te r.,e.l.~.rt;'~l
f...' 1M rtx>cn.lf'to I~;;rr.e :'.p".t.:n ,on rx.llj~J
Ttt ES~kCila:eJ M.rlel F,el'll:;t,'\J G'C\~ F.er:! tM;~Ltr ~:~e.] I.'Illle l~o~t :'WCJCh.te t..ilotJ Ci'l Ire aj.,;.r.tstr S ;.n;;;....:t-~ ,1:Tle 1~:.ietl mJ:~el ,nl
TtIe ler.tal H'lJA~ Ii blitJ cn ~r"l ,,'\1(;1 "~me!1 rer:~ rote s~r.eJ'~ co1 resllJtr.!iJl ~c~-e:11t1 The (J:c~~ F,e:':: r.'~:\fil.<!l 6 b~J en ~!~l a.'\]lil (Uner1
1.'-",SI$ cl plCes a.'\1 m1;l..et lte~ lur re\lde1~1l ",\.~:11t~
fOlll'(cme ~odJCn) ;.rc~:1.es. Xll,l.lllelts, _JCa.'"ICItS .'\3 t'toert!>t1 I1.M bttn rtiXl~e.J .l:'d WI,:eJ The-I Mle L-een I,Is.eJ lJ ItCI~llu1l1le lents
'l::a."Y:tsl')jeJ~nses
[J' SUBJECT PROPERTY OFFERING INFORMATION
tleM~Ip1cpe:tj
Io.ccordn;tIO publ1c r.~ccrd "nd H~lt14::.st~n''1 Ser'Jlce
h1S.o:;tteel1~e[ejfcl5J:eI'1ID!~I30i1lj1.
IBl.IlItIt'i_,ntlt~ICf~lol$
w~c1l~[ej 1\lI ~ Ylthn the plSl 30 d.1;i 101 S
Offern) dClm.llqn YfJ:u;cmrr.ttJ Il'Ilht 1t\.llltCcrcta:tln cl_.1l\Ie
Ollert1g ~orlMon ff,lS,n;Uc~lt~ 1'1 tie 1m ItCcnt&.tiOll r;t _Jlue
~etNJ nOlmJ:on w;SS ~t avJ.U:;\e- Th! le.lWlS IJI ur..l'fol.l!.t:lil.tj a.'\J l~.e ~!~pS [:den Iq ltle ,lW,1;~~1 a;e el;.u."I'!j U:!r 11'I tt".$ Utef\1jjm
O.SAlES HISTORY. OF SUBJECT. PROPERTY
....,. .. .
A"or~l(j Publlc recoro and Mult1-11~t 5VS';.Cr.l the$~bleclplc;ttt,
t-3Snr;;tlla.'tl~r.l~inthe ~lo\eMmcr:M
t..u tlJ".~~tH~ 1'1 the P:blll\el,e mcr.tflS
,I.} plJl ~e~ ",hath :-..M v.c~!:~J III :~.e ~l)lllot:-'e r:'cr:tr-:s.tt ~~lej telClI a.'\J reccnct:e-j lol~ a;V.l:~eJ V1.....~, e~~: illIte tvJ, r;t tt.e rt~:t CI
tll~~nl1
D..'e
5..1" JIlin
Docllment II
Siller
8111er
r::r FEMA FLOOD HAZARD DATA
Sy~;~l f.oIC~ttti l5.JJ;t~t.~J tI.l fEI,v.. S~ia1 fiNd H.t:J'jAru
SYll,~1 plo;e:tj l5.);U~':J 1'1 j FEMA. S~tcl.Jl fbOO K.I:.lI~ A:t!
H"ml 01 Commllnll,
lone
ftMA M",;p"n.1 "
MapD.I.
:;~:a: <: 4;'\l3S~ Q..dJ/~~
ille (~:r.m~":j o.Uf\t~,t<..<.;J:': rll~ t.J:iCnJI FiJt.iJ lnS~r.\'l(e Prc.i'arl
The ccm:r'lIr'~f o.u ,.ttli;"'J:~ Il'I L"le Il.t,r,Ji FwJ Ir\jj!.L'\:~ PI07.L'TI
IllS'C,t:tJtJ.l[~'.!;U"'''Tl'':1
ill)tl.lltieJtJiMltllti7.j'l(:,P~1.':\
E<'l'j~ r"r.n~t',-r" 7':\.m~ln'
Pqlc.l2
f"ir:\ !,'FA _ 'TOi:'L iCC~ !;;r ','.,nx.s' l;~UI!..ll Sl:.~Al:e l', J LI rr.c.k I"lC -1-ECC.;.u.!,'j~t
i~l CURRENT SALES CONTRACT
----.... .--~-_.~-_._-_._.__.... -.--
il'. ~~:t'1 ~Ulf'rt, ~ ,~:;t;i'i p.,t ~rJ':-:l ,~'r;'J,K1
11.-.: CLr(I....1 Jn~~ hCIVtl ~"\',!I~cl...n\ IIe:e ll.lliJ.:.tt,.< 1.11(,1;(1 T'''IlIW,II_':,~!, '" I~" {",r~:.t.:!" u;i.J/'t'J l~PI If1 \'.1' Jli"',a ~";to..r.
it... ,,:1:.)::1 ,,-___11,;1 ~~!"... n'.~;W{:..n\ litre 1(~I':MJ 1tt'1~1."'.'"l] \~~rr.~';B t!1;' (crt:~!
~~nll.c:l D.l.___~_!~~...!'!D'!~!.
Conlr.c:'f'IlU hUrl
________ _~u_____.
,
_.____._.______~__.___.i
i
I
l~ c(;~I...:1 nJ.ct~ ll~....! ....:>U~~ P~;.f':t/ ....b fl.l f\;.1,;...'tJ ....l~' ~ It
Tt~ CL~:lcllll.:(.~d U:JI ~~:~Lr.~ 1'!"';.~I~1 t'o,b r-"w';':J ~ ("n.'>,.:e J ",l
(\:r...t~j C(;.":ll':'~~wr, .,l;,,~ 1'1 S
Pt:~r"':plJ~ff, fl.l)~tlr1.t..;J':JlI'lt'lel;."'" l~et'.:.:~u:e
Pt'!...;n~ ~!Citltt ll,u ~h.i~J lIIlf~ 1..11 ,.1:~e nl.ft..le
1 rot (..ltr):l nU.l:rJ rt.llr..J."u!'J ~c;);m..;;r~ cr ctur ,",trt.,t~
Tr:.e Cl,)~r.1Cl n!.c.!:r.j tr~ I~'::,,'''',,~ 'I.-~m...,,~ ("r .r.:'~h'"
~ C'OCt\SiCn~ Cl "t:'1l~ltS tl....L l~ Cvrr,,'.J:,~ltS .t't chrdeJ I...r SlIr.~ Ct;:'(.~S~I'IS.L'lJ .ltl>lC~I~~ .:w,ilsl<~.erJs ...elt m~.l a;.t~~~ ~
In.!: 1~INl~.tl.e Cl,jI'(l.l>>.;nlS" c~m~!.lr"e .~nl~ I.t~~.tl\'.tJ~e ~!~J ~re"'.
:0. MARKET OVERVIEW
lndudt","plllllllonolcunn! mllk,l concU:J)ftIlndlrendl,
o to) rr.or.tlls IS CO~J)!led ~ re.1!.Crutle m.wi.!!('I) r,trlOd IOII~ $ilb;'!tl ,",Wrtt tibtj en
current ~3!r.~t lndlcdtor.
[J. AOOITIONAL CERTIFICATION
lhe;';:pla;strce~.tsa.'lJaJ'et$I~..ll
(1) ll"e a.".r,Ses. (;~~r.s a.'\1,crctm;r.s ...e:e GeoelJ~~J. a.'1d l!lIs rejICl1l'lir> ptr-i:eJ 1f1 cl,;~,rmti .~~ l~~ Ur~crn ~ll'la-.>> (,! P1C!~SSiC:'.t
':'t~l~ PfJc.l,e ('UsPAP'), tr:e;t tlUI L~ Ce~,J(.l;fe Prc.~n ct t~.e U~PAP OC-6 n:;l J;~'I
at T~.tl cc.m~~flU'n lS,...t cc.nl:."qent 11;001'1 tr.e rej,(ol100] c.l ~1tl%lelm."ti1 ~.ll\;e 01 (1JetOO:111 ~J.'l.e tnJ: l"i;IS l~ c..t.;Yo cllf')e ct.er,t, ~ ,),~Cllnt
..1 tn! ~a:~e tsl.~a:e, l~.e a:'.J.~enl cl a st;,ul.l:eJ les~t lit tne OCClIlIeOCt ct.1 s~tsequenl: e.er.l
IJ) Tl\s a;,~r.ujJ .1S$9",",ert fillS,...1 buJ en .1leq~ltj monor:lum ~":.UliCn. .1S~~( V.l!lItiCn. CI t1e a;'~Ii;.aI cl a k<401
::1 ADDITIONAL (ENVIRONMENTAL) LIMITING CONDITIONS
1!'t V.i;..t esl.m.tei1cs taseJ cnLh.e ~su~~l.(;ntr.a:tte p.:;~e:tl IS n;l ~~,e1i t:etleJ by L'le e.l.$!ence (,,1 lU:'i::';..~ fo~t-~I401Ces cr c:el;.'T.ert~
e,"t,fcr.":w::.Il tcna.:~ IIi'lleS$ ttrleflll~ sttej ~ 1M le;~11 lhe !;ptWlIS n:1 01.' e.;..'!rt., I~ dent:,a:"n ct to.uJl);\lfo folitrsta."(es c.c oet!~'f':er.t1:
erto.onr.:e:-'...\! C.Crd:GM The a;,~!"'ser' s ro..l.~ ~'s~llCr, ct 3.'\l ~I~ ~OlOt!he s~tj~1 P!C~;t; lW Il.:;l ()e.eK;~ a."T/lrl.:rmti;tl 1t'.JI t\J(XeJ
a." a;,;,.~ent ~!"~Cl.";t h\:JlJ;li'. '.u~slJtl.;es cr iJ<r.lI:l!'.ertl: e:,:.~.:;rJTe:':l'" c":;111C1'li -.!l(h -.Cul;l ~e:t lhe ;.rO~r., ~;1l,\et; IInitss c'J~r,,~ Slte:J
., 1M le;<.r, illS toCss,t1e l~ tesls a,"Ij ~!>~tC:",r.s mot,)! ~l a liJJ;!.ej lU:'.llOC\lS S~tlS:l"(t;roJ tl':i,or"1':er.:~e~.e11 "'CUll re~t.1l r.-e eQ!exe cl
r.l!llXuS ~~llsl.V'Ces Cf oe:rll'l1t:tll er.i,cr.l'tl!n:31 c~~,t";) c., Cl a:o~!'Ij tle PCo,(r:'f I~ '/\c~\j r.e~~',e~, ~~l h u;~
. [J AOOITIONAL COMMENTS
Apora~sers ~tate llcen~e . h9 04e'23 L
.....~~~:~;:~~E2~:~;,:rJ;ElCE~,:::::~I::, 2' ,,6
,l.W1;Se(S Ij,),'r,t II'fIl'llI GEO!!~ R. ULSH P~ne II !
$U:e?;" :.:.:li:ense ~:Cer::dGnll R:"C0040SoL Tul0..
OJ:ePrrp.l:tiJ Jur,~ ':9,
t ! 1 -: ~o::.;- 5:::
:3.::15j'290e
1':'9€
. CJ CO-SIGNINO APPRAISER'S CERTIFICATION
ltt CO'S<<;M) a;J?/a.ser lW:~I~~r,,},~im;~tejlht S~t.jec.1 ~:wrt,. t'l:ith II'lSde J.'\l o~l 01."\J~.r. mlJe.l.' e':~:':l rroSlf;l..:n 1,;11.1 CCrr.~:II~.e SJ.'es
L~ld IIllhe 1~""r1 T~ 1~;.;J11 \'l:l'O ~le~Jlej by ~ a;'~1..">tr j;00.)e1 wetl s~pel'l'O,"1'I 01 ~ cll.slI}"""1.lOY'''-",,~1 Hit CIHq~ J;;,r"-~l ~'~;,l)
les~!'IS<:li.t, lOf lhe ccf'Ilerts cl t.":t le;.:;11 l.1C;JJo"lo) l~ I ~~~ (I,;r(t..!!.(.r.s a.'lJ l!'t k1',~~ (~r.;.!...~~, <l."J c~rl.:rr,s I~JlI,"t cert1(.tc:\S <1;.,';
M'I 10 ~ c.o.s'1'.II) ~,~rwr
Hot c.c.sl)I'l'!'IIJ appl~r ~~ r.tH':IW,i~' ~?c:eol~ G,-liGl ,,11!'lt s~:,~ttl tICtt<t, a.">J
N,~ l':"..trn~I~J t~ ~~~rl,)l cll~t s~t,:etl ~~~~"~i a;';.t1 c;;m~xJ::lf S,tes ,s!~J;f\ t,'",<! l,.;v~
r~_m~~:~jt"l! e~~liGl cllfot hr.,..:l ~:c~,.:fl ,,-",j,3;1 cc.'Tp.\:1:.:t Sle:. h:~j .'1 1ft ;,.;..,1
T~ 1..~r1 'to.U pe?l:~l bll,~ ~~1.1~"1 ~r..:tr ~etl SJ~'t~,.,~n "Ilfe cv-s'1~.'''IJ o!;;.a"'tl i~ (1I,....]'I."l) .1O:r,t~': .t::r;:. ;,.,;..~,;~,~. I,I:~
Cyr;:en:s 1.>1 t~ r~lNlt. n:;~l~ ,!i"t Cvrw;l,jS~r.s l.'\ll~ ~m.lo1lJ (~n}t""nl .ll',J (r.;r:':ms I~,ll lf1l ,,.,:~IC.t:",r,~ "'1", I"i', :.::~ ,.;o-~.;"',,~;
,1j.pj.!ltI....::,I~ e,ct:liGn cl trP. ce:ltc.t.l.,nl"1~Jn) ~t11Ca: k1:,~'I..i'l$ Ttt ~'\J.e ~~I.1.,.\ tl~ "1,1 ~l r.".,~t{:":n j't;\,,"f J h :'~
cc.s.l]'~,lHIa:se!
1~1! Cy.SllJf.lI'lj .l;~.LS~l S ~,,.I cl (;5'.t'cl.on r.,;J';e~.~~J (', :~... a;v~}l p~;HSS ",':1 c.~t!(.~..;.., n c~.mj f:"'ft~I' lr1::V J.l~'r';l ~l'I:!c
dl~lJ;P:.L<...\l
-j CO-SIGNING APPRAISER'S SIGNATURE & L1CENSElCERTIFICATION
CO.S7.J"lt)
AW.1."Ser~S'}1.tu'e
Co.S.,......; ,:.wa;s~r s tl.r.,e l;r,Jj
5:,ie Lcense
t'';:~P:fll;.J ____
f:'e,heO.c.
Ctrtt.ctrcntl
r:\;r,e _
h.lIO-
P.r,e2c!2
F(;IM M?A - 'T01.l.L :CCC kl ,,';~"'s' .1;,I.\\.ll sc~u'e t;.lLl r.-.....:..e, n: - H:C.A(.;I.IGDE
BOIIO'lltl f.!ll"_l.!:...2.! St.~l2..h_<llU!~I~!.r!~_____.______..
fu''trty~dot!.n_f. .L4__JlI_!-!HI..r!"L!.~"'__,____"_____
'~.J;nllla (,,;~!.tJ Ss,::!eU"}):L_
,ro.1l'1 UIA
___~_~t.j~ l;<t'(fl 'T 1
__.~________:~ttuJ\" ..._._ _
-_._~---.-._.._-----
;'i_C~i':_..~::": '._
APPRAISAL AND REPORT IDENTIFICATION
lhls Appraisal conlOlmslo one 01 Ihe lollowltlg d,IIOIIIOIIS:
::: Compl,j, Appraisal
The act or process 01 estlmalmg value, or an estimate of value, performed WIlhOul mvoll.lng tile
Departure PrOVision.
~~ Limited Appraisal
The act or process 01 esllmatlng value, or an esllmation or value, performed under and resultmg
Irom Invoking tile Departure PrOVision.
lhls Report Is ane 01 ll1elollawlng types:
:! 5,11 Contaln,d "'port
A wn",n report prepared under Slandards Rul' 2.2(A) 01 a compl':' or Iimll'd appraISal perlorm'd
under Standard 1.
:::; Summary "'poll
^ wlIt1en report prepared under Standards Rule 2-2(8) or a complete or limited appraisal perlormed
under Standard 1.
=: Restricted Report
A wflt1en lepolt prepared under StandardS Rule 2.2(C) of a complele or limited appraisal perlOlmed
under Slandard 1,
Comments on Appraisal and Report Identification
Nole any d'partures Irom Slandards Rul,s 1.2. 1.3. 1.4. plus any USPAP."lared Issu,S reQuillng disclosure:
R&l,lWlW~$SOC"':et Geor;eR.UlSl'l lnJJSGIU,
101m 101- 'TOTAl2OC(l10l Wn);J,.,' Wm s.m,...! by &l&mOOe,". -l.llOO-"LAMCO(
DEfiNITION Of MAIIKEl VALUE: It" IT\!,! ~ldl"r. t>~(t: ,~h,(r, ~ ~!i"t~:!' \1.,.,1 ~wl tl .t (Vq,.~t ,t"'l: ~.t1 ~',\I~t ~~)ol .\J t"r.:.l':'n\
ltl;\l>).r W .t 1.iIl \.\~. the LUJtl ",..,.1 ~;.f'I, u:.h .:IJIJ ~Jl'~!( m../I..jJ'..:,I, .l.".1 .',w~~J)1 I'" ~l(t ... a..~ ,t"t<:.!~J t., ,,"J..~ \1J1'...',., if'"vld Il tm
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fI,(ll'; 1llI,.1;..a:~,1. (2) lI",th p;lf") .A:t ...d d",trlw:J i.A ....d lte."J .\,')1 t.t..h ,':'I:-IJ ;\ ,,'.11 tl!' ("r...VI'o 1.'0 IMr H~ rtM~1. (j' a It.~~."" 1~.I! ~ L,,/IltJ
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STATEMENT OF LIMITING CONDITIONS AND APPRAISER'S CERTIFICATION
CONTINGENT AND LIMITING CONDITIONS: l~ :tf.P~':ttl' tt~'(.t(.n U\t dt-~.n .r. I~" .1O.~r!;~a awt I) '~liitcl to t~ IO:""'ll'lQ
ce~1ll1'l$
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lhe 1ft 1!Il]'..oo artJ tlU'l..tlJ.:l't ~'ld. L"tltlU!t, i\lIocl It~1 JtI, lJi:.......n1 olU"ll~ u:e l!'le ~I~~r., IS .a;.~~J;'J:J f,;:'\ trtl.: t~u ct I ten) llr..1e1 It';.orr.tJ~
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2. ltle ~1J4:W tI.lS ~o".)ed a \Iel,h Il'llhl: a;.;.r~ lt~ 10 ~III at'.,roltnJ:e d&:r,mICM c.ll~ (l'.r,fc,trr.trH .1.'\3 t"t ~It:cfl 6 n;.~je.j cnJ, 10 U~61
t/'lf.: ItUI ct the ltr.cm III '6LWIlNllL'Ie ple~;1y aN llMerslm"q I~ Jtit-Ia.~f\ ~telm.n.tl<n cf b we
3 lhe .w~.I6tl h>> e.lJtTltrj 1I'.e a-...uLlt 100<1 m!;o\ 1M: ,n PU;IJtJ t( r.--e FtJtloll Err.t:7r(; l,\L'U'jt<:'.tr:: ;"7;"1;j .~I (.::-Jo!'i 11:<1 ~ll:tt'tl anJ ~.u n.;.tN
Il'l ~ ~~I.1MlIWJ(1 ,.~.htl the ~tI,tcl ~e 6 lltteJ Il'l .sn /.k:;Ulltj ~~~>I! F),;~J HJ:$J ~rtJ B~::&.M t:-'. Jt~:~)tl 1\ n.l .I )~l.t,..l, t.t 'I ~ m.>>es
l'WJ Q'.ulr:tt\. e.;o:t\S CI tnp\d. 1t<"j1:iJJY) 1M !)eltrm,"IJtlCn
~, lhe a;?!l;\tl "tJ m Q'.e tt!.t;tT-./Jrty III 4~e.I; \1'\ cc"," t.~Me he cr $t~ m.ue .),1 x...:",sa: I:lI~1f: ~!qf:1, .n lO~tsl":;.'. lI~ht>> 1~t:'C 1l1rq:lT'.tIt, III .).;
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5 If'le 3;Ool1.y.r t.lS esliITI.teil ~ ;,}",t olltle IJ.."I.l1ll ~ w,! a;.,lt.KfI a: h rJtltlol arJ t.t~1 ~!.t ",'\1 1~ io"T.pc,er.-.erH aI :r.e: t~:.t;~I~, w>>.it l~s.e
~~....-a:e vtll.t.;;M cf l!"Ie l.1ro1 ar.1 tn~lc.tlt.trh r.'.\Ol1 no:.l t.e II~J III C(.fi",:"(.liCn ....VI Ml'; C.t!"'.l a;~I~S~ ","oj it'e 1f'l',t...,J , It.t, ~e ~ u!oeil
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lht l!JpW UnIe$\ C~l"'l!oe 5-1J:t(l Il'\ tte Jt.;ri.ll\..ll Jt.,crt Ill': .l;,~r.t,':)tl 1'Ll't ~ ~['I;'...:ti7 ..:1 a.~1 t..J)':l C! llf.J;..vtl'l! ,,,r':':..:.n\ ct t~ II'c;.-ert, "I
~tt~ rlT;l(jnm~ItJl tor04iOf1S \rckJc.-., Itt p1t$toce of tulilOOll\ Yol\tes. 10":: ~~\I,),"(U. el: /l:ul ....ell\1 rn.>>e t:'e ;.tc~lfl r:l{.le CI ItS5- 1alllatJi!, a.~
h..U .uw~ 1l'.Jl L"lete ale ~ Sllttl cclillGnS ,),'\1 m>>e' no g.J.1IJ:'Ilet\ 01 ....a.rIJ."l!:.t1., t1pie\!. CI lm~';d 1~1V;:'''''; the tcn:1cn cl tfle p1e~:ti' Ttt
arpIWI .". n;1 toe le~po~illi! leI ~"It ,och cc:'Glcns 11'..4 !)3 tll11 Ul till a.'tj m:}."1eeu'IO C1 It\t'lg t...,JI motot t.r Itl,'IlUeJ 10 ~)("'"et ,.l'lt'JleI such
cooJ4;(,~ eJl!lt eecau!oe the ~~Ia.~1 6 l'l.l an eJ;.tl1 11 ll't lltld cf e~lcM'lertJI tu:.1l'h. Ule aw~ It;.crt IT.II" ~ tr ccnsajelN as .,
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le~1e Md be!le'tU them to te !llle 3.~ cCllect The aji~WI ooe\ l'l;t tlS\lime re~pcll\:tI:!ti to! the XClllaq c.l 'LCh ~tms UUI ....tfe Illll'l6o"tJ tly ctttl
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The awJiW Yoil 001 (J&"-!oe !he ccnttlt\ cl ItIe a;:~ulYl lewr1 elCe;.l ;u rc~IJeJ 1;1 t1 1!'Ie Ur~;rr.l SI,),'IJ1:~1 cl PI~e\\~nJ! ,1,;p~ll Ptxlce
9 The a;~305.e1 haS ba.\td I'\IS tll hel a;~w It",,:t a."IJ vJ.'1;.tcn tcrc~1Qr\ leI ..., Ji.,P"'\Jl tIl.I! l) \...b.t~l Ie u:~~.tC:cli' written. lt~a'" CI
~~aIlJns en Ire as.\um~bJn tl\.t comp'ttlJn cl the n;.tu_e:neru Iililllt ~rtcm,,~'J r\ 11 'Iocllrn.ll'lIJe m.rv'ltl
10 lhe ,.:.~.u;loeJ mil$! p1QH~ tI\ 01 ttl ",':1 "I:ttn Wl!.el'il ttlOle L'le It:-..ltL,l.trl *~~~J 10 t!'t .l;p.w..a; :fl.;rl ,,),~~::.t~le r.Jt J;;U.U It!);ll
tif'(~oJtg Cct'lC~1(,~ t\tlCl.1 the ~f,;~ ~~. L'Ie ~V'.)IlotI' defttj a."IJ p',lm.:na: lhqn.Clin\ .L'\J 1t1~ftrxtl IJ .\"t t'l;,;lh\),)l\Ji 4'ill~
(j/o.Wl~Ql'l\ CI the I.m wth "lIItfllfle a;;pl~ I!I ~l.teJI to oVt,cn! l,;et:l lh.In lhe bOllo...el, lhe mcl1<}'Jrt l'l tl '-ICCU!>\;11 .\'\1 .&\1'i". ~ mor1~~
t1S\Ilel. tOMl.IY'd: ~olt\Wl\JI a;~1.1JI OIl&":IUliOn\. a."I1 \late Cl lwel~" J;;C1cleJ ltlJ{l(J.5 tl:J:~I",;n .;( ..", ;)>..\1rt't:'ll, .}'rc" Of ...sl111mel1~J
of lit: Unte.1 SUlt\ Of Mrt "te 01 tl'le D61fct ct Columtnl. rJ.C:t;.t tM t:'le 1t1'l~I,t~11 mIl d,)t1t~~! the I"C.~!t, Jt~I,I';~ Y'.:l"n .;1 t~ I~Nll \,\"tt III MIl
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SAFE DEPOSIT BOX
INVENTORY
Ploa.o Print ar Tvpo
MUST BE COMPLETED BY REPRESENTATIVE or F1NANCIM INSlIIUTlON WItERE SAFE DEPOSIT BOX IS lOCATED AND RETURNED TO ABOVE ADDRESS
COUNTY CODE filE NUMBER SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER
- 1/'-1. 5" 7
DATE OF DEATH
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NA E. ADDRESS AND RELATIONSHIP (Ii' ANYI TO DECEDENT. OF PERSONIS, PRESENT AT THE BOX OPENING
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MUST BE COMPIElED BY REPRESENTAtiVE or IINANCIAlINSlIIUTION WIIERE SAfE DEPOSII BOX I~ IOCAllD AND Rl1URNED 10 ABOVE ADDR[~~
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INSTRUC-YIONS --,..--->' ---.-.. . ~_.... ..-.-. ----._--_.."..._-~--_.__..- --~- ...
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(3) Obligation. 01 U. S. Govornmonl: Numbot 01 ilom.. dolo 01 illuo. laca valuo. namo. in which roOi.IOtod
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1973 ~ I a;o fe50
Register of Wills of
Cumlw,' 1 IIntl
County, Pennsylvania
INVENTORY
[51.110 of
STEPHEN II. HAMPTON
1996-00461
No
.1-;'0 known 85
Dale 01 Death
U1t!2C,/96
. Deceasod Social SCcuflly No.
?07.1,1,.6577
PAMELA A. HAMPTON
Personal Represontalive(s) 01 Ihe above Estate. deceased, vonly thai tho ileuM appoaring in the following Inventory Include nil allho
pOlsonal assets wherever situate and all of Ihe real eslalo in tho Convnonweallh of Pennsylvania of said Decedent. thai tho vnluation
placed opposite each item of said Inventory represents its fai, value as of the date of tho Decode nt's doath, and thai Decodent owned
no real estale outside of the Corrvnonwralth 01 Pennsylvania ellcept thai which appears in a I11Omorandum at the end of this
Inventory. I fWo verify thaI the statements made in this Inventory are true and correct. I/We understand that false stalemt'nls herein
:uo made subjecllo lhe penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to aUlhorities.
~'~;:'e~ STEVEN J. SCH I FFMAN
POISonal Reptosontaltv} ~,_
Signaluto ~ l ~ A--~
PAMELA A, MPTON ---
I D. No.: 25l,88
Signature:
.\ddross:
SERRATELLI, saUF'FMAN, BRa'IN, ET AL'Addtoss:
2080 LINGLESTOIlN RD., SUITE 201
HARRISBURG, PA 17110.9445
END I COlT , NY 13760
1110 RODMAN ROAD
rolephono: 717/5/,0-9170
Tolophone: 607 /7/,8.698/,
Oalod: ~~'l
Description
1. Household Personalty
2. Cbin Cb11ection
3. Autonobile
4. Cbrmonwealth of Pa. (Final Salary)
5. Cbrmonwea1th of Pa. (Accrued Sick & Vacation)
6. Refunds & Reimburserrents
7. 1/2 Interest in 819 Brian Dr., Eno1a, PA
8. 1/2 Interest in lobntgoITery Funds
9. 1/2 Interest in PSECU Account #2207446577
10. 1/2 Interest in PSECU Account #0207446577
11. 1/2 Interest in PSECU Account #1207446577
12. 1/2 Interest in PSECU Account #0211183286
13. 1/2 Interest in Dreyfus Account
753 ~O~o
47,116.50
5,206.00
1,601.05
16,516.55
522.91
32,000.00
13,147.06
2.18
244.17
89.51
1,376.70
1,661. 96
AIt.1Ch additional sheels if necessary)
To.al 120,237.59
nOTE: Tho Momotandum 01 roalostato outside tho Commonwo"llh 01 Ponnsylvanla may. ,1I'ho oloct'on ollhe petSonal tept.s.nta."o.
Include lhe value 01 each item. but such figures should not be extended into the total ollhe Invenlory
rt"j.Jrt'd by lhe Pennsylvlnll S" Assocllllon
C, ,-,light {(J 1996 fo,msoflw"e only CPSyslems, Inc.
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1851 03 COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT O' REVENUE
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
.'
DNo. AA
RECEIVEO FROM:
D
ACN
ASSESSMENT P:'
CONTROL ~
NUMBER
AMOUNT
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STEVEN J SCHIFFMAN
2080 LINGLESTOWN ROAD
SUITE 201
101 SC,81C.6J
HARRISBURG, PA
17110-9483
fOlDH'"
SSN 207-44-6577
(FIRST]
(Mil
m TOTAL AMOUNT PAID
.2,812.63
PB
..r
I
REGISTER OF WILLS
,'/, ,'; ~r~ "
RECEIVEO BY"''' (, i, , l,.:: (/,,,/,,/ ' 1'.:/
, ~GN"'U}! '" . t"':"
MARV C. LEWIS ,::~ '.;..~,/Al/)"~
REGISTER OF WILLS?
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
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BUREAU OF INDIVIDUAL TAXES
IHtllAIUHCl fAit DivisioN
DlJlI. :aDttOI
IlAAR1S!lUAG. PA 11118-0,01
NOTICE OF INIlERIT ANCE TAX
APPRAISEIlENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSIlENT OF lAX
'''-1'"1 IIIIf III.'"
STEVEN J SCHIFFMAN
STE 201
2080 LINGLESTOWN RD
HBG PA 17110
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-21-97
.tAMPTON
04-26-96
21 96-0461
CUMBERLAND
101
STEPHEN
W
I
AMount R...i Uad
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiiv:iS4TEif-jiFP--iiii-:97Y-Nij;'-icE--o"-YNHEiiiTANcE-Ylix-jippRiiisEHENT-.--jiLi-owANcE-OR--mn-n-------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HAMPTON STEPHEN W FILE NO. 21 96-0461 ACN 101 DATE 04-21-97
TAX RETURN WAS: I X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..I Est.t. (Schedule Al (l)
2. stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/P.~tn.rshlp Inter..t (Schedule C) (3)
4. Hartgagas/Nota. Raceivable (Schedule DJ (4)
5. Cash/Bank Dapollts/Hlsc. Parsonal Property (Schedula E) IS)
6. Jointly Owned Property (Schedule f) (6)
7. Transfars (Schedule CI 171
8. Total Assat.
I CHANGED
NOTE: To insura proper
credit to your account,
subnit the upper portion
of this for~ with your
tax paynent.
.00
.00
.00
.00
71. 716.01
48.521.58
.00
IBI
120.237.59
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral E~pens.s/Adn. Costs/Hisc. Expenses (Schedule H) (9)
10. Debts/Hortgage Liabilities/Liens (Schedule I) (10)
11. Total Deductions
12. Het Value of Tax Raturn
13. Charitable/Covern.antal Bequasts (Schedule J)
14. Het Value of Est.te Subject to Tax
23.533.76
1.304.81
1111
1121
I1Sl
1141
~4.R3R ~7
95.399.02
.00
95.399.02
If an assessment was issued previously, lines 14, 15 and/or 1&, 17 and 18 will
reflect figures that include the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
15. Anount of Line 14 at Spousal rate (IS)
16. Anount of Line 14 taxable at Line.l/Class A rate (16)
17. Anount of Line 14 taxable at Collateral/Class Brat. (17)
18. Principal Tax Due
TAX CREDITS:
PAYIlENT
DATE
07-24-96
01-23-97
NOTE:
.00 X .00:
50.249.78 X.06:
45.149.24 X .15:
I1BI
.00
3.014.99
6.772.39
9.787.38
RECEIPT
NUIlBER
AA146553
AA185103
DISCOUNT I')
INTEREST/PEN PAID I-I
348.74
.00
6.626.01
2.812.63
AIlDUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
9.787.38
.00
.00
.00
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN II. NO PAYIlENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI. YOU IlAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I
RESERYATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
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E.tatl' of dlcedent. dying on or before DecI.ber 12, 1982 -- If any future Intere.t In the 8.tate I. tran.ferred
In po.se..Jon or .njoy.ent to Clas. B (collateral) beneflclarle. of the decedent after the e~piratlon of any e.t.te
Ilf. or for y..r., the Co..onwe.lth hereby e~pre..ly re..rve. the right to .ppr.lse and asses. tr.nsfer Inherlt.nc.
.t the lawful Cla.1 B (coll.ter~lt r.te on .ny such future Intere.t.
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Ta~e.
To fulfill the requlre.ent. of Section 21~0 of the Inherlt.nce and E.t.te 1.~ Act, Act 21 of 1995. (72 P.S.
Sect Ion 9140).
Detach the top portion of thl. Notlc' .nd subelt with your p.y.ent to the Register of Will. printed on the rever.e .ide.
uHake check or eoney order p.yabll tOI REGISTER OF MILLS I ACENT
A refund of . t.M credit, which w.. not reque.ted on the T.M Return, ..y be r.que.ted by coepletlng an ~Appllcation
for Refund of Pennsylv.nla Inheritance and E.tate 1.~" IREY-llI3). Applic.tlon. .re .v.ll.ble at the Office
of the Regllter of Will., .ny of the 23 Revenue District Office., or by calling the .pecl.1 24-hour
.nswering .ervlce nuabers for for.. ordering: In Penn.ylvanl. 1-300-)62-Z0S0, out. ide Pennsylv.nla and
within local H.rrlsburg .re. (117) 181-a094, IDOl (711) 17Z-Z2Sl Ofe.rlng I.p.lred Only).
OBJECTIONS: Any p.rty In Inter..t not ..tlsfled with the appralse.ent, allow.nce or dlsallow.nce of deduction., or ..se.seent
of taM (including di.count or Interest) .. .hown on this Notice eust object within slMty (60) d.y. of receipt of
this Notice by:
ADHIN
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENal TV:
INTEREST:
uwrlthn protest to the PA Dep.rt.ent of Revenue, Bo.rd of Appeals, Oepl. l810l1, H.rrlsburg, PA 17lla-l021, OR
-.election to h.ve the ..tter deterelned .t .udlt of the .ccount of the per.on.1 repre.entatlve, OR
--.ppe.1 to the Orph.n.' Court.
Factual errorl dl.covered on this ..se..eent .hould be .ddressed In writing to: PA Cep.rt.ent of Revenue,
Bureau of Indlvldu.1 T.Me., ATTN: Post Assess.ent Review Unit, Dept. 2a060l, H.rrlsburg, PA 111la.0601
Phone (111) la7-6S05. See p.ge S of the booklet "In.tructions for Inherlt.nce T.M Return for. Re.ldent
Oecldent" (REY-ISOI) for .n e~pl.natlon of adelnlstr.tlvely correctable error..
If any taM due I. paid within three ()) calendar eonths after the decedent'. de.th, a five percent (S~) discount of
the taM paid I. allowed.
The 15~ t.M .an..ty non-p.rtlclp.tlon pen.lty I. coeputed on the total of the t.M and Int.re.t ..ses..d, and not
paid before J.nuary la, 1996, the first day .fter thl end of thl t.M .ene.ty periOd. Thl. non-p.rtlclpatlon
pen.lty I. .pp.al.ble In the .... .anner .nd In the the .... tlee periOd .. you would appeal the t.M .nd Int.r..t
that h.. been as..ssed .. Indlc.ted on thl. notice.
Int.re.t I. ch.rged beginning with first d.y of delinquency, or nine 191 .onths .nd on. Cl) d.y fro. the data 0'
d.ath, to the d.te of p.y..nt. T.Mes which beca.. delinquent before J.nu.ry 1, 198Z b.ar Int.rest .t the rate of
six C6~) p.rcent par .nnu. calculated .t . d.lly rate of .000164. All t.Mes which bac..a delinquent on and .fter
January I, l,aZ will bear Interast .t a r.te which will v.ry fro. c.landar ye.r to calend.r year with that r.t.
.nnounced by the PA Departeent of Revenue. The appllc.ble Inter.st r.tes for 1982 through 1997 .r.:
'!!!! Lnterut Rat. Dally Inhrut Fftctor !!!! Interest Rftte Dally Int.rut Factor
1981 lO~ .000S~8 1'81 .. .000247
I'U 16% .00043a 1988-1991 IU .000301
1984 11% .000301 1992 .% .000l"7
1985 13% .00D3S6 1993-199" n .000192
1986 In .000174 1995-1997 .% .0002'"
ulnt.rut Is calculahd .. follows:
INTEREST = BALANCE OF TAX UNPAID X NUnBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
.-Any Notlc. Is.u.d aft.r the taM blco... d.llnquent will r.flect an Interest c.lcul.tlon to flft..n CISJ day.
b.yond the data of the as..s...nt. If pay.ent I. ..d. .ft.r the Int.r.st co.put.tlon d.t. shown on the
Notlc., additional Int.r..t .u.t ba e.'culated.
IN RE: Estate of
STEPHEN W. HAMPTON,
Deceased
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
No. 2196-0461
AFFIDAVIT OF SERVICE
I, steven J. schiffman, being duly sworn according to law,
depose and say that I served a copy of the petition and First and
Final Account of pamela A. Hampton, Administratrix of the Estate of
stephen w. Hampton, including the schedule of proposed Distribution
upon the following creditors and/or beneficiaries by depositing it
in the United states mail, certified, return receipt requested on
June 11, 1997, addressed as follows:
Julia L. Hampton
22 cornell Drive
Camp Hill, PA 17011
The Return Receipt Cards
hereto.
William w. Hampton
P.O. Box 572
Lock Haven, PA 17745
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steven J Sch man, Esq.
sworn and subscribej to SERRATEL I, SHIFFMAN, BROWN ,
before me this ~I day CALHOON,' P.C.
~~"d ' 1997. 20BO.Linglestown Rd., suite 201
{ I r Harr1sburg, PA 17110
zJ!//I,r1~ (717) 540-9170
NOTARY PUBLIC , Attorney for Estate of stephen
_ 'c W. Hampton
My Commission Expires:5.7-)O~
are attached
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Debrs A. Evangelist!. NotatV Public
Susquohonna Twp.. Dauphin Counly
My Commission ExpitoS May 7. 2000
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canllo ~u.
-AnKh this form lolhe 'toot 01 the maltpiece, or on IhI blck If aplce don not
ponnl.
'Wnl,"RMm R<<>>ipf RIq~"td'on the mailpieCe below Ihl ,"ad. numblr.
IThI Rltum RlCIipl WI. ahow loYdlomIhl .rUd. wa. d,lrdftd and thl dill
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5. R.c.lved By: IPrfnl NB~}
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146553 COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
'*
~nUD""AJ
RECEIVED FROM:
i
ACN
ASSESSMENT P:'
CONTROL ~
NUMBER
AMOUNT
SCHIFFMAN STEVEN J
2040 LINGLESTOWN RD
SUITE 106
101
'6,6e6.01
HARRISBURG, PA
17110-9483
lOlD HU'
ESTATE INFORMATION:
~ FilE NUMBER
Y 21-1996-0461
r:I NAME OF DECEDENT (lAST)
~ HAMPTON STEPHEN W
~ DATE OF PAYMENT
1M / 4 /9
Cia POSTMARK DATE
COUNTY
SSN 207-44-6577
(FIRST) (MI)
CUMBERLAND
DATE OF DEATH
04/26/96
REMARKS SERRATELLI SCHIFFMAN
BROWN & CALHOON PC
SEAL CHECKIl 009243
m TOTAL AMOUNT PAID 156,626.01
PB
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RECEIVEOBY", /. I.)',t'-'J/..,"v'
51GNArU /' /, ,.
MARY C. LEWI S ~ ,,'/ U./..J (. ". ,:
REGISTER OF WILLS ,r.l
REGISTER OF WILLS
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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
No. 1996-00461
FIRST & FINAL ACCOUNT OF
PAMELA A. HAMPTON. ADMINISTR~~~~ OF
THE ESTATE OF STEPHEN W. H N
Date of Death: April 26, 1996
Date of Executrix's Appointment: June 12, 1996
Date of First Complete Advertising: July 5, 1996
Accounting for the Period: April 26, 1996 to May 20, 1997
Purpose of Account: Pamela A. Hampton, Administratrix offers this
account to acquaint interested parties with the transactions that
have occurred during her administration.
It is important that this account be carefully examined. Requests
for additional information or questions or objections can be
discussed with:
Steven J. Schiffman, Esq.
SERRATELLI, SCHIFFMAN, BROWN
, CALHOON, P.C.
2080 Linglestown Rd., Suite 201
Harrisburg, PA 171103
(717) 540-9170
Page I
PRINCIPAL RECEIPTS
current Value Fiduciary
Acauisition
Value
Real property
1. N/A
Please note that the real property located at 819 Brian
Drive, Enola, pennsylvania was jointly owned by the
decedent and pamela A. Hampton as joint tenants with
the right of survivorship and thus, became the property
of the surviving tenant at the time of death.
REAL PROPERTY TOTAL:
$-0-
Personal property
1. Household Furnishings
a. Waterbed (sale price)
b. stereo speakers (Sale price)
c. Tennis Racket (Sale price)
d. RCA Color TV (Sale price)
e. Coffee Table (Sale price)
f. End Tables (Sale price)
g. Dinette Set (Sale price)
h. Fireplace Set (sale price)
i. Bar stools (Sale price)
i. Entertainment Center (Sale price)
j. Recliner
j. Auction Sale (Fahnestock's)
k. Color TV (Sale price)
1. Sharp VCR (Sale price)
m. Auction Sale (Fahnestock's)
n. stereo
o. Auction Sale (Fahnestock's)
50.00
30.00
2.00
50.00
10.00
20.00
65.00
10.00
20.00
40.00
15.00
90.90
35.00
75.00
147.60
40.00
290.70
991. 20
$ 753.00
(Appraisal)
2. coin Collection
a. Auction #l
b. Auction #2
c. Auction #3
(Addition Error on settlement
Sheet)
d. Wrapped coin Proceeds
e. Auction #4
$47,116.50
(Appraisal)
17,408.12
15,038.14
8,546.53
PERSONAL PROPERTY TOTAL:
730.45
8.065.501
49,788.74
50,779.94
'The Costs balance of $751.39 for the sale were advanced by Pamela Hampton (See
Administratrix Costs), Therefore, the net proceeds of the sale were actually 7314.II.
Page 2
Subseauent Receipts
.DAte
Payor
i
7-23-96
7-23-96
7-23-96
7-23-96
7-23-96
7-24-96
8-8-96
8-20-96
9-12-96
5-5-97
5-7-97
Bell Telephone (Refund)
Rayovac (Refund)
Motorists Mutual (Funeral Benefit)
Patriot News (Refund)
Delta Dental (Insurance Reimbursement)
Motorists Mutual (Car Ins. Refund)
Motorists Mutual (Car Value)
Commonwealth of Pa. (Final Payroll)
Commonwealth of Pa. (Accrued Vacation
and sick Leave)
IRS Reimbursement Check
Pamela A. Hampton
(Reimbursement for Direct Deposits
from Stephen Hampton's account for
utilities for real estate)
SUBSEQUENT RECEIPTS TOTAL:
$26,466.53
TOTAL PRINCIPAL RECEIPTS:
$77,246.47
Page 3
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Amount
16.72
2.50
1500.00
27.00
57.40
75.09
5206.00
1601.05
16,516.55
1062.62
401. 60
PRINCIPAL DISBURSEMENTS
Debts of Decedent
Date. ~heck 4 ~reditor "mount
7-24-96 001 university Physicians 5.00
8-05-96 101 PSECU (Visa) 991. 49
SUBTOTAL: $ 996.49
funeral Expenses
C.A.2 Funeral 6859.00
C.A. Grave opening 695.00
10-19-96 C.A. Horst Memorials 845.00
SUBTOTAL: $8399.00
~dministrative Expenses
6-10-96 SSB&C) Register of Wills 118.00
(probate Fees)
6-13-96 SSB&C cumberland laW Journal 40.00
(Estate pUblication)
7-9-96 SSB&C George R. Ulsh 300.00
(Real Estate Appraisal)
7-19-96 SSB&C cumberland laW Journal 20.00
(Add'l Estate pUblication cost)
8-7-96 SSB&C The sentinel 78.38
(Estate publication cost)
9-10-96 102 John T. Ensminger 1500.00
(personal property APpraisal)
2A11 costs indicated with a CA were costs advanced by the Administratrix Pamela A. Hampton
for which she received reimbursement from the Estate by Check # I 07 dated 5/5/97.
'AlI costs indicated with SSB&C were costs advanced by Serratelli, Schiffman. Brown and
Calhoon.
Page 4
1-13-97
1-28-97
1-23-97
103
10.00
C.A.
Register of wills
(Filing Fee-Inventory)
Register of Wills
(Add'l Probate Fee)
Deposit to Checking Account 200.00
105
45.00
C.A.
Postage (Return Coins) 6.10
postage (Return Coins) 7.34
Administratrix Bond 340.00
C.A.
C.A.
C.A.
Administratrix Bond Renewal 340.00
C.A.
Electric (3-25-96 to 4-23-96) 108.32
Replacement of Safe Deposit
Box Key 12.50
Auction 44 - Amount due to
Auctioneer per contract 751.39
C.A. (Julia Hampton) Duplicate Title for 5.00
Car
C.A.
C.A.
SSB&C
Inheritance Tax Filing Fee
15.00
SUBTOTAL:
$3897.03
Federal & state Taxes
7/24/96
1/13/97
5/7/97
5/7/97
104
Register of Wills
Register of Wills
(Inheritance Tax)
6626.014
2812.63
C.A.
Pa. Department of Revenue
Pa. Department of Revenue
(pa. 41 to 3/31/97)
3.00
110
570.00
111
Internal Revenue service
(1041 to 3/31/97)
1856.25
SUBTOTAL:
$5241.88
4The amount of $6626.01 was paid individually by Pamela A. Hampton and Julia Hampton for
funds which were held as joint tenants. thus the figure is not included in the totals.
Page 5
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PROPOSED SCHEDULE OF DISTRIBUTION
Total Available for Distribution: $51,207.57
Julia L. Hampton
22 Cornell Drive
Camp Hill, PA 17011
SSN: 211-18-3286
One Half of Estate: 25,603.78
Less ~ Reserve: 1,000.00*
Total: $24,603.78
william w. Hampton
P.O. Box 572
Lock Haven, PA 17745
SSN: 210-12-1037
One Half of Estate:
Less ~ Reserve:
Less support Arrearage Claim:
25,603.78
1,000.00*
43,998.00
Total:
-0-
TOTAL TO JULIA HAMPTON:
$49,207.56
*The Administratrix will be reserving the total amount of
$2000.00 in order to pay any outstanding attorneys' fees and
costs which are incurred as a result of the accounting process as
well as for the payment of any future fiduciary taxes. Upon
receipt of the final Order in this matte~distribution will be
made without the need for a further formal accounting.
Pamela A. Hampton, Administratrix of the Estate of stephen
w. Hampton, deceased, hereby declares under oath (penalties of
perjury) that she has fully and faithfully discharged the duties
of her office; that the foregoing First and Final Account is true
and correct and fully discloses all significant transactions
occurring during the accounting period; that all known claims
against the estate have been paid in full; that, to her
knowledge, there are no claims now outstanding against the
Estate; and that all taxes presently due from t e estate have
been paid. n \. 'jl._
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P HAMPTO
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STATUS REPOR'r UNDER RULE 6,12
Name of Decedent:
STEPHEN W. HAMPTON
Date of Death:
APRIL 26. 1996
Admin, No, 1Q96-00461
IHll No.
Pursuant to Rule 6.12 of the Supreme Court Orphans I Court
Rules, I report the fOllowing with respect to completion of the
administration of the above-captioned estate:
1. State whether administration of the estate is
complete:
Yes
No
x
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete: June 1, 1997
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes ____ No____
b. The separate Orphans' Court No. (if any) for the
personal representative's account is:
c. Did the personal representative state an account
informally to the parties in interest? Yes ___ No____
d. copies of receipts, releases, joinders and
approvals of formal or informal accounts may be f' ed with the
Clerk of the orphans' Court and~aY b ~ d 0 is repo t.
Dated: I 1::>'1 Iq..,
~ Sgnatue
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2080 Linglestown Rd" Suite 201
Harrisburg. PA 17110-9445
Address
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(717) 540-9170
Telephone Number
capacity:
Personal Representative
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Counsel for Personal
Representative