HomeMy WebLinkAbout04-04-08
-I
15056051047
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
INHERITANCE TAX RETURN
RESIDENT DECEDENT
File Number
Date of Birth
Decedent's Last Name Suffix
Decedent's First Name
MI
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
_ 1. Original Return
c:::>
4. Limited Estate
c:::>
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
c:::>
2. Supplemental Return
c:::>
c:::>
c:::> 4a. Future Interest Compromise (date of
death after 12-12-82)
c:::> 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
c:::> 10. Spousal Poverty Credit (date of death c:::> 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
i
8. Total Number of Safe Deposit Boxes
-
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
~O SI~~OR FILING RETURN
ADD~SC8-' ~ fu h
SI~ATURE OF ~!~~THER ~~ REPRES~~~~IV~
fA )/I/d.-
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051047
15056051047
--.J
-I
15056052048
REV-1500 EX
Decedent's Social Security Number
Decedent's Name:
RECAPITULATION
1. Real estate (Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2.
~1. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5.
6. Jointly Owned Property (Schedule F) c:::> Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c:::> Separate Billing Requested.. . . . . .. 7.
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8.
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . . 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10.
11. Total Deductions (total Lines 9 & 10)... .. ... ..... ............. ......... 11.
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14.
TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0_
16. Amount of Line 14 taxable
at lineal rate X.O!1S
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
15.
16.
17.
18.
19. TAX DUE. " . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
c:::>
-L_ L
2.....,)
'CJ
Side 2
15056052048
15056052048
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Decedent's Complete Address:
DECEDENT'S NAME
_:r-bomCAS__- B _\i_;n~\e.._(nQ(\ . Sr
STREET ADDRESS. - \- \ lot
3-d-fw-kr __S__Cef..1" }~--- -8-
File Number Ol. 0\08 -000 3y
REV-1500 EX Page 3
CITY f(\
A
ZIP
'lOlc5
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discounl
(1 )
3 ~.(.C
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00_
O.~_
Q.CV
O..cP
(j ,CO
Total Credits ( A + B + C )
(2)
0.00
Total Interest/Penalty ( D + E )
4. If Line 2 is (Jreater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
0.00
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5)
(5A)
(5B)
~50, 00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
2>50. cD
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.......................................................................................... 0 ~
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 tgI
c. retain a reversionary interest; or.......................................................................................................................... 0 ~
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 129
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ............. 0 ffl
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 ill
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the sUNiving spouse
is three (3) percent [72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the sUNiving spouse is zero (0) percent
[72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a sUNiving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the sUNiving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-is02 EX+ (6-98)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE ~. ' _ FILE NUMBER
I n6fr7() S f) "YVlntlerYlat1 Sf' Joo8.()O() 3'1
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
1188 Sky l,ne I We<f Rid ,1-7(0'1. i /cr I(J& 1e d
C{+ 3~ Let1ier Sfrmt Lo+ 8 (f1avn+
J ./
I-b/ly Spn\?) S J PA 170/P5~ awflld
~Iely b1 rkce<h.(/+
VALUE AT DATE
OF DEATH
~ (p SCO. '0
:;
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
(P. 500. a:i
J
REV-1503 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
~() S 8 V1!t()lclemOlfl :y
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
FILE NUMBER
atIJ9rCOO3l/
ITEM
NUMBER
1.
/
/
/
/
/
I
/'
//
DESCRIPTION
VALUE AT DATE
OF DEATH
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
~
0:>
REV.1504 EX +.1'.97)
SCHEDULE C
CLOSEL Y.HELD CORPORATION,
PARTNERSHIP or SOLE.PROPRIETORSHIP
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
E~OF fL ..'...._J,l C^
r YlG'I11a -5 0 V\J \ '( ~ e~n ~.
FILE NUMBER
J..0J8 - em 3 LJ
Schedule C-1 or C-2 (Including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprie rship.
See instructions for the supporting information to be submitted for sole-proprietorships.
ITEM
NUMBER
1.
DESCRIPTION
TOTAL (Also enter on line 3, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
co
REv-rsos EX+ (6-98)
SCHEDULE C-1
CLOSELY-HELD CORPORATE
STOCK INFORMATION REPORT
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
6 Wait
FILE NUMBER
a~~(J1)3ll
ESTATE OF
ProducUService
Date of Incorporation
1. Name of Corporation
State on Incorporation
Address
City
2. Federal Employer 1.0. Number
3. Type of Business
State_ Zip Code
4.
STOCK
TYPE
Voting/Non-Voting
TOTAL NUMBER OF
SHARES OUTSTANDING
PAR VALUE
VALUE OF THE
DECEDENT'S STOCK
Common
$
$
Preferred
Provide all rights and restrictions pretaining to eac class of stock.
. . . . . . . .. 0 Yes 0 No
Time Devoted to Business
5. Was the decedent employed by the Corporation?
If yes, Position Annual Salary $
6. Was the Corporation indebted to the decedent? . . . . . . . . . . . . . . . . . .. ............... 0 Yes 0 No
If yes, provide amount of indebtedness $
8. Did the decedent sell or transfer an stock in this compan
if the date of death was prior to 12-31-82?
DYes 0 No If yes, 0 Transfer 0 S e
Transferee or Purchaser
Attach a separate sheet for additional transfers
of the decedent? ..... 0 Yes 0 No
Net proceeds payable $
7. Was there life insurance payable to the corporation upon the dea
If yes, Cash Surrender Value $
Owner of the policy
ithin one year prior to death or within two years
Number of Shares
Consideration $
Date
9. Was there a written shareholder's agreement in ffect at the time of the decedent's death? ....0 Yes 0 No
If yes, provide a copy of the agreement.
10. Was the decedent's stock sold? . . . . . . . .. ........................................... 0 Yes 0 No
If yes, provide a copy of the agreement of ale, etc.
11. Was the corporation dissolved or liquid ed after the decedent's death? .................... 0 Yes 0 No
If yes, provide a breakdown of distrib ons received by the estate, including dates and amounts received.
12. Did the corporation have an inter t in other corporations or partnerships? ............. 0 Yes 0 No
If yes, report the necessary info ation on a separate sheet, including a Schedule C-1 or C-2 for each interest.
A.
B. Complete copies of finan lal statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years.
C. If the corporation owne real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have
been secured, attach opies.
D. List of principal sto holders at the date of death, number of shares held and their relationship to the decedent.
E. List of officers, th ir salaries, bonuses and any other benefits received from the corporation.
F. Statement of di Idends paid each year. List those declared and unpaid.
G.
ation relating to the valuation of the decedent's stock.
(If more space is needed, insert additional sheets of the same size)
REV-1506 EX+ (9-00)
SCHEDULE C-2
PARTNERSHIP
INFORMATION REPORT
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
-rhoy('Q~ 6 ~~/fY'Oln S--
FilE NUMBER
eX rAfT OOj3l{
1. Name of Partnership
Address
Date Business Commenced
D.
State
City
2. Federal Employer I.D. Number
3. Type of Business
4. Decedent was a 0 General
Product/Service
5.
A.
B.
c.
6. Value of the decedent's interest $
7. Was the Partnership indebted to the decedent? ....... ......................... 0 Yes 0 No
If yes, provide amount of indebtedness $
9. Did the decedent sell or transfer an interest
prior to 12-31-82?
DYes 0 No
Transferee or Purchaser
pon the death of the decedent? ..... 0 Yes 0 No
Net proceeds payable $
8. Was there life insurance payable to the partnership
If yes, Cash Surrender Value $
Owner of the policy
this partnership within one year prior to death or within two years if the date of death was
Percentage transferred/sold
Consideration $ Date
10. Was there a written partnership reement in effect at the time of the decedent's death?
If yes, provide a copy of the a reement.
11. Was the decedent's partner ip interest sold? ....................................... 0 Yes 0 No
If yes, provide a copy of t agreement of sale, etc.
DYes 0 No
12. Was the partnership di olved or liquidated after the decedent's death? ................... 0 Yes 0 No
If yes, provide a brea own of distributions received by the estate, including dates and amounts received.
lated to any of the partners? .................................... 0 Yes 0 No
14. Did the partn rship have an interest in other corporations or partnerships? . . . . . . . . . . . . .. 0 Yes 0 No
If yes, repo the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
calculations used in the valuation of the decedent's partnership interest.
B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years.
C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. Any other information relating to the valuation of the decedent's partnership interest.
REV-t507 EX+ (1-97) _
~..: ':.I~ :"'i ..t
~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
~~~s fl
~ 0 Wln):,kYflClf1 y
FILE NUMBER
ac:n6- em 3 4
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-l508 EX + (1-97)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INH~:~;~~~~ DTEAtE~~~~RN PERSONAL PROPERTY
ESTATE OE-rh (l W C' _
I ()y()a S LJ "f\UtrY\Olf):::J.
FILE NUMBER Y
aCX>f'r cro3
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
~,
3.
4.
5.
~~
1.
8,
VALUE AT DATE
DESCRIPTION OF DEATH
O("~i) ~k.) 'Y.t).~f<. a.SJ.I S\\\~~enshu(2t PA J'~57 .$ J OS1. 33
L~\...\ f\~ l\ccc;\) n+) -I:\:. Hjtocco~L\ Y.J lJeD Vol\le, )
19 <=11 ~O\d.. Ec~ \ \f\Q. 1 5C'{ C\"f'\ (~; \\ of' ~ \-e
~~~ . Sc\J, ~ \ess ~f") Fr"\v
'CQukU.~ Va'() ""oJ. b\CV\l (\ b'"\J l NL )
0>-5" em. h(Af\cl- ~~
)
fY)eJ\'-Jt~~ rt\cd\Ca' LLl~+ccl ,'0. \ ACCfJUrt+
D\~bv~Q'r) fr\eJ\~~ ~." Ad'J:~~rV'C.J
a.. \to _ A \'^~ia Tro~lJ ()\J iedc FL 381(0 ~
~t:\ \\'€d a~~ ~
~~ o~ ~\40..\ t\~ tf6~S prem\\J<V\.
\4-~~ tcrvll\ Sh\~~~ 0, \ +0\ ~~\G\ ~"1~~
~~~ .~ r~~~r r~ ~I
\<N'\;):~\€. ~"'\ p~~ 0\ ~A
C. ~~ ) c\J().\ (" <; ) \0. b \-e ')
~ loCO, 00
'J
ao.lS
9yO, (00
l\o~, a\
YdL).53
. '" toy
I ~.
5 rot 00
TOTAL (Also enteron line 5, Recapitulation) $5 9 to4 ,YCf
(If more space is needed, insert additional sheets of the same size)
REV.l509 EX. (1'-97)
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
~0n1Dt ~ ~ ~~ \, n't \.e#'CtV\ Sr
FILE NUMBER
~~- Cf)D3Y
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
A.
B.
c.
JOINTLY-OWNED PROPERTY:
LETTER
ITEM FOR JOINT
NUMBER TENANT
DATE
MADE
JOINT
DESCRIPTION OF PROPERTY
Include name of financial institution and bank account number or similar id
deed for jointly-held real estate.
1. A.
DATE OF DEATH
VALUE OF ASSET
'10 OF
DECO'S
INTEREST
TOTAL (Also enter on line 6, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
RELATIONSHIP TO DECEDENT
DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
0,
REV-1510 EX '11-97)
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTA~ .
(fV'{\0- S
PJ W4\-eMOt'1 Sf'
FILE ~ ~. em 3>Lf
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER
1.
DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER
ATTACH A COpy OF THE DEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
%OF
DECO'S
INTEREST
EXCLUSION
TAXABLE VALUE
If APPliCABLE
TOTAL (Also enter on line 7, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
CQ
REV-1511 EX+ (10-06)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
~lJ:J~' ()c)D 311
ESTATE OF
!h{)mQ ~ ~ W\l\t\-e-t'(\~1\ Sf
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
FUNERAL EXPENSES: l ?o..'o...- -\0 ~~ -~~ \i!'Q.rC\l
\. Tro\"Spo<'~1iCfY"\ (mr\- crt- ~P)
2. tJ~~ () b.-I-v (><0,/ No\ice -~' \IS ~ Se ,,+<('i~ \
3 - (u\\.(:; e~ (<:Rl'€-~ o~ ~=\-~ C{f-\\~c~~
4 ~\~rs .
5 _ ~ Ad;- ~ \~5l(NS ~('\l\ce.l~O-s-\or ~;P{) 'J
AMOUNT
/o--rVs(e PA II(Q(~
-f4 100,00
'1 3.a<o
(.()
~,
') O(p. (J.)
1 CO . l-\:)
s, ADMINISTRATIVE COSTS:
1, Personal Representative's Commissions
Name of Personal Representative( s)
Street Address
City
State _Zip
Year(s) Commission Paid:
2. Attorney Fees
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant. \h0'f('\0-~_ f:> 't\ \ (\k.\~~C\ V'\- ':5 R_
StreetAddress_:2~ -L~~- st('(JL:\) Lc 1- 5__
CityJf\O\)~ \-\n\\~pr\nd ~ State ~ziP\'l~5
Relationship of Claimant to Decedent _~ _ _nn
probateFeeSC:\j\n~~~cl. ~. Q.o~(Q~-\\"'QV'\lO:\~(~O+leS1 .J~,tV
,^r,\\ -ll5) Sh~~ C.~%C~lR.$~O JL~ f:"&-"\O~~~ 0
Accountant's Fees .J J
IID.L{)
3 500. (,C)
J
4,
5.
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ ~ OLl 9 I a <0
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-03)
SCHEDULE I
DEBTS OF DECEDENT
,
MORTGAGE LIABILITIES, & LIENS
ES~F
I hOYYU3 (j WlntJ-fd\Ul'l Sr FILE~UMBER
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death 'n I d' . ~ 'Lrn 34
ITEM ' I c u 1n9 unrelmbursed medical expenses.
NUMBER DESCRIPTION VALUE AT DATE
1 0 ' Lc \ _ j OF DEATH
. lIT ::ro..nv..\l\j eNd. ~ 511 I SS uecl o(i",-k 1)00 bd $ 4 I O. t..Q
c.o. s hnol 0.. +-kr ckA-h r / 10
J.
3.
~.
5
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
hn~~ phcrN b; IlJ po-iJ -k EI'iIlx,..r$ c>-W \x)D
(aQ..-t ~ 1rl-y~<o.t)3o~ .lets)
R (\(). \ e\ ecWI c. bJ' ~<Ai J -to !t\d - Ed o.+c\e r CllD
l~CC\- ~ l~aCl\'-l8106~)
~no.\ [o.b~ \>.\\.1 po.;<J -lp ~\-&6\e.~h~D
(acc~ ~ O~~t1llloSIr{)3--O)
\=;('0\ ~th\c-\e, Ls\JlO.rce. \tm\Il<l\ QIJ\'ol off, D::1l
. .......,...., . J
(te~r .l--n'S. Co }
~
3.
59.d~
51. ,1
5 '7. ~ 1
TOTAL (Also enter on line 10, Recapitulation) $ ~ 31 ! 4 \p
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
""'"
('
lelYlQ()
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. fhCfr(\Q3 e, W lt1CIenxx", 'J" ('
?:> ~ C~{\~ 'Sr\-re.Q+) Lo+ 8
ff\C!0'\.\- \\ol\~ ~f\~S PA llMo'S
('- T\<::I-~~
~ "' OJ'~\~\~~~
~{~
~ . ?o~,.~\J. ~~ \
(o(}08 E(~(fu~(1ve
'\lo...r (\ -s \, u~ P A 1111~
-c~
:soY\.
~~~-kr
AMOUNT OR SHARE
OF ESTATE
q () 70
1070
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
REV.1514 EX. '''.0.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
Check Box 4 on REV.1500 Cover Sheet
EST~ 6 hi 1-JA C - FILE NUMJ'~ER 3
) (11 LfCmQ;/1 .Y dcJ;(j' Ct:D '-!
This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89,
actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit.
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4
and in Aleph Volume for dates of death from 5-1-99 and thereafter.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return
o Will 0 Intervivos Deed of Trust 0 Othe
o Term of Years
o Term of Years
o Life or 0 Term of Years
o Life or 0 Term of Years
o Life or 0 Term of Years
1. Value of fund from which life estate is payable . . . . . . . . . . . . . . . . . . . . . " ..................$
2. Actuarial factor per appropriate table ........................... .....................
Interest table rate - 0 3 1/2% 06% 010% 0 Variable Rate
3. Value of life estate (Line 1 multiplied by Line 2)
o Life or 0 Term of Years
o Life or 0 Term of Years
o Life or 0 Term of Years
o Life or 0 Term of Years
1. Value of fund from which annuity is ayable............................................$
2. Check appropriate block below . . . . . . . . . . . . . . . . . . . . . . . . . .
Frequency of payout - 0 We Iy (52) 0 Bi-weekly (26) 0 Monthly (12)
o Quarterly (4) 0 mi-annually (2) 0 Annually (1) 0 Other ( )
3. Amount of payout per pe . d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
4. Aggregate annual pay ent, Line 2 multiplied by Line 3 ...................................
5. Annuity Factor (see' structions)
Interest table rate 0 3 1/2% 0 6% 0 10% 0 Variable Rate %
6. Adjustment Fac r (see instructions) ..................................................
7. Value of an ity - If using 31/2%, 6%, 10%, or if variable rate and period
payout is a end of period, calculation is: Line 4 x Line 5 x Line 6 . . . . . . . . . . . . . . . . . . . . . . . . . .$
If using v riable rate and period payout is at beginning of period, calculation is:
(Line 4 x Line 5 x Line 6) + Line 3 ..................................................$
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through
G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18.
(If more space is needed, insert additional sheets of the same size)
e
(Last Name) (First Name) (Middle Initial)
This schedule is appropriate only for estates of decedents dying on or before December 1 982.
This schedule is to be used for all remainder returns when an election to prepay has been filed under. e provisions of
Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of tr t principal.
REMAINDER PREPAYMENT:
REV-1644 EX + (3-04)
'*'
INHERITANCE TAX
SCHEDULE L
REMAINDER PREPAYMENT
OR INVASION OF TRUST PRINCIPAL FILE NUMBER
~S
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I.
II.
A. Election to prepay filed with the Register of Wills on
B. Name(s) of Life Tenant(s)
or Annuitant(s)
(Date)
Date of Birth
C. Assets: Complete Schedule L-1
1. Real Estate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
2. Stocks and Bonds. . . . . . . . . . . . . . . . . . . . . . . . . .$
3. Closely Held Stock/Partnership ...............$
4. Mortgages and Notes . . . . . . . . . . . . . . . . . . . . . . .$
5. Cash/Misc. Personal Property ................$
6. Total from Schedule L-1 . . . . . . . . . . . . . . . . . . . . . . . . .. ...........................$
D. Credits: Complete Schedule L-2
1. Unpaid Liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . .$
2. Unpaid Bequests. . . . . . . . . . . . . . . . . . . . . . . ., .$
3. Value of Unincludable Assets . . . . . . . . . . . .. ...$
4. Total from Schedule L-2 . . . . . . . . . . . . . " ......................................$
E. Total Value of trust assets (Line C-6 minus ne 0-4) .................................$
F. Remainder factor (see Table I or Table II' Instruction Booklet) . . . . . . . . . . . . . . . . . . . . . . . . .
G. Taxable Remainder value (Line E x Li F).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
(Also enter on Line 7, Recapitulatio
C.
Date of Birth
Age on date
corpus
consumed
III. INVASION OF CORPUS:
A. Invasion of corpus
B. Name(s) of Life Tenant(s)
or Annuitant(s)
.......................................................... ..$
D. Remainder factor (see Table I or Table II in Instruction Booklet) . . . . . . . . . . . . . . . . . . . . . . . . .
E. Taxable value of corpus consumed (Line C x Line D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
(Also enter on Line 7, Recapitulation)
JJ!1~)tc6'3 tf
6
Term of years income
or annuity is payable
Term of years income
or annuity is payable
ReV-16A5 EX+ (7-85)
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I. Estate of
INHERITANCE TAX
SCHEDULE L-'
REMAINDER PREPAYMENT ELECTION
-ASSETS-
FILE NUMBER
(First Nome)
II. Item No. Description
A. Real Estate (please describe)
Total value of real estate S
(include on Section II, line C-1 on
B. Stocks and Bonds (please list)
Total value of stocks and bonds S
(include on ction II, line C-2 on Schedule L)
C. Closely Held Stock/Partnership attach Schedule C- 1 and/or C-2)
(please list)
otal value of Closely Held/Partnership S
(include on Section II, Line C-3 on Schedule l)
D. Mortgages and N es (please list)
Total value of Mortgages and Notes S
(include on Section II, line C-A on Schedule l)
Miscellaneous Personal Property (please list)
Total value of Cash/Misc. Pers. Property S
(include on Section II, Line C-5 on Schedule l)
III.
TOTAL (Also enter on Section 1/, line C-6 on Schedule L)
(If more space is needed, attach additional 8Y2 x 11 sheets.)
S
aJn~fCCo3i
6
Middle Initial)
Value
FilE NUMBER~...()(X)3lf
,
REV-1646 EX+ (3-84)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
INHERITANCE TAX
SCHEDULE L-2
REMAINDER PREPAYMENT ELECTION
-CREDITS-
I. Estate of
~
II. Item No. Description
A. Unpaid liabilities Claimed against Original Estate, and payable from
reported on Schedule l- 1 (please list)
Total unpaid liabW les $
(include on Secti II, line D-1 on Schedule l)
B. Unpaid Bequests payable from ass s reported on Schedule l-l (please list)
Total unpaid bequests $
(include on Section II, line D-2 on Schedule l)
C. Value of ssets reported on Schedule l-l (other than unpaid bequests listed under
"B" a ove) that are not included for tax purposes or that do not form a part
of th trust.
Co utation as follows:
!
i
Total unincludable assets
(include on Section II, line D-3 on Schedule l)
III.
TOTAL (Also enter on Section II, line D-4 on Schedule l)
(If more space is needed, attach additional 8Y2 x 11 sheets.)
6
(Middle Initial)
Amount
$
$
REV-1647 EX+ (9-0.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE M
FUTURE INTEREST COMPROMISE
Check Box 4a on Rev-1500 Cover Sheet
9h~s 6 ~tkvrbY1 S1- F'~&b3~
This Schedule is appropriate only for estates of decedents dying after December 12, 1982.
This schedule is to be used for all future interests where the rate of tax which will be applicable when the fu e interest vests in
possession and enjoyment cannot be established with certainty.
Indicate below the type of instrument which created the future interest and attach a copy to the ta
o Will 0 Trust 0 Other
NAME OF BENEFICIARY
RELATIONSHIP
AGE TO
NEAREST BIRTHDAY
I. Beneficiaries
1.
2.
3.
4.
5.
II. For decedents dying on or after July 1, 1994, if a surviving sp
9 months of the decedent's death, check the appropriate blo
exercises such withdrawal right.
o Unlimited right of withdra
III. Explanation of Compromise Offer:
se exercised or intends to exercise a right of withdrawal within
and attach a copy of the document in which the surviving spouse
o Limited right of withdrawal
IV. Summary of Compr ise Offer:
1. Amount of Future nterest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
2. Value of Line 1 xempt from tax as amount passing to charities, etc.
(also include a part of total shown on Line 13 of Cover Sheet) ......$
3. Value of Line passing to spouse at appropriate tax rate
Check One 0 6%, 0 3%, 0 0% . . . . . . . . . . . . . . . . . . . . . .$
(also inclu as part of total shown on Line 15 of Cover Sheet)
4. Value of ne 1 taxable at lineal rate
Check 0 e 0 6%, 0 4.5% ...........................$
(also in ude as part of total shown on Line 16 of Cover Sheet)
5. Value f Line 1 taxable at sibling rate (12%)
(also i clude as part of total shown on Line 17 of Cover Sheet) ......$
6. Value of Line 1 taxable at collateral rate (15%)
(also include as part of total shown on Line 18 of Cover Sheet) ......$
7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ......................$
(If more space is needed, insert additional sheets of the same size)
REV-1648 EX (11-99)
SCHEDULE N
SPOUSAL POVERTY CREDIT
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX DIVISION
(AVAILABLE FOR DATES OF DEATH 01/01/92 TO 12/31/94)
FILE NUMBER
r '1
This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet.
6.
1. Taxable Assets total from line 8 (cover sheet)
........................................... .
2. Insurance Proceeds on Life of Decedent ................................................ 2.
3. Retirement Benefits ................................................................ 3.
4. Joint Assets with Spouse ............................................................
5. PA Lottery Winnings ...............................................................
6a. Other Nontaxable Assets: List (Attach schedule if necessary).. 6a.
6b.
6c.
6d.
SUBTOTAL (Lines 6a, b, c, d)
6.
7. Total Gross Assets (Add lines 1 thru 6) ........................... ..................... 7.
8. Total Actual Liabilities .............................................................. 8.
9. Net Value of Estate (Subtract line 8 from line 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.
If line 9 is greater than $200,000 - STOP. The estate is not eligible to im the credit. If not, continue to Part II.
I " .
Income: 1. TAX YEAR: 19 2. TAX YEAR: 19 3. TAX YEAR: 19
a. Spouse . . . . . . . . . . . 1a. 2a. 3a.
b. Decedent ......... . 1b. 2b. 3b.
c. Joint ............ . 1c. 2c. 3c.
d. Tax Exempt Income . . 1d. 2d. 3d.
e Other Income not
listed above ....... . 1e. 2e. 3e.
f. Total ............ . 1f. 2f. 3f.
4. Average Joint Exemption Incom Calculation
4a. Add Joint Exemption Income fr m above:
(1 f) + (2f) + (3f)
(+3)
1.
Insert amount 0 taxable transfers to spouse or $100,000, whichever is less
1.
2.
3.
Multiply by credit percentage (see instructions) ........................................... 2.
This is the amount of the Resident Spousal Poverty Credit. Include this figure
in the calculation of total credits on line 18 of the cover sheet. ............................... 3.
5.
For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the
decedent's gross estate ............................................................. 4.
Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal
Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet. . . . . " 5.
4.
- R-"'I-1649 EX. (1-97)
SCHEDULE 0
ELECTION UNDER SEC. 9113(A)
SPOUSAL DISTRIBUTIONS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTTh (j (. t. ~ S . FILE-'1NY_M~ER 3L(
rfi1b. s kt VI emafJ r ~r{XXJ
Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) ofthe Inheritance & Estate Tax Act.
If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust
This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit, etc.).
If a trust or similar arrangement meets the requirements of Section 9113{A), and:
a. The trust or similar arrangement is listed on Schedule 0, and
b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0,
then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in th lection to have such trust or
similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a ta Ie transfer on Schedule 0, the
personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement The erator of this fraction is equal to
the amount of the trust or similar arran ement included as a taxable asset on Schedule O. The denominator is e ual to the total ue of the trust or similar arran ement
Part A Total $
PART B: Enter the descri tion and value of I interests included in Part A for which the Section 9113 A election to tax is bein made.
SCRIPTION VALUE
VALUE
PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless
survivin souse under a Section 9113 A trust or similar arran ement.
DESCRIPTION
Part B Total $
{If more space is needed, insert additional sheets of the same size}
REGISTER OF WILLS
CUMBERLAND COUNTY
PENNSYLVANIA
CERTIFICATE OF
GRANT OF LETTERS
No. 2008-00034 PA No. 21-08-0034
Estate Of: THOMAS B WINKLEMAN SR
IFirst, Middle, Last!
Late Of:
MT HOLL Y SPRINGS BOROUGH
CUMBERLAND COUNTY
Deceased
Social Securi ty No:
WHEREAS, on the lOth day of January 2008 an instrument dated
January 13th 2004 was admitted to probate as the last will of
THOMAS B WINKLEMAN SR
(First, Middle, Last)
la te of MT HOLL Y SPRINGS BOROUGH, CUMBERLAND County,
who died on the 19th day of December 2007 and
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA FARNER STRA SBA UGH , Register of wills ~n and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
ROBIN VANESSA MCNEAL
who has duly qualified as EXECUTOR(RIX)
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 10th day of January 2008.
**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
':"l;:;1
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,......)
LAST WILL AND TESTAMENT
OF
THOMAS B. WINKLEMAN~ SR.
I, THOMAS B. WINKLEMAN, SR. having my legal residence at 32 Center Street, Lot
#8, Mt. Holly Springs, Cumberland County, Commonwealth of Pennsylvania, do hereby declare
this to be my Last Will and Testament, revoking all other Wills and Codicils heretofore made by
me.
I declare that I am not married and that I have the following children born to me; Robin
V. McNeal and Thomas B. Winkleman, Jr.
ITEM ONE: I direct that all my valid debts and the expenses of my last illness
and funeral be paid from my estate as soon as practicable after my death.
ITEM TWO: I give all the residue of my estate to my children; Robin V.
McNeal and Thomas B. Winkleman, Jr., in equal shares, per stirpes.
ITEM THREE: I may leave a Memorandum listing some of the items of my
tangible personal property which I wish certain persons to have and request that my wishes as set
forth in the memorandum be observed by my Personal Representative. Any items of tangible
personal property not so designated shall be divided and distributed among my children as
follows:
A. All items of tangible personal property shall be inventoried and valued at a fair
market value.
B. Each of my children may select one item, in rotation, in order determined by lot,
until such time at which the items chosen by that child reach such child's proportionate share of
the total value of my trust estate, or until such time as the child wishes to make no further
selections.
C. Any items not selected shall be sold and the net proceeds used to equalize the
shares.
D. To the extent that my children are unable to agree, the decision as to what may
constitute "one item" for purposes of this selection shall be made by my Personal
Representative(s).
E. Any disputes concernmg this method of allocation shall be resolved by my
Personal Representative in the Personal Representative's discretion.
ITEM FOUR: Should any beneficiary of mine be under the age of twenty-five
(25) years, my Personal Representative shall hold such beneficiary's share of my estate; as
Trustee, IN TRUST and shall invest, reinvest and distribute the principal and net income of such
beneficiary's share as follows:
A. Until such beneficiary attains the age of twenty-five (25) years, my Trustee, in my
Trustee's sole but reasonable discretion, may payor apply the income and any or all of the principal
of such beneficiary's share for the health, maintenance, support and education of such beneficiary
considering all other sources of income available to such beneficiary and known to my Trustee.
Upon such beneficiary attaining the age of twenty-five (25) years, my Trustee shall distribute the
balance of the principal and accumulated income, if any, of each such beneficiary's share to such
beneficiary.
B. Should the principal of the Trust Estate, in the sole opinion of my Trustee, be or
become too small to warrant placing or continuing of such fund in trust or should its administration
be or become impractical for any other reason, my Trustee, in the exercise of their sole discretion,
may pay such share absolutely to the person maintaining such beneficiary or may place such shares
in the beneficiary's name in an interest-bearing deposit in any bank, bank and trust company or
national banking association of his choosing, payable to the beneficiary at majority, or if said
beneficiary has reached his or her majority, then to him or her directly.
2
C. All shares of principal and income hereby given shall be free from anticipation,
assigrunent, pledge or obligation of my beneficiary(s), and shall not be subject to any execution or
attachment.
ITEM FIVE: I appoint my daughter, ROBIN V. MCNEAL, Personal
Representative of this my Will. If ROBIN V. MCNEAL, is unable or unwilling to act or
continue to act as my Personal Representative, I appoint my son, THOMAS B. \V1NKLEMAN,
JR., my Personal Representative. I give to my said Personal Representative(s) the same powers as
are hereinafter given to my Trustee. Such powers shall be in addition to those conferred by law. No
bond shall be required of any fiduciary hereunder in any jurisdiction. No fiduciary hereunder shall
have any liability for any mistake or error of judgment made in good faith.
ITEM SIX: I appoint my daughter, ROBIN V. MCNEAL, Trustee of the
Trust(s) created pursuant to ITEM FOUR, above. If ROBIN V. MCNEAL, is unable or
unwilling to act or to continue to act as Trustee, I appoint my son, THOMAS B. WINKLEMAN,
JR., Trustee of the Trust(s) created pursuant to ITEM FOUR, above.
ITEM SEVEN: I authorize my Personal Representative and Trustee to exercise the
following powers in addition to those given by law, to be exercised in their sole discretion:
A. To retain any or all of the assets of my estate, without regard to any principle of
diversification, risk or productivity;
B. To invest in all forms of property without restriction to investments authorized for
any type of fiduciary;
C. To compromise any claim or controversy;
D. To loan money to or buy property from my estate;
E. To borrow money from any person, including any Executor or Trustee, and to
mortgage or pledge any real or personal property;
F. To sell at public or private sale, to exchange or to lease for any period of time, any
real or personal property, and to give options for sales, exchanges or leases, all for such prices and
upon such terms and conditions as they deem proper;
3
r
G. To allocate receipts and expenses to principal or income or partly to each as they
deem proper;
H. To repair, alter or improve any real or personal property;
1. To distribute in cash or in kind or partly in each at valuations fixed by them;
1. To keep reasonable amounts of cash in a bank uninvested if deemed advisable for
the protection of the principal;
K. To subscribe for or to exercise options for stocks, bonds or other investments; to join
in any plan of lease, mortgage, merger, consolidation, reorganization, foreclosure or voting trust and
to deposit securities thereunder, and to generally exercise all the rights of security holders or
employees of any corporation;
1. To register securities in the name of a nominee or in such manner that title shall pass
by delivery;
M. To add to the principal of any trust created by this instrument any real or personal
property received from any person by Deed, Will or in any other manner;
N. To exercise all power, authority and discretion given by this instrument after the
termination of any trust created herein until the same is fully distributed;
O. To use their sole discretion in deciding whether stock dividends on stock they hold
in trust should be apportioned to principal or income, except stock dividends of regulated invest-
ment companies, which shall be added to principal;
P. To commingle the assets of any trust estate created by this Will in anyone or more
common funds for greater convenience and flexibility;
Q. To employ agents, accountants, engineers and such other persons, professional or
otherwise, as may be necessary for the proper administration of this estate or trust and to pay their
compensation from such funds; and
R. To disclaim all or any interest in a property passing to me or my estate.
ITEM EIGHT:
I realize that Personal Representatives are given discretion by law
to make various elections which affect the income and estate taxes payable by estates and
beneficiaries, as well as the relative shares of beneficiaries, such as taking administration
expenses as deductions for either estate or income tax purposes, selecting options for the
4
payment of employee death benefits, electing to take a qualified terminable interest as part of the
marital deduction, selecting alternate valuation dates, postponing the payment of taxes, filing
joint income tax or gift tax returns and redeeming corporate stock. The decisions made by my
fiduciaries in any of these matters shall be binding upon, and not subject to question by, any
affected persons. I rely upon my fiduciaries to take into consideration the total income and estate
taxes payable by reason of their decisions including those payable by my survivors, and they are
authorized in their discretion, but not required, to make adjustments between income and
principal as a result thereof.
ITEM NINE: I direct that all estate, inheritance and other taxes in the nature
thereof, together with any interest and penalties thereon, becoming payable because of my death
with respect to the property constituting my gross estate for death tax purposes, whether or npt
such property passes under this my Last Will and Testament, shall be paid from the principal of
my residuary estate, and no person receiving or having a beneficial interest in any such property,
whether under this my Last Will and Testament or otherwise, shall at any time be required to
contribute to or refund any part thereof; PROVIDED, however, that this direction shall not apply
to the taxes on any property included in my estate solely because of a power of appointment
thereover which I possess but have not exercised or on any qualified terminable interest or to any
generation- skipping transfer taxes.
ITEM TEN: If any person or entity other than me singularly or in conjunction
with any other person or entity directly or indirectly contests in any court the validity of this Will
including any codicils thereto, then the right of that person or entity to take any interest in my estate
shall cease and that person or entity shall be deemed to have predeceased me.
ITEM ELEVEN: Should any of the provisions of my Will be for any reason declared
invalid, such invalidity shall not affect any of the other provisions of this Will and all invalid
provisions shall be wholly disregarded in interpreting this Will.u
5
)
IN WITNESS WHEREOF, I have at Harrisburg, Pennsylvania, on ///3 ,2004 set
my hand and seal to this my Last Will and Testament consisting of six (6) pages plus the
Affidavit.
ro~flY~
TOMAS B. WINKLEMAN, SR.
SIGNED, SEALED, PUBLISHED AND DECLARED BY THOMAS B. WINKLEMAN, SR.,
the above named Testator, as and for his Last Will and Testament, in the presence of us, who, at
his request and in his presence, and in the presence of each other, have hereunto subscribed ou'[
names as witnesses.
-./}
;/~ / ~?/' Residence..fi':Y9 l?o;;lp'j'jJqI-SX0;?Efis,&'-p;h11/;?,?j7
~~~
Residence~. ~~
)
6
AFFIDA VIT
COMMONWEALTH OF PENNSYL VANIA
: SS:
COUNTY OF DAUPHIN
We, THOMAS B. WINKLEMAN, SR., A~Y' J: &Jn4AJ andl~\.(\e.\\e~
the Testator and the witnesses respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the
Testator signed and executed the instrument as his Last Will and Testament that he had signed
willingly (or willingly directed another to sign for him), and that he executed it as his free and
voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence
and hearing of the Testator, signed the Will as witness and that to the best of their knowledge the
Testator was at that time eighteen years of age or older, of sound mind and under no constraints
or undue influence.
7.t<<~ &/~
THOMAS B. INKLEMAN, SR.
'~/
LWiJ //~
{/> IT,NESS
~u.~
WITNESS
Subscribed, sworn to and acknowledged before me by THOMAS B. WINKLEMAN,
SR., the Testator, and subscribed and sworn to before me by 4Y9'r if: &/A.J/Y1Aid
~ I I .
and f\\\\t)\<\Q. W S~~Q witnesses, on ;//.1? tJ7
Cc -;, /]
. 1, Y ,'j
~'rz/(--t~, / / ,/ '
NOTARYPUBlfb.. ,
L;' 'vI .
. ,II iMP! .
(/-r-y.{ (j i <..~
Notarial Seal \
" ~,~. Lei ;'~)!e, Not<iry Public
,',k.", """f.r,," County
! ::'_l-; -".,' ~- '" ~ "f~!~::: 1 ~',d05 \
,
,-~, -". ._--_.-----~
\' ',-'-
7
RFV.485 EX + {3.041 . .~~'...' ~
ro. /, .
V........ ,
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.~.,~~,
~"i'//L!.L fl ()f f)E:r\J~'~~:Y: ,I\r~:/,
DEPART MieNT OF ReVeNUE
INHERITANCE TAX DIVISION
DEPT 280601
H/\RKISBURG. f'A 17128-0601
SAFE DEPOSIT BOX
INVENTORY
,:,-', ,l;i':t;t.,,,
, '
<,,:;'-;-,~-<::::: ,'.",': ',', ~,
Ple~';,;:~PJ,~~-or>ry~e
<. - ':
MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETur-:NED TO A~vli ADDRESS
COUNTY CODE ~ FILE NUMBER ~SOOAL SECUR~~:eqUi;;dIOR DEA~H CERTIF:CAT~NU~~~~:~;~:~::wnIJ
DECEDENT'S NAME (LAST FIRST!;;1IDDLE) , -n DATE OF.DEATH . '_, I
. /1 <:,- /)///7<<"5 .C /,;2 - /tl.2(( /" I
. ADD~E/SS. OF D~EDE.NT / (STR~E). ~jr _. '/ (CJTY) (S:IATE) (ZIP CODE).. _I
1.-----' / ~ C~-L' I ) It '/y1- J- / S ',' C' ~ ,/ :lr~2?/-<') I
U NAME: AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE'DEPOSIT BOx! . ]1'
I (NA~pV_ / . , 147
/yL;' 1'7 1/ I? /(2 //h2 / I
(STREET NAME) . I I
~x[ ,~? /pnc r ' J. t'___ t /C' I
NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE' B X OPENING
a, (NAME) (RELATIONSHIP)
(STREET NAME)
(CITY)
(STATE)
(ZIP CODE)
b, (NAME)
(RELATIONSHIP)
(STREET NAME)
(CITY)
(STATE)
(ZIP CODE)
c. (NAME)
(RELATIONSHIP)
(STREET NAME)
(CITY)
(STATE)
(ZIP CODE)
NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
&i}j/
'--A~'
")
NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX
a. (NAME)
b, (NAME)
(STREET ADDRESS)
(STREET ADDRESS)
(CITY)
(STATE)
(ZIP CODE)
(CITY)
(STATE)
(ZIP CODE)
. NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY
WAS A WILL IN THE BOX? 0 YES '~O If yes, a. Date of will:
b, Name and address of personal representative, if named in the will
(NAME)
I
I
I
I
i
(STREET NAME)
(CITY)
(STATE)
(ZIP CODE)
C. Name and address of attorney, if any
(NAME)
(STREET NAME)
(CITY)
(SlArE)
(ZIP CODE)
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
Page_____of
The Department is authorized under federal law , 42 use S 405(c), to use the decedent's Social Security number In
administering this state tax law, The Department uses Social Security numbers to establish a decedent's identity and
ensure proper credit for tax payments,
(1) Cash: Report total only,
(2) Stocks: List in detail every common or preferred certificate, warrant or other nghts found in box, Stocks are to be
designated by name of company, certificate number. date of certificate, name in which stock is registered, and
number of shares and class of stock.
(3) Obligations of U.S. Government: Number of items, date of Issue, face value, names in which registered and
type of ownership, i.e., jointly held, payable on death, etc.
(4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds)
(5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing In book.
name of bank and branch, and balance.
(6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible.
(7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully
as possible.
(8) All other contents.
ITEM DESCRIPTION
3'3 7:S'('
r- '
~.2
L /;/// c" ,9:3"> C
'j nf<lL''-i) \'2 J '\..
,C(~
i
(. If) C
!CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS
. CORRECT AND COMPLETE TO THE BEST oF' MY KNOWLEDGE AND BELIEF.
.SIGNATUR..E. :; \...- --""7/' ... Jd;1.-. -
----'-}--,' // C
./ / "I, .,' - c: ~ -J.~ .~.,
PRiNT NAME
;-;}) c' I cL'''-- ( '/c/ ~ / _';'c //
PRINT TITLE DATE
I ('7~:/_".. /) ~'€cutor(tnx) 0 Admm>siralorttrIYi
;: /'r.... 17<' i j) ), '),t 'L ! / I /.. It . -/ ,S/ 0 Estale Represental,,,e !XI Jo,nl owner of safe dep05'llK"
NOTE: Attach additional 8'/," x 11" sheet(s) if necessary or use duplicates of this page of form.
PERSON RECEIVING COpy OF
SAF POSIT BOX INVENTORY:
\1 ,\/1 ) ".iJ
- I v \..(, \..Q.(
Tuesday, NOL'ember 27,2007
Thomas \Vinkleman.$r
32 Center Street
#8
WIt Holly Springs, PA 17065
File: 0712001
RE: Tholnas Winkleman
1988 Skyline/West Ridge - 32 Center Stt'eet, #8, lVIt Holly Springs, PA
Cost Approach
N.A.D.A. Manufactured Housing Appraisal Addendum
Value SummelY (Rounded to Nearest Hundred)
Guide Book Addition: Sept / 2007
Yellow Section Chart: # 314
Region: MA
State: PA
Est. Physical Yrs: 8
1) Book Value - Main Structure
State Code: Location Adjustment (103%)
$ 13,388
$ 13,800
2) Condition Adjustment (68%)
$ 9,400
3) Components
Repairs
4) Depreciated Replacement Value of Honle
$ 4,500
$<1,652>
$ 6,552
75) Comparable Park Adjustment (94%)(IPLV $<352>)
$ 6,200
6) Accessories
$ 333
7) Indicated Value By Cost Approach
$, 6 ~00
'<J,J,J
8) Comparable Market Adjustn1ent
$
" lid Market Value
I
/(~C)l i'(})](Jiriull)
$ 6,500
DatCJl/n/"f
\ Ceriifieutio!1 if 480'1
TITLE PAGE
NATIONAL APPRAISAL SYSTEM
CASE / FILE NO 07112001
@
It is a Question of Value
A Division of National Appraisal Guides, Inc
PO Box 7800, Costa Mesa, CA 92628
PREPARED FOR:
Firm Name
Address
City
Phone:
State
Ordered by
If Repaired ~~ In Present Condition
Per Plans/Specifications
PREPARED PURPOSE: To provide an opinion of market value for the subject property (as checked)
As of Date
AS: 'l{, Personal Property
(Home set on rentall/ease land)
Home with Land
(Home not attached by foundation system)
FOR:
Broker
Seller
Purchaser
Tax Agency
Lender
Purchase
Refinance
Foreclose -L, Other
Intended Use:
Other (list)
CLlENTfUSER:
Name THOMAS WINKLEMAN
Address 32 CENTER STREET #8
City MT HOLLY SPRINGS
State P A
Phone:
Insurance Company
Legal Owner of Record:
Name
Address
City
Phone:
State
Legal Description:
Fee Land y, (MHC) JENNY LEE MHP
Address 32 CENTER STREET # 8
City MT HOLLY
Map Reference
Tax Code
State
Appraiser:
Name HeatherAnn Howie
Address 4 Woodview Dr
City Mt Holly Springs
Phone (717) 486-0057
State PA
Certificate of Value Number
NAS, Subscriber I.D Number..
Professional Certification 1.0. Number......
Real Property
(Home attached by foundation system)
Zip
As-Is
. Other
Ins. Co. (Loss Claim) ;~ Other
Other
Other
Census Tract
107112001
14661366
14809 CMHA
Copyright@ 2004 by National Appraisal Guides, Inc. NAS. Form #2 Updated 9104 V.P.
Zip' 17065
Zip
Zip
Zip 17065
@Cole and Associates. Inc. and Office Creation Services. All rights reserved. Reproduced with Permission by National Appraisat System - Form Version 10
(800) 966-6232
(714) 556-8715 Fax
Page C
CASE / FILE NO, 07112001
@
It is a Question of Value
SUMMARY APPRAISAL OF
ADDRESS:
32 CENTER STREET # 8, MT HOLLY,
FOR CLIENT/USER:
THOMAS WINKLEMAN
EFFECTIVE DATE:
REPORT DATE:
11/28/2007
BY:
HeatherAnn Howie
Page D
NAS, Form #2 Updated 9/04 V,P, Copyright@2004 by National Appraisal Guides, Inc,
@ Cole and Associates, Inc, and Office Creation Services, All rights reserved, Reproduced with Permission by National Appraisal System _ Form Version 1.0
Client/User THOMAS WINKLEMAN
CASE / FILE NO. 07112001
SUBJECT HOME
Left Front Angle 4x6 Photo
SUBJECT HOME
Right Front (Or Rear) Angle 4x6 Photo
Page 12
NAS. Form #2 Updated 9/04 V.P. Copyright @ 2004 by National Appraisal Guides, Inc
@ColeandAssociates, Inc. and Office Creation Services. All rights reserved. Reproduced with Permission by Nationai Appraisai System _ Form Version 1.0
924 Sq.Ft.
0 Sq.Ft
0 Sq.Ft
:: 0 SqFt
:: 0 Sq.Ft
:: 924 SqH
3 3'/2 3%
Client/User THOMAS WINKLEMAN
CASE / FILE NO. 07112001
SUBJECT DESCRIPTION
Year 1988 Manufacturer Name SKYLINE
Trade Name WESTRIDGE
Home Size
V None
v None
v None
v None
14
o
o
o
o
x
X
X
X
X
66
o
o
o
o
Tag-A-Long ...................... ................,.,..................................
Expando ....................................................,.......................... ...
Tip-Out ................... .............................. ........................... ....
Other (List)
Estimated Total Living/Perimeter Ratio
FLOOR PLAN
Bedrooms:
Front:
oj 3
\/ 1
1
Kitchen
Baths;
2
4
5
1'/2
1%
2
Living Room
Bedroom Total Room Count: 6
Other (list)
IDENTIFICATION NUMBER(S)/CONSTRUCTION CODE(S)/STICKER(S)/LABEL(S)
ID Serial Number(s) 2F10 0616X
Construction Code Label Number(s) ULI 287057
Tax Assessment Sticker Number(s)
i~ HUD
For Year
ANSI Std. A1l9.1
By
Not Verified
, Not Verified
~, Not Applicable
loiJ Not Applicable
:~ Not Applicable
r-=:: Not Applicable
Not Applicable
Not Applicable
Not Applicable
~j Not Applicable
-~ None
None
None
Vehicle Type License Number(s) State of
Vehicle Type Reg. Tab Number(s) Expiration Date
HUD Compliance Cert./Data Plate List Location MASTER CLOSET
HUD Wind Zone (Post 1976) ................ I" I l II : III Exposure: D
HUD Heating/Cooling Zone (Post 1976) i~ II III
HUD Roof Load Zone (Post 1976) ............ North Middle ~ South
Set-up, Installation Approved, Sticker Number Issued By: State Local
Smoke Detector(s) # of Units Power Source: Wired in 110 Volt Battery
Water Heater - Gas (Label Approved) for MH Installation ................. Yes No N/A - Electric Unit
FireplacelWood Burning Stove (Label Approved) for MH Installation ......... .~ Yes No _ Factory (OEM)
FTC Thermal Standards (Post-1983) Roof/Ceiling R- Exterior Walls R- Floor R-
Comments
The N.A.S. Appraiser(s) Certification and Statement of Limitations require you to locate the following (when applicable):
Effective 6/15/1976 HUD set national standards for factory-built (mobile home) structures. Any unit when in its traveling mode is 8 feet or more
in width and 40 feet or more in length, or when erected on site is over 320 square feet based on exterior wall dimensions, falls under the 1974
HUD TitleVI Part 3280 Construction and Safety Standards and 3282 Procedural and Enforcement Regulations.
Not Applicable
HUD COMPLIANCE CERTIFICATE/DATA PLATE (Attached inside of home)
It is found either on a wall in the master bedroom closet, on a door under the kitchen sink or next to the main electrical breaker box. From this
document the appraiser will find the Zone Maps for:
1.) Heating and Cooling Design 2.) Structural Roof Design 3.) Structural Wind Design 4.) UfO, R-Values
HUD CONSTRUCTION CODE LABEL(S) PERMANENTLY ATTACHED TO HOME
The appraiser is also required to locate (when applicable) the red metal certification label(s); located at the taillight end of each transportable
section, approximately one (1) foot up from the floor and one (1) foot from the roadside.
FEDERAL TRADE COMMISSION RULE
The appraiser should locate the FTC Consumer Insulation Information Form given to the buyer from the seller (if available); it lists R-values for
the floor, exterior walls and ceiling. (See the N.A.S. Field Instruction Manual for example of FTC Form.)
AMERICAN GAS ASSOCIATION. GAS FUEL CODe
The appraiser should locate the water heater and verify that a label is affixed to the (gas) water heater (effective 10/4/1977). (See the NAS.
Field Instruction Manual for examples.)
PRE.HUD STATE AND INDUSTRY STANDARDS
For structures manufactured prior to the National HUD Standards the appraiser should look for (if displayed) labels or certificates issued by a
state. industry association, or manufacturer. (See the N.A.S. Field Instruction Manual for examples.)
Copyright @2004 by National Appraisal Guides, Inc. NAS. Form #2 Updated 9/04 V.P.
@ Cole and Associates, Inc. and Office Creation Services. All rights reserved. Reproduced with Permission by National Appraisal System - Form Version 1.0
Page 1
ClienUUser THOMAS WINKLEMAN
Year
Manufacturer Name SKYLINE
VALUE SUMMARY
CASE / FILE NO. 07112001
1988
Trade Name WESTRIDGE
Guide Edition Sep-Dec
Month
White Section - Part 1, Page #
2007 Codes
Year
or SVS Page #
region state
Yellow Section - Part 2, Chart #
(See NAS. Manual Guidelines)
1. Base Value of Structure.
\/ None
Tag-A-Long
\/ None
Expando
\/ None
Tip-Out
other (List)
\/: None
a. Location Adjustment .................................. State Code
MA
PA
Gray Page #
Estimated Remaining Physical Life
14
X 66
X 0
X 0 ...............
X 0
X 0
o
o
o
o
PA
314 Older Chart
%
11
yrs.
$
$+
$+
$+
$+
Subtotal $
X
13,388.00
0.00
0.00
0.00
0.00
13,388.001
1.03 %
Total Guide Book Retail Value $ I 13,800.001
(rounded to the nearest hundred $)
2. Condition Adjustment ............................................. (See NAS. Manual Guidelines) ...............................
(A) From Page #3 Excellent Good Fair..{J Poor
a. ECONOMIC OBSOLESCENCE ADJUSTMENT ...... (See NAS. Manual Guidelines)
USED l;li No Yes Use line 5a for dollar adjustment
3. Running Gear: \f' Not Inspected
Wheels with Tire(s)
Tow Bar(s)
Axle with Hub(s)
Frame(s)
x 68%
$ I 9,400.001
(rounded to the nearest hundred $)
OK
#
Note: These components are a technical requirement of the HUD 1976 Construction Code.
o
o
$<->
0.00
0.00
0.00
0.00
4,500.00
1,652.00
0.00
6,552.001
94%
Missing
OK
Missing
#
Missing #
Missing #
o
o
OK
OK
deduct $55.00 or 5+ $27.00 ea.
deduct $125.00 or 5+ $62.00 ea.
$<->
deduct $245.00 or 5+ $122.50 ea. $<->
deduct $1,050.00 ea. ................... $<->
4. Cost of Repairs (8) From Page #3 .............. (Includes missing Appliances/Components) ..................
5. Components (C) From Page #4 .............
a. Foundation System Other (List)
6. Depreciated Replacement Value of Home .............:............ ...................... Sum of Lines 1a or 2,3,4,5,5a
$<->
$+
$ (:t)
$
Lines 7 & 8 blank - Home not located in (MHC)
7. MHC Sales Ratio Adj. (D) From Page #7 100% %; + MHC Adjustment (E) From Page 7(:t -6% %)=. Total X
Equals Total of Home and Community Location $ I 6,200.001
(rounded to the nearest hundred $)
8. Community Location Value (IPLV) Subtract Line 6 from Line 7 + or <->
9. Accessories (F) From Page #5.................................
a. Repairs of Accessories (G) From Page #5...................................
10. Indicated Value by the Cost Approach ......................
a. Comparable market adjustment (H) From Page #8...
11. Land Value
a. Other (List)
$
-352.00 IN-PLACE LOCATION VALUE
(for reference only)
................. Sum of Lines 6 or 7,9,9a
$+ 333.00
$<-> 0.00
$+ I 6,533.001
$ (:t) 0.00
$+ 0.00
See Addendum................................................ .......... ............. .....................................
12.
Pl~ans & Specifications
I
Sum of Lines 10,1 Oa, 11,11 a
Other (List)
4809 CMHA
$ (:t) 0.00
$+ I 6,500.001
(rounded to the nearest hundred $)
Page 2
Designation/Certification
NAS. Form #2 Updated 9/04 VP. Copyright @2004 by National Appraisal Guides, Inc.
@ Cole and Associates, Inc. and Office Creation Services. All rights reserved. Reproduced With Permission by National Appraisal System _ Form Version 10
Client/User THOMAS WINKLEMAN
CASE / FILE NO. 07112001
((
o
r;:
L
l-
X
L...
CONDITION
Check Problem Items Cond.lAdd Points List Deferred Maintenance/Repairs
Running Gear/Frame Missing (Use Page 2, Line 3 for costs) HUD Code Label(s) Missing (List on Page 1)
Evidence of: System/Structure Modifications, FirelWindstorm Damage (List Below or use addenda)
Exterior
RUSTED SIDING/POOR ROOF CONDITION
Paint/Roof
Doors/Entry
Left - Side
Right - Side
Front - Side
Rear - Side
Storm - Doors
Storm - Windows
Screens - Doors
Screens - Windows
Check Exterior of Home
for HUD/State or ANSI
A 119.1 Std. Construc-
tion Code Labels and
Running Gear
Condition/Points
Excl 62 Good 48
Fair 34 v Poor 20
Excl13
Good 8
Living Room Dining Room
REPLACE CARPETING/REPAIR WALLS
~ Walls
;:, Doors
:: Ceilings
...J '.. n Windows/Drapes
~ Carpeting
~,,___ Floor Linoleum
...J ... Light Fixtures/Ceiling Fans
..J i.. HUD Compliance
..J Certificate Missing
c:{
I i=~ Walls
>- :C~ Doors
= m Ceilings
~ Windows/Curtains
:J ".~' Floor Coverings
Z c=, Counter Tops
.~. Sinks i. Excl9 Good 6
u Faucets None 4
- ....... Cabinets/Doors
:x: Light Fixtures/Ceiling Fans t,{, Fair 3 Poor 2
i...... Walls I L Excl9 e- Good 6
. Doors
(f) 'n_ Ceilings
"'"' ..... Windows/Curtains
~~:=i
o Floor Coverings
o CabinetslDoors
i ...... Faucet~
..... Lavatones-
ra .=' Water Closet ,-- Excl 9 Good 6
m' Tub/Showers 'itJ None 4
Fi Light Fixtures/Ceiling Fans ~= Fair 3 ,Poor 2
Master
'. HUD Compliance! Excl 6 Good 4 REPLACE CARPETING/REPAIR WALLS
Certificate Missing '--=:. _
Walls v' Fair 2 Poor 1
=. . .. ., Second
i _, Doors 1'- Excl 6 Good 4 REPLACE CARPETING/REPAIR WALLS
,;i.. Ceilings None 3
.~ Windows - '. -
6-- Carpeting .~ Fair 2 .~ Poor 1 Third
o Floor Linoleum Excl 6 Good 4 REPLACE CARPETING/REPAIR WALLS
rr: Closets/Doors None 3
o
..u W/R Doors .,j. Fair 2 Poor 1
::0 ~.-c Light Fixtures/Ceiling Fans... _-
Drapes Excl 6 Good 4
Curtains~' None 3
Smoke Detectors ~ Fair 2 Poor 1
MISSING APPLlANCE(S)tc:;OMPONENTS (In base book'"alue) Single Dogr Refrigerator $ 0.00
ffi Range $ 0.00 Fumace $ 0.00 Water Heater $ 0.00.. Drapes/Curtains $ 0.00
I FOR A 1988 THIS HOME IS IN POOR CONDITION. THE SIDiNG is RUSTED, THE DECK AND SHED ARE DILAPIDATED AND
~ FALLING DOWN THE INTERIOR IS IN NEED OF REPAIRS INCLUDING NEW CARPETING THROUGHOUT AND WALL REPAIRS.
o THE HOME HAS LITTLE TO NO VALUE IN IT'S CURRENT CONDITION
'\/ Fair 4
Poor 2
Great Room -
Den
- Excl13
_ Family -
Good 8
'''</.: None 6
Fair 4 i Poor 2
Kitchen
REPLACE FLOORING/REPAIR WALLS
-:-' Excl9
Good 6
~: Fair 3_ Poor 2
-- Excl 9 Good 6
'I: None 4
Fair 3 Poor 2
Utility Room
Nook
Hallway(s)
Master
.vi Fair 3 Poor 2
'- Excl 9 , Good 6
i\i, None 4
Fair 3, Poor 2
Second
Other
Other
Total Points. From Above I
(A) CONDITION Excellent (140 & Above)
Convrinht @ 2004 bv National Aooraisal Guides Inc.
(B) TOTAL COST OF REPAIRS (Transfer to line 4, Page 2)
Good (139-103) Fair (102- 61)'0,/ Poor (60 & Below)
NAS. Form #2 Undated 9/04 V.P.
60
@Cole and Associates, Inc. and Office Creation ServIces. All rights reserved. Reproduced with Permission by National Appraisal System ~ Form Version 1,0
list Cost of Repairs/
Replacements
or use Addenda
3,000.00
300.00
300.00
300.00
300.00
300.00
4,500.00
(rounded to the nearest dollar)
(Transfer to line 2, Page 2)
Paae 3
Client/User THOMAS WINKLEMAN COMPONENTS CASE / FILE NO. 07112001
COMPONENTS NEW 1-2 Years 3-4 Years ,f. 5+ Years EXTENSION
CheGk l1ems Check Dollar Amounts
HOUSE TYPE ROOFING (Rolled Galvanized Metal Standard)
By Floor Size 14 X 66 924 Sq. Ft $991 $821 $.62 $.46 $
HOUSE TYPE SIDING (Vertical corrugated Aluminum Standard)
By Sides & Ends = 160 Un. Fl. 8521 6981 5.44 391 $
WINDOWS/DOORS (Over Standard)
Walk-A-Bay/Bow . . # 0 each 431 335 276 201 $
Garden . # 0 each 306 224 196 142 $
Skylight .... # ..JL. each 289 237 185 133 $
,f Storms, single/multi-wide. 773 1288 633 1056 494 824 ,f 355 592 $ 355.00
~ Dual Glazed, single/multi-wide. . 494 578 406 474 316 370 228' 266 $
Sliding Glass Door.. . # 0 each 316 259 202 145 $
CARPETING (Complete) (Average Grade Only)
Single Wide. 6641 5431 425 305 $
Multi Wide (Triple Wide x 1.12) ... 642 699 545 392 $
- BATHROOMS (Standard Fixtures)
y, (Commode & Lav; Only) # 0 each 4931 4031 316 226 $
% (With Shower Only)... # 0 each 787 646 504 363 $
,f Full (With Tub, etc.) ... # 1 each 886 728 568 '''- 408 $ 408.00
BATH FIXTURES (Over Standard)
Fiberglass Shower Stall # 0 each 294 242 188 136 $
.~ Fiberglass Tub - Combo # -r- each 417 341 267 .-t 191 $ 191.00
Garden Tub. # 0 each 493 403 316 226 $
Tub Enclosure (Glass)... # 0 each 116 96 75 54 $
Marble Lavatory Tops. . # -L each 197 162 126 91 $
Porcelain Fixtures .. # -L each 120 99 57 44 $
KITCHEN APPLIANCES (All Makes and Capacities)
Single Door Refrigerator.., Missing 394 323 252 182 $
Double Door Refrigerator (FF) . 521 427 333 240 $ 240.00
Side-by-Side Door Refrigerator (FF)... 857 704 549 398 $
Ice Maker (Including Plumbing) ... 143 117 91 66 $
Cook Top and Oven (Built In) .. 673 494 443 309 $
Range Over/Under (Eye Level) ... 878 722 564 405 $
Range 30" Free Standing. Missing 551 452 354 254 $ 254.00
Microwave Oven (Built In) . .. 502 411 322 231 $
Dishwasher (Built In) . 385 316 247 177 $
Garbage Disposal. 81 67 51 37 $
Trash Compactor ...... 366 300 234 16 $
. . HEA TING-PLUMBING-ELECTRIC (All Mak~and Fuels)
Baseboard (Electric) 0 Un. Ft. 5.88 4.81 3.75 $
Furnace 69,000 or Less BTU's ... Missing 305 251 196 $ 140.00
Furnace 70,000 or More BTU's... 495 406 317 $
Air Conditioner Ready Furnace ... 247 203 157 $
W/P WasherI220-volt/Gas Dryer .... 165 135 105 $
150-200 Amp. Electric Main. 247 203 157 $
. 20 gal. Water Heater Missing 105 86 67 $
~~ 30 gal. Water Heater ..... . 137 113 87 .>( $ 64.00
40 gal. Water Heater.... 153 126 99 $
H_ 50 gal. Water Heater.. . 177 146 114 $
OTHER (Custom Buitt In)
,... Drapes/Curtains. Missing 526 431 242 $
Fireplace (Built In OEM) ." 1653 1355 762 $
Mirrored W/R Doors .. # 0 set each 197 161 91 $
Secul1ty System . 876 718 403 $
Smoke Detector(s).. . # each 71 59 32 $
Intercom/Radio System. . 263 217 121 $
Bar - Walk Up . . 375 307 173 $
Bar - Walk Behind. 707 580 326 $
Cooler Overhead Duct .. # 0 each 659 237 133 $
Cooler Roof Vent w/5-way Switch.. 150 122 69 $
MISCELLANEOUS (List and Assign Value)
CATHEDRAL CEILINGS
STORM DOOR
Paoe 4
NAS, Form #2 Uodated 9/04 V.P.
1 652.00
CENTRAL AIR CONDITIONING SYSTEMS
non. ..12,000 BTU's.. .. ...#~ each
1% Ton.. .....18,000 BTU's .............#~ each
2 Ton... .....24,000 BTU's... ..........#~ each
2% Ton .. 30,000 BTU's ..#~ each
3Ton. . ... 36,000 BTU's..........#~ each
3% Ton. ..42,000 BTU's. ....#~ each
4 Ton ....... .. 48,000 BTU's..#~ each
5 Ton. ...60,000 BTU's ......#~ each
GAS
3Ton . .. 36,000 BTU's ......#~ each
4 Ton..... 48,000 BTU's ...............# 0 each
HEAT PUMPS & SELF-CONTAINED
2% Ton ........... 30,000 BTU's ..............#~ each
3Ton ........ 36,000 BTU's ...... ......#~ each
3% Ton ...........42,000 BTU's ...............#~ each
4 Ton .............. 48,000 BTU's .............#~ each
WINDOWIWAll MOUNT
8,000 BTU's .........................................#~ each
12,000 BTU's ...... ........#-5L- each
18,000 BTU's .....................................#~ each
WATER COOLERS - Roof Or WindowlWall Mount
Evaporator Water Unit ............................#---2- each
AWNINGS - Includes Permits & Safety Stakes
Window-#~......~x~=~ Sq.Ft.
Free Standing ............ 000 x ~= ~ Sq.Ft.
Carport ..................... ~ x ~= ~ Sq.Ft.
Patio........................... ~ x~= ~ Sq.Ft.
Unitizing - Awning Trim. .................. By Ft.---2- Un. Ft.
PORCHES/DECKS - With Carpet, Rails (add for steps)
-( Width to 8 fl. ................................. Length~ Un. Ft.
Width over 8 ft. .............................. Length~ Un. Ft.
Steps with Rail - Set of (Custom) ...........#~ each
ENCLOSURE ROOMS - Requires Roof
Screen Only (w/kickplate) ........................ -L Un. Ft.
Honeycomb Insul. Wall (wlwindows) ....... ~ Un. Ft.
Suspended Ceiling ... ~ x ~ = ~ Sq.Ft.
Doors (People) ........................................#~ each
SKIRTING TO 30" HIGH (Measure Around Perimeter)
Metal or Vinyl (Vertical)/Split Block .......... ~ Un. Ft.
Shiplap (Horizontal) ...................... -E..- Un. Ft.
Masonite ....... ........................ ~ Un. Ft.
Simulated Stone (Fiberglass) ................... ~ Un. Ft.
GARAGE ADD-A-ROOM '. Site Built to State/Local Code
with wood or metal exterior siding (jncl. foundation/slab)
Metal Roof ................... -E..- x ~ = ~ Sq.Ft. 14.67 12.02
HouseTypeRoof..........~x~=~ Sq.Ft. 16.01 13.15
Plumbing (Water, Drain & Fixtures) ............................... 743 609
Electrical (110 or 220 volt) ................................ 361 296
Doors (people) ....... ............. .........#~ each 133 109
Doors (Automobile) .... .............. .............#~ each 260 213
Windows (Std. Sizes) . ............#-5l- each 43 35
Finishedlnterior............~x~=~ Sq.Ft. 2.65 2.17
STORAGE BUllDINGS............................#~ each (Custom Installed)
Aluminum (Vertical) .. .... ~ x ~= --L Sq.Ft. 6.85'-- 5.62 4.39
Shiplap. .-Lx~=~ Sq.Ft. 9.10 7.47 5.83
Masonite or Wood ...-Lx~=~ Sq.Ft. 11.85 9.71 7.58
Steel............... 0 x 0 = 0 S .Ft. 4.48 3.67 2.87
MISCELLANEOUS (List and Assign Value. Adjust for Homemade Items, Unique Costs, Etc.)
18 X 14 DECK WITH AWNING - VERY POOR CONDITION NO VALUE GIVEN
8 X 14 SHED - PLYWOOD - POOR CONDITION NO VALUE GIVEN
Client/User THOMAS WINKLEMAN
ACCESSORIES
Check Items
COST OF REPAIRS FOR EXTERIOR ACCESSORIES
CheCK Dollar AmOunts
(All Makes Up or Down Flow)
1,267 1,041
1,442 1,185
1,525 1,236
1 ,584 1,298
1,665 1,366
1,836 1,507
1,944 1,594
2,318 1,901
(All Makes Up or Down Flow)
3,8031 3,1181
5,099 4,188
(All Makes Up or Down Flow)
2,704 2,2871
2,947 2,417\
3,152 2,585
3,553 2,913
(All Makes 110-Volt Only)
5061 4151
727 596
859 705
(All Sizes and Drafts)
6701 5491
(Custom Installed)
5.05 4.13
7.48 6.13
4.48 3.67
4.48 3.67
4.09 3.42
(Custom Installed)
501 42\
66 57
218 179
(Custom Installed)
47 40
65 54
4.09 3.36
137 112
(Custom Installed)
4.55 c: 3.72
9.47 .... 7.66
11,73 9.61
14,34 11.76
- (Custom Installed)
(Ust and Assign Value)
Copyright @ 2004 by National Appraisal Guides, Inc. NAS. Form #2 Updated 9/04 V.P.
CASE / FILE NO. 07112001
3-4 Years "5+ Years
851
927
974
1,014
1 ,056
1 ,176
1,244
1,484
2,434
3,270
1,767
1,886
2,017
2,274
324
558
550
429
9.41
10.26
475
231
85
166
27
1.69
(F) TOTAL $ +
ransfer to Une 9 P e 2
(G) TOTAL $<->
Transfer 10 Line 9a Pa e 2
EXTENSION
613 $
670 $
703 $
729 $
767 $
846 $
894 $
1,066 $
1,749 $
2,350 $
1,551 $
1,665 $
1,760 $
1,944 $
233 $
334 $
396 $
308 $
2,32 $
3.43 $
2.05 $
2.05 $
1.92 $
24 $
32 $
101 $
23 $
30 $
1.89 $
64 $
2.08 $ 332,80
4.35 $
5.39 $
6.59 $
6.75 $
7.38 $
341 $
166 $
61 $
119 $
20 $
1.22 $
3.15 $
4.18 $
5.44 $
2.05 $
$
333.00
Rounded to the nearest dollar
$
0.00
Rounded 10 the nearest dollar
Page 5
COMMUNITY LOCATION ADJUSTMENT
Retailer Lot or Fee Land/Condo Ownership'H
Date Community Opened
Total Sites
State P A
Manager's Name
Manager's Site/Lot Number
Yes ~. No National Flood Insurance Map
Is $ 230.00 And Includes
Gas Use of recreation facilities
Client/User THOMAS WINKLEMAN
Subject home and/or accessories are located on:
Name JENNY LEE MHP
Address 32 CENTER STREET #8
City MT HOllY SPRINGS
Community Phone
Manager's Phone
HUD Identified Flood Hazard Zone
Monthly RenULease for Site # 8
Trash Sewer Electric
Other (List)
COMMUNITY - by federal regulation is :<1 Open Age
Senior:
80% (55 & over)
CASE / FILE NO. 07112001
THIS PAGE BLANK
Zip 17065
. i Water TV Cable
Use of RV storage area
Date
100% (62 & over) Meets HUD Fair Housing, HOPA Act
HOMES IN GENERAL
Homes Skirted with Manufactured Skirting ..... .H.H........H....... ......HH..H.
Homes Well Maintained ...H...... ............H... ....H....H.......
Homes with Patio and Carport Awnings ......................HH... .H...H...........H..H.. .
Homes with Hitches Covered or Removed ......H.H.......H.H... H..HHHH..H.......H...
Homes with Custom-Built Porches with Rail HH'HHHH.H .H....HHHHH
Homes with Custom-Built Steps with Rail .HHHHHH'HH."HH HHH....HH.H.H
Homes with Landscaping (Trees, Flowers, Bushes, Lawn, etc.) "H" HHHH."HH'
1. SUBTOTAL
WEIGHTED POINT SYSTEM - CHECK THE APPROPRIATE BOX & TOTAL THE POINTS BELOW
ALL
100 - 90%
\{ 5
7
10
5
10
5
l~ 10
5
MOST SOME NONE
89 -50% 49 - 26% 25% & under
4 2 0
~ 5 3 1
8 6 \( 4
4 >/, 2 0
8 y'; 6 4
4 ~; 2 0
6 2 ,0( 0
+ 5 + 10 + 4 24
SPECIFIC SPACE/SITE LOCATION
Frontage on Lake or Golf Course ...................................................................... 10
View or Next to Recreation Facilities .................................................................................... 8
Average Location in Community ............................................................................................................. y'
Next to Entrance or Storage Area(s) ............................................................................................................
4. SUBTOTAL 0 + 0 +
COMMUNITY FEATURES. Check Appropriate Box if Yes
3 Swimming Pool ,m. 2 Street Ughts
3 On Duty Management ;j. 1 Street Signs
5 Public Utilities Metered . 4 Paved Off-street Parking
5 Concrete Patio Slabs 0(. 5 Paved Street
2 Laundry Facilities'- 3 Recreation Buildings
8 Individual Mail Delivery 2 Storage Area for RV's
~ 2 Underground Utilities 1 Paved Carports
2 Underground IV 2 Concrete Carports
. 2 Sidewalks .. 1 Underground Phone
2 + 6
COMMUNITY IN GENERAL
Proximity to Shopping. ................ .............. ............... ......................................
Proximity to Schools...... ......... ................................ .......... ...... ...... ....... .... ......
Proximity to Employment Centers ..................................................................
Proximity to Public Transportation ..................................................................
Proximity to Police and Fire Protection............................................................
Condition of Entrance/Streets...... ............................ .................... ..................
Vacant Sites Maintained (If None, Check Excellent)..........................................
General Landscaping of Community ...............................................................
Overall Appearance. .......................................... ............. ...............................
Fencing/Walls Surrounding Location............... .... .... ...... ..... ..... ... ....... ..... .... .....
2. SUBTOTAL
SPACE/SITE FEATURES IN GENERAL
Well Maintained Sites ................................................................. .....................
Homes on Either Side are of Similar Size, Age, & Condition .......H...................
Surrounding Homes in Good Repair ............. .......................................
3. SUBTOTAL
5. SUBTOTAL
EXCL
1-4 mi.
,.~: 8
\l 8
'If, 8
:'<{ 9
\{~ 10
5
'l/ 8
9
10
8
51
ALL
100 - 90%
8
.~. 6
7
6
+
GOOD FAIR POOR
5-10 mi. 11-15 mi. 16 mi & over
6 4 2
6 4 2
6 4 2
7 5 3
8 5 0
4 ~' 2 0
- 6 4
2
7 .~. 5 3
8 " 6 4
6 1 0
+ 0 + 13 + 0
-
MOST SOME NONE
89 -50% 49 - 26% 25% & under
6 ,v. 4 2
4 2 0
;,j 5 3 1
+ 5 + 4 + 0
64
15
6
6
4
o
6
+
3 Jacuzzi
1 Car Wash Facilities
3 Satellite TV Facilities
~. 4 Cluster Mail Box Delivery
3 Private Water/Sewage System
. _. 3 Concealed Waste[rrash Garbage Containers
6 Fire Hydrants
__ 1 Recycling Bins
Sauna Bath
Spa
4
12
121
Using this point count, check the appropriate community location adjustment box on page 7
THIS IS NOT A COMMUNITY (PARK) DEVELOPMENT APPRAISAL FORM TOTAL POINTS
Page 6 NAS. Form #2 Updated 9/04 V.P. Copyright @ 2004 by National Appraisal Guides, Inc.
@Cole and Associates, Inc. and Office Creation Services. All rights reserved. Reproduced with Permission by National Appraisal System - Form Version 1 0
ClienUUser THOMAS WINKLEMAN
CASE / FILE NO. 07112001
SUbject home and/or accessories are located on:
RV ADJUSTMENT
Count the Total Number of MHC Sites Rented to Overnight Motor
Homes, Travel Trailers or Park Model Units. If over 5% of total
spaces, drop one community adjustment level.
COMMUNITY SUMMARY
Retailer Lot or Fee Land/Condo Ownership...
SALES RATIO
If the Community is New to 3 years old and still filling, use a
ratio of 100% in the block below.
List the number of Homes for Sale ..............
CHECK BELOW
QUALITY COMMUNITY ADJUSTMENT
UNIQUE................. 192 and over ................................ + 20%
EXCELLENT ...........191 - 172 ..................................... + 17%
GOOD ................... 171 - 152 .................................... + 12%
_ _ STANDARD .............151 - 132 .................................... + 8%
Y FAIR ..................... 131 - 112 ..................................... (-) 6%
POOR .................... 111 - 92...................................... (-)10%
SUBSTANDARD ....... 92 and under .............................. (-)14%
*EMERGENCY DISASTER PLANS .................................. + 17%
*SITE - RENTAL/LEASE (-) 5%
FEES .................. Increasing or Decreasing ..........
*EXCAVATED INSTALLATION ....................................... + 15%
FEES RENTAULEASE COMMUNITY SITES * Add or Subtract % to community adjustment.
Decreasing -(Explainonp.lO)orseeaddenda .._____ (E)MHCADJUSTMENT (TransfertoUne7,Page2) :i: I -6.00% % I
Increasing - Excessive changes annually or at the time of subsequent resale transfer or turnover.
Stable - Change(s), if any, are a percentage of the Consumer Price Index (C.P.!.) or fair local market rents per year.
RESTRICTIONS
Rent Control ; vacancy Control (Describe on p.lO) or See Addenda
Subject Home/Accessories approved to remain in (MHC).J No {Describe onp.iO)o~~:-See Addenda
Access for legal transportation of home Normal' Difficult (If difficult, describe on p.lO) or See Addenda
REAL ESTATE (MHC) DEVELOPMENT INFORMATION
Data request left with (MHC) Manager Not Available (Explain on p.l0) or
Partnership/LLP Corporation Name
Phone: Other (List)
LAND USE (MHC) PERMITS -= Data request left with (MHC) Manager
Issued By City County State Other (List)
Permanent . Conditional Term In Years 0 Date Expires
Flood Elevation Located in 100-year Flood Zone No Yes (Explain on p.lO) or
Electrical Power Provided by Public Utility Private Power System Other
Sewage Disposal Provided by Public Sewer _ Private System Individual Site Septic Tanks Other
Water Supply Provided by Public Utility Private System Individual Site Septic Wells Other
Gas Supply Provided by Public Natural Gas Utility . Central LPG System Individual Site LPG Tanks
HEALTH AND SAFETY
Flood Hazard - Posted Community Evacuation Plan Yes" No
. Seismic Hazard - Posted Community Medical/Recovery Plan Yes.-.(- No
-'. Tornado Hazard - Posted Community Shelters/Safe Rooms Yes-:.t No
NOTE
This weighted analysis technique is used only to establish the Subject's In-Place Location Value (lPL V) and Community Adjustment
(Check One)
..~. No, Adjustment (under S%)
(List Count) I
o
Yes, Drop One Adjustment Level
VACANCY ADJUSTMENT
List total number of vacant sites
o
Then divide by total number of sites
This equals a vacancy percentage of
%1
o
CHECK ONE BELOW:
Community is new to 3 years old and is filling, no adjustment.
.~. Community is full or percentage is under 20%, no adjustment.
Community is older than 4 years and vacancy is greater than
20% , drop one community adjustment level.
Community is 6 years old and vacancy is greater than 40%,
drop two community adjustment levels.
Data request left with (MHC) Manager
Fee Simple .. j Lease Term in Years
Name
THIS PAGE BLANK
List the number of Vacant Spaces ...............
Total.........................................................
(D) SALES RATIO (Transfer to Une 7, Page 2) I
(See System Manual for Ratio Chart)
COMMUNITY LOCATION
o
o
o
100.00%
%1
See Addenda
Phone:
Not available (Explain on p.lO) or
Date Expires
See Addenda
Addess
Not available (Explain on p.lO) or
See Addenda
Other (List)
See Addenda
Other
Community Permits Homeowner Site-Installed Shelters
THIS IS NOT A COMMUNITY (PARK) DEVELOPMENT APPRAISAL FORM
Copyright @ 2004 by National Appraisal Guides, Inc. N.A.S. Form #2 Updated 9/04 V.P.
@ Cole and ASSOCiates. Inc. and Office Creation Services. All nghts reserved Reproduced with Permission by National Appraisal System - Form Version 1.0
Page 7
NUMBER 07112001
PREPARED FOR
N.A.D.A. APPRAISAL GUIDES
CERTIFICATE OF VALUE
FHA /VA CASE NO.
CASE / FILE NO. 107112001
See below
(list)
DESCRIPTION ../. HUD Code Modular Code
Year 1988 Mfg. Name SKYLINE
Trade Name WESTRIDGE
Other Tag-A-Long Expando
Total Eshmated living Area
ID Serislll 2F10 0616X
Construction Label(s) UlI287057
FTC Thermal Standards RooffCeihng R-
(Post-1983)
HUD Wind Zone (Post 1976) ../t
HUD Heating/coOling Zone (POSt 1976)
HUD Roof Load Zone (Post 1976)
Condihon Rating
State (ANSI) Code Park Model (RV) CODE
Firm Name
Address
City
Zip
State
Size 14 X 66
Tip-Out Size 0 X 0
924 SqFt
Not Verified
Phone
Borrower
Client
'V' Other
Name THOMAS WINKLEMAN
Address 32 CENTER STREET #8
City MT HOllY SPRINGS
Zip 17065 Phone
State PA
Not Verified
Exterior Walls R- Floor R- Not Available
II III Exposure C D Not Applicable
V' II III Not Apphcable
North Middle ~ South Not Applicable
Excellent Good Fair ..t Poor
Location
Fee Simple Land
Retailer Lot
APPRAISED VALUE
Cost Guide Edition
Yellow Value Chart
Estimated Remaining Physicai Ufe
Depreciated Replacement Value of Home
In Place Location Value of Home (tP.LV)
Value of Exterior Accessories (less repairs)
Indicated Value by the COST APPROACH
Fee Land Value (wllmprovements)
Other (List)
MoNr
Page #
Yrs
Sep-Dec
314
11
2007
'V'1 Rental/Lease Community
Name JENNY LEE MHP
Raling FAIR
Total Spaces
Address 32 CENTER STREET #8
City MT HOllY SPRINGS State PA
Phone Manager
Flood Hazard Zone .., No Yes Map Page
Seismic Hazard Zone No Yes N/A
Installation Field (Set-up) as per manufacturers' or contractors' procedures
'~-i Standard (PierlBlock) Excavated(Dtg.in) Approved (HUD) Foundation System
I (WE) ESTIMATE THE MARKET VALUE TO BE
$6,55200
($352.00)
$0.00
$6,533.00
$0.00
$0.00
$6,500.00
Zip 17005
DATE OF INSPECTION
i. made \j! "as is" subject to completion per plans and specifications.
subject to the repairs, alterations, inspections or conditions as listed
AND THE EFFECTIVE DATE OF THIS REPORT. This appraisal is based upon the definition of market value and
Other (List)
APPRAISER(S) CERTIFICATION AND STATEMENT OF LIMITATIONS
I (WE) HEREBY CERTIFY THAT
I (we) have researched the subject mal1tet area and have selected a minimum of three recent sales Qf properties mOS1 similar and proximate to the subject property for consideration (if applicaDte) in the sales comparison analysis. If a signific8r1t
item in 8 comparable property is superior to the subject property 8 negative adjustment to reduce the adjusted sales price of the comparable is made; if a significant item in 8 comparable property is inferior 8 positive adjustment to increase the
adjusted sales price of the comparable is made.
(A) I (we) have no undisclosed interest in the herein described subject property or its site location.
(8) I (we) have no pl1K:.Gnt, nor contemplated future int8l'Bsrt in the property that i~ the su~ct. matter of thi~ .ppratSA\ report.
(C) I (we) have not been influenced in any manner whatsoever by race. religion, sex or national Origin of any person reSiding in the property, or in the neighbomood wherein the subject property is located.
(0) No important facts ha\le been intentionally withheld or over looked in estimating lhe SUbject properties' current market valUe.
(E) It is understood that compensation for the appraisal services rendered is in no way contingent upon the valuation found, but is dependent only upon the delivery of this completed appraisal report.
(F) Neither this report. any portion of its contents, nor any copy thereof. shall be used for any purpose, (advertising, putxic relations, new releases, sales or other media) by any person or entity. including the recipient client, without prior. written
approval of the author(s) of this reoort and the client
(G) This appraisal is made on the premise that there are no encumbrances or regulations limiting the utilization of the appraised property, other than those herein reported.
(H) The legal description was taken from the identification numbers on or in the structure (if accessible) or from registration records (if available) and no inspection of the tiUe was made. It is assumed that the registered/legal owner(s) have right
to pass title
(I) No liability is assumed for the legal character or other influences affecting the property, otner than those herein reported
(J) No engineering t~~ nave been made, end no r~n~ibtlity i~ ~mcd, fortne ~undne~ of the 5tructure or for the !ltendlllrd/exoevated fieid insllllllllltion (Mrt~up), or HUD approved foundation ~'j$\em.
(K) No engineering tests have been made, and no responsibility is assumed, tor the and load bearing density or capacity of the soil as found under the Subject property site.
(L) It is assumed that (if applicable) efficient on-site management and adequate maintenance shall exist in connection with future use of a rental/lease community, P.U.D., or fee property, other than those reported
(M) I (we) have examined (if applicable) the subject prOperties HUD structural Wind Design Map and have noted the zone on this report.
(N) I (we) have examined FEMA (or other source) flood maps and have noted on this report ff the subject is located in flood hazard area.
(0) I (we) do not represent that (if applicable) a rentalllease community (park) is in compliance with the Federal Fair Housing Amendmeots Act of 1986
(P) I (we) have personally and thoroughly inspected. both inside and out, this subject property and made a drive-by inspection, with photographs, of each comparable sale used in the marlc:et analysis
(Q) I (we) have examrned (if applicable) the subject properties HUD structural Roof Load Design Map and have noted the zone on this report.
(R) I (we) have examined (if applicable) the subject properties HUD Heating/Cooling Design Map and have noted the zone on this report.
(S) The information contained in this report. gathered from reputedly reliable sources, cost estimates obtained from published manuals, or any other figures, values, or representations, are believed to be reliable and to be true and correct
(T) This report is in conformity with the profeSSional standards tor the (NAS.) Nationa! Appraisal System aod the standards of any other slate or appraisal organizationS with which the appraiser(s) is affiliated.
(V) I (we) shall not be required to testify, or appear in court by reason of this appraisal report, with reference to the property described herein, without prior arrangements made with my consent. My consent can be given accordingly, as time
oermits and for a fee charqed for such expert testimony
(V) Any breach of the above listed proviSions shall render the material contained herein invalid and subject the violator to any and all liability resulting from such actions.
fORMALDEHYDE~ BUIICllng proClucts or materialS normally usea In the cOnstructIOn OT mot>nelmanuTactureCl nomes may release alroome contaminants or formaraehyde vapors IntO the home. Prior 10 Feoruary 11, 19e;~, tnere were no
governmental standards or requirements relating to the emission of vapors or contaminants from residential building products or materials. With no established standards, and not being a trained air quality expert. it is submitted at the time of
this appraisell did not detect any unusual air emissions or vapors. A Formaldehyde notice (effective Februat'f 11, 1985) is required in all new manufactured homes sold per HQU. . Code Title 24 Part 32-8
RADON GAS. In certain areas of the United States a naturally occuning radioactive gas may form in or under $Orne site built homes. On September 12,1966, the federal publ" ealth sef\o'ice issued a lung cancer threat notice. II is submitted at
the time of this appraisal, as r am not a trained E.P.A. Air QU8lity Expert, This appraisal is based on the assumption this subject home is ffee of a hazardous radon gas level
POLLUTtON HAZARDS ~ Some ~anufactured home communities and/or sites have been developed on land fills. This appraisal does not include a report or tests to indicatr. . er past or current activities in, on or near the subject home have
contaminated its soil. water or faCilities. (National Environmental Policv Act 1967.\ / .
f I ,.
Date Report Signed 11/28/2007 NAS. Subscriber 1.0. #. 4661366 ! '
HeatherAnn Howie
-i did
did not inspect property
Type
State
HeatherAnn Howie
Appraiser Print Name
y.- I Personally inspected property
Certtflcatlon # 4809 CMHA
or State License #
Supervisory Appraiser (ff Applicable) Print Name
Certification #
4809 CMHA
or State License #
Firm Name
HeatherAnn Howie Appraisal Services
4 Wood view Dr
Phone
(717) 486-0057
State
PA
Zip 17065
Address
City
Mt Holly Springs
Client/User THOMAS WINKLEMAN
CASE I FILE NO. 07112001
CERTIFICATE OF VALUE & STATEMENTS
Attach Appraisal Certificate (Form #3) with Appraiser Certification and Statement of Limitations.
PROFESSIONAL STANDARDS OF THIS APPRAISAL DISCIPLINE
All Subscribers to the National Appraisal System agree to the following:
1. A SUBSCRIBING MEMBER shall refrain from conduct which is unprofessional and could be detrimental to The
National Appraisal System.
2. A SUBSCRIBING MEMBER shall comply with all applicable state or local real estate appraisal license
requirements, regulations, or laws.
3. A SUBSCRIBING MEMBER shall comply with the Federal Reserve System's FIRREA Act of 1989 Title XI licensed
or certified law effective 7/1/91 (including current USPAP updates) for federally-related transactions.
4. A SUBSCRIBING MEMBER shall accept only appraisal assignments that he/she has the technical ability and
facilities to complete, unless assistance is received from a Supervisory Appraiser and the appraisal report form is
countersigned by both individuals.
5. A SUBSCRIBING MEMBER shall follow The National Appraisal System quality control appraisal discipline and
submit final market conclusions on the appropriate report forms, indicating their personal N.A.S. Subscriber's
I.D.Number.
6. A SUBSCRIBING MEMBER shall comply with the System's Certification and Statement of Limitations Form, and
attach a signed copy of this numbered form to all Appraisal Reports submitted to a client
7. A SUBSCRIBING MEMBER is cautioned that they are not authorized to use the System's registered, National
Appraisal System Logo, the words National Appraisal System (NAS) or the trademark letters N.A.DA
8. A SUBSCRIBING MEMBER is cautioned that by the purchase and use of The National Appraisal System they are
neither certified nor employed by N.ADA Appraisal Guides, Inc. or by HUD Title 1 Regulation and can not
represent themselves as such in any way to a client.
CERTIFICATION
I certify that, to the best of my knowledge and belief:
1. The statements of fact contained in this report are true and correct;
2. The reported analyses, opinions, and conclusions are limited only by the reported assumptions and limiting
conditions and are my personal, impartial, and unbiased professional analyses, opinions, and conclusions;
3. I have no present or prospective interest in the property that is the subject of this report and no personal interest
with respect to the parties involved;
4. I have no bias with respect to the property that is the subject of this report or to the parties involved in this
assignment;
5. My engagement in this assignment was not contingent upon developing or reporting predetermined results;
6. My compensation for completing this assignment is not contingent upon the development or reporting of a
predetermined value or direction in value that favors the cause of the client, the amount of the value opinion, the
attainment of a stipulated results, or the occurrence of a subsequent event directly related to the intended use of
this appraisal;
7. My analyses, opinions, and conclusions were developed, and this report has been prepared, in conformity with the
Uniform Standards of Professional Appraisal Practice;
8. I have made a person inspection of the property that is the subject this report;
9. No one provided significant personal property appraisal assistance to the person signing this certification.
10.
11 .
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\Dat .//\ / Signature of Appraiser
THE BENCHMARK OF MANUFACTURED HOME ~PPRAISAL METHODS
SEE BACKSIDE OF CERTIFICATE OF VALUE FOR APPRAISER'S SIGNED CERTIFICATION AND STATEMENT OF LIMITATIONS
Copyright @ 2004 by National Appraisal Guides, Inc. N.A.S. Form #2 Updated 9/04 V.P.
@ Cole and ASSOCiates, Inc. and Office Creation Services. All rights reserved. Reproduced with Permission by National Appraisal System - Form Version 1.0
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ORRSTOWNBANK
A Tradition of Excellence
Free Checking
Thomas B Winkleman Sr
32 Center Street Lot 8
Mt Holly Springs PA 17065
Date 1/04/08
Primary Account
Enclosures
106000444 (Continued)
Electronic Debits and Withdrawals
Date Description
12/21 ATM WiD. 12/20
5785 ALLENTOWN BLVD
HARRISBURG PA 350004
ATM Or Cross Border Charge
ATM W/D. 12/21
5785 ALLENTOWN BLVD
HARRISBURG PA 350004
0-860-7098 HSPTL ACC INS 80
PPD
12/24
12/24
1/04
Date
1/02
12/07
12/14
12/19
* Denotes
Amount
302.00-
1.25-
202.00-
5.05-
Page 2
106000444
Check No
577
579*
580
581
missing check numbers
CHECK SUMMARY
Amount Date
460.00 12/14
no.oo 12/17
409.21 12/13
57.79 12/19
Check No
582
583
585*
586
Amount
-See above-
-See above-
200.00
-See above-
Daily Balance
Date
12/06
12/07
12/13
12 / 14
Information
Balance Date
2,289.80 12/17
2,179.80 12/19
1,979.80 12/21
1,511.35 12/24
THANK YOU FOR BANKING WITH ORRSTOWN BANK
Balance
1,454.36
1,057.33
754.08
550.83
Date
1/02
1/04
Balance
590.83
585.78
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A Tradition of Excellence
P.o. Box 250
Shippensburg, PA 17257
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Thomas B Winkleman Sr
32 Center Street Lot 8
Mt Holly Springs PA 17065-1728
Building? Buying? Remodeling?
We can help!
1.888.0RRSTOWN - orrstown.com
Date 1/04/08
Primary Account
Enclosures
Account Title
CHECKING ACCOUNTS
Thomas B Winkleman Sr
Free Checking
Account Number
Previous Balance
1 Deposits/Credits
15 Checks/Debits
Service Fee
Interest Paid
Current Balance
106000444
2,289.80
500.00
2,204.02
.00
.00
585.78
Deposits and Additions
Date Description
1/02 ANNUITYPAY MET LIFE
PPD
Electronic Debits and Withdrawals
Date Description
12/14 BILL PYMT MET-ED
CHECK # 582
BILL PYMT Embarq
CHECK # 583
ATM Or Cross Border Charge
A TM W / D. 12/19
5049 JONESTOWN RD
HARRISBURG PA XE0962
CHECKPAYMT FRONTIER CITIZEN
CHECK # 586
ATM Or Cross Border Charge
12/17
12/19
12/19
12/19
12/21
Check Safekeeping
StctLement Dates 12/06/07 thru
Days In The Statement Period
Average Ledger
Average Collected
Amount
500.00
Page
10600044
1/06/08
32
1,120.25
1,120.25
Amount
59.24-
56.99-
1.25-
302.00-
35.99-
1.25-
1/=-0/08
Thomas B Winkleman Sr
32 Center Street Lot 8
Mt Holly Springs PA 17065
Messages Internet Banking
Available Balance:
Collected balance:
Current balance:
Yesterday's bal:
Last stmt balance:
Avg collected bal:
Avg ledger balance:
Interest rate:
Stmt/Service chg/Int cycle:
Automatic NSF fee:
Statement/Passbook code:
Deposit Inquiry Page 01 of 11 10:45:05
CIF number: FORTNEY WOOl186
Phone: (H) (717) 486-8302 Birth date:
(B) (999) 999-9999 8/16/1952
Tax ID number: 169-44-6020 Br#: 006
Account type: Free Checking
Account number: 106000444
1 of 1
1709/08
5.05
5/25/05
533.25
533.25
533.25
533.25
585.78
529.88
529.88
.000000%
5
Yes
Statement
Waive ATM Foreign Fee (Y,N)... .... N
Fl=Addl functions F2=Image
F5=HisLory F6=Messages
Date last active:
Last Dep: 1/09/08
Date last overdrawn:
Date opened:
Date last statement:
Date last contact:
Closing balance:
Accrued interest:
Service charge:
SC Waive expiration:
Service charge code:
F3=Exit
F8=Maintenance
7/02/98
1/06/08
0/00/00
533.25
.00
Yes
0/00/00
60
More.. .
F4=Sweep Inquiry
F24=More Keys
1/10/08 Deposit Inquiry
Thomas B Winkleman Sr Account number:
Messages Internet Banking
Last stmt balance: 585.78 Last stmt date:
Current balance: 533.25 Statement cycle:
l==View 6==Print T==Tset Control: From
Posted Check No S Tic Debit Credit
12/17/07 583 C 183 56.99
12/19/07 T 132 1. 25
12/19/07 T 227 302.00
12/19/07 586 C 183 35.99
12/19/07 581 P 091 57.79
- T21217DT~ T 132 1. 25
12/21/07 T 227 302.00
12/24/07 T 132 1. 25
12/24/07 T 227 202.00
1/02/08 C 163 500.00
1/02/08 577 p 091 460.00
1/04/08 C 183 5.05
1/07/08 584 p 091 57.58
1/09/08 C 163 5.05
10:48:46
106000444
1 of 1
1/06/08
5
To
F4==Redisplay F7==Scan Fwd F8==Scan Bkwd Fll==Prior bal
F17==Top F18==Bottom FI9==EDI F20==Onfold
Balance
1,454.36
1,453.11
1,151.11
1,115.12
1, 05-1_. 33
1,056.08
754.08
752.83
550.83
1,050.83
590.83
585.78
528.20
533.25
Bottom
FI5==EFT Fl6==Sort
F22==T/C F23==Checks
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C:onmlOD\Vealth of Pennsvhania
Coumy of Dauphm:
, :/ 'f i~ 'I " I ' ' ,
thlS tne ----'-_ day oi / I Ii f (('-, ,2UU(' ,b: me
/\ noUn~, publJC the undersign~d offjc'~r, personalJy appeared:
/
l,;// / /}ICL-!I
/,/; (1/ /) -.l;/) / (, Ai /i '-
I ,/
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t:2:_!~L,(_
K-I10'ND IO me or satisfactorily proven to be the persoDv{hose name is subscribe to the wlthin
Instrument and acknowledged tha1 she /he/thej' executed the san1t for the purposes their 111
Contamtd,
...~
d" - -~ (/) ,(, /1
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In witness whereof, I hereby set my hand and official seal:
Sworn and subscribed before me this ?'-i-i~ day of /} [' [! rf /"
. 200 ~)
I
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/ / / (
, . j' _ 'I (" A-'/--' t c. ;
, , ,. j{otary Public
,.~/
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
KIMBERLY A. CABLE, Notary Public I
Susquehanna Twp., Dauphin County ,
~J Commission Exoires Sept 11, 2008
BILL OF SALE OF MOTOR VEHICLE
FOR AND IN CONSIDERATION of the sum of Two Thousand, Six Hundred Dollars
($2,600.00) in hand and of which receipt is hereby acknowledged,
Robin V. McNeal, executor for Thomas B. Winkleman Sf. of
6208 Elmer Avenue
Harrisburg, Pennsylvania
17112
(Hereinafter '''Seller'')
hereby grant, sell, transfer, convey, deliver and give to
Connie Danforth of
7318 Pueblo Court
Westerville, Ohio
43082
(Hereinafter "Buyer")
the following described Motor Vehic1e:
MAKE: Ford
VEHICLE IDENTIFICATION NUMBER (VIN):
IFDEE14L1 VHA19047
MODEL: Econoline E-150
BODY COLOR: Purple
\rp,AR: 1997
ODOMETER READING: 66,820 Miles
PAYMENT AND SCHEDULE
The Buyer has paid seller the full purchase price of Motor Vehicle. Payment was made
via Cash.
TITLE AND WARRANTY
The Seller declares the following are true:
A. The Seller is the executor of the registered owner's estate and has the legal
right to sell the Motor Vehicle;
B. That the Motor Vehicle is currently free and clear from all liens, claims or
encumbrances of any kind.
C. The Seller is selling the Motor Vehicle "As Is" and BELOW fair market value
beca the Motor Vehicle needs an engine.
Seller Signat ,; ,tvv,-~ 0 [rV\;l:U60iG Buyer Signature:
-, '
Print Name: L:'OLli'l \!
i . i (0'
J ,I.,
.-.-.... i ,\... / J \~';
-~.i L/, ( /( )
" l\ I "
IT I,' '. (\ 'f,/, 1- c.,r,>
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Print Name:
Date:
Date:
Hoffman-Roth Funeral Home & Crematory, Inc.
219 North Hanover Street
Carlisle, PAl 70 13
(717)243-4511
January 31, 2008
Robin V. McNeal
6208 Elmer Ave.
Harrisburg, PAl 7112
The Funeral Service for Thomas Bernard Winkleman Sr.
15199-263
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
FACILITY, STAFF, EQUIPMENT
Graveside Services . . . . .
$3025.00
USE OF STAFF & EQUIPMENT
Transportation. . . . . .. ....
FUNERAL HOME SERVICE CHARGES
$100.00
$3125.00
SELECTED MERCHANDISE:
Coleman 20 ga Casket . . . . . . . . . . . . . . . . . . . .
Monarch Interment Receptacle. . . . . . . . . . . . . . . . . .
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THATYOUHAVESELECTED . . . . . . . . . . . . .
$1690.00
$1120.00
$5935.00
Cash Advances
Opening Grave, . . . . . . .
Newspaper Obituary Notice - Sentinel.
Certified Copies of Death Certificate .
Flowers. . . . . . . . . .
TOTAL CASH ADVANCES AND SPECIAL CHARGES.
$850.00
$73.26
$60.00
$106.00
$1089.26
Total
Total Cost .
$7024.26
. . . . . . . . . . . . . . . . . . . . . . . . '"
History
01/31/2008 M icrodata Systems, Inc
01/3 J /2008 Discount Received. ,
$-6287.24
$-297.76
TOTAL AMOUNT DUE
$439.26
This statement is net and payable in full within 30 days of receipt.
RECEIPT FOR PAYMENT
GLENDA FARNER STRASBAUGH
Currberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Receipt Date:
Receipt Time:
Recelpt No. :
1/10/2008
09:42:49
1051145
WINKLEMAN THOMAS B SR
Estate File No. :
2008-00034
Paid By Remarks:
ROBIN MCNEAL
AJW
------------------------- Receipt Distribution ---------------------___
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST
WILL
SHORT CERTIFICATE
JCP FEE
AUTOMATION FEE
Cash
Total Received....... . .
60.00
15.00
20.00
10.00
5.00
----------------
$110.00
$110.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
CUMBERLAND COUNTY GENERAL FUN
~"..;t,,<;*~;,,,,,~i ~.
EMBARG
Monthly Statement
January 4, 2008
Page 1 of 5
Account Number
717-486-8302-795
M
'-
Payment Options & Contact Info Current Charges At-A-G1ance
'"
co
~
M
O Retail Store in Your Area
CARLISLE
346 York Road
In the Embarq Building
EMBARO Services
Total
Pay Online
EMBARQ.com/myaccount
JJ.. Local and Optional Services - Page 3
'1 Long Distance - Page 3
-15.09
15.00
Pay by Phone
'-877-813-7604
Taxes and Surcharges - Page 3
3.35
Customer Service
'-800-829-8009
Repair Service
'-800-788-3600
Internet Address
EM BAR a.com/residenti al
--
--
!!!!!
-
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56.99
-56.99
.00
3.26
$3.26)
01/29/08
$3.30
--
--
-
--
!!!!!
--
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Previous Balance Payments & Adjustments
Balance
Total Current Charges
Total Amount Due
-
--
Current Charges Due By:
If received after Februarv 4:
236
* Please Recycle
,,~-=
EMBARQ"
Please return this portion with payment
Customer Service Internet Address
1-800-829-8009 EMBARO.com/residential
Account Number
717 -486.8302. 795
Due Date:
Total Amount Due:
$3.30 if received after February 4
January 29,2008
$3.26
AV 01 002198 42484 8 9 A**5DGT
111111111111111111111111111111111111111111111.111111'1111111,1
THOMAS B WINKLEMAN
UNIT 08
32 CENTER ST
MT HOLLY SPGS PA 17065-1728
Amount Enclosed:
$
Write YOJr 13-diglt account number on check
Make checks payable to:
Embarq
PO Box 96064
Charlotte NC 28296-0064
1'11111111",111111"1111.1' 11111111,11,1,1,,11.11.1
,~ ~'~UALA~n~'QCQ nnnnnnnnnnn,"
MMI""lr"'\---- - - - ~
Your previous bill was
Total payments/adjustments
Balance at billing on January 09, 2008
Current Basic Charges
Met-Ed - Consumption
ue an
I Account Number: 1000201486881 Page 1 of 4
M68
Bill for: THOMAS B WINKLEMAN
JENNY LEE TRLR CT
32 CENTER ST LOT 8 .
MOUNT HOLLY SPRINGS PA 17065
I-
I
59.24
-59.24 I
0.00 0.00
61.38
Met-Ed
January 09, 2008
A HrstEnergy Ccmp~
Billing Period: Dec 07 to Jan 08, 2008 for 33 days
Next Reading Date: On or about Feb 07, 2008
Bill Based On: Actual Meter Reading
Prorated Bill
To avoid a 1.50% Late Payment Charge being added to your bill, please pay by the due date.
~
Bill issued by:
Met-Ed
PO Box 16001
Reading PA 19612-6001
Met-Ed
AfnIE(lt$g;.~
Customer Service 1-800-545-7741
Automated Outage Reporting 1-888-544-4877
Collections 1-800-962-4848
visit us on-line at www.firstenergycorp.com
For you to save,
5.9 cents per kWh
See. other pagesfot addI11()/1aJ information andteJephon~numl>~rs
Met-Ed
----
A FirstEnergy Company
Return this part with a check or money order
Payable to Met-Ed
Account Number: 100020148688
1"1111111111111.111111.11'1111111,1..1.111,1.1111.1111.,1,1.1
*******AUTO**SCH 5-DIG1T 17007
00016606 01 AV 0.312 P2
THOMAS B WINKLEMAN
JENNY LEE TRLR CT
32 CENTER ST LOT 8
MOUNT HOLLY SPRINGS PA
17065-1728
Amount Paid I I
Please Pay $61.38
Due By January 29, 2008
MET-ED
PO BOX 3687
AKRON OH 44309-3687
1.1..1,11111111,11111111111.111111111,,1.1111111,1.11111111111
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INTEGRATED PA YMENT SYSTEMS INC. . ISSUER
Greenwood Village, Colorado
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82-4011o:!1
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MONEY ORDER RECEIPT - NON NEGOTIABLE
::;T 206562 lOC 000098 DT 012208 $57.17 **~;7DOLLARS AND *******
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IMPORTANT INFORMATION 8 ON BACK.
PURCHASE AGREEMENT: Y agr&e
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