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HomeMy WebLinkAbout06-06-08 (2)15056041147 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue county code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 0 7 0 8 61 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 175 62 1373 09 02 2007 09 22 1979 Decedent's Last Name Suffix Decedent's First Name MI KIMMEL WILLIAM J (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL tN APPROPRIATE OVALS BELOW X^ 1. Original Retum ^ 2. Supplemental Return ^ 3, Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Retum Required (date of death after 12-12-82) 8 Decedent Died Testate ~ Decedent Maintained a Living Trust (Attach Copy of will) ^ (Attach Copy of Trust) 0 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113 A between 12-31-91 and i-1-95) (Attach Sch. o) ( ) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number DIANE G RADCLTFF (717) 737 0100 Firm Name (If Applicable) DIANE G. RADCLIFF, ESQUIRE First tine of address 3448 TRINDLE ROAD Second line of address City or Post Office State ZIP Code CAMP HILL PA 17011 REGiSTER~~IILLS UNLY ~ c~ . ~: '~ ~ _-. r-- - ~ :;.,m ~~ ~ t - rn ~:- .. ~~ ":jC= ~ ~ - - .~ D~E FILED ~ " , t Correspondent's a-mail address: Und•er 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 6rue, correct and comp. Deciarat~ of preparer other than the persona! representative is based on all information of which preparer has any knowledge. Jean L Kimmel h ~~ ~Q Kim Acres Drive, Mechan RTiIE;E OF PREPARER OTHER THAN REPF Camp Hill, PA 17011 Diane G Radcliff Side 1 15056041147 PA 17055 15056041147 J~;,~ REV-1500 EX 15056042148 Decedent's Name: William James Allen Kimmel RECAPITULATION 1. Rea! Estate (Schedule A) .......................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D) .......................................................... 4. `i• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. Ei. Jointly Owned Property (Schedule F) [~ Separate Billing Requested ............. 6. i'. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) [~ 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 8~ 10) ......................................................................11. 12. Net Value of Estate (Line 8 minus Line 11) .............................................................12. 13. Charitable and Governmental Bequests/Sec 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, of transfers under Sec. 9116 (a)(1.2) X .00 0 . 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .045 14 , 2 0 7.13 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18. 19. Tax Due ...................................................................................................................19. .?0. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Decedent's Social Security Number 175 62 1373 112,500.00 9,899.00 128.08 122,527.08 6,159.54 102,160.41 108,319.95 14,207.13 14,207.13 0.00 639.32 0.00 0.00 639.32 Side 2 15056042148 15056042148 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-07-0861 DECEDENT'S NAME William James Allen Kimmel STREET ADDRESS -" _-- 30 Kim Acres Drive CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C:. Discount 501.00 26.36 Total Credits (A + B + C) (1) 639.32 (2) 527.36 3. Interest/Penalty if applicable p. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2 Line 20 to request arefund -- 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 111.9 6 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 111 .9 s 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 :.................................... c. retain a reversionary interest; or ...............................................................................................................~ ^x d. receive the promise for life of either payments, benefits or care? ..............................................................^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................................. ....~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................~ 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 surviving 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 surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving 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-1502 Fa(+ (5-98) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA I INHERITANCE TAX RETURN IJ RESIDENT DECEDENT ESTATE OF FILE NUMBER Kimmel, William James Allen 21-07-0861 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 pries at which property would be exchanged between a willing buyer and a willing seller, neither being compelletl 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. (Ir more space is neetletl, atlditional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 6-98) Rev-7508 EX+ (6-88) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY (:OMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Kimmel, William James Allen 21-07-0861 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Federal Income Tax Refund 2,368.00 2 Insurance Refund -Mountain Road Property 176.00 3 State Income Tax Refund 35.00 4 Dodge Truck (1985) 100.00 5 Ford Mustang (1992) 500.00 6 Suzuki GSXR 600 Motorcycle (2007) 6,720.00 TOTAL (Also enter on Line 5, Recapitulation) I 9,899.00 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-f509EX+(6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Kimmel, William James Allen 21-07-0861 If an asset was made joint within one year of the decedent's date of death, it must be repoRed on schedule G. SURVIVING JOINT TENANT(S) NAME 30 Kim Acres Drive Mechanicsburg, PA 17055 RELATIONSHIP TO DECEDENT ADDRESS A. Jean L Kimmel B. C. JOINTLY OWNED PROPERTY: Mother ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH ALUE OF ASSE % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 A 1/1/2007 AmeriChoice Federal Credit Union - 5.00 100.000% 5.00 Savings Account 2 A 1211411990 Members 1st Federal Credit Union - 130.50 50 000% 65 25 Savings Account No. 118032-00 . . 3 A 6/14/2004 Members 1st Federal Credit Union - 115.66 50.000% 57.83 Checking Account No. 118032-11 TOTAL (Also enter on Line 6, Recapitulation) I 128.08 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) Rev-1502 EX+ (6-98) SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS f:OMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Kimmel, William James Allen 21-07-0861 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) REV-1151 EX+(12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Kimmel, William James Allen 21-07-0861 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: Wayne McFadden -Funeral Expense 100.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Diane G Radcliff 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Robert and Jean Kimmel Street Address 30 Kim Acres Drive city Mechanicsburg state PA zip 17055 Relationship of Claimant to Decedent Parents 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 2,000.00 3,500.00 254.00 40.00 265.54 TOTAL (Also enter on line 9, Recapitulation) I 6,159.54 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (6-98) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ~~OMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Kimmel, William James Allen 21-07-0861 Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 2007 School Real Estate Tax -Clyde Flohr 629.84 2 Allstate -Car Insurance 122.14 3 Allstate -Car Insurance 43.05 4 AmeriChoice Federal Credit Union -Mortgage on Land 84,947.18 5 Capital One Visa -Account No. 4862 3623 1414 3143 1,048.87 6 Citibanc Credit Services (Home Depot) -Account No. 6035 3201 7559 6079 156.86 7 HSBC Business Solutions -MAC Tools 2,600.00 8 Jonestown Bank -Motorcycle Loan Account No. 609 048 4 9,748.54 9 Met-Ed -Electric Bill 10 Met-Ed -Electric Bill 11 Met-Ed -Electric Bill 12 Met-Ed -Electric Bill 13 Real Estate Taxes -Clyde M. Flohr, Tax Collector 14 Visa -Members 1st FCU 15 West Shore Emergency Medical 16 West Shore Tax Bureau - 2007 taxes 28.15 11.73 12.70 19.58 186.91 2,495.65 100.00 9.21 Total of Continuation Schedule See attached page TOTAL (Also enter on Line 10, Recapitulation) 102,160.41 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV•1513 EX+ (9-00) SCHEDULE J A ANIA F COM w ~ BENEFICIARIES T I ANCE AXRET RN NHER RESIDENT DECEDENT ESTATE OF FILE NUMBER Kimmel, William James Allen 21-07-0861 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT Do Not List Trustee s (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal f ~ ers distributions, and trans under Sec. 9116(a)(1.2)] 1 Jean L Kimmel Mother 1/2 residue of 30 Kim Acres Drive estate Mechanicsburg, PA 17055 2 Robert A Kimmel Father 112 residue of 30 Kim Acres Drive estate Mechanicsburg, PA 17055 Total Enter dollar amounts for distributions shown above on lines 15 through 18, as appropr iate, on Rev 1500 cove r sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTIO N TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS oN ulvt 13 Vr Ktv-~5uu cwtlt srltr. ~ v.vv Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) Dear Jean, Enclosed you will find a comparative market analysis you requested for the property located at 1284 S. Mountain Road in Dillsburg, Pennsylvania. I have also enclosed a full report of the tax map from York County. The property is presently assessed at $45,410.00 . In my reviewing the property I have found the following to be useful in determining a market value for the property. The subject property has 3.5 Acres and also includes 2 outbuildings. The outbuildings appear to be in fair to average condition. The one is of metal structure unfinished inside with NO water or electric. This could be used for storage. The second building has 5 horse stalls with dirt floor, there is currently water & electric and additional space for storage. Holes in the roof appear to allow water to leak into the structure. The grounds are mostly cleared with a view of a neighboring mobile home in the rear. There is now a minimum lot size in Franklin Township of 4 acres, so the property could not be further subdivided. Should someone desire to build a residential home on the property, they would have to obtain a satisfactory perk & probe arranged with the sewage enforcement officer. There are no similar "sold" properties available that show vacant land with outbuildings only and no residence. The comparables that were chosen are vacant land with no residence and no outbuildings. The price for the land suggest a median price of approximately $ 89,900. In regards to the outbuildings, the current insurance company has the price allowed for both outbuildings of $ 23,000. I will use this figure to add to the median price of the land for a TOTAL MARKET VALUE RANGE OF $ 110,000.- $ 115,000. Regar Beth Shoop Associate Broker Jack Gaughen Realtor ERA William Kimmel Estate Account Date Description Outflow Inflow Balance Initial Balance $ _ 11/14/07 Sale of Mt Road Property $112,500.00 $ 112,500.00 11/16/07 Pay off Members 1rst Visa $ 2,495.65 $ 110,004.35 11/16/07 Pay off Motorcycle Jonestown Bank $ 9,748.54 $ 100,255.81 11/16/07 Pay off Mt Road Mortgage Americhoice $ 84,947.18 $ 15,308.63 11/16/07 Pay off Capitol One Credit Card $ 1,048.87 $ 14,259.76 11/19/07 Pay off Citbank (DCM Services LLC) $ 156.86 $ 14,102.90 11/28/07 Pay Register of Wills $ 501.00 $ 13,601.90 12/8/07 Dep Insurance Rebate (Mt Road Property) $ 176.00 $ 13,777.90 1/5/08 Reimburse Jean Kimmel Estate Expenses $ 1,591.19 $ 12,186.71 1/6/08 Pay Diane Radcliffe $ 545.00 $ 11,641.71 2/2/08 Deposit sale of Mustang $ 500.00 $ 12,141.71 3/5/08 Tax preperation expense(Robert Bowers) $ 40.00 $ 12,101.71 3/10/08 Pay West Shore Personal taxes $ 9.21 $ 12,092.50 4/7/08 Pay Property taxes (Clyde Flohr) $ 186.91 $ 11,905.59 4/18/08 Deposit Motorcycle Check $ 6,720.00 $ 18,625.59 4/18/08 Deposit State Tax Refund $ 35.00 $ 18,660.59 5/9/08 Deposit Federal Tax Refund $ 2,368.00 $ 21,028.59 5/27/08 Payment Estate Recoveries (MAC Tools) $ 2,600.00 $ 18,428.59 5/29/08 Pay CCS (West Shore Emergency Med) $ 100.00 $ 18,328.59 5/31/08 Sale of Dodge Truck $ 100.00 $ 18,428.59 " $ 18,428.59 $ 18,428.59 $ 18,428.59 $ 18,428.59 $ 18,428.59 N ~ M u~i r~„-:s-s n,t ~' N ~ ~`:jf' ,~t ~ Q .j(. 4 _tilt jai ''11j1~1+~ ~ ~ 4 3~ o o' ~ ~ ri iC- ,; U 173 Y ,~ ~~.: ~y , _` -`- r' N N "`- ~ t~,~~-~~ ~ Ili 3 `~ ~ ''3 Ca ~' Q. ~' 4 O ' o~ ~ a ~ X H ~ `', N 00 ~ ~ 9 C"' 0o Z ~ c ~ { ~n r, cr ,.,,, ,~ ~- ~~4 ~ cn O -; v ~ ~ 0 4 ~, ~' S N Q. 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Lfl ,~ ru ,, ~: ~ 3 ru ] 31 LO • 3 sS'i ~- ~~ No ~3~5~5 ~5 l4 T F'A TITLE NUMBER (AS SHOWN ON ATTACHED TI L E ) MAKE OF VEHICLE MODEL YE A R s Q /~ ~~~ jj''' / // 77- /(y^' C' . ~ J~ ~/~ /~ 2 ~ ~ /L11 /o / L-'1 (See Nole on ReveEse) ~~~ f % )/ U Q ~ .~ / ~ .~ l.- R,/ 1 ~+ ~ ` / ` ' O ~`„/ w U '/EHICLE IDE N TIFICATION NUMB E C O ND IT IO N > a J~~'` , /L ~/ Y J / R ~ l ~ f ~ ~~ ~ I ~~ LESS TRADE-IN R / [ v I O GOOD O FAIR / B. tr IAST NAME O FULL BUSINESS NAME) FIRST NAME MIDDLE NAME , ~-- J 1 rn rn~ ~ ~ ~ ~ M TAXABLE AMOUNT J w CO E ER ~, E ~ -~~c~ ~ C~c~l ~x ~ X -t~ 1 SALES TAX DUE "~ rn( u 2~l. - . C LAAST NAME (OR FULL BUSINESS NAME) FIRST NAME MIDDLE NAME PA DL/PHOTO ID# DATE OF BIRTH X 6 % (.06) OR X 7% (.07) OR BUS. ID# ` * (See Note on Reverse). z I '` ~~ ~ 1A. EXEMPTION ~ L~~V~"~ REASON CODE (must = CO-PURCHASER LAST NAME FIRST NAME MIDDLE NAME PA DL/PHOTO ID# DATE OF BIRTH be a number from 1 to v0-i w N 23 or O) N a _ 1B. FIRST 1B. SECOND ~ :>T EET COUNTY CODE ASSIGNMENT ASSIGNMENT N ~ 6 \ ( rl'1 'C PS ~--~ ~ 2 2. TITLE FEE CITY STATE ZIP CODE DATE ACOUIREDI REFER TO COUNTY CODES ~~ \ _ 1(1(~ ~1~ 4~ ,/~ ~ PURCHASED LISTING ON REVERSE SIDE ~' CS ~~ ~ 1~`. iiiJJJ 'j~ OF YELLOW COPY 3. LIEN FEE p LAST NAME~(OR FULL BUSINESS N E) FIRST NAME MIDDLE NAME PA DLIPHOTO ID# DATE OF BIRTH OR BUS. ID# 4. REGISTRATION OR PROCESSING FEE r CO-PURCHASER LAST NAME FIRST NAME MIDDLE NAME PA DL/PHOTO ID# DATE OF BIRTH w ~ N FEE EXEMPT NUMBER _ = AS ASSIGNED BY THE Cn U DEPARTMENT rn ~ STREET COUNTY CODE rn a "' S DUPLICATE REG p O r . . FEE NO. OF N N CARDS ~. CITY STATE ZIP CODE DATE ACQUIRED/ PURCHASED REFER TO COUNTY CODES 6. TRANSFER FEE LISTING ON REVERSE SIDE OF YELLOW COPY E MAKE OF VEHICLE VEHICLE IDENTIFICATION NUMBER 7. INCREASE FEE J ~ U_ p = C MODEL YEAR BODY TYPE (CP, TK, ETC.) CONDITION ~ ~ 8. REPLACEMENT FEE O GOOD O FAIR O POOR TOTAL PAID 9. 10. F O TRANSFER OF PREVIOUSLY ISSUED PLATE (ADD 1 THRU 8) ~ ' O PLATE TO BE ISSUED BY ~ TRANSFER & RENEWAL OF PLATE DEPARTMENT (PROOF OF INSURANCE MUST BE O TRANSFER & REPLACEMENT OF PLATE 11. GRAND TO L SEND ONE CHECK IN ATTACHED.) O TRANSFER OF PLATE & REPLACEMENT Or STICKEP, (ADD 9 8 10) THIS AMOUN O EXCHANGE PLATE TO BE REASON FOR REPLACMENT ISSUED BY DEPARTMENT O LOST O DEFACED O STOLEN O NEVER RECEIVED (Lost in Mail) 7 TEMPORARY PLATE ISSUED EXPIRES NOTE I("NEVER RECEIVED" block is checked, applicant must complete Form MV-44. ~ BY FULL AGENT Month Year ~ O TRANSFERRED FROM TITLE NO. VIN z~ o~ ~~ v rn SIGNATURE OF PERSON FROM WHOM SIGN HERE RELATIONSHIP TO APPLICANT a w TEMP. PLATE NO. ~ PLATE IS BEING TRANSFERRED (IF a ~ OTHER THAN APPLICANT) 4 `JEHICLE PURCHASED WEIGHT GVWR UNLADEN WEIGHT REQ. REG. GROSS WT. RED. REG. GROSS COMB. WT. INFORMATION IF APPLICABLE INCLUDING OAD L IF APPLICABLE ~NSURANCE ~~ NJ(1ME ,. . `` ' ' I L' + ~ 4 ~ O O 0 h . Y FFFE I~ ~E PL O ~ ~ R L O`1 ~ l I AT TACH B1 ND .,.• ~ DATE DA*B,1. ~ ~ I CERTIFY THAT ON MONTH__ __ DAY _ YEAR_ ISSUING AGENT (PRINT NAME) A GENT NO. ISSUING I HAVE CHECKED TO DETERMINE THAT THE VEHICLE IS INSURED AND AGENT ISSUED TEMPORARY REGISTRATION TO THE ABOVE APPLICANT IN INFORMATION , COMPLIANCE WITH ALL APPLICABLE PROVISIONS OF THE VEHICLE ISSUING AGENT SIGNATURE T ELEPHONE NO. CODE AND DEPARTMENT REGULATIONS. ( ) G• IIWE CERTIFY THAT I/WE HAVE EXAMINED AND SIGNED THIS FORM AFTER ITS COMPLETION AND THAT THE INFORMATION GIVEN IS TRUE AfJD CORRECT. IF ANY EXEMPTION IS CLAIMED, THE PURCHASER FURTHER CERTIFIES THAT HElSHE IS AUTHORIZED TO CLAIM THIS EXEMPTION. INJE ACKNOWLEDGE THAT IIWE MAY LOSE MY/OUR OPERATING PRIVILEGES(S) OR 'JEHICLE'I REGISTRATION(S) FOR FAILURE i0 MAINTAIN FINANCIAL RESPONSIBILITY ON THE CURRENTLY REGISTERED VEHICLE FOR THE PERIOD OF REGISTRATION. I/WE ACKNOWLEDGE THAT IIWE MAY Z O 13E SUBJECT TO A FINE NOT EXCEEDING 55,000 AND IMPRISONMENT OF NOT MORE THAN TWO YEARS FOR ANY FALSE STATEMENT THAT I/WE MAKE ON THIS FORM. a Signature of First Purchaser or Authorized Signer: r Telephone No. U u 1ST ~ ~ U ASSIGN- MENT Signature of Co-Purchaser/Ti(le of Authorized Signer C7~'71 ~ I ~ _ l~f t7 I a-C+ 2ND Signature of Second Purchaser or Authorized Signer Telephone No. ' ASSIGN- MENT Signature of Co-Purchaser~tle of Authorized Signer ( ) H Q o NOTE: IF A CO-PURCHASER OTHER THAN YOUR SPOUSE IS LISTED ANO YOU WANT THE TITLE TO BE LISTED AS "JOINT TENANTS WITH RIGHT OF SURVIVORSHIP" ION DEATH OF ONE OWNER, Z w ~ TITLE GOES TO SUR`/IVING OWNER.) CHECK HERE ^. OTHERWISE, THE TITLE WILL BE ISSUED AS "TENANTS IN COMMON" (ON DEATH OF GNE OWNER, INTEREST OF DECEASED OWNER ¢ r ~ GOES TO HIS/HER HEIRS OR ESTATE.) o ~ ~ NOTE IF THE VEHICLE IS TO BE USED AS A GAILY RENTAL OR LEASED VEHICLE, CHECK THIS BLOCK ^. IF BLOCK IS CHECKED, COMPLETE AND ATTACH FORM MV-1 L. a z MESSENGER NUMBER: -_ ~ t A. CERTIFICATE OF T1TLE FOR A VEHICLE . ~,4R j (~ _ a .. ~. - ~~~ ~~ ,o .... .. Z~b7 ~L. "a t~R.,~.,...~....o...,., .......o~._ __ _ B ~ ~ 4 1B 7`Nta],~±~'1ES~E~~~'~ ~r9H5I ODBGE :371~Sis45~I1Ijy .KI T10N NUMBER YEAR II MAKE OF VEHICL ~~ VEHICLEIpENTj}IPIGA - I{ E {{} T~ '.UMBER TE ODOM, MILES. ~ ODOM- STATI ~~ BODY TYPE ~~~ I ~ ~D~U~ ~I ~~SEAT CAP I~~~ PRIOR TITLE STATE~~~ ~ OGO~~~ ~~ ~~ ~ I ~~~~~ ~ I ~ ~~ .~ ~ ~ a~ " ., ~ .,~. .. ::~ .r .. DATE PA TITLED ~ DATEOF ISSUE ~ UNLADEN WEIGHT ~~ GVWR ~ GCWR I TITLE BRANDS QD9METER STATUS 0 c-ACTCULb1H.£Af'E J _MILEAUE EX.C.EFCS TeE ME'. Hp',I:: AL -.LIMi fS 2. NfJT R1E A~TUAL t1 LI-Ar E ~+''a T 3 ~ NOT TNt 4CTL~.s`_ MILE 4l-E GCr!ME f H 'gt^~ k ,~~~ ~ ~'_ TAf1PEA WU VERIFEL} '. ;g ~~~~~~~e_~ r~s'it i1~ 4 . E7(E A1PT FROM GUJM ETER DI;+.,L l F.E ' 2~~~~~ 1` RE I TLRED CJ r1ER(Joy ? ~ ti~ i ~,wA- ~h~-~'~9. .... ~ ~nrcTlE EHICLiFg I~ w' ~ f~~'~ rx ;: 'Q~ - C . flAS C~EMICF ~n~ ~~ I >~ r'S~~ .~ }~ ~ ~',~~~ 1_ ~ ~~,tJ r,oritd~"fixdlAfi~S tatRuf~, !,Q o ~4TaLE wu-L~ _ F ~+.,7 ~F _wt R1 ° I' ~ ~.y ~ H~ R IhnllY AIF iD FOF t/r47 k.5 ~i~ti `IC I 1+4W .~f fil,~~ ~K r ; ~.~ > a~ .,h;,vr~V, R G P'A 17 fl 5 S H gGRICULruRti EhrLE MIrOH A N 1';0..;519U L . LOtlDING VEhI~LE P.. IShVASA PDL'~:E `: EF",'„.E '` R = RECANSTRIk:TEJ - : S .. STREET RQD T->o a~ ~.EHE, THEFT vEHIQE V'.? E SC'EC-_NT. IY~PEI~y~EO '1!r! .W v ~.,D ~F; H,r L_ ~ FIRST LIEN FAVOR;OF: SECOND LIEN FAVOR OF: E ". ~ -- - _ -. II a second Ilenholder s Isted upon sat sfactfon of the Ira lien Ir,n lull Ilenholder must forward thte The to ths- Bureau f 61_I r V r- • ih thu - I FIRST LIL . F_ EASED ' eppropneto form and (ee DATE i BV SECOND LIEN FELEASED AUTHORIZEDREPRESENTATIVE.. DATE MAILING ADDRESS '! ~ _ ' BV' AUTHOAIZED REPRESENTATIVE 1 2 WILLIAM J KIHMEI_ E 3Q KiM ACRES DR MECHANICSaURG PA 1X155 t cattily as of tna date of Issue, the official recortls of the PennsylveNa Department - ~ ~ ~ ~;~ ~~ .Y ~ ~ ~ "~ ~ ~'' .". . 'orTraii9poitetion raflectihal=the person(stOr compenynnmed'hemin'ia'the lawful"owner -~~ '-'-' --~-"~-~ ~-~-. -' '-"n^>:r,:`-a"--~"~- -'^~ d the said veh~le. jecrelary of TranSpoJtatlon ~~ . ~~~ W -~'~ -J W ~~ If a CD-purChaSOrOtherthan your Spous SUBSCR IBED AND SWORN be Ilstedas "Joint Tenants Wdh eight Tq.BEFO FEME: ... ran ~ U~.v - venR :. owner title goes to surviving owner).C _ i„ wilt be issued as "Tenants lrtpommon" ' p~u ` ~~ aft- r ~~ !{~ { ,p I ~ deceased owner goes to his/her halts o r F P a.~~l y.~s:~b.c:. Ilr ~ G TH -1ST LIEN DATE'. 1ST LIENHOLDER MAY 31 2008 T a , REET u n aTY ~Y' ~ ~ ~ FINANCIAL INSTITUTION NUMBER 2ND LIEN DATE: Theuntle sa^atl rareby m eygfratlon anM1Cate of Title ra Ina vehicle tlexribed .no.e,,u~n,io. mre~enrcmyhrn/nceo e»d an.r leoxl gems .~etw~rih/.nera 2ND.GENHOLDER /fI ~~ _ /~' t STREET . CITY els listed and you want the title ta;"' of Survivorship r (On death 01 one' :: HECK H~FiE ^. Dtherwisar tt?5 title (pn ds .Io! one owner; ntm~3~2of-, r estate --~ IF NO LIEN, CH STATE ZIP --' IF NO LIEN. CHECK ~ ` STATE ZIP ~, X31 - _ __ __. (TYPE OR PRIN T) Certificate of Title must be submitted withi f n 20 days, unless the purchaser is a registered dealer holding the vehicle for resale WARNING - FEDEflAL AND STATE LAWS REQUIRE THAT YOU STATE THE MILEAGE IN CONNEOTIq((,JJ. WITH THE 7RA7JSFER.'OF OWNERSHIP TO C MPLE''rE ORPRObIDING A: FALSE STATEbtENT MAY RESULT IN FINES AND FAILURE OR IP P . .. : A RISONAIENT. ASSIGNMENT ~ ag lead da~~s ~ 1 e~ ;rt t r M~2.A a, M/2,81 ~A OF TITL ' . - a rsq I ed Oy law If p h r ,OT s elated oea,er usT FIRST M I ' eaio U h ~ ~ ~ . . n t e I I I ml I„rrr moat be cam paled. f~PUI.L 1/We tpeLbf~~J)m r 'hula e Ih't Iha tMo eI readng 's 7ij~E V t ~ ~~~l r_.rH i -_-Liu.. l,tnP 12o~ F i h' r r ~ ~ W - ~----_ _ L ~ CO-PURCHASER l~~i! ' Lv X miles and rellects the teal il Rl r . m ge I Iha vehde, I ~T unless one of the fcllowing boxes Is checkad~ i f~i'FAs -__------ A Reflects the amount of mlie e ~' ^ U^ ~LY~~ ti ~ r ~ ^ a - - 9 ~ Is NOT the a Iual .eace In excess of its dlechanlcal Ilmits ~-- 'YARNING: Od 1 i ~ a ter d screaancy ~ _ I/We lurther certlfy that the vehlcle Is Irae ot.any encumb a ~e end that o ship is Hereby ~ ~" `M t~ ` lit n~ ~ ~ C -LV-'~-~_ translerred to the parson(s) or the dealer listed I ~ ,. _ __- ~ ZIP .\ PURCHASE 'TRICE C OR DIN SUBSCRIBED AND S ORN 3- Q Z W ~ TO BEFORE ME. t ~ ~ y MO. DAY ___ yEAR _~ ~ URGHA C sIG R ~ ~ - rH -~ ~ ~' Y - ' b .., !,7C77`ij - CO-PURCHASER SIGNATURE PURCHA Z SER ~O PURCHA NA O` - (~ ~~ MAY 31 2008 GN ~ O~~.rn i n'1s~A'hG o ~{ ~ ~ ® '"~ '" ' SI NATURE F CO SELLER - ' C . ~--w.~~„ ';~,, SELLER AND/OR {~~ C0.SELLER MU97 .; - ~ y HANOPRINTNAME HERE ~ M'o'le ~, `Ll(, - ..-. I/We certHy to the best o/ my/our knowledge lost the odometer reatling is ~~ Z - renrns LAST FIRST M:I. O - -I- X miles and rellact3 the actual mileage of the vehlcle PURCHASER.OR FULL n unless one of the following boxes is checketl. .. BUSINESSNAME ^ Reflects the amount of mileage ^ IS NOT the actual mllea9e CO PURCHASER In excess of its mechanical Ilmits WARNING Od m ometer tliscrepancy, lM/e further carUty Chet the vehlcle Is free of any anrumbrance and that theownershlp Is hereb AD tr n f H h ~ y a s eme DRESS to t e person(s) or the dealer listed ~ SUBSCRIBED AND SWORN clrY L7 TO BEFORE MF: 2 MO. DAY YEAR STATE ZIP PURCHASE PRICE OR DIN O 2 SIGNATU HE OF PERSON ADMINISTERING OATH PURCHASER SIGNATURE Z Z m J CbPU RCHASER SIGNATURE Q PURCHASER AND/OR _ ._ _- CO-PURCHASER MUST LIJ m HANDPRI T NAME HERE (4 VJ Z SIGNATURE OF SELLER m SELLER MUST .HANDPRINT NAME HERE O __ • ~ ~ • _ ~1 IANe certify, to the best of my/our knowledge that the odometer reading is Z ,rerlrH; LAST FIRST M.L. '- - = X tulle fl d Q r s an . re ects the actual mileage of the vehlcle PURCHASER OR FULL unless one of th BUSINESS NAM ' ll f . e o E owing boxes ie checked: ^ Rellects the amount of mileage ~ Is NOT the actuerm lease CO-PURCHASER In excess of Its mechanical Ilmits WARNIN n m G- Odom to ~d screpancy IANe further certif th t th hi l y a e ve c e Is tree of any encuritbrance and Ihet the ownerslilp is heroby ADDRESS trensfened tottie person(sl or the dealer Ilstetl. lT~ - SUBSCRIBED AND SWORN. clrY ~ TO BEFORE ME O f"t0 ~AV YEAR STATE Zlp PURCHASE PRICE --- GR DIN m --- _... m SIGNATUR Q E OF PERSON ADI;7INISTERING OATH ---- - _____ PuacHnsERSIGNAruRE y - -- O a J ._ CO-PURCHASER SIGNATUPE PURCHASER AND/OR -- Q - CO-PURCHASER MUST W HANDPHINrNA ME HERE__ _ m //~~ .' - __ SI ,NATURE OF SELLE i X~ ~ SELLER MUST I7 ---- , WW HANDPRINT NAME HERE - - O - ~ , ~ - , I/We certlfv to the best of my/our knowledge that the odometer rAading~ls .~ - ~ ~ TENTHS LAST FIRST `A4 1 . . --- - x: miles and reflects the actual mileage of the vehlcle, PURCHASER OR FULL ~ unless one of thefdllaw~ng poxes I9 bhecksd: - BUSINESS NAME - ~. ^ Reflects ttie a aunt of mileage ~ Is NOT the acwal ease CO~PURCHASER In excess of Its n e.henlcal Ilmits ~ A W RNING: Odometa d srrapency STPEET -. I/We further certiy that tte vehlcle ~s free of any encumbrance and that the own rapt / transferretl to the person(s) or the dealer Ilstetl° P Is hereb• I gpDRESS -_ '{ Clra SUBSCRIBED AND SWORN __ 1'O BEFORE ME - -- MO DAY YEAR STAT- ZIP. - PURCHASE PRICE -. _.___ OR DIN _ SIGNATURE OF PERSON ADMINic'rcR r,~r nn.~ J CO-PUB RASE SIGNATURE .. _ ____ PURCHASER AND/OR o W CO-PURCHASER MUST o ~ H NDPR! T NAM HE _ _ _ _ __ , ~_ MV-3 (7-03) Commonwealth of Pennsylvania Department of Transportation Bureau of Motor Vehicles Harrisburg, ?A 17104-2516 MOTOR VEHICLE VERIFICATION OF FAIR MARKET VALUE BY THE ISSUING AGENT This form is used in conjunction with Forms MV-1, MV-4ST, MV-217A and an on-line processing. Applicant Summary Statement. FOR DEPARTMENT USE ONLY TYPE OR PRINT ALL INFORMATION AS REQUESTED ' A~ 'VEHICLE DESCRIPTION ~~` Model Year ~_ ~_. ~ Make or Vehice E~ ~ Model ~ ~ I S Body Type IL ~ ~y FF~E 1 ~0 ~ `-• C~ -:_J .~ O 2~LC~. ~ - 3 Vehicle Identification Number (VIN) ~ 7 ~ ~ a•T - FFs ~ ~o ~s~ Odometer Reatlinq (No Tenths) I a ~ , y-o~ ~ B AGENT VERIFICATION OF FAIR MARKET VALUE -Check (/) the appropriate block: I certify that the average Fair Market Value for the vehicle described above is $ as verified by the current edition of a PENNDOT approved publication. This vehicle or the fair market value for this vehicle was not listed in a current edition of a PENNDOT approved publication in my possession. Signature of Authorized Agent Agenl Number Dale C PURCHASER INFORMATION Last Name (or Full Busines ~ Name) First Name Middle Initial Co-Purchaser ,.:e ~. :. pURCHASER/SELLER EXPLANATION Explain in detail why the purchase price listed on Form MV-1, MV-4ST or MV-217 is less than 80% of the average Fair Market Value, or if the vehicle is over 15 years old and the purchase price is less than $500, explain how the purchase price was determined, or if the vehicle is not listed in a PENNDOT approved publication, explain how the purchase price as listed in Section A was determined. Please use additional paper if more space is required. NOTE TO PURCHASER: An additional audit of this vehicle sale by the Department of Revenue may occur. Please retain copies of this fotTn, your cancelled check or original cash receipt, and your receipt from the aeller of this vehicle, along with either your copy of the Application for Cartifcate of Title (MV-1), the Vehicle Salea and Use Tax ReturnlApplication for Registration (MV-4ST) or the Application by Financial Institutions for Certificate of Title After Default by Owner (MV•217A). ~,.~t+>~~, c~ ~c ~ ~~r c 1,~~ WECe c~~inS ~ J~.~~~ -}-~-e ~~c..K 1 ~ n ~u:~ \tlS~ Pc~.c~ L ~Q ~~v~~ ~~ (~ 1100 Win. 1~ ~C~E' ~ v' =- i 0 r ~ cY `S`EAL AND SIGNATURE OF SELLER -NOT REQUIRED FOR VEHICLES PURCHASED OUT-OF-STATE SUBS(RIBED AND SWORN 1/We state that I/we have read and signed this form after its completion, and I/we TO BEFORE ME: MONTH DAY YEAR swear or affirm that the statements made herein are true and correct, and that any statement made on or pursuant to this form is subject to the penalties of 18 PA C.S. - Q l Section 4903(a)(2)(relating to false swearing), which shall include punishment of a . ~,,, u fine not exceeding $5,000, or to a term r imprisonment of not more than two years, s ~`E~gv,: `:F,',:~~~~~~EIVT or E DO,t~IQT ~(~TTT~E UN ESS f atu of Seller (i Ci,t~ ~;~ CuCIr-~-w.~.~ SI y ELL R IN Signat of Co-Seller A P E •NC OF NOT RY ~ L ~ o `~~/ -y- lephone Number (rj (7) q -7 - S .3 $c7 F SEAL AND SIGNATURE OF PURCHASER SUBSCRIBED AND SWORN I/We state that I/we have read and signed this form after its completion, and I/we TO BEFORE ME: MONTH DAY YEAR swear or affirm that the statements made herein are true and correct, and that any statement made on or pursuant to this form is subject to the penalties of 18 PA C.S. Section 4903(a)(2)(relating to false swearing), which shall incude punishment of a SIG § . G3F•"P; fine not exceeding $5,000, or to a term or imprisonment of not more than two years, . 5 ,~~' ~R L I ~ or both. S , ` ~, i ~ ~~ENT Signature of ur ha r ~ ,, E D NOT ~[~~LES ~~ / r SIG ED B ISE IN Signature of Co-Purchas r A RESEN OF N TARY L ~Y _.. O Telephone Number (~ ) / L T PHIS FORM MAY BE PHOTOCOPIED I Messenger No. .cAU OF MOTOR VEHICLES ATTACH PA "TITLE - YYPE OR PRINT Ir • • • - MAKE CHECK PAYABLE TO COMMONWEALTH OF PENNSYLVANIA HARRISBURG, PA 17106-8593 •• MV-4ST (7-07) ® ~ t ~,y~, / r 1 • A PA TITLE NUP,IBER (AS SHOWN ON ATTACHED TITLE) MAKE OF \/EHICLE MODEL'IEAR p _ ~, PURCHASE PRICE ff ( ~ C (./ " . Jf'" / L ~ ~~ ~ .~ ~ ~~ ~ "~ f /~ , ~~ / (See NotA on RPV~rse) C ~ ~~ t/ . , ` .-. 4 . w p VEHICLE IDENTl FICATION NUMBER COONDITION a ~ ~_'~ ~,.-~~ ~ f r a~ ~,~ `~-/ ~ ~ ~~.~ /' l ~ LESS TRADE-IN D GOOD y ,FAIR O POOR '~B s LA T NAME (Ofj GULL BUSINESS NAME)-\ FIRS/ll NAN(~F MIDDLE NAME C ~ , + ) 1 1 /~. al -- J ~\ ~ ~~~ { ~. -_5~..____ TAXABLE AMOUNT w, m _ co-sFLLER 1. SALES TAX DUE (~' LAST NAME f,OR FULL BUSINESS NAME) FIRST NAME MIDDLE NAME PA DLIPHOTO ID# DATE OF BIRTH X 6% (A6) OR X 7% (.071 "'1 '1 OR BUS IDaf ~ (See Nole nn Reversel_ `~ , ~ 7'L l / d' - 7' : f ~ j ? ~ r 1A. EXEMPTION ~ y ,~ ~ ~ . / j U ~ 1 ~ „4 `/,j'- j _...~_~~ REASON CODE (must ~ t9 ~ CU-PUIPUHAS'e hi LAST NAME FIRST NAME MIDDLE NAME PA DL/PHOTO IDit UATF OF BIRTH be a number from 1 (o ~ N N 23 or O) 1 q = a-- ~ __ _ ~ ~~ 1B. FIRST 1B. SECOND ~n ~ 7 __ ~ ~~ STREET COUNTY CODE ASSIGNMENT ASSIGNMENT a F. in / ,~5 .,.+ `_," i, J ~~Z'i r_'._~ti'a^,. C!~ f - 2. TITLE FEE rC t • ) L'IT'fSTATE ZIP CODE DATE ACQUIRED/ REFER TO COUNTY CODES _ . _ lJ .I ~ ! /~ ~ ~ F ~~"~ PURCHASED p ' ~ ~ ~' ~~ LIST"ING ON REVERSE SIDE r:°" ~t L / .,~. " ~ d OI= YELLOW COPY 3. LIEN FEE ~ l.A` NF ME (OP I=LJ I_L BUSINESS NAME) FIRST NAME MIDDLE NAk4E PA DLIPHOTO ID'd DATE OF BIRTH r;R BUS. TUN 4. REGISTRATION OR _, PROCESSING FEE ~ ~ CGFI/R HASF-f. I_~Sl~ NAME FIRST NAMC MIDDLE NAME Pq DIJPHOTO IDt{ DATE OF BIRTH w ~ FEE EXEMPT NUMBER ~ ~` AS ASSIGNED BY THE C9 j ~ ___._...._-._ _._A..~_. -._.. ~,._._..______,,,,,,.,, DEPARTMENT m ~ STREET ~ a /~ COUNTY CODE ~ 5. DUPLICATE REG. Z Z i FEE NO. OF _.- ... .-~ _ ~__--L___ CARDS__ CITY STATE ZIP CODE DATE ACQUIRED/ PURCHASED REFER TO COUNTY CODES LISTING ON REVERSF_ SIDE 6. TRANSFER FEE OP VELLO'/V COPY ^,9AKI CI= ~/EHK.-- ~ VEHICLE IDEMTI FICATION NUMBER 7. INCREASE FEE w p ~ pia U p _ w ~ MODEL "EAR BOD'f TYPF_ (CP. TK. ETC) CONDITION } ~- 8. REPLACEMENT FEE O GOOD ~ FAIR O POOR s 10 rorALPAID r--, , ,.-- . '~ ADO 1 THRU 8 ~ , • F- i`1 I I TE TO BE I' SUF_D BY i 1 RANSFER 01= PREVIOUSLY ISSUF_D PLATE ( ) ~ L 1 f~ l F F RTMFN PR OF I 1 T AN`,FER 3 RENEWAL OF PLATE I I U O ti 'UFANCI f4U5T EL ri 1 RANSPER & REPLACEMENT OF PLATE 11. GRAND TOTAL SEND ONE CHECK IN ..I TAl?~ED) . O ?'P,ANSFER OF Pl..ATE & REPLACB/~ENT OF STIC!<ER (ADD 9 8 10) THIS AMOUNT '~ D I X(.IIANGE PLATE TU BE L - _ RL=ASON FOR REPLAClv1EN7 li ~~ BY DFFAhTMENT O LOST I") DF FACED CI STOU_N rl NEVER R GI Ib'ED !i t . l 7 Tf I I _~IdAF I "LATE ISSUED EXPIRES ~ os n Ma l) NCTF I('NEVER RECEIVF_LT block a cherked, ao (rant mn 1 ;om lele ~- ~ I p m ><IV~~I ~ p z 3! h-U~L AC,cNT Month Year ~.r_ __..-..~_..~___~.~ O - ~ TRANSI Ef PED I ROM TITI E NO VIN ~ _~ z /- O ~ / a~. Jam ' l ~ V n SIGNATt1RC OF PC RSON FROM WHOM `ilGhi HL=RE REI ATIn NSIiIP T(I APPLICA NT w ~ 1 Elv4P PLATE NO ~ PL; T ~ e~EIN ~NSFLI~fFED (IE a a. UTHFF THAN API LICAM~I d v,T-ilCl f 111.r~H'FD yNEI/ 11T ~,R -~~ UNLADEN f4~FIGHT RF) PEG. bROSS INT. ~ _ RFf' EEC,. GROSS COMB. W7. ~~'~~ INFURNI!AIION IF APPI.ICABLEI _ __ IN(I UDING LOID IF APPLICF,f LLy ~ ~ _ ~ ~ ~ t ~ INSURAP}~P COME ANV NAME POLICY NQ. (OR POLICY FFCF CTIVF POLICY EXPIRATION ~ ~ >r" ~ /~" L/~ j T)~ /' -~~ / 1•f ~ ATTACH BINDCR y I ~ ~ " ~ /~ _ . ,. c DATE - DATE C . I H<TIF=' HAT r~nl M(. NTH DAV fCAI? ISSIIINCo AGF_NT !PRINT NAME) A ,ENT NO I I~f I HCC KLD I'1 DLll FYI NE THAT HE /FHI~I CI;IN U FDAND 1L _ !E I1 OF 4u 1' FI C I tATIOIV O THC P 7.f ~F'PI I Ally IN ~_ .-_- _~._-______~,~._..__._~. ~__. ( _ INFO '/~TK',N f 1L I IANC r vl I I /N.I PG ITABI E I LOVISIOl to OF THI A/T HI'lE ISSUING AGENT SIGNATURE TN EPHONF_ tJ0 - ~ _ -__._._~__ Cv _, IF .vND~LEP;>.ti fMFNI hvGUl Al IUN_.~._~~.~..~.__._~-__~ ~, ~.~~. ~_ ( l _-~_.._._..~ ~ ' ~-.~ , ` ' S - - kINL ;I 1< IF . HAT IIWE I-IAVE EXA9-TINED AND SIGNED THI ;FORM AFTER ITS COMPLETION AND THAT THE INFORMATION GIVEN IS TRUE AND CORRECT. IF ANY EXEMPTIr N IS L; LAIMED. THE PUnc.li~5rr- ~ .LTIICR C=RTIFIES THAT HGSHF_ IS AUTHORIZED TO CLAIM THIS F_XEMPTION. I1WE ACKIJOWLEDGE TI-TAT 1/WF_ MAY LOSE MY/OUR OPERAT7IVG PRI`/ILC ,E_ SI OP /EHICLE R.FC i~ I .'i I ~~ '- ~ All URC TO MAINTAIN FINANCIAL RESPONSIBILITY ON THE CURRENTLY REGISTERED VEHICLE FOR THE PERIOD OF REGISTRrT l )N :rWF ACKNOWLFDC,E THAT !V:/E ^.4AV z O FE ` UBJ'- I I , f -dam '!OT EXCEEDING b5.000 AND IMPRISONMENT OF NnT P.40RE THAN TWO YEARS FOR ANY FALSE STATEMC-NT THAT BANE MAKE Oi~J TIII ; FORA Q u 'ST S gnature of F st P iroh aser or AUthorized Signer ~ j'~ /~- .._ ~ , '-a.s..~, TJe~ ~ Nn. . a ASST(; N- MCNE , :. a. r„nf, a~ -..hasr Ilz ~(Aulh~-,. r.J.,gn~au% -_. ,_ _- _ c.~ (s// ,~ ~~~.f~ ~<-.1~< w ~~ 2_ND Signature of Second Purchaser or Authorized S~pner Te'en~~nne Nn ASSIGN- MENT Signature of Co-PUfchasedTitle of A~-Ifhorized Signer ~ ( ~„~ ~ z U N( T = IF c ~ O-P"IP.CH \SER OTI II R LtIAN YOUR SPOUSE IS LISTED AND YCJIJ WANT THE. TITLE TO BE LISTED AS `JOINT TENANTS WITH RIGHT OF SURD/IVORSHIP" (OfJ DCATH OG ONE OWNER. T I U _UF_ ~U SURVIVING OWNFH) .;HECK HERE ^. OTHERWISE. T!-IE TITLE WILL BE ISSUED AS 'TENANTS IN COMMON" (ON DEATH OF ONE OWNER. INTEREST OF DF I,EASFC OWNER ~ ~ ~ _ ~ ~ F' TLT HIS'H[R HEIRS OR ESTATE.i ~ r rr p ~ a z NOT- 11=THE VEHICLE IS TO BE USED AS A bAILY RENTAL OR LEASED VEHICI_F. CHECK THIS BLOCK ^. IF BLOCK IS CHECKED, COMPLETE AND ATTACH FORIA MV-1 L. MESSENGER NUMBER: MV-~ (~-o~~ Commonwealth of Pennsylvania Department of Transportation Bureau of Mcrtor Vehicles Harrisburg, PA 17104-2516 M®TUR VEHICLE VERIFICATION OF FAIR MARKET VALUE BY THE ISSUING AGENT This form is used in conjunction with Forms MV-1, MV-4ST, MV-217A and an on-line processing Applicant Summary Statement. TYPE OR PRINT ALL INFORMATION AS REQUESTED FOR DEPARTMENT USE ONLY A VEHICLE DESGRIPTION Model~e ~ Make of Vehicle Model Body Type PURCHASE ~_ ~ ~~1~~~ ~/-../~f/'2 ~I PRICE ~~/C.9 ~- Vehicle Identification slumber (VIN) ~~ , Odometer Reading (NO Tenths) B AGENT VERIFICATION OF FAIR MARKET VALUE -Check (/) the appropriate block; ~-'~ I certify that the average Fair Market Value for the vehicle described above is $ as verified by the current edition of a PENNDOT approved publication. ~-~ This vehicle or the fair market value for this vehicle was not listed in a current edition of a {{{ PE=NNDOT approved publication in my possession. .__.~~_ Slynaturs of Authonz©d Agent _ ~ Agent Number Date C _ PURCHASER INFORMATION Last Nerve (or Full Business Name) rust Name Middle Initial `-"' ., .~~t ~ i I C" ________ ~ ~~ z~ Co-Purrhaser C D_ PURCHASER/SELLER EXPLANATION Explain in detail why the purchase price listed on Form MV-1, MV-4ST or MV-217 is less than 80°/ of the average Fair Market Value, or if the vehicle is over 15 years old and the purchase price is less than $500, explain how the purchase price was determined, or if the vehicle is not listed in a PENNDOT approved publication, explain how the purchase price as listed in Section A was determined. Please use additional paper if more space is required. NOTE TO PURCHASER: An additional audit of this vehicle sale by the U@partment of RQVenue may occur. Please retain capios of this form, your cancelled check or original cash receipt, and your receipt from the seller of this vehicle, along with either your copy of the Application for Certificate of Title (MV-1 ), the Vehicle Sales and Use Tax Return/Application for Registration (MV-4ST) ar the Application by Financial Institutions for Certificate of Title Aftor Default by Owner (MV-217A). i ,~ I~~•(1~. ~'i1C{ 1``-> ~.,~~LC~ ~~:~,T`, ~~'f1CC~' ~\Ci.Y1~~CC,'~: rv ) . E SEA:_ AND SIGNATURE OF SELLER -NOT REQUIRED FOR VEHICLES PURCHASED OUT-OF~STATE SUBSCRIBED AND SWORN ,:,.-~ I/We state that I/we have read and signed this form after its completion, and I/we TO BEFORE ME: -, - gN~rF~ DAY YEAR M swear or affrm that the statements made herein are true and correct, and that any ,^ -_...~._ _____ statement made on or pursuant to this form is subject to the penalties of 18 PA C.S. Section 4903(a)(2)(relating to false swearing), which shall include punishment of a SiGNATUr~E cF rer3sor%DMwfsreRiNG oArH fine not exceeding $5,000, or to a term or imprisonment of not more than two years, S _ ~ ,, or both. __ ~~ Sf~ftature of eller ~ ~, - ,- E ~E UNLESS O O -... ___~' C C~_~~~_ _ )171,1 ~,~C. ~ C~c~,+tx~ ~,~-:~+ S GN ED BY Ttf~ .SELLER IN ~ Signature of -Seller A i ES~ENGf OF NOTARY R ~ L ~ - C~-'" Telephone Number (r~ I -/~ ,~f ~ _ c , cis ; ( -, ~ c F SEAL AND SIGNATURE OF PURCHASER ~ SUBSCRIBED AND SWORN I/We state that I/we have read and signed this form after its completion, and I/we TO BEFORE ME MOfdTH DA'Y YEAR swear or affirm that the statements made herein are true and correct, and that any statement made on or pursuant to this form is subject to the penalties of 18 PA C.S. Section 4903(a)(2}(relating to false swearing), which shalt include punishment of a SiGNAtuRE OF PEr~soNaonniNisrERiNG oA7r+ flne not exceeding $5,000, or to a term or imprisonment of not more than two years, _ ~ or both. S ~ Signature o~urchaser E DQ NOT~NQTARiZE UNLESS ~-~,, _ `SIGNED BY THE P~RCHASER IN ignature of Co-Purchaser A ~ -~'RESENCE (7F~NOTARY L ~ Telephone Number (,.~~ 7 ) ~ ~ ~ _, -~. c ~- ~ .C ~C~ THIS FORM MAY BE PHOTOCOPIED (Messenger No. ~~! ~ J ~~- ~~~~- ~ l ~~l L ~, ~,,~ , ~ r-~~~~~ El ~~~ ' % S 5 7 Z ,~ . ~• . .. Cw+ner' a Phone i WEST SHORE SUZUKI CONSIGNMENT AGREEMENT " e1 0 ~ ~(,~ ZU~:i 5 ~ IL ~ x'1'1 E~ c` (~~ 5 I"Yl ~ ~ ~ i ~ y r?~ I ~~ l_ 5 ~1-j - ~ ~ ~~L~ C~11 ? Yes (~,~ No (~ Conoignment Terms Price O~mer'a Signature/Date IU `(v - ` -1; ;mil > ~---- ti --~ ~ `l ,~ ~~ ~- " 7(30 ~ "J/'~~t ~~ic~ 5 /J ~ O~O. 7 S ~ r ~A 5TA`~ ~rS/-~`i cT~~ ~ ~D ~ -' ~ # yZ66 (~ 7 z ~ ~, C,~ ~ S ~ ~ ~ c L ~ ~ ~1 ~j,_ .. 1< I r St 0 MEMBERS 1St FEDERAL CREDIT UNION SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established Ownership Type CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established Ownership Type VISA ACCOUNT: Account Number/Suffix Date Issued Principal Balance at Date of Death Collateral Held as Security Name of Joint Cardholder LOAN ACCOUNTS: Account Number/Suffix Date Loan Established Principal Balance at Date of Death Loan Type Interest Rate Collateral Held as Security Name of Co-Borrower *Loan has credit life insurance. 118032-00 12/14/1990 $130.50 $.00 $130.50 Jean L. Kimmel 1 211 4/1 9 9 0 Right of Survivorship 118032-11 06/14/2004 $115.66 $.00 $115.66 Jean L. Kimmel 6/14/2004 Right of Survivorship 4121449991180329 04/01 /2003 $2,475.65 Contractual Pledge of Shares None 118032-08* 11 /02/2006 $6,274.59 Unsecured 10.74% Signature/Contractual Pledge of Shares None EMBErRS 1ST FEDERAL RE ION ~,'~.~_ y~ ~ Danielle A. I~ Insurance Services Specialist October 12, 2007 Estate of: WILLIAM J. KIMMEL Date of Death: September 2, 2007 Social Security Number: 175-62-1373 5000 Louise Drive PO. Boy; ~}0 Mechanicsburg, Pennsylvania 17055 (80U) 283-2328 ~~~~~~~.niemberslst.org I1ov-14-2007 023E Pr1 Ar~eriChoic~ F~U - SPGF.TIR~G GRiJ 71?59196 95 ~ ~ is^_5525;'F~ A;tiT?RTC'HOI~'E I''1~~~'.AL CRE7T.''' UN-~11 FF.CE 1 SETH 'n~I~`IFS_P, IyCCC~u'NT rISl'GRY y1f-~ ~ j J'' 14:06:50 ~_i'C1~. ~ 38542 ~~a:I~r~7~L, i~azLLZ~r~ ~7. 3,1 K~.i~I I~~~RE~ DR TEL. _nJl'3I~I:ER ~,77.~1 6J7-53Fi i~iF'CI L~.NTCSBUR~`,P.~: 11055-5559 L.aTES 1 ~ Ol.,r p % TH~U 11 ' 1.~? j C~? ~~ T~xhL~TS~C! ~ G3:3 R~' ~' TOT AL L~~fJ i~Cf'~N ~CCG'tJ=~`r ~T.TE DESCRTP`1'rON T~IT~IBR '1`~.~1~d ILR'!T ITIT AIWI'I' PRIN .SNIT BAL~`N^E Shi:RE ~LrF"r~~ O1 RFGULr.R S; L~:ti' ~E~~ ~~°_T 5 . C~ 0 3/26fG7 DEPOST'I' 70517 :1003.65 108.65 3J?7f~7 A7T0 TR O1 TG 5? 11135 10;.73- 1700.;2 3;'~71~7 hJTQ TR 01 1'G 5~ -_1?35 76;.35- 5~-3.`i7 3/27 ; C'7 ti.J'I'U TR C71 '1'a c3 11.185 767 , 5- 166 . 2 3,'27f C~7 ALTO TR Ol 'T'O 53 i.11g5 161.22- 5.00 /31/';7 Div~D~ND X317 .G5 5-b'~ 4/Olfr7 AUTO Tic 01 TG 53 11.493 .05- 5_QO 4f 05;~C7 F~ 33542--53 7595? 107.73 11.7 J~~/~ ~I^'7 4r V.~~ ~~ X3542-53 75958 767.35 380.08 4 X05 f ,7 ~':R_ 33542-53 753E0 757.35 15~I i - 43 ~,'O :,f0 ? . 355 42-53 FR G1 53 ? 2 1.61.2 1 8 08. 5 7 ~~ ~ C'/'1JJf V ~ n 7 FR. 3OJ t2'~~J ' 7 ] 7 J~lF~G+ ~ ~JJ { y - }{ } L~Jb~e !V ~~,= f77 ~~.sH t~.~.Tr31Ju.~w~r ~syE~~ ~ boy . aa- cos . 70 f 05/ J? ;~Sl? i'ti~TH~Ftpi^I1~.L ?59G ; 803 . 7b- 5.00 r--~--- ~, - }~} - f~~ ff - _ `,~,G~i~~' ~ ~ ~' ~~~~ ~ln~ ~~ OC; ~c~c-LCD ~~t t -C ' ~ r '~ ~1 C ~Crt.tG. 4'1. c ~ L~~ ~~ ~ Z Z UO ~ Gt. i2C~ Y ~_ 6'Yl~'t e rt ~ a -~ ~~~ t, ~tt, ~~~ ~~ S LC fXS <~~} {fly i~ C~ ~ ~ f ,p+~ ~ /~, r ^~ _- ~~ ~.! ~ytitlr~ e ,~ , C ~"tG+ ~ ~- `~l~- ~~'~~c"~~~1~ ?1,;~ - :4-~;C?:'~^ 0~ : `J3 Pt°i Arne-'iC'-:mice FU1J - SP~RTI[~G ~RP~ % 1?5 1 "~ `~.`;, i'°i.;~0~~1.~ ~111~ERICH~T,G~' CE'~'E?~~ Ci;E.r7IT U_~ICiN 1 ~~' ~~?;v-; c-~Tr ACCOUNT BTATU,~ .ENQUIRY (riember Accounts Info=ration) i ~ ~ ~~ : v ~',~Ctl Srx. 38542 / BLu 3~r ~%EL l2E<ti1~BEF_ riSeinber Irformatze.n _ ___ ~ A'ddress' ' ' _ i'v~I??P KIMMEL~ WIL£,IAtd J. ~c1ci`r1. 30 KI1K ACRES DIZ ~.~i~'.. 175-62-13?3 Emp~.. MECY.ANICSB~7RG, I=A 17055-5589 ~;G~~ 09;22/1979 28 Fm~%over. ... TC~ 06,r't75 688 ~'1''P Dc.. 0/'00/00 ~~ddx-. ~~ ~.. ;r1?-697-5380 G'~~'1~. `~'a- ~ Cope... G~T!%xt°nsic~t?. . ?.~~nr_~:........ _ 05 Account ~=oc~°.. _ I JOwn~. Kl'MMEL, JEAN L. :!_'It~f ~c~~::15. U S.SN~'DOB/~~~:. 210-~?4-5553 j 33/18/1954 Oi 9/4/07 'ZEC'D NOTICE THAT MEMEER WA5 PILLED 4~?' 9/3/0?. (More) G ,S~ Desc ~ --BaYanCe P.Zdy/Front AvI/Payoff b'M/Due DT Fate Delq ri.`rtfL7a~- ~? ~ rF~~,n RS S . 0 _ :.2 iJ.1,~1~ FI/_r o53. %~ ~T 33609 F. x'90 ~~ LJ~?~,Q P :" 5.; %~~ .:i.Z I (~ ; . 35 8488E. 0'2 iC ~'I FG7 a'. ->50 ' ~?9. 30 59 ~ottori~ F-eca~d z~eac~~ed. ~ _ __ _ __ F3=%nu Fd-Notes F6=l~fisc Name Fi=Backward FB=Forward F9=Apps Status F10=Bxocks F11=1~ic~re F13=JaiAt r1~=biv/Int YTD F25=X-SeI1 F16=Activity F2~-1~Sore Ke}~~s I1o~~-14-G00? 0:54 Pt°f AmeriCnoi~e F:'U - SP~F.TIC~G GF~N 71?5;1~69~ nr,,,1,,~,,, ?~. ~n7ER.ICi~OICE ~'EDEF~ CREDIT UNION :, _~~."I-i Joiz2t Owner Information _~cc-a~~nt~ 38582 K_I_M_M__EL, WIL.LTA.~S J. JOINT OF~NE~2S ON THIS ACCOUNT 15:54:3 Suffix Joint Oss~er Name S5~' Phone ntzrr.ber z`zemner zvo 2?G-44-5853 0~0 __.... . .Eo t ti~~m ACCOUNTS Tf•LnT THIS AsEASBE.R IS ALSO A 4.TGINT OWNER ON .~sffix Joint Owzler Name 55N ~ Phone n~~~er hIe,~er Na F3--Exit FB=Beneficiary I.nfo.rmatiozz F~2=Previous O N ~ ts~ r rn v o OG ° F- ~ cn O m w U t- O 2 H H 4 N W 4 Y a 0 N CL V J 1 V ~ cr ~ ~~ O~ - Jr~ ~ N ~ ~ ~ ~ ~(, M ~ ~ d' N r ~ ~ d ~' a' C7 0. ~ Zp Q Q~~ p Y ~=- J ~ N O J ~~ W ~ Q Q ~ ~ r l- F '" W l is t 4 Ll1 t' ¢ ¢ °' ~ ao ~ Y M ~ m n y Qj"' Z r ~ _. _..___~__ ___. __ ~ _.._ .__..~_~ b O °~1 ' '' Q. 00 ° ~'N I V o ml a`~ ~ c ~ ~ I~ a as A O i'~ ev ~ r, M V ao p a~ Zd ~~ ~ 1- ? ~Z N ~ N _ (~ d w Q ~ I N O 4 O Q r Z Z ~n 1 ~ ~ -? W W w ~ W I 4 N w ~ ~ ~ W ~ Z 4 Q ~I ~ O w = LL ~" 4 N p ~ r Q Z a yd ~ ' .. < w r O ~ O p rG. ~' ~ w aLL° h1NcV J Q ~~ a ~ ~ Q Qp~ W~ CG U N ~ - r M4L ~°z -r-~.. ~ w ~Q~,. ~ mma 4'+~r U ~ j_ D ~V CL' ~QZ ~ ~a~ ~ N • ~ ~ = u ~ Z w = m o . ~ n .oo ~ ¢ y ~ ~ ~ f]GOQ N~~ ~ Z ~ oW YM~ . N u o ~ Y ~~C7 O~ o "" ~ O 0 ~ r a o ~Na U ~ = N ~ ~ ~, tU Q J f/1 r ~ P N O w r ~" 11 ~~yy yy W J tJK ~O Or ~ (, NQ ~-- J W J m N 1 F ` ~ ! `~ x 0.~ 4 O~ ~ I ¢ ¢ a ~O Q ~ C ~_-J-- a ~.~ ~ ~.v~.~ 11 ~J till fllilC-1v11V .1 ~.._ 1vV J1 ~J11111vV Vli1V I1iJil%V%J --~ FEDERAL CRE17r7 UNtOPV 8uifdirrg f~'~I~Piorislri~, For ~.i~o Attention: Deo Fax # 717975-0697 Phone # 717737-0100 November 13, 2007 Re: William Kimmel 1284 South Mountain Rd Account # 385~iZ-53 1 i 1 As requested, we are faiwar~~ing a payoff For the above referenced loan account. The payoff i+-ifortriation is as follows: Payoff 31 (including interest threugh 11J30/07) ~ 85,OZ1.87 Per Diem $ 15.03 Satisfaction (not included in pay off) $ 30.50 Total due to satisfy $ 55,052.37 The payoff should be Forwarded to AmeriChaice FCU, ZO Sporting Green Drive, l~lecl-ianicsburg, Pa 17050 Attu; Beth Hul{. if you (717) '`~ ! ~I B t}l k a n AtAt AmeriCi /~ ~~ s DATE ~ "" - ~ ~~ ~~~ ~ ~O. RECEIVED FRO ~ ~ ~`to~ ~' ~~ `t DOLLAR Q FOR RENT v Urn ACCOUNT CASH ~_ ' FROM PAYMENT OCHECK ~- BAL. DUE MONEY `` BY OORDER ~ ~,m, Silver SErrinG CO[71rTtUnS l7ifice: 'G ~{'porting Clrccn Ilrivc o tileci7anicsbw,r;, Pr; 17(150 ~ !'hone: (71 ?) 5°1 -9690 Q FaK: (%1 r } ;yi -LJi-~y-7 ^~ ]:,ti ~1~ebsite: +vww.arnerichoi~e.nr~ r~ ~' ~ ~~~~ n~:,,. ~JwJ'FS ~~~' 1_EfV DFR C; H}rq'f UNI(i^I;i LENDEF ---- -c.. TO PO BOX 36347 HOUSTON TX 77236-9998 October 29, 2007 COC)0114-0000920549-070601 I~~~III~~~lll~„~I~I~~I~1~„I~II WILLIAM J KIMMEL 30 KIM ACRES DR MECHANICSBURG PA 17055 u`.~ianyc vi r~uuiwo Address City b330 Gulfton, Houston, TX 77081 - r C State Zip Phone Creditor: apitalO.~.e=Bank Balance: *,~~7 11 AccQu~if: 4862~36,~314143143 _,-,'" Amount Enclosed I~~I~II~~I~~~I~II~„1..1,III~~~I„1~1~~1~~1~~11~~1~~1~~11~~~1 Send Payment To: Capital One Bank PO Box 70884 Charlotte NC 28272-0884 Please write your 7 6-di it account number on your check or money order made payable to Capital One Bank and mail in the enclosed envelope. P~cMNT-,oe, Creditor: Capital One Bank October 29, 2007 Balance: * $1,257.11 Account: 4862362314143143 The above account has not been paid and has now been placed with GC Services for collections. Please remit the full balance to Capital One Bank at the address provided on the remittance section above. A representative is available to answer any questions you may have at our toll free number (877) 290-8894. Sincerely, B. Nelson Collection Manager ~~ ~ ~~ e ,~. . , ~`~ ,, , ~~ J f~ * Because of interest, late charges, and other charges that may vary from day to day, the amount due on the day you pay may be greater. Hence, if you pay the amount shown above, an adjustment may be necessary after we receive your check, in which event we will inform you. NOTICE: SEE ENCLOSED INSERT FOR IMPORTANT CONSUMER INFORMATION. PLCMNT - ,081 .~- DCM SERVICES, LLC ~{~ 5O OLSON MEMORIAL HIGHWAY, SUITE 200 MINNEAPOLIS, MINNESOTA 55422-481 1 TELEPHONE 763-852-8620 FAx 877-326-8784 TOLL-FREE 877-210-9116 1~ ~ I ~ Hours (CST): 7:00 am - 9:00 pm M - TH (,' t 7:OOam-5:OOpmF ~ (~ - 8:00 am-12:00pmS ~~~ I - ~ ~ ` J -- October 12, 2007 Account No Unsaid Balance Reference No ************6079 $156.86 4068304 Dear Sir or Madam: Our company represents Citibank South Dakota) N.A. THD CONSUMER. We have learned that BILL J KIMMEL, who was a ~~alued cost^mer, has passed av:ay. Please accept condolences from our client and our company. As indicated above, there is an unpaid balance on this account. Please accept this fetter as a Notice of Claim on behalf of our client. This letter is sent to you solely in your capacity as personal representative of the Estate of BILL J KIMMEL. Please call our office toll free at 1-877-210-91 16 to discuss resolution of this matter and payment on this account. If you are not the personal representative, please contact us with the name and address of the personal representative or attorney who is handling the estate. Cordially, DCM Services, LLC *IMPORTANT NOTICE* Unless you notify this office within 30 days after receiving this notice that you dispute the validity of this debt or any portion thereof, this office will assume this debt is valid. If you notify this office in writing within 30 days after receiving this notice that you dispute the validity of this debt or any portion thereof, this office will obtain verification of the debt or a copy of a judgment and mail you a copy of such judgment or verification. If you request this office in writing within 30 days after receiving this notice this office will provide you with the name and address of the original creditor, if different from the current creditor. This company is a debt collector. We are attempting to collect a debt and any information obtained will be used for tha l purpose. Calls may be monitored or recorded for quality assurance purposes. NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION -Side 1 of 2- fONBAL001 INTL7001 01:42p Special Handling PO Bo;c 15380 ® Baltimore, Maryland Z 1220 Address Scrrlee Req ucsted F9 MTF RFCO\'E R1EF. IEI C. Oftce Hours (Easters Time) b4 - Th: 9am - 9pm -- Fri: gam - Spm Ph: 866-794-1323 Fax: 443-451-2702 Jean Kimmel IDEIYTiFYING ITFORMATION I'~'ious Creditor: Household Retail Services C~rtt Creditor: Estate Recoveries, Inc 1 Retail affiliate; Mac Tools Account Holder: William 7 Kinunel ERI ~~ Number. ERIH000006I975 ACCOC.~iYT BALANCE: $2,897.69 ail Kim Acres Drive 05~'26i0s ItiTcchanicsbnrg, Prt 17055 Dear Ms_ Kimrnel: W'e are pleased to advise you that the settlement offer we have discussed has been approved. The terms of this agreement are as follows: Settlement Amonnt: $2,600.00 Due Date: 05/30/08 A. letter confirming that the account has been sett]ed in full will be forwarded to you once the Settlement amount is received. Please make check {s) payable to Estate Recoveries, Inc and forward in the envelope enclosed with the rcrnittance slip found at the bottom of this letter. To ensure proper posting, please write the ERI File number on your chec)c or money order. If you have arty questions, ar require assistance with this matter, please contact us at 866-794-I323 Ext. (7529}. Sincerely, Mr.1im Lisle Estate Recoveries, Inc. NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION Jean Kimmel 30 Kim Acres Drive Mechanicsburg, PA 17055 443-451-2702 p,2 IDENTIFYING INFORMATION ERI File Number: ER7FIf)00,0061975 Creditor Account Number: 780701!000287'240 Creditor. Estate Recoveries, Inc SETTLEMENT AMOUNT: $2,600.00 Amount Errcfoacd:.. ~~a~~~ Make Check Payable Ta Estate Recoveries, Inc. PO Box 403761 Atlanta, GA 30384-3761 U Remittaocc 8D 11I 1 J! LCJ CI i 11 1 L i 1 t DO-J CJJ47 ~J UIVC~ I UWJIV rHut ~~~ ~~ rf of w '~'1 9 r n ~' ri - EE o r-! ~ p rT . ( _ Y; r m q^ R f] H n C" C y ~h K ~' o ~ ~ x n ,~ rt m `, -~ y.w rtiK ry n • ~• h N v n ~ c •ry ~< ar'o ~, v C~+ o~ n p O, o n n '-' d ~ n 14 K D N rn ~ rJ !' ~S H to ~ n ,_~ ' ~ m ~ ~7 ~ m r ~ i-1 a ~ o~ C' 6 'C (6 hl h to ~ [+ ~^ R n h h~ t R f*] r T. w ~ N n• u m m '0 x1 w ~ n Y R ry m rt l: UI r ~ ~_ G V P N ~1 ~ iG •; U ' R U ~ ~ v t,~ ~ ~ 'J T 0 5 O .. (} .~ O n: "< ~_, a m i• _ ,z In ~a~ - ~,.; 6 t. ~ D N c~ r* ro ~ ~ In y b ~ ~ i G ~. o D G R C 1 or . -r C b •G YJ -r1 U H J ,SI i~ L~ T' "tl r G G J "1 C I ' y G f ~~ n , ~ ~/ v ~c ~•1 v v r,i m v ~ r 5 (`J fJ :] (T' Y H C m ~ r r, A+ m °' ro ~, ~~o. r rf T, 1_~ l.~ Jp ~c ~P Vy ~0 ~O ~D lD tC l6 N i- `~. ~ OJ •t ~+ io n> O C O 7 C C r~ r +t+ 1-+ p] CO S W I M ^~ M C IC M 4~ R: lr' O O -..~..,.. m ~ "ro to ~ o o cr c V~ V+ r r r r+ -, D M a m p c ,, le a e~ MAKE CHECKS PA YABL E TO: CLYDEMFLOHR, Tax Co//ecior 226 LOST HOL LOW ROAD DILLSBURG PA 17019 PHONE: 717-432-4498 PROPERTYLOCATION: 1284 S MOUNTAIN RD 2008 REAL ESTATE TAX BILL FOR COUNTY OF YORK, PA & FRANKLIN TOWNSHIP BILL NUMBER: 959 BILL DATE: 02/15/08 District No. 29 o 0 o s s s PROPERTYIDiPARCEL ID NO: 29-000-NB-0073-DO-00000 KIMMEL WILLIAM J 30 KIM ACRES DR MECHANICSBURG, PA 17055 ASSESSMENT 1 f ~ LAND: 45,410 ~ LQi~ l IMPROVEMENT: 0 TOTAL: 45,410 TAXES TAX RATE TAX AMOUNT DURING THIS PERIOD PAY ONE AMO!I!~!T Q!~lLY County Real Estate Total 4.000 ML 181.64 2% Discount Period 02/15/08 -04/14/08 $186.91 Municipal Real Estate 0.200 ML 9.08 Municipal Real Estate Total 9.08 pace Period 04/15/08 - 06/13108 $190.72 10% Penalty Period 06/14/08 -12/31/08 $209.79 T t l F o a ace 190.72 UNPAID TAXES RETURNED TO TAX CLAIM AFTER DECEMBER 31, 2008 WILL RESULT IN ADDITIONAL CHARGES. County Website: WWW.YORK-COUNTY.ORG IF YOU DO NOT DESIRE A RECEIPT, KEEP TOP SECTION FOR YOUR RECORDS *IF YOIJ DESIRE A RECEIPT, ENCLOSE ASELF-ADDRESSED, STAMPED ENVELOPE WITH THIS ENTIRE BILL *Detach and return bottom portion with your payment* St MEMBERS 1St ®FEDERALCREDIT UNION WILLIAM J KIMMEL Account Number: 4121 4499 9118 0329 Closing Date: 10/24/07 Credit Limit: $2,500.00 Available Credit: $0.00 \~~ Account Inquiries ~~~ .~x`, Customer Service: (717) 795-6035 ((~~,~ Lost or Stolen Card: (866) 839-3485 \,~y, Please Direct Written Inquiries to: \\~~ ~~-.:,f r~~ CUSTOMER SERVICE "` __"~ ~ PO BOX 30495 TAMPA , FL 33630-3495 ,~,~.,~~ ~~ `~ I t ~,~ 0 7 a~0 ..~ Payment Information ~ ~ TotaE Minimum !payment Due $150.t)t? ~__ ~_~. Payment Due Date 11/19/07 ~f' 20.00 Q~p4 'C.>vt~ Minimum Payment $ 50.00 Past Due Amount $ 100.00 Mail Payments to: VISA PO BOX 4517 CAROL STREAM IL 60197-4517 Important News TO REPORT A LOST OR STOLEN CARD PLEASE CALL MEMBERS 1ST FCU AT 717-795-6035 OR 866-604-0381 AFTER HOURS. TO OBTAIN ACCOUNT INFORMATION 24 HOURS A DAY CALL 800-299-9842. ---- ~ Account Activity Since Your Last Statement Payments, Adjustments and Others 09130 09/30 PPLN01 74121447273254273562004 LATE FEE $ 30.00 09/30 10/24 PPLN01 70008207297777297140015 LATE FEE -REVERSAL 30.00 - YOUR ACCOUNT IS NOW TWO MONTHS PAST DUE. YOUR ABILITY TO PURCHASE ON THIS ACCOUNT HAS BEEN SUSPENDED. Plan Le ve! Information _ - - - Plan Plan FCM Previous Average I ~ ( e Periodic Corresponding Finance Fees/Finance Effective I Ending Name Description Balance Daily Balanc Rate "~ APR Charges Charge APR Balance Purchases PPLNOI PURCHASE G $2,475.65 $2,454.39 _ 0.0000% (~ 0.0000% $0.00_ $0.00 0.0000% $2,475.65 Days In Billing Cycle: 29 _ APR =Annual Percentage Rate 'See last a e for ex lanation of Finance Char e Method FCM "Periodic Rate M =Month/ D =Dail Account Summary Page 1 of 2 ~/ISA Previous Balance $ 2,475.65 Purchases + 0.00 Cash + 0.00 Special + 0.00 Credits _ 30.00 - Payments _ 0.00 Other Debits + 30.00 Finance Charges + 0.00 NEW BALANCE $ 2,475.65 utin..n ntKt Hrvu KtIUKN iuP NuK,iuN W1IM YOUR PAYMENT PO Box 60550 Consolidated Collection Service, Inc. Harrisburg, PA 1'7106 (800) 521-7559 Creditor Account # WEST SHORE EMERGENCY MED 3091000A Amt Owed 100.00 ~~ ~~~ ~L1 DEAR WILLIAM J KIMMEL ~~ SEVERAL ATTEMPTS HAVE BEEN MADE TO CONTACT YOU RECENTLY i WE HAVE NOTIFIED YOU REGARDING THE CLAIM AGAINST YOU BY THE ABOVE NAMED CREDITOR. FURTHER DELAY WILL LIKELY RESULT IN AN EVALUATION TO DETERMINE. WHETHER FURTHER STEPS SHOULD BE TAKEN. rAY PHIS BILL !!! IT IS THE RIGHT THING TO DO !!! CALL 717-652-8601 IF YOU HAVE ANY QUESTIONS. THIS IS AN ATTEMPT TO COLLECT A DEBT. ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. DIANE G. RADCLIFF, ESQUIRE 3448 Trindle Road, Camp Hill, PA 17011 Phone: 717-737-0100 Fax: 717-975-0697 E-mail: dianeradcliff@comcast.net c,, `~ - G 0 ~' -- 2008 June 4 ~'~ - '' , ~ , ~ ~.:; , J i"~'t p ~~ 1 ~ _ _ i r '. r 7 ~.1 Register of Wills , -~ ,r, f;~~ ~ Y.~ C .~ Cumberland County Courthouse '~-~ ~ - ~'- ~~ One Courthouse Square z -- Carlisle, PA 17013 ~"' RE: Estate of William J. Kimmel No. 21 07 0861 Enclosed please find: DESCRIPTION OF ORIGINAL DOCUMENT NOS. Inheritance Tax Return and Inventory Original + 3 copies Inheritance Tax Payment $111.96 -- Filing Fee - $30.00 -- Return Envelope -- I would appreciate it if you would file and docket the original(s) of the above referenced document(s), and time stamp and return the copies to this office in the envelope provided. truly your LIFF, ESQUIRE DGR/dr Enclosure(s) cc: File Transmitted by Mail ~' r d t -~ ~~ ~~ ~ ~~; ~~~ W ~~~:'. C dao W ~ ~ W W Q N N ~ ~ M c_n U~o a~ ~- T Q •.-- ~ ~ 0- U -~ N LT1 ~ ~ N ~, U ca ~ ~ CU ~~ U t 1 1