The URL can be used to link to this page

Home My WebLink About12-04-08 (2)15056051058 REV-15 00 EX (06-05) OFFICIAL USE ONLY PA Depadment of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 OS ~~ 5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 209-12-6216 03/04/2008 08/17/1925 Decedent's Last Name Brewbaker (If Applicable) Enter Surviving Spouse's Information Below Suffx Decedent's.Firs[ Name MI Sr. Charles N Spouse's Last Name Suffx Spouse's First Name MI Williamson Alice M Spouse's Social Security Number 200-22-6735 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW l7: 1. Original Return 2. Supplemental Re[um 3. Remainder Return (date of death _ 4. Limited Estate _ prior to 12-13-82) . 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required tleath after l2-12-82) •A 6. Decedent Died Testate (Attach Co of Will 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes py ) (Attach Copy of Trust) ... 9. Litigation Proceeds Received ... . 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Penney A. Noss Firm Name (I(Applicable) First line of address 317 South Enola Drive Second line of address City or Posl Office Enola State ZIP Code PA 17025 (717) 737-194 o _ ~ REGISTER ~ LS USE ~ m t r'.. -~ 2 ~g~ ~ I ~~~ F.. r~ TI [~~~ ss ` ~ -. , _r C7 = F i D~ m _ =ri r'. GATE FILED N ' Correspondent's a-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 or which preparer has any knowledge. SIGNAT OF PERSON RESPONSIBLE FOR FILING RETURN DATE G l41 ~-_ ~ a- o~ .~ ADDRESS - _ _ - _ - - - __ ~ -- 317 South Enola Drive, Enola, PA 17025 _- _ _ _ SIG TURE O REPARSR.QTHE THAN RE RESENTATIVE - - - I{V' _- .1 ) /~ / n ~ D/A~TEp j ADD t S ~ _ _ _. _ - _ --. 1~:r1_9 ~ _. _ _. _ 13 S to Meet, Haerisburg, PA 17101 PLEASE USE ORIGINAL FORM ONLY 1 505605 1 058 Side 1 L. 15056051058 U ` S J° ~ ~ s~ ~ ~ =_ \~ ~~~ .~ ~~ 15056052059 REV-1500 EX Decetlent's Name: Cilar~eS RECAPITULATION N Brewbaker 1. Real estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule 8) ........ ..... ...... .. .... .. ...... ... ... 2. 3. Closely Held Corporation, Pannership 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) .::1 Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ..':';: Sepamte Billing Requested........ 7. Decedent's Social Security Number 209-12-6216 0.00 0.00 0.00 0.00 34,626.43 0.00 0.00 34,626.43 8,293.00 0.00 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 Bequesls/Sec 9113 Trusts (or which an election to tax has no[ been made (Schedule J) ........................ 13. 14. Net Value Subject to Tax (Line 12 minus Line 73) ..................... ... 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 00 26,333.43 15, i6. Amount of Line 74 taxable at lineal rate X .0 _ ig 17. Amount of Line 14 taxable at sibling rate X .12 17 78. Amount of Line 14 taxable at collateral rate X .15 18 19. TAX DUE ............................. .... .. ............. .... ..... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 8,293.00 26,333.43 0.00 26,333.43 0.00 0.00 15056052059 Side 2 I_ 15056052059 REV-7500 EX Page 3 ,. Flle Number ueceaenrs complete Atldress: 21 08 DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Charles _ N Brewbaker STREETADDRESS - _ - - 209-12-6216 317 A South Enola Drive clTV _ _- _ Enola 5 ATE I ZIP PA 17025 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments (1) 0.00 A. Spousal Poverty Credit __ __ B. Prior Payments - - - C. Discount - - - - -_. _ _.. _ Total Credits (A+g+C) 3. InteresUPenalty if applicable (2) 0.00 D. Interest E. Penalty - _ - - Total InteresOPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) 0.00 Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) 0.00 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 :................................................................................... ....... ^ b. retain the right to designate who shall use the property transferred or its income :..................................... ....... ^ c. retain a reversionary interest; or ................................................................................................................... ....... ^ d. receive the promise for life of either payments, benefts 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 secudty at his or her death? ........ ...... ^ ^Q 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ...... ^ ^Q 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 fling 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 al 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)]. Asibling 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-7511 EX+(72-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Charles N. Brewbaker Sr. Dehts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' Blue Ridge Memorial Gardens- Opening the Grave 1,160.00 z Mike Murray Funeral Home, Inc. 5,474.00 a Dora Yohe - Summerdale United Methodist Church -Luncheon Costs 200.00 R. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Numher(s)/EIN Numher of Personal Representative(s) Street Address City .State Zip Year(s) Commission Paid: 2. Attorney Fees 860.00 3. Family Exemption: (If decedent's address is not fhe same as claimant's, attach explanation) Claimant Penny Noss stmet Address 317 B South Enola Drive City Enola Stale PA _Zip 17025 Relationship of Claimant to Decedent Daughter/Estate EX2CfUriX 4. Probate Fees 5. Accountant's Fees 6. Taz Retum Preparer's Fees 7. Register of Wills of Cumberland County 140.00 s. East Pennsboro Ambulance Service 77.50 s. PP&L Final Electdc Bill 125.24 1D. UGI Final Gas Bill 214.46 1 ~ ~ Verizon Final Phone Bill 41 80 TOTAL (Also enter on line 9, Recapitulation) $ 8,293.00 (It more space is needed, insed additional sheets of the same size ?688 1160.00 Blue Ridge Memorial Gardens For Opening of the grave r 1689 200.00 Dora Yohe Summerdale United Methodist Church ~ =or Luncheon after funeral 4690 110.00 Register of wills Cumberland County 4721 125.24 PP&L Electric Bill 4722 77.50 East Pennsboro Ambulance Services ~ 4723 214.46 UGI Gas Bill/ 4725 41.80 Verizon Phone Bill 4728 5474.00 Mike Murray Richardson Funeral Home, Inc_ cash 30.00 Register of wills Charles N Brewbaker Sr. 4688 4689 1160.00 200.00 Blue Ridge Memorial Gardens For Opening of the grave Dora Yohe Summerdale United Methodist Church For Luncheon after funeral 4690 110.00 Register of wills Cumberland County 4721 125.24 PP&L Electric Bill 4722 77.50 East Pennsboro Ambulance Services 4723 214.46 UGI Gas Bill 4725 41.80 Verizon Phone Bill 4728 5474.00 Mike Murray Richardson Funeral Home, Inc. cash 30.00 Register of wills Car mileage 2001 Buick 64291 ~. STROKOFF & COWDEIV, P. C. ATI'OANEYS ATLAW TELEPHONE 132 STATE STREET (717) 233-5353 P.O. BOX 11903 HARRISBURG, PENNSYLVANIA 1710&1903 wwwstrokoffandcowdeacom Chazles Brewbaker Estate c/o Penney Noss 317 A South Enola Dr. Enola PA 17025 --- Legal Fees --- 06/1 Of2008 EAS Telephone conference with Noss re: Bucher address; prepare Rule 5.6 filing; resend notice to Bucher Total Legal Fees .. . --- Expenses Incurred --- 06/30/2008 06/30/2008 Photocopy charges Postage Total Expenses .. . Total Current Work Previous Balance --- Payments Received --- FAX (717)233-5806 Page: 1 Tuly 02, 2008 Account No: 2085-OOM Statement No: 14630 Rate Hours 260.00 0.40 104-00 0.40 104.00 0.60 1.68 2.28 106.28 $277.40 06/20/2008 Received Payment -277.40 Please pay this amount .............. . We accept VISA and MasterCard, cash, check and money order for payment of bills. Please fill out and return the enclosed form if you wish to charge your balance. PLEASE USE CASH ONLY WHEN PAYING IN OUR OFFICE DO NOT SEND CASH THROUGH THE MAIL. $106.28 ~~~s`~~ STROKOFF & COWDEN, P. C. ATTORNEYS AT LAW TELEPHONE 132 STATE STREET (717) 233-5353 P.O. BOX 11903 HARRISBURG, PENNSYLVANIA 17106.1903 www. strokoffandcowden.cam Charles Brewbaker Estate c/o Penney Noss 317 A South Enola Dr. Enola PA 17025 ---Legal Fees --- 05/05/2008 EAS Review materials sent in by Executrix; letter to Executrix 05/12/2008 EAS Draft OC Rule 5.6 notices To[aI Legal Fees .. . --- Expenses Incurred --- 05/30!2008 05/30/2008 05/30/2008 Photocopy charges Photocopy charges Postage Total Expenses .. . Tota! Curtent Work Previous Balance --- Payments Received --- 05/22/2008 Received Payment Please pay this amount .............. . FAX (717)233-5806 Page: I June O5, 2008 Account No: 2085-OOM Statement No: 14536 Rate 260.00 260.00 (~`~ Co-I(n-U~ We accept VISA and MasterCard, cash, check and money order for payment of bills. Please fill out and return the enclosed form if you wish to charge your balance. PLEASE USE CASH ONLY WHEN PAYING IN OUR OFFICE DO NOT SEND CASH THROUGH THE MAIL. Hours 0.60 156.00 0.40 104.00 1.00 260.00 0.50 1.30 15.60 17.40 277.40 $225.41 -225.41 $277.40 STROKOFF & COWDEN, P. C. AT7baNEYS AT LAW rELEPxoNE 132 STATE STREET (7 i 7) 233-5353 P.O. BOX 11903 HARRISBURG, PENNSYLVANIA 1710&1903 www.strokoffandcowden.com Charles Brewbaker Estate c/o Penney Noss 317 A South Enola Dr. Enola PA 17025 --- Legal Fees --- 04/30/2008 EAS Initial consult with Executrix -Penny Noss Total Legal Fees .. . --- Expenses Incurred --- 05/(3/2008 Postage Total Expenses... Total Current Work Please pay this amount .............. . We accept VISA and MasterCard, cash, check and money order for payment of bills. Please fill out and return the enclosed form if you wish to charge your balance. PLEASE USE CASH ONLY WHEN PAYING IN OUR OFFICE DO NOT SEND CASH THROUGH THE MAIL. FAX (717)233-5806 Page: 1 May I5, 2008 Account No: 2085-OOM Statement No: 14439 Rate 225.00 Hours 1.00 225.00 1.00 225.00 0.41 0.41 225.41 $225.41 ~~ S-1~~~ Eaat Pennaboro Ambulance Service, Inc. Post Office Box 47 Enola, PA 17025 (717) 732-5552 FAX (717) 728-9507 Federal Tax Number 23-2464545 BILL TO 317 A South Enola Drive Enola, Pa 17025 PATIENT NAME: ADDRESS: ADDRESS: PICK UP: TAKEN TO: -- - .DESCRIPTION: Invoice DATE INVOICE # 2/28/2008 OS-388 Charles Bn;wbaker 317 A S. Enola Dr Enola, Pa 17025 Holy Spirit Hospital Residence _. Stretcher - _.. -_ TRIP NUMBER OB-14587 - DATE OF SERV... DESCRIPTION UNIT RATE AMOUNT 2/27!2008 Stretcher Transport - 1 Way (Member Rated 70.00 70.00 2/27/2008 Str Van Mileage -Loaded Miles S 1.50 7.50 4~~'~~ For your conveniencq we now accept Mastercard, Visa and Diswver. Card Type: Name on card• Credit Card Numher Fspintion:_ / _ Amount to be charged: S _ I agree to pay the above total amount aaording to card issuer agreement TOTAL DUE Signalnre: Comments: Payment due upon receipt Medicare and most insuraocp do not cover this service. Unpaid acwunts will be sent to a collection agency after 90 days. $'77.5 ~ REV-7508 EX+ (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Charles Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolnlly-owned with dght of survivorship must be disclosed on Schedule F. ITEM NUMBER ,,,-,.,.,,,,,,.,,,., VALUE AT DATE 1 Certificate of Deposit M&T Bank ,One M&T Plaza, Buffalo, NY 14240 Account # 31003915181091 , . 5,458.91 2 Certficate of Deposit M&T Bank ,One M&T Plaza, Buffalo, NY 14240 Account # 3100391518108 , 5,458.91 3 2001 Buick Regal LS (Kelley Blue Book Value) 6,645.00 4 Pending personal injury suit settlement payment 468.75 5 State Farm Mutual Automobile Insurance Company refund 28 72 6 State Farm Mutual Automobile Insurance Company refund 84.56 7 UGI refundforoverpayment 30.43 8 Certificate of Deposit M& T Bank One M&T Plaza, Buffalo, NY 14240, Account # 31003915181116 10,992.24 9 Certificate of Deposit M& T Bank One M&T Plaza, Buffalo, NY 14240 Account # 31003915181124 , 5,458.91 TOTAL (Also enter on line 5, Recapitulation) S I 34,626.43 (Ir more space is needed, insed additional sheets of the same size) One M & T~uttalo. N2~ Summerdale Plaza March 14, 2008 -- ~s7o - CHARLES N BREWBAKER 5R 317A S ENOLA DR ENOLA PA 17025-2810 Re: CD Account Closing Notice _ _ - _-Account #-3.1-0039-15-1109-1----- -- _ _. __ _ _ _ _ __ Dear Charles N Brewbaker Sr, We are writing to confirm that on 03/10/08, your CD account was. closed or transferred. At that time, the balance was $5,458.91. We'd like to remind you that M&T Bank is committed to providing you with solutions to all your financial needs. To find out more about the many ways we can help you with those needs, simply stop by any MBcT Bank office or call the M&T Telephone Banking Center at 716-626-1900 or 1-800-724-3222. Or if you'd like, visit the M&T website at www.mandtbank.com. Thank you for banking with M&T Bank. Sincerely, Mteh¢Qe CoQ¢-Hec#ox Michele Cole-Hector Customer Service Manager SMACCt. AZRCSI ~~One M & T PBZa~ guffala~k Summerdale Plaza March 14, 2008 - is7t - CHARLES N BREWBAKER SR 317A S ENOLA DR ENDLA PA 17025-2810 Re: CD Account Closing Notice _____ACGQUnt-##31003915] 8LLD8.__ _ -- - - __ -__ --_ _ - Dear Charles N Brewbaker Sr, We are writing to confirm that on 03/10/08, your CD account was closed or transferred. At that time, the balance was $5,458.91. We'd like to remind you that M&T Bank is committed to providing you with solutions to all your financial needs. To fmd out more about the many ways we can help you with those needs, simply stop by any M&T Bank office or call the M&T Telephone Banking Center at 716-626-1900 or 1-800-724-3222. Or if you'd like, visit the M&T website at www.mandtbank.com. Thank you for banking with M&T Bank. Sincerely, MtehePe Cope-Nee#oa Michele Cole-Hector Customer Service Manager SMACCL AZAC51 EM"°VEENDM9ER DEBIT• WIP TRANSACTION ORIGINATING ~ -- ~' ' / c~nGiTER `. ~. ~ /` .r. c..~ ( AUTHORIZATION - -__..... ' / c t ~~ CUSTOMER;'NAME(PRINn SUB PRODUCT AQCOUNTI#.,,; I ~ I -' ~~'I '~ ~`~ ~ I "' I ~ I / `~' ~ -'~ ~ ' DESCRIPTION .Original -Processing Work Copy 1 - Cental 0alancing Copy 2 - Banch/Dept. - ~~ I . t' GF-26912/WI DATE `~ ' ' ~ ORIGINATING G/L NO. POSTING COST CTR. JULIAN DATE COST C ENTER SEQ. NO. 2 1 9 0 7 8 7 AMOUNT :I ~'- i ORIGINATING ~ / / EMPLOYEE NUMBER DDGT ,y3 -/ z -; L, I DEBIT: WIP TRANSACTION cENreR _ ~ AUTHORIZATION. %3-= ~ / ~ ` SUB PRODUCT A;~000NT# 't / ~-/ / - ' I I ~~ I V ~i I ' CUSTOMER NAMFaPRINT t Orlginai -Processing Work Copy 1 -Central Balancing Copy 2 -Branch/Dept. Gr ~ Izron DATE r-; ./ /` ,!, 2 1 9 GCTT~I POSTIN~ 0 7 8 7 JULI~ i% Ci ORIGINATING COST SE i ~ AMOUNT I MANUFACTURERS AND TRADERS TRUST COMPANY *** CERTIFICATE OF DEPOSIT *** DATE: 11/14/2005 OFFICE: Summerdale Plaza 3i0039151811i6 CHARLES N BREWBAKER SR 317A S ENOLA DR ENOLA PA 170252810 ACCOUNT NUMBER: 31003915181116 OPENING DEPOSIT: $10,000.00 ACCOUNT TERM: 13 Months INTEREST RATE: 4.40 ANNUAL PERCENTAGE YIELD: 4.50 MATURITY DATE: 12!14/2006 Thank you for choosing M&T Bank. `"` NOT TRANSFERABLE (AS DEFINED IN 12 CFR 204) *'* "` NON-NEGOTIABLE "" Member FDIC MANUFACTURERS AND TRADERS TRUST COMPANY *** CERTIFICATE OF DEPOSIT *** DATE: 11/14/2005 31003915181124 OFFICE: Summerdale Plaza CHARLES N BREWBAKER SR 317A S ENOLA DR ENOLA PA 170252810 ACCOUNT NUMBER: 31003915181124 OPENING DEPOSIT: $5,000.00 ACCOUNT TERM: 13 Months INTEREST RATE: 4.40 ANNUAL PERCENTAGE YIELD: 4.50 MATURITY DATE: 12/14/2006 Thank you for choosing M&T Bank. "' NOT TRANSFERABLE (AS DEFINED IN 12 CFR 204) "' "' NON-NEGOTIABLE "' Member FDIC O State Farm Mutual Automobile Insurance Company '"`~ One Stale Farm fN Concordville PA 19339 3853 5 57Q 00'163 BREWBAKER, ESTATE OF CHARLES 317A S ENOLA DR ENOLA PA 17025-2810 ~u~~~~m~~~um~r~r~~~u~~r)~u~uu~)~~urur~~~m~r~~u~ MAR 10, 2008 RE: Policy Number; Refund Amount: 667 9352-F16-38H "***28.72 AGENT BRENDA WAGNER 4701 LOCUST LANE HARRISBURG, PA 17109-4516 (717)540-1103 The attached refund is a result of an overpayment or rating change which reduced your premium. If you have any questions, please contact your State Farm agent. Policyholder Service 00063 67489-5-Q 734-6775.1 Rev. 07-01-2002 (o7b0101b) Check Na 20501324 Date 06/16/2008 CHARLES NBREWBAKER' 317 S ENOtA DR ENOCA PA 17025 -'-- INVOICE# PO NUMBER 1NV DATE GROSS DISCOUNT NET AMOUNT - INVOICE# PO NUMBER INV DATE GROSS ' OISCOUNT; NET AMOUNT AMOUNT AMOUNT PAID PMOUNT AMOUNT PAID 08061680014- O6/16108 ..30,43 0.00 30.43 :REFUNDS221614605538317SE IA DR Direct Inquiries tot Accounts Payable Dept., PO Box 13578, Reading,.PA 19612-3578 Tomis ao.aa o.oo oa.u UGI Ufilities, Inc. Accounts Payable Department PO Box 13578 Reading, PA 19612-3578 CHARLES N BREWBAKER 317 S ENOLA DR State Parm® Providing Insurance and Fnancial Services One State Farm Or Concordville PA 19339 00533 3853 5 57P BREWBAKER, ESTATE OF CHARLES 317A 5 ENOLA DR ENOLA PA 17025-2810 '/11111/1111111111'111'III/dIII/IIIIIIIII111111111111111~1111 ,,,,w„ ACKNOWLEDGEMENTOF CANCELLATION REQUEST GATE MAY 02 2008 POLICY NUMBER 667 9352-F16-38H AUTD MULTICAR POLICY EFFECTIVEI DATE OE CANCELLATION APR 16.2OOS ILOtAM. STANOAflO TIME AGENT BRENDA WAGNER oos33 87~B-5-P AI-NONPI PflEMIUM flEF31N0 ""'84.56 As requested, this policy hasheen canceled as ofthe efFective date shown. We thankyou for having given us an opportunityto provide this insurance.: 00533 137-5325 e.l 07-28-2006 Iote017c61 P .~ ~ v~ cv a r a 4~ PAVroTHe 3853 5 57P oaoeaoF gREWBAKER, ESTATE OF CHARLES a` 317A S ENOLA BR ti A z ENOLA PA 17025-2810 - - N o 87fi9 ""`84.56 -^elce7r-wua aNO ssnoo oouaas^ cygl2n+nN '~~~~.~r ".3L39~6451u• 1:06LLL27881: 329 91l 353211• LaSalle Bank THE JAQUES ADMIRALTY LAW FIRM, P.C. TROY, MICHIGAN 48084 TRUST ACCOUNT 980 MALC DIVISION 720 00359 1370 PENOUSCOT BUILDING DETROIT, MI 46226 PAY '#"FOUR HUNDRED SIXTY EIGHT AND 75/100 DOLLARS TO THE DATE - ORDEROF 04/14/08 # i i## k k k##* i i# i#* i i k## k## Charles H. Srewbaker`#'** 317R South Enola Drive Enola, PA 17025 No. 356468- 356468 AMOUNT #i`$463.75 IRAL W FI , P~ .+ w LJ SECURITY FEATURES INCLUDED. DETAILS ON BACK. Qi 11.35646811' 1:0 7 200080 5: 359400014811' THE JAQUES ADMIRALTY LAW FIRM, P.C. 3 C C A G 0 DETROIT, MI 48226 JJ UU ~~--ff~~ UU OO J. d4 ,~' ~ `~ ~~ Our File # 66044 Charles H. Srewbaker ~ ~•.. ~ Amount of Settlement by Defendant Manville ~ _~, Personal Injury Settlement Trust, ONLY $625.D0 Proportional Attorney Fees of 25% $156.25 Balance to client of partial settlement $46$.75 Sentllnquiresio: S~ 5000 Loulse Drive PO Box 40 Mechanicsburg, PA 17056 aaaa.memoersas[.osg Main SwltchboeM: (717) 697-1161 ar (800) 283-2328 EZ Call: (717) 6974372 or (600) 283-4372 TDD: (717) 697-5312 or (600) 283-2320 exl. 5312 ® Telearanch: (717) 795-6049 or (600) 237-7288 MEMBERS 1St FEDERAL CREDIT UN[ON 7258 1 AV 0.324 14515-7258 ~ iu~lllu,lllunrl,lrl,lurlr lln iuuilliun ulllu,l ll l _ ESTATE OF CHARLES , u N BREWBAKER 3176 5 ENOLA DR ENOLA PA 17025 Statement of Accounts Apr 30, 2008 thru May 24, 2008 Account Number: 328880 Account Balances at a Glance: Checking : 763.59 Savings: 3,038.21 Certificates: 0.00 Loans: 0.00 Money Management: 0.00 Page: 1 of 2 Did you know that we offer FREE seminars? Want to learn more about financial.. aid, auto buying, construction loans or buyingyourfirst home? Sign up for one of our FREE seminars today! Visit www:members1st.orgfiol• more information. CHECKING ACCOUNTS 11 -CHECKING Date Transaction Description Apr 30 Ba/anceFonvard Additions Subtrac8ons Balance Apr 30 Depositby Check: 1,000.00 0.00 1 000 00 May 06 Withdrawal ACH DELUXE CHECK , . TYPE: CHECK/ACC. ID: 1410216800 CO: DELUXE CHEGK 11,00- 989:00 May 23 Check 000101 Tracer 0001666631 May 24 Ending Balance 225,41- 763:59 768.59 CHECK SUMMARY Check # Amount Date Check # 000101 225.41 May. 23 Amount Date - SAVINGS ACCOUNTS 00 -REGULAR SAVINGS Date > Transaction D 'Lion Apr 30 Ba/ante Fonraid Addlfbns Subtractions c, Balance Apr 30 Deposit by Check Apr 30 Deposit Dividend 1:000% 2,953.57 0•W 2, 953.57. Annual Peicenlage Yle/d Earned 0.990,6 hnm 04/30/20081'hmugh 04/30/200E ... 0:08 2,953.65 May 06 Deposlt by Check May 24 Ending Balance 84.56 3,036.21 3,038.21 05 =MONEY MANAGEMENT Date Transaction Descri Lion May LG. Ba/anceForwaid ` _ Addifbns Subtractions Balance May 24 Ending Balance - 0:00. 0.00 -- Conflnued on following page --- e, " Sentl Inquires lo: @~ S 5000 Louise Drive + PO Boz 40 Mechahlcsburg, PA 17056 www.memhers/storg Main Swltchboartl: (800) 283-2320 EZ Cali: (717) 6974372 or (800) 2834372 TDO: (717) 697-5312 or (800) 283.2328 ext. 6312 ® TeleBranch: (800)237-7288 MEMBERS 151 - FEDERALCRED[T ONION 10444 1 AV 0.324 20887-10444- v illllll lllllill 111 illlillllllli lrll 111 llliirlrlll liillli il l .= ESTATE OF CHARLES l rl N BREWBAKER '- 3178 5 ENOLA DR ENOL.A PA 17025 Statement of Accounts May 25, 2008 thru Jun 24, 2008 Account Number: 328880 Account Balances at a Glance: Checking: 486.19 Savings : 3,040.78 Certificates : 0.00 Loans: 0.00 Money Management: 0.00 Page: 1 of 2 With zero origination fees lower interest rates and flexible repayment options, it's easy to see why our new sfudent loan product is a better way to ..pay for college. Visit http://members1st.studentchoice.org for more information. CHECKING ACCOUNTS 11 -CHECKING ~~~~ aY Balance Fon4a7d:; ouuu-acuons a~nce Jun 23 Check 000102 Tracer 0001345271 763`59 . Jun' 24. Ending Balance 277.40- 486.19 486.19 Check # ' CHECK SUMMARY Amount Date Check # - -000102 277.40 Jun 23 Amount .Date SAVINGS ACCOUNTS 00 -REGULAR SAVINGS Date Transaction Descli Bon Additions May 25 BalanceFo7waM,. Subtractbns ' Balance May 31 Deposi4 Dividend 1 000°/a 3,038.21 . Mnua/ Pe7ce71tage Yield Eamedf.OfO;G from 05/01/2008 through 05/31/2008 .2.57 .3,040.78 Jun 24 Ending' Balance 3;040.78 05 -MONEY MANAGEMENT Date Transaction Descri fbn May 25 Ba/ancaFoiwartf Addltons Subtractrons Balance Jun 24 Ending Balance 0.00 0.00. YTD SUMMARIES TOTAL DIVIDENDS PAID 00 REGULAR SAVINGS 2 OS MONEY MANAGEMENT p, Op 11 CHECKING 0 --- Continued on following page --- ve PO Box 40 Mechanicsburg, PA 77055 vnvw.memberststorg Main Svritchboard: (800) 283-2328 F1 Cali: (717) 697-4372 or (800) 283-4372 ® TDD: (717) 697-5312 or (800) 283-2328 a#.5372 Teleeranch: (800) 237-7288 MEMBERS 1St FEDERAL CREDTI'UNION 11971 1 AV 0.324 11971-11971 ~ lullllrulllruulrlilrlrnli llrrl~u~lllluu ulllu ilrtl i _ ESTATE OF CHARLES s u N BREWBAKER 3176 S ENOLA DR ENOLA PA 17025 Statement of Accounts Aug 25, 2008 thru Sep 24, 2008 Account Number: 328880 Account Balances at a Glance: Checking : 379.91 Savings: 3,07$.91 Certificates: 0.00 Loans: 0.00 Money Management: 0.00 Page: 1 of 1 Your aggregate balance as of September 1st is $117.72. An aggregate balance of $2,500 and having 3 products will place you in the Silver MLR level. __ - Accessover 25,000 surcharge-free ATMs. in the United States. See he enclosed insert for more details. CHECKING ACCOUNTS 11 - CHECKING- ,,,.y, <~ aaiance rorwaro - Sep 24 .Ending Ba/ante ~~,~"~~ 379.91 379.91 SAVINGS ACCOUNTS 00 -REGULAR SAVINGS Date Transaction Descri lion Aug 25 Ba/ante Forwam!... Additions Subtractions Balance Aug 31 Deposit Dividend 1.000'/0 3,076.30 Annual Percentage Yield Eamed 1.000/ from OB/01/2008 through 08/31/2008 2.61 3,078.91 Sep :: ~':d„":g B31arcc- _ _ s,U7+s.91 05 -MONEY MANAGEMENT Date Transacton Descd Tion Aug 25 Balance Fdrward - Additions Subtractions Balance Scjo 24 Ending Balance 0.00 0.00 YTD SUMMARIES TOTAL DIVIDENDS PAID 00 REGULAR.SAVINGS 10.35 OS MONEY MANAGEMENT p_pp 11 CHECKING 0 ~ ~~ Sentl Inquires io 5000 Louise Dd Total Year To Date Dividends Paid 10-~ Estate Of Charles N Brewbaker Jr. EIN Number 90-6089982 Account at Members 1st 328880 Deposit made to Alice Brewbaker account Of $10917.82 Cashed two CDs Checks written to pay for Charles Brewbaker expenses 4688 1160.00 4689 200.00 4690 110.00 4721 125.24 4722 77.50 4723 214.46 4725 41.80 4728 5474.00 cash 30.00 7433.00 10917 82 7433.00 3484.82 Deposit to estate account Presets this card when you conduct business M Members 1st Name ~~. ('a-ti,rkg~ L3r~ +baktar ' Account Number .~~~~ Operations Cellar Membero 1st Online Nelp Oesk i (717)697-1161 (/17)795-5170 (800)283-2328 (800) 895-2699 TOD EZ Call (777) 697-5372 Tatabroncd (717) 697-4372 (7,7)7958049 (800) 283-4372 (800) 237-7288 www.mem6eralst.org maRStao-os REV.3106 S~ WEBERS 1~ t•~ta~(t n r: rre Rpl~r w~l~~ Enola 392 East Penn Drive Enola PA 17025 Inquiries Call: Acct X}DDDCX%880 Eff: 09/30/OB Tlr: 0276 717-728-1299 ESTATE OF CHARLE Data: 04/30/08 Time: 2:02pm Deposit to CHECKING 11 prey Bel: 0.00 Amount: 1,000.00 New eel: 1,000.00 Seq: #69214fi Deposit to REGULAR SAVINGS 00 Prev BaT i' 0.00 Amount: 2,953.57 Hew sal: 2,953.57 Seq: #692150 Chk hld xle 05/09/08 1,000.00 due to New Account Chk hld rte 05/09/08 2,953.57 due to New Account Chock Received 468.75 Check Received 3,484.82 ID Source: ^ Drv Lic ^ SigCard ^ Known ^ Other Authorized 6y "Jump into spring" with our Visa Credit Card and receive a low 3.99$ APR on home improvement purchases! Ask for details. ESTATE OF CHARLES N BREWB No 343223 `I . I :A PATITIE NUMBER (ASSHOWN ON ATTACHED TITLE)` 'MAKE OF VEHICLE " MODEL YEAR G a T ,( + ! ~~ ! ~ l1 PURCHASE PRLCE (See'Nole o Re e ' iJG ( ,. fL/ (:-:~..: ~ i= ~'- > n v rse) . w ~ VEHICLE IDENTIFICATION NUM1IBER CONORION ?~ n '} ' S ~ r ~ ~ ': i~ ~ ~) ~ r ~..~ ~ LESS TRADHN " ` r~+ ' + f + I O GOOD O FAIR O POOR :.R rc LAST NAME (OR FULL BUSINESS NAME) FIRST NAME MI IW LE NAME y / ~F~ ( ~ 3 ,' r J . ~, ) Y C ft C.. ~,.-~ ~ V ~ A%ABLE AMOUNT ~ CO-SELLER 1. SALES TA%OUE . '$ BYNAME (OR FULL BUSINESS NAME)-FIRST NAME MIODLE.NAME pq DL/PHOTO IDq AATEOF BIRTH 6%jo67 oR %TY. (O?).. 2 ~ OR BUS IOq - *(See Nok on ReVerseT i '. ar L `. ~, ~ °~1° :: i"} r ~. ' % 'L : ( ) ~1 i <~ - ~ [j {f' 4'a REAS N CODE j u t= r O W CO-PU CHASER LAST NAh1E FIRST NAME MIDDLE NAME . Pq pUPH0T0IBA DATEOF BIRTH m a , bee nwnbe LLom 17o * k 23 of 01 ~~ , °r T x ~ y STREET ~ COUNTY CODE 1& FIRSF ~: ASSIGNMENY ` {& SEC ASSIGNM OND a ENT - ~ ~ . ., OAS X !-S,'N, a .n ..~J _~. ^R'(..„ ain. ~ y ~ L < ~ ~ 1 # 5 +% 4- J T G r ~ 2 ITLE FEE . CITY STATE ZIP CODE DATE ACQUIRED/ : T ~ ~ ~ PURCHASED REFER TO COUNTY CODES v ;. -I ~]~ I ~w i.. <~ +P -t, s : x~~..., LISTING ON REVERSE SIDE . OF YELLOW COPY 3 LIEN FEE 'D LAST NAME (OR FULL BUSINESS NAME) ,FIRST NAME MIDDLE NAME.: PA DL/PHOTD IDq DATE OF BIRTH '' OR BUS IDp ( ' 4. REGISTRATION OR= < F p z ~ CO PURCHASER LAST NAME FIRST NAME MIDDLE NAME 'pA OLIPHOTO IDq DATE OF BIRTH PROCESSING FEE + ~-` £ w m FEE EXEMPT NUMBER ~ ~ ' ~ u ~ AS ASSIGNEDRV THE ~ ,h„ .; ~a m ~ STREET DEPARTMENT , w .n.T_. n COUNTY CODE ~ 5 pUPLICATE REG n FEE NO.OF n CARDS CITY' .STATE LP CODE DATEACQUIRED/ PURCHASED:. REFER Tq COUNTY CODES RA LISTING ON REVERSE SIOE S T NSFER FEE ' OF YELLOW COPY E MAKE OF VEHICLE VEHICLE IDENTIFICATION NUMBER w o T: INCREASE FEE Up ma MODEL YEAR BOGY TYPE (CP, TK, ETC) CONDITION ~'ti S. REPLACEMENT FEE OGOOD:. OFAIR : OPOOR` TDiAL Pao e. 16. E (J PLATE TO BE ISSUEp BY ^ TRANSFER OF PREVIOUSLY ISSUED PLATE ( - ADD 1 THRU e( DEPARTMENT(PROOFOF 0 TRANSFER $RENEWAL OF PLATE .INSURANCE MUST BE, TRANSFER $ REPLACEMENT OF PLATE 11. GRAND TOTAL SEND ONE CHECK IN ' ATTACHED) L7 TRANSFER OF PLATE $ REPLACEMENT OF STICKER ` (ADC9$10) THIS AMOUNT ~ t^^ ~ ' EXCHANGE PLATE TO BE . ~ y ; ISSIIEO OY OEPf~RTMENT f " ,.;~ .~_~ ~', ~ REASON FOR REPIAGMENT ' OLOST ^ OEFACED ^ } fEMPORARY PLATE ISSUED E%PIRES ' .S ' TOLEN ^NEVER REGEIVEp (LasM1n Mal) rc BY FULLAGENT -MOnIA .Year NOTE: II NEVER RE GEIVEO block is checkeq applrcan(musLmmpkte forni MVi4 OZ 'p'O F _ ; TRANSFERRED FROM TITLE NO VIN J~~} y /N ~~~~ ~ ~~ ~ I 4 T SIGNATURE OF PERSON FROM WHOM SIGN IiERE ~ - ; RELATIONSHIP TO APPLICANt PLATE IB BEING p tMF PLATE NO!, , TRANSFERRED (IF ¢ .. _ ~: , OTHER TFTAN APPLIOANTf ~. '; I , VEHICLE;PURCHASEO WEIGHT GVWR UNLADEN WEIGHT, REO REG GROS5 WL.. RED REG GRO55 COMB Wi . -ON I P `. .f I IF P 1 AB INSURsP CE CAMP YNAME POLICY NO. (OR -. ~„ * j POLICY EFFECTIVE POLIGY,EXPIRATION. I-` ~( ) ~''= TT ! f "s J' C ~ I ~ T - e- A .< ACH BINDER d 1 GATE / ` G3 X GATE f i ~f C' , 1 CERTIFY THAT ON MONTH ~/ OAY VEA@~_ _ ISSUING AGENT (PRINT NAMEI AGENT NO ISSUING (HAVE CHECKED TO DETERMINE THATTHEVENICLE IS INSUREQAND ~~/. t ~ . e; t~i~ ~ AGE ' ~~ E , ! Lf _. NT ISSU D TEMPORARY REGISTRATION TO THEdBOVEAPPLICANT IN - r -.t/= I NFORMATION COMPLIANCE WITH ALIAPPLIGABLE PROVISIONS OF THE VEHICLE ISSUINGAGENT.S) NATURE TELEPHONE NO. CODE AND DEPARTMENT REGULATIONS f Y / Lr a (fie ' p ; r ~~ ~ p ~' I P MrE CERTIFY THAT IANEHAVE EXAMINED AND SIGNED THIS FORM AFTER ITS COMPLETILfN AND THAT?HE INFORMATION GIVEN IS TRUE AND CORRECT IF ANYEXEMPTION IS CLAIMED THE URCHASE R , R FURTHERCERTIFIES TIiAT NEISHE IS AUTHORIZED TO CLAIM THIS EXEMPTION. INVE ACKNOWLEDGE THAT I/WE MAY LOSE MY/OUR OPERATING PRIVILEGES(SJ OR VEHICLE EG STR z B I ATION(S)FOR FAILURE TO MAINTAIN FINANCIALRESPONSIBILITY ON THE CURRENTLY REGISTERED VEHICLE FOR THE PERIOD OF REGISTRATION gINE ACKNOWLEDGE THAT UVUE MAY ESUBJE O CT TOAFINE NOT EXCEEDING Sd,060 ANDlMPRISONMENi OF NOYMORE:THANIWO YEARS FOR ANY FALSE STATEMENT THAT UWE MAKE ON THIS FORM. ^u 1ST ' Sgn W,y4 of FusL PurchaserwAPNOiaetl Si9~er TekPhoAe Na ~- ASSIGN- ¢ MENT: Signahae of CO PUrtlr@serf!'Na of AUllq~¢etl Sgner 1 ~ i ,~. C ) ! ,w V ,3 ~ /.I c, < 3N0_: Sgnalure oESewrM Purchaser ar AUNorizee Sgner Telephone NO ASSIGN . MENT' gnaNreo er ille of ul orizee Signer ( ) H.a z0 NOTE; IFACO-PURCHASER OTHER TITAN YOUR SPOUSE IS LISTEDANO VOU WANT THE TITLE TO BE LISTEDAS'JOINT TENANTS WITH RIGHTOF SURVIVORSHIP'(ON DEATH OF ONE OWNER : : z w F OJ< , - TITLE GOES TO SURVIVING OWNER.) CHECMHERE O. OTHERWISE, THE TITLE. WILL BE ISSUED AS -TENANTS IN COMMON' (ON DEATH OF ONE OWNER INtEREST OF DECEASED OWNER Frp , GOES TO HISMER HEIRS OR ESTATE) o~O w z NOTE IF THE VEHICLE IS TO RE USEDAS ADAILV RENTAL OR LEASED VEHICLE. CHECK THIS BLOCK O. IF BLOCK IS CHECKED. COMPLETE ANOATTACH FORMMV-tl. 3. APPLICANT'S COPY /TEMPORARY REGISTRATION (VALID FOR 90 DAYS) RWL INSPECTION REQUIRED/DIESEL VEHICLES E%EMPT COUNTY: CUMBERLAND ~~~~! CUSTOMER ORDER 'r'"~~ CENTRAL L6NC®p_Pd N7ERCliRL•, Inc. 717-564-3055- SUBJECT TO APPROVAL BY MANAGER Chambershill & Penhar Rds. Harrisburg, Pa. 17111 FAX # 717-SF4-Dr1RF SERwL NO. COST. /1 DATE RESR BUS 11 CUSTOMER ADDRESS f`t` ZIP CODE t„1n, t, .3 t3 ax_~~^.? 1 .~)_:L art. J .7: ENTER MY ORDER FOR '-1+ MAKE t'T'., ~~•~ MODEL ~. r_ TYPE. °1 `7:t :. tN COLOR LvF. T'P~ STOCK NO t.i~)'J ~= E%T9 eERVICE PIAN YES:' NO' i~ ~:- '~ x a. ItT SIGNATURE TOTAL ACCESSORIES , . , , TRANSPORTATION TOTAL REBATE REBATE REBATE REBATE Tratleln Year Make Model Color Serial No. Sock NO Title NO. License NO. Expires ALLOWANCE t$/f Tradedn Year ' a3 ~, Make r+'r r ! F ,. Model ) ' I' A' Color ~ Serial NQ ° A •i'? -.. Stack tJd IC'I .j ~.r..JCi ~ .TIIe NO..?xJrrb 19111 <T Oy.1i'jLklxnse Nd. •~ ~ Expires ALLOWANCE ti (t i1, ~}, i°' ~ Sub-Total !1, Ua'-,. ~'a9 Pr I' `' r ` Penna Sales Tax -~ ~ INS COrt r t POLICY NO '$-"' ~ . ~ ~ ~ r The Tax r, AcENr PHONE Doctamentar Fee ~, f);;P AooRESs , Notar Fee .: ~ Balance Owing On Trade To LICENSE # iii r'r~} LIEN FEES $ t,j/Zi. TRANSFER # rj ~; T ITLE $ :;''.TEMP. TAGS $ ~'7,' ~%. . ~' ~} _.{. • - e FACTORY WARRANTY Th l b a Online Title & RegistrationFee ~ i,.~l e ad ry w ranty consliluM5811 of the warranties vi Ih respect b the sale of thk I Th ' Online Dealer Service Fee tem/Items e gall h reby expres ly tl sdaims all wananges either expressed or implietl including any impfetl warranty of membamahilily or fitness for a particular purpose, antl the seller neither assumes r ' Luxury Tax j no . auihor zes any other person b assume (or it any liabildy n connec0on with the sale of Itis tlam/items. ~ ^ USFA CAR WARRANTY Used w 5 core tl by a I'miled warrnry delaletl In a se arate document TOTAL / fJ p . AS IS ~ This motor v h¢le is sold "AS IS' without any warany either expresses n Implied. The r RECEIPT NO.: $ ' purcb er will bear iha a No expense of reps ling or correcting any tlelecl Poal presently exists or that RECEIPT NO.' $ may o cui in IbeveMCle. ~ BALANCE DUE: $<;t 1 > , } ll PURCHASER'S SIGNATURE X • USED CAR CONTRACTUAL DISCLOSURE STATEMENT THE INFORMATION YOU SEE ON THEWINDOW FORM FOR THIS VEHICLE IS ` ~r' PART: OF THIS CONTRACT. INFORMATION ON THEWINDOW FORM t'~P r'r OVERRIDES ANYCONTRARY PROVISIONS IN THE CONTRACT OF SALE. '- • ' T I r-; ? ??) e•• Federal regulations 2quire you to state the odometer mileage upon transfer ofownership An . waccuiate statement may make you liableJor damages to your trans/eree, pursuant to section 409//a) gNNUAL PERCENTAGE RATE of the.Motw Vehicle InlomTation and Cost Savings Act 012972. Public law 93-52$ as amended by Po6 L Q • a 6c aw u4-47 I hereby state that the odometer mileage indicated on the vehicle sold at [he time o1 transfer ~ i~j ~;i(IU"L CHARGES BEGIN ON . TO BE REPAID TO T IN MONTHLY ~ Miles 2. Total Mileage Unknown INSTALLMENTS OF $ EACH ON THE DAY OF 3. Total Cumulative Miles Known to Be Over 100,000 THE MONTH BEGINNING 20 x Customer agrees that this order includes all of the terms antl conditions on both the (ace antl reverse FOR CENTRAL LINCOLN MERCURY, INC. side hereof Ihat Ihis ortler cancels antl supersedes any prior agreement antl as of the tlale hereof ~^, ;,. r ' f I"ir i composes the complete and extlusive statement of the terms of agreement relating to the subject .. 1. v . 4 if SALESMAN mailers covered hereby. This ortler shall not become bindino until acts tetl b the tl I h' authorized representative. You the customer may cancel 11 's conlr 1 d (II I tl APPROVED CENTRAL LINCOLN MERCURY INC, any time bemre receipt or a couy of h' I I 'a d by ih d d I p I r bV THIS ORDER IS rvoT VALm UNLEES SIGNED AS ACCEPTED"ERE giving wri11e0 notice oL cancellation to the tlealer. Customer by his execution of Ihis order RY ` acknowledges Ihal he has re atl its terms and conditions and hasreceiJetl a Igre copy of Ihis order. CREDIT APPROVED CUSTOMER SIG1J5 X / CO-SIGNER SIGNS .x 2001 Buick Regal -Suggested Retail Value -Official Kelley Blue $... http://www.kbb.coadKBB/OsedCars/PricingReport.aspx?Yearld=20... i(effey Bfue book r._,____ _~ 3 THE TRUS'fEO RESOURCE aaverdsement Homes Naw Cars Used Cars Research & Explore News & Reviews Reatly To Buy elaaelBeda Loam $ insurance KBB® Green Usetl Car Prices 1 Search Used Car DstinGS I Certified Pre-0wned I Compare Vehitles I Perfe¢ Car Finder I Mosl Researched VeNtles CARFAX Vehicle Hi4ory Wdoame eedt I Slgn In I Create ACCpunt I41y RED ZIP COda; 1202s Rxently Vierred You FOgh[A6o Gke Frees Dealer Price Qwte x_m> uw a>> Ipot > pxx> aa~l> uwan ao '~ SavC Vehicle Pnn[ f ~ Email 2001 Buick Regal LS Sedan 4D ' Trestle-[n Value PrivateParty Value BLUE BOOKSUGGESTED R EiA: VALUE :;:,„_.... Suggested Reta71 Value Photo Gallery ' ` Condition , - :.. Value ComVare Veh¢les -~ 7 Blue Book Review Excellent $6,645 Consumer Ratings Fintl Your Mext Car C.ar ~ 4E"L aupgespd Recall Valuo graume Eacelleot Specifications -...,..., .,,,...nrv~ ..Yi. cgnalHon.,. n!pre FIO2 P k otos ! ~ Shopping Tools " ' J( ~ E X STEPS C 1 • Free ARFAX recortl check Frte CPRFA%Remrtl CF._ J; Auto Loan tram 6.34% AP0. Compare Insurance Rates Average Consumer Ratlng (1 94 Reviews) Read Reviews Payment Calculator - "- - 4.5 out or 5 Revi era Nis Vehrtle Extendetl 1Varranty Qmt- 6~9YA U$EC lhF, Vehicle HI9h09h!s on Blue Book ClasslfleAS^ aWPage: n,aoo ~~ ~ Enallte: V1i 3.8 Lher TmrswnlWoni qufmnatlc RBI _ DMvebeln: FWD 30 Mlles er less ZIP GMB 11625 SelcRetl Equipment CM1an9e Equipment To wew ads Ultls STaltdard OIr CMallhwYryl UR Wheel Dual Fronk qtr Bags PowerSmednp f+uke COnlrG Aas (4-WhmJ LIST YOUR (AR FOR SALE P0"'^'IMnd^~ gM/FM Sty. Tmdbn mrrc.a SpaIM PaWga OReH Power Door tad¢ Usseae Power Seat For one low price you ~°^HI ®n mach millions of tired mr shoppers. $Ingle COmpaR Dlsc IeaNer Leam more row HAD INE RIGIIt iAR Compam used va. Rew ss,adorosfo,oaD I eoM Mew am used - ~~ ~.. ro New L)st, CIIM _ EStimafcd Payments 313D /mo ~ s 56 loft "" 11/6/08 1:47 PM