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10-13-09 (2)
15056051058 REV-1500 Ex (06-05) PA Department of Revenue Bureau of Individual Taxes OFFICIAL USE ONLY County Code Year File Number PO Box 28oso1 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 09 0099 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ..183-40-0425 __ _ _ October. 30,..2008 _ 'April 12, 1949. Decedent's Last Name Suffix Decedent's First Name MI Minaya _ ' Mr. Jed V ; (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Minaya_ __ _ _ _ Mrs. '.Barbara q Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE __ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate 7. Decedent Maintained a Living Trust $. 'ot~-Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) i 9. Litigation Proceeds Received 10. Spousal Poverty Cred'R (date of dea>~ 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 Herschel Lock, Esg. 717-23861 r•~ ~~ Firm Name (If Applicable) _ C- - '~ "~ REG~~OF L'YtLLta"'nSE D~ c _ ~ First line of address _ _ ' rn r I ~-' ~ ...._. ~ ~ ..a 1 i..~3 C„ 3107 N. Front St. ' `~ ~ ~_ Second line of address 4~~~ -c7 ~' D City or Post Office State ZIP Code ~ DATE FILE Harrisburg _ _ _ PA _ 17110 Correspondent's e-mail address: Under penalties of perjury, I declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE O ERSON RESPONSIBLE FOR FILItaIG RETURN DATE ADDRESS SIGNATURE OF EPARE~ O~FiER TAI-IAN REPRESENTATIVE ~ r~ p~1TE c~t~( Q(• rl / 9/(AJ 9 ADDRESS _T ~ 31(17 N Frnnt ~t Harrichnrg PA 1711n PLEASE USE ORI ONLY Side 1 15056051058 15056051058 15056052048 REV-1500 EX Decedent's Social Security Number Decedent's Name: TPd V M i na ~B 1' 8 3. 4 0 0 4' 2 ~' RECAPffULATION 1. Real estate (Schedule A) ............................................. 1 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. PAortgages & Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vvos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8 2 5 3 8' 9 T 7. 3 2 S 8. 0 3 8. Total Gross Assets (total Lines 1-7) ............................... ..... 8. 1 5 5` 7 9 6. 9 4. 9. Funeral Expenses 8 Administrative Costs (Schedule H) ................. .... 9. 1 6 1 3 6 • 9 $' 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ............ .... 10, 11. Total Deductions (total Lines 9 8 10) ............................... .... 11. 1 6 1 3 (. 9 $ 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. 1 ' 3 9 6 5 9 • 9 6 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~ 1 3 g 6 5: 9' 9 6 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .0 _ . 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. • 18. Amount of Line 14 taxable at collateral rate X .15 18_ 19. TAX DUE ..................................................... .... 19. 0 •- 0 , 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 15056052048 15056052048 REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER 4 0 0 4 2 5 ~ - 1 8 3 - - STREET RESS 4 Hone suckle Drive Mechanicsbur PA 17050 CITY STATE DP PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty (3) (4) (5) _n_ (~) (5B) n (1) -0- Total Credits (A + B + C) (2) Total InteresUPenalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 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, 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 RETUR 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 spc is three (3) percent 172 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) per [72 P.S. §9116 (a) (1.1) (ii)]. The statute does n_ of exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets 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 adoptive parent, or a stepparent of the child is zero (0) percent p2 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 note 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, ul Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX+ 16-9B) r ~~~ SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE AF Jed V. Minaya FILE NUMBER 21-09-0099 All property jointly~owned with right of survivorship must be disclosed on Schedule F. ids ........ .......... . ..A..J ........+ .. J.1:~:......1 ..I,....i.. ..i N... ......... ...-..\ o01a O N O ~"! --~• ?7 ~"'1' ~~ i"" ~ ~ ~ ('~ n .~, aQ.a -+ c aQm ~ " ~ a _ O O y .-r ~ ~ o~y~ ~ a ~ o : ~ ~ 3 m o~ 3m~ ~ ,° u u i o Q o, o j 7 ~ d j~ n v .. o a y ~ `° ~u~a ' ^~ -v n a- ~ ~ to Q k 3 `~ a ~ m~'o o~~ V a°m C m m° : ' ~ O a o ~ ~ tss d , n `D ' --~ ~ 3 m tN ~ fa N . °.cr. ml OCn m ~, c ~- `~ W A cD d ~_~~ ~~~ ~ O O O~ ~ .O-~. ~ ~ N ~ 3 n• ~ ? jp' ~ f/- ~ fy 69 O O ~ O I O O p7p. G ( / m- ~ a o0 n n ~ n po ~ ~ o- ~ ~ on ni fl, o ~ d ~ d ~ Q4 . in ~ ~ m d ~ c m n n O C C H H H r + N N ~ t71 U1 ~1 !J ~ ~ W r y9 EA CT. ci GD CTi O O .~. -t ~~oo~d N H_ H N W C~J1 CTf N V ~ OD O p p Cp t0 Q1 O O t71 p7p' ~` ~-+ O O N G ~ rn rn cn m ~ > > ~ a c c ~ ~ ~ ~ ~a l~f ~ ~ ~ ~. f~A N L ~ j O r y C Y ~ _ Q ~ N C N ~ n n O ~D rC A 1 Q .-r C n rl v c H ~ m IV .1i V cn .v M '~" o rn ~ ~ °~ er. O W " w p o c 0 c C N t p 8 H ~ y Ui i N H N p p tc~D C ~ III ~ GwJf O O O ~ I C N c D p, 80 9 ) b £. cDn ~ D ~ D O 3 c `- _~ cn v v cp =' --I ~7 ~ ~ rn ~ ~ ~ rn N. z7 z ~ (D D S '~ ~ ~ mD~ m O 0 ~ O < D ~ ~ ~ o z ~ ~ ~ ~ D D ~ N ~ y AO N ~ O '' M O n O v w N N - O O O O W A W ~P O O D to ~ O ~ N !--' ~t '~ m da W 0 F+ O fD ~"'t ~• ~~ ~ ~ ~"" ~ ~ n a~ O ? X (D ~ CD a~• ~~~ ~ ~ ~ m ° ~ ~ v ~ ~ ~' ~' d o v \ c n \oo 'o ~ ~ ~ 1 ~ y~ .,'O 3 (D n ~ N ~ 0) H ~ ~('3^ ~ c 3 m v.~ ~, ~ ~ m ~ o n y~ ~~y.~ o cD ~ ~ ~ ~ (D ~ sl < N (D y C2 ~ (D ? (D .-. ~ rn o a ~ m , c ,-. ~~ a y ~ ~. N O ~ ~a ~ 3~0~~ , N~ N ~ y ~ 1 W ~ - . ~ ~ (D ~ -w ~ N N~ Ott V r N< or,iv_,a~ ~ vi y' C wd _ (D O ~ ~ j ~ ~ p O m ~a~ ~ oc>>•~~ y y ~ ~ ~ 0 •-• - O N y' ~ ~ ~ O ~' : O S. -1 v ~ o n ~ m (A ~D cD CD (7+ c<o ~ a n H ~ N N ~ w a w ~' N ~ ~ O O O ~ O N fD a d r O C d 7 L'1 O 3 cfl c 3 3 a~ ( /) ~ c 809b£_ ~ ~ ~ D Z m ~ o N m ~ D ao nn-~ .~ n ~ ~o~QOn I j OC :J y ~ ~ O d °R n `~' ~ c O ~ o o _ ~ m ~ ~ ~ ~' ~ n In ~ i~ ~ rn ~N y n o c ~ ' C 3 3 ~ O N, N W ~ ~ N U1 O i ~ v 7 ~ _ A ti i p p ~ ~ O O CJt O I I O O (Ji ~ I N 6- H W N 0 N cD -.+ w ~-' O p p 07 ~ O C71 CO ~ 0 1 <O O x.71 perp' 0 i a oo ~ D Drn ~ ~ D ~ CD D z 'v. D D ~ ~ D N• DD CD ~ O ~ ~ ~ ~~ n 0 ~ c ~ 0 r-F Q ~ W p ~ m m ~ n i- ~ ~ c ~ ~ `~ o'~ < ~ < ~ 3 ( N N < ~ (D 7 O C n (~ v n d ~ ~~' w p ~ O O m °o ~ m rn c Si g rn H ~-` rN-. W N ~v-v ~ N w m O O cD A ~. ~ ~ o O S O o a c n .,. N c 3 3 0 O O O W W ~P O O ~ A Qp O O ~ N ~' F' ik O1 °~ r M 1+ O 8 W N Y N W N r'" 0) ~ tD O ~ A ~ ~ 1 v~ W ~p N CD O ~ 3 ~'! ~• N . ~ ~ n .- O ` ~ 1 ` L L A W m a~ m` N _~ ~o ~ ~ n n O .~-. N N 7 ^ d n C © ~~~ Z O T X m Q C"1 N ~~-. O ~ ~ N _ d r.• ? CD tnD O ~ p ni ~ C7 n ~ ~ _ t~i~ .+ n C~ d ~ ,~ a O m t n (n O C O _: fp " m ~ °' oa N 3' ° m °" ~ ~ y y N O ~ ~ a ~, n j ~ ~ N H • f+ -+ t~ N 4l (SI CT1 v! ~"' ~ n = ~1 O H O ~ ~ N ~ ~ C F+ 1-+ O O w W ~ ~ N Q N o D p ~ F+ O N ~1 ~-+ ~ Q=Q p ~ ~ ~ O ~ N ~ O o, ~ m ~ lili 0 m ~ N N O O ~ ~- ~ O. y cc io 0 iv 0 ~ ~' .~'. °~ ~a° o ;~ !V 0 0 0 O f.71 ~--~ W GO O 00 O Q1 CO W ~+ O W Q> O O W ~ H fA --~ --~ w W ~ ~ ~ ~ to ti co E» W ~' NON W A O C 71 ~D O tD N --~ .p p p -~ O --` A O OD CO a t+ O W O) O 0 w v 0 ~~~ m~~cn m ~ ~ °~ ~ y ~r;.a is ~ a -. ~ . fD .. p, ~ n ~ oa O A~1 ~ ~ N 7 y~ ~ :~ o QTR ~ ~ ~ 7C n C ~ N 9i /l ~ ~ ~ ( 7C ~ t C C ~ ~ ~ 3 s?~ ~ ~ ~ c D _~ c `° ? ~ c ~ ~ a ~, j m ..+1 m ~ 7 ~ o~ ~ 7 fl' O ^' 01' ? v ~ ~ '- (D fD Ol ~ 3 3 c ~o m c d ~ O `< ~+ 7 C H9 ~ ~ cflD d d Q 3 O ~ 1 Ol C 0 ~ 'A 6H A ' -"' N R7 ~ ~ W N CU D ~ ~ n ~ N ' N O C -,` O ~ ~ ~ CJ1 . ~ ~ ~ ~ O ~ ~ ~ i~ S: F-~ !00 O QO O c0 d 1 ~. O, ~ ~ ~i 3 ~ c' ~ i ~ ~ t n w o ~ v ~ `~ '+ ~ ~ O ~-+ N O ~ A d ~ : N C>] N g o ^' ~ N N to o ~ ~ N ~ O ~ N ~-' O O !~ O tb G O ~_ 0 O n d !A b M d1 fp M EA (A g r W L+ O v D O t J~ O ~ O ~ O ( 3~ 8 S 8 p pp O pp 8 O O O O O O O ~ ~ O .o 0 ~ ~ C v i 0) C ~ fD J I .~ ' ' ~ ~ 'O N o n f , .~ O ~ o ~ ~ o ~ _Y I u u r ~ 0 ~ ~ ~ o i ~ N ~ N ~ I O w W w ~ j ~ OD .o , N I m F-~ Q 1 O ^~ W N /~ 0 0 //O~ VM N 180/9)lr£~ 3~D ~ ~ W rn (D D ~ ~. '~ W 7 Z D (~ D ~ D ~ C Z ~ ' _ ~ ~ ~ D < (D ~ ~'•~ n C ~ C (~ a 1 O n O 0 0 < ~ ' C G7nn~ O (D (D ~ a ~ .~+ ~ Z Z 0 C C c v Q ' (~ (D O O s~ ~ ~ N N w~~ -~ O C7t ~F-'N f'' O O O F.a ~.a O i-~ ~ m O v z c Z ~ ~ = N cfl .- Vf p m ~ O ~ N ~ d .-, ~ s. ~--' -n N 'D O ® 1 ~ ~ _, REV-1508 EX+ 12-87) ,.~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DKEDENT SCHEDULE E CASH, BANK DEPOSITS AND MISCELL-ANEOUS PERSONAL PROPERTY Jed V. Minava Please Print or (All property jointly-owned witl- the Right of Survivorship must be discbsed on Schedule F) ITEM DESCRIPTION VALUE AT NUMBER DATE OF DEATH 1 PSECU acct. 0425(S1) 2 PSECU acct. 0425(S4) 3 Vanguard acct. 3490 4 PNC acct. 1038 5 1965 Triumph motorcycle TR6_ non operational 6 1989 Honda GB 500 motorcycle 7 1982 Honda Silverwing motorcycle 8 14' Fishing boat &- Sher-~•~~g -trailer 9 1985 VW Bus 10 1970 VW Bus (non-operational) 11 1989 Honda Civic automobile 12 1986 Honda Civic automobile 13 Accident claim made to Hartford Life & Accident Insurance Co. 14 12' Fishing boat &- TeeNee trailer 15 Yamaha jet ski & trailer 383.76 559.55 5,136.49 6,093.23 1,810.00 2,880.00 795.00 700.00 1,000.00 1 00.00 250.00 200.00 52,200.00 450.00 700.00 TOTAL (Also enter on line- 5, Recapitulations I $ 7 3 , 2 5 8 . 0 3 (Attach additional 8Yx° x 11" sheets if more space is needed.) ~SEC~ Herschel Lock Attorney at Law 3107 North Front Street Harrisburg, PA 17110-1310 Re: Jed V. Minaya, Deceased. PSECU Account # 0183400425 Dear Mr. Lock: f February 25, 2009 ~ ~ ~~ t,~. ~ ;...,k ... _..,, The account was opened on June 17, 1981. The Share accounts were held solely by Jed V Minaya. The Mortgage Loan held jointly by Jed V. and Barbara A. Minaya. The following are the Date of Death Balances for Mr. Minaya's account with PSECU: Account Date of Death Balances Interest October 1 - 30 Savings (S 1) $ 383.76 $ 0.40 Checking (S4) $ 559.55 $ O.12 Loans: Mortgage Loan (FIGS # 3) $ 69,946.52 If you have any questions, please contact me at (717) 234-8484 or toll-free at (800) 237-7328, then press 6, extension 3120. Sincerely, `~~'' ~ i Roxann Myers Service Advisor PSECU Pennsylvania State Employees Credit Union Main Address: 1 Credit Union Pioce, Harrisburg, PA 1 71 1 0-2990 • 717234.8484 • 800.237.7328 Moiling Address: PO. Box 67013, Harrisburg, PA 1 71 06-701 3 • 717.777.2100 (TDD) • 800.472.1967 (fDDI psecu.com This credit union I; `ed~rolly insured by the Notional Credit Union Administrotion. Equa{ Opportunity Lender Jed V. Minaya Bene Of Joanne R. Minaya 48 Honeysuckle DR Mechanicsburg, PA 17050-3167 Account value summary ,. Page > 1 of 1 ,.. Vanguard' Report for 10/30!2008 Client Services: 800-662-2739 .. _ __. otal report value: - -- -.__ ___.. $5,136.49 (Total report value includes any accrued dividends.) Name Fund & Account ~ Date PricePer + Number ~ pe ( Accrued O ned ~ Shares I Share ! Value* j Dividends Wellesley Income Fund Inv 0027-09950363490 ; 09/05/2001 ~ 283.158; $18.14 , $5,136.49 Totats $5,136 49 ~ $0.00 ' Dcesri't include accrued dividends. ~ - - ---- -- ___.. _ 1257853713 02/18!2009 13:41:57 .__~. cvv ~ r . ~Ji~. i 1Y4 vlS T'1 4 I ~ T~~~/r'! /_ __ _.. !~'v. ~'~~~~ T ~! ~~~~ t~asnu~z~ew~Y February 9, 2009 Herschel Lock Attorney at Law 3 l 07 N Front St Harrisburg, PA 17110-1310 RE: Jed V Minaya SSN: 183-40-0425 DOD: 10-30-2008 Dear Mr. Lock: In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Checking Account Account # 5080337764 Established: 07-OS-1994 JED V MINAYA BARBARA A MINAYA DOD balance: ~ 463.24 + 0.08 accrued interest Interest paid 011 10-30 2008 S 0.89 YTD ---~_. Savings Account Account # 5004001038 Established: 0624-2002 JED V MINAYA DOD balance: ~ 6,091.57 + 1.66 accrued interest Interest paid O1-Ol -2008 thru 10-30-2008 S 31.75 YTD Please note that this office provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings). We do not process any 5naacial trans9ctions or provide st9temcnts. If you need assistance with any of these items, please ca111-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch off ~e. SincePeiy, National Financial Services Center PNC Bank, N.A. Member FDIC Page 1 of 1 ~~ .. ~~, ` y 5_ ~ t ~~ 3~ ' ~ r f' r . r r 1 '~~ ~ ~"'"~' TRANSPORTATA VEM~cii..G ;~~ rs+ DEPP.RTMENT ~F FOR _.___ '"" , T E O F r 1T LE _ _ _--_ - --- _~ C E RT 1 ~ ~ G ~~ f-__---._.-- -- `--:-- -^. Penru ylvaitia Consolidated Statutes fl fl1 -'' the Vehicle Code, Title 7~, 8?1Sba'fl510C12460- issued in accordance with Section{J129fl 5fl r . JED V MI~lAYA 624 STH S3 ?6652 HUNTi(dG'3'7N PA CODE LEGEND A =ANTIQUE VEHICLE C =CLASSIC VEHICLE F = pUT OF STATE VEHICLE H =AGRICULTURAL VEHICLE L =LOGGING VEHtCLE P _. FpRttItERLY A POLICE VEHICLE R =RECONSTRUCTED VEHICLE X =FORMERLY A TAXI ~~ - s C ~L fl q T 65 TRIU``~PH rw~•: se,, gar ,,ACE~oR~lu `~~ . 4r3~ l~~ ~1 ~ fitAf(EgFVEF,rCAE I ~ 173~D o~L VEAR TITLE NIF~R ,.. ~ MAX Gi905S GO^d8. YJEIGFtt p1322? 611 ~, Ax GaossvE,~~'=~~ .vE~c,Nr ~1 ~, vEttiGLE ~ENTtE1CATIOr'r NtJQt"t^g~ER t~~y I.. ~3~ > ODOtitET L`~ F . PATE FA TF7LED DATE ISSUED ullon'in g f i~rs: uN~ADenvrtlGr,T l.i{•:~ ItELF„NSF;1) ir:,~rt: ~ -' Tke z'chicle desrrihed hereua is`srihject to the ~ f~ ' t.rr.~ Hr~r.nttt Kl ,~r nrrrwrzr.n er:racr•r:x'r,~tr~'r~ ~~ - '~ 1.1F.N Kl.1.EA5h;1) p.nlF. I E3 OF. 1f- 5FCON1) LIEN FAVINt ' ~' 1) gY ni~rnue~i.ruKr:~hctsF.nrnrwr. .~~ the slpfenrrrrts wnnhle diti;;ence has hero ue't{ in rraurinurg -P s;..,*~. clod tea.' 't'ide ur dre rrhidc described ilicvdinn r _ F; - ceAiJ)' rcafiun Jur Ce+lificatr uJ rr e` ii7rrl w•i!h paid aPP -!r rrsented in thryNPPt P ,rJ said rrhirle 1 ~ ' `~ ficmn ax (ax'("/ °N°rcr uJ .~1. ~ P J uwaershi J ""„„ _: and that fhe P J this ceA+f rate nwnnr tke app tit Iha~ said warrnnts the rscuunc'e uJl ccAijv drrtfas njdre 7~,lanspanah nrere~r. thr ojficra r"Z =M ; said rehicle_ gherejurc, uAarrrd of '•-r' = dre Penasrhania Lard ~eluck -.~, ~ ,.. recants aI ~- _~ ~ atrPlicanl is the tawJirl owner of . ~r~~ ~u~„=" - 1'f'7T-i y I \ 1 l1lJa~41 rr 1t ~«Ji.i,'~~• ,. r w.. tiecntar) ul' 1 ~aiw~IwnYati-gym ~~ 1971 Triumph T100R Daytona Motorcycle Trade-In Value & Price -Kelley Blue Book '~ G~elle Blue Ba~ok . y +,=4 TFtE TRUSTED RESOURCE Welcome Back i Sign [n ~ Create Account ~ My KBB ZIP Code: 17110 Recently Viewed -~w~.~.~.__-_w __.__.-__ .- , ..h < G. You Might Also Like Free Dealer Price Quote Latest Car News GM Bankruptcy Reorganization Plan Approved More News Home > Motorcvcie Values > Motorcycle > 1971 > Tn~umoh > TIOOR Daytona 1971 Triumph T100R Daytona Vaiue a. , July 8, 2009 •~ 2-Cylinders 4-Stroke SOOcc Trade-In Value (Good Condition) 5875 Trade-in Value is what consumers can expect to receive from a dealer for a trade-in unit assuming an accurate appraisal of condition. This value will likely be less than you would receive from a private party sale because the reselling dealer incurs the cost of safety inspections, reconditioning and other costs of doing business. Trade-in values are based on Gean units in good condition, with all original standard equipment. Mileage/condition and i ~ n I eauiament may have a substantial impact on the value shown above. NEXT STEP: Copyrght O 2009 by Kelley Blue Book Co., All Rghts Reserved. 5/1/2009-8/31/2009 Edition. The information in this report is intertded for the personal use of the customer only and may not be solo or transmitted to another party. We assume rw responsibility for erors or omissions. Shopping Toals r Email t. Bt)OKMRRK it 't ~_. advertisement Motorryde Insurance. Get Started! Get a Ree Motorcycle Price Quote Sell Your Motorcycle Motorcycle Store Featuring Car Insurance Gas Mileage Champs Fintl A Car Dealer Best Car Deals 5 Great Car Deals Car Rev!ews Cars For Safe Cash For Clunkers About KBB About Us Contact Us Careers FAQ Media Advert+sing Unking Privacy Site Map Copyright & T2derrarks Terms or Service ®1995-2009 Kelley Blue Book Co., Inc. http:/ /www.kbb.com/motorcycle/trade-in/ 1971/triumph/t 100r-daytona/251173 7/8/09 5:37 PM rx ~J Page 1 of 1 ..... r ,: =- _ L.ERTIFICATE OF TiTl_E FOR A VEHICLE ~ ,_ __ .- ~. •765 .. ,. ; DD]lb~Q0:7•~48513~ Opk a JH2PC1,~'~]aKKL~Q~~'.~? ,.I.9~9~~ NOND.A {{ VEHICLE IDENTIFICATION NUMBER ~ .. ~ ~. -.- " .. .. ~~:~~ ~~ ~ ~ .7~:~ ~ ~ 0 ~ ~ l ~ ~ YEAH MAKE OF VEHICLE BODY TYPE -.... ~ DUP ~ 'SEAT CAP ~ ~~PRIOR TITLE STATE. ~ ODOM I ~ ~JD~ ~~..:.-0~~. M~~ T I ~ ODOM S',ATUS ~ DATE PA TTRED DATE OF ISSUE I UNLADEN WEIGHT ~ GVWR `° ' ' It( ~ - , ~.,GCWH ' 7TRE BRANDS ~~ . f -. S, ~~ ODONETEA STATVS ~ ~. r' .. -0 =ACTUAL kILEAGE } " 1 = AULEAGE E%CEEDS THE MECHANICAL ~ _ 2 = NQT THE ACTLfAI Mtl_EAOE ~~ ~ - ~ ~ • 3 = IVO,T THE ACTUAL Mll.F.AOE'ODOAETER TAMPERING Vt7i1FlED s 00©MFTER QiSCLOSURE~~1~~~`8X ~E;}ERAL LA{~ `=E><E~fPTRT~,,,DDD.IETERD~D~ ~' S REGISTERED OWNER(S) ~ ~~~ - J ~ D ~ ~-I ~ A YA~. _ ~mvJSt ) 7Jrm sno raf'i'u* ' ~2~ D _ COU-ECTIBIE YE111CLE ^x N y8 < ~iONEYSU£KLE Dfi ~ L ~ - _ f -pui~IADNTRY G = 1NiIGeJAijY MFCaO. FOR NCNi1.S~ ~lECHANItSBURG PA 17Q 5 DSTRIBLrT10N ' H =AGRICULTURAL VEHICLE L = LOGGMG VEHICLE ' P = LbWA$ A POLICE VEHICLE. ' R =RECONSTRUCTED '~ S =STREET ROD ~ ~~ T _. RECOVERED THEFi:VEHK:I.E , V =VEHICLE CONTAINS REISSUED vqt. FRST UEN FAVOR OF: w = FLOOD VE:HiCLE ~ - SECOND LIEN FAVOR OF: X = SAS A iAxl FIRST LIEN RELEASED DATE BY AllTf10RIZED REPRESENTATIVE W1LttJ(' ADDRESS D29513 JED` V NIi~3AYA 4$ HONEYSUCKLE. DR MECHAtVICSStlRI; ~A 17055 tf a second lieratolder is listed upon satisfeaion. of the first 4en, the'first IlenhoMEV must (orwald this Tdk b ifle &aeau d htotpr Vehicles lvith the ' appropriate form and fee. SECONp LIEN RELEASED - - - • DATE. - - BY '. AUTHORIZED REPRESENTATIVE i I corWY.. rn al are dsM of issue. the official records of are PemsyNania Department C Tterrrportsrroe wllecr tlu2 Yw pwsarys) a wrrlpany ruarned herein is LIe teaAW owTre: of eIe said vslirla-. Secretary of Trmtsportation _". - - wtacweED AND SWORN r0 It a ta}puriGfasor other dlan your spouse is fisted and . BEFDRE ME: you want thB fide tti ;. he fisted as 'Joint Tenants Nfdh Right of Surviv rhi • ~~ u0 ~.,. AR ar p (pn death,of orle.- owner, tike goes t0 surviving owner.} CHECK HERE O. Otherwise the title . wiU be issued a5 'Tenants in Common' (On deagl Of one owner interest of i SIGWTURE OF PERS9N ADIAIN:S1ERrNG OATH , deceased owner goes to his/her heirs or estate . } ' : -~~ 7ST LIEN GATE: --~ IF ND UEN. CHECK ^ }r -~~1: II:S' I b 7ST LIENHOLDER _ ~Q EEEW STREET i CITY STATE 21P i FINANCAL INSTfTUTION NUMBER ~ ,~ ." t1 1 'I" ""~'s"+'ed ^B' M Tax=s anq.~u,n ro. ;en,care a Tae a ma ..r:cb eesl.~e~eo npore ' i 2ND LIEN DATE: • IF NO LIEN, CHECK ^ f ~J . s~ yec[ n ~Ne ercuw:a.~er rre mM. kyy cMwms uI brm Me. i 2ND LIENHOLDER " w / ~ ~ STREET ~~ V ! SIGNATURE OF A%~L:GNT Ofi AU rtpgIZED Sar ER I I CITY STATE ZtP ' :~.~ ~ ._..SIGIM1ViE~CO~Ar~fR1CANTTTLE OF AUrHORIZEO SIGTB:q c ~ FINANCIAL INSTITU71prr NUMRER j ~7 • _ • • _ e e ..., r • ~ <J 00 Motorcycle Trade-In Value & Price -Kelley Blue Book 3 HondaGg 7/8/09 5:39 PM _..__ ~ ~eY Blue Book _ _.~~___~__ __.~_ __ T 'TRU5TED RESOURCE ! ~~ ., -- - .,.t~~~ _ - -" ;ign [n ~ Create Account (My KBB ZIP Code: 17110 Recently Viewed You Might Also Like Free Dealer Price Quote dcomesa~K Latest Car News +;M Bankruptcy Reorganization Plan Approved More News "" Email . ": 13001U1fiRK ~" , ~.. atlvertisement 1-Cylinders 4 -Stroke 500cc Trade-tn ~atue (Good Condition) x2880 Trade-in Vas assum ngt aaccu~rarte appraisalcof cond ion f This values wi lolikely trade-in Uan you would receive from a private party sale because the reselling be less th the cost of safe Ins coons, reconditionin and other costs of dealer in~~ ess. Trade-in values are based on clean units in ood condition, doing busrn final standard equipment. Mileage/condition and g i ' nal with all orl9 ay have a substantial impact on the value shown above. eauior~~t rn NEXT STEP: Copyright $~~~ 2009 Edition. The mfomnYan in tfirs reportdis 5. 1 /2009- the personal use of the customer only and may not be intended fOr~tted to arather party. We assume no responsibility for sold or trans s errors or ortrissron Shopping Tools Motorcycle Insurance. uet Started! Get a R'ee Motorcycle price Quote Sell Yaur Motorcycle Motorcycle Sore Car Insurance Gas Mileage Champs Find A Car Dealer Best Car Deals S Great Car Deals Car Reviews Cars For Sale Cash For Clunkers FNt~~ K66 About Us Contact Us Careers FAQ Media .Advertising t,n;ciny Privacy Site Map Copyright & 7rademarics Terms of Service AfM~ 2ppg Kelley Blue Book Co., lnc. ® 1995. kbb•com/motorcycle/trade-in/ 1989/honda/gb500/69434 h «pa lWl"""r Page 1 of 1 ~ cle Values > Motorcvde > 1989 > Honda > GBSOO µom > Mo 0 1959 Hpnda GB500 Value ]uly 8, 2~~9 .__ _ _ _ ' CERTIFICAT ~ - E OF T --- _ . ITLE FOR A ~/EHICLE _ } _ _.. __--- ~2~~~:~~3~~~~32~2- t~]r - ~- = VEHICLE InENTIFICATION NUM6ER I - ~~~~~ ~~' M ~ ~~°?~3~ ' MI ~ ~ ~~~~'~ - AK CF VEHICLE • TIRE NUMBER ~ L ~ BOCV TYPE DUP~ ~ $ SEAT CAP + PRIOR 7fTLE STATE ~ OD ~~ ~~ ~ ~ ~ D~ ~ ~ ~ ~ .. OM ODOM STATUS 2114/c~5 { yl~~l#3 2 I I ~" ~ ~ t , DATE PA TITLED GATE OF ISSUE UNLADEN V.'EIGHT ... GVWR ~ f GCWR I ' T 7LE 6rlANDS - 'ODOMETER STATUS 0 ~ ACTUAL MLLEAGE t .MILEAGE El(CEEDS THE MECHANMAL - - LIMRS - 2 =NOT THE ACTUAL MILEAGE 3 =NOT THE ACTUAL hNLEAGE-0DOAAETER r TAMPERING VERIFIED - - REGISTERED CWNER(S) ~ ~+- 4 =EXEMPT FtiOM ODOMETER DISCLOSURE t+^ ' l ~ ~ TRLE BRANDS r J E D Y ;N I ~1A YA a,a J ,. ,.I.: ,. - ,~a:+'~'~ A = ANTIQUE VEHICLE G ~ .,~,~,«,: I 4 8 ~ ~l'at Y S U C K t E flat Q D COLLECTIBLE VEHICLE F_ pUr DF COUNrpy G ORIGINALLY MFGD. FOR NDN11.S. y £ 1i~~ /~ p p y~ ~L f~ t7 I ~ ~'~f A ~ ~ L S $ U{t ~ A ~~ ] OtSTRIBUDON V ( ~ ~ H = AGRICiJLTURAL VEHICLE = LOGGLNG VEHICLE P = IS/WAS A POLICE VEHICLE R = RECONSTRUCTED S = STAEFTROO '6 T .RECOVERED THEFT VEHICLE FIRST LIEN rAC^-= CF V =VEHICLE CONTAINS REISSUEO VIN , i w = yL000 VEHICLE ~ SEOOND LIEN FAVOR OF: X ' ~ 'WAS A TAXI f! a r3s s~ RRST LIEN RELASED DATE 6Y AUTHORIZED REPRESENTATIVE MAILING ADDRESS J~~ Y >'?iNAYA ~+~ }?©t~1=YStiIrICLE 13f2 !~rCHANICSBURG PA Z~355 if a second Gea»Ider is IisteU upon salisiaction of VIe'Test 4eh. "the firs! _ lienhdder must. toward His Title to the Bure3u.a Motor Venides.with the aPCrMxia.e fcmi antl lee. SECOND LIEN RELEASED DATE BY AUTHORIZED REPRESENTATIVE ® I certly as of the date d wJe, the olFicial records ri the Pennsylvania peparVnent of 1"rdnsponation reflect Btal Ble e • a ~ ~~ ~~: PNSO^(s) or company named herein is tlu lawful owner r J i4. • i IS."y^~ ~ i i 1 ~ r 1 .'glut,. ~~9'!'1 ~~A~?~1=Y I` ~lALLI)RY Secretary of Trar~portation JI:HSCRIBED AND SWORN TOBEFORE ME; MQ ~ DAY TEAF ~~ JY~ :ilCrUTUfi~ OF PER5Cl1 AOIWMSTERe1G OATH ~. ~'71 La .. ~~~~ ~~ ~_1 ~ ~ i //V I I V~ ~ t1e ugeJSgnep 1<rypy mobs . \ ~ a,ae- suDjeC m me encwnerAn,BS aM,oew br Cert:tyle ct T::x to Ih, . ~~~...e. c...x~wei \JMl! C Mp claims se: brU: M~c- w O ~ SIGNATIIac OF APPLICgN~09 AJ'H()<i Z'f` t ~J~J tit(Jy TO.4E Gr .;C;~.:YPLICANT,TIIIE OF A~71NJR!ZF"fl S:!:~:'c,• .'r.'. - - .__~ ..L: ~~~ -a r~ STREET CITY St.ATE [Ip FINANCIAL IN$ i ITUTlON NUMBER If a purchaser other than your spouse is bated and you want the title to be I'ISted as 'Joint Tenants With Right of Survivorship' (On death of one owner, title goes to surviving owrnec) CHECK HERE ^ Otherwise the title wdl be Issued as Tenants ih Common' (On death of one owner, nterest of ;deceased owner goes to histher heirs or estate). 1ST Lic'N DATE: - --~ IF NO LIEN, CHECK ^ 1ST LIENHOLDER s STREET CITY STATE Zip t FINANCIAL INSTITIlTIOfJ NUMBER '~ 2ND LIEN DATE: ~ IF NO LIEN. CHECK ^ 2ND LIENHOLDER 1982 Honda GLS00 Silverwing Motorcycle Trade-In Value & Price -Kelley Blue Book ~: `~ Kelley Bice Book ~;- THE TRUSTED RESOURCE Welcome Back ~ Sign In ~ Create Account ~ My KBB 7/8!09 5:39 PM 2IP Code: 17110 Recently Viewed Home > Motorcycle Values > Motorcvde > 1 82 > H n a > GL500 silverwirq 1982 Honda GL500 Silvet~ wing Value July 8, 2009 2-Cylinders 4-Stroke 500cc Trade-In Value (Good Condition) 6795 Trade-in Value is what consumers can expel to receive from a dealer for a trade-in unit assuming an accurate appraisal of condition. This value will likely be less than you would receive from a private party sale because the reselling dealer incurs the cost of safety inspectiorts, reconditioning and other costs of doing twsiness. Trade-in values are based on dean units in good cond8ion, with all original standard equipment. Mile / nditi n and a n I eguioment may have a substantial impact on the value shown above. NEXT STEP: Copyright O 2009 by Kelley Blue Book Co., All Rights Reserved. 5/1/2009-8/31/2009 Editan. The information in this report is intended for the personal use of the customer only and may not be sold or transmitted to another party. We assume no resportsibility for errors or omissions. You Might Also like free Dealer Price Quote Latest Car News GM Bankruptcy Reorganization Plan Approved More News °, Email BpptMRRK trr [~- Y_ t advertisement Shopping Tools Motor;ycle Insurance. Get Started Get a Free Motorcycle Price Quote Sell Your Motorcycle Motorryde Store - -- -------~-- --- • •••--y- ~•~~~~~w ~ ~~~.:.. ~a~ ~.ea~e~ oex mar ueais ~ c,reat Car Oeaic Car Reviews Cars For Sale Cash For Clunkers About KBB i+L~oul Us Contact Us Careers FpQ Media Advertls~ng u.^.king Privacy Site Map Cepynght & Trademarks Terms of Service ® 1995-2009 Kelley Blue Book Co., Inc. http://www.kbb.com/motorcycle/trade-in/1982/honda/g1500-silverwing/69202 Page 1 of 1 ~~ CERTIFICATE OF TITLE FOR A VEHICLE ~~ ¢_~ ~~ -i ` 'Yi~~ .~ ~ .. .... . ... ... .. ~~ 'clq~a'RC"`r°" N~ ` ~ Ma ._rEA._".,_ . ~..,. ~,_wa~oF. ., ~ .. ~' ~"`I`~` ,. ~ w ,.~ <,. IYiE ~' ~ tT11P ~ 6FJ1T CAF I rRIDR TITLE STATE ~ ~ OOOY. PRDCO GATE ~ ODDM MMES ~: ~ OOOM STATUE ~.., tJ rrq'rj .. OATE !•A Trt1ID 1 DATE OF 198DE 1 UNLAOEn wExin ~~. fiM ~~: °.'~.` ~ .,~' . ; ~/ r r: '` ,yt }~ i' vgFWrR of ty(tm~ J r .# £ `' ~~ r . +I^~ * t~' sty fi . f1 ' ~ ~ .,K M' Al+~F~3 ~;e P A 17 ~ ~II ~'=~ r ~~ ".x"°" i. ~` vatTOF: . ~ a~ ~ ~k, ~~ 1~ ~~ ~ ~~ N AUi-ORI7Z~ fNTATNE fMLMti ADDRESS ~?9~65 JEtJ V Mt'dAYA 48 H~?~IEY'SUGKLf P~ N4fGNANIC53URG ~~i 17~5Q ~,,a. *~' .. ~ ~ EI®IFT RIID11 ODOIEIeI DNQOllM1E ~ , ~ Tpt,E Mwlo. \ .~ . A ~ AM'IOIR Va11Ct ' , .~ C rC1A881{,Vaq,E '~,~ ~~E ~ F . Wf Of.ODLM111r ~~ i f O . p110MNLY MlRa010n NOMili: 19 r f may OERTtt~iS01 ., . r N . AGIrGR:TtM1i1L 1~.YE ' ~ .LC.anovaiae P . W WM. A /'OUC! Yd/C!i r ..TNitft Y6lglti. v . ws~ctFLpIMMY 1 vw w . ~ooo vaaa; r x ..f6twAS A 7MC SEODIq UEM FAVOR OF: 'R 5 ~ A q•a~ .. f~ ~. ` ' r ...mb YNiwd.r r tr re .~ tni ~t + Wrf~ ~ ~rrow.r ..w birM hlr Tw b-b tiww d Me~of, r~ ~ ~" i' ~Wr1Ol•b M. x 7 ~- ~ ~ '47 SEf~lO LB1 RESEAREO DYNE er AUTiOR~D REAF~NTATIYE 1 aAtr . w n. w. a r.... w. agar ~ a w. w~..rlwll. D.F.mw+ A L 1. E ~ [3 8 ~ E H 1_ f R w Twr~wwm Aw.e wr TIM paon(y a aamFra ~nw Iror r w rw o.Rrr w ti ale w+ar, ~f d Tn~rlrti *~ ~ ~ . ~~~ ~ ~ ~: ,~. rwry.r r..w+,~ ~rr+~• r c.w r Tr. r •..r~. anaA.i ~iwe wllrrawree~ww.r+rrr~aw~rr~wlw. _. ,MINT111E OF AMl1CNff OII MlIMOR® li0MH1 it ~ ao~pllrollwr dhM tlnn your MwuM r trtw ald you Twit taw tltls a b~ trra r 'Joint 7plrlr WMI tildlt d 81Mwatip' pn deitll d olr a+Yllr, ttil. qo.s a.I.w~illp owrlor~ t~i6C1CHEREO. gtlluwiN,, *1. rlr v.yt t» rwlw .. •r«w+r to t3ollnlorr toa~,dralp d oln ertrwi, UMorNt:d okl~wd oww poN b tlrRur F+rMrt or ~).. ' R TST I.IBI GATE: ~ ~.:: ~ yi !ID ttal C-IBCIt ~ ~~ . 1ETLBlgtDER ,. .. ~.. , sTREET y.s~~ > ti; crrV ` ~ STATTE ni ao 1~1 DATE: ~+., IF taD x, . 2!D LIEIii0LDl3i ~ ~`~~ ~'u4~. q. ,~ ~~ ~",~^~ ~h~. STREET 8 ~,,~ i 24 r,. ~J",y ~ ~ ~t,r 4 , ~', r ~ CIT11 ". ~ 3TA~1't'~'~~ aP 'r""~, P~~ude~ . fNiANCY1L MiSTiTUfION NUMBFA ~~~ _. _ ~ . , .. rF ::." ',. t ,., ^.,:"itltr:,~, ,. ':rt ^~ • ' .t. i. . I .-. It Ht .V% .pl ~ ~. .".?~~ ~s lei i, ~i rlF' .fmv-""ryF . ^ 1F, !_.<_._,~~u.4SfWa .:uTS1_ ji I DEPARTMENT OF TRANSPORTA'T'IO N ~ ';__ _ ~:C~t~=IFICATE OF TITLE FOR A VEHICLE ~~ i f ~`" ~; ~ 910520018000517-OOZ I . ~-~''' I ~ ~ 2302224636 I 70 I VOLKBWAGE{~I ( 2],306239706 MI w-. z .~ VEHICLE IDEN'i IFICATIOtJ NUMBER YEAR MAKE OF VEHICLE TREE NUMBER ~~ ~ MTRH I 0 ~ ~ ~ 8000 I ~ F ` BODY TYPE -0UP SEAT CAP UNLADEN WEIGHT GVWR GCVJR TI1LE BRANDS 511t1/70 ~ 2/25/91 I XX I 2/25/91. ( 020D07 ~ 1 _j 1 DF~ rE PA TITLED DATE OF ISSUE PRIOR TITLE STATE ODOM. PHOCD. DATE ODOM. MILES ODOM. STATUS ~-- ( --_--I ~ - ~ .'~ '. - u ~ M I L c A G E EXCEEDS THE - _~ o%^L~:`A'4^. ,.^'.tir. ,.~.1.'z ~~.iw .-, MECHANICAL LIMITS ,,. ODOMETER Sl'ATUS D =ACTUAL MILEAGE t =MILEAGE E%CEEDS THE MCGiANICAL LIMRS ....2'~i"NOT:TFfE+'ACT1)AL MILEAGE 3 . NOT 7HE ACTUAL MILEAGE - GDOMETER TAMPERING VEiiWED < =EXEMPT FROM ODOMETER DlsaGSDRE w~i - ~teclsTe;+E~owNER(s) , . - _._ .. .. . TITLE BRANDS JE D ~1INAYA . a~ E ~ L Y ROL ~ 19 W 28TH ST f ~~T~ CUI R, • f r a clrva s Mhcc I nR r,ON-U.S. . :~~I ~ H~INTIN~DON PA Zb65C rSfRl~„ ~,N hl AGRIC[3kTUAAL VEr1 ~~_F R ~ L = LSJGGING VEHICLE ~ .T ~ I : P « WRMERLY A POLICE ~'E":ui:LE ~ R ~ RECONSTFiC1C f`-'D '.~ S .STREET FkJG - ~ V£RICLE COrtTp UJS RC".~JED 4lN Y FIRST L'F N FAVOR O~ : T z fQRMERLY A fAxl _ SECONflT;lEN FAVOR Uf r y '' - M,a serbrtd lienholder is listed, upon satisfaction of the first lien, me ;Jrst -iRS' ~ :7 REL.FASEu _ lienholder must forvrard Ihis Title to the Bureau of Motor Vohirtes with the appropriate form and iee. OAiE ' ~ BY ~ AUTHORIZED REPRESENTATIVE SECOND LIEN RELEASE[r - " . j MAILING, ADDRESS ,: ;Pr h. .s. -. DATE Q . .S. °'I]i2 1~~~~:;>~!R519id'T:."'~veN«.'_rk:,~:t~'al~tk,,... ,. ... ~ JED MiNAYA BY AUTHORIZED REPRESENTATIVE 3t9 W 28TH ST ~. HUNTINGBON PA 26652 .:. - -_ %iL+FY wu' ic.r~.~V.T7t~C 1 ... - ~ I certify as of the date of issue, the oHicla! records of the Penns aria De '? ~ - Yh' partment of '-4 V. Tran spcrtetion reflect thatihe person(s)orcompanynamed herein-is the lawful-Owner - - _ of the said vehicle. , - , Secretar~ of Transportation = - - D. APPLICATION FOR TITLE AND LIEN INFORMATION TO BE- COMPLETED BY PURCHASER WHEN VEHICLE IS SOLD AtJC ih1E - APPROPRIATE SECT - y~. 4 .- . IONS ON THEREVERSE SIDE OF THIS DOCUMENT ARE COMPLETED. ' • •~^- ~- SU&SCRIt3ED AND SWORN TO BEFORE ME: When apptying for title with a co-Owner, other than your sQouse, check one of tMsa pocks.'p( no bock IB-thackry IiUe wig be Lgsued as ~ T t i C " '~ -s: , MO, cAY YFi1R , enan s n ommon. A ^ Joent Tenants wilh^Right of Survivorship (on rfeelh or one owner, title goes ~ . ,~. t b m9 SUIVIVIng OM'n@I). B ^ Tenants h Common (dn death of one owner, interest of deceased owner L - SIGNATURE OF PERSON:ADMIN15fERING OATH .goes tohrs or her•heirsar estate). ~~ ,~ - LIEN DATE: IF NO LIEN CHECK BOX ~ ; -• ~' ~ ~SI FIRSTLIENHOLDER . V J uuW 1~ \.i/ uW i"~ O J ~ .NAME :' . ~ - 6 ::: 4 4: ~~;'~ ld STREET . CRY STATE LIEN Th b e undersiyned here by makes application IorCertificate of Title to the vehkb described DATE: a ove, subject to the encumbrances and aher legal Claims. set forth here. SECONI ' r NAME MA ~ ~ i STREET - TFIORIZEO 51 _ CITY ZIP - IF NO LIEN (""~ CHECK BOX u STATE SICiNArURE OF CQAPPDCANLRITLE OF AUT^I.IEN _._ __ ZIP :~NSFEfY F Ow ERSHIP: FAILURE TO WAR N I N G L LT~ F MP O S S I - COMP RfS NMENT ETE OR PROVIDING R FALS E STATEMENT MAY R SU IN FINES ANDIO i` /4 Registered dealers must compels forms MVaTA or MV27Bb". ASSIGNMENT OFTITLE - requlrad b7i!ISFr. d twanmer- m NQT •'i•~•~ diralerc iAST FIRST M.1. Sectbn D on the front d Mibbrm must ba. compNted. , .: ~ PURCFERSFA OFt FULL /,//y~) 11We cerT}y. m the best et my !our knowledge Thal the odometer reading is ~~ l-~~ 'BU8WF.361NAAtE / / /lI L. tEnt"s X miles and reflects the actual mileage of the vehicle, CO~PURCHASER _ __._--__ _ _ _ _ _ _ unless one of the Following bozos is checked: S~~'"'~" ` ',.~oDRESS,- u h ~I r'N- ~ un ~ ^ Reflects the amount of mileage ^ Is NOT the actual mileage , TY C in excess of its mechanical limits WARNING: Odometer discrepancy I rCdYJe Y/~~•~ I / We tunher certify that the vehicle is free of any encumbrance and that ownership is hereby y - ~ )PURCHASE PRICE transferred to the persoMs) or the dealer fisted. , STATE ZIP (/ OR DIN SUBSCRIBED AND SWORN TO BEFORE fvfE: MO. DAV YEAR NATO SIGNATVRE OF PERSON AdJIMSTERING OATH. CO-PURCHASER SIGNATURE • PL1RCIrtASER AND / OR il7QPCIpCNA3ER MUST AUNDPIwM N AME HERE ~ L6 ~ ~.~~u ~ ~~ ! ~ ~j/ J l~-2~t! ~-% « l~ I 0~. -~. ~1-~c`- ~ ` ~ ' {~~ ~ i ~ Y" stcH~TUREOFSeuER ( ~, , ~_t, ._ 1.T9 Cyt~ 1 ~1 3~ ,, , . h Y ~ _ - r ', ~t ~ ` ~ ~ ~~` ~ `~^ r f t u;~ ._ 7, rl" 4~ F.~ r sl _ ~Ar SIGNA.'Ur1E OF COSELLER .SELLER AND./OR //~ I ~s '~ Gt t' . ! i ~r ` ~ ,„,M . .. . { i r Y . t[ / y !i •' HAIe01PR1lIT NAME HERE /a LC i 'E~ L~' ~ , • _ ~ ~ ~ ` ~ ». a reglstaretl`~salet...... ql. ~ tiaH of thfa hxm musf'bw:.- .'F.' _ = _ _ 1 I We certity, to the best of my /Our knowledge that the Odometer reading fs TENTHS LAST FIRST M.r. _ _ _ _ _ X miles and reflBCls the actual mileage of the vehicle, FULL ~ ~ ~ ~ artless one of the Folbwing bozos is checked: E e us erE ^ Reflects the amount d mileage ^ Is NOT the adual mtleaye COPURCHASER in excess of its mechanical limits WARNING: Odometer dlsttepancy STREW 1 ! We further cenily that the vehicle n tree d any encumbrance and That ownership k hereby ADDRESS transferred to the person(s) or the dealer listed. cm SUBSCRIBED AND SWORN 70 BEFORE fdE ' STATE ZIP PURCHASE PRICE ~ DW MO. OAY YEAR SGNATURE OF PERSON ADMINISTERING OATH PURCHASER SIGNATURE :R ~~~~„~ ~t ~,~, v ` ~ CO-PURCHASER SIGNATURE Q }- ~ I b~ C3 t v r ~ , ~~ 1§' PURCHASER AND / OR ~ . x~ .r Nr l, E ~~yy r~ r ,, [[.~ < 4 . ~ ~ a°..,.TF+ f ~ t Y. <~ ,~ - I ~i~ ~ SIGNMTURE Of SELLER h `:~ ~ • ~~: ~ ' .. , i ~4.A ~ -r^1. /GIIOPIY/Vl NAME HERE ~ ~ ~ - fired daiiiel~Section D,.~.. ¢dhf ol:this~fdrm:_ . , I / We certify, to the best of my /our knowledge that the odometer reading is . _ LAST FIRST M.1. TENTHS _ _ _ _ _ _ X miles and reRects the actual mileage d the vehcle, ~~I ~ RA NLL unless one d the Folbwing boxes is checked: E ^ Reflects Ne amount of mileage ^ Is NOT me actual mieage in exce s f it m h i l li it r'~R s o s ec an ca m s WARNING: Orbmaler tl raparlcy ~~~ I / We IurUter cerlily that Ine vehicle i4 free d any erleumbrance and that ownenh'p fe tleraDy iransfemetl t th th d l li ADDRESS o e per5oM5) or e ea er sted. SUBSCRIBED AND SWORN CITY TO BEFORE ME: STATE ZIP PURCHASE PRICE MO. DAY YEAR OR DW SIGNATURE OF PF0.CON AtSNINISTERWO OATH PURCNASER SGNATURE S~. ~ .. ~. „ r~ t' rte ~~i ~r1,J~l tiFx~'i'yi~.,~, ~~` ~' - C6PlIRC11ASER SIGNATURE a ~yx~ t 3, JC~G , E'rv r v~•~ ~/' / ~: ~ ~ ' Cf~HARSE AiUS~,T ~ . . t . ~t; ' T' S I(a1111DIPR/1Yf NAME HERE U) ~ Ya.~ v "3''1d+~:~ ~; -7 - ~'r'V~Y i ~. ~~. ~' ~ ~ y p 3 ~ { ~ A , T't SIGNATURE OF SELLER ~ •. Jr ^~~1x~~~4,. ~,~' _ NAAOPNWTNAkE HERE • ~ ~ ~ ... desler~ p1otT.must.p~i~ ' ~~ ' t , .:F .. .::9 ee ~ [J +"^ ' . 1 / We cerfily, b the beat d my / ow knowtedge that tM odometer reading is ~ LAST FIRST M.I. TFNiRa _ _ i miles and retracts the actual mileage of iha vetlids, PURCHASER~tYi FUII unless dire d the Folbwing boxes is Ct1aCk@d: Hl1SM1ESS NAME ^ Retletis the amount of mileage ^ N NOT IM actual mieage M excess of its mecharlkal Emits WARNING Od ' CPPURCNASER : ometer d I / We further cerltly that me vehicle is has d arty encumbrance and roar ownership i hereby Iranslerred to the peraorl(s) a the dealer R t d UORESS a e . SUBSCRIBED AND SWORN CITY. TO BEFORE ME: STATE Lp PURCHASE PRICE MO. DAY YFJ1R OR DIN SIGNATURE OF PE0.SON ADWNISTERMG OATH PURCHASER SIGNATURE L' i ~ '}-j'4' ~J 1~ f ~ ~ ' ' "" ! ~ ~ i ~ h , V ~ itS K }r F a~~! 1' ~ 1 9ak' ~ C6PURr.71ASER SIGNATURE _ .~q, CF ~s~~y-~ ,~+ }~+~j,~ Iya ~y ~~~.r. •T `f j ~ ~ ~ T ~:"~ ' ~ ~ :, . t PURCHASER ANDIOR ~ P ~]G-eA i ~ j 3 v („T j Q .- >tiV ' `d.~a;1: NANOPR~NAME HF .RE r ~ 1lIFtW Y.~T7 t(T rti 'y~~~j.~ SIGt1ATVRE OF SELLER T ~.yy ;tv 's~,H. T.7. rrs ~~: '1~ ~ ~ '~~~ SELLER MUST , ~;;. < NMpPR/NT NAME HERE F _'~~p.y ~ - P.~'~ °m ti m 0 m ~_ 2 Z r Z 2 m Q a Z O n 0 m a Z m Z _~, ~_~_ - E0=,42 i $ 2 2 51 ~ MARK W. LAUVER 313 362248395 y 70 SPRINGER'S LANE NEW CUMBERLAND, PA 17070 DATE.-- rt ~ ~ ~ ~- P.4YTOTHF "~~ r [ ~ - ORDcR OF ` ~. ~ •F _ s,- . s _... "~ •" -DOLLARS ~ 6.`a:._~-. _ •~ ~ ~~~~ '~ LISTENING IS JUST THE BEGINNING.:'" , ~:03L301422~: 3622 4839511• 225L _~~ ._,~. . I 1 _ _ _.,. - f : ils3Q8L•D2DDD~J76~.-DOb - ; i 1HGEC36~4KADb3177 - 198 ~ : .HONDA. _ .. ~ ~~54~74'6a©~ MI ~ VEHICLE IDEHi1FICATION NUMBER 1 YEAR MAKE OF VEHICLE TITLE NUMBER ~SDN ~ Cl I . ~ ilA ! 131/1,7/D~~ ~x~~~PT I w ~S EDDY TY PE DUP SE AT CAP PAIOR TRLE SATE f O!~C~i 7R~ ~~J. Cq~=_ Cam..... ~ ~E& lJ C~.._ 5,... W / / }~ / ~ DATE PA TRLED DATE CF ISSUE ::~7 - ' s...' - ..- ~~ --A! - ,.:c Z~% OOO~IETER QISCLOSURE° EX~M~-T~$~ F~D~RAL LAk RED19TERED owNEltge ~ y .. "~~~ - .lEO V MINAYA 7~~,-~°f'~°~>~, ' ~#`l HCNEYSUCKL~ Cfi - ~"ECHANICSBURG PA 1?[l5D ___ r.:_=a:m°.~ae=: ~_~ ~~7~~'7 JEt? Y MINAYA - 49 HQNEYSUCKL~ DR MECHANICSBURG PA b?~J~D . V?~ufi c ~~6"5t~<C.:Jr<'u:x.: Ly'.-~ - . ~t rrE 4,:..AL ei6~ -~}w.'z.+.yObE'^i T.T:E tIRAt::.s A . AfiT10t'E vesa.E '~ ~.w,~ D . DD{1FK1neLE VHNO,E ; ~, P-our avcoanm .~~- N . AowwLTUaAL vorcee L . Loooer¢ vorraF v . IswAs A vaLlce va~ctF R . RECONSTRDCTS. 5 . 9TP.F.ET .i0f. 7 . nEL`JYsP~D Tlg3'r 4'~f~!.E. Y7 . A.."L^s.' S'J~'~.La mac, r- X . i$VlAQ A TA?i :~+v_=r. ^-.s: ':-- - :^-t T:'a !t 7e 9~.:re~::t err_- ae^~.v-~s .r~,^ rs xsc orr, . ... ~~-t t. e.rk aa..d. w. er.'-ar ~S.!„! dfidal, racorAs a me Pernsyl~ d Tr~rporLfon rdM.i riM ew Pwron(s) or compz^'/ reme° neretii n "ifei"3:Gi0 uwwr ® d rr we wlrfl.. SUBSCRIBED MID SWORN To sEGORE tae Tt+e wad~glW ~AC- ~~ alirofon b L1YIb1e d Tr b M r.liclp bevbe a0cie. abpW b b ~ W wti9/ plbb ap brw 1lA. 71e1MT11~ a A/RIfJVrf p1.W ~HOR7ED 9101~R wiMTINF 6ODAPNIGfNfRn{E OF NIf1Ol$DIMiNEA _ _ ALl.~M 0 8I ~HL~R Seerela+7 ~ 7ra~epKtatios t K 8 oo•prlydraser other ttlan your spame is kited end you tyrant the title to'. ba ,bred es 'Joint Tenants WNft Right of Slxvivorship' (t'kl death d anal owner. title goes b survirirq owner.} CHEgC HERE ~. Otherwise. the gtlel j witl rye issued as 'Tenants in Gantrran' (Art death d one owner. intenlat af''. decessed owner goes to higher heirs or estase}. tliT UEN DATE • E NO LEN, CIicCK ~.. ~'~I . tST uE7MOLOBI srREE- CRY $iATE ~ ~ TleS IS AN ELT, DECK IiERE FII/AIIGAL . ~ NOTE FM REOURED ~ WSRTUTION NO. - - j ~MD LIEN DATE: • ENO LI9~ CH~K -... { 12IID UENMOLDER IYtY E TIPS E AN QT, CIECIC HERE NOT& Fei fEOUfED SPATE 2E FINAIMJAL e~TRITTION NO. <.~~ oNroai 09-031810349 ~.~-,~, PAY EXACTLY , . _ I~ ORDER OF ~lil~/~'~ ~ ~~~~ _. IIa1L71a/~ fY~ IV110111g101 MIOMIY R>•pla11i~1pI1a01107D11l11lr1i 011E I~ MMltw Odor Wlry Ottlar trod Oa'tiDn it a salvka twill d VNglre UdM MdNN~. IneRaf~br tt 1MY/s Fago Yalll6ner .harMw - DmlaMOrs, NA. 6raN Jmeym. CalaaAo ~: LO 2 L00400~: 40090 3 L8 iu ~4 y -r~+~ r^ ~ A W Q O - ~p _ z ~ 0 0 w ~ 4 .~.~„~ll~aal„,~~.~lll.aootl.~. PUfiCt1A4E AtaflEEAlEtlf: rw tlr parnasar +qM llna a « slaw IP8 OiOar ft l l h q F~~ > Yr:1~~~1 l~aa~ fie" inr al a! ^ 6 ~ 4s d tlaa y an. « ra a a w an, «rap ~ ana (2) va+ tavaa wa lau «wll p RS In ei~ "ra~:gt ~r~w tr y?aa+~.rfra.!i sY+eq~ tie.._~!~??3 r~l~ . ~n0 rou pwl0, lPS ftla ana~r ~.a~±!?!a!a.s,!!~c., e+ t-~oo-yw -.. tJ! * 003 1 8 1 O~4J ~*~ - 11111 II ill 11 lil 11111 i ~ I I II I Ills ~ ~; , ~y CERTIFICATE OF T1TLE FOR A VEHICLE __-_-.. ` RECONSTRUCTED RECONSTRUCTED ,372 0803500160D12D0 D01 ._ . :;_ RECONSTRUCTED' RECONSTRUCTED JHl1AK?432GSD47?9b ` 1986, HONDA ': ~. ~ I ,61323538006. !1I VEFaCLE IDEMFICATION Nl1AABER ~~ tdAKE ~ YEIi1CLE TITLE NUMHER SDN I D.. ~~ ` (.. NJ .` ~ _ 2/12108 053396 1 0 wL STATUS ,: aOOY„ IPE DUP ~ SEAT CAP PRIOR ,TRE STATE I ODOM. PROCD. DATE OOOM. Mr.ES oDO .. 1/04/d5 1 2112108 ;;.~. ::. EN NIEgNT ~ GVMIR ~ ~ ~... .. : .,~ OLWR .. .~ R , ;~ .: TffLE BRIWDS DATE PA 1TTLED 1 GATE OF ISSUE U10.AD , ~r ti RE>d1aTERED OrrN6ifSl- `fi'~_j ~. t•- tY _ .'~ 1. V.~~.. Y MINAYA. ~~ r~:•=t .rv.,: Ls-t,v,_s~I~~r.-: s.. A 4,$,~HONEYSUCKLE DR ~`. _ nEtHANICSBURG PA 17D50 ' itKRT LIEN iRVOR OF: RRST LtB1 RELEASED OA7E SECOND UEN FAVOR OF: ODOMETER STATUS O. ACTUAL MLEAOE , . MILEAGE EXCEEDS THE AECHANICAL ~' UMTS 2. NOT TILE ACTUAL MRFAOE a. NOT THE ACTUAL WLEMTE~OOOMETTtII - TAMPERa10 YERIfa~ s .EXEMPT FROM ODOMETER DISCL0811RE T,TiE tMiAY1DS A . ANTXXIE VEI•CL.E C . Cl/1881C YEIK:LE D . COLLECfIeIE VEIw1E F . OUT OF COUNTRY G . ORpRMLLY MFOD. FDR N0141i6. pSTRIeUTIDN N . AGRIC1A.TtXML VEHICLE l . LoocuNG vEHIaE P . iSAAIAS A POLICE VEHICLE R . RECONSTRUCTED S .STREET ROD ' T . pECOVERED THEFT VEItlCLE V .VEHICLE CONTAwS REISSUED VXA W :FLOOD VEHICLE X . IyWAS A TA%I e • saoand M•Ielder k haNtl upm wae,aUl•I: d tlIe het Yen. the IK•t YeIVlolder nelet blwwA rti• TiIN b M» Bureau d AAObr VehcMe wah to ' appropdele loan and M. ~, SECOND UEN RcI occn AUTigRIZED REPRESENTATIVE 161264 JED V MINAYA 48 HONEYSUCKLE DR MECHANICSBURG PA 17050 DATE BV AUTHOPoZED RIEPRE~NTATNE i ALLEN D BIEHLER - ~ I ae.wy as d aIe dllr d Uau.. er denial woad. d eIe PrmeyNari Department -~~ ' a TAragolaY•R rehea isI 4te pwaoe;N « tXteepry Iwnad twraal Y a rr wla Yaliob ttr kadut oeerr 5~J d Trallganatlaa - . • • urdlassr otl,er d,an your ePDUSe is paced and you want t11e tiYe b tlo M 6URttCIaR®AIO ~ a W pMed as 'JokM T yYp1t RipM d SIXWvorailb (~^ dsaM,I d olla j tple pons to aulvhNp owrlsr.) CHECK HERE O.OItlerwiw, tIM ipM orerlsr I : , wq De issued ae TenaMC MT Conllllon' (On death d orr oaarT, 41urest d l0 hlalller heirs or estate) I ~ . deceased owner pose '~~ P NO LIEN. CMEpt TST L.EN DATE ~. ~^7M r,. ... ~• C~1~WEr1L ~ Fi OF ~ NNSYI.VANW ,sr L,ENHOtnER :i: SCaI STREET Ndary r~J°L' - - N r Tftht@ . . . tYtty Co Sher $pting Twp., Cui!betland ~~, STATE Z1P ; ~_ M Q W ~'yt~-S, ~j~ E)~(P,$ ~J3~1. Zcar Lv~Z IF TIMS 1S ~ 0.T~CHECK HERE D WSTIMION NO ~ ~ . IAt;Tnbli PEf1f19 anla ASSOC~8tIOn Of NOtf.(k'S ~p LEN DATE: • W NO LI@I, CHECK l.., ~', ile .~7N u.uYl .rAw .opa•et es Q,elur a 7M. r er 4er OuuYYd ` eYp....Y/• r d! W WM..iw, W ar+ry a..>..a IeT Irr. 2ND LENHOLDER fit STREET ' ~`V ~Y STATE LP IF THIS IS AN ELT. CHECK HERE D FINANCUIL 7 TTON NO a.Tw*uaE of caePRieeHTrtrtlt os eUTHOW2O) aIDNeI .~.__... _...._~.. -,.- _, .... .. ~.. _____.___ . TTlf ' NOTE' FM: REQUIRED INS ___ sa. .~j _~=-, ., 5{'a N~. The Hartford Explanation of Benefits HARTFORD LIFE INSURANCE COMPANY If you have any questions after reading this summary, please contact our office at 1-888-563-1124, or at Benefit Mgt Srvs, P.O. Box 2818, Hartford, CT 06101-5302. Always use your claim number on any future correspondence or inquiries. PAYEE Barbara Minaya 48 Honeysuckle Dr Mechanicsburg, PA 17050 CLAIM FOR INSURED Jed V Minaya POLICYHOLDER FINANCIAL SERVICES ASSOCIATION 400 DUKE DRIVE FRANKLIN, TN 37067 POLICY NUMBER 20ADD003262 CLAIM NUMBER ADNSTER 4926173 Dori Bianchi SOCIAL SECURITY NUMBER CHECK NUMBER XXRXY0425 0000253951 DATE OF LOSS: 07/19/2008 BENEFIT: Accidental Death NOTES: 718973474 PA-9285 Form ELC-21-1 -. POLICY NUMBER 20ADD003262 INSURED BENEFIT AMOUNT: 5,000.00 TOTAL BENEFITS: 5,000.00 i DETACH AT PERFORATION Beneff3 Mgt Sros CHECK N0. 0000253951 62-26 P_D. Box 2818 DATE 08/12/2009 311 Hartford, CT 06107-5302 CLAIM NUMBER 4926173 Jed V Minaya 1011-09 MUST BE PRESENTED WITHIN 60 DAYS PAY }*F+VE THOUSAND AND 00/iD0**~~*****1E~***~~~***~~~~*** DDLLARS TxE DARTFORD $5000.00** To The Barbara Minaya Order of 48 Honeysuckle Dr ~~~- Mechanicsburg PA 17050 Chase Manhattan Bank Delaware Wilmington De 19801 - - --- ++'D000 2 5 3 9 5 i++• ~:0 3 1 LOO 26 7+: 6~ 30 15 10 1 1 5 50 9+-' The Hartford Explanation of Benefits HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY If you have any questions after reading this summar 1-888-563-1124, or at Benefit Mgt Srvs, P.O. Box 2818,pHartfordntCTt06101~5302e at Always use your claim number on any future correspondence or inquiries. PAYEE Barbara Minaya 48 Honeysuckle Dr Mechanicsburg, PA 17050 CLAIM FOR INSURED Jed V Minaya CLAIM NUMBER 4926174 SOCIAL SECURITY :YUMBER X)IIQIX0425 DATE OF LOSS: G7/19/200$ BEh"EFIT: Accidental Death TOTAL BENEFITS: NOTES: 651002296 POLICYHOLDER FINANCIAL SERVICES ASSOCIATION 400 DUKE DRIVE FRANKLIN, TN 37067 POLICY NUMBER 20ADD010900 ADJUSTER Dori Bianchi CHECK NUMBER 0000253950 BENEFIT AMOUNT: PA-9285 Form ELG21-1 POLICY NUMBER 20ADD010900 INSURED Jed V Minaya ~~' " Benefit Nlgt Srvs P_O_ Box 2818 Hartford, CT 06101-5302 26,000.00 26,000.00 DETACH AT PERFORATION -" `'~q+ m.. ~ ~ ter. c~`xt'ir~[~ ... _.. CHECK N0. 0000253950 62-26 DATE 08/12/2009 311 CLAIM NUMBER 4926174 1011-09 MUST BE PRESENTED WITHIN 60 DAYS PAY **TWENTY-SIX THOUSAND AND 00/100******~~*****.~********** TxE HARTFORD DOLLARS $26000.00** To The Barbara Minaya Order of 48 Honeysuckle Dr Mechanicsburg PA 17050 ~~~,~~" ~hase Manhattan Bank Delaware Wilmington De 19801 Authari~e~d Signature ~~'ODOD 2 5 3 9 50~~' +:p 3 i iO0 26 7+: 6 30 15 i0 i l 5 50 4i-' _ T __- The Hartford Explanation of Benefits HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY If you have any questions after reading this summary, please contact our office at 1-888-563-1124, or at Benefit Mgt Srvs, P.O. Box 2818, Hartford, CT 06101-5302. Always use your claim number on any future correspondence or inquiries. PAYEE Barbara Minaya Administrator Of Estate Jed Minaya 48 Honeysuckle Dr. Mechanicsburg, PA 17050 CLAIM FOR INSURED POLICY NUMBER Jed V Minaya 20ADD010901 CLAIM NUMBER ADJUSTER 4925866 Dori Bianchi SOCIAL SECURITY NUMBER CHECK NUMBER X~C0425 0000254908 DATE OF LOSS: 07/19/2008 BENEFIT: Accident Hospital In BENEFIT AMOUNT: 11,200.00 07/39/2008 Intensive Care Unit 10,000.00 TOTAL BENEFITS: 21,200.00 NOTES: POLICYHOLDER FINANCIAL SERVICES ASSOCIATION 400 DUKE DRIVE FRANKLIN, TN 37067 PA-9285 °orm EtC-21-7 DETACH AT PERFOAATlON CHECK N0. 0000254908 62-26 DATE 08/28/'2009 311 1011-09 THE HARTFORD Benefit Mgt Srvs P_0_ Box 2$18 POLICY NUMBER Hartford, CT 06909-5302 CLAIM NUMBER 20ADD010901 4925866 INSURED Jed V Minaya MUST BE PRESENTED WITHIN 60 DAYS PAY *~*TWENTY-ONE THOUSAND TWO HUNDRED AND 001900*~***~*~~~~~**~~~~ DOLLARS $21200.00** Barbara Minaya Administrator To The Of Estate Jed Minaya ~ /~ Order of 48 Honeysuckle Dr. ~~i.c,,.a.-f'.~s- Mechanicsburg PA 17050 Chase Manhattan Bank Delaware Wilmington De 19801 --- ---- Authortized Signature ~~'0000 Z 54908~i' ~:0 3 l LOO 26 7t: ~ 3^ L 5 LO 1 L 5 509~~• BOB ~ L. DEII~L Geneirai Contractor _ ~ - ~~ ~~ J~ ; :: , lf7-Aid-Gap-~oad .r flid TO T,.~. 'L ~. ~.. r a ~ . ,~ -~-~ ~~'' Get -~ ~. _ _: JOB ESTIMATE PHONE DATE _ _ ~--- ~ JOB NAME/LOCATION ~ Y ~~ ~`. _`/~~ r~ . t, ~. fi r` _........... _ ~ ~. F THIS ESTIMATE IS FpR COMPLETING THE JOB AS DESCRIBED. ESTIMATED ABOVE. IT IS BASED" ON OUR EVALUATION AND DOES NOT IN- JOB COST CLUDE MATERIAL PRfCE INCREASES OR ADDITIONAL LABOR AND MATERIALS WHICH MAY BE REQUIRED SHOULD UNFORESEEN PROBLEMS OR ADVERSE WEATHER CONDITIONS ARISE AFTER THE WORK HAS STARTED. 'ESTIMATED ~' % , _ ,%' : ~, waollCrzls ~wm.cmmn.wwmm.TOaarrHa~rou~~~ao-~saeo ao%Pre~ConsumelConteru •1096Post~ansunerCorNent COMMONWEALTH OF PENNSYLVANIA PENNSYLVANIA FISH AND BOAT COMMISSION CERTIFICATE OF TITLE TO A BOAT OWNER(S) NAME AND ADDRESS JED V MINAYA 48 HONEYSUCKLE DR MECHANICSBURG PA 17055 (SEE REVERSE SIDE FOR LEGEND) 0011447-0101 I 05/12/2009 ~ 10/09/1998 I ( [ Tide Number Due a<laws Date of Original lnue Tide Braatdr 1994 YAMAHA MOTOR WRA700S YAMA2331J394 Yew Maswfictsrer Model Hull Idenri6catioo Number N e~ ~~ ee Seri) Number Mwufietwer Hone Power Rating Serial Nsunber OlJ'fHOARD MOTOR (1) ' If a seaad isaholder u lead. ~ satbfacdast of the fiat lien, the fist ' FIRST LIEIVHULDER ~ Genltolder mart fensred tLb Tide m the Pemsylrania FiaA and Boat Commiuiat with the apprapdree form atd fee. 1 CERTIFY AS OF THE DATE OF ISSVE, THE UPFICIAL RECORDS OF THE PENNSYLVANIA FISH AND BOAT COMMISSION REFLECT THAT THE PERSON(S) OR COMPANY NAMED HEREIN IS 'f HE LAWFUL OWNER OF THE SAID BOAT. ,. -: !~ ~ ~"' 1PUCAT~ PA 8595 BK '.~ )uplieue PA 1te~rtrurleu Nmnbar ~ 9 1 4I 3 ~t 11 T ~ 1..~ Hd Prep ~Fini Use ~ ~ >R! I re MrsrSctuta fa ~ Horm Power R.dog' _ OU2HOARD MOTOR (~ - ~ : ~:;• :i4 _ .. ~ .iii ..~ 1st LIEN REI.F1lSED 'fir IN17E . •.~ BY AVI)IOR178D 4>!RfffidfATVE t: ::~ tad LIEN RFI EASED 1)rllE' ;: ': :+C '~ BY -_ __- AValORa7mTRillltlS@IfATVB ,~ -.. f $ ` 4 TEN DOUGLAS J ~ ~j ,~ ~•~, ~- 17LEClIt7VE DIRBLTOA :{ ' - ~ , ri ANY ALTERATION OR ERASURE VOIDS THIS TITLE ^~ J `V V .`f,~ V :~ r..-a.~a~rr~r_rtrrn)~i d~1Pi[rFi7'i1iT'Ttr1I ~.tN• rh >r M~ ~`d th rs ~ ~~ ,;. ~ DEPARTMENT OF TRANSPORTATION =;~ CERTIFICATE OF TITLE FOB A VI_HICLE ~~' ~ = 3.49 -- ___ -- __ _ - y _. I :.a ~~~~3~~b~~~~4~~-~~~ ~~. yCt~~~ __ _.~ I~~~f SC7.L7~~f~.~K 17"Li"=F[-..- -_~~~~~7~.373~~~~~ ~~.I . I -- ----- -- VEHICLE IDENTIFICATIOfJ NUMBER YEAR MAKE OF VEHICLE TITLE NUMBER .-~ _~ _ BOL)V TYPE T)W I $EAT CAP PRIOR TITLE STATE I ODOM PROGD. DATE OLIOM. MILE$ ODOM. STATUS '1' - --x~ _- -. DATE PA TITLED DATE OF ISSUE r ( GVW R G~ TFRE BRANDS .,F ~NLADEN WEIGHT ODOMETER STATUS .` r & ACT MILEAGE __ - ~~ r~+ :"T _ 0 MILEAGE ET(CEEDS THE MECHANICAL ,4 FtlSL4'L:Ck.1r.cS•~ar.59r3M1Y T^•::. tSY~.ni[{:1`i F`.t~;++tCr931'alE't~'y:~y, Y':cru 7131~:A~-~- 'UIJIIS[n. Pl-`,+.. ~i 2= MOT THE ACTUAL uu FACE ..y 4 ~, .. , ~ ~ 3 NOT THE ACTUAL MLEAGE ODOMETER flD~hl~T~R ; DIS~~DSUItE ~~X~*tPT $1' ~~t3ER~AL Ali ~ rn~FeNCVEawEO~:~ _ .= ExEhwr~ooouEr~D~osur~ P.EGISTERED OWNER(S) - (fit y y~ TTTLE BFIANDS~ . (1~ Y; T7 ~ ~ A I ~ ~ - A ~ AHTIOUE VEHICLE Y~- ~[j~(~~,i ~/ rV tn1 pp C . CLA SIC VEH1ClE }~ _ 4~ ,iTDJ+1EY-SU~T~.E. JR' D=COLLECTIBLE YEHlCI.E '; ~~, - ,, _ F a ~ ~ ~~~, C JyE ~J7ANIC SBURfi f ~ 1?gSS_ G>. pRIGINALLY MFGD. FOR NOKJ)s _ DISTFi18U T10N - :~. _ _ H : AGRICULTL/FiAL VEHICLE L LOGGING VEHICLE -. ' P : ISAYASAI?OLICE VEHiCL'E ~1. . P =RECONSTRUCTED S ~ STREET ROO - T =RECOVERED THEFT v6iICLE' ' 3 ;,~ V = VEr11CLE COMAMLS:REISSUED VttJ W ~ FLOOD VEHICIP -, - ~i7.iTilENFAVOROF: SECOND LIEN FAV X=IyWAS ATAXI OR OF: ~_ i ~ I i"y~~I ~_ H a secmd Ieirfloider w4sted r. I! ~A~ salislaction d dTe first ben. the fKSt". ' IierYldtler must forwartl ttus Tale to the Bureau d Mobx'VehiCes >nnfi thei' FIRST UEN RELEASED aPPropeiefe form erM tee - PATE s I I ~ ~:." AIJTFK)RI~DREPfiE,$EIVTATIVE ~ SEC01$~i UEN RELEASED rC.!k~d++~_. _ MAILING ADDRESS - - .r~:m->m~.~7.s'fLtx:::. dz,,,,.A.. ~ ~,~: ~--~ I • ~, 3 AIITT1pRIZEp REPHESENTATfVE ~ - ~ 4S Ht)NE75U~lCLI= DR ~~tHANIC58U~2~ PA ].?CI55 r= ~,. _ r y~ ~* ~7 ~j _ r 1 ~' Ac or the mw`d iarklo, Ile dficiAl records d.1he. PeretsyNarlia Defleronem U.ll ~ CJ ~ ~ i ~ i7 A L ~ U i\ Y ~ d Transpoltatgp re11eC ttlat Ihea,or canpary nertled heron is the IawfW owner '~= d the sad vehicle.. r ' ~~ ~ Tn~~~ Hof ~ ~ • ~• ~ ~ - $Uj~SCRIBEp AISD~ SMKJF*~l ,. ;. ~ Viflell eppYypiy ier tale wldl a, ooowfla[~ elfler alai yq+r Spouse, C11erJl ohed - . Tf~BEFORE ME - tfrose blocks.rno bbckuchecked. 6tlewiEbe esi,ed as.'Tmenbwi Cammn". ~„ +itting M~. DAV YEAR A ^ ~T ,~ d ~r,A~,~,~, dew d ~e~w~e,. ~e ~s = ation ..e Q Terwib n Common ton death d one owner, nrerosl of Deceased owrrer _ goasto his or F+e. heirs'or elute} It~nA __ SIGNATURE OF PERSON ADMWSTEP.ING OATH __J 1ST LIEN DAT (~~>: ~. • IF NO LIEri, CHECK =U ~~ 1y sue: r" iST UENHOLDEH ~ i i ~n ~ !II Q `r. i ; .~ STREET ' CITY STATE ZIP "I ~ _ \ FINANCIAL INSTITUTION NUMBER ~~ 2ND LIEN DATE: - ~ • IF NO UEN, CHLGK Tne urltlersgrred rre,eby nuMes apP-cation br Cemtlcate d Title to the vehicle tlescabetl ~ -~; aeoc, SuDreu ro tM encvrrArarK:es aria otlierbg>d dairris set tam tiara: - 2ND LIFldHpLDER ^?u~ ~~' ~ ~ STREET ~ ~. _ SIGNATURE OF APPLIGgrTr pp ALR11pR17FD'S!GNER ~:.• 1+. ri CRY ~ ,.. STATE ZtP ~./w ~.~} SH',NATURE OF ~-APPLICANT~TiTLE OF AUTHDRQED SIGNEli FINANCIAL INSTITlJT10N NUMBER ~ K ~~~ h ~0,6~ - ~'~/c 6~ c ~.~:~ ~;~ zQ lfl ~~ ~ ~ ~ ~ Ql OO ? c ~ [~ 1 K A +.~ 'J Q ~x~ *-' ~~, ~1 N e--1 ® ~ ~' ~ lD M ~ ~ ~ O ~Q m ~_ ~ a H c ~ ~ '.F/~ y. ._..._ REV-1511 EX+ (/-B8) SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Please Print or Jed V. Minaya 21-09~~0099 ITEM DESCRIPTION NUMBER AMOUNT. A. Funeral. Expenses: 1. John B. Brown Funeral Home, Huntingdon, PA 7,927.82 Foster Monuments, head stone 612.00 B. ~~ } COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT 1 2. 3. 4. C. 1. 2. 3. 4. 5. 6. 7. 8. Administrative Costs: Personal Representative Commissions _ Social Security Number of Personal Representative: Year Commissions paid 'Attorney Fees Herschel Lock, Esq. Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address City State Zip Code Probate Fees Cumberland County Register of Wills 147.00 Miscellaneous Expenses: Cumberland Law Journal - advertisement 75.00 The Sentinel - advertisement 191.16 (If more space is needed, insert additional sheets of same size.) TOTAL (Also enter on line 9, Recapitulation) I $ 1 6 , 1 3 6 .98 7,184.00 Browr~'s ~I JOHN B. BROWN FUNERAL HOME, INC. 417-419 WASHINGTONSTREET HUNTINGDON, PENNSYLVANIA 16652 (814) 643-1256 November 24, 2008 Mrs. Barbara A. Minaya 48 Honeysuckle Drive Mechanicsburg, PA 17050 Dear Barbara: Enclosed please find our receipt for funds received from American General insurance. There check in the amount of $5,690.00 pays Jed's funeral statement in full. Thank you for your confidence in allowing the Brown Family to serve your family. Most Sincerely, - Brown's - .~ i Cheryl Pf: itchey Office an ' er %C: 09010 Enclosure cpr FUNERAL DIRECTORS: ~~ Tr`"""`~~"'F"'I~,r~"' J. WILLIAM RUMBAUGH,SUPERVISOR SEL/E~CTED G ``~ L L ~ DOUGLAS A. HALLINAN I~eren~nt l.J ~ ~ ~• FUtiERAL HOtv1E THOMAS F BROWN A1emfKr 6v lnaimtiun ~' A / R FUNERAL ~~ ~ CL~. ~ r• i) Y1 j~'~(j~, CUSTOMER ! NAME OF DEC ED OR DESCRIPTION ACCT. ! NO.L_ RFROM FIRM ! ~A / R FUNEAAL CU R ! ^ -~_ ACCT • L RECEIV® No. _ FROM _ FIR ! John B. Brown Funeral Home, inc. J. WILLIAM RUMBAUGH, SUPERVISOR 417 WASHINGTON STREET HUNTINGDON, PA 16652 3ALANCE / ~ ~ -~7, iECE1VED Z ! „~(~,~ 1DJ. wIALANCE ~ /~j~,~ DATE ~" - 5 f7 ~ e Thank You! BALANC E` ~~.~Q RECCE ED - ~~-~S~-LCSL ADJ. ~' DUE __ ~ • r ~? 1~.;~8 John B. Brown Funeral Home, Inc. J. WIWAM RUMBAUGH, SUPERVISOR 417 WASHINGTON STREET HUNTINGDON, PA 16652 y__ .__(YI ~.~4y~ NAME OF DECEASED OR DESCRIPTION a. ~ ~ ~ John B. Brown Funeral Home, Inc. DATE Ol=: Browns J. William Rumba ugh, Supervisor .Death October 30, pp Q$ I Thomas F. Brown, Douglas A. Ha]linan Arrangements October 31, 20 ~>~ 477-419 Washington Street -Huntingdon, PA 16652 Funeral Ceremony November ~, 2p (Z~_ Telephone (814) 643-7256 STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Charges are only for those items that you selected or that are required. If we are required by law or by a cemetery or crematory to use any items, we will explain the reasons in writing below. If you selected a funeral that may require embalming, such as a funeral with viewing, you may have to pay for embalming. You do not have to pay for embalming you did not approve if you selected arrangements such as a direct cremation or immediate burial. If we charged for embalming, we will explain why below. FOR FUNERAL SERVICES OF Jed V. Minaya A. ALTERNATE PRICING METHOD Offering (q) $ C. CASH ADVANCES Cemetery Charges Rigergi.ew , .... $ 500.00 Cemetery Equipment ................. . $ A. CHARGES FOR SERVICES SELECTED .............................. Death Certificates # 15 _ 0 $ 6.00 , . _ ... • • $ 90.00 PROFESSIONAL SERVICES Fees to other Funeral Homes . Bache . F.H.... Znc.. $ 790 00 Non-Declinable Services of Funeral Director and Staff ..... $ 1,160.00 _ Fksrist Charges . , heaver, the ,Florist, , • • . • $ 212.00 Embalming ..................................... $ , Honorarium .............. $ 100.00 ........................ Sanitary Care .................................... $ Obitua Local ..... $ 35.00 ry - ............................. Restoration, Cosmetdogy, Dressing, Casket Placement Obituary- Out of Town Har.~Fisbu7rg, Patriot • • $ 10.82 and HairstyAing ................................ $ ~ .00 Telephone/Telegrams ........... ....... $ ............ they ........................................... $ Transportation Fees Common Carrier ................. $ TOTAL ........................................ S 1, 295.00 . Weekend/Holiday Cemetery Charges ................. $ ADDITIONAL SERVICES AND FACILITIES +NeekendrHoliday Vauff Company Charge .............. $ Use of Facilities and Staff Services for ViewinglVisitation .. $ 245.00 Other_ _ Single Grave Space-Riverview $ 500.00 Funeral at Facility, Church, or Other location and Staff Services .............................. $ 330.00 $ Memorial Service at Faality or other Location _ $ We may receive a cash discount on the above items except for and Staff Services .............................. $ , honoraria, for payment within specified terms Use of Operating/Preparation Room .................. $ . ;graveside Equipment and Staff Services ............... $ Sheltering of Remains .............................. $ Other TOTAL OF CASH ADVANCES ............ (C) S 2,237.82 $ D. SPECIAL CHARGES TOTAL ........................................ S 575.00 Forwarding of Remains ......................... $ AUTOMOTIVE EQUIPMENT .... Receiving Remains ...................... $ Transfer of Remains to Funeral Home ................. $ .......... Immediate Burial .......... . Funeral Coach .................................... $ Sedan for Funeral Procession ................. $ 110 00 Direct Cremation .................................. $ TOT ....... Utility!Senrice Car AL SPECIAL CHARGES ............. (D) $ 0.00 ................................. $ 70.00 Other E. ITEMS ORDERED LATER $ Death Certificat s • ... , .. $ TOTAL ................ ....................... S 180.00 TOT 4 ~ti ~ Clt~~ /. ~ ~ ~i£ CS AL CHARGES FOR SERVICES SELECTED ....(A) S 2,050.00 TOTAL OF ITEMS ORDERED LATER (E) $ ~~1 ~~' B. CHARGES FOR MERCHANDISE SELECTED ..... , Casket as Selected Kai estic - 18 >za. $ 1,840.00 SUMMARY OF CHARGES Protective by Matthews A. Charges for Services Selected or Cuter Burial Container Eagle Sentinel $ 1, 285.00 Plastic Lined Conc t V Cha es forAltemate Prici ~ ~ • • • • • • • • • • • • • • • • • (A) $ 2,050.00 re e ault Cremation Um B. Charges for Merchandise Selected .... . . . . .... . (B) $ 3 ,550.00 $ Gothing C. Cash Advances ............................ (C) $ 2,237.82 $ Sundry Items: Acknowledgment cards # ........... $ 30 00 D. Special Charges ........................... (D) $ 0.00 TOTAL OF ALL CHARGES Register book(s) ......................... $ 30.00 ................... $ 7,837.82 Memorial Folders ........................ $ __ 35_00 PAID AT TIME OF ARRANGEMENTS $ Prayer Cards .......................... $ Temporary Grave Marker .................. 30.00 ......... BALANCE DUE S ~s 7 cP~Z E. Items Ordered Later ~ ......................... (E) $ Cd. $ Total of Sundry Items TOTAL ACCOUNT BALANCE ................ S~IZ7, ~'Z ........................ $ 125.00 Mileage _ Greensbure PA [200mi S 1 5~ 300 _ 00 Cremation If any law, cemetery, or crematory requirements have required the purchase of any of $ Other the items listed, the law or requirement is explained ttelow: Cemetery $ Other requires cave-proof outer burial container. $ TOTAL CHARGES FOR MERCHANDISE SELECTED . (B) $ 3,550.00 Reason for Embalming: Final disposition exceeds 24 hrs . The undersigned hereby states that I/we have the authority to arrange for the funeral ceremonies of the above named deceased and hereby authc•rize John B. Brown Funeral Home Inc. to Earn sh the mer h di , c an se , professional services. special charnel anti r•.ash arNanrac ac cninrmri• ANNUAL FINANCE Amourrt Finartoed Total of Payrrterrts Total Sale Price PERCENTAGE CHARGE The amount of credit provided The amount you vwll have paid The total cost of your purchase RATE The dollar amount the to you or on your behalf. after you have made all scheduled payments. on credit, includi our down- payment of $ ~ Y The cost of your credit credit will cost you. as a yearly rate. % $ $ - $ $ Your Payment Schedule will be: _, No. of Payments Amount of Payments .When Payments Are Dti~ $ Monthly, beginning , 20 $ . Security: You are giving a security interest in the goods or property being purchased. Late Charge: If a payment is more than .10 days late, you wip be charged 5% of tFie payment, but rrot more than E5.00. C, Prepayrmmtr If you pay off early. You will rat have to pay a penally. ~' ~ See your contract below for any additional information about nonpayment, defauR, arty required repayment in full before the scheduled date. and prepayment refunds and penalties l" ""'s ~O"t'a`~ Foster Monuments, 702 West Fourth Street, the seder, Lewistown, PA 17044 •(717) 248-5322 You are, _ ~. the Buyer(s) ~; ~ • ; ..r If there is more than one Buyer, each of you wil be o legated, se~paratelyr d together, for aA sums due us and the performance of all agreements as provided in this Contract. The Terms shown in the boxes are part of this Contact. Under the terms of this Contract, you have agreed to purchase the following. property and its extra equipment, which is called the "Goods" in this Contract. WE REQUEST THAT YOU PROVIDE THE. FOLLOWING MARKER DIE BA GRAS ILLOW SLANT C-STONES ~ ~•.. ~ ~ f , . , .GRANITE POLISHED DIE SI E ~ , , : <„ c .~ BASE SIZE DESIGN ~{",~ ~,,_ , i z ~ ~;,., ~ , ;~;~ ~ ~ NAME OF CEMETERY '~~'~,, ,.,i,~ ,~ ~ ~ ~, # OF SPACES AND SET IT ON OUR LOT IN ~~ This contact is.between seller and Buyer. M disclosures have been made by send. Phone: ti ""~ w ~,~:. ~i'1 (,~ "~~ ~4 ltemization of Amount Financed Cash Price $ ~.~~ `~ Foundation Cost ~t ..f , 1 L ? c, $ '~ Down Payment - ~.. 1' Unpaid Balance Amount Financed ~-~'$'~~'+ ~~~ y MARKER WILL NOT BECOME PART OF THE .PERMANENT LOT UNTIL PAID IN FULL AhID CAN BE REMOVED FOR NONPAYIViIENT, BUT YOU WILL STILL BE LIABLE FOR PAYMENT. Inscription to be as follows: '~, ~ ~ ~> ~,,, c ~ ,~ ~~„~, t: ~t~+ ~. ~.~-~- T - j.~~t ~, ~••.r. By signing below, we agree that the inscription YOU ACKNOWLEDGE.RECEIVING ACOMPLETED COPY OF THIS is correct and that all dates, Hanle and IOCatIOrIS CONTRACT AND INTEND TO BE LEGALLY BOUND BY ITS TERMS. NO MARKER WILL BE SET UNTIL HALF PAID FOR. are also correct. ,. BUYER ~ ~" ~ : ~ ~~ 'r~_ ~,:.°. SELLER ~ ~ `~ ~ BUYER , ~: _ BY --°~ ~. ° ~.:.~,.. ~ '~+ ; ; ti ._ ~ ~ x ~,'~ DATE "'~ ~ 1 a ~t ~C,Cs i ~ ~ ~~ ~~ ~ i ~ O ~ ~ ~ - ~ . '~ ~,; ~ i 1 0' r,, t ~$ ,~ .. J ~_ Page 2 of 2 i ,, ,~ i ,i 1 i r `, ~ ~! i i i r t s i 1' `: i }! I t f t 3 ~. f I i ~n w. • ,~ i ~ ~~~- cC`/r` ~e~'J~ PA1fT+p TFIE O ~p f +Ili~llTf~'A~IE ~~. tt~t'~t?'~1 F~1R. .,ONLY +~20~414 ® Copyright 2009. The PNC Fnancial Services Group, Inc. All Rights Reserved. ~, f~,onlinebanking.pnc.com/alservletlImagePrintSaveServlet'?returns=N&date... 7/21 /2009 HERSCHEL LOCK REMITTANCE ADVICE ~~5 . Attorney at Zaw 313 (717) 238-6661 AA'' .{ 3.:107 NORT'EI FRONT STREET I V~ 6 Z 9 . HARRISBURG, PENNSYLVANIA 17110 ~-- ~~ j~ ~ AM UN _ . ~ i "`t T 1 O / c DOLLAR, CHECK AM( ~~~ ~.~~,.. r ©-MRtT$ANK-ManufacUuarsandTradersTrustCompany - ~ ' --------'~ AUTHORREO SIGNA7URE 11.006291u• ~:031302955~: 98421304i21r ,.. DAIS _ TO THE.ORDER OF v~ 3~ -~ ~ :~' err RECEIPT FOR PAYMENT GLENDA FARMER STRASBAUGH Cumberland County - Orphans Court One Courthouse Square Carlisle, PA 17613-3387 MINAYA JED V File Number: 2008-00099 Paid By Remarks: HERSCHEL LOCK JN ------------------------ Receipt Distribution Receipt Date: 4/27/2009 Receipt Time: 15:40:28 Receipt No.: 1039090 Fee/Tax Description Payment Amount Payee Name DISCLAIMER 15.00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 6382 $15.00 Total Received......... $15.00 RECEIVED APR 2 9 20~ +~ ~. .' RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Orphans Court One Courthouse Square Carlisle, PA 17613-3387 MINAYA JED V File Number: 2008-00945 ~ ^~ f Paid By Remarks: LOCK CJ ------------------------ Receipt Distribution Receipt Date: 5/07/2009 Receipt Time: 10:48:52 Receipt No.: 1039176 Fee/Tax Description Payment Amount Payee Name PHOTOCOPIES 3.00 CUMBERLAND COUNTY GENERAL FUN Cash $ _ 0 Total Received......... $3.00` RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Orphans Court One Courthouse Square Carlisle, PA 17013-3387 Receipt Date: 6/16/2009 Receipt Time: 08:47:57 Receipt No.: 1039584 MINAYA JED V File Number: 2008-00945 Paid By Remarks: HERSCHEL LOCK WZ ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name ANNUAL RPT GRD EST 15.00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 6844 $15.00 Total Received......... $15.00 ~+ ~'"Ayl ~~ ~y.~S' y!'~' ~Q `~ ~~ t::' .. ~.. ~~ n,1 s a `' ~~~~ J c'tiA~~, CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (71712493166 Fax: (7171249-2663 February 27, 2009 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and 6s designated by the Court of Common Pleas as the oifificia! legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Herschel Lock, Esquire RE: Jed V. Minaya Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: February 13, February 20. and February 27, 2009 Advertising Cost Proof of Publication Second Proof Request Payment received Total Amount Due $ 75.00 $ 0.00 $ 0.00 $ 75.00 $ 000 Becky H. Morgenthal, Executive Director RETAIN THIS PORTION FOR YOUR RECORDS SENTINEL - LEGAL BOX 130, CARLISLE, PA 17013 dBER CLASS 364347 10 PUBLIC NOTICES ~IESTATE NOTICE NOTICE IS HEREBY GIV THE SENTINEL - LEGAL TOTAL AD CHARGE HERSCHEL LOCK ATTpRNEY heckb 02/25/09 START DATE 02/11/09 LIONS RATE NET AMOUNT 3 LGL 191.16 191.16 3//0~ ~Gaa~ 36 * 2 DAYS RUN 02/25/09 ` PAY THIS AMOUNT 191.16 jed v minaya MESSAGE: Thank you for advertising with The Sentinel. 229.39* Deadlines for in-column legal advertisements: Monday is Thursday at 5 p.m; Tuesday is Friday at 5 p.m.; Wednesday is Monday at 5 p.m; Thursday is Tuesday at 5 p.m; Friday is Wednesday at 5 p.m Saturday is Wednesday at 12 Noon; Sunday is Wednesday at 5 p.m. If you have any questions regarding your Legal bill please call Classified Manager at 717-240-7176 Fax your legals to 717-243-3754 attention Classified Manager You can also EMAIL your legal to Classified ads: classified@cumberlink.com Please send a cover letter including your name and;~ddress as an attachmdnt t~ ~t ~~~~ ~~ ~ ~ 20Q~ REV-1513 EX+ tY-87J i' SCHEDULE J COMMON WEALTH OF GFNNSYLVANIA B E N E FI C I A R i ES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jed V. Minaya FILE NUMBER ~~_nA ~nn~A ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE OF ESTATE A. Taxable Bequests: ~' Barbara A. Minaya widow 100$ of 48 Honeysuckle Drive esiduary Mechanicsburg, PA 17050 estate ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY B. Choritable and Governmental Bequests: 1. N/A AMOUNT OR SHARE Of ESTATE TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS Also enter on line 13, REKapi-ulotionj I$ (If more space is needed, insert additional sheets of same size)