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HomeMy WebLinkAbout03-30-11 15056ZOZ05 REV-1500 EX loz-ii1!F;) PA Department of Revenue enns Iv OFFICIAL iJSE ONL!` P Y ania --- Bureau of Individual Taxes ~ `~`~~~ "'° ""` Countv Code Year File Ivumae- INHERITANCE TAX RETURN PO BOX 28060; Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~~ I ~ (~ i ~ (~~,~ <' ENTER DECEDENT INFORMATION BELOW , ..r Social Security Number Date of Death MMDDYYYY Date of Birth MMD[~YYY';' 203-52-4845 10/22/2010 12/01 /1960 Decedent's Last Name Suffix Decedent's First Name MI KECK BRYAN S (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name ~q NIA Spouse's Social Security Number THIS RETURN MUST BE FILED iN DUPLICATE WITH THIS REGISTER 4F WiLLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (G)ate of Deatr Prier to 12-13-8 O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax R'.eturn Required death after 12-12-82` O 6. Decedent Died Testate O (Attach Co of LVill 7. Decedent Maintained a Living Trust _ O _ $. Total Number of Safe Deposit Boxes py ) rAttach Dopy of Trust } O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113fA` Between 1?-31-91 and 1-1-951 (Atl.3ch Schedule O: CORRESPONDENT- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX Name INFORMAT60N SHOULD BE DIRECTED TO: Daytime ~'tvlenhone Number ROBERT R BLACK . (717) 243-3727 RESISTER OF VltiirLS USE ONLY' ~ :,? i ,..... . _.. _t ~ -t ,_ . (~ _ First Line of Address ~ i ~ ~ , . _' . 36 South Hanover Street . .~., , ~~ t _.t_ ±.~'7 ..-~ ~ r ! ~P -~~ : _ ~-- ~ ~ . . ' Second Line of Address ~: ~~ _ ,. ~ .~ ~ -~; -~. ~ , ....~ __ t . _.. , . •. ~; ~ ~,_~-,~ _i...t `~._ _. i F , City or Post Office , r ` ~ ' J ti':;~' i '?t Stage LIP Cade ~ DATE FILfi..i1:.{ ~,- Carlisle PA 17013 .~-- ~,~~ - ' ~ Correspondent's a-mail address: robtrblack@embargmail.com Under penalties of perjury. ! deriare that 1 have examined this return, including accompanying schedules and statements, and -a) the hest of my knowlenae and he,F• it is true, correct and complete. Declaration of preparer other than the personal representative is based on allsnfortnation of F~~hrch preparfir has ar~y Knovr4ecc- SIG RE OF PERSON ESPO SIBLE F(~R FILING RETURN ,/ , ~ C~.. r,/ j ADDR S.~ '~._~ / ~ 1 13 Win est r G dens, Carlisle, PA 17013 SIGNATU QF ;t .')'GNif= ~ nea c~t_ty cc~.~~rr~r~,.,~-. ADDRE `c: =~~ e 36 South Hanover Street, Carlisle, PA 17013 PiEasl~ us>s o€~rtGraAC. ~oRna oNt-v ~-... Side ? :~51~5~1Q105 15~7~#~1G~,L"ld~ ~EG~f~Bnt~S snCi£d! .~~C:ilrity #V~t{dirt':' !,~flGr~dent's Narr~ KECK, BRYAN S. 2p3-~2-4g45 RE~AP#TULATI©iv ..~...~.~......,...,~. ~ . Rea- Estate i ~crFedu-e ,? i .. ........... 0.00 2. s#ocks <3nd 8dnds lSche~ule B? ........ 0.00 3. C;asefy H~?#~ C;~,-~~rati;~t?, ~'artr•,ecsk~<,, ar ~ai~-Pro~!rifit;~rsh;p (-Schedr!ia Gi ;3 o.oa ~ ~',~'~^•f~^..;~C:°y ?J'c'~ t'~tf~iP.~', ~f?C;p1U:1. ~'~!A t „~.~('.f!QC{7 {~0 1 d O.Oa 1. i<.. ~. ~ J ~. '` ~ Eat i. Ce~:~<,i=~ ~„~' }.1~,;:;!-r-:4,. ~ ~ ;, + ,-,.. ..„ ~; ,~ ~:~., r,yc :4;, P . „~r:.~: ,.v „l'r~ia)r ~~.. ... _, 38,952.39 ~`. .1Cir?;it~ L1M'r crr :~rni;,ar•t~~ !jr nan„ic ~; 1~ ~e`D~r;;'tE' ~+,{Iit?n ~;~?i:I::E?~t E!'~ t; . 7. {:?ter-Vivas Tr .r15*ers & ivtrrrg{laneocls Nan-Fro~ate " rro~e -; 0'00 roc;":~~u1,4 fw, £~~ 5f'i?arar.e ~I!!ir?._, F>GGt.!e:Str;r{ n- 1,483.41 t5 T~tat Gross A:~sets fTni.a! t.i;,(es t '.!~r(„!c?', 7l . fi 38,435.80 ~t.liil?t .Yr L~Yt'.a~-,ca ~~ ~ 1 ~ ....~ .i ..~ ~:-%~ .~E7?iT!(:t r.~:Ytl4~FA 1 'nci,S f4.^i~..a ~~. tl~ f"~1 ,, ~~. ."""".. - - .. 14,719.40 ~~. l1rG iC h> ~?t C:RF 2 t:i . .. ~ :;E _ `it. ~~.~C"4".6,_~}a 1.;%3it,:}tiF:~", i3!':iv` ~1~/yti .`tir~t5x?Sl;~i~ {,( 1: . . 5,612.00 ifi. lotai t7ect~ctions rtnEi~i Lir:~s ~ and 1;~ : .............. . ............... ... ~ ~ . 20,331.40 ?2. Feet Valus of ~stafe (Line ~ mit~~{c Lsne i1 i . ... ~. l.~'i3fitr'i"?f8 _1rtFi {~~t~~'8fr?{i?Prlt~'~~ ESF' rf1P5#S"~$e': ~1i'3 Ir:J;itc 1Cif \4;r;;::'' {~? 18,104.40 _ 1 ? Q.Oa ",i. ~-!~:':::=mow.°-_~:. ,rs. ,y `: ' .. ._.. ,.:, . ~ .- ,,, ,.~; , , ~ ~ 18,1(}4.40 TAX Cr<t! Ctl~.AT#~t~ - ~~~ #~#S~'!~i~~^T#~J~S ~~R nP'#~E.l~r'4.~E_E RAT~~; .~.,.~-- ~...... ~•`.. Ht71(:N.ir1 of ~.~rtc 14 „x:;r?!' ffii!1 Jaf;f4 11 {~-;C~r.! ;:; i?t;, ~!1'i'; ;~:~{i.2? ~..;~45 18,104.40 ~2X<,hi. r, ~' 814.70 77. r~i7~~ilnt c: Lii-;e t~ t;~;~anie i o. a:itt}(1)1t of t_;nA 11 1:.)1~~'r1(c~ . 1`.:+. Tt~IX I.rt1E . .. z ~:~ 8'f 4.70 ;'. i,J. }"il.. i.. ~~ t~~ Z.J vii i~.. ~~" •1''~~.3 f~~`.~ %"~~~~~:?71~LS lit ~~i'~{4~k.1 L3~' 1$~'$ ~\I~Y~dj"'a~t~~a~`~~S i ?,~;il4la~,f~f~~~; F?F~;! ? inn cv ,cn t~ - Gecedent's Complefie Address: nECEL,FNT•ti tv~,r~ BRYAN S. KECK STREET AGGRESS 13 Winchester Gardens CITY Carlisle ST~,TE ~ f F~ PA 17013 fax Payments anti credits: 1. Tar, nine (Page 2 Line ?9) ~. ~reditS/Pa'Jmc?rii;: A. Prior Paymen# R, nlSCQUn' 3. lnteres~ 4. !f Line 2 is greater Than Line 1 + ~ ine 3. enter the difference. This is tine 0~/E~tt ~Yl4iirNT. fill in oval arr Page 2, Lire 20 to request a refund. 5. if Line 1 + Line 3 is oreater #han Line 2, enter the difference. Ti-~is is the TAX QUE. 814.70 Total Credits l A } B l='i ___ ________.________----___-_- 0.00 ~,~~ 814.70 Make check payable to: REGISTER GI" ~V1L~~. AGENT. PLEASE ANSWER THE E'~i.LOWING QUESTIt}NS ~Y PLACENG AN "~" IN TI-~E ARPRQPRiATE ~LC?CKS i Gid decedent make a transfer and' YP.S (yt1 a, retain the use or income of the property transferred ................................... ._-~ u, retain the right to designate who shall use the property tra; sferred or its income ............................. . .. ^ c. retain a reversionary interest .......... - d, re~:.eive the pror,~ise for life of either payments, benefits ar care? . -- ; 2. If death occurred after Dec. 12, 1 G82, did decedent transfer property within one year of ~!eatr withcut receiylnq adequate cansideration? ............................................ - 3. Cid decedent o~~~n an "in trust for„ or payable-:,upon-death bank account or s?curirr ai his or her death?..........., ~' 4, Gid uececlent own an ir?dividuQi retirement ar~c~~unf aria+.,;t,~ ~ - ~~ !__.~ ^ y Ur Othar rior?-prob«c~ properly, wr~t:~ ~ contains a beneficiary designation? ................................. !E THE ANSWER TO ANY OF THE ABOVE QUESTfONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FEL ~ J E .T AS PANT OF THE RETURN. For dates of death ot~ or after July 1. 1994, and before Jan. 1, 1995, the tax rate imposed an the net yaiue of transfers to or for the use of the survivine~ spnusn is 3 peroent (72 P.S. X9116 i_a! (1 i } (; ~' For dates of death on Or after Jan. 1, 1995, the tax rate imposed on the net value of transfe~s ~o o, ,or .he t„~~ of t.,,., surviving spouse is G percent r ~ r f t ~~o ho [72 P.S. &9116 ;a;i ;1.1'; (il)l. The statute does not e.Xemot a transfer to a sur~~~iving spouse from tax. and the statutor/ rE:quirements for aisciosure of assets ana filing a tax return are still appiicahle even if the surviving spouse is the only henet~riar; For dates of death on or after Juiv 1. 2C~OC!: • The tax rate mpose ± on the net y~lUe Of transfers from a deceased Child 2'1 years of ace or ,-ounaer at ....ath ~~, or r tf ~ ~ ~ ~ n. a tr, ~ r, rQ ; ,, a+soptiye parent or a stepparent of the chid is 0 percent {72 P.S. ~9116(a1(, .~;: `~~ `' fc. r~ s~, ~ .. na..,ra. ~.a. „rt. a: ~ ~,. • The tax rate imposed on the nPt vahae of transfers to or for the use of the decedent's lineal hPneficiaries is 4.5 perr_.en:, except as noted in ~i2 P.S. ~91~6ia1(1 } • The tax rate imposed on the net value of transfers to or fcr the use of the decedent's siblinns is 1 ~~ ercent 2 ' S. 9116 a)~1 3~- t' o• ~, under Section 9102_ as an in~'ividual who has at least one parent in rorrmon k'~ith tl,e decedent, v~~'izether "y b ~a~ or adonti ~,- , , '1 A sit~,inp is d.,tine,:. i ilf idt111~~ie?; P,E`~I-itiCo Ek- ' ~i i-i ~'~ ,.~ i p~lnnsytv~ni~l L~'tPP.RTiviENT OF ZE~IEi~4i IiVHERl'iriNCE TAX, k.ET~JHN RES;DEiVT DECEuE(J ~" CASH, BANd( DEPOSITS & MISC. PERSONAL Pi~ORERTI~ ' ESTATE OF: ---- FILE lwUMBEE~: KECK, BRYAN S. 21-10-1126 Include ttie proceeds of litiyation Arid the crate t;~e pruceeds Yvere received by the rstat~ Ali property jointly owned with right of survivorship must be disclosed on Scf~eduie l;. ITEM I - NUh1BER f)ESCRrPTION ' VAi.UE AT bAT~ IJF I~EATu 1. ~ Members 1st Federal Credit Union -Checking Account #344464-0011. See attached letter _ ~~ . 2. i Members 1st Federal Credit Union -Savings Account #344464-0000 See attached letter if~~ ~ r ; . . ~ 3.~J~5.?' 3, ~ Members 1st Federal Credit Union - Money Management Account #344464-0005 S . ee attached letter. i ~.n 1 Q ~ 4. I Metro Bank -Checking Account #537312647. See attached letter. ~ ~ 5 ;~ _., - i 5. ~ Metro Bank -Savings Account #626846703. See attached letter. ~ 2.C?0~ 6. I Progressive Insurance Co. -Refund ~ `161.uC 7, ~ Health Management -Refund ~ I 5t?.3~ g, ~ Chase Card Service -Refund i r~r, a6 v ..~ g, ~ Ameritrake -Payoff - 401K Account I 10. !Better Homes & Gardens -Refund ~~ J'~ ' i i (y ~ g1S.l~4E 1 11. ~ Union Fidelity Life Insurance Co. -Refund j ~ 3.t 12. j Myers Discount Warehouse -Sale of Personal Property 1 t 2.Jt'~~.2,' 13. ~ 2006 Dodge Dakota Club Cab SLT Pickup Truck. Fair Condition. See Kelly Blue Book & copy of title attached ~ r'.825.Oi`~ 14. i Mayne Myers Auction Service - Appraisal of Guns attached . , ~~ ,~ TOTAL (Also enter on Line S, Recapitui~-tion ~ ~ 3o.y~~.3~; if more space is needed, use additronal sheets of paper of tr,e same size. ri per~r~S~rt~a~r~ia ~ ~~~E~~LE ; `~-~aFTr.~; N i f..)F uEV~~dU_ ~ INTER- Y i Y ~S 1 ~ RANSFERS ANEW „~Nr=r;irahcE T;,>: ~aruFr~ ( NIiSC, N®N-PRQBATE PRQPERTI~ R:S1Lt~Ni il~Ctr_:tIVT 1 ~ ES7ATE QF - FIi.~ NU'MBEIi KECK, BRYAN S. 21-1()-1126 I li5 Sf;iIE:UUlC f11~5t ~!E C~rTlp~elell c}rlli IIi~J II file answer lu anv Ui dt!NS`if1Yi~ 1 t~rir'n~~nh is at. ,. _-~- -' 701'A~ jA}so enter on Line 7, Recapitulat:~n) $ ! ~ .d}~; if more space is ^eedec, use ad~;tiona~ sheets of nano + - ------- r r'-r O, the same si?e. ~~ p~r~~~~w~r~~~ ~ ~~~~~~ °F°pR".'"~~ "` FF`'F"`,F FUNERAL EXPENSES ANC3 lf~HERl1ARCE "(itiX RECUP,fv ~ ADMiNiSTRATIVE CQ-STS- RE,to~r,T ore: n~:-:- ESTATE OF ~ - FILE ~tUMfiER KECK, BRYAN S. 21-10-112Ei Decedent's de~1s must ~e ~e~art~d oa Sci~i~clule i. - iT~"h.! ~ TOTAL ;Also enter or• Line 9, Reeapit~lation} ~ ~ `f~,;T~~.~.~ Ir more space is seeded, use additional sheets of paper of the samz size. ____. -^- "' i pernr~Sytv~t~~~ DE?Aa,TMfNT pF gFVFryUE IfVNERITANi;c TAX P,ETU°.^J RESIDENT DE!'EDEl~T ~~~~~ ®EBTS OF DECEDENT, MORTGAGE LIABIi.ITIES $c LIENS C,INIC Vt BILE NI~MBEl2 KECK, BRYAN S. 21-10-112E~ Stepert debts incarred by the decedent prior to death that remained unpaid at the data of deat!-, irciud~ng e.Inreirnb:.~rsed er~edicai expense; ITEM NiihiuER j DESCRiF ~ iu~i ~ VALUE AT h3rc ~,~i Or DENT i ~ r MS Hershey Medical Center -Invoice ~ __ i . ! Gig. aC~ 2. ~ CBCS -Senior Care j 723.n~~ 3. j Hospice of Central PA -Senior Care ~ 7QO.Oi~ 4. ; U.S. Treasury - Retum VA Disability Payment -November 1, 2010 j TOTAL (Rlso enter can Lire ' 0, Recapitul atiar; ~ ~ f,i r,1 ~ !~I~° If more space !S needeh, !!15e1't a~d!tlpnai sReets o± the same SIZE, -1~ --- - L~EuN'a'.i"tctil C %?r,,r.!iilr INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE BENEFICIARIES ESTATE OF: KECK, BRYAN S. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).j 1 • Richard E. Keck, 13 Winchester Gardens, Carlisle, PA 17013 S.S.N. 20430-5640 2. Betty L. Keck, 13 Winchester Gardens, Carlisle, PA 17013 S.S.N. 186-30-6456 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Father Mother ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: I 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. FILE NUMBER: 21-10-1126 AMOUNT OR SHARE OF ESTATE ,,. ,. ~? %, ~~ TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ i_~ i? If more space is needed, use additional sheets of paper of the same size. MEMBERS 1St FEDERAL CREDIT UNION Landis & Black 36 South Hanover Street Carlisle, PA 17013 January 7, 2011 RE: Brian S. Keck To Whom It May Concern: Per your request the following is a listing of Mr. Keck's accounts and infor_-nation wi th Members 1St FCU. All accounts are in the name of Brian S. Keck alone, and balance s are as of 10-22-10. 344464-0011 Checking $763.47 344464-0000 Regular Savings $3045.11 344464-0005 Money Management $3010.21 Sincerely, ~~ ~ GL~~ '--~...~ `. Records Processor Central Files Members 1st Federal Credit Union 5000 Louise Drive Mechanicsburg, PA 17055 Telephone: (800) 283-2328 ext. 5115 Fax: (717) 795-6047 E-mail to: tobinl@members 1 st.org We put our members first" 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800 2g3 _2 • ~ 328 wwwmemberslst.org 'HETRO BANK 3801 Paxton Street Harrisburg • PA • 17111 mymetrobank.com 888.937.0004 January 14, 2011 Landis & Black 36 S Hanover St Carlisle PA 17013 RE: Estate of; Bryan S. Keck Tax Identification Number: 203-52-4845 Date of Death: October 22, 2010 To Whom It May Concern: This letter is in reference to decedent account information you requested for the individual (i=ted above. We are able to provide the following: Account Type: Checking Account Number: 537312647 Date Opened: 04/07/2006 Date Closed: 12/07/2010 Primary Owner: Bryan S. Keck Date of Death Balance: $15235.57 Account Type: Savings Account Number: 626846703 Date Opened: 09/12/2008 Date Closed: 12/07/2010 Primary Owner: Bryan S. Keck Date of Death Balance: $2004.51 Please feel free to contact me at (717) 412-6127 if I may be of further assistance. Sincerely i Diana Reynolds Metro Bank Research Associate/Deposit Services nnrc-IJ'LUl l t lv~! ir_~ v~ u~~.sTO~N B~~ A .?'raditYOn of Excellence March 15, 2011 Robert R. Black, Esq. Landis & Black 36 South I ianover Street Carlisle, I'A 170 ~ 3 Fax 241-4829 Re: Estate of Bryan S. Keck Social Security Number 203-52-4845 Date of Death October 22, 2010 IT IS HB~~Y CL~'TIFIED THAT THE ABOVE NAMED DECEDENT FIA1~ T.H. FOLLOWING ACCOUIV7' WTI'H ~ORI~STpWN BANK; CFIECKING ACCOUNT Account No. - 204000378 Account 'I~rpe - Direct' Dep Int Ck. Date Opened - 5/ 13/ 10 Joint Account (name/date) - Richard E. Keck 5/ I.8/ 10 Balance -- $4,483.40 Accrued Interest -- $.Ol Best Regards, Vicki L. Gulli~on Customer Service Specialist 77 East King Strcct P.O, box 2~0 Shippensburg, PA 17257 1.888.ORRSTOWN WENW~ ~ 6'1'3 ~~111I1'~.C01'S'8 `~.,., .LVU~~, Lanvt,a t.tUU L,d.p _ ~ raae In value, blue book v alp,.. Page ~ of 2 -___ ____ _______ Kelley Bfu~ Book THE TRUSTED RESOURCE __ klb.c~ ~ Send to Printer BLUE BOOK® TRADE-IN VALUE Vehicle Highlights Condition Excellent Good (Selected) Fair dd'vP.t'i=ISP_i71P_rlt Va I u e ~ ~~1~] $9,600 . , ~ , .; $8,950 $7,825 Mileage: 60,000 Engine: V6, 3.7 Liter Transmission: Automatic Drlvetraln: 2WD Selected Equipment Standard Air Conditioning Power Steering Power Windows Power Door Locks Dakota Extended Cab Tilt Wheel Cruise Control AM/FM Stereo CD (Single Disc) Advertisement ~' -r~~l li CaP ~~ ~,o- Dual Air Bags Alloy Wheels Check aut our hest available offers. 'it M V ;~ g ~ ~ .. ~ ~'~"5N- 1; w { y~~ ~ ~: Internet Price Build & Price Incentives View Inventory ' Get a Brochure Find a Dealer C ~5e Window Presented by: NAM .. - -_..~~u ~,~wu ~.ao SrL ~ Pickup 2D 6 1/2 ft *c r tyR 1 ~ ~ - - - --------~ .A.o.~,.,, ~f' tv; {,'''~~~~~~ CEI~TI1~~ICA~E OF TITLE 1 OR A VEHICI..~ , R ,,~'~ 3 ' . +. u' ki3t 4~ l'1~ S}t,11~tt" , u+.r•-~-+;:-•~.n.y'•-*-: .~. _-._ ....~.-..,......__ _.~ ~„".,..,,. ` ~, ~' r '~'4~ Ill ~' t t ~ 9 G r~, s r ~ rl'~, h /,}t ly l ~ ,C 5' ~ y ~ ~M +j 7~t4lth it, t ~ ~ h 4nr~~ r l~~ ~jr, S 4'1 4v~ ~ x r' r ..~ .. r. n •'i er . Yt/ , r • .t `' ` '~~~d6~,'~~!~~~Jf~CICI~i~*~~1~1 ... .. ,. ... ,.., _ ,. .. ,,. .,.., .. ~~ ~,1D7HE+~2K~I,b~S8~893~ '~ 2ODb ~' ~OD~E:;; bZ8561~[1Q1Q4....K~.. r .. , ~':V~AI$L~ IDENTIFICATION+IJVMBER YEAR ~ ' MAKE OF VEHICLE ~ I T TL z i. -~ ' ' I ~.NUMBEtj ~ ~, Lx ~ , Srti r{ ' :` r.:+._ ~~ ' t i Y a ~~~ ~ R ~pUP ,':~ .' ` ~~• . ,,. ~... ATE ODO P -'~ ,,,~. ., .. , . }~"~' $EAT CAP PRIOR.TITLE $T I~ M. ROCD.'DATE ~ ..QDO„1. MILES~~. `~ ~ '."'Crj4-„}.p^TA~•U ~'. w ~ •~:. •~: ,.. .; ~.. { T~ pq. E;QF,19$UE UNLADEN WEIGHT, ~ . GVWR L s+sr ~ •. , . h. GCbIR ~ ~ TIjLE,R3FlArIpS '', iir k~ I r.~ ~ ; ~ e , " + j: " ,I,,, ~ y s' , Ipt70MF'fER STATUS r^'xt~'~~'+dl t ~ ' 0 = ACTUAL'f,11CG l3~ ~.. I lr'~ tit tuf yl r ' 1 1?' ~ t .MILEAGE EXC!-EbS fH(c IAECH IQAJ_~ ~~ l+ 5 ~ r V~ LI T t}II Ml S 1~1< e st; t :; ~ ~' 2 NOT'T}IE AC7lJr M I, >I,S I ,°iri ~ ~~{' ~ ~krt: ~j• j 3~ ~ 3 a NOT~THEgF7UAL MILE~G~•o~bME>-E +~ ~+I '% ro§ i a r ,,~,,,,(( ~~~ '. TAMPERINQV£RIFII;QlS~~~~ ~~~4iir~'lY,i~~~, `# , ~ ~r a'w,. ' 4 = EXEMP7 FPOM ODOMETER DISCLO$UrSE ,~ ISili~lE'D ~N t~ > r , • rl ~ 1 ~,et y~cy~t' ` t ,t , .,r' r A{ '~'~ ~ ,TITLE'BRANp r ., dY°~~k. ~~~A~.~ ~D~~~'~l~,t'1 ~' 7 /+•l~:rr,i I, I ~ : f at~ f~, ~ ~ A tt.~T}CYL16 V~}iI~iLE~y/~. ~ 7.. ~ } ._-- ~~"~'`~>~~~.~~{~til``H~'~L'",f\;; fs•;rtx~t "~s ~' ^~t~ "~ ~~ ~b`;4~{ C .~C t C,~1C~,r~, ~r!~~;~l~Y~'JY ',. . _ .._ d + t tMr r . ' __:.. I-. "^ ~ ~ r'~ ~~ ~ Q K C,1OI..L£.C"T,I~s~A~~US,~' w^Nr~i~1~j' ~~i`It ~P i ~t 5,~~^ i x ~ v •s 9 ~.s` v }.s,_ ---II'-"---...a_ . _ _~.. ~.__~ _.._. L rf.-ulS1l1Y~E.(~C N7 Lt u ~vly~~~i 3~=_ ~~" , E 1 11 T'sA4q~ eXi`~~. ~~ r~'~~T :ST Tr ,,...F t'- ~ -~ ~,k..tf ~f~I'A`,d v :C+ e,', G = ORIGINALLY MFGD. fOR NO;J.,J S ~l rr S ti Y,t ] ~~:y?` ,,~,t. v~•,:~?T~ ~:t~F,t i DISTP,I6UTION L'~~ I''~'~.~ .:PA-' ~'1,7Db ~ '~ ' ~"a~~ H =AGRICULTURAL VEHICLE L .LOGGING VEHICLE' ' P = IS/WA9 A POLICE.VEFi1CLE "" R ~ REpONS7FIUCTEO,' ' • e '~ S =STREET RP4 ~ ` ~ ~ s ,. + D" ~ ? ,7 s RECOVE1iE11;THE~ YEHIG~ r , ~~ '' > V _ VEHICLE C!~N7AIKSfiEISS~IED V{N ' W o flC)00 VEk{(GLE ,' ~' ~IR$T. LIEN FAVOR OF I X ^ IS WAS A TAXI t .q - ~ 5,~'aa1~.~,++z , _ I x,'., . ' `; < • . `SECOND LIEN fAVOR OF: ~' w'•~ ,4 , ~ ~ , ~~ ~ fg ti4 . ~ i. 1 ti~ e ~ 4 v ~: + ~, ., P < 1 3m~~. ~t~~ ~ r ~ t~ ~ ,, , ~ i I ~,~ t 117 b~ _. N a second, nholder is listed .upon sstislactlq{t oT that first lien„ ~g pry4~i+~~ ~r1~t~i xl~~ Nentiolder mu ! lorward this Title to the' Bureau p{., , ti , t s;~~~ aFl $t)'1W`RELf<A$Eq Motcn-yehlcles syith fhb l~, r q~. aPProPriata form and fee. I ' + • , s ,~ ~~~5 s+yt{ ~ `{ T SY ~ SECOND LIFt;N RELEASED rt`5 1 {~ ~'a`''r ~ AUTHOAIZ~Q REPRES,ENTATIV~ ~, j y .. o>~M~R~N~, A~SIS ~;~~ i r D ~' ~; : _ DATE {~ ,..~• n~,< + ~ r ~ ; AUTHOFIZED RERRESENTATIVE , ~ kt r;','r k~4,'~ ` y ! ~i ~ ry `~^~~l~y~ ri~ARL~~StE~ pA ~?fl1~~ ~• ,. ~if ~ _s ~ I.;` ~ ~ ~ ~;,, r • ~~~td 'I :, , r I - , - ,,~~ ~ ~ - _F,~, .. u I,, of ~1~ ~tc ~j' ell, { `{ ,, ~~ ..' A l h ' • ~,~'-CerUf~lw'µegt4the :data nt laeue the official recrorde of the PannsytvayiaDepartment; ~LI_~~ ~~ ^1~ { R „ I~ . • pIpTTTranypo Ion re ec t a ~F'ie` persons of company named-FIAYeInTn the law u~'i-o-wiier ~ -"~" " --- ---~~_~ ~•w! ~?~~' f a, M1• .~ ~ y ~..•.,t of the said.vehfcle. -. ::- .,. Secretary of Tiarupo '.; ~ c c , . . f't.9ti0t1 :., ,•.. ;;~ .. StJ G~t-eED ANp.sw~ 1 1 k P ©~~~~~ r Es F; a' t iJfW If a co- urchaser other than your spouse Is (isted anti ou ,want the (rtle;to ' + 1,., ri ~~ittYt>4a~j1~:11t5~1, t,~~~~~`~ ~ ,1 DA ; • ;. be Ilstetl as 'Joint Tenants: With Right of Stitvivbr§hiRy n deaf 4 `! ~'st ~` ,~ *~ ~ ii "k ", + ..I vEA owtjier„titl~:9oes to~survivin' , w ~Q h ot~o ~ r, ~ ~~L t >. ~`~. ,a . x .°J ` will ~ 9 o nel':o CHECI~rH~RE [7; Qt~enll~ if-he"~Iil~ ~t j~ : , i ~$ l~' rr~ , f~~ , ( be Issued as "Tenants to ComiTl (p F ~ ~ al xt~y ~ ~~~x~ !~`,~t rr ~'r} ?tt:'(t' ,,', r', deceased.~bwner (! d~atl)rRf,on~' r'stet 8 t , oes to hisfitlr herra or, estate). tti ~ ,~ , ~j` ,"~ 5~ ~~ ~~~gqu! s, i J 'Yt " 1`~IP ~. '•~.~~~ nt441~~1~1 4 t ti ..1 ! 4 ,1 -i' l ~. j .: ~. rj ,, ,: r Y.,. ~ rT~ft~'t,: j ~';=~ Q 5 ~~t1 ~'''6i~+~'wSiy.:t•f ',j'!tr, r. t IF NOUEN,.CHECKO ISTHIS`ANEL. i. v.t~t c',4,k rt,~}tw ;dj+ =• .= ~1, 3 ' ~+~'4t,4n t;~ 7~'(IF~'E3.F'INRf;rgUIREDpr Y~$~/ ~f"~ [~~ ~ ~a t ;, I }~ 1ST UENHOLDER FINANCIAL INSTITUTIOCa NUMBER ~ ~~• ~+ { S + ~.''qY ~ II ~ ~ Q~r '~^,"i~~>r~ ~~'~ t!-~~~~'~~..~i~.,a:: 1 i~ "v fir{`+,:'" k.v).•'{' iST.L1ENHOLDEFI'NAME ;, .fit I tr ,x .r -~ ~ r~~ - ", +, Q {t STREET' r F=- ~- ~., ~ ~~ >< Py j ~ ~ _ CITY ~ ~ STATE ' '. t> ~'~' +~ ~~ ~ b~' ~~~ yp {~ r~4~5~ ,ray ~ ~ vahiclr 1F NO 2ND LIEN, CHECK ^ IS 71-11S AN EL'-9 IF ` 4 ^ :s ~ uW °M>lt~py"~^'a~"S~ngsJ"n 'd `. ( IYES Ft F)~q IRED) YES Q N~:(~r~5. V 1 •; s ', 7 n •. y; r ~y ~'~~ ~y~ tSivy ~ "' +{~r'~Y'~ ' ; 4 ' '. r : , , "t ,j N h 1 1,3 5<t s l ~}1Y ,,n., x }~ ~~## ~, ' , N '' ~ ~ ~ h' 4~~~ ~, ~ ate <} 4'`7 ~ 1; ~ i ND LIENH LDER FINANCIAL INSTITUTION NtljMi~ERi;`~tlitr ~ ti',~{~'~i, ta~J'tf~t4t~iti;J{~~i~l ' J{ r ~a3ty~~~ g~S .; r ~. ~ ..' ,:. r I I ~ b.~ i s ;~fi;,,~11 '~ ~~5.•' 1- s q rv j ,4~ r * s Y` r t. z. 2ND LIENH~(.DER NAti4E ~l h, s}t~ "`h ; ~t1~h "sl I '~' il~'t ~i'f35;~ I r' '+ ' ~` { ~LIGAf'I[.L~R,JI(/1'I~QRIZED SIGNER ! , ~1^ 4. i ~ t '` r l , te. , t t i~ tt t`ti~~~ilkkU ~ ~'A1i~= a.{ ; ~u~'~3 .~.+7j I F ° " ,:~ ~ STREET t .+y x 5r,~~ky~r~,1,' ~~ try ~ +~'7W'+~,`}~~1. ~~ t~~i~ ~'rt1t~E;OFCS}MPUC~INt/T77LF~OF AI)T1~OFiilEO SI(3N~Fi •~CITY ~ ~ - ' +'4r " --- /) 1'1 hid - r~r ~rrrraa `~w~' :+~,~,.h,....w'1t~. ~T~.._ :4klh,trr,t ,., ,v ...~. ~ .,, _ 'STA7 F.~. ~ ....._ ., ,1'S%',.~.-•I. . ~r a • AUCTIONEER WAYNE MYERS SERVICE 92 Greens Valley Road Land i sburg, PA 17040 Phone: 717-789-4264 Fax: 717-"x$9-4692 • APPRAISER A ~ ~L~~~ ~/ ~ ~~~ O I \I ~i~u ~ ~ ~~~ ~~ ~~k ~,~ ~~ ~7r~~;~~~ '~l~ ,cam ~ Cam ~ c~,e;, ~.~ SGc a -; ~ ~ fi ~; a ~r~ y - /~ Gb ~~ s- ~^~ ~~ , ~j~f cz ~~~ a_ crz ~eNti~cate I, the undersigned, do hereby certify that I have personally inspected the property appraised, that I have no present or contemplated future interest therein, that the fee received for' this assignment is in no manner contingent upon the value reported, and that no important factors affecting the value of this property were knowlingly overlooked or withheld. The information contained in this report is not guaranteed; however, it has been gathered from sources we believe to be reliable. The appraiser certifies that to the best of h s knowl- edge and belief, the statement, information, and materials contained in the appraisal are correct as set forth. I certify that this report has been completed in conformit with recognized industry standards. The a raisal ass' y not based on a re uested mi ~ pp ignment was q nimum valuation or specific valu- ation for approval of a loan. i~ SignE Firm Date KAS-660 ©1996 Kiefer Supply Co. Fergus Falls, MN (800) 435-2 27 6