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HomeMy WebLinkAbout04-01-11x ~ 15056041125 REV-1500 ~ (~) PA Department of Revenue County Code Year File Number &"'~" of ~"'~ T~`~ INHERITANCE TAX RETURN PO BOX2t1~171~.06p1 RESIDENT DECEDENT 2 1 1 0 0 1 1 0 0 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 4 8 2 8 3 4 8 5 1 0 0 4 2 0 1 0 0 6 2 3 1 9 3 5 Decedent's Last Name Suffix Decedents First Name MI B A L L J O H N H (If Applicable) Errter Surviving Spouse's information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number FILL IN APPROPRWTE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI ® 1.Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (date of death error to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of death after 12-12-82) ~ 5. Federal Estate Tax Retum Required T t t ~ Decedent Maintained a Living Trust 7 8. Total Number of Safe Deposfi Boxes 0 a e es 6. Decedent Died (Attach Copy of Will) 9. Litigatan Proceeds Received ~ . (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ~ 11. Eled'an to tax under Sea 9113(A) (Attach Sch. O) CORRESPONf~NT -THIS SECTION tAl1ST BE (XXiIPI.ET®. ALL CORRESPOlAF~It~ AND CONFIDENML TAX NIFORMATiON StiOUI.D BE DIRECTED TO: Name Daytime Telephone Number H A R O L D S I R W I N I I I E S Q 7 1 7 2 4 3 6 0 9 0 ~.~ Finn Name (ff Applicable) I R W I N L A W O F F I C E First line of address 6 4 S O U T H P I T T S T R E E T Second line of address City or Post Office C A R L I S L E Correspondents e-mail address: State ZIP Code REGIST~OF Ni1LLS U9E~ONLY ~"~ O ~.~ z, ~_~ x r- ~A ~ rTl I [ ;`.~ -~; ~~.y ~ c~a ATE FILED `F ~ ms's PA 1 7 0 1 3 Under penalties of perjury, I deda-e that I Move examk~ed ttus ret~xn, induding arxompanying schedules and statements, arxi to the best of my krrowledye and belief, it is true, correct and compl~e. Declaration of preparer other than the personal n:presentatne is txrsed on all information of which preparer has arty krxrwledge. SIGNA F PERSO ~BL~E FLOR IE(~NG RETURN ~ ~_D~AT _~"_ ~ 1 j 1 STREET KITTRELL NC 27544 DATE 64 SOUTH PItTT ST 15056041125 CARLISLE PLEASE USE ORIGINAL FORM ONLY Side 1 PA 17013 15056041125 J l 15056042126 REV-1500 EX Decedent's Social Security Number Decedents Name: JOHN H. BALL 1 4 8 2 8 3 4 8 5 RECAPITULATION 1. Real estate (Schedule A) ........................................ 1 0 0 0 2. Stocks and Bonds (Schedule B) .................................. 2• 0 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. - 0 0 0 4. Mortgages 8~ Notes Receivable (Schedule D) .....................:.. 4. 0 0 0 1 2 1 8 7 6 3 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 0 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 0 0 0 (Schedule G) ^ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 1 2 1 8 7 6 3 9. Funeral Expenses ~ Administrative Costs (Schedule H) ...... .......... 9. 1 0 1 8 8 4 5 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .. .......... 10. 2 5 8 6 7 7 11. Total Deductions (total Lines 9& 10) ................. .......... 11. 1 2 7 7 5 2 2 12. Net Value of Estate (Line 8 minus Line 11) ............... .......... 12. - 5 8 7 5 9 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 8 '7 '7 3 5 0 an election to tax has not been made (Schedule J) ........ .......... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........ .......... 14. - 9 3 6 1 0 9 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 _ 0 0 0 15. 16. Amount of Line 14 taxable 0 0 0 at lineal rate X •0_ 16. 17. Amount of Line 14 taxable 0 0 0 at sibling rate X .12 17. 18. Amount of Line 14 taxable 0 0 0 at collateral rate X .15 18 19. Tax Due - .:..............................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056042126 Side 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15056042126 REV-15RU IX Page 3 De~edeilt's Complete Address: File Number 01100 DECEDENTS NAME JOHN H, BALL STREET ADDRESS 1811 PINE ROAD CITY NEWVILLE STATE PA ZIP 17241 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty 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. 0.00 Total Credits (A + B + C) (2) 0.00 Total InteresUPenalty (D + E) (3) 0,00 (4) 000 (5) 0.00 (5A) (5B) ~ 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................................................... ^ a b. retain the right to designate who shall use the property transferred or its income; ............................... ^ ^X c. retain a reversionary interest; or ................................................................................................ ^ d, receive the promise for fife of either payments, benefits or care? ....................................................... ^ X^ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................... ................................ ^ XQ 3. Did decedent own an "intrust for' or payable upon death bank acx:ount or security at his or her death? ......... ^ Q 4. Did decedent own an Individual Retirement Acx;ount, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent (/2 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemat a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-0ne years of age;or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent (72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) p2 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whetherby blood or adoption. REV-1502 EX + (6-98) SpCH/~ED~UTL~TE A COMMONWEALTH OF PENNSYLVANIA REAL ES 1 N 1 E INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER JOHN N, BALL p~~pp All real properly owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which properly would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant fads. Real ro which is ' in owned with ri ht of survrvorshi must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NONE p pp TOTAL (Also enter on line 1, Recapitulation) ~ S 0.00 (If mon: space is needed, insert additional sheets of the same size) REV-1503 EX + (&98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT t51Alt VF FILE NUMBER JOHN H. BALL 01100 All properly jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, NONE 0.00 TOTAL (Also enter on line 2, Recapitulation) I Z O DO (If more space is needed, insert addfional sheets of the same size) REV-1504 EX + (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP JOHN N, BALL FILE 01100 Schedule C-1 or C-2 (including all supporting infomwtion) must be attached for each closely-held corporatioNpaMershipinterest ofthe decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NONE 0.00 TOTAL (Also enter on line 3 Recapitulation) ~ S O 00 (If more space is needed, insert additional sheets of the same size) REV-1507 EX ± (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES ~ NOTES RECEIVABLE ESTATE OF FILE NUMBER JOHN H. Bi4LL p~~pp All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NONE O. p p TOTAL (Also enter on line 4, Recapitulation) ~ p,pp (If more space ~ needed, insert addfional sheets of the same size) RI=V-1508 EX + (8-98) .SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER JOHN H. BALL 01100 Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule f. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MOBILE HOME (on rented lot) 1 Y00,00 s Value Based on Sale Price See copy of payment attached as Exhibit °B° 2. 1964 BUICK STATIONWAGON 1,100 00 Value Based on Sale price See documentat/on attached as Exh/b/t "C° 3. MISCELLANEOUS HOUSEHOLD CONTENTS 813,00 See auct/on reco-ds attached as Exh/blt °D° 4. BUICK LITERATURE COLLECTION 8,773.50 See documentat/on attached as Exh/b/t E" 5. METRO BANK 501,13 Check/ng Account No. 0536847841 See bank statement attached as Exhibit °P' TOTAL (Also enter on line 5, Recapitulation) ~ S 12,187.63 (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (B-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN ESTATE OF FILE NUMBER JOHN N. BALL 01100 Han asset was made joint within one year of the decedents date of death, it must be reported on Schedule G. SURVMNG JOINT TENANT(S) NAME A. JOINTLY-OWNED PROPERTY: TO DECEDENT ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET 96 OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTERESI 1. A. NONE O 00 0.00 TOTAL (Also enter on line 6, Recapitulation) I S 0.00 (If more space is needed, insert additbnal sheets of the same size) REV-1510 EX + (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER JOHN N. BILL 01100 ThLs schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY u+auoen~wu~oFn~rRr~,iFiEIRRflATIONSYgPTODECEDENTAND ~"E°"h°F'R/'"s~R"mac""c~w°F'"E°EE°F°RR~ES~"~. DATE OF DEATH VALUE OF ASSET X OF DECD'S INTEREST EXCLUSION nF~wPUC~ TAXABLE VALUE 1. NONE 0.00 0,00 TOTAL (Also enter on line 7 Recapitulation) I ; O,Op (If more space 's needed, insert additional sheets of the same size) REV-15'! 1 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES ~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER JOHN H, BALL 01100 Debts of decederrt must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HAWTHORNS FUNERAL NOME348,00 2. KENSICO CEMETERY 1,529.00 B. ADMINISTRATIVE COSTS: ~, Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(suEIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2, Attorney Fees IRWIN LAW OFFICE 3. Family Exemptan: (If decedents address is not the same as claimants, attach explanation) Claimant Street Address City State Zip Relationship of Claimant ~ Decedent 4• I probate Fees CUMBERLAND COUNTY REGISTER OF WILL8 5. I Acxountant's Fees 6. I Tax Return Preparers Fees 7. CUMBERLAND COUNTY TAX CLAIM BUREAU - Outstanding Taxes on Mobllehome 8. MABEL STI7T, TAX COLLECTOR -Outstanding County and Township Taxes 9. J.C. TAI/I.OR, INC. - Automo6l/e Insurance 10. DIRTY DOG HAULING -Trash Removal *iom Residence 11. JOHN H. BALL, II -Executor's Trave/ Expenses 12. EOWE'S AUCTION SERVICE -Auction o/ Persona/ Property 750.00 127.50 292.10 329.32 8200 475.00 1,985.98 239 55 TOTAL (Also enter on line 9, Recapitulation) ~ ; (If more space is needed, insert additional sheets of the same s¢e) REV-1512 EXa+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS ESTATE OF FILE NUMBER JOHN H. BALL 01100 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. SHIPLEY ENERGY 185.81 Utility BI/1 2. CENTURY LINK 179 34 utn~ty em 3. KUHN COMMUNICATIONS, INC. Utility BI/I 4. ZIMMERMAN AUTO REPAIR Outstanding Car Repair Blll 5. VERIZON Outstand/ng Phone BIII 6. CURRIE 8 HECHT ORAL SURGERI~ Medics/ Blll 7. KINETIC IMAGING Medlca/ Blll 8. PINNACLE HEALTH Med-ca/ Blll 9. MOBILE HOME PARK Rent owed for n~oblle home lot TOTAL (Also enter on line 10, Recapitulation) I S (If more space is needed, insert additional sheets of the same size) 37.73 247.33 148.40 355.00 120.00 13.16 1,300.00 REV-1513 EX + (9-pp) ` SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT t51Alt VF FILE NUMBER JOHN H. BALL 01100 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [ndude ou ' ht spousal distributions, and transfers under Sec. 9116 (~a (1.2)] 1. JOHN H. BALL Lineal 136 Church Street 113 Residue - Kittrell NC 27544 2. SUSAN B, KUNKLE Lineal 3690 Stark Street 113 Residue Eugene OR 97404 3. VIRGINIA B, iANORELLA Lineal 77 Lakeview Avenue 113 Residue Clifton NJ 07011039 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. NONE 0.00 B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. BUICK LITERATURE COLLECTION 8,773.50 Bequeathed to Bufck Heritage Alliance See Inventory and appraJsa/ attached as Exhlb/t °F' TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS~ON LINE 13 OF REV-1500 COVER SHEET S 8773.50 ilr more space Is neeaea, Insert aaaltlonal sheets of the same size) ~~ ... _ ` i n..~:_ V! ..i..• LAST WILL AND TESTAMENT 201 ~Q~ -4 PM I ~ 3 I ORPHA IR'S ~0(;Ri I, JOHN H. BALL, of 1811 Pine Road, Newville, Cumberland County,. ~,21~q do hereby make, publish and declare this to be my last will and testament, hereby revoking all wills heretofore made by me. . 1. I direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. I direct that all inheritance taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property, whether or not such property passes under this Will, shall be paid by my personal representative out of my estate. 2. I direct that I be buried in the Ball Plot at the Kensico Cemetery in Valhalla, New York. 3. I direct that my daughter, Susan B. Kunkle be given an advance payment from her share of my estate to cover travel expenses to attend my funeral. 4. I authorize and empower my personal representative to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefore, in fee simple, as I could do if living. My representative is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said representative. 5. I give, devise and bequeath all of my estate of whatever nature and wherever situate as follows: A. To the Buick Heritage Alliance, the following items of Buick memorabilia: 1.) My complete collection of Buick automotive literature from 1906 forward; 2.) My complete bound volumes of the Buick Bugle magazine; and 3.) Any Buick related books or magazines that my personal representative deems appropriate to be donated; and all the - B. Rest, residue and remainder to my children, share and share alike,. the child or children of any deceased child taking the share their parent would have taken if living. 6. I nominate and appoint John H. Ball, II to be the personal representative of my estate, to serve without bond. If he cannot or does not serve, then I appoint Susan B. Kunkle and Virginia B. lanorella to be the substitute personal co-representatives, with the same powers and also without bond. 7. t suggest that my personal representative retain the services of Harold S. Irwin, III, Carlisle, Pennsylvania in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 29~' day of September 2008. H. EAL) Signed, sealed, published and declarede above-named person as and~for a last will and testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses... ACKNOWLEDGMENT AND ,AFFIDAVIT WE, JOHN H. BALL, SARAH A. HARDESTY and KATHRYN M. MULLEN, the testator and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his last will and that he had signed willingly, and that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the will as a witness and that to the best of their knowledge the testatar was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND '; ~' ~~ ,. .: i ~l.O N H. BALL ~_.."" 4~ f SA A. HA ES ~~ KATH N M: MULLEN :ss: Subscribed, sworn to and acknowledged before me by JOHN H. BALL, the testator herein, and subscribed and sworn to before me by SARAH A. HARDESTY and KATHRYN M. MULLEN, witnesses, this y8~'' day of September 2008. / n ~a~ ray I COMMONWEALTH OF PENNSYitiVAN1A NOTARIAL SEAL Harold S. Irwin Iii, Esq, Notary Pubiic Carlisle, Cumberland County MY commission expires Febnrary 06, 2411 Notary Public EXHIBIT ••B" N N ~-1 V) R F Q 0 L ~~ /\~~ l ~ { O -~ ~ N ~1 N V wz ~~ ~~ ~ ~~ z~~ c W ~~a W~t;N~ Lt~~-~! ~ ~ ~ 3 a~~~~ L fL N a a s ti .-~ r~u EXFIIBIT ^C°' 12.7.10 This is a letter saying that: Leroy Eschelman 1226 Pine Road Carlisle, PA 17015 PAID IN FULL OF $1,100.00 to: Jack Ball 136 Church Street Kittrell, NC 27544 _Sheck #: 042830 ___`_ For the purchase of the following: 1964 Buick Station Wagon Skylark. As is. Thank You, tk Ball -Date ~~~~ ~~ Leroy E Iman -Date ROWE'S AUCTION SERVICE (RH 79L) Bill Rowe (AU 1538L) 2505 Ritner Highway Carlisle, PA 17015 Dave Rowe (AU 2295L) 249-1978 69?-4784 249-26?7 Auction Is Action Call KR.owe" F r Satisfaction ~s-~~ d~ d~ ~~~ SELLEE.S NAME _~ ~ DATE ~r~3-1d ADDRESS ~~m ~~.y-- /~-c.~. 1 3 b ~ 11~4~u..~r i ~ PIiONE~ OTHER ~ ~~ ~-:' Z M-«-,~ AJ c 1"I S"y~ AUCTIONEER % ~~ AUCTION DATEILOCATION ~0 ~S Z ~?,, ~ CLERK 96 DESCRIPTION OF MERCHANDISE ~'"`'"`'~ ~~"S / __ ~~ r~nf~ ~ ~m,c.-. Lam, r ~fn ~~ MaA l{ ~' ~/~'A ~v J 1~t ~~ .3'' ~eaTers I Com~iission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise to be sold as is & grouped as necessary to obtain bids. I certify that I am the owner ~ authorized r~resen- tative of the merchandise, goods and or property and have good title and the right to sell and that they are free from all incumbranees. I agree to accegt all responsibility for providing merchantable title and for delivery of title to the purchaser. I agree to hold harmless the Auctioneers agaiast any claims of the nature referred to in this agreement. ~~ i. ~ _ il~O~z AUCTION SIGNATURE SELLERS SIGNATURE Total Sales {Clerking Tickets Attached- $ ~~_f Less Sale Expense: ~ S ~ 3 ~' % Commission Auctioneer $ °~o Commission Clerks $ OTHER: ~u-A-~.c C-Q ~'- ~-S ~^ p, ~~ ;--- TOTAL SALE EXPENSE DEDUCTED $ ~-~ t SELLERS NET $ 3 ~ ~ ~-~'"-~ METRO BANK >07420 6656607 001 092140 JOHN H BALL OR MARK F BEARER 1811 PINE RD NEWVILLE PA 17241 t s~ a~ l~~ 3801 Pardon StreeR tierrisbtug PA 17111-1418 -88&937-0004 rnyrnetrobankaorr, W~a~+e Mre 7 days a +vrret4 24 flows a day at 1-8dd-R1T-0004. Check Transactions ffNa>>t>K Dais fltrrwwd Nunrbsr oat. Amount Date MauM Nams danolea with an'E' ars atectroris erMries and wtfl not rr.vs a ohedc inage. deno0ed wMh an -" rdica~ pocesesa abate a,c of aequaree. 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