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HomeMy WebLinkAbout08-25-11INVENTORY REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland SS File Number2011-66~'~ ~ ~, Personal Representative(s) of the Estate of Nicholas Jon Majerchik deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memor um at the end of this inventory. ~- I verify that the statements made in this Inven- ~ ~ _ tory are true and correct. I understand that false state- ~ ments herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. Attorney -- (Name) Timothy A. Holmes (Supreme Court I.D. No.) 87758 (Address) 122 S. 16th Street, Camp Hill, PA 17011 (Telephone) 717-343-3256 DATE OF DEATH LAST RESIDENCE DECEDENTS SOC. SEC. NO. May 25, 2011 168 Carol Street, New Cumberland, PA 17070 175-44-1510 FIGURES MUST BE TOTALED ING Direct-savings account, account number 40830744 Toyota Highlander-2004 Lexus RX-2003 Jaguar XK Series-1997 PPG Payroll Check payable to the estate of Nicholas J. Majerchik $79,351.73 $16,300.00 $14, 565.00 $10,110.00 $10,211.97 ~..~ -, _. , r ~_ ,~'~ -~; r~.,.1 ; `~' _. ~-.. 7 _... . ._ _... ~. ~ .,. . • _ ' -... . - i_... j } ~~_.,. ~~ (Attach additional sheets as needed) TOTAL: ~ $130,538.70 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S ,~ 3301(b)) Form RW-09 rev. 10.13.06 2004 Toyota Highlander Limited Sport Utility 4D Trade In Values, Re~Tiews -Kelley Blu... Page 1 of 4 -- -- - _- ~~~ ~{~S VV\/RL THE YRIfSTED RESOUlCf CI ~: ra' Vc31U~ Q ~at;.Ar~ -- - - home ~ car values t cars for sale ! car revie~n~s kbb to-: picKS researcr tools Popular at KBB.com ~C~ ~ootes? :a. 'Jnoe- ~i~.DO{ aaverclsemen*, w.m aas "I~m~ 'tea' ',: atllac. > ~' 1•lCic > ^tlaniar).7?' > ~':)i!~ > JT_)lic > ~pLl~n~ Z~~~ Toyo~o ~ Highlander QO umited Spot Utility 4C - 2004 To ota Highlander y 1 Limited Sport Utility 4D Mlleage:82,615 chancr_ edi; options Chant= sNie Uk.e this car ` - 2 "ei. _ _ _-~•~_ _ :~~~~~.~ 3 See Blue Book Value - -'"^ ~ - -' e - ~'atues s~!ecs new ca- `trade' used cars for sate ~nmte a reviev~• consumer revietirs '~"~-~~e- E ~l~e~~ ~1~~~~s See Used i„ar Prices ~a:~~-. private °ar±y Excellent Good Fair Char:pe condition. 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STATUS ' D DA ~,... ., ~ , ,. a ,~ DATE PA TITLED DATE OF ISSUE I 'UNLADEN~WEIGHT ~ GVWR ~, ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~ G~WR ~ T(TLE BRANDS ~ ~ _. , r ,.: It a second ~lienholdelr as listetl,:u on satisfaction of th n, the 1i ~ P e fiat lie rst lienhblder must forward his THIe !to .;,the 'sureeu ;6i 7Momr Vehidles with 'the FIRST.LIEN RELEASED appropriate.lonn and lee. _ ~DA3E ~ BY - ~ ecrnnrn irceier=i cr.ccr. AUTHORIZED REPRESENTATIVE MAILING .ADDRESS ° 2~32~b t~ICI-I~L~~ J M;~JERCHIK . ` 3~.b 8 C~R~L ~T - NE~I ~~1MBERLNI~ PA 1?Lf?~ - :. =- DATE BY_ AUTHORIZED REPRESENTATIVE ° I certify as of fhe date of :issue, the official records of the Pennsylvani _ _. ~ " a .Department ALLEN D B I E-H L E R ° of TrAriapoitatiori Faflact that the person(s) or corripeny named herein is the lawful owher - - -- ~ • Dt the said le. Secretary of Transpotta6on ' . . - > . . " :. `- . = SUBSCRIBED ANDS O If a co- urchaser other than ours ouse is listed and ou -want -the title to F Y P Y ME T p H l ~' F ~ I ~ i I ~ ~ be listed as "Joint Tenants With Right Hof Survlyorship"'(On death of one ~ ~~ l ' ~" l,,;;, hlJ I i B+I t 4 ~ '~ , :D ~ owns[; title goes t+i ~urvivlrJg ,owner) ',CHECK,NE,RE ~. ,tltf;erwise, +the ;title tl!/'~ ,IlUlpl ; u~~~l~~ ~'lu,~ ~ ;,'',~ ,, '~! ~ r ~ will~e sued=as"T~nantsin.Dommori"~(On,deathof,one:ouvner,~,lriTer~stof srr N ' ~ f,/'' )FI! 4~ ., . ~ I °deceased owner goes.to his/herhelrs Dr •estate). . ~ ~ vt ~ GN „'~ DMINIST 1 D J ~ ~ 'l~'i '~ih ~Ni N!I{li 'I ~ 41h 1 ~!1,! g ~'~~I~~ ' ~ 'ISTI:IEN DATE. ~ dF Nv LIEN, CHcGK _ ~= = ~ l ~~ ~~:NI~~~. {3.~1t=T1"'I N ~ ~ .-: : • y. . 7 ST LI HOLDER cz:: : ~v - -_ s~ 11 {I i j ~;~l~~~tV~IE ~fdl ~3EDEflERa ~o~2ty`dPiU~IIC.i~; ~ ~~~ I,i, .,, ~ sTRe ' damp Niil ~~Di'D, ~',tlmberla~iS ~dUTf~ ',;, °, ~ cITY sT TE z C1J ommissiDn Expires taugust20, '~Oj3 A IP My C ~* ~ „ IF THlS ~tS AN ,ELT, CHECK HERE j-3 " FINANCIAL ' W _.~, ,., NOTE• l=fN REQUIRED j-J ' INSTITUTION NO. 1 Q J i 2ND LIEN :DATE:, • IF NO LIEN, CHECK I ,Tt>E undersrpneC hereby makes eppNCatlon for >reRlflple of Tlik to 'ihe vehicle described W above adbiecl tc the eruymbr.rjbes end othor.bperGsmis set olth hear 2ND LIENHOLDER ; ' ^^ W . I ,~ J ~ J STREET CITY STATE zIP L ,CHECK H_RE FINAN SIGNATURE OF CD APPLICANT?ITLE DF AUTHORIZED SIGNER NOTE. FIN REQUIREC INSTITUTION NO 1.997 Jaguar XK Series XK8 Convertible 2D Trade In Values, Reviews -Kelley Blue Book ~'~ ~ '~ Kelley Bfue Book THE TRUSTED RFSUURCFs Rnd Cdr values Or r~turps home ( car values ( cars for sale ( car reviews ' kbb to icks ,. p p~ I research tools ^~ rs~~. 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Ei~?h~ v.+ith c Sp?`Ia115; n~41~ I want to list my car for safe Ge: y~~r free Seller's T~~{ki: '~'` Top 10s & News •' 1~~ ~r..v Jle>f raiS UnUer 5~~,~7J - 7r-i: • 2u:.2 BMV~~' EbOi Conve-ibie: t; Graphic P; imar • Top 1D =ar-~ily Cars of 2i;~~, t Rve Grea: Gar Deals pceaG Wore tdeva searcr~ Si'_`_ . ge yaur tool~;it S~~are T~rsr: h~~~ ~2ecentil ti'te::~ri Saved Cars save ~t~ I:~lIPCodei:~;i ~ Si~n'r of 4 8/14/11 11:03 AM 1997 Jaguar XK Series XK8 Convertible 2D Trade In Values, Reviews -Kelley Blue Book i jaguar XK Series - BaakofAmeriw ~i 4:nov~ yeti- credit score ~:aal~' for an a;Jtc isan. More von 5u\' ~ s~~inc at x.54% i !R"' ~.-~. `;y advertisement Fnd Your dew Czar Explore new-car reviews, ratings, and mare, ti~en get the Fair Purchase Price. R°g;~st a Quote Get a Brochure Glfi,1, a D~34°_ Test iJ`IVe Presented by I A G U A R rc K wny acs- ~ price your next car ~ Popular Topics Car Reviews & News Help Company Industry Relations Auto Shows Latest News FAQ About Us Advertising Top 10 Family Cars for 2011 Featured Article Site Map Contact Us Media Center 5 Great Car Deals 1036 f:xpert Reviews Find a New Car Careers Linidng Policy 2011 Best Resale Value Awards Car Yrdeos What's My Car Worth guys ~~~ New Cars ID36g" Mobile Follow KBB RSS Twitter Facebook YouTube Mobile Apps iPhone® AndroidTM Windows6 p 1495-2011 Kdley Blue Book Co ~, Inc. All rights rte. Copyngh± & Tidemarks ~ Termc of Se~~ice: ~ Privacy Policy Have comments about our Blue Book Values? Give ~s your feedba:.4 © 2011 Kelley Bfue Book Co., Inc All rights reserved. 8/12/2011-8/18/2011 Edition. The speclhc information required to determine the values for this partcular vehicle was supplied by the person generating this report Vehicle valuations are opinions and may vary fmm vehicle to vehicle. Arbral valuations will vary based upon markex cernditions, spedficalrons, vehicle condition or other particular oirrlrmstances pertinent to this particular vehicle or the transaction or the parties to the transaction. This report is intended for the indnidual use of the person generating th6 report only and shall not be sold or transmitted to another party. Kelley Blue Book assumes no responsibility tror errors or omissions. (v.11082) Share E=ri:~t aF,~` 2e::er;t:~ \'ie:'.~ Sa~t;d Cars save `f' KBrLIPCodd.?~i~~ Si~-r it of 4 8/14/11 11:03 AM Estate of NICHOLAS J MAJERCHIK 168 CAROL STREET NEVV CUMBERLAND PA 17070 PPG iD: 10310:.. Soc Sec No: Check No. 30b~267015 ANowa~r~e 1Attthhoiding Status FecSerai: 0 5 ingl e State (PA) : 0 Not Used .. _ . :;Hc~ur~ :. Current Y 'T D ~ De Earnings _ - .: ... ~ ~: 'AYNIENT AT DEATH 14149.62 14149.62 'AYMENT TO ESTATE 12211.22 12211.22 Y-T=D . .. ; .: ` rent Cu `Y~~T-D . S Description ~ Ctirrenf ~ Y-T-D :: <:D~esCr~P;ion .:. r 0 00 U ,: ; .. r asr 122 ~ , 22 -- 12211.22 Federal Tascablf Grass 0.00 . :.. p>:>~M`~ . 1lrass ,. Pre-Tax Deduction 0.00 o . 00 State Taxable C ross~ 0.00 0.00 . A 111! Tax Deductions 0.00 0.00 00 0 FICA Taxable Gzoss 0 Q0 0 00 Y A .Other Deductions 0.00 . R >_ NET PAY _ . 12211 . ~2 ~.2~~.1 . ~2 , :. - .:: ,; Y Detach and retain this statement of earnings Arid deductions PAYROLL CHECK PPG iNDUSTf~IES PAY Twelve Thousand Two Hundred Eleven Dollars And 22 r TO THE Estate of NICHOLAS J MAJERCHlK ORDER OF: 188 CAROL STREET N:EW :CUMBERLAND PA 17070 1NACHOVtA BANK, N. A. -CHAPEL HILL, NC 27514 (.--.J AUTHOAiZED SIGNATUAE PPG INDUSTRIES, INC. ,~•~n>;a~l;?nLS~f' ~:D53i0L56L~: 20?9900L~93~18i~' ~ ~ ~ t i ~u c.~~c.;~ >!c3 July 11, 2Q11 Ms. Lisa A. Majerchik 168 Caro! Street New Cumberland, PA 17070 Dear Ms. Majerchik You recently processed a total distribution of the PPG Empiayee Savings Plan as. the beneficiary of recently deceased plan participant fV1r. Nicholas Majerchik's Savings Plan account balance. Please accept m~- condolences on his death. v~'e discovered after the monies had been transferred into your account and subsequently paid out to you that his account had not been adjusted for the May Savings Plan deductions and matching company contributions that were deducted on his original May paycheck but then refunded back to him after his May 25 passing. !f you look at his May 2D11 month-end check you will not see any Savings Plan deductions. The May deductions and company matching contributions overpaid to you total $1,999.25. The $1,999.25 overpayment includes $1,634.00 in before-tax contributions and $365.25 in company matching contributions (see the attached for the posting of these contributions, to his account). Please send a check made payable to PPG Industries in the amount of $1,999.25 to my attention at PPG Industries, 4nc., One PPG Place - 4tr' door, PGH, PA 15272 to clear up this overpayment. V~~e apologize far this error and any confusion the contents of this letter may cause. If you have any questions or need a further explanation, please call me at (412) 434.3925. Sincerely,r ~ L7 . L.- oseph G. Lyra, Manager PPG Employee Savings Plan Attachment ~~:.b~'S'~ k~-. "~~Wf'~.. .4.A~~»~"1~+~.:.'r+F~.;1M^ -..-~. ~~' r . r' ~..M.'Ki'~'*,~:+• ~K~ Nicholas J . M~jerchik Estate 60-8095/2313 ~ OO ~{ Lisa A. Majerchik, .Executrix 168 Carol St. New Cumberland, PQ ~ 7070 ~y;~~~ ~r7 ~1 ~ ~ DATE Qf~ ( ~ ~^ J~ ORDER OF E ~1 V -~d~i~{ h'VJ~L ~ L...+~ ~ 1 ! -I ~ . ~ V T~~I~ ~ ~~ ~ ~ ~t~, ~ 1 ~ ~~''`~ ~~iuns o ~ ~~~ ~~~ ( ~ , t LAh~ ~L. ~ ~'`ti ----i._'.4+- ~ AfZS ~. / I~~.L ~ Baca ~BELCO COM/AVNRY CRfDR L1NlOli Baarcr /,~E i. Jmr Ga.~ /~i /J// FOR ~ V ,`~ ~~,` ~~ ~ - - I ` ~ r J ~~...._ NP ~: 2 3 Z 38099 ?~: 00089 29 3 58~r' . SOD ~ ~~;:vn_ ... l .. .v. W. A.. 4 +d Jam. ,. y..^f S" ~F.~.bM~mJ ~ !. r .. • Jf 'iG~n•~.~'. _ -.. .x. ~ tS,... .ice M h !.. ".~`wT~~{" ~~'`~y ~"y ~ ~ul/ ~: ~ Lisa Ann IViajerchik ~ ~ ~i ,; ~~1~~1,.~-~,'?~" jet ~ -f-~1~ ~ ~ !~' ~-~ 2 c~ i ~ -~~~~ ~c ~~~ ~~r J {'`~'l~ i C'JL L' ~''+ t {~ - i~ t~ C ln~~i~ ~ c t d ~~ c1 - ~ ~ ( ~'~ a~ tc i.~cl v cs~ - rye ~, RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Receipt Date: 8/25/2011 Cumberland County - Register Of Wills Receipt Time: 13:24:18 One Courthouse Square Receipt No.: 1066772 Carlisle, PA 17613 MAJERCHIK NICHOLAS JON Estate File No.: 2011-00657 Paid By Remarks: TIMOTHY A HOLMES DB ------------------------ Receipt Distribution ---~--------------------- Fee/Tax Description Payment Amount Payee Name INVENTORY 15.00 CUMBERLAI~TD COUNTY GENERAL FUN ---------------- Check# 1110 $15.00 Total Received......... $15.00 v, ~- :~ ' In„G ~,l°° CIERT;~~FICATE OF ~"ITLE FOUR A V:~H:~ICL~E ari! 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I v TIC ~N ITLE BRA DS r - ~'DATE%PATCfLED ;; ~~~DATE:OF~ISSUE• ~~~~ r~~UNLADEN~WEIGHT~~ 77;' t3VWR ~:~~~ AGCWR • ~ ~ ~ obonnr=rERS~'A~US ,d~IN'il~I~u~Pu~Flh~~~ ~ ~~ ,~ 0 !!'ACI(IlJ/~t411M111P.IhGE r11711q~f16llnil~~~~l~' ~I -'. i t~ ~ 1 7 = Mlt.'EAGE EXCEEDS ~#4EIIMECh9~~ ~'AL ~~~ I II '" I LIWItTS , l~ i~l !I rl~ ~ 1. • Jh, _ ,~~°~ `~' ` tu`"' _ n 12 =NOT THt ACTiJAL MI'c' I,~ I+~~ 111 11 ~~I 1 I .. w ~' - k E I II NNl,nnl, u1''!! `I" ~ ~~p`w.. ,3 = NDT T+1E,ACTUAL MlLJ6Y~t:~E Otl~NI 7 ~I t ~T~ ~y~T i ~ TAMRtAINGayERIFIEglill~llul' lliil~llNl~I~IVU,~II!!h'~ °~ ,.< ~~ .~ 4:EXEMPT FROM ODOMETER DISCLOSURE Q ~~~ ISTEFtED OW j8; I I! I II I '< `""`~'° ~ ~ T LE BRANDS I.n , 1'! 11 I Fr ~~l F Iy,1~'.Y _ .~ ~ ~ IIJJ 1 I ^- p .. A ANTIt]IY._U1~EHICLE ~ ' ~~ ~ ~1 ~ ~~711r'tr h~"l7tlul~lt 11,111 rj7l,li `' 1 L ''~" -.: -~ ~ '~ ~ }e"4~y`~ C = CL'ASSIC'r1lEHICUE ,\,'t .- I Hl a IIlIII ~.L~'a _ N ~r~, I ~ I y, ~ ~~~~ I ~~ ntg~'y~t~6por~tkr(t ~ ID OOLLECT,IBL'€ VEHIOLE ,.; It~t ~;t ~. a _ ~M ~- 1 `'I jy~h I I J- I t r~r I 1 -~- -t r°',~ ~..h 1' ~.^ t• ~F ..flU?-0F ODLJNT-AV ~.5 ~~;. ~ 11691' IJt Irll~l 11(jlll Hp Ir~~! 4 t~ ~ ~ ^-r° i'~'~" ~,~,_:: G `OAIGINAI;IY:,MFGD. FOR NDN~U S ~;,1 ,i~t F 1 Jrlu ill I+ 01 r~"**yt IW DISTRIBLIS~ON 1i' ~ .. `~ Ill lru+ +r ~ .!~ Irrljl! ,I a '~ -. 1 pl . lr 1„~I ! ~_ ~~- .~ _ o H = AQRIOWITURAL 1(6MICLE ' .<' .I I !!^i' ~~~ ~~•"~,~~ ~- -L = LOOGINGbEHICLE P = IS/WA6 A POLICE VEHICLE w~~ 'i R =RECONSTRUCTED y~5t ~ ~ " - I I'; p'.. S sTaEET ROD ~ ~ ? u I ~ :T = SECOVEF3ED":T+IEFr'aIEHICLE ~ w ~„ 1 I III' ills Ili Itt ~ II V s,VEFiICLE~+QNrAINS REISSUED VIN = I ~ ~~~ ,; ~ ~,t 1 ~: 'W =•F.L.OOD VEHICLE ~ , ~ l' X = ISANAS A TAMI c~EN FAVOR OF. ' '16ECO~IpILIEtIgIf~W(V~1~jT.~F. ~ - '~ 11y,1, 11 III p'.,t It 1 Id . a Vic; fi~ ~ I~'ti 1.. ~ It ..1.. 1 ~ .L ~ ~c ! 1 l dhyy~~~,,llll l,Ill~l iii ~' , ~ , ~i ~ ~~~ , , '1 " r, ~ L.' `.. : f ~~~~ ~-' r if a second tllBnholdsr :is Ilsted I ,Pon slatistacbon IA1 Itha 11 t6t Nel~;rldf a ~II'' 1 I~l,I~ Iilll~l~ ~1~11 ~ , ,. ri ~`. ~ ~ Jienholder _'~must ~farward ~thls Title; ~ldo tha IBureau Df ,Motsir ~/ehi~eall~~l' ~tth ,~ I!! . r ~ ~~ ._ ~ . , ",. ~ ~ ~: appropriate'form and fee. ~ rl 911 I , "Ill~l dill 'l~ll~ h~l ~ I .' ~ I ~ I , I'llllf~ r~''pp frr ~ „ ~ ><: ;DATE ~ .. :~~~ , . ,;~ ~ Ill . r, BY ~ SECONDiL;IEN RELEASED . :AUTHORIZED. REPRESENTATIVE DATE ~J41LlNG ADDRESS BY • ~ _ AUTHORIZED REPRESENTATIVE ~ zap :. ~ . ,~ ~ C • , m~" L.•• ~ 111' - l: . 2~.; / • - - ,~ . ~ r, ! ~ '- ~ 'I. certiFy es. poi the,,date of issue, the oHlcial records of the Pennsylvania .Department ~ ~ ~~' { ~ ~ ~ ~~~ ~ of Transportetiori reflect that the person(s) or company named herein is the lawful owner e • poi ltte •seld vehicle. Secretary of'Transportation • a~ ~ ~ I' w ~ ~ S`r<hSOt~IBED34ND~WOl3• If a co-~urChaser other than your espouse is !listed and you want .the title to "` ~ be ,Ilsted as "Joint Tenants Wrth Right Df ~5uruivorship (w,©n death cif one ~ ~ ~ 1~~1'~ ~n~;Jf~li~~ul~ Ill,:' ~ ~~ Il . r 1,,~~ 1.,..i~ .a dlnfl ~Iha~nnll nlt .. AY Wn6T~~1t183,~08S.t0~~SUNIVIng,~~O1NnB1'.~?l..'I"'IE~ol~.,,~~RE'~~.I~tfJeIWIS~ S~~>rle 11 r l~ I, I nJ~„~~! ~,hmla~'I(•µ!h'I~Ip1IdJi„ ~ _ illbe~ss~ed-ash"T~narrts;in;~Comrnon"(f~iraldeaIh;oi~onevu~net;,antare5t~rf . I I . ~. , ~"~ ~ I ~ ~ ~' it U Il,r,l~ Idle _ ~ ased>bwner gDesto his/her hairs orbstate). ~ 1, "1 4 ml,~~I~1,~1,~,'~.~`I' ~ l STIJEN DATE ~ etF ND LIEN,~CHECIQ '~~. ~ -.: ~16'f~'A~~~''~~A~ ]STLiENHOLDER r , _ ~,, rs~~x ~ ZR~'~l~ ~~ ~'~I~~~k~R, Na~ar~y ~ublle STAfi ,j II ~~~~it ~ ~~y{r1y~m~ ~ii~a~~z~~ ~~~er,,,~a~d~1L,~, o~~mtttt ~ ,t i ~, ~ I ~t lid i rl; a 'I~~~ ~ , ' ~ ~. ~ l < f.MM, .,1~ 'N44.r V l _h. ~ ,~ . II I i i I 1 ,~ r~,~ ~y~ ,,pp,,~~4 qq I ~ ~ d~f~%~omr~rssid iris ~u~ ' i ' '' STATE z,P C I `. ~.._.-- -"~ _ ~~ Sr a,~` .,. ~ Yluo~~~„~r~I~ti31~11 ~ 1~11i~ u9a. _ - ~ - ~ ~~ ~' .+ ~ t ~ 1 FINnj'Ij)Q~AL If~tSTiiTiU~ tT~G3N NUMBER - - 1111 , _ ' ~+~"~', h~ I I it , f,l i , i41', , a i. i ., . I t,,.... • ~ ~ 0 H CK 2ND LIEN DATE: ~ IF N LIEN C E ' ..'z. _, -~ gmkss apptlcptbn for CMtllCete of Tine Yo :the veMOie .tla»crdlstl - b ~ lOISCWItIfagLY6 entl lnllnr~legd dh4nt set 4oAh_Mre. - .~ Iull~llN 11 _ 2ND WENHOLDER I'It~y fllN >~ i 1 ujllm 0 = ~ •1.„~~ 1 nll~l(~~Illlll, T ~ 1 STREE? rlI <.J ~ ~ U A ON 1 _, . _,. - TE ,, ~ .. N - . CITY $TA 21P O FINANCIAL INSTITUTION NUMBER -~ ~ ~ SIQNATUREOF C4APPLIGANilrITLE OF AIfrHORIZED SIGNER .., ,1 ;,_ .1 flu ~, 1 ~... .- .,,,.. ., ... ~~. ~, ..... ,. ~, .... 1 ~~,,.,: -.., .,, ,. n~,~ ~ . - - . ~. ~~. •. /':' .. ...- ., _ .. ..-._~ .__ ..~.. V'% L~. ..'C Vim. .. ~J.: Ur v,GJ-. .~. C ^. J;J!~ ~V ~. ~. C., ~. i,~J V.. .. .. ~. ....~ ''J: ~JQIC. VIfJ4RNING -FEDERAL AND STATE LAVr~S REQUIRE THAT YOU ST.;TE THE ~/;ILEAGE j (ODOMETER READING) IN CONNECTION WITH THE TRANSFER O = OWNERSHIP. FAILURE TO COMPLETE OR PROVIDING A FALSE STATEMENT IVIf~l' RESULT IN FINES AND/OR IMPRISONMENT, ~M P~F~T~-.~T ~TI~~ Please be advised that in lieu of notarization on this form, verification of a person's signature by an issuing agent who is licensed as a vehicle dealer b,r the Pennsylv``ania ~ ~ State Board of Vehicle Manufacturers, Dealers and Salespersons, o, its employee is acceptance. ~ ne signature and printed name of the issuing agent or the issuing agent's ~ employee, date of verification, the issuing agent licensed dealershila's dealer identifi- cation number (DIN) and business name, must be listed in the space provided for - notarization. Vehicle seller and purchaser must sign only in the pre.9ence of an officer empowered to administer oaths or an authorized agent as identified above. ' .. - .- .. ,LAST 'FIRST 'M't ,; rJ/UVe derfify to th~ t of m Imowledge that the odometer reading is , °t_ ' TENTHS antl, PURCHASER:OR FULL ~ ~ ,~ ~ tla e actual mileage of ttie vehicle,. 33USINESS'NAME , ~ ~'/ _ `1 ~ d'y ~1, ~ /~liL.r ^tJ!~Y`NM, lWd I ~ 1 ~ h: .: l1 r~' II ~N~jrl R~( ~r ~ ,r h 7 .@~~~~~ ~~~h~ ~~ ~Ci r~~ tq~7i(~hl~(ft d,l~~'~ CDiPUROHASE ` ~ , ~~ { ~~ o e ~a~`~A9~xt~4Js d~ F ~ „1„„ I~ „ od~4 ~' (d, ll fl "l~"pr~j ~ ~jj( Il 'j~ 71,. ;' 1~lr~~DT ihe-actual mileage ; `~DDR S " ~' ` r, ` ~! ~ ~~ 1,: Ida `~1 `'1 ~N~~,: M~ ~P I l , ,r Y'~I IJ ~( >4RNINCi~:T9tlnmetarrhscri~panoy ~ n ~ p wW 1 ~.r, ,I~ , i ~ N 1- 1, f k(,I ~C1T1' / ,{1n '~ ~~ .?1,"1~~14~~"''~~ IIWe p.oerilfj! ~ e'isI,1it.and:ei~fYf~Fanceandlhat~ownershiplsherahy~ ~_ ~" ~,,`~`'" ~ ~ .d'~~~~` 'r'i'ed n ' ~ ` ' ~ iranafe ,tothe erso t+ b ~ ~ SIP ~~ ~P.l9RCF1ASE PRIC rtfhe deaier•Ilsted. STATE ~ OR DIN tt~i; ~ ' b ~ , rt ~ ~ ` , Si.4BSCRIBE{~ AIV ,SWDRN ~ , I~% I I~~~' ` ,H tit, 1`4'`~ 1~1~1~1 I`~``'I N~~~1{n. ~dd1' % ~ : '1 ~ ~l' ~1',~ ~{ ~, ,;x. TrD~'F©F3E: ~(A~ IIC~ v ~d~ 1 1,446' I ~ , ~ i' , r i d,' r , , nr~ {~ ]~~, m-,a., ~SI BNAT '~ ~''` i '~~ ~u I' ~~~ i ~~~ I ~~, II, tliyllltl~.~ 4,h~r,,, ~I N~~111r1111 ~'~ ~~~, . /~.. ~ ~ ` ~prL~ {I~, I ih~, {~i~'t~d ~1f y + ~ , ^ p ~ Y 'PER ITE '1111~~~1~,"ad'„II"1'1i ,~'~Ml,,,dl'~~ ~~G~11~ `4~~!llllrlly~~~ C0.PL1R4!-IASER SIGNATURE e '?e:~x~ ~ ' ~~~,:~rt, ..~ ,,. ' `r.dlll'r ~ i>aIG1NUVE'H ~F.~P.ENNSYLVANIA %7~. HAS6R~AND/OFId%~It.t" J.~ .C P PRCiVT NAM~US R ~[.!J ~ E/G..-t`J'L~ ~E~L ~ 'A~SARIA'1. ~u ara ~I,~ ilh`r,~, ',4i F u3 ; _ ~#"3D ~'~*~; f'..utlllC ~ r ``~1 ~ ~ ~ ' F ' ~ '~ ~k~ ~ i , l ' . 11R I 3~IJ ~ ~~'~L[W.~~~a^^~w""'1~C71111~~~' ~ ,,,,11~r "" , 5 ~ ~S7 c I Il~~l!~N I'~I' ! r l I '~~I f~ ~II~~ ~~( 1 Ac ~~R'~, ;~Lt~$' "` ~ ' ~ ; ' 1 wl r ~ ,tf 'I sl© ' of ~ ;o• r ° ,~ il!I,~ ,~1 1 ~ ~ . , ~ .. ,_ _ ~ •, __ ..__ ___ . . ,._ ~ `~~ ,~ utx~l~yr~ ~'" ~~ „,~pl ~ ER ANWOR ~ ~ f ,~ r ~'. C ELL'ER':71AUST i ? PRIA!TNAME:HERE !~" " V ~ . ~ ., r e _. .- : e UWe oertity 'io the rbest of mqi/our IknovWa'dge thei the odometer ~readin8 fs ~gT FIRST M I . n vor Nnre 9 3 NrHStI I'~ ~ it r, R,hr g e. ., . ,.. :~ , r ,~~ ,,~r1~1IGr a (19!(,dctual milea a of the arehicle, Je : Id n~Il'- AI ~ r ~ ~ ("~, t d r~~ r^il ~ II~I7,~~t' xlPl~(~~4 y ~ , f , g~' 4. r,,u (~If~rJ~ N r rl('•'I° 3 ~ r ou 1 ~~~ ~I , e. 0T1he actual mileage ~ I ~{, ~ ~,r ;WI~ANIN(3~Odomeierzllacn~pancy, ~ ,~ „n, rv ,I ~ 4~'sntlthatfherownershiplSrhareby a Is il~ r gn ,. ~ ?PURCHASER ~R FUL:L . , ,, ^ 1`r ~ ` "~ d ~ ` 1y. \\"S ' ~~' " ~ ~~1°~,~~~~ 1'~i' BUSINESS 3JAME Ai N9 : ~ , l' F ~'"V~~ 1'~ DO~?URC+IASER ~, r ,I r, A I `,\ ~ 1 ~, \+~ 'r ~"d a~ ~ ~ a ~, ,,,~~~ ~~ r;; ~Gµ t~ ~, ~d ~, , u~"S'REET r , ~ P~ d M 1 , , ~ , r ~ ~, J~i~" ~ I~~ '_ATIDRESS = ' ~ ~~"', ` , d ~ ~ tran thepe r Ji4the dea ed '!~1~~,„ I'IN171,I;.; ~,dd I~rh, ,.. d 1 ~ , ~ , C~ ~`1 i ,~` `~n~ ~~n ~~" I a !SUBSCRIBED AND:SWORN TO ~EFORE,~ME: '` I ~ MO. ~ DAY I iJ'Y AR,lu ,i~,1'I,~I~ ~~ I~,,I{{{pY ' ~P.uaDHASE PRICE II,rT~ATE ,..a ~ ti4r' ~ I,t~l~~~i~tl ~{~m;; ZIP ~DR:DIN _`b'~ ,,~'. ~{;~ ' ~ ~I ~ t %1~~"~11"~~ }, I~,, , '~ I,Ir 1~Pi ,n,a,l,l IIII~I@{ ~- ~~ , , , '~ %~ ` 11 ~ I _ ~e ~ ~{~ ., ~ ~ SIflNATURE dF.PER50N ADMINISTERING OAS .~. p , k ~~ q ~ edr PURCHASER SIC i~ATURE - 5 ..~, ~~ NCO-PURCHASER S GNATURE ' ~] Q r ~ ~ ~ 'RURCHASER ANDiOR n rlhhs I'~ III (r l N,i~~i yn irl„~I~~1, ~ (" + *.. GD=PURDE3A~uER~ilUS7 ~~ ~I (~~ r' , ~i p `~ f~ ~, ~ . ;~ , ~ ~ i~ i i ~ Yl ij; ~A7JDPF71Nr~VAM HERE n, , , ,, i fi s. 174 Y, ~ ,~~r,' ~1~~~~llli~ lu u ~~ F. ~ ~ ilk 1 ~~III ll! ~ r~~INll~ll~' ~ ~I ('~ I, ~ u "% I I' I ~ ~rr' ~ ~ ~ ~ ~~~~ ~ .~ _, . - ", . _ ~ ~ ' N ~ , ' I ~I1 ~ ~. (~I~'1 tiy~ n~~il~;,~ , ~ of ~, ' l ~7~~~4~''~'M~ er~~~ r. .__; _." ; . ~: ~, ,t ._ ,H ~~ ;: ~~ ~ _. ,e, ~~ELLER ~uSU6~ ~~i( ~~~~ ~ ~~~' ~ I ~ ~ ~f ul '~~~ , ~I ~ _ '~ h ': A ~, ~l~A4VDPRIAIT NAMEieERE JR„ti„ II ~ ,J ~ ' • ~ ~ ~ • ~ . V1Na aertl(y lptrthelbest of rrlylourlkndwledge'ihat'the+odomater readln8 ~ se J16 1 io 1 ~ ! 66 {I - 'Li4ST ' F7R5T ~ ~:I. ~ . 1 p~~~ l l - ~ 17Np111~. t f ~ f ~ ~ - ~. o . aandl „ f P, r B otual~mllaege of th®~ hlole I ( ~`~ r r ~ 1l I 1 6 I'JIN~H~AI ' ' , ',: ~ - ~~~f~ 1 1 yr.N ,~,~ ~ yN ~I ~ ~ J ~" i w ~ ~ i`~~ r r ,1~?~ , ~t[HRCHASERDR F171.L p ~ \I~ h u ~1D91NES5 AIAME y { ~ ~ ~ ~ I a i1 ~~1 g11'~u ~ p0, , r r~gJ) r, r 6 h ~~ I,+t ~,,'FFl~tiil rr ~: u "r ~ nf~;3~ OT th® eGtual mlleaae ~ ~ ~D•P,URCHRSER , `' 1 ,t~ ~t 1 ~ ~f~,',k, ~ , r ~, dl~~`~ " I iacr~icy ; ~ ~ ~ ' n:. t~1Q`~~_ tlomPterd nY .®nd~4hattlaer>avnerahtp r~era~y rp `I ,~~~~,r~~d r rY~ ~1 ~f1EET r e. ~ 1 r ~ ` ` ,~ ADDRESS "~;d ~``` \' ' ~' X01 ~~,~"VM~ 1 , d , _ ... :CITY , 'adr~id SU3SCRtf3ED AND SWORN . ~t T{3BE~T~E ME: , ~ tl lv~ ,I ~~~ yglu~~ r l ~ l~" u` ilia Pt7F3CHASEPf3IBE .t . I ~ E I ~l MO. ~ rDAY ,. m. ,1^Y46AR1 dr`utd61 ,,~ ,; ~,;;,T P . DA~DIN ~, ~ o I u° vl,1l Z '~ II' I I+ , 1 1 dC ' 1 I '~ ~ ~ ~ , ' !' ~ ~ - ~ N y , ~ 4 t St(3NATURE~OF~PER^aC9N ADMINISTERING QAtit~ sn. i „~, , i _ r ~ ! ~, PLRCHASER SIG( ATURE - ni n ~l I ` , ~ ~ i' C0.PURCHASER Sli (NATURE r3 - PUACHASER AND/O$ ~ ~ I, ~ y, rr ~tIN l CCr-PURGHASERSMUST i11i , ~,~I ~Ifi,~,, I~I M, J,iA~iIDPRINT~IAtJIE~3ERE r'!rll4 IIJ!s ~ I~j', ~ ~ I~ IiY~I I I J _ I;1 l ,;+ ~. k I i ~' it I N !' J1 ~- ~ '~ ~~ ~N ~e ' I '- ~ '. ~ ~ ~ I I ' I' l~ l ~ SIGNATURE OF S: ~E_ °~i ~I!„~ rll•.,I.!.'~ ~ _ SELLER MUST ~ir~ rjl'Itti !i(Iw~' ~Ilyh,i!", RANDPRINT NAME HERE ~ dlr "' C. ; .. ; .~~ ,k~R~~ E 1F . PP,~iC~4TION FOR:;RE,I4LEI~ T,(TLE,,AND COMPLFT~ C.~~....., , .~ T)L,~ G I:~1 ~.~s,.,~,,,---,--,.,.. ., „ " ,,. ,.., „~ ,,.,, SE ON D TI N CE`RT,IFICAT~;E OF TIT~L'E FO:~' A VEHIC'L'E ' t _ ~ ODOMETER STATUS D =ACTUAL MILEAGE •- _ ~' 1 =MILEAGE EXCEEDS THE MECHANICAL _ _ - -~ ' 2 =NOTTHEACTUAL MILEAGE -= - .~ 3 = NOT'T+IE fiCTUAL MILEAGE-ODDMETER ~~ n 7AMPERIfJG VERIFIED - <*~ ~ Y _ -. '- } 4 =EXEMPT FROM ODOMETER DI6CLOSURE . Ott D~ r sR S71~EDOWI~=P{S)=~ ~ - ~~~~~~ ,- - ; ~~`~~c S TITLE-BRAND r.(`~ r7TNnar1-I'it.J.l°t,f7rr.., ,, .,rt,„,,,~. ~ A-= ANTIQUE VEHICLE ~~r~~~~~ ~~ ~~~~t~T~ `4' C= CLASSIC VEHICLE !r ?7 1 D = COLLECTIBLE VEHICLE ,rmltY _ l , i ,.. ... - - ~ _.. ^,... ~ 1 _~~ ~ ~ - QU7' OF~OOUNTRD ON-US ... -.I' ,';~. G DRIGINALLY MFG . FOA N ,~~ j' ~,ii ~ ~ t~ ~ ~f *Y 9l ~ x `~ "j (~ ~ ~ DISTRIBUTION ~+cca. il;+.f 7~ tR Tt LS A 3T • +-.- H AGRICULTURAL VEHICLE ,t II I+4 IL LOGGING VEHICLE II t~ll~illli~ k~ + (P = J57INAS;4 POLICE VEHICLE:i 0`,+~+ ~ R = RECONSTRUCTED r II li '" -S =;IST.REET ROD i i, ~T = AECOVEREDTHEFT'VEHICL'E ^u = VEHICLE ;CONTAINS REISSUEDINI~J . "' W = iFLOOD VEHICLE X = 'IS/WAS A TAXI ~FIRSTLIEN FAVOR OF: SECOND LIEN FAVOR OF: `.I~,' ,~t~l+ '.~1I ~~~+~+,+~ '~I~~ilt1 ~ It asecon'd~lieriholder is listed upon satisfaction Af the first lien, the-first FIRST+L• ~ JI~ lienholderinustiforward this Title to he Bureaurri~MotorVehicles with the IIII,' , ? FEN RELEASED ~ ~~ ~ ~ ' eppropnafe foml'end tee. DATE ~~~ ~ t[ CDND:LIEN RELEASED "BY SE <DDATE 11!',~~I`4`I~I~ I t ~+: HUTHORIZEDIREPRESENT E + '1L'~NG~;A~itDRESS HY till'``,+''tl IPt1+~t~t,ill ~ ~~ AUTHORIZED,R_PRESENTATIVE +'~1~~~i~lll' ~i1''l1 nn c ,) ~p ~ L3 ~ ~ ~3 ~'u~`~t+iti j~~l'I,~~i'~~ A -fps ~' ~ ~ ~ ~'+~~ II+Iulllul;" L'7~~ ~ ~~; ~ "~ ~ ; ~- ,~"` ~~ - ppN,rt~lt,+ , .~ _ilVoeiStlty,:es afithe date of issue. the. official records ot'the Pennaylvania.Depal drlTragspgrtahon reflectlthal'the persoh(s) or,cornpany,named herein is tfie'lawiul dY t~~lrald ~ehfdle. " , l `. nul+t+l'1+ ,„',I!~ ,vu++ c , 'SUBSCRIBED AND RN ~ / ~ / ~ ~ J TO EFOAE ME: l..C/ ` • .~-~ ~,_ .: ~~ , ~-~"<€ ~ON I 6T IN - ~~ - - is ' -~ - 1171MOh11N~ALTH DF ~f~lf~SYL~ANIA _ - .NOTAAIAI SEAL• .:. ,~ S~ll~AN.NE 'M.:DfDEAER; Notary Pl~bl c ; . xn Camp Hlii•Soro .Citmberlanti~ogniy ;Illlt+i ,; + M~ C'omii~tlssfon Expires Abgust',~'D; 2D13 M iI~ ' / t ~ ?f ~ ' f The,uiuterslgnetl`haieby~makes,application for Oanlficate~ol:Tltle'tolthe vehicle descrlbetl N abovq,~~stibject to the enoumbrehces end other lapel claims set forth here. _ _. I f'iL~ ~ tr4'Rt5 b-efblN i ~~~ SIGNATURE OF CD-APP.LICANTlrITLE OF AUTHOR2ED SIuNER t c ~ '.' ••GdC1'j,.,gF - ','„I'~ - I .1 i ~~{''-it""Si~.~°~ i f:•`vr~4Mkt iI, - ~4!' _\,~r' i.f c c• ar iM ~ ~` - ~,q -1i a co-purchaser other than yourspouse 1s listed and you want the title to be 'listed as "Joint Tenants With -Right of 8urvivorshi (On:death of one owner, title goes to surviving owner.) -CHECK :HERE ~ "Otherwise, .the title; -~ wlllfieassued as"Tenants in-Common"';(Dn death :of one owner,'interest~ai - deceased owner goesto hislher heirs ror ~sta'te). / 1STLIEN DATE. _ ~ 1F NO:LIEN, CHECY. ~-,} _ _ _ _ L'~ ~~ _a ST LIENHOLDER - STREET ` CITY STATE ZIP ~~ FINANCIAL'tNSTITUTION 'NUMBER ' 2ND LIEN DATE ~'dIF NO LIEN, CHECK 2ND LIENHOLDER L~ STREET ` CITY -STATE- ZIP FINANCIAL INSTITUTION NUMBER ~" VEHICLE IDENTIFICATION NUMBER -'" I YEAR I ~ MAKE OF VEHICLE I TITLE NUMBER ~ - ~ ~ rrt urc rxin ~) ~ercmcate or I me must De subml>zea within zu aays, unless the purchaser Is a reglsterea aeaie holding the venlcie 1Dr resale. O R Q T ' N 7 ~iJSFER OF OWh1ER5HIP. rA1LURt O A I R1 M A p FA SE STATE MENT M OV D G A E ~OR P ~-°V,r'l1•l''I lI ~ I V~ ~' TO COMPLE ND/OR ,I MP 50N E IN FINE Y RESULT Registered dealers must complete forms MVZ?ti or MV27B If purchase is NQ'f e registered dealer by law ASSi6NMENT UF?TITLE as Tequired LAST FIRST )~.I. ~a . , ,Section D on the #ront of ~this:;form must ba completed.. ,~p(~ ~ . ~/ )'~ PURCHASER OR FULL ~ ') ,! ~~ ~r r ~ ° ~ :INVe certlfy,.to 1he<best.ot my/our knowledge that the odometer reading is , , A -~(..~i .BUSINESS NAME C/i i ~ r I. y )._ 1 ! l / ,.°. ~r ~ ° TENTHS w ° ~ CD•PURCHASEF l waw ,/\ miles and retiects the acual mieaoe of the vehicle, o., ;wµ lL~~ STREET hepolb sheckeu• ~ne:t>f d R Sithe IleaBe _ Is NOT.tne actual mileage Jn of I,hmU6 ^ WARNINGi Odometer discrepancy CITI' ~ 1 ~:~ - I ~~. = ;IL41i r'~ a is.free Pf~ehy encumbrance and That ownership is hereby _ _ STATE r ~ ~ I PURCHASE PRICE = - , ZIP ~ ' ~/ 0 8 o~ltie daelerJtsted ~~ v ,'~ _ , OR DIN __ I ---- / J~ ~ ~ ~ ~ ,~~ ~ J1 ~ jf t ~ ( j ~ L ~ v1"'I O. AY `•' °N P - ~ /~+~'!!~-"~ I , T P `~L. I ! ~ -- ~ ri ~ ~ R5 J41, f~N f l ~'~~I i~ Q~?H AS ,I CSI L'~ _~ ,,~ '. , ~ ~ ~ CHASER AND/OR i i LVANIA •PURCHASER MUST °Pa/^rr"NAME HEfAE O. ' ~ QN1NEf~L'f~H 9~ PENNSY - ~ ;DTARIAt' SEAL ~ ~ 1 f i ~, ~ ~ ' J ~ ~ , _LLER _ 'Sl1ZANNE'M: GEGER;EFI, Nclary Public I County Cumberland p HiII•Boro 'Ca i I , , m SIGNATURE DF CD SELLER _! y _ GaRI?'1(5 011 ~' 1rE$-:AU U5I ~~, 2013 tT~ p ~ ~ i ~ -- " ~ ~j ~J ~-j,, f ,~~ C0~$~LERMUST ~ ~ 'Cr'L.LYL L_7s._ I' ~ ~~`~' ~ Y ~ r ~- - ~ - A/NTNl1ME11 HA P . ~ NNDD RR ` - - LJ. :IlUV~ .. ~the:~bt3sfnl ~/oiir~pwledge tttal the3ldQ[nelerTeading is - .. - - LA"ST z - FIRST - M;i = I ~- - - °e, o,w mna°onne,r.oerw o 'TENTHS - ,'w;„ N~9~„1ve>00~,aYO~~ )moo NOeo r. I °erwee+..°e,n°~,.:e„we,w.e„w..r X miles and teflecis the aqua, mileage of the vehicle; --- -- - --.-. PURCHASER OR FULL BUSINESS-NAME -v unless pna:of the 4dlowirtg boxes _is checked: CD-PURCHASER Aetlacts,lhe~amount Df mileage Is NOT the actual mlleaee llmits ^ ,WARNING: Odometer discrepsncy ^ `In~exoessnf Its.mecharfical S7REE1' . Ji'NJe~iurther pertify lhet'ltia vehicle is drse.of'any encumbrance antl that ownership is hereby ApDRE55 Qrairsferred1o She, rsonls) or'ffiE daeler;listad. GITK :SUBSCRJBED.AND SWORN '~ PURCHASE PRICE i TO?BEF,ORE ME: STATE '. ZIP OR DIN DAl' YEAR ~ MU SIGNATURE OF PERSON ADMINISTERING LATH ATLIRF . CD~PI'1RCHA5ER::IGNATURE V ' PURCHASER AND/OR `' " J ;CO•PURCHA5ER MUST i SIGNATURE'DF S :LLER .SELLER"MUS7 HANDPRINTNAME HERE ., .,, ,, • . • - -• >ILYI A+teraeriif~++'lbl3ha`beattpf~my/ourlkhowledge,theithe°ddometarreading is " LAST FIRST 'Mil r se ,,,,, ~ rr.wr,wmw wee .°°onw ee' b .we ~ 1EI'1TIic '~ : ;,,e; °,°',,,,,,°";;~;e °° "°p°, b "', ~/' /•'~. miles aritl n3tiecrs the actua~~mileeoe of the vehicle, ' ,. r.°0w°~: „ ~" RVp ' '00 ^ 1p01 n o . PURCHASER OR FULL ':BUSINESS,NAME w,nwe we ,, e e, e. w °, ..w , .eo . °, ' ::unless one of'.the opowing boxes'':is checked: CO-PURCHASER Reflects theamourn of mileage Is NOT the actual mileage ^ .in"nxoess of Ns mechenlcel'ilmits ^ WARNING: Odometer discrepancy STREET d th n r hi is hereb t b ADDRESS ' y ow e s p rance an a llWeSurlher oertHythat the aehrole`.islree of any encum @l~Clerreti:to_~he aereohls or iFie~fealer listed. _ : -=T C,TY _ ' _~ Cf~~D At~T1~~VUF~1V' ,~ '~ -. A F~F3F.ME:. ~` _ _ _ ~ _ = ~ PURCHASE PRIGS - T STATE JP OP. DIN ,.. - ~~-._-" :. - '710.- - - -DA'Y YEAR ..- °; -1 ~.~~ - - _ _ _ _ _ ,_ ___ I - i _ ~ ~ ' -`~`~` 31C•~Nh"JF3E OF PERS~N~iDMIiVISTERING OATH ~yJAF i - - - ~CD•PURGHASEP.: GNATURE :1 - PURCHASER~ANb70R '1' ~'~, - ~ ;CO;PURCHASER MUST ~ ~' ~ ,.~. ~~, SIGNATURE~~C)E~51 LLER I , ;HANDPRINT NAME HERE ~ ~ ~ ~ ' • • • • P' l~efti~e ,ii~1o~P+lmeviileti~i"63tHt8t1h9br9~3er.reading~is - ,,. -°-- - .cLA'ST FfRST _ __ itA:i--3 . s i .°wen+°,.o°*..°M° .w,nrr,w ew„wee,.w - _ '• aw,.rewa,wwnr°nwr»wnum.wmw,e.en, _ _ ..nr°aeaena°nese«..r,.r,w.,.,wrw.rw°nw ~/ milesar+dreflects-the~ctualmUeapeoilhevehic~ "- ,/~. P.URCHASER,OF FULL - _ `. ` " _'.~ HUSINESSNAME - --- =- •,,,,~,,,,•,,,,,•,,,,.,,,,,,,,,,,,,.,,,,,e,,,,,,,,,,, . AIIIM~ _ Ydl-~ Is,dsecked: ~ ~ ~- ~ •~~ ~ ~ "" ~O=PURCHASED, _ - - s ~ ge 1s NOT She actual mileage ~ g saofAtsm _;~. 1t6 _r - ^ ~JARNINC•rOdomaterdiscrepanct 1JVYe,furtt~i catSNy3hat the vehf~ d1s free of erry ericiimbrence aricl that'ownership is hereby -STREET -- ADDRESS traneterrad.to.ttie• raohfs) oi;ihe dealer listetl. CITY ~ Rra ~ -, - , , . , aU$SCI~IBED 7A~ID S1NO ~ ,, 'v PURCHASE PRICE , R~,nn~; 71~~,~E~Q ~~ STATE ZIP ~ OR DIN - YEAR ,, r MD ~ DAY rs- ... i ~SIGNATUREOF PERSON ADMINISTERING'OATFi c r T- iii CO-PURCHASER S GNATURE I `O r .:1 .. PURCHASER AND70R CO-PURCHASER IvSU.`,T N nRl M1F HARE ~ _ ~ t». - =J SICI~tiTJ7E OF SE LLER _ _ I - - , SELLER MUST _ I - - =_.. - ~ HANDPRiNTNAh4E HERE -- _ _. -I ~~,^ CHECK HERE IF APPLlGL.Tldn FOFt DEALER TITLE AhD COIthPLETE SECTION D: TITLING FEES - ---_.__. _.__._ -----_ . _-.__W_ i