HomeMy WebLinkAbout02-19-14 J REV-1500 1505610143
EX(02-11)
yi
�Ijj OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania county Code Year Fee Number
Bureau of Individual Taxes eEMRTMENT Or REVENUE
PO BOx280601 INHERITANCE TAX RETURN 21 13 01220
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
03 10 2013 05 22 1937
Decedent's Last Name Suffix Decedent's First Name MI
MIR-ESHGHI GHASSEM
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
SHAMS BOROMAND ZOHREH
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.Reomainder13et8 r (Dale of Death
❑ 4. Limited Estate ❑ 4a. Future Interest compromise ❑ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
❑ e Decedent Died Treat. ❑ Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
❑ 9. Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(Date of Death ❑ 11.Election to tax under Sec.9113(A)
between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
GERALD J BRINSER 717 838 6348
REGISTER OF WILLS USE ONLY
First Line of Address ? -„
l'J T
� CJ ,' iI.
6 E MAIN STREET -,,, )-r _ , I.--,
Second Line of Address
PO BOX 323
�OATEFILED — '>
City or Post Office State ZIP Code
PALMYRA PA 17078 Tm
COS
Correspondent's e-mail address: gibrin @aol.com
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING PET N DATE
-lZohr� 5ha1n413oromoL f7 Zohreh Shams Boromand
ADDRESS
1614 Fox Hollow Road, Mechanicsburg, PA 17055
SIGN RE OF PREPARER GTHFR THAN REPRESENTATIVE DATE
Gerald J Brinser
DRESS
Brinser,Wagner&Zimmerman
6 E. Main Street, Palmyra, PA 17078
Side 1
1505610143 1505610143 J
1505610243
REV-1500 EX
RECAPITULATION
1. Real Estate(Schedule A).......................................................................................... 1.
303 , 177 . 70
2. Stocks and Bonds(Schedule B)............................................................................... 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C).......... 3.
4. Mortgages&Notes Receivable(Schedule D).......................................................... 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)................ 5. 62 , 115 . 0 8
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested.....:...... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............. 7.
8, Total Gross Assets(total Lines 1 through 7).......................................................... 8. 365 , 2 9 2 . 78
9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 488 . 50
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................. 10.
11. Total Deductions(total Lines 9 and 10).................................................................. 11. 488 . 50
12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 364 , 804 . 2 8
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to lax has not been made(Schedule J)................................................. 13.
14. Net Value Subject to Tax(Line 12 minus Line 13)................................................. 14. 364 , 804 . 28
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.00 . 364 , 804 . 28 15. 0 . 00
16. Amount of Line 14 taxable
at lineal rate X .045 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 00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑
Side 2
1505610243 1505610243
REV-1500 EX Page 3 File Number 21 - 13 - 01 220
Decedent's Complete Address:
DECEDENT'S NAME
Mir-Eshghi, Ghassem
STREET ADDRESS
1614 Fox Hollow Road
w
CITY STATE ZIP
Mech'anicsbUrg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) - (1) 0.00
2. Credits/Payments
A. Prior Payments
B. Discount
Total Credits(A +B) (2) 0.00
3. Interest
(3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
Check box 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. (5) 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:............................................................ x
b. retain the right to designate who shall use the property transferred or its income;.................... x
c. retain a reversionary interest:or.................................................................................................................. x
d. receive the promise for life of either payments,benefits or care?.............................................................. x
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?....................................................................................................................... ❑ ❑x
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?...................................................................................................................... ❑ F
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 Jan.1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3 percent[72 P.S.§9116(a)(1.1)(1)].
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 0 percent
[72 P.S.§9116(a)(1.1) it)). The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of
assets and filing a tax reiiurn 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 21 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 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 4.5 percent,except as noted in
[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 12 percent[72 P.S.&9116(a)(1.3). A
sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,Jether f y bloo�or adoption.
�2jia�8
��� Ifl �IUIINfllul�illl
Emparw by_alm Return . 0011-4F
While,Settlement Services,Inc.
4919 Township Line Rd.
PMB 302
Drexel Hill,Ps 19026
6104593636
File No.ACCOMODATION ONLY
Parcel m M 13252430116
Tbio Nbenture, made the day of� vo9
between
GAASSEM Mat BSHGHI
(hereinufter called the Grantor),of the one part,and
MOMMEN MIR 1 MGM.A 309E INTEREST
(hereinafter called the Orantee),of the other part,
WI M504, that the said Grantor for and in consideration of the sum of ONE dollar 00/100(111.00)
lawful money of the United States of America, unto him well and truly paid by The said Grantee, at or
before the sealing and delivery hereof, the receipt whereof is hereby aclmowledged, has granted,
bargained and gold, released and confirmed, and by these presents does grant, bargain and sell, release
and confirm unto the said Grantee,as owner of 309E interest.
ALL THAT CERTAIN lot or tract of land being situated along the East side of Lisburn
Road, SR 2017, in Lower Allen Township, County of Cumberland, Commonwealth of
Pennsylvania said Lot being shown as Lot Nu. 6 on a Final Subdivision Plan lot High
Meadow, Phase 4, dated July 19, 1996,and last revise August 27, 1997, as recorded in
the Office of the Recorder of Deeds in and for Cumberland County, in Plan Book 75,
Page 94,said Lot being mute particularly hounded and described w rulkrws;
BEG2(NING at a Imint on ttn:Wmtcrn del-of•way line of Fox liollow Road,said point
being the Northeasslcrn wmcr of the above described Lot and the Southeastern corner of
Lot Nu.5 of the above referonccd Subdivision Plan; thence along the same rightof-way
line , a corn to the left with a radius of 1,425 feet and an arc length of 131.33 feet toa
point; throw along the Northern property line of Lot No.7,South 44 degrees 44 minutes
13 seconds West, 175.65 feet to a point on the Eastern rigldoGwuy Gnu of Lisburn Road
(SR 2017); thence along the saute rightof--way line, North 50 degrees 52 minutes W
seconds West, 150.00 feet to a point; thence along the Southern property line of Lot No.
5 North SO degrees Ol minutes 01 seconds Bas4 197.18 feet to a point, (king the point of
BEGINNING. IMNTAINING an area of 25,907 square feet(0.595 acres).
THE ABOVE DESCRIBED lot is under and subject to the following easements as shown
on the above referenced plan;
A 50 foul wide landscape buffer.
UNDER AND SUBJECT to Declaration of Protective('.twenanis,as ru;orded on March
20, 1979, in the Office of the Reotndur of Due& in and for Cumberland County, in .
Miscellaneous Book 242,page 215.
ALSO UNDER AND SUBJECT to all rights-of-way, casements and restrictions M
record on&,dale hereof,
SUBJECT to all rights-ot-way,casements and restrictions of record on the date hereof.
BEING the same premism which GREGORY A.RE513TAR„by deed dated 9/23/08 and
rcexdcd 9/211 A in INSTRUMENT tYM32740 in the Office of the Recorder of Aecds
in and for the County of Cumberland, Pennsylvania, granted and cunvcycd unto
GHAMSEM MIR ESHGHI in fee.
THIS IS A TRANSFER OF 30% FNTERFST FROM BROTHER TO BROTHER AND
IS THEREFORE TRANSFER TAX EXEMPT.
SeSobtr britb all and singular the buildings and improvements, ways, streets, allcys, driveways,
passages,waters,watercourses,rights,liberties,psivilugus,hcraditaments and appurtenances,whatsoever
unto the hereby granted premises belonging, or in anywise appertaining, and the reversion% and
remainders, rents, issues, and profits thereof; and all the ustaw,rigid, title, interest, property,claim and
demand whatsoever of him,the saiJ grantor,as well at law as in equity,of,in and to the same.
98 aabe anb tt1 bulb the said lot or piece of ground dustAbud above, with the buildings and
improvements thereon erected,hereditamcnts and promises hereby granted,or mentioned and intended so
to be,with the appurtennnu es, utdo the said Grantee,his heirs and assigns, to and rnr the only proper use
and behnof of the said Grantee,his baits and assigns,forever.
SO the said Grantor, for himscir and his heirs, executors and administrators, does, by these presents,
covenant, grant and agree,to and with the said Grantee,his heirs and assigns,that he, the said Grantor,
and his heirs,all and singular the hcrcditamutls and premises herein described and&rented,or mentioned
and intended so to be, with the. appurtenant es, unto the said Grantee,his heats and assigns,against him,
the said Grantor, and his heirs, and against all and every other parson and persona whosoever lawfully
claiming or to claim the same or any part thereof,shalt and will
Warrant nub jForeber Advib.
Ill Wittlt8g WbereOt the pony of the first part has hereunto set his hand and soul.Dated the day and
year first abuvc written.
Ouleb anb Jklibereb
in the Presence of Us;
(// r
(SEAL)
CWASSEM MIR F,SNGIIL
2
Commonwealth of Pennsylvarda i ss
County of Cumberland f
On this, the �"�dmy of before me, the undersigned
Notary Public,personally appeared A ENGHL known to me{(tr salisf aclorily pnrven)to
be the person whose name is subscribed to the within inalrument,and acknowledged that he executed the
same for the purposes therein contained,
IN WITNESS WHEREOF,I hereunto set my hand and oflieiid send.
taary Puhfic
My commission expires
The precise residence and the tyemplete part officc
address of the sboro-namod Grantee is: COMMONWEALTH OF PENNSYLVANIA
2601 Allen Glen Drive Note at Seal
Mechanlesblar&Pa 17055 Pamela Ann Reeei Notary Public
Upper DarbyTwp. Oelawa�a County
MY Commission Expires May 27,2070
behalf of the Grantee Member,Pennsylvania Association of Notaries
n
3
elVta az fdW RECORDER'S USE ONLY
REALTY TRANSFER TAX em v U
COWMONWEAUH OF PENNSYLVANIA STATEMENT OF VALUE
'DEPARTMENT OF REVENUE ^rt
RUMAU OF INDgOM TARES ocU
HARRI�m,FAA160sr12er,603 See R#vert*for Instructions
Complete each section and file In duplicate with Recorder of Deeds when(1)the full value/consideration Is not set forth in the dead,(2)when the deed
Is without consideration,or by gift,or 3)a tax exemption is claimed.A Statement of Value b not required if the transfer is wholly exempt from tax
based on:(1)Family relationship or 22 public utility easement. If more spas h needed,Attach addttbnai sheetisl.
A CORRESPONDENT- All Fnauiries may be directed is the folowtng persons
Name Telephone Number.
Mobile Settlement Services,Inc. Area code( 610 ) 788-3636
Street Address State Zip Code
4919 Township Line Rd.,PMB 302 Drexel Hill Pa 19026
B TRANSFER DATA M Acceptance of ume.t 8/29/09
Drama DSAWW14 Grow" euee to
GHASSEM MIR ESHGHI MOHSSEN MIR ESHGHI
ail rest Street Address
1614 FOX HOLLOW RD. 2601 ALLEN GLEN DRIVE
Clii— Sense up-&-g—City State Zip Cq&
Mechanicsburg Pa 17055 MECHANICSBURG PA 17055
C PROPERTY LOCATION
Eau City,Township,Scrovib
1614 FOX HOLLOW RD. Lower Allen Township
aunty school n1arld ox Parcel Number
Cumberland WEST SHORE 13282430116
D VALUATION DATA
1.Aoual Cask anon Z.omer Consideration 3.Total Conedwailon
1.04 + node s 1.00
A. my Aux a mmarr eta rasa a.Fair Matkat v
406 670.00 X 1.26 as 512,404.20
E EXEMPTION DATA
a.Amount of Exompaar Ctabsted I b,Percentage of Interest
TOTAL 30%
2. Check ApproPrtate Sex Bellew fey FsemPAM Claimed
❑ Will or intestate succession
Name of 0e ( aab pas Numb"I
❑ Transfer to Industrial Dwelopmsnt Agency.
❑ Transfer to a trust,(Att«h compote copy of bust agreement identifying all I»tsildarin.)
❑ Transfer between principal and agent. (Attach complete copy of agencylstraw party agreement.)
❑ Tro ufirt to the Commonweohh,the United Stows and larnatentoales by gift,dedicatiay condemnation or in Hsu of condemnation.
(IF condemnation or in lieu of condemnation,attach copy of rssolutien.)
❑ Transfer from mortgagor to a holder of a mortgage in default. Mortgage Book Number ,Page Number
❑ Correafve or confirmatory dead. (Atrodt compote copy of the prior deed being corrected or confirmed.)
❑ Statutory corporate consolidation,merger or division. (Attach copy of articles.)
® other(Please explao exemption claimed,fo#w than Bred above.) TRANSFER OF ,INTFRES1 FRAM BROTHER
TO BROTHER AN13 S THEREFORE TR cFG TAX X MPT"
Under penaltiss of law,l declare thol l have exambed title Statement,inciu&Rg aceampaeybg tnfeymuaon,and to the bestof my tuowtedge
and belief, It is true, correct and complete.
ignatun of Correspondent or Responsible,/arty Daft
Mobile Setdemord Services,Inc.,By. 8129/09
ROBERT P. ZIEGLER
RECORDER OF DEEDS
CUMBERLAND COUNTY
1COURTHOUSESQUARE =
CARLISLE, PA 17013 -
717-240-6370
Instrument Number-200934286
Recorded On 10/5/2009 At 1:16:12 PM *Total Pages-5
•Instrument Type-DEED
Invoice Number-53643 User ID-KW
•Grantor-MIRESHGHI,GHASSEM
•Grantee-MIRESHGHI,MOHSSEN
•Customer-MOBILE SETTLEMENT SER INC
*FEES
STATE WRIT TAX $0.50 Certification Page
STATE JCS/ACCESS TO $10.00
JUSTICE DO NOT DETACH
RECORDING FEES - $12.50
RECORDER OF DEEDS This page is now part
PARCEL CERTIFICATION $10.00 of this legal document.
FEES
AFFORDABLE HOUSING $11.50
COUNTY ARCHIVES FEE $2.00
ROD ARCHIVES FEE $3.00
WEST SHORE SCHOOL $0.00
DISTRICT
LOWER ALLEN TOWNSHIP $0.00
TOTAL PAID $49.50
I Certify this to be recorded
in Cumberland County PA
c
REda OBE o D Ds
+-Information denoted by an asterisk may change during
the verification process and may not be reflected on this page.
00IL4F
III IIIIIIIIIIIIIIIIIIIII III
COURT OF COMMON PLEAS
CUMBERLAND COUNTY. PENNSYLVANIA
ORPHANS' COURT DIVISION
1
NO.
ESTATE OF GHASSEM N4IR-ESHGHI, DECEASED
DISCLAIMER AND RENUNCIATION
1, BABAK MIR-ESCHGHI, hereby exercise the rights granted to me in Chapter 62 of the
Probate, Estates and Fiduciaries Code, 20 Pa. C.S. §§ 6201-6207, and I hereby disclaim and
renounce any right,title or interest of my intestate share in the probate assets in the Estate of my late
father, Ghassem Mir-Eshghi, that may be situate in the Commonwealth of Pennsylvania, USA.
In WITNESS WHEREOF,and intending to be legally bound hereby,and intending that this
Disclaimer and Renunciation shall be filed of record in the Office of the Clerk of the Orphans'Court
Division of the Court of Common Pleas of Cumberland County,Pennsylvania as provided in 20 Pa.
C.S. § 6204(a), I have hereunto set my hand this day of 12013.
BABAK MIR-ESCHGHI
z
of,
Dint t
Before the undersigned personally appeared the
party executing this Disclaimer and Renunciation
and certified that he executed the Disclaimer and
Renunciatt n for the purposes stated within on
this day of 2013.
Notary Pub
My Commission Expires:
(Signature and Seal of Notary or other official qualified to administer
Oaths. Show date of expiration of Notary's Commission.)
COURT OF COMMON PLEAS
CUMBERLAND COUNTY,PENNSYLVANIA
ORPHANS' COURT DIVISION
NO.
ESTATE OF GHASSEM MIR-ESHGHI, DECEASED
DISCLAIMER AND RENUNCIATION
I, CIAMAK MIR-ESCHGHI,hereby exercise the rights granted to me in Chapter 62 of the
Probate, Estates and Fiduciaries Code, 20 Pa. C.S. §§ 6201-6207, and I hereby disclaim and
renounce any right,title or interest of my intestate share in the probate assets in the Estate of my late
father, Ghassem Mir-Eshghi,that may be situate in the Commonwealth of Pennsylvania,USA.
In WITNESS WHEREOF,and intending to be legally bound hereby,and intending that this
Disclaimer and Renunciation shall be filed of record in the Office of the Clerk ofthe Orphans'Court
Division of the Court of Common Pleas of Cumberland County,Pennsylvania as provi in 20 Pa.
C.S. § 6204(a),I have hereunto set my hand this 21 th day of November 2013.
i
CIAMAK MIR-E ,HGHI
Reg.No. 3473/2013 R
Before the undersigned personally appeared the
party executing this Disc mcr and Renunciation
and certified that he exect#ed the Disclaimer and
Renunciation for the p sea stated within on
this 21 th day of ho4em. ber 2013.
• i j
BGp4� 1
blie Prof. Drt. Peter Rawert
s
ssionExpires: lifetime
0 re and Seal of Notary or other official qualified to administer
s. Show date of expiration of Notary's Commission.)
COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO.
ESTATE OF GHASSEM MIR-ESHGHI, DECEASED
DISCLAIMER AND RENUNCIATION
I. PARHAM MIRESHGHI, hereby exercise the rights granted to me in Chapter 62 of the
Probate, Estates and Fiduciaries Code, 20 Pa. C.S. §§ 6201-6207, and I hereby disclaim and
renounce any right,title or interest of my intestate share in the probate assets in the Estate of my late
father, Ghassem Mir-Eshghi, that may be situate in the Commonwealth of Pennsylvania, USA.
In WITNESS WHEREOF,and intending to be legally bound hereby,and intending that this
Disclaimer and Renunciation shall be filed of record in the Office of the Clerk of the Orphans' Court
Division of the Court of Common Pleas of Cumberland County,Pennsylvania as provided in 20 Pa.
C.S. § 6204(a), I have hereunto set my hand this day of27,ov&-,,rl t�ch , 2013.
PARHAM MI SHGHI
Before the undersigned personally appeared the
party executing this Disclaimer and Renunciation
and certified that he executed the Disclaimer and
Renunciatr n for the purposes stated within on
this_ - �' day of y2 tij hcE , 2013.
Common Wealth of PA
NOTARIAL SEAL
� Parvin M.Mehrtash,Notary Public
pp erAllenTw U
p., Cumberland County
Notary Public / My Commission Expires March 07,2016
My Commission Expires:
(Signature and Seal of Notan,or other official qualified to administer
Oaths. Shoo date of expiration of Notary's Commission.)
O
ti
P.
COURT OF COMMON PLEAS
CUMBERLAND COUNTY,PENNSYLVANIA
ORPHANS' COURT DIVISION
NO.
ESTATE OF GHASSEM MIR-ESHGHI,DECEASED
DISCLAIMER AND RENUNCIATION
I, KAVEH MIR-ESHGHI, hereby exercise the rights granted to me in Chapter 62 of the
Probate, Estates and Fiduciaries Code, 20 Pa. C.S. §§ 6201-6207, and I hereby disclaim and
renounce any right,title or interest of my intestate share in the probate assets in the Estate of my late
father, Ghassem Mir-Eshghi,that may be situate in the Commonwealth of Pennsylvania,USA.
In WITNESS WHEREOF,and intending to be legally bound hereby,and intending that this
Disclaimer and Renunciation shall be filed of record in the Office of the Clerk of the Orphans'Court
Division of the Court of Common Pleas of Cumberland County,Pennsylvania as provided in 20 Pa.
C.S. § 6204(a), I have hereunto set my hand this G 4 day of •. 1 2013.
I ;
KAVEH MIR-ESH
EMBASSY nF SG'�!I T iERLAND
-� U.= �_y4TIQl\
Seen fc� a of the signa-
f CI I'a
,al of
Before the undersigned personally appeared the
( �!!>...k-:<{LC,tt.l..��„k k....r.. ...
party executing this Disclaimer and Renunciation !?s.'a:..i`r a...: ...
and certified that he executed the Disclaimer and l,,;;},; ;I >Iy, 34..r. .! . ........
Renunciation for the purposes stated within on _
�-.C.e.'................
this day of. ,2013.
This authentlrefi(?n concerns
only the sigor_itre(s) and not
the cont=nts of the documents)
Notary Public GHFy{.= IRR
My Commission Expires: Tehran,N ',
(Signature and Seal of Notary or other official qualified to administer Fov the A! teas 2dor of Switzerland r'
Oaths. Show date of expiration of Notary's Commission.) , • F-+��lr�i:<,
it ;� "N,...Y.... -n...._..� 111 � `?C•... �C:r�j� .�
2E��J'N
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i i 7fti
COURT OF COMMON PLEAS
CUMBERLAND COUNTY,PENNSYLVANIA
ORPHANS' COURT DIVISION
NO.
ESTATE OF GHASSEM MIR-ESHGHI, DECEASED
DISCLAIMER AND RENUNCIATION
1, NIMA MIR ESHGHI, hereby exercise the rights granted to me in Chapter 62 of the
Probate, Estates and Fiduciaries Code, 20 Pa. C.S. §§ 6201-6207, and I hereby disclaim and
renounce any right,title or interest of my intestate share in the probate assets in the Estate of my late
father, Ghassem Mir-Eshghi,that may be situate in the Commonwealth of Pennsylvania, USA.
In WITNESS WHEREOF,and intending to be legally bound hereby,and intending that this
Disclaimer and Renunciation shall be filed of record in the Office of the Clerk of the Orphans'Court
Division of the Court of Common Pleas of Cumberland County,Pennsylvania as provided in 20 Pa.
C.S. § 6204(a),I have hereunto set my hand this day of ,4/d Ver,b�r , 2013.
NIMA MIR IA HGHI
{r'.`_�, DIMCAS="OF SWITZERLAND
t'_ t
US., HNTE_RESTS .5'_CTION
of the signa-
ure of
Before the undersigned personally appeared the
party executing this Disclaimer and Renunciation
r r
and certified that he executed the Disclaimer and '• !•1 ••• i ,�.,_ i,,,;i,,4; j�,,,
Renunciation for the purposes stated within on tx'- .]..:i l,.h..lf ... .�1�..................
this day of 2013. This authentication concerns
only the signautre(s) and not
the contents of the documentfs)
Notary Public CHRiC= IRRAir_c CCCtHri l[l` l-� c•v
My Commission Expires: Tehran,Ne•, r t 3 L 3
For the Ambassador of Switzerland
(Signature and Seal of Notary or other official qualified to administer
Oaths. Show date of expiration of Notary's Commission.) \a�l•fir_ter_\
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CERTIFI
CATE OF TITLE FOR A VEHICLE
141
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4-wi X"`xi !"lEC1c�19c*3 ._.`� LOI1`1I FIITSl1f3ISHt I Iw9,539484J:g2 MS
VEHICLE IOENTIFlCATICN NUMBER YEAR, MAKE OF VEHICLE _e TITLE NUMBER 4;
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O.ACNALMILEAGE r'
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REGISTERED OWNER(S) ., (y7 i5 r 1 �'�. A= {I TrEVSnAANDS
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v^1-1AwSEM: MIR—ESF'IGH'Y( . ' c=LVSSICVEHIVE
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oramaunm ", 1,MtCHANI"CSBURG PA ]i705 " H=ABwcufiRUwSNICE
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FlRST UEN RELEASED WNmpdete tors era Poe. ''I
DATE
BY SECOND UEN RELEASED
AUTHORIZED REPRESENTATIVE DATE
MAIUNG ADDRESS _
BY
AUTHORIZED REPRESENTATIVE
GHASSEM MIR-ESHGHI
1614 FOX HOLLOW RA
MECHANICSBURG PA 17055 It
pennsylvania
DEPARTMENT OF TRANSPORTATION
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I wdlfy as d the data of Is.., me oeMel ..M. of me PannatAv.1.Depamnam BARRY J - S CHOCH i P. E
of TmeA,satlon.0.0 That th.petson(s)In Osprey remad Resin Ia me lawful owner
of
the sdd yahlde. - Secmtery of 1YeamporNt{on
SUBSCRIBED AND SWORN If a co-purchaser other than your spouse is listed and you want the title to
TO BEFORE ME: be listed as'Joint Tenants With Right of Survivorship'(On death of one
oAV owner,title goes to surviving owner)CHECK HERE 11 Otherwise,the.title
- will ba issued.as?manta In Common"(On death of one Owner,interest of
deceased Owner goes to Nether heirs or estate), N
. .
IF NG IJEN,CHECKS IS THIS AN ELT?(IF YES,FIN REOUIRED) YES[j NO❑
1ST UENHOLDER FINANCIAL INSTITUTION NUMBER'
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1ST,iENHOLDER NAME
STREET, -
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Kelley Blue Book Page 1 of 2
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P RO G R E 5 Y9 VE=i--ir--$I 6 EVEN IF IT'S NOT WITH U5. i
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Sell To Private Party I
i 2009 Mitsubishi Eclipse
Pricing Report
C'
canE don 51D,o710,07
s "�`an'
S9,275 S10,350
Style:Gs Coupe 2D { • �-i Ecawmo i
Mileage:2o,000 r $10,725
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I Vehicle Highlights i
! Private Parry Values valid for your area through
Fuel Economy: Max Seating:4 2/1312014
City 19/Hwy 26/Comb 22 MPG
Doors:2 Engine:4-Cyl,2.4 Liter I
Drivetrain:FWD Transmission:Automatic.4-Spd
w/Overdrive b Sportronic
EPA Class:Sub Compact Cars Body Style:Coupe
Country of Origin:Japan Country of Assembly:United States
Your Configured Options
Our prnse!ected options,based on typical equipment for this or.
/Options that you added while configuring this or.
Engine Comfort and Convenience Exterior
4-Cyl,2.4 Liter Air Conditioning Rear Spoiler `
Transmission Power Windows Wheels and Tires I
Automatic,4-Spd w/Overdrive& Power Door Locks Alloy Wheels
Sportronic Cruise Control
Drivetrain Steering
l FWD Power Steering
Braking and Traction 711t Wheel
ABS(4-Wheel) Entertainment and Instrumentation
AM/FM Stereo
MP3(Single Disc)
Safety and Security
Dual Air Bags i
Side Air Bags �, i
Glossary of Terms
Kelley Blue Book®Trade-in Value-This is the am cunt Tip:
you on expect ro raeNe when you Dade h
your tar to a dealer.This value Is determined based an the style,condition,mileage and options It's Crucial to know your car's
Indicated. true condition when you sell it,
so that you can price it
http://www.kbb.com/mitsubishi/eclipse/2009-mitsubishi-eclipse/gs-coupe-2d/?condition=go... 2/7/2014
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AUTHORIZED REPRESEWAMW DAM
MARINO ADDRESS By
AUTHOFIEZEO FSPRESEWFATIVE
GHASSEM MIR ESHGHI
1614 FOX HOLLOW RD
MECHANICSBURG PA 17055
ALLEN D BIEHLER
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NrierCSemeot Wiry ads? .
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Sell To Private Party
2008LexustS
Pricing Report a
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F. GJn016on Very GOatl
CWA M $31,359 caiuon
Style:t5 460 Sedan 4D S29,459 d $32,159
Mileage:2ooric, e Trir Ga;r` , eanai
32,759
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at i
Vehicle Hightights
jFuel Economy: Max Seating:9 Private Party Values"lid for your area through
I City 16/Hwy 24/Comb 19 MPG
2/13/2014
!� Doors:4 Engine:V8,4,6 Liter
Drivetrain:RWD Transmission:Automatic,8-Spd
w/Overdrive t
i
EPA Class:Large Cars Body Style:Sedan
s
Country of Origin:Japan Country of Assembly:Japan
Your Configured Options
Our pre-selected options,based on typical equipment for this car,
- tOpClons that You added while omfigurin9 this car.
! Engine Comfort.and Convenience Seats
V8,4.6 Liter Keyless Start Dual Power Seats
Transmission Air Conditioning Leather
Automatic,8-Spd w/Overdrive Power Windows Roof and Glass
Drivetrain Power Door Locks Moon Roof
I RWD Cruise Control Lighting k
Braking and Traction Steering HID Headlights
1 Traction Control Power Steering Daytime Running Lights i
I( Stability Control Tilt&Telescoping Wheel Wheels and Tires 1
ABS(4-Wheel) Entertainment and Instrumentation Alloy Wheels
AM/FM Stereo
MP3(Multi Disc)
Biuetooth Wireless
i Safety and Security i I
Backup Camera
Dual Air Bags
I1 Side Air Bags
F&R Head Curtain Air Bags
'
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Tip.
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RECEIPT FOR PAYMENT
GLENDA FARNER STRASBAUGH Receipt Date : 11/15/2013
Cumberland County - Register Of Wills Receipt Time : 13 : 18 : 22
One Courthouse Square Receipt No. : 1076232
Carlisle, PA 17Q13
MIR-ESHGHI GHASSEM
Estate File No. : 2013-01220
Paid By Remarks : ZOHREH SHAMSBOROMAND
DB1
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS ADM 60 . 00 CUMBERLAND COUNTY GENERAL FUN
RENUNCIATION 25 . 00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 20 . 00 CUMBERLAND COUNTY GENERAL FUN
JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN
INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN
INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN
Check# 508 $163 . 50
Total Received. . . . . . . . . $163 . 50
RECEIPT FOR PAYMENT
-------------------
GLENDA FARNER STRASBAUGH Receipt Date : 12/09/2013
Cumberland County - Orphans Court Receipt Time : 16 :22 :30
One Courthouse Square Receipt No. : 1053687
Carlisle, PA 17613-3387
2afo — 6 3 -) �;'
MIR-ESHGHI GHASSEM
File Number: 2013-01220
Paid By Remarks : GERALD BRINSER
CJ
-- Receipt Distribution --------- ---- -----------
Fee/Tax Description Payment Amount Payee Name
DISCLAIMER 25 . 00 CUMBERLAND COUNTY GENERAL FUN
Cash $25 . 00
Total Received. . . . . . . . . $25 . 00
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LAW OFFICES
BRINSER,WAGNER&ZIMMERMAN
6 EAST MAIN STREET-SECOND FLOOR
(EAST MAIN&SOUTH RAILROAD STREETS)
P.O.BOX 323
PALMYRA, PA 17078
PHONE:(717)838-6348
FAX:(717)838-6912 MECHANICSBURG OFFICE
MESSIAH VILLAGE
GERALD J.BRINSER 100 MT.ALLEN DRIVE
KEITH D. WAGNER MECHANICSBURG,PA 17055
JOHN M.ZIMMERMAN PHONE/FAX(717)697A666
CALEB J.ZIMMERMAN
February 17, 2014 C) = ��
1'
Glenda Famer Strasbaugh, Register of Wills `'" r=_;
Cumberland County Courthouse
1 Courthouse Square
Carlisle,PA 17013 ? v = rn
"Tl
Ca
In Re: Ghassem Mir-Eshghi Estate
File No. 21-13-01220
Dear Register of Wills,
Enclosed you will find two (2) copies of the PA Inheritance Tax Return for the above-
captioned estate. Also enclosed is a check in the amount of$300.00 in payment of the additional
cost of letters.
If you have any questions, please feel free to contact me.
Thank you.
Very truly yours,
BRINSER, WAGNER& ZIMMERMAN
: d q. &. w-�
Gerald J. Brinser
GJB/wlc
Enclosures
c: file