HomeMy WebLinkAbout04-30-14 1505611185
REV-1500 EX(02-11)(1
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Indiddual Taxes
County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN +1 E �
Harrisburg,PA 17128-0601 RESIDENT DECEDENT o� "(
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
10212013 10011919
Decedent's Last Name Suffix Decedent's First Name MI
WILEY GEORGE W
tlf Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
® 1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return(Date of Death
Prior to 12-13-82)
❑ 4. Limited Estate ❑ 4a. Future Interest Compromise(date of ❑ 5. Federal Estate Tax Return Required
death after 12.12.82)
® 6. Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust 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
ry
MARK E • HALBRUNER, ESQ . 717-731600 —G rn m
REGISTFItf UMLS USE 014.Y L7 <>
m = C-> -H a
First Line of Address ^r,- Z C:D —p 0
crs
2109 MARKET STREET T o
Second Line of Address C �7
I✓ m
f t�
City or Post Office State ZIP Code
.VNT£FIt.ED N
CAMP HILL PA 17011
Correspondent's e-mail address: M •HAL8RUNERa@HHGLLP • C0M
Under penalties of perjury,1 declare that 1 have examined this return,including accompanying schedules and statements,and to the best of my knovdedge and belief,
it is true,correct and complete.Declaration of preparer other then the personal representative is based on all infomnation of which preparer has any knmvledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ATE
VIRGINIA S . FLESHMAN �, — ,E�� Af—� 9 —/4f
ADDRESS
2513 BOLO COURT MECHANICSBURG, PA 17055
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
MARK E . HALBRUNER, ESQ • 7/ � � �— it kci
ADDRESS
2109 MARKET STREET CAMP HILL, PA 17011
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505611185 OM46473,00 1505611185 J
��t
1505611285
REV-1500 EX(FI)
Decedent's Social Security Number
_ Decedent's Name WTI FY GURGE t
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 $0 - 00
2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . 2 $0 . 00
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C), , , , , 0 $0 00
4. Mortgages and Notes Receivable(Schedule D) , . . , . . q $0 . 00
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , , , , . 5 $11804 • 64
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested , , , . 8 *111123 - 40
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested . . . . 7. *311925 • 36
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . 8 $441853 • 40
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9, $515 - 00
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) , , . . . . . , 10 $0 - 00
11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . 11. $515• 00
12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , 12. $441338 • 40
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J), , , , , , , . , 10 $0 • 00
14. Net Value Subject to Tax(Line 12 minus Line 13) , 14 *441338 40
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers un�er Sec.9116
(a.........D_ $0 . 00 15. $0 . 00
16. Amount of Line 14 tjjxable
at lineal rate X.0 L5 $441338 . 40 16. $1995. 23
17. Amount of Line 14 taxable
at sibling rate X.12 $0 . 00 17. $0 . 00
18. Amount of Line 14 taxable
at collateral rate X.15 $0 - 00 18. $0 . 00
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. $11995 . 23
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
1505611285 1505611285
OM4648 3.000
REV-1500 EX(FO Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
WIL FOR W
STREETADDRESS
RT
CUM R
CITY STATE ZIP
MECHANICSB RG PA 17055- _j
Tax Payments and Credits:
t. Tax Due(Page 2,Line 19) {t} $1,995.23
2. Credits/Payments
A. Prior Payments *0 - 00
B. Discount $0,—OD
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.
Fill in box on Page 2,Line 20 to request a refund. (4) $0 . 00
5. if Line i +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) $1-t995- 23
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 . . . . . . . . . . . . . . . . . . . . . . . . El
b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . . 0
c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . . ❑
2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ❑ FRI
4. Did decedent own an individual retirement account,annuity,or other non-probate property,which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ® ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE 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 172 P.S.§9116(a)(t.1){ip.
For dates of death on or after Jan. 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)(11)(ii)l.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 return are still applicable even if the surviving sparse is the only beneficiary.
Fix 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
adaptive 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.§91 tfi{a){t.3}]. A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption-
0 M4e71 2.000
I
REV-1508 EXa(0612)
pennsylvania SCHEDULE E
DEPPRTANCE TAX RETURN CASH BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN �
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF:
_
George W. Wiley FILE NUMBER:
Include the proceeds of Iltiga ion and the dale the proceeds were received by the estate.
All property 'oIntl owned with right of Survivorship must be disclosed on Schedule F.
ITEM
VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
I Cash
$1,804.64
TOTAL(Also enter on line 5,Recapitulation) $ $1,804.64
2w4eAD 2.000 If more space is needed,use additional sheets of paper of the same size.
REV-1509 IX+(61-16)
pennsylvania SCHEDULE F
DEPPTMENT OF RE UE
INHERITANCE TA%RETURN JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
George W. Wiley
If an asset became IWRW owned within one year of the decedents date of death,It most be reported on Schedule C
SURVIVNG JOINT TB4ANT(S)NAWS) ADDRESS RELATIONSHIP TO DECEDENT
A Fleshman, Virginia S 2513 Rolo Court,
Mechanicsburg, PA 17055 Step-Daughter
JOINTLY OWNED PROPERTY:
Ere, =ER 047E DESCRPTION OF PROPERTY % OATEOFDEATH
vc JONT MADE mcwcE xar.�awiwxcut�rvsmurlpa nrvoRArvzACCwm xllRBER CR SwuR DATE OF DEATH DECEDENTS VALUE OF
"'MBER TENANT JDM !R'ixp NiAgFR,ARACN G4.E0 FQE![v1Tty HE{y REAL EBTATE. VALLEOFASSET INTEREST DECEDENTS WEEREST
1 A 3/8/2004 297 Shares
PNC Financial
Services Group, Inc. ,
common stock
DOD High $75.21 per
share; DOD Low $74.60
per share; DOD
Average $74. 905 per
share $22,246.79 50.0000 $11,123.40
TOTAL (Also enter on tine 6, Recapitulation) $ $11,123.40
9W46AE 2.000 If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF
George W. Wiley
FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM MLLOET w.eE Or THE EFAMFEREE.THEIR REwTICNSHP TO DECEDENT Aim DATE OF DEATH %OF DECO'S EXCLUSION
NUMBE TEE DATE 0,R FER ATTACH ACOPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST FAPPUCABLE TVALUEE
1. New York Life
Annuity No. N3 165 406
Owner/Annuitant: George
W. Wiley
Beneficiary:
step-daughter, Virginia
S. Fleshman $31,925.36 100.0000 $0.00 $31,925.36
TOTAL(Also enter on line 7,Recapitulation)$
$31,925. 6
If more space is needed,use additional sheets of paper of the same size.
9W46AF 2.000
REV-1511 EX+(1609)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
George W. Wiley
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FLINERALEXPENSES:
None
B. ADMINISTRATIVE COSTS:
7. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees: $500.00
3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
7,
1 Register of Wills
filing fees $15.00
TOTAL(Also enter on Line 9,Recapitulation) $ $515.00
9W46AG 2.000 If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX-(12-12)
pennsylvania SCHEDULE I
OEPARTMENr OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN
RESRM M IDE MORTGAGE LIABILITIES & LIENS
ESTATE OF FILE NUMBER
George W. Wiley
Report debts incurred by the decedent prior to death that remained unpaid at the data of death,including unreimbursed medical expenses.
ITEM
VALUE AT DATE
NUMBER DESCRIPTION
� OF DEATH
None
TOTAL(Also enter on Line 10,Recapitulation) E $0.00
2w4eAH 2.000 If more space is needed, insert additional sheets of the same size.
REV-151jEX. 1-10)
nsylvania S CHEDULE J
ITANT EF AX RET BENEFICIARIES ITANCE TAX RETURN ENT DECEDENT
ESTATE OF;
Geor a W. Wile FILE NUMBER:
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[Include outright spousal dislnbutions and tra,ears under
Sec. 9116(a)(1.2).]
1. Virginia S. FleshMan
2513 Rolo Court
Mechanicsburg, PA 17055
All Of Residue: $44,338.40 Step-Daughter
$44,338.40
ENTER DOLLAR AMOUNTS FOR DISTRIBLMONS 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:
1.
S.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. E $0.00
9W46Al 2.000 It more space is needed,use additional sheets of paper of[the same size.
}
1i
1
Last Will and Testament
OF
GEORGE W.WILEY
1,GEORGE W. WILEY, domiciled and resident in Warrington Township, York
County, Pennsylvania, fully aware of the significance of my acts and intending to dispose of my
entire estate, declare this to be my Will. I revoke all Wills previously made by me.
FIRST: I direct that all funeral expenses,expenses connected with my Iast illness,or other
expenses connected with the administration of my estate,be paid from the assets of my estate as
soon after my death as can be done conveniently.
SECOND: I direct that all inheritance, succession, transfer and State taxes (both State and
eral)or like taxes,that may be assessed or levied against my estate on property passing by reason
of the legacies and devises herein made,or which may be in any way or for any reason enforceable
against or collectible from my estate, shall be paid not by the respective legatees, devisees,
recipients or beneficiaries,but by my Executrixes out of my residuary estate without prorating,and
hould any tax be not due or assessable at the time of my death,I give my Executrixes discretionary
power and authority to compromise such future tax with the proper governmental officer or
authority and to pay the amount so fixed and determined.
I
THIRD: I give,devise and bequeath all of my estate,all articles of real and personal property,
and wheresoever situated,to my son,Lary W. Wiley, my stepdaughter, Virginia S. Fleshman,and
to my stepdaughter Betty L. Anderson, in equal shares. In the event that any of my beneficiaries is
not alive at the time of my death, that beneficiary's share shall not lapse, but their issue, then
surviving shall take the share of their deceased parent.
FOURTH: I have intentionally made no disposition in this Will for my son,Marvin L.Wiley and
for my stepson, Merl C. Hess.
FIFTH: Unless otherwise specifically provided for in this Will,a beneficiary of my Will who
fails to survive me by thirty days shall be deemed to have predeceased me and shall not share in my
estate.
SIXTH: I nominate and appoint my stepdaughters, Virginia S. Fleshman, and Betty L.
Anderson,as Executrixes of this,my Will. I direct that my Executrixes shall not be required to give
bond, and if any is required by law or by statute, I direct that no security need be posted thereon.
SEVENTH: Byway of illustration and not byway of limitation, my Executrixes shall have the
llowing powers in addition to those vested in them bylaw or by other provisions of my Will;such
powers shall be applicable to all property, whether principal or income, exercisable without court
approval,and effective until actual distribution of all property,
(1) To retain,invest and reinvest in all forms ofreal and personal property,without
eing limited to what are known as"legal investments,"or to the investments to which Executrixes
are confined by statute;
(2) To sell or exchange and to give options for sales or exchanges or otherwise
dispose of real or personal property, for any purpose, at public or private sale for cash or credit;
I
-2-
(3) To renew notes or debts of mine and to borrow money for any purpose from
any person or persons, to execute promissory notes or other obligations for amounts so borrowed,
and to secure the payment of any real or personal property;
(4) To compromise or settle claims by or against my estate without obtaining the
consent of any beneficiary;
(5) To make distribution in cash or in kind, except as to properties specifically
devised or bequeathed;
(6) To pay directly any payment to which the beneficiary shall be entitled
hereunder for the maintenance and welfare of such beneficiary,should such beneficiary,by reason
of illness or any other cause in the opinion of my Executrixes, be incapable of disbursing it.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last
Will and Testament this_day of February, 2007.
wo�
George W. Wil
SIGNED,SEALED,PUBLISHED AND DECLARED by George W.Wiley, above named
Testator,as and for his Last Will and Testament, in the presence of us,who, in his presence and in
the presence of each other, have hereunto subscribed our names as witnesses.
GYL
I
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08-MAR-2004
P.O.Box 2388 PAGE 1
CComputershare ChicaBo,IL 60690-2388
ss / $L,— / �z -3s �46
PNC FINANCIAL SERVICES GROUP INC
COMMON STOCK
PNC/CO1
!'GEORGE W WILEY &
VIRGINIA S FLESHMAN JT TEN
125 MINE BANK RD
WELLSVILLE PA 17365 CUSIP 693475105
ISSUE DATE O8-MAR-2004
C t RUN/TRANS 0339/00119038
M � 4 N < S -m &y Pp / 70,5-5 IDENTIFIER 2
P C
�-' HOLDER ID 00009662723
CERTIFICATE NUMBERS NUM DENOM TOTAL
!CPT00356803/CPT00356803 1 X 297 297
L yA-
Q OCT o 1 �S
c
TOTAL TRANSACTION 297
MARKET VALUE 17,433 . 90
INSURANCE PREM . 00
POSTAGE • 37
PA REV-1500
SCHEDULE G
INTER-VIVOS TRANSFERS and
MISCELLANEOUS NON-PROBATE
PROPERTY
452430
NEW YORK LIFE INSURANCE AND ANNUITY CORPORATION(NYLIAC)
(A DELAWARE CORPORATION)
PO BOX 6916
CLEVELAND OH 44101-6916
1-800.695-9873
www.newyorklife.00m
Agent
November 22,2013 JAMES D DAY LUTCF CHFC CLU
(717)486-8866
>000083 2676030 0001 092154 10Z
GEORGE W WILEY
2513 POLO CT
MECHANICSBURG PA 17055-5897
Policy: N3 165 406
Annuitant: George W Wiley
Dear Valued Customer: °L
The following information pertains to an additional annuity deposit of$3,000.00 received on
November 22, 1989.
The current cash value of this deposit is $9,128.07. It is guaranteed to earn an effective annual yield of
4.00%from November 22,2013 through November 21, 2014.
�er 22,2013,the total cash value of your annuity policy, including all other deposits, is
$31,925.36.
If you have any questions regarding your annuity policy, please call your agent or one of our customer
service representatives at 1-800-695-9873.
Thank you for making New York Life The Company You Keep@. New York Life Insurance and Annuity
Corporation is a wholly owned subsidiary of New York Life Insurance Company.
Sincerely,
Paul Pecorino
Corporate Vice President
ANNUITY
POLICY INFORMATION DETAILS
Policy Number: N3165406 Annuitant: GEORGE W WILEY
Policy Dale: 07/24/1989 Owner: GEORGE W WILEY
Policy Status: PAID UP Plan: SINGLE PREMIUM RETIREMENT ANNUITY A0084
Prepared On: 02108/2005 Tax Status: NON-QUALIFIED
._MESSAGES
1 AUTO 10%TAX WH REQ NNVO
VALUES-SUMMARY DETAILS _
Total Current Values Basis and Gain Information
Quote As Of: 02/08/2005 Pre-TEFRA Cost Basis: 1,028.52
Accumulation Amount/ Post-TEFRA Cost Basis: 3,114.28
Death Benefit: 22,614.26
Surrender Charge: Total Cost Basis: 4,142.80
TSA Loan and Interest: Federal Taxable Gain: 18,471.46
Net Surrender Value: 22,614.26 State Taxable Gain:
Surrender Free Window
Surrender Free Window: 22,614.26
Amount Used:
Amount Remaining: 22,614.26
"VALUES-TSA LOAN DETAILS
�VALUES-PERIODIC PARTIAL WITHDRAWAL DETAILS
(PREMIUMS-SUMMARY _
Premium Mode: SINGLE Total Premiums Current and Prior Year:
Premium Amount: 7,184.13 Extra Credit Amount:
Last Premium Activity: 12/0411989 Total Withdrawals Current and Prior Year:
Paid to Date: TSA Quarterly Loan Repayment:
Next Bill Date:
PREMIUMS-ADDITIONAL DETAILS
Policy Date: 07/2411989 Orig Premium: 7,184.13
Current%: 4.00 Prior%: 4.00
Additional Premium Details
Source Date Dash Value As Of Amount Cash Value Current_% Prior%
471/22I19S9 -_111122/2004 11
- _ 3_000.001_ .4 .88 -. 4.001- 4.001
PREMIUMS-CHECK-O-MATIC DETAILS
PREMIUMS-COMBINED BILLING DETAILS
tt--PREMIUMS-OPTIONS DETAIL
`PREMIUMS-RIDER INFORMATION DETAILS
iBENEFICIARY DETAILS
01/21/2004 1ST VIRGINIA S FLESHMAN STEPDAUGHTER
:CLIENT DETAILS
Part I Date:
Part II Type: Part II Date: 07121/1989
Name: GEORGE W WILEY— Role: OWNER/ANNUITANT
Client ID: 000452430 HOuseHoldlD: 9811100003130644
SSNrrax ID: 1B4-12.3546 DOB: 10/0111919 Sex:M
Address: 125 MINE BANK RD Phone: 717432-3322 HOME
NEWYORK LIFE INSURANCE Mutts m0oct trenseWions processod by the Company up to the Prepared On Date.Values P Sk N3165406
AND ANNUITY CORPORATION may vary due to unprocessed trensections.For Anther dotahs,cell your Now York Lire Agent Pdnrod on:?/6/1005
(A DELAWARE CORPORATION) or your New York Uto Service Cantor page I