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HomeMy WebLinkAbout09-16-14 1505610143 REV-1500 Ex(02.11, PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes nerurrasx*er aeveeue County coda Year File Number PO BOX.280601 INHERITANCE TAX RETURN Harrisburg,PA 17128-0601 RESIDENT DECEDENT 21 14 0528 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 05 18 2014 04 07 1921 Decedent's Last Name Suffix Decedent's First Name FLOYD MI VIRGINIA g (if 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 OVALS BELOW X❑ 1. Original Return ❑ 2. Supplemental Return ❑ 3, Remainder Return(Date of Death Prier to t2-13-82} ❑ 4. Limited Estate �� qa Future Interest Dompm12s8 S. Federal Estate Tax Return Required (tla19 of death after 12-12-92) ❑ Q ® g Decedent Died Testate r 7 7 Decade tMainta nadeLiving Trust 1 (Attach Copy of Will) !� (Aptta�h RGopy rolrv�OrwU —_ B. Total Number of Safe Deposit Boxes ❑ 9. Litigation Proceeds Received •C� 1p.b89=6n P2 3 9i eatddltJDaf of DeaM ❑ 11.Election tO tax under See,9113(A) e (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MARK A MATEYA 717 241 6500.., c:> REGISTESIt9WILLS ONMff First Lino of Address M ? r- —4 _ —I t it 55 W CHURCH AVENUE Y � Crs Second Line of Address cr n CD I r City or Post Office DATEIFILED C:> State ZIP Code ^„ CARLISLE PA 17013 Correspondent's e-mail address: mamOmatevalaw com Under penalties of perjury,I declare that I have examined this return including accompanying schedules and statemenLS,and to the best of my knowledge and belief, it is true,correct and complete.Declarakion of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE Of PERSON RESPONSIBLE FOR FILING RETURN DATE ah e L �iri Carol Zeigler ApORE9S Q 612 Wiis n Street Carlisle PA 17013 SIGNATURE OF REP RER OTHE�THAN UPRESENTATIVE DA'rF ` `Vt,7rL ADDRESS Mark A. Mateya gjt,slf{� 55 W. Church Avenue,Carlisle, PA Side 1 1505610143 15056113143 J .J 1505610243 REV-1500 EX Demdert's Name: Floyd, Virginia S Decedent's Social Security Number RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 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. 1,327, 997 . 03 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous h{Dq-Probate Property (Schedule G) a Separate Billing Requested............ 7' 85, 788 . 39 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 1, 413, 785 . 42 9. Funeral Expenses and Administrative Costs(Schedule H)............ s. 44, 952 . 78 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 1, 628 . 44 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 46,581 . 22 12. Net Value of Estate(Line 8 minus Line 11)............................. .. . . 12. 1,367,204 . 20 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)............................................... 13. 143,206. 42 14. Net Value Subject to Tax(Line 12 minus Line 13)...................... 14. 1 ,223, 997 . 78 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 15. 0 . 00 16. Amount of Line 14 taxable atlinealrateX .045 1 ,223 , 997 . 78 16. 55,079 . 90 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. 55, 079. 90 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. X I_ Side 2 1505610243 1505610243 J - a REV-1500 EX Page 3 File Number 21-14-0528 Decedent's Complete Address: DECEDENT'S NAME Floyd,Virginia S STREET ADDRESS 18 Todd Circle CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) j1} 55,079.90 2. Credits/Payments A. Prior Payments 53,000.00 a. Discount 2,754.00 Total Credits(A +B) (2) 55,754.00 3. Interest (3) 4. if Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 674-10 Check box on Page 2,Line 20 to request a refund 5, if Line I +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 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;................... ....... ...................... .......... b. retain the right to designate who shall use the property transferred or its income;........... ..... ....... *...... LJ x c. retain a reversionary interest or............................................................................................. ... .. ...... 8 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?..........................................................................................................-........ ❑ 10 3. Did decedent own an'in trust for or payable upon death bank account or security at his or her death?....... ❑ Q 4. Did decedent own an individual retirement account,annuity,or other non-probate property which ❑ ❑ contains a beneficiary designation?........_...._............._......................._......................_.__._..._..............._.... x . 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)(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 0 percent 172 P.S.§9116(a)(1.1)(ii)). The statute does not exempt a transfer to a surviving spouse from lax,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 21 years of age or younger at death to or forthe use of a natural parent,an adoptive parent,or a stepparent of the child is 0 percent 172 P.S.§9116(a)(1.2)1. • 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 172 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)1. 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. Rev-1508 Ex+(11-10) SCHEDULE E peRWENTOvan REVENUE CASH, BANK DEPOSITS, & MISC. INHERITANCE NT ED RETURN .PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF Floyd,Virginia S FILE NUMBER 21-14-0528 Include h�proceeds etl withl�the night of suhh,oreh p must he e disclosed on schedule F. All roe y 8 T4Wilmington DESCRIPTION VALUE AT DATE ine and G&C Gold-Proceeds from sale of coins OF DEATH 1,065.00 nk-Account 15004200053540 138,511.97 nk-Account 1121235 15,895.19 ton Trust-Proceeds from Trust Account 1,171,258.68 uction Service-Gross sales of.personal/household items 1,010.00 e nsurance -Refund on insurance premium-Policy No. Q591807930 58.00 7 The Sentinel-Refund on newspaper subscription 8.19 8 United Healthcare Insurance-Refund of Premium 190.00 TOTAL(Also enter on Line 5, Recapitulation) 1,327,997.03 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10) Rev-1510 EX+(09 09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF Flo d, Vir inia S FILE NUMBER e 21-14-0528 g This schedule must he completed and Find if the answer to any of Questions 1 through 4 on p ethreeoftheREV- 1500 is yes. ITEM DESCRIPTION OF PROPERTY NUMBER THE DATE OF TEROANSFER SATTACHTA CO V of 7HOE�EIED�ORERI I ES qTE. DATE OF DEATH %OF DECDB VALUE OF ASSET INTEREST (IF EXCLUSION ) TVAALUEE 1 M&T Bank-IRA Account 35004202974869 85.788.39 85,78$.39 TOTAL(Also enter on Line 7, Recapitulation) (If more space is needed,additional pages of the same size) 85,7$$,39 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09) REV-1511 Ex«(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF Floyd. Vir inia S FILE NUMBER 21-14-0528 ITEM Decedent's debts must be reported on Schedule I. NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s)attached 6,051.50 B. ADMINISTRATIVE COSTS: 1 Personal Representative's Commissions Name of Personal Representative(s) Street Address City State _ Zio Year(s)Commission Paid 2. Attorney's Fees Mateya Law Firm 32,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. Probate Fees 1,008.50 5. Accountant's Fees 5. Tax Return Preparers Fees 7. Other Administrative Costs See continuation schedule(s)attached 892.78 TOTAL(Also enter on line 9, Recapitulation) 39,952.78 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Floyd,Virginia S 21-14-0528 ITEM NUMBER DESCRIPTION AMOUNT Funerai Expenses 1 Carlisle Brethren in Christ Church-Funeral Luncheon 175.00 2 Hoffman Roth Funeral Home-Funeral Expense 5,876.50 H-A 6,051.50 Other Administratin Costs 3 Cumberland Law Journal-Legal Advertisement 75.00 4 Rowe's Auction Service-Auctioneer Commission on gross sales 353.50 5 Rowe's Auction Service-Hauling Fee for Trash 35.00 6 The Sentinel -Legal Advertisement-Ad No. 431549 211.78 7 U.S. Postal Service-Expense to return Life Alert Unit 7.50 8 Westminster Cemetary-Engraving on memorial marker 210.00 H-B7 892.78 Copyright{c}2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1612 EX+(12.08) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Floyd,Virginia S 21-14-0528 Report debts incurred by the decedent prior to deatb that remained unpaid M Me date of death,including un a mbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Carlisle Regional Medical Center-Medical services for April 30, 2014 912.00 2 Century Link-Telephone Service Account No. 314302983 104.13 3 Cumberland Goodwill Fire&Rescue-Ambulance Fee from Carlisle Regional Hospital to 51.85 Sara Todd Memorial Home-Invoice#14-150990 4 M&T Visa-Credit Card Account No.417095xxxxxx1132 128.11 5 Sarah A.Todd Cottages -Final assisted living expenses 339.23 8 West Shore EMS-Ambulance Service-Account 25315714W 95.12 TOTAL(Also enter on Line 10,Recapitulation) 1,828.44 (If more space is needed,additional pages of the same site) Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08) REV-1513 EX+(0140) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF Flo d, Virginia S FILE NUMBER 21-14-0528 NUMBER NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE PERSON(S)RECEIVING PROPERTY DECEDENT I TAXABLE DISTRIBUTIONS [include outright spousal 0 a it s ee (Words) ($$$) distributions,and transfers under Sec.9116 a 1.2 Nancy K Bennett 412 Tuttle Ave Child 615,241.89 Spring Lake, NJ 07762 Carol Zeigler 612 Wilson Street Child 615,241.89 Carlisle, PA 17013 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 ovoerasheet,as a ro riate '230,483.78 II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 Brethren In Christ Church 143,206.42 TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 143,206.42 Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule)(Rev.01-10) RECORDED OFFICE OF REG1S; ER CF "'ILLS' LAST. W&VY42Arff TESTAMENT CLE;t; OF CIlIlORPII/,Ids' COURT J I, VIRGINA S. FLOYD, the 13 Voi gW' Marlft, Cumberland County, Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. 1. I direct my Executrix to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether Or not such property passes under this Will, shall be paid by the Executrix from my estate, and that none of the aforesaid taxes shall be prorated among those persons named herein or are otherwise beneficiaries hereunder. 2. My Executrix may, at her discretion, compromise claims, borrow money, retain property for such length of time as she may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as she may deem proper; and invest estate property and ;.:: income without restriction to legal investments unless otherwise provided hereunder. I authbnze and empower my Executrix to sell any realty and/or personalty ov.med by me at'my death.arid:got - f specifically devised or bequeathed herein, at public or private sale or sales,and to",give=go`odnd � sufficient deeds and/or bills of sale therefor, in fee simple, as I could da Xf itvtn'g vI'r) x is authorized and empowered to engage in any business rn whrch?I may beiengd . for such period of time after my death as seems expediienv,�o s-6d X't'611. . z r. s 4e 1� sj~i�tJS s,`F,7Q'TkM�r.r,s, k R �A+.. ��W- ,7-,. W K.1'Sr T & N 2 * 454 3. I give, devise and bequeath all of my estate of whatever nature and wherever situate as follows: a. Ten Percent(10%)to the BRETHREN IN CHRIST CHURCH located at 1155 Walnut Bottom Road, Carlisle, Pennsylvania 17013; and b. All the rest, residue and remainder to my two(2) daughters, CAROL A. ZEIGLER and NANCY.K. BENNETT, share and share alike,the child or children of any deceased daughter taking the share their parent would have taken if living. 4. I nominate and appoint CAROL A. ZEIGLER to be the Executrix of this my Last Will and Testament. In the event she has predeceased me, failed to qualify or is not able or does not serve for whatever reason, I then appoint NANCY K. BENNETT to be the substitute Executrix of this my Last Will and Testament, whereby the said Substitute Executrix shall have the same powers as are given to the original Executrix hereunder. 5. No person(s) shall benefit hereunder unless such beneficiary shall survive me by sixty (60) days. 6. No Executrix acting hereunder shall be required to post bond or enter security in this or any other jurisdiction. 2 7. No beneficiary may assign, anticipate_or pledge his or her interest in any income or principal held or distributable hereunder, and no beneficiary's creditors may levy, attach or otherwise reach any such interest. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 9h day of February 2011. (SEAL) IRGINIA S. FLOYD Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in our presence, who, at her request, in her presence and in the presence of each other have hereunto set our names as subscribing witnesses. a,Y f \ .?2 i•�:�AK'y y z�4#��ta'�r=�2`ktk` �?§°,�a�'�c!}!\r S�y1F - ,, � j 1+ r 'r '.s rxs -' -�'x s.,; 'w !." d +1.`�° ttp rt' % �dwk�•s�, $ya � � � -vk v +< ' t`� ' -;r � E �? "7 � } r\ r ... ] 1J Sv t,� a• -c�y1 ,F r;t ,t wl r�} < ra- f - tet dry, ✓I+.r '• 't v.a ,� ``'L' tv �"� �y'4 E �+s'' "LY tir"'r k�".�•, � MP C`C�F1{ �,Jr ��y }'Y+S�� M vG`T�St V ry0'�l �J y � � X21 5�S5� Y S \ } 1 Y 3 S�.'S: jy�sr � �� . d � ,.z rE5• �'2� ! �'�`tP. � �Yt',��" s��� a�' }'� �k�"3-'� a r p .�,f� ; !v}G�i '�' +sF C 4't}� � °i5 a"J't'•y� i i f '�Jr'�krtn'R �d � a°K l�L ?Y� �t �<% �, R''trt + p� �` 4 v i it t ' P^ti r 'As•yys,. , kY ?{aI t q 4 �' - tf'22'y Ft at LJ µ J 4rt, S'fatJ 'Llk{i W �a Ctt l�r�i'lt} C A ta*' al r'"''r1 yjySt T'.n4tF Yal 2fr Z' 4 � 1 >cii �)s tl�� ; yx (X t`i.� J �1l^ � l' (�`l i tf •'R'—lV� 'J } .f..�tt'�t..j. J'C' M1�'', J�{wJ.Hr,Ya F.t 1 - ��F..5 .. t i' .'r,.l t. :'� � a ._3 �Ysz r v+-K, o ✓.✓k \>. ,a ?' t z j r .k � '. Lg ACKNOWLEDGMENT AND AFFIDAVIT WE, VIRGINIA S. FLOYD, MARTHA L. NOEL and SHARON L. SCHWALM, the Testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the will as a witness and that to the best of their knowledge the Testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. IRGINIA S. FLOYD (( vj'�W- MARTKA L. NOEL SHARON L.SCHWALM COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF CUMBERLAND Subscribed, swom 'to and acknowledged,.before me by VIRGINIA S. FLOYD, the Testatrix:"herein;':;and.'subscribed 'and .sworn;to. before,me°by. MARTHA. L. NOEL and SHARON L SC ALM,witnesses,this 9a day of February 2011. ij ryyy` ZyK'{ 1Se4i1CYFi(fy, iv f4 5 ^+JIf 'f S f < Notary. Public >' S �}, 1 r '•�t�° hr4��el�� f��! it xF`.>, ,y �. , m < �. r NWFALTH OF PENNSYLVANIA . •P �{.vI<.a4'� rGS1` Y� Y��41 qty- . t.L i2wuY,yt� i �.•2Y�HIS.+`� ,'�k +' ;a 'rr y,.yyr�i- r?� TRe. { ( Notarial Seat Roger B.Irwin,Notary Publie 1y4/i� •v�'y r � y`£ .r s,trtsyx t r Cenuve goro,Cumberland County �•y N yRe a, ,hSa�LS,C-> V '?� Y COmmlulon Expires Oct.3,2012 Member,Pennsylvania Aeeodall Of Notaries f. y y_fLS Y 5 < qp ROWE'S AUCTION SERVICE (RH 79L) . 2505 Ritner Highway • Carlisle,PA 17015 Bill Rowe (AU 1538L) 249-1975 215-1044 574-1008 Dave Rowe (AU 2295L) Auction Is Action Call "Rowe" For Satisfaction SELLERS NAME dAA , DATE °? ADDRESS �I,7 � ��//dli`> PHONE 2 42-3095° OTHER �ti `�GG� / 70/3 AUCTIONEER % 35' AUCTION DATE/LOCATION CLERK % DESCRIPTION OF MERCHANDISE / arm eC X . / r_ e r � .e 6 Ynd G/lar S' Ar�t Z „ oc!ef!�QAJ r fj,• oltc P' C �, G;n I Commission 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 or authorized represen- tative of the merchandise,goods and or property and have good title and the right to sell and that they are free from a i c brances agre a all responsibility for providing merchantable title and for delivery of %title t chW&Zi agr t d armless the Auctioneers against any claims of the nature referred to in this a en X AUCTIO SIGNAT -�,/ SELLEASAIGNATURE Total Sales (Clerking Tickets Attached) $ 1 " Less Sale Expense: %Commission Auctioneer $ 2i S 2a % Commission Clerks $ / OTHER: (4&t-- -� al- TOTAL SALE EXPENSE DEDUCTED $ SELLERS NET $ 62 �"' ) avow on A 201, WITZA9 NOW 1 10CL An Sal 4 2505 7110�r Munns;' Millylo, TP 17317 757-M 1002 ahtln, L,� CLYA TOWIni coo ZZY, Map ; E12 W1130n DI CaFlIals PA 1701 '', UIZCPIPUI vice -0.1 UL pv . lopp" W k i t c4w-1 lal /oFfiamph pwyzmix"-� 5. 4ab M flwh�are luo MWI C OL - flatwovL 1A 34 me! OF 1A ! K/KUUwrKa! j W M Frame 10; C oral-1 /bOok 1A M. M. rug/misc. W ' 1. 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I i..cdY .. .i f: .iC i��4i ... � .. ,.... � i'�d.i.�t x:14.4 � 4J: 'J :}Li. .. _,� r.li .: 08 06 2011 1113010't ROW3 MAW seryice 2503 Ritner Highwai Carlisle, PA 17017,' 717-574-IOOC lindenhallMol. com Atlement Zeigler pagcL Mera 17) item Description Wise My TMI z Harry Line 14A gnid watc"-) 11'1 50. CIO, itemmi 1 A iii ountL 250. 00 Commission at 35. 000,' S7. WO Less •adjustmwtsw 87. 30 - ------- - -- Net due to Wlevg I G 2. 5101 Thank you for your busineW