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HomeMy WebLinkAbout02-08-79 - '~/-1/ 1,/.~lJ<' ~A.. , J - v ,~ _,~ _ Form RCC-33 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS COUNTY OF RESIDENT DECEDENT CUMBERLA~D IMPORTANT: This return must bE! completed in detail and filed in duplicate, with will attaChed, with the Register of Wills of the County where decedent resided; Return is due within one year after date of death, unlt~ss an extension is granted hy the Secretary of Revenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.) . .. . .. ". .... ........ ............... ..... ..............". IN THE MATTER OF THE ESTATE OF ................... ........M.JCHA.EL.E...,J1JL1ER. (State full name of decedent) } AFFIDAVIT OF JR. .... JllaK<<.mk I Cumb er ~ij ADMINISTRATOR Late of ......E...c:l:13.t::Pel1rlsb():r-()1.'~p, State of ...Pennsylvania Coanty of Cumberland Charlotte I. ..........}ss: .......,_. Miller Administra tor of the estate of the above-named decedent being duly sworn, depose S and say S Decedent dJed ....... ........ Nov~mb e r (Month) Name and address of attorney or} other authorized representative to whom all correspondence should be mailed. 6 (!lay) 197.8....J testate leaving a last will, copy of which is hereto attached. } (Y~ar) L intestate Fowler, Addams Shughart......... 28 South Pitt Street, Carlisle, Pa. 17013 . .....,................................... That as such Admin.isootr.a..tr.ix deponent IS familiar with the affairs of said estate and the property con- e J<:XI'(,,'l tor- Admin istrator) stituting the assets thereof and their fair market value. That at the time of death there was no safe deposit box registered in decedent's individual name, or jointly with, Or as agent or deputy of another, or in decedent's individual name, with right of access by another as agent or deputy, with the exception of the following:_ OTHER INSTITUTION SAFE DEPOSIT BOX THIS SAFE DEPOSIT BOX RENTED IN NAME OR NAMES OF RELATIONSHIP OF JOINT HOLDERS TO DECEDENT Juniata Avenue and Enola Enola. Pennsylvania That the contents of said safe deposi t box or boxes are itemized under Schedules NA of this return, with the exception of the fOllOWing, for the reasons hereinafter set forth: Contents limited to papers of no intrinsic value That Schedule A attached hereto and made part hereof sets forth fully and in detail all the real property in the Connnonweal th of Pennsylvania of which decedent died having an interest therein. It also sets forth the mortgage encumbrances Upon each parcel of real property at the date of death, giving the amount still due at death, name of mortgagee, date, rate of interest, and book and page of record thereof. It also sets forth in the columns provided therefore the assessed valuation of each of said parcels, the estimated market value thereof as of date of death of decedent. That SChedule B attached hereto and made part hereof sets forth fully and in detail all personal property wheresover si tua ted owned by the decedent at the time of death; all moneys left by the decedent at the time of death, whether in deeedent's innnediate possession, standing to decedent's credit in banks of deposit, savings banks, trust cOI~anies, or other institutions, whether indiviiually, or in trust for any other person or persons giving also separately the accrued interest thereon, if any, down to the last interest day prior to decedent's death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal savings, treasury certificates or notes and other evidence of in- debtedness of the United States to the decedent; all obligations, whether by statute or agreement they are designated as tax free, of the United States, or any state, or political subdivision thereOf, or of any foreign country, which are owned at the time of death; all wearing apparel, jewelry, Silverware, pic- tures, Looks, works of art, household furni ture, horses, carriages, automObiles, boats, and any and all other personal chattels of whatsoever kind or nature, left by decedent, together with the fairly estimated market value thereof; all bonds and mortgae:es held by decedent and of all claims due and owing decedent at the time of death, and all promissory notes or other instruments in writing for the payment of money of Which decedent died possessed, of whatsoever nature, with interest thereon, if any, giving the face value and estimated fair market value thereof, and if such estimated fair market value be less than the face value, it sets forth briefly the reasons for such depreciation as to each item; all moneys payable to the estate from life insurance poliCies carried by decedent; all annuity and endowment contracts the proceeds of which were payable upon the death of the decedent; and all the corporate stocks and dividends due thereon and unpaid as of the date of death, bonds and accrued interest thereon to the date of' dece- dent's death and other investment securities owned by the decedent at the time of death, with the market value thereof at such time. Executor In the case of securities of close or family corporations, the values reported are as far as l' 0" i b1 e ",b' tan t I a ted by f I nand al ,ta t emen" a l' Ih e cocpoca tl 00', ,haW 1 ng thc a"e t, and 1 i "bHI tl " theccor aR of the date or ,Ieath. Tbe "hedule aHO ,." focth the Intec"t af deeedent at the time or death In any co_pactnec,hlp oc bu,ine'" and In suppoct or the value or such lntecest thece " anuexed ta said schedule, financial statements showing the assets and liabilities of said co_partnership or business. ,\ copy 0 f t he on-I''' too" hip a,ceemen t, (H 0,,1, a ,ta temcn t ,e t tlng I'M th the nR tn' e or the a<,eemen t) to,,"lh" with a statement ,.Wng racth the c,""et" or the b,,,'neaR, Its location, and aud' othe' rac" pe,talning ta the 'uslne,' a' may be pe,tlnent to a rai' and ju,t app,alsal or tbe deccdent', intece,t the ,e In m." t be ,ubm It ted. It' hou 1 d al ao ,e t roc I h in Item I "d rocm, to ge t b" with the fal, m.. Ire t ,,1 ue thereof, any other property owned or bequeathed by the decedent at the time of death. The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry contaloed the"ln and in the c~e ortnn,re" orp,opec", "aJ OC p"annal, wlthln Iwo yea" or decedent', death, in contemplatlon or decedent" death, oc lntended to take erfeet In po,se"lon oc enjoyment at oc art" death, oaid ..hedule se" rocth the natuce and "oiue or ,uch 1"01'''''' to whom "ansrened, tbe celationshlp or the tcan,r"e" to the decedcnt, the penpoctlonate shace "ceived by each tcan,re,ee and all othH roc" or a pectinent natoce 'egacding ,.101 tc"n,re". in the CO" or "anafHS intended t.o take errect in po,ses'ion oc enjoyment at oc artec deatb, thece i' aI'o attached t.o the "hedule a ,0RY or the deed, teust .gccement 0' othH inst,ument ceeating the tcu,t. ThH" i' ateo act fMth ,n aaid schedule a list or ali pcopecty, ceal and pec,onal, witb it' value, which pa,'" at decedent.'a death by vI c tue or the exeCO I ee by decedent, eithec i nd i vl duall y, M j 01 n t 1 Y with ,no the" 0 c an Y pOWH 0 l' appo 1 n t- ment V" t,d in decedent, ei thec 1 ndi vidoal1 Y oc join t1 y, by the will, deed, M 0 th'C In' t",~en t or ano t.hH, with a copy of the instrument creating such power attached to the schedule. That S,hedo" 0 attached hHetO acd made pact heceor ,et, focth the 0"'" and addte"" of all l' e"on' hene n ei all y in tee" ted in thia es tate at the time 0 l' doceden t' a death, the n" tote 0 l' t.he te ces- pectlve lntece,ts, thelc cel.tionshiP, II' any, to the de,edent., t.ogethec with tbe agc' at the t'me or 01 e ceden t' a dea t.h 0 l' all m' no", annu lt. an t, and benerl c t.a d ea I'M 11 re undee d ceeden t.' s Will. it al so contains a ,tatement showing which or the benerl,i,cle, named In the de,edent', will, 11' any, di~1 p,ioc to decedent, the date' or tbeic death, theic laSue, andtbe ceiation'bip or ,och isauc to tl.e henefl,lacy. That S",do'e E attacbed hecet.o and made a pact heceof ,et' ro,th all p,opecty, ceal and peC- sonal, owned by the decedent. jointlY with anothe' oc othe,a, including intangihle, ,tandIng in the name or the decedent and othec', plu' the date and place or cecocd or In,tcumenta errecting the ve'tlt.oce or ,eal estate and the date or ac~,isitlon or pe,sonalty, plu' tbe name, addce" and ,elation'hip, ir M'y, of co-owners to the decedent. That S,h,do" F attached heceto ond made a pact heceor set' mcth !'Wly and in detail all debta and dedoc tions claimed roc and an behall' 0 l' thi' dceeden t' s e, tate, i n" mil ng 1\mecaJ e'pe"''' paid; ram1Iyexemption, whece appllcahle; co,t, ar ,dmini,tcat.lon or thta e,tate; ,00n,e1 ree' ,nd 1\,dlel'CY', ,oami,sion' paid 0' to be paid; co,t expended 1'0' bocial tcusta, tomhstones oc gcavemackecs, and cell- giouS "cvices, In consequence or t.he death or the decedent; debt' and claim' nw'ng an,1 unpaid at. time of death; tave' accc,~d Cb,cgeable roc pe,iod pcloc to decedent', ,Ieatb (e,eept thosc allowed ,mdec SOctlnn 651 or the inhedtance ,nd E,tate Ta> Act); t.ogethee wlt.b n ,tate,~nt nr collatHal pJ~Jg~1 roc ob11ga- tl on', i l' any... it is agteed th,t the nduei acy will pce,en t pcoo l' 0 l' sal d e1 aimed a bllga tI ons upon ce- qne,t, th,t ir the amount aetuaily paid in ,ettJement or any ree, eomml,sian 0' debt I' Ie" th,n the esttmated amaunt claiming and ,liowed, that tbe ,ame will be c~'octed ta the Reg"tec ar "11', and that. the amount of tax assessed can be reassessed in accordance therewith. That tbe totaiS or the appcopciate column' In Scheduiea ".", "B", "CO, "E", and "F" as di,eeted thecein, have been carried forward and properly registered in the Summary. Subscribed and sworn to before me thi......................... ~~o..&--ttJ>. ;:) ~~ ..2~. ...... day of *..$.....w":"~ ..... 191'1;-"b.6~~~!.!;S:A!~i~i;;;f/i.............. .... .. ....... ... .... ;&~.~~ cf .. ~~ !a]('!Jrti:;!fif..c;;;,:!/ed........--... ~~,. .0., p, ,..;;:Ci~;:;'i";; ""dIL'Yl>fY.IEKPflLi:PILLZIJCl..3m My'" " ",g. 23, l' (City or Town .nd State) NOTE' Be roce ,I go in. ,frl olav it. make 'u ce all b I sck '1' ae", in th e am 01 ow it. and so hedu lee annev ~I ace riiled tn with details oc the wocd "None", and tn ea,e the as,et' in,lude cace and unll,ted ,ccnc'tie', ,ecu,iti.' or cioae 0' r~IIy cocpo,at'on' oc an lntece,t 'n any eo_pa,toec'htp 0' bua'ne'" that tbe da ta ,n,1 st. temen ta ce qn teed undee the pa eag caph aboye eel' tl ng to Se hedn 1 e "B" ace a tinehed. AI ,n "ake certain that column #1 in the "Summary" has been properly completed as above-directed. RCC<t4 (1-64) . COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "A" REAL PROPERTY - Real property in Pennsylvanio, with statement of mortgage encumbrances upon each parcel at death of dece- dent. Where property held as joint tenant or tenancy by entireties, report on Schedule "E". Property held by the decedent as tenant in common with another or others, should be identified as to quantum of interest and the estimated value should be that of the decedent's interest only. The real property located in the Commonwealth of Pennsylvania should be described by lot and block number, street and street number, together with a general description of the property, with ., reference to the record of the conveyance by which the decedent took title; if a farm state number of a- cres; also statement of mortgage encumbrarlces upon each parcel at death of decedent. Taxes, assessments, accrued interest on mortgages, etc.,are to be I isted on Schedule "F" and must not be deducted from this schedule. (1) (2) (3) DEPARTMENT VALUATION CAUTION (Do not write In this space) ASSESSED VALUE FOR YEAR OF DECEDENT'S DEA TH ESTlMA TED MARKET VALUE 1. Legal title to tract of land, Township of East Pennsboro, Cumberland County, Pennsylvania, 75 feet by 150 feet, being improved with brick and aluminum cape code style residence with one story addition and attached one car carport, subject to a mortgage and bond in favor of Cumberland County National Bank and Trust Company. Valued in accordance with attached appraisal of Joseph McGraw, Inc. Purchased from Frederick L. Clements et ux Deed Reference: ---- 19 "F" 246 \::.- . $4,650.00 $39,000.00 -- Insert this total opposite "real property", Schedule "A" in the "As Reported" co/umr on th'~ lost noge of this return. /' xxxxx $39,000.00 I) 0 000 ~) -\ '\ .... -', , tJ"-" Rce -3.5 . RESIDENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY CO~~fONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX I KSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually by the decedent, at the time of his death. Property owned by the decedent jointly with another or others must be listed under Schedule "E". Intangible personal property, titled in the name of the decedent, but payable at death to another or others, including but not limited to P.O.D. U. S. Savings Bonds and tenta- tive trust accounts, must be listed, despite the fact that they are not of the administered estate. Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household goods, and furnishings, books, paintings, automobiles, boats, etc.) Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank, stocks, mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay- able to the estate or f'iduciary in said capacity, partnership interests, interest in any undistributed es tate of or income from any property held in trust under the will or agreement of another, even though located outside of the State, at the time of death, should be listed in this schedule. I tern No. ITEM List and describe fully UNIT VALUE ESTIMATED MARKEr VALUE DEPARTMENT VALUATION (Do not write in this space) 1. 2. Clothing and other personal effects. One-sixth personal property interest in cabin and contents situate in Susquehanna River (no interest in real estate owned), value based upon actual sale price. 1973 Ford Bronco, value based upon insurance proceeds paid for complete loss. 1970 Ford truck, value based in accordancE with actual sale price. 1965 Chevrolet Sedan, valued in accordancE with attached appraisal. Carlisle Camper, valued in accordance witl attached ~ppraisal. 1971 Rupp mini-bike, valued in accordance with attached appraisal. 10.00 450.00 3. 4. 4,048.13. 900.00 5. 500.00 6. 150.00 7. 40.00 Insert this total opposite "Personal Property", Schedule "B" in the "As Reported" column on the last page of this return. x X V---" $6,098.l~ \';\,-)(l\:; l--:2) - . RCC- 36 COMMO\\'VEALTI! OF PENNSYLVJ\N I A THAXSFER INHERITANCE TAX SCHEDULE "c" THA.NSFEnS liES IDEXT DECEDENT (1) Did decedent, within two years of death, make any transfer of any material part of his estate, without receiving a valuable and adequate consideration therefor? (Answer yes or no) No (::!) Did r1ecedent, within two years of death, transfer property from himself to himself and another or others (including a SpOUSE') in joint ownership? (Answer yes or no) No (3) If the answer to (1) or (.2:) above is in the af'firmative state: (a) Age of' decedent at time of' transf'er (b) State of' decedent I s heal th at time of making the transf'er. (Note 1). (c) Cause of' decedent's death. (Note 1). (4) Did decedent, in his lif'etime, make any transf'er of' property without receiving a valuable or adequate consideration theref'or which was to take ef'f'ect in possession or enjoyment at or af'ter his death? (Answer yes or no) No (a) Was there any pOssibility that the property transf'erred might return to transf'erer or his estate or be subject to his power of' disposition? (Answer yes or no) (b) What was the transf'eree's age at time of' decedent's death? (5) Did decedent in his lif'etime make any transf'er wi thout receiving a valuable and adequate consideration theref'or under which transferor expressly or impliedly reserves f'or his lif'e or any period which does not in f'act end before his death: (a) The possession or enjoyment of' or the right to income f'rom thE' property transf'erred? (Answer yes or no) No (b) The right to designate the persons who shall possess or enjoy the property transferred or income theref'rom? (Answer yes or no) No (G) If' the answer to (5) (b) above is in the af'f'irmative, state whether the right was reserved in decedent alone or others (7) Did decedent in his lif'etime make a transf'er, the consideration f'or which was transf'eree's promise to pay income to or for the benefit of' care of' transferor? (Answer yes or no) No (8) Did decedent, at any time, transfer property, the benef'icial enjoyment of' which was subject to change, because of Ii reserverl power to al tel', amend, or revoke, or which COllld revert to decedent under terms of transf'er or by operation of' law? (Answer yes or no) No (9) If the answer to (8) above is in the af'f'irmative, was the power to alter, amend, or revoke the inter- est of' the benef'iciary reserved in the decedent alone or the decedent and others? (Answer yes or no) NOTE 1: The answers to these questions should be supported by af'f'idavit by the attending physician as well as a copy of' the death certif'icate. NOTE 2: If' answer to any of' the above questions is yes, set f'orth below a description of' the property transf'erred, it's f'air market value at date of' death, dates of' transf'ers and to whom transf'erred, with relationship of' transf'erees to decedent, if' any. Submit copy of' any trust deed or instrument, if trans- f'ers are claimed to be non-taxable, also submit detailed statement of' f'acts on which said claim is based. NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E. ITEM DESCRIPTION MARKET VALUE (Es tima ted) DEPT. VALUATION (Dept. Only) NONE Insert this total opposite "Transf'ers", Schedule "C" in the "As Reported" column on the last page of' this return. NONE N'.. , 0"-'--- ::lCC-3S nr~I])EKT DECEDEr\T SCHEDUI.lE "E" JOINTLY OWNED PROPEHTY COM\IU\;WE\LTH OF PEN\'~YLVi\NL\ TlL\!'i~I:~n I\"HE1UT\Nn: TAX I\STHl'CTIO'iS: This schedule must disclose all property, real aTH! personal, owned by the decedent jointly wi th another or others, including intangibles, standing in the name of the decedent and others. List real estate first, as entireties, or joint tenants, giving brief description, as indicated under Schedule "A", plus the date and place of record of instrument effecting vestiture, but rlo not include entireties or out of state real estate value in estate valuation column. Personal property should be listed as in Schedule "B", plus date of acquisition, and the name, address and relationship (if any) of CO-owners to the deceden t. Description of Property, Date of Acquisition, Name I unitl~perce~t~~e-I Es-tate Address and Relationship of CO-Owners, and Place : Value Sharp Valuation of Record of Instrument, where Real Estate. ! -- - - ..-" ---x ' y ('\, x, DEPART~ffiNT VALUATION CAUTION-Do not Write In This Space. Value of Value of Entire Decedent's Property Interest .;xv NONE Insert this total opposite "Jointly Owned Property", Schedule "E" NONE in the n As Reported" colwTD1 on the last page of this return. IN(;~ RCC-37 (12-63) COMMONWEALTH OF PEN;\JSYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT - SCHEDULE "D" /j BENEFICIARIES ::. BENEFICIARIES AND ADDRESSES RELATIONSHIP I SURVIVED DATE INTEREST OF State full names and addresses of all who . (If step-chIldren or I DECEDENT BENEFICIARY IllegitImate chIldren STATE YES OF aYe an interest, vested, contingent or other- are InVolved, set OR NO BIRTH IN ESTATE wise, in estate) forth this fact.) Wife Yes 7/19/39 11S t $20, uOO + 1i2 Charlotte I. Miller tremalnder Diana L. (Miller) Timlin Daughter Yes 5/22/57 1/6 of remainder E. Miller Son Yes i 1/6 of remainder Torrence I 7/8/59 Judith L. Hiller Daughter Yes I 3/10/63 1/6 of remainder i , I - - - , \ h ?ponent further says that all the above-named benef'iciaries are living at this time except below: NAME ::: DATE OF DEATH RESIDENCE ----- -~ -.: ...... ..... ....... ...... $ $ $ $ $... $45,098.13 ( 1 ) (As Reported) 39,000.00 .6,098.13 -0- ( 2) (As Determined) .... o ' ....."'.... r:<'" ..... - ~ '~ -Q) S 'S Q) ~ '00.0 < S .'-' , O. ....'-''0 o Q) .......... ..... ::l '" .... '-' ::l 0 ~ S g. ~ p:: Real Property Personal Property Transfers SUMMARY (Sch, "A") .. (Sch,"B") . (&h. "e") $ $ $ $ $ '" '. Gross Taxable Estate ............ .... . .......... . 00 r--; Poi cri .,-1 r--i ,..c: t- '0 (/) Z Q) ~ ... til r '" 6 o::l ~~ .l Q) - 6:l ~ I-)~ E-i ..( til 0 rIl C""l r.fl - ..... . 0 ..( \..0 -< cO ~ H o::l ~ ~ ~ r4 0 '1j '2 =- r---; p.. 0 j ,.0 g o::l =- p.. .=: I w -< w (/) ..( r-I :I: :I: til H ~ r-I :.-. ~ ~ t- V> Q N til ~. ~. H ;: 0 ~ - I.<.. -< Q) Q) Ii) Z ..... 0 t- Z t- rIl P4 ~. p.. ~ ~ til ~ ..... i- ~ +J ;j 0 0 ...4 (/) u ...c ~ a ~ ~ cd ~ 0 0 ~ ~ =- ',C w ::r:: ill ..... o::l t- ..... ;.. ~ .b t- u 0 ..- >= V> -< H ..... 0 '2 ..... ?: 0 .c. E 's "" ~ S E - - 0 :;""0 " .....-< ~ U U .. . . TELEPHONE 737.0415 INC. APPRAISALS . PROPERTY CONSULTANTS P. O. Box 7. LEMOYNE, PENNA. 17043 3RD AND MARKET STREET. LEMOYNE. PENNA. December 18, 1978 Mr. Dale F. Shughart, Jr. Attorney at Law 28 South Pitt Street Carlisle, Penna. 17013 Re: Michael E. Miller Estate 107 Mountain Street Summerdale, Penna. Dear Mr. Shughart: of the 1978. In compliance with your request we have made above property to estimate its Market Value Our findings are outlined as follows: a series of studies as of November 6, Site South side of -"_U.:..ru:ain Street in the East Pennsboro Township community of Summerdale. Utilities include electricity, telephone, water and sewer. It is not in Flood Haz- ard Area. Approximate dimensions are 75 feet frontage by 150 feet in depth. Improvements Brick and aluminum Cape Cod style residence with one story addition used as a taxidermy office and an attached I-car carport. Main Level Living room with fireplace; dining room; modern kitchen; two bedrooms; 3-piece bath; . taxidermy office; and storage room. Upper Level Master bedroom (unheated). Basement Partitioned into furnace room and paneled work room. Concrete block foundation walls and concrete floor. Heat is oil forced warm air; electric service is 100 amp. Condition Average 'lCAN INSTITUTE OF REAL ESTATE APPRAISERS SOCIETY OF REAL ESTATE APPRAISERS mEmBER NATIONAL ASSOCIATION OF REAL ESTATE BOARDS AMERICAN RIGHT OF WAY ASSOCIATION . . Atty. Dale F. Shughart, Jr. 28 S. Pitt St. Carlisle, PA. Re: M. E. Miller Est. 107 Mountain St. Surnmerdale, PA. 12/18/78 - 2 - A market study of area sales with adjustments for differences has indicated the value of the Miller Property as of November 6, 1978 to be in the range of: THIRTY-NINE THOUSAND DOLLARS - - - - - - - - - - ($39,000.) I / -: Respect~.'JJ/ljj( ~m :.'t.,t..ed, ,I! ' /1/kJo .l' / ../! /,!)ji/ Josep7 MdGra~~ ~.AI-SREA George C. Clauser Staff Appraiser GCC/ j f )SEPH McGRAW . Appraisals. Property Consultants . THIRD and MARKET STREETS, LEMOYNE, PA. ~[[(j L.B. 5)mD~~,~~(j;. Ford Division Market Street at Twelfth, P. O. Box 138 Lemoyne, Pennsylvania 17043 Phone: 717 - 761-6700 //3~//7 Ii Iv~./~u<roe'~: . ~z;;7& /PC.' 8/&'27<;:6'/7 t:. '5 q1~SA. AJ- ~ '1;-otJ*' ~ cZa- / ~ c"~~ ST ANDARD RETAIL RV BUYERS CONTRACT MAf(nN CAiv:?:-:R SALES 717/766-5569 - 1503 Carlisle Pike MECHANICSBURG, PENNSYLVANIA 17055 PHONE: I S0LD TO DATE ADDRESS SALESMAN I SnJECT TO THE TERMS ANO CONOITlONS STATEO ON BOTH SlOES O-;-:;:;;IS AGREEMENT SELLER AGREES TO SELL ANO THE PURCHASER AGREES TO PURCHASE THE FOLLOWING OESCRIBEO PROP_ER~--] -MAKE -- rODEL _~ IL APPf:x [STOCK ~UMBE~~__------, ",,., NOM'" ~ - ~, NeW -Fmo, ~o.o"o ~Fn NON"" i J~_~ USED I _ ~lIVERY DATE I -- _I CUSTOMER MAY CHOOSE PERSON FROM WHICH INSURANCE IS OBTAINED. III P~ICE OF UNIT :!$ -+' ~- N; COVE~:~UERt~~Y~~~E:~g~:~~~ow O~~~~ET~S Ii $ I ~~~~~FA~:T~U~PP:~~: _~__- -1 -1 o FIRE AND THEFT - CAC I I I I =:J FiRE AND THEFT ~ COMPREHENSIVE I. SUB-TOTAL o PERSONAL EFFECTS O-HOMEOWNER'S :i -CLOther insuranceJDes:.~ 11 SALES TAX IF NOT INCLUDED BelOW IN '4.1 NON-TAXABLE ITEMS --r-OT Al Pli'tMlUM fOf '"iuronCe {oy.rog_' on the (o.....mod;ly if obtained hom Of through ,.11.. .. FEES IF NOT INCLUDED BELOW IN (41 ~se purchose the co~-;r-~ges~ed;d above. SIGNED X o Pvrchaser has purchased required insurance tn rough: "GENT!> "DO"'ES~" I I 1. CASH PRICE TRADE_IN ALLOW ANCE lESS BAL. DUE ON ABOVE NET ALLOW ANCE CASHDOWN PAYMENT CASH AS AGREED SEE "REMARKS" 2 LESS TOTAL CREDITS 3. UNPAID BALANCE OF CASH SALE PRICE $ $ I I \-- 1$ ......Mf OIC ,....Su"l......CE CO>.1"''''NY $ --~- THIS IS NOT A TRUTH.IN-LENDING-ACT DISCLOSURE FORM INSURANCE AGAINST LIABILITY FOR BODILY INJURY OR PROPERTY ~AMAGE TO OTHERS IS NOT INCLUDED IN THIS TRANSACTION OPTIONAL EQUIPMENT, LABOR AND ACCESSORIES ,:... / b. t .I-. .)...., 1... c: ~;~~:-; -/.;L C 00 ? 7 7 50 q F 14.: L't/,; eo-~ c':'~ 4. OTHER CHARGES a. Official Fees' Specifyl $ VSI $ b. Iniuronce on Commodity. $ c. Credit life Insurance. .$ 7 d. Credit Accident & Health. $ e. TOlles [Not incl, above) . $ t. License Feu $ }$ :::!:.... Regist. Feu $ (Totall (er'if. of $ Title Fe.s REMARKS: TOTAL OTHER CHARGES (0 + b + c + d + . + II. $ s. UNPAID BAL. - AMOUNT FINANCED 13 + 41 . . $ 6. FINANCE CHARGE. . . . . . . $ 7.ANNUAL PERCENTAGE RATE I "I B. TOTAL OF PAYMENTS (S + 61 . . $ 9. TOTAL DEFERRED PAYMENT PRICE (1-t-4+6) ..,.... $ Payable in monthly in.tallments of S of each successive month commencing I I each) , all payable the liMe dale I' ,19-. I I 1-- '-~-------aALANCE CARRIED TO OPTIONAL EQUIPMENT Title 10 the within described lJnit posses os of the date of signing of the retail installment or security ogreement by the purchasers. even though physical delivery may not b. mad. until a later date. and one final installment of $ ijESCRIPTION OF TRADE-IN x j IT IS MUTUALLY UNDERSTOOD THAT THIS AGREEMENT IS SUBJECT TO NECESi I SARY CORRECTIONS, AND ADJUSTMENTS CONCERNING CHANGES IN NET Ii PAYOFF ON TRADE.IN TO BE MADE AT THE TIME OF SETTlEMENT I II SOCIAL SECURITY II ~i SOCIAL SECURITY $ BEDROOMS SI':R'Al NO COLOR .,ADE-iN u:'::ST TO BE PAID BY ~ DEALER =:: CUSTOMER -_._- .__._.__._~-------- - --_.---.- , J,c;'_"$I\Jil2d cert,fy I".JI n-.e m,:Jt;er prinled on the back hereof is agreed 10 as a part of this agreement, the same as if it were printed above Ihe Slgna- ._. 1':,' C .:...'OIgnec" c-r S:Cjtui,.;, i a,,~ or nos been legally emancipated; that the purchase of the above described trailer, mobilehome or vehicle; Ihe OfJ' . ':) <!2;.',"'iC. . (Jri(i a:c'O,scr,es th,:rson, Ihe Insur'~nce os described has been volunlary; that the property being traded in is free f'om all encumbrances ~.sc:,ve'. .HC2,:l1 c, I,uled here,n The undersigned agrees each paragraph and proviSion of this contract is severable; if one portion Ihereof is invalid the re -,'J.lnlng pOrtl0f' .:.nail. nevertheless, remain in full force and effect. __....J MARTIN CAMPER SALES _.___~.____.__________. ________ ______DEALER ""'01 Valid unless Sl~ned and Accepted by on OftlCU of the Company I, OR WE, HEREBY ACKNOWLEDGE RECEIPT OF A COPY OF THIS ORDER SIGNED X PURCHASER 8, SIGNED X PURCHASER ..\P~"O'..-fi'u Sublecl 10 Q(cep!once ot f,non(InQ by borlk or finance company :- :J r;:\^ 777 !'C< c< M,o, ahcone P'inle" ''- 'I .....:;;s.c0..;10'"' II; COPYright 1977 Prmted In uSA DEALERS COPY ~ ST ANDARD RETAil RV BUYERS CONTRACT MA~~TlN CAf~?ER SALES 717/766-5569 - 1503 Carlisle Pike MECHANICSBURG, PENNSYLVANIA 17055 PHONE: ,O,D TO DATE AGE: N T 5 ,...A,.n ....GE: N r S "'OORE '~s N.......E OF 'NSURA,,<CE CO....PANY INSURANCE AGAINST LIABILITY FOR BODilY INJURY OR PROPERTY DAMAGE TO OTHERS IS NOT INCLUDED IN THIS TRANSACTION e. Toxes INol incl. abo....el $ $ $ .$ $ $ OPTIONAL EQUIPMENT, lABOR AND ACCESSORIES b, Insurance on Commodity. v,r-:; c. Credillife Insurance /-"7, )7 , I ~:~ / d. Credit Accident& Health , ,1.;"7 'I f license Feu $ I 1 I Ii TOTAL OTHER CHARGES 10 + b + c + d + . + II . II 5. UNPAID BAt. - AMOUNT FINANCED 13 + 41 , 6. FINANCE CHARGE. . . . . . 7.ANNUAL PERCENTAGE RATE I 8. TOTAL OF PAYMENTS (S + 61 }$ ITotol1 Regist. Feu $ ~~;ti~ ~~ts $ $ .$ .$ "I $ 9. TOTAL DEFERRED PAYMENT PRICE (1+ 4+ 6) , ...... $ I [ 1--- ~ -_.~.._---- ~SC!~!T10N ~j:D~~~ C_A~~~_~_D TO OPTIO~~~ EQUIPMENT ......f '-lODE!.. BEDROOMS Titl. 10 the within described unit pone~ os of the dote of signing of the retail installment or security agre.ment by the purchasers even though physical delivery may not b. mod. until 0 later dot.. Payable In_____monthly in.tollments of $ ond one lonol in.tollment of $ I I each! x _, 011 poyoble the li,e dotel ,19-- I !I . ----~.J liT IS MUTUAllY UNDERSTOOD THAT THIS AGREEMENT IS SUBJECT TO NECES.I i!SARY CORRECTIONS, AND ADJUSTMENTS CONCERNING CHANGES IN NET! :1 PAYOFF ON TRADE.IN TO BE MADE AT THE TIME OF SETTlEMENT l! SOCIAL SECURITY , SOCIAL SECURITY of each slIccessive month commencing $ , . -- _.~~~--_._---~ I T ,f , ~~- ! .....C'l.. O....,...G TO .....HO"'! I~ ~RADE-IN DEBT TO BE PAID BY =: DEALER I--:--i CUSTOMER __.____ ~he unders'gned certify that the maUer printed on the bock hereof is agreed to os 0 port of this agreement, the some os if it were printed above the Slgno- I lures; tnat undersigned IS of statutory age or hos been legally emancipated; that the purchase of the above described trailer, mobtlehome or vehicle; the op- ',onal equipment and accessories thereon, the insurance os described has been voluntary; thaI the property being traded in is free from 011 encumbrances whatsoever, except os noted herein, The undersigned agrees each paragraph and provision nf this contract is severable; if one portion thereof IS onvol,d the re' mainong porI Ion shall, nevertheless, remain in full force and effect. Sf: RI"l "10 COLOR .= DEALER I, OR WE, HEREBY ACKNOWLEDGE RECEIPT OF A COpy OF THIS ORDER SIGNED X PURCHASER MARTIN CAMPER SALES NOI Valid Unleu Sllj;~ned and Accepted by on Officer 01 the Company By Appi'"oved. Sublect 10 occeptance 01 finanCing by b(]nk or finonce compony. SIGNED X PURCHASER Printed In l.J S A FO RM 777 .:t"'ni(lns Mob;~ehome Pfln'er~. \\)~outoh. III . CopyrIght 1 '177 O[AL[IlS COpy REV-5IR (s-n) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF F!ELD OPERATIONS P.O. BOX 7.970 HARRISBURG 17105 IN YOUR REPLY PL.EASE REFER TO Inheritance Tax Division NOTICE OF FiliNG OF APPRAISEMENT Charlotte I. Miller 107 Mountain St. Summerdale~nna. 17093 (Executor or Administrator) In Re: Estate of _________-.l!ichael~.k1j.,ller Cumberland County - Fi Ie No. 21-78-0639 Dear You are hereby notified that the . Original appraisement in the estate of Mlchael E. Miller has been fi led in the office of the Register of Wi lis of_(;umberland County on 17 April, , 191.9__, Said appraisement reflects the following va I uatj ons: Real Estate Persona! Property___ Transfers Jointly Owned Total Md__ 19 ,000 00 fi,09R.l1 ~ ~O..D~ 45~098. 13 _ As to such tax that is paid within three months from date of death, a five (5%) percent discount is allowable. As to any tax that remains unpaid after nine (9) months (fifteen months when death occurred from December 22,1965 to June 16,1971, inclusive; and twelve months when death occurred prior to December 22, 1965) from date of death, interest at the rate of six (6%) percent per annum is charged. Any party in interest who is aggrieved by this notice may object thereto within sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and Estate Tax Act of 1961, 72 P. S. 2485-1001, P. L. 373. Dote 17 April 79 Si gned 'L-t '<; \;_-"-=~- _~~ Administrative~icer Titlc_ Note: This is not a bill. REV-457 (8-78) DEPARTMENT OF REVENUE BUREAU OF FIELD OPERATIONS P.O. BOX 2970 HARRISBURG, PENNA, 17105 COMMONWEALTH OF PENNSYLVANIA I... RESIDENT INHERITANCE TAX A,PPR,l\ISEMEf\JT 11 .Ii DATE _. COUNTY 17 April 79 ___~ Cumberland ii-78-0639 FlU: (;0, , ,,,:~,". ~''''''''''''''''''~.'' "-<>>1' ___ .r . Whereas, Michael E. Miller late of _ East Pennsboro in the County of Cumberland _ Commonwealth of Penn,yl"a"ia, C''I th e 6 th day of - _ Novemb e r _ 1 9 ~, seized an d poes.""," of '0 ""M' subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, Leo Ful~initi _ ,an appr;user duly appointed '" haVing been designated to make a fair and conscionable appraisement of the said estate, and to asse,,, ",.j ,," n" value of all annuities and life estates growing out of said estate, hereby file the following appraisement -..... - -"'_.~""..,-,,-,",~_....- to ", "", '''' ", '" ,"" "","" " '"'' ""', " '"'''''''' " '"'~"'" 0, "j o,m", " M""" ",'" '" to, '""", ." c, co, "'" ," ," ot '"' """ to, ",' 00 '00 "m. ''', Com m ",w""" ",re" ..",,,,, m~"" e" ,''',' '0 0" ,",," "" ","" ,,, 'H" """,,"',. ,,, ,,, " ' ", ",W t, '0'"", rate on any such future interest. DESCRIPTION OF ASSET Total Assets ---'"'.~"'-''''''.'''''''''-~'~'''--'""''''''L__IE. ~-"-~'_.cr,,=''''''''''''''~-'''~''''-'A~'''''''___ ' u~" fjl AOI"'."'E'rnsnt [I \}",'-')I,::;. 10~/,';;',~;~,tsJllce -= I, "'-. = ~~ --<Ii~~,~_.<!~~,,,,.,~ /, I, II 6 098 113 . ~'-'t---~-"""'O=I''"''''"~=.m.''',_," 'I I r- ..NouQ .-1-,_, I Nnn., J.,._l I II' I. ~ : ,I -"-.r-----V1'...'-_-....____".....~~...-...~"-"'.,^..; 1/ :: '-ff<-.!!2 , 098 -I'-1.L~..!. I .; H~-----T----; !' , -!~-'---.i--1 ~-------~--1 I I; -.L-..._~.,____I_.....j Ii' ~ I ---1 - ,t---i Ii ,. :1 I "'-+--, 1'/. ;; I. ----j,.,; -1+--1-1 i I: I --r--I =-i, I 1 ---1'- -"-T~! II ! i -t+-----r~ ,J " - 1/ __~--. If" I ----t--,-.~ t II I ~I-- - I -. ~[.r -=+-=! <( I j i --J-- II I: ~-k! -- Real prop~rt~ P"TQnn~l PTnp"T~y Transfers Jointly Held Property = (Post Office) . , Penna, =- Have been duly SWorn according to law, 1 do hereby certify that the above appraisement is made in co::!~rmilY th the law on this I hh day of L:' c-'!><P_ 19 __ e '~" t L..J<~:-~ _. App r,ll set \ _.> (Nl(!J1ber al'd .street) tiarrlSburg, c ~ i\{l. --.1' "tj I ~ <<'. . .-I '-"'$01 <;:;-Q) ..1 ~u il( 3 $01 QJ P"'I P"'I ~ , ~ .....I ~ -u ;1 u (j) CI) III (j) o (j) (~ too....... o (j) +-> III >--1 0: $01: 0: .0: tIl: l=l: 1:1: Ill: p...: .. ~; - : . : ! : ..Co +-> III (J) Q '<.... o (]) .;-> ru o 0: 0\: .-4: '-0 :> ,.9, ..:... .;-> (~ ~ ,..) () C~ 4~ ,-' f() E c:> CI) .(C >~ C}.. Q. cC 0\; ....: 0'. .-I: ....; $01: ~': ,,; .....: 0..; ~ tr, (~j k- sf <..:: <,.... C ,u, t; t~ "D (t. c:c: u (j) \--0....;_ ILl -, :2 w,.1 -. ~ !:C ~ o r- Z w ! i ;?- r- j ...- H <( '. 0- W '10 I ~ .:0 x ru -10- ~ (",-; o -' >~ :3 o E .:.:t:, , .. i ~ ....:j <:, ::> C c Q) ,~ Q- v: "2 Cr,. r, ,........ s. 0.; c.-t "?~ c::r: C. <1:"'; ;-' :3 o ...0 ~ <i) ,-, c ~ X r _. ~ ....>.....: ~ ~~ (;'. ~f:; ~-. ~, c' t: o <t. (l) .......l r, ~. ~ "C n, C;, O' ;.: c ~, <b Cl.. ~ ....... 7" tr \-. -~ 1:.1"3