HomeMy WebLinkAbout02-23-06
..
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--.J
15056051047
REV-1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes
PO BOX 280601
____ Harrisburg, PA ~7128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
2 1 0 6
~\~~
Date of Birth
180
2 2
4 0 2 8
1 1
2 3 2
005
Suffix
032319
Decedent's First Name
2
9
Decedent's Last Name
MI
SIP E
BET T Y
F
(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
_ 1. Original Return
c:>
2 Supplemental Return
c:>
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
C)
c:> 4a. Future Interest Compromise (date of
death after 12-12-82)
c:> 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
c:::J 10. Spousal Poverty Credit (date of death c:> 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
CJ
4. Limited Estate
c:>
c:::J
J a ill e s D.
Firm Name (If Applicable)
F lower, J r.
7 1 7 2 4 3 6 22~ 2
HEGISTER OF
S aid i s, F lower &
First line of address
L i n cl say
26 vJest
Second line of address
Ii l g h
S t r e e t
City or Post Office
State
ZIP Code
DArE FILED
;-'.,)
Car 1 i s 1 e,
P A
1 7 013
Correspondent's e-mail address:
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 pre parer has any knowledge.
:NAT~RE OF P~t'J.RESP~ FOR FILING RETU-~'----"-'---'- ------..--- DATE --.-----
A~~~:m~ CarliSle, PA 170I;----~-02-"23/0G
E OF PREPARER TH N R RESENTATIVE DATE
o 06
J:.li..sle.+ P A 1.1..0..1.3.__.
PLEASE USE ORIGINAL FORM ONLY
---......./
Side 1
L
15056051047
15056051047
--.J
---I
15056052048
REV-1500 EX
Decedent's Social Security Number
Decedent's Name:
RECAPITULATION
180
22402 8
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.
6. Jointly Owned Property (Schedule F) c::> Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c::> Separate Billing Requested.. . . . . . 7.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . .
.10.
8 2 4 1 90 9 0
8 2 4 1 90 9 0
1 7 6 6 20 5 9
1 6 1 9 00 4 5
3 8 8 5 30 0 4
4 8 5 6 60 8 6
00
4 856 60 8 6
8. Total Gross Assets (total Lines 1-7). . . .
.................... 8.
9. Funeral Expenses & Administrative Costs (Schedule H). . .
... 9.
11. Total Deductions (total Lines 9 & 10). . . . . . .
.......11.
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . .
. . . . . . 14.
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) XOAS
16. Amount of Line 14 taxable
at lineal rate X.O_
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
4 856 608 6
15.
2 1 8 505 0
16.
17.
18.
19. TAX DUE.
...19.
2 1 8 5 05 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
c::>
Side 2
L
15056052048
15056052048
---I
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Betty F. Sipe
STREET ADDRESS
201 Woodlawn Lane
File Number
e--- ---
_ __un _
Carlisle
_n ISTATE~~ .--
ZIP
CITY
17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
2,185.50
3. InteresVPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C ) (2) 0
TotallnteresVPenalty ( D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
A. Enter the interest on the tax due.
(3) 0
(4) 0
(5) 2,185.50
(5A) 0
(5B) 2.185.50
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
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;.......................................................................................... 0 KJ
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 KJ
c. retain a reversionary interest; or.......................................................................................................................... 0 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............................................................................................................. 0 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 0
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 January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. S9116 (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 zero (0) percent
[72 PS. S9116 (a) (1.1) (ii)]. 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 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 twenty-one 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 zero (0) percent [72 P.S. s9116(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 four and one-half (4.5) percent, except as noted in
72 P.S. S9116(1.2) [72 P.S. s9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. s9116(a)(1.3)]. 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.
REV-1509 EX+ (6-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BETTY F. SIPE
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
21-06-
SURVIVING JOINT TENANT(S) NAME
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
RELATIONSHIP TO DECEDENT
A. Judy L. So sa
B.
C.
JOINTLY-OWNED PROPERTY:
ADDRESS
201 Woodlawn Lane, Carlisle, PA 17013
Daughter
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY.HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. Real Estate situate at 201 Woodlawn Lane, Carlisle, (South Middleton 160,780.00 50% 80,390.00
Tnwn~hin\ P"nn~\Ilv::.ni::. - A~~"~~,,rl \/::.111"
2. A Checking Account, Members First Federal Credit Union 803.62 50% 401 .81
3. A. Savings Account, Members First Federal Credit Union 25.08 50% 12.54
4. A 2000 Toyota Camry LE Sedan 4 door, Kelly Blue Book Value $4,820.00, 3,231.11 50% 1,615.55
Ip.~~ $1 SRR R~ fnr rl::.m::.np. tn hp. rp.nilirp.rl
TOTAL (Also enter on line 6, Recapitulation) $ 82,419.90
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)_
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
BETTY F. SIPE
FILE NUMBER
21-06-
Debts 01 decedent must be reported on Schedule 1.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Funeral Home
Westminster Cemetery, grave marker
Westminster Cemetery, Interment
7,717.00
3,919.00
1,045.00
2.
3.
B. ADMINISTRATIVE COSTS:
1 . Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
2.
Attorney Fees
750.00
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Judy Sosa
Street Address 201 Woodlawn Lane
3,500.00
City Carlisle
State PAZip 17013
Relationship of Claimant to Decedent Daughter
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
8.
West Shore EMS, Ambulance Service
Register of Wills, filing Inheritance Tax Return
716.59
15.00
7.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
17,662.59
REV-1512 EX+ (12-03)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BETTY F. SIPE
FILE NUMBER
21-06-
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. VISA Account #4121 4400 1109 6777 2,438.44
2. AARP Credit Card Services, Account #4408 0399 8395 2803 11,423.60
3. Wells Fargo Financial, Account #89043257 1,408.29
4. Wells Fargo Financial National Bank, Account #8526000434 920.12
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
16,190.45
REV-1513 EX+ (9-00)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BETTY F. SIPE
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21-06-
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 distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Judy L. Sosa, 201 Woodlawn Lane, Carlisle, PA 17013 Daughter 46,381.36
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00
(If more space is needed, insert additional sheets of the same size)
T A X I N FOR MAT ION
February 6, 2006
Cumberland County - South Middleton School Dist. - South Middleton Township
Name as it appears in Tax Duplicate:
SIPE, BETTY F
& JUDY L SOSA
Acct# 40-24-0758-123
Location: 201 WOODLAWN LANE
201 WOODLAWN LANE
CARLISLE, PA 17013
Land
Improvements
Total Assessment
32,160
128,620
160,780
T A X
S TAT U S
Tax
Year*
Taxing
Authority
Face Amt
Status
Amt Paid
Date Paid Amount Due
--------------------------------------------------------------------------------
2005 County 322.52 PAID 316.07 04/27/05
2005 Library 28.94 PAID 28.36 04/27/05
2005 Township D ' (J D PAID [), 00 04/27/05
2005 School 1,792.70 PAID 1,756.85 08/31/05
----------
----------
Total Due
* The School tax year is July 1 of the year shown, through June 30 of the
following year. Both the Township and County use the calendar year.
If prior year info is needed please contact The Cumberland County
Tax Claim Bureau.
I, Judy Campbell, Tax Collector for South Middleton Township do hereby
certify the above information to be the true and correct Tax Status
of the above listed property.
~~R
~/G./()tP
I / DATE
(Please return lower part with payment.)
STATEMENT
Fee for the above certification $0.00
Tax certification for: SIPE, BETTY F I
Make check payable to: Judy Campbell, South Middleton Township Tax Collector
6 Hope Drive
P.O. Box 300
Boiling Springs, PA 17007-0300
NEW OWNER:
MAILING ADDRESS:
** PLEASE PAY TAX CERTIFICATION WITH A SEPARATE CHECK **
THANK YOU!
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Account: CHECKINGjll -=:&TT'f F. ~ PE
Account details from 11/23/2005 to 11/23/2005 follow the Summary Information table
below,
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Year to Date Interest
As Of
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I Date[J
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Id[J
002580
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-$45.00 $1,116.37 ~ c:&~c..J
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~~ AS OF d3 NOv OS',
I) J 16.37 /:
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. Kelley. Blue Book - Trade-In Pricing Report - Toyota, Camry Page 1 of 3
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2000 Toyota Camry LE Sedan 40
)- Trade-In Value
Private Party Value
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BLUE BOOK'"! TRADE-IN VALUE <lO.lHf>T'S THIS~
Condition
Excellent
Value
$5,275
.... 1.l)Hf1T'S THe?;~'
Good
$4,820
(Selected)
~. WHfii'$ THIS "?
Ci3 More Photos
$4,050
Fair
~ l1.lHiH'5 THI~.?
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Vehicle Details
Change Equipment
Engine:
Transmission:
Drivetrain:
Mileage:
4-Cyl. 2.2 liter
Automatic
FWD
72,000
Selected Standard Equipment
Air Conditioning Tilt Wheel
Power Steering Cruise Control
Power Windows AMIFM Stereo
Power Door Locks
Cassette
Single Compact Disc
Dual Front Air Bags
Selected Optional Equipment
Power Seat
Blue Book Trade-In Value
Trade-in Value is what consumers can expect to receive from a dealer for a
trade-in vehicle assuming an accurate appraisal of condition, This value will
likely be less than the Private Party Value because the reselling dealer incurs
the cost of safety inspections, reconditioning and other costs of doing
business,
Vehicle Condition Ratings
Check Vehicle Title History
Excellent
f"'..~.lll~"..!","'8Illil""~. ,...
LJLJLfL3LJ
$5,275
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"Excellent" condition means that the vehicle looks new, is in excellent
mechanical condition and needs no reconditioning. This vehicle has never'
had any paint or body work and is free of rust. The vehicle has a clean
title history and will pass a smog and safety inspection. The engine
compartment is clean, with no fluid leaks and is free of any wear or visible
defects. The vehicle also has complete and verifiable service records. Less
than 5% of all used vehicles fall Into this category.
Good (Selected)
00a1') $4,820
"Good" condition means that the vehicle is free of any major defects. This
vehicle has a clean title history, the paint, body and interior have only
minor (if any) blemishes, and there are no major mechanical problems.
There should be little or no rust on this vehicle. The tires match and have
substantial tread wear left. A "good" vehicle will need some reconditioning
to be sold at retail. Most consumer owned vehicles fall into this category.
Fair
000 $4,050
"Fair" condition means that the vehicle has some mechanical or cosmetic
defects and needs servicing but is still in reasonable running condition. This
vehicle has a clean title history, the paint, body and/or interior need work
performed by a professional. The tires may need to be replaced. There may
be some repairable rust damage.
Poor
o N/A
"Poor" condition means that the vehicle has severe mechanical and/or
cosmetic defects and is in poor running condition. The vehicle may have
problems that cannot be readily fixed such as a damaged frame or a
rusted-through body. A vehicle with a branded title (salvage, flood, etc.) or
unsubstantiated mileage is considered "poor." A vehicle in poor condition
may require an independent appraisal to determine its value.
* Pennsylvania 02/16/2006
Accurate Condition Appraisal Change Condition
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determining its Blue Book value. Taking our 16 question condition quiz will
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Copyright @ 2006 by Kelley Blue Book Co., All Rights Reserved. 2006 Edition. The
specific information required to determine the value for this particular vehicle was
supplied by the person generating this report Vehicle valuations are opinions and may
vary from vehicle to vehicle. Actual valuations will vary based upon market conditions,
specifications, vehicle comJltion or other particular circumstances pertinent to LNs
particular vellicle or tile transaction or the parties to the transaction. This report is
mtended le)r the individual use or tlw person general:in9 t!lis report only and sllall not
be solei or transmitteel to anotller party. Kelley Blue Book assumes no responsibility ror
errors or omissions. (v. 06016)
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Page 2 of3
')/1 ()//OO{)
02/16/2006 at 10:33 AM
30157
BOB BAISH GLASS + BODY SHOP, INC.
Federal 1D #:251697568
(Established in 1964)
1249 Holly Pike
Carlisle, PA 17013
(717)249-1353 Fax: (717)249-1350
PRELIMINARY ESTIMATE
Written By: Tom Mahoney
Adjuster:
Job Number:
Insured: JUDY SIPE Claim #
Owner: JUDY SIPE Policy #
Address: 201 WOODLAWN LANE Deductible:
CARLISLE, PA 17013 Date of Loss:
Business: (717)245-3159 Type of Loss:
Point of Impact: 12. Front
Business: (717) 249-1353
Inspect BOB BAISH GLASS + BODY SHOP, INC
Location: 1249 Holly Pike
Carlisle, PA 17013
Insurance
Company:
2000 TOYO CAMRY LE 4-2.2L-FI4D .SED WHITE Int:
VIN: 4T1BG28K5YU852837 Lic: Prod Date:
Air Conditioning
Cruise Control
Clear Coat Paint
Power Windows
AM Radio
Cassette
Passenger Air Bag
Bucket Seats
Rear Defogger
Intermittent Wipers
Power Steering
Power Locks
FM Radio
Search/Seek
Front Side Impact Air Bag
Automatic Transmission
1
Days to Repair
Odometer:
Tilt Wheel
Dual Mirrors
Power Brakes
Power Mirrors
Stereo
Driver Air Bag
Cloth Seats
Overdrive
02/16/2006 at 10:33 AM
30157
Job Number:
PRELIMINARY ESTIMATE
2000 TOYO CAMRY LE 4-2.2L-FI 40 SED WHITE Int:
NO.
-------------------------------------------------------------------------------
OP.
DESCRIPTION
QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
1
2
3
4#
5
6
7
8
9*
10
11*
12
13#
14#
15
16
17
18#
19#
20
21#
FRONT BUMPER
Repl Bumper cover
Add for Clear Coat
FLEX ADDITIVE
FRONT LAMPS
Repl RT Headlamp assy
Aim headlamps
COOLING
Rpr Radiator support US built
HOOD
Rpr Hood US built
Add for Clear Coat
CAR COVER
FENDER
BInd RT Fender
BInd LT Fender
NIB REMOVAL
PIN STRIPE - TAPE
OTHER CHARGES
E.P.C.
1 256.50 1.8
1 10.00 T
1 214.45 0.5
0.4
s 1.0
1.0
2.8
1.1
1.5
3.0
1.2
1 5.00 T 0.2
1.0
1.0
1 0.5
1 25.00 T 0.3
1 3.00
-------------------------------------------------------------------------------
Subtotals ==>
2
513.95
5.2
12.1
02/16/2006 at 10:33 AM
30157
Job Number:
PRELIMINARY ESTIMATE
2000 TOYO CAMRY LE 4-2.2L-FI 4D SED WHITE Int:
Parts 470.95
Body Labor 5.2 hrs @ $ 42.00/hr 218.40
Paint Labor 12.1 hrs @ $ 42.00/hr 508.20
Paint Supplies 12.1 hrs @ $ 21. OO/hr 254.10
Body Supplies 4.3 hrs @ $ 1. OO/hr 4.30
Sublet/Misc. 40.00
Other Charges 3.00
----------------------------------------------------
SUBTOTAL
$ 1498.95
$ 1498.95 @ 6.0000% 89.94
Sales Tax
----------------------------------------------------
GRAND TOTAL
$ 1588.89
ADJUSTMENTS:
Deductible
0.00
----------------------------------------------------
CUSTOMER PAY
INSURANCE PAY
$ 0.00
$ 1588.89
ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR
OTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM
CONTAINING ANY MATERIALLY FALSE INFORMATION OR CONCEALS FOR THE PURPOSE OF
MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL THERETO COMMITS A
FRAUDULENT INSURANCE ACT, WHICH IS A CRIME AND SUBJECTS THE PERSON TO CRIMINAL
AND CIVIL PENALTIES.
ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE OR DEFRAUD ANY INSURER FILES
AN APPLICATION OR CLAIM CONTAINING ANY FALSE, INCOMPLETE OR MISLEADING
INFORMATION SHALL, UPON CONVICTION, BE SUBJECT TO IMPRISONMENT FOR UP TO SEVEN
YEARS AND PAYMENT OF A FINE OF UP TO $15,000.
THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO
DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: D=DISCONTINUED
3
02/16/2006 at 10:33 AM
30157
Job Number:
PRELIMINARY ESTIMATE
2000 TOYO CAMRY LE 4-2.2L-FI 40 SED WHITE Int:
PART A=APPROXIMATE PRICE B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS
M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED
MISCELLANEOUS ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND
CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT
EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED
MISC=MISCELLANEOUS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE
NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY
REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS
RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL
R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT
W/O=WITHOUT wi =WITHI #=MANUAL LINE ENTRY *=OTHER [IE..MOTORS DATABASE
- -
INFORMATION WAS CHANGED]. **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO
LINE NAGS=NATIONAL AUTO GLASS SPECIFICATIONS. MQVP=I1ANUFACTORER'S QUALITY AND
VALIDATION PROGRAM. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER
OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT.
THE ATTACHED ESTIMATE REPRESENTS AN APPRAISAL OF THE COST OF REPAIR FOR THE
VISIBLE DAMAGE TO THE VEHICLE NOTED AT THE TIME OF INSPECTION NECESSARY TO
RETURN THE VEHICLE TO ITS PREDAMAGED CONDITION. COSTS ABOVE THE APPRAISED
AMOUNT MAY BE THE RESPONSIBILITY OF THE VEHICLE OWNER. THERE IS NO REQUIREMENT
THAT THE VEHICLE OWNER USE ANY SPECIFIED REPAIR SHOP. INFORMATION REGARDING
REPAIR FACILITIES WHICH WILL BE ABLE TO REPAIR THE VEHICLE FOR THE APPRAISED
AMOUNT IS AVAILABLE FROM THE INSURANCE COMPANY. IF USED PARTS ARE SPECIFIED,
THEY ARE REQUIRED TO BE OF LIKE KIND AND QUALITY TO THOSE BEING REPLACED.
INCIDENTAL CHARGES SUCH AS TOWING, PROTECTIVE CARE, CUSTODY, STORAGE,
DEPRECIATION, BATTERY AND TIRE REPLACEMENT ARE NOTED WHEN APPLICABLE.
4