HomeMy WebLinkAbout03-13-06
w
<(
~!:::U)
oc:::~
wa.o
IOO
oC:::-l
a.a:l
a.
<(
C~MMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE DEPT.
280601 HARRISBURG, PA 17128-0601
REV-1500
(8)
$13,587.30
$23,048.31
(11 )
(12)
OFFICIAL USE ONLY
FILE NUMBER
').. \ ~ ~""
~...~\
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I-
Z
W
C
w
o
w
c
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Enos, Dan B.
DATE OF DEATH (MM-DD-YY) DATE OF BIRTH (MM-DD-YY)
7/14/2005 7/24/1947
(IF APPLICABLE) SURVIVING SPOUSE'S NAME
COUNTY CODE
YEAR
NUMBER
1. Original Return 0 2. Supplemental Return
4. Limited Estate 0 4a. Future interest Compromise
6. Decedent Died Testate
I-
Z
W
o
z
o
a.
U)
w
C:::
C:::
o
o
NAME:
Taylor P. Andrews, Esquire
FIRM NAME:
Andrews & Johnson
TELEPHONE NUMBER
717 243-0123
SOCIAL SECURITY NUMBER
174-38-9548
THIS MUST BE FILED IN DUPLICATE
WITH THE REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return
o 5. Fed. Est. Tax Return Req'd
8. Total number of SOB's
COMPLETE MAILING ADDRESS:
Taylor P. Andrews, Esq.
Andrews & Johnson
78 W. Pomfret S1.
Carlisle, P A 17013
$0.00
$0.00
z
o
i=
<C
....I
::J
!:::
Il.
<C
o
w
0::
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3.Closely Held Corporation, Partnership or Sole-Prop.
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Misc. Personal Prop.(Sch.E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Misc. Non-Propate Prop.
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses & Administration Costs (Sch H)
10. Debts of Decedent, Mortgage liabilities, & Liens
11. Total Deductions (total lines 9&10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts
for which an election to tax has not been made (13)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amnt of Line 14 taxable at the spousal rate,
or transfers under Sec.9116(a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
$0.00
$6,684.50
$26,255.00
,.-.,--j
"'j
$32,93'9.50
$36,635.61
($3,696.11)
($3,696.11)
x.O_
x.045
x.12
x.15
$0.00
$0.00
$0.00
$0.00
$0.00
(1 )
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
z
o
i=
<1:
I-
::J
a.
~
o
o
><
~
$0
$0
$0
(15)
(16)
(17)
(18)
(19)
R~
ece en s ample e ress:
STREET ADDRESS
104 Big Spring Terrace
CITY STATE ZIP
Newville PA 1 7241
D
d t' C
I t Add
Tax Payments and Credits:
1. Tax Due
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discounts
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total Credits (A+B+C)
4.
TotallnterestlPentaHy (D+E)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5.
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
(1 )
(2)
(3)
(4)
(5)
(SA)
(58)
$0.00
$0.00
$0.00
$0.00
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 transerred or its income:
c. retain a reversionary interest: or
d. retain the promise for life of either payments or care?
2. If death occurred after December 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?
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary disignation?
o
o
o
o
o
o
~
~
~
~
~
~
~
o
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of pe~ury, 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.
DATE AI I
V -CJ(P
DATE -/3-C'J{;
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 3% [72P.S. Sec. 9116(a)(1.1 )(1)].
For dates of death on or after January 1, 1995. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. Sec. 9116(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 deseased child twentY-<lne years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. Sec. 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%, except as noted in 72 P.S. Sec. 9116(1.2) [72 P.S. Sec.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% [72 P.S. Sec.9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
-
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANIOUS PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
Enos, Dan B.
ITEM
NUMBER
Accounts at PSECU 8201:
Savings account - as per statement attached
Include the proceeds of litigation and the date the proceeds were received by the estate
All property jointly-owned with Right of Survivorship must be disclosed on Schedule F
DESCRIPTION
VALUE AT DATE
OF DEATH
$4,041.68
2
Checking acocunt - as per statements attached
$1,423.81
3
Credit balance with Suburban Energy for propane to home
$1,219.01
TOTAL (also on line 5, Recapitulation)
$6,684.50
r~tlL _
IIU"I~UUI!l, """vv 'VIV \uvv/_v, . v_v \"" .
websfite - http://www.psecu.com
Pennsylvanio.5tote Employees Credit Union
COLLEGE COSTS ARE ON THE RISE!
GET THE MONEY YOU NEED WITH A
SIGNATURE LOAN OR A HOME EQUITY
LOAN. LOW RATES, EASY ONLINE
APPLICATION. WWW.PSECU.COH
1111111111111111111111111111111111111111111111111111111111I111
DAN BENDS
104 BIG SPRING TER
NEWVILLE PA 17241-9110
JOINT OWNER
PAGE 1
..':~~~~,~i~~::~:~:;n ....
2462.46
1579.22
4041.68
:.' : : . :,; . . :'~:: ;: ;', :. : .
.,' .... .....
. ...,~." . ~
4.044.15
TO DATE
8.78
=======================================================================================
=======================================================================================
1167.49
1897.49
..
.........
:....' .
4169848
PSECL;
Pennsylvo'nlo State frnp'oyees [redit Union
" " "IJ I
Harrisburg, PA 17106-7013 (800) 237-7328 (Nationwide)
we~s[te E http://WVlV{.pS-ecu.com
EASY & CONVENIENT
USE YOUR PSECU CHECK CARD
INSTEAD OF CASH OR CHECKS!
1...111...1..1.1.1..1...111.1.....11...1111...11....1..111...1
DAN B ENOS
104 BIG SPRING TER
NEWVILLE PA 17241-9110
JOINT ONNER
PAGE 1
08/01 ID 01
08/12
DATE
9.69
-===-==-======-=====--=================================================================
4059521
Mary M. Enos
104 Big Spring Terrace
Newville, PA 17241
August 17,2005
Attn: M. Fairfax
PSECU
P.O. Box 67013
Harrisburg, PA 17106-7013
Re: Account 8201496828 of Dan B. Enos, deceased 7/14/05
Dear Sir or Madam;
As per instructions provided by your customer service representatives to my
attorney, Taylor P. Andrews, Esq., I hereby provide this letter of instructions.
I am the mother and only heir of Dan B. Enos. He was unmarried, with no
children and no brothers and sisters. His father predeceased him. I enclose the death
certificate that indicates Dan's death on July 14,2005. ' ...., .
The above account represents the only asset in Dan's name alone. I ask that you
close the account by issuing a check to the Funeral Home that provided the funeral for
Dan. That is Humbert Funeral Home, Inc., in Confluence, PA 15424 [phone 814 395-
3000]. My attorney has previously faxed a copy of the funeral bill, but, for your
convenience I enclose a copy as well. The balance due is $8,432.30, so there will still be
a balance due after the final balance of the credit union account is applied.
I hereby indemnify and hold PSECU harmless from any loss that it may suffer as
a result of taking this action for my convenience.
Please send a draft payable to Humbert Funeral Home, Inc. to me at the above
address or to my attorney, Taylor P. Andrews, Esq. at 78 W. Pomfret St., Carlisle, PA
17013.
Please contact attorney Andrews if you have any questions or concerns.
Sincerely,
Mary M. Enos
MME
Enc!.
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
FILE NUMBER
Enos. Dan B.
if an asset was made joint within one year of the decedent's death, it must be reported on Schedule G
Surviving Joint Tenant (s):
NAME
ADDRESS
RELATIONSHIP TO
DECEDENT
A
Mary M. Enos
104 Big Spring Terrace, Newville, P A 17241
Mother
Jointly-owned property:
ITEM NUMBER LETTER FOR DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF TOTAL VALUE OF DECD'S % INT. DOLLAR VALUE OF DECEDENT'S
JOINT TENANT INSTITUTION AND BANK ACCOUNT NUMBER OR ASSET INTEREST
SIMILAR IDENTIFYING NUMBER. ATTACH DEED
FOR JOINTLY-HELD REAL ESTATE
1 A 18-Jul-03 2003 Fleetwood 52' x 28' $52,510 50% $26,255.00
mobile home
valued as per tax assessment - tax bill
with assessment attached Original
purchase price of home in 2003 was
$52,036.50
TOTAL (also on line 6, Recapitulation)
$26,255.00
..... N
~ U
I:'"- (J) ~ I:'"-
g \.0 r-f t::a '"' C"'l r-f'
"'"
C"'l '- ,~ ..; \.0 '-
j 01 r-f 1"1: I!') r-f
EO r-f E-i ""'-l r-f
0
CD I!')E-i . CD
'- 0 0:: ...:l '-
'- 01 '-0::0 ...:l 0 01
"" r-ft::aE-i I!') H -,.
i.ij i.ij r-f
;a r-fl!') E-i C"'l>U \.0 III ~ I!') r-fl!')
ill NO 5(J) '-Ot::a CD (J) NO
ill N ...:l \.00) ~ .:"r>:
W '-'- c:~ :JJ N '-'-
(J) I:'"-I!') ~t':lE-iU r-f0...:l 0"" 0 (Il I!') I:'"-I!')
ill ~,
'" N (I)~Ut::a t::a0 o I!') 'It N
0'- :1"1:00 ><ZU om t::a 0'-
::e:::e:ZN I- I I I III 0:: I I E-i ::e:::e:ZN
11"1.. 1"1: r-f ~><E-i =:JE-i \.0 CD 1"1: ll.ll.I"1:r-f
\.01:'"- i: ...:lll.> OE-iZ ""C"'l 0 \.01:'"-
(J)O:: S=:Jt::aO H t::a 01 I!') (J)O::
I I><t::a (J) 1"1:t::a=:J "" ::e: . 0 I I><t::a
1"1:E-i ll.1Il0l =l:l=1:'"- o I!') 0 1"1:E-i
I!') ::e:::e:o~ Z Z r-f 0:;\.0 N ::e:::e:o~
0 ll.ll.HI"1: =:J...:lH E-i ~C"'l ll.ll.HI"1:
0 r-fr-f~ E-i ...:J...:J U=#: \.0 r-f r-fr-f...:l
wN 0>< Z >< ~Ht::a U(J) (J) w 0><
!;( ><::I:...:J =:J E-i H~O 1"1:(J) ><E-i lci:>< ><::I:...:l
Cr-l ><1"1: Z ...0 ...:l 1"1:~ Q...:l ><1"1: Z
1"1:000 09.Ut::a1"1: Ot::a ~ 1"1:000
>< 0(J)t::a (J)UZ IJ 0(J)t::a
...:l (J)O::(J)::I: HI"1:t::a 0\.0 (J)O::(J)::I:
~ t::a=:J0(J) mCD t::a=:J0(J)
IJ =:J::I:...:J1"1: ::Ii N ~ =:J::I:...:J1"1:
E-iE-iUU (J)I:'"- ~ E-iE-iUU
<< HI
~ llI.'PoilI_p)j.ooKT/111 N ...:l K\1t"io"';:''if..;.rr,:,a
t::aC"'l 0
...:l ...:ll!') 0
0 ... E-i ::I:
0 09. HO:; U
::I: E-i0 (J)
U IIlLO
(J) ~
::E 0\.0 ~
~ 1JC"'l
<< t::a \.0
U ~...:J t::aE-i
1"1: .1"1:E-i UU
E-i 0:: .t::a~ HH
t::aU 0:: ll.t::a E-i0::
UH t::ar-l ll. OE-i
HO:: N E-i"" .1"1:r-f Z(J) N
E-iE-i 0 N I:'"- H 0
O(J) "" t':ll:'"- 0:::C"'l ~O ""
ZH I:'"- Zr-l .00 1"1: I:'"-
0 01 H I E-i...:J 01
~ I"1:C"'lN 0:::1"1: .E-il:'"- 0 I"1:C"'lN
1"1:...:J Or-lCD ll.ll. =um li::IO Or-lCD
E-i0 0:::0::: ON Z(J) -t::a\.O E-i::I: 0:::0:; ON
0 t::a I:'"-I!') 1"1: t::a '0::: I"1:U t::a I:'"-I!')
...:l::I: ll.li::Ir-l1 0t':l...:J '0:::0::: E-i(J) ll.t::ar-ll
I"1:U H...:J C"'l H...:l .00 (J) H...:J C"'l
Z(J) ll.1Il1"1:"" "Ill H U t::at!l ll. III 1"1:""
0 I"1:ll.N (J) > I!') Z I"1:ll.N
(J)t!l 'E-i - O""~ 0\.0 ...:lH 'E-i -
0:; Z.. ~(J) "I:'"- :2000 ZOt::a E-iC"'l 1"1: 0:; .. ~(J) "I:'"-
t::at--t;1 Zt::ar-l mol!') t::ar-fZ \.0 t::a ll. g Zt::ar-f
ll.o:i:! ::I:0:::...:l1:'"- t::al 0:; (J) ~ ::I:O:;...:JI:'"-
lliJl 1"1: 1"1: (J)- ZO ~ 1"1: 1"1: (J)-
a;\.Ou.!:;: O:::IIlH H"" ~ \.0 t!l ,. O:;IIlH
< 0 ~ 0 ...:J . -...:IN :c 0 H~ 0 ...:J .
w I t!lii III 0 O:::...:J . 0 ~ I 1I11:l III 0 O:::...:J
>I!')I-Il! t::a1!')1"1:t::a 1"1:...:l I!') !l! t::a1!')1"1:t::a
><orrP OC"'lUE-i t::a...:J >< 0 '-' OC"'lUE-i
~ 0 \\! 01"1: ~O ~
N ~ U N ll!
,/1"": )
".'.:, I i
tft
\:li :<
i~i~
L. '>
H!~
r'
II~I
E-i
(J) I
=:J I
t!l E-i U I
=:JUli::I
"',Ul
..."... 1"1:00
<J' I I I
::I~ ><E-i
"::1~ ...:Jll.>
::'I=> ~~~
"10
:l1!
E-i
Z ><
=:J E-i
) 0 ...:l
Ut::a1"1:
(J)UZ
HI"1:t::a
:!l!
Il.
~
.
:;;
...
....
a:;
...
....
:i r-lr-lm
t::all!') CD CD I:'"-
10:::'::; . . . i
\.Om""
J~ C"'l""r-l
\.0\.01:'"-
Olr:!!
01 ~~
::I:'O
uj r-l
l(J),
'I
r-fr-fm
CD CD I:'"- !
\.Om"" :
C"'l "" r-l '
\.0 \.0 c-- i
1
I
I
I
I
0
t::a
E-i
.. t::a (J)
III t::a
=:J
...:J Ol
...:J t::a
t::a H 0:::
U ~.
1"1: 0 (J)
0:; (J)U E-i
0:; t::a ll.
t::a ~O H
E-i ll. I"1:Z t::a
::I: '0 E-i1"1: U
t!l ::e: l::: ...:J t::a
Z rtl I!') 0::: 0::
H t::a ...:J ot::a
0::: U '-Ill ...:J
0.. 1"1: 0 r-l::e:
(J) 0::: Z C"'l=:J '0
0::: '-U=:JO
t!l t::a N 1"1:1"1:
H E-i r-l0t::a
III cv E-i0:::0:::
t!l e >< =:JO
Z 0 1Il0:::1Il~
H ::I: t::a
0:::"" o>::e:t::a
"" ll.OCV HOHt::a
0 (J)r-fr-l 1"1: 1"1:~
r-l ''; ll.Cl...:J
t!lE-i.o zt::aUO
HOO =:JZ 0
1Il...:J::e: O:::~ .
~=:JI"1:r-l
HE-iE-i-ln-
><
01 Z
N 1"1:
"" li::I ll.
0 U ::e:
r-l 1"1: 0
0::: 0:; U
E-i 0:::
li::Ir-l t::a
>< E-i"" t!l.
I!') 0::: N 1"1:
0 1"1: t!ll:'"- ..t!l
0 ::e: Zr-l E-i
I H 0:::
I!') ~ 0:::1"1: 0
r-l ll.ll. ::e:
I!') Z (J)
0 1"1: li::I 0:::
I Cl t!l...:l =:J
01 H...:l 0
0 IIlH ><
I (J) >
\.0 0 ""~ 0
"" Z Oli::l E-i
t::a r-lZ
0
Z
E-i
U (J)
U H
1"1: ~::I:
HE-i
FORM PA 24.SLC IRev. 4/00) SIMPLE INTEREST
PENNSYlVANIA .
MOBILE HOME INSTAllMENT SALE CONTRACT WITHOUT REAL ESTAT,EDaled
(,.
ZCt'>3 {!~
_:WQ;l;'
. ~ . Account"
July 1$
ANNUAl
PERCENTAGE RATE
The cosl of your credit as
a yearly rale.
Amount Financed
The amount of credit provided
to you or on your behalf.
r otal of Payments
The amount you will have paid after you
have made all scheduled payments. '
FI NANCE
CHARGE
The dollar amount the
cre.dit will cost you.
n .. F
. .J
%
lH,360.00
$ 6,1 -'lAO, SO
46,919.20
Total Sale Price
The total tosi 01 you, purchase on
cledit; including your downpayment
5,190.30
Of$
116,550.30
~ecu~!ty:,You _ar~ giving' asecu!ily interest in the mobile home'being purchased.
P.~e~ayment: II you pay. off early, you will not:haye to pay.-apenalty.
When Payments Are Due
Monlhly. beginnin~>eptem
Filing Fees: $" 1'1/~ . _. .,' _' , . ""':"'d_'
late Charge: If a payment is latfl. you wlllbe c~arged2% of the portion of the payment which is late for.each month, or par10fa mQnlli gre_ater th.a~ 10 d~y~, Ih~Ut remain.s unpaid.
Assumption: Someone buying your Mobile Home cannot assume the remainder of thj~ Co~tract on the original terms. .
See bel?w and any other Contract documents for 'any additional information about -nonpayment, default, any required .rep_ayment in full before the sch~dule4; date and prepayment refunds and
penalties. e means estimate
In this Contract,. ,.
we are pmlNIl~ mn9.lIT8. HOMES, me c, . .
the SElLER. IQ40 (<1\R",I~,f"E PIKh, (.I\RJ,r.."u~, PA 170.1.3
Name Address
Zip Cnd.e
You are EHO(J., PIIN I\. , .1.04 BIG SPRHtGS Tm.umCE
the BUYER(S). Elms, t1/lHY tL, Nm~NII,r,E, PA 17241
Namelsl . Address(es).. Zip Codels}
PROMISES JOINT AND SEVERABLE: If there is more than one Suyer, each of you promises, separately and together, to pay all sums due us arid to '
perform all agreements in this Contract. -
TRADE.IN:
You have tr~ded in
lhe following vehicle:
n/a
Yeat and Make . Description
If a balance is still o~ing on the vehicle you have, traded tn, the Seller will pay oil Iryis amount on your behalf. You warrant and ~epresent to us that any
trade.in is free from lien, claim, encumbrance or .s~curity mteresl, except as shown as the "Uen PayoWln the -Itemization of Ambunt Financed-.
PROPERTY INSURANCE: You may choose the person Ihrough wh~m insurance is obtained against_loss-or ,damage to the Vehicle and against.liability
arising out of use or ownership of the Vehicle. If you obtain property insurance through us, the premium costs fo'r the insurance terms indicated' below'
are included in Ihe item called "To Properly Insurance Company' of Ihe "ITEMIZATION OF AMOUNT FI.NANCED" seclion 01 this Contract. In Ihe
seclion called 'YOUR PROMISES ABOUT INSURANCE" on the reverse side 01 this Conlract. you are promising to:insure the:Vehicle and keep it insured.
Mobile Home Other
Physical Damage Ins. $ ---------'--_ Term Mos. (Describe)
_ Comprehensive on Other
Mobile Home Term Mos. {Describe)
fire and TOTAL'
Theft $ Term Mos. CHARGES $
CREDIT INSURANCE IS NOT REQUIRED: Credit Lile Insurance is nol required .to .nbtain credit.. and will not be provided unl.", you sign below an~
agree to pay the additional cost. Please read the NOTICE. Of PROPOSED CREDIT INSURANCE on Ihe reverse sid~. Your insurance c~.rtificale or policy ,will
tell you the MAXIMUM amount of insurance available.
.:Term.
term
~Mos.
n/a
CredilUfe Insurance will -X.not be provided. _ be provided for the term of the cre~it. _ be provid.ed for ~ months.
By signing, you select Single Credit Ufe Insurance, WhaUs your By signing,' you bothseled Joint
which costs $ age?~Years Credit Ufe Insurance, which-costs $
Whalare
your ages!
Signature of Buyer to be insured for Single Credit Ufe lnsu~
I.
_y'~ars
2. _Years.
Signatures of both Buyers to be i~suredfor Joint Cre~it life I.nsu.rance
Insurer:
VEHICLE: You agree to purchase, under the terms ofthis Contfact, the following mobile home and its appliances, fur~Hure, equipment andlixtures,'
which is called the "Vehicle" or "Mobile Home" in this Contract. : ' .
N/U
.: Serial Number
$
PAFt322ABS1Q25CY1;! Fin~nce Charge'
$
T.otal of Payments ~Tl BallC'i.~. 00
$ . .'..
. .
Year 'and Manufacturer
Length & Width
;'00:1 Ff,EETWOOD
52x :,m
N[i.\4
Equipped
with
ASSIGNEE: We may assign this Contract and Security Agr.eemenl to the Assignee named-in this ~ection, whIch is the -"Assignee.''' If af any: timt!lhe
Owner of the Contrad-assigns the Contract to another assignee, the term then refers to such other aSSignee. After the Assignment, all rights and, benefits
of the Seller in this Conlract andin the Security Agreemenlshall belong to and be enforceable by the Assignee. The Assignee is;
. .'
Ul-HT~;)JTHU8't. HANK.
r . O. BOK 6000,. 1130 Uplyrr: 22 mIST
PFJl)Gm~l\.'l'E.R, n.J nBDO 10010 . . . . .
CO-SIGNER: Any person signing the Co.Signer's Agreement below promises separately and together with aUCo-Sign~r(sl,and 8uyer{srlo pay all sums
due and to perrorm all agreements'in this Contract. Co~Signer will not be an Owner of the Vehicle.' . . ... ' ,'.
CO-OWNER: Any person signing the Co.Owner's Security Agreement below gives us a security inlerest in the Vehicl~ and agre~s separately 'and.together'
wilh all Co.Owner(s) and Buyer(s); to perform all agreements in'the Security Agreement and all other partso! IhisContracl ellcept the'~Prom[se toPay"-
section
TERMS: The lermsshown in Iheboxes abol/eare part. 01 this Contract.
PROMISE TO PAY: You-'agree 10 pay us the Total Sale~~ke ftJr_t~e Vehicle ~y ma,kingt~e Cash
Downpaymenl, ~ssigning the Trade-In, if sho~n above,-.and paying us the Amount Fir1ance~'plus
interest. You promise to make payments in accordance with the Payment SchedUle. You promise
to make payments on or bdore the same day 'of each'month a5the first payment doe dale. You
ag~ee 10 pay ,i1I1, other ~mouhts which maY.become:due-.und.er thelerms of this_Contract. .YOQ
agree to pay the Seller or Assignee costs of suit You- also agt~e to pay reasonable. attorneys' fees
if Seller or Assignee hires an attorney to collect amounts due lInder this Contract or to protect or
get possession, of Ihe Vehicle. You a.gree to make payme.nls at the place or to s,~nd pay_me~ts to
the addr,ess whic'~ the Assignee mos.t recently specifies in the written notice to you.
By s;gningbelow, we agree to sell the Yehicle to you under the terms of this Contract.
,
, -:
If YOU DO NOT MEET YOUR CONTRACT
OB,IGATIONS,YOU MAY LOSETHEMOBILE-
HOME AND P~OPERTY THAFYOU BOUGHT
WITH THIS CONTRACT. AND/OR MONEY ON
DEPOSIT WITH THE ASSIGNEE.
T~is' ~o~tra,ct is between SellerandBuyer. All
disclosures have been made by Seller: Seller
int~nds to assign thi~. Contract to the! Assignee.
Itemization of Amount Financed
Cash:Price ,52/03_6.~ ~O.
.
Ca.sh Oownpayment 5,190..30
Trade-In \
Value of Trade.ln
Mos.
L1en-PayoUTo:
$
Unpaid Cash Price B-lJiJ1;'iJ46. 20
$ ,
~ To Credit-Insurance Companl\/a.
I, $'.'
~ ;~prOpe~Ylnsurance com.p~'a . '
-.e To PublicOffidals for:
&. license, Tags and Registration
" $. .. .' nt@.
~ Uel1Fee
nJa
nIt),
~ $
~ Tq
, -ot:H
";,1
~IJ.GO
1$
To Tit1!l
$
4:) . DIl
o _ld
$
:;; ToU a
~
n/a
1'1/".
Amoun~. Finance,d
46,919.20
64,440.80
PaYl1],nt Sch~dule - You agree to P1Y
to us the Amount ~i~anced plus interest in
Z9Y uninterrupt~d monthly
paymenls of $ ;'j71.:.!O .
each.;, a.nda final pa-y-me'nt of
$... 371. 20e . . The firsl
payme1J!d~)~i due on Sept 01,
, I . , and then pa~ments
will be-due-onthat same day of each month
following. . . .
SECURITY. AGREEMENT:' TO,secure,thepaymimt of alqumsdiJe,'and' the performance of aU
required obligations underthis Contract, you give a security interest in the' Vehicle, in -all
appliances, furniture; equipment8nd fixtures (called "accessions") attached to the-Vehicle at any
later time, ana in any proceeds of the Vehicle"including insurance proceeds. The Assignee may
set.Qf~ any~ amounts due. and unpaid. unqer this Contracl against. any ot. your mo~ey on deposit
,- w_it~ . As.signee. This !ncludllSjany rn.~n. ev ~h.ich is !l~W ,:0., r !'TIay, i.n. thl! l':lt.ure bedeposite~ with
ASSignee by you. ASSignee may do tli,s wlthouf anY'pnor,nollce to you. "
ADDITIONAL tERMS AND CONDITIONS: THIS CONtRACT CONTINUES ON THE REVERSE SIQE.
YOU ARE OBLIGATED TO ALLTHE T~RMS OF.THE CONTRACT WHICH APPEAR ON THE fRONT AND,
. REVERSE~IDSS... . . ......,. '. ......
I. ~~Df.E"IO ~~U.~~~~~Q!-InO!.,slg~.~~I~n~2.~~~~q!~I.~~~~~~;r'(9,~}~I
ESTATE OF
Enos, Dan B
SCHEDULE G
TRANSFERS
FILE NUMBER
This schedule to be completed and filed if the answer of the question on the reverse of the cover is yes.
ITEM DESCRIPTION OF PROPERTY TOTAL VALUE DECD.% EXCLUSION TAXABLE
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT
NUMBER AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. OF ASSET INT (if applicable) VALUE
1 Prudential Group Life Insurance $40,000 100% 100% $0
beneficiary is Mary M. Enos
2 Pennsylvania State Employee's $194,338 100% 100% $0
Retirement System Death Benefit
beneficiary: Mary M. Enos
SS#: 174-38-9548
TOTAL (also on line 7, Recapitulation)
$0
COMMONWEALTH OF PENNSYLVANIA
STATE EMPLOYEES' RETIREMENT SYSTEM
30 NORTH THIRD ST STE 150
HARRISBURG, PA 17101.1716
1-800-633-5461
www.sers.state.pa.us
September 20, 2005
MARY M ENOS
104 BIG SPRINGS TERRACE
NEWVILLE PA 17241
Re: DAN B ENOS
SSN: 174-38-9548
Dear Beneficiary:
We are writing to you regarding the above named account.
The enclosed forms must be completed by you, according to the printed instructions, before we can
proceed with the processing of this account for payment. Please note: The Retirement Code does not
provide for the payment of interest on the principal sum of a death benefit.
If you are a spouse, please read the enclosed information pertaining to the recent change in the Federal
tax law. Also, please complete the Election form and the Trustee to Trustee Transfer (if applicable) and
return to the system as soon as possible.
If you are not a spouse, please complete the Withholding Election form along with the required forms
and return to this system as soon as possible.
To aid you in making an option selection, the following information is provided.
Death Benefit Payable to you:
Taxable Portion:
Non Taxable Portion:
$194,337.56
$194,337.56
$0.00
If you have any questions or need assistance, please contact the field office nearest you at
1-800-633-5461 .
Sincerely,
~,,~ m. n,~
Linda M. Miller, Director
Benefits Determination Division
Enclosures
11111111111111111111111111111111111111111111111 III1I 11111 1111111111111
SCHEDULE H
FUNERAL EXPENSES, ADMINISTRATIVE
COSTS AND MISCELLANEOUS EXPENSES
ESTATE OF
FILE NUMBER
Enos, Dan B.
Debts of decedent must be reported on Schedule I.
A.
ITEM DESCRIPTION AMOUNT
NUMBER
Funeral Expenses:
1 Humbert Funeral Home, Confluence, P A $8,432.30
2
Administrative Costs:
1 Personal Representive Commissions
Name of Personal Representative(s)
Social Security Number of Personal Representative:
Street Address:
City: State: Zip:
Year(s) commissions paid:
2 Attorney fees to Andrews & Johnson $1,640.00
3 Family Exemption $3,500.00
Claimant Mary M. Enos
Street: 104 Big Spring Terrace
City: Newville State & Zip Pa, 17241
Relationship of Claimant to Decedent: Mother
4 Probate Fees to Register of Wills - Inheritance tax return filing fee $15.00
5 Accountant Fees
6 Tax Return Preparer's Fees
7
8
9
10
11
12
13
14
15
16
17
18
19
TOTAL (also on line 9, Recapitulation) $13,587.30
B.
SCHEDULE I
DEBTS OF DECEDENT
MORTGAGE LIABILITIES AND LIENS
ESTATE OF
FILE NUMBER
Enos, Dan B.
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1/2 of loan on mobile home reported at Schedule F $22,589.50
2 Discover Card $130.51
3 1/2 of school taxes due on MH $318.40
4 School personal tax $9.90
TOTAL (also on line 10, Recapitulation)
$23,048.31
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
Enos, Dan B.
ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE
NUMBER Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRlBUTIONS linclude outright spousal distributions, and transfers under Sec. 9116(a)(1.2)J
] Mary M. Enos Mother ]00%
]I NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. Charitable and Governmental Bequests:
TOT AL CHARITABLE AND GOVERNMENTAL BEQUESTS (also enter on line 13, Recapitulation)
$0