HomeMy WebLinkAbout06-4139
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THIS IS AN ARBITRATION
DAMAGES HEARING REQUIRE
GORDON & WEINBERG, P.C.
BY: FREDERIC I. WEINBERG, ESQUIRE
Identification No.: 41360
PAUL M. SCHOFIELD, JR., ESQUIRE
Identification No.: 81894
21 SOUTH 21ST STREET
PHILADELPHIA, PA 19103
215/988-9600
Erie Insurance Company
P.O. Box 2013
Mechanicsburg PA 17055
Vs.
Gregory A. Meyers
c/o Gregory Abelin, Esq.
37 E. Pomfret Street
Carlisle PA 17013
COURT OF COMMON PLEAS
CUMBERLAND COUNTY
DOCKET NO. : oto clUt?? yy?
NOTICE
YOU HAVE BEEN SUED IN COURT. IF YOU WISH TO DEFEND AGAINST THE CLAIMS SET
FORTH IN THE FOLLOWING PAGES, YOU MUST TAKE ACTION WITHIN TWENTY (20) DAYS AFTER
THIS COMPLAINT AND NOTICE ARE SERVED, BY ENTERING A WRITTEN APPEARANCE PERSONALLY
OR BY ATTORNEY AND FILING IN WRITING WITH THE COURT YOUR DEFENSES OR OBJECTIONS
TO THE CLAIMS SET FORTH AGAINST YOU. YOU ARE WARNED THAT IF YOU FAIL TO DO SO
THE CASE MAY PROCEED WITHOUT YOU AND A JUDGEMENT MAY BE ENTERED AGAINST YOU BY
THE COURT WITHOUT FURTHER NOTICE FOR ANY MONEY CLAIMED IN THE COMPLAINT OR FOR
ANY OTHER CLAIM OR RELIEF REQUESTED BY THE PLAINTIFF. YOU MAY LOSE MONEY OR
PROPERTY OR OTHER RIGHTS IMPORTANT TO YOU.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A
LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE
YOU WITH INFORMATION ABOUT HIRING A LAWYER.
IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE
YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE
PERSONS AT A REDUCED FEE OR NO FEE.
CUMBERLAND COUNTY BAR ASSOCIATION
32 S. BEDFORD STREET
CARLISLE, PA 17013
(717) 249-3166
COMPLAINT IN CIVIL-ACTION
1. Plaintiff, Erie Insurance Company, is an insurance carrier authorized to do business
in the Commonwealth of Pennsylvania.
2. Defendant(s), Gregory Meyers is an individual listing an address of their attorney listed
above.
COUNT ONE
3. Plaintiff issued to the defendant(s), at defendant(s)' special instance and request,
certain insurance policies and suretybond, as are more particularly set forth in Exhibit "A" attached
hereto.
4. The defendant(s), and its/their agents, servants and employees were insured by
plaintiff pursuant to said policies, pursuant to the terms thereof, and as required by law.
5. Pursuant to the terms of said policies, the defendants agreed to pay plaintiff the
premiums for the coverages provided under said policies, as calculated pursuant to the terms and
conditions of said policies.
6. Pursuant to the terms and conditions of said policies, Plaintiff was forced to pay on
the bond a total of $6,003.53 as a result of Defendant's dishonesty.
7. Defendant's failed to pay applicable sales taxes, passed worthless checks and failed
to fulfill their legal obligations to submit 16 vehicle transactions to the Pennsylvania Department of
Transportation.
8. Copies of the worthless checks and vehicle titles are attached and labeled Exhibit A.
9. As a result of Defendant's actions, Plaintiff was forced to settle a claim with the
Commonwealth of Pennsylvania for a total amount of $6,003.53. Copies of release and receipt are
attached and labeled Exhibit B.
10. As a further result of Defendant's actions, Plaintiff, has paid money on behalf of the
Defendants for which Plaintiff demands remuneration from the Defendant.
11. Payment of the aforesaid sum has been demanded, but the defendant(s) have failed
and refused to pay same.
WHEREFORE, plaintiff, Erie Insurance Company demand judgment against the
defendant(s), in the sum of $$6,003.53, together with interest and costs of suit.
COUNT THREE
11. Plaintiff incorporates by reference all the allegations contained in paragraphs 1
through 10 inclusive, as fully as though each were here set forth at length.
12. Plaintiff sues the defendant(s) for the reasonable value of insurance coverage
provided by plaintiff to defendant(s) all as more particularly set forth in Exhibit "A" hereto annexed.
13. Payment of the aforesaid sum has been demanded, but the defendant(s) have failed
and refused to pay same.
WHEREFORE, plaintiff, Erie Insurance Company demand judgment against the
defendant(s), in the sum of $$6,003.53, together with interest and costs of suit.
GORDON & WEINBERG, P.C.
BY: /--?
TREDERIC 1. WEINBERG, ESQUIRE
PAUL M. SCHOFIELD, JR., ESQUIRE
Attorney for Plaintiff
VERIFICATION
PAUL M. SCHOFIELD, JR., ESQUIRE, hereby states that he is the attorney for the
Gordon and Weinberg, P.C.
Plaintiff(s) in this action and verifies that the statements made in the foregoing pleading are true and
correct to the best of his knowledge, information and belief.
The undersigned understands that the statements herein are made subject to the penalties of
18 Pa.C.S.A. Section 4904 relating to unswom falsification to authorities.
Date: v ? By. i
P (chi , Jr., Esquire
-0
?•? _ ' , DGAILERAGENTME55EM:EWS"VOM 10 MIMMA
e? eOrw MMreaa 11un is- .. 1. ••
MAMNACTURENDEALERJFULL AGENTIMESSENGER SERVICE.SALVOR BOND
Gregory A. Myers 6 Robert F. Myers, Sr
A.+.. nw..}
doing busiMetfM Myers Auto Sates _-__-
healed al -- 1207 ILtner Rw. _----
34Lppe sbura PA 17257 ri.wt,.r l vie
NOTE: It Yloe We illy branch Oft". Check here. and hit them at the bonorn of fh,j 1,151 page or
tlaach s Ist) a Pill
IGpML
Will trio Insurance Company
100 trio Insurance Place rrrl•
M 16530 Erie
aUOtW OGM incorponded under the laws of the Slate of Pennsylvnnin I'll- W'....1
Is do business in D1e Comttgnwealth of Pennsylvania. wdh main office herein 1OCd1ed
M 100 Was tosrrsaee Place tine tbs++
mm&tAno
rn. ?.
as S M v ace hold DOIMW unto the Commonwealth of Pennsylvania (Commonwealth), and to any Ihll son who
MM ~ Onto ally t?arlsadion with the Prvttapal in IM! Prmcrpal s official capacity as allttiOriZed by It le 1-011 11110M
taleala?, at d fool in Ow to and jusi sum of S 20, OW. oo to be paid to the Commonwealth or AY if65fyns
k21 10 110- 09/MM Wedo hWOV bind ourselves #=fly and severally. our heirs, executors. admrnisvalors
1'- 1
ISt?Ip11e0 af111 eN1W On June 25, 996
WhefeM the PtlnNpal is applying for desgnahon as one o• more of the foi,owul5 and „
are bond as provided in the corresponding depahment lawsrregulahons
Yes NO
10 0 Fug Agent 47 Pa Code Chapter 43
0 0 moseenger service 75 Pa C S 7502
E 0 DealerJtAanuficturer 75 Pa. C.S 1335
0 0 salvor, 75 Pa. C.S 7302
NOW, THEREFORE. the condition of this oblgabon is that it the Principal, duni I tr+e tar, n r• ,
Or MY MIMMr111, in 1hr oplducl of the business of manufacturer, dealer, lull agent. messenge, ,rr v., 1
tlrv0/ a1tMWn" 1MIb VW Plod oni of Ore law and regulations governing me conduct of sucii uu.,i:, ,:;;1
all IWCNtne arty MOnf ry IiM to the Commonwealth in connection with the business limited to !el..:., w:
¦R 104 P OINWy perliW IN Mtsn llws obligation shell be null and void. otherwise it shelf remain m fur
1b11re, and eaep.
lA . I
sr :oIATTEST
tryere erto s.t«
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By
BY
1 u.eneo gomphev W(TNEB$ OR ATTEST:
-NAM(: Of SURETY COMPANY
! ?`..
n
TITLE _ ?aoas 6. Wt[T/Attorey-Ie-Feet ??
ADORES$ OF AOEKT ?i ?M' Y• ' , ?
S!+0 E?Se leaureeta Plate $6A1
Fria, rR l6S30 `Y "
TELEPKME (914) $70-2000
Btrrdl eBItM; r W6 "Mr, ?ddrarN slwgs? E nix' s
Wrrorret Im bwod dAoia)
'A'MA
. _ (71
?K
Myers Auto Sales (Din 8619402) Tpr Dane Colyer
Checks
Case # Face Amount Penalty Total
204336 646.2 160 806.2
213766 603.2 40 643.2
218692 971.63 50 1021.63
218693 22.5 30 52.5
218760 123.5 50 173.5
218761 142.5 50 192.5
302564 184.5 40 224.5
302605 436.5 40 476.5
3590.53
Titlework
Name
Abbot
Dietrich
Mainville
Martin
Means
Novales
Novales
Novales
Novales
Novales
Ott
Swartz
Young
Beecher
Myers
Reasner
Vehicle Identification Number
1G4NJ52TXVC458647
JHMAR5528GC002030
2GCDC19Z2J1 y 96125
1FTEF14NXKNA99240
3P3XA46K3PT584712
1 GNDM15Z2KB780
1HGC87854LA117549
JACCH58E2L7905594
SAJAY1345GC442283
JA3EA11A3R0009733
1FALP52U9TA134354
2P4GP4531TR530939
2b4hb2174dk398154
1FTEF14N1KNB82104
KLAVA6925XB178020
1 B3XA5631 LF725149
Sales Tax State Fees Total
150 58.5 208.5
6 58.5 64.5
81 81
3597 28.5 388.2
120 58.5 178.5
18 22.5 40.5
18 22.5 40.5
30 58.5 88.5
90 58.5 148.5
12 22.5 34.5
357 28.5 385.5
150 28.5 178.5
60 28.5 88.5
300 58.5 358.5
33.5 33.5
15 58.5 73.5
1685.7 705.5 2391.2
Attachment A
E
MV-131 l9-971
4h
COMMONWEALTH OF PENNSYLVANIA
Department of Transportation
Bureau of Motor Vehicles
Harrisburg, Pennsylvania
171042516
IN REPLY REFER TO
Regulated Client Services
Dcaler/Agent Services
1101 S. Front Street
Harrisburg, PA 17104
a
To Whom This May Concern:
.
•` Principal
Business Name:
Bond Number.......: ..,
Enclosed are copies of °uncollectible checks" remitted
and made payable to the Pennsylvania Department of
Traasportation totaling logo",
in addition, copies of the billings are included that were
mailed to the Dealer/Agent notifying them of the "uncollectible
checks". To date, the Department has not received payment to
satisfy the OULSLanding balance due the Commonwealth.
We are entering a claim against the Bond listed above in
the amounts as follows:
•
2
Please make check(s) payable to the Commonwealth of
Pennsylvania and forward to the Dealer/Agent Services Unit at
the above address.
Should you have any questions concerning this claim, please
feel free to contact W at XIIN OW-
Sincerely,
Kurt J. Myers, Director
Bureau of Motor Vehicles
Enclosures: copy of Check(s) and Billing(s)
Executed Bond
cc +o ND v7ld?
M'.1-406 C! 94)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OFTRANSPORTATION
BUREAU OF MOTOR VEHICLES
RETURN CHECK TINYI
HARRISBURG. PA 17122-5610
MYER;i; AUTO .ALES ING
1.203 Rr:T'TE::R r-IWY
SI-17:F'I'ITtQE;NE.IlZf.3 I''A :1.72"i'7
I::E:::TI.IRN (::I-II''I" NOT:I:CEE
10 RE:I`I_.Y R1.: 1E:R ?1?0
:
I1 E:AL.. E: I< RIi161'.5T RAY ION CEENTEi:R
I`(iONlii:; 171.71 787--975°6
I:iE:ALE: R ? 0861.7742
CASE NUMBER: 0302605
T f I I S I:11i-PAR'TME.N1 TS :1N RI(;f_:IPI (1F CIHE:CK(E;) WR1:TTIiEN 1.1Y Y01.1 AND RElLlRN1-.-D
BY YOUIR BANK AS UNC:(JI...LECT:1:131_.IF f:'OR 11111:: IdEi.A;i;(:1N L_ STI''D BI::.L_OW
REASON: IN SUI, F.T.CE.EEN'L' F'Ui?D?3
BANK: M & T
ACCT' N(:
CHUCK NO: 1.2s.3.3
FA!:11:: AMT: $436.50
I' E:NAL.TY : 10.00
CREO11' '1'O DA11:: 0,00
TOTAL.. AM'L' DUE: liei76.50
TO SETTLE T'H.T.Sii ACCOLIN1 YOU MUST' REMIT A CE:RTIF'IED 1':I1F:C:K (3P<` MONEY ORDER IN
U.S. DOLI-ARS MADE PAYABI._B: '1'(1 1'1°II::: Cf)MMOiNWI::.ALHI (Al: PFNNSYLV JNI.r4 FOR THE
AMOUNT DUE. IN EASE RE'I'IJRN 1lUB NO'I'IC:G: WITH YOUR P0YE41:;:flJI
CKII A1'Ei: 10...7.._02. DATE: OF DI-P'
WID NO: 03064 3352 000729 001
TITLE- NCI! 00000000
CL ? 4o 1)7/ ?')..
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COMMONWEALTH OF PENNSYLVANIA
DFI-ARIWIENT OF TRANSPORTATION
BUREAU OF MOTOR VEHICLES
RETURN CHECK UNIT
IIARRISRUR1i. PA 17122.8630
MYERS AUR! SALES
1203 RITNlAf HIGHWAY
SHIFlPLN5B!.1RP, PA :1.772";'7
RE:TURN CI-FCK. NOlfCl.-:
0(11,03i0"..
TO I;'.I:::P'I_A REi:E1:R TO:
1AillLE::R REia:!: STRA'I-.T.(:!N CEN'IFR
PHONE: l07--9796
DEALER: 01:361.7742
CASE NLIFfBE:R: 0302564
THIS Ilr_E'AR'l'Mj,::N'1' IS IN RECEIPT OF CHECK(S) UR:I:TTE:N BY YOU AND RETURNED
BY YOUR BA14K AS L. 1NC1:!I.-LE:CTIBLE FOR 'THE REASON LI;'TE:II REI.-OW;
REASON; TNfif.!FFIE::LE:N"1" I UNDS
BANK: M ?T EN4K
ACtCT N0
CHECK NO: :1..273
FACE AMT: W4,50
PENAl- IY: 40,00
CRRE:.1.!IT" "(0 DATE: 0.00
'101AI... AM'I RUC-Et $224.',:50
'1"0 SETTLE `11115 ACCOUNT YOU MUSI" REMIT A CERTIFIED CHECK OR MONEY ORDER IN
U.S. DOLLARS MADE_ PAYABLI_: 'FO l1-I1[:: COMMONWEAI..T'H OF PENNSYLVANIA FOR 'THE'%
AMOUNT DUE::. PLEASE: ftIS:TL!RN 1H.P.3 NOTICE:: W1:114 YOUR PAYMENT,
DATE OF CH1:i:OK 9-26--02, OI E'Ofi :CTfi. l.7 .1.0--9--02
CHICK WAfi WRT'FTE:N FOE:: AMANDA W1:NI)OMAKER.
WIU NO: 03064 3353 00067,`.1 001
TITLE NLI: 00000000
CC +o ko i?70
PLEASE
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COMMONWEALTH OF PENNSYLVANIA
DEPAR'1'NIENT OF I-RANSPORTATION
BURISALI OF NIO'I'OR VEHICLES
RETURN CHECK UN1'I'
HARRISBURG, PA 17122-8610
MYERS A!.M.) iAl...E!3 INC;
J.203 R:ITNI?:R 1-1:I(31-fWAY
E;l'IIPPENSl:MRCi F IA 1.7257
PF-THRN C.;I-IECK, NOTIOE
02/:1.1./:1 ;(I
:LiJ f•'E:PL.Y' I?I:::1=1ER Ti:);
1.)filAL.I R IR11:61STRA1'1.0N C:EN*11c:l@
PHONE; : (71-*2) 7C.;7--9'796
Fiir AL..C-R : OSAI 7742
CA£ilii: NUMBER: 02J.8761
7'1-11S OE:PARTMI?.N'I' JS IN RECEIPT' Of" (:IIE:CK(5) WRTTI'E::N BY YOU AN1I k'l T'LIRNE:1:)
BY YOUR DANK AS UNG01-.1 ..EC:'T'1BLE FOR '1'1°IE:. REWSON L.. T. !Si'F. I:1 BE.1...OW:
REASON: 1NSLJI='F'TCI1::.NT P?17NUS
BANK! M & I BONK
ACCT NO:
(]I-ILC:K NO: 1:143
r-6A C' E A M'r : $142, 50
PENAL-1y; 50.00
C., R( 011 TC.I 0A'T'E_1 0100
rfi'r AI_ ANT, I)l.l l:::: +67.'s 5>.so
TO Slmy"T[J; 14-115 ACCOUNT' YOU MUS'l' REMIT' A CE RT.T.FTEI) MIEC;K OR MONE•:Y IIROER IN
U.S. 001_L.ARS MALI l:i PAYAIiI...l:: I'D Till:.. COMMONWEALTH OF PEMNSYI._VAN:I:A FOR 'THE
AMOUNT' 1)I.IE. PLEAM-- RETURN THIS NOTICEi. WI:T'FI YOUR PAYMENT',
IN)IF 01: (7FIEi:CK P:;--7--02, OE:POSI'I'IE:D 5.•.14--02
CI-IEC:K WAS WR1'1°' LN FOR BRE:NT GROUP,
WIO NO: 023:1.7 ::1383
1111-1: N CI: 00000000
CC + No iNb
000993 001.
PLEASE READ REVERSE SIDE
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF TRANSPORTATION
BUREAU OF MOTOR VEHICLES
RETURN CHECK UNIT
HARRISBURG:, PA 17122-8610
MYERS AUR) SALES INC
1:203 RIVNIER SAL.E:S
6111PPE::Nf3BUR(:J PA 1721,57
RETURN CHECK NOT'ICL
.I.N Rl-PI..,Y UI-1 1: 1) T"O;
DEAI...F.i:R RE::(:i1: ;T"RA IC ON CE:N"I'I-:R
P FION G:; (71.7) :7 EiJ ;'._-9/"'6
r..11-AL.F_R: 086:1.774
CAS 1.7 NUMDE.R: 0218760
THIS OE:i:PARTMENT .113 IN RE::CL'::EPT OF CHECK(S) WRI-i"TE:N BY YOU AND RE:rLjRNI5L1
BY YOUR BANK AS I.)NCOL..L.ELC"rl:Bt.j:: F°OR THE:: REASON LISTED B E I ._OW:
REASON: I:NSLJF'1='ICI.E:N"i" FUNDS'
BANK: M h T' 13ANK
ACC"T N0:
FACF: AM 1: $123.50
PENALTY: 50, "NO
CIRF.:-01r TO 1.)AFE:: 0,00
TCYrAL. AMT DLII:; !6:1.7;53.'!;0
TO SE::T'I'L_E. TITS Af.000NT YOU MUST REMIT A CERTIF-l.EO CHECK OR MONEY ORDER IN
l1, S. JIOI...J.-ARS MADE: PAYABLIE TO TE•IIF. COMMCINWESAL..'T'H OF PENNSYLVANIA FOR THE
AMOUNT DUE:, PLEASE RETURN THIS NOI"7:CE: WI'll-I YOUR PAYME:NT'.
06ATEi: (IF CHEICK 5"-6-02, DE:POS:1T1-:CI ki-14-02
CHECK WAS WRITTEN FOR PAME:1...A ,.J MICHAEL.
WID NO: 02317 3383 000978 001.
TI:TLF.. NO: 00000000
CG ? No
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n0.406
COMMONWEALTH OF PENNSYLVANIA
llfiPAR'I'MFNl' OE"('RANSPO)ITATION
BUREAU OF MOTOR VF.n7CLF,S
RETURN CHECK UNIT
HARRISBURG, PA 17122$6111
RETURN I::I{:CK 00 '1')CE
ii1;?!:I a!1 2;
t4YF.RI3 AUliI SAL.EC!3 T, NC IN 12 ESP1..,`( P, 1:1V E:; R 'lCi;
1.203 I'iNt":R FII Y
a::(.L.rR RI::GV2I'
RAT'1'CRJ CFi;N'1'E 13
SIIlPPfCNfS6URG PA :17257 1. H(:)hlF:i:i (Jt ):9 7....1i'796
DE:.AI..ER; 0001.5'40:'
CASTE NUMfil-R: 021£:3093
TLi:I:S DFPAR'1'MEN'1 I'S TN RECEIPT' OF CHECK(S) AIRVIIIIN BY YOU AND REETURNEO
BY YOUR BANK AS UNCOLUCTI:BL.I::'. FOR THE REASON L.:CSTft) OW :
REi:ASON: 1.N13111='F-1C1ENT' f. UN DS
BANK: M •S T BANK
ACCT NO:
CHECK NO: 1. 3, 12
FACE AM7': 71'2_x.:'.;0
PE:NAI...TY: 30100
CK01T TO DA IT. 0100
TOTAL.. 0ir DUIF:: $59111.13()
TO SETTLE PUG ACCOUNT YOU MUSY IR MTT A Ct_RT:1,F1:I;EI C:HE:C:K OR MONEY QRfIFR IN
U.S. DOLLARS MALI.' PAYABI_F TO THE CCIMIIONWEAL I-I OF F'I_.NNSYL..'•IANTA FOR THE
AMOUNT' U(,71 PL.I"ASE RETURN THIS N0l lCI:_ WTT'H YOUR PAYhl'- !T.
DATE OF CHECK 4•-1::5-02, EIE:POSI7't U 9-•26--011`
MiECK WAS WRITTEN CHECK WAS WRITTEN FOR UE:ALF..R 1'.T.'1'I...I.-
WSU NO; 02317 3303 000096 001
TITLE NO: 00000000
E k No 117/M
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF TRANSPORTATION
BUREAU OF MOTOR VEHICLES
RETURN CHECK UNIT
HARRISBURG, PA 17122-8610
MYh:R:> AUT'(:) SALE-S INC
1,703 R:I TNE:R 1-CE6IIWAY
!iHIPPE:NSiBI.aR(3 1'0 1.'72:`.i'7
RIi::T'URN CHECK NOTICE:
02/11/113
IN I'1-':PLY RE:F[6:R TO:
r.)EAI ER RE:GIS'IRAT'ION CENTER
PHONE!:: (71,7) 707-9/76
11li:Al...ER: OB61.7742
CASK is NUNBE:R; 0210692
THIS DEPARTM[E:N'i' IS IN RECEIPT (IF-- CHECKS? WRITTEN BY YOU AND REJURNE::D
BY YOUR BANK AS UNCOlL.E:C'I'IBL..E: I-OR THE. REASON L.IS'IED BELOW:
REASON : INEIUFF I CIE:: N I I` UN DS
BANK: N . 'T' BANK;
ACCT NCI:
CHECK NO: 11:37
FACE ANT: $971.63
PENALTY: 50.00
CREDIT TO DATE: 0.00
TOTAL.. ANT 1)UEi:: $1.,021.6:3
TO SETTLE THIS ACC OuNT YOU 1911::91' REMIT A CERTIFI:EU Cl-R::CI( OR MONEY ORDER IN
U.S. D01-1.ARS MADE PAYABLE 'CO `i'HE: CONMONWEALTl-I OF PENNSYLVANIA FOR IME:
AMOUNT 1:1(.)F.-. PLEASE: RETURN THIS NOITCEi: WI:T'H YOUR PAYMF.::N'('.
DATE: (:)I CHECK 4-22-02, DIEPCIS:I:TED 5.1-02
CHECK WAS WRITTI.:N FOR SUSAN L.. & C.;NARI...E:S L.. 019RIF.i:N.
WIO NO: 0231.7 3383 000010 001
TITLE: NO: 00000000
CC i HO 1I7#
PLEASE READ
0
0
0
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENTOF TRANSPORTATION
BUREAU OF MOTOR VEHICLES
RETURN CHECK UNIT
HARRISBURG, PA 17122-8610
1.223 R:IINUR HWY
£il-IT P1)V. NSBUM3 PA 17'2157
RETURN C.:I-IIS:CI< MITI:M:
1:N RE: PLY R1:..VI...R 10
RF. )URN CI 11.CK S1:1.(::'1'1:0N
PI-11)NIE:: k/17) 71:37.._9796
CASE NUM1:31:::R: 021.3766
ilIN3 UF.T.PARDIEN'T' 1E3 IN RECIii:.T.PI' C.)I'' (:A-IrECK(S) WRI?T?TE::N BY YOU 6NU Rl-TURNED
BY YOUR BANK ACS U14:01...I.E:I. f rW..F:' F(rl.' I.1-K PI ?):,f::i`l I 'r!-.ll!:.Ir )t G..l._f)(J;
REASON: F:13M S
BANK: M ', 'f BAN!
ACCT NO:
CI°IEQI< NO: 1..14".?
I-A("Ei: Am I $60J, .20
PI:::NAL.'I'Y: 40.00
CREi3:f.1 TO UAfE.; 0,00
101M.. Am l f_)UE:: 1;643. 20
'1'(:) fll:"f'IL..E: TI 11S AC:C(.)UNI Y01.) MUf11 RFEM:FI' A C)FR"TTF IE:D CA11'.C:K () R M1.)NCY ()I21)E.R IN
U.S. 1](11 ...i._Aw mAlili. I`(;Yrtl:;l..15 I?f.l (I-1 Cf)MMON111Al...'M Ol PENNSYL.VAMIA FOR THEE:
AMOUNT IME:. PLEASE: RETURN 'i'I-IJA3, NOTICE., WITH YOUR PAY'ME:N°f.
C.:K DATE: 15-02 1),)J'E: DE"f.)El:) l'.; 24-02
WID NO: 02226 33,`52 001258 001.
TITLE NO: 00000000
T, k H6 i/7/?
PLEASE READ REVERSE SIDE
• _____i
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0
MV-406 (2-947
COMMONWEALTH OF PENNSYLVANIA
DFPARTMF.NT OF TRANSPORTATION
BUREAU OF MOTOR VEHICLES
RETURN CHECK UNIT
HARRISBURG, PA 17122.9610
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.I. .1,.1:. i. f:E Nl)', ;7rt:"rpt;ICi!)C) 000 I.J. 6 00.)
CC +o Ho 11716q
PLEASE READ
Failure to settle this account will result in either a complaint being filed charging you with issuing a worthless check
to the Commonwealth, causing additional fines and costs to be imposed, or it being referred to the Attorney
General's Office for collection.
REGISTRATION FENS
If your check was issued to pay registration fees, the Department, in accordance with Section 1373B(2) of the
Pennsylvania Vehicle Code, may suspend any registration without providing an opportunity for a hearing when the
Department finds sufficient evidence that the required fees have not been paid.
Failure to respond within 30 days of the state of this invoice will result in a suspension being placed on your vehicle
registration.
OTHER FEES
If your check was issued for fees other than registration, failure to settle within 30 days will result in a suspension
being placed on the records in accordance with the Vehicle Code.
PENALTY FEE
Pennsylvania Statutes (71 P.S. Section 240.19A anti 75 N.C.S. Section 1957) authorize the Department to collect an
uncollectible check penalty fee of $20.00 ]'Or each check returned to the Department, and a fee of $10.00 for each
driver's license, registration, replacement of tags, transfer of registration, certificate of title, whether original or
duplicate, special hauling permit, and each other unit of issue by the Deparunent plus all protest fees to cover the
cost of collection. This penalty is reflected on your billing.
INSTRUCTIONS FOR "PAYMENT STOPPED" ITEMS
Enclosed is a copy of your check forwarded to this Bureau for collection. If replacement has been made, please
forward a copy, front and back, of the cancelled check, and we will be able to close this file. However, if
replacement has not been made, it will be necessary for you to forward a certified check or money order in the full
amount as billed, as we are not permitted to accept personal or business checks. Should there be other reasons for
"payment stopped," please advise so that we may proceed accordingly. Registration plates, cards and stickers may be
returned, if unused, in lieu of payment. All other fees must be paid.
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0107069 o? 16p
< )
RELEASE, RECEIPT ANC
ASSIGNMENT OF CLAIM
RECEIVED from Erie Insurance Company the sum of 51X Jil m three ara ?jt?a
($ Po("J?3 •? ) dollars, in payment in full and/or in compromise settlement of claim presented by the undersigned,
under said Company's bond numbered Q90 .5 3 and dated -ULP C A5 te..?in favor of the undersigned
by reason of the default and/or dishonesty of: U n uslVLe`j5 Ivt?VYI?__ ICI S
Auk _._.F. -
NOW, THEREFORE, for and in consideration of the aforesaid payment to the undersigned, by said Company,
the undersigned hereby releases and discharges said Company of and from any and all claims, demands, actions or
causes of action, accrued, or to accrue, by reason of, or in any manner growing out of said alleged default, under the
terms, conditions, or provisions of said Bond, and, furthermore, as a further consideration for this agreement, the
undersigned hereby assigns and sets over unto said company, all its rights, claims, demands, actions, or causes of
action, accrued, or to accrue, which the said Bond, and the undersigned hereby appoints said Company, or its authorized
representative, its Attomey-in-Fact for the purpose of signing the name of the undersigned to any and all papers
necessary to enjoy the rights herein provided and assigned to said Company.
IN WITNESS WHEREOF, the undersigned has hereunto set its hand and seal this
ATTEST:
STATE OF
COUNTY OF
, SS:
day of
Before me, a notary public in and for the County of ___ and State of
personally appeared
personally known to me to be the person who executed the foregoing release and assignment of claim, and
acknowledged that he executed same as
therein set forth.
Notary
My commission
free act and deed, for the uses and purposes
NOTICE: 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.
FIDISUREtY
C-240 PA 2foo
05/28/2003 Claims Management System CSPP037B
14:51 other Than Auto LOSS Report Page: 1
Req: SCHAMBACH B
Pol: q90 7560034 Ins: MYERS AUTO SALES INC Clm: 010170682166
Handling office: 017
LOB---SUR----------- ? n
Accident Information l/J'/?/
D/L: 06/25/2001 Day: Monday Time: 00:00 Cat:
Loss Location: SITE St: PA
Summary: OWES TAXES TO PENN DOT FOR TAXES AND TRANSFER
Details:
*******ASSIGN TO MIKE CA$$ATA--E88W'"?""":rsr>tt:x,r'r+:•:::r:r': iru 9r ?: it it :r&?kk?tr it :k :r ir'r :k :r
001 DID NOT PAY PA. DEPARTMENT OF TRANSPORTATION FOR SALES TAX, TITLE A
ND REISTRATI0N FEES.
Insured Owner information
-------------------------
Clmt: 001
Owner:
MYERS A SALES INC
Addr: 1203 RITNER HWY
City: SHIPPENSBURG
zip: 17257 - 9553 -
County/Province:
Country:
UNIT: 001 AS PER PIDP
Accident Related Details
----------- -------
sal?:
Police/Fire:
REPT BY: AGT
Type: - - Ext:
Hours: to
Contact:
Type.- - - Ext:
St: PA Hours: to
Contact:
TYPE: - - EXT:
Hours: to
Contact:
x:00 -C1
r
Sub?:
Incident:
DT: 05/27/2003
CMS Dt: 05/27/2003
lo-C
tiN
05/28/2003 claims management System CSPP0658
14:51 Print Options Exception List Page: 1
' Req: SCHAMBACH ,8
Pol: q90 7560034 Ins: MYERS AUTO SALES INC Clm: 010170682166
D/L: 06/25/2001 Day: Monday Time: 0000 Cat:
Option Reason not printed
-------------------
Property Damage - ---------------
Nothing found ------------------------
for this claim -------------
Injury Nothing found for this claim
witnesses Nothing found for this claim
MV-1711(9-971
COMMONWEALTH OF PENNSYLVANIA
Department of Transportation
Bureau of Motor Vehicles
Harrisburg, Pennsylvania
17104.2616
IN REPLY REFER TO
Regulated Client Services
Dealer/Agent Services
1101 S. Front Street
Harrisburg, PA 17104
? ' ? ? s ®c Ix?,b
z§'
t
Principal:
Business Ndme
Bond Number: _•,..,.
To Whom This May Concern:
Enclosed are copies of "uncollectible checks" remitted
and made payable to the Pennsylvania Department of
Transportation totaling °`
In addition, copies of the bi7.lings arc included that were
mailed to the Dealer/Agent notifying them of the "uncollectible
checks". To dale, the Department has not received payment to lV?ti;
satisfy the outstanding balance due the Commonwealth.
We are entering a claim against the Bond listed
the amounts as follows:
CASE FACE AMOUNT PENALTY FEE
above in "
d
i' I s
?511?
GRAND TOTAL: ".:.,....:::,
41
GJ
v
2
Please make check(s) payable to the Commonwealth of
Pennsylvania and forward to the Dealer/Agent Services Unit at
the above address.
Should you have any questions concerning this claim, please
feel free to contact at l
Sincerely,
Kurt J. Myers, Director
Bureau of Motor Vehicles
Enclosures: Copy of Check(s) and Billing(s)
Executed Bond
Qb
aa? ti1
W`
RELEASE, RECEIPT AND
ASSIGNMENT OF CLAIM
RECEIVED from Erie Insurance Company the sum of `?If( hr21? andUo
($ (p d 3,: ) dollars, in payment in full and/or in compromise settlement of claim presented by the undersigned,
under said Company's bond numbered KrLV-0-09 and dated in favor of the undersigned
by reason of the default and/or dishonesty of: 1(A Jv1V vC _.l plLytylX?7 fyrlYYtY?
-Alwo 50k-51.__ ?-
NOW, THEREFORE, for and to consideration of the aforesaid payment to the undersigned, by said Company,
the undersigned hereby releases and discharges said Company of and from any and all claims, demands, actions or
causes of action, accrued, or to accrue, by reason of, or in any manner growing out of said alleged default, under the
terms, conditions, or provisions of said Bond, and, furthermore, as a further consideration for this agreement, the
undersigned hereby assigns and sets over unto said company, all its rights, claims, demands, actions, or causes of
action, accrued, or to accrue, which the said Bond, and the undersigned hereby appoints said Company, or its authorized
representative, its Attomey-in-Fact for the purpose of signing the name of the undersigned to any and all papers
necessary to enjoy the rights herein provided and assigned to said Company.
IN WITNESS WHEREOF, the undersigned has hereunto set its hand and seal this day of
ATTEST:
STATE OF
COUNTY OF SS:
Before me, a notary public in and for the County of and State of
personally appeared,__._
personally known to me to be the person who executed the foregoing release and assignment of claim, and
acknowledged that he executed same as free act and deed, for the uses and purposes
therein set forth.
Notary Public
My commission expires: _
to
NOTICE: Any parson who knowingly and with intent to deheud any insurance company or other parson fees an application for Insurance or
statement of claim containing any materially false Information or conceals for the purpose of misleading, Information conceming any fact 4s
material thereto commits a fraudulent Insurance act, which Is a crime and subjects the person to criminal and civil penalties.
FID/SURE:TY ry
C-240 RA 2/00 ' ?
lit
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF TRANSPORTATION
OFFICE OF CHIEF COUNSEL
VEHICLE & TRAFFIC LAW DIVISION
MOTOR VEHICLE SECTION
August 9, 2004
TO: Tina Lee
Dealer Services
r
FROM: David Markowitz 1
Assistant Counsel w
Motor Vehicle Section
SUBJECT: Dayton Motors, Inc. and Myers Auto Sales, Inc. releases
The attached settlements were approved by Steve Roth of the Office of Chief Counsel and have been
accepted by Brenda Schambach of Erie Insurance. Please forward for execution by Bet;y Serian and
send to Ms. Schambach at the following address:
Brenda Schambach
Commercial Liability Claims Specialist
P.O. Box 3543
Shiremanstown, PA 17011
220/DM
4?
q-oo
MV-131 {9-q7) COMMONWEALTH OF PENNSYLVANIA Q / 0170 ?o Cp
Department of Transportation
Bureau of Motor Vehicles
Harrisburg, Pennsylvania
17104.2516 IN REPLY REFER TO
pboxwlw
Riverfront Office Center
Regulated Client Services
1101 S Front Street
Harrisburg, PA 17104
Dear Sir:
The Department of Transportation has obtained documents
associated with the application for title and registration of
vehicles from the above listed business.
A total of piece(s) of title work was never submitted to
the Department for processing. The total amount of money due
the Commonwealth for sales tax, title, and registration fees on
the total work is ° .'
The money collected by the dealer/agent was never forwarded
to the Department. Enclosed is a copy of the MV-1 or MV-45T
prepared by the dealer/agent, for each applicant that was never
submitted to the Department.
We arc entering a claim on behalf of all claimants in the
amount of Please make check payable to the
CommouwealLh of Pennsylvania and forward to the Regulated Client
Service Section at the above listed address.
Should you have any questions concerning this claim, please
feel welcome to contacts at „•,,..,
Sincerely,
Kurt J. Myers, Director
Bureau of Motor Vehicles Qvi
Enclosures: Copies of MV-1/MV 45T
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7. APPLICANT'S COFYlTEMPOPARY RIOI{TRATION )VALID FOR 90 DAY{) • ` ', _ .' ^?1•,.',
•?. c 1 u 1 Nom' 117?,t ADD i i aoirl' 43*6- 's r •?
M V-t 5-00 I. TAX / FEES
A
7OF VEHICLE
VEHICLE IDENTIFICATION NUMBER MIJIL IF TRACING
ELY T REVERSE THIS COPY
BODY TYPE (SDN, IS. MODEL YEAR
BUS. ETC.) -
PURCHASE ...
PRICE ??
See neat on IA../
arms VVESxxE WT. L DINMECHAMC I ¢ED NOTART NMIC OR CEMI ED LESS
MTING IN6PECTION MECHANIC (PRIM NAME) TRADEIN
? DtESEL? ELECTRIC e
CNECN THE APPROPRIATE MOCK IF THE VEHICLE I IadXTNM IMVe Wdaed RLI a Nab, SIGN HERE TAXABLE
IS TO DE UBEO DR WAS FORMERLY uBED AS A ggeyp Ty°Nt M eYRRd MM tllal aR AMOUNT
TAXI ? OR A O POLICE VEHIIX.E OF FPPUGM.E1 exva VIN Y correct,
8. UST NAME (OR FULL BUSINE
NAME) KIRST NAME MIDDLE INITIAL
S
S DATE AGOUIREW X 6' (.O6) SALES TAX
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(IF APPLICABLE) CREDIT
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} SALES TAX
j<g'j'j'j
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- NOTE: If a ce-purchaser other than your spouse is Isted and you went the Lille tot.156 listed n'JOW Tenants With IA ETAmPINn me
1
R' W Surv'lvorslvp` (On death of one owner, tills s to SU NN10 o4or- CHECK HERE O. OIhemse, tM title
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NOTE: IF THE VENICE IS TO BE USED AS A DALY %W&OR LEASED VEHICLE. CHECK THIS BLOCK V . IF BLWX I9 rA1EC , COMPLETE AND A TTAN FON MVk. f (4 O ??
C. REFLECTS THE AMOUNT OF MILEAGE IN EXCESS ? IS NOTR W AMAL MIIEE
GE ODOMETER READING 2 TITLE ??YY
R
OF ITS MECHANICAL Ll1AIT8 V
DISCREPANCY FEE
WARNING: FEDERAL AND STATE LAWS REOUIPE THAT YOU STATE THE MILEAGE IN CONNECTION
WITH THE TRANSFER OF OWNERSHF
FAILURE TO COMRETE OR PROVIDING A FALSE .y TEN S
?/tCY1lI?
? 3.
LIEN
.
STATEMENT MAY RESULT IN FINES ANDIOR IMPRISONMENT. I _ FEE
D. IST LIEN DATE'. AW E NO LIEN. CHEC MD LIEN DA rE: IF NO LIEN. CHF,CKLJ l
REGISTRATION OR
IST UENHOl2TER 2ND LtENHOLOER PROCESSWG FEE
$E STREET STREET F. ExrRX N~aF
Ik_ GN STATF. ZIP CITY STATE ZIP O81bY aW 9MV°U
FINANCIAL INSTITUTION NUMBER FINANCIAL. INSTITUTION NUMBER &DUPLICATE REG.
rEE
Ey MAKE OF VEHICLE VIN MODEL YEAR NO. OF CARDS-
BODY TYPE (SON. SUS, TK. ETC.) CONDITION OF VEHICLE G000 FAIR POOR B_
TRANSFER
F, II??I1 OTHER ??11
ASSEN
SS
GER Q igkl LIMOUSINE LJ
SEATING CAPACITY FEE
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AflYOYES OND RA
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MOTOR S MFR: BODY MAKE
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FEPLAC
TRMLEP R OF AXLES: RED. REGISERED GRO6 WT. IINCLUDINO LOAD) B.
BELOWfIAWTi'S' UNLADEN Wf. IEMPTYI TOTAL IADD
GISTERED GPWSS COMBMA710H Wi. GROSS COMBINATION WT. RATING
00# chsJt
Sew
IMPLEMENT OF
NDRY
PE
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FOR
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G' ORIGINAL RATE ? Che°a CM El THIN' t.F Pn2VKKIRY 458UE0 ` [] TFI,9 n F 1IEN AL of N F
C]
BY
TE T
UE
ER OF KAM L KR "UsNI OF
f-
LJ IMNR`ER L HERACEWW 0 PUTS 0' gF
(PROOF
BUREAU
INS
URANCE
MUST BE
TTACH R
A
ED.) PLATE NO. nFASON FOR REPLACEMENT
a TO BE
0 EXCHANG PL
F
SI BY S, IXPRIES LJSi Q 61OLEN DEFACED ? NEVER RECD (LOST IN MAIL)
TEMPORARY RATE Wain Yew NOTE: 11 "NEVER RECEIVED" biocK is Checked, applicant must complete Fonn MV-".
E ED BY Fl AGENT TRANSFERRED FROM TITLE N0. VIN \
y '
$ W /
YL SIONATU1 E OF PERSON FROM WHOM SIGN HERE RELATIONSHIP TO APPLICANT
IF] PUTE IS SELNO RIANSFEPRED (IF OTHER
;
TEMP. RATE NO. THAN APPLKA
IMURA COMPANY NAME POLICY NO. (OR POLICY EFFEORVE POLICY EXPIRE ION
ATTACH BWOERI 7 DAT'5 - 7?-o Z
( OAT /
•?
AGENT N0.
ISSUING AGENT (PRINT NAME)
I
YET?
R
_.
ISSUING CEFMPY THAT DH MONTH DAY -
.
b
GENT
HAVE VE CHECKED
1 TO DETERMINE THAT DIE VEHICLE IS INSURED
AND G
INFORMAPION ISSUED TEMPORARY RE(XBTPATKIN TO THE ABOVE APPLICANT, IN ISSUI GEM SIGMA RE TELE ONE NO.
OOMPLIANCE WITH ALL AM
PROVISIONS OF THE VEHICLE CODE
I
.
r
AND DEPARTMENT IEGULATI
ONS (
1
22z I
ME ACKNOWLEDGE THAT VWE MAY LOU MY10101 OPERATING PRIVILEGE(S) OR VEHICLE REOIS1MlIONtS) FOR FAILURE ViTAIN fN1ANClAI RESFOIISISIISY ON THE
CURRENTLY REGISTERED VEHICLE FOR THE PERIOD W REWSMATTON. VINE FURTHER ACKNDWLEOOt THAT LFNE MAV ¢¢ TO A FREE IIDT' EXCEEDMO 18,000 AM
e IWM80NNENT OF NOT MORE THAN TWOMYEAM PoRY FALSE STATEMENT THAT 2WE MAKE ON TM FORM, AND VWE CERTIFY THAT YWE NAYS O MIIW AND SMD THIS
AN
C FORM AFTER The C LETKIN' AND THAT IF AN EXEM
PTION FA IM PAYMENT OF BALES TAX IB CLAIMED. 1 A1BWE ARE AUTHORIZED TO CLAW THIS E,Yp,MPROM ME
q
s 31 D ANCI SWORN L fYRTNFA CERTIFY THAT ALL STATENEMTE HEREIN ARE IFIN AND CORMCr AM MAKE APPLICATKM!
S TELEPHONE NO.
IGNA RE O INOIVIOU/J_ OR ED SIGNS
D
R NG OATH /
_
f/l LW ( } P ^:J
i i RE W C60WNEM E OF A CHIZED SIGNER _>>
A
? MESSENGER NUMBER:
j
Xl v SIGN IN PRrESENCCg OF?o
rARY
?l?
?
ry
1
1 7
1. BUREAU OF MOTOR VEHICLES
No. 0068893
G
A M TIME NLMBE=Sl??OIN ATTICIE011/lE) MAKE ON VElMpIE MODEL YEAR RNk'."ASE
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ICGRnFI nMTuJMCNnI_ CA 1'EM •+alN1G NI IPRWTIW.IE) A!i INO
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G I/WE CEfif Y TIME LAVE I0VE EXAMINED AND SIGNED rule FORM AFTER ITS COM'LETION AND THAT THE MIFORMATKN GIVEN IS TRUE MD COMiELT. F AN EXEAVTHON
, IS GYAaEfA THE PJRC? f1IBHER CERTIFIES THAT HE/SI E IS AUTM)MIED TO CLAM THIS EXEMPTION, IM'F A NOWLEDGE TMT Vwli NMY LOSE MY1" OPEROMIN i
PRMIELYt51 (Fi VEHICLE RF.GIe11UTgNL31 FOR FAI.UK TO MXNTAN FINANCIAL RESPONSMLRY ON THE CURRENTLY REGISTERED VEHICLE FAIT THE PEIIRTO OF
HEG5nMl1ON, I'M ACKNKIMEDGE THAT IMF. MAY BE SUaHCCT TO A FINE NOT EXCEEDING SbL= AND MAPRISONMENT OF NOT MORE THAN TWO YEARS FOR ANY
rALSE SIATF Nt THKE I MPKE HTINSfORA.__,? ?-
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ASe GN
MENT 9wwlum a Co-AKCInFa/Ti1b a Aa1N11[e0 Spa
SpAtvn d Co-$rvbr
H. NOTE: It a co-purchaser other than your spouse is listed and you want the title to be listed as "Joint Tenants With
Right of Survivorship' (On death of one owner, title goes to surviving owner.) CHECK HERE [). Otherwise, the title
1 will be issued as 'Tenants in Common' (On death of one owner, interest of deceased owner goes to hisfher heirs or
estate),
NOTE IF THE VEHIQI IS 10 M USED AS A DAILY RENTAL OR LEASED VEHICLE, CHECK THIS BLOCK . IF BLOCK IS CHECKED. COMPLETE AND ATTACH FORM MV M,
0 MESSENGER NUMBER:
1. BUREAU OF MOTOR VEHICLES
No. 0068966
A. M TRLE NUMBER (AS SHOYM ON ATTACHED TIRE) MAKE OF VEHICLE MOML YEAR VJR%tkW
OCE
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Sea nee oe re.en•1 'Z 000'OV
YEMLL
EICATION NUAteER
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B. ) FIFERNAME w AL TAXABLE
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SELLER _ eX ale
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F. ORIGINAL RATE CIrdl One
? 7I1MISFEIi OF PnEV10USLY ISSUED RATE
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PUrE TO BE ISSUED BY
BURFAU
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EXCfMNGE RATE TO BE . A&I9 a 101
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G. VWIE TNAT VWE H" IXAMED MO SIY.ED n•9 FORM AFTE M AND T TIE. XfOMSATKIN GNEN R 11111E NA CORRF
Cr F M EXEWWR
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B ClAa1ED, THE RFCWASE11 FIRIIER C67MES 71W HM/SHE IB AVDIORRED TO CLAIM THIS EXEAIPPI VVE AGNNO VIEDGE TIVT UwE MAY LOSE MYTOIR OPERA NG
PRV1lEGE(S) OR VEHICLE REGfRW10M$T,FOR FAILURE TO MA&nM FRAWAM- RESPORWAirY TN THE CURRENTLY REGM1 RED VF
IFCIE FOR THE PERIOD OF
.
REd3TMTgN V1VE AC"AWREDGE rHAT VVE ANY BE SUBJECT TO A rNE *IT MFEOIRo S5,(go AND IMPRISONMENT OF NOT MORE TUN Tw1J YEARS FOR ANY
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9TA .IA
a 11? e' TELEPHONE NUMBER yld
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sAFne•e of CPPIFr)1tarTlal a AMNa4A4 57rr 94yiua as ra-sulM
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H. NOTE: If a co-purchaser other than your spouse is listed and you want the title to be listed as 'Joint Tenants With
$ Right of Survivorship' (On death of one owner, title goes to surviving owner.) CHECK HERE ?. Otherwise, the title
will be issued as 'Tenants in Common' (On death of one owner, interest of deceased owner goes to hislher heirs or
estate).
NOTE IF nE VEHICLE IS TO BE USED AS A OAILY RRRAL OR LEASED V@ILCLE, CNEO( 7ha M= ? . IF a{= E CHEDIED, coiuLM ARB ATTACH Fain. MV-L
l CY' \I MESSENGER NUMBER:
\`/yt 1. BUREAU OF MOTOR VEHICLES
No. 1491635
z
I
A. hT TnIE NUWWP HAS SHOWN ON ATTACHED TIRE) MAKE OF VEHICLE MODEL Y
`I?ev(a\e 00
NU A COFOITON
VEHICLE
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E. MAKE OF VF.IIOLE VF:InCT.EO TFIC TION NUMBER
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PLAIr ro RE n:Yurn DY (I TIWI;:rrR & rwi,A-,L OF I'1 ATE (AM 1 e a)
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GERFY THAT
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Won, ISSUED TEMROMF% RECISTRATON TO THE ABOVE APPLICANT. N T SONIOURE M'
1'RDWSOM OF TIE VEM(YE cCOE
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IS CLAIMED. THE RIPCWdrER FU DIEn CEIRFES THAT 1EISHE 19 AUTHORIZED TO aAN THIS EXET,Pn)H VVE ApeAONLEDCE TlW V WE MAY V
PRMlEGE1S1 OR VEHICLE RELISIRATOMS) FOR FAILURE M "HiAIN FFWICW. SeSR]1GINMY ON THE C1IRRENRY {IEGLSTEIFn vFItlr1E Fnn THE PERIOD OF
IFEGISTOAF ON I/VIE ACKNOWLEDGE THAT I/WE HAM RE SUBJECT TO A ME NOT EKCEEDFO Uoo) AND ILtlPg90(rAEM OF HOT MORE THW Two YEARS FOR ANY
FNSf 5101111114ENT 1 /„E NUJ( ON TI IS FORA _
raF sa¢NAke' TELER/DNEMAd" 9eb
1 1
aCtrPllalYS MaAWUlia s,Fw
MEM
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M w S Wm RVaaez. TELEPHONE NU
MBER tL
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a
H. f a co-purchaser other than your spouse is listed and you want the title to be listed as'Joi nants With
Survivorship' (On death of one owner, title goes to surviving owner.) CHECK HERE p. Othe ise, the title,
ssued as'Tellants in Common' (On death of one owner, interest of deceased owner goes to his/her heirs or
S estate).
NOTE IF TIE VEHICLE IS TO BE USED AS A DAILY RMMAL ON LEASED VEHICLE, CHECK THIS BLOCK 0 . F MOCK IS C Ep®, COWU E AM ATTACH FOW W.R.
MESSENGER NUMBER
1. BUREAU OF MOTOR VEHICLES
No. 1491634
A
P VEHICIE NODEL YEAR
A TITLE NIAEER HAS SHOWN ON ATDCNED TM-E) PUI
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n re.ere.l
se
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V EHICLE IOEMFICATON NIaEEN oOtJDIrION LEss
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D LAST NAME Ion "A I- BusFEss NAME' FIRST NMIE MIDOLEMiLA1 OAE ACQUIRED/ Rog, tM a
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INSURANCE OnNiPANY NAME 1 NO. inR FDIH:
A ACH R) DATE M1E
r CERTIFY TINY g1M(wTH, _ , IsBINNG AGENT (PRINT rw,El NBEM NO. (,
Il?UN3
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NFOI4 ABSUED TEAWORARY RE944fMMIN 10 THE ABOVE Ar'R IG1rTr N IS $I sIGNATITRE TE MOUE NO
VENCIE COUE
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ATIIION VATH All APRICAalE PR9A9510N56 n
AND DEPMT MREGLFUTr0N8. I 1
(i uWE L'ERIIFY TNT VME RAVE XAMNED ! SIGNED TM FORM M1ER HIS COIMREnOrI AW TINT 11E I FORMATgN GNEN IS TRUE AND F AN aXE.vrlon
EFIXTI
.
. NG
L4 OLMAED, THE RFK]NSER FURTHER tEMV%S TART RE/SHE IS AURIORREP TO CLAM THIS rXEMf TiON. IPAe ACKNOMEOM THAT IAYE MN( LOSE IWICUR OF
FRMEGFISI OR VFNCLE REGISIRAnOMs) FOR FAILURE TO RAPJIfiMll FNNiCAl RESPONSEIRITY ON THE CIFNENTLY REGISTERED VEHIIXE FOR THE PEIaOD OF
REGL41Ng1 EA I/NE A(](NDNLFOGE TNT VNF MAY 8E SMECT TO A FINE NOT EXCEEDING 55.000 MID PIPRIBO #A OF NOT MORE TNN TWO YEARS FOR ANY
F STAT MT r a e eFOiFA.
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a fAKAvwa AdeB 3brw
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9yrW d SeFOM Paauwra AUeaI SEAT TELEPHONE AMBER $ereN••d5epa
2ND
ASSIGN•
)
egrmlwed W-seltr
MEM sig"t e d O?PVdWa(TMF aAumodzetl TAprwr
H. NOTE: It a co•pufchaser other than your spouse is listed and you want the title to be listed as 'Joint Tenants With
Right of Survivorship' (On death of one owner, title goes to surviving owner.) CHECK HERE Q. Otherwise, the title
Eg will be issued as 'Tenants in Common' (On death of one owner, interest of deceased owner goes to his/her heirs or
estale).
M
V-l
NOTE: F THE WHIDE A TO BE VSED AS A DNLY REMM OR I-EASED VENCIE. CIIEtlt TTAs am O . F e ocK Is cNCKED, co%vtuE AND ATrAcm Pom
(-? b MESSENGER
\l??/J) 1- BUREAU OF MOTOR VEHICLES
No. 0068988
Al P A TIME EaaAaEP IAa S/om CN ATiADHEDIME) LW(E OF VF A(WEL YF,Aq .. .
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ISSUED SY FULL M6ENr Mrx•M1 Ye. NOTF;4'NEVBRR CEIVED_'bMCF is cNUkad, rrAm F«m AIV?
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INFOrt ISSUED fEMPIXAPY REGLRIMT10N TO THE AHWEAFPIJCANT,W ISSU,,Q
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REGUL.A
MAnw AW DEPARTMENNT
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WE CERTIFY THAT WIME HAVE EXAAIBED AND SICNEO THIS FONM AFTER Do COMPLETION AMD nWTHE INFOPAATgN GIVE TRUE COraECr. F MJ EXEMPTION
U
Is CLAmok TIE PURCHASER FUATHEP CERTIFIES THAT TE/SHE IS AUTHORIZED TO CLAIM TNa EXEMPTION. 11WE ACKNO WEDGE THAT I/WE MAY LOSE MY/UUP GPEPAIMO
MAWTrVN InNNICIAI FESiNXtsIB4JTY 4p0UN THE CURRENTLY REGISTERED VEMLE FOt TEE PERIOD OF
PHMLEGE I m VEHICLE RE ISIPATIO 41 P FAXDNE10
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AND IMPRISONMENT OF NOT MORE T41P1 TWO YEARS FOR ANY
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tlu Ibned SMn« TELEPMINE NUMBER Sgmwm
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MMENr mCa PUrcNr16•r/Txkm WalMA=ed Sxlrur ?I Q -371-.- m -SeMr-'
&dh•MW dSN:atl P•TAm««AMN«lAed SiepS IELEPFIONE MBAR B'AAp11A•m SNkr
2ND ( I
AS9 GN-
MENT
Si4ntlua O( Co• hmha mlTMe m AuNaax•d Is
91I{Dature of Co-Selltl
H. NOTE: If a co-purchaser other than your spouse Is listed and you want the title to be listed as 'Joint Tenants With
Right Df Survivorship' (On death of one owns(, title goes to surviving owner.) CHECK HERE 0: Otherwise, the title
li will be issued as "Tenants in Common" (On death of one owner, interest of deceased owner goes to hiedher heirs or
estate).
NOTE: IF THE. VEHICLE IS TO Be USED AS A DAILY RFNTM OR LEASED VEHICLE, CHECK NIS BLOCK 0 F BLOCK IS CHECKED, COMPLETE AND ATTACH FORM MV-L
0111111111- less
1. BUREAU OF MOTOR VEHICLES
MESSENUEM NUMCGH:
No. UUWJy '
MV - 4,T (5-00) tAZFH?
A, r MfffmwoimR(AS SHOWN ON AT=Wo TRLE) AVAfE OF VEFBOIE AADDEL YEAR
. ° 1 rz u, is..AM.M ..?1 o.
V E IOFNiFIGTNIN NUMBER tas
,, NAM
LAW NANE LLBUE I ff"
WNBLE
AMWNT
(-e- -
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to IpKEITrAIan(? ONe?!
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STATE 21PCODE-- -Es
UC I LiBn Feu
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D. LAST RARE ( OR FIX I. BUSMW NAME) FIRST NAME fAIDOIE WT1A4 ORE NCAIp1ED!
PUPr;IMRED K, RNisKallm a
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STREET .•-..-_.-..--.-..-.- CWNTY CWE s.p°Aeae(lep.
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CRY STATE BOER TO (q TY TX1p
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usTNDONRENER3E SOE
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E MAKE OF VEHK]E YElIII;IFMNRFIOATKANNUMBER
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F- '- .
F. OITMRNL RATE G: OTC l TIWISf CR OF PREV'AUSLY ISSUED FLAIE TOT. I"AID Y' 10
El AAM IOOEISSMD BY 1
? TRANSFER A RENEW OF PLATE (PM IY„y HA
BUReAU(PROOF OF W-
?IILWGFENA REFtACEMENT OF FLAIE
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PLATE TO BE
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PLATE NO EA.,CW iOR nEPLACEWW
Y BUREAU
ISSUED B
ISSWO . (]LOST ? aFIGEb ? smsH
^
L J 'TEMPOIiMY PLATE
ISSUED BY FULL AOCE EKIUES
1A,Oh YeJ ?NEYEA nfCENFDILa'1 INAWI
11UTE M'NEVER RrCENED' Mack u cNCCFUd r2°I a Farm nN?•.
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11WISFEIIHFD fAONi TITLE NO ?-YIN
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9s .. TEW. PLM NO. PLATE S O[giD TRNlS
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POUCY ?IFECTNE 1bUCY E)(1•RATgN
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4?
MICRO" 0OUKWICEWIT11A1L APRAL:AeLE RFiOVI^u10f1s OF Tf YEIBCLE COD
AND DEPARTMENT REGUI,ATIOf1S 1 1
G IF AN EIlEAPTtON
I/WE fYRiIFY nMT VVYE IUbE EKAAMED ADp sIGNFP iTES FORM AFIEF fIS COIAPtEl1Of1 AND i1W THE afon""nON IS TRUE Ara
ill gPEnr
TiN6
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L4 CL.AJAEO. TTE PU1CIM;,EA FURRER CERIffE$ t1 W TIE/SIZE IS A1R110NITED lp (AAM TN$ E%EArOllOfl. I/WE AGIiNOwtE 1/NT I/1VE A
F
WTAW gtoukoV Fe po BRIUTY ON THE CURRENTLY REGISTERED YHE. PERIOD O
LEGEM OR VEFBCLE REGISTRA"SI FOR FAILURE TO MA
REoreT IONVwE ACKN(AWLEXFE TNT I/WE IMY BE SUBECT TO A FIRE NOT EKLEEDIIIG $5000 AND "Frrsiwes r OF N(n ,,nE EARS FOR AiIY
FALSE .STA MNTn TaI TWn F
ST eA
3t 1 1
ASS
'slwa2a
M
ePMel P,RfIAWr AMNOIeb 9Slaer
Sa~ d s TEtEPHME MRAER Shcor
q
H. NOTE: If a Ca-purchaser other than your spouse is listed and you want the title to be listed Tenants With
h
Right of Survivorship(On death of one owner, title goes to surviving owner.) CHECK MERE wise, the iftla
1 will be issued as'Tenants in Common' (On death of one owner, interest of deceased owner isiher hairs or
estate).
a
r NOTE. IF TIE YFRKAE W TO BE USED AS A DAILY AIM .F,,D VEHICLE, CHEO( THIS BLOCK ? IF BLOCK Is GIECKED, COMTACH FONA 1Av?
m Lms: o6,
1. BUREAU OF MOTOR VEHICLES
MESSENGER NUMBER:
No.14yUbJb
?OmEmm
A. M TTIE NUMBER (AS SHOWN ON ATTACHED TITLE) MAKE OF VEHICLE MODEL VF1A
VEHIC
EIIDENTIFICATION NUMBER COND"
L
AIN ?MOR 7
F
HIML
MT )ADDLE NAME
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.,,,C S ?.-L74V C AMI?
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AA 6%1
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JBUSWESSNAME)
FIRST NAME MEHME INRIAL
LASTNVAE(CIARL
WTE ICWIHEOr
A
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N 0 14 ?? LJ?1
%RCHASEO -O
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c Z6 PURCHASER IB F•M AaAgm•A TB Ssmnd MNpNterl
t
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S STREET
-.... ... COUNTY CODE
' '1\ 11
OO I? 2. Till. Fclct
G'
GnY {per (] (? - STALE ]JP clz C? 14FER m cXMAeY G 3
M:L VV[
F
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3
TIA? 1 ?: .
OfwM CWY .
? LAST NAME tact FULL BUSINESS !WALE) PAU NAME MIDDLE IMTIAL DATE ACOURED/ l
.
PURCHASED Dn
N.R re
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•
CO.0.10Ge5ER •?
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m Naelyd a eN .
3 6TnEET GrIUNIY CODE 6 D,vlir, 1. HN
] / Ft,,,
S
i CRY STATE LR CODE PETER lO COMrTY CODES
IJRM ON PEVEIn,E ^# G. TrDn;kr Fea
p `1,1P, "Y
E- MARE OF VEHICLE vEMGE UENTFIOAII(lN NUMBER
TI,..+naso Tae
51G
g
s
MODEL YEAH
IfDOV TYPE(CP. M. Elc)
(]GIDITKR
S naPlvcrvmn)
Y II??II
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POOR
I?t GOOD FAR ....
F. on iGimm PLATE V/ DNwA DAr (
] RNM$FEn G IYSVIOUSLY I:'.tKICO RATE TOTAL "No V .
^. W
PLATE TO BE ISSUED tlY _
? IIVNSrEP b RENEWAL, OF PIAIE IAm I Ihrv RI -
-
-
UDnLAU1F1OCFOFN-
SId1LE MUSr OF. AT- TTWNSFERb REPUDEMENT OF PI.AIE
1 GMNO TOTA stmfOlna
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ULVV'T Cj DEFIf.FD [] SId EN
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THIN. PLATE ND FEWEDIF OILER AN
MR)CNrti
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INCLUDING LOUD WT IF NAPl1GABLE)
INSURANCE CORY POLK:Y NO DR T'()IIDV ET CTVE POLICY FXPIRAM'R
'
'
ATTAL
N BINfI(PI W1F IMIi
ISSUING ICF.FT l1NATn IM _TMY a YEAnOn - ISSUING, A;ENT IPRLNT NAEE)- AGENT NO.,
)
-
AGENT IHAVEG CKED IuYEiW1 VEHICLEISNSIK+EDNJD Qn,-j
f-t .?
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ItFOn- BSIIED IEAH(AO FE0*7RATION TO THE ABOVE APPLICANT. M 156 AO SIGNATURE TEIEPFKINE
PROVISK7N5 OF ME vEFIGIE CODE P
GTE T_a,-z
4-
NA DEPARTMENT REIRMTION,A
4 rY
1?
T
G KEmFMN
1/WE GERI EI THAT CANE HwE Exm*ED AND SIGNED THE FORM AFTFA ITS coMRLETION A o TWAT THE INFORFAATION GMEN E TRUE'AW CCRRECL F AN E
. IS CLICHED THE PUB04AWA FURTHER CERTIFIES THMT HE/SHE IS AUTHOAQ!ED TO CLAM THIS EXEMPTION. IrNE ACKNOWLEDGE THAT I/WE MAY LOSE WICUR OPERATING
HA'LEGEIS) OR VEHICLE FEGISTRATION(S) FOR FAILURE TO MANTAR FINANCIAL RF..RPONSBKJTV ON THE CLFRENTLY REGUSTERED WFMCIE FOR THE PERIOD, CF
REGWP4KMK NINE A KNOMEDGE THAT FFWE MAY BE SUBJECT TO A FINE NOT EJICEEDRD U.010 AND IM MSONMENT OF NOT MORE THAN TVA) YEARS FOR ANY
FALSE STATEMENT TRIO H/ MACE ONT FORM ......_
_.... _„
of Ml!PI I MpJ Sign ELEPHOMENUMBPR ._
Sllra dSNlar
ET -
E
ANSeIG d [o Pl•dueer/IIk d MM••ixed Surer SAI"NT", d CaSdb
aMNNIe d S• FRJ PI o. d Aadaw Sow IELEPINOHE HLEER SIQ.1A,• d $41nr
21A
ASSIGN. 1 )
MENU ElaTah•• d CuA•dwaz/rAM d AANa1ceC Styes Sgnalwa d Ca-^
NOTE: If a Go-pu(ehaser other than your spouse is listed and you want the title to be listed as 'Joint Tenants With
H.
i
Right of Survivorshlp' (On death of one owner, title goes to surviving owner.) CHECK HERE 0. Otherwise, the title
will be issued as 'Tenants in Common' (On death of one owner, interest of deceased owner goes to his/her hells or
estate)-
`
NOTE: F ME VEWCLE IS to SE USED AS A DAILY RENTAL OR LEASED VEHICLE, CECIL THIS al ? . IF BLOCK IS DECKED. COMFIETE AND ATTACH FORM MVAL
MESSENGER NUMBER:
1%W V
t, BUREAU OF MOTOR VEHICLES
No: 0068970
A. VEMGIE MODEL
p! RUICIED lrREl OF
S Me?Ef
1A9 SIIDM!
M TIM
1
M
E
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VI
T
'T
r Sn6vi QJsQ Ir
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e
CWAmON
VEINCE IDENfFCARIN NUMBER
? GOOD ? FAIR ? FF T
MIDDLE SMALL
E
n
le
m ravemol.
Sa.
a v? [
see
C
M FIST NAME MIDDLE INITIAL
4
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LAST NAME IIXI FULL BUSINESS N ATE ACQUIRED/
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5
4TREE
T T Y CODE
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5 Q -?+?'7 f?
5
1 (j J- R ? 1.,1?
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2 Fps
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GODE
CRY STATE Z
._
FEFFP TO CUUm GODEe ..
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P IIS1pp ONRVEP3E 00E 3.lient.
ee M
A-
.-IL DF AAf UJFY
p LAST NAME TOR M.L BIISINE59 NAME) rsisT NAME MOPLEINITNL DALE ACOl11fIED/ 9. fxymlrAUrnm
( VRCWSED P1PCeeeNA Fee
CA-PURCHASER
STREET COUNTY GOpE flry
5.
FAA
Nee
a W.U(l =
¢ _
STATEy--- LIICODE M'EH mf
UU11YrMCJ
p Gny .
URZONPEYFIM
L# r F
e
a lrAn F
V e
e -
E. MAKE OF VEHOI.r wmi r POn FCATON NUMBER
i.li 'renae iFA etl
4
? MODEL VEAR BODY tYIt CIF. M,ETC.1 (:rNIDITON e. WxWemonl
Y
R LJ OW, ? FAH P R FRB, e
F.
(MIGIYI. MATE J Gteav Q•
TRANSFER OF PHEV10Ue+1 v ISSIIEU PLATE
TOTAL PAO e. m
I4ATE TO nC OWED BY IP.WSFkH 6 RENEVAL OF RATE IACd t IMU PI e /,,. -
BUREAU (PFOUFOFW- )RANSFERIFEKAF,EMENr Or PLATE ....- Sell Orv
TSUfW1CE MUM BE AT, TRANSFER (Jr MAlE 3REFLACEMENI OG STK;KFA 1LGILWD III OTAL
IAIMNA teI
G1xcK In
ThN Amount
4
U E%GMNUE MATE W BE nFA50NPOR REPLACEMENT
NasuEO BY BURM RAENO. ?wsr ? x ED L]
?
o 55UEMlAL AGENT
WrLCanl r,wl rrnpblo Fam MV-aa.
n NOTE,M"FNE'!FPRE?FPiED"LbcA is crlecFN+
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x
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1rNN.SFr.RREB FROM T NOM -y 0 VIN F^/? 0
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ONSHN TU APP
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yB TEW PLAIENa. ?
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FEREDIFOHERTIMN AP%CWn
- -? ?
PEO. WG GFOSS COMB,
VE E CVNfN LALADFN WEONIT PEO REO. GROSS W,
WEM.HT INFn IIK;I,UDNNIi I.JAU w i. (IF APPUUADLE)
IF MRIC
-.. -..
_ ?(
f Y EFFECT PnOl1LY E%PIiNT10N
WSURANgE'lMF1Y NMIE
l ( PoV1
A
v ^ u ?.
11F
J '
A T
ISSUING (CERTIFY IIW ON MONfX_ DAY YEM ISSU PKIT
AGENT T TUNE cPFWD To DMISFIME n ED D
IWOR- ISSUED TEMPORARY REGISTRATION TO nE ABOVE AFPLKG N LSSUWG AG SIC I TEIEPIrOHE W.
I
WITH
PROV1S"$ OF THE VEHICLE CODE 2 2,14
NAMON) COMPLIANCE
LL AAPKICABLE
R
MONG
AM DDEPA
G !/WE CERTIFY LAM HAVE EXAMINED AND SIGNED THIS FORM AFTER RS COMPLETION AND TFNT 1HE WFORMATION GIVEN LS CORTEGE. F AN EXEMPTION
. 15 CL,MEq TAE pUSCHk%A FURTHER CERTFIES TINT IE/FAE L5 AUTHORRED TO CLAIM TMIS FXEMPTGN. VWE ArKNpirt LOGE THAT If MAY LOSE MY/OUR OPEMTFR3
PTINLEGEIS) On WHOLE REGISMOTONl51'FUP FAILURE TO M,KTAN RNANCM RESPONSIB11.11Y ON THr CURAEN ILY nEtiISTEREO VEI M FOR THE PERIOD OF
FEGIHfPAIgN. 1/WE ACKNOWLEDGE i Vvie MAY BE SU"CT TO A PINE NOT EXCEEDING S6.003 AND IrAPRI::rAWNT OF NOT MORE THAN TWO YEARS FOR ANY
?WIIT TVE AN(E ON1NS
E
PTl a AMNRriMEW
Siate TELEPHONE NUMBER 9lpru
alprpNna
H. NOTE: It a co-purchaser other than your spouse is listed and you want the title to be listed as 'Joint Tenants With
Right Of Survivorship' (On death of one owner, title goes to surviving owner.) CHECK HERE C]. Otherwise, the title
will be issued as 'Tenants in Common' (On death of one owner, interest of deceased owner goes to his/her heirs of
estate).
NOTE F THE VEHICLE IS TO eE USED AS A DAILY RENTAL OR LEASED VEHOLE, CHECK THIS BLOCK . IF BLOCK IS CHECKED, COMPLETE AND ATTACH FORA 101L
MESSENGER NUMBER:
1. BUREAU OF MOTOR VEHICLES
Na. 0068981
i?- 7.0 3 & 0'01-r/-1 7z,Vrd' d?o ?k Co-P a
A
P A TILE NLNKR(AS 8110MON ffD0EDTPIEI EOF VEHICLE MODELYEAA R1pC1
YSIf
. l ma-t ( E
(see roN m
revuse,
,
_
VEHICLE IDENIF1GMON NUMBER CONDMON lEss
w p7/
13.000 13 FAR ? POOR TPIDE.
.
FBI Rw MYDDI T
.._? AMOUNT
O.
w CO-SEUER ar LLe
1 3afe
sT
t
o
)
r
RT%
rmla
90enoHr m 2+.ue)
C IEI
FUIST NAME MIDDLE WIML WIE AA.CQUIRRED/
RR FLU BUSINESS RA
LAST UAME((O IA E?=,;,j4 ...
8
Mn
GM
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?
M T'H
M
.
?R?ygfq 1
tB Fly AMgnmed is BBCAtl'_AYSIWVI1rIM
c(VE
r-co-u?
? I. Tine
r(?
CIIY 'STATE 21V CODE PF. PER m W tY Ctxx
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H. NOTE: It a co-purchaser other than your spouse is listed and you want the title to be listed as 'Joint Tenants With
Right of Survivorship' (On death of one owner, title goes to surviving owner.) CHECK HERE O. Otherwise, the title
will be issued as 'Tenants in Common' (On death of One owner, interest Of deceased owner goes to his/her heirs or
estate).
NOM F THE VEHICLE IS TO BE USED AS A UAL( RENAL On LEASED VEHICLE, DECK 7III5 SLOCX ? . F BLOCK IS CHECKED. COMKETE AND ATTACH p 111 MV-E.
MESSENGER NUMBER:
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FROM :RMRNDA & LIES
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iRECEIVED TIME.: FEB. 10•r?11:10141101 1NT TIME:;FEB.10:,11:16Ah{
EXHIBIT "B"
RELEASE, RECEIPT AND
ASSIGNMENT OF CLAIM
WHEREAS Erie Insurance Company (Erie) executed as surety a bond in the
amount June 25, 1996, in favor of the Commonwealth of Pennsylvania (Commonwealth)
to cover the obligations of Gregory Myers d/b/a Myers Auto Sales, Inc. (DIN 08619402),
a dealer of motor vehicles in the Commonwealth; and,
WHEREAS the Commonwealth presented a claim on that bond (Erie Claim #
010170682166) because the Commonwealth found that Myers Auto Sales, Inc.,
submitted eight uncollectable checks and failed to properly fulfill its legal obligation to
submit 16 vehicle transactions to the Department (see Attachment A, setting forth the
uncollectable checks by case number and items of title documentation by name of
transferee, which is hereby incorporated into this paragraph by reference); and,
WHEREAS Erie will pay six thousand and three dollars and fifty-three cents
($6,003.53) to settle the Commonwealth's claim.
NOW, THEREFORE, for and in consideration of the aforesaid payment to the
Commonwealth by Erie, the Commonwealth hereby releases and discharges Erie of and
from any and all claims, demands, actions or causes of action, accrued, or to accrue, by
reason of, or in any manner growing out of the aforesaid alleged default, under the terms,
conditions or provisions of said Bond, and, furthermore, as a further consideration for this
agreement, the Commonwealth hereby assigns and sets over unto Erie, all its rights,
claims, demands, actions, or causes of action, accrued, or to accrue from the alleged
default, and the undersigned hereby appoints Erie, or its authorized representative, its
Attorney-in-Fact for the purpose of signing the name of the undersigned to any and all
papers necessary to enjoy the rights herein provided and assigned to Erie.
NOTWITHSTANDING the terms set forth above, this Release, Receipt and
Assignment of Claim extends only to the aforementioned Claim. The Commonwealth
reserves the right to make further claims against the Bond up to the remaining bond penal
sum of thirteen thousand nine hundred and ninety-six and forty-seven cents ($13,996.47).
Furthermore, the Commonwealth reserves the right to pursue further legal action against
the Principal, but not the surety, for any claims in excess of the amount of the Bond.
MA
IN WITNESS WHEREOF, the undersigned has hereunto set its hand and seal this
17 7/f day of .Srore, 3Wa ,2004.
ATTEST:
State of "?4
County of SS:
Before me, a notary in and for the County of , a bay . and
State of' PA personally appeared ??e77y 5rL R.
Personally known to me to be the person who executed the foregoing release and
assignment of claim, and acknowleged that he executed same as
free act and deed, for the uses and purposes therein set forth.
NOTAgIAt SM
I V4 JOHN W. HAWMAK Nobly N*
OWM AM M 800 OWL 2T27
J
Id tary Public
7 l aQd `?
My commission expires: 0'!
!" 1
?l-
SHERIFF'S RETURN - REGULAR
CASE NO: 2006-04139 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
ERIE INSURANCE COMPANY
VS
MEYERS GREGORY A
WILLIAM CLINE , Sheriff or Deputy Sheriff of
Cumberland County,Pennsylvania, who being duly sworn according to law,
says, the within COMPLAINT & NOTICE was served upon
MEYERS GREGORY A the
DEFENDANT
at 1518:00 HOURS, on the 27th day of July , 2006
at C/0 GREGORY ABELIN ES
CARLISLE, PA 17013
SHELLY SYDNOK
37 E POMFRET STREET
by handing to
OFFICE CLERK
a true and attested copy of COMPLAINT & NOTICE
together with
and at the same time directing Her attention to the contents thereof.
Sheriff's Costs: So Answers
Docketing 18.00
Service 4.40
Affidavit .00
Surcharge 10.00 R. Thomas Kline
.00
32.40? 07/28/2006
q'?_?/O4 ( GORDON & WEINBERG
Sworn and Subscibed to By:
before me this day eputy Sheriff
of A. D.
Curtis R. Long
Prothonotary
Office of the Protbonotarp
Cumberfaub Countp
Renee K. Simpson
Deputy Prothonotary
John E. Slike
Solicitor
Vi - 1413 ! CVIL TERM
ORDER OF TERMINATION OF COURT CASES
AND NOW THIS 28TH DAY OF OCTOBER, 2009, AFTER MAILING NOTICE OF
INTENTION TO PROCEED AND RECEIVING NO RESPONSE - THE ABOVE
CASE IS HEREBY TERMINATED WITH PREJUDICE IN ACCORDANCE WITH PA
R C P 230.2.
BY THE COURT,
CURTIS R. LONG
PROTHONOTARY
One Courthouse Square • Carlisle, Pennsylvania 17013 • (717) 240-6195 • Fax (717) 240-6573