Case 14-19275 Claim 14-1 Filed 08/01/14 Page 1 of 2 CLAIM #44 ...
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Filed 08/01/14 Page 1 of 2
B10 (Official Form 10) (04/13)
UNITED STATES BANKRUPTCY COURT District of Maryland Name of Debtor: Western Maryland Transport, Inc.
PROOF OF CLAIM
Case Number: 14−19275
FILED U.S. Bankruptcy Court District of Maryland
NOTE: Do not use this form to make a claim for an administrative expense that arises after the bankruptcy filing. You may file a request for payment of an administrative expense according to 11 U.S.C. § 503.
8/1/2014
Name of Creditor (the person or other entity to whom the debtor owes money or property):
GE Capital Commercial, Inc.
Mark A. Neal, Clerk COURT USE ONLY
Name and address where notices should be sent: GE Capital Commercial, Inc. 1010 Thomas Edison Blvd SW Cedar Rapids, IA 52404 Telephone number: 319−841−7129
Check this box if this claim amends a previously filed claim. Court Claim Number: (If known) Filed on:
email: [email protected]
Name and address where payment should be sent (if different from above): Check this box if you are aware that anyone else has filed a proof of claim relating to this claim. Attach copy of statement giving particulars.
GE Capital PO Box 644479 Pittsburgh, PA 15264−4479 Telephone number: email:
253749.19 1. Amount of Claim as of Date Case Filed: $ If all or part of the claim is secured, complete item 4. If all or part of the claim is entitled to priority, complete item 5. Check this box if the claim includes interest or other charges in addition to the principal amount of the claim. Attach a statement that itemizes interest or charges.
2. Basis for Claim:
Money Loaned
3. Last four digits of any number by which creditor identifies debtor:
(See instruction #2) 3a. Debtor may have scheduled account as:
3b. Uniform Claim Identifier (optional):
(See instruction #3a)
(See instruction #3b)
5004
4. Secured Claim (See instruction #4) Check the appropriate box if the claim is secured by a lien on property or a right of setoff, attach required redacted documents, and provide the requested information. Nature of property or right of setoff: Real Estate Motor Vehicle Describe: Title/Lien Cards on Trucks Value of Property: $ Annual Interest Rate (when case was filed) 18 % Fixed or Variable
Amount of arrearage and other charges, as of the time case was filed, included in secured claim, if any: $ 26353.94 Other Basis for perfection:
Title/Lien Card
Amount of Secured Claim: $ Amount Unsecured:
253749.19
$
0.00
5. Amount of Claim Entitled to Priority under 11 U.S.C. §507(a). If any part of the claim falls into one of the following categories, check the box specifying the priority and state the amount. Amount entitled to Domestic support obligations under 11 Wages, salaries, or commissions (up to $12,475*) Contributions to an priority: U.S.C. §507(a)(1)(A) or (a)(1)(B). earned within 180 days before the case was filed employee benefit plan − or the debtor's business ceased, whichever is earlier − 11 11 U.S.C. §507(a)(5). U.S.C. §507(a)(4). Up to $2,775* of deposits toward purchase, lease, or rental of property or services for personal, family, or household use − 11 U.S.C. §507(a)(7).
Taxes or penalties owed to governmental units − 11 U.S.C. §507(a)(8).
Other − Specify applicable paragraph of 11 U.S.C. §507(a)( ).
*Amounts are subject to adjustment on 4/1/16 and every 3 years thereafter with respect to cases commenced on or after the date of adjustment. 6. Credits. The amount of all payments on this claim has been credited for the purpose of making this proof of claim. (See instruction #6)
$
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Filed 08/01/14 Page 2 of 2
7. Documents: Attached are redacted copies of any documents that support the claim, such as promissory notes, purchase orders, invoices, itemized statements of running accounts, contracts, judgments, mortgages, security agreements, or, in the case of a claim based on an open−end or revolving consumer credit agreement, a statement providing the information required by FRBP 3001(c)(3)(A). If the claim is secured, box 4 has been completed, and redacted copies of documents providing evidence of perfection of a security interest are attached. If the claim is secured by the debtor's principal residence, the Mortgage Proof of Claim Attachment is being filed with this claim. (See instruction #7, and the definition of "redacted".) DO NOT SEND ORIGINAL DOCUMENTS. ATTACHED DOCUMENTS MAY BE DESTROYED AFTER SCANNING. If the documents are not available, please explain: 8. Signature: (See instruction #8) Check the appropriate box. I am the creditor.
I am the creditor's authorized agent. (Attach copy of power of attorney, if any.)
I am the trustee, or the debtor, or their authorized agent. (See Bankruptcy Rule 3004.)
I am a guarantor, surety, indorser, or other codebtor. (See Bankruptcy Rule 3005.)
I declare under penalty of perjury that the information provided in this claim is true and correct to the best of my knowledge, information, and reasonable belief. Print Name: Kevin M. Evers Title: Litigation Specialist Company: GE Capital Commercial, Inc. Address and telephone number (if different from notice address above): s/ Kevin M. Evers
(Signature) Telephone number:
8/1/2014
(Date)
email: Penalty for presenting fraudulent claim: Fine of up to $500,000 or imprisonment for up to 5 years, or both. 18 U.S.C. §§ 152 and 3571.
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 1 of 44
LOAN DAMAGE CALCULATOR--BANKRUPTCY Claimant reserves its rights to seek the allowance of an unsecured deficiency claim to the extent that the value of the collateral is less than the amount of its claim.
Account Name: Loan Number: GE Case Number: By: Date Prepared: Date Updated: Default Date: Bankruptcy Petition Date: Date Equipment Sales Proceeds Received: Interest Rate:
WESTERN MARYLAND TRANSPORT, IN 8467018001 65004 Diane Lensing 7/31/2014 7/31/2014 6/1/2014 6/6/2014
18.000% CLAIM CALCULATION AS OF DATE CASE FILED
A. Principal Balance: Balance from amortization schedule row: 44 Less partial payment: Amount of Interest attributed to partial payment Remaining principal balance:
$ $ $ $
58,870.75 58,870.75
B. Collection Fees: Unit Cost
$
Number of Charges
-
Aggregate
$
-
C. Repossession Fees: Unit Cost
$
Number of Charges
-
Aggregate
$
-
D. Interest: Days from Default Date to the earlier of Date Proceeds Received or Petition Date
Daily Interest
29 5 Unpaid Interest from Partial Paid payment
Aggregate
$
E. Net Equipment Sale Proceeds:
$
F. Balance After Accounting for Equipment Sale:
$
$147.18 59,017.93
G. Interest: Days from Proceeds Received to Petition Date, if applicable
Daily Interest
0
Aggregate
0
$0.00
H. Late Charges: Unit Cost
$ $
163.78 162.46
Number of Months
15 1
Aggregate
$ $
2,456.70 162.46
I. Other Charges: Unit Cost
None
$
-
Number of Charges
Aggregate
$
-
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 2 of 44
TOTAL CLAIM (This total does not include applicable legal fees)
$
61,637.09
ARREARAGE AS OF DATE CASE FILED A. Regular Payment: Unit Cost
Number of Months
$ 3,275.68 $ -
1
Unit Cost
Number of Months
Aggregate
$ $
3,275.68 -
B. Late Charges: $ $ C. Other Charges:
163.78 162.46 Unit Cost
$ $
Aggregate
15 1
$ $
Number of Charges
-
Aggregate
$ $ TOTAL ARREARAGE
2,456.70 162.46
$
5,894.84
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CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 10 of 44 I
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THIS IS NOT A TITLE YEAR
VEHICLE IDENTIFICATION NO
1HTXRAPT18J27O235
{
EXCEPT
4X
GR. VEH. WT
70000
11
MAKE
INTL
GR COMB WT
OON/A
BODY STYLE CLASS ODOMETER
TK
EPD
BRAND
TITLE NUMBER
182 A
41175380
INSPECTION DATE
FEE (FAGS)
N/A
$1837.50
DATE ISSUED
08130/10
CO.OWNER S SOUNDEX I DRIVER LICENSE NO
OWNER'S SOUNDEX J DRIVER LICENSE NO.
Z-975-001-978-425
_ ODOMETER CODES
NAME(S) AND ADDRESS OF REGISTERED OWNER(S)
A Actual Mileage B Excoo xcoeds Mechanical Limits C Not Actual Mileage
WESTERN MARYLAND TRANSP ORT INC 45 LOCUST LN PO BOX 278 BARTON MD 21521-1039
00131827 THIS IS TO CERTIFY THAT A SECURITY INTEREST HAS BEEN DULY FILED WITH THE MOTOR VEHICLE ADMINISTRATION IN THE NAME OF THE SECURED PARTY BELOW ON THE VEHICLE DESCRIBED
TERMINATION STATEMENT I THE UNDERSIGNED 00 HEREBY RELEASE ALL RIGHTS AND INTERESTS IN THE VEHICLE DESCRIBED ABOVE -C
SIGNATURE OF SECURED PARTY
OFFICIAL CAPACITY
DATE OF RELEASE
NAME AND ADDRESS OF SECURED PARTIES
GE CAPITAL COMMERCIAL INC PO BOX 35707 BILLINGS MT 59107
OFFICIALLY ISSUED ON THE DATE SET FORTH
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INISTRATOR OF MOTOR VEHICLES
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J VR-002 (03/09)
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CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 11 of 44
Federal and State law requires that you state the mileage in connection with the transfer of ownership Failure to complete or providing a false statement may result in fines and/or imprisonment
LL 0,
To be used by secured party (Lien Holder) named on the face for securing a repossessed certificate of title or for the conveyance of ownership of the vehicle to a subsequent purchaser I/We the undersigned hereby certify under penalty of perjury that the Motor Vehicle described on the face has been repossessed because of the debtor's failure to meet the obligation in the settlement of the lien indicated on the face of this form The lien contract covering the vehicle was executed in full compliance with article 95B of the annotated Code of Maryland I/We also warrant title to the vehicle described and agree to defend it against all claims
Z0 Oy IJU V U)
SIGNATURE OF SECURED PARTY
Witness My/Our Hand(s) and Seal This
PRINTED NAME
Yr
Day of
LL
REPRESENTING FIRM OR COMPANY
a W¢
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked
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q 1 The mileage stated is in excess of its mechanical limits (no tenths) ODOMETER READING
q 2 The odometer reading is not the actual mileage WARNING ODOMETER DISCREPANCY
The undersigned hereby certifies that the vehicle described in this title has been transferred to the following
Name(s) of Buyer(s) Address of Buyer(s) CITY OR TOWN
STREET ADDRESS IM W z
STATE
COUNTY
ZIP CODE
I certify to the best of my knowledge that the odometer reading Is the actual mileage of the vehicle unless one of the following statements is checked
O
SELLING PRICE
q 1 The mileage stated Is in excess of Its mechanical limits
_
U. O
DATE OF SALE
F Z W 2
(no tenths)
2 The odometer reading is not the actual mileage
q
WARNING ODOMETER DISCREPANCY
ODOMETER READING
SIGNATURE OF CO-SELLER(S
Z
SIGNATURE OF SELLER(S)
y Q
PRINTED NAME OF SELLER(S)
PRINTED NAME OF CO-SELLERS
SIGNATURE OF BUYER(S)
SIGNATURE OF CO-BUYER(S)
PRINTED NAME OF BUYER(S)
PRINTED NAME OF CO-BUYER(S)
-
-
--
--
Name(s) of Buyer(s Address of Buyer(s CITY OR TOWN
STREET ADDRESS
ZIP CODE
STATE
COUNTY
Give Maryland Driver a License Number and Date of Birth If you do not have a Driver IS License give Date of Birth
Z O
DATE OF BIRTH
CO-BUYER S DRIVERS LICENSE NO
DATE OF BIRTH
BUYERS DRIVER S LICENSE NO
IAMOUNT OF LIEN
IF NOT SUBJECT TO A LIEN INDICATE NONE
KIND OF LIEN (DESCRIBE)
DATE OF LIEN
H ADDRESS OF SECURED PARTY
NAME OF SECURED PARTY W M
Vm horeby nuke appviuTL•on for
Now T."
Now TNO Wit
Q
(Chock opplWb10 block)
and Togo
Tronsfor of Tags
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If you are Imnsioning tags from a vehicle that you sold to this vehicle give the following (II applicable)
W F
NAME OF PERSON TO WHOM YOU SOLD THE OLD VEHICLE CERTIFICATION
0
OF
Z
INSURANCE
. Now TIL'o Only
IF 110TORCYCLE UST ENGINE NUMBER IF TRUCK/TRACTOFUTRAILER LIST WEIGHT GVW
L_J No Tag.
GCW VALIDATION STICKER NUMBER
TAG NUMBER
CLASS OF VEHICLE
ADDRESS
NAME OF INSURANCE COMPANY (COPY FROM YOUR POLICY) NAME OF AGENT
POLICY OR BINDER NUMBER 1
TITLE D AS JOINT
TO
. AWAR E
O D O METER C ERTIF IC A TION MAD
L
TENANTS • V M
IL CL
SIGNATURE OF BUYER(S) [] TENANTS BY ENTIRETIES
0 JOINT TENANTS
PRINTED NAME OF BUYER(S)
NOTARY NOT REQUIRED I/we certify under penalty of porlury that the statements made heroin arc two and correct to the best of my/our knowledge
SIGNATURE OF CO BUYER(S)
information and betel and hereby state that the manufacturer's
identification number shown on the taco hereof agrees with the number plate on the vehicle Witness My/Our Hand(s) And Seal
PRINTED NAME OF CO BUYER(S) •. COSIGNATURE OF PARENT GUARDIAN OR RESPONSIBLE ADULT REQUIRED WHEN APPLICANT IS UNDER IS YEARS OF AGE
This
Day of
20_
MUST BE SIGNED BY OWNER(S) OFFICERS) OF CORPORATION OR PARTNER IN PARTNERSHIP
The undersigned hereby certifies that the vehicle descnbed in this title has been transferred to the following
Name(s) of Buyer(s) Address of Buyer(s) STREET ADDRESS
Z
SIGNATURE OF BUYER(S)
-
-
STATE
COUNTY
CITY OR TOWN -
W 2
PRINTED NAME OF BUYER(S)
0
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked
tJ) W
Q J Q W 0
ODOMETER READING
(
no tenths) )
ZIP CODE
SIGNATURE OF CO BUYER(S) PRINTED NAME OF CO-BUYER(5
q 1 The mileage stated is in excess of its mechanical limits 2 The odometer reading is not the actual mileage DATE OF WARNING ODOMETER DISCREPANCY DELIVERY
CERTIFIED SELLING PRICE TRADE IN ALLOWANCE
DEALER S NO
SIGNATURE OF AUTHORIZED AGENT
TAXABLE PRICE PRINTED NAME OF AUTHORIZED AGENT GROSS TAX COLLECTED PRINTED NAME OF DEALERSHIP STATE
VIN OF TRADE IN IF NOT SUBJECT TO A LIEN INDICATE NONE
AMOUNT OF LIEN
NAME OF SECURED PARTY
ANY ALTERATION OR ERASURE VOIDS THIS DOCUMENT.
DATE OF LIEN
COLL FEE 127. OF GROSS OR $24 MAX FEE ALLOW NET TAX REMITTED
ADDRESS OF SECURED PARTY
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 12 of 44
LOAN DAMAGE CALCULATOR--BANKRUPTCY Claimant reserves its rights to seek the allowance of an unsecured deficiency claim to the extent that the value of the collateral is less than the amount of its claim.
Account Name: Loan Number: GE Case Number: By: Date Prepared: Date Updated: Default Date: Bankruptcy Petition Date: Date Equipment Sales Proceeds Received: Interest Rate:
WESTERN MARYLAND TRANSPORT, IN 8467018002 65004 Diane Lensing 7/31/2014 7/31/2014 5/10/2014 6/6/2014
18.000% CLAIM CALCULATION AS OF DATE CASE FILED
A. Principal Balance: Balance from amortization schedule row: 44 Less partial payment: Amount of Interest attributed to partial payment Remaining principal balance:
$ $ $ $
58,793.64 58,793.64
B. Collection Fees: Unit Cost
$
Number of Charges
-
Aggregate
$
-
C. Repossession Fees: Unit Cost
$
Number of Charges
-
Aggregate
$
-
D. Interest: Days from Default Date to the earlier of Date Proceeds Received or Petition Date
Daily Interest
29 27 Unpaid Interest from Partial Paid payment
Aggregate
$
E. Net Equipment Sale Proceeds:
$
F. Balance After Accounting for Equipment Sale:
$
$793.71 59,587.35
G. Interest: Days from Proceeds Received to Petition Date, if applicable
Daily Interest
0
Aggregate
0
$0.00
H. Late Charges: Unit Cost
$ $
163.57 162.38
Number of Months
13 1
Aggregate
$ $
2,126.41 162.38
I. Other Charges: Unit Cost
None
$
-
Number of Charges
Aggregate
$
-
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 13 of 44
TOTAL CLAIM (This total does not include applicable legal fees)
$
61,876.14
ARREARAGE AS OF DATE CASE FILED A. Regular Payment: Unit Cost
Number of Months
$ 3,271.39 $ -
1
Unit Cost
Number of Months
Aggregate
$ $
3,271.39 -
B. Late Charges: $ $ C. Other Charges:
163.57 162.38 Unit Cost
$ $
13 1
Aggregate
$ $
Number of Charges
-
Aggregate
$ $ TOTAL ARREARAGE
2,126.41 162.38
$
5,560.18
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CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim Filed 08/01/14 Page 21 of 44 IL 14-1 Part 2 AL
61
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THIS IS NOT A TITLE YEAR
VEHICLE IDENTIFICATION NO
1H1XR4PT6BJ270232
MAKE
BODY STYLE CLASS ODOMETER
11 INTE TK EPO
EXCEPT
GR- VEH- WT
GR COMB.. WT
4X
70000
DON/A
FEE (FAGS)
TITLE NUMBER
4117050
INSPECTION DATE
$1837.50
OWNER'S SOUNDEX / DRIVER LICENSE NO.
BRAND
54 A N/A
DATE ISSUED
08/13/10
CO-OWNER'S SOUNDEX 4 DRIVER LICENSE NO
1-975-001-978-425 NAME(S) AND ADDRESS OF REGISTERED OWNER(S)
ODOMETER CODES
WESTERN MARYLAND TRANSPORT INC 45 LOCUST L N PO BOX 278 BARTON MD 21521-1039
A Exece B Excceeds eeds Mechanical Limas
C Not Actual Mi;eage
-
C0088441 THIS IS TO CERTIFY THAT A SECURITY INTEREST HAS BEEN DULY FILED WITH THE MOTOR VEHICLE ADMINISTRATION IN THE NAME OF THE SECURED PARTY BELOW ON THE VEHICLE DESCRIBED
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TERMINATION STATEMENT •.
I THE UNDERSIGNED DO HEREBY RELEASE ALL RIGHTS AND INTERESTS IN THE VEHICLE DESCRIBED ABOVE
SIGNATURE OF SECURED PARTY
OFFICIAL CAPACITY
DATE OF RELEASE
NAME AND ADDRESS OF SECURED PARTIES
GENERAL ELECTRIC CAPITAL CORP PO BOX 35707 BILLINS MT 59107-5707
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INISTRATOR OF MOTOR VEHICLES
OFFICIALLY ISSUED ON THE DATE SET FORTH
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CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 22 of 44
Federal and State law requires that you state the mileage in connection with the transfer of ownership Failure to complete or providing a false statement may result in fines and/or imprisonment
LL 0Z
To be used by secured party (Lion Holder) named on the face for securing a repossessed certificate of title or for the conveyance of ownership of the vehicle to a subsequent purchaser I/We the undersigned hereby certify under penalty of per)ury that the Motor Vehicle described on the face has been repossessed because of the debtor's failure to meet the obligation in the settlement of the lien indicated on the face of this form The lien contract covering the vehicle was executed in full compliance with article 95B of the annotated Code of Maryland IANe also warrant title to the vehicle described and agree to defend it against all claims
z0 0y
SIGNATURE OF SECURED PARTY
Witness My/Our Hand(s) and Seal
PRINTED NAME
Cn LLQ a
This
Yr
WM
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked
Day of
REPRESENTING FIRM OR COMPANY q 1 The mileage stated is in excess of its mechanical limits (no tonths)
q
2 The odometer reading is not the actual mileage WARNING ODOMETER DISCREPANCY
ODOMETER READING
The undersigned hereby certifies that the vehicle described in this title has been transferred to the following
Name(s) of Buyer(s) Address of Buyer(s) STATE
COUNTY
CITY OR TOWN
STREET ADDRESS W
ZIP CODE
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked
z SELLING PRICE q
_
O LL
1 The mileage stated is in excess of its mechanical limits
DATE OF SALE
0 l'Z W
(no tenths)
q 2 The odometer reading is not the actual mileage WARNING ODOMETER DISCREPANCY
ODOMETER READING
2 -- - SIGNATURE OF CO-SELLER(S)
Z 0
SIGNATURE OF SELLER(S)
y
PRINTED NAME OF SELLER(S)
PRINTED NAME OF CO-SELLER(S)
SIGNATURE OF BUYER(S)
SIGNATURE OF CO-BUYER(S)
PRINTED NAME OF BUYER(S)
PRINTED NAME OF CO-BUYER(S)
-
Name(s) of Buyor(s Address of Buyer(s)
CITY OR TOWN
STREET ADDRESS
ZIP CODE
STATE
COUNTY
Give Maryland Driver a License Number and Date of Birth if you do not have a Driver a License give Onto of Birth
Z
0 H IZ H
KIND OF LIEN (DESCRIBE)
DATE OF UEN
AMOUNT OF LIEN
IF NOT SUBJECT TO A LIEN INDICATE NONE
DATE OF BIRTH
CO-BUYER S DRIVERS LICENSE NO
DATE OF BIRTH
BUYERS DRIVER S LICENSE NO
ADDRESS OF SECURED PARTY
NAME OF SECURED PARTY W Q Z
Q W F
Now Tillc Vwo hCrc make appllconon for (Chonk o plIcab 0 Nock) q and Tegt
IF MOTORCYCLE LIST ENGINE NUMBER IF TRUCK/TRACTOR/TRAILER LIST WEIGHT
GVW
O No Tugs
if you are transfomng tags I1om a venicle tnat you sold to this vehicle give the following (II applicable)
GCW VALIDATION STICKER NUMBER
TAG NUMBER
CLASS OF VEHICLE
ADDRESS
NAME OF PERSON TO WHOM YOU SOLD THE OLD VEHICLE CERTIFICATION
Lo LL Z 0 F
Now Tltlc ^.n0 TranOcr of Tags
. NowTloo only
NAME OF INSURANCE COMPANY (COPY FROM YOUR POLICY)
OF INSU R ANCE
NAME OF AGENT
POLICY OR BINDER NUMBER
R
"I AM AAWARE O ODOMETER CERTIFICATION SIGNATURE OF BUYER(S)
IL a
JOINT TENANTS
0 TENANTS BY ENTIRETIES
NOTARY NOT REQUIRED I/wo certify under penalty of perjury that the statements made heroin are true and correct to the best of my/our knowledge informetlon and belief and hereby state that the manufacturers idontilicatlon number shown on the toco hereof agrees with the number plate on the vehicle Witness My/Our Hand(s) And Seal This
20_
Dey of
--
-
PRINTED NAME OF BUYER(S) SIGNATURE OF CO BUYER(S)
-
PRINTED NAME OF CO BUYER(S)
CO-SIGNATURE OF PARENT GUARDIAN OR RESPONSIBLE ADULT REQUIRED WHEN APPLICANT IS UNDER 1e YEARS OF AGE MUST BE SIGNED BY OWNER(S) OFFICER(S) OF CORPORATION OR PARTNER IN PARTNERSHIP
The undersigned hereby certifies that the vehicle described in this title has been transferred to the following
Name(s) of Buyer(s) Address of Buyer(s) STREET ADDRESS
STATE
COUNTY
CITY OR TOWN
SIGNATURE OF BUYER(S)
SIGNATURE OF CO BUYER(S)
W 2
PRINTED NAME OF BUYER(S)
PRINTED NAME OF CO BUYER(S)
a
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked
Z
Fn 4 W
(no temps) ODOMETER READING
q 1 The mileage stated is in excess of its mechanical limits q 2 The odometer reading is not the actual mileage DATE OF WARNING ODOMETER DISCREPANCY DELIVERY
y
ZIP CODE
CERTIFIED SELLING PRICE TRADE IN ALLOWANCE
DEALER S NO.
SIGNATURE OF AUTHORIZED AGENT
TAXABLE PRICE J Q W p
PRINTED NAME OF AUTHORIZED AGENT GROSS TAX COLLECTED PRINTED NAME OF DEALERSHIP STATE
VIN OF TRADE IN IF NOT SUBJECT TO A LIEN INDICATE NONE NAME OF SECURED PARTY
AMOUNT OF LIEN
DATE OF LIEN
COLL. FEE 1 2% OF GROSS OR S24 MAX FEE ALLOW NET TAX REMITTED
ADDRESS OF SECURED PARTY
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 23 of 44
LOAN DAMAGE CALCULATOR--BANKRUPTCY Claimant reserves its rights to seek the allowance of an unsecured deficiency claim to the extent that the value of the collateral is less than the amount of its claim.
Account Name: Loan Number: GE Case Number: By: Date Prepared: Date Updated: Default Date: Bankruptcy Petition Date: Date Equipment Sales Proceeds Received: Interest Rate:
WESTERN MARYLAND TRANSPORT, IN 8472701001 65004 Diane Lensing 7/31/2014 7/31/2014 6/1/2014 6/6/2014
18.000% CLAIM CALCULATION AS OF DATE CASE FILED
A. Principal Balance: Balance from amortization schedule row: 43 Less partial payment: Amount of Interest attributed to partial payment Remaining principal balance:
$ $ $ $
61,891.45 61,891.45
B. Collection Fees: Unit Cost
$
Number of Charges
-
Aggregate
$
-
C. Repossession Fees: Unit Cost
$
Number of Charges
-
Aggregate
$
-
D. Interest: Days from Default Date to the earlier of Date Proceeds Received or Petition Date
Daily Interest
31 5 Unpaid Interest from Partial Paid payment
Aggregate
$
E. Net Equipment Sale Proceeds:
$
F. Balance After Accounting for Equipment Sale:
$
$154.73 62,046.18
G. Interest: Days from Proceeds Received to Petition Date, if applicable
Daily Interest
0
Aggregate
0
$0.00
H. Late Charges: Unit Cost
$ $
164.03 162.56
Number of Months
16 1
Aggregate
$ $
2,624.48 162.56
I. Other Charges: Unit Cost
None
$
-
Number of Charges
Aggregate
$
-
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 24 of 44
TOTAL CLAIM (This total does not include applicable legal fees)
$
64,833.22
ARREARAGE AS OF DATE CASE FILED A. Regular Payment: Unit Cost
Number of Months
$ 3,280.59 $ -
1
Unit Cost
Number of Months
Aggregate
$ $
3,280.59 -
B. Late Charges: $ $ C. Other Charges:
164.03 162.56 Unit Cost
$ $
16 1
Aggregate
$ $
Number of Charges
-
Aggregate
$ $ TOTAL ARREARAGE
2,624.48 162.56
$
6,067.63
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 25 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 26 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 27 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 28 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 29 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 30 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 31 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 32 of 44 y^ r r` _ 'r r
`Y
fly THIS IS NOT A TITLE YEAR
VEHICLE IDENTIFICATION NO
1HTXRA:PTB8J270233 EXCEPT
4X
OR. VEIL WT
MAKE
1.1 INTL
OR. COMB.. WT
70000
OON/A
BODY STYLE CLASS
TK
ODOMETER
EPD
FEE (FAGS)
TITLE NUMBER
BRAV4D
156 A
41176170
INSPECTION DATE
$1837.50
N/A
DATE ISSUED
09/17/10
CO-OWNER'S SOUNDEX I DRIVER LICENSE NO.
OWNER'S SOUNDEX / DRIVER LICENSE NO
Z-975-001-978-425 ODOMETER CODES
NAME(S) AND ADDRESS OF REGISTERED OWNER(S)
e 8A EActual Excee xceedss re.oc tJ:echanlcal Limits C Not Actual Miicage
WESTERN MARYLAND TRANSP ORT INC 45 LOCUST LN PO BOX 278 BARTON MD 21521-1039
C0185719 THIS IS TO CERTIFY THAT A SECURITY INTEREST HAS BEEN DULY FILED WITH THE MOTOR VEHICLE ADMINISTRATION IN THE NAME OF THE SECURED PARTY BELOW ON THE VEHICLE DESCRIBED
TERMINATION STATEMENT I THE UNDERSIGNED DO HEREBY RELEASE ALL RIGHTS AND INTERESTS IN THE VEHICLE DESCRIBED ABOVE
SIGNATURE OF SECURED PARTY
OFFICIAL CAPACITY
DATE OF RELEASE
NAME AND ADDRESS OF SECURED PARTIES
GE CAPITAL COMMERCIAL INC PO BOX 35707 BILLINGS MT 59107
OFFICIALLY ISSUED ON THE DATE SET FORTH
J
Gam` '_ AH /INISTRATOR OF MOTOR VEHICLES
VR 002 (03/01
716 ^
-v r
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 33 of 44
Federal and State law requires that you state the mileage in connection with the transfer of ownership Failure to complete or providing a false statement may result in lines and/or imprisonment
U. 0 z
To be used by secured party (Lien Holder) named on the face for securing a repossessed certificate of title or for the conveyance of ownership of the vehicle to a subsequent purchaser I/We the undersigned hereby certify under penalty of penury that the Motor Vehicle described on the face has been repossessed because of the debtors failure to meet the obligation in the settlement of the lien indicated on the face of this form The lien contract covering the vehicle was executed in full compliance with article 95B of the annotated Code of Maryland I/We also warrant title to the vehicle described and agree to defend it against all claims
z2 ON H (n
This
SIGNATURE OF SECURED PARTY
Witness My/Our Hand(s) and Seal
PRINTED NAME
Yr
Day of
LL
REPRESENTING FIRM OR COMPANY
Ha W cc
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked
U
q 1 The mileage stated is in excess of its mechanical limits (no tenths)
q
2 The odometer reading is not the actual mileage WARNING ODOMETER DISCREPANCY
ODOMETER READING
The undersigned hereby certifies that the vehicle described In this title has been transferred to the following
Name(s) of Buyer(s) LL in cc W
Address of Buyer(s)
2 3
O U. O 0 Z W 2 Z
CITY OR TOWN
STREET ADDRESS
STATE
COUNTY
ZIP CODE
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements Is checked
_
. _
SELLING PRICE
q 1 The mileage stated is in excess of Its mechanical limits
_
DATE OF SALE (no tenths)
q
2 The odometer reading is not the actual mileage WARNING ODOMETER DISCREPANCY
ODOMETER READING
SIGNATURE OF SELLER(S)
SIGNATURE OF CO SELLER(S)
PRINTED NAME OF SELLER(S)
PRINTED NAME OF CO-SELLER(S)
SIGNATURE OF BUYER(S)
SIGNATURE OF CO BUYER(S)
PRINTED NAME OF BUYER(S)
PRINTED NAME OF CO BUYER(S)
Name(s) of Buyer(s Address of Buyer(s) CITY OR TOWN
STREET ADDRESS
STATE
COUNTY
ZIP CODE
Give Maryland Driver s License Number and Date of Birth It you do not have a Driver a License give Date of Birth
z 0 H
AMOUNT OF LIEN
IF NOT SUBJECT TO A LIEN INDICATE NONE
DATE OF BIRTH
CO-BUYERS DRIVERS LICENSE NO
DATE OF BIRTH
BUYER S DRIVERS LICENSE NO
KIND OF LIEN (DESCRIBE)
DATE OF LIEN
H ADDRESS OF SECURED PARTY
NAME OF SECURED PARTY W I=
Now Title and L_j Tmn.tor of Tngb
Now Tillo Only
IF MOTORCYCLE UST ENGINE NUMBER IF TRUCKrrRACTOR7rRAILER LIST WEIGHT
Q
New Title Vwu hereby aka application for (Chock app' caolo block) Q and Tag.
Z Q
II you am transferring tags from a vehicle that you cold to this vehicle give the following (I applicable)
W J
NAME OF PERSON TO WHOM YOU SOLD THE OLD VEHICLE CERTIFICATION
GVW
Q No Tags
TAG NUMBER
= F VEHICLE
GCW VALIDATION STICKER NUMBER
ADDRESS
NAME OF INSURANCE COMPANY (COPY FROM YOUR POLICY)
OF L Z O
INSU R ANCE
NAME OF AGENT
POLICY OR BINDER NUMBER
I AM AWARE O ODOMETER CERTIFICATION MADE BY SELLER-'
F V J
a
0 JOINT TENANTS
q TENANTS BY ENTIRETIES
NOTARY NOT REQUIRED I/we certify under penalty of penury that the statements made herein are true and correct to the best of my/our knowledge
SIGNATURE OF BUYER(S) PRINTED NAME OF BUYER(S) SIGNATURE OF CO BUYER(S)
information and belief and hereby state that the manufacturer's
itlentlflwtion number shown on the lace hereof agrees with the number plate on the vehicle Witness My/Our Hand(s) And Soul
PRINTED NAME OF CO-BUYERS) -CO-SIGNATURE OF PARENT GUARDIAN OR RESPONSIBLE ADULT REQUIRED WHEN APPUCANT IS UNDER IS YEARS OF AGE
This
Day of
20 _ MUST BE SIGNED BY OWNER(S) OFFICER(S) OF CORPORATION OR PARTNER IN PARTNERSHIP
The undersigned hereby certifies that the vehicle described in this title has been transferred to the following
Name(s) of Buyer(s) Address of Buyer(s) STREET ADDRESS
STATE
COUNTY
CITY OR TOWN
Z W 2
SIGNATURE OF BUYER(S)
SIGNATURE OF CO BUYER(S)
PRINTED NAME OF BUYER(S)
PRINTED NAME OF CO-BUYER(S)
CD
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked
N ( tenths) (no W Q y UJ J Q W p
ODOMETER READING SIGNATURE OF AUTHORIZED AGENT
q 1 The mileage stated is in excess of its mechanical limits q 2 The odometer reading is not the actual mileage DATE OF WARNING ODOMETER DISCREPANCY DELIVERY _ DEALER S NO
ZIP CODE
CERTIFIED SELLING PRICE TRADE IN ALLOWANCE TAXABLE PRICE
PRINTED NAME OF AUTHORIZED AGENT GROSS TAX COLLECTED PRINTED NAME OF DEALERSHIP STATE
VIN OF TRADE IN IF NOT SUBJECT TO A LIEN INDICATE NONE NAME OF SECURED PARTY
AMOUNT OF LIEN
DATE OF LIEN
COLL FEE 1 2T OF GROSS OR Std MAX FEE ALLOW NET TAX REMITTED
ADDRESS OF SECURED PARTY
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 34 of 44
LOAN DAMAGE CALCULATOR--BANKRUPTCY Claimant reserves its rights to seek the allowance of an unsecured deficiency claim to the extent that the value of the collateral is less than the amount of its claim.
Account Name: Loan Number: GE Case Number: By: Date Prepared: Date Updated: Default Date: Bankruptcy Petition Date: Date Equipment Sales Proceeds Received: Interest Rate:
WESTERN MARYLAND TRANSPORT, IN 8469984001 65004 Diane Lensing 7/31/2014 7/31/2014 5/3/2014 6/6/2014
18.000% CLAIM CALCULATION AS OF DATE CASE FILED
A. Principal Balance: Balance from amortization schedule row: 44 Less partial payment: Amount of Interest attributed to partial payment Remaining principal balance:
$ $ $ $
61,717.87 327.39 347.16 61,717.87
B. Collection Fees: Unit Cost
$
Number of Charges
-
Aggregate
$
-
C. Repossession Fees: Unit Cost
$
Number of Charges
-
Aggregate
$
-
D. Interest: Days from Default Date to the earlier of Date Proceeds Received or Petition Date
Daily Interest
31 34 Unpaid Interest from Partial Paid payment
Aggregate
$
E. Net Equipment Sale Proceeds:
$
F. Balance After Accounting for Equipment Sale:
$
$1,049.20 19.77 62,786.84
G. Interest: Days from Proceeds Received to Petition Date, if applicable
Daily Interest
0
Aggregate
0
$0.00
H. Late Charges: Unit Cost
$ $
163.57 162.35
Number of Months
15 1
Aggregate
$ $
2,453.55 162.35
I. Other Charges: Unit Cost
None
$
-
Number of Charges
Aggregate
$
-
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 35 of 44
TOTAL CLAIM (This total does not include applicable legal fees)
$
65,402.74
ARREARAGE AS OF DATE CASE FILED A. Regular Payment: Unit Cost
Number of Months
$ 2,944.00 $ 3,271.39
1 1
Unit Cost
Number of Months
Aggregate
$ $
2,944.00 3,271.39
B. Late Charges: $ $ C. Other Charges:
163.57 162.35 Unit Cost
$ $
15 1
Aggregate
$ $
Number of Charges
-
Aggregate
$ $ TOTAL ARREARAGE
2,453.55 162.35
$
8,831.29
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 36 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 37 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 38 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 39 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 40 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 41 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 42 of 44
-
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 43 of 44a r^xr yMPAW
1 '
1 '!
1
ter'
'c
THIS IS NOT A TITLE YEAR
VEHICLE IDENTIFICATION NO
1HTXRAPT3BJ270236 EXCEPT
4X
GR. VEH- WT
MAKE
GR COMB WT
70000
BODY STYLE CLASS ODOMETER
11 INTL TK EPD FEE (TAGS)
OON/A
TITLE NUMBER
41175594
INSPECTION DATE
N/A
$1837.50
OWNER'S SOUNDEX 1 DRIVER LICENSE NO
BRAND
64 A
DATE ISSUE}
_
09/07/10
CO-OWNER'S SOUNDEX I DRIVER LICENSE NO
Z-975-001-978-425 ODOMETER CODES
NAME(S) AND ADDRESS OF REGISTERED OWNER(S)
WESTERN MARYLAND TRANSPORT INC 45 LOCUST L N
A Actual Mileage B Exceeds Mechanical Limits C Not Actual Mileage
PO BOX 278
BARTON
MD 21521-1039
- • a
C")143452 THIS IS TO CERTIFY THAT A SECURITY INTEREST HAS BEEN DULY FILED WITH THE MOTOR VEHICLE ADMINISTRATION IN THE NAME OF THE SECURED PARTY BELOW ON THE VEHICLE DESCRIBED
_
TERMINATION STATEMENT I THE UNDERSIGNED DO HEREBY RELEASE ALL RIGHTS AND INTERESTS IN THE VEHICLE DESCRIBED ABOVE
SIGNATURE OF SECURED PARTY
OFFICIAL CAPACITY
-
-.J
DATE OF RELEASE
NAME AND ADDRESS OF SECURED PARTIES
GE CAPITAL COMMERICAL INS PO BOX 35704 MT 59107-5704 BILLINGS
6E
OFFICIALLY ISSUED ON THE DATE SET FORTH
INISTRATOR OF MOTOR VEHICLES I
61 VR 002 (03/09)
l
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 44 of 44
Federal and State law requires that you state the mileage in connection with the transfer of ownership Failure to complete or providing a false statement may result in fines and/or imprisonment
LL 0, z0 0W H LIJ VN u.0 CL WQ
To be used by secured party (Lien Holder) named on the face for securing a repossessed certificate of title or for the conveyance of ownership of the vehicle to a subsequent purchaser I/We the undersigned hereby certify under penalty of perjury that the Motor Vehicle described on the face has been repossessed because of the debtor's failure to meet the obligation in the settlement of the lien indicated on the face of this form The lien contract covering the vehicle was executed in full compliance with article 95B of the annotated Code of Maryland I/We also warrant title to the vehicle described and agree to defend it against all claims SIGNATURE OF SECURED PARTY
Witness My/Our Hand(s) and Seal This
PRINTED NAME
Yr
Day of
REPRESENTING FIRM OR COMPANY I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked q 1 The mileage stated is in excess of its mechanical limits (no tenths) ODOMETER READING
q 2 The odometer reading is not the actual mileage WARNING ODOMETER DISCREPANCY
The undersigned hereby certifies that the vehicle described in this title has been transferred to the following
Name(s) of Buyer(s) a
Address of Buyer(s)
W Z O
CITY OR TOWN
STREET ADDRESS
cn
STATE
COUNTY
ZIP CODE
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked SELLING PRICE q 1 The mileage stated Is in excess of its mechanical limits
_ LL
DATE OF SALE
0 F. Z W
(no tenths)
q 2 The odometer reading is not the actual mileage WARNING ODOMETER DISCREPANCY
ODOMETER READING
Z
SIGNATURE OF SELLER(S)
SIGNATURE OF CO SELLER(S)
V) Q
PRINTED NAME OF SELLER(S)
PRINTED NAME OF CO SELLER(S)
SIGNATURE OF BUYER(S)
SIGNATURE OF CO BUYER(S)
PRINTED NAME OF BUYER(S)
PRINTED NAME OF CO-BUYER(S)
Name(s) of Buyer(sl Address of Buyer(s) CITY OR TOWN
STREET ADDRESS
ZIP CODE
STATE
COUNTY
Give Maryland Driver a License Number and Date of Birth If you do not have a Driver a License give Date of Birth Z 0 I-
DATE OF BIRTH
BUYERS DRIVER S LICENSE NO
KIND OF LIEN (DESCRIBE)
DATE OF LIEN
AMOUNT OF LIEN
IF NOT SUBJECT TO A LIEN INDICATE NONE
DATE OF BIRTH
CO-BUYER S DRIVERS LICENSE NO
IADDRESS OF SECURED PARTY
NAME OF SECURED PARTY W M
Now Title and
NEW Ttlo On No Tugs Y
IF MOTORCYCLE. UST ENGINE NUMBER IF TRUCK/rRACTOR/TRAILER LIST WEIGHT
a
Now 7110 Vwc horco nuke app-'cation for Q and Tugs (Check applicable block)
Z Q
II you are :ransteMng tags from a vehicle that you sold to th:s vehicle give the following (II applicable)
W J
NAME OF PERSON TO WHOM YOU SOLD THE OLD VEHICLE
jr
CERTIFICATION
0 LL Z
OF
a
GVW TAG NUMBER
CLASS OF VEHICLE
GCW VALIDATION STICKER NUMBER
ADDRESS
NAME OF INSURANCE COMPANY (COPY FROM YOUR POLICY) NAME OF AGENT
POLICY OR BINDER NUMBER
IN SU RAN CE
F Q
IL a
L_J Trar sfor .!Tags
AMA AR O ODOMETER CERTIFICATION MADE B SELL
IS THIS VEHICLE TO BE TITLED AS JOINT
TENANTS OR TENANTS BY ENTIRETIES? JOINT TENANTS
SIGNATURE OF BUYER(S)
-
E TENANTS BY ENTIRETIES
-
-
-
-
PRINTED NAME OF BUYER(S)
NOTARY NOT REQUIRED I/we coolly under penalty of perjury that the statements made herein are two and correct to the best of my/our knowledge Information and belief and hereby state that the manulacturars IdentIficatlon number shown on the face hereof agrees with the number plate on the vehicle Witness My/Our Hands) And Seal
SIGNATURE OF CO-BUYER(S) PRINTED NAME OF CO-BUYER(S)
CO-SIGNATURE OF PARENT GUARDIAN OR RESPONSIBLE ADULT REQUIRED WHEN APPLICANT IS UNDER 18 YEARS OF AGE Day of
This
20
MUST eE SIGNED BY OWNER(S) OFFICER(S) OF CORPORATION OR PARTNER IN PARTNERSHIP
The undersigned hereby certifies that the vehicle described in this title has been transferred to the following
Name(s) of Buyer(s) Address of Buyer(s)
Z
W 2 Z a
SIGNATURE OF CO-BUYER(S)
PRINTED NAME OF BUYER(S)
PRINTED NAME OF CO-BUYER(S)
-
W
(no tenths) ODOMETER READING
q 1 The mileage stated is in excess of Its mechanical limits q 2 The odometer reading is not the actual mileage DATE OF WARNING ODOMETER DISCREPANCY DELIVERY
SIGNATURE OF AUTHORIZED AGENT W _J
-
- -
--
-
CERTIFIED SELLING PRICE TRADE IN ALLOWANCE
DEALERS NO TAXABLE PRICE
PRINTED NAME OF AUTHORIZED AGENT
%W p
ZIP CODE
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked
Vl
cc N
STATE
COUNTY
CITY OR TOWN
STREET ADDRESS
SIGNATURE OF BUYER(S)
GROSS TAX COLLECTED PRINTED NAME OF DEALERSHIP STATE
VIN OF TRADE IN IF NOT SUBJECT TO A LIEN INDICATE NONE NAME OF SECURED PARTY
AMOUNT OF LIEN
DATE OF LIEN
COLL FEE 121 . OF GROSS OR $24 MAX FEE ALLOW NET TAX REMITTED
ADDRESS OF SECURED PARTY
B10 (Official Form 10) (04/13)
UNITED STATES BANKRUPTCY COURT District of Maryland Name of Debtor: Western Maryland Transport, Inc.
PROOF OF CLAIM
Case Number: 14−19275
FILED U.S. Bankruptcy Court District of Maryland
NOTE: Do not use this form to make a claim for an administrative expense that arises after the bankruptcy filing. You may file a request for payment of an administrative expense according to 11 U.S.C. § 503.
8/1/2014
Name of Creditor (the person or other entity to whom the debtor owes money or property):
GE Capital Commercial, Inc.
Mark A. Neal, Clerk COURT USE ONLY
Name and address where notices should be sent: GE Capital Commercial, Inc. 1010 Thomas Edison Blvd SW Cedar Rapids, IA 52404 Telephone number: 319−841−7129
Check this box if this claim amends a previously filed claim. Court Claim Number: (If known) Filed on:
email: [email protected]
Name and address where payment should be sent (if different from above): Check this box if you are aware that anyone else has filed a proof of claim relating to this claim. Attach copy of statement giving particulars.
GE Capital PO Box 644479 Pittsburgh, PA 15264−4479 Telephone number: email:
253749.19 1. Amount of Claim as of Date Case Filed: $ If all or part of the claim is secured, complete item 4. If all or part of the claim is entitled to priority, complete item 5. Check this box if the claim includes interest or other charges in addition to the principal amount of the claim. Attach a statement that itemizes interest or charges.
2. Basis for Claim:
Money Loaned
3. Last four digits of any number by which creditor identifies debtor:
(See instruction #2) 3a. Debtor may have scheduled account as:
3b. Uniform Claim Identifier (optional):
(See instruction #3a)
(See instruction #3b)
5004
4. Secured Claim (See instruction #4) Check the appropriate box if the claim is secured by a lien on property or a right of setoff, attach required redacted documents, and provide the requested information. Nature of property or right of setoff: Real Estate Motor Vehicle Describe: Title/Lien Cards on Trucks Value of Property: $ Annual Interest Rate (when case was filed) 18 % Fixed or Variable
Amount of arrearage and other charges, as of the time case was filed, included in secured claim, if any: $ 26353.94 Other Basis for perfection:
Title/Lien Card
Amount of Secured Claim: $ Amount Unsecured:
253749.19
$
0.00
5. Amount of Claim Entitled to Priority under 11 U.S.C. §507(a). If any part of the claim falls into one of the following categories, check the box specifying the priority and state the amount. Amount entitled to Domestic support obligations under 11 Wages, salaries, or commissions (up to $12,475*) Contributions to an priority: U.S.C. §507(a)(1)(A) or (a)(1)(B). earned within 180 days before the case was filed employee benefit plan − or the debtor's business ceased, whichever is earlier − 11 11 U.S.C. §507(a)(5). U.S.C. §507(a)(4). Up to $2,775* of deposits toward purchase, lease, or rental of property or services for personal, family, or household use − 11 U.S.C. §507(a)(7).
Taxes or penalties owed to governmental units − 11 U.S.C. §507(a)(8).
Other − Specify applicable paragraph of 11 U.S.C. §507(a)( ).
*Amounts are subject to adjustment on 4/1/16 and every 3 years thereafter with respect to cases commenced on or after the date of adjustment. 6. Credits. The amount of all payments on this claim has been credited for the purpose of making this proof of claim. (See instruction #6)
$
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Filed 08/01/14 Page 2 of 2
7. Documents: Attached are redacted copies of any documents that support the claim, such as promissory notes, purchase orders, invoices, itemized statements of running accounts, contracts, judgments, mortgages, security agreements, or, in the case of a claim based on an open−end or revolving consumer credit agreement, a statement providing the information required by FRBP 3001(c)(3)(A). If the claim is secured, box 4 has been completed, and redacted copies of documents providing evidence of perfection of a security interest are attached. If the claim is secured by the debtor's principal residence, the Mortgage Proof of Claim Attachment is being filed with this claim. (See instruction #7, and the definition of "redacted".) DO NOT SEND ORIGINAL DOCUMENTS. ATTACHED DOCUMENTS MAY BE DESTROYED AFTER SCANNING. If the documents are not available, please explain: 8. Signature: (See instruction #8) Check the appropriate box. I am the creditor.
I am the creditor's authorized agent. (Attach copy of power of attorney, if any.)
I am the trustee, or the debtor, or their authorized agent. (See Bankruptcy Rule 3004.)
I am a guarantor, surety, indorser, or other codebtor. (See Bankruptcy Rule 3005.)
I declare under penalty of perjury that the information provided in this claim is true and correct to the best of my knowledge, information, and reasonable belief. Print Name: Kevin M. Evers Title: Litigation Specialist Company: GE Capital Commercial, Inc. Address and telephone number (if different from notice address above): s/ Kevin M. Evers
(Signature) Telephone number:
8/1/2014
(Date)
email: Penalty for presenting fraudulent claim: Fine of up to $500,000 or imprisonment for up to 5 years, or both. 18 U.S.C. §§ 152 and 3571.
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 1 of 44
LOAN DAMAGE CALCULATOR--BANKRUPTCY Claimant reserves its rights to seek the allowance of an unsecured deficiency claim to the extent that the value of the collateral is less than the amount of its claim.
Account Name: Loan Number: GE Case Number: By: Date Prepared: Date Updated: Default Date: Bankruptcy Petition Date: Date Equipment Sales Proceeds Received: Interest Rate:
WESTERN MARYLAND TRANSPORT, IN 8467018001 65004 Diane Lensing 7/31/2014 7/31/2014 6/1/2014 6/6/2014
18.000% CLAIM CALCULATION AS OF DATE CASE FILED
A. Principal Balance: Balance from amortization schedule row: 44 Less partial payment: Amount of Interest attributed to partial payment Remaining principal balance:
$ $ $ $
58,870.75 58,870.75
B. Collection Fees: Unit Cost
$
Number of Charges
-
Aggregate
$
-
C. Repossession Fees: Unit Cost
$
Number of Charges
-
Aggregate
$
-
D. Interest: Days from Default Date to the earlier of Date Proceeds Received or Petition Date
Daily Interest
29 5 Unpaid Interest from Partial Paid payment
Aggregate
$
E. Net Equipment Sale Proceeds:
$
F. Balance After Accounting for Equipment Sale:
$
$147.18 59,017.93
G. Interest: Days from Proceeds Received to Petition Date, if applicable
Daily Interest
0
Aggregate
0
$0.00
H. Late Charges: Unit Cost
$ $
163.78 162.46
Number of Months
15 1
Aggregate
$ $
2,456.70 162.46
I. Other Charges: Unit Cost
None
$
-
Number of Charges
Aggregate
$
-
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 2 of 44
TOTAL CLAIM (This total does not include applicable legal fees)
$
61,637.09
ARREARAGE AS OF DATE CASE FILED A. Regular Payment: Unit Cost
Number of Months
$ 3,275.68 $ -
1
Unit Cost
Number of Months
Aggregate
$ $
3,275.68 -
B. Late Charges: $ $ C. Other Charges:
163.78 162.46 Unit Cost
$ $
Aggregate
15 1
$ $
Number of Charges
-
Aggregate
$ $ TOTAL ARREARAGE
2,456.70 162.46
$
5,894.84
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 3 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 4 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 5 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 6 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 7 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 8 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 9 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 10 of 44 I
I
'LF'
I
:^
I
I
5
THIS IS NOT A TITLE YEAR
VEHICLE IDENTIFICATION NO
1HTXRAPT18J27O235
{
EXCEPT
4X
GR. VEH. WT
70000
11
MAKE
INTL
GR COMB WT
OON/A
BODY STYLE CLASS ODOMETER
TK
EPD
BRAND
TITLE NUMBER
182 A
41175380
INSPECTION DATE
FEE (FAGS)
N/A
$1837.50
DATE ISSUED
08130/10
CO.OWNER S SOUNDEX I DRIVER LICENSE NO
OWNER'S SOUNDEX J DRIVER LICENSE NO.
Z-975-001-978-425
_ ODOMETER CODES
NAME(S) AND ADDRESS OF REGISTERED OWNER(S)
A Actual Mileage B Excoo xcoeds Mechanical Limits C Not Actual Mileage
WESTERN MARYLAND TRANSP ORT INC 45 LOCUST LN PO BOX 278 BARTON MD 21521-1039
00131827 THIS IS TO CERTIFY THAT A SECURITY INTEREST HAS BEEN DULY FILED WITH THE MOTOR VEHICLE ADMINISTRATION IN THE NAME OF THE SECURED PARTY BELOW ON THE VEHICLE DESCRIBED
TERMINATION STATEMENT I THE UNDERSIGNED 00 HEREBY RELEASE ALL RIGHTS AND INTERESTS IN THE VEHICLE DESCRIBED ABOVE -C
SIGNATURE OF SECURED PARTY
OFFICIAL CAPACITY
DATE OF RELEASE
NAME AND ADDRESS OF SECURED PARTIES
GE CAPITAL COMMERCIAL INC PO BOX 35707 BILLINGS MT 59107
OFFICIALLY ISSUED ON THE DATE SET FORTH
--^ l
INISTRATOR OF MOTOR VEHICLES
6
J VR-002 (03/09)
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CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 11 of 44
Federal and State law requires that you state the mileage in connection with the transfer of ownership Failure to complete or providing a false statement may result in fines and/or imprisonment
LL 0,
To be used by secured party (Lien Holder) named on the face for securing a repossessed certificate of title or for the conveyance of ownership of the vehicle to a subsequent purchaser I/We the undersigned hereby certify under penalty of perjury that the Motor Vehicle described on the face has been repossessed because of the debtor's failure to meet the obligation in the settlement of the lien indicated on the face of this form The lien contract covering the vehicle was executed in full compliance with article 95B of the annotated Code of Maryland I/We also warrant title to the vehicle described and agree to defend it against all claims
Z0 Oy IJU V U)
SIGNATURE OF SECURED PARTY
Witness My/Our Hand(s) and Seal This
PRINTED NAME
Yr
Day of
LL
REPRESENTING FIRM OR COMPANY
a W¢
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked
U
q 1 The mileage stated is in excess of its mechanical limits (no tenths) ODOMETER READING
q 2 The odometer reading is not the actual mileage WARNING ODOMETER DISCREPANCY
The undersigned hereby certifies that the vehicle described in this title has been transferred to the following
Name(s) of Buyer(s) Address of Buyer(s) CITY OR TOWN
STREET ADDRESS IM W z
STATE
COUNTY
ZIP CODE
I certify to the best of my knowledge that the odometer reading Is the actual mileage of the vehicle unless one of the following statements is checked
O
SELLING PRICE
q 1 The mileage stated Is in excess of Its mechanical limits
_
U. O
DATE OF SALE
F Z W 2
(no tenths)
2 The odometer reading is not the actual mileage
q
WARNING ODOMETER DISCREPANCY
ODOMETER READING
SIGNATURE OF CO-SELLER(S
Z
SIGNATURE OF SELLER(S)
y Q
PRINTED NAME OF SELLER(S)
PRINTED NAME OF CO-SELLERS
SIGNATURE OF BUYER(S)
SIGNATURE OF CO-BUYER(S)
PRINTED NAME OF BUYER(S)
PRINTED NAME OF CO-BUYER(S)
-
-
--
--
Name(s) of Buyer(s Address of Buyer(s CITY OR TOWN
STREET ADDRESS
ZIP CODE
STATE
COUNTY
Give Maryland Driver a License Number and Date of Birth If you do not have a Driver IS License give Date of Birth
Z O
DATE OF BIRTH
CO-BUYER S DRIVERS LICENSE NO
DATE OF BIRTH
BUYERS DRIVER S LICENSE NO
IAMOUNT OF LIEN
IF NOT SUBJECT TO A LIEN INDICATE NONE
KIND OF LIEN (DESCRIBE)
DATE OF LIEN
H ADDRESS OF SECURED PARTY
NAME OF SECURED PARTY W M
Vm horeby nuke appviuTL•on for
Now T."
Now TNO Wit
Q
(Chock opplWb10 block)
and Togo
Tronsfor of Tags
Z 4
If you are Imnsioning tags from a vehicle that you sold to this vehicle give the following (II applicable)
W F
NAME OF PERSON TO WHOM YOU SOLD THE OLD VEHICLE CERTIFICATION
0
OF
Z
INSURANCE
. Now TIL'o Only
IF 110TORCYCLE UST ENGINE NUMBER IF TRUCK/TRACTOFUTRAILER LIST WEIGHT GVW
L_J No Tag.
GCW VALIDATION STICKER NUMBER
TAG NUMBER
CLASS OF VEHICLE
ADDRESS
NAME OF INSURANCE COMPANY (COPY FROM YOUR POLICY) NAME OF AGENT
POLICY OR BINDER NUMBER 1
TITLE D AS JOINT
TO
. AWAR E
O D O METER C ERTIF IC A TION MAD
L
TENANTS • V M
IL CL
SIGNATURE OF BUYER(S) [] TENANTS BY ENTIRETIES
0 JOINT TENANTS
PRINTED NAME OF BUYER(S)
NOTARY NOT REQUIRED I/we certify under penalty of porlury that the statements made heroin arc two and correct to the best of my/our knowledge
SIGNATURE OF CO BUYER(S)
information and betel and hereby state that the manufacturer's
identification number shown on the taco hereof agrees with the number plate on the vehicle Witness My/Our Hand(s) And Seal
PRINTED NAME OF CO BUYER(S) •. COSIGNATURE OF PARENT GUARDIAN OR RESPONSIBLE ADULT REQUIRED WHEN APPLICANT IS UNDER IS YEARS OF AGE
This
Day of
20_
MUST BE SIGNED BY OWNER(S) OFFICERS) OF CORPORATION OR PARTNER IN PARTNERSHIP
The undersigned hereby certifies that the vehicle descnbed in this title has been transferred to the following
Name(s) of Buyer(s) Address of Buyer(s) STREET ADDRESS
Z
SIGNATURE OF BUYER(S)
-
-
STATE
COUNTY
CITY OR TOWN -
W 2
PRINTED NAME OF BUYER(S)
0
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked
tJ) W
Q J Q W 0
ODOMETER READING
(
no tenths) )
ZIP CODE
SIGNATURE OF CO BUYER(S) PRINTED NAME OF CO-BUYER(5
q 1 The mileage stated is in excess of its mechanical limits 2 The odometer reading is not the actual mileage DATE OF WARNING ODOMETER DISCREPANCY DELIVERY
CERTIFIED SELLING PRICE TRADE IN ALLOWANCE
DEALER S NO
SIGNATURE OF AUTHORIZED AGENT
TAXABLE PRICE PRINTED NAME OF AUTHORIZED AGENT GROSS TAX COLLECTED PRINTED NAME OF DEALERSHIP STATE
VIN OF TRADE IN IF NOT SUBJECT TO A LIEN INDICATE NONE
AMOUNT OF LIEN
NAME OF SECURED PARTY
ANY ALTERATION OR ERASURE VOIDS THIS DOCUMENT.
DATE OF LIEN
COLL FEE 127. OF GROSS OR $24 MAX FEE ALLOW NET TAX REMITTED
ADDRESS OF SECURED PARTY
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 12 of 44
LOAN DAMAGE CALCULATOR--BANKRUPTCY Claimant reserves its rights to seek the allowance of an unsecured deficiency claim to the extent that the value of the collateral is less than the amount of its claim.
Account Name: Loan Number: GE Case Number: By: Date Prepared: Date Updated: Default Date: Bankruptcy Petition Date: Date Equipment Sales Proceeds Received: Interest Rate:
WESTERN MARYLAND TRANSPORT, IN 8467018002 65004 Diane Lensing 7/31/2014 7/31/2014 5/10/2014 6/6/2014
18.000% CLAIM CALCULATION AS OF DATE CASE FILED
A. Principal Balance: Balance from amortization schedule row: 44 Less partial payment: Amount of Interest attributed to partial payment Remaining principal balance:
$ $ $ $
58,793.64 58,793.64
B. Collection Fees: Unit Cost
$
Number of Charges
-
Aggregate
$
-
C. Repossession Fees: Unit Cost
$
Number of Charges
-
Aggregate
$
-
D. Interest: Days from Default Date to the earlier of Date Proceeds Received or Petition Date
Daily Interest
29 27 Unpaid Interest from Partial Paid payment
Aggregate
$
E. Net Equipment Sale Proceeds:
$
F. Balance After Accounting for Equipment Sale:
$
$793.71 59,587.35
G. Interest: Days from Proceeds Received to Petition Date, if applicable
Daily Interest
0
Aggregate
0
$0.00
H. Late Charges: Unit Cost
$ $
163.57 162.38
Number of Months
13 1
Aggregate
$ $
2,126.41 162.38
I. Other Charges: Unit Cost
None
$
-
Number of Charges
Aggregate
$
-
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 13 of 44
TOTAL CLAIM (This total does not include applicable legal fees)
$
61,876.14
ARREARAGE AS OF DATE CASE FILED A. Regular Payment: Unit Cost
Number of Months
$ 3,271.39 $ -
1
Unit Cost
Number of Months
Aggregate
$ $
3,271.39 -
B. Late Charges: $ $ C. Other Charges:
163.57 162.38 Unit Cost
$ $
13 1
Aggregate
$ $
Number of Charges
-
Aggregate
$ $ TOTAL ARREARAGE
2,126.41 162.38
$
5,560.18
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 14 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 15 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 16 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 17 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 18 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 19 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 20 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim Filed 08/01/14 Page 21 of 44 IL 14-1 Part 2 AL
61
wa 1, 11101
4 A"
^-
_J -
4
THIS IS NOT A TITLE YEAR
VEHICLE IDENTIFICATION NO
1H1XR4PT6BJ270232
MAKE
BODY STYLE CLASS ODOMETER
11 INTE TK EPO
EXCEPT
GR- VEH- WT
GR COMB.. WT
4X
70000
DON/A
FEE (FAGS)
TITLE NUMBER
4117050
INSPECTION DATE
$1837.50
OWNER'S SOUNDEX / DRIVER LICENSE NO.
BRAND
54 A N/A
DATE ISSUED
08/13/10
CO-OWNER'S SOUNDEX 4 DRIVER LICENSE NO
1-975-001-978-425 NAME(S) AND ADDRESS OF REGISTERED OWNER(S)
ODOMETER CODES
WESTERN MARYLAND TRANSPORT INC 45 LOCUST L N PO BOX 278 BARTON MD 21521-1039
A Exece B Excceeds eeds Mechanical Limas
C Not Actual Mi;eage
-
C0088441 THIS IS TO CERTIFY THAT A SECURITY INTEREST HAS BEEN DULY FILED WITH THE MOTOR VEHICLE ADMINISTRATION IN THE NAME OF THE SECURED PARTY BELOW ON THE VEHICLE DESCRIBED
t•
TERMINATION STATEMENT •.
I THE UNDERSIGNED DO HEREBY RELEASE ALL RIGHTS AND INTERESTS IN THE VEHICLE DESCRIBED ABOVE
SIGNATURE OF SECURED PARTY
OFFICIAL CAPACITY
DATE OF RELEASE
NAME AND ADDRESS OF SECURED PARTIES
GENERAL ELECTRIC CAPITAL CORP PO BOX 35707 BILLINS MT 59107-5707
i
-
j
3 --i
-
vt +
\^
INISTRATOR OF MOTOR VEHICLES
OFFICIALLY ISSUED ON THE DATE SET FORTH
_
VR 002 (03/09)
`J.
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CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 22 of 44
Federal and State law requires that you state the mileage in connection with the transfer of ownership Failure to complete or providing a false statement may result in fines and/or imprisonment
LL 0Z
To be used by secured party (Lion Holder) named on the face for securing a repossessed certificate of title or for the conveyance of ownership of the vehicle to a subsequent purchaser I/We the undersigned hereby certify under penalty of per)ury that the Motor Vehicle described on the face has been repossessed because of the debtor's failure to meet the obligation in the settlement of the lien indicated on the face of this form The lien contract covering the vehicle was executed in full compliance with article 95B of the annotated Code of Maryland IANe also warrant title to the vehicle described and agree to defend it against all claims
z0 0y
SIGNATURE OF SECURED PARTY
Witness My/Our Hand(s) and Seal
PRINTED NAME
Cn LLQ a
This
Yr
WM
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked
Day of
REPRESENTING FIRM OR COMPANY q 1 The mileage stated is in excess of its mechanical limits (no tonths)
q
2 The odometer reading is not the actual mileage WARNING ODOMETER DISCREPANCY
ODOMETER READING
The undersigned hereby certifies that the vehicle described in this title has been transferred to the following
Name(s) of Buyer(s) Address of Buyer(s) STATE
COUNTY
CITY OR TOWN
STREET ADDRESS W
ZIP CODE
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked
z SELLING PRICE q
_
O LL
1 The mileage stated is in excess of its mechanical limits
DATE OF SALE
0 l'Z W
(no tenths)
q 2 The odometer reading is not the actual mileage WARNING ODOMETER DISCREPANCY
ODOMETER READING
2 -- - SIGNATURE OF CO-SELLER(S)
Z 0
SIGNATURE OF SELLER(S)
y
PRINTED NAME OF SELLER(S)
PRINTED NAME OF CO-SELLER(S)
SIGNATURE OF BUYER(S)
SIGNATURE OF CO-BUYER(S)
PRINTED NAME OF BUYER(S)
PRINTED NAME OF CO-BUYER(S)
-
Name(s) of Buyor(s Address of Buyer(s)
CITY OR TOWN
STREET ADDRESS
ZIP CODE
STATE
COUNTY
Give Maryland Driver a License Number and Date of Birth if you do not have a Driver a License give Onto of Birth
Z
0 H IZ H
KIND OF LIEN (DESCRIBE)
DATE OF UEN
AMOUNT OF LIEN
IF NOT SUBJECT TO A LIEN INDICATE NONE
DATE OF BIRTH
CO-BUYER S DRIVERS LICENSE NO
DATE OF BIRTH
BUYERS DRIVER S LICENSE NO
ADDRESS OF SECURED PARTY
NAME OF SECURED PARTY W Q Z
Q W F
Now Tillc Vwo hCrc make appllconon for (Chonk o plIcab 0 Nock) q and Tegt
IF MOTORCYCLE LIST ENGINE NUMBER IF TRUCK/TRACTOR/TRAILER LIST WEIGHT
GVW
O No Tugs
if you are transfomng tags I1om a venicle tnat you sold to this vehicle give the following (II applicable)
GCW VALIDATION STICKER NUMBER
TAG NUMBER
CLASS OF VEHICLE
ADDRESS
NAME OF PERSON TO WHOM YOU SOLD THE OLD VEHICLE CERTIFICATION
Lo LL Z 0 F
Now Tltlc ^.n0 TranOcr of Tags
. NowTloo only
NAME OF INSURANCE COMPANY (COPY FROM YOUR POLICY)
OF INSU R ANCE
NAME OF AGENT
POLICY OR BINDER NUMBER
R
"I AM AAWARE O ODOMETER CERTIFICATION SIGNATURE OF BUYER(S)
IL a
JOINT TENANTS
0 TENANTS BY ENTIRETIES
NOTARY NOT REQUIRED I/wo certify under penalty of perjury that the statements made heroin are true and correct to the best of my/our knowledge informetlon and belief and hereby state that the manufacturers idontilicatlon number shown on the toco hereof agrees with the number plate on the vehicle Witness My/Our Hand(s) And Seal This
20_
Dey of
--
-
PRINTED NAME OF BUYER(S) SIGNATURE OF CO BUYER(S)
-
PRINTED NAME OF CO BUYER(S)
CO-SIGNATURE OF PARENT GUARDIAN OR RESPONSIBLE ADULT REQUIRED WHEN APPLICANT IS UNDER 1e YEARS OF AGE MUST BE SIGNED BY OWNER(S) OFFICER(S) OF CORPORATION OR PARTNER IN PARTNERSHIP
The undersigned hereby certifies that the vehicle described in this title has been transferred to the following
Name(s) of Buyer(s) Address of Buyer(s) STREET ADDRESS
STATE
COUNTY
CITY OR TOWN
SIGNATURE OF BUYER(S)
SIGNATURE OF CO BUYER(S)
W 2
PRINTED NAME OF BUYER(S)
PRINTED NAME OF CO BUYER(S)
a
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked
Z
Fn 4 W
(no temps) ODOMETER READING
q 1 The mileage stated is in excess of its mechanical limits q 2 The odometer reading is not the actual mileage DATE OF WARNING ODOMETER DISCREPANCY DELIVERY
y
ZIP CODE
CERTIFIED SELLING PRICE TRADE IN ALLOWANCE
DEALER S NO.
SIGNATURE OF AUTHORIZED AGENT
TAXABLE PRICE J Q W p
PRINTED NAME OF AUTHORIZED AGENT GROSS TAX COLLECTED PRINTED NAME OF DEALERSHIP STATE
VIN OF TRADE IN IF NOT SUBJECT TO A LIEN INDICATE NONE NAME OF SECURED PARTY
AMOUNT OF LIEN
DATE OF LIEN
COLL. FEE 1 2% OF GROSS OR S24 MAX FEE ALLOW NET TAX REMITTED
ADDRESS OF SECURED PARTY
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 23 of 44
LOAN DAMAGE CALCULATOR--BANKRUPTCY Claimant reserves its rights to seek the allowance of an unsecured deficiency claim to the extent that the value of the collateral is less than the amount of its claim.
Account Name: Loan Number: GE Case Number: By: Date Prepared: Date Updated: Default Date: Bankruptcy Petition Date: Date Equipment Sales Proceeds Received: Interest Rate:
WESTERN MARYLAND TRANSPORT, IN 8472701001 65004 Diane Lensing 7/31/2014 7/31/2014 6/1/2014 6/6/2014
18.000% CLAIM CALCULATION AS OF DATE CASE FILED
A. Principal Balance: Balance from amortization schedule row: 43 Less partial payment: Amount of Interest attributed to partial payment Remaining principal balance:
$ $ $ $
61,891.45 61,891.45
B. Collection Fees: Unit Cost
$
Number of Charges
-
Aggregate
$
-
C. Repossession Fees: Unit Cost
$
Number of Charges
-
Aggregate
$
-
D. Interest: Days from Default Date to the earlier of Date Proceeds Received or Petition Date
Daily Interest
31 5 Unpaid Interest from Partial Paid payment
Aggregate
$
E. Net Equipment Sale Proceeds:
$
F. Balance After Accounting for Equipment Sale:
$
$154.73 62,046.18
G. Interest: Days from Proceeds Received to Petition Date, if applicable
Daily Interest
0
Aggregate
0
$0.00
H. Late Charges: Unit Cost
$ $
164.03 162.56
Number of Months
16 1
Aggregate
$ $
2,624.48 162.56
I. Other Charges: Unit Cost
None
$
-
Number of Charges
Aggregate
$
-
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 24 of 44
TOTAL CLAIM (This total does not include applicable legal fees)
$
64,833.22
ARREARAGE AS OF DATE CASE FILED A. Regular Payment: Unit Cost
Number of Months
$ 3,280.59 $ -
1
Unit Cost
Number of Months
Aggregate
$ $
3,280.59 -
B. Late Charges: $ $ C. Other Charges:
164.03 162.56 Unit Cost
$ $
16 1
Aggregate
$ $
Number of Charges
-
Aggregate
$ $ TOTAL ARREARAGE
2,624.48 162.56
$
6,067.63
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 25 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 26 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 27 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 28 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 29 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 30 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 31 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 32 of 44 y^ r r` _ 'r r
`Y
fly THIS IS NOT A TITLE YEAR
VEHICLE IDENTIFICATION NO
1HTXRA:PTB8J270233 EXCEPT
4X
OR. VEIL WT
MAKE
1.1 INTL
OR. COMB.. WT
70000
OON/A
BODY STYLE CLASS
TK
ODOMETER
EPD
FEE (FAGS)
TITLE NUMBER
BRAV4D
156 A
41176170
INSPECTION DATE
$1837.50
N/A
DATE ISSUED
09/17/10
CO-OWNER'S SOUNDEX I DRIVER LICENSE NO.
OWNER'S SOUNDEX / DRIVER LICENSE NO
Z-975-001-978-425 ODOMETER CODES
NAME(S) AND ADDRESS OF REGISTERED OWNER(S)
e 8A EActual Excee xceedss re.oc tJ:echanlcal Limits C Not Actual Miicage
WESTERN MARYLAND TRANSP ORT INC 45 LOCUST LN PO BOX 278 BARTON MD 21521-1039
C0185719 THIS IS TO CERTIFY THAT A SECURITY INTEREST HAS BEEN DULY FILED WITH THE MOTOR VEHICLE ADMINISTRATION IN THE NAME OF THE SECURED PARTY BELOW ON THE VEHICLE DESCRIBED
TERMINATION STATEMENT I THE UNDERSIGNED DO HEREBY RELEASE ALL RIGHTS AND INTERESTS IN THE VEHICLE DESCRIBED ABOVE
SIGNATURE OF SECURED PARTY
OFFICIAL CAPACITY
DATE OF RELEASE
NAME AND ADDRESS OF SECURED PARTIES
GE CAPITAL COMMERCIAL INC PO BOX 35707 BILLINGS MT 59107
OFFICIALLY ISSUED ON THE DATE SET FORTH
J
Gam` '_ AH /INISTRATOR OF MOTOR VEHICLES
VR 002 (03/01
716 ^
-v r
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 33 of 44
Federal and State law requires that you state the mileage in connection with the transfer of ownership Failure to complete or providing a false statement may result in lines and/or imprisonment
U. 0 z
To be used by secured party (Lien Holder) named on the face for securing a repossessed certificate of title or for the conveyance of ownership of the vehicle to a subsequent purchaser I/We the undersigned hereby certify under penalty of penury that the Motor Vehicle described on the face has been repossessed because of the debtors failure to meet the obligation in the settlement of the lien indicated on the face of this form The lien contract covering the vehicle was executed in full compliance with article 95B of the annotated Code of Maryland I/We also warrant title to the vehicle described and agree to defend it against all claims
z2 ON H (n
This
SIGNATURE OF SECURED PARTY
Witness My/Our Hand(s) and Seal
PRINTED NAME
Yr
Day of
LL
REPRESENTING FIRM OR COMPANY
Ha W cc
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked
U
q 1 The mileage stated is in excess of its mechanical limits (no tenths)
q
2 The odometer reading is not the actual mileage WARNING ODOMETER DISCREPANCY
ODOMETER READING
The undersigned hereby certifies that the vehicle described In this title has been transferred to the following
Name(s) of Buyer(s) LL in cc W
Address of Buyer(s)
2 3
O U. O 0 Z W 2 Z
CITY OR TOWN
STREET ADDRESS
STATE
COUNTY
ZIP CODE
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements Is checked
_
. _
SELLING PRICE
q 1 The mileage stated is in excess of Its mechanical limits
_
DATE OF SALE (no tenths)
q
2 The odometer reading is not the actual mileage WARNING ODOMETER DISCREPANCY
ODOMETER READING
SIGNATURE OF SELLER(S)
SIGNATURE OF CO SELLER(S)
PRINTED NAME OF SELLER(S)
PRINTED NAME OF CO-SELLER(S)
SIGNATURE OF BUYER(S)
SIGNATURE OF CO BUYER(S)
PRINTED NAME OF BUYER(S)
PRINTED NAME OF CO BUYER(S)
Name(s) of Buyer(s Address of Buyer(s) CITY OR TOWN
STREET ADDRESS
STATE
COUNTY
ZIP CODE
Give Maryland Driver s License Number and Date of Birth It you do not have a Driver a License give Date of Birth
z 0 H
AMOUNT OF LIEN
IF NOT SUBJECT TO A LIEN INDICATE NONE
DATE OF BIRTH
CO-BUYERS DRIVERS LICENSE NO
DATE OF BIRTH
BUYER S DRIVERS LICENSE NO
KIND OF LIEN (DESCRIBE)
DATE OF LIEN
H ADDRESS OF SECURED PARTY
NAME OF SECURED PARTY W I=
Now Title and L_j Tmn.tor of Tngb
Now Tillo Only
IF MOTORCYCLE UST ENGINE NUMBER IF TRUCKrrRACTOR7rRAILER LIST WEIGHT
Q
New Title Vwu hereby aka application for (Chock app' caolo block) Q and Tag.
Z Q
II you am transferring tags from a vehicle that you cold to this vehicle give the following (I applicable)
W J
NAME OF PERSON TO WHOM YOU SOLD THE OLD VEHICLE CERTIFICATION
GVW
Q No Tags
TAG NUMBER
= F VEHICLE
GCW VALIDATION STICKER NUMBER
ADDRESS
NAME OF INSURANCE COMPANY (COPY FROM YOUR POLICY)
OF L Z O
INSU R ANCE
NAME OF AGENT
POLICY OR BINDER NUMBER
I AM AWARE O ODOMETER CERTIFICATION MADE BY SELLER-'
F V J
a
0 JOINT TENANTS
q TENANTS BY ENTIRETIES
NOTARY NOT REQUIRED I/we certify under penalty of penury that the statements made herein are true and correct to the best of my/our knowledge
SIGNATURE OF BUYER(S) PRINTED NAME OF BUYER(S) SIGNATURE OF CO BUYER(S)
information and belief and hereby state that the manufacturer's
itlentlflwtion number shown on the lace hereof agrees with the number plate on the vehicle Witness My/Our Hand(s) And Soul
PRINTED NAME OF CO-BUYERS) -CO-SIGNATURE OF PARENT GUARDIAN OR RESPONSIBLE ADULT REQUIRED WHEN APPUCANT IS UNDER IS YEARS OF AGE
This
Day of
20 _ MUST BE SIGNED BY OWNER(S) OFFICER(S) OF CORPORATION OR PARTNER IN PARTNERSHIP
The undersigned hereby certifies that the vehicle described in this title has been transferred to the following
Name(s) of Buyer(s) Address of Buyer(s) STREET ADDRESS
STATE
COUNTY
CITY OR TOWN
Z W 2
SIGNATURE OF BUYER(S)
SIGNATURE OF CO BUYER(S)
PRINTED NAME OF BUYER(S)
PRINTED NAME OF CO-BUYER(S)
CD
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked
N ( tenths) (no W Q y UJ J Q W p
ODOMETER READING SIGNATURE OF AUTHORIZED AGENT
q 1 The mileage stated is in excess of its mechanical limits q 2 The odometer reading is not the actual mileage DATE OF WARNING ODOMETER DISCREPANCY DELIVERY _ DEALER S NO
ZIP CODE
CERTIFIED SELLING PRICE TRADE IN ALLOWANCE TAXABLE PRICE
PRINTED NAME OF AUTHORIZED AGENT GROSS TAX COLLECTED PRINTED NAME OF DEALERSHIP STATE
VIN OF TRADE IN IF NOT SUBJECT TO A LIEN INDICATE NONE NAME OF SECURED PARTY
AMOUNT OF LIEN
DATE OF LIEN
COLL FEE 1 2T OF GROSS OR Std MAX FEE ALLOW NET TAX REMITTED
ADDRESS OF SECURED PARTY
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 34 of 44
LOAN DAMAGE CALCULATOR--BANKRUPTCY Claimant reserves its rights to seek the allowance of an unsecured deficiency claim to the extent that the value of the collateral is less than the amount of its claim.
Account Name: Loan Number: GE Case Number: By: Date Prepared: Date Updated: Default Date: Bankruptcy Petition Date: Date Equipment Sales Proceeds Received: Interest Rate:
WESTERN MARYLAND TRANSPORT, IN 8469984001 65004 Diane Lensing 7/31/2014 7/31/2014 5/3/2014 6/6/2014
18.000% CLAIM CALCULATION AS OF DATE CASE FILED
A. Principal Balance: Balance from amortization schedule row: 44 Less partial payment: Amount of Interest attributed to partial payment Remaining principal balance:
$ $ $ $
61,717.87 327.39 347.16 61,717.87
B. Collection Fees: Unit Cost
$
Number of Charges
-
Aggregate
$
-
C. Repossession Fees: Unit Cost
$
Number of Charges
-
Aggregate
$
-
D. Interest: Days from Default Date to the earlier of Date Proceeds Received or Petition Date
Daily Interest
31 34 Unpaid Interest from Partial Paid payment
Aggregate
$
E. Net Equipment Sale Proceeds:
$
F. Balance After Accounting for Equipment Sale:
$
$1,049.20 19.77 62,786.84
G. Interest: Days from Proceeds Received to Petition Date, if applicable
Daily Interest
0
Aggregate
0
$0.00
H. Late Charges: Unit Cost
$ $
163.57 162.35
Number of Months
15 1
Aggregate
$ $
2,453.55 162.35
I. Other Charges: Unit Cost
None
$
-
Number of Charges
Aggregate
$
-
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 35 of 44
TOTAL CLAIM (This total does not include applicable legal fees)
$
65,402.74
ARREARAGE AS OF DATE CASE FILED A. Regular Payment: Unit Cost
Number of Months
$ 2,944.00 $ 3,271.39
1 1
Unit Cost
Number of Months
Aggregate
$ $
2,944.00 3,271.39
B. Late Charges: $ $ C. Other Charges:
163.57 162.35 Unit Cost
$ $
15 1
Aggregate
$ $
Number of Charges
-
Aggregate
$ $ TOTAL ARREARAGE
2,453.55 162.35
$
8,831.29
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 36 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 37 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 38 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 39 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 40 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 41 of 44
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 42 of 44
-
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 43 of 44a r^xr yMPAW
1 '
1 '!
1
ter'
'c
THIS IS NOT A TITLE YEAR
VEHICLE IDENTIFICATION NO
1HTXRAPT3BJ270236 EXCEPT
4X
GR. VEH- WT
MAKE
GR COMB WT
70000
BODY STYLE CLASS ODOMETER
11 INTL TK EPD FEE (TAGS)
OON/A
TITLE NUMBER
41175594
INSPECTION DATE
N/A
$1837.50
OWNER'S SOUNDEX 1 DRIVER LICENSE NO
BRAND
64 A
DATE ISSUE}
_
09/07/10
CO-OWNER'S SOUNDEX I DRIVER LICENSE NO
Z-975-001-978-425 ODOMETER CODES
NAME(S) AND ADDRESS OF REGISTERED OWNER(S)
WESTERN MARYLAND TRANSPORT INC 45 LOCUST L N
A Actual Mileage B Exceeds Mechanical Limits C Not Actual Mileage
PO BOX 278
BARTON
MD 21521-1039
- • a
C")143452 THIS IS TO CERTIFY THAT A SECURITY INTEREST HAS BEEN DULY FILED WITH THE MOTOR VEHICLE ADMINISTRATION IN THE NAME OF THE SECURED PARTY BELOW ON THE VEHICLE DESCRIBED
_
TERMINATION STATEMENT I THE UNDERSIGNED DO HEREBY RELEASE ALL RIGHTS AND INTERESTS IN THE VEHICLE DESCRIBED ABOVE
SIGNATURE OF SECURED PARTY
OFFICIAL CAPACITY
-
-.J
DATE OF RELEASE
NAME AND ADDRESS OF SECURED PARTIES
GE CAPITAL COMMERICAL INS PO BOX 35704 MT 59107-5704 BILLINGS
6E
OFFICIALLY ISSUED ON THE DATE SET FORTH
INISTRATOR OF MOTOR VEHICLES I
61 VR 002 (03/09)
l
CLAIM #44 FILED 8/1/2014 Case 14-19275 Claim 14-1 Part 2 Filed 08/01/14 Page 44 of 44
Federal and State law requires that you state the mileage in connection with the transfer of ownership Failure to complete or providing a false statement may result in fines and/or imprisonment
LL 0, z0 0W H LIJ VN u.0 CL WQ
To be used by secured party (Lien Holder) named on the face for securing a repossessed certificate of title or for the conveyance of ownership of the vehicle to a subsequent purchaser I/We the undersigned hereby certify under penalty of perjury that the Motor Vehicle described on the face has been repossessed because of the debtor's failure to meet the obligation in the settlement of the lien indicated on the face of this form The lien contract covering the vehicle was executed in full compliance with article 95B of the annotated Code of Maryland I/We also warrant title to the vehicle described and agree to defend it against all claims SIGNATURE OF SECURED PARTY
Witness My/Our Hand(s) and Seal This
PRINTED NAME
Yr
Day of
REPRESENTING FIRM OR COMPANY I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked q 1 The mileage stated is in excess of its mechanical limits (no tenths) ODOMETER READING
q 2 The odometer reading is not the actual mileage WARNING ODOMETER DISCREPANCY
The undersigned hereby certifies that the vehicle described in this title has been transferred to the following
Name(s) of Buyer(s) a
Address of Buyer(s)
W Z O
CITY OR TOWN
STREET ADDRESS
cn
STATE
COUNTY
ZIP CODE
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked SELLING PRICE q 1 The mileage stated Is in excess of its mechanical limits
_ LL
DATE OF SALE
0 F. Z W
(no tenths)
q 2 The odometer reading is not the actual mileage WARNING ODOMETER DISCREPANCY
ODOMETER READING
Z
SIGNATURE OF SELLER(S)
SIGNATURE OF CO SELLER(S)
V) Q
PRINTED NAME OF SELLER(S)
PRINTED NAME OF CO SELLER(S)
SIGNATURE OF BUYER(S)
SIGNATURE OF CO BUYER(S)
PRINTED NAME OF BUYER(S)
PRINTED NAME OF CO-BUYER(S)
Name(s) of Buyer(sl Address of Buyer(s) CITY OR TOWN
STREET ADDRESS
ZIP CODE
STATE
COUNTY
Give Maryland Driver a License Number and Date of Birth If you do not have a Driver a License give Date of Birth Z 0 I-
DATE OF BIRTH
BUYERS DRIVER S LICENSE NO
KIND OF LIEN (DESCRIBE)
DATE OF LIEN
AMOUNT OF LIEN
IF NOT SUBJECT TO A LIEN INDICATE NONE
DATE OF BIRTH
CO-BUYER S DRIVERS LICENSE NO
IADDRESS OF SECURED PARTY
NAME OF SECURED PARTY W M
Now Title and
NEW Ttlo On No Tugs Y
IF MOTORCYCLE. UST ENGINE NUMBER IF TRUCK/rRACTOR/TRAILER LIST WEIGHT
a
Now 7110 Vwc horco nuke app-'cation for Q and Tugs (Check applicable block)
Z Q
II you are :ransteMng tags from a vehicle that you sold to th:s vehicle give the following (II applicable)
W J
NAME OF PERSON TO WHOM YOU SOLD THE OLD VEHICLE
jr
CERTIFICATION
0 LL Z
OF
a
GVW TAG NUMBER
CLASS OF VEHICLE
GCW VALIDATION STICKER NUMBER
ADDRESS
NAME OF INSURANCE COMPANY (COPY FROM YOUR POLICY) NAME OF AGENT
POLICY OR BINDER NUMBER
IN SU RAN CE
F Q
IL a
L_J Trar sfor .!Tags
AMA AR O ODOMETER CERTIFICATION MADE B SELL
IS THIS VEHICLE TO BE TITLED AS JOINT
TENANTS OR TENANTS BY ENTIRETIES? JOINT TENANTS
SIGNATURE OF BUYER(S)
-
E TENANTS BY ENTIRETIES
-
-
-
-
PRINTED NAME OF BUYER(S)
NOTARY NOT REQUIRED I/we coolly under penalty of perjury that the statements made herein are two and correct to the best of my/our knowledge Information and belief and hereby state that the manulacturars IdentIficatlon number shown on the face hereof agrees with the number plate on the vehicle Witness My/Our Hands) And Seal
SIGNATURE OF CO-BUYER(S) PRINTED NAME OF CO-BUYER(S)
CO-SIGNATURE OF PARENT GUARDIAN OR RESPONSIBLE ADULT REQUIRED WHEN APPLICANT IS UNDER 18 YEARS OF AGE Day of
This
20
MUST eE SIGNED BY OWNER(S) OFFICER(S) OF CORPORATION OR PARTNER IN PARTNERSHIP
The undersigned hereby certifies that the vehicle described in this title has been transferred to the following
Name(s) of Buyer(s) Address of Buyer(s)
Z
W 2 Z a
SIGNATURE OF CO-BUYER(S)
PRINTED NAME OF BUYER(S)
PRINTED NAME OF CO-BUYER(S)
-
W
(no tenths) ODOMETER READING
q 1 The mileage stated is in excess of Its mechanical limits q 2 The odometer reading is not the actual mileage DATE OF WARNING ODOMETER DISCREPANCY DELIVERY
SIGNATURE OF AUTHORIZED AGENT W _J
-
- -
--
-
CERTIFIED SELLING PRICE TRADE IN ALLOWANCE
DEALERS NO TAXABLE PRICE
PRINTED NAME OF AUTHORIZED AGENT
%W p
ZIP CODE
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked
Vl
cc N
STATE
COUNTY
CITY OR TOWN
STREET ADDRESS
SIGNATURE OF BUYER(S)
GROSS TAX COLLECTED PRINTED NAME OF DEALERSHIP STATE
VIN OF TRADE IN IF NOT SUBJECT TO A LIEN INDICATE NONE NAME OF SECURED PARTY
AMOUNT OF LIEN
DATE OF LIEN
COLL FEE 121 . OF GROSS OR $24 MAX FEE ALLOW NET TAX REMITTED
ADDRESS OF SECURED PARTY
