HomeMy WebLinkAbout08-20-07
IN RE: ESTATE OF
JOHN F. KIMMEL,
LATE OF CAMP HILL,
CUMBERLAND COUNTY,
PENNSYLVANIA,
DECEASED
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-06-1018
NOTICE OF FILING ACCOUNT
NOTICE IS HEREBY GIVEN that Lois A. McKeon, Administratrix of the
Estate of John F. Kimmel, deceased, has this date filed her First and Final
Account and Statement of Proposed Distribution in the above-captioned
Estate in the Cumberland County Register of Wills Office where the same is
filed as public record and may be inspected. Enclosed herewith is a copy
of the First and Final Account as filed.
YOU ARE FURTHER notified that any exceptions or objections to said
Account must be filed in writing at the Cumberland County Clerk of the
Orphans' Court Office not later than the audit day of said Account sched-
uled as set forth below.
UNLESS written exceptions or objections are filed thereto, said
Account will be presented to the above-captioned Court at 9:30 A.M. on
Tuesday, October 9, 2007, at which time said Account will be audited.
Date: ~l;a.olo(
c;
1'_)
(~;;.)
c::::-.
_..J
cc:
.;J
.-:J --I
Shawn F. Arnold (via certified mail, return receipt reqUested)~
c
Misty E. King (via certified mail, return receipt requested)
Lois A. McKeon, Administratrix
Esquire
for t e Estate
One West Main Street
Shiremanstown, PA 17011
(717) 737-8761
~JIll
, ,
'. -
c::
L-)
1'.)
o
v
N
-"It
DECEDENT'S ESTATE
COURT OF COl\1MON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DMSION
ESTATE OF
JOHNF. KIMMEL
, DECEASED
No. 21-06-1018
PETITION FOR ADJUDICATION /
STATEMENT OF PROPOSED DISTRIBUTION
PURSUANT TO Pa. O.C. Rule 6.9
o
(:::;0
'--=g
--(J
~~,p ~-
f"7l
-n
""
c-::>
c:.::)
-.J
:J:'>'>
f=
This form may be used in all cases involving the Audit of the Account of a Decedent's Estate. If
space is insufficient, riders may be attached. Attach the spouse's election, if any; the papers
required under items 8-19 inclusive; and any instrument pertinent to the adjudication.
INCLUDE ATTACHMENTSAT THE BACK OF THIS FORM.
Name of Counsel: James D. Bogar, Esquire
Supreme Court I.D. No.: 19475
Name of Law Firm: Law Office of James D. Bogar
Address: 1 West Main Street, Shiremanstown, PA 17011
Telephone: (717) 737-8761
Fax: (717) 737-2086
Form OC-01 rev. 10.13.06
Page 1 of! 0
o
C)
f')
o
-0
. 'I
C')
1"',) -;"1
01
Estate of
JOHN F. KIMl\1EL
, Deceased
1. Name(s) and addressees) ofPetitioner(s):
Name:
Lois A. McKeon
Address:
633 Allen Street
New Cumberland, PA 17070
Identify any executors or administrators who have not joined in the Petition for
Adjudication and Statement of Proposed Distribution and state reason:
Is this the first accounting by this fiduciary? . . . . . . . . . . . . . . . . . . . .. ~ Yes D No
If not, identify prior accountings, the accounting periods covered, and the date of
adjudication of the prior accounting.
2. Decedent died on 7/31/2006
[] Letters Testamentary or ~Letters of Administration were granted to Petitioner(s) on
11/17/2006
Date ofWi11 (if applicable): N/A
Date(s) ofCodici1(s) (ifapplicable): N/A
Date of probate (if different from date Letters granted): 11/17/2006
Was a bond required? [JY es l2] No If yes, state amount:
Are proofs of advertising of the grant of Letters attached? ......... r2) Yes [] No
Dates of advertising of the grant of Letters: The Patriot News 11/29, 12/6 & 12/13/06
Cumberland Law JoumalI2/1, 12/8 & 12/15/06
Form OC-01 rev. 10.13.06
Page 2 of 10
Estate of
JOHNF. KIMMEL
, Deceased
3. Was decedent survived by a spouse? ............................. DYes f2]No
If yes, name of the surviving spouse:
4. Has the surviving spouse filed to take an elective share? ............ . DYes D No
(See Section 2201 et sea. of the Probate, Estates and Fiduciaries Code)
If yes, date of election:
5. In the case of an intestacy, state the names of the decedent's surviving children or
surviving issue of deceased children (if none, so state):
Shawn F. Arnold
Misty E. King
6. Did decedent marry after execution of Will or Codicil(s)? . . . . . . . . . .. DYes lEI No
Were any children born to decedent after execution of
Will or Codicil(s)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DYes lEI No
If yes, give names and dates of birth:
Name:
Date of Birth:
7. If required by the Medical Assistance Estate Recovery Act,
62 P.S. ~ 1412, was a request for a statement of claim sent to
the Department of Public Welfare? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I2]Yes D No
Form OC-01 rev. 10.13.06
Page 3 of 10
Estate of
JOHNF. KIM:MEL
. Deceased
8. Written notice of the Audit as required by Pa. O.C. Rules 6.3, 6.7 and 6.8 has been or will be
given to all parties in interest listed in item 9 below, all unpaid creditors and all claimants
listed in item 10 below. In addition, notice of any questions requiring Adjudication as
discussed in item 14 below has been or will be given to all persons affected thereby.
A. If Notice has been given, attach a copy of the Notice as well as a list of the names
and addresses of the parties receiving such Notice.
B. If Notice is yet to be given, a copy of the Notice as well as a list of the names and
addresses of the parties receiving such Notice shall be submitted at the Audit
together with a statement executed by a Petitioner or counsel certifying that such
notice has been given.
C. If any person entitled to Notice is not sui juris (e.g., minors or incapacitated
persons), Notice of the Audit has been or will be given to the appropriate
representative on such party's behalf as required by Pa. O.C. Rule 5.2.
D. If any charitable interest is involved, Notice of the Audit has been or will also be
given to the Attorney General as required under Pa. O.C. Rule 5.5. In addition, the
Attorney General's clearance certificate (or proof of service of Notice and a copy
of such Notice) must be submitted herewith or at the Audit.
9. List all parties (charitable and non-charitable) of whom Petitioner(s) has/have notice or
knowledge, having or claiming any interest in the estate as beneficiaries under the Will or
Codicil(s) or as intestate heirs if there is a complete or partial intestacy:
A. State each party's relationship to the decedent and the nature of each party's
interest(s):
Name andAddress of Each Par tv in Interest
Relationshio and Comments, if anv Interest
Shawn F. Arnold
FR 5511,5706 Glad Pike
Somerset, P A 15501
son 50% ofrest, residue
and remainder
Misty E. King
643 Bethel Road
Paw Paw, WV 25434
daughter 50% of rest, residue
and remainder
Form OC-01 rev. 10.13.06
Page 4 ofl 0
Estate of
JOHNF. KIMMEL
, Deceased
Name andAddress of Each Party in Interest
Relationship and Comments, ifanv
Interest
B. Identify each party who is not sui juris (e.g., minors or incapacitated persons).
For each such party, give date of birth, the name of each Guardian and how each
Guardian was appointed. If no Guardian has been appointed, identify the next of
kin of such party, giving the name, address and relationship of each.
N/A
C. State why a Petition for Guai-dian/Trustee Ad Litem has or has not been fIled for
this Audit (~ee Pa. o.c. Rule 12.4).
Appointment of GuardianlTrustee is not required
D. If distribution is to be made to the personal representative of a deceased party,
state date of death, date and place of grant of Letters and type of Letters granted.
N/A
Form OC-01 rev. 10.13.06
Page 5 ofl 0
Estate of
JOHN F. KIMMEL
. Deceased
10. Other than the claim for the family exemption, list the names of all known claimants and
the amount of their claims and state whether each claim is admitted.
Name and Address of Each Claimant Amount of Claim Claim Will Claim
Admitted? Be Paid In
Full?
N/A DYes DYes
DNo DNo
DYes DYes
DNo DNo
DYes DYes
DNo DNo
DYes DYes
DNo DNo
If the estate is insolvent, attach a schedule setting forth the order of preference under
20 Pa.C.S. ~ 3392 and the proposed payments.
11.
Was family exemption claimed?
DYes 12] No
Was family exemption allowed?
DYes
DNo
Family exemption claimant's name and relationship:
Name:
Relationship:
Form DC-OJ rev. 1O.J3.06
Page 6 of 10
Estate of
JOHNF. KIMMEL
, Deceased
12. The amount of Pennsylvania Transfer Inheritance Tax and additional Pennsylvania Estate
Tax paid, the date(s) ofpayment(s), and the interest(s) upon which paid, are as follows:
Date
Payment
Interest
03-14-2007
$0.00
13. On the date of death, was the decedent a fiduciary
(personal representative, trustee, guardian, agent under power
of attorney) or surety on the bond of a fiduciary? . . . . . . . . . . . . . . . . . . . DYes ~ No
If yes, provide the name of the estate, indicate whether an account has been filed and
confirmed absolutely and all awards performed, or, in the alternative, how the
decedent's estate will be discharged for the decedent's fiduciary administration of the
estate.
14. A. Describe in detail any questions requiring adjudication and state the position of the
Petitioner(s) as to each question:
N/A
B. Has notice of the question requiring adjudication been given
to the parties identified in Paragraph 9 above? .................. DYes D No
15. IfPetitioner(s) haslhave knowledge that a share has been assigned, renounced, disclaimed
or attached, provide a copy of the assignment, renunciation, disclaimer or attachment,
together with any relevant supporting documentation.
Form OC-OJ rev. JO.13.06
Page 7 of 10
Estate of JOHN F. KIM:MEL
, Deceased
16. Had the decedent been adjudicated an incapacitated person? . . . . . . . . . . D Yes ~ No
If yes, attach a copy of the Order if available; otherwise state the Court, term, number,
date, and name of Hearing Judge.
17. A. List or attach a separate list of additional receipts and disbursements since the closing
date of the Account.
None
B. Has notice of the additional receipts and disbursements been
given to the parties identified in Paragraph 9 above? ............ . DYes D No
18. If a reserve is requested, state amount and purpose.
Amount: 950.00
Purpose: Costs to conclude administration of Estate, including certified mail
charges, possible unpaid medical bills, preparation of Fiduciary Income
Tax Returns
If a reserve is requested for counsel fees, has notice of the
amount of fees to be paid from the reserve been given to the
parties in interest? ........................................ DYes [a No
If so, attach a copy of the notice.
19.
Is the Court being asked to direct
the fIling of a Schedule of Distribution?
DYes [a No
As to real estate only? ........................................ DYes I2]No
Form OC-OJ rev. 10.13.06
Page 8 of 10
Estate of
JOHN F. KIMMEL
, Deceased
Wherefore, your Petitioner(s) ask(s) that distribution be awarded to the parties entitled
and suggest(s) that the distributive shares ofincorne and principal (residuary shares being stated
in proportions, not amounts) are as follows:
A. mcorne:
Proposed Distributee(s)
Amount/Proportion
Shawn F. Arnold
$0.00
Misty E. King
$0.00
B. Principal:
Proposed Distributee(s)
Amount/Proportion
Same as "A"
Submitted By:
(All petitioners must sign.
Add additional lines ifnecessary):
NIDne o~er.l /tt~~
'1/6((J7
Name of Petitioner:
Form OC-01 rev. 10.13.06
Page 9 of 10
Estate of
JOHNF. KIMMEL
, Deceased
Verification of Petitioner
(Verification must be by at least one petitioner.)
The undersigned hereby verifies * [that he/she she is title Administratrix
of the above-named name of corporation Estate of John F. Kimmel and] that the facts set
forth in the foregoing Petition for Adjudication / Statement of Proposed Distribution which are
within the personal knowledge of the Petitioner are true, and as to facts based on the information
of others, the Petitioner, after diligent inquiry, believes them to be true; and that any false
statements herein are made subject to the penalties of 18 Pa. C.S. 94904 (relating to unsworn
falsification to authorities).
,~ A. tuct2<r-_'(;I/~/o7
Signature of Petitioner \
'" Corporate petitioners must complete bracketed information.
Certification of Counsel
The undersigned counsel hereby certifies that the foregoing Petition for Adjudication!
Statement of Proposed Distribution is a true and accurate reproduction of the form Petition
authorized by the Supreme Court, and that no changes to the form have been made beyond the
responses herein.
cs ll(, Lo7
sel for Petitioner
Form OC-01 rev. 10.13.06
Page 10 of 10
THE PATRIOT NEWS
THE SUNDAY PATRIOT NEWS
Proof of Publication
Under Act No. 587, Approved May 16,1929
Commonwealth of Pennsylvania, County of Dauphin} ss
Joseph A. Dennison, being duly sworn according to law, deposes and says:
That he is the Assistant Controller of The Patriot News Co., a corporation organized and existing under the
laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 812 to 818 Market
Street, in the City of Harrisburg, County of Dauphin, State of Pennsylvania, owner and publisher of The Patriot-
News and The Sunday Patriot-News newspapers of general circulation, printed and published at 812 to 818 Market
Street, in the City, Cotmty and State aforesaid; that ThePatriot-New~and The Sunday Patriot-News were
established March 4th, 1854, and September 18th, 1949, respectively, and all have been continuously published ever
since;
That the printed notice or publication which is securely attached hereto is exactly as printed and published
in their regular daily and/or Sunday/ Metro editions which appeared in the 29th day(s) of November and the 6th
and 13th day(s) of December 2006. That neither he nor said Company is interested in the subject matter of said
printed notice or advertising, and that all of the allegations of this statement as to the time, place and character of
publication are true; and
That he has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this
statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimouslypassed
and adopted severally by the stockholders and board of directors of the said Company and subsequently duly
recorded in the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book "M",
Volume 14, Page 317.
PUBLICATION
COPY
C\ /A1;jj) - ~
s;;':'~'~~~~';;;';~~~~;;;;;';:'~~~~';:~."
L/ COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Terry L. Russell, Notary Public
City Of Harrisburg, Dauphin County
My Commi ion Expk June 6, 201 0
Member, Pe sVlv ni ociation 01 Notaries
... EXECUTOR'SNOTICE
Estate of J..... F. Kimmel
;" .".. a/kla J..... Kimmel ..'"
Letters "of Administration on the Es-
tate of John F. Kimmel a/kla John Klm-
mel.>lateof Camp Hili," Cumberland
CcluntY. Pennsylvania. have been grant-
ed to the undersigned. All persons know-
Ing themselves to be Indebted to said Es-
. tate are requested to make Immediate
payment. and those having claims will
present them. without delay. for settle-
mentto:
Louis A. McK_
"cloJames D. __r, Esquire
One West Main street
Shlremanstowll. PA 17011
JAMES D. BOGAR
ATTORNEY-AT-LAW
ONE WEST MAIN STREET
SHIREMANSTOWN, PA. 17011
PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May 16, 1929), P. L.1784
COMMONWEALTH OF PENNSYLVANIA
SSe
COUNTY OF CUMBERLAND
Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and
State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law
Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid,
was established January 2, 1952, and designated by the local courts as the official legal
periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly
issued weekly in the said County, and that the printed notice or publication attached hereto is
exactly the same as was printed in the regular editions and issues of the said Cumberland Law
Journal on the following dates,
V1Z:
December 1, December 8 and December 15, 2006
Affiant further deposes that he is authorized to verify this statement by the Cumberland
Law Journal, a legal periodical of general circulation, and that he is not interested in the subject
matter of the aforesaid notice or advertisement, and that all allegations in the foregoing
statements as to time, place and character of publication are true.
-
SWO 0 AND SUBSC ED before me this
15 day of December. 2006
Kimmel, John F. ajkja John
Kimmel, dec'd.
Administratrix: Lois A. McKeon
c/o James D. Bogar, Esquire,
One West Main Street. Shire-
manstown, PA 17011.
Attomey: James D. Bogar. Es-
quire, One West Main Street.
Shiremanstown. PA 17011.
NOTARIAL SEAL
LOIS E. SNYDER, Notary Public
Carlisle 8oro, Cumberland County
My Commission Expires March 5, 2009.
2- .:;-, OlJD 0
In the Court of Common Pleas of Cumberland County, Pennsylvania
Orphans' Court Division
File No. 21-06-1018
Estate of John F. Kimmel, Deceased
Late of Camp Hill, PA 17011
First and Final Account
and Statement of Proposed Distributions
Lois A. McKeon, Administratrix
~~o
, -TJ
'::-tn
.~ r--
~ "\
::-,
1"--,'
c-::"\
c:>
-~
~
C
G')
l"'J
C)
"_..' ......-..,
,. ~~ ~;:;; -0
::::-1:)
~J--'-I
f'V
,'-; (-)
Date of Death:
07/31/2006
en
Date of Executor's Appointment: 11/17/2006
. . The Patriot News: 11/29/06,12/6/06, 12/13/06
Date of First Complete Advertisement: Cumber land Law Journal 12/1/06, 12/8/06, 12/15/06
Accounting for the Period: 07/31/2006 to 08/16/2007
Purpose of Account: Lois A. McKeon, Administratrix, offers this Account to acquaint interested parties
with the transactions that have occurred during the Administration.
It is important that the Account be carefully examined. Requests for additional information or questions
or objections can be discussed with:
James D. Bogar
Bogar & Hipp Law Offices
One West Main Street
Shiremanstown, PA 17011
717-737-8761
Supreme Court 1.0. No. 19475
SUMMARY OF ACCOUNT
Estate of John F. Kimmel, Deceased
For the period of Julv 31. 2006 throuah Auaust 16.2007 Fiduciary
Current Acquisition
Proposed Distributions Paae Value Value
to Beneficiaries 4 0.00
PRINCIPAL
Receipts: This Account 1 25,104.89
Net Gain (or Loss) on Sales
or Other Dispositions 0.00
25,104.89
Less Disbursements:
Debts of Decedent 2 128.35
Funeral Expenses 2 10,890.60
Administration Expenses 2-3 5,758.66
Federal, State & Local Taxes 3 2,327.28
Commissions 3 200.00
Fees 3 5,800.00
Family Exemption 0.00 25,104.89
Balance Before Distributions 0.00
Transfer to (from) Principal 0.00
Distributions to Beneficiaries 0.00
Principal Balance on Hand 0.00
For Information:
Investments Made
Changes in Holdings
INCOME
Receipts This Account 0.00
Net Gain (or Loss) on Sales 0.00
or Other Dispositions 0.00
Less Disbursements 0.00
Balance Before Distributions 0.00
Transfer to (from) Income 0.00
Distributions to Beneficiaries 0.00
Income Balance on Hand 0.00
For Information:
Investments Made
Changes in Holdings
COMBINED BALANCE ON HAND 0.00
Verification 5
SCHEDULE A
RECEIPTS OF PRINCIPAL
Fiduciary
Acquisition
Value
07/31/2006
Cash
Adjustment for expenses paid by Pauline Bartley 8.729.32
from personal funds - listed here to balance
account. It is to be noted that additional
expenses have also been paid by Mrs. Bartley.
Pennsylvania Bar Institute- Accumulated sick 3.988.38
and vacation pay (gross amount due $4,318.77,
net check amount $3,988.38)
Pennsylvania Bar Institute - Final Paycheck 653.86
PNC Bank - checking account number 7.398.74
5140168166
Tredegar Corporation - Payment in lieu of 6.84
uncashed checks
Holy Spirit Provider Services - Refund for 40.00
overpayment
West Shore Tax Bureau - income tax refund 97.45
2006 Federal Income Tax Refund 1.347.92
Total Cash 22.262.51
Personal Property
1992 Ford F-10 Pickup - VIN # 1.700.00
1FTEF14N6NKA63194 - Sold at private sale
1993 Ford Explorer - VIN # 1FMDU34X7PUAI4Z82 1.000.00
- Sold at private sale
Total Personal Property 2.700.00
Stocks I Listed
9.0000 shares Tredegar Industries Inc - Common Stock 142.38
Total Stocks / Listed 142.38
Total Receipts of Principal 25.104.89
07/31/2006
07/31/2006
07/31/2006
07/31/2006
01/11/2007
03/21/2007
07/31/2007
07/31/2006
07/31/2006
07/31/2006
1
09/29/2006
07/31/2006
08/14/2006
08/30/2006
11/10/2006
11/17/2006
11/17/2006
12/05/2006
12/05/2006
12/15/2006 .
12/20/2006
12/20/2006
01/11/2007
03/02/2007
03/05/2007
TO BE PAID
03/13/2007
SCHEDULE C
DISBURSEMENTS OF PRINCIPAL
Debts of Decedent
Union Plus Credit Card*
Total Debts of Decedent
Funeral Expenses
Rolling Green Cemetery*
Musselman Funeral Home*
Gingrich Memorials*
Total Funeral Expenses
Administration Expenses
PNC Bank - Payoff of auto loan number
4001008110754461
James D. Bogar - Preparation of Power of
Attorney for John F. Kimmel prior to his death
Register of Wills - Probate Fee
Camp Hill Emergency Physicians
Holy Spirit Hospital
Cumberland Law Journal
Patriot News
Register of Wills - Short Certificates
Register of Wills - Short Certificates
A to Z Tax Service - Preparation of Final
Personal Income Tax Returns
CitiGroup Smith Barney - Fee for sale of stock
RESERVES: - Cost to conclude administration of
Estate including First and Final Account;
preparation of Fiduciary Income Tax Returns
Nephrology Associates
128.35
2.790.00
6.420.60
1.680.00
3.752.82
150.00
105.00
40.00
50.00
75.00
124.17
8.00
16.00
63.00
8.67
950.00
256.00
128.35
10.890.60
* Denotes expenses voluntarily paid by Pauline Bartley, mother
of John F. Kimmel, from her personal funds.
2
SCHEDULE C
DISBURSEMENTS OF PRINCIPAL
Continued
03/13/2007
Register of Wills - Filing fee for PA Inheritance
Tax Return and Inventory
Register of Wills - filing fee for Court Accounting
Total Miscellaneous Administrative Expenses
07/18/2007
03/13/2007
Federal. State & Local Taxes
Register of Wills, Agent - payment on account of
PA Inheritance Taxes
Total Taxes
TO BE PAID
Commissions
Lois A. McKeon - Administratrix Fee
Total Commissions
03/13/2007
Fees
Bogar and Hipp Law Offices - One-half of
attorney fees for representation of Estate per
Agreement
Bogar and Hipp Law Offices - One-half of legal
fees for representation of Estate per agreement
Total Fees
TO BE PAID
TOTAL DISBURSEMENTS OF PRINCIPAL
3
30.00
130.00
2.327.28
200.00
2.900.00
2.900.00
5.758.66
2.327.28
200.00
5.800.00
25.104.89
PROPOSED DISTRIBUTIONS TO BENEFICIARIES
Current Value Fiduciary
08/16/2007 Acquisition
or as noted Value
TO:
Misty E. King
Shawn F. Arnold
0.00
0.00
0.00
Total
0.00
4
In the Court of Common Pleas of Cumberland County, Pennsylvania
Orphans' Court Division
File No. 21-06-1018
Estate of John F. Kimmel, Deceased
Verification
Lois A. McKeon, Administratrix of the Estate of John F. Kimmel, Deceased, hereby declares under
oath that she has fully and faithfully discharged the duties of her office; that the foregoing Account
is true and correct and fully discloses all significant transactions occurring during the accounting
period; that all known claims against the Estate have been paid in full; that, to her knowledge, there
are no claims now outstanding against the Estate; that all taxes presently due from the Estate have
been paid; and that the grant of Letters of Administration and the first complete advertisement
thereof occurred more than four months before the foregoing Account.
This statement is made subject to penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn
falsification to authorities. .
d:;.. l ~~tL
Lois A. M Keo '1
Dated:
1//(0 in 7
.
5