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Home My WebLink About00-0548 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT GREGORY HAMILTON STRAWN 28 CEDAR CLIFF DRIVE CAMP HILL, PA 17011 -----~-- fold ESTATE INFORMATION: SSN: 186-26-5091 FILE NUMBER: 2100-0548 DECEDENT NAME: BA YLER JOYCE RUTH DATE OF PAYMENT: 03/17/2008 POSTMARK DATE: 03/1 7/2008 COUNTY: CUMBERLAND DATE OF DEATH: OS/26/2000 NO. CD 009420 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $4,657.06 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 3205 SEAL INITIALS: AJW RECEIVED BY: REGISTER OF WILLS $4,657.06 GLENDA FARNER STRASBAUGH REGISTER OF WILLS Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 5/05/2008 GREGORY HAMILTON STRAWN o So ; -,~ ::0 j:go i j '~...._ ,... ;~~?? 't3Q -:0 ,,0--; -'"'~ 28 CEDAR CLIFF DRIVE C]~P HILL, PA 17011 RE: Estate of BAYLER JOYCE RUTH File Number: 2000-00548 Dear Sir/Madam: t-...:J = = <:::0 ::Jt ::>- -< I -J -0 :z: N .. r~1'~ ,--) ~f5 ~~~.~~~ C.:J C) - ," -'n .... ;::~.::;:.) r11 W .&:- This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 5/26/2008 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, c...,f,fP &". / /-L_ J l') ,.-:- ) ")-- '_ ". ,.,-, ,,it '''/ (:&LlJ~('.1j,l,~Z ~"'2U~sr-L Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel In Re: Estate of BAYLER JOYCE RUTH ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2000-00548 rv n c~ - _ ~ ~i 'r7 :_ °.. ~ S - ~ti ._....~ .~ C.) , i 3 iT NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: GREGORY HAMILTON STRAWN Counsel for Personal Representative: Date of Decedent's Death: 5/26/2000 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. u'~ Date: 6/13/2008 Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File JUN 1 ~ 200 ORPHANS' COURT DIVISION IN RE: ESTATE OF COURT OF COMMON PLEAS OF BAYLER JOYCE RUTH CUMBERLAND COUNTY PENNSYLVANIA NO. 2000-00548 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: GREGORY HAMILTON STRAWN Counsel for Personal Representative: Date of Decedent's Death: 5/26/2000 Date of Delinquency Notice: The undersigned, Glenda Farner-Strasbaugh, Clerk of Orphans' Court, in accordance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules was given on the above date and that the ten (10) day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. ~~ J~ .r~r tal Date: 6/13/2008 Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled July 7, 2008 at 11AM in Courtroom No. 2 . If the Status Report is filed prior tot ann date, the hearing will automatically be cancelled. 1 Edgar B. Bay ey, J. Pa. ®.C. Rule 6.12 S'TA'TUS REP®R'T REGISTER OF WILLS OF CUM ~F,/l.l.An/A COUwTY, PEN-NSYLVANIA Tvame of Decedent: LL~1 ~./L ~b~e_~ ~uTl-~ Date of Death: ~-~~ L6 "' L o0o File Number: ZOO D -dGS~~ Pursuaiit tv Pa. v.`. Ri.iie v.i% I r°"'Crt the f~lln~xnno tznt}; racnart to !`.tlt1'1Y11P.Yt(lll of the adlll7T11$tratlon Of ~ "N ~~a r--- r------- the above-captioned estate: 1. State whether adniiiiistration of the estate is complete :.................... ~ Yes ~No 2. If the answel"is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is YES, state the following: a. Did the personal representative file a final~account with the Court? ....... Yes to b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? ............................... ~ .Yes 0 No d. Copies of receipts, releases, joinders and approvals of foi?ral or informal accounts may be filed with the Clerlc of the Orphans' Court and maybe atta ed to this report. Dnte V L//~ ~ `rl Z~ Signature of P rs n Fiiing this Form Capa/city: Personal Representative Q Course] ,f~ ~J rl L s2 y ~. ~'r2 ~lWu/ N e of Pzrson Filing t Form ~ rt G ~~ti C ~z r ~~_ l~~ ~~rc Address !_, A.M n l~{ ~c.t.. T~i~ 17~ l !-~i~ ~ 7.~ 7 --333-7 ephaze form RN%10 rev. lOJ3.06 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES ~~N~'~,~#~~AN~~ -TAX INHERITANCE TAX DIVISION S~ArtEME T ~ ~¢ 'ACCOUNT PO BOX 280601 - -~ HARRISBURG PA 17128-0601 '" ~ REV-1607 EX AFP (03-05) ?(~~~ ~~~ _~ ~~ T~j 05-27-2008 4\~E OF STRAWN JOYCE R DATE OF DEATH 05-26-2000 ~~~~~ C~' FILE NUMBER 21 00-0548 GREGORY H STRAWN C~OR~'r' ' ~'~ry~-~~~UNTY CUMBERLAND ~~, _ ~`lA~ 101 28 CEDAR CLIFF DRIVE Amount Remitted CAMP HILL PA 17011 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE --~- RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1607 EX AFP C03-05) *** INHERITANCE TAX STATEMENT OF ACCDUNT *** ESTATE OF STRAWN JOYCE R FILE N0. 21 00-0548 ACN 101 DATE 05-27-2008 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-16-2001 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): 72,977.00 PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 08-23-2000 AA451148 3,648.85 90,000.00 05-04-2001 REFUND .00 20,671.85- TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. * IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 72,977.00 .00 .00 .00 ~~ i COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES ~-,r ~ "'° r-~.-Ifi1HERITANCE TAX INHERITANCE TAX DIVISION ,~ S TATE M E N T O F A C C O U N T PO BDX 280601 G_~_ ,~ ~ ~,.,i HARRISBURG PA 17128-0601 C!..Fr~t ~F ORFH,R,~~~'~ ~',~r~~~ GREGORY H STRAWN ~~'" °~'~- ~'`'' ' ~' ~~ 28 CEDAR CLIFF DRIVE CAMP HILL PA 17011 REV-1607 EX AFP (03-05) DATE 05-27-2008 ESTATE OF STRAWN JOYCE R DATE OF DEATH 05-26-2000 FILE NUMBER 21 DO-0548 COUNTY CUMBERLAND ACN 201 ~- Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~'1 RETAIN LOWER PORTION FOR YOUR RECORDS f- REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF STRAWN JOYCE R FILE N0. 21 00-0548 ACN 201 DATE 05-27-2008 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE> APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-21-2006 PRINCIPAL TAX DUE: PAYMENTS CTAX CREDITS): 4,657.06 PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID 03-17-2008 CD009420 .00 4,657.06 BALANCE OF UNPAID INTEREST/PENALTY AS OF D3-18-2008 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. * IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 4,657.06 .00 2,053.79 2,053.79 `5~ COf;MONW@ALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 ' PENNSYLVANIA ESTATE TAX RECORD ADJUSTMENT `''r~~ `~.~ ~2 F~ ~ • n~ n~ -~i _ ". i ~. - T r_ Cl.~'. _ ~~'~, GREGORY H STRAWN 28 CEDAR CLIFF DRIVE CAMP HILL PA 17011 REV-1623 EX AFP (03-05) DATE OS-13-2008 ESTATE OF STRAWN JOYCE R DATE OF DEATH 05-26-2000 FILE NUMBER 21 00-0548 COUNTY CUMBERLAND ACN 201 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NO7E: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE _ _~_ _ RETAIN LOWER PORTION FO_R YOUR FILES ~ ___ _____ _ ___ REV 1623 EX AFP C03 05~ ~ ~ ** PENNSYLVANIA ESTATE~TAX RECORD ADJUSTMENT ** ~~ ~~ ~ ~~~ ESTATE OF STRAWN JOYCE R FILE N0.21 00-0548 ACN 201 DATE 08-13-2008 ADJUSTMENT BASED ON :ADMINISTRATIVE CORRECTION CODE 706 1. Credit For State Death Taxes as Verified 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) 4. Total Inheritance Tax Assessed 5. Pennsylvania Estate Tax Due 69,328.15 00 6. Amount of Pennsylvania Estate Tax Previously Assessed Based on Federal Estate Tax Return 7. Additional Pennsylvania Estate Tax Due TAX CREDITS: 73,985.21 69,328.15 4,657.06 .00 .00 PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 03-17-2008 CD009420 .00 4,6;57.06 08-11-2008 WRITEOFF .00 2,Oi53.79 TOTAL TAX CREDIT 4,657.06 BALANCE OF TAX DUE .00 • INTEREST AND PEN. .00 TOTAL DUE .00 ~ IF PAID AFTER THIS DATE, SEE REVERSE SIDE ~ IF TOTAL DUE IS LESS THAN $1, NI] PAYMENT IS REQUIRED. (~/ IF TOTAL DUE IS REFLECTED AS A "'CREDIT" CCR), YOU MAY '-"'~j REV-1470 EX (6-88) ti n~. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box. 280601 DECEDENT'S NAME REVIEWED BY ITEM SCHEDULE NO. Joyce R. Strawn Eunice Baker r INHERITANCE TAX EXPLANATION OF CHANGES FILE NUMBER ACN EXPLANATION OF CHANGES 2100-0548 201 In accordance with The Department of Revenue tax and interest has been waived. ROW Page 1 Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone:(717) 240-6345 Date: 4/30/2009 GREGORY HAMILTON STRAWN ~ ~' C ~ w ,'~ ~, _ 2£3 CEDAR CLIFF DRIVE r 'zc-7 .-~ ~~ C~~'IP HILL, PA 17011 ' "'~'~=-' ~ •;~ O .J _ c~ _`J =L) ~~ RE: Estate of BAYLER JOYCE RUTH File Number: 2000-00548 Dear Sir/Madam: TYiis notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. A~> per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, N0. 103 St1PREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. Tr.~is filing is due by: 5/26j2009 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, V Glenda Fanner Strasbaugh Clerk of the Orphans' Court cc: File Counsel ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF In Re: Estate of CUMBERLAND COUNTY BAYLER JOYCE RUTH : PENNSYLVANIA NO. 2000-00548 ~~; c-? ~: ~: "moo ..t~ _~, ~ c~- _-_ ` ~ as...- ~~7 NOTICE OF FAILURE TO FILE STATUS REPORT =, ~_~ - Personal Representative: GREGORY HAMILTON STRAWN =_-: -~ , .n. ~~~ ~-° - Counsel for Personal Representative: c::: Date of Decedent's Death: 5/26/2000 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. ~~~~ Date: 6/1/2009 Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File n-, JUN "~ 6 ZUOy~, IN RE: ESTATE OF BAYLER JOYCE RUTH ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2000-00548 NOTICE OF FAILURE TO FILE STATUS ~REPME COUR ORPHANSOCOU~T RULE HEARING PURSUANT TO RULE 6.12, SUP : _-~ ,,d _ ;_c;: a j ~- ~ .1=~7 Personal Representative: GREGORY HAMILTON STRAWN ~} m ' , -_~~;;~ -mot =., ~_-=; `~,,~ Counsel for Personal Representative: ` ~, c ~~ ~ _ ~_~ ~> 5/26/2000 -~=~ a' ~-7 Date of Decedent's Death: a N ~t+ Date of Delinquency Notice: The undersigned, Glenda Farner-Strasbaugh, Clerk of Orphans' Court, in accordance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberlande oersonal re resentathve have filed with the al representative nor the above named counsel for th p P Register of Wills or Clerk of the Orphans' Court his, her or its Status Repu suant to Rule 6.12, 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, p Supreme Court Orphans' Court Rules was given on the above date and that the ten (10) day notice to file the Status Report has expired. A unders glyed requestds that a CCourt conduct a Court is hereby notified of such delinquency and the ~ hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. ~'' Date: 6/15/2009 Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled Mondav. Julv 27, 2009 at 11AM date ill in Courtroom No. 2 • If the Status Report is filed prior to the ng automatically be cancelled. ~ ~ ~ Edgar B. Bayley, J. tea. ~.`:. ~~~e de~~ ~~_~~~'~ ~ ~ C-i~T~~ Ur `vzv"Ii_i.S OF-~UM~LC~[ 1--..e[~ COL~~TY", i ~~~- -~ +a le 0I Dec°~:°.-~ -- ~Dy~~ _L t/4 I `"' - Dare ~fDean;' _ ZOOD - GS' S - °''°~ File'~urmber: - paSy~ ~Lir~uuiil iv `c~u. U.C. ~Ui.', v. ~? T reravr~t the :'.~,llc`:: ~nC ~zn'i~ ~ e~Tl Pt_t i!1 !_(17 _l Yl1 P_. }'~ 1 . ~~~ r On pt Isle aCi111i11~rrari0ll Oi the abOVe-GaptlOned eSt3te: l . Mate ~uhelher adn:inistratior: of the estate is complete :................... . ~ Y~ s ,~'~ o 2. if the ans-vve~°is No; state when the personal representative reasonably believes that the administration will be complete: 0 3. If the answer to No. 1 is YES, state the following: a. Did the personal representative file a final~account with the Court? . . ..... Yes L1 No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? ......... . .. . ~~'es 0 ~; o d. Copies of receipts, releases„otp~lers and approvals of for-ma1 or informal accounts maybe filed with the Clerlc of `d7e Orphans' Cour and may be attached to this report. Dnte dG og pq Signature of" rson ri u2~ this corm GI~ '~:- _ ~1 ~~.'.~~v~~Q 5S ~Z1 ~+~- p? ~~~ ~uQZ u .: r,;, Forst P~,' l0 rain. ;O~fJ.OG ~ -- Capacity: ]Personal Representative []Counsel Name afPztson Ffltn,, dus arm 7 S?~~~~1~/~ ~JL~'f~t ndd, es, CAM ~ ~,4~ 71z/~_ S7/ - So77 Te[epho.ie ~~ Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF ( U NI ~ ~~ ,~,cl/~ COUNTY, PENNSYLVANIA Name of Decedent: J ~ Y ~ 1` ~V"f'r~ ST/Zf~wrtJ ~/~ ~ y r ~~ Date of Death: ~i"9' y ~6.?n< ZGoo File Number: Z ~0C9 - U D S =( $~ Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of the above-captioned estate: I. State whether administration of the estate is complete :.................... Yes ~ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is YES, state the following: a. Did the personal representative file a final account with the Court? ....... ]Yes I]No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the pazties in interest? ............ QYes ~No ................... d. Copies of receipts, releases, joinders and approvals of formal or informal accounts maybe ,//~~ filed with the Clerk of the Orphans' Court and may be attac d to this report. Dnte /~/~v~rr3,~%L /~ 20 o q LX~cuiZ~ Sign we of rsan Filing this Form 'dd ~ 0~ Q~'vi;i~BrRn~ Capacity: QPersonal Representative ~ Counsel ~anao `s`,r~-r+~dao ~ z,~ c r,R Nl /~, S', ~w,~ ~O na~~J Nmne ofPerson Filing tlus Form £ ~ I Wd 91 AON 60DZ Z ~ CE_OfF2 CczFr° /~~cs~>= Aedrers ~U 7JU9U'~~~wJ~)J-1`~~ ~~7^ S7/^ Sd77 Telephone ---~~