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06-25-08
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PEAIR MAX 15 FORTUNA LANE ENOLA, PA 17025 --- told PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: ssN: t92-3o-7s77 FILE NUMBER: 2107-0583 DECEDENT NAME: PEAIR DOLORES E DATE OF PAYMENT: 07/01 /2008 POSTMARK DATE: 06/25/2008 COUNTY: CUMBERLAND DATE OF DEATH: 06/06/2007 REV-1162 EX(11-96) NO. CD 009956 ACN ASSESSMENT AMOUNT CONTROL NUMBER 08120145 ~ 5123.22 08120146 ~ 567.74 TOTAL AMOUNT PAID: REMARKS: MAX PEAIR CHECK# 613 SEAL INITIALS: AKK 5190.96 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMDNWEALTH OF PENNSYLVANIA DEPARTMENT OF REYENUE INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE NO. 21 07-0583 DEPT. 280601 ACN 08120146 HARRISBURG, Pa 1712a-o6ol TAXPAYER RESPONSE DATE 05-12-2008 REV-1543 E% AFP (09-00) TYPE OF ACCOUNT EST. OF DOLORES E PEAIR ®SAVINGS S.S. N0. 192-30-7787 ^ cHECKINc DATE OF DEATH 06-06-2007 ^ TRUST COUNTY CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS TD: MAX J PEAIR REGISTER OF WILLS 15 FORTUNA LN CUMBERLAND CO COURT HOUSE ENOLA PA 17025 ~ CARLISLE, PA 17013 SOVEREIGN BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, You were a point owner/beneficiary of this account. If You feel this information is incorrect. please obtain written correction from the financial institution> attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth cf Pe^r,sYlvaria. ~~,estions may he answered by cal.liro (717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0924037005 Date 12-17-2004 To insure proper credit to your account, two Established I2) copies of this notice must accompany your Account Balance 903.13 payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax 451.57 (3) months of the decedent's date of death, TaX Rate X , 1Gj you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 67.74 nine C9) months after the date of death. PART TAXPAYER RESPONSE :~:a.~~:~E~~.:~r~~:::s-~~en~u~::~:~.~:~:_::;or;a~~s~..~.:...r~..a~•:::~~:~~r~*~r:a~:~r:e~;~a:~~:~~~~~~r:~~~~~ ~a~a__~r;u'r:x~~;~~~~~-;;~;. A. ~ The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. ONE BLOCK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. i s t o a i f e r n t t o r t e l e a s e state our ::;:;::;;€;~ :;e:ii ~ ~:€:;i+ ::::::::::::::: ~::::; _::::::::: :::::::::;::;:::::::~ ;:i ::;:: ~:::::: _::::::::.:.:::: PART If You Ind a d f e x a , P Y ::::;~_::`s=iss;::s:=_;::::ii:~~~~:::si::;{:~~.ii:::;r~i:;p:~€~, relationship to decedent: :...:.:.:.-, :.:.:.:.::.:::.:.:.:.:.:.:::.:.:.~:.::.:.,.:::.~,;_:.:.:.:.:...;:.:.:.:..::.:.-:. ;. ::::::~,::~_:::~:::;::::::: .............. .............:.:: 2 s_=~ss~~4~~D~l ::°HE~sITiifl::: ~E~FE~IUEi U T 0 0 A D JO NT/TRUST ACCOUNTS :'' ::• ::~::::::::::~ :::::::::::::::::::::::~::::.....:- _::~::::::::::::::~:: :~:~:;::~::~ ~~;:~R::: TAX RETURN - COMP TA I N F T X N I ~ •.•....__.__._....• ._._.__ ::::.::::....::._";::' L I is E :. D e t e E, t a b 2 i c h e d 1 ':?__:~ €.;:?;]:;;iia+:'.ai_ia;+-tu't~:::~:::. ..:.....:::::::: ;:.::-,-'::, ~~i!~::~'s;: 2. Account Balance 2 ~`` "~• ~~ ~~• ~~~•~~~ 3. Percent Taxable 3 X ~ ..;: ••: .:;:~;:::~;::-......:..::~:::::;:;:;.~;:{:';~ a ::::::::::::.::::: ~:~;:;,:::;:;:;:;::~::;:;:; :~::::;. 4. Amount Subject to Tax 4 ;€~~:=•[,;:;:t:;;:z;:i:::;:~~;:;:;:;, . :......::::..:.::~;:~:::~;:~::~;~:;,::::::;.......,.. ........ ::: ~ .. •.:,:. ] ................. w:w~+~.eF ................. :::: ::::::::: ~::: .......... ....:... .........._...., s:~;rr ....; 5. Debts and Deductions 5 ................ 6 . Amount Taxable 6 ~ :::::::::::::: ~:;:;:;:;:;:;:;:::;::: ;:;:;- • 'ii'i€€~:€i;ii=~ ~ i;izii's~i `tai=€i'i`iiii€~ i-_a"•.; 7. Tax Rate 7 X ~isi~' ::::: ::::::::::.:::::~::;:,.~ .. ........... ~iii~ i~ :s:a':~::;~€:'~~?€~` €i~':i':i€~iiii4~`:ii~€s ~ ii':i:~ :~ iii €~;si€isiii~i€i€i€sii':i':i€s:..:i:!..::_:ci `;s;::;:;:;:;: ............. 8 . Tax Due 8 ~:::::::::~ ::::- , :i :::::: .::.::::::€:::: i ::~ :;:;:::;:;:~ ;:::: ~;::,:;:;:; ~ :;:;:::;: :::::s:::::~ ::~ :::~ :::: PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID A URE TELEPHONE NUMBER DATE TOTAL (Enter on Line 5 of Tax Computation) S Under penalties of perjury, I declare that the facts I have reported above are true, correct and complgte,~t/o/the b t of my knowledge and belief. HOME C ~~ ~ ~'~a' / J '~ • WORK C ) GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with apvlicable interest based on information submitted by the financial institution. 2. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. A joint account is taxable even though the decedent's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one near prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one Year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fu11Y• REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with vour check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1546 EX) upon receipt of the return from the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17126-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 an according to the instructions below. Sign two copies and submit them with vour check for the amount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of dea NOTE: taxableefullyta~transfers.12However,Atheretiswancexclusionenotttouexceedo$3t000mperwtransferee(regardless ofatheavalue of the account or the number of accounts held. If a double asterisk (^~) appears before vour first name in the address portion of this notice, the $3,000 exclusion already has been deducted from the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is tau able for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: X 100 = PERCENT TAXABLE 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY SURVIYINGBJOINT OWNERS JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 100 = 16.7% (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one near of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one near of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 7. Enter the appropriate tax rate Cline 7) as determined below. Spouse Lineal Sibling Collateral Date of Death 6/ 15% 15% 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 0% 4.5%* 12% 15% 07/01/00 to present ^The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%. The lineal class of heirs includes grandparents, Parents, children, and lineal descendents. "Children" includes natural children natural parentstand theirbdescendents,bwhethersoranottthevhhaveebeendadoptedhbYdothersLladoptedsdescendentsnanddtheirldescendantsf the and step descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficDE$TS AND DEDUCTIONS CLAIMED CLAIMED DEDUCTIONS - PART 3 - Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually Paid the debts after death of the decedent and can furnish proof of paymen . C. Debts being claimed must be itemized fully in Part~~3a^ Ief additional space is needed, use plain paper 8 1/2" x 11". Proof of COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE FILE No. 21 07-0583 BUREAU OF INDIVIDUAL TAXES AN D DEPT. 280601 ACN 08120145 HARRISBURG, PA 171za-0601 TAXPAYER R E S P O N S E DATE 05-12-2008 REV-1543 E7( AFP (09-007 TYPE OF ACCOUNT EST. OF DOLORES E PEAIR ^ savlNGs S.S. N0. 192-30-7787 ®cHECKING DATE OF DEATH 06-06-2007 ^ TRUST COUNTY CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS T0: MAX J PEAIR REGISTER OF WILLS 15 FORTUNA LN CUMBERLAND CO COURT HOUSE ENOLA PA 17025 CARLISLE, PA 17013 SOVEREIGN BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a point owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of ?enn~ylrania. Cuestions may ba ansrere~! b,• calling (717? 7A7-A:i?7. COMPLETE PART 1 BELOW * * ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0921727232 Date 08-25-2004 To insure proper credit to your account, two Established (2) copies of this notice must accompany your payment to the Register of Wills. Make check Account Balance 1 , 642.91 payable to: "Register of wills, Agent". Percent Taxable X 50.000 NDTE: If tax payments are made within three Amount Subject to Tax 821.46 (3) months of the decedent's date of death, Tax Rate X lrj You may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 123 • 22 nine C9) months after the date of death. PART TAXPAYER RESPONSE ,~::~"~'.~~~t~~":: _,:'C':#~~,_~'.k~"'~' '~:Y~'1135:-.,Ll,'E"~.~...:~r'.~y.~).E:..~e.:•.y~~.isF~3~'~.'~'1...C'C'fii~'%''1:~;~L:~ii:}'!i~'S7i.'~~'"'itCf~C"'~f''~C137~~~i?!''~F:'6:~Cfi:''~i3!!1:<t!'~1'f3i31:}::..a~i.:EIE~F:ICiEii; i3l:Ifi:'1~11!':!%~ilL}:.} A. The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. C 0 N E ~ BLOCK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/or PART 3^ below. t~ PART If ou ind'ca e f r Y i t a di fe ent tax rate, please state your ::::::::::::.:::::::::::::~:::::::~::::::::::.•-•.:: i:`i:'Si~i:`:`':i'ss'i;~ii':i. ` .:i . -.:,:.:.:::::.:.:.::::.:.: -_ -:::-:,...___:.:::::::,::::,:::: °"""""'`"'' '"'"='`'° ` ° ""' ': ` ;li ~ ........ ~ ::€::~€€€ ii~^ _...;,..., ::!i:'i ~ 2 r e 1 a t i o n s h 1 P t o decedent : .:.:::.:.:.:.:.:.:.:.:.:.:.....:.:.:. : ...:.::..::.. ............................ :::::a:::::::: ~:~ :::.:::: < ~:, s:::~ -~• -~'': ;; ~ ;:;;:sss ' ~ ~`~ ~':~ ~ ~ ~ ~ ~i''~.:: . :. : 'a"':s[ii ° ....:~: . ~ ~~€'iEiiESiEsiEsi TAX RE TURN COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS :: g;~'?7~4D;;'':°°°::::"°::::°°:~' ~:• ~~::=::::_: ~~^'::: "~:::::-:::::: LINE I. Date E s t a b 1 i s I ~ e d 1 .. ::::: ::::::::::tii€s s:€:p _:'sii=_;:~~ :~ :. .................. .. ...u ._ :,:,:,:,:,:.:.::.:.:,;:.:.:.:.:....: ;:1;::: :,;:;:~ ss; ....... 2 . Account Balance 2 ::::::::~ ::: ~::- • .: -:,:,:.::~::::,:::,.: ~ i:::... .. • :.:.:.::€ ~~~ :: ;_ :i:;:€:;:;::;,;;€~ €:;:; ~:-~ !ap:~ ;tt;€¢:;a;t~ €[ 3 . Percent Taxable 3 X :s~:::s:=;: ~;; ....:::::::::::::::::::::::::: ~:::::::.. :..::......:.............:.:.....................:::.... iiiiiii ~' iii€~ s ....:::~::,:,:,: . . . ;:::;:;:;;:::::: .,~' ~'i€i~;9i~i:€i:`:;<.~"s'iE's' : nisi:;':€:~ii:€s: a* . mount Subject t o Tax 4 s:.:: s :::::::::: ~:::::: iii~~iiiisi:.: ~ i::~ _ ~ ;:s~' ;::;;:~ ::~ :: :::::::::::::::: ~ ;:;,•. .utiwr, .. : '.[_ri~ ~ ~~z'1='i=;;=€'€[i~ ~ iisi~ ~- :.:;: S°~s~ ;;~ ins;€iRiii9iii€i ..:::::;: ;:;:,;:;:; .:.:.:,:,:,,:,:.:,:;:;:; • rs :. ~:;:;- =;:;:; __;:;:;:: ~~" ~a~a:~,: 5. Debts and Deductions 5 - ::: :: :~: r :::. i 6. Amount Taxable 6 - 7. Tax R to X a 7 :iiii'~`i~~'[~~I?`~=~ i~~''i'5`;i_~~~rs~~~~a~~~`':5~=~~~i ~i'i ... ................ 8. Tax Due 8 ~, PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) S Under penaltie of perjury, I declare that the facts I have reported above are true, correct and compl to to t be t of my knowledge and belief. HOME C ) ~ ~1~ f, ,,~ WORK C ) TAXPAYER•SI NATURE TELEPHONE NUMBER DATE GENERAL INFORMATlun 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. 2. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. A joint account is taxable even though the decedent's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one Year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REY-1548 EX) upon receipt of the return from the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative> place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 an according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of deat . NOTE: iaxableefullytasytransfers.12However,Atheretiswancexclusionenotttouexceedo53t000mperwtransferee(regardless ofatheavalue of the account or the number of accounts held. If a double asterisk C^~) appears before your first name in the address portion of this notice, the 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The vercent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY SURVIYINGBJOINT OWNERS X 100 = PERCENT TAXABLE JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 100 = 16.7% (TAXABLE FOR EACH SURVIVOR) B. The Dercent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4 . 7. Enter the appropriate tax rate (line 7) as determined below. Spouse Lineal Sibling Collateral Date of Death 6% 15% 15% 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 4.5%* 12% 15% 07/01/00 to present 0% The tax rate imposed on the net value of transfers from a deceased child twenty-one Years of age or Younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children natural parentstand theirbdescendents,bwhethersoranottthevhhaveebeendadoptedhbYdothersLladoptedsdescendentsnanddtheirldescendantsf the and step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficDEBTS AND DEDUCTIONS CLAIMED CLAIMED DEDUCTIONS - PART 3 - Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of paymen . C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper B 1/2" x 11". Proof of payment may be requested by the PA Department of Revenue. Y Q ~„~ ; ~ ~ ~ O ~~, r ~ ~ ~ ©N a.0~~ o ~" ~ o .n Z~ v' ~ ~ x t r~ o ~1 J ;. u Fy o o ~~~ a ~ N Z D ~d ~ - ~-M V \w ..~~ L~ ` ..... ~~ .r~ ` ~. 3 } ..... ~ T~y e r , i C:. ~ ! .~ ~ ~~ ,y „. ~.... t' i ~ ~ _. .~.A _ ~~ ~ ~ C+~ ~~~-t,, `- i I ~.,- 1' _~~