HomeMy WebLinkAbout02-11-09 5056051058
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 08 00598
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
185-26-9123 05/12/2008 05/29/1936
Decedent's Last Name Suffix Decedent's First Name MI
Williams John Fi
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Williams Shirley M
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
• 1. Original Retum 2. Supplemental Return 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required
death after 12-12-82)
• 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
Ricky Patrick, Executor (717) 766-2763
Firm Name (If Applicable)
REGISTER OF WILLS USE ONLY
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First line of address ~ ~ __
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121 Rldge Hill Road _L ~ ~ t
Second line of address ~ ~ -- ~ ~
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-f:~'- .f. _.~-1
City or Post Office State ZIP Code DAT~~F LED ~ ~ "'; :-r
Mechanicsbur --
9 PA 17050-1770 ~ ~ ~~ ~ ~ ~ ~;
Correspondent's a-mail address: rlCkpatrlCk@COn1C8St.net
Under penalties of perjury, I declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of pre aver other than the personal representative is based on all information of which preparer has any knowledge.
SIGNAT ~ERS R P SIBLE FILING RETURN D TE
ADDRES~ 4' ~
SIGNATURE OF P ARER OTHER THAN REPRESENTATIVE DATE
- '- >l /7Zt~'
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056051058 15056051058
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REV-'1500 EX
15056052059
Decedent's Name: X01111 H WIIIIamS
RECAPITULATION
1. Real estate (Schedule A) ............................................. 1
2. Stocks and Borids(Schedule B) ....................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages & Notes Receivable (Schedule D) ........................... .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5.
6. Jointly Owned Property (Schedule F) Separate Billing Requested ..... .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested...... .. 7.
8. Total Gross Assets (total Lines 1-7) .................................. .. 8.
9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............... . 10.
11. Total Deductions (total Lines 9 & 10) .................................. . 11.
12. Net Value of Estate (Line 8 minus Line 11) ............................. . 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ....................... . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... . 14.
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0 0 11,282.93 15.
16. Amount of Line 14 taxable
at lineal rate X .0 _ 0.00 16.
17. Amount of Line 14 taxable
at sibling rate y; .12 0.00 17
18. Amount of Line 14 taxable
0.00
at collateral rate X .15
1 g,
19. TAX DUE .........................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059 Side 2
Decedent's Social Security Number
185-26-9123
20,917.90
20,917.90
9,634.97
9,634.97
11,282.93
11,282.93
0.00
0.00
0.00
0.00
0.00
15056052059
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 08 00598
DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER
John H Williams 185-26-9123
STREET ADDRESS
706 Cedar Ridge Lane
CITY STATE zlp
Mechanicsburg PA 17055-6917
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments 0.00
A. Spousal Poverty Credit
B. Prior Payments 0.00
C. Discount 0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
0.00
(1)
Total Credits (A + B + C) (2)
Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A.. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
0.00
0.00
0.00
0.00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred :.......................................................................................... ^
b. retain the right to designate who shall use the property transferred or its income : ............................................ ^
c. retain a reversionary interest; or .......................................................................................................................... ^
d. receive the promise for life of either payments, benefits or care? ...................................................................... ^
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. ^
3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? .............. ^ ^x
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ ^ ^Q
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July '1, 2000:
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 zero (0) percent [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is iwelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
John H. Williams 210800598
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorshia must be disclosed on Schedule F
(u more space is neeaea, insert addmonal sheets of the same size)
EV-1511 EX+ (12-99)
SCHEDULE N
COMMONWEALTH OF (PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TA;{ RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
John H. Williams 210800598
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1 ~ Parthemore funeral Home and Cremations Services
9,525.97
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
0.00
Name of Personal Representative(s) Ricky N Patrick
.Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 121 Ridge Hill Road
city Mechanicsburg .state PA zip 17050
Year(s) Commission Paid: N/A
2. Attorney Fees 0.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 0.00
Claimant
Street Address
City State .Zip
Relationship of Claimant to Decedent
4. Probate Fees 109.00
5. Accountant's Fees 0.00
6. Tax Return Preparer's Fees 0.00
7
TOTAL (Also enter on line 9, Recapitulation) I $ 9,634.97
(If more space is needed, insert additional sheets of the same size)
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REGISTER OF WILLS
CUMBERLANa COUNTY
PENNSYLVANIA
CERTIFICATE OF
GRANT OF LETTERS
No . 2008- 00598 PA No . 21- 08- 0598
Estate Of : JOHN H WILLIAMS
(First, Midd/e, Lastl
Late Of : UPPER ALLEN TOWNSHIP
CUMBERLAND COUNTY
Deceased
Social Security No: 185-26-9123
WHEREAS, on the 2nd day of June 2008 an instrument dated
October 3rd 2007 was admitted to probate as the last will of
JOHN H WILLIAMS
(First, Middle, Lastl
1a to of UPPER ALLEN TOWNSHIP, CUMBERLAND County,
who died on t:he 12th day of May 2008 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE;, I, GLENDA EARNER STRASBAUGH Register of Wi 1I s in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
RICKY N PA TRICK
who has duly qualified as EXECUTOR(R/Xl
and has agreed to administer the estate according to Iaw, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 2nd day of June 2008.
~ ~ -
2l2.ec.
egiste Ills
C~.
e
* *NOT~s'* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
Last Will And Testament
Of _~
JOHN H. WILLIAMS ~~ °° z l `A'
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_i (J
I, JGHN H. WILLIAMS, of Cumberland County, Pennsylvania, bei~$f sour mi>id; ~'
disposing memory and full legal age, do hereby make, publish and declare this to be my I~xst Will '
and Testamf;nt, hereby revoking all Wills and Codicils heretofore made by me.
PARAGRAPH 1. I direct my Executor or Executrix, as the case may be, to pay all of
my debts, funeral and administrative expenses as soon as convenient after my decease.
Furthermore, I direct that all state, inheritance, succession and other death taxes imposed
or payable by reason of my death and interest and penalties thereon with respect to all
property composing of my gross estate for death tax purposes, whether or not such
property passes under this will, shall be paid by the Executor or Executrix of my estate.
PARAGRAPH 2. My Executor or Executrix may, at his or her discretion, compromise
claims, borrow money, retain property for such length of time as he or she may deem
proper; lease and sell property for such prices, on such teams, at public or private sales, as
he or she may deem proper; and invest estate property and income without restriction to
legal investments unless otherwise provided hereunder. I authorize and empower my
Executor or Executrix to sell any realty and/or personally owned by me at my death and
not specifically devised or bequeathed herein, at public or private sale or sales and to give
good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living.
My Executor or Executrix is authorized and empowered to engage in any business in
which I may be engaged at my death, for such period of time after my death as seems
expedient to said Executor or Executrix.
~~
Initials: ~
PARAGRAPH 3. I give, devise and bequeath all of the balance of my estate of
whatever nature and wherever situate, including but not limited to all tangible personal
property owned by me at the time of my death, together with all insurance policies
thereon, unto my spouse SHIRLEY P. WILLIAMS, if she survives me by thirty (30) days.
PARAGRAPH 4. In the event that my wife predeceases me or fails to survive me by
thirty (30} days, I then give, devise and bequeath all of the balance of my estate of
whatever nature and wherever situate to my sisters and brothers, JOAN GELORMINO, of
Patton, Pennsylvania, BRENDA WILLIAMS-DENZER, of Belsano, Pennsylvania and
TIMOTHY H. WILLIAMS, of Strongstown, Pennsylvania, in as nearly equal shares as is
practicable, not per stirpes.
PARAGRAPH 6. I direct that any and ail Inheritance, Estate, and "transfer Taxes
imposed upon my estate passing under this will, or otherwise, shall be paid out of the
principal of my residuary estate.
PARAGRAPH 7. I nominate and appoint my brother-in-law, RICKY PATRICK, of
Mechanicsburg, Pennsylvania, to be the Executor of this my Last Will and Testament. If
he predeceases me, fails to qualify or is not able or does not serve for whatever reason,
then in ]lis place I appoint my spouse, SHIRLEY P. WILLIAMS, to be the Executrix of
my e:sate.
PARAGRAPH 8. In addition to the powers conferred by law, I authorize my Executor,
in his absolute discretion:
(a) To retain in the form received, and to sell either at public or private sale any
real or personal property.
Initials: _~~«/
(b) To manage real estate.
(c) To invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principle of diversification.
(d) To exercise any option or rights arising from ownership of investments.
(e) To compromise claims without court approval, and without the consent of any
beneficiary.
PARAGRAPH 9. No person(s) shall benefit hereunder unless such beneficiary shall
survive me by thirty (30) days.
PARAGRAPH 10. No Executrix, Executor or Trustee acting hereunder shall be
required to post bond or enter security in this or any other jurisdiction.
PARAGRAPH 11. No beneficiary may assign or anticipate his or her interest in any
incorr~e or principal held or distributable hereunder; and no beneficiary's creditors may
attach or otherwise reach any such interest.
PAR.a-GRAPH 12. (OPTIONAL PARAGRAPH) I direct and otherwise recommend
that rriy Executor and any successor Executor utilize the services of the Law Offices of
Peter ;1. Russo, P.C., of 3800 Market Street, Camp Hill, Pennsylvania 17011 to pc•obate my
estate as they have become familiar with my wishes and desires.
Initials: ~~~~
IN WITNESS WHEREOF, I have hereunto set my hand and seal this J
' ~.t- ; ,~ ~'~, 2007.
day of
/~1J ~f t r
J H. WILLIANIS
Initials: ~ `'~
The preceding instrument, consisting of this and 4 other typewritten pages, was on the date
thereof signed, by the above-named Testator as his Last Will, in the presence of us, who at his
request, in l~-is presence and in presence of each other, have subscribed our names as witnesses
hereto.
~,
Ashley R ipe
3800 Mar et Street
Camp Hill, :PA
~ -Gt-~.,~,'t~.
Dorothy D. eberle
3800 Market Street
Camp Hill, PA
~,
Initials: ~u'
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
I, JOHN H. WILLIAMS, whose name is signed to the attached or foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I signed and executed
this instrument as my Last Will; that I signed it willingly, and that I signed it as my free and
voluntary act for the purposes therein expressed.
Jq H. WILLIAMS
Sworn to and subsc~ed
before me this :3 ~' day of
Lr'~~'~IC-- , 2007
~..~~
Notary Publiic
~4MM EALTfi OF PENN YLVANIA
Notarial Seal
Cesar L. Buono, Notary Public
Camp t~ili Boro, Amtbeiiand Cotmty
My Commission E~ir~es Jan.15, 2008
Member, Penn»ylva~ia Association Ot Notaries
Initials; •-~ G~
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY ()F CUMBERLAND
SS
We, .Ashley R. Sipe and Dorothy D Haeberle, the witnesses whose names are signed to the
attached or foregoing instrument, being duly qualified according to law, do depose and say that
we were present and saw JOHN H. WILLIAMS, Testator, sign and execute the instrument as his
Last Will; and that he executed it as his free and voluntary act for the purposes therein expressed;
that each of tis in the hearing and sight of the Testator signed the Will as witnesses; and that to the
best of our knowledge the Testator was at the time 18 or more years of age, of sound mind and
under no constraint or undue influence.
'` ~~,
Ashley R. i e
3800 Mark ;street
Camp Hill, PA 17011
Sworn to and ;subscri d
before e this 3 ~ day of
K~ , 2007.
Notary Public
Initials: ---y-F~=~
-~ ~. ,
~~
Dorothy D. H Berle
3800 Market Street
Camp Hill, PA 17011
CUMMQN EAI.~iH OF PENNSYLVANIA
Notarial Seal
Cesar L. Buono. Notary Public
fianp FYiI Born, C~m~bertand Cotuity
My C:orrx-~ssion ExRiras Jan. 15, 2008
l,~eintier, PBnnavlvan~A AssoCtatton Of Notaries
F>r•ee Checking ~~ccount Statement
f'~;C Bank
For till9 period 06/04/2008 to 06/18/2008
EST OF JOHN H WILLIAMS DECD
RICKY N PATRICK EXTR
121 RIDGE HILL RD
MECHANICSBURG PA 17050-1770
For 24-hour banking, and transaction or
interest rate information, sign on to
'a PNC Bank Online Banking at pnc.com.
For customer service call 1-888-PNC-BANK
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Para servicio en espallol, 1-866-HOLA-PNC
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® Write to: Customer Service
PO Box 609
Pittsburgh PA 15230-9738
Visit us at pnc.com
TDDterminal:l-800-531-1648
For hearing unpaired clients Drily
IMPORTANT 1NFORl~4ATI01\f ABOUT ATM TRANSACTIONS AND PURCHASES
For your convenience, under certain conditions we may allow you to overdraft your checking or tnoney market account when using your PNC
Bank Visa Check Card or PNC Bank Banking Card at PNC Bank ATMs, non-PNC ATMs, and for merchant purchases. At PNC Bank ATMs
we can give you the choice to ca.ncet the transaction if it would cause an overdraft. We are not able to provide you this choice when using a
non-PNC Bank ATM or when rrlaking purchases.
Effective .tune 22, 2008, if you would prefer not to have overdraft access, caN our Telephone Banking service at 1-877-222-5401 between
6 atn - 12 midnight, Eastern Tune, seven days a week.
If you have called previously to opt-out of overdraft access at non-PNC ATA4s, you are automatically excluded from overdraft access for all
A'11~t transactions and purchases and do not need to call again.
For more information, please see our Consumer Schedule of Service Charges and Fees, Other Account Charges and Services and/or Account
Agreement for Personal Checking and Savings Accounts, Withdrawals section.
Free Checking Account Summary Est Of John H Williams Decd
Account number: 50-0428-13 i6 Ricky N Patrick Extr
nsa~ancs ,ummary
Please see the Activity Detail section for
Beginning Deposits and Checks and other Ending additional information.
balance ocher additions deductions balance
-~ 20,917.90 AO 20,917.90
Average monthly Charges
balance and Tees
20,91'7.90 .p0
Activity Detail
Deposits and Other Additions
Date t OescriFdion
06/04 20,917.90 Deposit Reference No 022147402
Dail
B
l
D
il
y
a
ance
eta
D Value of CDs 31300282517
ate Balance
o6/n4 20,017.90 ,
31400325820. 31600324727, at
time of death rolled directly into
estate account.
PNCBANK
Primary account number: 50-0428-1316
Page 1 of 1
Number of enclosures: 0
mere was 1 Deposit or Other Addition
totaling $20,817.80.
FORM953R-1005
PNC BANK, N.A.
10/09/2007
e~~
JOHN H WILL:[AMS
706 CEDAR R][DGE LN
MECHANICSBURG, PA 17055-5469
B PNCBANK
Dear Customer:
Thank you for investing with us. The information shown below provides a confirmation of your
reinvestment instructions or to other changes made on your account. Please review it for accuracy
and keep this information with your other important records.
Should you have any questions about your Certificate of Deposit or any of our other services stop by
any PNC Bank olTce or call us at 1-877-BANK-PNC. '
Thank you for banking with us. We look forward to continuing to serve you.
>~ `C~
David F. Ross, Vice President
Product Management and Marketing
JOHN H WILLIAMS
706 CEDAR RIDGE LN
MECHANICSBURG, PA 17055-5469
Certificate Investment
Number Additional Total
Amounnt
000031300282517 $10
653
60 Amount
0 Investment
,
. $.
0 $10,653.60
Investment
Dexription
1 YEAR FIXED RATE
ronHOa tyros
iu~ni _mn,c
Certificate of Deposit
Investment Confirmation
Renewal Interest Annual Percentage
Date Rate Yield (APY)
10/09/2(108 2.800%, 2.84°l0
Certificate of ]Deposit
"Account Verification
PNC Bank National Association
JOHN H WILLIArvIS
706 CEDAR RIDGE LN
MECHANICSBUR',G PA 17055
Base
Interest Rate
2.5200
Package Points
0.0500
Page 1 of 2
B PNCBANK
Account used to purchase this certificate:
PNC Bank 5140069141
Interest Rate Effective Until
2.570 02/11/2009
040 Please review the Account Agreement on reverse side for important information about this account. Member
EFORM000055-0505 F~~C
Certificate of Deposit
Account Verification
PNC Bank National Association
JOHN H WILLIAMS
706 CEDAR RIDGE LN
MECHANICSBURG PA 17055
Base
Interest Rate
3.2030
Package Points
0.0500
Page 1 of 2 ~ pNCBANK
Certificate Number
31600324727 Reference Number
3300111613
Purchase Date
03/11/2008 Purchase Amount
$ 5.000.00
Maturity Date
08/11/2008 Term
5 MONTHS
Annual Percentage Yield
3.2900
Renewal Type
AUTOMATIC
Product Description
FIXED RATE CD
For Information, Call
1-877-BANK-PNC
Account used to purchase this certificate:
PNC Bank 5140069141
Interest Rate Effective Until
3.253 08/11/2008
040 Please rf;view the Account Agreement on reverse side for important information about this account. Member
EFORM000055-0505 ~D'~