HomeMy WebLinkAbout08-22-111505610143
REV-1500 EXr41-10)
PA Department of Revenue Imo- OFFICIAL USE ONLY
pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO Box.2sosoi INHERITANCE TAX RETURN 21 ~ ~ ~1 ~~ >I 1
Harrisburg, PA ~ 7128-060 RESIDENT DECEDENT V `'1
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
180 07 1593 06 13 2011 04 19 1924
Decedent's Last Name Suffix Decedent's First Name MI
TOCKET NEILO J
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
1. Original Retum ~ 2. Supplemental Return
3 Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ qa. Future Interest Compromise
(date of death after 12-12-82) ((~~
l-J 5. Federal Estate Tax Return R wired
eq
~___1 g Decedent Died Testate
~J (Attach Copy of Will) (
L~ ~ Decedent Maintained a Living Trust
(Attach Copy of Trust)
8. Total Number of Safe Deposit Boxes
9. Litigation Proceeds Received ~ 1 p. Spousal Poverty_ Credit (date of death
between 12-31- 1 and T-1-95) ~;~
~
~ 1 ~,~ .Election to tax under Sec. 9113 A
( )
-- (Attach SCh. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
DAVID J LENOX 71.7 4 3 2 9 6 6 6
First line of address
3 N BALTIMORE ST
Second line of address
City or Post Office State ZIP Code
DILLSBURG pA
Correspondent's a-mail address: daVelenOX@COn1CaSt.net
REGISTER OF~ILLS USE ONLY
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vnoer penat[les or perjury, t deGare that I have exam d this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, ct and complete. DeGaration of preps r other than the personal representative Is based on alt information of which preparer has any knowledge.
SIGN RE PERSO SPONSIBLE F FILING ~RN DATE ~
Ai ~r - - ,
nthia A. Shee
s-~i~
7 Longwood Drive, Mechanicsburg, PA 17050
SIGNAT PREP THER AN REPRESENTA
D TE
David J. Lenox g ~ - ~~
ADDRESS
3 N. Baltimore St., Dillsburg, PA
Side 1
1505,10143 1,505610143
J 1505610243
REV-1500 EX
Decedent's Social Security Number
Decedents Name: Tocket, Neilo J. 18 0 0 7 15 93
RECAPITULATION
1. Real Estate (Schedule A) ....................................................................................... 1.
2. Stocks and Bonds (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. 2 , 217.15
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers & Miscellaneous I~.oq Probate Property
(Schedule G)
S
u
eparate Billing Requested............ 7.
42,650.14
8. Total Gross Assets (total Lines 1-7) .............. 8
. 4 4, 8 6 7. 2 9
9. Funeral Expenses 8 Administrative Costs (Schedule H) ....................................... 9. 1 , 3 98.4 7
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .............................. 10. 2 , 68 9.05
11. Total Deductions (total Lines 9 & 10) ....................
............................................... 11 • 4 , 08 7.52
12. Net Value of Estate (Line 8 minus Line 11) .........................
. ................................
12. 4 0
7 7 9
7 7
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. 4 0 , 7 7 9 . 7 7
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 .00 15, ~ . 0 ~
16. Amount of Line 14 taxable
at lineal rate X .045 4 0, 7 7 9. 7 7 16. 1, 8 3 5. 0 9
17. Amount of Line 14 taxable
at sibling rate X .12 0. 0 0 17. 0. 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 0. 0 0 18. 0, 0 0
19. Tax Due .................................................................................................................. 19. 1 , 835.0 9
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^
Side 2
L 1505610243 15D5610243 J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Tocket, Neilo J.
STREET ADDRESS
2100 Bent Creek Blvd.
CITY
Mechanicsburg
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
91.75
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
1,835.09
91.75
(5) 1, 743.34
Make Check Pa able to: REGISTER OF WILLS,. AGENT.
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOC
KS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred :................................
.... ........................................... x
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? ............................................................ ~ x
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ..............................................................................................
...................... ^ 0
3. Did decedent own an "in trust 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? ...............
.......................................................................
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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the survivin
spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. 9
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 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 21 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 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 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 12 percent [72 P.S. §9116 (a) (1.3)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
File Number 21
STATE ZIP
PA 17050
(1)
Total Credits (A + B) (2)
(3)
(4)
Rev-1508 EX+ {6-98)
COMMONWEALTH OF PENNSYLVANIA
INNFRITeNt^c Tev ocr iow~
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
FfLE NUMgFR
"-' ~~-~-•~„--•••-•s ~^••~~ ~~•~~ .~~~ ~~y~~~ car surnvorsmp must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Refund Bridges at Bent Creek
2 Refund Comcast
3 Refund United American Insurance
VALUE AT DATE
OF DEATH
2,073.50
14.65
129.00
TOTAL (Also enter on Line 5, Recapitulation) I 2,217.15
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
Rev-1510 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
T....L..~ wl..:~.. ~
FILE NUMBER
21
I rns scneoule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 CCIVER SHEET is yes.
~~, ~ ~ ~~~ ~ ~Na~C +~ ~ ~aeueu, aaDl[lonai pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98)
REV-1151 EX+ (10-06)
COMMONWEALTH OF PEN YLVANIA
INHE~IT CE TAX R T~RN
RE (DENT OE EDEN
ESTATE OF
Tocket, Neilo J.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ITEM
N MBE
A.
FUNERAL EXPENSES:
FILE NUMBER
21
AMOUNT
See continuation schedule(sj attached I 883.47
Debts of decedent must be reported on Schedule I.
DESCRIPTION
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State zip
Year(s) Commission paid
2. Attorney's Fees The Wiley Group, PC 500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State
ZiD
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
15.00
TOTAL (Also enter on line 9, Recapitulation) I 1 398 47
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF
Tocket, Neilo J. FILE NUMBER
21
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Ex -nSpc
1 Funeral Luncheon
569.36
2 Mapezzi Funeral Home
Copyright (c) 2002 form software only The Lackner Group, Inc.
314.11
H-A 883.47
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1512 EX+ (12-08)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE i
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Tocket, Neilo J.
FILE NUMBER
21
Report debts incurred by the decedent
rior to d
th
p
ea
that remained unpaid at the date of death, including unreimbursed medical expenses
ITEM .
NUMBER DESCRIPTION VALUE AT DATE
1 OF DEATH
Alert Pharmacy
15.43
2 Alert Pharmacy
23.62
3 Return of Veterans Administration Automatic Deposit
1,644.00
4 Visiting Caregiver Bill Owed at date of death
1,006.00
TOTAL (Also enter on Line 10, Recapitulation) I 2,689.05
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 12-08)
REV-1513 EX+ (11-08)
COMM_Q~~EAITDF pF~~yLyANIA
SCHEDULE J
BENEFICIARIES
ESTATE OF
Tocket, Neilo J. FILE NUMBER
21
NUMBER NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOU
PERSON(S) RECEIVING PROPERTY DECEDENT
I TAXABLE DISTRIBUTIONS [include outright spousal (Words)
distributions, and transfers
under Sec. 9116 a 1.2
1 Susan Richter Daughter 50%
8 Irongate Court
Mechanicsburg, PA 17050
2 Cynthia A. Sheely Daughter 50%
7 Longwood Drive
Mechanicsburg, PA 17050
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 ovOeasheet as a I ~
jI• NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
T OF ESTATE
($$$)
20,389.89
20,389.89
40,779.78
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET
Copynght (c) 2009 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 11-08)
LISTENING IS JUST THE BEGINNING.'"
July l , 2011
The Wiley Group
3 N. Baltimore Street
Dillsburg, PA 17019
Dear Mr. Lenox,
RE: Neil J. Tocket, deceased June 13, 2011
In response to your recent inquiry concerning the accounts maintained in the name of
the decedent, please be advised that the following account was open at the date of death:
Checking #3622-22782 Date of death balance $42,,650.14, opened 10/23/02,
titled in his name alone In. Trust For Cynthia A.
Shealy and Susan Richter (Cynthia and Susan both
added 3 /25/ 11)
If you have any other questions, please feel free to contact me at (717) :Z91-2436.
Sincerely,
~~
.loshua A. Groff
Credit Confirmation Pr;,c?ssor
VV~~~~~~~~~~
This in#or~nation is #umighed as a matter of Ausineas oaarlesy
in answer to your wry, and is br your confidant~at uoe only.
The bank #umishfia~ this information does rx~1 repreeerx t-r
quarxntee the accuracy, completeness or rel+>ab~ity of the
information provided, No resExx>rgibility sa a ~ the
hank or any of its officers. ampbyeee or aper>~. My c+pbion
Herein expresfB>•<i is sr,h~~ct is change without notice
1.800.FULTON.4 ~ fultonbank.com
Fulton Bank. N A Me.-~;~.- ~- sir ~~.,,-,t~pr of the Fulton F:nanri,,~ '- ~n,~l
Jan M. Wiley
David J. Lenox
THE WILEY GROUP
Attorneys at Law
August 19, 2011
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
In Re: Neilo J. Tocket, deceased
Enclosed please find an inheritance tax return and original death certificate for this non-probate
estate. I am also enclosing a check in the amount of $1,743.34 for payment of the inheritance
tax, and a check in the amount of $15.00 for the tiling fee.
Please return the receipts to my attention. I am enclosing an envelope for your use.
Sincerely,
David J. Lenox., Esquire
DJL/sdg
encl.
3 N. Baltimore Street • Dillsburg, PA 17019 Phone: (717) 432-9666 (800) 682-4250 Fax: (717) 432-0426
i1~F.90~ n.~ V.(lil;
This is to certify that this is a true copy of the record which is on file in the Pennsylvania L-epartment of Health, in accordance with
the Vital Statistics Law of 1953, as amended.
WARNING: It is illegal to duplicate this copy by photostat or photograph. -
Marina O'Reilly Matthew
Acting State Registrar
0272704
No.
H705-U3 REV 11/2006
TYPE !PRINT IN
PERMANENT
~ByACK INK
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JU L 012011
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~~ V ~ ~ - ~r
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CERTIFICATE OF DEATH ~ "; ; r ~' '~-^z~
(See instructions and examples on reverse) CTATF F11 C Al11AA000MCI ~-~ i.../
i. Name d Decedent (First, middle, Iasi, suffix) 2. Sex 3. Sodal Security Number 4, of Death (Month, day, year
,
Neilo J. Tocket Male 180 - 07 - 1593 ~. .
1 1
5. Age (Last Birthday) lAMer 1 ar Under 1 da 6. Date d Birth Month, da , rr 7. BiM ace C' and state or for e' n coon 6a. %ace of Death Check one
Months Days Hours Mnutes Hospital: Other
91 yrs. A ri 1 19 1920 Pen 1 PA ^ Inpatient ^ ER / Outpebent ^ DOA Nursing Hone ^ Residence ^ otrt« -Specify:
86. County of Death &. Ciy, Boro, Twp. of Death 8d. Faciiry Name (If nd institution, ghre street and number) 9. Was Decedent of Hispanic Origin? ®~ ^ Yes 10. Race: American Indian, Black, WMte, etc.
~ al yea, apecky aban, (spe~;
Ctiimberland Silver in
Spr
g TWp. Bridges At Bent Creel{ Mexican, Puedo Rican, etc.) Wlz7. e
11. Deadent's Ustrel d work done mast d world Me. Do rat state refired 12. Wes Decedent ever In the 13. Decedent's Education (Speciy only higtx~at grade comp leted) 14. Marital Status: Marred, Never Married, 15. Surviving Spo use (If wke, give maiden name)
Kind of Work ~nddBu~ine~s/Industry U.S. Amred Forces? Ebmenbry /Secondary (P12) College (1-0 «5+) W~~' Div«ced (sG~H)
District Mena Retail ~ Yea ^ No
16. Decedent's Meikng Address (STreeL oily I town, state, zip coda) Decedents lvania - L~f
S11Ver SAr1I1CX
d
i
~
~nt
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L~
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21 00 Bent Creek B1Vd. Twp,
v
e
n
e
m
17c.
Yes, Decedent Lived
Actual l3esiderae 17a. Sffite
- Township?
ed ~t0 ived wthin
~
Cucnberlarbd 17d. ^ qc
17b
t
C
Mechanicsburg, PA 17050 L
j
oun
y
.
City/ Boro
16. Fathers Name (First, rttiddle, last, suffix) 19. Mother's Name (First, midde, maiden sumeme)
Van Zbcket Johanna Zanette
20a. IMormaM's Name (Type /Pmt) 20b. InfonreM's Masing Address (Sheet, pN /town, affita, zp code)
Cynthia A. Shealy 7 Lon Drive Mechanicsb PA 17050
21 a. Method d Dlspoaltion r ~ Cremation ^ Donation 21b. Date d Diapmkion (Momh, day, year) 21c. Plaa d DbposAion (Name of cemetery, crematory «dMr pba) 21d. Location (City/town, state, zip code)
^ Budd ^ Removal from Stab i Wr CramMlort «DOnatlon AWhodzad
^ ~,,,,- r EyYadlealF~tantYrer/CarorrrT ®Yes^ No
June 15, 2011
HOlli er Cremat0
Mt.Hpll Sri s PA,
22a unerel «person acting a such) z2b. Licenr Number 22c. Noma and Address d Fadlity . 8 Market Plaza Way
~ FD 014889 Mal zzi Funeral Hone Mechanics PA 17055
' atgn certify' 23a. o the best d my , deslh du to end place stated. (Signature and title) 23b. License Number 23c. Date Signed ( th, day, r)
1> ~ ref ova at t:~ d d.a
oy 9 ~ ~ /3
6
~~. ddrtn. -
s
Ibme 24.26 ~ ~ bt, ~~ 24. Time d Death 25. Dale Dead ( nth, day year) 26. Was Casa R Mafiosi Examiner /Coroner br a Reason Otlrer than Cremation « Donation?
who prorarxar death. QZ . ,r '7 1r` M. ~ /3 ~ ~ ^ Vr No
CAUSE OF DEATH (SN htatruetlons and examp ) r Approxkneb interval: Pad II: Eider dher f>wmi6aerd conditions contrbutire m death. 26. Did Tobacco Use Contdbu[e to Death?
Item 27. Pad I: Enter the -diseases, irgurbs, « compliratlons • Mtat directly caused the firth. DO NOT enter terminal events such as cardiac arres4 r Onset to Death but not resukng in the undedylrg cause given in Pad I. ^ yes ^ Probedy
respkaary anest, «vereicubr fibrillation vrikaut ahowirp the etiology. List on each line. r
r ^ No ^ Unknown
IAMEDIATE CcAUSE /IFinal disease or i 29. It Female:
rnrdidon resnrltlnq in dam) _~ a r ^ Nd
re
nant within
ast
ear
Due b oQ: r
$e~~pagy ~ ~, M rY, b i
_ p
y
p
g
^ Prognant at time d death
^
badrq b the tear fisted m lire a. r
Einar bra UNDERLYING CAUSE Duero (« coreaquence oq: ~ Nd pregnant, but pregnant within 42 days
of death
(d'err « hjury that Ndtlabd firs
°'
t 43 d
t
1
^ N
b
~
events rrnltirg n deelh) LAST.
Due to jor as a coreequance oQ: r year
ut pregnan
ays
o
ot pregnant,
berore firth
d. ~ ^ Unknown 'rf pregnant within the past year
30a. Was an Autopsy 30b. Were Auropsy Rndhgs 31. Man of Death 32a. Date of Injury (Month, day, year) 32b. Descdbe Haw Injury Oa.urred 32c. Place d Injury: Hama, Farm, Street, Factory,
~
Perkaned.
Avaibbb Pri« ro completion
of Cause of Death?
Natural ^ Fbmidde office Building. etc. (SpedlyJ
^
~
^
^ ^ Accident ^ Pendng Irneetigation 32d. Time d Injury 32e. Injury at Work? 32f. 11 Tronspodalion bjury (Specify) 32g. Laetion of (Street, GN /town, sffiffi)
Yes Yes
No
^ Suicide ^ Could Nd bs Determined ^ Yes ^ No ^ DriverlOpsreror ^ P nger ^ Pedestrian
M. ^ Other - Specify:
33e. Certifier (check oNy one) 33b. Signaro ~~ Ne of Certifier ~~
CartYyNtp physlWn (Physiden cerlilying cause d firm when arother physicffin has pronounced death and Meted Item 23)
dsstAoccunaddrbtheuuee(a)endmrnerrstatad
Ta1MMatdm
lugwbd
e
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p
33c.
33d. D ( r)
,
' Prorauttdrq and grtllylnp ptryskir (Phyaldan batlr pranouraing death and certilyirq ro cause d death)
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On the Mob of examinaUon and / «Invsatlgetbn, b my opinion, bMh eceurrod al t 34. N
me
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Disposition Pem,k No 0599469
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