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HomeMy WebLinkAbout10-28-11 (2)1505610101 REV-1500 °`t°'-'°' m OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Coun Code Year File Number oewnm[xr or •EVexue Bureau of Individual Taxes INHERITANCE TAX RETURN PD sox zso6oi ~ ~ ~ p p D D f7 Harrisburg, PA s~~z8-o6oi RESIDENT DECEDENT S oci a l S e curit y Nu m r b e Da t e f D o eafh MMDD YYY Y Date of Birth MMDDYYY Y ~~ '' (( ~~ ~~ '' ~~ ~~ ~~ ~~ lI ; ' W.Z'LJ.~L~J~~ '~ ~~ ~ ~ ~ ~ ' ~ G.L'lJ `~ ~ LJ ~ `~ 1- _ / 9 LI Decedent's Last Name Suffix Decedent's First Name MI A/ SD ~-~• ® LC ~1 1~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI ~~ Spouse's Social Security Number ~--~••~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - t ' REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Retum O 2. Supplemental Return O 3. Remainder Realm (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust l7 8. Total Number of Safe Deposit Boxes (Attach Copy of Wifl) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 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 TO: Name Daytime Telephone Number s , , , , , ~ ~ ~-re-a•~~ REGISTER OF WILLS USE ONLY First line of address ~ p_~ ~~ G D ~ 7~ Q7 C., ~..T ; . D ./~ ~ Second Ifne of address .-z, ~ --a ,t, '~a- ~ ^~ n~ ~~ a ~ :~Oii r, City or Post Once State ZIP Code ~ FILED ~ e A ics uR ~~~ ~9 ~ ~; ;_: ~~ o Correspondent's a-mail address: L' @Sh; e~o/s3(J L'onaeaat yet Under penaltles of perjury, I declare that I have examined this return, inducting accompanying schedules and statements, and to the best of my knowledge and belief. k is true, correct and complete. Declaretion of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT(Ip~p-E OF PERSON//p/'~}SPONSIBLE FOR FILING RETURN DATE ADDRESS ~.u ~ F (~Il U.SON J / Z ~{ COGIfGI.%1 Sf~ /17e(AfRX i PS~ H /~~ P/K / 70.5 SIGNATURE ~ PAgjER OTF~EFj TH RE~r~TATIVE DATE i /o/~~/!/ ADDRESS ~//rQ[ES E. SH/E~,S ~ C/ouser- ana~ /ye~j~;esbu~'~ P~¢ /7oss PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J REV-1500 EX Decedent's Name: ~'~IE/') m• ~/ w~ ~ hs0~'1 1505610105 1. Real Estate (Schedule A) ........................................... .. 1. 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 3. Closety Held Corporatkm, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. AAortgages and Notes Receivable (Schedule D) ......................... .. 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 6. Jointty Owned Property (Schedub F) O Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate P-opertY (Schedule G) O Separate BNling Requested...... .. 7. 8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8. 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... ... 10. 11. Total l~ductions (total Lines 9 and 10) .............................. ... 11. 12. Net Yalue of Estate (Line S 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. Decedent's Social Security Number 6 1 ~ z~ S3_?,_8 9.1 . ~ _~ ~ 7a.g6o.8( 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers Under $eC. 9116 ~ "~'~ '• rr~gpywun P~~ sms (ax1.2) X .OfZ A 1 ~i ' G o 15. 16. Amount of Line 14 taxable at lineal rate X .0~ D O i6. 17. Amount of Line 14 taxable at sibling rate X .12 ~ a y S ~ 17. 18. Amount of Line t4 taxable at collateral rate x .1s , , ~{ 3, ~{ 9 6- N $ 18. 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING AREFUND OF AN OVERPAYMENT ~S~2Z,~i9 f Z 1 3~ 6 z 3 ~~ 55.9z4,o~ Side 2 1505610105 1505610105 O J ~T•aX L'•K cuc.~ T oN ~~ Esc ~ of Ezc~ ~ . G~oe9i~/~Sod. NFr ~.a~uE s~r,ar~zT 7 /.~X sff=7e~Z A~ 1SE-.D~r~r~orus .Ayv~ .duow.¢ir~ {~.~ ~'.fi~'lr.~BL~' _ ~tiT.Qi.B~r ryo,~r = ~sS, 4~ y, oq.; _ ,~ _ ,~~ E _~' "~ aos o,~ :6z, ~~7.8z - f _ _ ~ _ ~? y ~7, sb . ~7'z. .~ /~1~19u' . ~ _ ~ a70Jo q'e h1, /37 8z 12, '/ ~7, 56 /fl~r~~~. f cS,~ a70fv old lP21 ~7, 82 . ~/.? S~Z7, s7. . . ~ctc~ = l5~c = ~ ~. SG~f./3 j .+ /~c~r~t~ ~ ~~~.~ ~~ o~ 6z~/37.sz = ~ G,zl3,~ 78' ~ ~w ~ /S~o t; 93z,o7 _ } ~ ~~ ~. _ y soy. o~ G,2,/3~~z -- _ _. ~~, , ~.~e . z niece = lS~o +_ _ f y32,0~ _ - _ j <<.,c .,P. ~6~irs~., - _ ___ ..__ ~ _ _ _ </a/ s~,~aX= ~ 015.78 ~1'Z ~ o1s.78 ___ _ _ __ _ ,t ~. _ _ _ ~j _ _ __ _ __ _ _ ;, } ; 1 :; COA1MpIWEALT71 OF PBrNSV~vMnn D~MTMH~ OF 11EVENVE REV•1182 EX(11-88) lU11fAU OF MIOIVIWK TAI(ES DEPT. 2!0601 IMIIIIg6U11G, PA 77126.0607 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 014168 ROBINSON PAUL EUGENE 1124 COCKLIN ST MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT CONTROL NUMBER ___ ,.» ESTATE INFORMATION: sSN: 19t-ta-3236 FILE NUMBER: 211 1-0007 DECEDENT NAME: ROBINSON ELLEN M DATE OF PAYMENT: 03/22/2011 POSTMARK DATE: 03121 /201 1 COUNTY: CUMBERLAND DATE OF DEATH: 12/24/2010 101 ~ 56,412.50 TOTAL AMOUNT PAID: REMARKS: $6,412.50 CHECK#1003 INITIALS: SAP s~-L RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX Page 3 Decedent's Complete Address; ~~ Number ,Z/-// - 00'7 DECEDENTS NAME /I~ ~~~~ m I~opigSOn STREETADDRESS ~"2 z ~ !vi%son Last cirr q,, /'1~~./CS6~ STATE n~ ~p - /" / ~ o SS Tax Payments artd Credits; 1. Tax Due (Page 2, Line 19) B. Discount T ~ 3'i3 7. So 3. Interest Total Credits (A + g) (2) ~ 6, 7S0 . ° ° 4. ff Line 2 is greater than Line 4 + ~ 3, enter the diflerenoe. This Ls the OVERPAYMEIMT. (3) O FNt ~ Duel an Pape 2, Line 20 to roquaat a rotund. t4) ~ 3.8~ 5. N Line 1 + Line 3 ~ greater than Line 2, enter the difle-ence. TMs is the TAX DUE (5) ~ ~~ 26 9, G?~ Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use w income of the Yes property transferred :........................................ ^ b. retain the right to desgnate wfw sfra8 use the property transferred w its income : ............................................ ^ c. retain a reversionary interest: w ................................... ................... d. receive the promise for life of either payments, benefits w care? ...................... 2. ff death occurred after Dec. 12, 1982, did decedent transfer ................................................ ^ without rer;eivi P-oPe-hr within one year of death ng adequate conside-ation? ........................................ ........................... 3. Did decedent own an "in trust for• w able. .......................................... . Pat upon-death ink account or seaxity at his w her death? .............. 4. Did decedent own an irxiividual retirement account, annuity w otirernon-probate pnppgrty, ~~h contains a benefiaary designation? ................................... ~ THE ANSMYER TO ANY OF THE ABOVE QUESTIONS IS r~~ YOU MUST G~LETE SCHEDULE G AN0 FILE RAS PART t -- Fwdates of death on Drafter July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on ttte net value of transfers to or for the use of the 3 perGertt [72 P.S. §9116 (a) (1.1) (i)I• surviving spouse is For dates of death on or after Jan. 1, 1995, the tax rate imposed on the r>et value of transfers to w for the rye of the (72 P.S. §9116 (a) (1.1) (ii)]. The stahrte does not exempt a transfer to a surviving spouse from tax, and the ~~~ ~ 0 fiHrKj a tax return' are stiN applicable even if the surviving spouse is the only bertefiaary, statuEort' requirements for disclosure of assets and For dates of death on or after July 1,2000: • The tax rate imposed on tfte net value of transfers from a det~ased child 21 years of age or younger at death to w for the use of a natural parerU, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(ax1.2)). • The tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is 4.5 percent, except ass nod in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)). • The tax rate imposed on the net value of transfers to w for the use of the decedents sibNn~~ss is 12 percent (72 P.S. §9116(aH1.3)). A sibling is defined, under Section 9102, as an individual who has at least one parent in common witty the decedent, whether by bid ~ arfoptan. aFw,woo~.tl+n SCHEDULE E COMMONwEALiNOFFENNSYWANU CASH, BANK DEPOSITS, 8i MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY -~-- o..+. ~ yr FILE NUMBER ~71cn /n. inSo~ Indude the ~/ - // r DO 7 prOCeeds of Wipatlon and the dale the Proceeds wem received by the estate. AN propsAy jpinyy.owned rvNh the right of survhrorship must bs dleclossd on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE Of DEATH ~~ i8e/Co Crtd'f ~fn:on .¢e~ yv. 56300 A~. Rc~u/ar Sarn9s C'• Chtck:.~ D. ~t'h f ac~cr, r6 dod sa 21r~wL' sec /a/aafiin /e/1~`~r q/~`a ~fud) off. i4s6aMy ~fNM~l.nifi'es, ?tt:. (~e{~,~ village} r'~*~.nc>t (sae Staf¢/liCnt affae%ed 3. U.S. TreasurJc ~~~d on paxscno~ income {•yc `f- ~// ~Prsona/fy o~ L1ny ~x a'ts~ss~ Gil f wR s t.li~ etf /UUl~~1/ic IIKC~io4 6y Chu/~k ~3~:~ker ire ~•c/~arahbr~ ~n•~ e/~ ~rR r1 c e : a /b // i//~rri,, ~io~rre_ s. ~ba'~ Gpl/11tcn:l7~sv ~.~ A+v~i(i'~uq~/ ~~hy/ ~. ~enehts P2atS~on ~w~n-e-,.t 7, ~ocia./ ~Seeurity P~~t R. I Z„ ~(rp,nsi+, uACrto~;1-~d Qu,}oma~ia ~rans~r ~eM ~¢mcrgoris~ (If more space is needed, insert TOTAL (Also enter on line 5, Recapitulation) I S sheets ~ the same size) ~/7, /83.3! s, zq 1~ 2,/03./6 ¢ D. /~ ~!~ 200. •o ~~ ~5! 2 y ~I~ oZl. IS ~ 9~z.oo ~ ~65<. mo ~,saa.z3 89/. !/ ~.~ir/ii ~ BE LCO C~MMUNIT~' IrKFDIT UNION Charles E. Shields,III Attorney-At-Law 6 Clouser Road Mechanicsburg, Pa. 17055 February 16, 2011 Re: Estate of: ELLEN M ROBINSON S.S. 191-18-3236 Dear Attorney Shields, Here is the information for the above referenced account. If you need any further information, please call me at 717 720 6414. Sincerely, Yvonne J es ~~- Finance Department DECEDENT ESTATE INFORMATION 1. Name(s) in which the account was held: ELLEN M ROBINSON 2. Account number: ~~ 3. Balance as of date of death: $19,286.47 Balance Accrued Dividends YTD Dividends Opened Regular SavingF S1 $17,183.31 $g.29 $32 ~ t R7D s Christmas Club: S2 Money Market: . S6 Checking: S4 $2,103.16 $0.16 $3 ~ lA1 ~ 0 9 Money Market: S15 . Certificates: Balance Accrued Dividends Certficate Number YTD Dividends $ $ 4. Date the account was initiated: 5. Name(s) in which Safe Deposit Box was held: N/A 8. Date the box was initially rented: 7. Branch address at which the box is located: 8. Loan Information: Balance Accrued Interest Per Diem Int A. Unsecured Loans: N/A L14 Classic Visa Card B. Secured Loans: N/A C. Mortgage Loans: N/A $ $ $ $ $ $ $ $ 9. Miscellaneous: sz.~zas~ s.oo sz,~zas~ I Statement Data Due Date ACCOUNT NUMBER 12/31/2010 Upon Receipt 2485 AMOUNT PAID S Please make check payable to BETHANY SKILLED NURSING MS. ELLEN M ROBINSON Remit To: c/o MR PAUL ROBINSON BETHANY VILLAGE 1124 COCKLIN STREET 325 YYESLEY DRIVE MECHANK:SBURG, PA 17055 MECHANICSBURG, PA 17055 Please detach and return this portion with your remittance to the address above. Comments our deai amount wiN be electron funds withdrawal from r bank accorxrt. Balance Forward $9.538.98 12/14/10 -12/14!10 ACH Payment 12/2010 Check #ACH 12/20/10 -12/20/10 Hospke of Central PA Check #44865 ' 11/29/10 -11/29110 BesutylBarber Shop Charge 1 $18.00 $18.00 12/01/10 -12/01/10 Be8'ulyBafber Shop Charge 1 $18.00 516.00 12/01/10 -12/01/10 Portable•Oxygen Tank Rental 1 54.00 $4,00 12/01/10 -12/23/10 Medical Supplies 23 $7.25 ;166.75 12/01/10 -12/23/10 Inoontlnence Care ModMeavy 23 $11.00 ;253.00 ! 12/03/10 -12/05/10 Portable Oxygen Tank Rental ~ 3 $4.00 ;12.00 ~ 12/05/10 -12/05/10 ~ Medical Supplies 1 $1.28 61.26 j 12/05/10 -12/05/10 Medical Supplies 1 ;1.86 51.96 i 12/05/10 -12N5/10 Medical Supplies 1 ;2.38 52.38 12/06/10 -12/06!10 t Beauty/Barber Shop Charge 1 ;16.00 $18.00 12/07/10 -12!10/10 Portable Oxygen Tank Rental 4 54.00 516.00 12/11/10 -12/11/10 MedicaFSupplies 1 51.213 51.26 12/11/10 -12/11/10 Medical Supplies 1 $2.38 ;2.38 12/13/10 -12/13/10 BeaulyBerber Shop Charge 1 518.00 518.00 12/13/10 -12/13/10 Portable Oxygen Tank Rerdal 1 54.00 ;4.00 12/15/10 -12/15/10 Beauty/Barber Shop Charge 1 518.00 $16.00 12/15/10 -12/15/10 Portable Oxygen Tank Rental 2 $4.00 58.00 ' 12/17/1D -12/19H0 Portable Oxygen Tank Rental 3 $4.00 572.00 12/19/10 -12/19/10 Medical Suppliea 1 51.26 ;1.26 12/19/10 -12/19/10 Medical Supplies '1 $1.96 ;1.98 12/1 9/1 0 -12/19110 Medical Supplies 1 52.38 52,38 1220/10 -122W10 Beauty/Barber Shop Charge 1 518.00 518.00 12/21!10 -12/22/10 Portable Oxygen Tank Ftentai 2 54.00 ;8.00 12/23/10 -1223%10 Medical Supplies 1 150.84 $50.84 1224/10 -12!31/10 Monthly Fee (8); ,,, S{906.00) 5(2,448.00) $9,b38.98 $330.00 FACILITY NAME RESIDENT NAME ACCOUNT NUMBER BETHANY SKILLED NURSING MS. ELLEN M ROBINSON 2485 a Statement Date Due Date ACCOUNT NUMBER 12/31/2010 Upon Receipt 2485 • _ ' ~ 50.00 AMOUNT PAID 5 Please make check payable to BETHANY SKILLED NURSING M5. ELLEN M ROBINSON Remk To: do MR PAUL ROBINSON 1124 COCIQ.IN STREET BETHANY VILLAGE MECHANICSBURG, PA 17055 328 WESLEY DRIVE MECHANIC3BURG, PA 17055 Please detach and return this portkm with your remiManoe to the address above. 12/31H 0 -12131/10 Refund: MorNhy Fee 12/31/10 -12/31/10 Refund: Medical Supplies 12/31/10 -12!31/10 Refund: Incwntinence Care ModMeevy TOTAL BALANCE DUE: 52,106.32 67.25 511.00 50.00 FACILITY NAME RESIDENT NAME ACCOUNT NUMBER BETHANY SKILLED NURSING MS. ELLEN M ROBINSON 2485 REVasia Ex • (+sn COMAtONVVEALTH OF PENNSYLVANIA INNERRANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF ~ ~ f ~ 50~ t ~~~ FILE NUMBER ni. d/- //- 007 This sdredule must be completed and filed 'rf the answer to arty of questions 1 through 4 ar the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY iNCwnETMeuAA~EOrTHETgreis~F,n~nnaATa~wtoxt~oerrunn~EwTEOFTwvavFert ATGCHACOP/OFTEOEEpFOnpEALE$fATE. DATE OF DEATH V(~ OF ASSET ~, OF DECD'S INTEREST EXCLUSION Aaaiae~E TAXABLE VALUE 1. /f ~1lSr.~t7riSG F.'ntt~:./ ~.-yotx~. , prt~niCt; /~c%'ve ~or'l'~~as, ~/li, 000689$.?663 (02/ f 3 06 y /d 0 ~v --O - ~ T an.~,- on Qt~hf c%syeahins.• ~ 7O 3 8, d6I, 7e ~. Pau 1 F lib; nson aa9o t~rol~r = ~7, 6/3 9~ , ~rsf GIn~1td /Y/etlod,5f G'~urcl, /Ofo C/lari y - f 3, SDG.97 C. El;zabef~i (xrtgcr ao fo Nicec ~ ~ 7, ~ 13,94 t`7. /-lrrrily ~. Slade Zofo Ni cu - *7, G~3. ~~ F /~iG~trrr/ l! Qs'bioSnn yp 90 r1 p~p/,cw = f~, ~b6. y9 N~'c~ ~3, 8oG.91 A' b: ~r ru+ p. a n~e~ /1P,~O~itN~ = 3, 8n6, 97 (see ~a/ua~io4 ~+d ~~shi6w~oq dafi'a a>Fa t:h~d ) more space is needed, insert additional sheets of the same TOTAL (Also enter an line 7, Recapitulation) I S 3 ~~ O 6 5', 7n fewer Page 1 of 2 CIIaM VbMrar Awlaacwnpan• Amer3pNse f'iMnCla1 Y~~eeiiM PRfi11R ~: A.~T~ Pbl'F~'~ia~", ~ , .,.... -. :: . ~ ... . AeeouM ProtIM ~ ~~ ~ Chock. I.auW Yeww _ f1w~ _ Tlw~~ T.-~--u-..- ..... ........_._. vwu oeie18i33 B 0210 CTNE ACCUMULATION CONS -- srship__~._._.---.-..,._ LLEN M ROBIN90NTOD _-...._. Ian Type^_.___._._._ - _ ON-QUALIFIED-~.---°__----.__.~--- aociaOadTIN: -_. ------191-18-3298-----. -- .._._.__._..__.--.--__.._--... ._ _ .- . .... 789345001 -_.-..._.........-_ .~_..._....._-,.....- ___ ~-IOUSEHOLD i 'BINARY BENEFICIARY ~~ 'AUL E ROBINSON BROTHER 20.0096 EL17.H8ETH LINGER NIECE 20.0096 AERRILY R SLAOE NIECE 20.0046 i1CHARD C ROBINSON NEPHEW 10.0096 .YNN A RAPP NIECE 10.0096 ITEPHEN P ROBINSON NEPHEW 10.0096 'IRST UNITED METHODIST CHURCH 10.0096 IECHANICSBURY PA I'S SUCCESSORS OR ASSIGNS Ticker ~_ Oesaiption Quenclly Eadnrale Symbol Held PdOa Pryc• Oak Market -~_.~.__.~,-__ -__---, Value )L OIV INC W CDVWX ._...._._ _____....---- ;~ ~:~;:~:::_., ..._.._ 12.8 0/122011 s5dsir CSCWX I 51.945 ~574.18+10M22011, -5738.58 -~ ttps://www8 • ex.is.ameriprise.com/oat/securefAccountprofile/Accountprofile.asp?alKey... 10/13/2011 Z'2•d £LbLS6L~01 b8b6 S2S LiL 3SI21dI2J~ki~IJOa~ HZS~ii iiOZ-£i-1~0 accounts a9 of 12/24/2010. Account Information Premier -Active Portfolios Account Number Ownership 00068782663 6 021 individual -TOP Premier -Active Portfolios Account Number T 00068782663 6 021 i Value 538,069.7 fleet Nasw:Amerrlrb9 Atlfile POItbBoa, ACTIVE ACCUMUIJgT~I OONB, t3LEN M ROBINBt)IV TOO Acct No'.000BB182tiB3 OQ1 Acct7ypr.Nwl~uat6Ne Aaad Nnla ile6ar Broai 61of. Nsrae grannty PMea Ip Y611w ~ G8M 111.33 1.00 111.99 col AB3LT RTN CIi18l91C - w RACWx• ~ IN ~~ 16969 1o,a 1,801.52 COL OIVER91F6cD BtTND - W RVBW1t• LON(aIMf1Ep1~D1 COLLOrbIA ATE- HINDS 0110UP 2,95097 487 14,680.94 COL OIV6>4<ND INOOME - w t9i1NYx LAflR1c CAP COl_ tJ~191A~~~ 43.0{ tAO~ 968.04 COL dVIDle11D OPP - W ~~ LAItOE CM COLUMBIA 72.78 T.78 508 25 STOCK FUND9 ORDl1P . 1971. EMERCIINO tVBtiS BD - W REMYVX• M A>~NpT ~ 208.49 11.18 2,101.43 ~ ~ COL GLOBAL BOND - W R• ptI6tNAT10IM1 COLUMBIA 316!44 7.01 238.25 POtLD NC06AE FL040.R GROUP COLF60NYIB.OBOIO-w RI4YWX• F00B)N1t:OME F~GI10lJP 1,097.10 27'9 2p52.18 COLIN6'OME-w CPIINX LONQBNi IRE-TgAM I COLUMBIA FtMWS aRDUP 381.34 9.01 9,760.79 COL INFLATION PRO 9EC - W RIPWX' LONiHiINEpI U ~ 105.75 10.9{ 1,D83.4T COLLARfM•COREQUWT-W RDEWIC• LAROECAP COLUMBIA 14260 5.43 774 32 970CK ftMD9~iRDUP . COL LARGE ORW t2tlANT - W RDLW7t~ LSARRiEK CAP CQlU ~~ r 176.25 6.76 1,565.01 COL LARGE VALUE GUANT - W RLCYYX' LARGE CAP COLUAIBIA 106.25 T.55 1106.15 STOCK Fi91D80RDUP COLNIONEY6IARIQrT-W RC,'YY)Ot` CI1_SH ~s C~O(.UMBU~_._ 675 O nvuP 1,141.77 tA0 1.141.77 Ct71. SMN1 CAP CORE- W C9CYVx L CI1P S D ~ 5193 19.x2 006 10 IC ~ Q . RVS OI$CPID INTL EvIY - w ROMIX• 94IERhIAT10IML COUItIBIA 211.89 7.32 1 551 77 s1acK F1o4DS oR1wP , . Rvs OLRCPLD s-1~AIiCP Eo - w R3EWX• MIDISMALL CAP COLUi1B1A 6F,ffi glD 7,r g ~ S70CK F1IID8 0110UP ,~ ~~ i36~6B.70 The date of death values provided are for estate tax purposes and are not a value to be paid. Accounts may be subject to market fluctuation as governed by oath product Please note that the values indicated for any Life Insurance product(s) with the insured deceased reflect the gross death benefit at date of death and not the cash value. Values indicated for Life Insurance Products with only the owner docoased reflect the cash value as of the date of death. Values for any proprietary mutual funds include accrued dividends as applicable. Values provides for brokerage products are manually calculated, and should be used as estimates only. Theprices used to provide values are estimates obtained from outside sources believed to be reliable. Ameriprise Financial provides these values as a service to its clients. Actual values used in preparation of tax returns or for planning purposes should be verified by your legal and ac~unting advisors, £i2'd £LbLS6L:01 b8b6 S2S LiL 3SI21dI213l~ti:W021d ti9S:T1 TT02-ZT-100 We appreciate tha opportunity to be of service to you. Please conuict us if you have any questions. Sincerely, Mthoay H Gusto Death 3ettletnanta Processing Taarrs Ameriprise Financial Center Minneapolis,lrrlN SS474 1-800-862-7919, Option 2, ask for Palate Settlemenq Please do not repy to this email. This database does not support lnooming mail. Please call the phone # within the letter B you n9quire assistance. Thank you. Life Events Team £~£'d £LbL56L~01 bi3b6 SZS LlL 35I21dI213Wtl~l.gNd tl9S~Ti iTOc-i?Z-170 REV-1511 EX+(10-06) SCNEDYLE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8i INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATNE COSTS ESTATE OF FILE NUMBER ~~~P.I) ~i-1Son o~- // -ODD Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. h1echan i es 6tir~ CCIII~f 7,rr, ~r .9uria.~ r tti - J t` ~FSD, DO z, Reyt.rs F/o[~/~ ,~r ~T•wu- SPrQy, ~t;,»b. ~ ~a../ ~Cod;nsoh S~ '~3 fig 3. ~unc•ta.J ~'IGaI- /T7abe~ Si'r~oc1C, r~imb. t P~.r.J Zlo6;ns6n . ¢1I 8,~8 ~• F/vnar~rikMS-- ~Gv. ~iaMPa, ~W, ~rnwn~n4, gym. ~ngrrcha~+~noryan- i5f /7'l D ~ ' , try/lai l , Norp.; ona/d Barnes, cf ux, ,TQgifiS~ n+'m~ ~ maw ~SSp 00 ~AbinS+n , S Non•/u/y~~ttn~ ~ ~i~t'nCr first'' ~# F,1-sF 4ni/i!t~ Me.Kud%t ChNr•..11 fy~ h~ tu~l'G. ¢/po..o meal. Ker mb fr ~,..1 f2sb~n5est e. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 11 Name of Personal Representative(s) !~Q„y,l E. ~p p. A So•1 ~ 2, O 2 S.7-/O street Address 11 ~ ~ ~nek/: n .~; nn Ciry Ih2G/14Ati CSI7rt ~+S State I"R Zip 17 G SS Year(s) Commission Paid: 2• Attorney Fees ~.f1A,--~GS ~ cYni~G/Q/S 3• Famiy Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant NO D/re G~~ i 6/G Non ~ Street Address Ciry State Zip Relationship of Claimant to Decedent l 4• Probate Fees pw( Otl~i~na~ ~13s?ttG oy~ SG~,tort eCr~r n~~s ~//~•~ 5• Accountants Fees ~ Cryrrs~'QI N~C~B r!' 7r'~' vc%Se-Op,~' /D~D, /Ojrs ~O ~p~$"D, 00 6• Tax Relum Preparer's Fees 7D-" ~~~// ~~ ~/j /~ _~S, ~ ~.3~0.60 '. Re;~nb~.rsement ~o taa./ ~'. (iii nson -~r add:f dea,f~t ecrl: ~ 9v. oa 8. ~jYrtisi~9 hi L~k~,6trGsyrd La•.J ,7varn,r/ ~ 75, ea /B• F:/ice~ Fae fp ~~qis~,- o~ !~~'//~ f~s.ao //. ~Pddyh:aa/ pnvdaf {>ce ~f~ o0 C~,~t-~ TOTAL (Also enter on line 9 Recapitulation) I S $, 3 ~ ~ ~ S~ (If more space is needed, insert additional sheets of the same size) i RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Receipt Date: 1/03/2011 Cumberland County - Register Of Wills Receipt Time: 14:29:05 One Courthouse Square Receipt No. 1063881 Carlisle, PA 17613 ROBINSON ELLEN M Estate File No.: 2011-00007 Paid By Remarks: CHARLES E SHIELDS III SAP Receipt Distribution Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 45.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 24.00 CUMBERLAND COUNTY GENERAL FUN JCS FEE AUTOMATION FEE 23.50 5.00 ----- BUREAU OF RECEIPTS CUMBERLAND COUNTY & CNTR GENERAL M.D FUN Check# 2006 ----------- $112.50 Total Received......... $112.50 _ _ ___ VitalChek Receipt Transaction ID: V99-1282682-1 (~~~~~,~~~~~~I~~ Date!['ime Requested: 1/27/2011 (a7 2:42 pm Certificate Type: DEATH Name on Certificate: ELLEN M ROBINSON Credit Card Authorization Code: Father's Name: CHARLES W ROBIlVSON Copies: 7 Request Fee this Item: $63,00 Carrier: UPS NEXT DAY AIR Other Agency Fees this Item: S 0.00 Delivery Telephone(s): (717)766-8922 J (717)766-8922 Handlin g A y O VCN Fee Fee Carrier Fee Request Fee Age ncy Fee Total Fee $ 10.00 $ 0.00 $ 17.00 S 63.00 S 0.00 $ 90.00 Ship To: PAUL ROBINSON 1124 COCKLIN STREET MECHANICSBURG. PA 17055 i .' ~~~"~ *** THE GROSS-ERY *** 30B Cheryl Avenue Mechanicsburg PA 17055 12/28/10 1717)95806138 OPER 12 59999 Valued Gross-ery Customer 999972 NONINV gift card 5127 1 8 25.00 ~ 25.00 827009 IMPERL CUP PAPER HOTS 2Z 1 A 3.75 3.75 Merchandise Total $28,75 Tax $,23 Invoice Total $ggT~g- AMOUNT TENDERED ~~ Check $- '6'~-g~ ORDER# 865947 59999 PIECES 2 Invoice #585451 K i N O N O ~ N { « s ~ \ C y ~ N n N N O ~ 2 « + ~ ~ N a ~r rm r~ ro ~ a e « -r n i a x k + O O .- -+- C Z C # \ ~ .-, ~ [') a N ti 3 Gl k 4 + + m ~ ~ C7 m m 1 C W 3££ T ~O E ~C = k i ~ N m a s m V 0 ~--i D O 47 D o-r r A L O m ~ O « D 1"- C 4 - O N d M < ~ ~ . r X r 1"" 0 .~ D 2 3 T S m ?7 . A D ~ S Z N V7 k { N + H T W ' m ~ y ~ T N~ N _ P O D D C7 ~ O ~ k N t ~ ~ ~ ["J N S = D C O ~~i D O O N « A 1C + ~ N fl'I ~ ~ ' O « m m + X d ~ a 1l ~ y °O v z m R ~n + p o y N D~ N ° c « N + of C7 K « } O fJ~ 7C « + 6 m * . O m _ O -~ -+ O ~ N O O N W ~ ~ N ~ p C O W ~ + V• V7 O b ~p ~ O O O 0 W * + I T ~i T Ti T ~1 A SPecia~ Note... ~~ any-•~-,~t ~ ~. mss' ~'Cc,aJ ~~ .33. 2 `~ //x.78 ~ 3uLV - E ~-~-~ • YERS` jtowers(yjtjtt BJ'S WHDLESRLE CLUB 3015 GETTYS RD 3805 HRRT2DRLE DRIVE CAMP HILL, PA CRMP HILL, Pq. (717)730-4090 717-763-9550 Clerk#: 53 LAUREN 12/27/2010 0025 002 9873 12/29/10 Transaction: 86077 REG #1 4:24pm CR5H-1 ts3 1 t7:o5:3s Ln# Pn Descr Oty Amount Ext Amt ****^*****^*^~rr*^^**^^^*************** 1 20 FUNERAL 1 92.95 92.95 *** MEMBERSHIP ID. 2580971983 *** 2 20 FUNERAL 1 92.95 92.95 *** MEMBERSHIP EMPIRES ON 01/5 *r* 3 23 FUNERAL 1 125.00 125.00 ***********ff************************* TaX: 18.66 60903277371 19 OUNCE JRR awf" qy Total: 329.56 90000016287 B8JHAMRLI6CT , t.99N VISA Tender: 329.56 90000016287 68JHRMRLI6CT 1.99N 90000018731 SAND BUN 12P 3 29N Account: XXXX-XXXX-XXXX-8078 EXp XX/XX 20356300000 K HONEY HRM . 19.99N Transaction #:31609629 20399700000 LDL WHT CHSE 2 79N Trans Type: Auth 20359700000 LOL YEL CHSE . 2 62N Entry: SWiped 9970006922 OM TURKEY . 6 99N Validation Cade: 5J5G 3950063202 LOL HRLF . Merchant I0: 1670198007 3805519221 SWEET BDLDG* 1 99N 6 Trans ID: 16036177Q686613 90oooo2s27s WF SWISS 2LB .99N 7 AuthCode: 242861 19572 PIL'K N' PRCK .69N 5.98N Thank-You For Your Patronage 73197199?5 WIEJSKE 96Z 5910091900 BUTTER 3.29N WWW.rOyerS.COm CHIPS 7676255010 BEAN SLO 692 3.g9N 6 2 ITEM TOTRL 15 . 9N 5UB Cardholder Copy Order Number: 27033 Delivery Date: 12/30/2010 Recipient: ROBINSON Address: 135 SIMPSON ST City/State: MECHANICSBURG PA Order Number: 27035 Delivery Date: 12/30/2010 Recipient: ROBINSON Address: 135 SIMPSON ST City/State: MECHANICSBURG PA Order Number: 27036 Delivery Date: 12/30/2010 Recipient: RDBINSON Address: 135 SIMPSON ST City/State: MECHANICSBURG PA TOTRL 77 82 PR 5TRTE TRX 6X 98 TDTRL 78.30 CHECK ~-- ~ ~7 -~-~- iHANH YOU FOR SHOPPING RT BJ'S may. 9 / ~~~~~"~ ^1229025029873^ weir THANKS FOR SHOPPING WEIS MRRKETS X58 5140 SIMP50N FERRY RD MECHpNICSBURG, PR. 17050 TELEPHONE: 717-697-1230 YOUR CASHIER TODRY WAS Melanie MAXWEL HOUSE 4.49 F WD FRT CKTL 1 19 F ICED TER 2.59 F DIET TEA 1.59 F W PR TRKY 4.99 F 2@6.97 AMISH POTATO SL PC 13.94 F SC AMISH POTATO DISC 0.98-F SC RMISH POTATO DISC 0.98-F 3 LB EGG 8 PDT PC 6.97 F SC 3 LB EGG & PO DISC 0.98-F 16 HOAGIE RMERICRN 6.99 B STICKY BUNS Q~cc~,, PC 99 f SC STICKY BUNS piSC ~ 00-F TRX 0.42 **+~* BALANCE 43.22 VF PERSONRL CHECK 43.22 CHAN6E 0.00 TOTRL NUMBER OF ITEMS SO' 0 ~°370~~~ Weis Club Savings Total 3.94 Your Total Savings: 8Z 53.94 12/29/10 05:SOr~n 58 109 26 108 J ~.~ ~ ~~ ~ ~ o 0 J J Q 0 n n A S S S O O O <_. 5. <. o~ m m C7 n C7 ~ ~ ~ N N N ~ n O F 7C 7r 7 7 7 00 t0 t0 v \! ~? W Z O C ~ ~ t0 D ~ D °~' n ~ n n d ~n Tl T T1 (~ > > > .~. N N W m m d m c~ > > > f0 N Q01 N T r T ~ C C C N N O N O d ~ d j f0 C a ~ a ~ ~ ~ `~ ~ ~ ~ n D 3 0 0 ocn "m 0 0 0 0 0 0 0 ~ 0 0 o j N N C N AUtk t -iti~1ATI0N SERVICE 4100 )ONES70WN RD HARRISBURG, PA 17109 12/31/2010 11:31:10 MerchantlD: 000000001669325 terminallD: 02508749 235177570993 CREDIT CARD VISA SALE CARD # X)OOOOOOOOOU(8078 INVOICE 0002 Batch #: oG0100 Approval Code: 321020 Enby Method: Matual Approved: Online li SALE AMOUNT $251,80 Mr. Paui Robinson 1124 Cocklin Street Mech anicsburg, PA 17055 NATION SERVICES OF PENNSYLVANIA, INC. PA 17109 • 1-500-720-8221 • Fax 717-541-9943 • Shawn E. Carper, Supervisor Dec 24, 2010 Ellen M. Robinson - Deceased SPECIAL CHARGES X Direct Cremation $1,595.00 X Nationwide Guarantee Program $295.00 Worldwide Travel Protection TOTAL SPECIAL CHARGES PROFESSIONAL SERVICES Services of Funeral Director & Staff Other Preparation of ahe Body Facilities & Staff for Memorial Service Staff & Equipment for Memorial Service Witnessing the Cremation Private Family Viewing/Witnessing Cremation Packaging And Forwarding Cremated Remains X Personal Delivery of Cremated Remains Scattering of Cremated Remains Medical Documents/Courier Fee TOTAL PROFESSIONAL SERVICES AUTOMOTIVE EQUIPMENT Removal Vehicle Lead Car/Clergy Car Family Car Service Vehicle TOTAL AUTOMOTIVE EQUIPMENT $85.00 101328 DAA .$1,890.00 $85.00 $0.00 MERCHANDISE X Register Book $45.00 6$ Tax X Memorial Cards 100 @ $70.00 6~ Tax X Thank You Cards 2 @ $24.00 6& Tax X Remembrance Package $120.00 6$ Tax Arrange For Burial X Minimum Oak Urn @ 148340 Urn Burial Vault Veterans Flag Case Grave/Memorial Marker TOTAL MERCHANDISE CASH ADVANCED ITEMS $2.70 $0.00 $4.20 $0.00 $1.44 $0.00 57.20 $127.20 Grave Opening Cemetery Equipment X Harrisburg Patriot Newspaper Notice Newspaper Vault Service Charge Clergy Church/Organist/Soloist Flowers Crematory Charge X Cumberland County Coroner Approval Fee X 10 Certified Copies of Death Certificate TOTAL CASH ADVANCED ITEMS SUMMARY OF CHARGES Special Charges $1,890.00 -„ Professional Services $85.00 Automotive Equipment $0.00 Merchandise ~. $352:20 Cash Advanced Items $274 60 SUB TOTAL CREDITS AMOUNT PREPAID Date TOTAL AMOUNT PAID Date BALANCE DUE 52,601.80 -$1,140.00 May 11, 1996-$1,210:00 $251.80 Dec 31, 2010 -$251.80 $0.00 $225.00 $189.60 $25.00 $60.00 $352.20 $274.60 THIS STATEMENT MAY NOT REFLECT ALL NEWSPAPER CHARGES Unline Services - U;nlme Image Yage 1 of 2 WACHOVIA ONLINE IMAGE Account Numt~er: 1010008235222 Check Number Amount Date Posted 3087 $450.00 01!03@011 _. _____ . ~ r ao~ NJ1. . i:03~00~31:i010008~'3S~22r' 3 8? >03y31503tSt Orrstawn Bank Shipp~nshn=g, P11 17257 L>boaez 717-532-6114 tans Dste: 12/31/2010 t3ran<sb/Teiles Dols/o3zs i2/asi2oao ].2:18:2! How To Save This Image PC users IMemet 1=xplorer: Right-dick on the check image, and choose "Save Picture As..." Others: Right-dick on the d~rek image, and choose "Save Image As.." MAC users Internet Explorer: Click ~ hold on the check image, and choose "Download Image to Disk." Others: Click 8 hold on the check image, and choose "Save this Image as https://icid.wachovia.corn/webapp/icid_app/servletfTitanium 1/13/2011 P1111L Hltl'i8lIE p(1RIN60N 308 ~t BT,~ ns~ ...~vi ~ o tA~, frA 17006 REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCMEDYLE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & DENS ESTATE OF n_~/~ J,ON/ ~G~~ ~, FILE NUMBER !C() 021- /l- Ooh Report dahts incurred try the decedent prior to death whleh remalnad unpaid as o(the date of death. Including unreBn6ursad maul .x~uAAAa (ir mac space is neeeeo, Insert additional sheets of the same size) REV-1513 EX+ (9.00) SCNEDYLE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~,LLE~ ~ B l~.S~ ~ FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not Ust Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)1 1. ~ewl ,I:. 1Pab:assn ,hr. K~e.r ~fo I [z4 '~.oc'kl:n at, /hcchar.icsbk,~, pA~ 17osS a. El%z.l~Kt A~. u~9cr n:eoe o?p9o 353 EYxsfs R.i/yc Tnt; /~ Rt/~~rt4, GA 3o3t~ `~ /ylGrri/y T, v/ade //Y /l7anb Rd., k/tsl;n~rN,iYC ?7s~~ ~~«- ao po s: Ri~hq•~ e ~26,ns.., "~~""' I o ~o /9 Cedar Gene, ~fZw~i~s~rvre, OR~ /7.363 6, [yy„ ,~. ~aOp 39 Non6ySuek/e fir,, /1leChanitsbur~, Pi4 hasp h;e~ -D ~o Stiff P. ~Pr6,~s'~r /336 Z.i1l/7tr~aa /~., ~ar/.s/~, ~A /7oi3 net hec~ y l D /a ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1' ~%~st Gin~fzd /~1Y.adsf ~ItKroh o~' /Ylech.tvtics/uvq l 0 90 (3S W. 5%stQ3oh 5fi., MechaniP,s6urr~, ~ 17oss ~ ~ ~°' z ~ 3.79 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S 5, S~f~. pt more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF ELLEN M. ROBINSON I, ELLEN M. ROBINSON, single woman, currently of Bethany Village, Mechanicsburg, Lower Allen Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. L I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise, and bequeath in the following manner: A) Twenty (20%) percent thereof to my brother, PAUL E. ROBINSON. B) Twenty (20%) percent thereof to my niece, ELIZABETH A. LINGER. C) Twenty (20%) percent thereof to my niece, MERRILY J. SLADE. D) Ten (10%) percent thereof to my nephew, RICHARD C. ROBINSON. E) Ten (10%) percent thereof to my niece, LYNN A. RAPP. F) Ten (10%) percent thereof to my nephew, STEVEN P. ROBINSON. G) Ten (10%) percent thereof to the FIRST UNITED METHODIST CHURCH OF MECHANICSBURG. 3. I nominate, constitute and appoint my brother, PAUL EUGENE ROBINSON, a.k.a. PAUL E. ROBINSON, to be the Executor of this my Last Will and Testament. In the event that he is unable or unwilling to act as Executor, I appoint my said brother's wife, MARJORIE A. ROBINSON, to be Executrix in his place and stead. In the event that she is unable or unwilling to act as Executrix, I appoint my niece, LYNN A. RAPP, to be Executrix in her stead. In the event that she is unable or unwilling to act as Executrix, I appoint my nephew, STEVEN P. ROBINSON, to be Executor in her place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~_ day of /Yis^-. , A.D. 2007. ~31+..~ ~lK a.>~..o,r..- (SEAL) ELLEN M. ROBINSON ~~ . 1 Signed, sealed, published and declared by the above-named ELLEN M. ROBINSON, as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. ~ ~ d~~o~~ ~~~~ ~~~ ~~ ~~~