HomeMy WebLinkAbout04-13-12J 15D561D143
REV-1500 Ex(°'-'°>
PA De artment of Revenue OFFICIAL USE ONLY
P Pennsylvania County Code Year File Number
Bureau of Individual Taxes nErnaTYENT OF fiEVEMIE
PO 80X.280601 INHERITANCE TAX RETURN 21 11 01078
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
162 22 3560 09 05 2011 02 21 1929
Decedent's Last Name Suffix Decedent's First Name MI
MODER KATHRYN E
(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
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
X^ 1. Original Return ^ 2. Supplemental Return ^ 3 Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ~ 4a Future Interest Compromise
(date of death after 12-12-82) ~ 5. Federal Estate Tax Return Required
u 6 Decedent Died Testate
(Attach Copy of wiu)
^ ~ Decedent Main fined a Living Trust 0
(Attach Copy otlTrust) 8. Total Number of Safe Deposit Boxes
^ g, Litigation Proceeds Received ^ 10. between i2 3i ~jCre dit~datgespf death ^ 11 Election to tax under Sec. 9113(A)
1
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
MARIELLE F HAZEN ESQ 717 540 4332
First line of address
2000 LINGLESTOWN ROAD
Second line of address
SUITE 202
City or Post Office State ZIP Code
FiARRi S13UtiG YA i 7 31 C
REGISTER Y~IF~IILLS U$E;ONLY -1-
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Correspondent's a-mail address: Info@ha2enelderlaW.COm
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 preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPOJ~ISIBLE FOR FILIt~C~,RETURN ~ neTc
i1 i
Moder Martin Lj- /Z - /,Z.
OF PREP ER OTHER THAN REPRESENTATIVE
1
DATE
Marielle F Hazen, Esq. ~- ~Z _ ~Z
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2000 Linglestown Road, Harrisburg, PA 17110
Side 1
L 15D561D143 150561D143 J ,;-~
REV-1500 EX
oeceaenc~s name: Moder, Kathryn Elizabeth
Decedent's Social Security Number
162 22 3560
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.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers ~ Miscellaneous N ,oq Probate Property
(Schedule G) ^~ Separate Billing Requested............ 7.
8. Total Gross Assets (total Lines 1-7) ..................................................................... g,
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 .00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 0 • 00 16.
17. Amount of Line 14 taxable
at sibling rate X .12 0 • 0 0 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0 . 0 0 18.
19. Tax Due .................................................................................................................. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505610243 1505610243
1505610243
4,883.38
2,013.97
6,897.35
5,648.84
1,282.95
6,931.79
-34.44
-34.44
0.00
0.00
0.00
0.00
0.00
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-11-01078
DECEDENT'S NAME
Moder, Kathryn Elizabeth
STREET ADDRESS
Bethany Towers, Apt. 205
335 Wesley Drive
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 0.00
2. Credits/Payments
A. Prior Payments
B. Discount 0.00
Total Credits (A + B) (2) 0.00
3. Interest (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
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. (5) O.Q~
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: 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 ............................................................................................................... ^ 0
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? ........................................................................................ ~
............................ x
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ^ ^
contains a beneficiary designation? .................................................................................................................. x
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 surviving
spouse is 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 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.
Rev-1508 EX+(6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Moder, Kath
Elizabeth
FILE NUMBER
21-11-01078
Include the proceeds of litigation and the date the proceeds were received by the estate.
All propertyjointlyowned with the right of survivorship must be disclosed on schedule F.
(It 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)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Moder
Elizabeth
FILE NUMBER
21-11-01078
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
THE DATE OF TROANSFERSATTACFi A CO Y OF THOE DEED FOOREREAL ESTATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLUSION
(IF APPLICABLE) TAXABLE
VALUE
1 MetLife Total Control Acct. #4057876878 - 2,013.97 100.000% 2,013.97
Beneficiaries Brian Martin and Georgia Martin, son-in-
law and daughter of decedent.
TOTAL (Also enter on Line 7, Recapitulation) I 2,013.97
(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 G (Rev. 6-98)
REV-1151 EX+ (10-06)
COMMNHERITANC~{E TFgP RETgURN ANIA
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Moder, Kathryn Elizabeth 21-11-01078
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
See continuation schedule(s) attached
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
2,861.60
Street Address
City State ZiD
Year(sl Commission paid
2. Attomev's Fees Hazen Elder Law 2,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 85.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 701.74
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 5,648.84
Copyright (c) 2009 form software only The Lackner Group, Inc. Forrn PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Moder, Kathryn Elizabeth 21-11-01078
ITEM
NUMBER DESCRIPTION AMOUNT
1 Funeral Ex e~nses
Auer Funeral Home
1,807.29
2 Funeral -flowers 105.95
3 Patriot News -obituary 421.67
4 St. Mark's Lutheran Church -Funeral luncheon 226.69
5 St. Mark's Lutheran Church -Funeral Services -gratuity for pastor and organist 300.00
H-A
O 2,861.60
6 ther Administrative Gosts
Cumberland Law Journal -estate notice
75.00
7 Easy Moves -expense to move personalty to storage unit 360.48
8 Hazen Elder Law - -disbursements 2.64
9 Sentinel -estate notice 232.02
10 Space Mart -rental fee for storage facility 31.60
H-B7 701.74
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1512 EX+ (12-05)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Moder, Kath n Elizabeth 21-11-01078
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
(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+ (~ 1-08)
SCHEDULE J
COMMNHERITANCEOTFgXP RETURN ANIA B E N E F I C IARI E S
RESIDENT DECEDENT
ESTATE OF
^~_J__ ~/_~~_-__ r
FILE NUMBER
~-wuc~, r~aan~ n cncau~an ~ 21-11-0 1078
NUMBER NAME AND ADDRESS OF
PERSON(Sl RECEIVING PROPERTY RELATIONSHIP TO
DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I~ TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 a 1.2
1 Georgia M. Martin Child 100 percent of
7 Nottingham Rd. the residue of
Camp Hill, PA 17011 the estate
Total
Enter dollar amounts for distributions shown above on lines 1 5 throw h 18 on Rev 150 0 cover sheet, as a r o riate.
II NON-TAXABLE DISTRIBUTIONS:
. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright (c) 2009 form software only The Lackner Group, Inc. Fonn PA-1500 Schedule J (Rev. 11-08)
REGISTER OF WILLS
CUMBERLAND COUNTY
PENNSYLVANIA
CERTIFICATE OF
GRANT OF LETTERS
No. 2011- 01078 PA No. 21- 11- 1078
Estate Of: KATHRYN EL/zQaFTH nnnnFR
(First, Midd/e, Lastl
Late Of : LOWER ALLEN TOWNSHIP
CUMBERLAND COUNTY
Deceased
Social Securi ty No: 162-22-3560
WHEREAS, on the 13th day of October 2011 an instrument dated
July 14th 2009 was admitted to probate as the last will of
KATHRYN ELIZABETH MODER
(First, Middle, Lastl
late of LOWER ALLEN TOWNSH/P, CUMBERLAND County,
who died on the 5th day of September 2011 and
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
GEORGIA M MARTIN
who has duly qualified as EXECUTOR(R/Xl
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARL/SLE, PENNSYL VAN/A.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 13th day of October 2011.
eg/ster o /l s
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* *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
LAST WILL AND TESTAMENT
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I, KATHRYN E. MODER, now domiciled in Cumberland County, Pennsylvania,
declare this to be my Last Will and Testament. I revoke all other wills and codicils that I may
have previously made.
Article I
My just debts and expenses of my last illness, funeral, and administration of my estate
shall be paid by my Executor from the principal of my residuary estate as soon as practicable
after my death.
Article II
All inheritance, estate, and succession taxes (including interest and penalties thereon, but
not including any generation skipping tax) payable by reason of my death shall be paid out of
and be charged generally against the principal of my residuary estate without reimbursement
from any person. This provision is not a waiver of any right which my Executor has to claim
reimbursement for any such taxes which become payable as the result of any property over
which I have the power of appointment.
Article III
I give, devise and bequeath my tangible personal property to my daughter, GEORGIA
M. MARTIN. In the event GEORGIA M. MARTIN predeceases me or fails to survive me by
thirty (30) days, then I give, devise and bequeath my tangible personal property in accordance
with any memorandum I have handwritten or signed, located with my will or with my valuable
papers and found within 30 days of the probate of my will. Gifts may only be to persons who
survive me or to organizations which exist at my death, and if there is a conflict, the
memorandum having the latest date shall govern. To the extent no such memorandum is found,
or all of my tangible personal property is not disposed of pursuant thereto, my tangible personal
property shall be added to my residuary estate and pass under Article IV hereof.
Article IV
All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situate, I give, devise and bequeath to my daughter, GEORGIA M. MARTIN, of Cumberland
County, Pennsylvania. In the event GEORGIA M. MARTIN predeceases me or fails to survive
me by thirty (30) days, then I give, devise and bequeath all the rest, residue and remainder of my
estate, of whatsoever nature and wheresoever situate to my son-in-law, BRIAN E. MARTIN, of
Cumberland County, Pennsylvania. If BRIAN E. MARTIN fails to survive my death by thirty
(30) days, I give, devise and bequeath all the rest, residue and remainder of my estate in equal
shares to GEORGIA M. MARTIN's children, per stirpes.
Article V
I nominate, constitute and appoint my daughter, GEORGIA M. MARTIN, of
Cumberland County, Pennsylvania as Executrix of my Last Will and Testament. In the event of
the renunciation, death, or inability to act, for any reason whatsoever of my Executrix, I
nominate, constitute and appoint my son-in-law, BRIAN E. MARTIN, as successor Executor of
my Last Will and Testament. I direct that my Executrix or successor Executor be permitted to
serve without bond. In addition to those powers granted by law, I grant them power to distribute
2
in cash or in kind, in like or in unlike shares, and to file any qualified disclaimer I could have
filed if living. My Executrix or successor Executor shall receive reasonable compensation for
services rendered to my estate.
Article VI
In addition to the powers conferred by law, I authorize my Executrix or successor
Executor, in her/his absolute discretion:
(a) to retain in the form received and to sell either at public or private sale, any real
estate or personal property except that which I specifically bequeath herein,
(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 principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any
beneficiary,
(f) to file any federal income tax return for any year for which I have not filed such
return prior to my death,
(g) to make distributions in cash or in kind, or in both, and to determine the value of
any such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by
my Executrix or successor Executor; and to pay from my estate reasonable compensation for all
their services,
(i) to conduct alone or with others, any business in which I am engaged in, or have
an interest in at time of my death, and
3
(j) to receive reasonable compensation in accordance with their standard schedule of
fees in effect while their services are performed.
IN WITNESS WHEREOF, I, KATHRYN E. MODER, hereby set my hand to this my
Last Will and Testament, on '~ / ~- ~ q , 2009, at Harrisburg, Pennsylvania.
KATHRY E. MODER
In our presence, the above-named KATHRYN E. MODER signed this and declared this
to be her Last Will and Testament and now at her request, in her presence, and in the presence of
each other, we sign as witnesses.
Name Address
i 2000 Lin~lestown Rd. Suite 202 Harrisburg PA 17110
~~ P 2000 Linelestown Rd. Suite 202 Harrisburg PA 17110
4
I, KATHRYN E. MODER, Testatrix, who signed the foregoing instrument, having been
duly qualified according to law, acknowledge that I signed and executed this instrument as my
Will, and that I signed it willingly as my free and voluntary act for the purposes therein
expressed.
Sworn to or affirmed and
Acknowledged before me by
KATHRYN E. MODER, the Testatrix
on ~- ( ~ __~ 2009.
~..~,-
Notary Public
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KATHRYN . MODER
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We, the undersigned witnesses who signed the foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the Testatrix sign and execute
this instrument as her Will; that she signed and executed it willingly as her free and voluntary act
for the purposes therein expressed; that each of us in her sight and hearing signed the Will as
witnesses, and that to the best of our knowledge, that she was at that time eighteen (18) years or
more of age, of sound mind, and under no constraint or undue influence.
Sworn to or affirmed and
Subscribed to before me
by li y t ~' ,I-f, 2 ..
and (1~. ~~ .-...- n n._n_
witnesses, on `~ ~ 1 ~, - ~ , 2009.
C~-~.
Notary Public
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~Bailk
499 Mitchell Road, Millsboro, DE 19966 Adjustment Services
Hazen Elder Law
2000 Linglestown Road
Suite 202
Harrisburg, PA 17110
Re: Estate of Kathryn Elizabeth Moder
Soclal Security 162-22-3560
Date of Death• September 5 2011
Phone 888-502-4349
F ax (302) 934-2955
March 6, 2012
Dear Sir or Madam:
Per your inquiry on October 17, 2011, please be advised that at the time of death, the above-named decedent
had on deposit with this bank the following:
Type of Account
Account Number
Ownership (Names o, fl
Opening Date
Balance on Date of Death
Accrued Interest
Total
Checking Account
61131873
Georgia M. Martin (POA)
Kathryn E. Moder
0828/1964
.$4,276.65
$ .00
- ------------------- -
$4,276.65
For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds,
Pl~e call the Mechanicsburg at 717-697-1515.
We were unable to locate any safe deposit box for the above-mentioned decedent.
This letter does not include any accounts in which the deceased may have been listed ~ poµ,~. of Attorney, Custodian of Uniform Transfers,
Representative Payee, or Trustee under a Written Agreement.
Sincerely,
Valarie Mercer
Adjustment Services
~~~ 0 ~ ZQ~2
~~ ~`]~1 Estate Planning • Elder Law • Special Needs Planning
2000 Linglestown Road 1~.: (71'~ 540-4332
Suite 202 Fnx: (717) 54011313
Harrisburg, PA 17110 www.HazenElderLaw.com
April 12, 2012
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Cumberland County Courthouse =-'<-->,-, ..,,,
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Carlisle, PA 17013 -~~ "' = "'''
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Re: Estate of Kathryn Elizabeth Moder
File No.: 21-11-01078
PA Inheritance tax return
To: The Register of Wills:
Enclosed for filing please find the original and one copy of the above-referenced
Inheritance Tax Return and Inventory, along with a copy of the first page of the
Inheritance Tax Return. Please time-stamp the first page of the return and a copy of the
Inventory and return them to my office in the enclosed self-addressed, stamped envelope.
Also enclosed is a check for the filing fees in the amount of $30.00.
If you have any questions or require any additional information, please do not
hesitate to contact me.
Sincerely,
~ ~J~~
Corinne Eggers Woodhouse
Paralegal
Enclosures
cc: Georgia M. Martin, Exec.
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