HomeMy WebLinkAbout02-01-1315D561D143
Ex (02-11) OFFICIAL USE ONLY
REV-1500 File Number
PA Department of Revenue pennsylvania County Code Year
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO 60X.280601 INHERITANCE TAX RETURN 21 12 00916
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW Date of Birth
Social Security Number Date of Death
06 24 2012 02 05 1915
Decedent's Last Name
WOOD S
Suffix Decedent's First Name
rTELLIE
MI
K
(If Applicable) Enter Surviving Spouse's Information Below MI
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW ^ ~ 3 Remainder Return (Date of Death
1. Original Return 2. Supplemental Return 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
6 Decedent Died Testate
(Attach Copy of Will)
^ ~ Decedent Maintained a Living Trust
(Attach Copy of Trust) O 8. Total Number Of Safe Deposit Boxes
^ 10. betweeriP2v31 ~J1 audit Da95~ f Death ~ 11Attach S~hedule O) Sec. 9113(A)
9. Litigation Proceeds Received ^
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIALD yt me Telephone Numbe BE DIRECTED TO:
Name
EDMUND G MYERS (717) 761 4540
First Line of Address
301 MARKET STREET
Second Line of Address
PO BOX 109
~EGISTER OF~LLS USE~ONLY
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DAT~FILE~D: ~`'~
City or Post Office State ZIP Code `~ ~ ~--~ ~:
LEMOYNE PA 17 0 4 3 ~._~ ~.~ ~,
e m dsw.com
Correspon ent's a-mail address: 9
Under pe alf s of perjury,ledecDeclahatiohof preparer of th han thelpersonal aeprasentative Iscbased on au Info mat on~of wh~h prepare has any knowledge belief,
it is true, o ect and comp DATE
SIGNAT OF PERSON RE S14L ILI G RETU f ~~
Gregory E Woods l
ADDRESS
122 Ashword Wa Cam Hill PA 17011 DATE
SIGNATU F PREPARER OTHER THAN REPRESENTATIVE ' ~ I
~~~ /_ EDMUND G. MYERS
301 MARKET STREET, Lemo ne, PA
L 1505610143
Side 1
1505610143
J
1505610243
REV-1500 EX Decedent's Social Security Number
Woods, Nellie K
Decedent's Name.
RECAPITULATION
.. 1.
1. Real Estate (Schedule A) .....................................................................................
2.
2. Stocks and Bonds (Schedule B) .............................................................................
• 3.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......••
. 4.
4. Mortgages & Notes Receivable (Schedule D ...........................
10 945.69
5
Bank Deposits & Miscellaneous Personal Property (Schedule E) ...............
Cash
5
,
.
6 2,049.91
.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............
7. Inter-Vivos Transfers & Miscellaneous Ilan; Probate Property
^J Separate Billing Requested............ 7. 1 4 67.7 6
~
(Schedule G) 4 6 3. 3 6
14
........................... 8.
Total Gross Assets (total Lines 1 through 7) .............................
g
,
. 3,434.57
. 9.
Funeral Expenses and Administrative Costs (Schedule H) ....................................
9
. 6, 639.92
10.
Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............................
10
. 10 , 074.49
11.
11. Total Deductions (total Lines 9 and 10) ................................................................
12 4, 3 8 8. 8 7
.
......................................
Net Value of Estate (Line 8 minus Line 11) ...................
12
.
Charitable and Governmental Bequests/Sec 9113 Trusts for which 13.
13
.
an election to tax has not been made (Schedule J) .......................
4 , 388.87
• 14.
14. Net Value Subject to Tax (Line 12 minus Line 13) ...............................................
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or 0 . 0 0
transfers under Sec. 9116 15.
(a>(1.2> x .o0 197.50
16. Amount of Line 14 taxable 4 ~ 3 $ $ , $ 7 16.
at lineal rate X .045 Q . Q Q
17. Amount of Line 14 taxable 0 , Q Q 17.
at sibling rate X .12 Q . Q Q
18. Amount of Line 14 taxable 0 , Q Q 18.
at collateral rate X .15 197.50
19.
..........
...............................
19. TAX DUE ...................................................................... .
ING A REFUND OF AN OVERPAYMENT.
20. FILL IN THE OVAL IF YOU ARE REQUEST
155610243
Side 2
1505610243
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Woods, Nellie K
STREET ADDRESS
Sarah Todd Memorial Home
CITY
Carlisle
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
STATE
I ZIP -
pq 17013
(1) 197.50
o.oo
o.oo
Total Credits (A + B) (2)
(3)
4. If Line 2 is greater than Line 1 + Line 3, enteat efu aerence. This is the OVERPAYMENT.
Check box on Page 2, Line 20 to request
5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(4)
(5) 197.50
Make Check Payable to: REGISTER OF WILLS, AGENT.
STIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
PLEASE ANSWER THE FOLLOWING QUE
Yes No
1. Did decedent make a transfer and: ................... ^ ^^x^
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;:....• :::::::::::::::::::•: ^ ^
..... ^ o
c. retain a reversionary interest; or ........................................................
......................................
d. receive the promise for life of either payments, benefits or care • •~~~"'Within one year of death without ^ ^
2. If death occurred after Dec. 12, 1982, did decedent transfer property x
. ... ......................................
receiving adequate consideration? .............
• n "in trust for" or payable upon death bank account or security at his or her death?....... ^ x
3. Did decedent own a which ^ ^
4. Did decedent own an individual retirement account, annuity, or other non-probate property x
.............. .
............ .
............................. .
..
contains a beneficiary designation? .....................
F THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RE
IF THE ANSWER TO ANY O
re Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving
For dates of death on or after July 1, 1994 and befo
spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)].
Janua 1, 1995, the tax rate imposed on the net value of transfers tX and the statut ryh equirelmentsf or disclosuee of
For dates of death on or after rY
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from a ,
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:
et value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural paren , an
.The tax rate imposed on the n
adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) (1.2) .
the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in
The tax rate imposed on
[72 P.S. §9116 (a) (1)].
ed on the net value of transfers to or for the use of the decadent n colmmon wit the decedent whether by blood or adoption.
. The tax rate impos
sibling is defined under Section 9102, as an individual who has at leas o p
File Number 21-12-00916
Rev-1508 EX+(11-10) gCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF 21-12-00916
Woods, Nellie K
Include then nrtlceownedlwt hlthearidht of surv worship mu teberdi closed on schedule F.
All property j Y- 9
VALUE AT DATE
ITEM DESCRIPTION OF DEATH
NUMBER 8,600.00
1 Genworth Annuity -Distribution to Decedent
53.72
2 Readers Digest Magazine -Refund of Subscription
1,767.80
3 Sarah Todd Memorial Home
524.17
4 U.S. Treasury -Refund received for 2011 individual income taxes
I I 10,945.69
TOTAL (Also enter on Line 5, Recapitulation)
(If more space is needed, additional pages of the same size) Form PA-1500 Schedule E (Rev. 11-10)
Copyright (c) 2010 form software only The Lackner Group, Inc.
Rev-1509 EX+(01-10)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
o~cinGnlT nFCEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
ILE NUMBER
21-12-00916
Woods, Nellie K
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME
q. Gregory E Woods
B.
C.
ADDRESS
122 Ashford Way
Camp Hill, PA 17011
RELATIONSHIP TO DECEDENT
Son
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY % OF
' DATE OF DEATH
VALUE OF
EST
'
LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT
TIFYING NUMBER. ATTACH DEED FOR S
DATE OF DEATH DECD
VALUE OF ASSE INTEREST S INTER
DECEDENT
ITEM FOR JOINT
NUMBER TENANT MADE
JOINT NUMBER OR SIMILAR IDEN
JOINTLY-HELD REAL ESTATE.
000%
50 1 ,302.63
0110112008 Belco Federal Credit Union Checking
.
2,605.25
1 A Account
2 I A 101101120081 Belco Federal Credit Union Savings Account
' TOTAL (Also enter on Line 6, Recapitulation)
(If more space is needed, additional pages of the same size)
Copyright (c) 2010 form software only The Lackner Group, Inc.
1,494.56 I 50.000%I 747.28
2,049.91
Form PA-1500 Schedule F (Rev. 01-10)
Rev-1510 EX+(08-09) SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF 21-12-00916
Woods, Nellie K
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
OF DECD'S EXCLUSION TAXABLE
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH INTEREST IF APPLICABLE) VALUE
NUMBER T E DATE OF TRANSFERSATTACNTA COPYEOF TIE DEIED ~OR REAL ESTATDE. VALUE OF ASSET ~
1,467.76 1,467.76
1 Genworth Annuity -Beneficiary: Gregory E. Woods
~ I 1,467.76
TOTAL (Also enter on Line 7, Recapitulation)
(If more space is needed, additional pages of the same size) Form PA-1500 Schedule G (Rev. 08-09)
Copyright (c) 2009 form software only The Lackner Group, Inc.
REV-1151 EX+(10-09) SCHEDULE H
FUNERAL EXPENSES AND
COM INO ERITANCEOTF/.~P RETURNANIA
RESIDENT DECEDENT ADMINISTRATIVE COSTS
FILE NUMBER
ESTATE OF 21-12-00916
Woods, Nellie K
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A, FUNERAL EXPENSES:
2,641.07
See continuation schedule(s) attached
g, ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
State Zip
City
Year(s) Commission Paid
750.00
2. Attorney's Fees JOHNSON DUFFIE
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
5. Accountant's Fees
6. Tax Return Preparer's Fees
43.50
7. Other Administrative Costs
See continuation schedule(s) attached
3,434.57
TOTAL (Also enter on line 9, Recapitulation)
Form PA-1500 Schedule H (Rev. 10-09)
Copyright (c) 2009 form software only The Lackner Group, Inc.
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
(FILE NUMBER
ESTATE OF 21-12-00916
Woods, Nellie K
AMOUNT
ITEM DESCRIPTION
NUMBER
Funeral Expenses
1 Harrisburg East Cemetery
2 Remaining Balance of Funeral Home Services
3 Trinity Lutheran Church -Funeral Reception
210.00
2,134.00
297.07
H-A 2,641.07
Other Administra ive Costs 43.50
4 Cumberland County Register of Wills Office -Filing Fee for Petition for Small Estate
H-B7 43.50
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1512 EX+(12-08) gCHEDULE ~
DEBTS OF DECEDENT,
I.
MORTGAGE LIABILITIES AND LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
oCelnGnl7 nFf:FI~FNT
ESTATE OF
Wnnr1S_ Nellie K
FILE NUMBER
21-12-00916
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
VALUE AT DATE
ITEM DESCRIPTION OF DEATH
NUMBER 40.09
1 CenturnLink
66.59
2 Diamond RX -Pharmacy Services
64.14
3 Millinium RX -Pharmacy Services
9.17
4 PA Department of Revenue
8.63
5 R. Lynn Magargle MD
6,451.30
6 Sarah Todd Memorial Home
' TOTAL (Also enter on Line 10, Recapitulation) I 6,639.92
(If more space is needed, additional pages of the same size)
Form PA-1500 Schedule I(Rev. 12-08)
Copyright (c) 2008 form software only The Lackner Group, Inc.
REV-1513 EX+ (01-10)
COMMONWEALTCCH OFpp,,P~~ENNSUUYLVANIA
IN RESIDENTEDECEDENTRN
ESTATE OF
SCHEDULE J
BENEFICIARIES
Woods, Nellie K
NAME AND ADDRESS OF
NUMBER PERSON(Sl RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)~___
Gregory E Woods
122 Ashford Way
Camp Hill, PA 17011
FILE NUMBER
21-12-00916
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
DECEDENT (Words) ($$$)
Son ~ Entire estate
I ~ Total ~
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet, as a ro r
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
4,388.87
4,388.87
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 FormEPA 1500 Schedule J (Rev. 01-10)
Copyright (c) 2010 form software only The Lackner Group, Inc.
ESTATE OF NELLIE K. WOODS
SCHEDULE OF EXHIBI TS
EXHIBIT A
EXHIBIT B
EXHIBIT C
Last Will and Testament for Nellie K. Woods signed and dated
September 21, 2007.
Copy of Decree of Distribution showing values of Joint Account
and Cash received.
Genworth Date of Death Letter on Annuity
537290
Last Will and Testament
OF
NELLIE K. WOODS
of the Borough of Camp Hill, County of Cumberland,
I, NELLIE K. WOODS,
t ~ ~~r ..~ 3- ~-~' do ll~ale, publish and declare this to be my Fast ~y`iil c.ild
Ci`3ii~il=r~a~~7c,ait3`i i^.•t i .,~u'1:+}~1~~111a,
revokin and making void ,any and all former Wills made by me.
Testament, hereby g
11 m le al debts and funeral expenses, which my estate is
ITEM 1. I direct that a y g
' feed b m Executor, as soon after my death as may be found
obligated to pay, be paid and sates y y
~ convenient.
e ueath all the rest, residue and remainder of my estate of
ITEM 2. I give, devise and b q
e tom son, GREGORY E. WOODS, and his then living
every nature and wherever situat y
issue, per stirpes.
son GREGORY E. WOODS, Executor of this my Last Will.
ITEM 3. I appoint my
Executor shall not be required to give bond for the faithfu
ITEM 4. I direct that my
performance of their duties in any jurisdiction.
J
Q
W ~~
W
~ •~
Q
H
J
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m ~ hand and seal this=day of
IN WITNESS WHEREOF, I hereunto set y
Zoos.
~~:~ f~ (SEAL)
NELLIE K. WOODS
e • nned -:=~P~.~~e:d., Ll.~?li shed and declared b~T the abovL~named Testatrix, as and for her Last
~~~ p
d Testament, in the presence of us, who at her request, in her presence and in the presence
Will an
of each other have hereunto subscribe
2
AFFIDAVIT AND ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA SS
COUNTY OF CUMBERLAND
E K. WOODS, ~ ~~ ~ . ~~~ ~~~ and
We, NELLI
,the Testatrix and the witnesses, respectively,
' ned to the att ched or foregoing instrument, being first duly sworn, do hereby
whose names are sig
declare to the undersigned authority that the Testatrix signed and executed the instruY~~erit as her
Last Will and that she had signed willingly and that she executed it as her free and voluntary act for
the oses therein expressed, and that each of the witnesses, in the presence and hearing of the
P~
Testatrix, signed the Will as witness and that to the best of his/her knowledge the Testatrix was at
that time eighteen years of age or older, of sound mind and under no constraint or undue influence.
Testatrix
Subscribed, sworn to and acknowledged before me by NELLIE K. WOODS,
and
and subscribed and sworn to before me by
witnesses, this ~ ~ ~~ day of ~ ~..~ , 2007.
. 1~J
Notary ublic
.~
~!~1~?~-al Sri
310349 ~~t1~ L. ~,~~;~,~, i~4~t~iy s~~~fi~
L~~s~g~a ~~ra, Gr.~r~R~; ~~.m~~ ~~~t~~
r1~lero~~c~, r~nrZSyl~t~:s^:s~ anss~yiG~tior'e ~~ IR!s~e~sf~~
3
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In the Court of Common Pleas of Cumberland Gounty, Pennsylvania
Orphans' Court Division
- C~
~,
IN RE: Estate of ~ ~' -~ ~ ~`
r~' _
NELLIE K. WOODS, ~' ~"-
~ ~ ~~:
Late of Carlisle, - ~ ~ --,
Cumberland County, Pennsy{vania _.~ ~~~ o~`~
- NO. ~~ I ~ --<
. ~.
Deceased
DECREE OF DISTRfBUTION
.~s ~.~
r- a T~ ^~
r'
_._
~ ~-- ~ r~
. , `,~ ~
w --t-z
c.~
And now, this day , 2012, upon consideration of the
fore oing petition and on motion of the attorney for the Petitioner, it is Decreed that the
g
Petitioner distribute the property of the Decedent under Section 3102 of the Probate, Estate and
Fiduciaries Code as follows
Name
Gregory E. Woods, Sole beneficiary
Amount
$1,758.00 (Refunds due from Reader's
Digest and Sarah A. Todd Memorial Home)
$1,500.00 (Checking Account at Belco
Federal Credit Union)
$3,258.00 TOTAL
This decree of distribution shall constitute sufficient authority to all transfer agents,
re istrars and others dealing with the property of the estate to recognize the persons named as
9
entitled to receive such property without administration, and shall in all respects have the same
effect as a decree of distribution after an accounting by a personal representative.
By the Co
Judge
A TRUE COPY FROMI he eoto ~ ~h O l~'1 a S A. ~ ~ a ~e}/ .
In Testimony whera ,
~ my hand and the seal ~~ m ~ O n PI ea s Judge
of said Court at ~ttisl8, A
J
T d~Y _ w
r 1 ~~
~~
~, /~.~ 5 w
.,~~~ Q
/ C~irk ~t 1hM Orphans Court
Cunnbar#ar+d County Q
Genworth
}t
August 28, 2012
Gregory Woods
122 Ashford Way
Camp Hill, PA 17011
Re: Deceased: Nellie Woods
Contract Number: 706134321
Dear Mr. Woods,
P,O. Box X3014
Lyn„tibury, VA <'4.iG6-~()1~'~
(8(~0} 635-805G
(43Y) 5d8-5783 Fax
gem,~o~1.i~.ccn~
n res onse to our inquiry, the account value of the above referenced contract as of June 24, 2012 was
I p Y
$1,467.76.
s know if ou have any questions concerning the contract. You may contact us at 800 635.8056,
Please let u Y
Monday -Friday 8:30 a.m. to 5:00 p.m. Eastern Time.
Sincerely,
Claim Division
MJH
Qff~liated Companies: Genworth Life Insurance Company of New York, Genworth Life and Annuity Insurance Company, Genworth Life Insurance
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OF COU~SEI:
~c)-i~ I~. \1\c7Shti
l l~)R:1~~E .~. Ji)li~stly
1f-:I1:vI~1. J. ('.1SS--)1
January 30, 2013
Register of Wills Office
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
RE: Estate of Nellie K. Woods ~;
File No. 21-12-00916 c
~ ~
rn ~
Our File No. 15123-1 ~ ~ m ~ ~
~~~:~
Dear Register: ~ ~'' '~ °'~` ~ `'
~v>
~ ~ ~~~,
Enclosed for filing, please find the following: ~, ~ ,,~ -~ -~'~t "~~`
~ ~, w._:~ ~ ..
1. 2 Original Pennsylvania Inheritance Tax Returns. There is tax due in t~ ount of-$197 ~ ;~~~his
Estate was not probated but a Petition for Small Estate was filed. ~~, ~~ ~~.», v~
2. Inventory ~~ `~
3. One copy of Page 1 of the Inheritance Tax Return that we ask that you time-stamp and return to us.
4. One copy of the Inventory that we ask that you time stamp and return to us.
5. Check in the amount of $30.00 representing the filing fees for the Inheritance Tax and Inventory
Thank you for your assistance in this matter. Should you have any question or require any additional information,
please contact the undersigned
Very truly yours,
J HNSON, D,I~FFIE, STEWART &WEIDNER
~~ ~~
r f~
Dana Wieseman
Estate Administration Paralegal
Enc.
c: Gregory E. Woods
:537298
X01 ~'I;~(ihET S"lE~f~.l~"f P.O. 13C?~ 10~i 1.I;11()1~I. Pt:'ti15111':1:ti1;~ 1 i0=17-Olllt)
1~~~~'~1'.Jl)Stl'.CO11 i 1 ".ih L~1 x=10 1~:~\: % l i . i f~ 1. x(11 ~1,111, ra (L~~I~.Cf)11
JOHNS01~, DUFFIE, STEWART &WEIDNER, P.C.