HomeMy WebLinkAbout03-07-14 (2) J 1505610101
REV-1500 EX(01-10) ~
�•" OFFICIAL USE ONLY
Department d ualTaxes Revenue Pennsylvania
Bu reau 2 Individual County Code Year File Number
PO BOX
Bu INHERITANCE TAX RETURN
Harrisburg,PA 17128-c6o1 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW % � .0 N
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
Decedent's Last Name Suffix Decedent's First Name MI
MI 171 d 10 IMI 81 1 1 1 1 1 11 ® RATE I I I I 1 11 N❑
(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
1.Original Return O 2.Supplemental Return O 3. Remainder Return(date of death
prior to 12-13-82)
O 4. Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
1 death after 12-12-82)
® 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
_ (Attach Copy of Will) (Attach Copy of Trust)
O 9. Litigation Proceeds Received O 10.Spousal Poverty Credit(date of death (=D 11. Election to tax under Sec.9113(A)
p `<� 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
09#141k- tES E SA1EGOS ii i -/ 17 7GG oao9
REGISTER OF WILLS USE ONLY
First line of address r�
/ o
(O
Second line of address - m0 d"
_Dtr- a7 f �7
/ n C `� t
City or Post Office State ZIP Code
/11 CHAN/ CS'BUQG /01¢ I70 ssi9,7� �.
Correspondent's e-mail address: CES/,i e 101.5 3(y Comcast. lie,
Under penal es of perjury,I declare that I ha examined this return.Including accompanying schedules and statements,and to the best of my knowledge and belief,
it is We, and complete.D claratio o preparer other than the personal representative Is based on all information of which preparer has any knowledge.
SIGNAT F P, ERSON RE O FOR FILING RETURN ATE
ADDRESS ATie iW �,4(,j
7P gayAn Crrc/e o S
SIGNA OF P EPAR OTH PRESENTATIVE DATE
ADDRESS CN*T�1 teLE5 A /. 'I� /Q CIO USU^ /Pq,, /fJLC//Q///CS4L//j, P/} /7oZW -'-
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610101 1505610101 J
1505610105
REV-1500 EX Decedent's Social Security Number
Demdenrs Name: Aevz;12
RECAPITULATION
1. Real Estate(Schedule A), 77):0,
12. Stocks and Bonds(Schedule 8 ............... ........ ............. . Z AL J�LG, 6161
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) 3, A:T I fl JJLE !0 0" '
4. Mortgages and Notes Receivable(Schedule D).............. ....... 4. 1
D
_
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)..... 5. J_ J_
6. Jointly Owned Property(Schedule F) C= Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) p Separate Billing Requested.. T
8. Total Gross Assets(total Lines 1 through 7).... .... ... .... ... .... .... 8
9. Funeral Expenses and Administrative Costs(Schedule H)..... 91
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) ....... 10.
11. Total Deductions(total Lines 9 and 10)......... ...........
12. Net Value of Estate(Line 8 minus Line 11) ............ . ....... ....... ... 12.
13. Charitable and Governmental BequestatSec 9113 Trusts for which
an election to tax has not been made(Schedule J) ........... 13, 12
14. Net Value Subject to Tax(Line 12 minus Line 13) .... ........ ....... .... . 14, 0
TAX CALCULATION-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– is
16. Amount of Line 14 taxable Jj��TPTO 010
at lineal rate X,OYS
0 0
17. Amount of Line 14 taxable
at sibling rate X 12 6)
18. Amount of Line 14 taxable
at collateral rate X.15 —M -IT'y 18,
..
7 0
19. TAX DUE............. .. ..........__............ ....... 19, L
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C=:)
Side 2
1505610105 150561010S
REV-1500 EX Page 3 File Numberd �-
Decedent's Complete Address:
DECEDENT'S NAME
STREET ADDRESS /LSf on
3.2 2$' Ales Z�ri ve t 3)07 . 3'. co
CITY STATE ZIP/ 70 jss-
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 19
2. Credits/Payments
A.Prior Payments
B.Discount Y>
Total Credits(A+B) (2) 19
3. Interest
(3)
4. If Line 2 is greater than Line i +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. If Line i +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5)
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.......................................................................................................................... ❑
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑
2. If death occurred after Dec.12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑
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? ........................................................................................................................ ❑
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 Jan. 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 172 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-0508 EX.OW)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHRESIDENT DECEDENTRN PERSONAL PROPERTY
ESTATE OF ,�/�//, // 041*&1 FILE NUMBER z —
Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of survivorship must he disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. ' �,ouso.,4�iy
/�SSe�fed,fem s �/4.?,yD
rice I'knw. ,sal /sf r &64eal Werek
TOTAL(Also enter online 5,Recapitulation) $ y.?�•�/O
(If more space is needed,insert additional sheets of the same size)
Nevin Whitcomb Inventory
Bed Room
Bed $ 20.00
Old dresser 18.00
Chest of drawers 22.50
Night stand 1.75
Small desk 5.00
Chair 2.00
Corner hutch(damaged) 35.00
Bookcase 10.00
Small cabinet 2.00
File cabinet 2.50
Small white stand 1.00
Humidifer-junk value -0-
Hamper .50
4 Small lams 4.00
Toy trucks and cars 50.00
Wrist watches don't work well 10.00
Money clip and change on dresser 82.40
2 Suitcases 2.00
Nic Nacks-snow globe, coasters, candles, etc. 4.00
Kitchen
Miscellaneous dishes and utensils 4.50
Toaster 2.00
Coffee pot 2.00
Canister set 2.00
Small canister set 1.75
Miscellaneous post and pans 5.50
Miscellaneous baking pans 3.00
Other
Old walker 7.75
2 Canes 1.00
Box of board games 1.00
Tool box w/miscellaneous hand tools 5.25
Vacuum cleaner 1.50
Broom .25
Bucket 1.00
Mop .35
Dust pan .35
Baskets and misc vases 2.00
1
Living Room
Old sofa 40.00
Old cushion chairs 6.50
Old recliner 12.00
Coffee table 5.50
2 Table lams 4.00
1 Floor lamp 4.00
Old TV and cabinet 5.00
Grandfather clock needs repaired) 25.00
Damaged corner stand 'unk value -0-
4 Folding chairs 2.00
-Ma gazine rack .50
r
REV 1509 E8.(1-91)
4& SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER ff
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 ADDRESS RELATIONSHIP TO DECEDENT
A. S, Jt&o 703 5an Haven C:role, /1lecliA»;csbctr�, P/l dau e�
moss
B.
C.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and hank account number or Similar identifying number.Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for joimly-held real estate. VALUE OFASSET INTEREST DECEDENT'S INTEREST
t. A. Aembw Ist fidenxl Cred,� union Av.&t,
&lR8lo3 RetJor Cvw,n1S Aae-. /7/193-00 7, 731.72 S7o 3,865.86
.1. 9. &1z8/o3 eheck.,j 4�'• 171193-11 O28�75 Soy m2. 38
Xnvestmeont Szvnys Amt MRS-05 917135_ soS
(see va�uolhon loiler Ia/fa�d)Dp
a.e xt+d has been r-L;ee,:ved -iron, Cliqlcit
TOTAL,(Also enter on line 6,Recapitulation) $
(If more space is needed,insert additional sheets of the same size)
St
MEMBERS V
FEDERAL CREDrr UNION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 171193-00
Date Account Established 10/03/1997
Principal Balance at Date of Death $7,731.64
Accrued Interest to Date of Death $.08
Total Principal and Accrued Interest $7,731.72
Name of Joint Owner Patrice S. Law
Date Joint Ownership Established 08/2812003
CHECKING ACCOUNT: ,
Account.Number/Suffix 171193-11
Date Account Established 10/0371997'" --_ `
Principal Balance at Date of Death $284.75
Accrued Interest to Date of Death $.00
Total Principal and Accrued Interest $284.75
Name of Joint Owner Patrice S. Law
Date Joint Ownership Established 08/28/2003
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix 171193-05
Date Account Established 04/13/2000
Principal Balance at Date of Death $171.34
Accrued Interest to Date of Death $.01
Total Principal and Accrued Interest $171.35
Name of Joint Owner Patrice S. Law
Date Joint Ownership Established 08/26/2003
BERS 1sT FED AL DIT UNION
Danielle A. Kline
Lending Insurance Support Specialist
January 9, 2014
Estate of: NEVIN H. WHITCOMB
Date of Death: 04104/2013
Social Security Number: 162-22-4421
5000 Louise Drive • P.O. Box 40 • Mechanicsburg,Pennsylvania 17055 (800) 283-2328 www.memberslst.org
REV-1511 EX+(10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Nevin �1. whtA&w6 2i i y
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
Mo142LZZ; 1 xAGYI[1 HPmL of �VlLCIilviUcc�iUr� 11 32 6,71,
°�• C;ngr;�6 /7)UnonalS ¢300.00
3, Cp/ercls�wn /Y7GJnoC/;s) CburLh r riGral meal, et . r3oo.o0
!see pJ�acl� 47�`ic/ILe(J
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions ,r/ /L/� �/�
Name of Personal Representatives) mIL�At/w,w�l�M� f /�tJITLL .S. Z.
Street Address 7�3�If p jyyY� Care/e ,,��,,tt
City meA a6csHltYvr -State�Zip /7055
Year(s)Commission Paid:
2. AltorneyFees ChAr�CS p�ntG/g3 ZrL 771,E
3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation)
Claimant _ 0i gNF EG/G//3LE
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees '/ /� /
5. Accountant's Fees Creedon 14ofFvnam e7" GrerA tkiii eft!. P/ I1echiii [S 0
btA r9, ?00,ao
PR — elPSL ox1"/o YO, of
6. Tax Return Preparer's Fees
7. l�;l�a� tree to Re�1sfP,+" *I AII'lls
TOTAL(Also enter on line 9, Recapitulation) $
(If more space is needed,insert additional sheets of the same size)
8 Market Plaza Way (717)697-4696
Mechanicsburg,PA 17055 www.malpezzifuneralhome-com
Jeremy J.Shartzer,FD Michael J.Malpezzi,Owner,FD Kyle C.Knipe,FD
June 3. 2013
Michael N. Whitcomb
32 Mavberry Lane
Mechanicsburg; PA 17055
This is the final statement for the funeral services of Nevin H. Whitcomb
We sincereh appreciate the confidence you have placed in us and«ill continue to assist}ou in even Nva}'.
PROFESSIONAL SERVICES:
Seixices of Funeral llvector/Staff
$5;475 nr.
FUNERAL HOME SERVICE CHARGES S5,475.00
SELECTED MERCHANDISE:
Poplar Veneer Casket $2,995.00
12 Ga. Regular $I,�-»00
Natures Tranquility Register Package $95.00
THE COST OF OUR SERVICES,EQUIPMENT,AND MERCHANDISE
THAT YOU HAVE SELECTED S10,100.00
CASH ADVANCES:
At the tune funeral arrangeme rrLs mere wade, n e adt�nncerl certain pmmrents to others as an ncconodation.
The follownrg is an accounting of those charges.
$950.00
Opening Grace
.00
$36
Cemetery Equipment $ 36.00
Certified Death Certificates $
Newspaper Notices-Patriot $327.31
New spape Notices-Sentinel $235.28
$225.00
Clergy $100-00
Organist
Flowers
$200.00
TOTAL CASH ADVANCES AND SPECIAL CHARGES 52,273.59
CONTRACT PRICE 512,373.59
HISTORY:
04/04/2013 Discount Pre-Need Guarantee $27046.83
04/11/2013 Pavtnent forethought $9,256.47
$1,070.29
TOTAL AMOUNT DUE
Pohl pet. clot 32,6'76
If you have atry questions or concerns regarding this bill. please call our office at (717) 697-4696.
r`, v
Citingriell
1 2-01995
MEMORIALS Since 1921 Drawing _ Drawing Sent to Cust. _ _ Approved
5243 Simpson ferry Road. Mechanicsburg, PA 17050 Found. BY_-------___......_.....__---.----- Found. Ordered_--------
;717)766-5622 - Fay. (717)766-8007
Vendor --_.-------.. .. ___---- ---_-.--....-_ Ack f#
ut+rN_gingrtc memorlak.cam
r Grave Position Verified _ Cremation _
SOLD TO
-- � Date of Order
t f-D _ . _ .._
-
t Cemetery .- :Y1 .5 taz �1�I tt,
Cemetery Location
Phony ar? ,. ?t;,L-; Cell Center-Over Graves Sec Loi
Email__
__...... i '^ i'}CS Apprcx Date of Completion ^ -
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Lettering .... _.—..-....._� T-
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Type c"Y:42'�:<: cq,Y`ct� ...._._._ Material_ T,F, __„_,_�,_..._.� Additional Lettering
Size -...... ac �'i X t< i —a
i ? UX *� t A X Finish r ry` '7 "te cG �Lt tBS;
__.—... El Back ❑ Base
Size X X Finish C t•£ t?dj' 13 �i T _ `
Description -_—„ i.U.. "n DG.S_����__ �.t-_--
z
..... _....-.._ t j........
-- __
Location on Cemetery _}'�
❑ Vase__,_,..-.-.._.. -_ . _._.............❑ Other
Agracment:A 54'.',deposit is required in,commencement of wvcr, COSTS'
Apreer to pay stated balance upon erection regardless of labor troucies or shipments or any othsr goad reasons i his order or Memorial S
contract cannot be ca^celle -------------
_d y c'us,omer uniass agreed 6y born pane=_.The article •sin mcaGoned ahan remain the Property Of
James R.Gingrich Memorials until paid in lull and they reserve the right to remove the sarre is n:'paid as-:rated. Foundation S
!agree to carefully proofread e!names and dates for accuracy and accept lull resporuibiliyy for any errors or omissions.THERE
WILL BE AN ADDITIONAL CHARGE FOR ANY LETTERING ADDED TO THIS MEMORIAL AFTER ERECTED ON THE Cemetery Fees
CEMETERY. T P
=-tutlh,., _ &rrrti7C_...�C'c'v�7.- S
c agree to o�ay nits bwbnoe stated'or Ipe work pz-'formed under frds contract rte'.,thirty;301 Cava o'receipt of the fina4
invoice and further agree that interest shall accrue at the rate of one and Drench percent it%n`o)par nionih On the:mpabd batanc2 $ ------------
aeea c J James R Gin Gingrich o msrriote egai proceed thirty(30)days of the I woia date Ir addition r.e eto.!agree'.it becomes —
Gingrich p
:ngt collect any funds due frorc me for ay aceui ,ring pas,due L`ririy
(30j tlP.ys.to pay all coun.Gvosis and attorneys lava incu-u.,hi dames 9 Grgne!'Merl unls to=Aect tho same, TOTAL C{.L #
L (1
Dealer
l '.( ........... ___......_...... ..............-..-...—...- DEPOSIT
si CustetBf & IIr 'L}� $�-- _.
Balance Due
._.. ... __ _..-.
._.. ;i further agree that the above naanos.spotting,and dales am Cocoon<.) U,^_pn Comp
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REV-1513 EX+(11-08)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF NW1'n H- 14161lwoi FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec. 2116(a)(1.2).] L/
I. A7;cltae/ /Y: WhiMOML Soh
3a May 6crry Lane
/veC4i"1Csbury, Pa
a. Palr%ce S. Ian dau�iler y2
703 Sun h/a✓en CirG/e
Methan1*C6&j,' P4 17055
(See7rNe And Cerretf ft(jrmed ol� �e &Pyr
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II — ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed, insert additional sheets of the same size.
LAST WILL AND-TESTAMENT OF NEVIN H.WHITCOMB
3/07 t6.
1,NEVIN H.WHITCOMB,currently of 325 Wesley Drive,Apartment 1.13
Mechanicsburg,Cumberland County,Pennsylvania, 17055 being of sound and disposing mind,
memory and understanding,do make,publish and declare this my Last Will and Testament,hereby
revoking and malting void any and all prior Wills by me at any time heretofore made.
I.
I direct the payment of all my just debts and funeral expenses as soon after my decease as the
same can conveniently be done.
La.
My 1954 Dodge car currently in J.L. Skelly's garage,I give to my son,MICHAEL N.
WHITCOMB. In the event he predeccasrs me,then to my son-in-law,JOE LAW.
I.b.
My collection of toy cars and trucks I give to my son-in-law,JOE LAW,
Lc.
My tools are to be divided between my said son and son-in-law in a reasonable and amicable
manner.
2.
All the rest, residue and remainder of my Estate,real,personal and mixed,whatsoever and
wheresoever situate,is to be dividcd and distributed in two(2)equal shares to my son MICHAEL
N.WHITCOMB,currently of 32 Mayberry Lane,Mechanicsburg,Cumberland County,
Pennsylvania, 17055,- ersrirocs and my daughter PATRICE S. LAW,703 Sunhaven Circle,
Mechanicsburg,Cumberland County,Pennsylvania 17055,rzer srtrces. In the event either one of
them has predeceased me and has not been survived by issue,then his or her share shall go to his
or her sibling,pe sr • ,R.
3.
1 nominate,constitute and appoint my son MICHAEL N.WHITCOMB,and my
daughter,PATRICE S. LAW,to be the Co-Executors of this my Last Will and Testament.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,1 have hereunto set my hand and seat this „ � day of
, P(pll A.D.2003
(SEAL)
VIN H.WHITCOMB
Signed,scaled,published and declared by the above-named NEVIN H.WHITCOMB,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,
5L�l�/y � Stielr� rs