Loading...
HomeMy WebLinkAbout08-27-14 (2) 1 1505607121 �1 REV-1500 EX (06-05) OFFICIAL USE ONLY PA DepeftM of Revenue Code Year FYa Number bet Bureau of POBOXaIndividual Tems INHERITANCE TAX.RETURN-�N - Hamsbum,PA 17128-0601 'RESIDENT DECEDENT ? 1 11 -4 0 7 1. 'ENTER DECEDENT INFORMATION BELOW 0 7 2 4 2 0 1 4 0 2 1 5 1 9 3 9 Decedent's Last Name Suffix Decedent's First Name MI G A R N E R M I L D R E. .D. L (If Applicable)�E�Surviving Spouse's Information Below Spouse's Last,NaTe s Suffix Spouse's R(st Name '• ,t MI Spouse's Social Security Number THIS RETURN MUST BE RLED IN DUPLICATE WITH THE REGISTER OF WILLS P LLIN APPROPRIATE OVALS BELOW - _' © 1.Original Return - 2.Supplemental Return E] 3.Remainder Return(date of death prior to 12-13-82) 4.LimHed Estate 4a.Future Interest Compromise(date of 5.Federal Estate Tax Return Required death after 12-12.82) ® .6.Decedent Died Testate Q 7.Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes .(Attach Copy of Will) - (Attach Copy of Trust) . 9.Litigation Proceeds Received 10.Spousal Poverty Credit(date of death C] 11.Election to tax under Sec.9113(A) - - between 12-31-91 and 1-1-95) (Attach Sch.0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: r Name - _ Daytime Telephone NumbpN - H AR 0 "L D S I W -IN I_ I 717,0 319 , 5;6rM-. o M,n Rrm Name(If Applicable) • - REGWEROF WILLS 9€ONU; I R W I N L 'A 4J 0 F F I C E 3U a r r"iT. First line of address 7r7-.+ 6 4 S 0 U T H P I T T S T R E E T n o Second line of address - fV Cn City or Post Office State. ZIP Code DATE F8:E6=1 - C A R ,L ; I S :L E A 1 7, 0 1 .3.; Correspondents'e-mall address:irwinlawoff ice®gmail.com Under penalties of perjury,I declare that I have examined this tetum,including aocompanyim schedules and statements,and to the best of my telowtedgeard beiref, „.. .4 I true,correct and complete.Dedaratim of preparer other than'the personal represpntative is based on all inbmation M which paperer has arty InowleAge. SIGNl1TURE OF PF�RSON- `R�IES PONSIB�E FOR FILING RETURN Jp E �/ ADDRESS 36 MILL STREET LOT 3 MT HOLLY SPRINGS PA 17065 SIG OFP PARER EPFiESENT E DATE ADDRESW f - 64 SOUTH PITT TREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 . ; ; 5 #�f7121 1505607121 1505607221 REV-1500 EX RECAPITULATION 1. Real estate(Schedule A) 1. 0 , 0 0 .. . . .. . .. . .. . .. . .. . .. .. . .. . . . .. .. . .. . . . . 2. Stocks and Bonds(Schedule B) 2. 0 . 0 0 . .. . .. . .. . .. . . . .. . . . .. . . . .. . . . .. . . 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . .. . . 3. 0 , 0 0 4. Mortgages&Notes Receivable(Schedule D) . . .. . . . .. . . . .. ... .. . .. . . 4. 0 . 0 0 5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E) .. . .. . . 5. 2 4 8 2 3 . 2 4 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested .. . .. . . 6. 0 , 0 0 7. Inter-Vivos Transfers&Miscellaneous N -Probate Property (Schedule G) 5 Separate Billing Requested .. . .. . . 7. 0 . 0 0 8.Total Gross Assets(total Lines 1-7) . . . . . .. . . . .. . I . .. . .. .. . .. . 1 8. 2 4 8 2 3 , 2 4 9. Funeral Expenses&Administrative Costs Schedule H 9. 9 9 8 9 , 5 5 10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule 1) .. . .. . . . .. . . 10. 6 7 6 . 6 3 11. Total Deductions(total Lines 9&10) . . .. . . . . . . I. . . . :.. . . . .. . . . . . 11. 1 0 6 6 6 . 1 8 12.Net Value of Estate(Line 8 minus Line 11) .. ... .. . .. .. . .. .. . .. . I. . . 12. 1 4 1 5 7 . 0 6 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. 1 4 1 5 7 , 0 6 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.045 1 4 . 1 5 7 . 0 6 15. 6 3 7 . 0 7 16. Amount of Line 14 taxable at lineal rate X.0_ 0 . 0 0 16. 0 . 0 0 17. Amount of Line 14 taxable 0 . 0 0 17. 0 . 0 0 at sibling rate X.12 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 . 0 0 19.Tax Due .. . . . . . . . . .. . . .. . .. . .. . .. . . . . .. . . . .. . .. . . . .. . .. . 19. 6 3 7 . 0 7 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505607221 1505607221 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 14 0712 `DECEDENTS NAME MILDRED L. GARNER STREET ADDRESS 103 EAST MAIN STREET CITY STATE ZIP PLAINFIELD PA 17081 Tax Payments and Credits: I. Tax Due(Page 2 Line 19) 0) 637.07 2. Credits/Payments A.Spousal Poverty Credit B.Prior Payments C.Discount 31.85 Total Credits(A+B+C) (2) 31.85 3. InteresUPenalty if applicable D.Interest E.Penalty Total Interest/Penalty(D+E) (3) 0.00 4. If Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT. Fill In oval on Page 2,Line 20 to request a refund. (4) 0.00 5. If line 1+line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 605.22 A.Enter the interest on the lax due. (5A) B.Enter the total of Line 5+5A.This is the BALANCE DUE. (58) 605.22 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 ................................................................................................ ❑ El d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ IR 2. If death occurred after December 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. Far dates of death on or after July 1,1994 and before January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three(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 zero(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 twenty-one 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 zero(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 four and one-half(4.5)percent,except as noted in 72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)1• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve(12)percent(72 P.S.§9116(a)(1.3)i.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-1502 EX i(8-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MILDRED L. GARNER 21 14 0712 All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property which isjointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NONE 0.00 1 TOTAL(Also enter on line 1,Recapitulation) $ 0.00 (If more space is needed,insert additional sheets of the same size) REV-1503 EX t(8-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MILDRED L. GARNER 21 14 0712 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NONE 0.00 TOTAL(Also enter on line 2,Recapitulation) $ 0.00 (If more space is needed,insert additional sheets of the same size) REV-1504EX•f6-e8, SCHEDULE C CLOSELY-HELD CORPORATION, COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP OR - INHERITANCE TAX RETURN RESIDENT DECEDENT SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER MILDRED L. GARNER 21 14 0712 Schedule C-1 or C-2(including all supporting information)must be attached for each closely-held corporation/parbtership interest of the decedent other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NONE 0.00 TOTAL Also enter on line 3,Recapitulation) $ 0.00 (If more space is needed,insert additional sheets of the same size) REV-1507 EX+(8-98) SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE RESIDENT DECEDENT RN RECEIVABLE ESTATE OF FILE NUMBER MILDRED L. GARNER 21 14 0712 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NONE 0.00 TOTAL(Also enter on line 4,Recapitulation) $ 0.00 (If more space is needed,insert additional sheets of the same size) REV-1508 EX*(6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY 'RESIDENT DECEDENT ESTATE OF FILE NUMBER MILDRED L. GARNER 21 14 0712 Include the pro ceeds of litigation and the date the proceeds were received by the estate. All property jointty-owned whh right of survivorship must he disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CITIZENS BANK 9,849.89 Checking Account XXXXXXX687-8 Value based on attached Exhibit"B" 2. CITIZENS BANK 14,378.25 Checking Account No. xxxxxxx426-1 Value based on attached Exhibit"B" 3. CUMBERLAND COUNTY EMPLOYEE BENEFIT FUND 345.10 Retirement pay due for 7/1/2014-7/24/2014 4. MISCELLANEOUS PERSONAL PROEPRTY 250.00 TOTAL(Also enter on line 5,Recapitulation) $ 24 823.24 (If more space is needed,insert additional sheets of the same size) REV-1509 EX+(6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MILDRED L. GARNER 21 14 0712 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. NONE B C JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FORJOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECUS VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENrs INTEREST 1. A. NONE 0.00 0.00 TOTAL(Also enter on line 6,Recapitulation) S 0.00 (If more space is needed,insert additional sheets of the same size) REV-1510 EX+(8-98) SCHEDULE G INTER-VIVOS TRANSFERS& COMMONWEALTH HERI PENNSYLVANIA MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER MILDRED L. GARNER 21 14 0712 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. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME Or ME TRANSFEREE THEIRRE TONSHIPTO DECEDENT AND DATE OF DEATH % DECD'S EXCLUSION TAXABLE NUMBER ME DATE OF TRANSFER ATTACH A COW OF THE DEED FOR RE ESTATE. VALUE OF ASSET INTEREST QFARRICMLEI VALUE 1. NONE 0.00 0.00 TOTAL (Also enter on line 7 Recapitulation) $ 0.00 (If more space is needed,insert additional sheets of the same size) REV-1511 Ex+(10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES& INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER MILDRED L. GARNER 21 14 0712 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: I. HOLLINGER FUNERAL HOME &CREMATORY- Funeral Expenses 5,771.05 2. HOLLINGER FUNERAL HOME&CREMATORY- Headstone 2,400.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Years)Commission Paid: 2. AttomeyFees IRWIN LAW OFFICE 1,650.00 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 CUMBERLAND COUNTY REGISTER OF WILLS 168.50 5 Accountant's Fees 6. Tax Return Preparers Fees 7. TOTAL(Also enter on line 9,Recapitulation) E 9,989.55 (If more space is needed,insert additional sheets of the same size) REV-1512 EX-(12-03) SCHEDULEI COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER MILDRED L. GARNER 21 14 0712 Report debts incurred by the decedent priorto death which remained unpaid as of the date of death,including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PP&L 126.63 Outstanding electric bill 2. CLAREMONT NURSING & REHABILITATION 550.00 Nursing services TOTAL(Also enter on line 10,Recapitulation) $ 676.63 (If more space is needed,insert additional sheets of the same size) REV-1513 EX*(9-00) SCHEDULEJ COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MILDRED L. GARNER 21 14 0712 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.9116(a)(1.2)1 1. HOPE M. MORRET Lineal 36 Mill Street, Lot 3 1/3 Residue Mt. Holly Springs, PA 17065 2. TRAVIS J MORRET Lineal 36 Mill Street, Lot 3 1/3 Residue Mt. Holly Springs, PA 17065 3. HOLLIS M MORRET Lineal 36 Mill Street, Lot 3 1/3 Residue Mt. Holly Springs, PA 171065 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18,AS APPROPRIATE,ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET E (If more space is needed,insert additional sheets of the same size) -t LAST WILL AND TESTAMENT I, MILDRED 1. GARNER, of 103 East Main Street, Plainfield, Cumbgrlano County, Pennsylvania 17081, do-hereby make, publish and declare this to be my last will and testament, hereby revoking all wills heretofore made by me. 1. I direct my personal'representative to pay all of my debts,funeral and administrative expenses as soon as convenient after my decease. •I direct that all inheritance taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property,' whether or not such property passes under this Will, shall be paid by my personal representative out of my estate. 2. 1 authorize and empower my personal representative to sell any realty and/or personalty owned by me at my death and not specifically-devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My representative is authorized and empowered to engage in any business in which I may be engaged at my death,for such'period of time after my death as seems expedient to said representative. 3. 1 give, devise and bequeath all of my estate of whatever nature and wherever situate to Hope M. Morret, Travis J. Morret,and Hollis M. Morret, share and share alike,the child or children of any deceased beneficiary taking the share their parent would have taken if living. 4. If any of my beneficiaries is under the age of twenty-one(21)years at my death, then the share of my:estate given to such beneficiaries, I give, devise and give, devise and bequeath to be held in trust,by the•hereinaftbr mentioned trustee according to the following terms and conditions: The trustee, as well as my representative, is hereby authorized to retain, unconverted, any ` property, real or personal, that I may own at my death and shall be under no duty to convert it into legal investments. The trustee shall have the power and authority to sell, transfer, convey, invest and reinvest and to pay over the net income of the trust property,to or for the use.of such beneficiaries or to accumulate it in the sole discretion of the trustee. The trustee is also authorized and ernpowered to pay over to, or for the use and benefit of-&ych beneficiaries such jY portion of or all of the principal of the trust.estate, as in the trustee's sole discretion seems proper for their support, maintenance, education, or medical care. My primary object is to insure the support,maintenance, education and medical care of such beneficiaries until they reach the age of twenty-one(21)years. When the youngest of such beneficiaries reaches the age of twenty-one(21)years,then whatever remains of income or principal of the trust estate shall be distributed to such beneficiaries, share and share alike. 5. 1 nomiriate'and appoint Hope M. IWorret to be the'personal representative of my estate, ! to serve without bond. If she cannot'or does not serve,then I appoint Arthur L. Rhoads, 11 to'be the substitute personal representative, also without bond. 6. 1 appoint M&T Bank,its successors or assigns, to be the trustee of any trust dreatdd herein. f suggest that my personal representative retain the seances of Harold S. Irwin, Ili, Esquire, in the settlement of my estate. IN WITNESS WHEREOF, I have.hereunto set my hand and seal this 22nd day of May, 2014. IJL�& EAL) MILDRED L. GARNER - Signed, sealed, polished and declared by the above-named persori.as and fora last wilf and , testament, in our presence,who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. ACKNOWLEDGMENT AND AFFIDAVIT WE, MILDRED L. GARNER, AMY J. MAZUTIS, and RACHEL 1. SHAW,the testatrix and witnesses respectively,whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned-authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly,and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses,in the IF presence and hearing of the testatrix, signed the will as a witness and that to"the best of their knowledge the,testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. ` AM AZ '1 RACHEL 1.SHAW COMMONWEALTH OF PENNSYLVANIA :as: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by MILDRED L. GARBNER,the testatrix hereirt, and subscribed and sworn to before me by AMY J. MAZUTIS and RACHEL I.SHAW, this 22a° %day of May, 2414. Notary Public 910;'9 Wd eaidx3 uopsiiwwoo dW AANti090MV1N39 3'Nnowo93lSf1NVo 94W AWN !I MIhUN)8 010pYN 1V3S IVItlVlON zmmg � Carl Ste FRIDAY, AUGUST 01, 2014 rt 11:12 Please save this receipt until you have n � verified your account statement. N Withdrawal 3 s Account Number: XXXXXXXXXXXX6878 E �e Amount: 59,849.89 _ r .. zi fi ♦! X CO W 0 ?' > e OD z z ° 0 ' r M c O k' # Teller Number: J030291 -1 - - Bank: 060 L; c D 81j (� •� Branch: 289 Ct r Transaction B: 3289058883 D a c ca sti€0 izensBank- 4 f � � n DO citizensbank.com t+' 1-800-922-9999 5 '{-�•�'' Please see back for imyorlasl disclosures. C ` r! C.') �. N 1-4 +, P" CY C1] --`_ CUSTOMER'S•RECORD a v a' o .0 } Carlisle FRIDAY, AUGUST 01, 2014 N 11:14 Please save this receipt until you have verified your account statement. N1 Withdrawal 3 Account Number: XXXXXXXXXXXX4261 E =. Amount: $14,378.25 1 it z � � to A ox < a y v Z to 9 O 23 rA ? ° C C) Teller Number: J030291 i es 1 13- * Bank: 060 D G) p Branch: 289 CD OL Transaction B: 3289058884 M r^ n Ml izens Bank• citizensbank.com g 9 1-800-922-9999 Rease see back Iw Imponanl Ciscloswes. w � � 11C p` ' to C" 1 '. & (--.) . O 00 Q -- r =�. .rte, CUSTOMER'S RECORD