HomeMy WebLinkAbout05-19-78 (2)
RCC.33 (4-73)
. ~
-.
,.QIiWMq.l'k>>,pAL TH OF PENNSYLVANIA
"^,' ; DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
,
l'1~V lQ197n IMp"',. :';Iif~
, " U COUNTY OF CUMBERLAND
,
RESIDENT DECEDENT
IMPORTANT,
This return must be completed)n detail and filed in duplicate, with all at.tached,.with the Register of Wills of the
County where decedent 'resided; Return is due with.in ~ine m~nthsafter dat~ of death, unless an .e~uension-is granted
by the Se~retary of Re'it~nue. (Section 703 of the Inheritance' and .-Estate Tax Act of 1961.)
Lote of
Cumberland
PENNSYLVANIA
} AFFIDAVIT OF
EXECUTl9&rX
ADMINISTRATOR
"1'
IN THE MATTER OF THE ESTATE OF
ARCHIE F'. BURK
(STATE FULL NAME OF DECEDENT)
County
County of
CUMBERLAND
} os,
Stote of
~
DOROTHY McDOWELL
of the esta,te of the above-nomed decedent being duly Iwom, depos'~ 5
Executoxr ix
and, 50)' 5
Decedent died
8
, 19~{teatote leavrn'~ ,0 last wlli, cop)' o("':'hich is here~o ot~Ched.:'}
'('(EARl i;rt~~X '. .
, .
(D'A'()
Thomas I., Mvers .
P. O. Box 125;
Mvers. Mvers, Flower & Johnson
, ,
Lemoyne, Pennsylvania 17043
That as such Executrix deponent is familiar with the, af(a;irs oLsaidestllte .and. the. property constituting
(EX ECUTO R-ADMINIST RA TORl
the assets thereof and their fair market'value.
That at the time of death there was no safe deposit box registe~ed' in decedent's individual name, or jointly with, or
as agent or deputy of another, or ~n dec'edent' s ind~vidual.name, with right.of access bY',another, as agent o~ deputy, with the
exception of the following: - ' .
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A S....FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
Dauphin Deposit Bank & Trust Co. IJeceaenT or
301 Market Street Dorothv F. McDowell Daughter
Lemoyne . Pennsylvania 17043
,
That, the contents of said safe deposit box or boxes are itemized u~der Sc'b.edules B
wi th the exception' of the following, for the reasons hereinafter set fo~~:
of this return,
That Scheclule A attached hereto and made pait hereof sets forth fully and in 'detail all the real property
. :. . .
in the Commonwealth ?f Pennsylvania of which decedent died having an interest therein. . It 'also sets forth the
mortgage encumbrances upon each parcel of real property at the date of death, givit:lg the amount. still du'.e at
death, name of mortgagee, date, rate of' interest, an~ book and page of re.cord thereof. It also sets forth in the
coluJtU1s provided therefore the assessed valuation of each of said parcels,. the estima~ed market value thereof
as of date of death 'of decedent.
That Scheclul. B attached hereto and made part hereof sets forth fully and in detail all personal property
wheresover situated owned by the decedent at the time of death; all mo~ey~..,left .by the dec,ede,nt at the time of
death, whether in decedent's immediate possession, standing to decedent's credit in banks of deposit, savings
banks, trust companies, or other institutions, whether individually, or in trust for any other person or persons
giving also separately the accrued interest thereon, .if any, down to the last' interest day priM to-dE'cedent's
death in the case of savings banks, and to the date of decedent's death in all other cases; alllJonds" .posta:-i
savings, treasury .certificates or notes and other evidence of indebtedness of the United Sta-~s- to "'the "d;':' ~o,
cedent; all obligations, whether by statute or agreement they are designated as tax free, of the United States,~ .,:. l
or any state, 'or, political subdivision thereof, or of any foreign country, which -are "owned ,a(th"ttime of death;~ .,. i
all wearing apparel, jewelry, silverware, pictures, books, works of art, household'furqiture,"horses,~ carriages~ ~
automobiles, boats, and. any and all other personal chattels of whats'oi~~r: kind-P~t;"ri~ture, left by decedent, ~.....
, \..
together with the fairly i_estimated market value thereof; all bonds and mortgages hel~ by dece~ent and'of all
claims due and owing decedent at 'the time of death, and all 'promissory notes or other'in'sirum-~nts in writing
for the payment of money of which decedent died possessed, o(~whatsoever natu're, with interesl thereon, if
any, giving the face value and estimated fair market value thereof, and if s'-~ch' estimated fair,market value be
less than the face value, it sets forth briefly the reasons for such depreciation a~. to, each item; all moneys
payable to the estate from life insurance po-licies carried by dece'denl; all annuity and 'e-ndow'~ent contracts
the proceeds of which were payable upon the death of the decedent; all and the corporate stocks and- dividends
due thereon and unpaid as of the date of death, bonds and accrued interest thereon to the date of decedent's
death and other investment securities ow~ed'by the decedent at the time of death, with the.market value there-
of ~t such time.
.
.
In the case of securities or close or family corporations, the values reported are as far as
possible substantiated by financial statements of the corporations, showing the assets and liabilities
thereot &s of the date of death. The schedule a180 8ets forth the interest of decedent at the time of
death tn any co-partnership or business, and in support of the value of such 1nterest there 1s annexed to
said schedule, financial statements .howing the assets and. liabilities of said co-partnership or Quslness.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of Uie agreement)
together wlth a statement setting forth the character ot the bUSiness, 1ts location, and such other facts
pertaining to the ~uaine8s as may be pertinent to a fair and just appraisal of the decedent's interest
therein must be submitted. It should also set f"orth in itemized form, together with the fair market value
thereof, any other property owned or bequeathed by the decedent at the time of death.
The Sch,dul. C attached hereto and made part hereof sets forth a true answer to each inquiry
contained therein and in the case of transfers of property, real or personal, within two years of decedent's
death, in contemplation of decedent'. death, or intended to take effect in possession or enjoyment at or
after death, said schedule sets rorth the nature and value of such property, to whom transferred, the
relationship of the transferees to the decedent, the proportionate share received by each transferee and
all other facts of a pertinent nature regarding said transfers. In the case of transfers intended to
take effect in possession or enjoyment at or after death, there is also attached to the schedule a copy
of the deed, trust agreement or other instrument creating the trust. Ther~ is also set forth in said
schedule a list of all property, real and personal, with its value, which passes at decedent's death by
virtue of the exercise by decedent, either individually, or jointly with another, or any power of appoint-
ment vested in decedent, either individually or jointly, by the will, deed, or other instrument of another,
with a COP3' of the instrument creating such power attaehed to the schedule.
That Sch~dule 0 attaehed hereto and made part hereof sets forth the names and addresses of all
persons beneficially interested in this estate at the time of decedent's death, the nature of their res-
pective interests, their relationship, if any, to the decedent, together with the ages at the time of
decedent's death of all minors, annuitants and benefieiaries for life under decedent's Will. It also
contains a statement showing which of the beneficiaries named in the decedent's will, if any, died prior
to decedent, the dates of their death, their issue, 8lld the relationship of such issue to the beneficiary.
That Sc~edule E attached hereto and made a part hereof sets forth all property, real and per-
sonal, owned by the deeedent jointly with another or others, including intangible, standing in the name
of the decedent and others, plus the date and plaee of record of instruments effecting the vestiture of
real estate and the date of acquisition of personalty, plus the name, address and relationship, if any,
of co-owners to the decedent.
That Schedule F attached hereto and made a part hereof sets forth fully and in detail all debts
and deductions elaiaed for and on behalf of this deeedent's estate, including funeral expenses paid;
family exemption, where applieable; eosts of administration of this estate; counsel fees and fudiciary's
commissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli-
gious services, in eonsequence of the death of the decedent; debts and claims owing and 1mpaid at time of
death; taxes aecrued chargeable for period prior to decedent's death (except those allowed under Section
651 of the Inheritance and Estate Tax Act); together with a statement of collateral pledged for obliga-
tions, if any. It is agreed that the f"iduciary will present proof of said claimed obligations upon re-
quest, that if the amount actually paid in settlement of any fee, commission or debt is less than the
estimated amount claiming and allowed, that the same will be reported to the Register of Wills, and that
the amount of tax assessed can be reassessed in accordance therewith.
That the totals of the appropriate eolumns in Schedules wAw, wB-, .e., .E-, and -Fw as directed therein,
have been carried forward and properly registered in the SUJIIlIary.
Subscribed and sworn to before me this _...._..........._.._........
~. . ~r;:tl:!---:--'~
~l' Exp eg Aug, 20, 1179
'~~;;li~ Cumberlaud ~
...d:~U$':~:1-.2L.~hd<.~e .__
DOroth McDOwell, xecutrix
"4705(iSrJC!N~tew"'Dl..i v..
.......CaltIP..I:l.iJ,.l..L..F-gnlJl?yJ,Yc:lpJc:lJ?..QJ.,l
(Citv or Toum ..tad State)
NOTE: Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are
filled in with details or the word wNone-, and in ease the assets include rare and unlisted securities,
securities of close or family eorporations or an interest in any co-partnership or business, that the
data and statements required under the paragraph above relating to Schedule "Bft are attached. Also make
certain that column #1 in the WSummary- has been properly completed as above-directed.
..-"-_.. ';,:,., :.......;~.._~-_..',.,.. .;..:..'~...' .
Rcc..i4'f4..,3l.i" ~
COMMOlllYEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
.:,....~',;,L'.....,.;:...~:-'~.f-'_4~____",..."'J.o,,,.,.~..~~~~_. -~ -.~
.",:~,--!'
SCHEDULE "A"
REAL PROPERTY
*'
Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Property held by the decedent as tenant,in cammon with another or other, should be identified
os to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held as joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E.")
The real property located In thi!l Commonwealth of Penneylvanla should be
described by lot and block number, street and ,treet number, together with
a general description of the property, with 0 reference to the record of the
conveyance by which the decedent took title; If a farm state number of a~
crn; also .tatement of mortgage encumbrances upon each parcel at death
of decedent. Taxes, assessments, Clccrued lnterest on mortgages, etc.,are
to be listed on Schedule "Fit and must not be d_educ:ted from this schedule.
(1)
(2)
(3)
DEPARTMENT
VALUATION
CAUTION
(00 not write
In thl. .pace)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
'DEI. TN
ESTIMA TED
MARKET V"'L~E
Real Estate - No. 613 Hummel Avenue,
in the Borough of Lemoyne, Cumberland
County, Pennsylvania. In the name of
the decedent and Pauline K. Burk, his
wife {Pauline K. Burk having predeceased
Archie F. Burkl by Deed dated October
16, 1919 and recorded in Deed Book 8-Y,
Page 36 - Cumberland County Records. ,
Sale Price
fle~~ S &AP/URl j.,A;'j, el.1..lI.~'I.rp II
{3 (., "}tJ
-----=:!-;:-
1'1 t V'~
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23,000.00 '~3. OtJO. &d
I
I
Insert this total opposite "real property", Schedule "A" in the
"As Reported" column on the lost page of this return.
xxxxx
23,000.00 Jftc2.3 !JetJ. ()()
I
Ilee -35 '
RESIDENT DECEDENT
SCHEDULE "Bn
PERSONAL PROPERTY
'*
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COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
by the decedent, at the time of his death. Property owned by the decedent jointly with another or others
must be 118ted under Schedule "E". Intangible p~rsonal property, titled 1n the name of the decedent, but
payable at death to another or others, including but not limited to P.O.D. U. S. Savings Bonds and tenta-
tive trust accounts, must be listed, despite the fact that they are not or the administered estate.
Tangible personal property should be listed first (e.g. jewelry, wearing apparel, househo~d
goods, and furnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank,
stocks, mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay-
able to the estate or fiduciary in said capacity, partnership interests, interest in anyundlstributed
estate of or income from any property held in trust under the will or agreement of another, even though
located outside of the State, at the time of death, should be listed in this schedule.
Item
No.
ITEM
List and describe fUlly
UNIT
VALUE
ESTIMATED
MARKET VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
8.
334 shares - CCNB Corporation Stock
@ 12.00 p/sh.
;; !M_ .tJO
..5ZJ. tJ 0
1. Household Goods
2. 1962 Oldsmobile Sedan
3. 12 U.S. Series E Savings Bonds dated
February 1959 - $100.00 each. . ~
Date of death value - $179.80~ .
4.
auphi~ Deposit Bank & Trust Compan
,C ec ng Account No. 18-64-84 -8
14 Certificates of Deposit @ $1,000.00
each - .
Interest to date of death for above
Certificates (See verification letter
attached)
Certificate of 'DEposit No. 2579
Interest to date of death
.3 Md,. 95
/
Ii (Jd{). (}O
/0. 7.j-
.:? O(}t!.Od
I
/- (p 7
5.
State Capital Savings,~
Savings Account NO.' 0"02-02-12703
West Shore savingj/& Loan Association
Account No. 1359 - Date of death balance
Interest
~ shares - Dauphin Deposit Bank &~Trus
Company Stock @ 30.00 plsh
o OritJ. OtJ
/ d'<?7.Jb
<J ;;ltJ. 00
,I
6.
7.
4,008.0
'i OO.J7. O{)
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of' this return.
x X
76,499.65
7?;, -/1'1. &S
,
Reo.- 36
COMM01\WEA.LTII OF PENNSYLVANIA
TRANSFER INHERITA.NCE TAX
SCHEDULE "c"
TR.\NSFERS
*~
RESIDEXT DECEDENT
(1) Did decedent, within two years of de 11th, make any transfer of any material part of" his estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no) No
(2) Did decedent, within two years of death, transfer property from himself to himself and another or
others (inclurling a spouse) in joint ownership? (Answer yes or no) NO
(3) If the answer to (1) or (2) above is in the affirmative state:
(a) Age of decedent at time of transfer
(b) State of decedent's health at time of' making the transf'er. (Note 1).
(c) Cause of decedentt 5 death. (Note 1).
(4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate
consideration therefor which was to take ef~ect in possession or enjoyment at or after his death?
(Answer yes or no) No
(a) Was" there any possibility that the property transferred might return to transferer or his
estate or be subject to his power of rlisposition? (Answer yes or no) No
(b) What was the transferee's age at time of decedent's death?
(5) Did decedent in his lifetime make any trans~er without receiving a valuable and adequate consideration
therefor under which transferor expressly or impliedly reserves for his life or any period which does
not 1n fllct enrl before his death:
(a) The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no) No
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no) Nn
(0) If the answer to (5) (b) above 1s in the affirmative, state whether the right was reserved in decedent
alone or others
(7) Did decedent in his lifetime make a transfer, the consideration for which was tr~8fereets promise to
pay income to or for the benefit of care of transferor? (Answer yes or no)
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserveil power to alter, amend, or revoke, or which co~lld revert to decedent under terms
of transfer or by operation of law? (Answer yes or no) No
(9) If the answer to (8) above is in the affirmative, was the power to alter, amend, or rev9ke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no) No
NOTE 1: The answers to these questions should be supported by affidavit by the attending physician as
well as a copy of the death cer-t.ificate.
NOTE 2: If answer to any of the above questions is yes, set forth below a description of the property
transferred, it's fair market value at date of death, dates of transfers and to whom transferred, with
relationship of transferees to decedent, if any. Submit copy of any trust deed or instrument, if trans-
fers are claimed to be non-taxable, also submit detailed statement of facts on which said claim 1s based.
NOTE 3: List applicable property" below in manner in which provided in Schedules A, B, or E.
ITEM
DESCRIPT ION
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
NONE
/J'znvJ
Insert this total opposite "Transfers", Schedule "e" in the
"As Reported" column on the last page of this return.
/fu7LU
. ~
RCC-3? (12-63)
COMMONWEALTH OF l'ENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
~*~
BENEFICIARIES
(
h
. , RELATIONSHIP
BENEFICIARIES AND ADDRESSES (If step-children or SURVIVED DATE INTEREST OF
State full names and addresses of all who illegitimate children DECEDENT OF BENEFICIARY
ave an interest, vested. contingent or other are involved, set STATE YES IN ESTATE
wise, in estate) forth this fact.) OR NO BIRTH
Dorothy McDowell Daughter Yes Adult One-fifth Residue
4705 N. Clearview" Dr.
Camn Hill Pa. 17011
John J. Burk Son Yps 7\,",,,,-/- C1"p-fi H-h D~
A (\(\ - " -, ~~'"' D~~,",
T n~_ ;~ 17(\ h
Geraldine Chandler Dauahter Yes Adult One-fifth Residue
321 Eiahth Street
New Cumberland Pa. 17070
Gladvs Waooner Dauohter Yes Adult One-fifth Residue
221 Gearv Street
New Cumberland, Pa.17070
Esther Miller Dauahter Yes Adult One-fifth Residue
, 0(\ "'~h~~' T.~~=
Landisville, Pa. 17538
.
,
.
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
SUMMARY (1 ) (2)
.. ~ (As Reported) (As Detcrmint't!)
o .
~ ~
:!.::!'" Real Property .....(Sch. "A") $ 23,000.00 $
~: c:
'c ~ E Personal Property . (Sch. "B") $ ...... 76d.99 . 65 $
'E 't .=
"Co.B Transfers (Sch. "C") $ -O- S
< E.
.:..8;, $.. $
o "
:i~'t
~"o $ .. $
" E 0. ......,.,...
r.l "
_ 0:: Gross Taxable Estate . $ .. ..99...499..65 $
l:::
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~ RCc;-3/t.
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the decedent jointly
wit.h another or others, including intangibles, standing in the name of the decedent and others. List
real estate first, as entireties, or joint tenants, giving brief description, as indicated lUHler Schedule
"A", plus the date and place of record of instrrunent effecting vestlture, but do not include entireties
or out of state real estate value in estate vtlluation column. Personal property should be listed as 1n
Schedule "B", plus date of acquisition, and the name, address anli relationship (if any) of co-owners to
the dec€tient.
Description of Property" Date of Acquisition, Name
Address and Relationship of Co-Owners, and Place
of Record of Instrument, where Real Estate.
"" ':X'> <<
unit
Value
percentage
. Share
Estate
Valuation
v'
80 Y
XS(<
0&">i
':X'>
">i
:xx:x ~
">i
::>(>:x
'VI. ::>(> y
':X'>
::>(>~
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
En ti re Deceden t t S
property Interest
"
">i
:x
~
None
Insert this total opposite "Jointly Owned Property", Schedule rlErI
1n the" As Reportedrl colurrm on the last page of thts return.
None
RCC-81 {5-73j
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
11121
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING or APPRAISEMENT
Dorothy McDowell '
4705 North Clearview Drive
Camp Hill. PA 17011
(Executor or Administrator)
In Re: Estate of
Archie F.- Burk
Cumberland
County - Fi Ie Na.
21-78-0028
Dear Mrs. McDowell:
You are hereby notified that the Original
appraisement in the estate af Archie F. Burk
has been filed in the office of the Register of Wills of Cumberland
County on July 20 ,19 78 , Said appraisement reflects the follawing
valuations:
Real Estate
Personal Property
Trans fers
Jointly Owned
Total
23,000.00
76,499.65
None
None
$QQ,4QQ ,,~
As ta such tax that is paid within three months from date of death, a five (5%)
percent discount is allawable. As to any tax that remains unpaid after nine (9) months
(fifteen months when death accurred from December 22, 1965 to June 16, 1971, inclusive;
and twelve months when death occurred prior to December 22, 1965) from date of death,
interest at the rate of six (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within
sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485-1001, P. L. 373.
Date July 20, 1978 Signed ~ 12< _ /<, .Jjh~
Title Chief Appraiser
Note: This is not a bill.
RCC.212.64)
COMMONWEALTH OF PENNSYLVANIA DATE July 20, 1978
. .
DEPARTMENT OF REVENUE RESIDENT INHERITANCE TAX COUNTY Cumberland
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127 APPRAISEMENT FILE NO. 21-78-0028
Whereas, Archie F. Burk late of Borough of Camp Hill
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 8th day of January 1978 , seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Ira K. Gleim . an appraiser duly appointed according to law,
having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix
the cash value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
In the event that any future interest in thIs estate is transferred in possession or enjoyment to collateral heirs of the de.cedent after
the expiration of any estate for Ufe or for years, the Commonwealth hereby expressly reserves the rIght to appraise and assess transfer
Inheritance taxes at the lawful collateral rate on any such future interest.
Unit Appraisement
DelcrJpUon of Anot Val\lOI Made for Inheritance
Tax P\lrpOIU
Real Property $ 23,000 00
Personal Property 76,499 165
Joint-Held Property None
Transfers None
TOTAL ASSETS $99,499 65
-
.
"
"
~
.
-
.
,
Having been duly sworn according to law, I do hereby certify that the above appraisement is made in con-
formity with law on this 20th day of ~ N, ~h...-.~ _ 19~.
.
Appratlef'
(N\1mber and Tf,et) . b
arr1S urg Penna.
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(Post 0fIIet!)
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