HomeMy WebLinkAbout10-16-78
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RCC.3'8 (4-731
COMMONWEALTH OF PENNSYLVANIA
, DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
~Cl -1 ~ rG7~ (OCT j ~
RESIDENT DECEDENT COUNTY OF
IMPORTANT, This return must be completed in detail and filed in duplicate, with all attached. with th
County where decedent resided; Return is due within nine months after date of death, un
by the Secretary of Re'\tenue. (Section 703 of the Inheritance and Estate Tax Act of 1961
IN THE MATTER OF THE ESTATE OF ,..,. } AFFIDAVIT OF
WILLIAM W. STONE EXECUTOR
(STATE FULL NAME OF DECEDENT)
Late of Cumberland ADMINISTRATOR
Pennsylvania .
State of J ..,
Cumberland -
County of
~ffilUliX Marjorie Ann Brymesser
of the estate of the obove.namod decedent being duly sworn, depoUl Clnd say ,
Decedent died November 10, 19~{t.".t. ''';''.0' I... will, '.py .f whl,
,
lMONTHl (DAY) 'v EARl lj;1h<lli0l!i;'::
Nome o.d odd,.., .f ."".ey " }, Robert M. Frey 1
other authorized representative to whom 5 South Hanover St., Carlisle, Pa.
011 corres.pondence should be mailed.
That as such. Executrix deponent is familiar with the affairs of said estate
. (EXECUTOR-ADMINISTRATORl
the assets thereof and their fair market value.
,
That at the time of death there was no safe deposit box registered in decedent's individ
as agent or deputy of another, or in decedent's individual name, with right of access by another
exception of the following: -
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED
IN WHICH DECEDENT RENTED A S.4FE DEPOSIT BOX IN NAME OR NAMES OF
NONE
That the contents of said safe deposit box or boxes .are itemized under Schedule s
~ith the exception. of the following, for the reasons hereinafter set forth:
That Scheclule A attached hereto and made part hereof sets forth fully and in detai
in the Commonwealth of Pennsylvania of which decedent died having an interest therein.
mortgage encumbrances upon each parcel of real property at the date of death, giving t
death, name of ~ortgagee, date, rate of interest, and book and page of record thereof. It
columns provided therefore the assessed valuation of each of said parcels, the estimated
as of date of death of decedent.
That Scheclule B attached hereto and made part hereof sets forth fully and in detail
wheresover situated owned by the decedent at the time of death; all moneys left by the d
death, whether in decedent's immediate possession, standing to decedent's credit in bank
banks, trust companies, or other institutions, whether individually, or in trust for any at
giving also separately the accrued interest thereon, if any, down to the last interest d
death in the...case of ~avings banks, and to the date of decedent's death in~ all other ca
. ~. -
savings, treasury certificates or notes and other evidence of in~ebtedness of the Uni
cedent; all obligati~ns, 'y.'_hethe~ by_ statute or agreement they are designated as tax free,
or any state, or political subdivision thereof, or of any foreign country, which are owne
-all wearing apparej,. jew~lr:r,. silv,~~a!~,_ pictures, books, works of art, household furnitu
automobiles, boats, and any and' all other personal chattels of whatsoever, kind or nat'
together with the fairly, estimated market value thereof; all bonds and mortgages. held h
claims due and owing decedent at the time of death, and all promissory notes or other
for the 'payment of money of which decedent died possessed, of whatsoever nature, wit
any, giving the face value and estimated fair market value thereof, and if such estimate
less than ~he face value, it sets forth briefly the reasons for such depreciation as to
payable to the estate from life insurance policies carried by decedent; all annuity and
the proceeds of which were payable upon the death of the decedent; all and the corporate
due thereon and unpaid as of the dale of death, bonds and accrued interest thereon to
death and other investment securities owned by the decedent at the time of death, with t
of at such time.
------ . --
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CUMBERLAND
e Register of Wills of the
less an extension is granted
.)
Execut:arix
h Is hereto attaChed,,}
and the property constituting
ual name, or jointly with, or
as agent or deputy, with the
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
of this return,
I all the real property
It also sets forth the
he amount still due at
also sets forth in the
market value thereof
all personal property
ecedent at the time of
s of deposit, savings
her pe;s\on". ~l per~ons
.'~..,I ..../_.
ay,f p.tiar .to decedent's.......
~.._... ~.~.-....../'l/. ./ ";.
ses'; aHoonds, plfsta'l< .,
'-~"'- ;.... ~ - ~
fed. Slates to_ the:"(Ie':-;':.
~of the.Uni~e~ Stales,;::;f
-_ _.t J"'".,..-:::,-. """"... . .:J
d at...the,tIme of death; ;:-
~ ~. .J~.. "...,..
reo; "hor.~e~-; c.alTia.ges,"~
ufl~,.flefi" by decedent,
y d'ecedeni and'of all
instruments in writing
h interest thereon, if
d fair, market value be
each item; all moneys
endowment contracts
stocks and dividends
the date of decedent's
he.market value there-
, . . .
In the case of securities of close or family corporations, the values reported are as far as
possible substantiated by financial statements of the corporations, showing the assets and liabilities
thereof as of the date of death. The schedule also sets forth the interest of decedent at the time of
death in any co-partnership or business, and in support of the value of such interest there is annexed to
said schedule, financial statements showing the assets and liabilities of said co-partnership or h,usiness.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of tne agreement)
together with a statement setting forth the character of the business, its location, and such other facts
pertaining to the business 8S may be pertinent to a fair and just appraisal of the decedent's interest
therein must be submitted. It should also set forth 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 Schedvle 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' 8
death, in contemplation of decedent's death, or intended to take effect in possession or enjoyment at or
after death, said schedule sets forth the nature and value of such property, to whom transferred, the
relationship of the transferees to the decedent, the proportionate share received ~y 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 a~so attached to the schedule a co~y
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 valuet 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 anotlter,
with a copy of the instrument creating such ~ower attached to the schedule.
That Schedu/~ 0 attached hereto and made part hereof sets forth the n~es 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 beneficiaries 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, and the relationship of such issue to the beneficiary.
That Schedule E attached hereto and made a part hereof sets forth all property, real and per-
sonal, owned by the decedent Jointly with another or others, including intangible, standing in the name
of the decedent and others, plus the date and place of record of instrmnents effecting the vestiture of
real estate and the date of acquisition of personalty, plus the name, address and relationship, if any,
of co-omers to the deceden t.
That Schedule F attached hereto and made a part hereof sets forth tully and in detail all debts
and deductions claimed for and on behalf of this decedent's estate, including funeral expenses paid;
family exemption, where applicable; costs 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 consequence of the death of the deced~t; debts and claims owing and 1mpald at time of
death; taxes accrued 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 fiduciary ~ill present proof of said claimed obligations upon re-
quest, that if the amount actually paid in settlement of any feet 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 therewit~
That the totals of the appropriate columns in Schedules "A", .B", .C., "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
............~:;~Bnd.::~f~..;:~;~:~:~..:::::::..~~.:..~:;::~~:..~~~_..___.__
(Ezecutor-Adminiatrutor )
b~~..S!~o~ ":::~:~:~~f~~~~1fj""""-'."'''''''''''''-
Carlisle, Cumberlend CO.,P.. ...... . ......................................................... ........................ ..........................
My Commission bpiresSept, S, 1981 (City or Toum 11M State)
NOTE: Before stgning affidavi t make sure all blank spaces in the aff'idavit and schedules annexed are
filled in with details or the word "None", and in case the assets include rare and unlisted securitiest
securities of close or 'family corporations or an interest in any co-partnership or businesst that the
data and statements required under the paragraph above relating to Schedule "B" are attached. Also make
certain that column #1 in the "Summary" has been properly completed as above-directed.
I , .. ;,
RC C-34 i 4"131
COMMONWEALTH OF PENNSYLVANIA
DEf'ARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDEN'r
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 common with another or other" should be identified
as to quontum of interest and the estimated va/ue.shauld be that of the decedent's interest only. (Property
held as joint tenants with right of surviarship or tenancy by entireties should be reported on Schedule "E.")
The real property located In the Commonwealth of Pennsylvania should be
described by lot ond block number, street ond street number, together with
o general description of the property, with 0 reference to the record of the
conveyance by which the decedent took title; If a form stote number of a~
cres; also statement of mortgage encumbrances upon each parcel at death
of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are
to be listed on Schedule lIFfI and must not be d_educted from this schedule.
(1)
(2)
ASSESSEO VALUE
FOR YEAR OF
DECEDENT'S
DEATH
~
(3\
DEPARTMENT
VALUATION
CAUTION
(Do not write
In this space)
ESTIMA TED
MARKET VALUE
Two adjoining tracts of land in North Middleton
Township, Cumberland County, .Pennsylvania:
Tract No.1: Unimproved lot containing 144
feet along an 8-foot lane or driveway and
extending Northwardly therefrom at an even
width a distance of 220 feet. it / ()
r;.u7(J 1;~ y
Tract No.2: Lot of ground containing 65 feet
in front along an 8-foot lane or driveway and
extending Northwardly therefrom at an even
width a distance of 220 feet, and having thereon
erected a dwelling house and other improvement .
Being the same two tracts of land which Lester
R. Ewing and Mildred I. Ewing, husband and
wife, by deed dated September 16, 1969, and
recorded in the Office of the Recorder of Deeds
in and for Cumberland County at Carlisle,
Pennsylvania, in Deed Book "J", Volume 23,
Page 694, granted and conveyed to William W.
Stone, widower.
Both tracts of land assessed as one parcel
having a total for the year 1977 of $2,420.00
2,420.00
,..
9,680.00 v l)bBD.C\:l
RuT, 1..; c;J"
/
f}L. 6-~ '5 . /;:0 (./
~ 6~-
L- A ~. z-?'
2)Y '1
~<10
11 10
Insert this total opposite "real property", Schedule "A" in the X X X X X
"As Reported" column on the last page of this return.
9,680.00
q 1.0 ~o.00
\
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RCC .35
RESIDENT DECEDENT
SCHEDULE "a"
PERSONAL PROPERTY
'*
CO~IONWEALTH OF PENNSYLVANIA
T!W'SFER INHERITANCE TAX
INSTRUCTIONS: This Schedule must disclose all tsngible and intangible personal property owned individually
by the decedent, at the time or his death. Property owned by the decedent jointly with another or others
must be listed under Schedule "En. Intangible personal 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 of the administered estatEt.
Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household
goods, and fUrnishings, books, paintings, automobiles, boats, etc.)
Intangible personal propert"y, such as bonds, treasury certi:ficates, cash on hand and in bank,
stocks, mortg&ges, 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 any undis tributed
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 ITEM UNIT ESTIMATED DEPARTMENT VALUATION
No. Lis t and describe fully VALUE MARKEr V AWE (Do not write in
this space)
. / tOo <00
1. Miscellaneous household goods and equipment 100.00 I-
2. 1966 Ford Station Wagon 50.00,.. '/ SO.Oo
I
-
Insert this total opposi te "Personal Property", Schedule "B" in X X 150.00 \50.60
the "As Reported" column on the last page of this return.
... .
RCC-36
COMMO:>WEALTJI OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
SCHEDULE: "c"
TRANSFERS
~.' f;..~ 1\
~
RESIDE:>T DECEDENT
(1) Dirt decedent, within two years of death, make any transfer of any material part of his estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no) ~O.
(2) Did decedent, within two years of death, transfer property from himself to himself and another or
others (including 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 transfer. (Note 1).
(c) Cause of decedent's 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 effect in possession or enjoyment at or after his death?
(Answer yes or no) ~O.
(a) Was there any possibility that the property transferred might return to transferer or his
estate or be subject to his power of disposition? (Answer yes or no) ~n
(b) What was the-transferee's age at time of decedent's death?
(5) Did decedent in his lifetime make any transfer. wi thout receiving a valuable and adequate consideration
therefor under which transferor expressly or impliedly reserves for his life or any period Which does
not in fact end before his death:
(a) The possession or enjoyment of or the right to income from th~ property transferred?
(Answer yes or no) ~O.
(b) The right to rlesignate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no) ~Oa
(6) If the answer to (5) (b) above is 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 transferee's promise to
pay income to or for the benefit of care of transferor? (Answer yes or no) NOa
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserved power to alter, amend, or revoke, or which c01l1d 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 revoke 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 certificate.
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 fact.s on which said claim is based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM
DESCRIPTION
MARKET V ALOE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
NONE
-0-
N c-L--
"
Insert this total opposite "Transfers", Schedule "e" in the
"As Rep.orted" column on the last page of this return.
-0-
; ~
RCC.38
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule mus t disclose all property, re al and personal, ownerl by the rleceden t join tly
wi t.h fLnother 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 tmder Schedule
"A", plus the date and place of record of' instrwnent effecting vest! ture, but rlo not include entireties
or out of state real estate value in estate valuation column. Personal property should be iisted as in
Schedule "B", plus date of acquisition, and the name, address and relationship (if any) of co-owners to
the decerlent.
Description of Property, Date of Acquisitio.n, NllJ1le unit percentage Estate DEPARTMENT VALUATION
Address and Relationship of Co-Owners, and PI ace Value Share Valuation CAUTION-Do not Write
of Record of Instrument, where Real Estate. In This Space.
@ ex yo ~ xx: >O<X>O<X>< :& ~ >0<: >0<: Value of' Value of'
iY: ~ 58: %>< Xl< :x X>O,888X ~ :x S88& Xl< Entire Deceden t t S
:x:x:x ::>0< 0< Xl<
'X ,)V< XX Property Interest
NONE -0- \-..J~
,
,
Insert this total opposite "Jointly Owned Property", Schedule "E" - 0-
in the "As Reported" column on the last page of this return.
, ,
~CC-37 (12-63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "0"
,.. <I.
,
.... ......"
. ~ : \',': 1 " I; r.:
. . ,,; ,.t. ~ I to'
BENEFICIARIES
,.
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h
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED
(It siep-children or DATE INTEREST OF
State full ~ames -~~nd 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 ,
-
,
Tammy Mar,ie Johnson, ;. , granddaughter yes entire estate
-R, D, #.3- Box-296 - .. ..-.... , ~'. " -'.'~ ,.... -' .--., , ,
. J... ... _.... ........
Carlisle, .Pa. .17013
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Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
, .
.
..
o '
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.. ..
..
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"S'"
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SUMMARY
.,.(Sch. "A")
. .. ............... ,.(Sch. "B")
.... .....,(Sch. "C")
Real Properly
Personal Property
Transfers
Gross Taxable Estate.
(1)
(As Reported)
.~.l)?Q.()Q
150..0.0.
-0.-
$
$
$.......
$
$ .............
$Jl..?~().Qo..
(2)
(As DetermiD<..,))
$.
$..
$
$
$ ..
$
f-. 0-
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Z ..c
:. ~ .51 rn:
.. ..l
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.... 0 E-< 0 '0 '" Ao
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f-. ~. .-I .-I .. Q
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0 Ii; ..... ..c ..
Z f-. ~ ~. S ....
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RCC-81 (6-731
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HA~RISBURG
17127
IN YOUR REPL Y PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING or APPRAISEMENT
Majorie A. Brymesser
809 Factory St.
r.~~1;91~, P~nna 17013
(Executor or Administrator)
In Re: Estate of
William W. Stone
Cumberland
County - File No.
21-78-0069
Deor
You ore hereby notified thot the Original
approisement in the estate of Ei1liam W. Stone
has been filed in the office of the Register of Wills of Cumberland
County on 6 November , 19~, Said approisement reflects the following
voluations:
Real Estote
Personal Property
Transfers
Jointly Owned
Totol
9,680.00
150.00
None
None
9,830.00
As to such tax that is paid within three months from dote of death, 0 five (5%)
percent discount is allowable'. As to any tax that remains unpaid after nine (9) months
(fifteen months when death occurred from December 22,1965 to June 16, 1971, inclusive;
and t';'elve 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'(1
Dote 6 November 78 Signed ~.?C- k. hA~
Chief Appraiser
Title
'.
Note: This is not 0 bill.
RCC-2.(2-64) DATE \ \ - 0 to - 1 '6
COMMONWEALTH OF PENNSYLVANIA
. COUNTY r. 0", 0 ()
DEPARTMENT OF REVENUE RESIDENT INHERITANCE TAX
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127 APPRAISEMENT FILE NO. 2. ~ - '1 '8- Co. 6 C{
Whereas. \j(), 0 ~ W . <;,~ late of N ' fY\ --iUJ '.00-4.--,......., ~lA 'G .
in the County of ~ Commonwealth of Pennsylvania, having died on
the \. ()-tl- day of N~ 19 '1 seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I,' \.. r\..-<-- G j) o. " , 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 decedent after
the expiration of any estate for life 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.
Unll Apprailement
Delcrlpllon of Allet Valuel Made for Inheritance
Tax Purpolel
R...e..,,~ 'PA.. , $q
." lo.{q 0 00
e~ ~~~.~ ISo 00
~A.A Ii. IJ. N P--'l
~t'r'\. "JL(\ We. 0 Jl ?~ D N~
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'\" rYt....J) ('I ^^ nb ~J)60 00
\,
.
.
.
.
.
Having been duly sworn aCl1{.~to law, I do hereby certi[Y,J.hat ~e abg~e appraisement is made in con.
formity with law on this () day of "-' ~ ~ ^ . A 1~,
(' l'v-. PI It ./'11 .
Appraiser
~~(;"":5.t) , Penna.
(PDDt
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