HomeMy WebLinkAbout05-18-05 (3)
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COMMONWEALTH OF
PENNSYlVANIA
DEPARThlENT OF REVENUE
DEPT,280801
HARRISBURG, PA 17128-0001
REV.1500
INHERITANCE TAX RETURN
. RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
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DECEDENT'S NAME (lAST, FIRST, AND MIDDLE INITIAL)
Grim, Calvin G.
DAlE OF DEAlll (MM-DO.YEAR) DATE OF BIRlll(MI.H>D-YEAR)
2/20/05 2/1~/26
(IF API'I.ICABLE) SURVMNG SPOUSE'S NAME (LAST, FIRST. AND. MIDDLE INlTIAL)
SOCIAL SECURI1Y NUMBER
205 16 - 4011
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 2. SUpplemen1al Relllm
o 48. Fu\Ur8lnlsresl COmproml..'...." __"."-82)
07. DecedonlMainlained . UVingTiusl(1ollod>...."T""'l
o .10. Spousal Poverty Credit. (dIOrofd.frbehlUr 12..11-9t~ j-1-95)
o 3. RemoIiiderRe~m ,...."""'......".13-82)
o 5. Fod8lal Eslale Tox Return Required
...Q. 8. Total NUmber of ~o illlposit Boxos
o I1.ElocIionlolaxunderSec.9113{Al_,",OJ
1. Real em. (SclleduIeA)
2. SIodls and Bonds (Sche<lUIoiB)
3. Closely Hold CorpomIon, Portnnhlp or _pr\o_p
4. Mollgagos & Nolss _ (Schedule D)
5. CasIl. Sank illlposlls & Misc:iIuaneous Personal Property
(ScheduIa E)
8. .IclII1Ily Owned Property (Sd1edule F)
o SeparaIs BiIi1g Requeatad
7. InI8r.V1ws T_ & I!iSOOIIanoous Non-Probals Property
(ScheclJfeGcrL)
8. Total GrooAuols (lotaILInes 1.7)
. 9. FlIl18fIII Exponaos & AdmInisti8aw Costs (~H)
10. IJebIs 0/ Deceden1. Mortgage LiabUllIes, & Uons (ScheduIo I)
1,. Total Deductions (lO/aI Unes 9& 10)
12. Not Value or &IN {LIne 8 minus LlneJj/
13. Charilable and Govemmen1aI Boquea1alSec 9113 Trusts for which an eIe<;tion to lax has not been
made (SchodUe J)
14. Nol VIIut Subjocllo Tax(Llne 12 minus Una 13)
SEfIN$TRUC11OHS OH IlEVEIlSE SIDE FORAPI'LICABLER'ATES
15. _ of uno 14_10 ollllo apOuuI tax
18la, crlransf8l1 under Sec. 9116 (s){I.2)
1Kl1. Original Relum
o 4. Umilsd Eslals
IRJ 6. illlcedonl DIed Teolals _ ...."WI)
o 9. U1igBlfon ProcOeds ~
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NAME
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FIRMNAME~_)
TELEPHONE NUMBER.
717-258-6844
COMPUETE MAlUNG ADDRESS
113 Front street
P.OBox 358
Boiling Springs, PA17007
(1) -0-
(2) 66,000.00
(3) . -0-
(4) -0-
(5) 7;3,380.23
(6) 47,570..00
(7). 13,895.93
OFFIC
SE ONLY
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16. Amcunl<fUne 14 _ atllneal.raf8
17. AmoonlofUnll14_als/b//ngrale
. lB. _dLlne 14 _atcaIIatBtaJ rale
. 19. TIl< Duo
CHECK HERE IF YOU ARE REOUESTlNG A REFUND OF AN OVERPAYMENT
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(8) $2..00,846.16
(9)
{j,023.29
457.48
(10) .
(11) 6.480.77
(121 194.365.39
. (13) -0.,.
. (14) 194.365.39
$10.0,609.20
x.O_ (15)
x.o~ (16) 4,527 .J 4
x .12 (17)
~ .15 (18) 14,063.43
(19) $18,590.84
93,756.19
Decedent's Complete Address:
STREET ADDRESS 560 Criswell Drive ..
. ,. . .. .
CITY Boiling Springs, '. 1 STATE. PA pP 17007
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. creditslPaymenls
A Spousal POveriy Credk
B. Prior Paymon1s
C. Discount
(1) 18.590.84
-0-
. -0-
':1)..':1. ::>4
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.. tolalCtedl1S ('M B + C )
(2)
" . 929..54
3. .ln~stIPenaIly Wappllcable
D. Interest .
E. Penalty
':"0-
-~ ....
.. . ,.. ... ........ . 'T01aI Iriierest/PenaltY(D + E) .(3)
4. ff Une 2 is'grealer than Une 1 + Lilie 3, inter lhe dlff~nce; This is the OVERPAYMENT; .
Chedt box on pag. tUn. 20 to request a refund
-0- .
(4)
5. . ffUne 1 + Une 3 is greaterlhan Une.2..enterlhe djlf8lehce. This.1s the TAX DUE..
. A. Enter ihe interest on the lax due.
.(5) 17,661.30
. (sA)
. -'0-. .
B. Enlsr the total of Une 5 + SA. This Is lhe IiALANCE DUE. (5B) 1 7 , 6 61 ; 30:
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLQCKS
1. Did decadent .make a transfer and: Yes No
a. Jetain the use or Income oflhe properlY transferred;.......................:.........;:...................................;................... D ~
b.reIaIn lhe right to desigh8te who sh8a use the property transferred or.11s Income; .;..............;...................;....... D . j[]
c. reIaIn a reversionaJy Interest; or..............................................:........................................................................... D ~ ..
d. receive the promise for lite pfelther payments. ben8fils oicaie? .....................,...............................,................ D ~ ..
2. ~~":u~=:=::m=::;:.~.~~.~~.~~~~..~.~..~~.~~.~~.~~~.................... D t5 .
3. Did decedenl own an 'n IruSt for" or payable upon death bank.account or securily.al his or her death? ........>... D: , . []
4. Old decedent own an Individual Retirement Accoun~ annuity, or other non-probate property which .. .
contains a beneficiary d8s1snaliDn? ...............................................................................;...............;......:....,.....;...;... I!l .. . D
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES; YOU MUST COMPLETE SCHEDULE G AND FILE IT ~SPART Of TIIERETl!RN;
Undlir~rl~.1_1I\alIha..oJlaml..UI1IaI8Un.Induding~_.....and_ls.ondloll1obestrl"'llo1owla<lQeand_r, kislnlo, correclandaxnpleto.
Oodanollonol__lI1onll1opelllllllllOpl1iooloUveisboiedonllinfolmollanof__IlasIllYknowlodgo. , . .. , ,. ,.. ... ..
SI~1JJREOFPERSON~pqtI~LEFORJ1L1NGRETURN. . r.. ... . . .... .. . DATE ..
7//~ 7?~ <?~..,~.<-:f7./~ . . ..5-/ttP~5
5;SOd~iJ~.I~~,7PAJ..-L4~~.~,/..;7CJt::I? ... ...
SIGNAT OF PREPARER OTHER EP ENli (/ f / DATE
.. - ...- . - '.'
For dates of death 00 Drafter July 1, 1994 and before. January " 1995, the tax rate Imposed 00 the net value of transfers to or for the use:of the survMng spoUse Is 3%
[72 P.S. S9116 (a) (1.1) (il].
For dates of death 00 or after January 1. 1995, the.1ax rete Imposed 00 the net value of transfers to or for the use of the.sinvlving spouse is 0% \72 P.s. S9116 (a) (1.1) (a)l. .
. The statute does not exemot a transfer to e surviving spouse from lax, and the stetirtory requirements for dlscIosure of assets and filing a lax relum are StilI.applicable .even W
the surviving spouse Is Ihe ooIy beneficiary.
For deles of death 00 or after July 1, 2000:
The lax rate imposed 00 the net.vaJue of fransfels frtinI e d,eceased child twenty-one years of age or younger at death to or for the ,use of a natural pa~ an adoptive paren~
or a stepparent of the child Is 0% [72 P.S. S9116(a)(1.2)]: .
The Iaxratelmposad 00 the net vallie of transfers to orforlhe use of the decedenfs lineal beneficiaries Is 4.5%, except asnotad In 72.P.S.S9116(1.2) [72 P.S. S9116(a)(I)].
The lax rate /mpOsad 00 the net value of transfers to or for1be ua8 ofihed8cedenr8B11ili~lsJi% [72 P.S. 5Q116(a)(1.3)). A sibling'ls delined, under SecIIon 9102, as an
individual who has alleasl one parenlln common with lhe decedent. wh9ther byblood or adoption. .. .
. _M"_"_~___,___._",,~___._.,,_
.EV.1S02 EX+ (12-851 '*
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
Calvin G. Grim
FILE NUMBER
(Property iointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should b. reported at fair market value
which 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 seU, both having reasonable knowledge of the relevant facts.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
See Schedule F
TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed, insert additional sheets of same size.)
S
-0-
--'...--.--'------.-.--.....----
REV.I503 EX+ 1...861
*'
SCHEDULE B
STOCKS AND BONDS
COMMONW!ALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DEaDENT
ESTAT OF
FILE NUMBER
Calvin G. Grim
(All property lolntly-owned with Right of Survivorship must be disclosed on Schedulo F.)
.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
L
2
One (1] series HH US Savings Bond at $1,000.00
Thirteen [13] series HH US Savings Bonds
@ $5,000.00 each
$1,000.00
65,000.00
10
-
yo.TAL (Also enter on line 2, Recapitulation)
S 66,000.00
. f .1',,_ _ _I ~&.__"- ..I ___ ..:... 1
....".."'.0."1.
COMMONWEAL1'H OF PENNSYLVANIA
INHERITANCE TAX lDURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE C
CLOSELY HELD STOCK,
PARTNERSHIP AND PROPRIETORSHIP
Please Print or Type
FILE NUMBER
Calvin G. Grim
Schedule C.l or C-2 must be attached for each business interest of the decedent, other than a proprietorship~
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
1.
NONE
-0-
TOTAL (Also enter on line 3, Recapitulation).$ - 0-
(If more space is needed, insert additional sheets 01 same si:te.)
llEV-l:507 EX. \1.88}
'*
COMMONWEALTH OF PENNSYLVANIA
INHEIITANCI TAX RI1'URN
RlSIDlNT DlCEDENT
SCHEDULE D
MORTGAGES AND NOTES
RECEIVABLE
Please Print or 'F e
I FILE NUMBER
ESTATE OF
Calvin G. Grim
(An ........"Y jointly_nod whh .... Right of Su"''''''....lp mu.t ... dl..l..... on Sch.dul. F.I
ITEM
NUMBER
DESCRIPTION
I
VAWE AT
DATE OF DEATH
NONE
-0-
- '.
TOTAL (Also enter on line 4, Recapitulation) $
-0-
(If more space ;$ needed, insert odditional sheets of same size.)
ll.f'f.l$08 EX. p_1l7)
'*
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Please Print or T e
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHIRllANCllAX RENIN
RESIDINT DECIDINT
ESTATE OF
Calvin G. Grim
(All property jointly-owned with the Right of Survivorship must be disclosed on Schedule FJ
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
$27,194.04
2.
M&T Select with Interest Checking account,
#1358006, at M&T Bank.
Money Market account, #70-33788, at
F&M Trust.
46,186.19
1.
TOTAL (Also enter on line 5, Recapitulation) S
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73.E.23
(A"oc:h additionaI81f.z" x llN sh.ets if more space is n"eded.1
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COMMONWU11'H OF PENNSYLVANIA
INHERITANC! TAX RETURN
RESIDENT o-EaDENT
SCHEDULE F
JOINTLY -OWNED PROPERTY
Calvin G. Grim
, fILE NUMBER
ESTATE OF
Joint tenant(s):
NAME
A. Mona P. Graham
ADDRESS
560 Criswell Drive
Boiling Springs, PA
RELATIONSHIP TO DECEDENT
Companion
B.
c.
Jointly-owned property:
I LmER DATE
mM FOR
NUMBER! JOINT MADE
JOINT ,
I TENANT i
1. I J 6/8/94!
I ,
I !
DESCRIPTION OF PROPERTY
i ,
TOTAL VALUE i DECO'S' DOLLAR VALUE OF
OF ASSET , % INT. : DECEDENT'S INTEREST
Real Estate situated at
560 Criswell Drive
Boiling Springs, PA
)~e A-fY~C4".1 ,i/-J:5'l' SJM ~.x'
$95,140.00' 50%' $47,570.00
TOTAL (Also enter on line 6, Recapitulation)
(If more space is needed insert additional sheets of same size)
S 47,570.00
.
.'
REV.t510 fX+ (2-87)
~.!-
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
TRANSFERS
PLEASE PRINT OR TYPE
ESTATE OF
FILE NU,MIlER
Calvin G. Grim
THIS SCHEDULE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OF THE QUESTIONS ON TME REVERSE SIDE Of THE COVER SHEET IS YES,
DEeD. DOLLAR VALUE . .,'"
% OF DECEDENT'S
INT, INTEREST
ITEM DESCRIPTION OF pROPERTY
NUMBER Include name of l'hetransF.ree, tnei, relationship to decedent, dote of transfer.
EXCLUSION
TOrAt VALUE
OF ASSET
..
1 .
IRA account, #1100005873,
at Sovereign Bank
,
, ,
$13,~95.9~ 100% $13,895.93
.
_ TOTAL lAlla enter an line 7. Recapitulation) S 1 3 , 895 . 93
Jl~_,!,_o"'_~flace is needed, insert add;~ional sheets of sam. size.)
3. Family Exemption
Claimant
Add.... of Claimant at decedent'. death
Street Add....
City
IEV-l5l1lhl1.Q1
E
ITEM
NUMBER
A.
B.
2.
4.
C.
1.
:2.
3.
4.
5.
6.
7.
8.
Plea.. Print or Type
R
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS IXPENSES
Calvin G. Grim
DEKRIPTION
1.
Funeral. Expen...,
Zimmerman-Auer Funeral Home
4100 Jonestown Road
Harrisburg, PA
1.
Admln.......tlw Cost.,
Personal Rep....ntative Commi..ion.
Sodal Security Numb.r of Personal. Repl&sentative,
Year Commi.sion. paid
Anarnll)' Fe.. Anthony L. DeLuca, Esquire
Relation.hip
State
Zip Code
Probate Fee.
Mil.ellan.ou. upen...,
Legal Advertising - Cumberland Law Journal
Legal Advertising - The Sentinel
Filing Fees for Inheritance Tax and Inventory
TOTAL (AI$o .nter on line 9, Recapitulation)
(If more .pace II n..deel, Innrt adelltlonal .h..ts of .ame llze.)
AMOUNT
$460.00
5,000.00
314.00
75.00
144.29
30.00
$ 6,023.29
1V.1512 EX+ (9-11)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE "I"
DEBTS OF DECEDENT,
MORTGAGES, AND LIENS
FILE NUMBER
Calvin G. Grim
ITEM
NUMBER
2.
3.
4.
5.
6.
1.
DESCRIPTION
AMOUNT
Jack E. Nace - 2004 Tax Preparation
$75.00
West Shore EMS-BLS - Ambulance
Health South Regional - Nursing Home TV
Mary. A. Murray, Tax Collector
1/2 of 2005 County, library, township taxes
Charles R. Inners, MD - Medical
Veterans Administration - Medical
136.01
4.24
111.23
110.00
21.00
,.-"'"
TOTAL (Also enter on line 10, Recapitullltian)
$ 457.48
HV.\511 EX+ 1;1.17)
-
COMMONWlALTH Of I'fNNSYLYANIA
INHIIII'ANCI TAX lnutN
_DlClDlMT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
Calvin G. Grim
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
1.
A. Taxable Bequests:
Vickie L. Enders
901 Butter Road
Dover, PA l7315
Rodney G. Grim
4 Coldsprings Apartments
Manchester, PA l7345
Mona P. Graham
560 Criswell Drive
Boiling Springs, PA l7007
Daughter
$27,194.04
2.
Son
79,895.93
3.
Companion
93,756.19
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charitable ond-Governmental Bequads:
1.
None
-0-
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS {Also enler on line 13, Recopilulolion}
(I' more apac. I. needed, In..rt additional ,"Nt. of same .iz.)
$
-0-
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OF
CALVIN G. GRIM
I, CALVING, GRIM, a resident of 560 Criswell Extended, Boiling Springs,
Cumberland County, Pennsylvania being of sound mind, memory and understanding, do
hereby make, publish and declare this to be my Last Will and Testament, hereby revoking
all Wills and Codicils heretofore made by me,
ITEM 1: I direct that all my just debts, the expenses of my last illness and
funeral expenses be paid as soon after my decease as the same can conveniently be done,
ITEM 2: I direct that there shall be paid out of my residuary estate all estate,
inheritance and like taxes together with any interest or penalty thereon imposed by the
government of the United States, or any state or territory thereof, or by any foreign
government or political subdivision thereof, in respect to all property required to be
included in my gross estate for estate, inheritance or like tax purposes by any 01'1 such
governments, whether the property passes under this Will or otherwise, excluding,
however, any property over which I have a taxable power of appointment, provided,
however, that no residuary beneficiary shall by reason of this provision be denied the
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benefit of any deduction, credit, favorable rate of tax or other benefit which by law
enures to such beneficiary,
ITEM 3: To the individuals listed below, I bequeath the following:
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CALVIN G, GRIM
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LAST WILL AN)) TEST~
OF
CALVING. GRIM
a, To my daughter, VICKI ENDERS, all of the proceeds that are in my
account at M&T Bank;
b, To MONAP. GRAHAM, all of the proceeds that are in my account at
F&M Trust Co.;
c. To my son, RODNEY G, GRIM, all of the proceeds that are in my
accounts at Waypoint Bank and Mellon Bank;
d. To my son, RODNEY G, GRIM, my Ford Pickup truck, if owned by me at
the time of my death; and
e. To my son and daughter, RODNEY G. GRIM and VICKI ENDERS, all of
my pets owned by me at the time of my death,
ITEM 4: I direct that my camper be sold and the proceeds divided, in equal
shares, unto II!y children, RODNEY G. GRIM and VICKI ENDERS,
ITEM 5: I direct that my remains be cremated and my ashes scattered over my
marker at Susquehanna Memorial Gardens Cemetery in York, Pennsylvania,
-;p'
ITEM 6: I give, devise and bequeath my house and any remaining contents unto
MONA P. GRAHAM, provided, however, that she survives me and is living sixty (60)
days after the date of my death.
d./...-<- -Y ~~-
CALVING. GRIM
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OF
CALVING. GRIM
ITEM 7: If and in the event that MONAP. GRAHAM, does not survive me and
is not living sixty (60) days after the date of my death, then and in such event, I give,
devise and bequeath my house and any remaining contents, in equal shares, unto my son
and daughter, RODNEY G. GRIM, VICKI ENDERS, and the brother and sister of
MONA P. GRAHAM'S, GEORGE PIPER, JENNIFER A. BROOME, provided
however, that they survive me and are living sixty (60) days after the date of my death.
ITEM 8: If and in the event that any of the persons identified in Item 7 do not
survive me and are not living sixty (60) days after the date of my death, then and in such
event, I give, devise and bequeath the interest in my estate, which such deceased person
would have received, if living, to the issue of said deceased person, per stirpes.
ITEM 9: I hereby nominate, constitute and appoint MONA P. GRAHAM,
Executrix, of this my Last Will and Testament, with full power to do any and all things
necessary for the complete administration of my estate, and direct that no bond or other
.
surety is required of her in this or any other jurisdiction for her performance of this
....'
office.
If and in the event that MONA P. GRAHAM, does not survive me and is not
living sixty (60) days after the date of my death, or does not complete her duties as
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CALVING. GRIM
3
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CALVING. GRIM
Executrix, then and in such event, I hereby nominate, constitute and appoint my son,
RODNEY G. GRIM, Executor of this my Last Will and Testament, with full power to do
any and all things necessary for the complete administration of my estate, and direct that
no bond or other surety is required ofhim in this or any other jurisdiction for his
performance of this office.
ITEM 10: If any provision of this Will or of any Codicil hereto is held to be
inoperative, invalid or illegal, it is my intention that all the remaining provisions thereof
shall continue to be fully operative and effective, so far as is possible and reasonable.
IN WITNESS WHEREOF, I, CALVIN G. GRIM, the Testator, have to this my
Last Will and Testament, typewritten on four (4) consecutively numbered pages,
subscribed my name and affixed my seal this,;.,-:;;/( day ofJune, 2001.
t" _ t?..........'
..d ~ (SEAL)
Signed, sealed, published and declared by the above named CALVING. GRIM, as and
for his Last Will and-Testament, in the presence of us, who have hereunto subscribed our
names at his request, as witnesses hereto, in the presence of the said Testator, and of each
other.
aJ~ Yi1J.k:..." ef residing at
IIJ r;."A--Y- ~~l"X
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J?hldt/;"~1 t/-JJ! g ~A"<7.residing at
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