HomeMy WebLinkAbout11-13-78
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
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RESIDENT DECEDENT
COUNTY OF CUMBERLAND
IMPDRT ANT,
This return must be completed in detail and filed in duplicate, with all attached. with the Register of Wills of the
County where decedent resided; Return is due within nine months after date of death, unless an extension is granted
by the Secretary of Re'lenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Cumberland
} AFFIDAVIT OF
EXECUTOR
J6XlMOOmlt~
IN THE MATTER OF THE ESTATE OF
VIOLA M. ADAMS
(STATE FULL NAME OF DECEDENT)
Late of
County
State of
PENNSYLVANIA
County of
CUMBERLAND
The
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6c<lOOOKOOXOOiX
First National Bank of Newville. Pennsylvania,
of the estale of the above-named decedent being duly sworn, depose and say
Executor
(MONTH)
Nome and address of attorney or }
other authorized representative to whom
all correspondence should be moiled.
(DAY)
19---1LJ testale leaving a last will, copy of which is herelo attached..}
(YEAR) ~!XiH:}q!2f
Decedent died
March
16
James R. Humer, Esquire
1 W. Hi~h St.. Carlisle. PA 17013
That as such Executor deponent is familiar with the affairs of said estate and the property constituting
(EXECU TO R~ADMINIST RA TOR)
the assets thereof and their fair market value.
That at the time of death there was no safe deposit box registered in decedent's individual name, or jointly with, or
as agent or deputy of another, or in decedent's individual name, with right of access by another as agent or deputy, with the
exception of the following: -
NAME AND ADDRESS OF BANK OR OTHER INSTITUT10N THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
None
That the contents of said safe deposit box or boxes are itemized under Schedules N/ A of this return,
with the exception'of the following, for the reasons hereinafter set forth:
That Schedule A attached hereto and made part hereof sets forth fully and in detail all the real property
in the Commonwealth of 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, giving the amount still due at
death, name of mortgagee, date, rate of interest, and book and page of record thereof. It also sets forth in the
columns provided therefore the assessed valuation of each of said parcels, the estimated market value thereof
as of date of death of decedent.
That Schedule 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 moneys left by the decedent 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 primT to decedent's
death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal
savings, treasury certificates or notes and other evidence of indebtedness of the United States to the de-
cedent; all obligations, whether by statute or agreement they are designated as tax free, of the United States,
or any state, or political subdivision thereof, or of any foreign country, which are owned at the time of death;
all wearing apparel, jewelry, silverware, pictures, books, works of art, household furniture, horses, carriages,
automobiles, boats, and any and all other personal chattels of whatsoever, kind or nature, left by decedent,
together with the fairly estimated market value thereof; all bonds and mortgages held by decedent and of all
claims due and owing decedent at the time of death, and all promissory notes or other instruments in writing
for the payment of money of which decedent died possessed, of whatsoever nature, with interest thereon, if
any. giving the face value and estimated fair market value thereof, and if such estimated fair. market value be
less than the face value, it sets forth briefly the reasons for such depreciation as to each item; all moneys
payable to the estate from life insurance policies carried by decedent; all annuity and endowment 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 owned by the decedent at the time of death, with the market value there-
of at such time.
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 dftte 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 show.ing the assets and liabilities of' said co-partnership or husiness.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of' the agreement)
together with a statement setting forth the character of' the business, its location, and such other f'acts
pertaining to the business 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 propert~y owned or bequeathed by the decedent at the time of death.
The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry
contained therein aml in the case of' transf'ers of'property, real or personal, within two years of decedentt s
death, in contemplation of decedent's death, or intended to take efTect in possession or enjoyment at or
af'ter death, said schedule set.s f'orth the nature and value of' such propert~y, to whom transf"erred, the
relationship of' the transf'erees to the decedent, the proportionate share received by each transferee and
all other f'acts of' Ii pertlnent. nature re.garding said transf'ers. In the case of' transf'ers intended to
take ef'f'ect in possession or enJo~yment at or af'ter death, there Is also attached to t.he scherlule a COllY
of' the deed, trust agr~ement or other instrument creating the trust. Ther.~ is also set forth in sald
schedule a list. of all property, real and personal, with its value, which pa~ses at decedent's death by
virtue of the exercise b~y decedent, either individually, or jointly with another, or any power of appoint-
ment vested ill decedent, either individually or jointly, by the will, deed, or other lnstrwnent of another,
with a copy of the instrument. creating such power attached to the schedule.
That Schedule 0 attached 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, Lheir relllt1onship, if any, to the decedent, together with the ages at the time of
decedent's death of all minors, annuitants and benef'iciaries for life unrler rlecedent's Will. It also
contains a statement showing which of the benef'iclaries named in the decedent's will, if' any, died prlor
to decedent, the dfl.tes of their death, their issue, and the relationship of such issue to the benef'iciary.
That Schedule E attached hereto and made a part hereof' sets f'orth 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 ot.hers, plus the date and place of' record of instnunents ef'f'ecting the vesti ture 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 claimed 1"01' and on behalf of this decedent's estate, including f'uneral eXIHmses paidj
family exemption, where applicaLlej costs of' administration of' this estatej counsel f'ees and ftidiciary's
conunissions paid or to he paidj cost expended f'or burial trusts, tombstones or gravemarkers, and reli-
gious services, in consequence of' the death of the decedentj debts and claims owing and lUlTHlirl at time of'
death; taxes accrued chargeable for period prior to decedent's death (except those allowerl 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 tfiX assesserl can be reassessed in accordance therewith.
That the totals of the appropriate columns in Schedules "Aft, ftB", "C", "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this
c!:<(1.tl.
THE FIRST
NEWVILLE, Pi
.....~.~<d~;f'p~
j v Comm:~~ion E:::pi~r..s Jul; v, 1911!
tI Cillis!e. PA Ccmberland COll~~1
---
(Street Number)
.. .N~:w.yt:L.:L.~>J'AJn4:L.
(City or Town a.nd State)
NOTE: Before signing affidavit make sure all blank spaces in the af'f'idavit and schedules annexed are
filled in with details or the word "None", and in case the assets include rare and unlisted securities,
securities of' close or family corporations or an interest in any co-partnership or business, that the
data and statements requi red under the paragraph above relating to Schedule "B" are attached. Also make
certain that colunrrI #1 in the "Sunnnary" has been properly completed as above-directed.
lite C'.34 (....73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
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 ather, should be identified
as to quantum of interest and the estimated value should be that of the decedent's interest only, (Property
held as ioint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E,")
The raal property located In the Commonwealth of Penn.ylvanla should b.
described by lot and block number. .tr..t and .tr..t numb.r, together wi th
a general ducrlptlon of the property, with a reference to the record of the
conveyance by which the decedent took title; If a farm .tate numb.r of a~
cre.; 01.0 .tatem.nt of mortgage encumbrance. upon .ach parcel at d.ath
of d.cedent, Taxe.. a.....ment.. accrued Inter..t on mortgag.., etc..are
to b. lI.ted on Schedul..IF" and mu.t not h. d.ducted from this .chedule.
(1)
(2)
(3\
OEPARTMENT
V ALUA TION
CAUTION
(Do not write
In tltls space)
ASSESSEO VALUE
FOR YEAR OF
DECEDENT'S
OEATH
ESTIMA TED
MARKET VALUE
House and lot of ground containing 0.89
Acres, more or less, situate in Lower
Mifflin Township, Cumberland County,
Pennsylvania, and improved with an
aluminum siding ranch dwelling having
two bed rooms and attached two-car
garage and being the remaining portion
of premises conveyed to decedent by
deed recorded in Cumberland County Deed
Book 22 "K" 5 84 less 1. 40 Acres conveye
to Bobb in 24 "D" 695.
Sale Price $36,000.00
(:1; 6200.00
36,000.00 ~
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Insert this total apposite "real property", Schedule "A" in the X X X X X
"As Reported" column an the last page of this return.
BCC -35
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
*~
CO~~ONWEALTH OF PENNSYLVANIA
T~\NSB~R 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 listed under Schedule "E". Intangible personal property, titled in 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 estate.
Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household
goods, and f'urnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, stich as bonds, treasury certificates, cash on hand and in bank,
stocks, mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay-
abl e to the es ta te or :rirluc iary in said capaci ty, partnership interests, interes t in any undis trlbuted
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.
I'rEM
List and describe t~lly
UNIT
VALUE
ESTIMATED
MARKET VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
1. Household furniture as appraised 4/4/78
by Ira K. Gleim, Pa. Inheritance Tax
Appraiser:
Living Room contents
South Bed Room contents
North Bed Room contents
(husband only)
Kitchen
75.00
50.00
0.00
100.00
2 2 5 . 00 ,/ Z'2.. 'S. 0 0
2/
The Farmers National Bank of Newville, PA
Checking Account, Balance
3045.14 Y"~S~ c{ "::> \'4
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" colunm on the last page of' this return.
x X
3270.14
'~2--7 Q . I L(
i~'.~,.~~...;'.~~1:"~,~ THE FARMERS N~9~TIONAL BANK
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~~i~J'1 OF NEWVILLE, PENNSYLVANIA 17241
WAYNE WOOD, President CAROLYN H, KOUGH, Ass!. Cashier
MERVIN J. MORRISON, Cashier MARY E. KELSO, Asst. Cashier
October 9, 1978
Mr~ Thomas E. Gsell
1St. National Bank of Newville
Newville, Penna 17241
Dear Mr. Gsell:
This is to certify that as of date of death of .
Viola M. Adams, March 16, 1978, a balance of $3,045.14~
was held in a checking account at The Farmers National
Bank of Newville.
Very truly yours,
/')/b~ Q- /J4v~vV
Cashier {I
'.
'.
,
\
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RCC- v-
('1)MMO\WFALlIl Ill" l'E~~,YLU\T ,\
THA\~FFH I\li1.:nrT;l\CF TAX
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J\ESIl);':\J lWC]<l)].'\T
(1) Oitl tleced(,Tlt., wit.hin two years ofdcatll, IIlake any tl'iHlst"er or any Illaterial purt of his psVit.e, without
recpiving a valuable and adequate eonsirlf'r<ltioll tht,,'pfnr? (Answer yes 01' no) No__
(:!) IHd r!pcedent, within two years of' r1path, tr1lnSfel' properl,y from himself' to llilTlselr and another 01'
(ithers (inclwiing a spouse) in joint ownership? (Answer 'yes or no) N~_._
UI) If the answer to (1) or (2) above is in the affirmat.ive sUite:
(a) A,f';p of' decedent at time of tran~;fer _~L_
(b) State of decedent's heal th at time of' making the transfer. (Note 1).
(c) Calise of decedent' s de~Jth. (!\ote 1).
(4) Ojri decerlent, in hi:;; lif'etime, make any t.ransfer o-r property wit.hout receIving a valnable or adequat.e
consideration therefor which was t.O take effect in possession or enjovmer>t. at. or af'ter his death?
(i\nswer yes or no) No . ~
(a) \oras there any -~lOssibility that the property trans-rf'rred might return to transf'erer or his
estat.e or be subject to his pow,:,r of' disposition? (Answer .J'es or no) ~~
(b) What. was t.he transferee's age at time of decedent's death? N/ A
(5) Did dece(l(mt in his I i t'e time make any t.rans-rer wi thont receiving a valuable and adc(Illate consideration
therefor llll(lf>r whieh transferor expressly or impl te(lly reserves for his lif'e or any period which does
not in fact cwl he fore his death:
(a) The posscssjon or er!joyment of or thE' right to income from Ulf:' property transferred?
(Answer yes or no) No
(11) The ri~ht to designate the persons who shall possess er enjoy the property transferred or
income thercf"rom? (Answer yes or no) No
(G) If' t.he answer to (5) (b) above is in the aff'irmative, st.ate whether the right was reserved in decedent
alone f)r others N/ A ______________
(7) Did decedent in his lifetime makp- a transfer, t.he consideration for which was ~'fmSf'ereel s promise to
pay income to or for tlle benefit of care of tl'at-:sferor? (Answer yes or no) 0
(8) Did decedent, at any lime, transf'er property, the benef'icial enjoyment of which wns subject to change,
beCiiuse of it r.,served power to alter, amelltl, or revoke, or which c01l1d revert to decedent uncleI' terms
o-r transfer or by operation of law? (..\nswer yes or no) No
(fJ) If the answer to (H) above i3 in the a-r-rirmative, was the [lower tf) alter, amend, or revoke the inter-
est of the hern~ficiary reserved in Uw decedent alonl~ or the decedent anrl others?
(Answer yes or no) No
NOTE 1: The Ilnswers to these questions should be supporterl by af't'iclavit ny the attending physician as
well as a copy or the rlellth certi ficate.
NOTE 2: If answer to any of the above (Itlt~stions is yes, set forth below a description of the property
transferred, it's fair market v,llue at date of' death, dates o-r transfers awl t.o l"nOJII transferrerl, with
relationship of transferees to decedent, i-r any. Submit cory of any trust deecl or instrwTlent, if trans-
fers are clOlimen to he Tlon-taxllhle, also submit detl-dlert st,atement of f'acts on which said claim is based.
~OTE 3: List apjllicahle propert.y below ln maImer in whieh provlrled in Schedules A, ll, or E.
ITEM
UESCHIf'TION
MAmmT Vi\I,{JE
(Estimated)
DEPT. VALLTAT.'::ON
(Dept. Only)
None
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i
I
Insert this t0tal opposite "Transfers", Schedule "C" in the
"As Reported" column on the last pag;e of' ttds return.
--
RCC-37 (12-63)
COMMONWEALTH OF PEXr-;SYYL\NIA
TRANSFER INlIERlTAXCE TAX
RESIDENT DECEDEr-;T
SCHEDULE "D"
BENEFICIARIES
BENEFICIARIES AND ADDRESSES
~Statc full names and addresses of all who
have an interest, vested, contingent or other
wise, in estate)
RELA TIONSIllP
(If step-children or
illegitimate children
are involved, set
forth this fact.)
SURVIVED
DECEDENT
STATE YES
OR NO
DATE
OF
1lI RTH
INTEREST OF
BENEFICIARY
IN ESTATE
Tan a A. Wa
424 E. Kin
ShiJUlensbur
ner
St.
PA
Gr.Grand-Niec
Yes
1 iI fllrn i tllre
esidue of estat'
St.
PA 17257
17257
Jason Lee Pensin er
St.
PA 17257
Gr.Grand-
Ne hew
Yes
424 E. Kin
Shi
--r--
Kenneth J. Adams Sr.
R. D. 3 Box 270
Newville. PA 17241
Husband
Yes
!
-j
2/25/14 11/2 residue of estat,
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
None
_._._--~.._-
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SUMMARY
(Sch. "A")
......(Sch. "B")
.....(SCh."C..)
Real Property
Personal Property
Transfers
Gross Taxable Estate.
(1)
(As Reported)
$
$..
$
$
$..
$
i2)
(As Determil1('d)
$
$
$
$
$
$
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RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
RCC-31l
COMMONWEAL TII OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must disclose all property, real awi personal, owneo. by the (tecedent jointly
with another or others, including intangibles, standing in the name of' the decedent and others. List
real estate first. liS entireties, or joint tenants, giving brief' description, as indicated nneter Schedule
"A", plus the dllte and place of record of instrument effecting vesti ture, but do not include ent1.reties
or out of state real estate value in estate valuation column. Personal property should be l1.sted as in
Schedule "B", plus date of acquis1.tion, and the name, address and relationship (if any) of' co-owners to
the deceden t.
Deseription of Property, Date of Acquisition, Name
Andress and Relationship of' Co-Owners, and Place
of' Record of Instrmnent, where Real Estate.
unit
Value
percentage
Share
Estate
Valuation
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of
Entire
property
Value of
Decedent's
Interest
None
N0r--X...
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Heported" coluilD'l on the lust page of this return.
REV-518 (6..78)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG
17105
IN YOUR REPLY PLEASE
REFER TO
*'
Inheritance Tax Division
NOTICE OF FILING OF APPRAISEMENT
1st National Bank
9 W. Big Spring Ave.
Newville, Penna.
(Executor or Administrator)
In Re: Estate 01
Viola M. Adams
Cumberland
County - Fi Ie No.
21-78-0153
Dear
You ore hereby notilied that the Original
appraisement in the estate 01 Viola M. Adams
has been liled in the office 01 the Register 01 Wills 01 Cumberland
County on 20 December ,19~, Said appraisement rellects the lollowing
valuations:
Real Estate
Personal Property
T ran siers
Jointly Owned
Total
36,000.00
3,270.14
None
None
39,270.14
As to such tax that is paid within three months Irom date 01 death, a live (5%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) months
(Iifteen months when death occurred Irom December 22,1965 to June 16, 1971, inclusive;
and twelve months when death occurred prior to December 22, 1965) Irom dote 01 death,
interest at the rote 01 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 01 said notice os provided by Section 1001 01 the Inheritance and
Estate Tax Act 01 1961,72 P. S. 2485-1001, P. L. 373..: ..'\ ... t
Dote 20 December 78 Signed (J;..../t.v~- t, .Vh'b==.-
Title
Chief .^.Pl'raiser
L.
-~-'-~--_..~..,-~.-
Note: This is not a bill.
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
FILE NO.) ~ - -1 '6 (, l So;,
Whereas, \ ") \ ~ "", O---cC-o-...--.-<> late of L_. r'v-\ c.A;/k-Q "-~
in the County of (L~-~-' ~ Commonwealth of penn~nia, having died 0:,
the \ (co \::::2-- day of M CA--,--<.J-- 191<3 , seized and possessed of an estate
subject to Inheritance\Tax under the laws, of th~ Commonwealth of Pennsylvania;
Therefore, I, _ r\ A.~_ G.~ . 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:
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE \ L... 0 2. D ...r t>
(, . ' 1 J:L
COUl''-T~L--v-vJ..,-L ,-v..~.
RC c"2 (2:-64)
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the d~edent after
the expiration of any estate for life or for years, the CommonwealU1. hereby expressly reserves the right to appraise and assess transfer
inheritance taxes at the lawful collateral rate on any such future interest.
Unit Apprai$ement
Dncrlptlon " AlIllt Values Made for Inheritance
Tn Pur pOles
\:2... ~--k p(~~ $.)1.. 0 2.J2
f-""",+_O\'l.-
?,'2-/\./~-.--,:;J. (J,,,-< , ~2:>. '210
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~avi~g been duly ~worn according to law, I do hereby cerw that the above appraisement is made in col1-
formlty With law on thiS "2_u day of ~..::J~,oo~,~ : 19-rS,
t: 1<. . .J:.e_"""':"'-
Appral~r
\-k (lfu~~ and,Strtet)
\./,-,~x.r4../\'--~
(Pan OfBet}...
, Penna.
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