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REV. 1500 EX + (S-oOJ
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REV-1500 r
COMMONWEALTH OF PENNSYLVANIA I INHERITANCE TAX RETURN I~LENUMBER
DEPAR~~T2~~~VENUE I RESIDENT DECEDENT 21 05 0231
-----------~~~A_17~":~__L______ ---------_ ___ ...__.___ .___ ___ ---_-.J__ ..9.Ql,JNTY CODJ;_ _ "y~AR ___ NU~_____
I DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)------ . ------.--------- SOCIAL SEC-URITY NUMBER----------- _____
~ I Kline, Gen<ge ~--- -- _ _ __ _ __ __ ______ '___ 192~1~62IL______ _
~ I DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
i:! 102/1312005 , 01/06/1923 ---L------__-"_"-G~TER_OfWIU.~_ _ __,
o I"' ",,,,,,eE,,"",,,,," ",0""', ...." CAS', "'" """'00"'""", i 'O''''''''o"rr ,"M'"
--- - -- ~18T 1.-0"'", R,"';'- - - -- ~-O- ',- S""",;;;,;;,a'A"'m ---- - -- - -- -- - - -- b ._"""""_,,.., ,,,,.-. .... ..." ".,,,,, _
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OFFICIAL JSE ONl y
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4. limited Estate
4a. Future Interest Compromise (date of death after
12-12-82)
7. DeCedent Maintained a living Trust (Attach
copy of Trust)
10. Spousal Poverty Credit (date of death between
o 5. Federal Estate Tax Return Required
6. Decedent Died Testate (Attach copy
of Will)
9. litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
AME
if f'~;:'~;;;~e~;~- -- -- - -- -- ----~I 5521 C"lislePike
~U""ON',".'" - - - - -, - ----- - - --- -- -I Meohani"b",g, PA 17050
-- __I 71 7.1697:.1 8()0 __ _ '_ _ _ ___ ___ _ _ _____ _____,___ _ _ _______ _ ___ _ _ __ _ __ __ __
- - --I'~ R'~IE'<a;;S;;,;;;,; A; -- -- ------ ---(;;----- ,~-N:';;'e--- - --- o,~'''~'',o,,-;-- _ _
I ,. S<oo" aod Boo'" (SoI"do', B) (2) Non e L .
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110. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
111. Total Deductions (total Lines 9 & 10)
112. Net Value of Estate (Une 8 minus Line 11)
113. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
I made (Schedule J)
__--+-l~..~~~~~lue ~~~~~!~~!~X (Li~El.~ITli~~s:~e_~~ ..... ___. n.... _ _ _. n_ .u__. _ ..
I SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
i 15.Amount of Line 14 taxable at the spousal tax rate,
or transfers under Sec. 9116(a)(1.2)
4. Mortgages & Notes Receivable (Schedule D)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
(3)
None
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Of:
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
(4)
None
-------------- --'-,-
162,154.46
c)
(5)
(6)
None
(7)
253,696.17
(8)
\.~:
415,850.63
(9)
--------._---._-----~------.-
32,509.67
- ----...------------
(10)
2,665.43
(11 )
35,175.10
(12)
-------- --._-~--_._---
380,675.53
(13)
(14)
380,675.53
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x .00
(15)
16.Amount of Line 14 taxable at lineal rate
380,675.53 x .045
(16)
17. Amount of Line 14 taxable at sibling rate
-- -- _.__n____________________
17,130.40
18. Amount of Line 14 taxable at collateral rate
------- ---------------.- -'-._-._--
x .12
(17)
RJ(
-- --"-- - _'__.n u_ _ ______
x .15
(18)
(19)
-___n_.___ __ _ _________ _______
17,130.40
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
'Decedent's Complete Address:
STREET ADDRESS
-
303 East Meadow Drive
CITY
--- - --- -------------- -- ---
Mechanicsburg
STATE PA
-- - --,-- --._-._--
[ZIP
I 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
17,130.40
------.__..__._----_._-----~--
16,000.00
---- --.---------.--.-----..-
842.11
3. InteresVPenally if applicable
D. Interest
E. Penally
Total Credits (A + 8 + C)
(2)
16,842.11
--.---------- -. - - - --,- ----
1.90
TotallnteresVPenalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPA YMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
(3)
(4)
(5)
(SA)
(58)
1.90
290.19
--------------- -- ------.---
290.19
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?............................... ........... ..................... ................... ....................................
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.................................................................................. ~ s
~. :;~ :":~~;;:~':~~::;;:;.'.h.'"~~el~~".'......:":I:':~~:'::;~ ;:~~~'...................................
d. receive the promise for life of either payments, benefits or care?..............................................................
2. If death Occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?............ ......................... ................. .................. ..................... ......................... 0
o
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
IF THE ANSWER TO ANY OF THE ABOVE QUESTTONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
--------------- --- - -._-._-- -- -- --- -.-------- -._-- -.- --------- -- -- ---- -------- ----------. -- ----------
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"""'''''''.'''''. ,-.... 'M~ _m..., '"' _m. ""'"' .-._ """OM~' .'_0 M'''",..."" M_~ _... "".... ~"M' ~"",.. '''''."~.
..- -.~........ -~.. ,"uoo ~",.o~'"~. ~~ ..,..,"".~ .~..~_ ~__ _ __~
SIGNATU OF ERSONREsPONSIBLEF-OR FILING REURN------~-,d.DDRESS-..- ----. '.-.. DATE
:::,,:0, ,,::~ '-"1'o'''~''a "",,, ~~J~\SP6o/i28 ~ t/~1fo-~- n
SlG.. NA~R'OFPREPAREif6.f..HER -THAN REP-RESENT ATIVE----
Th~: A t---
ADDRESS
5521 Carlisle Pike
Mechanicsburg, PA 17050
DATE
F" d".. <>f d'''h '" ,,,.,, J'~ " 1994 'M bero", J,",,,y " 1995, Ihe la, "'Ie ;mp"ed '" Ihe "et eel" ,ft",""", " " ro"he '" <>f the
surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)J.
F" dole, "de"h '" ,,,.,, J'"",,>, " 1995, the lox "la ;m"'''d '" Ihe "et ee'" 'ft"'""e" I, " ,,, II,. '" 'fth, ,"NM"9 ''''''' ;, 0%
(72 P.S. ,9116 (,) (1.1) (;;)). The 'let"", do,,, "<>I eeem<>l , I"'""e", , '""';';"9 """" 'rom la" '"d Ihe 'lal''',>, 'eq';"'m",~ '" d;,o",,,
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 I" "'Ie ;mp"ed '" Ihe "of ee'... <>f I",""", 'rom, d""....d aMd lwe"ly-o"e ye", <>f 'ge "\'0'"9" " de"h I, "ro, Ihe ",e ,', ""'''''
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116 (a) (1.2)J.
The"" "la ;mpOeed '" Ihe "of eel,e ,ft"""e~ " "",, Ihe ,.. 'fthe deoed"'f, ;;"..1 be",'o"" ;, 45%, .,"'" " ",lad;" 72 P.S. ,9116
1.2) [72 P.S. 99116 (a) (1)].
The la, "Ie ;mp"ed '" the "of '"'' ,ft"'"'Ie~ ro " ro, Ih, '" 'fthe de"'de"f, ';b';"9' ;, 12% (72 P .S. ,9116 (,) (1.3)J A ';b;;"9 . de'",d.
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Z-{.c-'Oh
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
--._._---~~-.__.._----
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF .
KlIne, George E
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-- --"---'----- --.-
~_ == .-~__~J:ILE~~~E~02~_~~~~--_ -~~~-
---- --------------------...-----..-----
------._--- ---_._---_..__._-----_._-----~_._._-_._- - -,'---- ----
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
--------------------------- - ----
ITEM
NUMBER
---- --._- ---------.----
1 Wachovia Checking account
DESCRIPTION
--- --"'-'--------"-.----.-- -- ------.--
2 Investment account # 3KH-013727
3 2002 Saab 9-3 SE Convertible
4 Miscellaneous personal items
5 1997 Sea Doo GTX Jet Ski
6 ICHP Refund (Health Insurance)
7 USAA Auto insurance refund
8 USAA - SSA Account
9 Riverside Anesthesia Associates refund
VALUE AT DATE OF
DEATH
--.. ---- -- ----- ---------------.--
11,282.03
129,347.29
16,750.00
750.00
2,200.00
147.10
162.95
1,486.80
28.29
~- -- ---~------------ - - - ---~--~- - ~ - - - - - ~- ~ - - ------~------ - ---~ --- --------------
TOTAL (Also enter on Line 5, Recapitulation)
162,154.46
i SCHEDULE G
I INTER-VIVOS TRANSFERS &
COMMONWEALTH OF PENNSYLVANIA I
INHERITANCE TAX RETURN i MISC. NON-PROBATE PROPERTY
----_ RESI~E/II-r:[)ECED~i'l.-r:_________-L____________ __ __ . _______
.
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'------.---.--.-~----.--.--- --------------- _'__n _ _ __'__"_ _'_._
ESTATE OF
Kline, George E
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I FILE NUMBER
- - --------- ----..------__._.n_____
- ---._- ---..--.----..----.-------
---------------- -- ---------------- ---
21 - 05 - 0231
This schedule must be completed and filed if the answer to any of questions 1 throu~h 4 on page 2 is }'es.
1------------------------- ---- - -; _ ___ ~_____ _ 1 _ _ __ ___,__ _ ____________
DESCRIPTION OF PROPERTY I I % OF . I
ITEM I '","00 ..._" ~ ,.-. .00 ~-''''"...,,''oo ....." ""'"' ,DATE OF DEATH, DECO'S I EXCLUSION TAXABLE VALUE
__NUMBER i __ _ __ :0000. ~ "~M ~_.. ",": ___ __ _ IV AlUE_:ASS_E;",~EREST i '" ~'UCA''',
1 I'RA Account # 3 KHO 13479 - benefidaries "'e his chHdren, r 253,696, 17, 1 ()()% 253,696, 17
I equally I I
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-- --'-'- - ___n'__.. __'_.__.___ _n _____.__.______________ _ __
253,696.17
- -.--..--------- "------- -'-'-- -,-- -
TOTAL (Also enter on line 7, Recapitulation)
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SCHEouLEH
FUNERAL. EXPENses &
AllVINIsTRAllVE COSTS
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I
----- -----._- ---'- -----..- -- ---.---.-------.- ---- ----.----.----.-
ESTATE OF KI' G E
me, eorge
- -----------.---------------------
- ------.--.----------------- ------.-.---------.--
FILE NUMBER
21 - 05 - 0231
- --'--- -----~---._-----_. --- --..---------------.---------- --- -'-".--- ----------
ITEM
NUMBER
-/i..-- !FUNERALEXPENSES;-----
I Malpezzi Funeral Home
B.
Debts of decedent must be reported on Schedule I.
-- - ----.---..- -- ------..-----------------------------
DESCRIPTION
----- -- -- --------.--.----
AMOUNT
2
8,396.60
Funeral luncheon - Pennsylvania (Knights of Columbus)
3
1,367.54
Funeral luncheon - New Jersey (Marco Polo)
2,503.30
ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Christine M. Kline
Social Security Number(s) / E/N Number of Personal Representative(s);
144-40-8641
5,000.00
2.
Street Address 140 Terrace Drive
City Chatham State NJ
Year(s) Commission paid 2005
Attorney's Fees Ahrens Law Firm, PC
Zip 07928
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
10,000.00
4.
City
Relationship of Claimant to Decedent
Probate Fees Register of Wills of Cumberland County
State
Zip
464.00
5.
Accountant's Fees Valerie J. Knisley , CPA
6.
1,250.00
Tax Return Preparer's Fees 2004 Personal Income Tax return
Estimated 2005 Income tax returns (1040 & 1041)
295.00
500.00
7.
I
Other Administrative Costs
Estate notice in the Sentinel
2
100.73
Estate notice in the Cumberland Law JOurnal
75.00
Total of Continuation SChedule(s) 2,557.50
TOTAL (Also enter on line 9, Recapitulation) 32,509.67
--- --"--.._--- ----.---.--.--.------
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COMMONWEALTH OF PENNSYLVANIA I FlIleraI Expellses & !
"'g~'i:i',i~~' _ _ _ L _ _ -- ~~~ ____1_ _________ _ ___ ___ _ ____
ESTATE-OF---- - - - - -- - - - - - - - ---- -- n -- ---- n n ------- -- - -!AlE -"UMSE" _ _ __ _ _ __ _
Klin<, Geo'g' E i 2] _ 05 _ 0231
3
Executrix travel expenses
--- ---.-------- --------- -- -----
- -------.-..--.--.--....--
200.00
4
Misc. expenses (postage, stationery, etc.)
5
Estimated cost to sell Timeshare located in New York city
150.00
6
P A Inheritance Tax filing fee
2,000.00
7
Wire transfer fees - Wachovia
15.00
8
Wire transfer fees - Pershing LLC
18.00
9
Additional short certificates
56.00
10
Register of Wills - Exemp letters, short certificates, photocopies, certif.copies
60.00
58.50
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Page 2 of Schedule H
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SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEAlTH OF PENNSYLVANIA I
INHERITANCE TAX RETURN I
-----_ ___~NT DE:E[)~~________ -_L ______
ESTATE OF
-----------.----..---------------- ---------------- - - --'--'---.-
Kline, George E
L __ ___ _ __
FILE NUMBER
21-05-0231
- -- - -.---.___.._u__.________ ___
- '-'.----.- -- -..---.---.-
Include unreimbursed medical expenses.
-. --------.--.-----..-.--- --..--.---.----------
------,.~--_._-----_.._------_._--_._-------- -----------------
ITEM
NUMBER
1 USAA Auto Insurance
--,- ---..-.- ---'--._- ----- -- --.------.----.----.-
DESCRIPTION
- ---.----...--..----..----..------------..----
AMOUNT
2
Bank of America credit card balance
337.99
3
Capital One credit card balance
1.00
4
USAA Credit Card balance
1,441.49
5
The Manhattan Club timeshare Maintenance fee
16.95
6
Pershing LLC custodial fee
833.00
35.00
2,665.43
--- -._~----.- --'------- -"-..- -,-- --.-- -----._--- --._----- ----- -
TOTAL (Also enter on Line 10, Recapitulation)
REV-1513 EX~ (9.00)
*
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COMMONWEALTH OF PENNSYLVANIA I
INHERITANCE TAX RETURN I
. -- - - _!lESII:)e:NT [)E:~E:~E:~T__ ___ ___ _ .. L
-- -----.------ -- ---.-----'------------
SCHEDULE J
BENEFICIARIES
ESTATE OF
Kline, George E
.. ~~:~~ r---":~E~~:::';:~~ :::~~~(~) RECEIV'NG PROPERTY
--- --.- ------~---------_._._-------_._--------------_._--- -. -- --- ...
I. I TAXABLE DISTRIBUTIONS (include outright Spousal distributions)
I Christine M. Kline
I 140 Terrace Drive, Chatham, NJ 07928
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I RELATIONSHIP TO
I DECEDENT
I
. - -- - - -T- - -.Do.Not.LlstJcuslee(s)_ .
FILE NUMBER
21 - 05 - 0231
- -------- - ---"-'----.--
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i Daughter
I AMOUNT OR SHARE
OF ESTATE
---/----- -.._-- ------
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II/8th
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2 I. Stephen G. Kline
140 Terrace Drive, Chatham, NJ 07928
3 I Jane E. McCaddin
I 138 Passaic Avenue, Summit, NJ 07901
4 I Kevin E. Kline
I 1460 Woodacres Court, Mountainside, NJ 07092
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5 I Michael J. Kline
I 130 Father John Drive, Lake Ariel, PAl 8436
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6 I Mary T. Kelly
I Hancock Street, Middlesex, NJ 08846
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I S" Conlinuatlon SCh'du'O/s) '''ched
I E"", don" ,mou,ls fo' d."'hulIon, 'hown ,ho" 0' "," 15 th,ough 18, .. ,pproP',t" 0' Roe 1500 """', 'hoe' I
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Son , I/8th
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Daughter ' I/8th
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Son II/8th
Son 'I/8th
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Daughter II/8th
II.
NON-TAXABLE DISTRIBUTIONS:
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IA. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
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- - ----.-----.--.---------------. ----'- --'--- -- __ n_ __ ~
--- -----.- -__..__.n.__ __,_ _ __ _n_._____
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART" - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET!
---- ----- -----------.-. - -.--..---..- -~--.-.. -..-.-.-- -.. - .-- -.-------- ----
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I SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA I BENEFICIARIES t d
INHERITANCE TAX RETURN " con inue
=-c:==~~=--~-R~~~~~Er-g:~~_-=c:-,-~-=~:c=.==--__ ___---: -C"'-=c:-=-- _ ___ ________
ESTATE OF
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NUMBER , NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
- - ------- _1 _______ ____ ____________ _.___ _____________. ",
J rr' AXABLE DISTRIBUTIONS [include outright Spousaldistribl.itions. and transfers under
. Sec. 9116(a)(1.2))
7 Patricia A. Kline
38 Hickson Drive, New Providence, NJ 07974
FILE NUMBER
21 - 05 - 0231
RELATIONSHIP TO
DECEDENT AMOUNT OR SHARE
--_D_o.No~LI"ITru-"le"is) __ -L- _____OF EST~~~____
Kline, George E
--------------------------- ----------------------
8 Matthew 1. Kline
110 Martel Circle, Di11sburg, P A 17019
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- ------ - ------- ----.-___n _____..____
- -- ---- --------
Daughter
II/8th
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Son
: I/8th
Page 2 of Schedule J
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