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					                                                           THE LAW FIRM OF

   EVAN H. FARR, CELA* CEA**
                                               EVAN H. FARR, P.C.                                         Paralegals
                                                                                                         APRIL BLUM
        Licensed in Virginia and D.C.
                                                   10640 MAIN STREET, SUITE 200                         KAREN SIMPSON
                                                     FAIRFAX, VIRGINIA 22030                           MARK SCHWERDT
                                                        Phone: 703-691-1888                           GRETCHEN THRASHER
         YAHNE Y. MIORINI                                Fax: 703-691-3061
      Licensed in Virginia and New York
                                                      www.FarrLawFirm.com                             Eldercare Coordinator
                                                     www.VirginiaElderLaw.com                      JENNIFER FITZPATRICK, MSW
                                                   www.VirginiaEstatePlanning.com



                                            INTAKE FORM & CHECKLIST
                                          TRUST &ESTATE ADMINISTRATION
                                                       (INCLUDING PROBATE)
WHAT IS THE PURPOSE OF THIS FORM?
The information you provide in this form and the documents you provide in accordance with the attached checklist are
to help you organize the decedent’s personal and financial affairs so that we have enough information to determine the
type of administration needed and the whether probate and/or tax filings are required. As noted in the form below,
several sections of this form need not be completed if the Farr Law Firm prepared the decedent’s estate planning
documents, as we should already have the relevant information.
WHO SHOULD COMPLETE THIS FORM?
Typically, the person completing this form (or on whose behalf it is completed) is a named fiduciary of an estate (the
term “estate,” as used herein, refers to a probate estate and/or a trust estate), i.e., either the named executor of a
probate estate under a Last Will & Testament and/or the named successor trustee of a trust estate. Alternatively, if
there is no will or trust, this form is typically completed by an adult relative or some other person who has an interest
in the estate.
WHO IS TO BE THE CLIENT?
Typically, this firm is hired to advise and represent the fiduciary of an estate in his or her fiduciary capacity. This
means that our legal efforts will be focused on advising and assisting the fiduciary to properly and legally carry out
his or her fiduciary duties to the estate as a whole. Quite often the fiduciary is also a beneficiary of the estate, and
may desire legal advice and representation as an individual beneficiary. We are happy to provide this service;
however, if we advise and/or represent you as an individual beneficiary, we can not also represent you in your role as
fiduciary because this almost invariably gives rise to a conflict of interest. The only exception to this is if you are the
sole legal and natural beneficiary of the estate, in which event there would be no conflict. So that everyone is clear as
to what type of advice and/or representation this firm will be providing, we request that you consider and decide this
issue in advance and place your initials below next to the type of representation you desire.

                            I/We desire representation in my/our fiduciary capacity and not as an individual beneficiary.

                            I/We desire representation as individuals(s) and not in my/our fiduciary capacity.
                            I am | We are the sole beneficiary(ies) of the estate and therefore desire representation in a
                            fiduciary capacity and not as individual(s).




                 *Certified Elder Law Attorney, National Elder Law Foundation
                 **Certified Estate Advisor, National Association of Financial & Estate Planning
                 * **Virginia has no procedure for approving certifying organizations
PART A. INFORMATION ABOUT THE DECEDENT OR PERSON UNDER DISABILITY

Please complete the information requested in this section to the best of your knowledge and ability, with reference to
the decedent, i.e., the person who has died. If you do not know and cannot easily obtain the answer to any question,
skip to the next question.

 Decedent's Name:                                              Decedent's Home Address at Time of Death:
    Mr.     Mrs.
    Dr.     Ms.



 Did Decedent ever use any other name?
     Yes
                                                               Was Decedent ever in the Military Service of the
             No
                                                               United States?    Yes       No
 Where?                      Why?

 Place of Birth:                                               Date of Birth:

 Social Security Number:                                       Work Phone:

 Name of Business / Ernployer at Time of Death:
                                                               Date of Death:

                                                                Place of Death:
 Business Address:                                                                      City                    State
                                                               Jurisdiction of Death:
                                                                                               Indicate Official City or County


FAMILY & BENEFICIARY INFORMATION
Was the Decedent married at the time of death?                 Did the Decedent have any prior spouses?
   Yes      No                                                    Yes        No
Name of Spouse:                                                Name:
Date of Marriage:                                              How Marriage Ended:           Death        Divorce
Address:                                                       Address:
Cty/St/Zip:                                                    Cty/St/Zip:
Home Phone:                                                    [Please Use an additional sheet of paper if there is more than
Work Phone:                                                    one prior spouse.]

Please list all of the Decedent's children, including adopted children. Be sure to name any deceased child and
indicate the names of the deceased child's children. If the Decedent did not have any children, please list the
Decedent's parent(s) if either is alive or the Decedent's siblings (if any) if neither parent is alive. Be sure to also
list all beneficiaries specifically named in the decedent's Will or Trust.

 1. Name:                                                      2. Name:
   Relationship:     Child       Parent       Sibling            Relationship:       Child           Parent         Sibling
   Address:                                                      Address:
   Cty/St/Zip:                                                   Cty/St/Zip:
   Home Phone:                                                   Home Phone:
   Work Phone:                                                   Work Phone:
   Email:                                                         Email:
   Names of Kids:                                                 Names of Kids:




   Farr Law Firm                          Estate Administration Intake Form                                              Page 2
 3. Name:                                                 4. Name:
    Relationship:       Child   Parent      Sibling         Relationship:      Child     Parent      Sibling
   Address:                                                 Address:
   Cty/St/Zip:                                              Cty/St/Zip:
   Home Phone:                                              Home Phone:
   Work Phone:                                              Work Phone:
                                                             Email:
    Email:
                                                             Names of Kids:
    Names of Kids:

 5. Name:                                                 6. Name:
   Relationship:        Child   Parent     Sibling          Relationship:      Child    Parent      Sibling
   Address:                                                 Address:
   Cty/St/Zip:                                              Cty/St/Zip:
   Home Phone:                                              Home Phone:
   Work Phone:                                              Work Phone:
   :
   Email:                                                    Email:
                                                             Names of Kids:
    Names of Kids:

 Does any above-named beneficiary have any special        Does any above-named beneficiary have any special
 medical, educational, or financial needs?                medical, educational, or financial needs?
    Yes            No                                        Yes        No



PART B. INFORMATION ABOUT PERSON(S) COMPLETING THIS FORM

Please complete the information of Section A, first Column, with reference to the person(s) completing this form.
Use Column 2 only if there are Co-Executors and/or Co-Trustees named or two persons are seeking to administer the
trust and/or estate.

 Name:                                                    Name:
   Mr.      Mrs.                                             Mr.     Mrs.
   Dr.      Ms.                                              Dr.     Ms.


  Home Address:                                           Home Address:



 Place of Birth:                                          Place of Birth:

 Date of Birth:                                           Date of Birth:

 Social Security Number:                                  Social Security Number:

 Name of Business/Employer:                               Name of Business/Employer:


 Business Address:                                         Business Address:




 Farr Law Firm                       Estate Administration Intake Form                                Page 3
 Email Address:                                                       Email Address:
                    May we send confidential messages?                                   May we send confidential messages?
                        Yes        No                                                       Yes        No

 Work Phone:                                                          Work Phone:

 May we leave confidential messages?                Yes         No    May we leave confidential messages?        Yes      No



 Home Phone:                                                          Home Phone:

 May we leave confidential messages?                Yes         No    May we leave confidential messages?       Yes       No



 Cell Phone:                                                          Cell Phone:

 May we leave confidential messages?                Yes         No    May we leave confidential messages?       Yes       No



 Fax Number:                                                          Fax Number:

  May we leave confidential messages?               Yes         No    May we leave confidential messages?        Yes      No


 Have you ever used any other name?           Yes          No         Have you ever used any other name?        Yes       No
 Where?                  Why?                                         Where?                  Why?

 Are you now or have you ever been in the Military                    Are you now or have you ever been in the Military
 Service of the United States?    Yes     No                          Service of the United States?

 How Did you Hear About Our Finn:


PART C. INFORMATION ABOUT THE DECEDENT'S WILL AND/OR LIVING TRUST.
Please complete the information requested in this Section to the best of your knowledge and ability, with reference to
documents signed by the Decedent prior to death. If you do not know and cannot easily obtain the answer to any
question, simply skip to the next question. Note: There is no need to complete this section if the Farr Law Firm
prepared the decedent's estate planning documents.


1. Did the Decedent sign a Will prior to death?      Yes         No     [If no, skip to question 7]

2. Do you have the original Will?                    Yes         No     [If yes, please be sure to bring the original
                                                                        Will with you to your appointment, and
                                                                        skip to question 7]

3. Do you have a copy of the Will?                  Yes         No      [If yes, please be sure to bring the copy
                                                                        with you to your appointment, and skip to
                                                                        question 7]
4. Do you have reason to believe that
   the original Will has been lost?
                                                    Yes         No      [If yes, skip to question 6]




  Farr Law Firm                            Estate Administration Intake Form                                       Page 4
5. Do you have any reason to believe that the original Will has been destroyed?             Yes        No
                                                                                        [If no, skip to question 6]
              Who do you believe destroyed
                         the original Will?

6. Please answer the following questions if you are able to:
          Approximate date Will was signed:
         Name of person who prepared Will:
      Last Known Location of Original Will:
     Last Known Location of copies of Will:



7. NAMED GUARDIANS FOR MINOR CHILDREN.
  If the Decedent had minor children (under age 18), please list the person(s) named as Guardian(s) in the Will. If
  there is no Will or no named Guardian(s), please list the person(s) who desire to be Guardian(s), if known.
  Note: There is no need to complete this section if the Farr Law Firm prepared the decedent's Will

      Check this box if the Decedent left no minor children, and skip to question 8.

 Guardian.                                                     Co-Guardian(s).
 Name(s):                                                      Name(s):
 Relationship:                                                 Relationship:
 Address:                                                      Address:
 Cty/St/Zip:                                                   Cty/St/Zip:
 Home Phone:                                                   Home Phone:
 Work Phone:                                                   Work Phone:

 First Alternate Guardian.                                     First Alternate Co-Guardian(s).
 Name(s):                                                      Name(s):
 Relationship:                                                 Relationship:
 Address:                                                      Address:
 Cty/St/Zip:                                                   Cty/St/Zip:
 Home Phone:                                                   Home Phone:
 Work Phone:                                                   Work Phone:
Second Alternate Guardian.                                     Second Alternate Guardian(s).
Name(s):                                                       Name(s):
Relationship:                                                  Relationship:
Address:                                                       Address:
Cty/St/Zip:                                                    Cty/St/Zip:
Home Phone:                                                    Home Phone:
Work Phone:                                                    Work Phone:



                                        {PLEASE CONTINUE TO NEXT SECTION}




 Farr Law Firm                          Estate Administration Intake Form                                       Page 5
8. EXECUTOR OR ADMINISTRATOR.
   If the Decedent had a Will, please list the person(s) named as Executor(s) in the Will and indicate if said
   person(s) is/are able and willing to serve as Executor(s). If the named person(s) are unable and/or unwilling,
   please list the person(s) who are able and willing to become Administrator(s), if known.
   Note: There is no need to complete this section if the Farr Law Firm
   prepared the decedent's estate planning documents.
      If the person(s) named as Executor(s) is/are already identified in Part A above, check this box and skip to
      question 9
Executor                                                       Co-Executor
Name:                                                          Name:
Relationship to Decedent:                                      Relationship to Decedent:
Address:                                                       Address:
Cty/St/Zip:                                                    Cty/St/Zip:
Home Phone:                                                    Home Phone:
Work Phone:                                                    Work Phone:
Is This Person Named in the Will?         Yes       No         Is This Person Named in the Will?      Yes           No

First Alternate Executor                                      First Alternate Co-Executor
Name:                                                         Name:
Relationship to Decedent:                                     Relationship to Decedent:
Address:                                                      Address:
Cty/St/Zip:                                                   Cty/St/Zip:
Home Phone:                                                   Home Phone:
Work Phone:                                                   Work Phone-
Is This Person Named in the Will?         Yes        No       Is This Person Named in the Will?        Yes          No

Second Alternate Executor                                     Second Alternate Executor
Name:                                                         Name:
Relationship to Decedent:                                     Relationship to Decedent:
Address:                                                      Address:
Cty/St/Zip:                                                   Cty/St/Zip:
Home Phone:                                                   Home Phone:
Work Phone:                                                   Work Phone -
Is This Person Named in the Will?         Yes       No        Is This Person Named in the Will?        Yes          No


                                        {PLEASE CONTINUE TO NEXT SECTION}




  Farr Law Firm                          Estate Administration Intake Form                                      Page 6
9. TRUSTEE OF TRUST.
  If the Decedent had a Living Trust or if the Decedent's Will expressly creates a trust upon the Decedent's death,
  please list the person(s) named as Trustee(s) in the Trust or Will, and indicate if that person is able and willing to
  serve as Trustee. If the named person(s) is/are unable and/or unwilling, please list the person(s) who are able and
  willing to become Trustee(s), if known.
  Note.- No need to complete this section if the Farr Law Firm prepared the decedent's estate planning
  documents.
    If the person(s) named as Trustee(s) is/are already identified in Part A above, check this box and skip to Part D.
 Trustee                                                       Co-Trustee
 Name:                                                        Name:
 Relationship to Decedent:                                    Relationship to Decedent:
 Address:                                                     Address:
 Cty/St/Zip:                                                  Cty/St/Zip:
 Home Phone:                                                  Home Phone:
 Work Phone:                                                  Work Phone:
 Named in the Will and/or Trust?         Yes       No         Named in the Will and/or Trust?          Yes       No

First Alternate Trustee                                       First Alternate Co-Trustee
Name:                                                         Name:
Relationship to Decedent:                                     Relationship to Decedent:
Address:                                                      Address:
Cty/St/Zip:                                                   Cty/St/Zip:
Home Phone:                                                   Home Phone:
Work Phone:                                                   Work Phone:
Named in the Will and/or Trust?          Yes       No         Named in the Will and/or Trust?          Yes       No



 Second Alternate Trustee                                     Second Alternate Trustee
 Name:                                                        Name:
 Relationship to Decedent:                                    Relationship to Decedent:
 Address:                                                     Address:
 Cty/St/Zip:                                                  Cty/St/Zip:
 Home Phone:                                                  Home Phone:
 Work Phone:                                                  Work Phone:
 Named in the Will and/or Trust?         Yes       No         Named in the Will and/or Trust?         Yes        No




                                       {PLEASE CONTINUE TO NEXT SECTION}




  Farr Law Firm                          Estate Administration Intake Form                                     Page 7
PART D.      CHECKLIST OF DOCUMENTS TO BRING TO FIRST MEETING

Please bring with you to your initial appointment copies of the documents requested in this Section. Please check
the box below in the first column if you are providing a copy of the document requested. If you believe that a
document exists, but you do not have a copy and cannot easily obtain one, please check the box in the second
column. If you believe that the requested document does not exist, please check the box in the third column.

 Copy of Document Document
Document
         Exists but is Does Not  DOCUMENTS REQUESTED
 To Be
         not available  Exist
  Given                         Label
                                   List of all Assets owned solely by the Decedent
                                   List of all Assets owned jointly by the Decedent and someone else
                                   List of all debts owned solely by the Decedent
                                   List of all debts owned jointly by the Decedent and any other person
                                   Wills and any Codicils
                                   Federal and State tax returns for the last three (3) years
                                   Gift tax returns (if any)
                                   Deeds to all real estate owned either jointly or individually
                                   Title to all automobiles and boats owned either jointly or individually
                                   Death Certificate
                                   Funeral Bill
                                   Brokerage statements for last full calendar year and current year to death
                                   Life insurance policies owned by decedent (whether or not on decedent's life)
                                   Last annual summary of death benefits paid by employer (decedent or spouse)
                                   Summary of retirement plan benefits owed by decedent's employer
                                   Summary of any other death benefits owed by decedent's employer
                                   Documents concerning any prior divorce or separation of decedent
                                   Documents concerning any armed services record of decedent
                                   Any will or trust of which decedent was a beneficiary
                                   Any will or trust of which decedent was a fiduciary
                                   Any contracts that decedent had entered into prior to decedent's death that have
                                   not been completed
                                   Any trust agreement created by the decedent




  Farr Law Firm                        Estate Administration Intake Form                                     Page 8
PART E. DECEDENT's FINANCIAL INFORMATION.

Please fill in, to the best of your knowledge and ability, the Asset and Liability Summary Tables and the attached
detailed Asset Schedules below. Whenever possible, the value of each asset in the Schedules should be stated as of
the date of death.

                           ESTATE ASSET & LIABILITY SUMMARY
                                                                                                           OWNED
                                                                                  OWNED                   JOINTLY
                                                          OWNED IN               SOLELY BY                 WITH
        DESCRIPTION OF ASSETS                              TRUST                 DECEDENT                ANOTHER*

        Virginia Real Estate (Sched. A)               $                      $                       $
        Real Estate not in VA. (Sched.A)              $                      $                       $
        Investments - Non-Retirement (Sched. B)       $                      $                       $
        Ordinary Bank Accounts (Sched. C)             $                      $                       $
        Life Insurance - Death Benefit (Sched. D)     $                      $                       $
        (Include Accidental Death Benefit)
        Tangible Personal Property (Sched. E)         $                      $                       $
        Business or Trust Property (Sched. F)         $                      $                       $
        Vested Retirement Assets (Sched. G)           $                      $                       $
        Vested Inheritances (Sched. H)                $                      $                       $
        Powers of Appointment (Sched. J)              $                      $                      $
        Other Property (Sched. K)                     $                      $                       $
                             ASSET TOTALS:            $                      $                      $


  *If an asset is owned jointly with another person, please list the value of the decedent's share of the asset. For
 example, if the decedent owned a parcel of real estate equally with 3 other people, and that parcel is worth $ 1 00,000,
 just list $25,000 --the decedent's 25% share. If the decedent owned an asset jointly with a spouse, just list the
 decedent's 50% interest..




  Farr Law Firm                            Estate Administration Intake Form                                 Page 9
Please fill in the below Liability Summary Table and attach all supporting documents.


                                                       LIABILITIES
                                                     OWED SOLELY BY                        JOINT
        DESCRIPTION OF LIABILITIES                     DECEDENT                         LIABILITIES
        Real Estate Loans - Primary Residence        $                            $
       Real Estate Loans - Other                     $                            $
        Vehicle Loans                                $                            $
       Personal Loans                                $                            $
        Business Loans                               $                            $
        Credit Card Balances                         $                            $
        Life Insurance Policy Loans                  $                            $
        Other Debts and Liabilities                  $                            $
                               LIABILITY TOTALS:     $                            $




  Farr Law Firm                        Estate Administration Intake Form                              Page 10
PART III. ASSET SCHEDULES.


Use these abbreviations to show how each asset is titled:     Use these abbreviations in connection with the value of each asset:
 T/E - Tenants by the entirety
       -
                                                                      -
 JT - Joint tenancy with right of survivorship
       -                                                      FMV     -     Fair market value (you may guess if you are not sure)
       -                                                              -
 TC - Tenancy in common                                       CV      -     Cash value
                                                                      -
  S - Decedent's sole name
       -                                                      PV      -     Proceeds of life insurance policy

                                              SCHEDULE A - REAL ESTATE

       Check this box if you do not own any real estate

  Primary personal residence:
   Street Address:                                                                                 Property Type
                                                                                            Single Family
   City/State/Zip:                                                                          Townhouse
                                                                                            Condo
   Fair Market Value:                         Mortgage Balance, if any:                                    Title
   $                                          $
                                                                                            T/E              JT            TC
                                                                                                      Sole

  Other real estate (attach separate sheet if necessary):
   Street Address:                                                                                  Property Type

   City/State/Zip:                                                                           Sgl. Family           Timeshare
                                                                                             Townhouse             Commercial
                                                                                             Condo                 Unimproved
   Fair Market Value:                         Mortgage Balance, if any:                                    Title
   $                                          $
                                                                                            T/E              JT            TC
                                                                                                     Sole


   Street Address:                                                                                  Property Type

   City/State/Zip:                                                                           Sgl. Family           Timeshare
                                                                                             Townhouse             Commercial
                                                                                             Condo                 Unimproved

   Fair Market Value:                        Mortgage Balance, if any:                                     Title
   $                                         $
                                                                                            T/E              JT            TC
                                                                                                     Sole




  Farr Law Firm                          Estate Administration Intake Form                                         Page 11
                             SCHEDULE B - NON-RETIREMENT INVESTMENT ACCOUNTS

Brokerage Accounts
 Name/Description                                                 How Title Held   Approximate value




Mutual Funds
 Name/Description                                                 How Title Held   Approximate value




Individual publicly traded stocks and corporate bonds
 Name/Description                                                 How Title Held   Approximate value




Individual Municipal bonds
 Name/Description                                                 How Title Held   Approximate value




Individual Long-term U.S. Treasury Notes and Bonds
 Name/Description                                                 How Title Held   Approximate value




   Farr Law Firm                     Estate Administration Intake Form                    Page 12
Certificates of deposit
 Name/Description                                                         How Title Held    Approximate value




Short-term U.S. obligations (T-bills)
 Name/Description                                                         How Title Held    Approximate value




                            SCHEDULE C - ORDINARY BANK ACCOUNTS AND CASH ON HAND

Checking accounts, including money market accounts
 Name/Description                                                         How Title Held    Approximate value




Savings accounts
 Name/Description                                                         flow Title Held   Approximate value




                                           SCHEDULE D - LIFE INSURANCE

Ordinary Life Insurance (Whole or Universal)
 Named Insured:
 Company:                                                Policy/Certificate No.:
 Policy Owner:
 Beneficiary Designation:
 Amount of Insurance:                                    Cash value:




  Farr Law Firm                         Estate Administration Intake Form                         Page 13
 Amount of additional accidental death benefits, if any:
 Loans against policy, if any:


 Named Insured:
 Company:                                                  Policy/Certificate No.:
 Policy Owner:
 Beneficiary Designation:
 Amount of Insurance:                                      Cash value:
 Amount of additional accidental death benefits, if any:
 Loans against policy, if any:

Term or Group Term Insurance

 Named Insured:
 Company:                                                  Policy/Certificate No.:
 Policy Owner:
 Beneficiary Designation:
 Amount of Insurance:
 Amount of additional accidental death benefits, if any:
 Loans against policy, if any:


 Named Insured:
 Company:                                                  Policy/Certificate No.:
 Policy Owner:
 Beneficiary Designation:
 Amount of Insurance:
 Amount of additional accidental death benefits, if any
 Loans against policy, if any:




   Farr Law Firm                        Estate Administration Intake Form            Page 14
Other life insurance or other insurance having life insurance features

 Named Insured:
 Company:                                                  Policy / Certificate No.:
 Policy Owner:
 Beneficiary Designation:
 Amount of Insurance:
 Amount of additional accidental death benefits, if any:
 Loans against policy, if any:

                      SCHEDULE E - TANGIBLE PERSONAL PROPERTY

Personal and household effects:
Automobiles

 Description                                                                 How Title Held   Approximate value




Valuable jewelry (indicate if insured)
 Description                                                                 Owned By         Approximate value




Valuable works of art (indicate if insured)
 Description                                                                 Owned By         Approximate value




Valuable antiques
 Description                                                                 Owned By         Approximate value




    Farr Law Firm                         Estate Administration Intake Form                           Page 15
Other valuable collections, e.g., coins, stamps, or gold

 Description                                                             Owned By           Approximate value




Other valuable tangible personal property that does not seem to be covered by any of the other categories

 Description                                                             Owned By           Approximate value




                                SCHEDULE F - BUSINESS/TRUST INTERESTS


 Description                                                             Owned By           Approximate value




   Farr Law Firm                       Estate Administration Intake Form                           Page 16
Interests in trusts
 Description                                                             Owned By           Approximate value




                           SCHEDULE G - PENSION/RETIREMENT PLANS
Pension & profit-sharing plans: IRAs, 401 (k) plans, TSPs, KEOUGHs, ESOPs or other tax-favored employee-benefit
plans that may be payable upon death in a lump sum.

 Description                                     Owner                Beneficiary           Approximate Vested
                                                                                            value




                             SCHEDULE H - ANTICIPATED INHERITANCES

 Description                                     Current Owner        Possible              Approximate
                                                                      Beneficiary           Amount




                               SCHEDULE J - POWERS OF APPOINTMENT

 Description                                     Who Gave Power       Who Has Power           Approximate
                                                                                              Amount




   Farr Law Firm                     Estate Administration Intake Form                              Page 17
                         SCHEDULE K - OTHER PROPERTY


Description                                              Owned By   Approximate value




                 SCHEDULE L - LIABILITIES (other than mortgages)

Description                                              Owned By   Approximate value




 Farr Law Firm             Estate Administration Intake Form              Page 18

				
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