STORMS & ALPAUGH, PLLC CERTIFIED PUBLIC ACCOUNTANTS P. O. Box Tower Blvd Suite 212 Victoria, Minnesota 55386

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1 December 18, STORMS & ALPAUGH, PLLC CERTIFIED PUBLIC ACCOUNTANTS P. O. Box Tower Blvd Suite 212 Victoria, Minnesota Phone (952) Fax (952) Serving Clients since 1972 Dear Client: Thank you for allowing us the opportunity to prepare your individual income tax return for. We have included a worksheet to help you gather the information necessary. Please complete the worksheet sections as appropriate and provide supporting documentation where necessary. Please provide us with the following additional information: A copy of your 2016 and 2015 tax returns, if not prepared by this office Forms W-2 (Wages) Form(s) 1099 for interest, dividends, etc. including year-end brokerage statements Schedule K-1 (income/loss from partnerships, S corporations, estates, trusts) Form 1098 (mortgage interest) and property tax statements Closing statements pertaining to real estate transactions Form 1095 IRS Health Care documents. All other supporting documents Any tax notices received from the IRS or other taxing authorities W-10 for child care providers. You can get it on our web site if you need one. As always, income tax returns will be prepared on a first come, first served basis, so the sooner we receive your information, the better the likelihood that we will be able to complete your tax return by April 17, Just a reminder, we have a policy of completing all individual returns by their due date if we receive the complete data no later than March 31, We greatly appreciate your cooperation and we look forward to the continuation of mutually beneficial relationship in the years ahead. We would like to thank those clients who have referred new clients to us. We do encourage our clients to refer us to their friends and associates and we will provide them with our usual timely and professional service. Your friend and accountant, Storms & Alpaugh, PLLC PAUL A. STORMS, CPA DAVID A. ALPAUGH, CPA BRAD R. STORMS, CPA, EA, MBA

2 YOUR NAME SOCIAL SECURITY # SPOUSE NAME ADDRESS STORMS & ALPAUGH, PLLC CERTIFIED PUBLIC ACCOUNTANTS P.O. BOX TOWER BLVD - SUITE 212 VICTORIA, MN TELEPHONE (952) / FAX (952) paul@stormsandalpaugh.com / dave@stormsandalpaugh.com brad@stormsandalpaugh.com Serving Clients Since 1972 OCCUPATION CITY STATE ZIP PHONE (HOME) INDIVIDUAL INCOME TAX QUESTIONNAIRE SOCIAL SECURITY # CELL PHONE OF BIRTH OCCUPATION OF BIRTH APT. FILING STATUS PHONE (WORK) SPOUSE CELL COUNTY SINGLE MARRIED UNMARRIED HEAD OF HOUSEHOLD WIDOW(ER) WITH DEP CHILD (YEAR SPOUSE DIED- ) DEPENDENTS NAME (FIRST, MIDDLE, LAST) BIRTH SOCIAL SECURITY # RELATIONSHIP LIVING WITH YOU (Y/N) MONTHS IF NOT 12 * - All W-2's for. NONCUSTODIAL DIVORCED PARENTS MUST HAVE EX-SPOUSE SIGN FORM 8332 OR HAVE A COPY OF YOUR PRE-1986 DIVORCE DECREE TO CLAIM YOUR CHILD AS A DEPENDENT INFORMATION TO PROVIDE * - All Investment 1099's for. You may not receive until mid Feburary. * - All other 1099's received for. * - K-1's or any other tax documents received for. * - We will need your 2018 Minnesota property tax statement or rent credit form to complete your property tax refund. * - Closing statements pertaining to real estate transactions. Office Use

3 Income Tax Return Annual Engagement Letter We appreciate the opportunity to work with you. To minimize the possibility of a misunderstanding between us, we are setting forth pertinent information about the services we will perform for you. We will prepare your Federal and State income tax returns. We will depend on you to provide the information we need to prepare complete and accurate returns. We will not audit or otherwise verify the data you submit although we may ask you to clarify some of the information. We have furnished you with a questionnaire to help you gather and organize the necessary information. All work in conjunction with your tax filings will be performed by employees of Storms & Alpaugh, PLLC. We will perform accounting services only as needed to prepare your tax returns. Our work will not include procedures to find defalcations or other irregularities. Accordingly, our engagement should not be relied upon to disclose errors, fraud, or other illegal acts, though it may be necessary for you to clarify some of the information you submit. We will, of course, inform you of any material errors, fraud, or other illegal acts we discover. The law imposes penalties when taxpayers underestimate their tax liability. Please call us if you have concerns about such penalties. We will use our judgment to resolve questions in your favor where a tax law is unclear, if there is a reasonable justification for doing so. Whenever we are aware that a possibly applicable tax law is unclear, or that there are conflicting interpretations of the law by authorities (e.g., tax agencies and courts), we will explain the possible positions that may be taken on your return. We will follow whatever position you request, so long as it is consistent with the codes and regulations and interpretations that have been promulgated. If the IRS should later contest the position taken, there may be an assessment of additional tax plus interest and penalties. We assume no liability for any such additional penalties or assessments. We are responsible for preparing only the returns listed above. If there are additional returns you wish us to prepare, such as sales tax, property tax, inheritance, gift or estate tax, other income tax returns for other entities, or other states= or cities= tax returns, please notify our office. Our fee does not include responding to inquires of examination by taxing authorities. However, we are available to represent you and our fees for such services at our standard rates, and would be covered under a separate engagement letter. It is your responsibility to maintain, in your records, the documentation necessary to support the data used in preparing your tax returns. If you have any questions as to the type of records required, please ask us for advice in that regard. It is also your responsibility to carefully examine and approve your completed tax returns before signing and mailing them to the tax authorities. We are not responsible for the disallowance of doubtful deductions or inadequately support documentation; nor for resulting taxes, penalties and interest. It is our firm=s policy to retain electronic copies of your tax returns and our work papers for seven years, after which they will be destroyed. We must receive all information to prepare your return by March 31, 2018, to ensure that your return will be completed by April 17, If we have not received all of your information by March 31, 2018 and your return is not completed by April 17, 2018 you may be subject to late filing or late payment penalties. We do not file tax extensions for clients unless specifically requested, in writing or by fax/ to do so. Fee for our services will be at our standard rates, plus computer charges and out-of-pocket expenses. Payment for service is due when rendered and interim billings may be submitted as work progresses and expenses are incurred. If the above fairly sets forth your understanding, please sign the enclosed copy of this letter and return it to us. If you do not sign and return this agreement to us; we will assume that you concur with the same if data is supplied to compile your tax return. We are pleased to have you as a client and look forward to a long and mutually satisfying relationship. Sincerely, Storms & Alpaugh, PLLC Certified Public Accountants January 4, 2018 Accepted: Sign & Date

4 MISCELLANEOUS QUESTIONS If any of the following items pertain to you or your spouse for the year, please check the appropriate box and include all pertinent details. Attach additional schedules if necessary. YES NO PERSONAL INFORMATION G G Did your marital status change during the year? G G Did your residence change during the year? G G Could you be claimed as a dependent on another person s tax return for? HEALTH CARE COVERAGE G G Did you and your dependents have healthcare coverage for the full year? G G Were you offered health insurance by your employer but declined? G G Did you receive any of the following IRS Documents: (Please bring in) G Form 1095-A (Health Insurance Marketplace Statement) G Form 1095-B (Health Coverage) G Form 1095-C (Employer Provided Health Insurance Offer and Coverage) DEPENDENTS G G Were there any changes in dependents? G G Were any of your unmarried children who might be claimed as dependents 19 years of age or older at the end of? G G Did you have any children under age 19 or full time student under age 24 at the end of, with interest and dividend income in excess of $1,050, or total investment income in excess of $2,100? INCOME G G Did you receive unreported tip income of $20 or more in any month? G G Did you cash any Series EE U.S. savings bonds issued after 1989 and pay qualified higher education expense for yourself, your spouse, or your dependents? G G Did you receive any disability income? G G Did you have any foreign income or pay any foreign taxes? RETIREMENT PLANS G G Did you receive a distribution from a retirement plan (401(k), IRA, SEP, SIMPLE, etc.)? G G Did you make a contribution to a retirement plan (401(k), IRA, SEP, SIMPLE, Qualified Plan, etc.)? G G Did you transfer or rollover any amount from one retirement plan to another retirement plan? G G Did you convert part or all of your traditional, SEP, or SIMPLE IRA to a Roth IRA in? EDUCATION G G Did you receive a distribution from a Education Savings Account or a Qualified Tuition Program? G G Did you, your spouse, or a dependent incur any tuition expenses that are required to attend a college, university, or vocational school? G G Did you make a contribution to an education 529 plan in? If so, how much $

5 YES NO PURCHASES, SALES AND DEBT G G Did you start a business or farm, purchase rental or royalty property, or acquire an interest in partnership, S corporation, trust or REMIC? G G Did you purchase or dispose of any business asset (furniture, equipment, vehicles, real estate, etc.), or convert any personal assets to business use? G G Did you buy or sell any stocks, bonds, or other investment property in? G G Did you purchase, sell, or refinance your principal home or second home, or did you take a home equity loan? G G Did you purchase any residential energy-effcient improvements or purchases involving solar, wind, geothermal or fuel cell energy sources? G G Did you have any debts canceled or forgiven? G G Does anyone owe you money which has become uncollectible? DEDUCTIONS INFORMATION G G Did you incur a loss because of damaged or stolen property? G G Did you work out of town for part of the year? G G Did you use your car on the job (other than to and from work)? G G Do you have a Health Savings Account (HSA) or Medical Savings Account (MSA)? If yes, provide for Plan Type: Single or Family (circle)? Contributions $ Qualified Withdrawals $ ESTIMATED TAXES G G Did you apply an overpayment of 2016 taxes to your estimated tax (instead of being refunded)? G G If you have an overpayment of taxes, do you want the excess applied to your 2018 estimated tax (instead of being refunded)? G G Do you expect your 2018 taxable income and withholdings to be different from? If yes explain any differences in income, deductions, dependents, etc.: MISCELLANEOUS G G Do you want to allocate $3 to the Presidential Election Campaign Fund? G G Does your spouse want to allocate $3 to the Presidential Election Campaign Fund? G G Was your home rented out or used for business? G G Did you have an interest in or signature or other authority over a financial account in a foreign country, such as a bank account, securities account, or other financial account? G G Did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? G G May the IRS discuss this return with the preparer? G G Did you incur moving expenses due to a change of employment? G G Did you engage the services of any household employees? G G Were you notified or audited by either the Internal Revenue Service or the State taxing agency? G G Did you or your spouse make any gift to an individual that total more than $14,000, or gift to a trust? G G Did your bank account information change within the last twelve months? If you would like your refunds directly deposited into your bank account then complete the following: Bank Name: ( Checking or Savings ) circle Routing Number: Account Number: How would you like your copy of the tax return? Paper Copy or Digital Copy

6 INTEREST AND DIVIDEND INCOME INTEREST INCOME TO* FROM AMOUNT IF NO 1099 DIVIDEND INCOME TO* FROM AMOUNT IF NO 1099 *USE (H) FOR HUSBAND, (W) FOR WIFE, OR (J) FOR JOINT PROVIDE SS# & ADDRESS IF SELLER-FINANCED MORTGAGE OTHER INCOME ITEM TAXPAYER SPOUSE TAX EXEMPT INTEREST RECEIVED SOCIAL SECURITY BENEFITS RECEIVED (ATTACH SSA-1099) UNEMPLOYMENT BENEFITS RECEIVED ALIMONY RECEIVED IRA DISTRIBUTION RECEIVED (TRADITIONAL OR ROTH) 401(K) DISTRIBUTIONS PENSION RECEIVED: TAXABLE NON-TAXABLE DISABILITY INCOME RECEIVED BARTERING INCOME RECEIVED INCOME TAX REFUNDS RECEIVED THIS YEAR: FEDERAL STATE CAPITAL GAINS & LOSSES (FILL IN IF NO 1099) DESCRIPTION ACQUIRED SOLD SALE PRICE COST ALL 1099-B FORMS MUST ACCOMPANY THIS QUESTIONNAIRE

7 INSTALLMENT SALE DESCRIPTION ACQUIRED SOLD GROSS PROFIT RATIO PRINCIPAL PAYMENTS RECEIVED CURRENT YEAR PRIOR YEARS COST ALL 1099-B FORMS MUST ACCOMPANY THIS QUESTIONNAIRE RETIREMENT PLAN CONTRIBUTIONS IF YOU AND YOUR SPOUSE HAVE AN IRA OR SEP RETIREMENT PLAN, LIST THE AND AMOUNT OF YOUR CONTRIBUTION FOR. ITEM TAXPAYER AMOUNT SPOUSE AMOUNT IRA - TRADITIONAL IRA - ROTH SEP IF THE AMOUNT LISTED IS NOT THE MAXIMUM, DO YOU WANT TO CONTRIBUTE THE MAXIMUM? YES NO YES NO ARE YOU COVERED UNDER A RETIREMENT PLAN WITH YOUR EMPLOYER? YES NO YES NO EDUCATION EXPENSES K-12 IS FOR MN AND COLLEGE IS FOR FEDERAL. PLEASE BRING 1098-T FOR COLLEGE TUITION. STUDENT NAME TYPE OF EXPENSE K-12 (TUITION, SUPPLIES, TRANSPORTATION, OUTSIDE EDUCATION, BOOKS, MUSIC LESSONS) ORGANIZATION OR INSTRUCTOR FOR OUTSIDE CLASS GRADE OR YEAR OF COLLEGE AMOUNT PAID THIS YEAR COLLEGE (1098-t TUITION STATEMENT AND, BOOKS) ESTIMATED TAX PAYMENTS MADE PERIOD 4TH QUARTER ST QUARTER 2ND QUARTER 3RD QUARTER 4TH QUARTER 2016 TAX DUE PAID IN FEDERAL PAID CK # AMOUNT MINNESOTA PAID CK # AMOUNT

8 ITEMIZED DEDUCTIONS M EDICAL EXPENSE (OUT OF POCKET ONLY) MEDICAL/DENTAL INS PREMIUMS: PAID OUT OF POCKET - NOT THROUGH PAYROLL DEDUCTION INTEREST HOME MORTGAGE (ATTACH FORM 1098) ND LONG-TERM CARE PREMIUM HOME MORTGAGE 2 (ATTACH FORM 1098) INSURANCE COMPANY (LT CARE ONLY) VAC HOME MORTGAGE (ATTACH FORM 1098) POLICY NUMBER(S) (LT CARE ONLY) OTHER SELLER FINANCED: ( AMOUNT ) PRESCRIPTIONS (NOT OVER THE COUNTER) NAME SS# DOCTORS, DENTISTS, CHIROPRACTORS ADDRESS HOSPITALS NURSING HOME CARE HOME EQUITY LOAN POINTS (ATTACH CLOSING PAPERS) GLASSES, CONTACTS, EXAMS PRESCRIBED MEDICAL ATTIRE INVESTMENT INTEREST MORTGAGE INSURANCE PREMIUM OTHER MEDICAL: STUDENT LOAN INTEREST PAID TOTAL OF STUDENT LOAN PAYMENTS INTEREST PAID ON STUDENT LOANS PARKING MEDICAL AUTO 17 AMOUNT OF ABOVE EXPENSES THAT W ERE REIMBURSED TO YOU CASH CONTRIBUTIONS **No deduction allowed for cash or check contributions unless donor maintains a bank record, or written communication from donee. (Name, date and amount). Donee acknowledgment required for donations $250 or more. TAXES STATE INCOME TAX PAID (OTHER THAN BY W 2) CHURCHES, SCHOOLS, HOSPITALS VETERANS ORG. FRATERNAL SOCIETIES OTHER REAL ESTATE TAX: LIST OVER $3,000 HOME SECOND HOME VOLUNTEER W ORK 14 OTHER VEHICLE LICENSES (NO. OF VEHICLES ) NON-CASH CONTRIBUTION TAX PREPARATION FEES M ISCELLANEOUS DEDUCTIONS **No deduction is allowed for contributions of clothing and household items that are not in good used condition or better. Detail is required if total is over $500. ORGANIZATION, ITEM, & VALUE EDUCATOR EXPENSE IRA/PENSION PLAN FEES INVESTMENT EXPENSES (PUBL, SUPP, ETC.) FINANCIAL ADVISOR FEES SAFE DEPOSIT BOX ALIMONY PAID

9 EMPLOYEE BUSINESS EXPENSES - RELATED TO W-2 EMPLOYMENT ITEM AMOUNT ITEM AMOUNT MEALS AND ENTERTAINMENT: UNION DUES MEAL AND ENTERTAINMENT EXPENSE PROFESSIONAL DUES & LICENSES REIMBURSEMENT NOT INCLUDED ON W -2 OR 1099 OTHER THAN MEALS AND ENTERTAINMENT: SMALL TOOLS UNIFORM & MAINTENANCE LOCAL TRANSPORTATION (BUS, TAXI, TRAIN, ETC.) PROFESSIONAL & TRADE PUBLICATIONS TRAVEL EXPENSE W HILE AW AY FROM HOME OVERNIGHT TELEPHONE OTHER BUSINESS EXPENSES MALPRACTICE INSURANCE SAFETY EQUIPMENT JOB RELATED EDUCATION REIMBURSEMENT NOT INCLUDED ON FORM W -2 OR FORM 1099 JOB HUNTING (MILEAGE, SUPPLIES, FEES) VEHICLE EXPENSE - USED FOR BUSINESS, W-2 OR SELF-EMPLOYMENT ITEM VEHICLE 1 VEHICLE 2 VEHICLE 3 MAKE, MODEL AND YEAR OF VEHICLE PLACED IN SERVICE TOTAL MILEAGE FOR YEAR BUSINESS MILEAGE FOR YEAR AVERAGE DAILY ROUND-TRIP COMMUTE TOTAL COMMUTING MILEAGE PARKING FEES AND TOLLS GASOLINE, LUBE, OIL REPAIRS TIRES INSURANCE MISCELLANEOUS AUTO LICENSES INTEREST (CAR LOAN) VEHICLE RENTALS QUESTIONS RELATED TO BUSINESS USE OF AUTO YES NO DO YOU (OR YOUR SPOUSE) HAVE ANOTHER VEHICLE AVAILABLE FOR PERSONAL USE? IF YOUR EMPLOYER PROVIDES YOU WITH A VEHICLE, IS PERSONAL USE DURING OFF DUTY HOURS PERMITTED? DO YOU HAVE EVIDENCE TO SUPPORT YOUR DEDUCTION? IS EVIDENCE WRITTEN?

10 PROFIT OR LOSS FROM BUSINESS BUSINESS NAME H/W/J ( ) FED. I D # PRINCIPAL BUSINESS OR PROFESSION PRINCIPAL BUSINESS CODE BUSINESS ADDRESS CITY STATE ZIP ACCOUNTING METHOD:CASH ACCRUAL OTHER DEDUCTION FOR HOME OFFICE? YES/NO WAS BUSINESS IN OPERATION AT END OF? YES/NO NUMBER OF MONTHS IN BUSINESS INCOME AND COST OF SALES DEDUCTIONS INCOME: GROSS SALES RETURNS & ALLOWANCES OTHER INCOME ADVERTISING BAD DEBTS FROM SALES OR SERVICES BANK CHARGES CAR & TRUCK EXPENSE COMMISSIONS COST OF SALES: BEGINNING INVENTORY PURCHASES LESS: PERSONAL USE COST OF LABOR MATERIAL & SUPPLIES CONTRACT LABOR DELIVERY & FREIGHT DUES & PUBLICATIONS EMPLOYEE BENEFIT PROGRAM INSURANCE (OTHER THAN HEALTH) INTEREST: FINANCIAL INSTITUTION OTHER COSTS OTHER ENDING INVENTORY LAUNDRY & CLEANING LEGAL & ACCOUNTING BUSINESS USE AREA TOTAL AREA BUSINESS USE OF HOME MISCELLANEOUS OFFICE SUPPLIES & POSTAGE PENSION & PROFIT SHARING RENT: MACHINERY & EQUIPMENT INSURANCE OTHER BUSINESS PROPERTY MISCELLANEOUS RENT REPAIRS & MAINTENANCE UTILITIES REPAIRS SUPPLIES SMALL TOOLS TAXES TELEPHONE TRAVEL MEALS & ENTERTAINMENT QUALIFIED DOMESTIC PRODUCTION DOMESTIC PRODUCTION GROSS RECEIPTS UTILITIES WAGES ALLOCABLE COST OF GOODS SOLD DIRECTLY ALLOCABLE DEDUCTIONS INDIRECTLY ALLOCABLE DEDUCTIONS

11 RENTAL INCOME PROPERTY KIND LOCATION PROPERTY A PROPERTY B PROPERTY C PROPERTY D PERCENT OWNED PERCENT TENANT OCCUPIED ITEM PROPERTY A PROPERTY B PROPERTY C PROPERTY D INCOME: RENT RECEIVED ROYALTIES RECEIVED EXPENSES: ADVERTISING ASSOCIATION DUES AUTO & TRAVEL CLEANING & MAINTENANCE COMMISSION INSURANCE LEGAL & ACCOUNTING LICENSE & PERMITS MANAGEMENT FEE INTEREST: FINANCIAL INSTITUTION OTHER REPAIRS SUPPLIES TAXES TELEPHONE UTILITIES WAGES & SALARIES DID YOU MATERIALLY PARTICIPATE YES NO YES NO YES NO YES NO

12 ADDITIONS TO FIXED ASSETS ASSET DESCRIPTION ACQUIRED COST OR BOOT PRIOR DEPR. ASSET TRADED INCOME (LOSS) FROM PARTNERSHIPS, S CORPORATIONS, ESTATES & TRUSTS NAME FEDERAL I D # K-1 PROVIDED (CHECK) G G G G MATERIALLY PARTICIPATE (Y/N) QUALIFIED ADOPTION EXPENSE NAME IDENTIFICATION # BIRTH FOREIGN ADDOPTION (Y/N) FINALIZED PAID 2016 PAID CHILD CARE EXPENSE PROVIDER INFORMATION (SEE OUR WEBSITE IF W -10 IS NEEDED) PROVIDER NAME ADDRESS IDENTIFICATION NUMBER (SS # OR EI#) AMOUNT PAID THIS YEAR AMOUNT PAID PER CHILD CHILD NAME AMOUNT CHILD NAME AMOUNT

13 FARM INCOME AND EXPENSE FARM NAME H/W/J ( ) FED. I D # PRINCIPAL PRODUCT PRINCIPAL AG. ACTIVITY CODE FARM ADDRESS CITY STATE ZIP FARM INCOME FARM EXPENSES SALE OF LIVESTOCK BOUGHT FOR RESALE AUTO AND % LESS: COST OR BASIS OF LIVESTOCK TOTAL MILES SALE OF LIVESTOCK RAISED FARM MILES DAIRY PRODUCTS SOYBEANS CORN OTHER GRAIN HAY & STRAW OTHER PRODUCTS TOTAL COOPERATIVE DISTRIBUTION CHEMICALS CONSERVATION EXPENSE CUSTOM HIRE (MACHINE WORK) FEED PURCHASED FERTILIZER AND LIME FREIGHT AND TRUCKING GASOLINE, FUEL, AND OIL TAXABLE COOPERATIVE DISTRIBUTION % TOTAL AGRICULTURAL PROGRAM PAYMENT INTEREST: FINANCIAL INSTITUTION TAXABLE AGRICULTURAL PROGRAM PYMT. OTHER C C C LOANS REPORTED UNDER ELECTION C C C LOANS FORFEITED OR PAID LABOR HIRED RENT OR LEASE: MACHINERY & EQUIP. TOTAL CROP INSURANCE PROCEEDS OTHER (LAND, ETC) TAXABLE CROP INSURANCE PROCEEDS CUSTOM HIRE (MACHINE WORK) INCOME FEDERAL GAS TAX CREDIT STATE GAS TAX CREDIT OR REFUND REPAIRS AND MAINTENANCE SEEDS AND PLANTS STORAGE AND WAREHOUSING SUPPLIES PURCHASED % % QUALIFIED DOMESTIC PRODUCTION: VETERNARY BREEDING AND MEDICINE DOMESTIC PRODUCTION GROSS RECEIPTS ALLOCABLE COST OF GOODS SOLD DIRECTLY ALLOCABLE DEDUCTIONS INDIRECTLY ALLOCABLE DEDUCTIONS GALLONS OF GASOLINE OR DIESEL (SPECIFY) PURCHASED FOR FARM USE SALE OF LIVESTOCK USED FOR DAIRY OR BREEDING PURPOSE DESCRIPTION SOLD ACQUIRED AMOUNT RECEIVED COST OF BASIS Farm Questionaire.wpd

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