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JOHN R. ROBINSON
Plaintiff
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: CIVIL ACTION - LAW
v,
MARGARET L, ROBINSON
Defendant
: NO, 96-3312 CIVIL TERM
: IN DIVORCE
MARITAL SETTI,EMENT AGREEMENT
AGREEMENT, rnade this '2 r<< day of March, 1997, between MARGARET L.
ROBINSON (hereinafter called "Wife") and JOHN R. ROBINSON (hereinafter called
"Husband").
WITNESSETH:
The parties hereto were previously Wife and Husband, having been married on
December 28, 1975, There were no children born of this marriage;
Pursuant to an Order of the Honorable Kevin A. Hess, dated October 16th, 1996
bifurcating the above-captloned Divorce action, the parties' marriage was terminated by a
Decree in Divorce dated October 23, 1996 (a copy of the Divorce Decree is allached hereto as
Exhibit" A");
The parties hereto desire to sellle fuily and finally their respective financial and
property rights and obligations as between each other, including without limitation:
(1) the settling of all mailers between them relating to the ownership of real and personal
property; and (2) the sellling of all mailers between them relating to the past, present and
future support and/or maintenance of Wife by Husband and of Husband by Wife,
NOW THEREFORE, in consideration of the premises and of the mutual promises,
covenants and undertakings hereinafter set forth and for other good and valuable
consideration, receipt of which Is hereby acknowledged by each of the parties hereto, Wife
and Husband, each Intendins to be legally bound hereby, covenant and agree as follows:
I, ADVICE OF COUNSEL
The provisions of this Agreement and their legal effect have been fully explained to the
parties by their respective counsel, Taylor P. Andrews, Esquire, for Wife, and James M,
Bach, Esquire, for Husband, Each party acknowledges that she or he has received
independent legal advice from counsel of her or his selection and that each fully understands
the facts and has been fully informed as to her or his legal rights and obligations and each
party acknowledges and accepts that this Agreement is, in the circurnstances, fair and equitable
and that it is being entered into freely and voluJltarily, after having received such advice and
with such knowledge and that execution of this Agreement is not the result of any duress or
undue influence and that it is not the result of any collusion or improper or l1Iegal agreement
or agreements,
2. PERSONAL PROPERTY
Wife and Husband do hereby acknowledge they have heretofore divided the rnarital
property, including, but without limitation, jewelry, clothes, furniture and other personalty,
and hereafter, Wife agrees that all of the property in the possession of Husband shall be the
sole and separate property of Husband; and, Husband agrees that all property in the possession
2
of Wife shall be the sole and separate propeny of Wife, Each of the parties does hereby
specifically waive, release, renounce and forever abandon whatever claims, if any, she or he
rnay have with respect to any of the above items which are the sole and ~eparate property of
the other.
3, REAL PROPERTY
All marital real property has been sold since the date of separation, Husband assurned
personal responsibility for the marital mortgage debt and Husband thereafter discharged the
debt in a bankruptcy proceeding. There is now, therefore, no claim asserted by either party
against the other for any ponion of marital real estate or for any responsibility or contribution
towards any marital real estate debt.
4, ALIMONY
Husband was ordered on October 10, 1996 to pay Wife alimony pendente lite at the
rate of $8SS.00 per month effective September 3, 1996, This Order was upheld after
Husband's appeal and a court hearing by an Order of the Honorable Kevin A, Hess, dated
December 30, 1996, (A copy of these Orders are attached hereto as Exhibits "B" and "C"
respectfully.)
The parties hereto agree that Husband shall pay Wife alimony In an amount equal to
the existing Order for alimony pendente lite, and that such alimony award shall be payable
through August 31, 1997, The amount and the duration of the alimony shall not be subject to
modification upon petition of either pany, The alimony shall terminate upon the death or
3
remarriage of Margaret L, Robinson or upon the death of John R. Robinson or on Augu~t 31,
1997, whichever event shall first occur, The parties agree to sign whatever slipulatlon shall be
necessary for an appropriate Court Order to be entered representing this alimony obligation.
5, LIABILITIES
Each party represents that they have not contracted any debt or liability for the other
for which the estate of the other party may be responsible or liable, and that except only for
the rights arising out of this Agreement, neither party will hereafter incur any liability
whatsoever for which the other party or the estate of the other party, wl1l be liable. Each
party agrees to indemnify or hold the other party harmless from and against all future
obligations of every kind Incurred by thern, Including those for necessities,
6, OTHER DOCUMENTATION
Wife and Husband covenant and agree that they will forthwith (and within at least
fifteen days after demand therefor) execute any and all written instruments, assignments,
releases, satisfactions, deeds, notes or such other writings as may be necessary or desirable for
the pro~r effectuation of this Agreement, and as their respective counsel shall mutually agree
should be so executed in order to carry out fully and effectually the terms of this Agreement.
7, ENTIRE AGREEMENT
Wife and Husband do hereby covenant and warrant that this Agreement contains all of
the representations, promises and agreements made by either of thern to the other for the
4
purposes set forth in the preamble hereinabove; that there are no claims, promises or
representations not herein contained, either oral or wriuen, which shall or rnay be charged or
enforced or enforceable unless reduced to writing and signed by both of the parties hereto; and
the waiver of any term, condition, clause or provision of this Agreement shnllln no way be
deemed to be considered a waiver of any other term, condition, clause or provision of this
Agreement.
8. BINDING EFFECT OF AGREEMENT
This Agreement shall remain in full force and effect unless and until terminated
pursuant to the terms of this Agreernent, The failure of either party to insist upon strict
performance of any of the provisions of this Agreement shall not be construed as a waiver of
any subsequent default of the same or similar nature,
9. SEPARABILITY
If any term, condition, clause or provision of this Agreement shall be determined or
declared to be void or invalid in law, or otherwise, then only that term, condition, clause or
provision shall be stricken from this Agreement and in all other respects this Agreement shall
be valid and continue in full force, effect and operation. Likewise, the failure of any party to
meet her or his obligations under anyone or rnore of the paragraphs herein, with the exception
of the satisfaction of the conditions precedent, shall in no way avoid or alter the remaining
obligations of the parties,
5
ANDREWS & JOHNSON
Attorneys at Law
78 West Pomfret Street
Carlisle, PA 17013
TAYLOR P. ANDREWS
RONALD E. JOHNSON
Telephone (717) 243-0123
Telefax (717) 243-0061
March 25, 1997
E, Robert Elicker II, Esquire, Dlvorc" Masler
9 North Hanover Street
Carlisle, PA 17013
RE: Robinson v, Robinson
No, 96-3312
Dear Bob:
I enclose a copy of Marital Selllemenl Agreement which has been signed by both parties and which
I have filed at record in the Prothonotary's Office.
You will see that this A8reement resolves all claims of the parties with the only continuing
obligation to be an award for alimony which Is to be entered In favor of Margaret L, Robinson which is
to be paid through August 31, 1997.
I look for your guidance as 10 whether you will make a recommendation for this alimony award
pursuant to the Agreement, Need I file anylhing further 10 have this mailer removed from your office?
I am more than happy 10 follow your recommendations In this regard,
HNSON
/'
,Taylor p, Andrews
TPA:rc
Enclosure
cc: James M, Bach, Esq,
JOHN R. ROBINSON,
Plaintiff
I
tN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
.
.
I
I CIVIL ACTION - LAW
VB.
MARGARET L. ROBINSON,
Defendant
NO.
3312
CIVIL
19 96
IN DIVORCE
STATUS SHEET
DATE:
ACTIVITIES:
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OFFICE OF DIVORCE MASTEH
CUMBERLAND COUNTY
COURT OF COMMON PLEAS
9 North Hanover Street
Carlisle, PA 17013
(717) 240-6535
.. Robert _licker, II
Divorce Masler
Tracl .10 Colver
Office MlIlagerlAeporter
We.. Shore
697-0371 Ex!, 6535
September 10, 1996
James M. Bach, Esquire
352 South Sporting Hill Road
lfeohanicsburg, PA 17055
Taylor P. Andrews, Esquire
ANDREWS & JOHNSON
76 West Pomfret street
Carlisle, PA 17013
RE: John R. Robinson vs. Margaret L. Robinson
No. 96 - 3312 Civil
In Divorce
Dear Mr. Bach and Mr. Andrews:
By order of Court of President Judge Harold E. Sheely
dated August 30, 1996, the fUll-time Master has been appointed
in the above referenced divorce proceedings.
A divorce complaint was filed on June 13, 1996, raising
grounds for divorce of irretrievable breakdown of the marriage.
Attached to the complaint was an affidavit under Section 3301(d)
of the Domestic Relations Code averring that the parties
separated on March 5, 1990, a period of at least two years.
On August 7, 1996, an answer and counterclaim were filed
in response to the complaint. The counterclaim raised the
eoonomic claims of equitable distribution, alimony, alimony
pendente lite, and counsel fees and expenses.
A petition to bifurcate was filed on behalf of the
Plaintiff on August 20, 1996, and has been scheduled for a
hearing before JUdge Hess on October 10, 1996, at 9:00 a.m. The
petition for bifurcation avers that the parties separated on or
about May 1991, a period in excess of two years,
I am not aware that there is an issue with regard to the
obtaining of a divorce under Section JJ01(d) of the Domestic
Relations Code although the parties may have some disagreement
as to the date of separation.
OFFICE OF DIVORCE MASTER
CUMBERLAND COUNTY
COURT OF COMMON PLEAS
9 North Hanover Streel
Carlisle, PA 17013
(717) 240.6535
.. Robert .lIcker. II
Dlvorca Millar
Tracl .10 Col~er
OIflca ManagariR.portar
We.' Shore
697.0371 Ext, 6535
September 13, 1996
Jamea M. Bach, Esquire
352 South Sporting Hill Road
Mechanicsburg, PA 17055
Taylor P. Andrews, Esquire
JOHNSON & ANDREWS
78 West Pomfret Street
Carlisle, PA 17013
RE: John R. Robinson vs. Margaret L. Robinson
No. 96 - 3312 Civil
In Divorce
Dear Mr. Bach and Mr. Andrews:
I am writing in response to Mr. Andrews' letter of
September 11, 1996, requesting that the directive to file
pre-trial statements be withdrawn since discovery has not been
completed. Apparently there are outstanding interrogatories;
therefore, I am going to withdraw the directive to file
pre-trial statements until the interrogatories have been
answered. I request that counsel immediately notify me when the
interrogatory answers have been completed, at which time I will
issue a new directive for the filing of pre-trial statements.
As previously noted, a hearing on the request for
bifurcation is scheduled before JUdge Hess on October 10, 1996,
and apparently there is a claim raised for alimony pendente lite
which has not yet been resolved.
Very truly yours,
E. Robert Elicker, II
Divorce Master
JOHN R. ROBINSON,
Plaintiff
VS.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. 96 - 3312
IN DIVORCE
MARGARET L. ROBINSON,
Defendant
RESCHEDULED PRE-HEARING CONFERENCE
TO: James M. Bach
, Counsel for Plaintiff
Taylor P. Andrews
, Counsel for Defendant
A pre-hearing conference has been scheduled at the
Office of the Divorce Master, 9 North Hanover Street, Carlisle,
Pennsylvania, on the 3rd day of March, 1997, at 9:30 a.m., at
which time we will review the pre-trial statements previously
filed by counsel, define issues, identify witnesses, explore the
possibility of settlement and, if necessary, schedule a hearing.
Very truly yours,
Date of Notice: 12/6/96
E. Robert Elicker, II
Divorce Master
ANDREWS & JOHNSON
Attorneys ut Law
78 West Pomfret Streel
Carlisle, PA 17013
TAYLOR p, ANDREWS
RONALD E. JOHNSON
Telephone (717) 243-0123
Telefu (717) 243-0061
October 14,
E, Robert Elicker II, Esquire, Divorce Masler
9 Nonh Hanover Slreet
Carlisle, PA t7013
RE: Robinson v, Robinson
No. 96.3312
Dear MaSler Elicker:
I reviewed Mr. Robinson's Answers to Interrogatories within two hours of their receipt. Atthls
time, I can not concur with Mr. Bach's certification lhat discovery Is closed, I have sousht clarification
of answers provided by Mr, Robinson from Attorney Bach, Only when this clarification Is resolved wlll
I be prepared to certify that no more discovery Is necessary,
Sincerely yours,
TPA:ss
cc: James M. Bach, ~sq.
Margaret L, Robinson
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i 10451,10 13183.11
I J 1oo1,lleou,lty "ifill 4 locl,1 HOUt'" ,.. "'"hhtkl
: 804S1,SO 374S,43
,
: I Medic.,. P'ftt.I! Irtd lip. I Medlo"l ,.. "1t~"'hI
: ID4~8.GO 818.15
i . 06i'nbol &''1'1'" &B~oo Corp, AEoo'l'I.,.. UN '2W
I 0 EMploy.,'. nl.l, .dd,..,. and tiP code
: GENESYS INFORMATION
SYSTEMS CORPORATION
4 NORTH PARK SUITE 400
HUNT VALLEY MD 21030
. AdvIflCI Ele pay"",,1
11 ,: ..... II pi...
P lB1I,"
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I JOHN R. ROBINSON
I 437 NORMA RD,
: AMBLER PA 19002
1__.
)1'--"11'1:1I111 .,."t.I,1
PA 2.1 61611
1 '11"',k1CCMMII.
, 1692,10
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10 Dependenl Gill btnefn,
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14 at"',
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60456.10
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21 Dee _...
j t..' EMPLOY~E W.2 WAGE SUMMARY 1~94
! " b0I2~3hll .
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i ' blUiltllAtt cllll'.
i ' ~ a BOX 320909 ,
'.' l'ADYIOEilcEl Rlb2909
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r. PAYROLLS BY MCHIX' 94354
For 19U.; you have no payroll adjusiNenis whlth aff.tied your F.deral
W'9'S (BOK II or silt. wlg.s. Th.r.for.. th. WIUIS on your ftn.' 1994
th.tk statlllnt should b. ihe .... .s ih. w.g.s reporied on your W.2
slatlllnt.
$
5
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'-. ."
.Form W-2 Wig. Ind TI. Stlt'mlnt 1994
o I -3178 0033-000100
Copy c, '0' -.play..., '..0,4,
.. .
................1....."'-
004-40-3506
.....
RISDI
I.... . I"', ~ II
lMI HI. 1'.II-cm1
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GLENNCRAFT CORP,
POBOX 320909
PROVIDENCE RI 02909
- "
..
III
,.."1111'
050397125
'II. _'II", I,.. .Ie.
7666,17
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219.00
1M: ly...
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700 .17 001.113
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766 ,17 111.17
'tall, PI PI
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99,04
. ,,". ..... ....
MARGARET L, ROBINSON
37 WINE STREET #2
EAST GREENWICH RI 02016
TNI~",*""~IaNHIrnII"",""",,,*,
.
~at Inco"" t~. WilllhhiTd-
75,72
1odaI"",1ty wat" ,. loolal HCUIMy' ta. w"htt.kI
~ 6U'-
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tOl2,50 14,66
Dtpl ~"'lvrtfUllon"
S U J , 1~
. IMpIoyfl', ....., ......., INMI ZIP coca.
CAPITAL VIDEO
ONE METRO PARK
CRANSTON RI 02910
. 1994 W-2 and EARNINGS SUMMARY 'I'"
j , ... t '. . . -.. t:,;;.' '~.' '~r"1ltrr'~~<<!~or~,""l~"t":I:~"~'" '.-..--.....,.
T1i1. bill. e.tnlngi Summ.ry ..ollon 1.'H&IUded with C6'ufW:} Is k,i~"i1~I'H&IIIJHi' 1;"11I,,,. d~ll.'
th.IIVlli. .,delnclud.. gen.tilllif&lltlilloH th.l ~oJini~ .168 fllid h"IIfUI~~rl~~f!".' "" " ".1'"
1, Thl tollowln Inlolm.llo,,,.h,cI. .UI h'I~H.u ,Iu~ Il1lri '" ullilllillilfllill\ihJcl b .iI. ':~
O,o,iPir tot2,I5O ,e..liISKu,lly ".,' a2,7B..,, hl,IIW.lri<omttb
TuWllhh.ld ' Bo. ISoIW.2 ','
Bo. 4 0/ W,2 IUL1lllf ...
75,72 i,t,dle,..T.. ,t~,es BoKt401W.2
Withhold
Bo. 60/ W,2
hd. Incom.
t.. Wllhh,ld
Be.2 01 W,2
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Betch 1230
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01.03'22 .4,.3501
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2, Your Ora.. ~.~ WII .dlu,led II folio... to pfoduc. your W.18t.lltnfht.
W'UOI, Tip" othll 8ocl.I8tcU,!ly Modi....
Comptt)I.Uon Wig.. W."".
80. 1 01 W.I 80. 3 01 W.I 80. . .1 W.I
IV, 11.11 W....,
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MARGARET L ROBINSON
37 WINf., 8T '2
E GREENWICH RI 02818
1.012,150
1,012,10
1,012,80
1,0tl,80
1.012,150
1,011,10
1,012,150
.,011,10
3. Employ.. W." Protll.. To chanD' your Employ" W.4 ProW,ln'orm.tlon, fll. . n.w W.04 with your p.Yfoll dept.
RI
11-
.
5 3 2264
. "...., pI.' Co
1012,60
,. Looallty nelM
MARGARET L ROBINSON
37 WINE ST 112
E GREENWICH RI 02818
20,12
II 00 w..... ..
21 ou .
, (W-2 REISSUED)
o lK4 AurOUAIlC llA'A'ROC!UlHO tHe
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1012,SO
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o E."aye,', nlllll, IIdd...., and ZlP cod.
CAPITAL VIDEO
ONE METRO PARK
CRANSTON RI 02910
.
bEII!l~"'" IJUlft t
5.038226.
7 loclll..curlty lIpe
. Advance fie ,-,."'.nl
li-HonqullHled plan.
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04.46.3506
. Allocated Ups
to Olpenthnt UI. beNtH,
. irian.nt.lncluded In };Ciii-
i40lM'
13.16 SOl
Soclll Sec:ullty Number: 00.......350.
TI..ble Malllal Stalul: MARRIED
E .emptlon./AIIow.nee.:
FEDEf1AI.: 1
9T ATE: None.
11l1.IT'" PtII_pla" lijitl'''' r~"'" rOtt"I..~;
.1 EMploy"'. ft.M.. ,.... .;;a ZIP code
MARGARET L ROBINSON
37 WINE 8T '2
E GREENWICH RI 02818
:N:~~~I~~e"D~- ::-::;:;J~!~~=~
20,12
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05- 4 0 10
Copy C For !MPLDYEI!'S RECOROa (ISM Notlo&) 01011 N" ,...._
T~In'O'M"'O" II tin, ,.,r"'."." to th'l~a.1I .,." r.qull.d to tilt. tu,. .........
186.75 3.11
. 1..,1t)'ll'. "''''', .dd,.... and ZIP ood,
Spectra Temps of RI, Inc.
260 W.st Exchange Street
suit. 1207
Providence, RI 02903
. ..our 't. I
.70
ca I p.
wuoe p,,,,,,"
...,"...... ......MIMlI'nu.....,
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Margaret L. Robinson
37 Wine street, '2
East Greenwich, RI 02818
.. M,r.:;n
te....
.
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" a.... ..,toret". '111.1.0. No,
~J_l~0~J~~~~1___
" I.." .101', tlPl, I'" tl lta'.lnco...... t.l...t,........ 10 Lo"I..,.., Up.,.... It L...I...".I...
186.75 0.86 RITDI 186.75 2.43
---------------------------------------------
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O"'D No, 1545_
. f 'p\ ( f 1,1 ','1'11 n, ' III { Ollll'
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13 30 00
3 - "curIty ""00'
Ff\lI!!! ~ III wIh/lIld,
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. Control number
b Emplo""1 IdonU!k:Illon numbor
os- 03C14701
a EmpIoytr', nlml. addr..., and ZlP ood,
R. I. TIlHPD, 1 Ne .
~A J~ffetBon Buulevnr~
WI11'wick
RI 02008.3030
I MId1cIrI _, II1d I/jl' I _I... wtlhhlld
1330.00 9. 1
1 Soc:Ili ,1CUItty I/jl' I AIlocIlod Upe
,00 .00
I Mien,," Ele PI\'ll1Onl 10 Dependent CIII bon,llt,
.flO .00
11 NonqUlUftod pll'" U Bontftlllndudod In Bo. I
.00 .00
t3 S..lnltrl. for BOil 13 14 Olhlr I
001- 17.30
II Empfoyt"l lodIIlecullly number
.: 004403506
I EmpIoyoo'1 nllllO, 1ddI.." II1d ZIP code
HAROARBT RODINSON
J1 WIRE STRRKT '2
RAST ORRBNWICH RI 1I201El
-
, II llIolo Employe,'",." 1.0, No, 1?S"o"'.g...... tl61OllInolrno III', II Loc:oJlly noma ZO 1<<1I_... 21lDcollnolrno III
" .h, r~b'~!!~~~;.L...,.. ....P:1!?...9.9.. ..:....~~:.~.. ..;........... .................................,
T ., Jffi ,
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-~---_.. - ....- _._.....U.'_..__._.____,____...___....... I
. .....,..,........ ......... aM 11' cocte
GENESYS INFORMATION
SYSTEMS CORPORATION
.. NORTH PARK SUITE 400
HUNT VALLEY MO 21030
BItch '725
.. .IIA IIW.Mf
08.32.8"$
, .,
10 ..... "MlM.
1995 W-2 and EARNINGS SUMMARY
t!.11 Llul I!lrnlngi 8Uminl~ iioilon I. Iric;Udid ...H'; ~OOi w.~ 10 he,p d'i~;,t;;;rtjoi1i In moil detIlI. <;;1
tj,. ti~.ri..ld. IncIUd.. ~.n.t.llntormitlciH IhilyciU mlV .'io ~hd h"pful.,' .' , , ., "
, j, the 'ollowlno In/orm.llon /In.el, ~oO, hnil U.i p.ptub phl. 'n~ "',u,tminl, iubmltlod b~ your .mplo,.,: . ..,.
Oro..I>,y 47020,84 8ocIolIltCUrl!y, 2832,Ot MO,BlotolneomHo 2881.12 ,;
T.. Wlthh,ld, Bo.11 01 W.z 'I'
Bo. 4 01 W,2 BUWot
882,33 1lu14 01 W,2 !
'.
Fld.lncoml
T.. "'''hhold
Ba.201W,.
0912,00 Modlu/lT..
"'''hhold
Bo.s oIW,2
I. Your Oral. PlY W.. Adlulttd II 'allow. to IHoduce your W., BI"lment.
W'8'" Tip" otho, 8ocIol8acOr"~ Modic".
Compenlltlon W.g.. W.p.
Bo. 1 01 W.. Bo. 3 01 W.. Bo. 10' W.I
MO, Blot. WOO...
TIpt, ~Ie,
110. 17 01 W.I
- ,.,....
t. '1Mf" IMludH In bo. t
OID"P,~
L... Mloe, Nan T uoble Comp,
R'I>ortld W.2 Wig..
47,020,84
1,343,34
45.877.80
47,02O,B4
1,343,34
4'. In, so
47,020,84
1,313,34
4'.ln.So
47,020,84
1,~3,~
45.177.S0
, t Of
3. Em loy" W'" Profll. To ching. your Employ.. W.~ Profll.lnformltlon, fll. I n.w W.~ wwlth your payroll d.pl.
..w....45 77.50
II Loc.IIty".....
JOHN R, ROBINSON
606 F KNOLLCREST PL
COCKEYSVILLE MD 21030
Social ~ullty Number: 201.32.1155
l..abte Mlrllal Stllul: SINQl!
e.empllonl/Anowancel:
FEOERAL: 1 135 Additional T..
BTATE: 1'42 Addltlon.1 T..
II oc.
o "" AU'OU"flCDAfA'AOCnSIHO tHe
"-'OIn...."..,u.......", .~
W~2
ICfq~
,
...
March 13, 1992
CITICORP'O
MCnTGAGE
John R. Robinson
Margaret L. Robinson
780 Grave1ley Hill Road
South Kingstown, RI 02879-4739
RE: CMI Loan # 9554907
Dear Mr. and Mrs. Robinson:
This letter is to confirm that citicorp Mortgage, Inc., has
agreed to the sale of the above referenced property for the
sum of $130,000.00. It is understood that the net proceeds
from the sale will be not less than $121,025.00.
Further conditions for approval:
1. The Robinsons are to net $0.00 (zero) from the proceeds
of the sale, which should be remitted ~
to CMI within 24 hours of closing. /q ~~
2. closing takes place on or before April '1!, 1992.
3. Realty commission is to be 6% of sales price.
4. There are no junior liens being paid from the
proceeds of the sale.
5. Any escrow balance shown as a credit will be retained
by CMII it will not be returned to the Robinsons.
6. Mr. Robinson will sign a repayment agreement with
Citicorp Mortgage, Inc., for the sum of $25,000.00.
Upon satisfactory completion of the agreement, the
original note shall be released as satisfied to the
borrowers.
Should any variance occur in the approved
must be contacted to approve the changes.
mail the proceeds check and a copy of the
statement to:
transaction, CMI
Please express
signed settlement
citicorp Mortgage, Inc.
15851 clayton Road
Ballwin, MO 63011
Attn: M.S.N,E. Theresa Simington
upon receipt of the required proceeds from the sale, citicorp
will release the Mortgage/Deed of Trust as satisfied. CMI
;j PITlTlON.....
I -;H181T
iIJ.d'ljO':'i ',m "~.ll
. .~ .,.
MONTHLY PAY AGREEMENT
FOR MODIFICATION/RELEASE OF NOTE
FOR VALUE RECEIVED, I acknowledge my indebtedness to
citicorp Mortgage, Inc., in the amount of $39,115.56.
I promise to pay Citicorp Mortgage Inc., the sum of
$25,000.00 under the following terms:
I will pay $0.00 at closing. I will pay beginning June 1,
1992 $298.00 per month for the next eightY-four (84) months
until May 1, 1999, and $266.00 as the final payment due on
June 1, 1999.
Upon the completion of this agreement, citicorp Mortgage,
Ino., will release the Note presently held by citicorp
Mortgage, Ino., as satisfied.
I also understand that I will be in breach of this agreement
if any payment is not received within 15 days of the due date
of said payment. In the event that a breach occurs, Citioorp
Mortgage, Inc., reserves the option to call the total amount
of the acknowledged indebtedness less the amount of
previously applied payments immediately due and collectable.
I agree to mail the first month payment and all other
payments to Citicorp Mortgage, Inc., P.O. Box 790024, MS 324,
st. Louis, Missouri 63179-0024, Account #9554907 to arrive at
the place specified above not later than the date due as
indicated above.
citicorp Mortgage, Inc.
Barry Luechtefeld,
Staff Vice President
Date
"'J ::. Fff J -
~ .. ~&.4- -?-
. John Rob nson
---
,5/~"/~;t
Date
7 8'0 G~ J iUu.., tI:/IJd.
.sn. J<::....O ~~( ~r ~:z.fI"'?...
Present Home Phone:~;"m-S"Wr. Present Work Phone:.;'#~-,,,'1-.J'';-o
SUbscribed and swore before me this ~ day of~1992 by
~,3n, [qq'f
-
Present Address:
I
My commission expires: 'j". ,
. 1 I..J
Notary PUblic: ~l'J.('u/> ./0,
I-f.'.;, , . l~' 1-
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,.... 4868
Application for Automatic Extension of Time
To File U.S. Individual Income Tax Return
OIolD No, 15C5-0I.. '
~L._.""''''''
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Your flrlt rwne If'd IMIII lIl' nem.
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It. tol"' tttum, 'ClOUI,'. ftt1t 1'1''''' and 11'111111 . llsl r,,,,,
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"""1 homI ~ 0'U'nt*. ItrMI.1ncI1P1. no, Of' Nral rout.). (II you hi..... P.O. DOl, III thllnltNC1lOl'\l.)
,"; I ,.J f/J l, l.. . \,"
City. to\'tn or poSI office, .tI~., and ZIP cOd' .
$:;.;.... ":f"~' r)~' ..'.?,'"
No'-: Fil. lhls form wfltlth. Inltrnll R.venu. Servlc. C.nler where you Ilf8 requl..a 10 nt. your incom. tax return, Itld ply .ny
.mounl(s) t'IlU OlW, TNt llnol III utlllllon of Um. 10 pey your tu.
I ,.quest III1IU1omatlc 4.monlh .xt.nllon 01 11m. to AuguSI17, 1992, to fII. Form 104M or Form 1040 lor the cal.ndar YIlT 11191
(or III "acal y.arFonn 1040 to ............................19 ........., lor Ih.lax y.sr ending..,................,........ 19 ........,),
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Tollltill IIlblllty lor 11191. Thll II lh. ll1lCunt you .xpecl to .nler on IIn. 27 or Form 1040A, or
line 53 01 Form 1040. II you too not .xpect to ow. lax, .nler -0-, , , . , . . , , . . .
C8lIlICIilI ~ flflJ8T trIlW In llllounl on /lne 1 or your .1I1.ns/on will be denl.d, You CIll1 esllmsl.
11* IIIlCllInt. bul III . _I IS you CIII wfltl!he /nformellon you Mve, /1 we I.ler nnd th., your
..rima,. wu nol -WW. !he Pl.nllon will be null .nd veld,
I FtdIrIIlncomt tu wttNtIId. . . . I . . I . . . . . .. 2 It) '?,l,
3 levl tlUmattd lax paymenllllncludl mo ovlrpavmlnlallowld IS s crldll) . 3
4 Olhll paym.nts II1d Cltdlll rou SlpaCt to Ihow on Form 104M or Form 1040, ,\
~. MJ Hnea 2. 3. enct.. . . . . . . . . . . , . . . . . . . . . . . . . . .
I . UUHCI DUI \NIlrIIlt IrMIlllnlm IIn. 1), 711 get "'" .llfIIIeIon. you MU., PI!' In fill tile
I _ L - hA dUe ""'" ,. line lilt IIlCIN than line 1 enler -0., , . ~
If rou upeot to OWl 11Ift or ..__tlvnolldpplng tmlIl.r 10111 tax, oomple1. line 71.nd ..
or Ib If 1IpplIo~1. Do not lnaIude ~ till on u.e IlneL I'" \he InelNolIon'"
., lfyGU Cltyoll'lllOIM_101lll Iglft lax "un \Fonn 709 or 700.Al lor 11191, } YoInIlf ~ 0
lI"'lIIatt due by ~ 111.11192, _ the 1nt1ruGtIon. and check here ,. IpouII ~ 0
II I!nIIr tIlIlIllClU1I of glIl or 08T till that rou III paying with thla toml. . , . . . . . . .
b I!nIIr Ihllmount of or 08T till that II I I wllh Ihll lann, . '
81gnature Il1d v.rtncatlon .
Uncl., IltIIIllIn 01 p.rjury,1 dtcIII1 tI1all 11m examlllld thll form. Including IccomDlltYlng lChlduln and llItlmenll, and to tht'btat 01 my knowttdoe
IIld bIitI, K 111M. COITIC!, 11III complt1l; Incl,. prlpertd by IOmlonl othlr lhIII thl iulJtytr,lhat 11m .utllorUtd to prlpalt t1111 form.
SlgI\IlIn 01 tupay9r .. 011. ~
I,'~ <': .. ~
SIijnI1ull 01 .paUI. ~
OSI. ~
~I ftIIng JoIn"y, BOTH mullllgn IVln II only one had income)
Slgllllw. of prwperer
OIhar thin wpayer .. 011. ..
II conwepcndenee "lItldlng thIt .X1enllon Is to b. ..nlto you at a" addrns other Ihan that ahCwrI above, or 10 an Igent acttng
for you, pl.UI enler till name ollh. agent and/or th. addrns wherllII IhCuld be tent.
Nama
PI....
Type __... _I<< P,O, bo........ M moj . no' doU_ '0 II..., --,
Of'
Print City, ...... or pool ofla, 11I11, oncl ZIP code
Oenerallnstructlons
'aperwwll ReduolIon Act Ilo1loe.-Wa
all for the information on thlt lann to
carry CUI IhIInl.mal Revenue ~ oltha
Unlled Sill... You.re required to glv.'UI
\he InlonnetJon, w. need 1110 ..... that
you III complying wllh th...lawl8(ld'to
Blow us 10 figure and conecllha rlghl
nount 01 till.
The lime nleded 10 compll" .nd ru.
Ihl. lonn will very d.pendlng on 1ndfv!dul1
cin:lA'nlllllces, Th. .sllmated .v.regt lime
Is: Rac.nskeeplng, 2B mln,; LetmlnO
aboul the b1w or \he lorm, 11 mln,:
Preptrlng the form, 20 mln,: .nd
. Copylng, a...mbMng. and ""ding the
lann to lhco IRS. 20 mln,
, "you hav. 'commenls concerning thl
accuracv of .h... tlm. .stlmal.. at
Cat/la, 131CIW
auggaeltone lor making Ihla lorm IT1Ol1I
IImpIe, WI would be hippy to hler !rom
you, You can w!tI. to both lhelnterMl
RavmJ'lIen\clI, WaI*lgIon. DC 20224,
^".nllon: IRS Reports ClNl1llCl OfIICIr,
T:FP; and Ihe Otnce of ~ IInlI
Budget, PaperwOfk Aeduc1Ion Pro)lct
(1545-01881. WnhIolglon, DC 20603, Do
not MIld this 101m 10 eItt1er 01 thne
oll1CII, Inst.ad, ... Whe,. To ,""
Fonn 48eS 1'"1)
'0
.
~
FORM CT.1040EXT
Appllcltlon Far Extension of Tlnle to File
Connecticut Indlvldulllncome TIX Return
(InoludlnD lohldull 384, Clpltl' Olin.. Dlvldlndl In~ In'..... TI.'
''''PORTANTI PLEASE READ INSrRUCrlONS ON PAGE 2 BEFORE COMPLWNG rHls APPLlCArlON
t ii, am. I ddlt oi . ~ .~. 'ltlur ,I IculitJ Humber
-,
SlATE OF CONNlClICUT
OEFlIRTMENT OF REVENUE SERVICES
92 Flrmln.ton Iwtnut
H,~I..d, CT 06105
1991
" '
TAXPAYER
IPllIlIlypl
or PrIRt) .
Iddl,lnlU,1
L.. ; ~o
IIo1M dl' Numb" ."If 5"11'
=to'i'o Grn "--II}' ~. \\..~
(1')1 " 01 Ani 0", . SI,lt
lop Cod,
THII II Nor AN I.TlNIION 0' TlMI TO ,AV YOUII TA. - raNALTIII AND INTIIIIIT MAY A"LY (SEE INSrRUCIIONSJ
AN I.TlNIION OIlAHTIO SY THI INTIIINAL IIIV.NUI IIIIVICI 0011 Nor AUTOMATICALLY UTlNO THI CONNICTICUT PlLINO OATI
I ,equllla 11.,month .".nllon 01 time to Oclober 15, 1992 10 1110 illY Connoclicullndlvlduellncomo T.. Relurn 10' celend" ye.. \991
0' unlll 10' nlcal Y'" endlnl
~ I ha.. requested a lederal ..tenllon I~ederal form 4868, AppllClllon 10' Au/om.llc E,'enllon 01 Time /0 file U,S, Individual Income r..
I Relurn 10' C,/end.. II", /99/, rYES 0 NO
III NO, the '''Ion 10' th, Conneclleul e"onllon I. ,., ",,""",,"" ",,,,,,,, ,""" " " "," """ " " """ " " " " " ",,," " " " ,," " ,,"" " " ,,, " ",'"
....................,.,......."........".......0......,........,..,.'....0'.......,.........................,...................................,...,................",."".".",.",..,.,.
I :::::::::::::::::::::::::::::::::::::::::::::~. ~~~: ~;ii: ~~: ~:~TI;;I~ :~~~; ii: ~~ ~~is;;'~ :~~~~~~r: :,~: ~:~~;~~:::::::::::::::::::::::::::::::::::::::::::::::
II
II. Tola' Connecticut Income Ta. lIablllly for 1991, lYou may ..lImale Ihll amountl",,,,,,,,,,,,,,,,,,,,,,,,,,,,, \
NOIE, You mUlt enlll an .mount on Una I, II you do not o.pect 10 owa I.., orllor zero (0),
ft
~ 2, Connecllcullncomo Ta. withheld ",,""""" , """ "",",","" 2
3. 1991 Connecticut t\llmatt'd 1.1 payment\ lncludin. llllt" Ifll ovtlp.tl11cnh.....3
4, Add Un.. 2 and 3 ""''''''''''''''''''''''''''''''''''''
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4
5, Connecticullncome T.. balance due (Sublllel line 4 Irom Una I), Pay In lull with thll lo,m,
11 line 4 II lreater Ihln llna \, enler ze'o (0)""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5
(!)
Make your check 0' money o,der payable 101 COMMISSIONER OF REVENUE SERVICES, W,llo you, Social Security Number and
'199\ fo,m CT,1040EXI' on your chock,
Relurn tllIo lo,m 101
Slalo 01 Conneclleut
Deparlment of Re\'enue Servlc~s
POO, 8.. 2977
lIa,lIo,d, CT 06104.2977
DICLARATIONI I declar. under the penallles 01 I.llt' statlment that 'his return has been e...mined by me and to the belt 01 my knowledae .nd bellel, II . hu.,
correct .nd complet. ftlurn. Deet'fltion of p,epa,,, lolhff Ih,.... the tl~patel) I, based on .11 11lIor,"llIon 01 whIch preparer hn anv knowl.die.
'l\)ul SIIO.luft O'lt Spouu', Slln,huI 0.11
IIDn Horl
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hd'l,l [n'ploy" , 0 Nun",,,
IJ;;-O&.O ''':Ie.
Cf S.tu TII R'lt'lllllon Numbtl
Keep a copy 01
lhls lelurn lor
you, ftcord,
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PaRe I
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. 2 Employ"l n , .ddllll, .nd lP code '. I
~ANG LA80RAfORJES, JINC.
ONE INDUStRIAL AV~
LOWELL ftA 011'1
. 0 111
'1I1'd WIll, .
IlllploVt'I' "
f I'd"'d' I.n i1l'h"n
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7 Allocated I.., " '"
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ZO",OO.U'
14 Medlomo wago. nnd lip.
l0400."
16 No"qunlll'od plo".
ill SocIoI..... Ill. WltI~1eId 12 Soclol.ocurtty wago.
: lZ6J~'4 20..,00.',
IV E~\'lHI'. name 1Idd,... and ZIP code
~t9'-OO'OJ4-0000006Z810_
. "OHN R RO'IN$UN
~IO GRAVELLY HILL ROAD
'SU~ MINGS tOWN Rl OZ81~
.. I-
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IS Medlen,ot.. withheld
Z95~4Z
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I '"'0","11" Dopl. 01 Ihe Treasury- nlernal Revenue Service
'.... W-2 Wage and Tax Statement 1991
EIY1Wvvo', .,wj ~ro'" COli'" COOllluedD
W-2
,qq I
"'idi.,*,".Mch'l.,.ti.rolI .
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i~ CO""~RCE U~I~p
WARWICK ~~ U~~1~
'llIocWMnI"I".~ II
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- W-2 Wage and Tax Slal~menl 1991
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and Tex Stetement 1 aa 1
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Copy 8 To 8e Flied WIth E""loyee'. re. Return 'or FEDEML
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DATA IMAGE INC,
828 HEBnON AVE
GLASTONBURY,CT
7144 II ....0".... .... ....... .. lIP CNt
, ".- JOHN ROB I NSON
(.i'~ ~~BO GRAVELLY HILL
08033 ~lJ /,OUTH KINGSTON.RI
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01104/12
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EMPLOY~E W.2 WAU~ SUMMAIIY 1992
Your 1992 payroll adJust"nts art Ilst.d b.,ow. This c~rt Indlcat.s If
th.y war. Includad (+), ..clUded (.) or dId not a".ct (N/A) )Our federal
wag.s (80x 10) and )Our st.t. wag.s on )Our W-2 steta..nt.
.. ..
1I1~ ", DATA IMAGE INC, 1144 REGULAR WAGES 68!34.86
~I 20 MEADOW STREET Voluntary Year to date 80x 10 CT
EAST HARTFORO,CT 0610B AdJustllll!nts Mount Wagll Wagll
~~ EXP REIMO 48S.54 NIA NIA
~~ ,.deral wIthholdIng .x.optlons M I 40lK 685.35 -685.35 -685.35
CT withholdIng .x"",t Ions X 0 SEC 125 724.08 .724,OS -724.0S
~~ AddItIonal f.deral tax wlthh.,d 110.00 CAR ALLOII 2889.00 +2889.00 +2889.00
AddItIonal CT stat. tax withheld 101.00
:~
JOHN ROBINSON
EMPLOYEE REFERENCE COpy
0.... .1 .... ,,,.....v . ..'....1 "....... ...,...
ClI4... 10.1I-ooo.
I lllpttytf', _. liMn,. 1M I. .Nt 144
OATAIMAGE INC.
20 MEADOII STREET
EAST HARTFORO.CT 06108
""ovn, UIOll lIIIp r"11 ,
08-1184427 4711131-000
1I11l1P1.y"', ..... ......, .. I. eM 7-
JOHN ROBINSON
437 NORMA RD
AMBLER. PA 19002
HllO( Mnl y
208-32-1888
11 5..lIIIbl. ,... f.. W-J
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age,and Tax Slateme!)! 1992
I I ,f I
!Ifllloyoo', II1d '""",1ft', "PI'_od
.
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P~ge Two
T~ylor Andrews, Esquire
October 16, 1996
3. The 401(k) b~l~nce is 0,
4. In 1988 the home known ~s 780 Gr~vely HilI Road, South Kingstown, R.I, was
purchased. The purchase price was $159,500.
The mortgage was $140,000.
At time of separation the mortgage balance had escalated to approximately $160,000
due to non-payment, late charges, and interest,
5. See enclosed photocopies of W-2's 1991-1995.
6. See enclosed 1991 tax return,
7. See enclosed evidence of $39,000 debt to Citicorp in the nature of a letter indicating
same.
I believe all of your recent inquiries have been answered well and truly. I believe
discovery is now cornplete, and I arn so certified for the record that discovery is complete and
am requesting that Master Elicker proceed to schedule a Master's Hearing,
Respectfully,
~1n1.~
iA'MES M. BACH
Attorney At Law
JMB/lsa
Encl: 1991 Tax Return
W-2's 1991-1995
Letter from Citicorp
Master Elicke../
John Robinson
cc:
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8 JOliN R. ROBINSON! N (),9.6q:::q,~~12qqq,qqq 8
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.MARGARET L. ROBINSON
DECREE IN
DIVORCE
....
AND NOW, ' , , , , , , , , , p.0f>~~, , , ~.2. , '. 19, ,ll~, '. it is ordered and
decreed that ."."""", ,~~~~, ,~~ ,~~l!~~~~~, ." , , , ,. , , , , , ". plaintiff,
and . , , , , , , , , , , , , , , , , , , , , ,~~~~, ,~~ , ~~~~~~,~~, , , , , , , , , , " defendant,
are divorced from the bonds of matrimony.
The court retains jurisdiction of the following claims which have
been raised of record in this action for which a final order has not yet
been entered;
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OF CUMBERLAND COUNTY
STATE OF .. PENNA.
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1996
.................
JOHN R. ROBINSON
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MARGARET L. ROB~NSON
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AND NOW, ........"..,.."..".. ,,, 19 ,~~..,' it is ordered and
decreed that.. .., .. .. .. .. " ,-!~~,~ ,I,t ..~ql,l:r~.., ............... plaintiff,
and...,.."""""."." ,~~~~ "~:, ~~~~~~"",..,"'" defendant,
are divorced from the bonds of atrlmony.
The court retains iurlsdic Ion of the following c/al s which have
been raised of record in this ctJon for which a final orde
been entered;
NONE
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AND NOW, ' , , ., , , , , , , , , ,. , , , , ,. , , , , " '. 19, ?!i, , '. It is ordered and
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decreed that""""""" '/o~,~ ,~, ,~9J;J~~,~9~",..""",.". plaintiff,
and..""".,."""" ,~~9~~, ~'." o,~~~~!l,~"""""",. defendant,
/
are divorced from the b9nds of matrim ny.
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The court retai?~ jurisdiction of the allowing claims which have
been raised of rec7d in this action for wh h. a final order has not yet
been entered; \
NONE
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JOHN R. ROBINSON
Plaintiff
IN TilE COUR'f OF COMMON PLEAS
CUMDERLAND COUNTY, PENNSYLVANIA
vs.
MARGARET L. ROBINSON
Defendant
NO.
3312, 1996
PRAECIPE TO TRANSMIT RECORD
TO TilE PR0'1'1I0NO'fARY:
'1'ransmil: the record, together wi th the following information,
to the Court for entry of a Divorce Decree:
1. GROUNDS FOR DIVORCE: Irretrievable breakdown under section
( I 3301 (cl or ( X I 3301 (dl (1! of the Divorce Code.
(Check Applicable Sectionl.
2. DA'1'E AND MANNER of service of the Complaint:
CERTIFIED MAIL 6/15/96
3. CmIPLE'l'E EI'rIlER PARAGRAPII (a) or (b).
(a) Date of execution of the Affidavit of Consent required
by Section 3301(cl of the Divorce Code:
By Plaintiff: 1 by Defendant
(b) (11 Date of execution of the Plaintiff's Affidavit
required by Section 3301 (dl of the Divorce Code:
6/12/96
(21 Date of service of the Plaintiff's Affidavit Upon
the Defendant: 6/15/96
4. RELATED CLAIMS PENDING:
NONE
5. DATE r.ND MANNER OF SERVICE OF 'l'IIE NOnCE OF IN'fENTION TO
FILE PRAECIPE '1'0 'l'RANSMIT RECORD, a copy of which is
attached, if the Decree is to be entered under Section
3301(dl (11 (il of the Divorce Code:
7/5/96 BY ORDINARY MAIL
fJ
DAell
torney 1.0. No. 18727
352 S. Sporting IIUI Road
Mechanicsburg, PA 17055
(7171 737-2033
Attorney for Plaintiff
----
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HIIBRBFORB:
in Divorce.
Plaintiff requests the Court to Enter a Decree
DY:
~~
JAHES H. DACn
Attorney 1.0. No. 10727
352 South Sporting IJiII Road
Hechanicsburg, PA 17055
717-737-2033
VERIFICATION
I verify that the statements made in this Compl~int are true
and correct. I understand that false statements herein made
are subject to penalties of 18 PII. C.S. ~4904, relating to
unaworn falaification to authoritiea.
2sh~~~~
PLAINTIFF
b - I ~ - q.t
DATE ,.
JOHN R. ROBINSON
Plaintiff
III 'l'lIl~ COUII'I' OF COI,II'IOII PI.E/\S OF
CU~IUEllIJIIIHJ COUll'!'Y, PEllNSYLV/\NI/\
va.
MARGARET L. ROBINSON
Uefendant
I
I C!vll IIcl:ioll - I,aw
I 111 DIvorce
IJEFEIlIJIIW!' I S COUIl'I'EII-/\I"f'lIJIIVl'I' lJt/lJ1':1I IlEC'I'IUN 330 II d I
OFo '!'HE uiii6ficEcoiili
1. Check either lal or Ibl:
101 1 do 1I0t oppooo tho olltry of n divorce decree.
(bl I Oppose the ollLry of a divorce decroe because
ICheck IiI, IUI or bothll
I i I 'I'he partJon to thiu actJotl have not lived
aeparate and apart for a (IoJ:iou of at leaol: two yoars.
(UI 'I'he marriago In tlot irrotrievably broken.
2. Check either lal or Ill):
101 I do not willh Lo mako Ilny claims for economiu
releif.I Underal:and that I may lose rightu concerning alimony,
division of property, 'lawyer '0 feen or expellses if I do not
claim them before 0 divorce in grollted.
Ibl I wish to claim ocolIOlllio rolief l~hIch may include
alimony, division of property, lawyer'u feea or expensen or
other important rights.
I verify that the statelllellts mnde in the cOllnteroffJdovil:'
are true and correol:. I Ullclerntollu thnt false stntelllellts herein
are made aubject to tho penalties of 10 1'0. C.S 4909 reloting
to unsworn falo!fical:1on to author Jl:iee.
Date:
DO f e iidiiii t
llO'I'ICEI If you do not wJoh to oppose the ontry of 0 divorce
decree ond you do not wish to moko allY cloim for ecotlomic relief,
you need nol: file this coutlteroffJdnvil:.
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JPOHN R. ROBINSON HI 'I'IIE COUIl'I' OF COMMON PI.EI\S OF
PLIIIN'rIFF . CUMUEIlLIIND COUNTY, PENNSYLVANIII
.
vs. . 9fi..,-3312 CIVH. 'I'ERM
.
MARGARET L. ROBINSON CIVil. I\C'I'lON - IJI\W
DEFENIJIIN'I' IN IHVOIICE
NOTICE OF INTENTION TO REQUEST ENTRY OF DIVORCE DECREE
TOI MARGARET L. ROBINSON
JOHN ROBINSON
the Courl: the al:l:achcd
jULY 26, ,1996,
be enl:ered.
, 'I'he PI,l\lN'I'IFF, intends to file with
Pr'aecipe to 'I'ranslllit Itecord on or after
requesI:ln9 that a final Decree in Divorce
~b~'-
Ol\ell
for Plaintiff
NOTICE OF INTENTION TO REQUEST ENTRY OF DIVORCE IJECREE
TOI MARGARET L. ROBINSON
You have been sued in an acl:lon for lJivorce. " You have failed
to answer the Complaint or file a counter-affidavit to the
Plaintiff'a affidavil:. 1'herefore, on or after JULY 26, 1996 ,
199 , the PLAIN'I'IFF can request the Court 1:0 enter a final Decree
in Divorce.
If you do not file with I:he' Prothonotary of the Court, all answer
with your signal:ure notarized or verified or a counter-atfldavit
by I:he above date, I:he Court can onter a final Decree in Divorce.
Unless you have already flIed wlth the Courl: a written claim
for economic relief, you muut do so by the above date or I:he
Courl: may grant the divorce, and you will lose forever the right
1:0 aak for economic relief. II COUll'I'EII-IIFFIDI\Vl'I' WIIICII YOU ~IIlY
FILl;: 1'11'1'11 'I'IIE PIIO'I'IIOl-lO'I'IIIlY 01" 'I'IIE COUIl'1' IS I\'I"I'IICIIEIJ '1'0 'I'IIIS
NonCE.
YOU SIIOULIl 1'I\KE 'I'IIIS PIIPEIt '1'0 YOU II 1,IIWYEIl 11'1' ONCE. IF YOU 00
NO'l' nl\VE 1\ IJIIWYER 011 CIIIINU'I' I\Ff'Oll1l ONE, GO '1'0 011 '!'ELEPIIONE 'I'IIE
OFFICE SE'I' FOIl'I'II OEIoOI'/ '1'0 ~'IUIJ OU'I' WIIERE YOU CAli GE'I' LEGI\L IIELP.
COUIl'I' IIlJ~l IN [S'I'IlI\'I' ION
f'onrth Floor
cumberland County Courthouse
Carlisle, I'll 17013
(717) 240-6200
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JOHN R. ROBINSON
PLAINTIFF
vs.
IN TilE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
96 - 3312
HARGARET L. ROBINSON
DEFENDANT
Civil Action
: In Divorce
CERTIFICATE OF SERVICE BY MAIL
PURSUANT TO PA. R.C.P. 1920.4 la) (11 (ii)
JAMES M. BACH, Esquire, being duly sworn according to law,
deposes and aays that he is the Attorney for PLAINTIFF, and
that he did mail a true and correct copy of a Complaint under
Section 3301(cl of the Divorce Code of 1980, along with a Notice
to Defend and Claim Rights, by regiatered/certified mail, return
receipt requested, deliver to addressee only, to the DEFENDANT,
on JUNE 13. 1996
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JOHN R. ROBINSON . IN THE COURT OF COMMON PLEAS OF
.
PLAINTIFF . CUMBERLAND COUNTY, PENNSYLVANIA
.
:
vs. . 96 - 3312 CIVIL TERM
.
.
MARGARET L. ROBINSON .
.
.
DEFENDANT . IN DIVORCE
.
CERTIFICATE OF SERVICE BY MAIL
I, JAMES M. BACH, Attorney-at-Law, do hereby certify that I
have mailed to the individual(sl listed below, a copy of the
foregoiug
Notice of Intention to File Praecipe to Transmit the RA~nrd
by placing a copy of same in the United States Mail, first class,
poatage prepaid, on the ~ day of July , 1996
and addressed aa follows:
MRS. MARGARET L. ROBINSON
37 WINE STREET (APARTMENT NO.2)
EAST GREENWICH, R.I. 02616
Date
7,h YhC
. .
BY:
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ttorney 1.0. No. 18727
352 South Sporting nill Road
Mechanicsburg, PII 17055
717-737-2033
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JOHN R. ROBINSON
. IN TilE COURT OF COMMON PLEAS OF
.
PLAINTIFF . CUMBERLIIND COUNTY, PENNSYLVANIA
.
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va. . 96 - 3312 CIVIL TERM
.
.
HARGARET L. ROBINSON .
.
.
DEFENDANT . IN DIVORCE
.
CERTIFICATE OF SERVICE BY HAIL
I, JAMBS M. BACH, Attorney-at-Law, do hereby certify that I
have mailed to the individuallal listed below, a copy of the
foregoing
NOTICE OF INTENTION TO FILE PRAECIPE TO TRANSMIT THE RECORD
by placing a copy of aame in the United States Mail, first clasa,
postage prepaid, on the l5..t.h. day of JULY , 1996
and addressed aa follows:
MRS. MARGARET L. ROBINSON
37 WINE STREET IAPARTMENT NO. 21
EAST GREENWICH, R.II 02818
Date
1/z I( (tj{,
BY:
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JAM H. BACII
Atto ney 1.0. No. 18727
352 South sporting Hill Road
Mechanicaburg, PA 17055
717-737-2033
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JOHN R, ROBINSON,
PLAINTIFF
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
VS,
: NO, 96.3312 CIVIL TERM
MARGARET L, ROBINSON,
DEFENDANT
: IN DIVORCE
ANSWER TO COUNTERCLAIM AND NEW MATTER.
AND NOW comes thc Plaintiff John R. Robinson, by his Attorney James M.
Oach and files the within ANSWER TO COUNTERCLAIM AND NEW MATTER:
7,.9. ADMITTED.
COUNT I.
COUNT II.
10.-12. DENIED, Plaintiff denies that the Defendant is entitled to alimony
pendente lite and/or alimony, as the Defendant is able to sustain herself. Defendant was
living without any spousal support or alimony pendente lite since she left the marital
residence in 1991.
COUNT 11/,
13.-14, DENIED, Plaintiff denies Defcndant's requests for counsel fees. costs
and expenses as the Defendant is more than able to sustain herself during the litigation
and pay her own counsel fees, costs and expenses,
WHEREFORE Plaintiff prays that the claim for alimony pendente lite and/ or
alimony and counsel fees, costs and expenses be dismissed,
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NEW MATTER.
COUNT I.
CLAIM FOR ALIMONY PENDENTE LITE AND ALIMONY,
15. Plaintiff requires financial support to sustain himself during the COlb'Sc.: of this
proceeding.
16. The Plaintiff herein seeks alimony pendente lite and alimony from the
Defendant.
WHEREFORE Plaintiff prays This Honorable Court to award Plaintiff alimony
pendenle lite and alimony.
COUNT II
CLAIM FOR A ITORNEY FEES, COSTS AND EXPENSES.
17, Plaintiff seeks attorney fees, costs and expenses as the Defendant is able to
pay this without hardship,
18. Plaintiff asks the Court to direct the Defendant to pay the attorney fees, costs
and expenses.
WHEREFORE the Plaintiff prays this Honorable Court to direct Defendant to
pay attorneys' fees, costs and expenses,
COUNT III
EQUITABLE DISTRIBUTION OF MARITAL PROPERTY.
19. Plaintiff alleges that all marital property has been divided and distributed
heretofore, however to the extent that some property has not been distributed heretofore,
Plaintiff seeks the equitable distribution of same.
20. Plaintiff seeks equitable distribution of marital property,
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8, The marital property of the parties has not been distributed equitably.
9. Defendant seeks an equitable distribution of marital propert)' pursuant to this divorce
proceeding,
WHEREFORE, Defendant prays your Honorable Court to equitably distribute the marital
property of the parties,
COUNT II
Claim for Alimony Pendente Lite and for Alimony
10. Plaintifrs aclual earnings and earning capacity greatly exceed the earnings and
earning capacity of the Defendant.
11. Defendant requires financial support from Plaintiff in order for the Defendant to
maintain herself during the course of this divorce proceeding,
12. Defendant seeks permanent alimony from the Plaintiff following a divorce,
WHEREFORE, Defendant prays your Honorable Court to award Defendant alimony
pendente lite pending this divorce proceeding, and thereafter to award Defendant alimony,
COUNT HI
Claim for Attorneys' Fees, Costs and El(penses
13. Defendant is unable to pay attorneys' lees and expert appraiser fees as needed during
the course of this divorce action without suffering hardShip.
14, Defendant asks the Court to direct the Plaintiff to pay allorneys' fees, costs and expert
fees incurred by the Defendant related to these divorce proceedings,
. .
WHEREFORE. Defendant prays your honorable Court to direct Plaintiff to pay attorneys'
fees. costs, and expert fees incurred by the Defendant related to this divorce aClion,
ANDREWS & JOHNSON
By:
Tay r ,Andrews, Esq,
Attorneys for Defendant
78 W, Pomfrel Street
Carlisle, PA 17013
(717) 243-0123
I verify that the statements made in this Answer are lrue and correct. I understand that
false stalements herein are made subject to the penalties of 18 Pa.C.S, ~ 4904, relating to unsworn
falsification to authorities,
Date: J -lor r;,
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DR 25.792
JOliN It ROBINSON,
PLAINTIFF/RESPONDENT:
IN TIlE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
VS
CIVIL ACTION. LA W
MARGARET I.. ROBINSON,
DEFI:NDANT/PETlT/ON ER
NO, 96...llil.. CIVIL TERM
ORI)ER OF COURT
AND NOW, this J..!llh.. day of Octoher, 1996, based upon the Court's determination that
PlaintiWRespondent's monthly net income is $3366,00 per month and Defendant/Petitioner's
monthly net income is $ 12/.0.00. per month, it is hereby Ordercd that the Defendant/Pctilioner pay
to thc Domestic Relations Section, Court of Common Pleas, $ 855,00 a month payable $ 427,50 hi.
monthlv as alimony pendente lite. enective 9/3/96. Arrears set at $ 1.710,00 as of 10/10/96, shall
be payuhle at $ 22,50 hi.monthly . First payment due on or before 11/1/96. and each month
thercaller.
Failure to make each payment on time and in full will cause all arrears to become subjecllo
immediate collcction by 1111 of the means as provided by 23 Pa,C.S,~ 3703, Further. if the Court
finds, aller hearing, thai the Defcndant/Petitioner has willfully failcd to comply with this Order, it
may declare the Defendant/Petitioner in civil contempt of Court and its discretion make an
appropriate Order, including. bUl not limited to, commitmcnt of the Defendant/Petitioner to prison for
a period not to exceed six months.
Payments must be made by cash, check or money order, Cash payments must be made in
person. All checks and money orders must be made payable to Domestic Relations Section and
delivered or mailed to Domestic Relations Section, 13 North Hanover Street, 1',0, Box 320, Carlisle,
Pennsylvania, 17013. Each payment must bear your Domestic Relations number (DR 25.792) in
order to be proccssed,
Defendant/Petitioner is responsible for service fees of~ to be paid within ~ as
determined by the Domestic Relations Section,
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JOHN R, ROBINSON
: DR 25,792
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYL VANIA
PlaintilT
vs,
MARGARET L, ROBINSON
Defendanl
: NO, 96.331.tC1VIL TERM
: CIVIL ACTION. LA W
APPEAL OF RECOMMENDED ORDER FOR AUMONY PENDENTE UTE
DATE OF ORDER: October 10,1996
AMOUNT OF ORDER: $855.00 for lhe support of MARGARET L, ROBINSON,
DATE OF APPEAL: October 18,1996
REASON OF APPEAL: Wife is dependant on Husband for her reasonable needs, The
calculation of Alimony Pendente Lite was based upon a net income for Husband which was in
error. The actual net income of Husband is $200 greater per month due to his excess withholding
of federal income tax. The significant disparity in income between lhe parties warrants Alimony
Pendente,Lite and Alimony after divorce,
NAME OF DEFENDANT REQUESTING APPEAL:
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SIGNATURE OF ATTORNEY FOR DEFENDANT:
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Tay r . Andrews, Esquire
78 st Pomfret Street
Carlisle, PA 17013
(717) 243.0123
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PLAINTIFF
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
NO, 96 . 3312 CIVIL TERM
VS,
MARGARET L ROBINSON,
DEFENDANT
IN DIVORCE
ORDER
AND NOW on this :(3,A day of aL~.tl'<l;G .1996, upon
consideration of the within PETITION TO B1FUR ATE, a RULE is issued upon the
Defendant to show cause why the within divorce action should nol be bifurcated,
This RULE is returnable and will be heard on the / ~ tl day
of (f).~~tLVL.J 1996, at q: CJ7) JlM/am, in Court room No,~, Cumberland
County Courthouse, Carlisle, Pennsylvania,
BY THE COURT:
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JOHN R, ROBINSON,
PLAINTIFF
: IN TilE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
NO, 96 . 3J 12 CIVIL TERM
VS,
MARGARET L, ROBINSON,
DEFENDANT
IN DIVORCE
PETITION TO BIFURCATE
AND NOW comes the PlaintilT, by his Allomey, JAMES M. BACH. and files
the within PETITION TO BIFURCATE:
I. Petitioner, John R, Robinson, is an adult individual residing at 4] 72,
Nantucket Drive, Mechanicsburg, Pennsylvania,
2. Respondent, Margaret L, Robinson, is an adult individual residing at37
Wine Street, Greenwich, Rhode Island,
3. John R. Robinson filed a Complaint in Divorce on or about June] 3, ] 996,
4. Margaret L. Robinson filed an Answer and a Counter-claim seeking equitable
distribution of marital property, alimony pendente lite, alimony, allomey fees, costs and
expenses, This Answer was filed on the 7th day of August, ] 996,
5. The parties separated on or about May, 1991. The parties in this case have
been separated in excess of two years.
6, The parties jointly own marital assets and have been unable to agree on the
division of same,
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a final Divorce Decree entered atlhis time,
WHEREFORE, the PlainlilT, John R. Robinson, respeclfully prays lhalthis
Honorable Court Bifurcate the property claims from divorce itself and enter a Final
Decree in Divorce.
Respectfully submitted,
DATE
~I /1/9(,
BY r4~
JAMES M. BACH, ESQUIRE
Attorney 1.0. No 18727
352 S. Sporting Hili Rd.
MECHANICSBURG, PA 17055
(717) 737-2033
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Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACflON . LAW
vs,
MARGARET L ROBINSON,
Defendant
96.3312 CIVIL TERM
AND NOW. this
IN RE: PETITION TO mFURCATE
ORDER
1(, .. day of October, 1996, after hearing, the court being
sallsfied that any detriment to the defendant by virtue of cancellation of her health Insurance can
be offsel by the payment of appropriate alimony pendente lite, the petition of the plaintiff for
bifurcation Is GRANTED and a decree, In appropriate form. will be signed by the court upon Its
presentation.
BY TIlE COURT,
,/IIi
lames M. Bach, Esquire
For the Plalnliff
Taylor P. Andrews, Esquire
For the Defendant
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DR 25,792
JOliN R, ROlliNSON
PLAINTIFF : IN TIlE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
VS : DOMESTIC RELATIONS SECTION
: CIVIL ACTION. SUPPORT
MARGARET L. ROBINSON
DEFENDANT : NO, 96.3312 CIVIL
ORDER OF COURT
You, Mnrunret L, Robinson, defendant, arc ordered to appear at the Domestic Relations Seelion, 13 Nonh
lIanover Streel, Carlisle, Pennsylvania before R,J, Shnddav on October4, 1996 at 9:00 a,m" forn conference, after
which the conference office may recommend that an order for suppon be entcred against you,
You arc funher ordered to bring 10 the conference:
(I) a true copy of your most recent Federal Income Tax Rctum, including W.2's as filed
(2) your pay slubs for the preceding six (6) monlhs
(3) the Income and Expense Statement attached to this order, completed as required by Rule 1910,11 (c)
(4) verificalion of child care expenses
(5) pooof of medical coverage which you may have, or may have available to you
If you fail to appear for the conference or to bring the required documents, the court may issue a
warrant for your arrest.
Date of Order: Selltember 19, 1996
BY TIlE COURT,
Harold E. Sheely, President Judge
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YOU 1M VE THE RIGHT TO A LAWYER, WHO MAYA TTEND TIlE CONFERENCE AND REPRESENT YOU, I I'
YOU DO NOT HA VE A LAWYER OR CANNOT AFFORD ONE. GO TO OR TELEPHONE TIlE OFFICE SET
FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP,
Court Administrator
Fourth Floor
Cumberland County Counhouse
Carlisle, Pennsylvania 17013
(717) 240-6200
AMERICANS WITH DISABILITIES ACT OF 1990
The Court of Co Inmon Pleas of Cumberland County is required by law to comply with the Americans wilh
Disabilities ActoI' 1990, for inlimnation about acccssible facilities and reasonable accommodations available to disabled
individuals having business before the ~oun, please contact our ortice, All arrangements must be mnde alleast 72 hours
prior 10 any hearing or business before the court, You must attend the scheduled conference or heuring,
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,
JOHN R. ROBINSON,
PlalntilY
: IN TilE COURT OF COMMON I'LEAS OF
: CUMDERLANI) COUNTV,I'ENNSYLVANIA
Il-if ,,:>/ (fJ) I
(i,H
v.
MARGARET L. ROBINSON
Defendant
: CIVIL ACTION
: NO. 96.3312 CIVIL
ORDER OF COURT
AND NOW, this day of , _.' upon consideration of
the attached petition for Alimony Pendente Lile and/or counsel Ices, it is hereby direcled that the parties
and their respective counsel appear before on
at o'clock _,m. for n conference, aller which the conference officer may
recommend that an order for Alimony Pendente Lite be entered,
You are further ordered to bring 10 the conference:
(I) a true copy of your most recent Fcderallncome Tax Return, including W-2's as filed
(2) your pay stubs for the preceding six (6) months
(3) the Income and Expense Statement attached to this Order, completed as required by Rule
1910.II(c)
(4) verification of child care. expenses
(5) proofofmedical coverage which you may have, or may have available to you
If you fail to appear for the conference or bring the required documents, the court may issue a
warrant for your arrest.
BY THE COURT,
Harold E, Sheely, President Judge
Date of Order:
Conference Officer
YOU HAVE THE RiGHT TO A LAWYER, WHO MAYA TrEND THE CONFERENCE AND
REPRESENT YOU, IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR
TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL
HELP.
Court Administrator
Cumberland County Court House, Fourth Floor
Carlisle, Pennsylvania, 17013
(717) 240-6200
AMERICANS WITH DISAI3ILlTIES ACT OF 1990
The Court of Common Pleas of Cumberland County is required by law to comply with the
Americans with Disabilities Act of 1990, For infonnation about accessible facilities and reasonable
accommodations available to disabled individuals having business before the court, please contact our
office. All arrangements must be made at least 72 hours prior 10 any hearing or business before the
court, You must attend the scheduled conference or hearing,
DIU
JOliN I{. ROBINSON,
Plalnllrr
: IN TilE COURT OF COMMON I'LEAS OF
: CUMDEI{LAND COUNTY, PENNSYLVANIA
v.
: CIVIL ACTION
MARGARET L. ROBINSON
Defendant
: NO. 96.3312 CIVIL
MOTION FOR ilEA lUNG ON
DEFENDANT'S CLAIM FOR ALlMONV PENDENTE LITE
Defendant, MARGARET L. ROBINSON, by hcr anorney, Taylor 1'. Andrcws, Esquire, of
Andrews & Johnson. respectfully represents:
I, Defendant filcd an Answcr and Counterclaim in the above-captioned divorce case on
August 7, 1996, The Counlerclaim contained a claim for alimony pendente lile in Count II,
2, Defendanl has recently been advised by her husband thaI he will discontinue his medical
coverage of the Defendant and Ihat he will discontinue payment of her automobile insurance effective
September 1996,
3, Defendant seeks a hearing on her claim for alimony pendente lite,
WHEREFORE, Defendant prays Your Honorablc Court to dircctthe parties to a conference at
the Cumberland County Domesllc Relntlons Office for the processing of Defendant's claim for alimony
pendente lite,
Respeclfully submitted,
Date:
~-(t5..5h
By:
Ta 0 p, Andrews, Esquire
78 . Pomfret Slreet
Carlisle, P A 170 I 3
(717) 243-0123
. ,.-,.,.
, ,
.
I
, r
JOHN R. ROBINSON
DR 25,792
PLAINTIFF
INTI IE COURT OF COMMON PLEAS OF
CUMBERLANIJ COlJNTY,PENNSYLVANIA
V
MARGARET L. ROBINSON
DEFENIJANT
:NO. 96-331 CIVIL TERM
: CIVIL ACTION - LAW
APPEAL OF RECOMMENIJEIJ ORIJER rOR ALIMONY PENDENTE LITE
DATE OF ORDER October 10, 1996
AMOUNTOFORDER $3386.00
FOR THE SUPPORT OF
MARGARET L. ROBINSON
DATE OF APPEAL
n,..t-nhl3i1'" 1 R 1 QQ,;;
.
REASON rORAPPEAL The Defendant Wife haa lived separately and
apart from Husband in exceas of five yeara. During the period of
aeparation this Defendant haa remained regularly employed on a full-
time basis while the PLAINTIFF has been employed only half the time.
In addltion to the long aeparation, this DEFENDANT haa demonstrated
and haa testified in Court, that her reasonable needs and expenses
have been met by her on a regular and continuing basia. The very
purpose of the Alimony Pendente Lite Law would be defeated if a person
were able to collect Alimony Pendente Lite after beinq separate and
apart in excess of five years, and then coming intc Court to suggest
that they require money for their own sustinance. The partiea' real
estate and all other marital asseta have been divided and diatributed
by the parties at time of separation, approximately May, 1991. The
parties have totally dis-entanqled themselves economical Iv aa far as
distribution of the marital estate is concerned. THEREFORE the Alimony
Pendente Lite Order should not qO forward. the Auoeal should be
sustained for reasons set forth herein and other reaaona to be r~e~F~1ar:
NAME OF PLAINTlrFf~RIlBt<lllAN'1/ REQUESTlNO APPEAL JOliN R. ROBINSON
11497
S/ONA TURE OF A'ITORNEY OR PLAINTIFFfDEFENIJANT
.~
aAMES H. BACH, ESQ.
352 S. Sporting Hill Rd.
Mechanicsburg, PA 17Q55
MUST BE FIl.ED IN DUPLICATE
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JAMES M. BACH
Attorney al Law
352 S, Sporting Hili Road
Mechanlcsburg, PA 17055
October 11, 1996
Tel: (7171737.2033
Honorable Kevin Hess. Judge
Court 0 f Common Pleas
Cumberland County Court House
One Court House Square
Carlisle, PA 17013
RE: D; ROBINSON vs. ROBINSO~
Iff NO. 96-3312 CIVIL
Dear Judge Hess:
You indicated at the close of the Petition to Bifurcate Hearing that the question of
medical insurance was causing you special concern. The enclosed case may be persuasive.
Accordingly, I respectfully submit this case in support of our position to have a
divorce issued at this time.
JMB/lsa
Encl: Case
cc: Taylor Andrew
Respectfully,
d::::~~ ~
Attorney At Law f ~i..< tliA.
~(JJu.tn1~
.
;1111 II'J~III
Bilger v. Bilger
SOl
IJifurL'alioll will he granted ill II divorce aClhm whl'rc the
panics have heen scparulcd h.T II y,,'ar!'oo alld Whl.'Tl' it i... ilgl"CL'd
lhal the I1lOlrriagc is irretrievahly hrokL'n. e\'en though will....
1l1\:dh:al hCllcfits will terminate upon divl'U:C. iI IIllll!t'!" Ihill
I.'pull! he resulved IhrulI~h alimony pl'udcl1ll' Iill', alilllllll~' liT
\\ 111...... ohtaining conllllllcd COVl'TilgC Irom anuther Canl\,'l,
I'etition for hifurcation, <-',I', of I\lontgllmery
("nlllty. nil. SO.\h2,lH.
,,11',11/11' 1.(://(,)(', fill' plaintiff.
./"11,, /l, C""I'"y, fill' dclt-ndan!.
YlllIN,.I.. Ikccmhcr 12. 1l'llll-l\larilyn 1',(;,
Bilger filed a cllmplaint in divllI'l'e Iln Nllvl'lnher I h,
IIISO, .Inmes (), Bilgcr pctitillns thl' Cllllltto hiflllcal"
Ihe divorl'e claim from the remaining nllleslllved
eCllnlllnic claims in the case. On .Il1ne H. I'JIJIl, the
Cllnn granted ddendant's petitic>n and Ilrdered hi.
furcation, I'laintiff filed exccplions tll this mder
which the COlin dismissed Iln August I h. !'NIl,
Pursuam to thc hirurcation. the cllun entered a
,leeree granting the divorce on Septemher Ill, !,IIIO,
Plaintifr appealed. arguing that the coun improperly
granted hifurcation of the claims and therdore erred
in entering the final divorce ,lccrcc.'
Plaimifr and defendant were married '111 August
Ill, 11)75. Ironically. although it was plaintiff who
initiated divorce proceedings four ycars later, the
I I-year history of this case is a saga of plaintiff's
resistance hoth to resolving the underlying eco-
nomic issues and to the entrv of a final divorce
dccree. Plaintirr filed her allfdavit of consent in
1. Plaintiff initially appealed the ClHlI'l's order granting
hifurcation. The Superior Court denied plaintiffs petili\Hl fur
permission 10 appelll bccllusc hirurc\lliul1 is .111 interlucutury
malter. \Vltilc the hifurcalion IIrtler j!ot 1101 iI final. appealahle
nrder. it is llpproprialc to raise the issue of hihlrcalioll UI1
appeal from the divorce decree itself. ,\10.\il'" \'. .\1o.\"i(',., 351)
POI, Super, IN7, SIN t\,~d N,IJ tPIM"I,
, '
504 Dilger v, Dilger 9 D. & C. 4th
decree. Although plaintiff filed two sets of excep-
tions to the bifurcation order, she did not file either
exceptions or post-trial motions after the court
entered the divorce decree. In order to preserve
issues for appellate review. plaintiff must file post-
trial motions:
"Where, as here, un order of hifureution is op-
posed prior to the entrnnce of the divorce decre~,
opposition must he expressed in some fashion utthe
time the court grunted hifurcution, und then, after
the entrunce of the divorce decree, post-trial mo-
lions must be filed pursuant to Pa.R.C.P. 227.1
stuting how the grounds were usserted in the earlier
proceeding. . .
"Because appellant hus failed to file motions in
accordance with Rulcs of Civil Procedure, 227.1 to
227.4 inclusive, following the issuance of the dl.
vorce decree, she has not preserved any Issues for
review." Mosier v. Mosier. 359 Pa. Super. 187,
195-6, 518 A.2d 843, 847 (1986).
However, even though plaintiff waived her right
to mise any issues on appeal, there is no merit to her
assertion that the court erred in granting the order to
bifurcate.
The Pennsylvania Divorce Code permils the sev-
erance or bifurcation of economic claims from di.
vorce claims. 23 P.S. ~401(b). "Bifurcation sepa-
rates the termination of the marriage from the dis-
tribut;on of property so that the marriage and each
party's personal life arc not held hostage to eco-
nomic demands." Walk v. Walk, 318 Pa. Super. 311,
315,464 A.2d 1359, 1361 (1983). The court need not
find compelling reasons before making a decision to
bifurcate. [d. However, this decision should be an
individualized rather than a pro forma determina-
tion:
SOO (1990)
"Each ca:
only follow
consequenc
greater benl
the petition
"Since tl'
we will rc"
hlfurcutlon
So longus'
mutlon, th.
then explui
defer to hi~
The cou:
issue of Ih,
The evlder
hud been n
II. Both s
trievably b
living with
marry. Pia:
filed an afl
ago. The r
equitable c
hearing wa
marital ass
awaiting di
Plaintiff
bcnefits t
would ten
social secl
the wife of
when the (
Welghin,
the advant
vantages. .
would be
matter COli
"
"
,..
..'
I'D, .I: C, ~Ih
two sets of excep.
, she did not file either
llions lifter the court
In order to preserve
plaintiff 11111st file post.
'1' of hifurelltion is op.
of the divorce decree,
.I In SOl11e fllshlonllt the
,clition, IInd then. lifter
decree. post.trllll 1110'
nt to PII,R.C.P, 2n,I
e IIsscrled In the emileI'
ailed 10 file motions in
ivil Procedure, 227.1 10
he Issullnce of thc dl.
reserved any issues for
" 359 I'll. Super. IH7,
86).
aintiff waived her right
, there is no merit to her
I in granting the ordcr to
, Code permits the sev-
momic claims from di-
(b). "Bifurcation sepa-
marriage from the dis-
the marriage and each
.t held hostage to eco-
olk. 318 Pa. Super. 311,
83). The court need not
rc making a decision to
, decision should he an
I pro forma determina-
51111 1I1)IJIII Bilger v, lIilger 50S
"Each case I11USt he reviewed on its own facts and
only following the court's dctermlnlltion thllt the
consequences of hiflll'cating the case will he of
crealer hendil than not hifurcating, should it grant
iile pelilion. . .
"Since the decision 10 hifurcate is di,;cretionary,
\H' will review lower COUrl decisions perlaining to
hiflll'cation hy using anahuse of discretion standard.
SIl long as the trial judge assemhles adequate infoI"
nwlilln, thoughtfully studies the Infol'lllation and
Iill'nl'xplains his decision regarding hiflll'cation, we
dder to his discretion." ltl,
Thl' eoun condul'ted a full hearing on the sole
,,,ue of Ihe pelition 10 hifurcate on April 17, 19lJO,
The evidel1l:e presented revealed thllt the parlies
had heen malTied for four yellrs IInd separuled for
II, Both sides agreed Ihat Ihe marriage was irre-
Iricvahly hroken, Since (9117. defendant has heen
living wilh another woman whom he intends to
lI1arrv, Plaintiff not only initiated the divorce bul
filed 'ao affidavit of consent to divorce eight years
ago, The parlies have been awaiting a hearing in
equitable distribution sioce that time. The delay in
hearing was largely allributablc to plaintiff. The sole
lI1aritalasset is now sold and the funds arc in escrow
awaiting distribution.
Plaintiff opposed bifurcation because her medical
henefits through defendant's former employer
would terminate upon divorce, In addition, the
social security benefits which plaintiff received as
Ihe wife of a social security recipieot would also end
when the divorce WIIS final.
Weighing all the factors. the court determined that
Ihe advantages far outweighed the possible disad-
vantages, Although termination of medical benefits
would be seriously detrimental to pluintiff. this
l11aller could be resolved through alimony pendente
"
,
In of one or
aea but &!eo
offenae, It
,Umed "'th
,nvlcUon for
commlsalon
le Ole Impu.
'Ol, Secuon
u a coun.
aUona In14r-
tlaUve appl~
:0 each oth.
ea are ludl.
.ut aen14ne-
lled to the
<<>nvlcted In
'late 01 the
etal <<>lU1 0'
po, Invalun.
bbcry u do.
(II) or (III),
301(a), kid,
rhloh Ih. 0',
Ir t<ekleuly
ther under
Indlfferen..
alent crime
IIh In .ff..,
(relalln, 10
nterimeJn
convlcllon
the hUlaIlI
ble.
~ .."'In
>non 0' ,,,.
'me durin,
led In any
if delenllon
')' the RIe-
I for olher
iW epllOd.
:Considered
oIlhl..o.,
lelude any
'I. pendln,
a added)
TAYU)R v. TAYLOR
ell,.. 50.1 A..U '". Ip..luper. .''')
dlatrlct attorn.y'a oWce which may, by the
simple .xpedl.nt of chsrging Incid.nts a.p-
arately which allow of any argum.nt .up-
porllng dillcr.tlon, aaaure long.r p.nalllea
than Ol. law might otherwlae allow,
(4) W. do not now nor will w. ev.r
deny tho propriety of conald.rallon by the
courl of oth.r oU.na.a In determining ..n.
tenc., "Prior conn.cllona, ot what.ver /Ia.
ture, with law .ntorc.m.nt authorillea aro
unqueallonably among the cl",umatance.
to be acrutlnl.ed Iln ..ntenclng)," Corn.
mOIll'~allh v, Laskari., 341 Po,Super, :138,
491 A,2d 845, 847 (1985) (citation. nmltt.d),
In point of fact, this eon.lderutlon Woa
glv.n by the eourl to uppeUont'. two t.d....
ul eonvlctlona, which quolity und.r our def.
Inltion tor Inclualon In a prior record .core,
and to one Montgomery County ottense
which did not so quaUty, as no s.ntenco
had yet been pronounced, The ted.rol ot.
tens.s W.re not tactor.d with r.gord to
opp.Uant's prior r.cord scor. because of
the difficulty of translating them Into of.
t.ns.s describ.d by the P.nnsylvonio
Crimea Cod., They w.re, th.r.for., In the
trial court's P''''.ptlon, unavalloble for uti.
lI.atlon aa s.ntenc. enhonc.rs; w. now
d.e1are Ole convictions herein chaU.nged to
be slmllorly inappUcoble for thot purpos..
(5) W., therefore, hold that prior con-
victions must precede commillslon of Ole
principal offeose to be Inelud.d in prior
reeord score calculotlons,
(6) In appellant's case, We find only the
logic behind the sentence and not the totall.
ty of the sentence Itself unacceptable,
Had the court chosen to sentence cons.cu.
tlvely at the top of the minimum ronge for
each offense, that Is 12 to 24 months, the
aggregate would have b.en the some, and
well within the allowable statutory maxi.
mum of 20 years Imprllonment for a felony
of the flnt degree, 18 Pa,C,S,A, I 1103(1),
We, therofore, vacote Judgment of sen-
tence and remand to tho lower court for
resentencing In accordonco with thil Opln.
Ion.
Pa. 439
Ronald E. TAYLOR
v,
Cora L. Youn, TAYLOR, Appellant.
Superior Courl of Pennlylvonla,
Argued Oct. 20, 1085,
~'lIed Jan, 17, 1986,
Hu.hnnd filed dlvo",e ncllon, and sub.
lequenlly pol/tloned for hlfu",atlon of dl.
Vo"'e octlon leporotlng dlvo",e decree from
re.nlullon of anelllnry motters Ineludlng eq.
ultable distribution of morltal property,
The Courl of Common Pleol, Montgomery
County, Civil Division, No, 83-16370,
Smith, J., gronted the pellllon for blfll"'o-
tlon ond decreed the parlles to be divo",ed,
and wife opp.oled, The Superior Court,
No, 751 Phllad.lphio, 1085, eo",one, J"
held thot: (I) state trldl COUrl hod jurildle-
tion OV.r divorce proe..ding, .v.n though
wife's bonkruptcy proc..dlng wna p.ndlng;
(2) dlsodvontag," wife had aU.ged from
bifll",ating proceeding were not so over.
Whelming or of sueh momltllde as to com-
pel rev.rsal of trial court's diseretionary
decision to bifurcate dlvo",e proceeding;
and (3) disallowance of evld.nce of chll.
dren's alleged speeiol needs for residential
stability In determining wh.th.r to blful'
cate dlvo",e Proc..dlng waa proper.
Affirmed,
I. Divorce p82
State trial court prop.rly ex.",lsed JUI'
Ildlcllon over dlvo",e proce.dlng, even
though bankruptey proce.dlng was pend.
Ing with relp.ct to wife, Baokr,Code, 11
U,S,C,A, I 1301 et seq.
2. Divorce pl45
Disadvantagea wife had alleged were
not 10 overwhelming or of such compelling
magnitude al to com'lOl revenal of dlscre.
~
t.1.
j
1
~ .i
,I
!!
TA YLOII v, TA YUlIl
Clt,.. 50J A.Jd 4)' ('.,Sup." 1'16)
we will look to general prlneipl.. of law
and to decisions of the federal bankruptcy
court.
(II From an historical point of view, the
consummation nnd dissolution of mllrriages
has olways been trcllted liS a mlltter which
Is quite proporly reserved to tlw sllltes,
See Barber I', Barber, 21 How, 582, 62 V,S,
58~, 16 1.,Ed, 226 (1859), This Issue waK
clearly dealt with In In rt Cunnillghalll, 9
Il,R, 70 (198\), wherein the bankruptcy
court dismissed a petition requesting relief
from the automatic silly provision and,
thus, allowing the partleK to continue with
dlvoree proceedings, The court held that II
federal bankruptcy court does not have
subject matter Jurlsdletlon over the divorce
petition Itself and, therefore, the requeKt
for relief was not pertinent. The Cun.
ningha III court noted, however, that, "The
denial of Jurisdiction over the divorce petl.
tlon Itself Is not to deny Jurisdiction over
the property of the divorce proceeding
when one of the parties Is n debtor In
bankruptcy, In re Benal'ide:, No, 8D-16llJ
ID,N,M" June 3, 1980)," 9 Il,R, at 71. See
0180 Schulze I', Schulze, 15 B,R, 106 (1980),
The bankruptcy court Is In a much better
position to Interpret the meaning of the
bankruptey eode than Is this eourt, We
find Its determination as to Its lack of sub.
Ject maller Jurisdiction In the dlvo""e pro-
ceedings, within the historical view, per.
Kaasll'e, Accordingly, we find that the trl.
01 court did not err In exercising Ita Juris.
diction over the divorce proceeding below,
Appellant next argues that the lower
court abused ItB discretion In granting ap'
pellee's petition 10 hlfurcute the divorce
proceeding from the reoulutlon of economic
mntte... This court's opinion In II'olk 1',
1I'0lk, 318 Pa,Snperlor Cl. 311, 464 A,2d
1:159 (1983), IK the seminal caso which sets
lhe parnmeten on thl! trlul cOUrl's dlscrll'
lion when deciding a bifurcation 10SUll,
TIIl''''lnwe sllltl!d:
4, While UI'pdlil111 l'unltnd, Ihlll ,f,,~ Ilrcd. tL"t).
1I1l11l1l' lH'1I1t't,;Uull fur lht Ilco);1 Ihrrc )'tarl, we
nult' IlulI !lht tlm', hn\'c lht uJlllnn II) prllllun
IIll!' hunknillh:Y c:uurt fur relief rrom lhe: Ill)' IU
.
Pa, 441
II]t IK obvious that the decision to bifur-
cate, though permissible, should not be
mnde pro forma ,,' Rather, such a
determination Khould be made only after
the dlsadvantoges and advanlllges have
been carefully explored and analyzed.
Elich case must be reviewed on Its own
facls and only following the court's de-
termination that the consequences of bl.
furcatlng the case will be of greater ben.
eflt thlln not bifurcating, should It grant
the petition,
ld, lit :118, 464 A,2d nt 1362, The Walk
court further set forth the standard for
awellate review.
Since the decision to bifurcate Is dlacre-
tlonary, we will review lower court decl.
slons pertaining to bifurcation by using
an abuse of discretion standard. So long
as the trial Judge assembles adequate
Information, and then explains hla lor
her] decision regarding bifurcation, we
defer to his discretion, In other words,
this determination should be the result of
a reflective examination of the Individual
facts of each case,
Id,
[2] The parties to this case have been
separated since 1980 and have two children
living with appellant, Appellee filed the
divorce action In November, 1983, At the
hearing on the bifurcation petition, appellee
asserted his reason for seeking bifurcation,
and a prompt divorce decree, waa that he
wlsbed to remarry. At the hearing, both
parties appeared to agree that, If blfurca.
tlon was not allowed, a final order could
not be entered for at least three more
years-the acheduled pendency of the
bankruptcy proceeding,' Appellant op-
(lOsed the petition becaule, due to medical
problum., Ihe rellel on appellee'l medical
Insurance, which she allegee will terminate
upon their divorce, Sho also opposes the
petition hecaule she will loso support pay.
mefltB upon divorce find yet not have the
AI In I'roc~~d lu . re.ohlllon ur Ihe ~connmlc:
'''Ut'I. Reller wal yralltcd (or luch purpole In
.'w:h14/ll "~, .'M'hull', JUprd. Appellant Clnnal U&e
Ihe IIAY (110\'111011 II hoth . aword and a shield.
, ,
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i !
. '
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,I
I
,
,
"
442 Pa,
503 ATI.ANTIC REPORTER, 2d SERIES
property aettlement to rely upon, Finally,
appellant allegea that a non,blCurcated pro-
ceeding will provide greater stability Cor
her children and that there are potentl&1
problems should appellee die prior to Clnal
disposition oC the economic mattere,
While we may be sympathellc to oppel.
lant's plight, the disadvantages that she
has alleged are not so overwhelmi"g or oC
such magnitude that we are compelled to
revene the discrellonary decision ot the
trial oourt, Appellant has an enCorceable
support order in place, If appellee is not
making the required payment.s, as alleged,
appellant haa a remedy which Is unrelated
to the biturcatlon Issue, It a slgnlCicant
change in circumstances occun, such as
the loss at medical beneClts, appellant can
pellllon Cor a modiCled support order, See
23 P,S, t 501(e),
[3,~) The entry ot a divorce decree
does not alter the right oC a tormer spouee
to alimony pendente lite or counsel Cees,
see Pastuszek v. Pastuszek, - Pa,Superl.
or Ct. -, 499 A,2d 1069 (1985), or to a
support or alimony award, McNulty v.
McNulty, - Pa,Superlor Ct, -, 500 A,2d
876 (1985),' However entitlement to sup-
port, alimony pendente lite, counsel Cees
and costa would ceaae upon appellee's
death, Pastuszek, mpra, whether or not
the parties were divorced, Appellanl ar.
gues that It appellee should die betore the
tinal dlsposlllon at the caae, but while they
were stili married, she somehow would be
in a better posillon, She never explains
how she would be advantaged, other than
the ract that Ihe marital property would be
held by the partiea aa tenanta by the entire-
ties rather than tenanta in common and the
tact Ihat appellee's ruture spouse might
5, M,'Nu/', v, MeNU/I', ,up'., - Po,Sup<rlor CI,
01 -, 100 ,Ud 01 880:
"Alimony" ,., II a dUlY arlllos ouI of mar.
rlaKt' but I, dllllnsuhhcd In that It conllnuC'1
after divorce when riled In conjunction wilh
a dh'orce or annulment decree, It, purpole i.
nol 10 reward one pany and 10 punl,h the
olher, bUI rlther 10 cnlure lhat rellon.ble
need. of .he person who II unable 10 luppon
hlmlClr Of heraelr throush appropriate em.
claim an Interest In appellee's shan ot the
estate.'
[51 Theee Cactore cannot be outside the
scope oC probabilities considered by the
Legielature .. reaeonable Incidenta ot bl.
Curcation, ThereCore, appellant's mere &e.
sertlon or such potentialities, without pro-
viding evidence oC specific disadvantages 10
henelt, is not enough, We turther nota
that appellant's interest In the marital
property would not be aitered by appellee's
untimely death. In Pastruzek, supra, this
court epeciClcally held that pending ancll.
lary matten, rollowing a divorce decree,
survive the death or one at the parties,
Therein we stated:
Once the [divorce] decree haa been en.
tered, the right or the spouse to the
distribution or marital property and other
economic claims where these maltere
have been properly put In Issue betore
the death at the spouse, is vested, We
do not perceive any contllct between this
rule and the provisions ot any statulAl
dealing with the estates ot deeedenta.
By virtue at equitable dlstrlbutlon ot
marital property and the dlsposltlon er
other economic claims, some property
may become an aaset at the decedent'e
estate and shall be treated by the pereon.
al representative aa any other estate 81'
set,
Pastuszek v, Past ruzek, supra, - Pa.Su.
perior Ct, -, ~99 A,2d at 1074 (tootnolAl
omitted).
[6J Finally, we note appellant'. claim
that the lower court abused Ita dlscretlon
by not allowing evidence ot the special
needs at the children tor residential stablll,
ty, The trial court correctly stated that
Instability is an Incident or every divorc.
and will be considered at the equitable die.
plo)'menl. are mel. S,m4l,k v. Slm4ld. III
PI,Supcrlor CI, I, 479 A,2d 1047 (1984),
6. We note here thai any fUlure lPOUse or appel.
lee would be IIDyed rrom luertlllllny Inlerest
In Ihe .ubJecl miller or Ihe blnkruptcy procc<d,
Inl. jUlt al Ihe panic. herein are stayed rrom
proceedlnl 10 Ihe equitable dlllrlbullon of Ihe
marital propeny.
Ill. I'< C, 3d
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i:
; Glenncraft Corporation
205 Fortin Drive Woonsocket, RI 02895-6116 (401) 769-0101
FAX (401) 766-1170
September 30, 1996
Mr,.Taylor p..Andrews
Andrews & Johnson
76 W. Pomfret Street
Carlisle, PA 17013-3216
Re:Margaret Robinson
Dear Mr, Andrews,
Ml!rgaret Robinson Is an employee of Glenncraft Corporation, She has asked me 10 clarify lhe
health care coverage available to her,
At'the curTant time Glenncraft Corporation does not have a health care plan available for Ms,
Robinson, '
'>
> I am In \he process of reviewing different health care programs. However a daclslon has not been
, m~da. Ms. RobInson will qualify once a program Is Inltlatad" '
. '.... . ,
. ',.,'. ,-, -".: ..
, Please contact ma If you require any additional Information,
, '
'Slnceraly; , ,
'~~iD
Carey Arico
President
CNl..J,doc
.
...
March 13, 1992
CIT1CORP-C
MCnTGAGE
John R. Robinson
Margaret L. Robinaon
780 Gravelley Hill Road
South Kingatown, RI 02879-4739
RE: CMI Loan # 9554907
Dear Mr. and Mrs. Robinson:
This letter is to confirm that citicorp Mortgage, Inc., has
agreed to the sale of the above referenced proporty for the
aum of $130,000.00. It is understood that the net proceeds
from the aale will be not lesa than $121,025.00.
Further conditions for approval:
1. The Robinaons are to net $0.00 (zero) from the proceeds
of the aale, which should be remitted ~
to CHI within 24 hours of closing. /q ~.
2. Closing takes place on or before April~, 1992.
3. Realty commission is to be 6% of salea price.
4. There are no junior liens being paid from the
proceeda of the aale.
5. Any escrow balance ahown as a credit will be retained
by CHI; it will not be returned to the Robinsons.
6. Mr. Robinaon will sign a repayment agreement with
citicorp Mortgage, Inc., for the sum of $25,000.00.
Upon satisfactory completion of the agreement, the
original note ahall be releaaed as satisfied to the
borrowers.
Should any variance occur in the approved
must be contacted to approve the changes.
mail the proceeds check and a copy of the
statement to:
transaction, CMI
Pleaae expreaa
signed settlement
citicorp Mortgage, Inc.
15851 Clayton Road
Ballwin, MO 63011
Attn: M.S.N.E. Theresa Simington
Upon receipt of the required proceeds from the sale, Citicorp
will release the Mortgage/Deed of Trust as satisfied. CMI
iU-6f5~:V :,f{1 ",!lj.4-i
...
Robinson, 9554907
Page 2
further reaervea the right to decline participation if the
above conditiona are not met.
If you have any further questions concerning this matter,
please feel free to contact me ae 1(8001695-0384 x5054.
Sincerely,
~~~
Asset Management Specialist
"
MONTHLY PAY AGREEMENT
FOR MODIFICATION/RELEASE OF NOTE
FOR VALUE RECEIVED, I acknowledge my indebtedness to
Citicorp Mortgage, Inc., in the amount of $39,115.56.
I promise to pay Citicorp Mortgage Inc., the sum of
$25,000.00 under the following terms:
I will pay $0.00 at closing. I will pay beginning June 1,
1992 $298.00 per month for the next eighty-four (84) months
until May 1, 1999, and $266.00 as the final payment due on
June 1, 1999.
Upon the completion of this agreement, Citicorp Mortgage,
Inc., will release the Note presently held by Citicorp
Mortgage, Inc., as satisfied.
I 0100 underatand that I will be in breach of this agreement
if any payment is not received within 15 days of the due date
of said payment. In the event that a breach occurs, Citicorp
Mortgage, Inc., reserves the optio.n to call the total amount
of the acknowledged indebtedness less the amount of
previously applied payments immediately due and collectable.
I agree to mail the first month payment and all other
payments to Citicorp Mortgage, Inc., P.o. Box 790024, MS 324,
st. Louis, Missouri 63179-0024, Account #9554907 to arrive at
the place specified above not later than the date due as
indicated above.
Citicorp Mortgage, Inc.
Barry Luechtefeld,
Staff Vice President
Date
~"-o :...-:;t6~.- ~ ~
\~n Rob nson
.5//7/1:1..
Dat!e
71lo ~Je.Gt..., tI:E/d
Sn. ~~() ~AI~( t:r dZP-,a,
Preaent Home Phone:#/~m-.!iWr Present Work Phone:.:;>..."-(~'9-.J'';:-o
Subscribed and swore before me this ~ day of~1992 by
~Mw_3(,1 [qq'{
-
Present Address:
"
My commission expires: 'j",-
... 1 I , ~~
Notary Public: ~7'J"I/(> (b
~'-:,,,"'I#.I ~
::Y"f .':",...,
,"
l ~ , "
-;:(:':"l.i ,It .,
....../. ...~,..-I _- ....'
'-
"-
JAMES M. BACH
Attorney at Law
352 S. Sporting Hili Road
Mechanlclburg, PA 17055
October II, 1996
Tel: 17171737.2033
ROBERT E. ELICKER, II" ESQUIRE
Divorce Master
9 N, HANOVER STREET
CARLISLE. PA 17013
RE: ROBINSON V5. ROBINSON 96.3312
Dear Mr. Elicker:
Enclosed herewith please find Interrogatories which have been answered by my client
John Robinson.
I am respectfully requesting that we move forward to schedule a hearing on this case.
I am certifying that discovery is dosed.
Respectfully,
ES M. BACH
Attorney At Law
JMB/lsa
End: Interrogatories
cc: Taylor Andrews
,/
.
B. "Document" means any wrlllen, printed, typed or other graphic mailer of any kind or nature,
Including but not limited to, agreements, contracts, asslglunents, lellers, telegrams, Inter-orncc
communications, memoranda, reports, rccords, transcripts, instructions, specifications, notes, notebooks,
diaries, minutes, minutes of meetings, plans, photocopies, charts, graphs, descriptions, photographs,
motion pictures, videotapes, mechanical or electronic sound rccordlngs or transcripts thcreof, and any other
retrievable data, whether an original or a copy made by any means, Including any non-Idcntlcal copy
(whether different from the original because of any alterations, notes, comments, or otherwise), together
with any supplements or allachments thereto or enclosures thercwlth,
C. "Oral Communication" means all non-wrlllen communications, whether face to facc, by
telephone or otherwlsc,
D. "Identlncatlon" or "Identify" when referring to an Individual, a corporation or other entity
means that you wlll set forth the name, present or last known address and, if a corporation or othcr entity,
Its principal placc of business, or If an Individual, his or her titlc or titles and by whom employed. Once an
Individual, corporation or other cntlty has been thus Identified in answer to an Interrogatory, It Is surnclent
thereafter when identifying that Individual, corporation or other entity to state merely his. her or its name,
E. "Datc" means the euct day, month and year If ascertainable, or If not, the best approximation
Including rclatlonshlp to other evcnts'
F. "Person" means an Individual, corporation, proprietorship, partnership, association or other
cntlty,
0, Whencver the expression "and/or" Is used In these Interrogatories, the Infomlatlon called for
should be set out both In the conjunctive and disjunctive, and wherever the Information Is set oUlln the
disjunctive, it should be given separately for each and every elemellt sought.
~
4
4, State your educational background since graduation rrom high school. Include all
educatlonallnstltullons allended, dates or allendance, degree or certificates obtained,
I. No de0rA~~ ~r c~rtlflcat~s obtained,
2. Att..J~,lej Phlljl.l!p'da :;ol1e;:e ::>f Te:-:tlles anj SclE'nce for
<Ipprodmatel,' I ye (If, nlc;:ht school. 1966.
3. ^ttl3....ded Penn 3tate e.;tflns:~on C:3R1PUS. O.;:ontz:, PA for 1 year,
nlc;:ht school. 1965,
q. Attend"J1 Rl'1'H' C,;:>lls:J6. Trenton, HJ f:Jl" Ila!f a \'ear,
....I'Jht school. 196."
,
~
S. If you are currently separated rrom your spouse. state the date or separallon.
May I, 199 1 ,
j,
<,
.
REAL ESTATE INFORMATION FORM "A"
INTERROGATORY #6
(NOTE: Complete one (II Form. A. for each real estate Interestl
a,
Address of propeny:
7All Gl'avellov Hi!! RO'3'j. S.:Jl.lt,l KinQ>itown. Rl
b. Type of property: (For example, condo, single family residence, unimproved lot, conunerclal, etc,l
SinQle Fami!v
c. Nature of your Interest: I~estdence
d,
Date of acquisition:
Septembtlr 1988
e,
Method of acquisition (purchase, Inherited, gift):
purchase
f. Name(s) In which title Is/was recorded: John & Marqaret Robinson
g,
Purchase price or value at acquisition:
$159.50U
h,
I.
Current fair market value: House W,):3 s\Jld fOI- $130.000.
Net aftJlt' re commls:llons S121.00p
Name and address of any co-owners and extent and nature 0 their Interest:
None
As to any mortgage, encumbrance or lien of any nature, provide:
I. Identity of mortgagee or holder of encumbrance: C 1 ticor'p
2. Identity of any co-mortgagors: None
3. Amount of original mortgage or encumbrance: unknowl'
4.
s.
Amount of present outstanding mortgage: hous e wa:3
I person~Ilv Incurre1 a $39.115.55 debt
Original term of mortgage:
said at a loss.
Variable rate, 30 years,
6. Remaining term of mortgage:
hou~e was sold in February 1992.
k. AUach any appraisal of the property that has been made within the last ten (10) years.
N/l\
oil
,
, ,
J. rr lhe property or your Interest therein has been sold or otherwise transferred within the pastlen
(10) years, slate:
I.
Date of sale or lransfer:
7./27/92
2,
3.
Idenllty of transferee(s):
stephen and Barbara Joyce
Consideration paid for transfer:
$130.000
4.
Tenns of sale or transfer:
'lnal sale. cauh
S. Whether any portion of the sale price Is stili due by way of note, bond or mortgage and, If
so, stale lenns and amounl due:
6, The disposition of the proceeds,
Citlcorp Mortgage Bank received $121.025
Caswell A~uociates R~altor received $7800
John Robln3on recellled m'~mthll" payment contract for
$39.115.56 owed to Cltl::orp for I'emdlnder of debt owed.
.,
,
III. I<:MPLOYMENT AND INCOME
8, Stale your primary occupation or profession,
i!
Bus i ness Ana 1 ~'s t
9,
Slate any other occupations or professions In which you have engaged within the pulten
(,
I,
'1
.
I
i
(10) years,
Market.inQ. Saies, Consulting
.
~
INCOME FROM WAGES, COMPENSATION, AND/OR SALARY FORM "0"
INTERROGATORY #12
(NOTE: Complete one (I) form "n" for each source of wage, compensation or salary,)
a,
EDS
210 Grandviaw D
Camp Hill. PA
Indicate which of the following Is applicable to lhe source of wage or salary Income Identified on
Ihls form:
Name and address of business from which you receive salary or wage:
b,
Self-employed
X Employed by another
Partnership In which you are a partner
Sole proprlelorshlp In which you are lhe sole proprietor
Professional corporation In which you are a shareholder
Olher, please Indicate
Tille or capaclly In which you arc employed, and nature of your duties:
austne'!!> Analyst. write rePDrt.!! ."bout customerl'l
Dale of your Inlllal employment: business process.
October 1995
Whether you hove entered Into a wrlllen agreement of employment, If so, aUach a c~of lhal
agreement: ~~x~*~~Il;~IIIIH(X~lll\~IlS;(~ij~i'~X\S~1SX~~~IUPO( XXX
None
Your gross yearly, monthly, or weekly Income: If paid on an hourly basis, slate hourly rale of pay
for both regular and overtime hours: Gross pay $2625 every two weeks
No overtirne
List all deductions from your pay, Including, butnotllmued to, taxes, Insurance, FICA, savings,
loans: Total 3933. F'eJ $535. F'ICA 157. St.stf'l $75. LucaI tax
$26. Insurance $14U
h, Your net yearly, monthly or weekly Income: tlet pay $1692 evory two
I. wee~tach your federal Income tax returns, Including all schedules auached Ihereto. for the Instlen
(10) years and Ihe last four (41 pay slubs received from your employer:
Have l'...tur.ns back to 19'n. lost or dQstr~yed before
If you receive any trovel allowance, expense account or other reimbursement of expenses from
your employer, slate amount received from your employer for each of the pastlen (10) years
Including lhe current calendar year to dote:
, dLrect expenses,
I hl1.v.f).. "I.ver l'ucoLI'O\! <I travj!l all<lwence. I alii relmbursed fOfr
k, :;ellon i any bonuses recelveu by you trom your employer In the pastlen (10) years Indica! ng date
and amount received: VIII 11 e '~ol-k I n'J fUI' NallQ Lah3, In 198/ I
recel ved n bO!ll1:l or' ,lppro,(, $JOOO. I havo not ra.:"i ved a bonus
e.
d.
e.
f,
g,
J.
..
.
IV. BUSINESS OR COMMERCIAL INTERESTS
13. Complete one FORM "CO allached hereto for each corporation In which you now hold or
have held wllhln the past ten (10) calendar years 10% or more of the outstanding and Issued capllalltock,
whether common or preferred, (NOTE: Use one FORM "CO for each such Interest),
Enter here the number of rorm "C's" allached. U
14. Complete one FORM "0" allached hereto for each partnership In which you now hold or
have held within the past ten (10) years any Interest. (NOTE: Use one FORM "0" for each such Interest).
Enter here the number of rORM "D's" attached. lJ
..
.
V. ASSETS OTIIER THAN COVERED IN PARTS II AND IV
IS, Identify any automobile, truck, camper, mobile home, motorcycle, boat, airplane or
vehicle of any nature that you own or have an Interest In, or have owned or had an Interest In since
January I. 1990, and set forth (use supplemental sheet If necessary):
a,
Make, model, year;
Sportcraft Sportfisher, 1984
b,
1988
c.
Date acquired;
Purchase price or value at acquisition; $1 8, 000
d,
Your opinion as to current fair market valuei. NONE
Rapoasessed by creditor, ~hawmut Bank
How title Is held; John & Margaret Robinson
e.
f,
Name and address of any co-owners or Interest holders;
N/A
Date, initial amount, present balance of any liens or encumbrances thereon
Shawmut Bank
Including Identity of lienholder.
g.
*Boat had a debt of $30,000, but was only worth $18,000, it had
a negative value.
'.
.
,
V. ASSETS OTHER TIIAN COVERED IN PARTS II AND IV
IS. Identify any automobile, lruck, camper, mobile home, mOlorcycle, boat, airplane or
vehicle of any nature that you own or have an Inlereslln, or have owned or had an Inleres! In since
1anuary I, 1990, and set forth (use supplemenlal sheellf necessary):
a.
Make, model, year;
Mazda 32,3. 1969
b,
Dale acquired;
1969
c, Purchase price or value at acquisition; S 12. 500
d.
Your opinion as to current fair market value;
$4000
e.
How lltle Is held;
John & Marqaret Robinson
f. Name and address of any co-owners or Interest holders;
None
g. Date, Inillal amount, present balance of any lIena or encumbrances thereon
Including Identity of lienholder, None
..
V. ASSETS OTHER THAN COVERED IN PARTS H AND IV
IS. Identlry any automobile, lruck. camper, mobile home, motorcycle. boat. airplane or
vehicle of any nature that you own or have an Imerestin, or have owned or had an Interest in since
January I, 1990, and !et forth (use supplemental sheet If necessary):
a.
Make, model, year;
Ford Thundorbh'd. 1987
b.
Dale acquired;
1989
c.
Purchase price or value at acqulsillon;
$14.000
d.
Your opinion as 10 current fair markel value;
1991 car sold
e, How title Is held; was John & Marc;/aret Robinson
f.
Name and address of any co-owners or Interest holders;
Dale~fnh~1 amount. present balance of any liens or encumbrances thereon
g.
Including idenlily of lienholder.
Ford Credit sold in trade
.
V. ASSETS ()'I'IIER 'J'IIAN COVERED IN PARTS II AND IV
15. Identify Iny Intomoblle, lruck, camper, mobile home, motorcycle, boat. airplane or
vehicle of any nature Ihal you lIwn or have anllllereltln, or have owned or had an Interest In Ilnce
Janulry I. 199(), and let forth (ula 10(l(llemenlallheetlf lIecessary):
a. Mlka.model, yelr: ChFlllolFlt lllazer. 1907
b, Dlla acqolred: 1907
c. purchasa (Irlce ur value at acqulshlon: $17.000
d, Your lI(llnlon allo current fair market value: car sold 1993
c.
\low Ihle Is held:
John Robinson
Nlme and address of any co-owners or Interest holdersisoId
Dlte, Inlllal amount. (Iresent balance of any liens or encumbrances thereon
Including Idenlhy of lienholder.
GMAC sold in trade
f,
B.
~
16, Idcntlfy 011 furnllurc, houschold goods, Jewelry, anliques, arl work, furs, guns, lools,
Apalllns c1lulpmcnl, collcctlons or olhcr hcms of value exceeding $50,00 which you owned as of lhe timc
IIf Icplrallonln 1992, 1'0r coch such Item sel forlh:
0, Dcscrlption
II, Purchasc price or value 01 acquishlon;
c, Your opinion os to fair markel value;
d, Prcscnllocalion,
"'''S'I'EII BI!:DRO':lM Se:TBed, .end t3bies, mattress a,It,!. boxf;prInll., ~
huruilus. lol,nps. vanity. mirror. ( Margaret kept)
t'a.I';CI'R'JNIi;S Sony .11" TV. ,;tlolJ'eo. tape plaYGr. VCR. radio.
!Ipeaker's ( Mar'Jaret kept)
31NGI.E E1EDRO,JM SlIT bureau. table. bed. mattress dnd boxsprinIJ.
( MBrt;taret kept)
LiVING 1l00M couch. love 5Gat. coffee table. lamps. oriental rUIJ.
and l:abl,}s. ro,-~kf)r. paintin9s. lIthrJgraph!,. nlck..nacks.
(margaret kept)
I>lNING ,ROOM l.Jak lions claw tolble elld chair". 3rt'1 rUIl. (Margaret
kopt.1
KtTCHEN ITE:/~S chinn, pIates IJlasaB5. sllverware. (stainIess)
t08Sl:1'I1' oven. mIcrowave oven. pats and pans. IIten:1Ils. gas Qrill.
(MBrIJBr'et kept)
P:ISlIHIG GEAR, 4 dB~p seo'! !"Ods and reeh.3. fre!lhlo/ater,rods .,and,
rllElls. 2 surf rods and reels., 2 tiJc~le bOKes ,(.J:ohn, kept).
JEWELI::RV diamond allnlversarv rIng. assorted other rings.
neckl'.lces. braC'let!l, earrlnyo. (Mal'garet kept)
rooLS .' .small tool bOK ('lcrew:\r I vera, wrencllesLJ1J.lJic;;,. i,t_em:o.
hummer. pllars. ( .!ohn,kept),
SMALL FR~~E?'En pal,! $3!)'.) owrth $IUO (John kept)
WASHER AND ORVER DaId $600 sold for $200
EXERCISE BI~E paid $10U (MarIJarvt kept)
LINENS AND BATIl ACCESSORI ES (MargaJ'et kept)
REFRIGERATOR Pol liJ $200 sold for $100
.
18. Complele one FORM "E" auached for each banking account (checking, passbook, NOW,
statement savings, certificate of deposit, savings certificate, elc.) In which you now have or, within the past
len (10) years have had, any Interest, ownership or power of wllhdrawal whatsoever, whether Individual,
Joint, as custodian or trustee for olhers, or as the beneficiary of an account held by another as custodial or
truslee. NOTE: IRA's, Keough's or other bank retirement plans need not be mentioned here, see question
28.
Enter here the number of FORM "E's" auached. 'i
~<j.jj.-,.- ...~.
.
BANK ACCOUNT INFORMATION FORM "E"
INTERROGATORY #18
(NOTB: Complete one (I) Form "E" for each account.)
a. State name of bank, title of account and account number.
Mell.~', BdrlV" ~,~mp lull 1I1.Jn.;h. lUU Ul:!) 1407
b. Type of account (checking, savings, certificate, NOW, etc.):
CheckinQ Account
c. Date you opened such account or date you acquired your Interest therein:
Pall 1995
d. Date you closed the account or otherwise ceased to have any Intercstthereln:
~/A
e. Name and address of any other persons who have either an ownership Interest or power to
withdraw funds from such account:
Non"
f. Identify possessor of statements for the past ten (10) years and describe location of statements. If a
checking or NOW account, Identify possessor of all checks wrluen during the past ten (10) years
and describe location of checks:
Mellon Bank
g. Balances as of the following dales:
I. Date of separation:
Q
2. Date divorce action n1ed:
';;''''3
3. Date you answered these Interrogatories:
1/21/96
.
BANK ACCOUNT INFORMATION FORM "E"
INTERROGATORY #18
(NOTE: Complete one (I) Form "E" for each account.)
a. State name of bank, title of account and account nwnber.
"~us r:rudlt U"!'JI1. Camp Iii 11. 6U950007
b. Type of account (checking, savings, certificate, NOW, etc.):
:iav i ntJ::J ,.'cc()unt
c. Date you opened such account or date you acquired your Interest therein:
fall 1995
d. Date you closed the account or otherwise ceased to have any interest therein:
N/A
e. Name and addr:5s of any other persons who have either an ownership Interest or power to
withdraw funds from such account:
None
f. Identify possessor of statements for the past ten (10) years and describe location of statements. If a
checking or NOW account, Identify possessor of all checks written during the past ten (10) yeara
and describe location of checks:
!OS Credit Unlol'
g. Balances as of the following dates:
I. Date of separation:
o
2. Date divorce action n1ed:
.lJJl'Jrox. $8~01l
3.
Date you answered these Interrogatories:
l/21/9f>
.
BANK ACCOUNT INFORMATION FORM "E"
INTERROGATORY #18
(NOTE: Complete one (I) Form "E" for each account.)
a. State name of bank, title of account and account nwnber.
Unl".lfl N.IlI);I l.Iank. :1ont,10merYIfIU". PA Account 1/
'Johnown
b. Type of account (checking, savings, certificate, NOW, etc.):
Cheek I ng Ac('r.JUn t
c. Date you opened such account or date you acquired your Interest therein:
1993
d. Date you closed the account or otherwise ceased to have any interest therein:
1994
e. Name and address of any other persons who have either an ownership Interest or power to
withdraw funds from such account:
'lone
f. Identify poss:5sor of statements for the pastlen (10) years and describe location of statements. If a
cherklng or NOW account, Identify possessor of all checks written during the pastlen (10) years
and describe location of checks:
'Jnloll r1,ltlunal Bunk
g. Balanc:5 as of the following dates:
I. Date of separation:
IJ
2. Date divorce action flied:
u
3.
Date you answered these Interrogatories:
JIJ.l/%
.
BANK ACCOUNT INFORMATION FORM "E"
INTERROGATORY #18
(NOTE: Complete one (I) Form "E" for each account.)
a. Slate name of bank, title of account and account nwnber.
1.lburl'{ Bdllk. E:.l:lt lI'l'Iu'~:'~n. (;.t. "08 UI..l664
b. Type of account (checking, savings, certificate, NOW, etc.):
'.:Imck I 11<,1 ACGOUII t
c. Date you opened such account or date you acquired your interest therein:
19')2
d. Date you closed the account or otherwise ceased to have any Interest therein:
199J
e. Name and address of any other persons who have either an ownership Interest or power to
withdraw funds from such account:
Noop
f. Identify possessor of statements for the past ten (10) years and d:scribe location of statements. If a
checking or NOW account, identify possessor of all checks written during the past ten (10) yeara
and describe location of checks:
1.1 bert y Bank
g. Balances as of the following dates:
I. Date of separation:
'I
2. Date divorce action flied:
I)
3.
Date you answered these Interrogatories:
3/.l1/9f,
.
BANK ACCOUNT INFORMATION FORM "E"
INTERROGATORY #18
(NOTE: Complete one (I) Fonn "E" for each account.)
a. State name of bank, title of account and account nwnber.
Uld ~t0~~ Oank. W~kufi~lj, RI 3009b0349
b. Type of account (chccklng, savings, certificate, NOW. etc.):
'::heck i nq ^,:..:oun l
c. Date you opened such account or date you acquired your intercsttherein:
unknown
;
;
r
I'
}
d.
Date you closed the account or otherwise ceased to havc any Interest therein:
1991
'I
e.
Name and address of any other persons who have either an ownership Interest or power to
withdraw funds from such account:
Maruarct Robinson
f. Identify possessor of statements for the pastlen (10) years and describe location of statements. If a
checking or NOW account, identify possessor of all checks written during the past ten (10) years
and describe location of checks:
Olr:! Stcme Bank
g. Balances as of the following dates:
1.
Date of separation:
320U
2. Date divorce acllon flied:
\J
3.
Date you answered these Inlerrogatorles:
U 21/96
21. If you have at present or If you have had wllhlnthe past ten (10) years an account with any
security dealer or broker, slale:
a. Name of broker or dealer;
None
b. Business location;
N/A
c. Identify the current cuslodlan of the monthly slatements of each account you have
had during the past ten (10) years.
NIA
22. Identify any safe deposit box which you have had or used within the past ten (10) years and
set forth:
a. Name and location of the Institution of each box or deposltorYi
N~\Iel' hall d Dafe dOPOSlt boll
b. The name ur names In which It Is registered;
N/A
c. Dale of opening and closing of each;
N/A
d. Present contents of each box or deposllorYi
~/A
e. The Identity of anyone who has access;
N/A
..;;....,.'"
.
23. State wheUler there Is any money owing 10 you now, or was any money owing to you at the
lime of separation, Including, but not limited to, Judgme:Jts. noles, conlract rights, loans, asslgnmenlJ, etc.,
and set forth:
No money was or Is owed to me.
a.
Nature and amount of each obligation and date incurred;
b.
Nanln and address of each debtor:
N/^
N/A
~/A
N/^
N/A
c.
Conditions of paymenl:
d.
Consideration given:
e. Collateral or security for obligation:'
f. Current balance due;
iliA
g. AUach writing Indicating proof of debt or obligation.
N/A
24. Do you antlclpale receipt of any devise, bequest, gifts, or Inheritance? If so, set forth:
a. When receipt Is anticipated;
Lat~ 1~96 or 1997.
b. Amount to be received;
Unknown at lhis time.
c. Prom whom receipt Is anticipated;
Death of father'.
d. Any documenls In support of such bequest, devise, gift or Inheritance.
Not at this time.
e. Idenllfy the personal representative for your Pather's Estate.
Peter E. Moore
f. Identify the offlce(s) where any filings have been made pertaining to lhe
administration of your father's estate (e.g., probale of will, filing of Inventory or
Inheritance tax return).
2.5. List all Insurance policies, Including life, health, major medical, In which you or your wife
are either the owner, Insured, or beneficiary, or In which you or your wife were lhe owner, Insured, or
beneficiary within the last ten years, and as to each policy set forth:
a. Identity of Insurance company and policy number;
b. Face amount and maximum benefit payment;
c. Amount of deductible, If any;
d. Type (whole life, major medical, health, ctc.);
e. Identlly of lhe owner, Insured and beneficiary and any relationship to you;
f. Arulual premiums and the payor;
g. Date of separation cash surrendcr value;
h. Present cash surrender value.
A. EOS Health Benefits. Self Admin.
B. lIe<JIlh. Pharm. Major Med./Life
C. $150 t1eductable -Health
O. Medical/Health/Lite
E. John Robinson
Connectlcut Mutual
1\159050
$50.000 Life IllS.
Life Ins.
rel"m Life
Owner John Ilobinson
Insured Marqnret rlobinson
$30U John Robinson
o
No cash vallie
~'. Appro/(. S 1 'iOO John Robi nson
G. 0
II. No cash value
27. If you have, or have had for you, prepared a I1nanclal or net worth statement within lhe
past ten (10) years, set forth:
I have nevur done one.
a. Dale prepared; N/A
b. Identity of preparer; N/A
c. Identify to whom slatement was Issued;
N/A
d. Purpose of preparation or Issuance:
N/A
e. A copy of the financialllet worth slatement.
N/A
28. Complete one FORM "a" for each pension ur other retirement plan. IRA, SEP, Keough,
etc., in which you now participate or have participated at any time within the past ten (10) years.
1
Enter number of Forlll "O's" attached.
VI. CREDIT, LIABILITIES AND OBLIGATIONS
29. For each credit card or charge acr.ount maintained by you at the time of separation,
whether In your Individual name or Jointly with others, state:
a.
Identity of Issuer of credit card or charge account;
Bank of America
Account number; 1024004685585271
b.
c.
In whose name account Is maintained;
John II. /~arqaret Robinson
unknown
Balance due as of date of separation and as of the date of your answer to these
d.
Date opened;
e.
Interrogatories.
$2106
a. 1l0SPITAL TRUST Sears cttibank
b. 706600160390 380320444215 -12'/136221065111
c. John II. Mo.lrqaret Robinson John & MarQaret John & Marqaret
d. unknown unknown unknown
e. $523 $lB52
1703
31. Sel forth In detail each of your obligations as of lhe date of sej)arsllon, whether Individual,
Joint or Joint and several, Including but nolllmlled to, contract obligations, financing stalements,
promissory or Judgment notes, Including:
a. Name and address of each creditor;
b. Form or each obllllallon and dale Incurred;
c. Consideration received for Ihe obllgallon;
d. Amount of original obllgallon;
e. Rate of Interest;
f. Description of any security given;
g. Unpaid balance on date of separation;
h. Present unpaid balance on the obllgalion.
32. State the amount of financial asslslance you have provided to Margaret L. Robinson since
your separation. To the extent possible, state the number of times you have provided assistance, the
approximate date, and amount of each occasion.
NONE
ANDREWS & JOHNSON
By:
Taylor P. Andrews, Esquire
78 W. Pomfret Street
Carlisle, PA 17013
Telephone: 717-243-0123
i
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JOHN R. ROBINSON,
: IN TIlE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: NO. 96.3312 CIVIL TERM
: CIVIL ACTION - LAW
: IN DIVORCE
Plalntlrf
v.
MARGARET L. ROBINSON,
Defendant
CERTIFICATE OF SERVICE
I hereby certify that on this llatc,
, 1996, I mailed a copy of Defendant,
Margaret L. Robinson's Interrogatories Addressed 10 Plaintiff, John R. Robinson by
regular mall to Plalnllrrs Counsel of Record, James M. Bach, Esquire, atlhe following address:
James M. Bach, Esq.
352 South Sporting 1111I Road
Mechanlcsburg, PA 17055
Respectfully submitted,
ANDREWS & JOHNSON
Date:
By
Taylor P. Andrews, Esq.
78 West Pomfret Street
Carlisle, PA 17013
(717) 243.0123
Supreme CourllD No. 15641
I
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tot hlv.a, Aal.nd
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X ,..,'IrI...,..".....1H
tll..nlfunr.1H
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U.S. IndIvidUal '"come Tax Relutn
1995
hr the ......... 1- b.L tI tl.. .,.u,,, ta. "," nnln
VI"" n,. ....... "II' Il.t
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t . .... ","'",.,......'tttl...M.lIlltltllll.
kAROARET L ROBINBO!l
fl..... .d~,...t"Il.""'" '''''I~ II 'U h...... r.o, ....,.n 'I.. II.
4172 NANTUCKET OR
Clfv. t,... " ,..I.,lIe., 11&1., .,.11I111'..11.. U "'" hi.. .ltu.l". .lId"... I.. "I' It.
HECIJANICBBURG PA 1'1055
1I1'.,ndl"
..In,...,
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Do yoU WI"t $3 to go to lhl. fund' . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . , , fl' . . . . . . . . . . . .
1,,1.,luln do" our ou" Willi t:J 10 10 1I~. fUl1d? . . . . . . I . I . I . I I , . I . t . I I , . , ,
81l1gl1
X M.nlod 1111111101111 ilIUm (evoll " o Illy onl h.d 111e0ll..,
MII.lad 11111111"".'11 ilium. elll", .pou.... 'na. ...,. 110. "llO" & ful h.rnl hllll ~
HOld 01 hOUllhold (wtth qoollfy!IIQ pili""" (s... p.g. '2.)lIlh. qUlillylllll pillIOn I. ~ child bul llOt your d.p."d""I.
."Ior 11010 elM
a Qulll/wl
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d II your chid dldll' I.. Wllh yoll bllll" dolmed.. you. dop. und., pII.'voa '11'0."'0111. chock.. ~[J
· Tol.1 nurnber 0' ...., Uolll diluted. , , . . . , , , . . , . . , . . . . . , . , . . . . . . . . . , . . . . . . . . . . . . . . . . I .
Wagas. '''1110', tip', 110. Attach FOln~lI) W-2. . . , , . . . . . , , , , . . , , , . . . . , , , , , , . . , . , . . , , . . , .
T...blol"IOIooIl'lOOII1II (.... p.go fe). ^""ch Schocl1Jlo b h ov., t-loo .. ............... ...
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bMdondlocome. AUechSchudulftBHovnr $400.,..,:,.."",..,.,.,., ......,..,. .....
T.."bl,'olllnd., ...dlls, a. oll..ls 01,,1.1. I"d Iocollncomo I.... (... p.go tS). . . . . . . . . . . . . . .
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90,III811Inoot.. ot (Iou). Attach Schodul. C 0' C"E2. . . . . , . . . . . , , . . . , , . , . . , . . , . , , , , , , . .
CllpllDl gal;. or (Iou,.llrequhd. IUlch Schndufa b.. ...., f ., ....,.,..,.,..,., , .., ..,...
othot gllln. 0' (Iollsn). Attleh rOlm 4107 . . , . . , . . . . , . . . . . . , . . . . , . . . , . . , . . , . . . . . , , . . . . t
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yoUt 1M dedueUon (Ilea p.ge 18), , .. . ......,. f..'. , ...",. 234
SpoUllu','nA deduclfon (lee PAQ1I10) , . . , , . , , , . , , . . , , . . , . ., 2311
Movl"lI n"p.n_. AUach ronn390:J d' 39O:J-r ...... .. .. ..... 24
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14 011101110111. I1l(k"A"'. Alloc:h F1I1I1I4707. . , .. . . . .. . . . . . .. , , . , . . , . . . . , . . , .. . . . ..
ISd 11lIall"^dl.IIIIIIIIIIIII. ..11Snl ___Ih In..III..II''"I1I(,..,,", II'
fOd Inl.ltll"lhlll'.IIIIAn"ulll.., ll!~l.~..______~ b 'nwnbln nllnlllll (non tJrt, 111
f7 hOHlnI,n'" nntnlo, luvnlllnn, ,.mlll"lnlllp". S f:U1f'tJ'ntllllm, tllloln, 411ft. Allnr-It 5chnduln e , ..
10 tnlllllnr.olllO 01 (~."nJ, ^llm:h ndlfutuln r. . . . . , , . . . . . . . . .. . . . , .. .. . . . . . . . . . . . . . .
19 UI1f1I1t>IoYlUfllll f:U1I'(lOIlMIIUI1 (!liNt 'lmlll tOI. , . ,
20d 511dnloocuIIIV """011I. . ~ .. .. . i i,' ~~;~bl~'~,;~,;t;,i i~~~ ;,~' i~j
21 OlllftllllCDI1K'
73.334
13
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22 Add Iho all"UIII.III Iho 'm II hi eOIIll~lIll11l1l111. 71h,uu h 21. lli1.I.
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b Spllu.o'.11lA d.dllclloll (A.ol'.!/1I 10' ' , , , . . . . . . . . , . .. 236
24 MoYh'll .'"OI1'M. M.d, Fill 111 :lUlU "' 3011:l.r , . . . .. . .. -24
25 Ollo-h.III1I..II""',.,ll1yll.II,II....................... -25
~ 20 SIIII-.II.>k'V..llllI.llh IIIAIII.IICII ,IoI1II1c:IIII" (A.. '10"" 21'.. "20
21 krnlllh 1.11'"11.,,,1 "IOIIIIA""-.II.,I"YIIII !lEI' d"d'II:II1111 . ., -if
20 "."nlly o".oIIV ..lIl1d, 0...1 c:1 ..,111",1. . , . . . . , . , . . , . . .. -20
211 AIII'''''V'IOld, n.dl>II1I1I'A Snll.. 2ir
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76.555
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31 5ubtlacll,IO 3D 110111110'"22. Ihl." 11\11. u.l.d '0111110010.....................
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32 Al",u'''''olun''o~1 (o1llllol""lIlIIooh.'"""I.....,.,,..,.......,.. "0'" .......
tll. 3311 e"..,~ II: 0 YoU WOI. ODlllhlol, Olllltlll; 0 !l"OIlNI WAn OD/oldot. lIu"d
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lalloll II II YIIIII t",ohllol 011""11I.1110011'0" "'0'11\ Y"" .. . ,I"ro"do,,', "I",,:~ hoto. . . . . ~ 3311
ISon h...... b "vou "0 '''.''Iod IW"d .0~Nol"ly ~lId Y"'!I"I."'I""I1""j,,,. dOlhl,,\I,,"oll' Y"u ~ 33c
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23,) 34 E lot i-It.1Il11l1t...""Olla".,llII" n"'",d"l" A, ""0 20. 011 }
l':~ SI."d.,d ...d\lollall.huw" billow '01 YlIIlIlIlI'IIIJloh".l1uIJ' yrU .I'.c~ld
t I'I1V bolt 01111':1 331 01 h. (JIIlf) J)n{to 2:1/"111 you. alnl! nil doduclloll.
'''00 If you chlleli. box 330, Villi' nlnl1UnllJ ( llf t1f:UIlI1I" '010.
01 , !llt..~o -- $~.O(lO I ""OIt ,,'lllllloohull .. $0,000
yolll: . M.i"OIII11I"U ~"..lIy IIIU"olllyl"'l wl1l"wIOl)'- $0.300
_' Mo,,'od IIIIIIlJ """01 ololy -- $:1.11"
35 !lllbllocl n"o ~H",,, """ 32. . . . . , . . . . . . . , , . . . . . . , . . , . . . . . . . . . , , " . . . . . . . . . . " . "
30 II ~"o 321. $03,000 ",inn., h"IiII,ly $2.~!lO I,y "'0 111101 hl""hOl ,,' 0'''''0,110''0 dolt"od ""
blln fin. II him 321" flvul $n:1,Onn. ""1111111 wtuknlll1olnl1 1111!111 2~ lul UIn nllMIUIII 10 nlllnt . . , , , ,
37 "h..hl. 'noolnl. SlIbllnd hlln:1o 1111111 fhm ar, II nlln::10 IIIIItrllO Ihnll Nllo 3D, nl1lnt ..0... . , . , ,.
311 tn.. ehOl;~ 111'011I n j!g Tn' Tohlo. b lJ 1..1101090111"1,,1,,.,0 t1 enllllol n.h. tn. WIII~-
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311 Addtlloll.llnxo., r;hlll:~ 111"'"1 n [] r",," ~!Ill1 b U ru,," ~0'2 "..... . . . , . . . . " , .
40 Addnuu.!Ioolld!lo..,.."..........."....."..,.""".,."........""." ~
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43 rlllolUII In. dndll, Allo"', rUIIII Illn . . , . , . . . . . , . . . . . . . . .. -4:r
44 011'0' Clodll. (00. "ono 2n}. Chfll:~ IIltu'" nO r"III'3noo
b D r01l1l MOO 0 U rUlli' 0001 d [J rUIIII 44
45 Add ""., 4'"lIlIlIlIh ~~. . . . . . , . . . . . . . . . , . . . , . . . . . , . , . . . . . . . " . , . , . . . . . . " . " " ,
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47 soll-on"IIIY"""I1... Allo"h !ld.rrrh'h,!lE. . . . . . . . , . , "" . . . . . , , . , . . . . . . . . . . " . . . ."
40 NlollIOllvOlllllhl.lln In.. Allot:1o rll"" 020 I , . . . . " . " " . . . . . " . . . . . " . . . . . , . , . , . . . , .
411 hocoplmo Inxo.. eloOl;~ 1111011I n [) rU1I1I ~2nn b [J rll"n 00 It 0 I::J rullll 0020. . . ... .
liO Sudnllocllllly nlld Modlco,o I.. ,,"11,. h",,",1O 1I11I'Or"llod III oll",lllYO', AII.d, rOlln ~13' ..,
5t t.. 011 ~lInllllod 1.lholl,",1 ~lnll..ItIl'III,II"III"^n. 1I10111lhod. oll.clo r01l1l 0320 . . . .. . NO. ...
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6 350
'10 ,205
30 4 900
37 65.305
13.351
13 351
53 Add UIIO. 40 Ihlou It 02. Thl.l. oll'lol.ii.......,.,,,.,,,,,,,..,,.,....,,,,...,, I-
6 r,.d,uIII"r."ItI.I". wnhl,.ht," '"y I. ,,"." tUII"'_II"''', ~It.l'" , . . ~ 54 15 . 361
55 t99~ ..1I111010d 10'1>0\'1110111'/1 Oll~. o/lI,II"d '"1111 10031nhlll'. 55
50 1!.ln.d IlIcahl. cl.dll. lI'IIlI"ItIllI, nllo"h !ldl. Elc ("'III 1'11.271. I I
"'olllo.nblo oo,"od hICUIlIO: 0'"1. I- I .-J 'II
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57 Allkllll,l ~old wllh FOIIIl ~OOO 10.1"''''011 IU~lIl1nll . . . . . . . . . , . 57
50 Exc"". .odol ooctlllly nlld IInlA 10. wllhholrl (0". pn'11I321. .. -50
!ill Oll'nt p.YIlIOIII., chock IlllOlIl 0 0 r,,,,,, w, b [J rOO"" 411.. 59
00 Add b.lII. D~ 1I.0llllh DO. '''.'0 o'u yo", 10111,.. "'.111. .... ... . . . .. ... , , . . . . , .. .. .. ..
of II nnA 00 IlIlnOlA IIlnll nnn 0:1. nllhllnd H.ln D:1 h"l11 nllO 00, 11111110 1110 ftllKJllll1 yoll OYEnf1AIO...
02 ^,'klUIII ullllo 01 YUII wnllll1l!FUNIIEn TO voll. . . . . , . , . . , . . " . . " , " . . . . . . , . , . . , ~
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04 "Milo 031.11"'0 thnll nllo 00, nllbltot:lll"o co h,,".lllu 03. TI,I.I. Ih. AMOUNT YOU OWE.
~ol .1.10110 Oil I,uw In poy.lllr:h'dhlll wltoll" WI 110 UII YUill pnYII..III. .on pogo 32.., , .....". 0
05 ~.UIII.lod I.. pOllnlly 1.110 pogu 3:1). Alou '"c1urlo UII 11110 0,1. . . 05 ,
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E.I. No, 43 -1632899
ZiPCoJo
rln'lnlf)f'f1~ Unln
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nltd .dd,.... LU'1'IIBiiVILLB, Mu
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183
13 534
15 361
1 027
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.
MR & MRSl
IJOIIN R ROBINSON
MARGARET b ROBINSON
1994 IlIcome Il1founnt:!on Worksheel:
............................n................................................
209.32'9655
IIIII\o4803511li
11/21/1942
9/29/191\8
"""""""."""""" FORM 1'1.2 1 N FOIlM/l'I' 10N "~"~A"~'"~"~"~"~"~"~"~"~"~"~
.........Wages......... . . . . . . . . . . 0 . . Taxes Withheld - . . . .. . . . . _ 0 .
MellI. Medi.
SoUrce '1'IS OrOE1F1 B.S. care Fedenl1 S.R. {!are s'r Sl:al:e I.ocal
GENBSYS 'I' 60459 611459 611459 131164 37411 0'/7 1'1\ 1693
R I 'I'BMP S LBO LBO LIlli 91 02 19 RI 26
SPBC."I'Il1\ S 107 In7 111'1 1 12 3 III .1
/(BLbY SF: S 2679 26'19 ;Hi'I'/ !'ill 166 39 Mil 1\1\
CAPl'I'AL S 1013 1 () 1.1 lOLl 76 6J 15 III 21
GLBNNCRA S 7666 766li '/666 002 4'15 111 RI 219
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. - - - ~ - .. -..-...... .. w........ .. ..--...... .. .. .. .. .. .........
73331\ 73334 '11111 14994 451\6 1064 2006
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HHHHHHH"'H'UHH I'ORM I099.R INFORMATION
UroAA 'J'i1xah1e Alllount
Payer '1'/0 '!'ype Code J\mollnl: 1\lIIollllt Rolled
VA'I'AIMI\GF: INC 'I' P 1 I1l3] 18B
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Federal ST state Local
367
1[133
11l.l3
367
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CONNBC'rICU'1' MU'!'UAL
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INTERES'I' INCOMI~ I.ERS
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'1' R 13
'l'JIAN $400 H'HUHHHHHHHH
NOlltax/Exempt: Adjust: Backup Will
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,,'CotIlom.,.IU.. /..,....1_......., . ,., _._._.___ __ ~ III ~.. (Ilbl""!1I*OI1"""llon'c..-Yol""rU"d~
\blvAllo.ooamoWloJl;t.Po"'l'lIn M ______._ ~ Iii _ ~ liIIIoullnQPo"'l'''''
~=. 'IrIVA"",,oCl~~I'.t,., 1<1 ._...___ __ ~ 11'1 __ .. 11'lrAcl:F"",,V1clnrc:o~'IY",llon
..011I0 Ilo1lvAnl'\1Ol>llatnt>.I, .. M .__.___._ ~ III _ .. Illnloo~II1dIIlt.thlo<I1I,""..lIllontund
-'" 1.'U9.~,,"pIrCon"'II" I" _......._ __ ~ III ~ IllCom..>l1I'o1icloOOFund
VI\9JU 20 ^mOlJnllub.hEFUIlUeolOYUUI.uhl'ncllhlo211,umllnolOI........".................. .... .... .2~"
rntlonlUu LTUOI tOltJIIlul"e I_
&/CI1ed
~
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r.'~1ont
r stEP I
j CooovIol'wl4c1
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i . ~'"
",\10011
'-- -.
i STEP 2
M Iltducllon.
.. 10 COmplll.
t ~g1n1.
t..obI.
J~
..
i
I
STEP ~
CGmput*
Your
L t...
hymenl.
IIId
Cr....
r BTEPl
COInptJI.
Amotlnl
i YoII Ow.
01
I YoUI
f h.lund
~
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L ..,....."'....
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crl ..._o(~_
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3/88
endlnq
1'.IlII.f1\U.u.,.... . II "I 'I' I , 'I
--1"""'-------' _0 r,f"lIlUlrt 1111In. 1101 nWI' ","JlAllIln nlJ" dl'IItWlltll.'. )1111111111 t V III 11'1' I" 1I.,.tfllll 1lI1l.
=.cd~:'::."J:t~~2!.. tl.l~ o~.!! ""III(;~I_~I!.!I!! l!I~. !!IU.I.I~!.III~~u~ l:~~'~~~'.!~ ~nl~~lI!..!h'~~~J~~I.~
~nloI\oOUfDAt~ut'nl"tlllrilhe"'D1""c"I.J"..k.I,.lo"lhb.y.Y..r1l,,"oltOl"'III"10,U:I.IIl:1O .. ~
.. b1!bUctlolJ bABE. II 0Cl.e2. S:I Of n~ hy 1IIlcllllyhl. JOllllo,y I, lo'm, 01110, $n,~12:
. ohtf.O!lOlovothytnlchIIY'II..JnllunIV 1.19'1!1,nfllnr$I~.9~~. '0
:Ill tol.1 !loc1.1 BocU'Uy Acl."d II.. 111.1I1U0d 110111011I0,,1 Ad h.".III.101l,,1,010,,110
oocl.hllCo'lIyb.".nl.I.... ,.... .. ... .. . . :10
~I Ave dtdacll"", 1IL111r. 211 I. 10,voI II.." L1t1r,:JlJ. ."hhodU"o ~o hOlllUIIO ~n 011.10111..110'0.
1I1111E 21I1.0,,1I.'V..lh.n liNE 30. .nl....O 00" fll.l. 0",,,""1 wlllh. u.....on lItlE ~~ I,olow) 31
tlllttg st,lu,1 Of 3: Ellh" IIlnounll'Dm III1,,:it In cotUlllll11 un I hi" :l5holuw
t.1nQ 81.luI2: Artd MI,,:lt. colUlI1n A flnel columll U. Ami mil". lolnlln Cnhlll1l1 tJ nnllNr= :1'i lJOlow.
tilletU SI.lu.~, ~"I.. ''''0",,11') hom llno 311" ",.I",m. ^ .lIIt tn/""'"11 Oil L1IlE ~!II..luw
,...."<.....,,:.IIt,, ,,,,,,11
U;,iiil\:ii,iy:vn;.;'
Mij;iili .Ii,,~, 'Vn;',
.
.
PAhl II. Aoolllolla to tEbEItAl AbJU9tEo olt09S ItICOMp.IMOI)
3~ 1,,1....1 00 ""IIV.lloll. 01 ,,11,.. 01.1.., "."'1.11,,". 1..lm.llllt"'". I.., bul "ul hUll. 01010 I.. . . . . ~~
~j od... .ddlllnolln l.d...I,,~ollod O,u..III""'oo .'I"",h'nllllll".hocllulI'. ^1I.ch "1.ldlloll,"1. . 3:1
:J.l tOTAL AbollloNa .dd kuu 3hlld :1:11. EIII., 1..'0 ,,'" ,"IUIIE IUll1fU1I1 . . . . . . . , .:J.l
pAltt IN. aUbtnAclloNa tllo'" t~bEn^l AOJU9 IEO 011099 ItlCot..E (tAOI)
3S Ag. dotludlnlllorl..p.,... who... .g.OJ '"d '''0' loy ",11,,,111"1, J."".., I. 19U9,
I,om 1In. ~I obav. . . " . . " , .. " , .. . ..II . .. .... . .. ..... .. . .. .. . .. . . .3S
38 Sl.t.lncome hlle lellll1f' Of oVR'f1nymnnl crnflll rnlKNlnlj n, 11If:lJlIlf1 fin yum
fed"aI ,.ILI'J1..tCI,lln Inlh. Inml column yoU IOIKNtttd lllo IlIcullln lInlllln 0 J . . . , . .30
~I Inl....1 or d1,Id.lld. 011 """V.lloll. Of ..ou,lIIn. 0111,0 lJ II
...."pl..om 11.1.locom. I..... 1001 "oll,,"III.d.,.II..o. . . . . , . . . . . 31
38 CacloI SllCUIlly Acl.od l<1ul,.I.1I1 0.. t O.lho.d n.II, .",.,,1 ^cl 10.11011I.
""",I"II.I...bl.lllc,"". OI,lotl...1 tall" tOolO, .. . .. . .. . .. . " .. . " .30
:to bfllbdlly Income (HAd Id cmn,Jul.. Ih.lmI9lAIIIICOlIlf. tAl cfmlll for ""11l1nnnully "11ft
lot.llydl..bl.d 118110111 Ulld.. .g. 85f...III.IIOcllu".. ^"oth 10,1...1 nollo.'ul. 01 . . . . 3~
~o 8.U..mplaym.nll... c1.lmed ".11 .ddllloll 10 fAol ~!!r~~.~.!9-!lO..Y~IIIIlI. ,.IO!!. .......".. ,,010
~ol'"S..llIlbucll.II..)C'''yov..l. t99S: Col. AL___l__ Col. oL__D
A Olw~'t..
\IIU I ~ d*'!d
B
t'Ulfl~lll.
CUM~"
... ..,
.
.
.
.
.
.
.
~ 1 OIh,,,"h1..c1la,,.I,,"" "Aol.. ,"o,ld.d Inl".hOdlo... . Mooh .."1.,,.110" , . . , , . . . . . . . . . . . ~ I
~2 ll)\AL aUblhActloNs .dd 11e,.. 3511.,,0 h ~I . ~nl."I." ."dunlllIE 9onllonl.. .... . ..~~
pAltt Iv .AIlOltloN to lAx, PEIIAlIY AND IHIEnesT (S..lnlllUcllon. 'A' ..ch""..1
~:I Addition 10 I.., II torm 700c 0 or ","III 160F 0 wo. cOIII"I.I.", .,,1.,1110 .",oonl cOl"I.ul.d. . . . . , . . .. . . . . . . . . . . . . ~3.
~~ ".""y; 8..1..lrucIl0l... II du.. choc~ 0 l.t. tlllllU ".nolly 011 0 ~.I.I"I,"II,.".lIy ."d .,,1.. olll.u"III." ..... . . . ~~ .
~S '.I....I:I"I....I.cc'uod on L1I1E 20 an 1'0111 .. . . .. . . , . . .. . . . . . , , . . .. .. .. . . .. , . .. . . . .. . ~s.
~8 TOTAL odd 11e..1 ~~, .u ..... ~5 . ~"IOlI.Ol.."d Of' litlE 22 all ho"t .....,........,.,..........,..... .1. ! . . . . . ~B
coAlPl.I!r! pARr V oNl y IF AMENblNlJ YOUR too~ nElUnN,
pAht y. coMpUn TilE AMENb~D AMoUNt yotl OWE on nErUlllJ TO DE IlECElvEO t8..llIlllIlclloll',' ~
~7 Amoulll ".Id wllh OIlvl".II.'''III. plll. .ddlllo".II.. 1..,.10110111 w..lllod . . . , . . . . . . . . . . . . . . . , . . .. . . . . . . . . . . . . . . . ~I
~d Add"I'~I.""II".ldOl1I,o"lo"d,"lefhOl' ....... .... .,... . .............. .......... ............ ..~S..
~. {)y..p.ymolll,lIe.y. ...howII "" OfIOlllol..lu," or .. ",o,'oonly .tllu.,.d .."...,......"..................... ~g
Iso bubh.ctk.. ~o hom II". ~B (...lo.II"cllo,,"' . .. . . . . , . , .. ..,. ... ......................................50
sl AMOUNt yoU OWE. 1111". I I 0111'0.11. ,,"". Ih." II". 50. .ubh.clll"o 50 1,01"11,,. 17, AII.ch p.y",.,,1 ........,... al ..
b:! hEtUNo 10 bllDc:.lvotl.IIlk..17 ,""IOfIII. 1...lho" Of u.llu U". 50, .ubb.et II". I I I,om II". 60 . . . . . . . . . . . . . . . .S2 ..
Fllelhl.,.lulII by ""dlllghl. May., 1995. wllh yOUI locnl Con,,"I..10f1nl 0' Iho 110.ellue, bheclor 01 Flllonco or Supervlsol 01
A.sollmolll.. AtTAclI All nEaUlnED VlllallllA BCI/EDUtE9 n"d n COMPLInE COpy 01 oMh lodolel Schodule A. c. C.EZ.
O. E 011' lII.d willi yout l.d.,ol,.luII; nnd nil olh.. .ch.duloo .""poIlIng ll,o.olncol"l. and dOfl,nclallori. (Boo '"sIrOcllol1o,'
IIWII,lhe Ul1drl,"lgnRrJ, dlcto,,, lJlldlJ;-~;;;iiy 01 tAw4ii;'~rii.w-;';h~\I~.~-~~;I~~~;d Ihl.IOllllII dlUllo 11111 tinst nl my 1m.!,) hnoV'lledoe, Ill!l d !rUIt, entl,e'"
Ind compl,le relurn. W.. nglRo IhAI fllll1g IIn,JR,nlp.ly Ull till, rlllllhlllrd ICIUflllItnkos Us lull1l1y nnd I8YOfRlly lil,bl. '0' Ihl all10Unl flf I... shown 10 bn dUB
on Ihlt tltUU1 .nd InV .,Iunds dUI will ho Im,dn pnynblplllll't 1IIIIIIIy
tile... ~Iqt> I . 1I.'!fI.... .,,,,,,bup""flIlOfl'l'llHnt.., 11omt~.o...""",,,"
Slg~ . -" o;./~ /.
1t1l'~"I"'" ii ;jJr;;;';9:~n ii~m::..,.ioi .m. o.ii.:t--- ~~.i,;;!;;;;b",...,."",,,,,.. .L_L_____....__
i'1'"P"'"'-II.-,"t . '.,.. 'm-'..,u'.'-i-i)\..v.....,)~L....- ..
U 6"f.I'.'v." I:.I~ ",,', '""''''' ..... n"..',.. BolI"OI'1O No.
H Ollly \~~ r;"'"Z:-i :'l~:;:,~~ i~.i~~i~~ ~-_. ... (/ /(0/~:.. I.'L(-O-'.Yrtif~~e l{rSiJI i~'jl)
____..~'"I!LQqK_.._.._._ . . . -.Llllhetvllle;-M/).21119~ ____
Vl\9.l1 4IU..tY4.74911
tJ.M!Nbl~~I1UI1H
I
(
II
I
I
. . tg n a II v Uo IIcom8 Tox 0 um , ii u_nANOChodo"".C
"IleAL yl!AIHILl:n9, t.~. ~2id.,. L't c=u ""''ll dal.
,...Atfo fiiln;n;hJ~iif ltOltornbQdiiiWi.ini;!iUiiij-- .tin",". . B~c:z~~Itr;;;~
AobAess ~~ ~-b1~M.Jgc.r L (?.OB,NMr,)
u.. · ... ~ I' air.., 01 IUI fOUl" Itrr F A pouM', flCUl"' nulnbtlt
~ Jf?!.:.~1lS!ii~~(:[; r ?L- · ()C1~J~nliS
llii Cud. liffiCiuli y"" rm,,,"o...!!f,~ .
!It...pr~ ~.O~.tYS:V/L(../: __.__f}10..____ 0l./03i) 1_1tr=-~. 0
ClI"",. VkglnlftClI,OICOUol,wh"'youwolI""'d,olo" 1/ I ~,CIIY," } ML/1.fli:K...- oddo... I"
1111'" mull hi..
J.".I. ",".IMronlANI, SEE IUstnUCIIOIIS. ,,,,.,, tOUI/IV """1"_.
Cl10dl "L1NO alA I'IS IClIECK ONLY ONEl ._ EXEMPIIONS (."'.II'Umbe!L-, lolaI bEII,notlAMoUHI
~ ~ """"'h\t''''lIdilf1d ..,ltHkonM, "''''''''''1:,'''1'''. m., VOlIN' 8!l0I0Yef BhI 0ependtnlI f........tont Eolltonlno 12b.lo"
,...... tn.... ,.. IhM'....11lul I I... III.hUCI .J
t IJlllntlaidalmlnoIadaoJlI.adolllout~oIdnn [/I lIJ + 0 + 0 .j. 0 . 0)( $000 . I 100 J
Sl.I..
Enlll 201l.,W,lIIntjolntl.I"" m + 0 + 0 .j. CJ. DK$ooo. I 100 I
11!.....""'....had_, .... .
r:.~lo,,' 3 DII."W, "'..10,...,...1.,0' IJJ + 0 + 0 .j. 0 . 0 x $000 . I loiil
CE"''' eoout".IOtItI"alll,
......... 1I............
tnd"".luInemt..... c;;j;~;;;;y~,~;.~i: VI + a.tHlF .1~1~ $000_
.. ~ ~."W.I.... j'r.it.I.~ on ~8M-
hr'C~I."'" ColulIIlI A, 8P.o-,!!!,__ _!.. _+__ + .j. . )( $000 -
5 It yoll ca~ bl cI.llnld 1.1 depenllenl on 1\1I011l0"118Iullllllld luul 0 AlJsElI~~ '8 IM'ltU-
t._""
Un8Drn, Income check h"8. SOl Ih. IlIlbuct!oll. tUf II". t I ... . . . . . . . . . . . I . II _,~ -...
StEP t 8 ^bJUBIEIl OnOB91NcOME "011I you, lodDl.I,.lulI' (lIullodoi.II...bl. klCOfltR). . .. e /(,J.JVOl . to z.~O.s
- -
e.,.oI "" lla 71\ildlllon.I,o'nllNE~OI,lh.b.ekollhlll.lu,,, ...................,.......... 7 .
. /'I;;..~ ---"./2t!3OS -
Ill&:.... e tot.l(oddlln.lI.ntlh"." ......,................................,....... II
"I ~ Bubh.ello".I,omLlNE~20"'II.bnekolllll"0IUl" ........................... II .
t.itwll
......... ... to vj;;;i"b1l1dtu.lod n,o..l"cofll~i.ubl'.elll". U "011I11". 01. . . . . . . . . . . . . . . . . . . . . . .10 /<1 ., <"h ~..1..qo
StEP 2 S1~ND~nDDEDUCIIDH I ~ OR" h.m'uJ ll(nl1blnlll.llllzodd.duellon.(geh AI
Ilodllcllon' r.'ll81.,,,, I: U.OOO .....N d' I l d .
rlnoj SI.,.. 3' IUllO ..., · D. ",I'''~ t Ihl ....Inl.." Inc.ll"co,n.I.. cl.hll.d .
to CoInpul. ro"g 8,.1.. 201~: 101.115.000 ='~I Do .d"d.. A It (el EqUnl. N.I VhUlllli 1I.1II1..d doduelloll'
~gIn/. II boductlon:91""".dorvAlloml..dlloductloll.ICh.ogodlollllll(GHk....udlono.). .... II _,~ = . <rK~iL -
lUobW 12 tnloi 11I....mptlon 1IIlOtJn1..."pulod .bo.. .. . .. .. .. .. . . .. .. .. . .. .. .. .. .. , . t~ 0 00 WClCI 00
Ineomt I~ cMd ondd"'""".Jc.....POIlM.doducllonlll1:t:l.:l:..hldl..'.......:U:r-loboooJ..... .13 .
ddl I .R """m..'" ~ CIaT .no $V
t~ lbt"' \. In.. I .th"d 13! i~'.'" . .. .. r" ................. ............ t
Ie vlnONIATAxABlI:lNCoME ,ubu.etll".1 ',om II". 101 ...............III..'..e /",..... .<r .~_ ~_ CO{
StEP 3 te INcoMETAx,F'omTluT.bl."'lO.n.I.Beh""ul......,.,.,............. ..::'1~ .r.::r <" : il, IrI
l:on1M. 17 TOTAL TAx(oddcoluIl1l1A."dcoIUl"" D. II". 101. .................,........ . ,.. 17 S ~c-
roUl 10 MIIlENIS I.) yolJr1 VkO'"I.I"cOlll.I.. ..lihh.ld 1.llleh ''''''~'Ii ... . . ; . . . . . . . .101.1 0 .
TIi, AhoCl1EIlltB: lbl GrousE'S VI,g1"I.I"cOlll.I.. ..lihh.ld loll.ell ''''m(.1i . . . . . . . . . . . tlltb) 0 .
~.rmonlt Ie) coIJOIHEO tm ..IIIO.lod I.. 1"'10.,,1' (I"clud. Clodll I,om '1/931. . t~ leI . .
tnd Idl CllIAtlIlEO..'ansIonp'''OOf~.mad...f1h Fonn JIIOE (.""e" F",," lllllEl .. t~ tdJ .
t:n.Itt aiJ'7 - .
t.lcoIJ~lEbClodll","'n Bch""ul. Cn(.II.ell Bchodulecn) ....,. .I~(.,
Iu TOIAlI'Ay....ENrB DCnEbllBI.ddh".'_'.!It.11h'ou9'(.J1............... :r 10 I .~tJ.., I
I PllfIII,ldfng Tour tllUl", do not c","",.,.II"OI 20 Uoouoh 21. "1OOIId to ...t V ori bocIc.l
BTEP~ 20 1I11UE t7I""00lIhllltllNl: IU. ."t.. III. dlll.,."e.. thl,I,'h.INCOlle TAllYOUOWe. B"'p 10 1111I 22 .....20. ..=Iltni'
21 IIlINI! IUI.I",g..llI.nlllIE 17,.nl..llI.dIIl01l"e., thl.I,lh.oVEIlPArMEtlr AMoUNT., I........... .21.
Compul. 22 Addlllon 101.., po""'I'.... 1,,1...,II,om liNE ~Oo"b.ek....,...............................:......22.
Amo\lnl 23 II yotJ "".1.. on LINE 211. .dd 11".. 2dllllt 22 . on. l'lINE 211. on oV""")'II1onlllnd lIlll: 221.10.11" 011II ~ 3mS
roU 0.. UtlE2t,11IIIoilh.dlll.,onc.. Thl.I.,h.AMOIJllrYoUOWE.I\II.chp.vmOn!...,..,......,.,.,.,.......2:I
01 2~ 1I11NuII,IIIgOl t1,,"llNE 22. lubh.elll". 22 100'" 11".21.,.1.,,1..11.. NI!T llVEIlPArrEllt AMoUNt.. .2~ ~
rout
n.lund 2e A.nounloI0YIlp.)'II1.,IOl'"""2~lobocnEDIJED'0 1995EBIIM^,nDklCOlllllu ..... .2S D"
2S M.I (.ublr.cllh.tol^lo' eolulO" A .lIIlcolulI1" b.ll"b 201,01011". 2~1 ..... ,;ii'...... ...",......... .28
27 AUIJ1OI11IEODEbUcllOllstnOt.lDVEnr^Yt.lEHl.lIL~I!'I1I.1 t..m 1IO....klS1luctJon' Addlrt.ltl1l111g1rUJbtIow.,.. .27
,.)eon_'.u.itlllool'__I..I'1 .- ~ (II .. (11~~I1aa"Ilon'c..""dIb,t'"drt
. \bIVAllonpmaWUil"'ll'll'.m..M -- _. .. ltl .. IgflbnlngFTogrn .
'''- 1\ " .. ~,I ~ ~~tAcI,t"""VIolont."'mnlb1
..._ .~IV llomoallk ."........("
..,,,,.. ~ldlvAl1opoJ.IIarnr.ly.......ldJ -- -- .. (II ~ tll~lnlllloablaJtl_laIIantund
-..... l'III.B.oIrnPicCommlllIl......(.) .. III .. lIICormuolz.....'IlFlhI
VMjO 28 ^lIIou"lIobonEFUtlOEDTO yOU',ubl,.elll".2JIr..ulI".201................................... ..2S ~
_11ft '0 rp' local U.8 LTODI rot OUk:_ U.. I- Codl"1l
_,....
..""" 011 IAOI
7f)"'O VI I I' I dl I~i~mniliil
n I
1994
~
tI
r
i
i
i
~
t
J
11
i
I
L
r
L
t:OAM 78U (1994) VAllfrtor 'A.....I "'''" f?l} e IIJ c- /1.1 .={O? - 3 :2-'1 b ~ S-
Mt!. AIIII billUctloN co....UtAlloN ~0IITAlt~AY!nIA0..2 AHO Dvm . 9roUIIE
Elich lpoU.. mull .,"""ul. "II '" htl ."'II'C:"I' 'V' d..tldi;;;;TtVou ;jij.hi;Toiiiil. d.ducll"" ."d I I!..,:~ 8ltIW. rod I
!he d.du.llon." .". ~V, .1.II.,h...1I "hk:l1 ,,!!~ Ih. ".,11. Vall .."".t .Iolm balh d.ducll",,". I M..,I" .11., . V...
En/If roof bAtlOl' lIlIllllIn'" 1M_ cW"'~II.lo.Uft.ll",v''''''OIII, r.. ..IIt1f1It:o:J.IM.:lIl.."... ..
IIll bl!DUcTIoN bAsl!.1I pg.b. U.. nH,"llfJ"Iul~. J.""." I, 109", ."t..ls.lr~:
. Dlthll.SS,".....b,,,,ld,,lQhl,J."UI', 1.1090..01..'.2.011........."
:lCl fbl.. S""I" StclJrU, A.t.nd tltt t n.",o..1 n.I".",.,,1 A.t 1I.".1i11 llI<1ul,.II"II.
tocltI1OCIMU1btntolll. , . . . . .. , . . . . . . . . , , . . , . , . , . . , . . ,. '...........,......... ,30
" Allldtducllo", II liNe "" l"g..lh."Ulm:1O. l"bll.<lII". :l01"0,, II". 2V ...10"10,'..... I
HlINe I19ltnoll..v.. ,,,.,,UNS30. .,,1.. "0.01'" 111,1. ....,"1 "III he IIlnd.., LINE 'Sb%w.I.."
~1Il"gSI.,,,. t.. 3: E"I.. Imall,,1 hOO1I1".,1 II, .,~""''' n.., U". :lOb.I"".
~1Itng BloIutl: Add II". 31. talu",o A ."d .01",.., n. '11I1."1.. 1"1.11,, .00UlO" 0 o"lItlE 35 btlo".
~...." 91.lut~: ~,,'tf 'IOaIlIIIIIII,.." lit.. 31 ", ""'''III'' A ."d co""o" n ...UNE:lO b.low,
Pogs 2
VDunSElF
hi."lh .111" v.iI
.
.
PAIlt II. ADDITIONS TO hblnAl ADJUS'ED OnOBlIHCOMllrADl1
'1 lol....t "" ""110111."1.1011.. 1111.., ....Ol~ """ l.d.,.1 I""..". I... ,,,11 "oll,om It.11 tl. . . . .:l~
:Ii 01"'" tddlllo,,"lo lod..II.d!lItlod Qlo,"I"c..". .11.",11,..11" "..1"",11..... AII..b ..pll".lIo". .:lj
:U tOTAL AIlIIITloH8ttdd Mn..3hnd:l:Jl, ellllll....."d..' ~IIIE ,..,10..,1 . .............. ,lJ.4
'AM IN. aU.TnAcTloHs ~nD'" ~EDEnAl AbJUS'ED anODD INcoIIE lrAOl1
:IS t: ~~:~.I~~~~:','.~'.~.':~ ~~...~~~~.~,.~b,.'~'~~':lu~,~..J~'~u...'~ .1: .t~~~: . . . . . , . . . . .3S
38 st"t.lncome t." Infund at oy,"pnrnltttll ctftdlllltfHMlnd "!llllcom. Oil yout
'.......IOIIMf\.tCl.II" I" 110...... coIlImn yo,II....,td Ihol"e.."o 0" II". 0.' . . . . . . , . . . . . . . . ,:l8
31 Int....I.. dIvId.ndl on obllg.'Io"",, 10.'kll'0. ollh.1t 0
,"ompIhomll.,.k..,om.I"...bulnollllolllet1...llo... ............................. .37
3tI Cuctol SICUIH, Acl.nd l<1ul.0I...1 n.. I n.n,o.d n.II,o,n.,,1 Acl bo".1iI1
IlpOIltd ..I...bl.ln.....o 00 lid..", ~OIm 'IHO. . . . . . . . . . , . . . . . . . . . . . . . .. . . . .. . . . . . ..:l8
:Ii bll"'lIl1, lneon.. ~otd I. compul. 110. 'od..oI ",.olO.t.. c"tllll.. po'",."."iI, o"d
100.llrdlltbltdp...o". ~odtf 00'1 B9 (I" kllhuellonl . AlI.eh l.do,.1 Reh..lulo nl . . ,...... ..311
10 9.1I,,,",,1orme,,1I...I.Im.d......ddlllo,,loFAoIOl".u, 1901"1.'.lum .............~
olo\.l\S..kllbue,tont./C.lIyo.tfloI190:eoI.A' - CoI.S[ 0
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B
lOUlI'll1t
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~I Oth..t''''tr..llontl,001 ~Aol"~'o,ldodln "'"truell".... AII..h o.pl.".lIon ...., ......, ... .~I
~2 to,AI. sU.TRActloNs 'addlln..:J5l1.atJaf1~IJ. E,,'.. h... ...do"UNE g..",..,I.,...... .12
pAnr Iv. ADDItiON to tAX, PENALTy AND INfEnEIT (Sit '""hlleilo,,. 10. .lIth ""'.1
~~ AddIIIon 10 I..: II ~"'m 1800 0.. ~"""00r 0 w.. c""'IIIII.d. 0,,1.,110. "...",1 COf11tlulod. . , . . , . . .. . . . . . . . . . . . . ~.
II totnftll,: 9o.1,,"I,"c1tan..11 du.. thllth 0 lol. rlll"g r.n.lI, on 0 E.I.".I.., 1'.".11, .nd 11,1.. "11Ou"II,," ....... .l~.
~D Intllttl: 1n1....I.""'utdOl1 liNE 20..,1'01,1 .".,',........."........................................ ..~D.
48 TaTAlItdd Ihlt. 4~. .u ...1451. e"I..I.... IIK1 ..,lI1lE 22 ..11'0,,1 ....,...............,.............1.:.....018
CDAlPI.~'! pAnr \I DNl \' ,I< AidEI/O/NO yoUn fu4 REtURN.
,Aht V . coMPUT!! Tltlt AMENbEllA"'oUNT yoll OWE on nErUllo TO DE nScEtvltll(S"',,"lnl.lIon..1
~1 Amount p.id ,,1110 ..lgln.I'.",o.l>lu..ddlllo".II.. pold .11.111 "..lIIod. .. .........,....... , .. ...,........... .~1"
~iI Add II". ~1.nd IIn. 19 ..,I,onl.nd tnl..llI.. ..............................................,.......... ..~B
~g bv..p."".nl.ll.n,... .h.w".., ..lgl".trol""".1 p,o,lo"nt, .dlu,l.d .........".".........,......,..... .411"
bO 9ubhtclIlnt411I'lIf11l1n.~01..01n'I'uello""J......,.",..,....,.........................................5O...
DI AMoUNt yoU owe. 1111". 17 ""',onlll _.111."",,. 50, .ubhn.1 "". 00 I,..n II". 11.AII,c1,p."".,,1 ........... .al r'
52 IWtlNIlIo btlllttl,od.lllklt 11.., 1,..,1 I. II.. Ih." .. 8<lunllo II". 00. .ubbtcln".II ".." Ihlt 60....,.......... .82"
l'!hl tll'atalum b~ mldnlghl, MIlY 1, t 99B. wllh your locol Comllll..lonsr 01 tllli t1sveIlUd, blteclot ot Rnollee bt Buporvltot 01
Am..mellls. AttAcH All neolJlneD VlnOINIA SCIIEOIJLI:B Slid d CoMPll!TI! COpy oleRch taderel Bchedule A, C, O.EZ,
ll, I: or F mad wllh yoUr I.dol.llaltllll Rnd RII olho, ..h.dul.. supporllng g,.,,'ecalpld 8I1d daproclallor1. (Bailln.hudlo"a.,
I (WII. 110. Und...lg"od. d.cln,o ~"d., pI".II, oi I.w Ih.iiTw;/,;;;;;;;;;;;;;j"od 1I".,.lu", Ind 10 'h. 6..1 01 10' ("u'l hoo"l.dgs. 11II s hu.. .o".e1
I"d complel, flluln. We "Afle IhRI filing npnrnloly nnlhl! COlli ,'nod relUlI1l11nkel UI folnllv .nd lIIy.rllly IInbl,lm the Dmounl 01 t.. Il1oWl1lo b, dUI
on 1~111.luln ."d "" ,,'undl duo will h. ",.do po,obl.lo U'lt.II,II,
1'1.... yOU! "",.11'" 11,1, 'fnt" butb,,1lhcmt nurntJ.r I hnmt pt~lt numb..
Sign X '. . .( ,
III" lOiVii'i;;o;;;;;;jilfiio.ir,;;.i;;;I,liiilll;;'iii-j .--- Uiii-- ~~jiii1M-l"ii~...._
f.P..~;:.-Jl;ij;;;;iI9~;;.. ',/,-)'---- ~f--- :.J....l.~ r......,--
NDol, X, ~-<... t'.".~.Y.t.:_.:.!'("L_.. '1/...1115: _( '/(0 J...!I..IJ'I:::2.r.,t'(rL___
~:;""'I~ ,.v" - ......."8.......... 'I' 1447 Yurk Rd. Suite 30
- It!JUJ.OQ.l.\_ .- __.. l,ulhetvlllerM941093 _ _I
VA93! 4IU.4lJ4.749U
.
, . 'SchedUle CR
CAEDIT COMPUTATioN SCHEDULE tor Forms 700f'700P... and 703
1994
AUach Ihlllo VlIur t.lurn. s.. InalruaUonl lor additional tequlred .Ulahmlllll.
.... 1IOCr.t800Ul"'''....... Aww. B
'R 0 IS I rJso,J u.., clnlooI lMW
;,J"eJOj !32. !?"SS t_I:.,.,.,- t.....,..
,...,_1 ... ...
'An, I-MAXIMUM lelllDUlI en enIDIII(c.mpul.lh. ",..Imu", .rodll.nll.bl.,
I Illi.lnt: r..m ISO.. t..", IllOl'V . ~nl..lIl1.ma"nl f"'fll t..m ISO, II". Is on F..", lSOPY,II". tl I
tDfm lU'~Il,..lh...nounllrDtnrOfm 783,1111118...............,."...........,.. II I I
PAn, 1I-0Uf.or.lrAtI TAX cnlDIf (~"'" flOOl ~"fII ISOPY,01 IrAII O~ nlSIDINel TAX CnlDIf I~o'''' ""
2 r.. tOl'" ISO: ""I xl ort b"kol Schedul. cn: rOl tOl'" lSOPV on tOl," 183: Schtdulo lI"y, 1'.111.. II I I I
'AnI 1"_NIIOlllonllooo ASIISfANel ACT CnlDIf In Ihl. crodlf I. no/ ".mod. .nl.. 0 art 1Ir.. S)
~ Aulh.t1.ed .moIlnl oIl101ghbothood A..I.I."", Acl crodll (...I".lrucllon.' . . . , , . , . . . . . . . . . , , . . ~
~ ClltyO'I.. crodlll'llI1IllIlot ,"'I'II.II.ch coml.ul.llo,,1 ".',..."...,......,....,.....,."., ~ -
II Add",I.:I.ncthn.~ """ ". ......".,..,.,..."......,...."..... ......0.... ,.,.... 8
I crodll ello...bli Ihl' "",lIn. S on II". 11...11". t. ..hlclr"..I.I..., . . . . , . . , , . , , . , . . . . , . . . 8
I CII""" tt.d1llo1IH8: L1". 8 1...11". I: SPOUSE VOUnBElr
PAnl IV-INllnpnlsIIDNI ACT cnlDtr 11/ /hi. ."dIIl. naf "./m.d, .nl" 0 ""Int I)
I crodll ill...libl.lhl. \,.,11,.", tOl'" 3011.II.ch t..,n aOll . .... ,................, ......... 8 I I I T
. ",,".1,,1n0 n.""lll"dobl. ttodll: UtI. II... II".. 2. S ."d 8 ................,................ ~ I I I I
PAnl V-COHSlnvAIIDH IIllAOllOUIPMINr cnlDlr III/hi. c,.dll/. nor cl.lm.d. ,nl", 0 .,,10.. la}
10 Ent"2S\\ofqu..I,Ino"'oplll,cotI0l.UOO...hlch"..I.I.....,.,.....,..,............,.. 10
It C''',OY'' tt.dlll'llI1I ~,Iot ,.III'II.II.clr cOl11pul.llo,,1 ....., . . . . . . . . . . . . .. .. . .. . . . . . . .. , . . . It
II Add IIntJOo"dIIn.It ...., ....."...,.......,....,....,......,.. ..............,.. ...11
I~ Crodll oIi.~obl"h1. ,ulll"..12 on IIn.~. ..hlch".".I... . . ,............,.............. t~
t~ h'''''''''n~nonlllllnd.bl.c'odll:Un. I 1...lln..2.e, Bond 13........... ................... t~
18 C.IlVO... c..dIIl0l11l5: lIn.121...II". 13: SPOUSE VOUnSElt
PAnl vl-FEnTlUzen AND PIITlelDe APPlICAlIOII EOUIPMEHI cneDlf,II Ihl. tIIdn I. n.' ".lmod. "'lor O""lIn. Igl
ts ~nI1l25\\ 01 cu".nl qllolll~"O .qulpm.nl co.1 01 h.750. which..., 1.1.... , , . ... .. . . . . . . . .. . . . Ii
t I c."'..", .IIdlll,OI11 p,lot ,.III'II.lIoch c..npul.llo,,1 ...................,.........:.."... t7
II Add II". tBonellln. tI .,...............................,........, ............... .....Ie
t. C..dhll....bl.lh",ulIlI... Idonll". U.whl.h..III.I... .............................10
20 "110."'100 nonlllund.bl. ...dll: lI". It... II".. 2. S. e. la .nd tv ...........................20
21 Cllryo... tt.dlllOl IllS: Un. 18 1...lln.lI: SPOUSE voUnBELF
PAnT VII-RECYCLABlI MAIEIlIAta pnoCEeelllo ECUIPMEHr cnEDIf (1/ Ihl. c"dIIl. n.' cI&\nod. "",,0 on /In. 271
21 ~nl" t~.lqu.III,ln~I..,cl.bI.oqulpm.nlcotl.......................... ...............22
2:1 C'''yOvor clldll I,om ",101 '.III"I.lloch cllI1IpUI.llonl ..,..............................., ..2:1.
2~ AddIln.22."dllnli2:t ................, ,......................... .............. ......2~
25 ~nl..4~.lIu~.".luln.. ....... ....... ,....................... ....,..,............28
2S t.l..lmu", ,..,d.bl. 10.1,,1.1. plot.ulno .qulpmo,,1 tted,,: lIn. 24 OIlIn. 25. which.... I. 10..... .28 '.'
27 C..dll.II....bl.lhl.,...,lln.2S0nlln.10...hlch....I.I... ........... ..................21
2d R.m.lnlng n","lund.bl. tt.dll: L1n.ll... hn.. 2. S. I. t~. 10 .nd 21 ........,...............28
20 C.lIvo... .IIdlll.. logs: Un. 2S I...lln. 27: SPOUSE YOURBELF
PAnT VIII-RIHT ReDUCTIoN rRoonAM CnEDII(IOI"'.'" coll.d Ih.londlOld n..ld.nlltl C"dll' flI II"...... I. not elMn.1t "". 0 ",,1In. 33/
30 ~nl" 5()q4, .lqu.III,lng,.nl..ducllon.or .10,000. ..hl.h....I.I... ........,....,............30
~t Corryo... clldill,OI11PIlot ,.i'I'II.liochco!npul.II"'1 ...,.................... i........... .al
~2 Add....3O."dlln.~1 ..,......, ,..... .......,.................. ........,........... .32
afc..d1t .1I....blli Ihl. '''" lI". 32 on IIn. 18, ..hlch.." 1.1... .............................3:1 .
a~ l1.m.lnlno non,.lllnd.bI. ttodll: lIn. II...lln.. 2, S. 8. 13. 10. 270nd a:l,. . .. ... .. .. . . . . . . .. ..~
3S CIIIVO... .II11III.. 1115: Un. a2 Iii. II". 33: SPOUSE yoUnsELF
PAnT IX-ClEAN.FUEl velllClI AHD CERrAIH nEFUElIHO pnOPEnn cnEDII IlIlhlt...dtl I. not .,.lnocl",'. 0 ""In. agl
ad Enl.. t~ olth. 10d",1 Soc. I itA d.ducUo"lor cl.o".'uol .ohlcl.."d c.,I.ln 1.lu.llno ~,op"l, . . .30
al c.",.... ",.dllllOmp,1ot ,u'I'II.lIochcompulollonl ......,...................,......... .31
as Addlln.3Bo"dll".~I .. ................................,....... .............,.......311
a. C..dll,U....bl.lhlli '''" Un. as on II".a4. which".. 1,1... ........,........,......,... .aD
40 110m.lnlnOhOnlllund.bl.clldll: L1". t I... IIno. 2. S,A. 13. Iv. 27. a3."d ao .,.......,....,.. .40
~I CII',"" .lIdll'orI8gl: lIn. 30 10../1". ago SPOUSE voUnBElt
PAnl X-ToIAteeIlEDUlE cn cnEDIf
.2 TOTAL SCIlEDU1EtncnEDlr. Addll"..2.S.S.13. 18,27.a3 .ndag ...................,.. .421 C
~:I COtJDlHED scllEDUlE cn cnEDII. A,ld co/umn ^ ...1 ",lulI1n O,lIn. 42.
Enlo"IOII.nd on tn"n 7S0, II". tn(.,. to'nI 7611PY.llno1A I') 0' t0110 ,&j.lin.IOld). . . . ... .. . . . . . ..... ........... .4:1
.
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VA Ofr' or 1A1lAl1ON
'toU$O
VMJ9
Schedule en (i1l94) . (~o t31~S(J
"AIlt kl-oUr.bl'.irAtll TAx tIlllllt ton ton" 710 tlLlnll ONtY
"..ot rllOl'Y IlIMl t..m r53 hlol. compI,I,It., ,ppllc.bl, .kl, at Bc:lltdul,llpy)
I t...I~,1ncomt "'1OI1ed lOt ."olh.. .1.",. "I..n. A """~ ollh, olh.. tI.I,'.lndlvldual
1ncomt1..I,'..nMUBtbi.lllthtdlod.lmllilt",...,. .........., ,..,.............".....,.., t
I. ~..conl'oo: b/vId.lh,IOIllOIJnl"'''1I1 by Ih, "'IOU"I Ill' '",m reo,lIn, 10. ,,,d ."""t ~ 'I. 8' %
u' ""canl'oi. hallo.."'" 100'140. e'IIT.ple: 0.310:1 btcotn.. 31.e'l4o ...........,..............2 i?'
~ V1rQlnl.lultomtlllmrSO,ltllte........, ,..,.., .............. ,............. .............3 -:i:.H~-
~ I.tuI1lp1y.1I3byIlnt2....,.."...,..... .". ... ,. ...~;.f...'...... ......., ..,..........~ ~-
a tolal k1COll1llu ~aId to .nolh.",.I"Il"n, oh,.t.: _.1 ..,.., .. .. .. . .. , ....I _ .? _
II enEOII, lkll ~..1Int s. "llid..,..I,I..., Enl.. h.., ."d Ill' "111 11,11,," I, IlI,I"..1 ... . ..,. ,'...... .1
I'''WIt
!"* ..
~3'
%
Oalllllellnlormatto"
"ead Ihe "Cledlll" eeclltHllnlhn Incollln InM IlInlrucllun booklol lot yoUr Income lox lelUrn. "yoll qUlllly lor any ollhe clldlla
en Schodulo cn, complole Schedule cn elld lrollsfer Ihe lolnlto youI Incollle lox lelulII.
Blllelel Inalruc\1ona For Schedul. cn, P.., II,
Out.OI.Blale Te. Cllldll Or BI.I. O. n..ldance tilt tledl'
InllrUctlon8 lor complellllg lho olrl.ol.llolo lox credll or lIlaleul lesldenctl tlbe credll bI' hi the IIno by IlnolnslructlOl111 lor your
hlcomotoM lelurn. Nolo Ihol SchedUle cn, Pori XI, Ie lor Use by FonM 70U "ILEnS ONLy. "ornl 76DPY IlIell (pall.yelr
lesldslltS) compute Iho out.ol.slole lrue clodll on Schedule NPY, sldo I, I"or' II. FOlln 76:1 lIIell (nonresldonts) compulo Ih.
elalo olleoldenctl cledll OIl Schedule NPY, Sld02, I"orlll. Altor compUllnd Iho credit, ellter Iho cledll on Schedulo cn, "bill!.
Whe' TII A\1ech To YoUr "atum 'n Addlllon TII Schedule en
111e IIsl bolow speclnes whalmusl be allnched 10 your lelurn to clehn any 01 tlltl credlla Ilsled below. A credll moy be disallowed
and processlnd 01 yoUI 10luIII Inoy bo dolayed II nn ollaclllnont Is mlsslnll.
OUT-oF.STATE TAX CREDIT OR STATE or-
hl!SIDENCE TAx tnEUIT (or 'lUa' benellclery cl1ldU)
,; COInl>leltl topy 01 11111 IndividUal Income lox rolurn hied wllh
Ihtl olattl (ot Ulsl/leI 01 Columblo) lor which yoU biD clnlmlrld
c1edll lot IMes !laid.
shareholdel8~ Allach a slolemenlhom the S corporollott
Bhowlnd compUtallon 01 your shblo 01lhl9 credit.
Trullt beneflclerleo locolvlng on accumulollon dlslrlbullon
158.1.370, Code 01 \/lrglnlo): AlIach n schedule 01 tho cledll
computalloll.
NEIGIISORIIOOD ASSISTANcE ACT CREDIT
.. Cerllllcolo Irom Ihe Neighborhood Asslslollco proJocllor
which lha Inveslment was provided.
ENTERPRISE ZONE ACT CREDIT
.. Form 30t:
.. Certlllcale 01 tluollllcallott rroll1tho Vlrglnln Deporhnenl 01
Hollslng ond CommUnity Development: nml
.. Cerllllcato bl UIIOJnploymenl TOM Crodlllrom Virginia
Employmenl Coml1lls910n, II appllcoblo.
CONSEnVATION TILLAGE EOUIPMEtlf CREDIT
.. Slole.nolll st.owlnll credit compulallon, pu.chaso dole and
de8CIlpllott.
V1\9J9/\
FEI1T1UZER AND PESTICIDE APpLICATiON
I!OUIPMENT CREDIT
.. Slalomenlehowtng trodll compulallolt, purchaso dalo and
dllllCllp\1Olt bI qUaJlMnllllqulptmitll: lII1d
· Slatomenllrotn Ihtllocal \/Irol"h! Sollllnd Woler Consorvo-
lion blslrlcllhal ybU t.avtl an approved hUlrlonl managomlllll
pion '" ploCll.
,.
tlECycLASU! MATERIAls PROCESSING
EaUlPMENT tnEDIT
,; BlalemBhlllhowlnd oompulalloll: and'
,; slalelntlnl lrornllltl \/Irglnla lJeparlmenl 01 Environmental
ouoill.. cerlllylnd Iho equlpnlenl (Fann bEQ50.II.S).
RENT hEDUCTlON ,,"OGRAM t:RI!DIT
I corllllcaltl 01 QUollllcllllon Irolt1lho \thglnlo l-Iou81nd
Devoloprnllnl AuthOlI't (TCP Fotnl.l): and
· COllllloalloll o. Tax Cledllti from Ihe VirginIa Hou81nd
Developmenl AUlhOllly (TCP Fo,m . J).
CLEAN.t:tJElIIElllcl.!! AND CERTA'N
tlEFUELlNG PROl"EATY CREDIt
. Bleletl1enl oho-Ml1d computation ohd de8CIfptlOl1 01 qualllylnd
plOptlrly.
. " '1' RHODE ISLAND INDIVIDUAL INCOME TAX A[TURN
. AI- 040 ~ol t..~ 0' 01\,.,1.. y'" , I'_,ndln, . . j I.
hit..... , lnIII. I.,. ,,~. v.. 1IoeW.."., ~
r l1JS!?..Ae€/ L 1~Q.(3..LN.6o 00'1- '18-.3Sa G.
f; ..IDIf1I,."'"..,..,......,.".. ...., l..eN..... I9ovMllIod"'HVIItr""'"""
8 I_~_
j r......I......_...I'.............'..I,...........,.,~..Il. ..n..~.."".,
c.r(J)t~ltt:~ ~~~'~E5 r J;1-;L -.----___-<~fa~ ~~.. ....~"..~.~.,
;111"0 Blllul I Oiiino,;------ 3m MI"I"'lIlIno "~I..II 1I1..n sO U,,"III,lnO ..ldo"I..' ,,1111 d.
fll.." JD Mftllhtd hllng Inll1ll,,11II1I .0 I'ud uf Itull",lmhl l'.nd.nl child lVII' tpou..
A ,IIIC~ onl I."n II "nl, un. ".d Ineu,n.1 I,,"h qUIIII,lnO pllIonl dlod 10 I
II tolll i..."piiiin. ,1."nllij1ggHiiiiiiiiiiiiiliiiiiiiiii fiii.iil fiiiiii1iirunliiiiiiiiiiiiiiiiiiiiiie,. i
OJ l'iiliiiTAilf.1iiJiinI foiiiiliilOlliiiKliiliiA I.Iii.lo:liiliifjllliii 3. iil -
-- lIocJillld rld"oIAtlI'Trom 'liOiT.lld,odulol,lliiii1~. iii
l! .!M!~1.OJul*l'l'!t!!!,.!!1 r'!.!!~~11 t'!!!!Li~t!i1,~"";iF!'i'!I-iii.u^ l1J,IO, tDtlllliiiUEZ lh.. ~ Of 'ecompulld. U
. Enl.. nlllo"nl ollk.. so 01 rod..nl tonn lo~u III IU4U^. .
r lliiiiiiiiiKi"uiifDltliilrlliO,liiilijiii:! 10m l~niiU!I!!i]iii hero oiiil iiii11iiD ii^~llCliiiTuliT.1'i . 21. ,
.11 ruu do 11QII..h. "" ,"ocRllullout tll tlIMllf.I."md l..roll'" ,ltlhll Il'"wll cl_lInlnG '''' oul olelll. ell,~l rotl.,I,I,'.CtfII peg. D'",
.N tOY "1., IIIndlllnllolllln nllCHftt,.I.lld Int''""'. r.ClIlIplll" ndllt,M" t Ult "'''0'' '1t,101' 1'lh"lIlQ rol,l' Itd'lrtllltCOnll' 1.1 ""bIIl, on lilt. t b.Jo1II
IN t'OU h,.. no '''Odlfle.llon.lo nl hk'OCt1l. hut tI"h" '''' nul nl II,U. [lfllIll, ton"...I. hili' .,... MIow. th,n compI.l. Bch.duleU on rig. ,
1994
.3 "75-
C)_
. I. tID4 tld...II"e.",. 'ol.tod.,nl ton" IIJ~II lI"n 53 In.. U"n. ~7, 50. 5~ o"d 60, IO~M U". 25 ........ ~ I. 1::J q t/. I
Ie.. lh' ~Oe: 1040~Z Un. 0 ,I... Uno 7: 0' GeI,.dul. I. Un. 17. I'"g. 2, 6'T7J
t I
2. nhod. 1,Iond Inco",. r 01 . 21 5% 01 .,nounl "n Un. I ~ 2. 3s{.,1
~ 211. nfloUE IslANU lI,,'S.I., ld. . M.eh ton" "~05 r. ISEE INS IIIUC f10NSI ~ 211.
:t 2D. Tolll TII . Un' 2 rlul Un. ~^. -~ 2D. .:lre,
~ A "hodo I,,'and Igg~ lf1com" Ta" wllhhnM ft'l"n~n Rlttleh loti"", ~ 3A 311 ,
~~ I
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texm "088 11"71
"HOP~ IslAND INDIVIDUAL INcOME TAX RETURN
1'0,19920' olh.,I.. Y." ,19 .ndlng I 111.
, .
1992
flf, ..Um..net Inllllt III loin' "Iutn UII Filii thm. .nd 111111.11 01 bOlh., l.;l NI'"' YOUI Bocl.1 S.cU,II.. tlulnblf
t..."Q..: J,)\'! \\JS,O Clo4- 4R~~S:oL
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\,;UMMUIMI:AI.IIIUI'VIIIUII-JIA ( 11/) .
DEPARTMENT OF TAXATiON .
OFFICF. or- coMpLIANcE "I~J I~~~
1',0. IJOX 015 'IItIi um;:fo'
3~~20/95 mel.IMoND, VlnOINIA23205.0015
p.lmtvy ssN
209-32-9655
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19'12
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1460 ollEtMlONf 1:,
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Under aUlhorlzal/on 01 "edorellew. Secllon Ot03(d} 01 Ihe Inlornol flevenIJo Code, the lJepllrtlllen' ollltxal/oll has
oblelned Inlortnello/j r,on1 the 'nlornal RevenUe Sorvlce thai you tiled II "odetol IndIvIdUal I"collle lax telUtH 101' Ihe
.bov.l.bble ~e8rshowlllg II \llrgllllllrnelllll(l addre99.1helnlorrnal/01l tecelvedlndlceleslhel you MAy bll teqUlred
10 lIIe II Vltglnllllndlvldullllncolllelax telurn: however, we ere Unable 10 Idehl/I}' II telurn lIIed by yoU, Undet Ihe above
sodal becUtlly IlUlllber(e), lor the yeat III qUesl/on.
II you have alreedy hied or ere NOT Ileble 10 lIIe a VlrglnlllllldlvldUallncometllx telurn, IIIells9 telet 10 Blocks A ot B
below, " you IIle tequlred to lIIe lllld hllve nolllled,lIlellse relet to Block 0 below.
II we do not tecelve II teply 10 tills leller Within 30 dayslrol11 the above delli, ~oU will be assessed Ihe abovlI atnounls,
t>IUsllcctUod Inletosl Undet Ihe ptovlslons 01 Secllon 58. j. 1 j j ollhe Code 01 Vltglnla.'n teplylnll. ~oU heed ohly check
Ihll approprIate staletnent.elllle bollol11 or lids lellet end IUrl1lsh Ihe tllllulrad Ir"orlnel/on.
Thahk you for yoUt COOtJerellon.
ROhrRT slJssHAN
(8nt 367-U551
beparlmenl 01 Taxelloll
OUIce 01 Compllence
P.O. Box 015
Richmond, VA 2320S.00ls
tMo ,. hol. hilI.
Dd Ilol ~end ~8vnlenl
bl Ihll 111111.
please check applOlJrlele block end lurnlsh lequosled IIIIollllOlIon:
A. 0 'lUed a Vlrglnlll IndivIdual Incollle Inx lelUrn OIl.. , (dele) lot the tax year Indicated.
(ENCLOSE A pUOTOCOPY or: YOUR COMPLETE RETURN, IlIcludl/lll all tequlred allllcfnnenla.)
"the above Inlormollon dlllers 'romlhal as shown on your Islum, please complele the 10llowhll1:
Name _ __
Address _'___'___ \
Social SecUllly NUlllber ____._________
0, JlI 0111 1101 Ilollle lilt \llrlllnla IntllvlduollncflInutax 111I Ihe year IlIdlcalod lor loesons slalod ort Ihe enclosed
NOIIII'et auesl/ollllnlre. (Altnch comflleled lJUeetlollltalte 10 Ihla lelter 811d telutIIIII Ihe illcloled
'/Iv.lop..'
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1992
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Form cr,i 040
CONNECTicUT hl:slUEIlT INcOME TAX IllnU1l1l
IlIIlht 1/ J.nUIf I. bee.",bct 31 1992, 01 olh., 11..,~le 01' ~bci!.!'"118 1 1992, "'::::~"I . 19_.
+ ""'1 " · iR,"" OC.r~fh....."
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10. All 1992 "II"",.d ~I,monl.
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U. S, INIJIV lIJUI\L INCOME '!'I\J( RB'I'URN
OMO NO. 1545-1309
. " . EXP1RES 12-31-93
10l\01'C FOnMl\'l' PI\GJ~ 1 OF 1
1040 PI\GE 1
1--.-----------.-0001\0
01\------------------19
23-------.--...--00061
31-.--.----------00061
1040 PI\GE 2
32---------------00061
34----------------6000
35---------------14061
36----------------1\600
31---------------69461
301\----------------__X
'30---------------14799
40---------------14199
46---------------11\199
53-----------.---14199
54---------------14100
51-----------------611
60---------------14199
61-----------------__0
62---------.---.--___0
63----------------___0
iJOIIN R ROllINSON
MARGI\/IE'!' IJ ROllINSON
1\31 NOIlMI\ ROI\U
/\Ml3t.1o:R, P/\ 19002
PPI~CF N SPECI' N I'S Z G/\-SELI' X GO-SPOUSE X
61':-'1'0'1'1\1. fl.
209-32-9655 SI\I.E9
004-1\0-3506 I\IJMIN1S'I'RI\'I'OR
PRI~P- - - . SUSI\N ROMI\NOFF'
FTllM---------JI R BLOCK
lIUU-----1 COMMRRCF: WI\Y
CS?'- - - - - - -JOJlNS'I'ON, RI
-----.-------02919
SSNP--.----Ol0-I\0-7079
PE1N--------I\I\-0601056
l'llRM 2119 - 20
1---------------052992
3. - - - - - - - -. - - - -. - - - --N
1\ - - - - - - - - - - - - - - - - - - --N
5---------------130000
G-----------.-----7000
7------------.--122200
0--------------.161900
9 - - -- - - - - - - - - - - (1\5700)
'1'O'!'/\L INCOME LrNI~ 23 000G'1 'I'O'I'AI, '!'/\X IJINI~ 53 11\'199
'l'O'l'I\L l'I\YMEN'l'S LINE GO .tI\ '199 ImFUNIJ IJ1NE G2 0
Uuder PBllhJ\:!ell of perjury, .I lleclflr.o I:hnl 1 hove oxolllll1ed lllla relurn fllltI
accompanying Rchedul11B !\I II I nlat:P.lllelll:n. autl lo lhe hesl: of I1IY knowletlge fllltI
beUof,~hey are lrue, corrod, nwl l!ompJol;o,H nppl!c:!lule, I cOllsenl: that my
rO[lIntl be tlirecHy doponitotl, J r joint tol:lIrn anti refund ill ~o be directly
depoll!\;ed/ ~hln is an irrevocnhle appoinlmen\: of I:he o\:her npollne all all
ngoll\: \:0 roceive I:he refUlltI. /Joclnrat:1ol1 of. preparer (o\:her. \:hnll l:axpayer)
ill balled all all illformnl:!oll of which preporor han nllY kllowledge,
Your Sigllal:u1'o
See l\l:l:ea\:al:1011
Prepnrerl a Siglmture
-uiite- spousO'EisIgllature
Unte
1ll\lIi!13
Uuto SO!f-Elllployetl-L Software Code 02
For Paperwork Rotlucl:lolI I\(:t Nol:tcQ Slatemenl, Bee 'I'nxpayer Notice 971\.
. . , .t992 Jllcome Jllfol"maUon Worksheet: '
110llN R. ROBINSON 209329655 11-21-42
MAA01\RB'J' L. ROBINSON, N OU4493506 _ _
....AAA'A"A*."'A*A*'**'*****'********'*'*'***'*"*'*'*"*"**.***'**'*'*'*'**
........ ............ -........ .......... -............................................... -.............. -...................... ..............................
~'orm 101\ 0 - pays 1
1,1 liS 'I - W- 2 IlIformal:ion
-----.---.Wagsa------.__ - - - - . - . - - . - - . - -"a)(es wil:hheld- - -- _ _ _ _. _.
Medi - Msdi-
SoUrce 'I'/S Oroas S.S, care Federal R.S. care St:at:e Local
.................. - .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ...
bATAIMJ\GB 'J' 70014 55500 '10'100 13391 3441 1025 C'l' :l6B6
TODAYS 'l'B S 4245 4245 1\:'.45 tEl:'. 263 62 RI 50
SCIIROFF I S 5'1B9 5709 5'109 615 359 114 RI 169
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ~ .. .. .. .. .. .. .. .. .. ... -.......... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
1l00l\0 65534 OO'l31\ 14100 4063 11'11 2905
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, SchedUle B
bille 1, - Int:erest: Income
Line 1. - Int:erest: Income
AmOUnt:
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...................... -........ -.... -........ -....................................... -............... -................................. ....................
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.;
.'
JOHN R. ROBINSON
PLAINTIFF
IN THE COURT OF COMMON
PLEAS OF DAUPHIN
COUNTY, PENNSYLVANIA
VS.
MARGARET L. ROBINSON
DEFENDANT
No. 96 - 3312
CIVIL ACTION
IN DIVORCE
fIBln1Irrs I'rc- Trial Statcmcnt Pursuant to H.uh:1920,33(b)
And now comes thc JOliN It. ItOIllNSON, by ond through his ottorncy, JAMI~S M,
UACII, ond /ilcs thc wlthlnl're-'('riol Stnlcmcnt pnrsnont10 I'n, It, Clv, I'. Nu, 1920,33(b),
III A list of assets, wblch may he In cbnrt form,
(I) the mnrltal assets, tbclr value, thc date ohnluallon, whether nny porllon oftbe VAlue
I. non marital, and any IIcn. or encumhraneesthereon, and
(II) tbe non marital assets, tbelr value, the dnte of valuallon, and any liens or
eneumbranee.thercon.
Thc moritnl osscts, os wcll os thc mnrltnl dcbts ore set forth on the chort ottnchcd to this Pre-
Trinl Stntcmenl ns EXIIIIJIT "A", which chnrt is hcrcby incorporotcd hcrein by relercnce os though
set forth in full, There ore nu non mnrltol nssets,
121 The name nnd address of eneh witness the party Intends to callas n witness.
(0) The PlnintilT does not intcnd to coli nny wilnesscs.
131 The nAme and address and a short summary of tbc tesllmony of eoch person, otber thnn
tbe party, whom the pnrty Intends to enllattrlnlns n witness.
(n) Thc PlnintilTdoes not intcnd to coli nny indlvidunls tu tcstlfy.
"
(b) Thc PlaintifTrcscrves the right to call other witnesses should thcy become necessary and
willlmmediutely advisc the Mastcr and opposing cOllnsel.
14) A list of all uhlblts the Ilarty expects to offer Into evidence, each containing an Identifying
mark.
(a) Exhibit" A" Invcnlory and lIppraisul, marllnl nsscls lIndmnrltal dcbt.
(b) Exhibit "D" I'lalnllll's payroll dcductluns, nndmosl currcntslutc nnd fcdcrul a Inclll1lc
tax rcturns,
(c) Exhibit "c" Incomc and CXpCIISC slnlcmcnl.
IS) The parties gross Income from all sources, each Ila)'roll deduction, and the parties net
Income, Including the parties most recent stnte and federal Income tHl returns and pay
stubs.
(a) The Plalntill's Gross incllmc pcr year is S 63,000. 00
(b) The PlainUll's Netlncomc pcr ycar Is $40,629, 00
(c) See EXIJIDlT "D" Allachcd to this Pre-Trial Statemcnt for Plaintill's payroll
deductions, and most current stale and federal a Income tax returns.
16) If the party Intends to offer any testimony as to his/her expenses, a current expense
statement In the form required by the practice and procedure governing an action In support.
(a) The PlalntilT willtcstify in regards to his current expenses. Sec EXIIJDlT "c" for
Plaintlll's Incomc and expensc statement.
17) The value of a pension or retirement benefits, the marital portion thereof, and the facts
and documentation upon which the party relics to support the valuallon,
2
(a) Thc I'laintilT hns no pension at Issue.
18/ If there Is a claim for counsel fees, the amount of fees to be charged, the basis for the
charge, and a detailed itemization of the services rendered.
(a) No Claim,
(91 Where there Is a dispute, the descrll,llon and value of any lIems of tangible personal
property, the method ofvaluatlng eaeh lIem, and the evidence Including documentallon, to be
offered In sUllport of the valuation,
(a) None
(101 A list ofmarllal dehts,lncludlnllthe amuunt ureach deht as of the dote ofseparallun, the
date of which the deht was Inlllally Incurred, the Inlllal amount of the deht and lis purpose,
the amounts and dates of IIDyments mode since the date ufseparatlun, and the evidence which
will be offered In support of the c1ahn
(a) See EXIUDlT "A" nllnched to II1Is prctrlul stnlclllcnl for n complcle IlsI ofmorllul debts
and rcluted informnllon,
1111 A proposed resolullon of the economic Issucs.
(a) PlaintllTproposes Ihal any property which was nol already distributed nmong Ihe parties,
be divided In n 50% spill for ench pnrty,
.
Respectfully Suhmllled,
JAMES M. BACH, ESQ.
~7/9~
lIy
Ja s M. lIach, Esq.
At oriley 1.0. 18727
351 S, Sporting 1I1111{ol1d
Mcchnlllcshurg I) A. 17055
(717) 737.1033
3
ASSETS OF PARTIES
The Plalntlrr marks on the list below those Items applicable to the case al bar and itemizes lhe assets on Ihe following
pages. If an Item has been appraised, a copy of the appraisal ,eport will be attached he,elo.
(X )
(X)
( )
( )
(X)
( )
( )
( )
(X)
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
I. REAL PROPERTY
2. MOTOR VEHICLES
3. STOCKS, BONDS, SECURITIES and OPTIONS
4. CERTIFICATES OF DEPOSIT
5. CIIECKING ACCOUNTS. CASH
6. SAVING ACCOUNTS, MONEY MARKET, and SA VING CERTIFICATES
7. CONTENTS OF SAFE DEPOSIT BOX
B. TRUSTS
9. LIFE INSURANCE POLICIES
(include face and cash values and currenl benenclarles).
10 ANNUITIES
II. GIFTS
12 INHERITANCES
13. PATENTS, COPYRIGHTS,INVENT10NS, and ROYALTIES
14. PERSONAL PROPERTY OUTSIDE OF HOME
15. BUSINESS, (list all owners, Including percenlage of ownership, and officer I Dl,ector
positions held by party with company).
16. EMPLOYMENT TERMINATION BENEFITS (severance pay, wo,kmans comp).
17. PROFIT SHARING PLANS
lB. PENSION PLANS (Indicate employee cont,lbutlon and dale plan vests).
19. RETIREMENT PLANS,INDlVIDUAL RETIREMENT ACCOUNTS
20. DISABILITY PA YMENTS
21. LITIGATION CLAIMS (malu,ed and unmatured).
22. MILITARY I V.A. BENEFITS
23. EDUCA nON BENEFITS
24. DEBTS DUE, (Including loans, mortgages held).
25, HOUSEHOLD FURNISHINGS AND PERSONALTY, (Include as separate category an attach
'.
Ilemlzed list If dlslrlbullon of such assets Is In dlspule).
( ) 26. OTUER
The PI.lnllfT marks on the list below lhose Ilems applicable to lhe clUe at bar and itemizes Ihe liabilities on the
following pages.
SECUREIJ
(X) I. MORTGAGES
( ) 2. JUDGMENTS
( ) 3. LIIlNS
(X) 4. OTIIER SECURED L1ADlLITIIlS
UNSECUREIJ
(X) 5. CREDIT CARD BALANCE
( ) 6. PURCHASES
(X) 7. LOAN PAYMENTS
( ) g. NOTES PAYABLE
( ) 9. OTHER UNSECURED LIADlLITIIlS
CONTINGENT OR IJEFERRED
( ) 10. CONTRACT OR AGREEMENTS
( ) II, PROMISSORY NOTES
( ) 12. LAWSUITS
( ) 13. OPTIONS
( ) 14. TAXES
( ) l5. OTHER CONTINGENT OR DEFERRED LIABILITIES
'.
~ lists all ma,ltal properly In which either or bolh spouses have a legal or equitable
Inlerest, Individually or with any other pe,son, as of Ihe date thaI this acllon was commenced:
lIem No Names of All Owners Dale or AcqulsUlon Vllue on Olle of Action
I. Mazda Automobile Joint (~aughter's sn) 1989 SII,OOO
2, Chevrolet Blazer Joint (lIusband's sn) 198' SIOO.OO
3. Household furniture Joint (wife's sn) During the Marriage S40,000. 00
4. Jewle Durin S3 '00. 00
,. 1I0use Joint Durin the Marrla e SI20 000.00
6. Ford Thunder Bird Joint (wife's sn) 1986 S6,OOO. 00
7, Checking Accounl Joint 1991 S200,OO
8, Boat Joint During the Marriage SI8,OOO.00
9, Lifo Insuranco Pollc for Wife
i 10.
u
!I
;. TOTAL ASSETS: $198,800.00
'.
~ IIsls all lIabllllles of ellhe, 0' both spouses alone or wllh any person as ofthe date this action
wu commenced:
lIem No. Amount of An Lien Naluruf An Lien Errectlve Date of Lien 1I0tder of Lien
I. $518,400. 00 Mongoge on house 1990 Clllco Mongoge
2. $523.00 Line of Credll 1990 1I0s Ital Trust
3. $1852.00 C,edlt Ca,d 1990 Sears
4. 2106,00 C,edlt Ca,d Visa 1990 Bank of Ame,lca
'1 5. $3703.00 C,edlt Ca,d Visa 1990 CllI Bank
6, $18,199.00 Loan on Boat 1990 Shawmut Arlington Trust
7. $3,487. 00 Car Loon T-Blrd 1990 Old Stone Bank
8. $2000.00 Excise Tax 1990 Town of S. Kingstown
9, $11,000.00 Ca, Loan Mazda 1989 Old Stone Bank
10.
TOTAL LIABILITIES:
$561,270.00
11
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ROBtNSON,JOHN R'
SOl SOO
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EXlunrr n
.
JOliN It ROBINSON
PLAINTIFF
IN TilE COURT OF COMMON
PLEAS OF CUMBERLAND
COUNTY, PENNSYLVANIA
.
.
.VS.
MARGARET L. ROBINSON
DEFENDANT
No. 96-3312
CIVIL
IN DIVORCE
INCOME ANI) EXPENSE STATEMENT
Of
John n. Rohlnson
INCOME:
Plaintiff, John R. Robinson Is employed on a full time basis by, E.D.S. Plaintiff Is paid twice
a month and his averagc carnings, every two weeks, are as follows:
GROSS PA Y.........................................................,..........,.........................$ 262500
DEDUCTIONS
FEDERAL INCOME TAX............................,......,....,.........,......,...............$ 535.00
FiCA.,,',.,,..,....,..,,........,.., ............................................... .................. .........,,$ 157 00
PA UNEMPLOYMENT TAX................................ ....................................$ 0
PA INCOME TAX........,...,............................",.,....,.....,.,....,....,....,............$ 75 00
LOCAL TAX,.. ...........,...,............................ .....................,......"........,...,....$ 26 00
OTHER DEDUCTIONS..,..,. ..... .,..,.., ..........,....,...,..................................,..$ 140. 00
TOTAL DEDUCTIONS.,..........., ....,.........,....,......,....,. ..........,....,..............$ 933 00
NET EARNINGS
NET PAY EVERY TWO WEEKS..............................................................$ 1692.00
EXPENSES:
Attached, as Schedule A, is a statcmcnl ofthc Plaintill's. approximate monthly living
expenses.
I understand that falsc statemcnts hercin are made subject to the penalties of 18 Pa. C.S.
4904. relating to unsworn falsification to authorities.
~~
DATE:'
1//?/?6
EXHIBIT C
, .
.
,
. '
SCIIEDULE"A"
MONTIIL V EXPENSJj;S
f10ME
MORTOA(JE I RENT"."...."".....",..."". ....".."..".........""".."""......"...... . ......".....".."".".""..".""""..$ 950 00
MAINTENANCE.."..,.....,..........,...., ..........". ...... ,.,........,........"".,.,,,..,....... """.."..,..",...".".""."."".."...".,,$ 100 00
UTILITIES. (Ielephone, ele'CI,;e, ele)....,....... ...........,.,...,..,..........,............,...,..,....,,,........,.,,,,,,.,...,,...,,,,,,...$ 300 00
EMI'I.OYMENT .
TRANSPORTATION.,."", .,..........., ..,............ ...".. .,... ."..,,, ....... .... ,...,.........,..,.,...".,....."."..".""...,..".,,,,,.,,..$ 0
l.U NCI I\,S,.. ......"..."..,,,.,...,...,..,,....., ..........,...,.."....."......,,,...,,.,...,,,...,,,,.,.,.....,,....,,.,,,.,....,,.,,,.,, ".. "."." "'" ,,$ ISO 00
TAXES
REAl. ESTATE., ,......,.....,...."... ....,.,..,.......... .,........ '....,.. ,.,...,...... ..,."........"...,..... .,...",,,,,..... ,.,,,.,,,,....,,,.,,...,.$ 0
PEI~SONAL PROI'ERTY,........,........"......".".,.,..,.......,..,,,,.......,.,.,,,...,...,...,,.....,....,....,,......,,.. .."......".".." ,,$ 0
INCOME....,..,.............., .,................... ....,., ...... ...... ..... "'" .,..,........ ...., ."..".....,."...."."...".,...."."...,,,,,,,,,,,,,,.,,..$ 0
INSURANCE
I !OMI'OWNI,RS.....""..."... ..............,..."", ,,,,...... ..."..........,...".,.....".,.,.....,."."..""."".......""...".....,.........,,$ 15. 00
AlJTOMOII/I.E...,....,........., ..........,....".. '''' .........,......, ,........................."....................................,..,................$ 45 ()()
J.IFE I ACClI>ENT IIIEAI:nl...............,.."..."......."".........""..............."..............""."......"............... "..$ ISI 00
UTI IER....." .............................................,........,..........,.,........,.,....,.,........... .....".,...... .""........"", "'''' "... .". ".$ 0
AlJTOMO/lll.E
LOAN I WASE......... ."........."......,.."....,...,.......,..."..........,...,. ".....,,,.............,,..........,,..... .""...."......." ". ....$ 3 7 4 00
FUEL... ."............... ...."..."................,....,...........,.,. ...".........., .........."......".......". .".... .".."..... .."..."..... ".".,,$ I 50. 00
REPAIRS.".............""."..".......".."..............,....".,..."........".............."..,......."..........".,."...."..""...".."."",,$ 150 ()()
MEDICAl.
DOCTOR I DENTIST"".. ......"""... .."........"...........,."... "...... "......"....., ...."." "."....... ""'"'''''' "." ..".. ....". ,$ .1ll!!..1l!L.-
I 10SPfT AI..". ......" ..".... ...... ........."....."...........".,......,....".. ..."....... ."....., ............... ..". .""."."... ""."" ."""".$ 0
SPEC fAL (glos""". b,oees).. ."..".."............., "........."... "'" """'''''''' "" ".... .""" ""...".."".. "'" """"'" ."."",,$ 25 00
EDlJCATlON
PRIY ATE SCI 1001..."...,,,...,,.....,, ......"."."."...,,,............,,,,,.,........,,.,,...,,..,,....,.,,........"""......"...".""."".$ 0
COI.I.EOIJ I T!WlE SCI 1001...."....,.."...".."....""".............."......"........"."......"......,,,.,,...,,....,,...,,,,...,,.,$ 0
PERSONAL
CLOTlIfN(J".."."."....""...."...""....."....................".,...."""..,,,.......,,",,..,,,,,,...,,,,,,......,,,,.,,,,.....,,,,,,,,,,.,,,,...$ 100. 00
FOOD........""".""........"",,,,,,....,,,,,..,,.,,..,,..,.,,.......,,...."...."""....."....."".."".."."..""....."."."".""".".,,.",,$ 400 00
CREDIT PA YMENTS 11.OANS............"".........."....".........,,,,,.,,..,,.,,,,..,,,,,,......."....""...".""..".""."...,,$ 0
OTlIER..."....""."...........".."."."""........,.""..."...."...,............"..."".........""..."......".".""..."..."...".."... ..,,$ lOll (]()
MISCELI.ANEOlJS
J 10lJSIJIIOLllllEI.P I CI IfLll CARlL.".............."...."."...."......."."........."""""......""......"""....""".$ 0
ENTERTAINMENT (pope,", "'..k., movies, vneUlioll)...."..".......""".."""...."."""..."""""""""......".$ 25 00
(JIFTS f CHARITAIII.E CONTRIIllJTIONS........"....,.",........"...,..,.,....""....""..".......".".........."...,.....$ 20.00
LEe JAL FEES...... ..."..".....,.......,,,.....................,.,,.... .....,...." ".".......,.....,... ".."...".,......"".".. ......"....". ..,,$ 300 Oll
CI IIW SUPPORT I ALIMONY PA YMENTS.........".."...""."..."."...".........".."....""."."...""""".."",,$ 0
OTIlER sp."i1y Pe,sollolCnlnntler ."..."........""........"...".."....""......""......"..""."..".".....".,,$ 5. OlJ
Wires Co, IlIsorollee.... ,....,......,.."....".......,....."........,..."....................,... ....." .......,,,....... ........... ..$ 120 (Kl
Wires Cn, I~epui"',.,...........................".,...."...,.........."..............,.,.,.........,,,.,.,.... ......."...., ...."... $ J 00 00
TOTAL
TOTAL MONTIIL V EXPENSES.................................................$ 3940. 00
,
.'
~
..
.
JOHN R. ROBINSON
Plaintiff
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
v.
: CIVIL ACTION - LAW
MARGARET L, ROBINSON,
Defendant
: NO. 96-3312
: IN DIVORCE
DEFENDANT'S PRE-TRIAL
STATEMENT AS PER PA. R.C.P. 1920.33fbl
I. ASSETS. Marital propcny that Dcfendant understood to exist at the time of sepcration
in May, 1991 is set forth on exhibit 1 auached hereto. For many of the items there is no value
stated, or the value Is Defendant's estimate. Defendant did not then have access to Infonnatlon
as to the marital finances and she has not had access to this information since sepcration, Without
her own records Defendant Is very depcndent on the information she can develop from Plaintiff.
Defendant acknowledges that the Plaintiff claims that the net marital estate at seperatlon was a
negative number. Defendant does not concede this. Records fonn the mortgagee are still being
sought to determine the mortgage balance at the time of sepcratlon which predated the sale of the
home by approxlmtely ten months.
2. EXPERT WITNESSES, Defendant does not anticipate the testimony of any expcn
witnesses, All real estate and employment benefits that existed at the time of sepcratlon have been
liquidated,
3. LAY WITNESSES. No lay testimony is anticipated other than the Defendant herself,
Defendant reserves the right to amend this ponion of the pre-trial statement with at least 10 days
notice to Plaintiff of any lay witnesses she intends to call,
- -~- -- -.---..,-
.
J
4. EXHIRITS
A. The parties federal income tax returns for 1993 - 1995, (copies are
attached)
B, The parties state income tax returns for 1992. ( copies are attached)
C. Available w-2's for the parties for 1991 - 1995 (copies are attached)
D. Pre-seperation federal tax returns for the parties for 1985 _ 1992 as
available from IRS, (not attached because not yet obtained)
E. Income and Expense statements from the Defendant. (copy attached)
F. Income and Expense statements from the Plaintiff. (copy attached)
G, Cumberland County Court Orders regarding
alimony pendente lite. (Copies attached)
H. Documents yet to be identified that report assets, debt or income of the
parties before, at, and after seperation.
5-6. INCOME/EXPENSES. Income and expense statements are attached as referenced
above in the list of exhibits.
7. PENSION/RETIREMENT BENEFITS. Neither party has any significant pension or
retirement benefits because prior benefits earned have been consumed and current employment
is of short duration.
"
A,
8, COUNSEL FEES. Both parties have made a claim for counsel fees, At the time that
the appeal of the award of Defendant's claim for alimony pcndente lite was being scheduled
Defendant opted to waive the claim for counsel fees, so the reviewing Judge would need to only
review the Issue of alimony pendente lite, Plaintiff was not required to make a decision about his
claim, Defendant Is satisfied to pay her counsel fees from the alimony pendente lite,
9, TANGIBLE PERSONAL PROPERTY. There has been no appraisal. The property
was divided between the parties more than four years ago and an appraisal now would not be
practical. In the absence of an appraisal, Defendant shall describe the personal property that
existed at seperation and the items that she received, and she shall state her opinion as to its value,
10. MARITAL DEBTS. Until hearing testimony from the Plaintiff at the bifurcation
hearing on the lOth day of October 1996, Defendant did not know that there was any marital debt
still remaining due. She does not concede the accuracy of Plaintiffs testimony, She was deprived
of information as to the marital finances while thc parties lived together. Our efforts to
reconstruct the parties' financial affairs as they existed beforc and at seperation are ongoing.
.
...
11, PROPOSED RESOLUTION, If no yet-undisclosed marital property Is found to exist
during the course of the master proceedings, Defendant proposes that the marital property be
divided consistent with the actual control of the parties since seperation. Each party would keep
what he or she has now in the way of property and debt. If additional marital property is
disclosed during the course of these proceedings, Defendan,t proposes that such property be
divided SOISO,
Defendant proposes that she be awarded alimony In the amount of $833 per month
($10,000 per year) so that she may be raised toward the standard of living that she previously
enjoyed when she lived with thc Plaintiff and so that economic Justice may be accomplished
between the parties, Defendant does claim that Plaintiff engaged In marital misconduct that
supports the claim for alimony,
Respectfully submitted,
By:
lor . Andrews
el for Defendant
78 West Pomfret Street
Carlisle, PA 17013
(717) 243-0123
Supremc Court ID No. 15641
'- b
,
1'040
label
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,.... 'ndln f I' aMI No. "4'-00'"
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209-32-9655
1Ip""-, H"MaUrtty MlM_
004-48-3506
d"'...... If th T....., _ ......... "..... .......
U.S. Individual Income Tax Relurn
1995
tor I'riv.ov Act.nd
PIp.rworllll.ducUolI
Act NoUo., "' p.g. f.
V.. No H."tChldln,-V..-
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p".ldonU.1 MECIIANICSBURG PA 17055
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I'" "a' II.' , II. 11I1r.hlrn do.. au'. OUIO w.nl $3 10 0 10 II~. hllld? . . . .. .. . . . .. .. . . , .. . .. .. ..
I 9111gl0
2 X M.nlod nlog Iolnlrohlrn (ovon " only on. h.d IIICOIllO)
3 Manlod nlng lI'p...lo rohlrn. Elller .pou..'. .00. '110, no. .bovo & fill n.mo hOI. ~
4 1I..d 01 hou..hold (wtth qulillylng p....n). (9.. p.go 12.) IIlh. qUIiIIyIIl~ p...on I. . child bul nol you, d.p.nd.1I1,
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MARGARET L ROBINSON
"""' add,.., lnu",b... ,"d ablll" II YOII h.v'. P.o. bu,," p',1 fl.
Apt...o.
4172 NANTUCKET DR
ell)'. l.w" "p.,1 olflu,.lIl.. .nd ZIP codl.1I "au hlu. rO'II," .dd'.... "1 p.,. t I.
d II vOU' chnd dldn' Iv. Wllh you bull. cllimed u you, d.p. und... pr.-1oOS .groomenl, check., ~ 0
· Tolal nUIllbor of 811 done c1ehued.... .. ........................ ..... .... . ...... ....,
Wllgns, !IIIIIOI, Up', Ila. Anech Fonn(!) W-2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . .
r..abl.lnloroollncome (.... p.g. 18). AII.ch Schodul. B II avo' $0400 . . , , , , , . . . . . , , . , . . , . , .
TU-...mptlnleUtsl (108 Pltg8 U5). DON'r 'nclvd. c" In, ,.. . . . . . . . 8b
Olvldondlncome.AUach Schedule B"ovorS~oo.....:.......................... .......
T"".bl. I.Iund., a.dit., 0' 011..1. 01.'.1. .lId Iaoli Incorn.loes (... p.g. lS). . , . . , . , . , , . . . .
Affrnony recelved..... .. .. .. . .. ... .. ........ ... .... '" . . .... .. ..... . '" . ....... I.
BUsll1..ol~co"'" Of (1ou). Alllch Sch.dul. C 0' C-EZ...,. .,. . . ".. . ..,., . . , ., . . ..,...,.
C.pitel geln 0, (10..)," foquk.d, .tI.ch Sch.dul. D.. .. '" ... , . .,., . , .". . . , .. , . ..,..."
Other gslnl Dr (Iosala). Anech Form 4797................. . . . ..... . ..... . ... . .........
rolollllA dl.blbuUOI1.". . , , , ". ~l LI b ro.blo l/IlQunl lpg. IS)
Tolal 1'011.1011. .nd Innuldoa. . . .. l1!!J -0 b ro.bl. l/IlQunl lpg. 10)
nOlllol,.oI 001110, lora/dos, pl/ll1....hlp., 9 corpOl.llono, bu.I., 010. A".ch Sch.dulo E. , . , , , , , . ,
Farm Incomo 0' (10..). Attlch Schodukt F........... ...... . ........ . .... . .... .........
UnoIJ1ploymenl COfTlJt!lnslUon (088 plge 17)......... .. .. .......... . ..... . .. " . ..... ...
Soclol.ecUIIIV b.nonl.. . . . . , . .. ~ b ro.blo l/IlQunl (PD. 19)
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YoU, IRAdoducdon(.eeplge1D)............ .............. 2:s.
Spouso'. IIlA doducdon (_ pag. 10) . . . . , , , . , , . . , , . , , . . . ., 23b
Movln~ .'pon.oo. AtllCh Fo,m 3903 0' 3903-F . . . , , , , . , . , , . , . 24
OIlO.hllll or IOIf-Oll1JkJYlnonllnx. . .. .. .. . .. "" ... . ... .... . 25
901f-.mploy.d hoollh In.ur."oo doducUon (.00 paga 21). ., .. . ,. 21
Koogh & .e1I-""",loved !lEP pl.".. II SEP, check ~ 0 ..., . . . 21
Penolty 0" ...IV wlthdr.wol 01 ..vlt'll' .. . . , . . , . . , , , . . . . . , , , . 21
A11r00"V ~.Id. Ileclpl.nl'. 9SN ~ 21
Add ffnol231lhrou h :i!9. Those"l our tolal. ulbnenlli.............................
9uhtractlfu. 30 '101111". 22. TI,l. I. VOU, 'dJu".d gr...lncom.. III... Ihan $28.613 .nd I chlfd
Ifvod wllh au 1...lh.n $',230" chlfd dld,,'1 Kv. will, ou,... "Earned lucomo Clodlr on . 21. ~ 31
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r.,.. 1040 1"11'
Form 1040 1808 JOliN R ANI> MARGARET L ROBll/SON 209-32-9655
32 MKJUnt 110m In. 31 (adJusted gra..lnootll8J........... ", ...,.. .... I.... I.... ... I.... I.. t
33 . Chock II: 0 You -. ea 0, older, 0 BlInd: 0 SpoUII WU 58 or older, 0 BUnd.. . .
AeIf Ih. number 0' bo... chlck.d .bov. .nd .nl. 1111101011.... , , , . , . , . , , . . , , , , .. ~
b II you, PO/.'II (0' oomoo". Iloe) can elolm you U . dop.n""nl, chick hol., , , . , , . . , .. 33b
a II you 01. mOl.I.d nRng oop".'eIy .nd your opou.. n.rr/,It d.ducUon. 0, you II'
I dUII.alatul a/fen, ... PII91 ZJ and check her.. . . . . . . . . . . , . . . . . . . . . . . . . . . . . . ... 330 0
l".ml'od dedu.uan. Hom Sch.dul. A, .no 2S, OR I
34 Enlo,. 5 "n<lold cIodu.uan .hown below 'or you, nD"g .'.hl.. But If you ch..ked
Ih. .ny boa an nn. ~ or b, go 10 PIl/I2Ilo nnd you, .I.ndud d.ductlon.
I..g.r II you ch..ked boa 330, you, .'.ndud daducUon 11,010.
01 . SI"gl. - t:J.OOO . MOI,led INlng Jolnlly 0' aU.Jllyfng wfdow(..) _ $S,8M . , , , , . ,
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3S Subtracl nn. 34 from lno 32. .. .......... ...... .....,.."".,.., ,.,., , , , ,.,., ..,...,.. 35
3S 1111".321. $00,028 0, I..., /nJltlply $2,!lOO by Ihalolol number 0' a.OI11>IIo". tlo/mod on In. 118.
II n"o 321. ovo' $SO,028, .88 Ih. wOlk.h.., on p.g. 24 'or Iha .mounllo anlO( . . . . . . . , , , , , , , , . , ,
37 r...b'. Incom.. Bubb.ellna 3S bom I," 38.
It II", ~.I, "'Oil th.n In, ~I, ,n'" "0.. . , , , . , , . , . , , . . , . , , , , . , . . , . . , , , . . , , , , , , . , , , , ,
31 Tox. Chock II '10m .ug Tax T.bl., b 0 Tax R.I. Sch.duleo, aD Copllol Go/n Tax WOlk,ho.I,
0' dO FOlm SSlS (... p.g. 24). Armulll bom Fonn(l) 88.4...., ~. L
38 Addlilo"oIl...., Chock I , m FOlm 4972 . , . , , . . , , , , , , , .
40 Add II".. 38 .nd 30.. .. I
4t C,adlll.r child .nd dope
42 C.odlllor Ih. .ldO(Iy 0, "
43 For.lg"l.. cr.dll. Alloch
4~ olhO( cr.dll. ('08 p.ge heck n bom
b 0 FOlm S30S .0 Form 080. dO Form
45 Add "".. 4 t IInough I .. .. .. .. .. .. . 4J
~s Bubll.clll". 48 '10m 8/ .........,.. 41
41 SoU-ornpkJymont to .., ,.,.,, " 41
45 Allom.i1v. nMmum 41
48 Aoe.phllo I..... Ch 40
10 'I
SO Boe/ol.ocurIlY.lld Up 0'1 8fIll Y.. AII.eh n ~137...,...., SO
Sl Tax 011 qu.lln.d .oll,ornonl pl.n., Including /Ms. It '.quk.d, .n.eh Form !l3:!l1,., ....,....."",. st
52 Advanca enrnod Income Cladl. p.yrnanta hom Fann W..a , ;', . . . . , . . 0 . , , . . . , . , . , 0 . . , 0 . , . . . . , . sa
S3 Uousohold OfTllloymol1ltaxes. AhlCh SchedulaH 0'.."."", 0 0'.".0..0'... 0"."..". O. 0 13
S4 Add Oneil t4B UVOU II 53. Thle hi oU, lotal.... 0.' 0'.. 0..0.0. 0... 0.....' 0.., ,...,.".,..,.. 54
SS Fodsrollncomo I.. wflhhold. If .ny II bom FO'm(.) 1000, chock ~ 0 15 J 90
SS 1S98 ..lImal.d I.. p.ymolll. and ",""unl oppll.d !rom 19901 '.hlm , .
S7 Ettned Income cr.dll. AII.ch Sch.dul. EIC II you h.v. . qUollfylnD
child. 1I0",...blo ..mad Incoma: .mounl. ~ I U
~~~ 00 ~
IS Amou,,1 p.ld wllh Form 4SBO '..I.nslo"'oqu..I),..,. .,. ..""", sa
SB E.e... .0eloJ ,0CUllly .nd RRTA I.. wllhhold (.08 p.g. 32) , . , , . , . , S8
eo Olho, paymonl., Chock II bom . 0 FOlm 2438 b 0 FOlm 4138 , , . so
tI t Add Ilno! tiS Unau h 80. The8e 8Ie Uf tolat. .nt.. . . . . 0 . , I . . , . 0 . . . . . . 0 0 . . . . . . . 0 . . . . ...
52 1111"0 S II. n.".lh.n 111884, oubbIlClI..1I4 born RI18 8t. Thl. I. the 11I1OU.1 you OVERPAID, . . , . . .
83 Amounlalhno82youwllnlREFUNDEDTOVOU 0... 0.00..0....'.....0......0.'..0..0..0..
e4 An.,unl ollln. 02 you w.nl APPUED TO lute EBTlMAT1!D TAlC" ~ e4
OS 1111"084 ,. 1l101.lh." Rn. st, .ubbocl I,.. St born RI18Il4. Tlllllllh. AMOUNT YDU OWE.
Fo, dol.n. on how 10 p.y .nd U08 Fo"" 1000-V, P.yrl18nt Vouch., _ p.g. 33 , . . . , , . , . , . . . . , ~
SS E.Um.lod ,.. .11.1 .08 a a 33 . A1oolr1clud. 0,,11".11II . , . , , , , , IS
"lfp.n.luoPIIU11'. .ell. .v.....'"". .nufn.n.eromp.nn.u.II...,.....m.n.,.n 0 ....""no"'....n
th.)'". tlUl. COII.e1. .nd cOlftpl.I.. D.eltf.Ua" 0' PIIPII"lolh., lh.n '..p.Y.fll. h...d on '"'n'Drm.Uan of which PUPil., h.. I")' ,"0"111I,..
75 487
3S
37
5
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14 66J
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14 66J
14 66J
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15
417
814
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r............ llA ().J\.l'-
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11 & R BLOCK
FIr"".n......larYPuI. ~ .
U ..II-."'ploy.dl.nd 7 0 W. MAIN 5'I.
....... MECIIANfCSBURG PA
Oa'.
Yau'lea/paUan
0"1
SYSTEMS MANAGER
SPow..'.lecvpl"'"
ADMINISTRATOR
0.11
"'.pI"".latl.I.leu,llrno.
168-40-J968
2J-2J14J57
4 03 96
ChlClI"
..I'-ulllloy.d 0
1:.1. No.
ZIPcod,
17055
'.
FOIl P1!NNSVLVANIA RESIDENTS ONLY
pA~OR . INCOME TAX RETURN
. "'YoU MUST FILE BY MID.lIIOI!T.MPUDAY, APRlt1S, ID.S".
[J ..1.eaIV,."n... B.""nlnll ,1I'llndlnl . '"'
Commonwlallh 01 Ponn. vIlli. PA 0 "!molll 01 R.v.nu.
209-32-9655 ROBINSON, JOHN R
004-40-3506 4172 NANTUCKET DR
MECIIAIUCSBURG, PA 17055
MAkE CORRECTIONS BEtOW
'lOut fI.cl.,llnvrlty U"""h'f
ITD CO [OJ]
N'III'llI.I, ,I,.tlnd MlddlllnlU"1
1
gR
5
orFtCI un ONLY
. . ,
lYPE FIlER (Checl< One)
sO "'rKJ JD
.'Nal! MAAAIID JO'N'
. "1"111"1"1,1.,
FD
"NAI.
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F,...lo 16,...,.1231.1."
NAME OFlIIE .ClloOl DI.,nrcr NAME
.h.,I)'ou'ndO,Ulftb.,3t.....
CUMBERLAND VALLEY
Stlut-Add'... pnCNdl"1I N"",blll Apt. No. nu,.1 naulo or Poll Olfle, Ou No. 2 1 1 6 0
I SI.I, CIlEcKIF YOU WILL Nor NIrOA '"'''~ ,,,.
Cll, IlpCDdo .00KtU r;J
il. OROSS PENNSVLVANIA COMPENSATION.. .. .....,. . . " III 10.707 00 INDICA" ftOWUANYO, lAC If
ib, UNREIMBURSED EMPLOYE BUSINESS EXPENSES.,.. . . " Ib I 00 FaRMan ISCtlIDULII!AffACItID
fo. TAXABLE PA COMPENSATION. Sub~1C1 Une lb ~am Un. 1....,., .. ..,::, . ..... , to 10.707 00 . 01 Forms W-2 ---L
2. TAXABLE INTEnEST. Compl.'. PA Schedule A" over .1,000.....,. ........ . ...., . 2 31 00 . 01 Sch.du'.. UE
TAXABLE DIVIDENDS. Con,,'.11 PA Schldule B" avor $1,000. .,....",..., .. . ,. , . -
,. 3 00 . of Schldul.. A
.. -
NUINCOME al ILOSSJ ham Ih'OP("~f10Nah BUIIINESII. pnOFrSSIONalFAnM,.... '" . .... 4 00 . 0' Schadul.. B
-
5, NET DAIN ar IlOIlS) hom IhI SAlE'. UCHANOlh, OIIlPOSIfION.f PROPlnN ........... . . . . . S 00 . 0' Sch.dul.. C
Sa. AMOUNT 01 GAIN EXCLUDED on PA Sch.dull PA-1B. . . . . ., ~II -
00 . 0' Sch.dul.. RK-I
NET INCOME or (lOSS) I,om RENTS, ROYAtTIES, PATENTS or COPynrOltTS . . . . , ., -
., 8 00 . 01 Schedul.. F
-
7. ESTATE Ind rnUST INCOME........ .... ..... .. ..... ................ . . . ... 7 00 . 01 Schldull. C-F
. 01 Schlclul.. 0 -
.. GAMBUNa end LonenVWINN1NaS. " ........... .......................... . 00
'orAL PA TAKADLE INcoJJr. Add lIn.. Io.l.~... I.' r .nd I. Do Nal O.ducIILa....I. . . . . . . . . . . 10.738 . 0' Schedu'.. 0-71 -
., B 00
PA TAX liABIliTY. MulIIDlv Unl . bv 2.B% 1.00B). . , . , .. . . . , . . , , . . , . , .. .. , , . . , , , . 301 -
10. fB 00 . .1 Schldul.1 PA- fB -
U. TOTAL PA TAX WITHBELO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . II 300 00 . 01 Schldul.. E -
IIBS ESTIMATED PAYMENTS AND CREDITS, R..d 1M In.~ucUon. au p.gl 00. I 01 Schodulo. J -
i21 CREDI"'am lB.4 PA TAX RETlJRN .,...............12. 00 . 01 Schldull. 0-1
l:zb lB.' ESTIMATED INSTAlLMENT PAYMENTS ..,....,. .I:zb -
00
i20 PAYMENT WITH IBB' EXTENSION REQUEST.....,., . ,120 00
i2d TOTAt ESTIMATED CREDIT. Add Unea 121, 12b Ind 120 , .".. .""."." , , , . t2d 100
TAlI FORalVENESS flom PA SCHEOULE SP. ROld 'hlln.~ucUan.1> InllluQ on poao 2'. Schadull SP 0
131 UOUSEHOlO MEMOEAS hamlln....'.'"I. P"lIclt.dul.SP.... .13. (Chock ollly " clal'rlng
13b IUOIBILItY I"COME ham Un. I. r." III. PA IIchldull SP. . . . . . . .13b I 00 llIl fa,glvlno..)
130 'fOUR 'OTAL IUCOME hamllnl 1I.IUlp I.SPWOnKSItU' .... .130 00
13d TAX'ORDlVENESshamllnl..Parllll,PAsllhldUIISP................... .......... 13c 00 . 01 Schoclul.. 0
i.. TOTAL CREDIT 101 TAXES PAID 'a OTHER STATES 0' COUNTRIES. , ; . , . , . . , . . , , . . . 01 Schldulee W -
14 00
15, EMPLOYMENT INCENTIVE PAYMENTS CREDIT, , . ,......" . ",. .:.".,... . .", -
IS 00
18, TOTAt CREDITS .lId PAYMENTS. Add Un.. II t2d, 13d, 14 .nd " . , , . , . . , . , , . , , . II 300 00
i7. TAlI DUE" UII. 10 I. ",oll'h.n Uno 18, reler 10 plgl 2f Ind co"..,I.'" PA Plymoll' Vouch.. 011 PIa. 38. . , . .., 17 1 1001
... OVERPAYMENT (LIne 10 Is hlOre fhln nno 10)................... ~............. .11 00
t... AMOUNT of LINE 18 10 be nEFUNDED.......... ........ . . ....,............ ........... ... .. . ..... fB 00
ilb. AMOUNT OF liNE to 'a b. CREDITED 10 you, IOB8 EST/MATED TAX ACCOUNT,." . , ,."" ,., .,... , , ,." Iii 00
.10. AMOUNT 01 liNE 18'0 b. DONATED 10 WltD RESOURCE CONSERVATION FUND.. , , ,.., .. "..., . , . . ,.,. Ilc 00
ild. AMOUNT 01 liNE 1810 bo DONATED 10 U,S. OlYMPIC COMMmEE, PA DiViSiON."...,....,.".,......, fB' 00
.~I
Thl TOTAt of Un.. tllth,au h tBd MUST E uII Unl tl,
SiaN YOUR RETURN. Ulld., p.II.III.. 01 p.r)ury, I (WI" flllllg tollllly) docl"o'h.'1 (w.) hlvo Ix8lr/1I.d 1111. '.lurn, IlIcludlllg olIlC<:Omplnylng echodulos
end .II'emollll, IlId 10 'h. b.., of '11'/ (our) bell.', h I. ~UI, coll8CII"d campl.lo.
'f""S1gnatufI Oltl YourOccupaUDn
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SYSTEMS MANAGER
Spau....OccvpaIlDn
IE SUFlI 'fOUIAND YOUn SPOUsrISION. CIlICKALL MATH,ATTACftALl SCftEOULUAHOFOnMs.
....p....'. N.~" II & R BLOCK
CAROLAllN WENDLAND
O.ytlm"lllphanINu,"b"
717-732-4312
"'IP""', hl.phan. Nu,"ber
766:"0901
., · 6'02 MARYLAND TAX RETURN "u@95 1111I1I1111~1II1'1I1111111111111
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2.1ii1 Manled IIIlno 101111 IIlU1n 01 SPOUII had /10 IlIcuml ....-.......... 0
~ 4.0 Mlnled IIIlno uparelllt L-_ ---.J (BI~O ~O ~O ~O::.: "IBI . 11.0001
5.0 Head of houslhold P1lUlIlIllC'..ulcunn'....I1. ..-... ........
0.0 OUelllylllO wldow(er) wllh dlpelldllll child ICI D.p.lld..1 Chlldn. ..... lei D. 11.100 1 _
7. 0 Oependenlla.payelil'" I' .........1.. I"H" 1n"",,,, II
PARf-lEAR !lESIDfNII AIIO MlurAny: ChICk ""I "you b.O'" D~
I)' ended teval ",!d,nee k1 MMyl.nd II11895 (SlIlnllrucllon 28) 0' U
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INCOME AND AOJUSTiUNI8 mOMH1lEML1IEIJlRH
f. W10lls,lllarle"llpl, elc. ..............., ..........,..,."...,.. ."......,..... '" '"
21. T..abll 10lll"lIncome .....,...,.....,."...,....,....",."..."...,....,....."..
2b. louoempllnlll"lIl1come 12bl I It,..~" hIli I. ,",~d, ""'OII lMlllllln.Ir"1lM III ....
3. Olvldendlncom.... ...... .,.... ."... ..,...", ..... ...... to... ..,.., .to"" .......
4. Taxabll ,,'undl, credlll, or ollsal. of Ilall IlId 10ClllncolIIll."s .,..,.,..."....,.,.",.",."
8. Alimony rllcelved . . . . . . . . . . . . . . . . . , . . . . . . . , , . . . , , . . . , , I I . I . . , . . , . . , . . . . , . . , , . . . , . . .
10 BUllnesllncoR1. or (losl) .,...............................,'..........".". I . . . , . . .
1. C.pllal gain or 11011' IllIcludlllpcal.llalpallldl.lllbullollsl ...,.,."...."..."...."..",.,."
II I. OlhlJ O.llIs or (loml)lhol/l 'ld",1 rOI1ll4/9/1..,.......,.",...,.,..,..".,..".,.,.,...
I ill. TolallRA dlllrlbutlonl 10., 1 I.. . , ... , ... , .... ..... , , ,.... .n, t...blumoulIl
10. Tolal plnllollS Ind IlInulllll l!:\ 1 ~ , , . , . . , . , , . , . . . . , . . . , . . .... "..blllmounl
II I 10. nenlS.loy1l1ll1, pllloershlps, S corpollllonl, IIlalll, hUll I, 110. (Chcl. Ippropll.IIIII,"' ,."""""
II. rllm Incoml 01(10111 .........,..,..".......,....,.",..",.......,.,.....",.....
lilt 12. Ullemploymenl co,"penulloll .. . . . .. ... . , , . ,... , .. ... .. , .. , , . , , . . . .. .. , . ..' , . . . , , .. , . ,
I II ::~. ~~:~II:~~~'~~ ~~~ ~'.e: ,I,~~ ~~~~I~t~.~. . . . . ..... ,I.... ~'. '........... ...... '... ,........,l~~: ~~~..b~~ ~~~~~I~
II) IS. 'ToI.llnco,"1 (Add IInllI lhlollgh 141,. . . . , . . . . ., . . .... . . ... .., . . . . . .... , , " ," , , . , , , . "
DJlI. II, Tol'l idlullmenls 10 IncoI/I.lrollll.dllll reluln (lnA, .lImony, .lc,1 . . , ... . , . ,., ,. . , .. . . , . , ". , . .
f 17, red",lld!ullld orolllncoml (Subhaclllne 10 hU11I 151..,.,....,..".,."..,.. .Inlll I" "nllt
AODIIIONS TO INCOME (See InlhucllolI 121
11. T",.",mpllntllesl on Ilal. IlId local obllg.llonllbondll olhll Ihall Mllylllld 1101111111. 2b ,..',..""
II. Taxabl.l.. prelerenclllllns (Alllch r01ll1 5D2lPI . .. .. .... , . , . . .. . , , . . . .... , , ..,.. , .. , , . .. ,
20. lump lum d(lhlbullolll ....... .. ... . . . . ... ... . .... , .. , . , . .. , . . '.J..U . . \..W..!. , '.u-' , 'I~
II. Dlher (fllllf codl lelllf(s) hom In.hucllon 12' .., , , .. , ,." , . , . .. , . , . 0 CI 1'_-' L-J
22. lolal (Add IInll181hlouOh 21) .....,...........,.......,..,...,.,..".., ,hili In II", II
8UIIRAClIONI FROM INCOME ISIIInshucllull131
23. 'axable relundl. CIIdlll, or ollsall of I(alllnd local InCOI/I1 ISIll hOIllIlIl. 4 IboY! . , . . , , , , , , , , , . , . ,
24. Child Ind dlplndlnl C"'uplllm . . . .. . . . , .. , , . . . , .. , . . . .. . . . , . . , , .. .. . . , .. , . . .. . , , . . ,
II. 11I1...shlld dlvldlllds hom U.S. obllgallons ...,.........,.,..,.,......,..,........."....
21. Pen.lon axclUllolIlAlIlCh rOlln 5D2rEI .."'..,.,.'........,...,.....'..,.,..',.,,...,..
27. taxlbll ~otl.llICurlry or hn blnllll. (lIlf I, IIlnd luppllmlnle(llncludld 1111111. Pd Dr t3b .boVl ".,.,
o .21. roVIIly 1"llIlIcoml hom woiksh..l. plge 5 .,....,......,..".."....."..,........'....
M II. IlIcollle IIClIVld durlllg plflod 01 nolllllld.nCl (5..llIlhucIl01l1 26 IlId 2/1 . . . , .. . . . ,. .. . . , , . , . . ,.
~ 30. Dlhlf Ifllllf code 1,lIerl'l "011I 11I.llOclloo 131 .. . . , .' .. . . , . , , . , . . .. . (~( I I=:J CJ
2l 31. SublolallAdd 111111 23 Ihlough 301 . , . .. , , , . ... . . . . . .. , . , . , . , . .. , . , . .. .. , , ,.... . . , , .. . , .
32. Two.lllcO,"lSublrlCllolllrnm wOlksh.." ppge 6 ,..".,.........,....,..,.........,.'......
33, tolal (Add IInll 31 alld 321 ...................,......."...."..'..,... ..Inlll U lint 54
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IIEMllED bEDUCI,VIHI AND.MAiiiUiiii'AiijliifM1R'1 ISII'"liiucilOi1l4/
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38. SI.I..nd lotallncom. I.... includ.d In I.dllll Sch.dul. A, II.. 510,lro", "Olklh,,'1n 1IIIlruelloll 14) . , . . . . , . , .
38. NoI ".mlnd d.ducllo.. ISub1r1C1 III" 35 "om nil' 3.) (r1l1'YeI1 IIIId.IIIII11 IlIIhuello. 101m" . . . f.l.. In IIn. 58
{Unll11.50 II. IIIII..d 101 lulOll UII. COIIII... 0111111' SII C.lllulll 11I111 .1I.mouIIIIIII 1111 100'00,111. bO<lI.
It. rodll" .dluslld g'oll lneom. (110"' II.. IT 011 Ih.lrolll ollhll'Ollll) . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . .. . . . ~ I!IJ
II. Addlllolll 10 Ineom'lllOmllll.22Clllh"lOlllollhlllolllll ...............,............................ till
13. TOIIIIAddNII1I51.nd511...,................,...........,................................. /!if
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I I I j Ijj1 , 11l,r:"lI<lIo 1""71
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II. M.ryl..dlullromT..Tabl.o,ComoulllloIlWolkl"ltll.......,....,.........,.......,..,.......... I!!J J I I~J.~I'/I IIJ]
II. EII.1d Incom. CIldll (K oll.dllll.lIl1.d Incom. clldlll rlolllllCColdlnO 10 lIulllb" ollllonlhl cOYllfd by Ihll IIlulII ,. ..liD J I I J I I m
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m. Loc.II.com.'u 1511 1IIIIfUClloll 19IEIII.r~f, 0111.. 02. ...................,..............,... liliI J I llJ:lllt{IJJ
I nd d II I d '"" , I 1:;'1,,,,;1""71
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n. Co"II'bullon 10: CI~"fII.lt BIY &EndlllO."dJi2-,c~1 ru.d r.lr C'"'"'I~" r:-a;~I'r r~'M!1 . .. 'UI I' I J 1 I 1""71
13.. ~ I LJ J 1-1 IJJ 131, .. [ [.I.r 1oI.1 cOlllllbollolll I!!.I .. . _ . . IL.LJ
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II. Amou.t 01 o..rp.ymllll o. II.. 1110 IE APPLIED TO till UlIMAIED 'AX" ti!J 1 I J I I J 1 I IJ]
II. Amou.1 01 OYtIP.ym,"t 011"" 711D IE RErUNDED TO YOU ISubllactll.. 721r01l1 "".711 ......... .1IID:!IIl!I:I!! I J I J I I [J]
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II. 'DIAL AMOUNi OUE (Add II.. 70 and ".. 7., " . .. .. . .. .. . .IF II on MOA!, PATlH tulL WIFII TillS AEtUnN @ I I J I I J I I m
Undtl ,.naIIln af pI'luty,1 dtt"" th" I hh' IUmlotd Ihll"hlllt,lncludln\J ~(cllmJllnrln" ICh,dvlt..nd M,., muh Dlr.blt to: cOMr,nOlUft 0' mt IIIWUR'.
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II Dthar C,ldItl .lndlcIt, Credit Form Numboll.
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o Tol.l. Idd lIn.. 304, 30, 3C, 3D. 38 Ind 3F
.. 30 I
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S. II Una 30 'I taro" than Uno 2B. '",.. ovenPAYMe'lI,
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7. "","unl 01 onrpl,""n1to b, credited 10 "US E.Uml',d 10.
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1:1 110
1:1 HO
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1995
.
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SOHEDUle I
RIIODE ISLAND MODIFICATIONS TO
FEDERAL ADJOBTED OROB8 INCOMI!
PAOF.2
I, Fodorol ~.tod gro,"I""".... Fodor'" Form 1040 Un. 31: 1040AUn. IS: 1040EZ Unl 4. ~I I,(QQ<'
ENTER ilEnE AND UNE C I PME 1,
.. Modlllc.Uonl IncrUllno l.d.r.l IdJUII.d 01011 Incom.. (S.. Ip.clllo InlhucUon.)
A. Incom. horn obllglUon. of lOW' 111'1 or H, patlllc.' lubdlvl.lon., olh" Ihln . OA
Rhod. 1.llnd
8. Incom. from U.9. obllg.lIon. 1.lmpl f,om hd"lllncoml In but nol lump' . 88
hom .1.1.lncom. I... (AlIlCh ..plonl"onl
e, Olher modlllclllonl'S" In.hucUon.. IlIlch ..plonl"on) . 8e
D. Tolll Idlullm.nll . Idd Un.. lA, 10, .nd DC. .0
10. Add linn I Ind 10. 10 I '~.;) I: CI
11, MOdlllc.Uon. d.clllllno I.dorll .dlu.l.d oroll Incom..
A. Incoma 'rom obllglUO"1 of the U.9, Oov"nmlnllncluded In lIn. 8 .bov. bue . tlA
,.empl from .'.I.'ncom....... ISubmll l.plan.Uon)
B. Olh" ModlflclllonllSlllnllruclllon, .,ubmll "plonl"onl. . tlB
e. Tolll Idlu.tm.nl. . Idd lIn.. ItA Ind 110. . lic
12- Modlllld I.dorll Id/Ullod oro.. Incom'llln. to I... lIn. IIC/. ENIEn ilEne AND O/l . 12 ','111<:\
lINe CZ PAOEI. C
13. En'" \,our deduction from F.d.,,1 Form '040 line 34, Form I040A line '9, Form '04oez lIn. e Dr . 13 - .. ') .."
.moun' 0' d,ducUo". "computed IS..ln'lrucllon.f. '-' .
14. lublll.llln. t3 hom lln. 12. . 14 I .l', ~l../
4A MUllm'r ",500 by the numb" of 'M:lmpllon. '"I ,rid on Form 1040 Lln. 8. or 1040A lIn. O. or .nl.r 14A .~C,~, \ I
Imo n 01 ph.,. out ...mpUon tS,,'n.trucllon.f.
4B Tulbl.lncom. Subtroctlln.14Alrom Un. 14. Ind .nl" h".. 4B icl~ '::'4
IA F.d".lIncom.',. on Ih. .mounlon Un. "D. Ch.c~ IIlromg...r..... 0 """~I -0'......'. . IIA 1'(: =.t,j
Fo,ml,'S814 IIIclud.In to,.I. " CI","o,,"r..w_
118 Addlllon.llu... Cl1oc~ Illrom 0 'orm "'0. on o 'o,m mz. I 16B
Ie OIh" TUn. 1b111 0' llIIOunll onl"od on lln.. 4a IIId 41 F.doral Form t040. . lie
10 Tol.1 F.dorlllncom. I.. b,'oll clldlll. Add Un.. 1M, le9 Ind 15C. . 110 , I
II. C'odIl1. lbl'" lmounll onlorod on lln.. 45 Ind S7 Fodorll Form 1040 or Un.. 240 Ind 200 Fodor.1 FOlm . 11
1040A. Of Fod.,,,, Form 1040EZ Un...
17. Tolol Fader'" "-nt lu. u.. leD loll Un. 1.. (Enlor hor. Ind on PIO' I,ll". t.J 17 I i5 31../
CREDIT FOR INCOME TAXES PAIi) TO ANOTHER STATE. RHODE ISLAND RES DeNTS ON LV
\....
SCHEDULE II
AII.oh copr olta'um mid wllh olhll ...11,
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I'. AdJultld Orolllncom. from olhr, 11110(1'.
11
.1.
TAX CRIDIT COMPUTATION
20,
lIn. 10
L1n. I or Un. 12
'0.0000
l( Un. IS
(S.. 'n.llucUon.,
1 TII due Ind p.ld ,". .o.clllo Inlllucllon., In..rl Him. 0'
2. 10 olhor .'.1""1. 11111"'. Plld
.
. 20
.21
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.u
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FOII~'1040
Filing Sl0lu8
(S... pogo 12,)
Chnr.h ollly
0110 bOM.
VoportnlfJllt of IIIR 1lnllRllfY -- hllmtlnl nflVUlII'" ~Ulvlt:n
U.S. IUdlvlduBllncome Tax Return
1994
Fallh, 'lfJ.n,I-U.c.31 ,". olath.rt.. IIlb. hutln
1I114.ndhl
99 illS U.. 0111 .- (.)Q nul w,ll, 0' I'.pllln thl,. In.
30
31
d II YOUf child dldn'lllv" with 'fnll hull. rL,lmlld II y,.ur ,1"1""lIl<Inl uneil". Jl'''~ ISU 'PI,,"u,,,t, chid: hIt. ..
e TolnllllullbOl ul OXfJl1 lIul1:J clnbllnd. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . , . . . . . , . . . . . . .
7 Wig", 1IIIa'I... Up" .Ie. ^lI.ll~h rllln,I'IW'l 'I~ Illlillll
7
00
1!1111'lil
9
10
11
12
13
14
15b
16b
17
10
19
20b
illll:/11
21
uu, loIolllleOIl1.. . 22
11111I II!
1111'1'lli
ili/I,I!/Iil
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30
31
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P,"lld"n"al ..
EI.e"on CampalYII r
1
2
3
4
JOIlN R ROBINSON
MARGARET L ROBINSON
GOG KNOLLCREST PL1\CE 1\""1', F
COCKEYSVILLE, MD 21030
,II OMB No, 1848-0074
You, .0el.1 lOeu,"v number
209-32-9655
SpOUI." locl.1 ..curllv ho.
004-48-3506
Note: CIIIlChlllg
V.I No "Ym," win nul clulllno
Vu vnLl wAnl $:1 In nn In Ihl~ fllllll'l . . . . , . , . , . . . . . . , , . , . . , . . . . . . . . . . . . . . . . . . . . X you, hill' or fodur.n
. X your fnhllld.
II a lilt 'OIUIII, dlJu!) UUI fl uuno walll $:llu u lu Ihl~ 1!ll1d 7. . . . . . . . . . . . . . . . . . . . . .
S1I1Rlo Fo' r,'vaoy Act and PIPlrwo,k nlducllon Act Nollol, 110 pig. 4.
X Mnlllud 11lII\q lullllll'llIIlI (nVIlIlII ul1lV I1l1n """ hll:UItKl)
"'''"I_lIllIIlIu ""A'.t" If'hulI. Ful'" W'lIllll,,'. mlt, fllll!~." IlItI f1.'nlllu'.... _
.---
flnm' III hllllnflllllld (wllh fjllnlilVltu, flltlnllll). (!lun 1'"1111 t:l.) If qUAIl/ViII" prnnun In n child bulllol yuur df1pol1dlltlt.
""1m ddld'n Ilnl1wl IInlll. ..
5 Uunlll hi wlduw fJI willi d;;~,~i,iclilld I. n JuUon dlIllJ.. to . Sno n 013.
00 X Vau,self, II YUill pAil fill (ur nlllllnnlln nl'1l1) f:oll dollll ynu n~ n dupnlldnlllnl1 IlIA/hm lAIC} Nil. 111 hn...
Exempllon8 011111110, do 1101 "'1O"h I... On, Dill bll 01110 I" <:I1O<:h b". 011111111 3:lb "" pnno 2 :~r:.'dnn" -L
ISoopllgo 13.) ~POUI',....."...... c,'-,-"',"-", :..:.:..:..:..::..:~...."....,........",..
c Depender11111 {'JCht, (3}1'''U'''nI''hl~', ~}II'fl.nd..",.~, No,offnU'
1111".'''' ,l.'!flnd"..!,,, '1IIIl"'.,,nllUV ,.,.Unn""fllo 1111.11.""" 'n r.hlldl'" nft fie
I tI.,", IIr.', 11I1lI.I,Imd lulIIAUI.1 '1'" nUI"b" lilt 'IW,.,U2'. ';'hn:
"""'0.111011 01.
dopOlldmllR,
000 pngn 14.
Incomo
AUleh
Copy B 0' you,
Forn,s W-2,
W-2G, .nd
10sS-R hi".
" you did 1101
gnl n W.2. nuo
png. 18.
ellclooo, bill do
not ..llnch, AllY
pnY"""1 wllh
you, .0IUIII.
AdJualmenls
10 Income
CIUllo., Son
'"ohuclloll' , ,. .
8n raxabl.'nln'mlt Incorno (Rnn 11""0 16). Alhu:h Schodllln B II Dvm $400 . . . . . , . . . . . . . , . .
b TI'-I..oopt 1111"0.1 (.no pn. to). UDN'r ",,:IlIdll 01111110 0.lJ!!U
9 Ulvldolld '"co"... AU..,h S<:hlldlllo D II "VIII $400 . . , , . . , . , , . , . . . , , , . . . , . , . . . . . . . , ,
10 TRxnblo 'olund!'l, clndlln, III oflnoln III nlolll nlld lur:nlllU:UlINl h1l(OO (Rno pl1nn to) ........
11 AIIII10ny ,nc.lvod . , . . . , . , . . , . , . . . , . .. .. . . . . . . , , . . . . . . . . . . . .. , , . . , . . . , . , , , ..
12 Buolllll,.'ncoll.. 0' (1,,0,), AU.d, Sclllldlll. C 01 C-EZ. . .,. . , . . . , . .... . . . . , . , . , . .'.
13 C.plln' g.'II 0' (I"..), "'IIqlllo..J, .1I..:h S<:hmlulll 0 (.1111 p.no 10) .,... , , . . . . . . . , . . . ,
14 Olh.o gain. III (I".n.n). AUn"h F"'1II4707, . , . , . . . , . . . .. . . . . . . , .... . . . .. . . .. . .. . ,
150 TII'nIIRA dlnlolbullon. " IJ!1iII .I b To.nbl. nll"1I1I1 (,"n pg. 17)
180 Int.,fl.n.,lIlll.lIIllln"Ullln.lJ]![____]b Tnwnbln nlnOllll1 (Ronpn. t7)
17 nnnlnllnnl fllllnln, IUvnll1fln, pmlllnlnlllrlll,!] r.UlpUlnlhum,lllloI9. nln, Allnr.h S(:hnduln E , , .
10 Fnlllllnr.ollto Of (llln!tJ. Allm:h flr.llflduln F. , , , . , , . . , . . , . , . . . , . . , , , . , .. . , . , . . . . , . .
19 UI1(lllt,lovmnlll CIIlllpnll9nllun (!lUll t>m'lJ In), , . . . . , , , , . , , . . , . , , . , . . , . , , , . , .
200 Suelnl.""U1l1y bo".lIIn . ~ J b To..bl. n""""1 (,,'" 1>9. to)
21 OIlIOIIIIco"".
22
230
b
24
25
20
27
20
29
Add 110. OIIlOu"l. IlIlho 1m 01 hi CUlllllllllullIII"" 7 UUUII h 21. Thl.l.
YOIII I"A dodllclloll (,un pn"o 10). . , . . . . . . , , . . . . . . . " 230
sp"u,"'.InA doducllulIlnoo I,ogo 10) ,. . . . . . . , . , . , . .. 2:iii
MoVlll" o'rm"".. AUnch F"'11I300:\ '" 3UO:I-F .. , . . , . .. 24
O"o-h.n uloull-."'PluYII."'lln., . . , . . , . , . , , . . . , , , . ., 25
Snll-nIl1l'lovnd IlfJnllllltlnlllnllCo dlJ(hll:lIllll (flIlfl pnqo 2.),. 20
Knunh tolllflfllnlll plnn 8. nnU-nl1lrJluVlltl HEP dlldtlf:lIlJll , " -27
po".lIy no onlly wllhdlownl III oovl"<I". , . , . . , . . . . . . . . .. 20
AllllklllY pold. noelpl""l'n SSN. 29
r:III'rlght r",,", ""flWIII. (1111.,. 11"4 U..lr:".IIII', ""4 IIl.oln I
..nrfwllhy"u
. dld,,'llv. willI
you dUlIlrI dlvQICII
Ot..".,..lh'"h"
flIIV' t<41
lhflllnd.llhO'1f1c
nol.nl.t.d.bnv.
^dd numb."
:~~~f::D~~ ~
73 334
13
1 83.1
~
1 .1.ll
7G 555
76 555
OflU 0 tin i,
FOil" 1040
Tax
Compu-
tallon
(Son pogn
23,)
IIYIIU wOIII
IholRRIII
nglllA vom
t"w,ft"n
p."o 24.
Cradlls
(Soo POUII
24.)
Olhar
TaKeS
(500 pogo
20.)
Paymenls
AIl""h
Forms W-2.
W'211hOlld
1000. on
pogot
Relund or
Amounl
YoU Owe
Sign
Hera
l<oop oC"PY
ollhln InlUlU
Iu' you,
',":ordn.
Paid
Preparer's
Use Only
fIr:13 0
1004 JOliN R & MJlRGARE'l' L ROBINSON 209-32'9655
32 A'''l"lll ""'I,II11n 31 (o~llI.llId 1I,"nn ",,'''''''' . . . . . . . . . . . , , . . . . . , . , . . . . , . . . . . , . . , , . '. . 32
330 ChOl,k II: 0 You WOlO oO/oldll'. 0 Blllld: 0 spou.. WAn OO/nldn" 0 Blllld'l! 'III
Add Ihn ntullbm of hOlm" chor:hOtI nbuv" nlltJ nnlmllm lnlnl 1In1" . . . , . . , . , . , . ~ 330 ; III'
b If your pRlnll1 ((If nOIlWKlIlI1 fllnn) I:nll dnlm Villi M n ,l"ponclnll', r:hm:k Im.n. , .. , ... 33b "I ill/I.,
C If ynu QIO fIIolllnd IIIltld oopnlnllllv ~lId VIII,II f\~nll!lo 1I,IIIllzml doducllunrl m vou ... 33c JIII'IIIIII.!
AIIt .. dllRl-otolllA nllmt; non pn!111 2.1 RIll I.hlll,k lOIn....,..."....,......,. ';11111/'1
34 E I {'.."nlu.... dflrlUCU0l18 1111111 Bdlllllllln At 11110 20. on } 11:1" II
t1:~ Of Slondord doducllon .1,,'wII billow 10' Y"'"II1111"JIOh'.. DutJ' yoU checked ii'llllllll
I fillY bo~ on 11I:r 33m 0' b. fJu Iu 'Jngo 2:1lu lhl yuu, olnn nld doducllon. I:! III1
Argo, If you checke box :J3c, VUlII tllnllUmcJ dnrlllf:llulIln ZnlO. ~I:jq I
nf . ~hlC,lf1 -- $:1,000 . "und III htlll!lnhuld -- $5,000 34
yom: _ Mni'l"d IUllld JulllllV 01 CJlInlHvllltJ wldnw(m) -- $0,:150 I'll '
_eMnlllodrmllqnflllnlnlllIV-_$:I,t78 'I III
35 SIIbl,""1 UIIO 34 Irr,mllllll 32.. . , , .. . , , .. .. , . . , . . , , . " " " . " " " . "'" " . . .. " . .. 35
36 II hl10 :l21n $03,O!jO nr lunn, f1Mllllp1v $2,'WO hv Iho tnlnllllllllbnr ul mlnllflllolm c1nlmod nil
linn DO. II 111m 32 Is W-'llI $1J:1,m;o, fUln 111ft WllIk!llll1l1t 011 pnq" 24 fm 1110 nl1KJllllllo nnlm , , . . . . 36
37 r.,u,bl. Incom.. Subltm:llllln:ln 111II1I11IIn:J!i IIl1lln:10 In 1I1111n lhnl1llnn 36, nlllnt "0-, ... . . , 37
38 To.. chllck IIl,ulII n l1<1 Tn< Tohlll, b LI To. nolll SohOllllln.. C 0 Cnpllnl 00111 To. Work-
flhuol,o' dO rnlln DOIP) lUll "p, 1"1. AlUllIlIll hllllt tflllll(n) On'4~ 8
39 Addlllnllnllmenn, Cllrlt~k II hUIII nO FlII1II4070 lJ 0 Fnlln 4972 , , . . . . . . , . . , ., . . . . ,
40 Add 111111. 30 .II~ 30..... . .... .. ..... ..... '" . . " ............., . ..........". ~
41 C"tdU'(If child ^ dopfllldnlll r:m" fUll', ^"ndl FlIl1l1244t .. ... 41
42 C'"~lIlor Iho IIldOlly '" III" dlnnhllld. AIIor:II Soh"dlllll R. . , . . . 42
43 FDlllllllllo. c'o~lI. Allooh FIIIIII IIln . . . . . . .. . . . . , . . . , . , . . 43
44 011101 crodlln (ono pnqIJ 2r,). Chuck If 'ItlllI nO rurlll 3000
b 0 FIIIIII 0300 C [J Furll' 000 I dO For", 44
45 Add 11110. 4 t 111111111111 44. . . . . .. . . . . . . , . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , .. .
40 Subllnclllno 45 flUllIlhlO 40. IlllllU 4519 IIMllo 1Ilnllllno 40, olllm "0-. . . . . . . . . .., . . . .... ...
47 Snlf-nrnplnYl1lfJld In II. ^Ilnr:h Sc:hodllln ~E. . . . . . . , . . . . . . . , . . . . . . . . . . . . . . . . . . , . . .., . .
48 AIInlllnllvo 1I~l>III"1II 10.. Allooh F""11 02~ I . . . . . . . , . . . , . . . . . . . . . . . , . . . . . . . . . . . . .. . . .
49 RocnplUln Imeno. Chock II from 0 0 Fnllll 42!iS b 0 FOlllI DO tiC 0 FOIIII 0028, . , . , , .
SO SoclalsOCllllly and Modic"," hIli nil lip hU:OI1K1l1ul ,opnrlnd In fJlllplovnr, ^Ihu:h Form 41:11 .. ,
5 j To. nil qll.lllllld rnll,nll.",1 plolln, IlIoh'dlllll IRAn. II 'n'l"l,"d, ollneh FDI'" 0320 , . . . , . NO. . . .
52 Advftf1cn onmnd llleom" crndll pnVlJlllllln fllllll FIIIIU W-2. , . , . . . . . . . . . . . . . , . . . . . , . , , , . .
r.,n 2
-'6.555
6 350
70 205
4 900
65.305
13.351
13 351
13 351
183
53 Add IIIIn. 40 lI11uu h 62. Thin I. Ullllol.II.............,....,.....,.....,.....,.. ~
54 f,"I."lIl1cnh'.'" ..Ilhh.ld.lhh.,. 1'lIn'n r"""I'lln,", thlll'" . . . .. 54 15 j 3 G 1
55 1004 .nll"'.lod I.. Poy,"ollln ^ Oil". OPI,IIl1d hlllll 1093 '011111'. 55
58 eo,ned Inca,.. c,.~II. II ''''IIII,"d, ollnr:h Sr:II. EIC (""11 f'lI. 27). ',I i/r'/
NOlllo.oblo oO'l1Od h'tllllKl: ."'1." I , IIII! i
olld Iypo ~ NO 50
57 AIIKIIIIII paid willi For", 4000 (n,lnll.loII 'oqllllnl) . . . . , . . , .. , 57
58 E.con. .oclnl o.cwlly olld nn rA 10. wllhhllld (nllll pO,," 32). . , 58
59 Olhnr pnvrnnl1l!1. Chock If "011I 0 0 rlllhl".~1I b 0 rllllll.'3". 59
60 Add II110s D4 IInou II &0. Tllooo QlII Olll tolat a lIIonl9 , , , , . . . . . , , . , , . , , , , . . . . . . , ., ..
61 II IIno no IA ruOlO Ihnn linn OJ, nllbllRct IIl1n 0:111(111111110 no, Thin 10 lho PI1IOUIII VOIl oveRPAID"
02 AIIKlIIIII "lIh," 01 YIIII wnlll nEFUNUEO TO YOU. . . . . . . . . . . . . . . . , . . . , . . . . . . . , . . , .. ~
03 AlIlClI'"1 111111111 01 YOII wn," APPLIED TO 1005 ESr. TAX... ~ ~
64 1/ 11110 53 In "'"0 Ihnllllllo 00, ollbl,or:11I1I1I 60 1""11111111 63. 1 loin In 1100 AMOUNT YOU owe,
Fo, dololl. 011 how III poy, "":llIdllq wlooll" wllln Oil Y"III POYIIKlIII. nno pogn 32. , . . , . . . . , , ,
05 E.lll11olud 10. ollnll DUO 0 II 33 . Ainu IlIdudn 01111110 04 .. . 05 Ii, ' ,III 11111 Ii lili.II!iililil'i"II,il!l
Ulldfll Pfllll\!Ilflo {I' f:OIhIlYl/ \.Iodmo 111011 hnvll O)lnll~llOd llll~ loltllll Rlld nCClllltpnllylllg nc:llOdul\J'I and alaIOlflqnt', Dnd ItJ UIA bnot
of my W'IUW'ut'OI1 n Id bonll. "IllY nlllllUn. 1:1111111:1. nud t:CJlflfllnln. Onc:lmnllulI II' plnpllnt (011101111111 'n.l(pIVo,) Is bRood nil an
InfoHnn! 011 01 W lie I fJlnJ1nlnl 1R9 nllV kllClwlndql1.
~ Your olgnnltlln Unln Your occupnllon
, MJlRKE'1'ING
~ Spousn'n nlllllnllllfJ, II" lulllllnhllll. [l(JII~ nl'1l1 Unln ~II or.cllpnlloll
, ADM ASS IS'l'AN'1'
CIIRr.k" r,opalo,'lIBoclnl nnr.lllllv 110,
.oll-oll~od 213 - 32 -1404
E.l.Nu, 43-1632899
ZIP codn
13 534
15
1
1
361
827
827
A~rnOl~~ Un~
olgllohllo, See Attestation 1\ I 95
Fhll". 1I01lKl(II' YO'"." tl ANU _R ULO~JS.._
1I.01l'olllfllnynd) ,IiJiJ7 YK RU !..11u1 1\94. '11\90
olldnddlnnn LU'l'lIERVILLE Mv
NIFflPl'
21093-0000
r,opftlo,. Edlllnn
('lIr~lllIhl r..,",. !'Inft"",.,. nlll.,., "p., 1I.lw, hlf:, tjq"IO""1
.
'. 1994 Income Information Worksheet
MR & MRS:
JOHN R ROBINSON
MARGARET L ROBINSON
.__._--~---.__a__..__aa____-_._a_a~a__aaa________a.__________....______......
209-32-9655
004-48-3506
11/21/1942
9/29/1948
........................... FORM W-2 INFORMATION ............................
---------Wages-----____ .. .. .. .. .. .. .. .. .. .. .. .. .. 'l'axee Withheld- - - . _ _ _ _ _ _ _ __
Medi- Medi-
Source 'l'/S tlross S.S. care Federal 8.S. care S'l' State Local
GENESYS 'I' 60459 60459 60459 13864 3748 877 PA 1693
R I TEMP S 1330 LBO 13Hl 91 82 19 RI 26
SPEC'l'RA S 187 187 18'1 :1 12 3 RI 3
KELLY SE 8 2679 2679 26'1'1 158 166 39 MD 44
CAPITAL 8 1013 IOU 1013 76 63 15 RI 21
GLENNCRA 8 7666 7666 'lfj(j(j 802 475 111 RI 219
.. .. .. .. .. .. - .. .. .. .. - .. .. ---oo-.. .. .. .. .. .. .. - .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
73334 73334 '13]]1 14994 4546 1064 2006
....aaam_ ....a=___ IIUII",Clctt"l'= l::tA_c:rr.ral::l _Cam__ 1:f1!:laaaa ---.... a_lama
Payer
DATAIMAGE INC
.......................... FORM l099-R INFORMA'I'ION
tlross 'I'axabl e Amount
'l'/S 'l'ype Code Amount Amollnt Rolled
l' P 1 1833 1833
..........................
- - - - - -'l'axes Withheld- - _ _ __
Federal ST State Local
367
------ ------ ------ -..-----
1833
1833
.. .. .. .. .. .. .. .. .. ..
------ ------ ------ -.----.
367
......................
payer
CONNECTICUT MUTUAL
_1iiI=__ __a_a
INTERES'l' INCOME LE8S
T/S/J Type OroAs
T R 13
'1'I/1\N $400 .**.....**.......******
Nontax/Exempt Adjust Backup W/lI
.. .. .. .. .. .. .. .. .. .. ..
-..---.. -----..----
13
Cl'1n=_===
=lIiIIa=_=r=_a-=-a
----.. _.__a__....
......................... ADDITIONAL INFORM/,TION ....t.......................
Return Prep Fee 133
Federal software version: 4.95.001
. :~:~ii'!.I1A~li~~E~;;mr;::~~;j~.~~~.I:~ii;,~~~~IV~tlU_~I.:l!~~~~~~~~,~~~lu:_'I._!"'=.t.... B--.' ;~(;;ti$r,~~::~.
ADoIIEss .JtJ LI fo...l_i?__i._Ll':J /l1fr:A.f?C T__'=._l< ~fAl rJMrL-.__ ~.~ I ::J..~_f.M~
P""n1 h<t.:i :",....100....... ...1 "'..... ...., ,...,., A '_' :od:l,""'.'....~
I:.Vk~ -1pfliL.J;.~Q'=-J~_c;,r?r;f..r.__?L..._..H__ltf c_ F' . ~rc__q,o_'LJ.1A$.:!o~
Othenrwfte. ell,. lownOf ptMl n"lr. .ntl ,t.l. . III' (Aide orr CIE USE 5endIJlACCfURAfmm:rUHO:
,-"'pI'" CO~E. y~V W.E I'nD <X I03() ::':=::',.f!"'-
Of type, V-~g1l1i;~ily;-;';;y;il;;;~)\I'lf-fl;~-~-;~~kf-~I;t~II-;,- ~~. ;. UCifY~;~---}--lA.lAEffX-- ::u~~~~:o flSO
J.n 1.1995 IMPOIIIANI, SEE It15I11UC'IOIl5 ,... ~1:OUUlV .'. - --..._- ""","'urn.. .. _
FILING SI A IUS (CIIECK ONLY ONE 1 ExEMPIIONS I...'.' nurnbot' '''~ EXEIIPIIONAMOUNT
"...."hv~.u4""'..,'h"Ir..._"t1"9r.."'hl"11l..m.' 'Y-~--'--'.-----;;;~;':'.'E '-a Enllfoolnel2btlow
'nuII.......'........,......1vt II... In'IfWfIIlJl''' ~~ ~OfOftlf ""'''' .,..........nt. .1tf1Jl.......
to.......I<~.....~".ldol,....~.<oI.""I.-h 1.1.1 + 0 + 0 + D - Ox $800 - I : 00]
20=~:..":o.'..r"':::'::::.., In + 0 + 0 + D - Ox $800 - I : 001
30M"'Iod,"""l"r"~IlII".' ,..., ODD 0 I -J
1t...._.'IOC'-''''...' ,.~ + + _ K $800 _ . : 00
numbtflr!'PIttlat~ __<
"4"-1~~,:'~:..7'::~...c~iu~~D:Y~;,;~i: 1.'!L + 0 + 0 + F' -I7Jx $800.. ~qqIQQ_
- V'lthl"_,,I... ~~~,!,II A:..sl'~u~!___ ..~ -~_CL.LD + 1 - t71 x $800 - P..o..Ll!Q..
5 If yoU C80 UII clllmed II' I dttpanrfmd on nnolhn,'.,nluln ,ulff had 0 A UStCJ="" 8 r~ot:~e:.
une.,oad Income chock hmo. Boe tho "lShucllul1s'or Illln 11 . . " .. .. . . . .. , . . 5 SlIM'IItNd.d .....
S AOJUSIEDonOS91NCOME homyou, ledo,nl ,o'"rr, (IIoll..tot.llo.lbIollleo",. }.... S Ie..< 7.0;-0 _. .__'-.z.30.s _.__
7 '~dIUon"Il"IIUNE34olllh.bnekollhl"olu," ...."...........,.,..... 7 7T~ _. __._._..,.._
8 Tot.I(.dd IIn. S and 11110 7) ...... ..... ......................... 8 ~~ _6~E.S..._
9 Subl,.elloll.I,nrnUNE42onlhobnekoflhl.,0Iurn .....,...........,..,., 9 .
to VllolnludJu.,lld uroo.lllcom'lsublraelllno 9 Iroln 11110 0) . . . . . . . . , . . . . . . . , . . . , . . 10 _1'1 2.SO
SlAHOAno OEOUC'IOH .- OR - "..nl,.d I I In, Tolnlll.rnl,.d dodueUon, ISelr A,
rllngSllUtlt I: 13.ooo.....bt..,. 0 .
Fling Slllus:J S2 500 ..., --.... .ducflon, t 11bJ Len slnle and lOCAl InCDfnll lu claimed .
ruM'll 5'"002",4. loll' 15:000 ':::"~=, On '<"od.'. Allie' Equ.l. tI.1 VI,gllll.lIornl,od d.duellon.
II Dllducllon:SI."d..dor VA lI..nl,lld OlldueUoo. (CIIIU1god f.. 199<4. Sttlnstruc:1lonsl '"'' It -i;fg-.;;;; .
12 Enlorl"'......pUon8lllOUIIlcornpullldnbo". ..,..............,........... .12 0 00
13 Chlldoncld.ptII1d""e....,porI...dtduC1IonI."".....,..""'.~f_.,~.....t-f.......3 .
. at\Achl<<Mlllformo..c:t..... u.....,.,
t~ TOloll.ddlln..tl.12.ndI31.............. ..... .........,..............I~ -"~u
IS VIROINIA TAXADll:lNCOME (subll.et II". 14II..n IIn. 10' ..................... IS I :l:ll. n " I
18 INCOME TAX:F,orn T.. T.bl. III 1.. R.lo Schedul. . .......,................. t8.r.::?<i ~
'7 TOTAl TAXI.ddcolurnllA.ndeolulllnD,"n.IO'....,.,.................... ' ;;r 17
18 PAVMEII1S I.) YOUn Vkgfnl. Incorn. I.. wllhh.ld I.".eb lorrn(11I . . . . . . . . . . . , . . IS (.) O.
N/OCl1ElXlS: lb,5POUSl:'S VI,glnl.llleom.I.. wllhh.ld 1.II.eh lorrn('1I ' .. ., , ... . .ISlbl . 0 .
(e) COMOINEO 1904 ..,ltn.,lld ,.. p.\'lIlOlllsllnclud. C1lldll ~orn '9lI:TJ. . 18 (e) .
(d,COMDlNEO..,,,,,,,," p.rmonls IlUIclo wlthFOI1IlI6DE(a"ocI'F0I1Il7llOE) .. tS(d' .
1.)coMDlNElJaedll.',ornSchedulnCR(nll.ehScboduIeCn) ......, IS(.) 3 '/7 - - .
10 10TAtPAYMEtII9ANDCREDII91.ddllll.SI8(.)1Il10ll1lh(.J) .....,......... 311 Ig I
PI .mendlng your ,.tum, do not c:ompItl.III... 20 IlIrough 21. Proeetd 10 Pelt V 011 ....../
20 II LINE t71.'lIg., '''''''LitlE 19, o,,'or lb. dlllo,.ne., Till. I. lb. INCOMe TAX yOU owe. Skip 10 lit.. 22 . ,...20.
21 II LitlE Ig 1.llIg., Ibon liNE 17, .nlor Ih. dllI.,one.. Thl.I. Ih. OVERPAYMEHT AMOUNT ........,......21.
22 Addlllor"ol..,pon.llyondlnl....II'ornllNE48onb.ek..........,.".,.",.,....."...........,..22.
23 II you ow. I.. on LINE 20, .ddllno.2O.ml22 .on. II LitlE 211..novorpol'J1efl1 and LINE 22 I. IJugor Ihan ..
lINE2t,.n,..lh.dllfor"",.. nll.I.lh.AMOUNTYOUOWE.^"nehp.)'Il1Of1l......... .."..,...,.,....23
2~ II LINE 21,. l..g"'lIon LINE 22, .ubl,net IIn022 from 1I".21.nd,"lorl'" NET OVERPAYMENT AMOUNT,. .2~ ~
2S Arnounl 01 ov"p.ymonl on 1iII. 24 lobtCnEDIlEOlo 1995ESlIMA'EUlnmrnelu..... .25 [-cJ~ _
28 lblal(subt,octlheIO'^LolcolufnnA..IldcolumnO.llno:?5flOmlln.24) ..............................2'0 _
27 AUIIlOllIZEOOEDUClIOIISFROMOVERPAV"'f!I.!.[2.!.1J!!' !'!!,Ior""n (,Q....mll.ctlomIAdd211.lllwoogllUlboloo..,., 27 __
II/Con. luma'.IU..,",...,..........., "/ ___.n"'h _h. ~ III ~__] ~ If'O\l"'Spocon.aNlion&Con"''''klnrund~
I ""VA""'-la""Wlo."'~""Nn 11iI!-._._..__._ ~ 111_ ~ IIJlIouoIngPt"l781n
.:= '1,)VAD.",o".'''P_ty. 1<1.. . n', .. ~ P'J ._ ~ IhlrACI:r_nlrVlolonctp,,,,,,,'kln
...UI. "ldlVARropubIIcanPNty lIII __.._ ._._ .._. ~ (II _____ _ ~ II'fkloo".ndDlublodI'wrotolklnrund
-'''' (.IUS OI""rO:C<>mor;n.. 1.' m_._.__. __h. ~ fII __ __ ~ fllConmJltfl'didrqrund
20 Amoullllo bo nEFUNUED to YOU (suhllll'.:lliIIO 21 flOlll 11'10 2.0j , , . , . . , . . ,28 ... J
'''''~.'u.. LTDOI '..,"",.u.. ,. c.....
VChock
r.".o
Slalus
Enler
lW
E..mplloo.
r STEP t
1 C"O"O'....IAII
Ill,.....
i ".1
...lftfl
- -.
~
I STEP 2
~ OtducUon.
10 Comput.
t Vlrglnla
J T...bla
lneomt
'II
..
f STEP 3
I Comput.
Yow
L Ta.,
Poymcnla
and
CrtctIl
r STEP ~
Compul.
Amount
i You Ow.
Of
I You,
f R.lund
~
I
I
VA930
KSUf.'O
L .....DUO
"'l.Af0fll1A11I
/...:L'1o~
<fP;s:.iL __
l?c.JI,L 00
,n..SD
.<0 "~5
_C)
~-.3_~
~'111
."1 1.KIf:._
.3188
l'At t."UbUC.1J ............. ---.^--.... ..-. -., . I
II, . ,-";;;pui;f.iIOf her own "",,nIRI" hU" lJ.Plhm.unn II Villi flUllhlV 11".1111" Ih.t!U.':liUII ft.III'
~lid:J::k:,!'~:711~: ::19. cl.lln Ihe ol1,!_whk:~~ bplI~~j~! ~~ I!.'d_"~~!ll ..~U~ t:.~I!"~~.,:ln.I~~I~lI.~~ln.d.I,'.~!~~I1.~.
En'" ~~nln"~tlnlheprOfNutofumf1lltMofllh U"y,Vfln, '0,,",,1. tor ...mphrUJ.04-:)(J ,'"
N OEOUCflON RABE .11110.81.8301 ni hy mlelllluht. Jp"u,.,y t. l'llm, ""tllf $0,"'1;
. ohlf alJfl8!1Of nvm by mldnlqllt. .'''"UOlY I, IW-J!l, el1lo, t.I?.9""
30 lot.1 Snel,1 floclJllly Act and' lor I ".IIIOIul J1nIlIOlIlfJrlI Act hone Ills (fUlulvnlnnllu
aocl.ll8Curlly blnellll) . .
3' Age deducllon~ If LINE 2911 hUQo, Illnll lIUE 30, lulllmct lilln:10 hpUlllnn "0 "11I1 ",,1m hOfn,
n LINE ~ I'not 101gOllh,1l\ LINE:1O. "nler "0 00" Ifhl. ","UIInI will hO'l!uwJ ol1llt~E 3ri tJnlow t 3t
~1tI"g SlsluI I Of 3: Enler nmounl hom linn :11111 column n 011 I Inn :J5lmlllw
FlUng Slfllull2~ Add line 3t, colUl11ll AIIINt colulIIll n. Rnd mllof Inlnlln cnhunnl1un liNE 35 bulow.
Filing S181u. ,t Enhu l",ouIII(.) from flno:Jt In r.olulfln ^ nnd r.nlurnnl1 onLINE :.I!llmlow.
. JJ'Hiil, . lint. '1..n;
.
~9 __~.~__.__.___ ___.
.
:10
PAIIT II. AODHIOHS TO FEDEnAl ADJUSTED DnOSSIHCOME IFADII
32 Inllfsl' on obllgollon!l 01 othef IIoln. lumpl '10m lodnrollnr.ulllft tn.., bul flol lItHn stnln 101C 32
33 Olher Iddlllons 10 fedeflllldluslod gIn!, InC()lfln n. IHovldoli IUIIl!lfucllons. Alloch o..plonnllon. 33
:w TOTAL AODITlOHS add 11".1 3~ a"d 3:J . E"lo' ho,o a"donllllE 7 0" 100,,1 . .301
PAIIT III. SUOTIIACTIOHS FIIOM FEDEIIAL ADJUSTED OllOSSINCOME IFADIl
35 ~:~I~U;:=III~~~~~'.I.~t,~...'~II.g,fJ.~~llJ:~V.RI.hy.rn~dl~1:'~II,JlIl1IlA.'~,t,'.'~~~" ....,. .35
38 Slllelncome tax ,nlund or oVOfpoymoll1 crrtdll '"'lOIlnd n,lncmlln nn yuur
fedeflllttu'fI..(Claltn In Ih, lome column you 'Rpo'tod tho Incomo on 11110 0) . , , , , . _ 30
31 Inlere,t or dividends on obllgollOfl' Of !Jer.urllles 01 "lit U 0
exempl from Itatelncome taxes, but nol from 'odofBllnlo! , . . . . . . . . .31
38 Codal Security Act and equlvAlenl Tlltf . O"lIrood neU,omonl ^cl bOllollls
reporled It faxable I"como on ledellll Form 1040. .38
39 OIslIblllty Income usorllo computeth. 'fHJornllllcolllfl tllM cfnflil 'or flfJIIIIRllnlllly Rnd
lotllly dllabl.d POlIO'" u"dare". 65 (lool""'"Cllo". . AIIReh IndOl.1 ScI..dlllo nJ . . . . 39
40 S.II..mployml"tl.. claimed ."""ddlllo,,10 FADlo!!.!'oll' 1990 Ulrfl"l. '0111111.. . . . . . . . . . .40
4D(IJ(S..I"II'"CIl0",.)CI"YOV.' 10 1995: Col. AC-=-]'::::~ Col.Or-- r I
AUSl:a~,,..,
_ -.. "*'!d_
B lUUl\."IUf
FCllIML,'''
_~."'I___.
.
.
.
.
.
.
.
~. other lublrllcUOI1!1 hOfn FAOlas provided In 11I1!fucl/om, . AlIneh "."ll1nAllol1 . . . . . . . . , . . . . . . ... t
42 TOTAt SUOTl1ACTlOHS Idd lI"a. 35110.011 10 41 . E"lo, ho,o o"d o"L1tlE 9 o"l,onl . . . . . . . . . 42
PAIIT Iv. ADDITiON TO TAX, "EH"tl"i AND IHTEnEST (Sa""ltrucllo".'o, ..ch II"..'
43 Addition 10 hur: II FOfm 1600 0 0' Form l00F 0 WAS com"lnted, onlo' Iho amount cOlnpulod, . . . . . . . . ~ . . . . . . . . . . , .43.
44 ".,,"lly: S..I"II.ucllo"I.1I dllO, chock 0 L.,o FIII"II "o"olly on 0 E.lo".lon "."olly ."d orll.' all1ounlloo,. ...., . . . "" .
45 1,,1.,..1: 1,,1....1 ICC,"edO" liNE 200" ho,,1 . . .. ....................... .45.
46 TOTAt .dd lI"al 43, .u ."d 45 . E"I.' h.,. a"d o"L1llE ~~ on ho,,1 . . .. . . , . . . . .. . . . . . . . . . .. . . .. .'. ! . . .. .48
COMPtrTI! PAllr V ONl Y IF AMEND/NO YOU" 1994 nETUIIN.
PAIIT V . COMPUTE THE AMENDEO AMoUHT YOU OWE on nEFUND TO OE nECElvEO (S..I"llrucllo"..,
4T Amou,,1 p.,d wllh ..1"I"alr.llIlI1. plusaddlllonnll.. "olrlollo, 11 wo.lllod '................................... ..47 ~
46Addll""470ndll".19onho"la,,d.nll,h.,. ....... ...... ......................................018
49 Ove'p.yme.I, II any, "' Ihow" 0" 0'1,,1,,"1 '0111111 or 1''''OVIOIl.ly odlll.lod .".................,..............' .49~
50 SlIblract IIn. 491'Dm 11"0 48 (1..lnllrucllo"I' . , . . . . , . . , .. .... ... . ....................................50
st AMOUNT YOU OWE, 1111". ITon "0'"I. 1l1OI. 110." IIn. 50, .nblrllclll"o 50 I'",n 11"0 17. ^"aeh "Iym."t ........... ,6t ~
62 nUUND 10 bl,oc.lved.lIl1n.17 on ".." 1.loSllho".. uollll ""0 60, lubhoct II". 17 "0111 11".50 ............... .S2 ~
Fllo Ihll"lurn by mldnlghl, Moy 1, 1995. wllh YOlllloeol COIIUI11oolono, 01 tho novonuo, Dlroclo, 0' Flnollco Of SUPOrvllOI 01
A..ollmonll. ATTACH AtL REQUIIIED VIIIGINIA SCIIEDUtES o"d 0 COMPLETE COPY 01 ooch ledo,"1 Schedulo A, C, C.ez,
0, Eo. F flied wllh you, lodorol rolurn olld nil olhlll oehndnloo ouppolll"g groBS locolpl9 nnd doproelollon. (Soo Inol.uello"o.)
I tWel. Ihe Undoullgnnd, declare undet f;ennlly~iIRw Ij~'~llf:';~;h~'~;;;;;;;;;;~d thl. lolurn nnd 10 lho fiJl,1 0' my (OUI) knnwlodgd. 111511 hue, CO";d
and complete folurn Wft ngleo Ihnl filing snpRrolflly un thl.. r.nmhinrd ICllllIIlllRkos Usl'Jlnlly Rnt.llovo,nlly lInbla fo, the amount ('I' tn.. shown 10 b" duo
on this fllUIn and any 'elund, duo will ho 1I10dn Ilaynblnln ,,, lointly.
"'..10 ~.... I . "../) Il.~./
Sign -"~~.- '//01<-<;
~~_e~:_~ ;I"r~_S}:~t~~"~~;i_'~_~: oi;; -----
Prop'ror'. ,..."~,Q".!!!.7y,:: .) ii.ii;--'-'"
U.. O"ly X ..&!~. ~-zA~:!:!:;~~___~~_~_~ ': __.. 'Ib I:'!:.::
r..n ,1I.m_IOl lOUIIII~" ,",pIn'''III''t~ll.hhf'" '{,
_____ ._HAn IILOC.K
l1uf 00"'." pholl, numbel EIomtt pt.o,~ ftUmbt,
~J.___L_____ .L_L____ _____
~P')"'"' bu,tnllS' r11Ofl. nunltwf
~~;;;,Pfwhnolllblf -- - -~iOjIW~;f iii Ho-.--
L'&_O_L.'Ifi'l-:7.J!:'?rL.____ __.___
1447 York Rd. Suite 30
LUlhervllle, MD 2109.~ ..
t\ I ().494. 7490
V^lJ .II
Cl A~IN~IO ~ITUnN
v
F18CALYEAIl~ILEnSIE~~d." . _ tl6-v.!ndIIlQdal. .8 . :-:J.":..,,:=c
IWIIAND F~otnomoiiiiil iil ~..~iOi..n,;;;;bUffii ... ii.ln....
AooREBI JO~l~Miii~..aJl'1t;,~cr L P-08/NMrJ ~13.::ll~
Un VIr~ ",...01 " ...<< a, ",.,1 Of fUt ;001., - A llOdeIMC:Urtt,
1IbeI...l4.o I, )t: N.~hb.-~~..I:..-_LL... A f"- F' · OOJ.\ ~J;~~
Clthenmt. Cltr, kMflOf PO"1 IIHIc:, ii;JI'111 iiJiCnde OffiCiUii ",ACCii.i iiiilllFUHOt
,,:pr~ _Co~e,.'ls:v.Lt",.(..t=-_.__/~D_.__.___cX / o3l) V",Itl3ltlllnllllllll.L _
'''''''=1'', 0
or, VI,glnlocltrOleounlr""'."YOUO"",..ld.nlon II I ~;"Ylll } EI'1.LA.Ei'tK. odell... IIIIn9 ".
.Iot.."""''''..
J.n.I,IQ95.IMPonTANTISEElIlsrnUCllOIIS ..n.o I:OUNIY _. .-. . -..".''''.
ChecIl flllNQ BrA TUB ICItECK ONLY ONEI , I!XEMPTIONB (.IIII1I1UIII~tl_. '011I UlMfT1Dll AMOUNT
r:u IlboIhhvllh."d....wtI.lllIdlntorM.u..... n...". '.'VI. ""' YOUI..II ...- IIIilll Oopondonl. I._loot Enltfon"'12b.row
IMUtl tit ....I.. INn,,, lit"" '1... --'''"xllm'l
I O'''''''~_.lIt.tdollloototooldms []J W + 0 + 0 + D. OK SBOO. I 100]
Slalus
En41f 20100"",.... folot I.t..n [~J + 0 + 0 + D . D K SBOO . I 100 I
1f.....onIr_htd_1 ..
r.'lIIIpIlont 3 O.."'W,....,..,...I."h"", 0] 0 0 D .[ lK $000. I : 00]
(fl'll".... '1ClC1II Ne\llIr + + +
"","",,~IpICI-
end tnI.IuI",",,"" Column D, Y.~~~~il F~R + R + Fl ~ 1=-41 ~ SBOO . ~g~ I 00
~ 4 {5;lMon"",IIII.."r,"""''''
IhI. e"""" " III" CO!~I A~o~!!.._....... + + + . I K $BOO . -r-
. '..QQ...
15 II you tail b, claimed II' d.pendent "n anolhor'. relurn Ind had 0 A 1J8E~,.. 8 YOII\'ll11
un..rnld Income chick h".. Bee Ih, Il1llrucllOfl1 lor IIn. t 1 ..., . . . . , . . . . . , . 15 f...It..
....,-- -....
BTEP t 8 ADJUBTED llnOBBINCOME '.om vom lod.,.1 '.'U'" 11101 lodor.II...blo klCClne). . ., B -L'f..2JJ)_ -- . t. .. Q",..
c...oo "" rlOl 7 'Ilild1l1on"'OIn lINE:J4 all Ih. b.ck ollhl...lurn . . , , . . . . . , . . . . . . . . . . . . . . , . . , ., 7 .
Ill...... 1'I2$U _JifMOr{' --
II.' 8 Tol.lladd IIn. BInd IIn. 7) .. .. . . , , . .. , , . , . .. .. . .. .. .. .. .. . .. , .. .. .. .. . ... B
'"!.lot" 9 BublraclloII' I,oon UNE A2 OI1lh. b.ck ollhl...lulll ',........."".....,...... II .
~ 1-+ 10 Vllolnludlu.'od o,OI.I'ICOIn~.iiublr.cllln. 9 hOlnllll. 01. .. . , . , . , . . . . . . . .. . . . . . to '<h L.V'o
STEP 2 IfANDARD DeDUCTION . OR. lI.mlrod II (.) Tol.llI.onl..d d.ducllon. (Bch AI
Dtducllon. riling 81"UI I: 13.000.... .
r~"lIOI"u.3 12.&00 .., -.... Dodu'''on~ IIlh)l....I.,..ndloc.llncolll.l..cl.lm.d.
to Compul. r~"g OI.lu. 2.. A, 'ot.II5,OOO =~, On S,h.do. A II (cJ Equ.'. N.I Vlrulnlall.onl.ad d.ducll.n.
VIrginia I I Doduc1ion: Slond.d or VA 1I11111.ocI DocIucllon. (Ch.ngocl lor 1904.910 111Ifructlom.) . . . . . t I /~ I_ . <fx~il.-
T l.abIt --
t2 EnlOllh. ..ompllon II110UIlI compulod .00.. ...............,................ I' lS 0 00 'i<<JO 00
Incomt 13 C1dlchnddopond.nlc....""n...doducllon(..._'I.\'l:..Ndo...,....,jtr"~...,.. 13 .
.nad1 II lor," m let < '01 .n.s~
t4 lblol \.dd 111101 t I, Ihnd 13~ i~ ... ., .. . . ...,. .., .. , ,., " ,...." .. ......,.. 14
18 Vlnll NIA TAXABLE INCOME .ubtraet IInl 14 hom IIn. 10) ....".,."., ,.." , ,I,IB /,,: ...... ~, , j.-
;~,..,,. 0 10-
STEP 3 18 INCOMETAlC'FtomTuTabl.orTa.n.'.9choclul.....,....,...,......... ..::t8 .0<1
CoqIuta t7 TOTAt TAlC (.ddcolumnA.ndcoluonn D,lIne IS), ....."..........,........ . ~ 17 I .3S ,c:-
Your tB rAI10IEHIS (al YOUn Vkulnl.lncom.'u wllhlo.ld ,.lIach ""mi'l! . . . , . . . . . . . . . , IB la' 0 . ,
Tu, ANOCI1fOlI8: (b) srouse'o V1'Ulnl.lncom.lu wllhh.ld 1.II.ch IllImi.l! . , . . . , . . , . , t8 (bl 0 .
PIynIOlIta (c) cot.IBIIIED 19U4 ..lIon.locI lu p."".nl. (Includ. ctodtl I,om '1llI3). , tI(c) .
hi (d' COMBINEO tlltntlon p.ymenIo m.do with rllllll71lOE I.lloch Fonn TIIOE) " 1 e Idl .
CrldlII (~COMOIllEO Cloclll. ',om Sehodul. cn (.tt.eh 9choclul. cn, ....,..18 (., iJ iJ'7 .
19 TOTAt PAYM NTD AND CnEDlTsiidd IIn.. to iii IIl10ughl;,ii ............,.. :r t8 I .'4V 7 I
I PI tIII1Indlng r_ /'Ilum, do"", COIl1llIII.II11.. 20 IhrOllllh 28. "'-d 10"" V on.......
STEP 4 20 1I11tlE t71.IIIUII IhlllllNE 19, .,,1., Ih. dltto'.lIeo. Thl.I.,h.IHCOMII TAX yoU OWl. 9"'p 10 II.. 22 .,...20. ..:! I~~ --
21 II liNE tg '.IIIUIf IhlnllNE 17, .RIOf Ih.dlll.,.nc.. Thl.I.,h.OVenPAYMIHT MotOUNr .,..,....".., .21 .
Compul. 22 Addlllontolu,pon."yondk".".lhomllNE4SOI'b.ck."..,.....,........,......,........;..... .22.
Amount 23 llyouow.t..onllNE20..ddll"..20a"d22 .011. IIUNE2t1"nllVOfllOV"'onlandllNE2:1I.lIIgorlhon ~ .3/88
YCMlOwa UIIE2t,onllfllo.dllllflnC..lhl.lllhaAMOUNTYOU OWE. Att.ch p.ymont. .....,....'....., . . ...... .23
01 24 II liNE :It 1"IIU.rthlllllIlE 22, .ubl,aclll". 22 I,oon 1111.21 .od.nl., Ih. NETOVIJ1PAYjlHr AMOUNT.. .24 ~
YCMlr
n.fund 25 Amounlollw.,pa""tnlonlln.UloboCnEDIlEDlcI90SEBIIM^'EOll1Clll1lllu.,... ,2S D~
2S lbl.I('ublracllh.TOT^tolcalumnA."deolll"'nD,lIn'~5Iro'nlln.24' ,."..,.....:.".,...... ,..,. ,28
27 AUlIlOI1llEOOEOUCIIOfISFROMoVEnPAVMEHT. ~!jJl!.'!!!!,I.r..m GO....lnt1Iudlon.lhld27I.ltlllouohUlbolow,.,. ,27
.~...",~.- ,., ~~. "'~. ",..._...........~,,~ j1
, IblvAHongomeVMf.rrogotln.1b1 __ _ ~ (gl __ ~ lulllouolngProgoom
.::= lelVADtmoalllc:p.ty....... leI _.__ _ ~ I'll __ ~ I'1lfACT:F""r_rr_
...",. '(IfIVA""""",""P,,ty .. "" .(d) __ _ ~ lit __ ~ (1IEldtdyondOlooblodT,_lIIJonrwd
-,.., (.,U.S.OIrmPcColornlnN.... .('1 ~ 1II ~ lIICOomul1yI'dlct1gFwd
V1\9JO ~ I
:10 ^"'ou""obonEFUHDEOTOYOUI.ubUoclllll.21huonlln0201.......,....."..,........,..,....,. ,2B
_""'0 rOf lOClI u.. LTDDI rOf O",CI u.. ,. Coding
_,....
""""'OIl"'"
'''"~ . rm'-liiii!J .
760 vlrglnlulndlvl~iiiiliiii:ome TUlI Return 1994
IIiIlIN.OCl(
.
i
i
2
t
J
'I
i
J
.
I
r
II
I
J
L
FORM'7eo (1994)
R.
:{o
:J.1b~-
p
2
y" VEr, OF lAIfAIKW, 1IOInl' ,oe IN r../)A J '-3 - ~> aga
"AlIT I. Aaa DlbUCTloN COUPUTAT)ON FOR TAXPAYEIlI AQIIZ AND OVEIl SPOUSE younSElP
Each .pauH mUll compul. hi. Of' her 0Wf1I11C.,tttlllgfl dudllCllon. II you QUlllly rex this deduction ftn~ I Uto"""_.",,U
."" doducllon 011 1111. 39. cl.lln Ih. 011. "hlch .".11I. ~'!.!h.Il1O.I. You c.nllol cl.lrn bolh dodocllo".. Monlll . u.r. YII' Moolh. u.r. v..,
EIll. rouollATI 01' BIATtllnlhe",_ oolutnnInMonlh.Olr,VII,'orm.1. ror...mllle: 03.04.30 . ... . . ~
2lI DEDUCTION bASE. ~.e:I, 03011\01 brmld"lgf.l. J.nulry t, 1995, Inl., 18.472; .
. IIIg. as 01 ov. br mld"k.l"l. JO"UIIY I. 1995, .nl., "2.11-I4, . . . . . . . . 2lI --
:JO TolII SocI.1 BlCo'"y Acl end TI.. t nlll,ood nolklllllnl Acl be"olll. {oqul'"',"llo .
eoclel'ICUtllrb...nl.,...,..,..,.,... . . , . . . . . """" ,,'.' .... ..... .... .......30
3 t Age doduellon: II LINE 29 1.llIg.. 1110" LINE 30. ."IIIr.clll"o 30 lroll1l1"o 29 IlId ."1.. h.... I
II LINE 2lI1.,.olI.,g.,lIl1n LINE 30, 0,,1., "0.00". (1111. omnu,,1 ""I II. u.Ad on LINE 3S below.). .31
Filing 8111uI t Of 3: Ent., .mount ,.om Iln, 3. I" column n on line 35balnw.
Filing SloluI 2: Add IIn. 3t, coIullln A .nd ColUIII" n. I"d "",., lololln column B on LINE 35 b.Io".
FIII"g SI.lu. 4: EIII.' .mou"I(., f,om 1111. 311n coIumll A ond column B nn LINE 35 bel....
A\.IS(~,.. B YOOOo;(\I
'....11..
PAIIT II. ADDITIONS TO FEDEAAl ADJUStED On09SINCOME (FADI' _41t_ -....
32 Inl.,1I1 on obllg.llo". 01 0111.. .1.1.., ...mpl ',om 1..1...II"COIn. I.., bul nol 110m .,.,.1.. . . . .32 -
:J:I Oth.. oddlllon.lo lode,.I.dJu.I'" g,o..I"oolll'" p,ovldod In I".lruellon.. Au..h ..plln.llon. .33
:\01 TOTAL ADDItIONS/.dd II... 32.nd 331. E"I.' II...."d on LINE 7 on f.olll . . . . . .. . . . . . . , . .304
"AAT III. SUBTIlACTlONS FIIOM FEDEnAt ADJUSTEO OnOSB INCOME (FAOll
3S ~: ~";:,,::.I~~~~~.'.~~'~.','~ ,..g... ~~t~,~',..' b.r. ~~d~I~~'~,J~~U...ry.l: .I~: . , , . . . . . . . .3S .
38 Stile Income 'Bill refund Of' oYllfJ1l1ymen' credllrepotled Bfllncome on yoUf .
,"'.." 1.lur/l-(CI.lm III Ih...m. column rou ..,..1'" 1I..I"cOln. on IIn. 0.' ' . . . . . . . , . . . . . . .:Ie
37 Inl....IOI dMd.nd. on obllgollon. 0' ...u,ItI.. 01 Ih. U B. .
..empt f.om .1.1. Incom. I...., bul 1101 hom led...II.... . . . , , . . . . . . , , , . .. . . . , .. , . . .. . .37
38 Coc:lalBlCUllly Acl.nd oqulval.nl T1.. I n.II,o.d n.II..rn."1 Acl b."olll. .
leporlodlll...bl.lncom.olllod..n1FOIm 1040........,.............",.......,.....38
39 Of..blll'r Incom. o.Ad 10 compu,.,h. fAdorellncom.lal c,.dll fOl p.'IlI.n'''"r and .
loI.llr dll8bl'" ".,oon. und., a9. OS {...In.I,uello".. Alloch fedOl.' Schodul. nl . . , . . . . . . . .39
40 SIII.employrn.nll.xclalmod a18,"ddlllon 10 FAGI on your 19jVI'f'"I81l1u.n ........,....040 .
oIO(.l(See III.l.UCllonl.1 Corryov., 101995: col. Ar Col. BC D
41 Ot"""ubl,.cIlOl1' ',om FAGlII p,o,ldedlll 11I11.ocllo".. AII.eh ..pla".lIon . ... . ..... ...,. .41 .
42 TOTAtSUBTMCTlOHB I.dd IIn.. 35lh.ouoh 411. Ell'" her. a"d o"lINE g on 1r0l.1. . . . , . , . .42
PAAT IV. ADDITION TO TAX, PENAtTY AND INTEnEST (a..lnllructlolll 'o'.och 11",1
43 Addlllon 10 lax: II FOIm 7SOC 0 01 FOIm 700F 0 "a. cnmpi.l.d, .,,1., Ih"1I1OI1/11 compul"'. . . . . . . . .. . . .. . , . . , . . .43.
44 "...hy: B..III.I,ucllonl.1I du., cheek 0 1.1. Filing ".n.llr on 0 E,'.n.lon ".II.ltr.nd .nl.. 8I/IOUnl h... ........44.
45 'nl.....: InIOl..llICCfUed on liNE 20011 "01.1 ...............................,......,.................... .4S.
45 TOTAt (odd II".. 43 44 Il1d 451, Enler h...."d on LINE 22 un (,onl ..,.....,........................ .', ! .. . .. 018 I
COMPl.ETE PAnr V ONL Y /F AMEND/NO YOUIl "~REWRN.
PAAT Y . COMPUTE THI! AMENDED AMOUNT YOU OWE on nEFUND TO BE IIECEIVED (SlIln.tructlo.t., __
47 AmounIPlid"lthOllglll.".'Uln,plo.eddtllon.lI..p.ld.II.'It"..lIIod,..............,.......,..,........... .47~
018 Add"n. 47 and IIn. 19 OI1I'OI1I.lId 8111.. h.,. .,..............,.,..............,.........................018
49 OvtIrp.ym.nl,lI.ny,.. .ho"n011 0I19'n.l..luIII 01.1 p..,llIunlr .d'u.lod ..............",......,.......,.,., .49 ~
00 8ubl'ocII1ne49I,omlln.40(...ln.lrucllon.)...,...................................... ..... .............50
st AMOUNT VOUOWE.IlIt". 17 on Ironl II 1l1OI.Ih.n IIn. 50. .ubh.olllno50 "OIn1l1ll17, Alleeh plym8l11 .....".... .st ~
52 IlUUND 10 be ,...I,ed. 1111'11 17 on "01,11. I... Ihon 01 0I1U", 10 11"0 50. lublrocl IIn. t 7 1.00n 11'11 50 . . . , , , , . . . . . .. . . 82 ~
File Ihle ,elurn by midnight, May 1, 1995, wllh you, locnl COlllmllsloner 01 Ihe Revenue, Director of F1nellCe or Supervisor 01
"lIellmellls. ATTACH ALL REQUlnED VIROINIA SCIlEDULES snd e COMPLETE COPY o'esch federa' Schedule A, C, C.EZ,
0, Ear F flied wllh your fodslsllslurn snd .11 olh., .ch.dules supporting grOl8I8Ce/ple and d.preclenon. (See IlIst,uctlone.)
IIWI), Ihlt undn'llgned, dlcl",e under penally allow thnlllwnJ hllve olnmll1ud Ihlll flturn Ind to Ihe ti.., 01 m~ (our) knowlldg., It I. altu., corrld
.,ld comple'e relurn. We ..g,1I thll filing "'pntnlery on Illls combined relurn makus ullolnUv .nd ..versify liebl, 0' lhl amounl of lax shown 10 b, du"
on Ihll '1luln Illd any "lund. due will b. mado payeblo 10 us IQlnlly.
~~.I.~~I~' 0.1. ~~~~ Ilomopho/...........
81gn X . .( I
II.,. -r.;;;;6iiiiii-..--m------ li---- __L-J
Spou.....IgnII"'.(lf Iflng 1.11,12014,80 I mu.lti;nl ..,. fiflOll."butlnIuphontnumbtt
X ___________ li------- .{_L_
PfP~r.r" rr.p..". ''9'\&1'''1 ~ . .11t r,.p...",phonenurnbM 8ollwI" 10 No.
U.. Onlr X~. ~~..::!.::~.:&(' (.~'L__ '1/..1fi?: _I '/(0 1_'/.!iJl-7'P?O
.........,.......W.. .""""'~Q.nd...... 1447 York Rd, Suite 30
... Ha.8_IJ.~ .- buthervllle,M94W94
Vh931
410.494.7490
'Schedule CR
CREDIT COMPUTATION SCHEDULE for Forma 7BO,'7BOPY and 763
h
1994
AUach 'hi. to your fltum. S.. Inatructlona lor addltlon.t l'Iqu'rwd Ittec m.nll. .
. .
IN.... - A ~I~.. 8
'Ro S IrJs.O,J ICUIlIII1
~()o; 132. :'le.SS m .1II1I'Y- far..",...
,..-. -...
PART I-MAXIMUM aCHEDULI CR cnEDITS (compul.lh. m..lmum crodll...II.bl.j
1 II u"n~: Form 1S0 or Form 160PY. Enl.. Ih. .mounl',om Form 160,lIn. la OR Form 1SOPV, IIn. IS
Form 1S3. EIII.. Ih..mounll,om Form 183,1111' IB . . , . , .. , , .. . . .. .. .. .. .. . .. .. . . . , . II I , I
PART II-0UT.Op.aTATE TAX CnEDIT (Fo'm 7800' Fo.m /BOPVI 0' STATE OF RESIDENCE TAX CREDIT IFo,m 1151
2 For Form 160: Pori xl on blC~oISchldul'Cn: For rOlm 180PY OR FOlIO 183: Schldult NPY, PII' II.. 2 I I , I
PART III-NEIQHaDRHOOD ASSISTANCE ACT CREDIT (1/ 'hi. ClldIt I. no/ c/./mId. .nlt' 0 on lint B)
3 Aulhorlzld .mounl 01 N.lghborhood A..,.,anc. Ael Crodll (",'n"lucllon" . . . . , . . , . . . . . . . . . . .. 3
~ Cllryovll erodll "010 prior ''''('lI.II''h compul.llonl ...... .. . .. . .. .. .. . . .. .. .. .. .. , .. .... ~
S Addlln.3.nd"",,~ ............................,...............,.....,.............. S
S C,ldl..llo...bl.lhli Y"" Un. B on IIn. 1,...1111.2, ..hleh.YII I. I... .. . . .. . . . . . , .. . . .. .. ... S
1 C."yOY., Clldlllor IDIlB: Un. B I...lln. S: SPOUSE YOUnsELF
PART IV-ENTERPRISE ZONE ACT CREOIT (1/ /fII. Clldlt I. nol c/.lmld. "',., 0 on MIlt B)
S Crodll .IIo...bl.thl. y..r Irom Fo'm301 (.II"h Fo,m 301' .. , .................,........... S I I , I
8 R.m.llllna nonr,'undllbl.Clldll: Un. I I... IIn.. 2, hndS ....,.........................,.. g I I , ,
PART V-CONSERVATION TlLLAOEEQUIPMENr CREDIT (II Ihl. Clldlll. no/ c/,/m.d, .ntor Don IIn. '3)
10 EnI1r2S'Itoolqu.HI,lngpr_IyCOllor 12.800, ..hleh.... I. I... ...,........................ .10
tl C"'1OYllc,ldllhomp,Ior,"'('lI.II.ehcompul.lIolll ,..,.................... .............11
12 Addlln.JO.ndlln. tl ..,......................................,........ ..... ....... .12
13 Crodll .,io~Il"'lhl. Y"" Un. 12 on IIn. S. whlc,,"y., 1.1... . . . . . . . .. .. .. .. . . . .. . . .. .. .. . .13 I
14 n.m.lnlng nonrolundlbl. c,ldll: L1n. I I...lln.. 2, S, Sand 13 . , . .. . . .. , . . . .. . . .. , .. , .. . .. . .1.
Is CllfYO... c,ldlllor ISS5: L1n. 121...lIn. 13: SPOUSE YOUnSELF
PART VI-FEnTlLlZER AND PESTICIDE APPLICATION EQUIPMENT CREDIT (1/ IhI. CIIdlll. nO/ c/tlmld. IIII1tO... lint 191
IS Enl. 25'1to of cUlronl qUllllylflll equlpm.nl co.l.. $3,150, ..hl.h..., 1.,.... . . . . . . , . .. . . , . . . . . , . IS
17 C"'1OVII c"dlll,om pllor Y"'('lI.II..h compul.llonl . ...... .....".,.....................11
18 Add IIn. ISlnd IIn. 11 ........................... .. .. . . . . . .. . . .. .. .. , .. . .. .. .. .. .. .. . II
IS Cr"""lllo..lIbl.lhl.,.." L1n. IS OR IIn. I., whl.h..III.,... .. . .. .. .. . . .. .. .. .. .. . .. .. .. . IS
20 n.m.lnlnS non,.Iund.bl. CI.dll: L1n. I I...lln.. 2, S, a. 13.nd 18 ......, . . . .. . .. .. , . .. .. . .. .20
21 Cllryovll crodlllor ISS5: L1n. IS "..lIn. IS: SPOUSE YOURSELF
PART VII-RECYCLABLE MATlAlAtS PROCElIINO EQUIPMENT CREDIT (1/ 11I/. clldtf I. no/ elMotd, 11I1" 0... In. 211
12 Enl. tCK40o'qu.llfylng'lCyct.br..qulpm.nICOlI ..........,..........................,...12
23 C"fj'O'" crod" "010 p,1or ''''('lI.lI.ch compul.llonl . . . .. .. . . . . . . .. . . . . . .. . . . .. .. .. . .. .. .23.
24 Addlln.l2.ndIIn.23 ......, ........ ...... ............................. .............2.
25 Enl.. ~ll'Ho olio p. rolurn.. . .. .. .. '" .. .. . . .. .. . .. . .. .. . . . , . . . . . . . . . . . . . .. . .. . .. . .. ..28
2S Molmum rocycl.bl. 1011",.,. proc''''n~ equlpm.nl Cladll: L1n. 2. ..lIn. 2S, ..hlch.... I.'..., . . .2S ,.
21 Crldlhllo...bl.thl.,.." lln.2S0n IIn. 20, whlchlY. ,. I". ..............,...,......... .21
21 R.mllnlng non"lund.bl. CI.dll: L1n. 11...lln.. 2, 8, S, 13, IS .nd 21 ..............,....."..28
29 ell/yoy.' crodll'.. ISSS: L1n. 2S I...lln. 21. SPOUSE YOURSELF
PART VIII-RENT REDUCTION PROORAM CnEDIT (lo,m.."..II.d Ih. L.ndlo.d R..'d.n"lI CI"""1 (II IhII CII<I/,. nol C'MoId. III'" 0... Iin. 331
30 En/If 60% 0' qu.'If,lng '.nl ,""u.llon. or "0,000, ..hleh....I.'... ......................,...30
. .
31 ClfryovIfC,ldllhomp,Ior,.II('J1.U..hcompu/.Uonl ................,....,..:........... .31
32 Addlln.3O.ndlin.31 .....................................,.............. ...... .....32
33 'Crodllollo...bl.lhl.,.." L1n. 320R IIn. 2B, ..hlchlY. 1.1... ....... .............,....,...33
34 R""'lInlng nonIlIUlld.bl. ..ldll: L1n. t I...lln.. 2, 8, S, 13, IS, 27 .nd 33 .. . . . . . . . . , . .. . . . . . . . .34
3S CII'IOVIf crodll'.. 1 DIlS: Un. 32'i..lln. 33: SPOUSE YOUnSELF
PART IX-CLEAN.fUEL VEHICLE AND CERTAIN nEFUEUNQ PROPERTY CREDIT (1/ 11I/. CIIdIII. noI eI. Met "',,, 0 ...In. 39/
3tI Enl.. Ill'Ho 01 Ih.11d..., SIC. t 1SA d.ducllon lor cl..n./u.1 ..hlel. .nd clfllln ,.Iu.llns p'opo'ly . . .38
31 C"ryovlfcrodll',omp,Iol,"'('II.II..hcompul.lfonl ......,......................,...... .31
3S Add IIn. 381l1dlln. 31 ................ ........ ...... ............................"...38
38 Cr.dllllfo...bl.lhl.Y.1f1 L1n. 3tI OR IIn'34, whl.h..1f 1.1... .........,.................. .39
.0 R"""'nlns nonlllund.bl. crldll: L1n. II... IIn.. 2. S. II. 13, 19,21,33 .nd 3S . . . . . . . . . , . . . . . , . .~O
~I Cllryov" crodlllor I811S: L1n. 3a '...lIn. 39: SPOUSE YOUnSElF
PART X-TOTAL SCHEOULE CR CnEDIT
.2 roTA1SCIIEDUlECRenEDIT.Addlln"2.8,8,13,19,21,33.nd39 ,.........,........... .421 I
43 COMSINED sellEOUlE en cnEDIT. Add CIlIurnn A .ndcolumn S.lIn. .2.
Enllfh"..ndonFnrm 760.lIn.18(.,.Form 760PY.llneIS(.'orFoffn 7S3.lin.19Id'........... ."............. .... .43
.
.
.
.
.
.
.
.
V"' DEPf 0' 'AkA'lDH
11014$0
VA 9 J 9
Schedule CR (1994) (~o e./~SON ~
~AIlT XI-OUT.OP:'TAT!! 1~ CREDIT FOIl FORM 710 FURl ONLY
(Form 780PY ond Form 783 hi.. complll.lho .pp1lcal. lid. oIllcl1odtd. NPY)
I TIllIbIo Income 'IpOfItd OI1l11Olh. .1.1.'.,lIu,". A copy of lho .Ih. 1I.1.'.1ndMdv1l
1ncomt1...."lfnMU9Tb..llochtdl.c1.lmlhltcrtdll. ..........",..................,...,... I
l P."nl~o: DIvId.lho omounl on IIn. I by Ih.1Il1OU111 on FIMm 780, nn.15, ond'lpOfl
i..porc.n1.ge,notlo..CNd toem. E..mplO:O.3183becom..31.S,", .............,.......,....2
3 VIrgInlllulromFIMm71O,ino IS... ,.......... ............ ........'........, .............3
4 Multlplyllno3by1lno2...., .......,.......... ...... ''''''f ............. .... .......,.....,~
s ToIlllncomtluplldl.lI1Olhorl'"'.tNIIlI..hl.ll: ~ I....................s
I cnEDlt: Un. 4 1M II.. S, which.... "I.... En'.. h..1 and on PIIlII,lIn. 2, on rronl ,.......,......., S
, ,$'5':
A u.a='ff!'f
-.--
B
'i3I
Cd/if ~fJ
%
s-
Oene..llnlormallon
Read Ihe "Credlls" secllon In Iho Incomo tax Insl,uctlon booklet lor YDur Incomo tax return, II you qualify lor any Dllhe credlle
on Schedule CR, complete Schedule CR and transfer Ihe tolallD your Income tax relum.
Specl., Instructions For Schldule cn. Put II.
Oul-Ol-Slete Tall Credll Or Slate 01 ResIdence Till Credit
Inslrucllons lor complellng the out'DI.slate lax credit or stale 01 resldencelSlC credit are 111 Ihe line by IInelnstrucllonl lor YDur
Income tax relum. Nole Ihat Schedule CR, Pall XI, Is lor uae by FORM 760 FILERS ONLY. FDrm 760PY IIIers (part.year
resldenlsj compule Ihe Dut'Dr.slale tax credit on Schedule NPY, Side I, ParI II, Form 763 IIIere (nDnresldents) compule Ihe
state 01 reeldence credll on Schedule NPY, Side 2, Part II, Altar computing the credll, enler Ihe credit on Schedule CR, Part II.
Whel To Allech To Your Relum In AddlllDn To Schedule CR
The list below specllles what must be allsched 10 your retum to claim any or the credlta listed below. A credit may be disallowed
and proceeslng or your relum mey be delayed II an allachmentls miSSing.
OUT-OF-STATE TAX CREDIT OR STATE OF
RESIDENCE TAX CREDIT (or lrual bensllclery creelll)
. Complele copy 01 the Individual Income tax relum flied wilh
lhe stale (or Dlstrlct 01 Columbia) lor which you ere claiming
credit lor taxes paid,
Shareholdere: Allach a slatement IrDm Ihe S corporation
&hawing computallon 01 your share ollhla credit.
Trusl benellclarlaa receiving an accumulallon dlslrlbullon
(59.t.370, Code 01 Virginia): Allach a schedule 01 the credll
compulallon,
NEIGHBORHOOD ASSISTANCE ACT CnEDIT
· Cerllllcate Irom Ihe NelghbDrhood Asslslanco pro)octlor
which Ihe Inveslment was provided,
ENTERPRISE ZONE ACT CREDIT
· Form 301:
· Cel1l11cale 01 Quellllcallon from Ihe Virginia Depollment 01
HDuslng and Communlly Davelopmenl: and
. Cerllllcate 01 Unemploymenl Tax Credlllrom Virginia
Employmenl CommlsslDn, lIappllcoble,
CONSERVATION TILLAOE EQUtPMENT CREDIT
. Slalemsnl showing credit compulatlon, purchase dale and
description.
V^939^
FERTIUZER AND PESTICIDE APPUCATION
EQUIPMENT CREDIT
· Slatementehowfng credit computation, purchase dale and
dll8CllpUon of qualllytng eqUipment: and
. Slatementlrom Ihelocal VIrginia SDII and Water Consarva.
lion District that ybU have an IIpproved nutrlentmanagemenl
plan 111 place.
,.
, .
RECYCLABLe MATERIALS PROCESSINO
EQUIPMENT CREDIT
· Slalement ehowlng computation: and
· Statement trom the VIrginia Department 01 Environmental
Quallly certllytng Ihe equipment (Form !lEQSO.ll-S),
RENT REDUCTION PROGRAM CREDIT
· Certificate 01 Quatlllcatlon 'rom the Virginia Housing
Development AuthOltty (TCP Form .L); and
· Certllloatlon 01 Tax Credits Itom the Virginia HousIng
Development AUlhOllly (TCP Form. J).
CLEAN-FUEL VEIlICLe AND CERTAIN
REFUEUNO PROPERTY CREDIT
. Stalsmenlshowlng computation and description 01 qualllytng
propnrly.
. RHODE ISLAND INDIVIDUAL INCOME TAX RtTURN
RI-'1040 For 1814 or other lu ~ee' , "_endIng , I. . '. 1994
'1r.IN.... ~. 1..IN..... .......1Ioc-W.......~
L 0 ' _ , 8-.35'0 Co
... Pnt ..turn, lPOVS', trIf,l nMtt ........ hl'MIme ",*,...Iod.l hcuttJ ~
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OL-LC~E.S r L /IPT
e"tbc.~'rys" /l LE h1D -<10 a.... d
Filing 51.lut 10 SlnOI. Jt9' MarrIed 1111110 "p",'e ,,'urn
rlu.e 20 Malflld '1!llllJ loin' '''hJlIl .. 0 HUd 01 Uouuhold
A chick on, Ilv.n II oll'r 0110 hAd IncolU~1 l'ffllh qu.III~I"g pilson.
B 'alii ..,mpllo"1 cl,hnld fli9ITidMiTio~;6;u;rid;;aj form I040A In, 8... Enl" number,
Cl Fed.,., AO, Fedorn Fo,m 1040 lI". 31;tii~iiA 1.1"0 iii:lii4oezlIii13.
C2 Ilod 0' O. 'om 0002, Schodu 0 " l~!~
o Elllor ou, doducllon ',om Fod.,ol Fo"n 1040 lhlo 3M2!'!!1Q!OA lhl.'9. fo,m 1040EZ lh1l4 01 Iteolll led.
e E,,'.' omou,,' olll". SO 01 F.dor.1 FOil" 1040 or 104eA.
F Enle, amounl 0 k'8 above subjecllo n. . IOJlollan hmler hUlD and on UIIO 0 . Schedu. I. .oe 2J.
CItJOf fltwnoll"."I..IlMIIC.
sO Ou.,II,lnO wldowlorlwllh dl.
p.nlf.n' child tV,., 'POUI.
dlld '0 I
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.If rou "..,. moc.IIllnllon. to nhotHltl.rtd Incom'. Compl.,. nclllutuln t on rl'l'" :111)41'0" IIlI'IIt1g rOut l.dlllllncoml I.. ...bllll, on Un. t below.
." ,00 hlY' no modl'lclllon. 10 n I. lncom., bul tlllm "" Qui ol,llIl. tl,flll, tompl.,. line. t IlId 2 below, thin complete Sch..,..,.. II on P'O' I
. 1. tVV4 Fldo,nllneolll. r...F.d...1 Fo,m 1040 linn 53 1...lIn.. 47, 50, 52 n"d 50, 1040A lIn. 25 ~ .. I. J:::JqJ/. !
I... l~lf 20e: t040EZ Un. 9,1... Uno 7; 0' Sch.dul" I, lln. 17. rno. 2. 6/
i I
2. nhod, Island Income f,u . 27.5% 01 pmounl on Unfl I .. 2. 3.:n~'
'" - fSEE INSlnUClIONSJ
ffi 2A, 1lI100E ISLAND U../S.,.. 1... Allueh FOlm r.205 r. . 2A. I-
:t ZD. 101.1 lex . 1I,," 2 rlu.ll,," 2A. . 2D, .:'><:;""(,
~ nhmht IIlland 'Ug" Incorn" Tal wllhhollJ 3A 31/ I
I%l!! A Ifllo",," alll1ch 10Ul"" .. I
Ira I
...... D "I,menls on t994 FOil" "' fO"OES and crodlts CIU"Otf lorwa'lf horn 1993. .. 38
11\5 I
OC C P,cperly h. n.ull' C,ndlllAllach roml n I. '040", .. 3C ,
~~ AT1N: P,lsons OY8I 65 Of disabled !
3. C,ecfil la' Income fa_us t1allllo olh.,r slalnSchollule It,llll' 22.AlInch
.. .. 0 . 3D 1
"'ill lI'gnfJd copy of olher ,llle ',IUfn I
~~ Ch.ek II
e Olh.r C,.dll. . Indlc.11 C,.dll FO'III /lumbo". .. I~e I e.lunlllon 0
a F Other "aymenls. . 3F I. AII.eh.d.
Ja a '01.' . .dd lln.. 3A. 3D, 3C, 3D. 3E ."d JF .. 3D 3/1 I
, /' I
. 4. If lIn. 28 1.'.'00' Ihnn lIn. 30. onlo' DAtANce OUE .nd pn, In lull wllh lolurn. .@ ( 1./-.<;'" 1
CHECK .. CJ II Fo,m 2210 I. nllneh.d IInEIIESI DUE on 0 S
S. If lInl 30 111.'O.,lh.n lIno 2D, Inl., OVEnPAYMENr. .. @ 5. I
I
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8'" II "II.',"III""Ulr01IUClQ 1'..-...1"...... blpaflll.". I.. '""14 ......I..H.I, ltote' ''''
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,... A ('-'- D 'I, 0 .---------______...I'IIIO"""IJ~I;:'::.~~=;~:c-
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I onuo rnOORAM ACCOUIIT r:J t:J t::J t::J I
C. fll)n 'hi, ron'"hullon "III "duct ,null.fund lit", Uoo 1'.00 01"" "'''''''t~11
J. Oll'-4PIC IIBlII'IQ...,......."......,\>o....""...,....." t::J VES t::J NO
CONIRIQiJi"ioN HO" ''''I 'OOI'''b.,_... ..~u ,.... ..'.....
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I. ..nrs ANO 'OUnlSM VEvUorMUH rUtH! l':J n tlO 1":1 I
tlOn 'hll COfllllbullolI willllllUC:I ,OUllllulld lioo "00 1000 011111 .."."'.-
I n 1- NONGAME WllOll'E 'UNO 1":1 0 t::J r:J I
a. NUll Ihrl COfllllbullon will lid"" ,DUI "lutlll I' 00 "00 11.00 OUIII ..........-1
, CltllDltOOO DISIASE VICTIMS' FUND 1:.1 Cl t:J t:J ,
It. NOli fhll CCHlI'lbullon ",tlltdUIt ,o"'ltl\lnd Ill'" "00 11000 01"11 .....................
U[lWI "",tUII allJefl"".1 dKI.,. Ih.11 h". "'""""'11". 1''',,"_ "IlIID 1111 b", 01 m, .no.leda. 'lid beU.I. Ill, II~. COUftl .nd Camplll,.
YOun. Ij~i,~tE'S ·
0 SIOIIA IUR! DAlE I Ii II A~IrR,1 SuUe..3n., OAT!
III
CD 810NA1URE &~o:J.E8S OF ~~ID PREPAnEn LUlhcrvllle, MD 21093 '1/1/c.;'
H Han BLOC ...::;IJ..I ).;! Jr...//'lt.-'I
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X Yourself. II VOllllllll11lll (IJI 1I1)1I"'UIIO ol!In) cnll C;IIIIIII vou nn II dopolldolll nil hls/lIn. Id.}" Nil, at bo...
ch''l''da,,',
-..- 'nhllll, do nul f:l1I1l;k bfJlC OR. nul t.ln JUliO 10 chock box 01111110 :J:Jb 011 PACJO 2 'nd let ~..
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(Son "OUD '2.)
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U.S. ItldlvldUollticolllo Tox Rolum
1993
IUIIU.,Onl
Fo,lh, ..,J.It. I.U,c. JI IItU III alII" I.. .., till Innlll
119.1 .ndln
JOliN R RO/JINRON
M1\RG1\HE'1' L RO/JINI1UN
1460 GHEF.NMON'l' e'l'
RES'l'ON, VA 22090
5
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10 Tallnblo lofulld!l, cludlln, or nlhlflhllJl alliIn nrut 'fJI~IIIIIlC1ll1I1J Imum (nun r-nlJfI t7) "".,.,
11 AlhllOlIV rocnJvnd . . . . . . . . . . , . . . . . . . . . . . . . . . . , . . . ,I. , . , . . . , . , . . . . , . . . , , , . . . . .
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JOIlIf R ROBINSON
MARGAqET L ROBINSON
:! 09 - J;! -9 6 5!i
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11/21/191\2
9/10/1948
........................... Form W-2 Inform!\tion ................~...........
---------Wngos--------- -------------'l'nxes wi thheld-------------
Medi- Hedi-
Source T/S Gross S.S. cnre Federnl O,S. care St:ote J..ocnl
GENESYS I 'I' 3303 3303 il30J 711 210 1\9 PA 95
DA'l'AIMlIGE 'I' 161\95 16495 164 95 3557 1023 239 PA 642
TODAYS TE S 2350 :!:J5U 2350 75 11\6 31\ RI 21 31
KELLY SER S 969 969 969 40 60 14 RI 13
GMPIIIC I S 1655 1655 IG!i5 169 103 21\ RI 46
RI 'l'EMPS S 11\ 00 1400 14110 61 07 20 RI 17
------- ------- ------- ------- ------ ------ -------- -------
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........................ Form 1099~R Information ........................
Gross Taxable --------Taxos withheld--------
Payer '1'/S 'l'ype Code Amount Amount Federal S'l' State Local
SCIIROFF INC S P 1 6024 5021\ 1365 RI
------ ------- -------
6024 5024 1365
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19' Am...' o'U.. 18 II bo OEIIlI'UlV . .. . . 19.
11,gb. Amo..1 .'U". 181' bo COIIIIIIO I, 'OUO 1m I~IIM^,IV lA' AC':OIlIlI . !h. '"'' .111... II.. lill
R ~~~m
lie. Amounl or tin. 1810 be [)()f"~'rn 10 Ihl WIlD nr!iOUfU;r Cllt/!iH1VAflml 'UU" . " ...._..""..... ..... 19c
~ IUd Amount olll", 1110 be OOllAIrO 10 Ih. U.S Ol\'MI'IC CllMMIIIU. I'A lJtVISlOtI .............".... J.lUSr Fll1allln. II to
u.. ,...... ,I 'tl~,. t 'n.. I.tt I"" ......, IfiIII ..,.... lllc..''''. MUlll'III'.... Ulllhlt. .., .111..."11. ,.. It... MIIII., llllllt',1 Ill' ....I... If". ..".,1 ... ""''".
r.;;r....,.. . - '-,"...'_ ~..~.....~~..~~~....._........""......-:..
S'gn.. -I1,.--=-'''''''om---I--._--,.,,,,__.l__ _ ./.IM :-. 1a1.
h." """" · .'"'''..''', 1"..-, )IInl1, I "'"I I"" "III N ...',.... "' 1m""" "P"" 11.~ Pl'I" I
.. )( I 'liJ] I {~!.f- (}5h j-
I.I!IBBI
rarm 4868
, __H._......
co _.I"._<D. ".
Application for Automatic Extension of Time
To File U.S. Individual Income Tax Return
OMO th>. '5~5 0'88
~oI"",,,,,,,,
"-nil..... .....
YOfIllrt' natne Ind 11'"111 l.,. flllllnlt
:..'I..\'U ._ '0; '.JJI..t'. \'~...I
" · totnl IIItMn, ."au.... II", ".m.lnd Inlll.1 l.,III.me
\, , . l.:.fu~J;._L_._.__.___..L_:...:L~~.:::,.. r
Iton..IddtH' (numb", Ihlftl. and Ifll n" II' IUfllIl,OHlflJ. If 'fOU ha"" I flO lxIII, 'N Ihe In.hucUo".
\.1 ""1 ill) f.. r' 1\ ,\:, \:1 ,
~ - '-__.L..:____.__._ __. _
City. lown Of PDtt Olflel, 1'1'1, .nd zlr Cod, l' I'
f.\ r" 1'/ \J....B~__._..____._\~~~.____-1. J (. t ,~__________.__.
Nol., File Ihls (orm with I/Ie Inlernal RevenrJo Sorvlco COllIe, Wlle,e you file your IlIcollle IIVt ,eluI/I elld pay ally alllounl(s) you
owe. Thl. I. nol .n ..'.n.lon of ~/1Il. 10 P~llour la!: h __ ..
I ,eque.l.n aulomallc 4.mOlllh exlellslon 01 lime 10 Augll.IIO. 1993.10 fIIo Form lU40A 0' Form 1040 lor Ihe calondor YORr 1992
or to . 19 ,Io'1I1~llox 1'00' olldlng 19 _
1 Tolel tox lIablllly lor t992. This Is Ihe omounl 1'011 expect 10 Oilier on Form lU40A. IIl1a 27. or
Form 1040. line 53. II you do nol expecllo owe lox, elller .0- . . , , . . . . . . .
C'UllOOl You MUST enler an alllounl olllllle , 0' 1'011' e"ensloll will be denlod. You call eslllllole
Ihls amounl. bul "" es e.acl as you can Wit/I I/,e In(ormallon you I,ave. If We laler find 1/101 your
esl/lllale was nol ,easonable. '''e exlellslOIl will bo lIull and void.
Federellncome lox wllhheld, , . . , . . . . . . , .. 2
1992 esllmaled lax paymenls. Include 1991 ove,payfllonl allowed as a c,edll 3
Olher paymenls alld c,edlls you expecllo show on fulm f040A or fo,m 1040. 4
Add IIn~s 2. 3. nnd 4 . . , . , . . . . , , . . . " .......
BALANCE DUE. Sublract line 5 Irom line I. II zero 0' less, enler .0., To gel thl. eXlenl'on.
vou MUST pev In lull II" bel.nce due wllh lI11e lorm. Allach check or money order lor lull
.mounllleYlble 10 "/n'erna' Revenue Service." Wrlle your name, ."dr..., .0cl.1 ..curlly
nUmb.~ d. me hone numb.~ .nd "lgg2 Form 4888" on It. . . . . . . . . ....
"VOU ..pecllo ow. gift or g.nerlllon.eklpplngl,enller lOST) lax, compl.le line 7 lend Oe
or 8b " '/lPlfclbl'l. Do nol/nclude Inoom. tu on Ihel. Ifn... S.. the Inll,uollone.
7 II 1'00 Of your lpoule plan 10 ilia a gill lox relurn (Form 709 or 709.A) lor 1992, J You"."... 0
generally due by Ap,1f 15, 1993. ee. Ihe Inslrucllons and check hera . " Spou..... 0
88 Enler the amounl 01 gift 0' GST lox you ore pnylllg wllh this form . . .
b Enler Ihe amoulIl 01 III or GST lax our I OUI. Is a In wlfh Ihls lorm
Slgnalur. and Verlflcallon
Under -"lei 01 "",",Y. I dool... '''''' hI'''' ...mlned """'OIm, h;IIId''1IlICcomp'''''.g ochtdu... ,"d .1.1.",.,,1., .nd 10 '''.be.1 0' m, """"Iedg. .nd belle',
" "'rue. tonICI. R cc:wnp.lr. and, ., pr"''''ed by tomeone olh., It"n Ih, t..p1VW. Ihllll," IUlhoflzed 10 prep.,. Ihll form.
~ Yo.. oJone"" 0.1. ~ 9pou.... .tgll".'.. III1Ilng 10'.'"
.
~@92
Pl....
~p,
Or
Print
2
3
..
II
II
,.-\ -'\ ,., r-\ _
II
~
Ol'e
py,,*,,', IlgoIlurl (olher II*, '''Ply..) 0.11
II correlpondence rego.dlng thll exlenslon Is 10 be snnl 10 you nl an addles. olher Ihan Ihel Ihown abo.a or to an agent acllng
lor you, plea.a enler Ihe name 01 Ihe agenl andlo, Ihe add,e.s who,e It shoulcJ be sent.
N.....
PI.a..
1YPe Number Ifld ,1r..1 (Include tulle, '0010. Of apt no) 0; P.O. bolt nunlbef~, nol dmlvttfed 10 IhHllddtes,
or
Print ell" 10"" Of P<>II ."le.. 01.,., Ilnd ZIP Codl
For P,perwork R.ducllo" Act Nollc" .., III.lIuellonl.
Nl31 10-40.73
""'''O''UI..
rOlm 4868 "g9ZI
RHODE IsLAND INDIVIDUAL INCOME TAX RETURN
FOI lGG2 01 ol~" tel ~'" ~ ,IG_,ndlng ,19
PI". Hlm..nd 'nIUI'III I~nl "Iu,n UIt ""1 Him. and lulll.I, 01 balh.1 LII' Him.
'~"Q..: 8
P""n' Hom. Addl'" CNumbtl .nd Sfl"I.I.nCludln~.lltn.nl No. p, nulll noul'l
~S ? '5i . ~\,)L- :\\: \\-\0
ell,. ""w ~~~\.(:: B{\ I ~~~~O
FilinG Blllul 10 BlnG" 3~ M''''ed IIIlng Slplllle leluIII.. ~ 0 Ou.'lly'ng "Idowler, wllh d..
. PIli" 20 M."I.d IIIIng 'o'nl relu'n 10 1I..d olllouSlhold p.nd.,,1 child IYII' Ipou..
.. .h.ek ont: I..on II only ono IlId Ineolllo' lwllh quoII'y'ng pello", dl.d Ig ,
8 Tol.'u.mpllono .1.lmld IIVg2 F.dll.1 1040 Lln. ao o. fed.1I1 fu,m '04QA L'ne Be., Enlll numb...
ModtIItd I.dllll.dfull.d grolllncom. r.d...1 od/U.I.d g.ou'"eom.. tOlOEZ L1n, 3,
C F,omLIn, t2. r.YIII..Id.Happllc.bl. ct r,d...IFo"n 'OIOLln.31: 10lOALlnl tq: C2 \
D Enlll\'OuI d.ducllon Itom F.d".1 Fo,m tOlO U". 3l. Fo.m 104M L1ne,g. Fo'," tOlOEZ L1no 4 01
Imounl 01 dlductlon. llcompul.d (SlIln"fIlCllonl).
. If rou do nol hi.... In, modlllclllonl to Rhod.l.llnd Incom. Indlor It, nol c1llmlng Iny oul 01.1.1. cfldll compl". fronl pig. unit.
t tf roo ha.... mocIftcItIon,lo Rhod'\Jt.od ~",'I eompl.l. Schtdul.. t on r.g, 2 belo" ,ull.,1na YOUI 'lJd.t.llneom.l.... lability on Un. I b.kJw.
. II you hi"" no modlllclllonllo n NJdalll.nd lncoma. bUll" cllhnlno AU OUt OF SJAJeCneOIT, compl.la Un.. , Ind 2 b.low
balofl comp'aUng 8chldul. . on P.o. I.
I t,gz F.dll.llneom. h..Fodll.1 Form tOlO L1"e 5] I... lillO' 11. 50. 57 ."d50, '04M
. LIne 25 Ie.. Line 2Be: 10lOEZ L1"e 7: or Sehedu'. t.lln. 17, r.g. 2.
. .
t1~1 040
.1992
,
000
..
I.
lD
\C\S
2,
nhod.l.l,rtd Ineom. Tu. 21.5% af amoun' on lIn. t.lIlln, , ,. "5.000 or t'll. Oul
II LIn, ii, gral'., th,n Its.ooo..1I tll r.'a .eh.dull.
A Rhodl 1.I.nd 1"2 In~ome T.. withheld. (Pl.... nlloeh 1011"'1
.. 3A ~\C\ I
I
I-
.. 38 I
I
I
.. 3C I
I
I-
.. 3D I
1
-j-
.. 3E I
I
Chock It
.. 3F I E.len.lon 0
I I. "1I.ehed.
.. 30
~ @ t
.. @ B. 'l '-\
.. B. ~ l\ 'Oft O'flCI USI ONU
.. 7.
"2.
3.
. 8 P.lymenl. on 1992 Fo,m 11.1. 'OlOES Ind .'edll. .I,,'ed In,wlld IrOlll '991,
C P,opllly ru Rellel C,edll (AIl.ch Fo,m R.I. t040Hl
A TTN: Pe"on. 0'"' 6~ or dllOb'ed.
D Clldlt lor Income r.... p.ld 10 olher ol.Iu-Sch.dule II.L'ne 22.^lIoch
algned copy 01 01 her .'ale relu,n.
E Olh.. Credit. Indlc.lo C,edlt.
Form Numbe"
FaIt... POYlllenl.
t
o Tolll. Idd L1n.. 3A. 3D. ~C, ~D. 3E I"d 3F
II L1nl 2 I. lo.ger th.n L1n. 30, enl.. BALANCE DUE .nd pny ,,, lull wllh reltj,,,.
CIIECK" 0 II Fo.m 2210 ,. Ilta.hed.INTEREST DUE OR .O.S
II L1no 30 I. 1.lger Ih.n L1n. 2 enler OVERPAVMENT
5.
5.
"moun I 01 o,erplymonllo be IIlunded
7.
Amount 01 oyerpaymenllo be clldlled 10 t993 E.lhnalod r..
,
A
ILlCIORAllYlll1ie ..1II1110llGll.l.... ..h,....'." "''''v''''''I''O'':
CON,nt_UIION INt .1..... ....... ,_'n. ........,_'.'......
........
B'"
NO
1"'11 _1.1t'1l....,1 II Mill." I' .1..... ,,1\1''' I.... ,.Id ...'1., '....IIIt ...llInl ,.,1,. ....'" ,,..
:~:'.::.:.'::~I: ~~':.;::.'II"" ....IIU'...I' II ,... .ltIlllt.... ...tl.... ,..-...U..........., .
1110 '..t'lnO.....'......flQ...."IA....,..' ""
K; II';. ;:''''''~'';.";' 'i"..,,;jIl,;;".i:c.7.id tin 11I11....1...... ,
C'J Cl j
110,00 QU'.' I-'".... ,_II 2!
CJ YES 0 110 Iii
"'
o NO ~
~
o
:t
o
X
"'
Q
ffi
~
7
D
nnuo rnOOnAM ACCOUIII
Hon. 1hl. conlll~llon "III ..duct ,ou' '.Iund.
CI
11.00
[J
SlOO
I'CII"l.llCl...,.....'.I"'~I'"...tl'..cIIM'1
HO"~ IN. '...1....1.... .11 "wet ,.... ..Iv....
IIODrUwfl........ItI"'...lh.....II"'lIll.'"
DYES
o n
"00 '\00
CI [J
HOO U 00
D CJ
C'J
'1000
CI
"000
C'J
CJ
Olhtf
o
Olh"
!-tll....__
!-t1l."'.........11
CJ
.SI^IF. or. alNNFClIClJI
IlErARlhlEH' OrREVENUE SERVICES
tOllhe .r J.nu. I. Decembe, 31 1992. or olher I...b'e e.. ~b. '"111"
.. 1m, 'I dl, nil' .ld .m.
H.m. ~ "":Tl'l I-IIJ C. , I?JlJJ l.N.~.l.l .
.nd l-rr. Kti'1ifRliu,n. srou.... nrst H.,nl .n~ Mlddlfl InlU.1 -a.... HI,",
Add.... iii ~
3 lJ;;fJdJii" NunlbHind j;,p;f--
~ ~ 11?.'1_lio~/"Jf\
~'Ib.,omtf
+ ~ 10'\ L6 P 00
Ch,c. II )OU IIStd . J1"pa", Ind do nol WAnt lotnll S4!nllo )'OU nul Y"jI. Chlckln. thl, 00.
doe. nol r.UeVl rou of tour ,.,pnnIILIUI)' 10 IU....,...,................."............................"...........,,,..,,.~ 0
Chid 11111 II you cO/llplelod rift I of Ftlflll C12210. ISulnlhucllonl for rOfm e, 2210)",..................... 0
Hor., lbuI 1111111 slolu, must b. Iho ""'e IS you, redellllllco"'e I.. 1111111 sl.lus '01 Ihls ye... Set III'huttlolls '0' deloll,.
~A'~ 51..1.
~B. Malll.d IIl1ollolnl fllllln Of QUllllrhlR .,..hlowlPlI
"'C. M.",.d 111111, SF/'~R~IF ..1..11, f~MJ5lJJ;.''I___~ ~ t1.~/1.J S ~ IJ ~ 0 E..t Jlr -6J11 (.
.. O. Bud of Hou",hnld SilO",", I Tvlr Il,m, -!pousi'fSCiCTil Sicum, Numb"
"' u~ O'on Income (r,orn htl.,41 rOlIl1 1040. L 11..1 0' n"ll 040^. L1nl Of
FllIm IIMOH. line 31
2. IIddlll.n.. II .., IIlOm S,h,d.l. I, lln. 291
3. IIdd li... I .nd 2
... SublllCtlona. ".ny (r,D," Srhttdull J. line 39)
_ 5. CCN'In.cllculldlusl.d OIOSS In corne (~ubl!.c1.!!.'~ _'!..IrOItl line 3)
6. I"comt ,u~ From b. 'bbl. 0' 'ot. Calcul.I/on Srhf.dulf!' ISH Inslrvc:tlonu
All UEMrrlONS ^ND CREDITS ARE INCLUDED IN 'liE lAX '^BlE
1. Cledll'llI Incom. I" ~.'d 100110" 1..lodl,lIn..lfoom Schedul. 2. U.. ~"'
8, Tollllnto"" tal !.SJili!!!f1.Jd!!!L!!.5!!!!.~J~!!..!I.~!!.!!_7-'!.I~e~J!!Jf!.o!'!.J!!!!.~I.~.lIhll OJ
9, Conntctlcut Tn withheld (Altach all W.2', .nd a.rbl" .0...., Su lruhucllnnlJ
10. All Ig92 OIl1m.,.d p.,m,nl.
II. PormOllt, ""d. .1110 ..1.n~OII "qu..1
~p..!1!!l.nl. lM!!J.!'!!! .2J!!!!!UI'LlU_____.._.
13, II L1n, 12111'"1" Ih,n line B, enl" ,11I0unl OYfll,...ld. tSublr.clllne Rho," lIn. J2J
U. Amou.1 0' line 13 YO" ...11110 b. .ppll.d '0 roup un ..Um.led Ie.
15. ^mo..1 olll.. 13 you ...110 b. 1.IUlld.d ,. ,ou CSuhh"lll.. 14 ,"'''' lin. J])
IS.. ",1111.,/..,,,.,11... be/oo) REI'UND ~ 15
16. II Lln. B ,. 1,..1.. 11,.. lIn. 12. en'.. II.. .",ou.' ., t." yo...... ISubllltlll.. 12 100'" lIn. 81 ~ ~
11. If 1.,., Enl.. r...II, 110% . ""'.111 OIl UII. 16 OR II '.I,.. 16 Is .".. ..1.. Sroo) ~Il
18, If 1.I't Ent" InIIl11111"% N nUl11b" of monlh, 1.IIt, Of ".cUnn Ih,,,o' )I' '"lounl on lint 16) ~ 18
19, .....11, IIlI UndllP.'...., 01 hllm.l.d ""11011I10'"' CI2210J ~ 19
20. Inhunl lot' Underp.ym,nl 01 hlln"l~d 'a. crull" rOlln Cf2210) II-
21.1I.I.n.. duo 01110 I"'. 10'.'" ChM Un.. 16 "!'.!'~a~2.!l} D_IL~!!~_I!..!,UE ~ 21
but bATI. A~,II 15, 1993. '0" 'A'lIIHTI AHD
I ...... WOU' chtclt p.,lbl. to COMMISSIOOUI or 'trV(flur S[RVICn '0" "UUND" MAIL '1'01 NO TAl DUI, MAIL TOt
t... WI", tINt locl.1 "'tUttlr Numbtthl and -1991 'nrl" Cf IO~O. OIll"Uf 11,t(1l ~ti~~:t;~,~' Rft'"u. S"~lc.. R'd'~'.:'2~,ai RI't.nu. Strvle..
.... Attech. cory of III.ppllelblt IChlduln tn4 lot"" la thlt f.hJln, 11,ltIOl", C' 06104.1916 U'IlIOId, Cf 061042911
J U.111n lhe .nwlopt pll;,.Id,d 10 rau with Ihll ..IUI" Of to Ihe .ddlfU "'own .1"..,1.
! DICLARATIONI I decl." und~; ,hp. ,..,nlllllo, O;~i;;I~;;tii;;jTj;.,.;-;;~Ij.;~IhiU;i~ln Unclud/Il. Iny 'jCQI"Plnrll1llchlldules .nd
Il.ttmenl,) ,"d. to Ih. bill 01 my ~nO'#lI,ct.. IlId bIll.,. 1111 hut, cflIllph,l. .nd cou,cl. Dfelll.llon of P'.'PIlIf {all., Ih.n Itle la.pIY',J II blltd on IU
Inform.lIon 0' ",hlch Pf1PII" hn .ny h0'llli1tdll.
'1bu, " rJ.li,' Spau,"".51In,IUII (II fOhii'ttu,n' bell
lo -~"\ '
B .. ~.~:_
W "an ,. 'Ip "'~SII"IlU' .
II You,
...tum 1,,'11 ~nd Ade s -.
""nll
1..luI
IlIcom.
.nd
T..
",'und
Dr Amounl
Ow.d
Form CT.1040
CONNECTicUT RESIDENT INCOMR TAX RETURN
CT.1040
1992
/eo AJ?_.
, 1992, ~elldll1 , 19
u, tit.. Stcu.h, Humbll
:"~.~1~bft2.ill:
~ I I
iXn1ir.phon, Hu~"
( )
lip ll>do
~ -1.
~ .2.
~.J..
~ 4
~
~o tJ ;3
,
7 0 ~.2.L
,
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~
~
~13
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nil.
I{_ ,1,. -'l..3
r'dll.1 (mploytl 1,0. Numb"
44.0601858
Cfiiiii1ilii;I'st,etlon Numb" -
HaR BLOCK ~,.J(9__.0.,I.,~L~
w.. . ,.. chilled ,lIhl' 'Of lhl pI!pllIlloo 0111111 "lulO or for IId.,lr, III Ih, Pf!p."t1un 011111, "Iulll'
C r l!i()
2422665
DYES 0 NO
I
. rill! NUMDEn
000010762
t:UMMUI~WI::ALI H OF VII lGINIA
DEPARTMENT OF TAXATION
OFFICE OF COMPLIANCE
P,O. BOX 615
g3~20/95 RICHMOND, VIRGINIA 23205.0615
(~~
",fmDly saN
209-32-9(,55
SllCOndn,y BSN
U04-48-35U6
1I\XAUlE YEAn
1992
rod,,"1 MIU.led .
Of 011 In com I .. .....:. ..,..
JOHN h & MAhGAR[r l ROOINSON
1460 GR[[NHONr cr
RESTON VA 22090-4050
lo.. 2 E.ompllo<lo 0 'lJ 0 0
lo.. OodUCllonISldlllm,. . . ! .
VA TIll.blol"como '" .. .. . . .
VA rill , . . . ... . . '" ~. . .... .
"o""lIy ...,...,...:., ..'.,.
.
,
'''10'".' Unu. .. . . .. . .. . . ... ,
80,061
1,600
5,000
73,46f
3,961
1 ,190
lJnder aUlhorlzallon 0' Fedorallaw, Secllon 6103(d' 01 Ihe Inlernol Revenue Code, the Department 0' 1lIxallon hae
obtaIned Inlormallon 'rom Ihe Inlernal Revenue Service Ihal you flied a Federal Individual Income la~ relUrn lor the
.bover...bl. f..rshowlng a Virginia mailing address. The Inlormallon received Indlcateslhal you MAY be required
to file a Vlrglnle IndivIdual Income tex relurn: however, we are unable 10 Idehllly a relurn lIIed by you, Under Ihe abova
soclalsecurlly number(e), lor Ihe year In quesllon.
" you have already flied or are NOT liable 10 lIIe a Virginia IndivIdual Income la~ return, please reler 10 alocke A or B
below. "you Rle required 10 lIIe and have nOlllled, please reler to Block C below.
II we do not recelva a reply 10 thlslaller wllhln 30 daye Irom Ihe above dale, you will be assessed Ihe above amounle,
plus accrued Interest Under the provIsions 01 Secllon 50.1.111 ollhe Coda 01 VIrginia. In replying, you heed only check
lhe appropriate stalemenlatlhe bollom 01 Ihle leller and 'urnlsh the requIred In'ormallon,
Thank you lor your cooperallon.
ROBERT SUSS"AN
(OUH 367-055'
Oepartment 01 Texallon
Olllce 0' Compliance
P.O. BOll 615
Richmond, VA 23205-0615
Thfe I. 1101. bill.
Do 1101 lend paymsnl
allhlsUme.
Please check approprlale block and lurnlsh requested Inlormollon:
A.D
IlIIed a VIrginia Indlvlduallncorne tall rei urn on , (date) lor Ihe lex year Indicated.
(ENCLOSE A PHOTOCOPY OF YOUR COMPLETE RETURN,lncludlng all required allachmenls.)
II the above Inlormallon dHrelS ',om thai as shown on your relurn, please complete the 'ollowlng:
Name
Address __. \
Social Securlly Number
I am not liable lor Virginia Indlvlduollncofl1elox lor the yaar Indlcaled lor reasons slaled on Ihe onclosed
Nonlller Queslfonnalre. (Allach complaled questionnaire 10 Ihls leller Bnd relurn 'n Ihe enclosed
,nvslope.)
C, 0 Relurn Is onclosltd. (Alloch Ihls 101101 10 Ihe honl 01 your relurn.,
B. m1
'onM I.'
~ADI!rfor fAICI\fklH
180505I IIIt:t
CJ( to/lttECllCUI
"""IIAEN' Of REVENUE SERVICES
,
tot Ih. II J.nu. I. Oecemb., 31 1992 or olh., I..,bl. u, ~ b. 11111111
+ 1m,. n. .e,m.
N:n~. i ,~ ~~"~"'M"~'; N".. .~f.f.i!r'-9~Il.....
Add.... fI ~
:I ....... Add.... /lumbtr ond S''"fI
It ~ IeOAl>
~ C J .
.... r.1 U3 P 00
Chid. " 1'00 01101 . PI' .... ..01 do .01 w'."..m. II.' 10 1'00 .lIlrolr. CIOlek'.. thl. boo
dOli nol f.ll", rou of row ..IponllbIUt, to fll........""........................,......."......,...."..."......".....~O
ChIck h..." u almPl.,od r..11 01 f..m CI2210, IS" '/I,hueIlOf1' I.. torm CI.UIO)....."..............~O
Notll 'hUI hllnlllllUI mUlt b. \ho lime II ",ur r.derellncomo l.. IIl1nlll.tUI 101 this ~II, S.. Inltructlons rOI detalll.
"A.~ SI.at.
~B. M./I,.d 1111..101.1 111.,. 01 Ou.III"". wldowt'"
~C, M'"I,d 1111.. stlllRNE 111.... ~ AI'./.i7 R OV!./ AJ SON ~ 0 0 'I .J.f 1 -asv c.
..D. 11,,01 ollloullhDld SiiOUii'Itu'iTiiim. spa..... Socl., Srcum, IIUmb..
If' UII Ora" Incom. (f,om ", 'f' 0'01 040, n. 0' Ofn! 04OA, n. G. Of
f..m I~OElo lI.. 31
2. 1dd11l0f1~ ".., 111001 Seh.dul. I. U.. 291
3. Add Un.. 1..01 2
4. Sublllet'''''' ".n, Ifrom Sch.dul. I. Un. 3g1
6. eonn.elleulldl.ll.d O'DII'n",,,,. ISublllet Un. 4 ',om Un. 3/
6. In",,", to" t..... to. tobl. 01 to. ealeul.IIDn S,hed.l, ISH 'n"ructlonu
ALL EXEI.tPlloNs AND CREOIlS ARE INCWOED IN lIlE TAX 'ABU
7. Clodll I.. Ineom, to. t>.'d 10 Dlh.. I."td'ell..llf,om s,htd.l. 2. lIn. 'B/
8. ""'1._. TII Subl, dUn. 7 I,om U". 6. IIlIn. 11. ,,,,.. Ih.n lI.. 6 ..,.. 0
9. eon.,elleul Tu wllhh.ld IAlI..h.1I W.2'. ind ClIl.ln IOU", 5.. In,tr.ellDn,1
10. All 1992 IIllrml,d P.,mo.',
II. r.,menl. INd. wllh ..I",~"" ..quill
12. blel ." 01 llni. 9 IInD. III
13.11 lIn. 121. ....,.. Ih.. Un. 8, ..,., ..,ou.1 _,p.'d. ISlIbtr", Un. 8 trDln lI.. 121
It Amount oIlIn. 13",u w..11o be .ppll.d '0 you, III:! ..dm.led I..
15. Amount oIlIn. 131'00 w..11a b. I.'und.d ID "'" (Sublracllln. 14 rlOm lIn. 13J
ISH m.l/ln, 'nllruc/lOf1. lit/mol nEFUND .. 15
Is. II lIn. b "111.1.. thin Un. 12. .nler Ih. .",,"nl 01 ill"'"...., ISublllclllno 12 "001 Un. 8)
17.111.,.. Enler ""'111r !lOll K in".nl 011 lIn. 15 on II lIn. 15 11.110, enl.. S50j
18.111.1.. Enl.. 1.".." 111111 K h.mbll of monlhll.t.... I"eUOf1lh".ol K .mDu.t Dn lIn. 15)
19, Pen"1r I.. Und"p.,menl or tlllm.l.d to. tf,om form Cr22101
20,1.1111111.. U.dllp,,,",.t D' hllm.oltd TII "'001 rOlm C1.2210)
2 1.1I.I.n.. due wllh Ih'. "'..n IllcJd Unll 16 Ih,ou I 201
DAtil AIM'I15, 1993-
.... ,htck ......~ tD, COllllISS'O'UI 0' I[V[HU[ l[flV'CU
...Iocll' hcurlt, Numb".at end -1991 ro"" CII040. l:W'l JOUI eliI'd' R"J~lm~~,ef A,...."u. Smlen
I toprolaU appllclbl. .ct"du1n tnd form. to this '.turn. .i..ibd, cr 06104.Jg1G
the '""lope INWkftd to)'W "lth Ihl, IIhn" CI' 10 lhl .dd,u. sllo.n If .'.ftl.
lCu'hATIONr I dlel.,1 bodtf lhe pen.III.. 0' ,.ISl! "oIll!";;;;tjj,,t f h.w ,q'nlnrd Ihf, "Iurn IllIcludlna IllY .ccon1f,lrlrhll ,r.hedu'l'lnd
'1....nl1l .nd, 10 Ih. bill 01 "" k....'.d.. ."d b.II.,. III. tru., '."'p,.l. .nd ,....,I. lle"...IID. 01 P"P"" 1.1110, I". ".. ".p.". ,. blled 011 .11
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'bIr I, spou;;.; Slln.lui'tiii 'alnt 'lium) bit.
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Incom.
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Form CT.1040
coNNECTICUT I1ESIDENT INCOME TAX nlnUnN
CT. 1 040
1992
.19_.
....1-
~
..
~ 4
~
-
70 /113
.
ton RnUNOI, IIA,L TO,
ton PAYMENT, ANa
NO TA. DUI. loA'L TOI
btplftmtnt af nrv.nu, StnkA.
r.o. DOl 29"
"""..... CI OGloh91/
"an BLOCK
n~-- 't'd..,.llmP!ottII,U. Numbn
If - .... ::1..J 44-oG01BSB
_. miiiliiiiitll~I"1on Numb"
((9_0A~L9
....
i /.. "'...ed .lIh" I.. It.. ""P."It"" o'lhl, Ifl.,n 0' ,.. Ad,'" In 110. ",'pII.IID" 0' Ih', "lUll"
C'150
2422GG5
DYES D 'I(J
RHODE ISLAND INDIVIDUAL INCOME TAX RETURN
. /'01199201 olhll t.. YOII ,19_ondlnu ,jo-,-,_..
~ -'-I .,_,_
1992
,...
You' 8ocl.ISlcu1llr Number
Cl()4- 't~- 35"0 In
8pou.... SocII 1 SleUlllr tfumbtt
~,() 't -~ ~~
ell, Of town 0' lIO.1 R..ldlne.
W '" "W\ ~
3~ M.rrlod 'IIlng SOPllil. 'olll,n.. 50 aUoli/ylng wldowllI' wllh do.
20 M.lllod lII'ng 'Dint 'olU,n ~ 0 llead ollloul.hold p.ndont child (r," 'poUI,
hock on.: llY.n II only Dna h.d Incom., (wllh qu.II'ylng Plllonl dl.d to I
ol,'oumpllon. ctolm.d IlVg2 F.dll.1 'O~O lIno 6. 01 F.doral Fo,m 104eA n.60., Enlll numbel.
IIod led""' 'd!u.f.d VfOlllncom. F.do,alad/UI'od g,oll h:om.. I~OEZ lIn. 3.
FIll/1l Ulo 12, lO.o,.uld. hppllcablo ct Fod.ral/'o"" t040 Un. 31: t~OA Un. tq: C2
III your daductlon I",," F.daral Fann ,~g lIno 34. Form 'lJ.4DA Un.'v, Fann fO~OEZ Uno ~ 01
.mount 01 d.ductJon"ocompufed (SIIInIIroct'onl'.
nol ... lilY modinc.llonl'o Rhod.,.I.nd 'ncom. '"dlOI ... nol dllm'ng .ny out 01.,.1. a.dl, colnp/"",.nl P'V' an'y.
ha.. modIIlcollono 10 flhod.I.1Ind m.n.. COIl1pIII. Sdlldut. t on r.g. , be,... '''1'''''' '"'" '1d..1I h:om'.1u bbla'y qn Un, , b.Io".
you h... no madll1c.Uon"o Rhod",'and fncoml. bul II. ct"mlng AN our OF orATE'tneOIT, compl.,. Un.. , .nd I b.lo"
,... campl.Ung Och.dul. . an P.g. I.
t,U F.dor.ll"com. T...F.dll.1 Fo,m 10~0 lI"o 53 l.nUnvl 41, SO. 52 ond 58. 10401\
lIn. 25 1...1I". 20c; 1040EZ lIn. 1; 0' Scl,odul. "Un. 11. r.g. 2.
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r.
:. C P,oplIly Tox n.ll01 C,odll lAll.eh Form n.l. t0401l1 .. 3C
A TTN: PII.on. 0'" 05 0' dlsablod. I
0 Crodll fo, Ineol11o rail, plld 10 olho, OlltlS.Schodul. 1I.L1n. 22.AlI.eh .. 30 I
.Ign.d eopy 01 olho, Ito'o ,,'u,n. I
,
E Olhll Crodll. Indlcl'o C,odll. .. 31: I
Fo,m Numbo.. I
Ch.ek If
' /' olhll P.ymonll .. 31' Edon,'on 0
r I. Alllehod.
0 Tolll . Idd linn 3A. 38, 3C. 3D, 3E .nd 31' ~ ~D
,U
I If Uno 2 II lo,glllh.n L1n. 3D. onlor bALANCE DUE .nd PlY In lull wllh 'olurn. ~ @ t
CIlECK" 0 II FOlln 2210 II .1I.eh.d.INTEREST DUE on .O.S
',,": II L1ni 3D I. 1.lgor Ih.n L1n. 2 onlll OVERPAYMENT @
.' ~ .. 5. "t \.\
,I Amuunl of o'"p.ym.""o b. "fundod .. 8. ~ l\ 'Oft O"'el UII oHU
I
,~ Amounl 01 oYl'Plymonl'o b. erodll.d 10 'U93 Eslllll.lod To. .. 7.
IUcrOfUl IYI flU IUId II'OClO 11.1.... ..,"'~ It" hll1lc......IIIIOII:
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.CC~.I"'"'.IC....Mt,
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.'
Dnuo rnoon~M ACCOUNI
liorr: Thl, conlllbullon will ..duct rOut f.lul'd.
CJ
&1.00
tJ
15.00
OLYMPIC "..ru,IllI".I.... ","'......."',hWlllM..
O~'nI8 liON HOIII 'N. ''''''-'"_.11 "_,,... It,......
A.t. OAOAN Illld'UOO..~"I....."""',,"..I_.,
TnANSPLANT ~UND HO":I..............I......I....U~,,'.....
~"'. ~P/D 10umSM DEVELOrMENI 'UND 0 l J L:J 1:1
"0'1: 'hI. Conltlbullon "III "duu '0\11' "fund I' 00 15.00 SID 00 0111.,
h.l. NOP/OAME WILDLifE FOlIO a- L'J CJ CJ
"OIl: 'N, conlllbullon wut ffthtct ,aUf 'lfilnd 1100 "00 11000 0111.,
C't1LDltOOD D'SEASE V'CIfMS' FUtIO 1:.J [J CJ I:J
14011: ThI. conhlbullon "'III ',duu '0Ul' I.fund 1100 I!\ 00 '1000 Olh" ..
- ''''~I
u_, ....",,, .1 ...,..,.1...,... '"" I.... "'''''''''Ih'' "''''. .... .. "" b,,,., m, .....,........ """, " " "... ,...." ... ,",,,,,,,,
--- <.J;; . . SrOUSE'S .
'ttf. III a,.; .~ . D~fE S,m'ftlUtlE
lURE & A mE~ OF PA'O pnEPAlnF.~_1 /J J,
dd.urf. .I' R).{y.."...u-..:....
tJ YES
tJ YES
tJ No
tJ 140
I
'''.'''''---
,....M~I
D~'E
1992
'U.S: :l:NDIVlIJU1\L INCOME 'I'1\X RETURN 1040PC
OM~ NO., 1545,1309
,E~PI~ES 12-31-93
FORM1\'l' P1\GE 1 OF 1
1040 P1\GB 1
7--------------.-80040
81\---------------.--19
23---.-------..--00067
31-.--....--..---00067
1040 P1\GE 2
32---,-.,-.------80067
34-----,---,.-----6000
35-----------.---74067
36---,------.-----4600
37---.--,-----,.-69467
301\-,------.------,-.X
'38--,---",------14799
40------.--,-----14799
46,----,--,--,---14799
53----,--",-----14799
54----,,---,-----14188
57--,---,---,------611
60,-------,------14799
61,---,,--,,-.-------0
62----,-----,--.-----0
63--,---,,-,---------0
JOliN R ROBINSON
M1\RG1\RE'l' L ROBINSON
437 NORM1\ R01\D
1\MBlJER, 1'1\ 19002
209-32-9655 S1\LES
004-48-3506 IIDMINIS'I'RJ\'1'OR
PPECF M SPECF tl FS ~ 6J\-SBLF X G8-SPOUSE X
6 E . '1'0'1'1\ I, 2.
PRr.P'--'SUSJ\N ROM1\NOFF
F'JRM"'-"-"II R BLOCK
1\1J1J'-.--1 COMMERCE WJ\Y
CSZ-'--"-JOIINS'1'ON, RI
-.-.-....----02919
SSNP-"'-.-010-40-7079
PEIN'.-..---44-0G0705G
FORM 2119 - 20
1,---.-.----..--052992
3-. -. -. - -. -. - - - -,..,-N
4. - - - - -. -.. -. - - - - -. --N
5-.----.-.---.--130000
6-..----...---.---7800
7-.--..-..-.----122200
0-.--.--------..167900
9- - - - -. --.-. - - - (45700)
TOTJ\L INCOMB LINE 23 80067 '!'O'I'J\L 'I'M LINE 53 14799
TOTJ\L PJ\YMENTS LINE GO 14799 REFUND LINE 62 0
Under pen~lI;ies of perjury, I declare that I have examined this return and
accompanying schedules and statements, and to the best of my knowledge and
belief, they are true, correct, and complete.If applicable, I consent that my
refund be directly deposited. If joint return and refund is to be directly
deposited, thia ia an irrevocable appointment of the other spouse as an
agent to receive the refund. Declaration of preparer (other than taxpayer)
is based on all information of which preparer haa any knowledge,
Your Signature
See J\ttestation
Preparer's Signature
Date
Spouse's Signature
Date
011G!/3
Date Self-Employed-'l- Software Code 02
For Paperwork Reduction 1\ct Notice Statement, see 'I'axpayer Notice 974.
, .
199:.! IlIcome Information Worksheet
" .
JOliN R. ROBINSON 209329655 11-21-42
MARGARE1' L, ROBINSON, N 004483506
.....~.........................................................................
Form 1040 - page 1
I,i lie " - W- 2 Information
....... ............. -........................... -........ -.... '*.............................................. -................ _00.........................
. - - . - - - - - - WageR- - - . - - - - - - - . . . - - . - . - - - - - Taxes withheld------._---
Medi - Medi,
Source 1'/s OrosR S,S. care Federal S,S. care state Local
................. . .................. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ... .. .. .. .. ................
DATAIMAOE T 70014 55500 70700 13391 3441 1025 C'l' 2686
TODAYS TE S 4245 4245 4245 IIl2 263 62 RI 50
SCIIROFF I S 5789 5789 57U9 615 359 84 RI 169
.. .. .. .. .. .. .. .. .. .. .. .. .. ~ .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
80048 65534 OU734 14100 4063 1171 2905
-----....- _.........~ eam1l::lal!lll:\la ....."'_.....,.. acta... ----..- -...-...... .aa_IIIa_.
Schedule B
Line 1, - Interest Income
Lille 1. - Interest Income
Amount
Backup WIll
.. ...... _oo................ .............. ...... __oo_........................................... _........................... __..___....................
CONNECTICU'l'
19.
---_oo....--......
..--....--..........
19.
nnQar:rl!ll..aa..aD
na_a_._.Daaa
.,
EXIIIBITS C
HiiilIM.... ... wMhhilr
egl2.GO
4 ..........!tv' t.. w,"",",
......1f!m.....~ ... ......."....bhtW
...".50 112.33
. C.......lMMtf t.
. .~..MMt,........MdZl'...
GENESYS INFORMATION
SYSTEMS CORPORATION
4 NORTH PARK SUITE 400
HUNT VALLEY MD 21030
Batch '725
d EMptor..', alA nu"'lMf
ZOg.n.1I55
. Abllt.du,.
to ~ftt .."IMMf..
.~...r
-
,..,-
II
~
14 at ,
-
...~)...".....
li1.
.........
...
JOHN R. ROBINSON
eocs F KNOLLCREST PL
COCKEYSVILLE MD 21030
...
145
W-45:77.50
It DClalftyna-.
, Zn'.12
. L............__ II LDClalInoCNMtu
1
,
i
;
;
;i
"
W-2
""".,,.
1995 W-2 and EARNINGS SUMMARY,. 'I
I '.'. '" . ".,... ........ ,.. ",' ._.,"....~.~'..,~., .._ . .,...~
thll blul ~llnlng. 8ummltV "ctlo~ ,. lneludld With VeUI Vi.a Ie h"p dHellilt ~cn' In met. citWl.. 'I
th.IIVli.. IldalneludlllltntlallnloltiltiUClllh.1 yoU mlV .ltllI IInd htlpM. . .' : ".' . \ir~
: j. 1 h,'olI.wlnd Inlonn.llo<1ltfttci. YoU. Ilnllltl.. 1iI,.lub I>ful .n, od/u.lminle iulHnlriH br yotJI.........,.,..;
OIO"P.~ ~7020.84 eocl.llItclJtlly 2832.01 1I0,81...lricIllneT.. 2881.12" j
T..Wlthh.1d 8oxtlolW.2 .,',
80.. of W.2 IUWOt '
BgI2.00 lIodl....T.. 882,33 8OJI1..,W.2
Wlthh.ld
8ox5" W.2
F.d.lncom.
T.. Wlthh.ld
eo. 2 0' 1'1.2
2. Your Oro.. Pay W" Adlu.ttd It tollow. to produc. YOUf W.2 8tatlmenl.
W'U'" Tip., olh.. 8oc1.llltc:utlty lIodlc...
Comptnlltton W.g.. W.g..
Box 1 of 1'1.2 Box hI 1'1.2 Box 101 1'1.2
110, 81... 1'1'01"
TIp.,!...
Box 17011'1.1
Oroll P,V
L... MIlO. Non T D.ble Compo
R.ported W.Z Wig..
47.020.84
1,343.34
45,177.50
47.020.8.
1.343,34
45,177.50
47,020.84
1,343.34
45,177,50
47,020.84
1,3.3,34
45,177.80
3. Emplov.. W." Profll. To ch.ng. your Employ.. W." Protll,'nform.lIon, nI.. n.w W... wllh yaur p.poll dtpL
JOHN R. ROBINSON
606 F KNOLLCREST PL
COCKEVSVILLE MD 21030
SocI.1 Secullty Number: 20'.32.1151
T...bI. M.,llal 81.lul: BINGLE
Elllmptlonl/Ai1owanc'l:
FEDERAL! 1 135 Addltlon.' Till
ITATE! 1 142 AddlUon.1 T..
o t... AUtOUAttC OA'A'NXnSIHa IHe
r'nfl_""I"I~~I""" "1-
\ qq s )
"""-" -..----..--.- -.-
EMPLOYE! W.2 WAGE SUMMARY 1995
6012.'178
, , .
GLEHkcRAlT tORP.
205 'ORTIN ORIVE
. lIOOHSOtkET. kl 02895
FEDERAL WITHHOLDINO EXEMPTIONS
RI WITHHOLDING EXEMPTIONS
..
'ar 1995. yaU have no payrall adJult..ntl .htch ,".ctad your ,.derel
.1911 (Ba. I) ar Itlt. .19.1. Th.r,'ar., tha .a9.1 an )Our ,tn.1 1995
ch.ck Itlt...nt lhould b. the la.. II the .aOII rlpartld on )Our W.2
ltat....t.
S
S
DARET L. ROBINSON 0033.000100
. PAYROLLS BY AIYCNlK46003
IForm W-2 Wlge end Tu 511tlment 1996
L -3178 0033-000100
Copy C. far .-ploy..t, r.ao,d.
..
I'" I "tIll, ~ II
lM He. I"HOll
t__I.. C I~" ..... ....n. .. II' ..
GLENNCRAFT CORP.
205 FORTIN ORIVE
~OONSOCKET RI 02895
-
n'
'I.'Y........ ~-:iI'E~
MARGARET L. ROBINSON
37 ~INE STREET M2
EAST GREEN~ICH RI o281B
..., pl. It 1!!'Pf"!l"
18008.82
, "',. IK'''lllllU
lluu8.82
. c., .'P' U~I
18008.82
. Ift.lr P'
...111 wi
1908.38
"',. ...."'1'1'1 ~'~'1
I.' I.. .,
201.10
b.. .:1
..01_
RISOI
198.10
...
...-
'&11'111" II,.
IO~Ul,_III'
, ,..
II ...11I. 1.'-'" III ... I
.... ,,,'1.111..
050397125
Jrliiil.,..... 11P1. 'le.
18008.82
r-liiii-I..... jU- IftDiiJur .....
521.05
'Hil.eI ..., Up', tit
. ...In
"Ii EMPLOYEE W.2 WAGE SUMMARY lU94
f;~\';oOtt.3178
?i ~!c ~.~ . ~
:;'l)'lltlilaWi tfll\~. .'
"'~.~". . 0 lox.120909. 6 .....
::/ . 'MOYlot...lI RI 2vvv
.
. .
, .
t;."
',-,
i--'
I., .
: ",
i. hlllM1. WlflllolblllG lxtlliitlolts
i hi WITIIlOlbl1lO UEMPTlOltS .
,. ".,'
r '" "".
f' , .. I _ "J ~ , . '
LIIMWit L/..6iihSOH i 0033.000100
F' .PAYROLl8llV M'CHIJ(' ~3a4
.t"
'or t99~. )'Ou hay. no payroll adjust"nts which aff.cIed )'OIli' feeleril
wag.s (10M I) or .tat. wag... Th.r.for.. the w.ge. on )Our tthal Ig94
ch.ck .tatlllnt should be the i... al the wag'l repo,t.d oft )'OUr W.2
ltat..nt.
$
5
I
I
Form W-2 Wlgl Ind TIX Sllllmlnl
b 1 -3178 0033-000100
Copy c. tor ___IDY..'. r.oord,
... . ItlWW'."
lMI No. 1i4l-1XIDI
,_,,,, ~ r!l" ..... ......, ,. c...
LENNCIlAFT CORP.
POBOX 320909
PROVIOENCE RI 02909
,.. Iff
. IIlpl.YH', ..... "'H', .. ,.. I_
MARGARET L. ROBINSON
37 WINE STREET .2
EAST GREENWICH RI 0281B
......... t~.
7866.17
, lot." ''''''' llft
... ... . luu6.17
c.. w., Ilr
7666.17
...., ..
I.. .
601.83
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111.17
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RISOI
99.64
..
..
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.
10'
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7666,17
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219.08
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OMB No. 1145-0001
b Employ.,', kMnltftcllloo number
,-""""'"'*"....fe\lIc!!~...~:
1330 00 . q
, lloc:I""ClHIty_. 4 lloc:IoI.ICIlItty..._
05.0)84701
a Employ.'" nllN, add,.... and ZIP cod.
R ,I. TEMptl. INC.
~A J~fl9rson Doulevnrd
I Mldlcafl wage. II1d tip.
1330.00
1 Boo" 'KU,"y Up.
.00
I Advonco Ele poymont
.1)0
. MIdlCllO..._1d
9. '/
Wl.lrwick
RI 1)201)8.30311
. AI1ocotod IIpo
.00
to Dtpondtnl...o l>lne",.
.00
II Bono,", Indudod In IIolII
.00
d EmpIoyM'. locIlI ItcUrlty number
" OOH03506
. Employee', hilmi, add".., Ind ZIP cod,
HAROARET ROOINSON
37 WInE STRRHT '2
RAST 1J1I1lBNWICH nI 02018
11 Nonqu",n.d plon.
,uo
13 BtIIlntt,...Of BOlli 13
14 Other
1.101-
I
17.31J'
lid
......-
: tl SIIlo Employot'..I.I. 1.0. No. t1S11lo_Ipl,,,, 11 SlII'_III , llloeolllyn.me 101.0<1I_"",,," 111.0<1I_11I
" .li, (lihl.~p~.:.L...... ....U.1!?:J~9.. ..:....?:~.:.~.? ..;........... .................................
:r ,~\
'0 "
." r~r...:.nn~ Ta. 1994 . Department 01 the Tr.asury-Internal ntvtnuI Service
.~-_.__..._._.__... . .... ..........-.....-.....-....--..... ---.--.....--. ........-- I
. eontu)! number Void
l:I"4UlS(lj\ 0
b Employer', kSenUflcal10n number
i 1-1919701
o Emptoyer', name, add"". Ind ZlP code
'IlL.AH IF~PO~Ah'
I011~ 'Q~iTO~ ~r, S,~ 7~~
:... L l A ~, ,... 7', b .'
d EmJ)IoyH" lOdaJ .aQJrlty number
C 4-~p.'5(1l>
. EmpJoyee', name, add".,. And liP code
I ~~<_~~, l rDrlNin~
!
\, ~ ,. .~ ': ~, q I" ~ 11 -1" ~
t,A'"I{~, -I I-"I't"
18 StIlt Elnployer', 118Ial.0, No, 17 SIIII",... trpI, *
Q IJ IJU 1511~ Q \ ~4 .....'..~..5..'.....1..~.
....... ........... ~..;.~..........
! W 2 Wlge end TI. 1993
l. . SIII.menl
-------..---.-- -~._.... -.-.-..
.
/'
WIgOl.~,__ . '_II_......./1oId ,
1557.75 74.-0
3 Sodal Itcurlly "u" 4 Sod" """1Iy la, WIthhold
.'5~1. .,~ 14~ .ld
I MedlclI. .'u.s AIld "pI I M~.t.. .,...lhh.1d
., lHl.n J4 . H'
, BadAl "corlly lip' I AJtocaled lips
. Advlflce EIC pllytnenl to Dependent car. berwt"I'
11 NunquIllhed pIA"S II lIe"'ftl'_~
13 Se. Inltr.. for Pal 13 14 Ollm
20 LaaI...,Jipt,* at Lu",*,-w!
.~.L~~.!..... .I..~t~~.n.....:s.~~.~.L
i
Oepftftm.nl oIlh. Tre.sury-Intema' Revenue Service
OMU No ISotS oooa
.-,. ~._-._.. - -----..._--- -----------..
EMPLOYEE W.2 WAGE SUMMARY 1993
0014.1144
"
,. oATAIlWli INC. .
:,' 10 IIAoov smut.
,; 0',. EAST HARTfORO, CT 08108 .
fldere' wtthholdtng .."",~Ionl M I
'A wlthholdln, e.tNPtlonl x 0
Addtttonel flder" teM wlthh.,d 110,00
Addlt ton. PA .tlt. tll withheld 101.00
I t,,'f'
!';t..1
JoIfI ROIl MSQIt
I PAYROLL9lIY AmlHIX'
0021-841018
94014
Form W-2 WIDI Ind TIX 5111.m.nl 1993
b
..
_fH' _..,.....,,_
2D9-32-9655
f_
PASUI 16.69
III. ....., 111I. lit.
167D4.25
Your 1993 payroll adjultllnt. ere ltlt.d below. Thll chert Indtcet.. tr they wer.
tncluded (+), ..cluded (.), or dId not efrtet (MIA) your rider.' .egel (10M I) end
your Itat. wag'l on your W.2 Itet...nt.
RIOULAA WAOES, 16104,25 '"
Yolunh,y Yeer to bat. 80d pA CT
AdjultMntl Mount Wagll WlglI 11'911
UP RElMll 1!6,U MIA MIA
SEC US 209.60 .209.60 MIA
Cop, c. '0' eeploy,,'. "'.f~'
,.... 'If
DOIDB
..... po" 04'9'4.ii5'
I ..,. ...."l4:nl4. BO
fa. ."'. u,.
16494.65
-,po
po
ta. 'u.
239.17
tt'"...... '", lilt
JDHN ROBINSON
437 NORMA RD
AMBLER PA 19DD2
... po
all II.
..
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Ill. .... I..
642.DD
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IC_ '"
, .
. .....,.,.. MMe,........, aM Z1111 oodt
GENESYS INFORMATION
SJTEMS CORPORATION
4 ORTH PARK SUITE 400
H NT VALLEY MD 21030
Balch '627
..~~.., ':JI'.....p-r
-I. l..-.- Og.32.....
T-.-r _ fA....
II 0tptMt'" u.. ..netlte
Irr.Mlii~IO""
.1 ............. I.. tl '4 0thM
0.0.. P'I
L... Mloc. Non Taubl. Comp.
R,pOlt.d W.I W.g..
,-(,f,'.".'
" . \ 1
.. Vall' 0.0" P., W.. Adloilod 1110110..1 to'~odU.' rolk w.i ...lIlIIInt.
W...I, TIp" othel 8oe111"'urltl. lIodlt'"
g:~r.7'A~~"" , :':::'01 W.e . :"';'01 W..
3,461.114 3,4111.54' 3."IILM
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,
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11011101... .
3,oIeU4
711.18
3,313,11
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.......... ;;le-
JOHN R. ROBINSON
437 NORMA RD.
AMBLER PA 19002
3. Employ.. W.. P,olll. To ching. your Employ.. W.4 P,olll,l,,'oun.tlon, fll,. n.w W'" wllh your p.yroU dept.
u
'4. 4
1, Iltt, ...... u~. .to.
3313. U
" H....oflooalMy
j'JtiiilIMCNM ".
JOHN R. ROBINSON
437 NORMA RD.
AMBLER PA 19002
Bocl,,1 s.cuflty Numbe,; 201.32.IIU
MIIII.1 Slttus: BINal!
Enmptlon./Atlow.nce.:
fEDERAL: '13' AddHlon.1 T..
BTATE.
Of. .
52.1 11112
o ltUAUlClllA'1C OA'''' I'nocU,ltld 11m
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EMPLOYEE W.2 WAUl! SUMMAIlV 199~
.
~
.
'. DATAII.lAGE INC,
20 MEADOW STREET
EAST HARTFORO,CT
71~4
OOIOB
,.deral wlthholdlnv .,aoptlons
CT wlthholdlnv a''"Ptlons
AdditIonal federal ta' wlthhald
Additional CT stat. ta' wIthheld
H I
x 0
110.00
107,00
JOHN ROBINSON
Form W-2 W. . .nd Tex Sl.t.ment 1992
Your 1992 payroll adjust.nts art listed bllow. This chbrt 1ndlcltll 1'1 .'
thlY Wlrl Includld (~). I,cluded (.) or did hat Iffect (N/A) ~ur feder' '
waVII (80' 10) Ind ~ur stat. WeIll oh ~Ur 11-2 stat...nb . ,
j, .
IlEGULAR \lAGES 68534 .86
Voluntary Ylar to dltt 80. to CT
Adjustlllnts ^"<lunt WaVII WaVII
EXP REIMB 488.54 N/A NIA
401k 685.35 .685.35 -685,35
SEC 125 124.08 .124,08 -124,00
CAR ALLOII 2889.00 +288V.00 +288V.00
EHPLOYEE REFERENCE COPY
'tH'.... '''Ill,
20..32.....
11 I" ..&I. I. ,.. w.a
o
0I0lI'" ".8-000_
I.......,..................,..,...
DATA IMAGE INC.
20 MEADOW STREET
EAST HARTFORO.CT
I.. .... lltlt..w. .........111....... .....11 flIP'''"' ut.
01-11'442 4711131-000
7 ",r 'i. ......,,,. _. ...;;,. .. If _ D2'FtlD2lf
JOHN ROBINSON
437 NORMA RD
AMBLER,PA
DOtDB
. :=' ...n," "=-
X
Ill'" In "I
133'0.12
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70014.43
r.. ... n II,.
701U.78
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70014.43
"",/I.ul 1_.. III
211811.10
,1Ilt~le......""I\ItIMCt"'....If>l.."M"--...oIc.
W-2
19002
Ii..
AI" Up'
,. IK..."..,.
fISotl.I'f(IlII~
3441.00
lL MdlC.. I.. wll"'''
10211.12
Itl,,'loulll., ....
CT
11 5otlt! IKllllr ...
1115800.00
"
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.
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3 III.
. .0
2U'.00
1...II,nlll)'_
IIM.lloul l.cOlN '"
SI.l,'llul W.....Upt. ftto
lqqZ
Contt number
1I1I\II\'l'W. 01.10 No.I54I<XlOl
2 Employ..', name, add..... and ZIP codo
1111'", ....' 1'1:'11'\11101',
1111 1\ l'I":'l'II.l1l P,I. ',\ t; . loll
([lIIV r r'lf f r,H'l O/YI' <, IH r [Hill', ~
I~" l' qu' II '" 1 , ~ I
.
I=~:;:,*"~
7 AJlocolo tlpo
,M1.~_ Void
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3E~"ldsnbftcallcnf1lJl11b8l
~ .,'. .; 1',1 L> (I "I 'I,
I " """"'Ulltlll
'''4 .tlt ~'''';''tl
. name, I "", and liP code
1I,.I'II,oI".:T I. "1"1111,,1111
4 Empkl,o.', '1.10
: I :1,1",''11''
g Fado.aIlncorno I.. wlthho
1111 . 1.1' ,
I Sod ,ocu. Iy t.. wllhhold
'I:h'~. 1',1
13 Social ,0cu.11y lip'
'r,~ ,', . r) I)
2 80dal oocu,ltV wogso
.I:~.' ~I. \1'.'
14 odicolo wogs' and lip'
VI~ \,:...,.,\
II onquI od pIon'
1\
,
It I t l. I..; I'", ... ., '/ "j ~,~! t .~
15 ~odlcolIl" withhold
..'
15 Ih..
1l;"'.I. "II'" Y "1', ,\ I .. I 1.1 I.
1.I(11l~1 11..1:.. II'. '.'.\lJll.,
..'
..
i
I
,
,.... W.2 Waae and Tax Statement 1992
Oept. of the Treasllry-lnll1ll81 Revenue Service IRS APP.
Thl, InfonnaUon II being furnish. to Ihe Inlllnol n....enue ServtcI. II you
are fequlred 10 file . flU flluIn, . "8OllgenCfl ponally or olh" .aocllon m.v
be Impoud on you " Ihll Income II huabl, and you I.U to repott II.
'j
.,
i
[i
,
INCOME AND EXPENSE STATEMENT OF
MARGARET L. ROBINSON
SSN 004 ....!t.!!.-. 3506 DRII R6528~4 DATE 11-70-Qf\
THIS STATEMENT MUST BE FILLED OUT
(1/ you are sel/.employed or 1/ you are salaried by a business 0' which you are owner In whole or In part, you must
also 'III out the Suppl.m.nt.1 h,come Stat.ment which eppoars on the last page 01 this Incom. .nd Exp.nle
St.t.m.nt,)
INCOME
(s) Wages/Salary
Employer & Address GLENNCRAFT CORPORATION, 205 FORTIN ORIVE, WOONSOCKET. RI Ol895
Job Title/Description RECEPTIONIST
Pay Period (weekly, bl.weekly, monthly) WEEKLY
Gross Pay per Pay Period .................................................................................................................... $ 370.00
Payroll Deductlon&:
Federal Withholding ..................$
Social Security ...........................$
Local Wage Tax ..........................$
State Income Tax .......................$
Retirement ..................................$
Health Insurance ........................$
Other (specl/y) ..tl\!ip.~g.~.l,{,\!i.........$
40.57
22.94
4.07 DBL
11.09
5.37
.........................$
.........................$
Net Pay per Pay Period ........................................................................................................................ $ 285.96
(b) Other Income Week Month
Interest/Dividends ......................$ -0- $ $
Pension/Annuity .........................$ -0- $ $
Social Security ...........................$ _n_ $ $
Rents/Royalties ..........................$ -0- $ $
Expense Account .......................$ -0- $ $
Gifts .............................................$ -0- $ $
Unemployment Compensation .$ -0- $- $
Workmen's Compensation ........$ -0- $ $
Total, Other Income .......................$ -0- $ $
Year
INCOME AND EXPENSE STATEMENT OF
I verily Ihel the slalemenls made In this Income and Expanse Slate.
menl .ro trUB and cortect. I understand thai 'allB IItalements haroln
a.e medo sublocl 10 Ihe penalties 01 18 PaC.S. ~1lO~ 'ollUng 10
unsworn 'ullllllcallon to lIuthorlllul.
Oalo:
Pi.lniiilo."b.liirid.'ni
Household Child Household Child
Week Wesk Month Month
EXPENSES
Home
Mortgage/Rent ........................................ $ $ $ 450.00 $
Maintenance ........................................... $ $ $ $
Utllltles (telephone, heating
electrlo, ete.) ........................................ $ $ $ 82.00 $
Employment (transportation,
lunches) ................,.............................. $ $ $ 60.00 $
Taxes
Real Estate ........................,..................... $ $ $ $
Personal Property................................... $ $ $ 9.00 $
Income ..................................................... $ $ $ $
Insurance
Homeowners ........................................... $ $ $ $
Automobile ........".................................... $ $ $ 80.00 $
LI'e/Accldent/Health .............................. $ $ $ 195.00 $
Other ........................................................ $ $ $ 200.001 $
Automobile (payments, fuel,
repairs) .I.9.l\"..l1n.~1I11..,'l.?L":lIlo.~.~QU. $ $ $ 112.00 $
Medical 150.00
Doctor, Dentist, Orthodontist ................ $ $ $ 20.00 $
Hospital ................................................... $ $ $ $
Special (glasses, brsces, etc.) ............... $ $ $ 15.00 $
Education
Private, Parochial School....................... $ $ $ $
COllege ..................................................... $ $ $ $
Personal 80.002
Clothing ................................................... $ $ $ $
d \ . $ $ $ 238.003 $
Food ..l\n.....'.\\P.II. .l.~.!\.............................
Other (1I.IIBatmbck"1Jl"P~xx 45.004
barber, etc.) ....h.d,r.lIJ;.~.M.\,,:.............. $ $ $ $
Credit payments and loans .................... $ $ $ $
Miscellaneous
Household help/child care ..................... $ $ $ $
Entertainment (Inc. papers, 250.005
books, vacation, pay TV, etc.) ............ $ S $ $
Gifts/Charitable contributions .............. $ $ $ $
Legal Fees ............................................... $ $ $ 250.00 $
Other child support/alimony
payments ............................................. $ $ $ $
Other (specify) ...........".................................. $ $ $ $
Total Expenses .........".................................. $ $ $ ..l2J6. 00 $---
I. Budgeted amount necessary to replace unreliable 1989 Mazda.
2. This represents on increase of $40.00 per month from the current level
of spending which is depressed os 0 moiler of necessity.
3. This reflects an increase from the current level ofspendin8 of$120.00
per month which is depressed os 0 moiler of necessity.
4. This is 0 desired budgeted amount. I om not currently able to offord
o hairdresser.
S. This is 0 desired budgeted amount. I currently hove no TV cable, magazlnf'
subscriptions, or any funds for vocation. recreation or entertainment.
"
(;.S'
., ..
~()\'\ INCOME AND EXPE~SE STATEMENT OF
~ R.o~/().s()"
SSN d~? .~. ~~ DAN <<579.;J DATE /~/.?/?~
THIS STATEMENT MUST BE FILLED OUT
(II you are sell-employed or If you are salaried by a business 01 which you are owner In whole or In part, you must
also 1111 out the Supplsmental 'ncome Statement which appears on the last page 01 this Income and Expense
Stalement.) .
INCOME
(a) WagaslSalary . ~ '
Employer & Address 6"a::i jl./6'~~vte...o fTJ€,._ PM~ /?1 /71::>//
JobTltle/Descrlptlon ~iS'lt;n...,. ...A~<l.o/~r- .
~~~s':e~~ydp(:e;~yp::i::~~I~:.i~.~~,~.'.~~........~.:..~.~.:':~~j[................................................... $ ~~.;2~ '
Payroll Deductions:
Federal Withholding ..................$
Social Security ...........................$
Local Wage Tax ..........................$
~JrJncome Tax .......................$
14~~.............................S
Health Insurance. ..:;>'.....f.. "1,:..."..$
. l-fltl .ue~
Other (speclly) .;1..........t! .:..........$
~$l"'" ~L.l:" .........................$
.:5"SS': I 0/'
/S'"7. <7li:2
02.~. eft::)
?~.D/
g~,?3
7tJ',;1..<{
Itr.:z.
t;,(':r
/~ .z.a
';'
~tfJ. .z::;...4$', .........................$
Net Pay per Pay Period ........................................................................................................................ $
ft?.st.,9/
(b) Other Income Week Month Year .,
InterosUDlvldends ......................$ -t!;J- $ $
PeneloilJAnnully,........................$ .-.t:::J- $ $
Social Security ...........................$ -t::J- $- $
Rents/Royalties ..........................$ -I!:J"- $ . $
Expense Account .......................$ -~- $-" '$
GI'tl.............................................$ -t:!?- $ $.
Unemployment Compensation ,$ -t:::>- $ $
Workmen's Compensation ..,,,,,.$ -c;> - $ $
Total, Other Income .......................$ - c;J - $ - 0- $ - 0
.
INCOME AND EXPENSE STATEMENT OF
I'verlly Ihlllho Itllomonls mldoln Ihlslneomo irid Expen.. SII'o.
man I Ira Iruo Ind eorroe!.1 undars'lnd thll rlr.. slllomenls hare'n
Ira mldo subJoet 10 Iho penllUol 01 18 PI.C.S. 4904 rollllng 10
unlworn IllslllelUon 10 IUlhor/U...
Olio: ..e'/$'~.6'
~
DRO N405
Household
Week
Child
Week
Household
Month
EXPENSES
Home
Mortgsge/Rent ........................................ $
Malnlenal1ce ........................................... $
UtllIUes (telephone, heating
electric. etc.) ........................................ $
$
$
$ CJ50,/JrP $
$ _ /Lf7?;? -H? $
$ .3a:1,~ $
~
$ /~t?_~ $
$
Employment (transportation,
lunches) ............................................... $
Taxee
$
Real Estate .............................................. S
Personal Property................................... $
Income ..................................................... $
$
$
$
$ c:7
$ ~
$. c:7
$ /5': de'
$ ..,~ ""'"
$ /1'f/.,p
$ CJ
Insurance
Homeowners ........................................... $
Automobile .............................................. $
Life/Accident/Health .............................. $
Other ........................................................ S
$
$
$
$
Automobile (payment.!!, 'ue,!.. , Po ~
repairs) .............t..",....fr!.'e;'...~.... $
Medical
Doctor, Dentist, Orthodonllst................ $
Hospital................................................... S
Special (glasses, bracas, etc.) ............... $
Education
Private, Parochial School....................... $
COllege ........................,............................ $
$
$ ,r;.7~tn7
$
$
$
$ kye>.,eJ
$_ 0
$ .:J.~_ ptJ
$
$
$ 0
$ ",
Peraonal
Clothing ................................................... S
Food ..............,...................."....,...........11.. $
$ ,h>,6e'
$ ;N~, rt:l
$
$
. .~
.$
Other (houaehold supplle~, ."
barber, etc.) "....1..................................1 $
Credit psymal1ta and loans .................... $ .
Mlacellal1eous
Houaehold help/child care .........,............ $
Entertainment (Inc. papers,
books, vacation, pay TV, etc.) ............ $
Gills/Charitable contributions .............. $"
Legal Fees ......................11111...........1........ S
Other child aupport/allmony , , h'" r.
payments ........111...................111............ S
Other (speclly) 1J.lfZkk~.k.?.:.:,............... $
tA...'1<J~
~~ r:~
Total Expenses ............................................. S
$ /h','r&'
$
$ "'6
. $ .
$
$'
$
.
$ z~_
$ 7",11r?
$ ~'H'
-l:;i1:'"" 1,1',\
$
$
$ r:? $
L2.-<t>..-P
$' a""''- $
-:),Gr?
$ 3q 'f,?J,tJP $
$
'.
,
. -"'
. '.
Child
Month
$
$
$
$
$
$
$
$ .
$
$
$
".,
"'"
$
$
.,
$
,
."
$.1 ;..,.
.,1":"
$. . ,.
$' '"
1,1
S'If' ,."
$
$
$
:"'1
. . .
~ ~~~~~~~~~~~~~ ....
. ~j ~
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DR 25.792
JOHN R. ROBINSON..
PLAINTIFF/RESPONDENT:
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY. PENNSYL VANIA
VS
CIVIL ACTION. LA W
MARGARET t.. ROBINSON.
DBFENDANTIPETITIONER
NO. 96...J.lll. CIVIL TERM
ORDER OF COURT
AND NOW. this J.2lh.. day of OClober. 1996. based upon the Court's detennination that
Plaintiff/Respondent's monthly net income Is $3386.00 per month and Defendant/Petitioner's
'monthly no/Income is S 124ft. 00. par month, it Is hereby Ordered that the DefendantlPetitioner pay
10 tho Domestic Relations Section, Court Of Common Pleas, S 855,00 a month payable S 427,50 bi.
monthly as alimony pendente lite. effective 913196, Arrears sot at S 1.710.00 as of 10110/96 I shal\
bo payable at S 22.~O bi.monthly , First payment due on or before 11/1/96, and each month
lhereal'ter, .
Falluro to make each payment on lime and in full will cause al\ arrears to become subject to
Immodlate collection by a\l of the means as provided by 23 Pa,C,S., 3703, Further, if the Court
finds, after hearln81 that the DefendanllPetitloner htls willfully failed to comply with this Order, it
may declare the Defendant/Petitioner In eMI contempt of Court and its discretion make an
appropriate Order, Ineludlns. but not limited 10. commitment of the DefendanllPetitloner to prison for
a period not to exceed six months.
Payments must be made by cash. check or money order. Cash payments must be made In
person, All checks and money orders must be made payable to Domestic Relations Section and
delivered or mailed to Domestic Relations Section, 13 North Hanover Street, P.O. Box 320. Carlisle.
Pennsylvania. 17013. Each payment must bear your Domestic Relations number (DR 25,792 ) in
order to be processed.
Defendant/Petitioner Is responsible for service fees of N/A to be paid within ~ as
detennined by the Domestic Relations Secllon.
EXlIlBIT G
2'd
ddO) Lll;ld)l.jI<3l~ WI;lLS:60 ':'6. T2 DO
.
DR 25,792
JOliN It ROUlNSON
PLAINTIFF/RESI'ONDENT : IN TilE COURT OF COMMON PLEAS OF
: CUMIIERLAND COUNTY, PENNSYLVANIA
VS
: DOMESTIC RELATIONS SECTION
: CIVIL ACT/ON. SUI'I'ORT
MARGARET L. ROllINSON
DEFENDANT/I'ETIT/ONER : NO, 96 - 3312 CJ vJl Torm
ORm;R (n' COUR1'
AND NOW,lhls 21st day oroelober, 1996, IT IS lIE/limy ORDERED AND
DIRElTED lhnllhe order ofOelohcr 10, 1996, is amended liS lilllows: John It Robinson Is lhe
plnhlllflYrespo/llJclIl nnd willmnko pnymonllo Iho Domcslle Relllliolls Scclion. Tho rcmnlndcr
nflhe llrdor slnnds in lIs onlirely.
BY TIlE COURT,
-Ad-
DRO: R.J. Shnddny
ee: plninliff nnd defcndnnl
ec: Jnmcs Bnch. Esq.
ee: Tnylor Andrcws, Esq.
TRUE COPY FROM RECORD
111 T 05t1mony whereof, I here unlo set my hand
'lid Iho seal of said Court al Carlisle, Pa.
Ihls d') 1" da~ 01 eX- t , , 19C1ll'
\. "- j\r,. C) r~\ ~".N(\n~\f'\ r~dJI.
Prolhonotary
J.
.
JOHN R. ROBINSON, : IN THE COURT OF COMMON PLEAS OF
Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA
V. : CIVIL ACTION - LAW
MARGARET L. ROBINSON, : NO. 96-3312
Defendant : IN DlVOI<CE
CERTIFICATE OF SERVICE
I hereby certify that on this date, IJt~../)p, 75"", 1996, I mailed a copy of
Defendant's Pre-Trial Statement to counsel for Plaintiff at the following address by U,S. Mall,
postage prepaid:
lames M. Bach, Esq.
352 S. Sporting Hill Road
Mechanlcsburg, PA 17055
-~
aylor P. Andrews
Counsel for Plaintiff
78 West Pomfret Street
Carlisle, PA 17013
(717) 243-0123
vs.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 96 - 3312 CIVIL
JOliN R. ROBINSON,
Plaintiff
MARGARET L. ROBINSON,
Defendant
IN DIVORCE
AND NOW, this
ORDER OF COURT
S J ~. day of ^Aetu.y-
1997, a divorce decree having been entered previously on October
23, 1996, and the economic claims raised in the proceedings
having been resolved in accordance with a marital settlement
agreement dated March 24, 1997, tne appointment of the Master is
vacated.
BY THE COURT,
ir~~E;.fJ.v-
co:
James M. Bach
Attorney for Plaintiff
Taylor P. Andrews
Attorney for Defendant
c~"'-' ~Q....,L 4-/dQ'1,
~-e.
I
:1
'j
..,
.,. '.
.
.
JOHN R. ROBINSON
Plaintiff
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: CIVIL ACTION - LAW
v.
MARGARET L. ROBINSON
Defendant
: NO. 96-3312 CIVIL TERM
: IN DIVORCE
MARITAL SETI'LEMENT AGREEMENT
AGREEMENT, made this il'l.,l~ day of March, 1997, between MARGARET L.
ROBINSON (hereinafter called "Wire") and JOHN R. ROBINSON (hereinafter called
"Husband").
WITNESSETH:
The parties hereto were previously Wife and Husband, having been married on
December 28, 1975. There were no children born of this marriage;
Pursuant to an Order of the Honorable Kevin A. Hess, dated October 16th. 1996
bifurcating the above-captioned Divorce action, the panics' marriage was terminated by a
Decree in Divorce dated October 23, 1996 (a copy of the Divorce Decree is attached hereto as
Exhibit "A");
The panics hereto desire to sellle fully and finally their respective financial and
property rights and obligations as between each other, including without limitation:
(1) the settling of all matters between them relating to the ownership of real and personal
property; and (2) the settling of all mailers between them relating to the past, present and
future support and/or maintenance or Wife by Husband and or Husband by Wife.
NOW THEREFORE. in considenllion of the premises and of the mutual promises,
covenants and undenakings hereinafter sel forth and for other good and valuable
~....
, r~_~1.
';', . ..J:,
,'.', -., ...
.
.
consideration, receipt of which Is hereby acknowledged by each of the parties herelo, Wife
and Husband, each Intending to be legally bound hereby, covenant and agree as follows:
I. ADVICE OF COUNSEL
The provisions of this Agreemenl and their legal effect have been fully explained to Ihe
parties by their respective counsel, Taylor P. Andrews, Esquire, for Wife, and lames M.
Bach, Esquire, for Husband. Each party acknowledges that she or he has received
Independent legal advice from counsel of her or his selection and that each fully understands
the facts and has been fully Infonned as 10 her or his legal rights and obligations and each
party acknowledges and accepls that this Agreement is, In the circumstances, fair and equitable
and that it is being entered into freely and voluntarily, after having received such advice and
with such knowledge and that execution of Ihis Agreement Is not the result of any duress or
undue influence and Ihat it is not lhe result of any collusion or improper or illegal agreemelll
or agreements.
2. PERSONAL PROPERTY
Wife and Husband do hereby acknowledge they have heretofore divided the marital
property, Including, but without limitation, jewelry, clothes, furniture and olher personalty,
and hereafter, Wife agrees thal all 01' the properly in the possession of Husband shall be the
sole and separate property of Hushand; and, Husband agrees that all property in the possession
2
.' ^.
.
,
"
of Wife shall be the sole and separate property of Wife, Each of the parties does hereby
specifically waive, release, renounce and forever abandon whatever claims, If any, she or he
may have with respect to any of the above Items which are the sole and separate property of
the other,
3, REAL PROPERTY
All marital real property has been sold since the date of separation. Husband assumed
personal responsibility for the marital mortgage debt and Husband thereafter discharged the
debt in a bankruptcy proceeding, There Is now, therefore, no claim asserted by either party
against the other for any portion of marital real estate or for any responsibility or contribution
towards any marital real estate debt.
4. ALIMONY
Husband was ordered on October 10, 1996 to pay Wife alimony pendente lite at the
rate of $855,00 per month effective Seplember 3, 1996. This Order was upheld after
Husband's appeal and a court hearing by an Order of lhe Honorable Kevin A. Hess, daled
December 30, 1996. (A copy of lhese Orders are attached herelo as Exhibits "B" and "en
respeclfully.)
The parlies hereto agree thaI Husband shall pay Wife alimony in an amount equal to
the exisling Order for alimony pendente lite, and lhat such alimony award shall be payable
through August 31, 1997. The amoulll and lhe duralion of the alimony shall not be subjeclto
modificalionupon pelilion of either party. The 1Ilimony shalllerlllinilte upon the dealh or
3
purposes set forth in the preamble hereinabove; that there are no claims, promises or
representations not herein contained, either oral or wriuen, which shall or may be charged or
enforced or enforceable unless reduced to writing and signed by both of the parties hereto; and
the waiver of any term, condition, clause or provision of this Agreement shall in no way be
deemed to be considercd a waiver of any other term, condition, clause or provision of this
Agreement.
8. BINDING EFFECT OF AGREEMENT
This Agreement shall remain in full force and effect unless and until terminated
pursuant to the tenns of this Agreement. The failure of either party to insist upon strict
performance of any of the provisions of this Agreement shall not be construed as a waiver of
any subsequent default of the same or similar nature.
I
.
9. SEPARABILITY
If any term, condition, clause or provision of this Agreement shall be determined or
declared to be void or invalid in law, or otherwise, then only that term, condition, clause or
, I
! I
i
I
. I
. I
I
provision shall be stricken from this Agreement and in all other respects this Agreement shall
be valid and continue in full force, effect and operation. Likewise, the failure of any party to
meet her or his obligations under anyone or more of the paragraphs herein, with the exception
of the satisfaction of the conditions precedent, shall in no way avoid or alter the remaining
obligations of the parties.
5
.,
10. HEADINGS
Any headings preceding the text of the several paragraphs and subparagraphs hereof
are inserted solely for convenience of reference and shall not constitute a part of this
Agreement nor shall they affect its meanings, construction or effect.
11. EFFECTIVE DATE
The effective dale of this Agreement shall be the date upon which it is executed by both
parties.
12. CONTROLLING LAW
This Agreement shall be construed in accordance with the laws of the Commonwealth
of PelU1Sylvania.
IN WITNESS WHEREOF, the parties hereto have set their hands and seals the day
and year first above written.
This Agreement is executed in duplicate, and in counterparts, and Wife and Husband,
as parties hereto, acknowledge the receipt of a duly executed copy hereof.
/lhrPf;J~jtt4-
~ "
6
JOliN It 1l01llNSON
I'I.AI N'I'I 1'1'/1( /!S 1'( IN I lENT
1>1( 2.~. 7'12
IN TilE ('0111('1' OF ('OMMON I'WAS OF
. (,lIMIIEIlLANI> ('OIINTY. I'ENNSYI.VANIA
VS
1>01\1I!STW 1((].ATlm~S SE('TION
('IVII. A('TION - Slll'l'llR'I'
MAllliAllE'I'1. IWIIINSON
11I!FI!NIMN'I'/I,/,'I'I'I'I(INI:Jl
NO. %-.1.112 (,ivil Tcrm
()JWEH OF ('OlIHT
ANI> NOW. Ihls 2'1'" da~ 111' Allglls!. 1'1'17. pllrsllalllllllhc parllcs' rnarilal sclllcmclIl
awecmclIllIl'March 2-1 1'1"7.
IT IS IILllUIY OIWI!IlEI> ANI> I>IRElTEI> Ihallhe alinlllllY pCllllellle hie is
lermillalcd IllIh a halance 111'$ !5"7"illll\lcd llllhc plallll,'1':rnd a $211.i11l scrv,ce Icc is 1111 cd In
thc I>omcslic Ildal,"ns Scclion.
IT IS 1'1110'1 WI( OIWEIlEI> Ihallhc halanccs hc paid in li,1I Ililhin si.\ly days illltlo
illslallmcnls nl' $K 11.75 nil or hdhrc Scplcrnhcl' 15. 1'1"7. allll Oclllher I.'. 1'1"7.
Th,s ordcl' shall hCCllrnc Iinallcn tla~'s allcr Ihc rnailing or lhc 1I11l1ce nl' Ihe c'lIry 111' Ihc
nrder 10 Ihe p:lrlies IInless dlher parl~' li/es a IlI'lIIell tlernallll II ilh Ihe I>orneslle I(elalinlls Seclillll
IiiI' a heanng tie 11111'11 hell're Ihe ('lIurl.
BY TilE ('OllRT.
'f~ /- . A /
Kevill A..~ ~
/
1.
f>IHI: IU. Sh'lIltlav'
ee: plmnlill'
,lclclld:1I11
ee: 'I'lI)'llIr AlIIlrells. !:sq.
ce: James Hach. lisq.
~
t\l~
q-~.ql
Func: I I TRNL FinancIal Transaction Log CALVANMH 11/151111 08:17
CASE 10: 1052000077 I Dist Hold: N Dist Hold Reas Code: D
Payor: 3676000037 ROBINSON, JOHN R.
Payee: 4676000033 ROBINSON, MARGARET L.
Total Debt Balance: 0.00 Payor has future collections on hold: N
DATE Transaction Description Reference 10 Trans Amt Debt 8al
09/12/97 DISBURSEMENT 2126700000100 26.00 0.00
09/12/97 DISBURSEMENT 2146760000331 1597.50 0.00
09/12/97 NORMAL DISTRIBUTION 2119970912KOO0307400 1597.50 0.00
09/12/97 OBLE FEE DISTRlBUTlO 2119970912KOO0307301 26.00 1597.50
091114/97 NEW OBLIGATION 26.00 1623,50
08/31/97 CONVERTED BALANCE 1597.50 1597.50
.~. 3506 DRII 8652854 DATE
THIS STATEMENT MUST BE FILLED OUT
(If you are sel/-employed or It you are salaried by a business of which you are owner In whole or In part, you musl
also till outlhe Supplemental Income Statement which appears on the lasl page 0' this Income and Expense
Statement.)
.... ~.
INCOME AND EXPENSE STATEMENT OF
MARGARET L. ROBINSON
SSN
004
9-30-96
INCOME
(a) Wages/Salary
Employer & Address GLENNCRAFT CORPORATION, 205 FORTIN DRIVE. wonNsnCICFT. AT n7AQ~
Job Tltle/Descrlpllon RECEPTIONIST
Pay Period (weekly, bl.weekly, monthly) WEEKLY
Gross Pay per Pay Period .................................................................................................................... $ 370.00
Payroll Deductions:
Federal Withholding ..................$ 60 ~7
Social Security ...........................$ 2' . Q4
Local Wage Tax ..........................$ 4.07 DBL
State Income Tax .......................$ 11.09
Retirement ..................................$
Health Insurance ........................$
Other (specl/y) .M.ED~CARE..........$ ~ . 17
.........................$
.........................$
Net Pay per Pay Period ........................................................................................................................ $ 285. 96
(b) Other Income Week Month Year
InleresUDlvldends $ 0 $ $
PensIon/Annuity. ~ _n_ $ $
Social Security. $ -0_ $ $
Rents/Royalties $ -0- $ $
Expense Account $ -0- $ $
GI/ts $ -0- $ $
Unemployment Compensallon.$ -0- $. $
Workmen's Compensallon ........$ -0- $ $
Total, Other Income .......................$ -0- $ $
S3I ~ c.V 'Ie..
INCOME AND EXPENSE STATEMENT OF
MARGARET L. ROBINSON
, PLAINTIFF'S
I', . EXH lIlT
/
.. -.
I .e,lfy Ihellhe Slalemenla made In thlalncome and E.penaa Slala.
men I are I,ue and correct. I unde,aland thai f.,.. atatemenla herein
are made sublecl IQ the pena'Uea of 18 a.C,S. 490-4 re'allf\ll 10
unsworn 'a'alllcaUon IQ aUlhorlUe~
Dale: 9-30-96
EXIIIDIT A
~ ~
1>!~~~ ~~
Housel1old
Week
Child
Week
Household
Month
Child
Month
EXPENSES
Home
Mortgage/Rent ........................................ $
Maintenance ........................................... $
electrlc,~ ........................................ $
$
$
$
$ 450.00 $
$ $
$ 82.00 $
$ 36.00 $
$ $
$ 9 no $
$ 85.00 $
UlllltJes (telephone, healing
Employment I
lunches) ............................................... $
$
Taxes
Real Estato .............................................. $
Personal Property................................... $
Income ..................................................... $
$
$
$
Insurance
Homeowners ........................................... $
Automobile .............................................. $
Llfe/AccldenIlHealth/..nllntaJ................ $
Other ........................................................ $
$
$
$
$
$ $
$ 80.00 STARTI.G 10/96
$ -0- AS OF 9/i6
$ $
Automobile . fuel,
repairs) ................................................. $
$
$FUEL $112.00 $
REPAIRS $50.00
$ ?o on $
$ $--
$ 10.00 $
Medical
Doctor, Dentist,
1I1................ $
$
$
$
$
$
Hospital...................................................
~... .glasses, I. , J ...............
Educallon
Private, Parochial School....................... $
$
COllege .............. .... ...................................
$
$
$ $
$ $
$ 40.00 $
$ Rn.nn $
$ 40.00 $
$ ',0 00 $
$ $
$ ~
$ $
$ $
$ $
$ $
$ (/3,'1 $
Personal
Clothing ................................................... S
Food ......................................................... S
$
$
Other (household supplies,
barber. etc.) .......................................... $
Credit payments and loans .................... $
Mlscollaneous
Household help/child care ..................... $
Entertainment (Inc. papers,
books, vacation, pay TV, etc.) ............ $
Gifts/Charitable contributions .............. $
Legal Fees ............................................... $
Other child support/alimony
payments ............................................. $
Other (specify) ............................................... $
$
$
$
$
$
$
$
$
Total Expenses ............................................. $ $
~-r- !n-~nn.,). ~ Sl V~_tPc.~~dI
OVOID
D CORRECTED
t O,on distrlbullon
S
2a'r..ftbl, amount
~@93
naml, It,.., II drill, City, Ilall, an IP code
SCHROFF INe PIS DISBURSEMENT AC~
O~O STONI TRUST COMPANY
110 SOUTH MAIN STRIIT
PROVIDENCE, RI 0210.2
OMU No 154'.0110
s
PAYER'S F.d....ld1tnllftc.llon numblf
2b T .ubl, amount r---1
nol dllll'mlned l-I
3 Capilal all" (inetudtd
In bOJl2a)
SO. 00
'~nrre::r::~=~"r"OI
S IU~,72
II ~ro;:';\~~r.rl'lIon In
AEC'PIENfSldlflbftcahon numb...
Total r~
ch'Jlbubon LJLJ
.. Fed... tocom.lAx ...ilhhtfd
01.0....,. 00.......1508
RECIPIENT'S nom., 1I"..odd"ll, Clly. 1'0" o.d ZIP cod.
MAROARIT L. ROBINSON
.J8.8 POST ROAD '1' 10.
WARWICK, AI 02'1'
9
Account numb., (opllonal)
o. 00
10 Stall incom,l.. withheld t 1 SlllwPayet'. Ilat, numb.
S
13 Locflllncom. tM wilhhtld 14 Name 0' locality
S
O. 00
'par1m.nl 0 I . r.alury. nlerna
lltJ /
,/
/\
TotJ
~I
PLAINTIFF'S
,. ........ EXHISIT
....~
............-
DI.lrlbutlallft I'ram
P.nalanaIAnnultl..,
RI lrem.nt or
Prolll.Bh,,'ng
Plana,IRAI,
Inlur.na.
Contrlctl, ':0.
Copy C
I'ar R.olplenl'a
R.oarda
%
Thll InformaUon
It being furnished
10lhelnt.rnlll
R.v.nuI Slrvlcl.
%
12 SI.t,dlltibutlon
S
15 local (h'flhub,,"
S
o. 00
IV' nUl Irvlet
C;-9
.
JOHN R. ROBINSON
: DR 25,792
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiff
vs.
MARGARET L. ROBINSON : NO, 96-331 CIVIL TERM
Defendant : CIVIL ACTION. LAW
APPEAL OF RECOMMENDED ORDEn FOR ALIMONY PENDENTE LITE
DATE OF ORDER: October 10,1996
AMOUNT OF ORDER: $855.00 for the support ofMAROARET L. ROBINSON.
DATE OF APPEAL: October 18, 1996
REASON OF APPEAL: Wife is depcndant on Husband for hcr reasonable needs. The
calculation of Alimony Pendente Lite was based upon a net income for Husband which was in
error. The actual net income of Husband is $200 greater per month due to his excess withholding
offedeml income tax. The significant disparity in income between the parties warrants Alimony
Pendente Lite and Alimony after divorce.
NAME OF DEFENDANT REQUESTING APPEAL: Margaret L. Robinson
SIGNATURE OF AITORNEY FOR DEFENDANT:
Ta 0 . Andrews, Esquire
78 est Pomfrct Street
Carlisle, PA 17013
(717) 243-0123
f '0
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....
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~
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>;}
I EXHIBIT - 6
..
,~ - $
"'-l
EXIIIDlT J
.
. I
'.
March 13, 1992
CITJCORP~
MCRTGAGE
John R. Robinson
Margaret L. Robinson
780 Gravelley Hill Road
South Kingstown, RI 02879-4739
RE: CMI Loan # 9554907
Dear Mr. and Mrs. Robinson:
This letter is to confirm that Citicorp Mortgage, Inc., has
agreed to the sale of the above referenced property for the
sum of $130,000.00. It is understood that the net proceeds
from the sale will be not less than $121,025.00.
Further conditions for approval:
1. The Robinsons are to net $0.00 (zero) from the proceeds
of the sale, which should be remitted ~
to CMI within 24 hours of closing. Ii( ~
2. Closing takes place on or before April~, 1992.
3. Realty commission is to be 6% of sales price.
4. There are no junior liens being paid from the
proceeds of the sale.
5. Any escrow balance shown as a credit will be retained
by CMI; it will not be returned to the RObinsons.
6. Mr. Robinson will sign a repayment agreement with
Citicorp Mortgage, Inc., for the sum of $25,000.00.
Upon satisfactory completion of the agreement, the
original note shall be released as satisfied to the
borrowers.
Should any variance occur in the approved
must be contacted to approve the changes.
mail the proceeds check and a copy of the
stateme~t to:
transaction, CMI
Please express
signed settlement
Citicorp Mortgage, Inc.
15851 Clayton Road
Ballwin, MO 63011
Attn: M.S.N.E. Theresa Simington
Upon receipt of the required proceeds from the sale, Citicorp
will release the Mortgage/Deed of Trust as satisfied. CMI
~ PBTrnON.....
I EXHIBIT
'-to
~U.o4l!1-::'. ',if1 ....~"i
EXIIIDlT C
~
,.
.....
RObinson, 9554907
Page 2
further reserves the right to decline participation if the
above conditions are not met.
If you have any further questions concerning this matter,
please feel free to contact me at 1(800)695-0384 XS054.
Sincerely,
~~!libc
Theresa Simington /
Asset Management Specialist
.... ...
.'
MONTHLY PAY AGREEMENT
FOR MODIFICATION/RELEASE OF NOTE
FOR VALUE RECEIVED, I acknowledge my indebtedness to
Citicorp Mortgage, Inc., in the amount of $39,115.56.
I promise to pay Citicorp Mortgage Inc., the sum of
$25,000.00 under the following terms:
I will pay $0.00 at closing. I will pay beginning June 1,
1992 $298.00 per month for the next eighty-four (84) months
until May 1, 1999, and $266.00 as the final payment due on
June 1, 1999.
Upon the completion of this agreement, Citicorp Mortgage,
Inc., will release the Note presently held by Citicorp
Mortgage, Inc., as satisfied.
I also understand that I will be in breach of this agreement
if any payment is not received within 15 days of the due date
of said payment. In the event that a breach occurs, Citicorp
Mortgage, Inc., reserves the option to call the total amount
of the acknowledged indebtedness less the amount of
previously applied payments immediately due and collectable.
I agree to mail the first month payment and all other
payments to Citicorp Mortgage, Inc., P.O. Box 790024, MS 324,
st. Louis, Missouri 63179-0024, Account #9554907 to arrive at
the place specified above not later than the date due as
indicated above.
citicorp Mortgage, Inc.
Barry Luechtefeld,
Staff Vice President
Date
~~<JL'- ..:r-
John Robinson
----
-
.3,0'/9;t
Ca~e
Present Address: 7'ilo G~ J.u.4., 4'~d
,s.,. r<:....~~~r' ~r l!)2.fI"?">
Present Home Phone: ~/~m- S'Wr Present Work Phone: ~,~ - (~ '9-.3'~o
SUbscribed and swore before me this ~ day Of~1992 by
--JJJ.tw - 3n\ (qq~
My commission expires:
1
iI, ,',
~1> 1 .. ,',' ~,
Notary Public:
. .
~7"..1.."1'/';
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MARITAl, DEPT. ASSUMED
BY JOHN R. ROBINSON A T SEPARATION
CEDrrOR'S NAME & ADDRESS DESCRIPTION AMOUNT
Account #
020-897-31-7453-945363 Purchase of bOa! $18,100
Shawut Arlington Trust Co.
PO Box 15470
Worcester, MA 01615-0470
Aa:ount #
209-32-9655
IRS- Special Procedurcs 1991 Fcdcml Income Tax $2,500
135 High SI. StotJ 155
Hartford, cr 06 10
Account #
209-32-9655
State of IU 1991 State of IU Income Tax $1000
Division ofTaxntlon & Excise Taxes $470
One Capital Hill
Providence, RI 02908-5801
Account #
4024-0046-8558-5271
Bank Alrericard Visa Chargcs $2,500
Bank Card Center
PO Box 7042
Pasadenn,CA 91109
Account #
9554907
Cillcorp Mortgage, Inc. Dcpl. nltcr sale of residence $40,000
1585 I Clayton Road at 780 GmveUy HII\ Rd.
Bnllwin, MO 63011 So. Kingstown, IU
Attn. MSNE Simington
Account #
4271-3822-1065-1119
Ford Citlbank Visa Visa Charges $3,700
Box 6062
Sioux Fnlls, SD 57117
Kenport Mwina Bont Stomge $700
650 Succotash Rd.
East Mntunuck,lU 02879
Account #
3-80320-44421-5
SeWli Roebuck & Co. Chargcs $1,700
43 Congress Street
Salem, MA 01970.5570
TOTAL $70,670
.. PLAINTIff'S
I ........ EXHISrr
![".
P\.AIN'llFPS
EXHIBIT
Jim Bach
352 South Sporting HilI Rd
Mechanicsburg, PA 17055
1
December 14, 1996
John R. Robinson
4172 Nantucket Drive
Mechanicsburg, PA 17055
Dear Jim,
As promised, I am submitting this list of tax disbersments covering the years
of 1991 through 1995:
1st & 2nd 3rd
YEAR FEDERAL STATE STATE MISC.
1991 -2288 RI -988 paid by JR
1992 -465 CT -465 RI+24 RI sent to MR
1993 +170 PA +174 RI -265 RI paid by JR
1994 +1827 PA +1693 RI -45 RI paid by JR
VA-3188
1995 +814 MD -525 RI +17 RI paid by JR
PA + 1
TOTAL +$58 ,$2,312 -$1,339
NOTE: All (-) debt was paid by John R for all years, in all columns. The
1994 federal return of $1,827 resulted from excessive witholding on John
R's federal tax by his employer. The RI tax arrangement that Margaret and I
had was, if there were any taxes due to the state of RI, I paid them. If there
were any tax refunds from the state of RI, I sent the return checks to her. In
addition, I paid the lllX preparation people every year (not shown).
As you can see, to date, Margaret has a positive benefit by our tax situation
of $ 3,593 (2312 + 1339,58).
".~ren'ncraft Corporation
205 FortlnDrlve Woonsocket ,RI 02895-6116
WtJ:<~D'
'rX-I.3-r-.
-, "-'.
,~. .: ...
(401) 769-0101
FAX (401) 766-1170
December 9. 1996
Mr.. Taylor P.. Andrews
Andrews & Johnson
78 W. Pomfret Street.
Ca~lsle, pA 17013-3216
. ;':\." .' ,.
. .
'.Re:.'Margaret Robinson :' .
".:...::j.~.;/~.\:::..::. .....;.-... ....:.....
Dear Mr. Andrews,
M~rgaret Robinson Is an employee of Glenncraft Corporation. She has asked me to c1anfy the
health care coverage available to her.
At the current time Glenncraft Corporation does not have a health care plan available for Ms.
Robinson.
I am In the process of reviewing different health care programs. However a decision has not been
mede. Ms. Robinson will qualtfy once a program Is Inillated.
Please contact me If you require any addillonal informalion.
Sincerely,
~A6Z~
Carey Arico
President
CNtaaj.doc
12/12/96 171133
1-<).926 POO2
Blue Cross
Blue Shield
+,
Adminillflbv. OffIC.1: (401) ~9-1000
C.StOll1tr R'lat,onl: (~Ol) 831-7300
Toil F,et: 1.800.627.7290
Vo,cI/l'OO Number: (401) 631.2202
"'Rhnrlttl~W:1
444 W.llmtn:i1et Sliter
I',ovldonce. III 02903.3279
Deccmber 12, 1996
Peggy Robinson
(401) 766.1170
VIA FAX
Dear Ms. Robinson:
Thank you for your intcrest in continuing your medical insurance with Blue Cross and Blue
Shield of Rhode Island.
In ordcr to mcet our eligibility requirements for our Sclcct Blue Plan, you must be a Rhode
Island resident, with a healthy lifestyle (i.c., non-smoker with no pre-existing conditions).
The rates for individual coverage arc as follows: for 11 female between the agcs of 40-49,
$207.Dl pcr month; for a female between the agcs of 50-59, $273.72 per month.
This policy docs not include dental covcrage.
If We can be of any further assistance, plcase contact our office at (401) 459-5000 or 1-800.
NEW-aCaS.
I
,
C;W~ QQ~ ~
Customcr Rclations Representative
81ue eros. & SluG Shiold 0' RI1od. Island
Ail Independenr Ucensee at the Blue ClOSS anlJ Blue snielCl Assoclirion.
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..- FOLD AND RE'MOVE
GLE~NCJlAFT CORP.
20$ FORTIN DRIVE
WOONSOCXET,RI 02895
MARGARET L ROBINSON
37 WINE STREET 12
EAST GREEHWltH,RI 02818
"/G04.48.3506 OP"OOOIOO EEI0033
rAX flLlIKI srAIU' PAY PEXIOO
FEDERAL S 01 09/22/96-09/28/96
RI S 01 CHECX DAlE
10/04/96
CHECXz1f1o
0012 3178 0007 000100
- ........n......'....'.,.....""
GLENNCRAFT CORP.
205 FORTIN DRIVE
WOONSOCXET,RI 02895
MARGARET L R081NSON
37 WJNE STREET 12
EASTGREENWltH.RI 02818
"'004-48-3506 opr/OOOIOO EEI0033
rAX flUIIG flAIUS PAY PER/DO
FEDERAL S 01 09/29/96-10/05/96
R I S 01 CHECX DAlE
10/11196
CHlCXz1f14
0012 3178 0006 000100
.. FOLD AND REMOVE
GLENNCRAFT CORP.
20$ FORTIN DRIVE
WOONSOCKET,RI 02895
MARGARET L ROBINSON
37 WINE STREET 12
EAST GREEHWICH,RI 02818
SSI 004-48-3506 opr/OOOIOO EEl 0033
F{~MN*81 SWUS 10/06d~!lffmf.fs
Rl S 01 CHEfMIN6
CHECX H,R
13461
0012 3178 0007 000100
REGULAR
OVER rrHE
REGULAR
RArI
9.2\0
!J.875
HOURS
40.00
.15
AHOIlN1
370.00
3.47
"0
1 'O'~L HAGES 'n47 ~':J.1410,29J
oc-sR---"~j.{6- 893.48
HEOICARE 5.42 209.04
FEOERAl 41.09 1564.38
RI 11./3 427.6B
OBI 4.11 1\8.53
~---'---'---'----------1
L!!'HE.Ll!At.---11l!l.46 IIl~Hi
RArE //oURS
9.250 40.00
~ HAGES
soCflc
HEDICARE
FEDERAL
RI
DBL
ANOUNT
370.00
"0
3l0~00
22.94
5.37
40.57
11.09
4.07
14m~w
214.41
1604.95
43B.77
162.60
l..!:!lYET P.H' 28\.96 11443.141
U1L HOURS AHaUNT rrD
VACATION 9.250 16.00 148.00
REGULAR 9.250 14.2\ 224.31
UalAL.1lAGI s
SOC SEe
HEDICARE
FEDERAL
RI
DBL
m.JL.-l5l5Z&oJ
23.06 939.50
\.40 119.61
40.92 1645.67
11.16 449.95
4.10 166.70
1"'!.iE!.!!1._____26T~6J__ 1l7io:77]
FOLD AND REMOVe ..
~~~~~:~ arj':f::IIP
"0
I
FOLD AND REMOVE ..
AOJUSrHENrs A~UN'
I \, nlnTrJ rift: nTU enNP
...w:
~-,-
FOlD AND REMOVE ..
~~~~~ o,~~U~JHP Y'~
..- FOlOANDREMOVe- - - -
GlEIfflCIIAFT.CORP.
20\ FORTIH DRIVE
WOOHSOCXET,RI 02S95
~BARET l ROSINSOH
37 WIHE STREET 12
EAST GREENWICN,RI 02SIS
SS/004-~S.3506 OPT/OOOIOO ((10033
IAIt fiLING STAIUS PAr PERIOD
FEDERAL S 01 11103/96.11/09/96
RI S 01 CHECK DAlE
11/15196
CHECK;ll1o
0012 3178 OOOS 000100
'. -
... FOLD AND REMOVE
GlEIfflCRAFT CORP.
20S FORTIN DRIVE
WOONSOCXET,RI 02S95
MARGARET l ROSINSON
37 WINE STREET 12
EAST GREENWICH,RI 02SIS
S$I 004-4S.3506 OPII 000100 EEl 0033
,ldMcL{N81 STATUS II/lOI{t.~ l'lflfJi
RI S 01 CHEfftftl16
CHECK N'R
un,
0012 3178 0006 000100
... FOLD AND RE~IOVE
GlENNCIIAFT CORP.
205 FORTIN DRIVE
WOONSOCXET,RI 02S95
MARGARET l ROSINSON
37 WINE STREET 12
EAST GREENWICH,RI 02S1S
S$l00~-4S-3506 OPIIOOOIOO fEI0033
fAit fILING STATUS PAr P(RIOO
FEDERAL S 01 11/17/96-11123/96
RI S 01 CHECK DAlE
11127/96
CHECK;lt!,
0012 3178 ODDS 000100
- -- -- - -~ -- -- -.~ .
"CATION
REGUUR
9.250 S.OO
9.250 32.00
.-'!.!!..L---!!9l!!!.~__~~
14.00
296.00
"0
".- -- -- -. -.- - - - -- - - --- - ----
r,a; At !-'ig"I~---110 .Q\L-1~6JI-&J
so SEe 22.94 103 .20
HEOlCARE 5.37 241.26
ffOERAL 40,57 180/.98
RI 11.09 494.26
OBL 4.07 182.97
~!NLLhr
HOLIOA'
REGUcAR
8ME !/OURS
9.250 8.00
9.250 32.25
285.9~ 12B7l.78]
AHaUNT
74.00
298.31
t'ro
FOLD AND AEMOVE ..
rID
1
AOJUS IHENrs A:fi;N'
ITlMnrr.tTH nTlI rmill
FOLD AND REMOVE ..
rf~~~~m: O,~::,gHP rT~
- .,. - -.' - -
FOLD AND AEMOI
AOJUsrNENrs ANOUNr ..r,
I \ flmTr.t T~~ nTlI111 rnllp
LlDIALliAGES
sac SEe
HEOleARE
fEDERAL
RI
OBL
1 ..NEr P....t'
REGULAR
RArE HOURS
9.250 40.00
! TOT....L H....CES
sac SEe
HfOleARE
fEOERAl
,~I
OBL
312 . 3 L....JIllQ1.1.QJ
23.0B 1054.28
5.40 246.66
40.92 1848.90
11.18 505.44
4.10 IS/.07
28/.63
13161.411
ANOUNT
370.00
r,o
llo...oo
22.94
5.3/
40.57
11.09
4.0/
IWU~
252.03
1889.47
516.53
191.14
-'-'J/(LJ'A~__.c~.5..16_j}_"4LJlJ
. '
..'
____4.~..r_ _no.
... FOlD AND REMOVE
, &lEHNCllAFTCllRP.
'21lHllRTlHllRIVE
. 1I00NSOCXET.R I 02095
HOLIDAY
REGULAR
~ArE HDURS
9.250 0.00
9.250 29.50
AHOUNT
74.00
272.BB
yro
FOLD AND REMOVE ...
r4.0:t~~~~m O,t:U;:HP
YT~
,,~
.:'->~,
~."~
,'.~~
,
. ~.
MARGARET L ROBINSON
37 WINE SllIEET 12 .
EAST GREENlIICH.RI 02010
SSI 004-40-3506 DPfI 000100 EEl 0033
LIIl1AL.NAGES
see SEC
HEOICARE
FEDERAL
RI
DEL
.146..~B
21. 51
5.03
37.10
10.14
3.02
17720'.641
109a:if
257.06
1926.\7
526.61
194.96
"j.,
,,:;~
~
. ":::<;:
.' .~.' .~
'FldMtLI'f1 SWUS 11/24/.ft~ {lfrff&.
RI S 01 . CHlfMtN6
CHECK HER
ZZffJ
',"
0012 3178 0006 000100 '
I--NEt PAY
269.28 13/16.651
.
-'.......
,
.
~~:"1l'..~".lo~,^',
INCOME AND EXPENSE STATEMENT OF
MARGARET L. ROBINSON
SSN 004 .~. 3506 DR~ 8652854 DATE Il-?O-Q6
THIS STATEMENT MUST BE FILLED OUT
(II you are sell.employed or II you are salaried by a business of which you are owner In whole or In part, you must
also fill out the Supplemental Income Statement which appoars on the last page of this Income and Expense
Slatemen!.)
INCOME
(a) Wages/Sslary
Employer & Address GLENNCRAFT CORPORATION , 205 FORTIN DR IVE. WOONSOCKET. RI
Job Tille/Description RECEPTIONIST
Pay Period (weekly, bl.weekly, monthly) WEEKI.Y
Gross.Pay per Pay Period ........................,................,..............,........".........................,.......,............... $
Payroll Deductions:
Federal Withholding ..................$
Social Security ...........................$
Local Wage Tax ..........................$
State Income Tax .......................$
Retirement ..................................$
Health Insurance ........................$
Other (speclly)..\\~!Wt!.\,I;l.!L.......$
.........................$
_.........................$
Net Pay per Pay Period .....................................................".......................................".........."............ $
02895
370.00
40.57
22.94
4.07
11.09
DBL
5.37
285,96
(b) Other Income Week Month
IntereSI/Dlvldends ......................$ -0- $ $
Pension/Annuity ....,....................$ -0- $ $
Social Security ...........................$ _0_ $--, $
Rents/Royalties ..........................$ '0- $ $
Expense Account. .....................$ -0- $ $
Glfls ..........................................,..$ -0- $ $
Unemployment Compensation .$ -0- $ $
Workmen's Compensation ........$ -0- $ $
Total, Other Income .......................$ -0- $ $
Year
INCOME ANO EXPENSE STATEMENT OF
------ - -
. "-" --_._~--_....----_.. _._---~._...-
I vOrlly lhallhe !ilalomcnls rn.lde in thiS Income and Expenso Slalo.
monl arc hUll <tnri couee!. I unlJcrstand thallalso statemenls heroin
are made 5ublf!cl 10 Ihe penalties 01 18 Pa C.5. 4904 totalino 10
unsworn falslllc;lIlon 10 DulhoflliOS.
Oalc:
. Plaintiff Or 60fcncianl
.
Household Child Household Child
Week Week Month Month
I EXPENSES
I
Home
Mortgage/Rent ......................,.......,......... $ $ $ 450.00 $
Maintenance .................,.."...........,......... $ $ $ $
Utilities (telephone, heatln(l
electric, etc.) ........................................ $ $ $ 82.00 $
Employment (transportation,
lunches) ........................,..,........,.......... $ $ $ 60.00 $
Taxes
Real Estate .............................................. $ $ $ $
Personal Property........."."..."................ $ $ $ 9.00 $
Income .............,.....................,.,............... $ $ $ $
Insurance
Homeowners .....,.................,................... $ $-- $ $
Autorpoblle ............................,................. $ $ $ 80.00 $
Life/Accident/Health .......................,...... $ $ $ 195.00 $
Other ........................................................ $ $ $ 200.001 $
Automobile (payments, luel,
repairs) .I.9.l\9...H.uIlA..~n..9.JillY~9u. $ $ $ 112.00 $
Medical 150.00
Doctor, Dentist, Orthodontist ................ $ $ $ 20.00 $
Hospital................................................... $ $ $ $
Special (glasses, braces, etc.) ............... $ $ $ 15.00 $
Education
Private, Parochial School....................... $ $ $ $
College .......................,............................. $ $ $ $
Personal 80.002
Clothing ................................................... $ $ $ $
Food ..i\O!!...~.\\P.P..\J.\'.~.."......................... $ $ $ 238.003 $
Other(R~Y8.RQkk8~~~xx 4
barber, etc.) ....h.~.i.r.lIh.~.M.~.r............... $ $ $ 45 . 00 $
---
Credit payments and loans .................... $ $ $ $
Miscellaneous
Household help/child care ..................... $ $ $ $
Entertainment (Inc. papers, 250.005
books, vacation, pay TV, etc.) ............ $ $ $ $
Glfls/Charllable contributions' .............. $ $ $ $
Legal Fees .........".................................... $ $ $ 250.00 $
Other child supporllallmony
payments ............................................. $--- $-- $ -.......-.- $
Other (specily) ............................................... $--.- $ -..---.....--- $ ------- $
Total Expenses ............................................. $ $ $ ..l219.JlJL $
I. Budgeted amount necessary to replace unreliable 1989 Mazda.
2. This represents an increase of $40.00 per month from the current level
of spending which is depressed as a maller of necessity.
3. This reflects an increase from the current level of spending of$120.00
per month which is depressed as a maller of necessity.
4. This is a desired budgeted amount. I am not currently able to afford
'1 hairdresser.
S. This is a desired budgeted amount. I currently have no TV cable, magazine
subscriptions, or any funds for vacation, recreation or entertainment.
-......,
, .
Slocks/Bonds ..............::9.-
..............::0-
Real Eslale ............"........
Value
$ $327.29
$
$
$
$
$
$--
$
$
$
$
$
$
Owne,shlp'
H GJ J
_--L
PROPERTY OWNED Descrlpllon
Checking Accounts }~~~PITAL TRUST
..00.4 856928
Savings Accounts .......::!l-
Credit Union ................nO-
Olher ............................::9.-
TOlal, Property.....................
INSURANCE Company
Hospital' ............~.9.::.........
Medical .............::9.::.........
Health/Accident .....0.........
Disability Income .....::0:::
Other (dental, etc.) ...::9.7-
('H. Husband, W . Wife, J . Joint, C . Child)
Polley No.
Coverage'
H @ C
_-L-_
SUPPLEMENTAL INCOME STATEMENT
A. This form must be filled out by a person who (check one):
_ (1) operates a business or praclices a profession; or
_ (2) Is a member of a partnership or joint venlure; or
_ (3) is a shareholder In and is salaried ~JY a closed corpora lion or similar enllly.
B. Altach 10 Ihls slatement a copy of the following documents relaling 10 the business, profession, partnership,
jolnl venlure, corpora lion or similar entily.
(1) the most recenl Federallncomu Tax Relurn, and
(2) the most recenl Profit and Loss Stalemen\.
C. Name and Address of business:
Telephone Number
D. Name and Address (If different. than C) of accountant, conlroller or olher person In charge of financial
records:
E. (1) Annual Income from business ............ . .. . .... .................... $_.. . _____."..
(2) How alien Is Income received? .......... . ..................................... $_... . ,,-,,---
(3) Gross Income per pay periOd ............... ................... ............... ............................... $_.__. .......____
(4) Nellncome per pay periOd ................. ......................... ..................................................... $__."...
(5) Speclllc deductions If any ............................................... ............................................... $