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WILLIAH $TAHC~VAa2
PlaLntHf
VB.
IN 'rUB COUR'r 01" COMMON PLEAS 01"
CUM8ERLAND COUNTY, PENNSYLVANIA
NO. 9~ . 4217 CIVIL
ALICS A. STAHCAVAOE,
Pefendant
5-f I P u,Ott~i (Jl')5
THf: I'lABTl!:RI
IN OIVORCrt
~r maS~4!. r'~ J.\t!AV:(/~.
Today i~ Tuesday, June 30, 1998.
Thil is the date set tor a Master's heorinq 1n the aboYe
oaptioned divoroe proceedinqs. Pre~ent in the hesrinq room are
the Plaintiff, William BtanOayag8, ond his counoel Mary A, Etter
DilBinger, and the Defendant, Alice A. BtonOaYage, and her
oounsel N. Christopher Me/1qes.
A divoroe complaint was filed on July 26, 1996,
raioing grounds for divorce of irretrievoble breokdown ot the
marr10qe and indignities. counsel hove provided the Master with
affidavits of consent and waivers of notice of intention to
request entry of divorce decree so that the divorce can be
oonoluded under Bection 3301(c) of the Domestic Relations Code.
The Master will fila the affidovits and waivers today with the
ProthonotarY'B Office.
The divorce complaint roi~ed the economic claims of
equitable distribution and counsel fees and expenses. On Auqust
16, 1996, wife filed a petition raising the additional economic
issues of alimony, alimony pendente lite, and restated the claim
for counsel fees and expenses.
The parties were rnarried on April 28, 1984, and
.
.~p.r.t.d Nov.mb.r 13, 1996, Th.y mr. the natural par.nts or
two ohildren.
The Maeter hag been advi.ed that arter ne90tiation.
thi. morning the pa~ti.. and oounsel have reaohed an agreement
with re.pect to the outstanding economic iseues. couns.l are
901n9 to place on the reoord the agU8Inent of the partie.. The
agre.ment IlB stated on the reco...d will be oonllidered the
subotantive agreement of the parties not subjeot to any ohanges
or modifioations except fo... co...reotion of typog...aphical errors
whioh may be made du~ing the t...anso...iption, Later this morning
the parties and oounsel are going to ...etu...n to ...eview the
agreement fo... typographical e......o...s, make any co......ection or.
typog...aphical e......o.... as ...equi...ed, and thon affix their
signatu...es by way of affi...ming the te...ms of the ag...eement as
stated on the ...eco...d at this time.
After the conclusion of the ag...eement, the Maste...
will p...epa...e an o...de... vacating his appointment. counsol, upon
receipt of the orde... signed by the Court vacating the Master's
appointment, will be able to then file the praecipe to tra~smit
the record to the court ...equesting the final decree in divo...ce.
Mr. Menges.
MR, MENGESI I will stllte the stipulation and
agreement he...e among the pa...ties and their counsel. That
agreement is as followsl
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1, Th.u 'h pro..ntly bein\l held in ..orow the II~," ot
'6U,70B.11 trom the very reoent lIale of the marital home.
, Tho.. prooeed. will be distributed at the time ot the
divorce deoree boinq obtained as followsl
$1~,026.00 to hUsb~nd and tho romainder of the esorow to
w1f..
a, In addition, hUBband will retain the motorcycle of
whioh he has POBsession of currently as well as the
Chevstte automobile he currently has possossion of.
~, Wire will retain ownership of the furnitul"I! she has
possession of as well as the aeo automobile she has
pOSlless ion of.
4. Titles to those two vehicles or how many vehioles need to
be exchanged, will be signed by each party as necessary
by the time of the divorce decree.
The Geo loan will also be the sole responsibility at wife
to pay and she will pay that in a timely fashion. If
because of that 000 loan, the Oeo automobile cannot havo
the titlo transferred by the time of the divorce decroe,
huaband ogrees he will sign that title over to wife
whenever that title becomes available for that Bignature.
5, In addition, tho parties huve already reached an
agreement before today relative to a chipper and a
shredder which they are going to be uBing jointly.
15. Wife will rClltain ownership of her life J\lSUrance which
the value is $997.51.
7. HUBband will retain hia retirement with Walmart/Sam's
Club which value is $1,022.38.
8, Husband will retain his Karn's profit sharing plan and
that is valued at $10,448.23.
9, Husband will retain his Walmart/Sam's Club stock that is
in a Walmart/sam's club program. That is valued at
$498,69.
10. All claims of alimony by wife are hereby waived.
11. All claims of oounsel fees, costs, and expenses
maintained by either party are hereby waived.
il
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VS,
IN 'rill> coUH'r or.' COMMON PLEAS
OF' CUMBEHIJANIJ CoUN'I"\' PF.NNSYLVANIA
CIVIL ACTION - LAW
NO, '11, 0 'I ;I /l (l I'" \
IN DIVOHCP.
WIl<l<IAM B'rANCAVAGE,
Plaintiff
Al<ICE A. BTANCAVAGE,
Defendant
PRABOIPE TO TRANSMIT REOORD
To the prothonotary I
Transmit the record, together with the following informRtion,
to the Court for entry of ft divorce decreel
1, Ground for divorce I
3301(d) of the Divorce Code,
Irretrievaple breaKdown under ~
2. Date and manner of
1996, by Unitod stntes mnil,
reoeipt requested.
3. Dnte of exocution of the Affidavit of consent required
by S 3301(0) of the Divorce Codel By Plaintiff June 30, 19981 by
Defendant June 30, 1998.
aervice of the Complaintl July 27,
certified, restricted mail, return
4 . Helated claims pendingl None.
a, Dnte Plaintiff's Waiver of Notice in S 3301(c)
Divoroe filed with the Prothonotary I June JO, 1998
Date Defendant's Waiver of Notice in S 3301 (c)
Divorce filed with the Prothonotary I June 30, 1998
Hespectfully submitted,
Datel July R, 1998
--o7'} "'-. C t ~A
Mary A. Eftter ~ss~
Dissinger & Dissinger
Attorney for Plaintiff
28 1'1, Thirty-Second Street
Camp Hill, PA 17011
(717)975-2840
001 N. Christopher Menges, Esquire
William Btancavage
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WILLIAM BTANCAVAGE,
pla1nt:1tt
IN 'l'Hl> COUWI' 01' COMMON PI,l>M.l
01" CUMI.lERLI\NIJ COUN'I'Y
PENNf.lYINAN IA
VI.
ALICE A. STANCAVAGE,
Defendant
CIVIL AC'I'ION
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NO. 'II.,. l',} /') I I..'
IN DIVORCE
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II 1. plaintiff is Willlam I'ltl\nonvllqo, a cithon of Penne-yivllnill,
,I l:'eliding at 8 Richlnnd Lane, Apt no I, ClItnp 11111, Cumbednnd
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I! county, pennsy 1 van ia.
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CONBOLID~TeD COMPL~IM~ IN DIVORce
,,2. Defendant is Alice A. stancflvage, a citi~en of Pennsylvania,
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Ii residing at 2295 Lambs Gap Road, Enola, Cumberland county,
I Pennsylvania.
3. plaintiff and Detendant are W jurili\ and have been bonBtide
i: residltnts of the commonwealth of Pennsylvania for lit least six
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, months immediately preceding the filing of this Complaint.
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4. The parties are husband and wife and Wel'e lawfu lly marr ied on
" April 28, 1984, in cumberland county, Pennsylvania.
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:1 5. The marriage is irretril!vably broken.
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I 6. Neither Plaintiff nor Defendant is in the military or naval
servioe of the United States or its allios within the provisions
of the Soldiers' & Sailors' civil Relief Act of the congress of
1940 and its amendments.
7. There has
instituted by
jurisdiction.
been no prior
either of the
action for divorce or annulment
parties in this or any other
VI.
, IN THE COURT 0' COMMoN PLEAS
I 0' cUMBERLAND COUNTY
I PENNSYLVANIA
I
I CIVIL ACTION
I No. 96-4217
I IN DIVoRCE
WILLIAM STANCAVAOE,
pla1nt:1ff
ALICE A. STANCAVAGE,
Detendant
WAIVI. or NO~Ial or INTINTION TO RRQUIST
INTRY or ~ DIVOROI DIORII UNDIR
53301 (a) or Till DIVORCI 0001
1. I oonsent to the entry of a final Deoree in Divoroe
without notioe.
2. I understand that I may lose rights concorning alimony,
alimony pendente lite, marital proporty or oo~nsel fees if I do
not olaim them before a divoroe is granted.
3. I understand that I will not be divoroed until a divorce
deoree is entered by the Court and that a ~opy of the deoree will
be ment to me immediately after it is filed with the prothonotary.
I verify that the statements made in this affidavit are true
and oorrect. I understand that false statements herein ara made
subjeot to the penalties of 18 Pa, C.S. 54904 relatJ.ng to unsworn
falsifioation to authorities.
Dated I ~. 30 flY(
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IN TIIB COURT 0' COMMON PLIAS or C')HBBRLAND COUN'l'Y, PBNNSYXNANIA
WILLIAM S~ANCAVAGB, ,NO. 9&~4217
,
. Plaintiff ,
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V. I CIVIL ACTION - LAW
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ALICB A. STANCAVAGB, I
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Defend~nt I DT.VORCE
PETITION FOR ALIMONY. ALIMONY PBNDIU1I
LITB. COUNSBL FBBS AND COSTS AND BXPBN3~
COUNT I
1. The Plaintiff is employed at Sam's Club, Harrilburg, PA
and hOB lub.tantial earnings.
2. The Defendant has insuffioient means of support for lelf
and the children of thiB marriage and is without suffioient fund.
to meet the coste and expenses of this litigation.
3. The Defendant requests alimony pendin9 the divoroe,
alimony after the divoroe, oounsel fees, oosts and expenses
inourred by the Defelldant in oonneotion with these prooeedings.
WHBRI!J1'ORB, the Defendant pT.ay" your HonorahV. rnlJrl; for the
relief requested.
Dated, ,gl,s/~~
,
enges, Esquire
o. 23166
street
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Varioul I:'etirement Itatements,
01:' former employorl.
and/or
letters
troll
4. Value of ~eneio~ and Retirement Benefitsl
Plaintift has a profit Iharinq (retil:'ement) program through
hiD employeI:'. The value on the date of separatiun wal $1,022.38.
He hu profit Iharinq with a former employer, Knnl, whioh is
unvalued at this date.
6. Claim for Counsel Feesr
Plaintiff filed this aotion. Plaintiff has made proposals to
the Defendant to settle thie matter. Plaintitt has reoeived no
responle from the Defendant whatsoever in an attempt to negotiate
any pro',isions of the equitable distribution. Plaintiff'. oounsel
went to Carlisle on June 17, 1997 to file a Motion to Appoint the
Master and was advised that ~ Motion had been filed on June 6,
1997. Neither Plaintiff's oounsel nor Plaintiff ever reoeived a
oopy of the Motion. Plaintiff has incurred unneoessory expense
beoause of thQ Defendant's unwillingness to negotiate. Plaintiff
has no idea what the Defendant's position is. If Plaintiff knew
Defendant's position, this mattor miqht be resolved short of a
Master's Hearinq and Plaintiff and Defendant oould avoid the
expense of oounsel fees.
I
16. Eauitable Distribution f
The items to be equit~bly distributed are the marital
residenoe, Plaintiff's retirement, Plaintiff's J(arne retirement,
Plaintiff's stook, the tax esorow, a motoroyole, Geo Metro
automobile, Chevette automobile, plaintiff's tools,
ohipper/shredder, and the household qoods.
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Hou..hold Child lIou..hold Child
Week W.ek Month Month
.x.......
HOllie
Mort~aq'\R.nt..... $ : :3:10.00 . :
Main .nano........ $
. uti1iU.. are inolud.d ill r.nl:
Utilitie. (telephone,
heatlnq, eleotrio,
atc.),.."....... , $ $ $ $
Employment
(trlSnsportation,
lunohes) 1""',... $ $ $ $
Taxes
Real Estate.. ..... $ i i !
Personal Property. : :10.00
Income. . . . . . . . . . . .
Insurance
Homeowners... I.." $ : $ ~
Automobile... ..... $ . 80.00
-includes motoroyole
Life/Accident/
Health....,....". . $ : : 20.00 ~
other. . . . . . , . . . . , . $
Automobile (payments,
fuel, repairs) . . . . $ $ $ $
Medical
Dootor, Dentist,
Orthodontist....... $ $ l :
Hospital.. .. . . . . . . $ $
Special (glasses and
medicino) . . . . . . . . . I $ $ $ $
Education
Private, Parochial
school. . . . . . . . , . . . $ : : . ~
Colleqe........... $
Personal
Clothing. . . . . . . . . . $ l : $
Food. I.... II...... $ $
Other (household
supplies, barber,
etc.)..... II...... $ $ $ $
Credit payments &
Loans. . . . . . . . . . . . . $ $ $130.00 $
MisceUaneous
Hou..hold help/
Child oar......... $
Entertainment Cino.
pepere, books, vaoation,
pay TV, .to.)..... $
aife./Charitable
oontribution... ... $
Legal toe...,..... $
Qth.r ohild support/
Al imony payments.. $
oth.~............ f" $
.... tbil aieaellen.oue
autoaobile, lunchel, and any
$ $ 150.00 $
$ $ $
~ ~300.00 ~
$ $ $
$ $ 90.00 $
a.penea aaver. tbe cOlt of fuel for
e.erqanaiu wbicb .ay el:'iee.
Total Expenses...... $ $ $1,010.00 $
PROPERT\1 OWNED DESCRIPTION VALUE OWNERSHIP
H W J
Ch.oking Aooounts Commerce $ 1,184.82 )(
National Bank
Bavinqs Aooounts Commeroe IS 301.68 )(
National Bank
credit Union $
stcoks/Ronds WalMart stocks $ 874.41
Real Estate Marital $65,870.00
Residence
Other $
Total, Property $68,230.91
INSURANCE COMPANY POLICY NO.
- - -
)(
-
x
Medioal
Health/
Aooident
Disability
Inoome
Health Amerioa
2091521852
COVERAGE
H W C
X X X
-
Other
(H - husband, W - wife, C - children)
......1.1 .~ .17.....L__~ ~- - . .-- ..1 .~. ._~~ _I '.J_~....~. . _I: ./.._:'_.":'.. ...l.. I.' .._.._._-..1. ..l...._~_.._... _~:.-:. ..'_lo~'''_''h' .1.._1'~,
INVENTORY AND APPRAISEMENT UNDER RULE 1920.33
I'l'EM I A. D. C. D.
MARITAL IS PROPER'l'Y BASIS paR NAME AND
PROPERTY IN CLAIMEO '1'0 I.lE CLAIMED ADDRESS Of'
WHICH EI'rIlER f;XCLUDEP FROM EXCLUSION PERSON OR
SPOUSE HAS MARI'l'AL ENTI'l'Y WI'l'H
L~:GAL OR PROPER'l'Y WHOM IN'l'EREST
EQUI'l'AIlLE IS HELD
IN'l'ERES'l' ON
PA'l'E m' SEl'.
1. Marital Joint
Res idllnce
:l . Tax Escrow Joint
3. Husband/s Husband
Retit'llmllnt
4. Husband's Husband
stock
5. Household Joint
Goods
6. Husband's Joint
tools
7. Chipper Joint
Shredder
8 . Husband's Joint
Motorcycle
9. chevette HUllband
10. Geo Metro HUllband
11. Husband's Husband
l(nrns'
Retirement
.
12.
13.
14.
INVENTORY AND APPRAISEMENT UNDER RUl,E 19:20.33
I'I'EM I. r. o. H. I. J. It,
I DATE COST OR VALUE ON AMOUN'I' NA'l'URE EFF. NAME &
ACQUIRED ACQ. VAl,UE DATE OF OF ANY OF [,IEN DA'!'E OF ADDRESS
SEPARA'I'ION OU'l'S'l'ANIJ LIl>N OF LIl';N
ING LIl';N HOLDER
ON DAT~~
-- 01' SEP.
1. $65,870.00 $10,796. Mort- 1./87 Harris
07 gage Savings
Bank,
PO Box
1711,
HarrIs-
burg,
PA
17105
2. $ 416.43
3. $ 1,0:22.38
4. $ 490.69
-
5. $2,000 to
$3,000
est.
6. $100.00
est.
7. $200.00
lilst.
-
8. unvalulild
9. unvalued
10. unvalued
11. amount not
ava Hable
at prep.
of I&A
12.
13.
14.
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WILLIAM BTANCAVAGR
Plaintitf
VI,
I IN THE COURT 0' cOMMON PLE^S 01"
I CUMBERLAND COUN'l'Y, PENNSYLVANIA
I I
f NO. 96 - 4~17 CIVIL
I
I
I IN DIVORCE
ALICB A. STAHCAVAGE,
Detendant
THE MASTER I Today is Tuesday, June 30, 1998.
This is the date set for a Mastor's hearing in the above
oaptioned divorc~ proceedings, Present in the hearing room are
the Plaintiff, William stancavage, and his counael Mary A. Etter
Dissinger, and the Dofondant, Alice A. stancavago, and her
oounsel N. Christopher Menges,
A divorce complaint wan filed on July 25, 1996,
I:'aising grounds for divorce of irretrievable breakdown of the
marriage and indignities, Counsel have provided the Master with
affidavits of consent and waivers of noticQ of intention to
request entry of divorce decree so that the divorce can be
oonoluded under Section 3J01(c) of the Domestic Rolations Code.
The Master will file the affidavits and waivers today with the
Prothonotary's Office.
The divorce complaint raised the economic claims of
equitabl~ distribution and counsel fees and expenses. On August
16, 1996, wife filed a petition raising the additional economic
issues of alimony, alimony pendente lite, and restated the claim
tor counsel fees and expenses,
The parties were married on April 28, 1984, and
..parated November 13, 199&. 'rhey ml:'e the natul:'al parent. ot
two childl:'en.
The Master has been advised that aftel:' negotiations
this morning the partie. and oounsel have reaohed an Rgreement
with respeot to the outstanding economio issues. co~nsel are
going to plaoe on the record the agreement ot th~ parties. The
agreement as stated on the record will be considered the
substantive agreement of the parties not subject to any ohanges
01:' modifications oxcept tor oorrection of typographioal errors
which may be made during the transcription. Later this morning
the parties and counsel are going to return to review the
agreement tor typographical errors, make any correction of
typographical errors as required, and then affix their
signatures by way of affirming the terms of the agreement as
stated on the record at this time.
After the oonclusion of the agreement, the Master
will prepare an order vacating his appointment. counsel, upon
reoeipt of the order signed by the Court vacating the Master's
appointment, will be able to then file the praecipe to transmit
the record to the Court requesting the final decree in divoroe.
Mr. Menges.
MR. MENGES: I will state the stipulation and
agreement here among the parties and their counsel. That
agreement is as follows:
1. There &s presently being held In esorow the Bum or
$60,708.71 from the very recent sale of the marital home.
Tho.e prooeeds will be distributed at the time of the
divoroe deoree being obtained as followSl
$15,026.00 to husband and the remainder of the osorow to
wir..
2. In addition, husband will ret.oin tho IlIotorcyole of
whioh he has possossion of currently as well as the
Chevetto automobile ho cur~ently has possession of.
3. Wife will retain ownership of the furniture she has
possession of au wJll as tho Geo automobile she has
possession of,
4. Titles to thoBe two vehicles or hoW many vehicles need to
be exchanged, will be signed by each party us necessary
by the time of tho divorce decree,
The Geo loan will also be tho sole responsibility of wife
to pay and she will pay that in a timely fashion. If
because of that Geo loan, the Geo automobile cannot have
the title transferred by the time of the divorce decree,
husband agrees lie will sign that title over to wife
whenever that title becomes available for that signature.
5. In addition, the parties have already reached an
agreement before today relativl to a chipper and a
shredder which they fire going to be using jointly.
6. Wife will retain ownership of her life insurance whioh
the value is $997,51.
7. Husband will retain his retirement with Walmart/sam/s
club which value is $1,022.38.
8. Husband will retain his Karn's profit sharing plan and
that is valued at $10,448.23.
9. Husband will retain his Walmart/Sam's Club stock that is
in a Walmart/Sam's Club program. That is valued at
$498.69.
10. All claims of alimony by wife are hereby waived.
11. All claims of counsel fees, costs, and expenses
maintained by either party are hereby waived.
U. 'rhflre I1l:'e no othe~' dolJtfl or Hnbilitlol!l or thfl partiu
8waept for n pOflai~lo uapitol galna linlJility from tho
sale of tho marital homo earlier thla month. The parties
agree th~t thoy will take responsibility for that oapital
gains liBbil1t\', 11:' any, !iH to wHo and J7\ by husband.
1:). 'rhere are no othor l\Sllota, onch !1l1rty n 1 ~'olldy pOtlaessing
certain itoms of household goous and so torth and each
will maintain oWI1Qrshlp of ouch of thoso ntl current.ly
owist,
14. The pnrtlos acknowledgo thnt the vnlue otated on tho
reoord aro unto of soparlltion vllluQO or valueD used by
their counsol for purpoooo of arriving ut this agreement.
The partieo a loa ncl~lIowlodge that 1101110 of those assets
that have beon onumerntod on tho racord mDY hove
appreciatod in value or dQprociDtQd oince the dllte of
separation, but none tho lOlls, they lire willing to aocopt
those valueu au blllnLJ tho fni~- IIli1rltDl value ot this time
and each party wi 11 oither reali?ll the inCrQllSO or
docroase of tho 'HHlot asuigned to tho porty in this
distribution.
15. Ewcept as hendn Qth..!l'wisu providod, each porty may
dispose of hill or her propuf-ty in any woy ond ll'ICh party
hereby waives and relinquishes any and illl dqhts he or
she may now hilV(! Of' horuafter acquire ullder the presont
or futurQ lawu 01 ilny jUrludiction to ul)'lro in tho
property or the l!Lltil t'/ at tho other '"J 0 rOtlU 1 t of the
marital rQlatiot1l3hip induding without limitation,
statutory allowaneo, widow's allowance, right of
intestacy, right to tako agninst tho will of tho other,
and right to act aLl administrator or executor in the
other's estate, Each will at the roquest of the other
execute, acknowledge, and delivor any nnd all instruments
which may be noeeLlsnry or advisable to carry into effect
this mutual waiVQr and rQlinquishmont of all SUch
intorests, rights, and claims.
MS. DISSINGER: Mr. Stnncnvago, have you heard the
a9reement as dictated by Mr, Mengos and as supplomQntod by
myself and the Maater?
MR. STANCAVAGE: Yes.
MS. DIHRINGHRt Po you undoratnnd the ogreemont as
r.ad into the I:'eaord?
MR. STANCAVAOEI Vel.
HS. DISSINOERI Are you satisfied to abide by and
adopt this agreement as your own?
HR. BTANCAVAGEl Yes.
MS. DISSINOERl Are you aatisfied that this is a
fail:' and equitable resolution of all of tho issues pending
before the Court today?
MR. S'rANCAVAGEl Yos.
MR. MENGES~ Ms. stnncavage, have you hoard the
agl:'eement and stipulation road into the record by oounsel?
MS. STANCAVAGE~ Yes.
MR. MENGES~ Do you beliove that to be a fair and
equitable distribution and agreoment?
MS. STANCAVAGE~ Yes.
MR. MENGES: And are you agreeing to this agreement
and understand it to be a final and total settlement of all of
these marital issues?
MS. STANCAVAGE: Yes.
I acknowledge that I have read the above
Itipulation and agreement, that I undurstand the terms of
settlement as set forth herein, and that by signing below I
ratl,fy and affirm the agreement previously made and intend to
bind myself to the settlement a9 a oontract obligating myself to
the terms of settlement and subjecting myself to the methods and
"
I
OFFICI OF DIVORCI MAITlR
CUMBERLAND COUNTY
COURT OF COMMON PLEAS
9 North Hanovor SIreol
Call1sle, PA 17013
(717) 240,6536
I. ....bert IlIak." II
Dlvorc. MII,.t
',aal .10 Col,.,
Offlc. MlII1llglrlRlpol1lr
w... IIIDI'lI
897.0CI71 e.t, 8531S
Mary A. Etter Dissinger
Attorney at Law
DISSINGER & DISSINGF.R
28 North 32nd street
Camp Hill, PA 17011
REI William stanoavage vs. Alioe A. Stanoavage
No. 96 ~ 4217 civil
In Divorce
Juna 16, 1997
N. Chriltopher Mengel, Elquire
MENGES , S~YDER
145 East Market Street
York, PA 17401
De~r Ma. Dissinger and Mr. Mengest
By order of Court of Preaident Judge Harold E. Sheely
dated June 11, 1997, the fUll-time Master has been appointed in
the above referenced divorce proceedings.
A divorce complaint was filed on July 25, 1996, raisi"9
grounds for divorce of irretrievable breakdown of the marriage
and indignities. I am going to proceed on the basis that
grounds for divorce are not an iseu~. If I am incorrect, please
advise and we will immediately schedule a hearing on
indignities.
The divorce complaint also raised the economic claims of.
equitable distribution and counsel fep.s and costa. On August
16, 1996, the Defendant filed a petition for alimony, alimony
pendente lite, and counsel fees and expenses.
I am going to proceed on the basis that grounds for
divorce are not an iSBue. I direct each counsel in accordanoe
with p.R.e.p. 1920.33(b) to file a pre-trial statement on or
before Friday, July 11, 1997. Upon receipt of the pre-trial
statements I will immediately schedule a pre-hearing conference
WILLIf\M S'l'f\NCAVf\Ol",
Plaintiff
I IN THI" COURT OF COMMON PLEAS OF
I CUMaE~LAND COUNTY, PENNSYLVf\NIA
I
I NO. 96 - 4217 CIVIL
I
I CIVIL ACTION - LAW
I
I IN DIVOIICE
VII.
I\LICE A. STANC~VAOE,
Defendant
ORDER AND NOTICE SETTING ItBI\RING
TOt William Stancavaga , Plaintiff
Mary 1\. I"t tar DiBs ingcr , Counsel for Plaintiff
Alioe A. Btancavage , Defandan t
N. Christopher Menges , Counael for Defendant
You are directed to appear for a hearing to take
*
telltimony on tho outstanding issues in the above oaptioned
divorce proceedings at the Office of the Divor.ce Master, 9 North
Hanover street, Carlisle, Pennsylvania on the ~4th day
of _ February , 199B, at 10~JO a.m., at which
place and time you will be given the opportunity to present
witnesses and exhibits in support of your case.
lly the Court,
u~ ~== .
~Old E. Sheely, presi n Judge
Date of Order and
Notioel 10/27/97
BYI
Divorce Master
IF YOU 00 NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR
TELEPHONE THE OFFICE SPoT FORTH BELOW TO FIND OUT WHERE YOU CAN
GE~ LEGAL HELP.
COURT ADMINISTRATOR
FOURTH FLOOR, EAST WING
CUMBERLAND COUNTY COURTHOUSE
CARLISLE, PA 17013
TELEPHONE (717) 240-6200
* Testimony will be limited to marital misconduct as that factor
affects wife's alimony claim.
WIl,L [AM B'l'ANCAVAO~~,
Plaintiff
va.
[N 'l'HIi: COUR'f OF COMMON PLEAS Of'
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 96 - 4217 C [V I I..
CIVIL ACTION - LAW
ALICA A. BTANCAVAOE,
Defendllnt '
IN DIVORCE
ORDRR ~ND NOTICB SB~TING HBARING
TOI Willillm Btllnoavage , Plllintiff
Mllry A. Et ter DiBs inlier , Counsel for PllIintiff
Alice A. Btancavago , Defendllnt
N. Christopher Menges , Counsel for Defendllnt
You lire directed to appear for a hearing to take
testimony on the outstanding issues in the above captioned
divorce proceedings at the Office of the Divoroe Master, 9 North
Hanover street, Carlisle, Pennsylvania on the, 17th day
of March , 1996, lit 9 tOO ~ a.m., at which
place and time you will be given the opportunity to present
witnesses and exhibits in Bupport of your cllse.
By the Court.
U~....n== .
k~rold E. Sheely,
.Judge
Dllte of Order end
Notloel I0I771Q7_
Bye
Divorce Malller
IF YOU DO NOT HAVE A 1,AWYSR OR CANNOT AFFOIID ONE, GO TO OR
TELSPHONS THE OFFICE SST FORTH BELOW TO FIND OUT WHERE YOU CAN
GET LIi:GAL HELP.
COURT ADMINISTRATOR
FOURTH FLOOR, EAST WING
CUMBERLAND COUNTY COURTHOUSE
CARLISLE, PA 17013
TELEPHONE (717) 240-6200
,
WILLIAM ST~NCAVAGE,
Plaintiff
va.
IN 'I'HE COUR'I' Of' COMMON PLEAS OF
CUMBERLAND COUN'I'Y, PENNSYtNANIA
NO. 96 - 4217 CIVIL
ALICE A. STANCAVAGE,
Defendant
IN IHVORCE
REI Pre-Honring Conforonce Momorandum
OA'I'EI Monday, Octobor. 27, 1997
Pr~sent for the Plaintiff, William stanoBvage, is
attorney Mary A. Ettor Dissinger, and presont for tho Defendant,
Alioe A. stancavnge, is attorney N, christopher Mengos.
A divorce complaint was tiled on July 25, 1996,
raising grounds for divorcl! of irretr.ievable breakdown of the
marriage and indignities. Counsel have advised that the par.ties
will sign and file affidavits of consent prior. to the hearing in
these proceedings so that we can conclude the divorce under
Section 330i(c) of the Domestic Relations Code, The complaint
also raised the economic issues of equitable distribution and
counsel feee and expenses, On August 16, 1996, wife filed a
petition raising the economic issues of alimony, ali~ony
pendente lite, and counsel fees and expenses, Counsel have
advised that there will be an issue with respect to the factor
ot marital misconduct as that factor affects wife'S 1I1imony
claim and we will schedule fI separate hearing on that issue.
The issue involves the f111egation that husband had an ongoing
relationship with fI temale friend prior to the separation ot the
parties.
The parties wer.e married on Apr il 28, 1984, and
separated on November 13, 1995, They are the natural parents of
two children, ages four find six.
Husband is 36 years of age and resides at 8
Richland Lane, Apartment 201, camp Hill, Pennsylvania, where he
lives with fI temale triend, Husband is a high school graduate
and is a warehouseman with Sam's club. His biweekly gross
income has been reported fit $936.78 and his net income, adding
back in the child and spousal suppor~, is $651,07 biweekly. Mr.
Menges has requested thot he be provided current pay stubs for
husband as he believes that Mr. stancavflge has had at least one
pay increase since the income information was provided. HUsband
is currently paying child support in the amount of $94.00 per
week and spousal support in the f1mount of $11,50 per week.
Husband has not raised any health issues.
Wif. i. 38 years of age and I:'esides at 229& Lambl
Gap Road, Enola, Pennsylvania, whore she lives with the two
childl:'en. She is a high sohool graduate and ourrently i.
Melr~employed cleaning houses. She has reported her gross
monthly inoome at $748.00 and her net monthly income at $414.39.
Husband oontends that wire has a greater earning potential And
that previously she had employmont making in oxoess of
$20,000.00 per year. Mr. Mongos, on the othor hand, pointed out
that sinoe the birth of the first child, wlfe has only worked
part-time. Wife has not raised any health issues. Counsel are
going to provide tho oost to wife to obtain COBRA benefits for
her oontinuation of medical insuranoe ooverage through husband's
employment.
The parties own real estate at 2295 Lambs Gap Road,
Enola, Ponnsylvania. The roal estate has been appraised at
$65,870.00 with a mortgage in favor of Harris Savings
Assooiation. The balance to payoff the mortgage is around
$10,800.00. Counsel will provide a current mortgage payoff
statement as of the date of the hearing. The mortgage payment
is $374.00 per month which includes taxes and insuranoe. After
discussion today counsel have indicated that both parties would
like to sell the house, so they are going to immediately arrange
for the house to be listod. Perhaps the house will be sold by
the time we have the hearing on the equitable dlstr,ibution issue
and we can use the Bale price as the current reflection of
market value. If the house is not sold before the hearing and
is aWarded to one of the parties, then we need to resolve the
issue as to the cost of sale and whether or not the cost of sale
should be considered in arriving at a net value for the house.
Attorney Dissinger indicated that at the time of separation
there was $416.43 in the tax escrow which should be considered a
marital asset.
Husband has a retirement with his curr~nt
employment and stock through that employment. According to
attorney Dissinger, based on statements which she has provided,
the date of separation value of the retirement was $1,022.38 and
the stock was valued at $498.69. Husband also had a profit
sharing plan at Karn's where he previously was employed and the
value of that plan is $10,448.23 as of December 31, 1995. That
plan is still being held with the Karn's Company although they
have indicated that they would like to turn over the plan to the
owner.
Wife claims that at the time of the purchase of the
parties' house, she contributed $15,000.00 from a settlement
that she had obtained as a result of an automobile acoident.
She believes that consideration should be given for her
f' I I
"I !, _,Iii
,\~
r' -'.
"-
p~.mal:'it.l aSDet oontribution for the puroha.. ot the marital
hom..
Wifo has a life insuranoe polioy with Allstate and
the oafth value as of date of separation was $997.51.
There are three vehioles noted on the pre-trial
statemonts, a motoroyole, a Chevette, and a l~94 Oeo Metro.
Aooording to wife the motorcyole, whioh is in husband's
possession, is worth $1,800.00. Husband is going to have the
motoroyole appraised. The Chevette was purohased for $300.00
and traded in and counsel are going to attompt to arrive at a
value to place on that vehiclo. 'l'he 1994 Geo Metro has been
valued by wife at $3,000.00 bnd she claims that the loan on that
vehicle ia around $3,700.00, giving us a negative valuo for that
vehicle. Husband, on tho other hand, wants to inquire further
into the value of the 1994 Geo Metro, thinking that it should
have a value in excess of the loan value.
The parties apparently have made a distribution of
the household tangible personal property and husband's tools,
and at present thore is no issue with any distribution of those
assets. However, counsel need to consider whether we should
have those assets valued if we do an equitable distribution
computation and make distribution according to a stated
percentage. ObviOUSly, however, the parties can agree to eaoh
keeping what he or she has in his or her possession and not
include a value in the equitable distribution computation.
Apparently the parties have agreed to commonly use a
chipper/shredder and a bench grinder.
^ hearing is scheduled for Tuesday, February 24,
1998, at 10130 a.m. to take testimony on the factor of marital
misconduct as that factor affecta wife'S alimony olaim.
A hearing is Bchedulod for Tuesday, March 17, 1998,
at 9100 a.m. to take testimony on the remaining faotors,
identifioation of assets, and valuation of assets. Notices will
be sent to counsel and the parties.
E. Robert Elioker, II
Divoroe Master
OCt Mary A. Etter Dissinger, Attorney for Plaintiff
N. Christopher Menges, Attorney for Defendant
WILLIAM S'rflNCAVAGE,
Plaintiff
VB.
t IN THE COURT OF COMMON PLEAS O~
t CUMBERLAND COUNTY, PENNSYLVANIA
I
I NO. 96 - 4217 CIVU,
t
I CIVIL ACTION - LAW
I
t IN DIVORCE
ALIClE A. S'l'flNCAVI\QJi:,
DefendAnt
~EOULF.o IlEA lUNG
OlU)lBR AN TICI! SliTTING HEARING
TOI Willian StllnclIvago , Plllintiff
Mary A. Etter Dissinger , Counslill fox: Plaintiff
Alice A. StanclIvago , Defendant
N. Christopher Menges , Counsel for Defendan t
You are directed to appear for a heax:ing to take
testimony on the outstanding issues in the above captioned
divorce proceedings at the Office of the Pivox:ce Mastex:, 9 Nox:th
Hanover street, CaX:lisle, Pennl!lylvania on the 1st day
of -2!:!.ly ,1996, at 9~OO _ a.m., at which
place and time you will be given the opportunity to px:esent
witnesses and exhibits in support of your case.
E. Hoff r, Px:esident Judge
Date of Order and
Notice I 2124/'lR
By ~
Divorce Master
IF YOU DO NOT HAVE A
TELEPHONE THE OFFICE
GET LEGAL HELP.
LAWYER OR CANNO'f AFFORD ONE, GO TO OR
SET FORTH BELOW TO FIND OUT WHERE YOU CAN
CUMBERLAND COUNTY BAR ASSOCIATION
2 LIBERTY AVENUE
CARLISLE, PA 17013
TELEPHONE (717) 249-3166
In th, Court or Common PI.lII or CUMlIl!RLANlJ County, P.nnsylnnlll
DOMESTIC IlI!LATlONS SECTION
IU.ICI A, STAlfCAVAOI ) OI'IJ,r Numher leu S n
Plllhlllff )
YH, ) PACSIlS CllIie Numhn 4 ~80000U
WI~LIAM STANCAVAGB )
Oerenl/IIIII ) Olher SIAle 10 Numher 09'1 ~V;l-
,
ORDER OF COURT
o Flnlll 0 Interim ~ Modlned
AND NOW, mm DAY QP APRIL, 1998 ,bailed upolltlle Court's
determination that the Payee's monthly net Income 15 $ e90. 9~ and Ihe Payor's
monlhly net income Is $ 1,4 U . n , Ills hereby ordered Ihlltlhe Payor pay to the
Domestic Rellltlons Section. Court of Common PlellS,
"
"
,
SIX HUNDRlD POUR DOLLARS ANP HIHBTY.BIOHT CENTS
Dollars ($ 604 .98
on arrears) payable
) a momh ($ 5&1.53 for current suppon and $ u ,U
BI-IfJIEK1..Y asrollows: 04J6,~9//II CSA' l$12e,~./M lilA,
The effective date of the order 15 01/22/98 ,
Arrears set at $ 698.27 as of APRIL 2~, 1898 are due In full
IMMEDIATELY. COnlempt proceedings, credit bureau reporting and lllX refund offset
certification will not be Initiated IInd Judgement will not be entered. lIS long as payor pays on
arrears on each payment date as specified above. Failure 10 make each paymem on time and
In full will cause all arrears to become SUbJect to Immediate collection by ail of the means
listed above.
For the Support of:
ALICE A, STANCAVAnE (/IIONTHLY/SPOUSIU.)
AMANDA STAHCAVAGB (DOB, ~/3/91)
APRIL STAHCAVAOB (oOB, e/11/93)
WILLIAM STAlfCAVJ\GB (SERVICll PllBS/IfJIIlKLYI
$
$
$
$
$
1$
1215.24
~18,15
218,14
o.eo
0,00
0,00
Fllm.OE.518
Wllrker 10 21105
Servke Type: /II
RECEIVEO AI~1\
, I
~ .
!~3'j
STAHCAVAOII
v. STAHCAVAOI
PACSES CalW NUIlII1cm ueoooon
Said money to be lurn~d over by the Domestic Relations Section to:
ALICS A, s'rANCJWAQS . PaymCnls must be made by
CHICK, MO~BY ORDIIR, WMII A'M'AClfl>lIlNT . All chccks and money (lrders must be
made payable Ill; DOMJISTIC RBLATIONS SlcnOH and mailed 10:
DOlllSTIC RlLATIOHS SICTIOH ut:
P.O. BOX 320. CARLISL~, PA, 1701J
\
Each payment must bear your PACSES Member Number In order to be processed, Do nOI
send cash by mall,
Unrelmbursed medical expenses are to be paid 70 % by defendant and 30 %
by plaintiff, <Xl Defendant 0 Plaintiff ONcllher pliny 10 provide mr:dlcallnsurance
coverage. Within thirty (30) days after Ihe el1try of this order, the 0 Plalnllff
<Xl Detc:ndant shall submit to the person having custody of the chlld(ren) written proof thaI
medlcallnsarance coverage has been obtolned or Ihatappllcatlol1 for coverage has been made,
Proof of coverage shall consist, at a minimum, of: I) the name of the health care coverage
provlder(s); 2) any a(lpllcable Idcntlt1catlonl1ufllbers; 3) uny curds evidencing coverulle;
4) the address to which claims should be mad~; 5) u description of any restrictions on usage.
such as prior approval for hospital admlsshlns, and the mUl1l1cr of obtaining upprovnl;
6) a copy of the benet1t booklet or coverage contract; 7) a description of all deductibles and
co-payments; and 8) t1ve copies of any claim forms.
\'
,
IMPORTANT LEGAL NOTICE
PARTIES MUST WITHIN SEV~N DAYS INFORM THE DOMESTIC RELATIONS SECTION AND
THE OTHER PARTIES, IN WRITING. OF ANY MATERIAL CHANGE IN CIRCUMSTANCES RELEVANT
TO THE LEVEL OF SUPPORT OR THE ADMINISTRATION OF THE SUPPORT OROER. INCLUDING,
BUT NOT LIMITED TO, LOSS OR CHANGE OF INCOME OR EMPLOYMENT AND l';HANOE OF
PERSONAL ADDRESS OR CHANGE OF ADDRESS OF ANY CHILD RECEIVING SUPPORT. A PARTY
WHO WIUFUUY FAILS TO REPORT A MATERIAL CHANGE IN CIRCUMSTANCES MAY BE ADJUDGED IN
COfffEMPT OF COURT, AND MA Y BE FINED O/lIMPRISONED.
S~rvlc~ TYI'~ M
RECEIVED APR ? 8 199a
Pa8~ 2 lit 3
FlIrm OE-~ 18
WlIrk~r ID 2110!5
'"
MARITAL PROPERTY
: (Plaintiff) (Oefendant) lists III marftal property fn whfch either or
, both SPOUSIS have a legal ontqultabl. Interest fndlvldually or wfth IllY
other person IS of the date this action wu COIIYnlnClldt
tem numbe r \
r tem number
Oeserl ptlon of
Property
HorM.. - ~dqS Ll1mb'S ~'t- ~W mdr~o
,,~o.f Aoad. flf!if
tNOLA PA
,
IqO~c,
Names of all
Own e rs
william St~nQ&.vo.Q 1'\'11' CJ--
J WI ,arn ,->"JUJ1CCIIJ
A Ijc~ 5+MCo.va9 C~\s C,()t.A. ~ If!
" IOI\\'~ f1M"~
B1.I.1?na Libf
Oa te 0 f
Acoul s I tlon
Cost cr Value as
of Oate of
Aco' f s I U on
11M -
Value as of
Oate Action
COlTTT'leneed
t3oIJO
Am:lun t of
Anv Li en
$
tem numb. r
rncJtJrc~~ -
1100 ~.
~o-h;......
~a(1. /)nkn~wJ
-
W;/ljorY\
Sto.n('~\I(19 t.
A litl.
~tMCI.\ vaqL.
oj O()O
f -
Nature of ,." 6Ylt
An Lien
Effer.ti ve Da te .. ../ ,CJ~I 17 6M.
of Lf en
\
trt,tp- 6
Holder of C
I n
, '
,
I, I
" .,...
I'
, ,(,
,
IN THE COURT OF COMMON I'LEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
WILLIAM STANCAVAGE,
l'lnlnllff
NO, ~6..4217
v,
ALICE A. STANCA V AGE,
Defendnnt
rltE.TRIAL STATF.!MI~NT QF AUCE A. STAISCAVAOe UN~
I. BACKOROUNI):
A, Dnte of Mnrrlnge: April 28, 1984
D, Dille of Sepnrntion: Approxhnnlely Novembel' 1995
C, Children: 2 Children nges 4 nnd 6 . Custody wllb Motber
II. MARITAL ASSETS: V ALUei
A. Marltal Residence: 2295 Lambs Gap Rand $72,500.00
Enolll, PA 17025
D, Vehicles: 1994 Geo Metro 3,000,00 (minus
the lien of
$3,684,26)
Motorcycle . 1100 Honda Sabre 1,800.00
(No Lien)
Unknown Model Car of Husband Unknown
Sold by Husband
C, Pensions, Savings &
Investment Plans: Husband's Wahnart Stock Ownership
Plan. Acet. No, 18051.69664 All of 12129/95
$524,32
Husband's WalMnrt Profit Sharing All of 1131/96
$2,555.95
Wife's Ufe Insurance Policy .
Allstate
Value Unknown
WAL-MAR~~ ~lr9t Chicago Trult
lVaJ:MlIl'I ,'b,I'IiL'illfl! SIock OIl"/l'rIilip P"III
ACCOUNT NUMbER 1273 IS061-69664
t"llh....lJlllti:lq"'lIlld..111
(oneilI'll"" 'leur .cc(unIIQ
r It I ...., '1~"IJl.J 'I"~I
erl' "'111' N,IJ!;II'1 PI,,.
tll~'1 1",1' Ol2J
C~"'~. II. 00070.0123
TollphOn. 1'000.030,0170
0012-S175
WI~LIAM 5TANCAVAGE
2295 LAMbS GAP ROAD
eHOLA PA 17025
1l~IlIlNIJ DATIE
12/29195
TOT^~ IHAIIU
U,S65
YA~UAT111N PIIXIlI
22,250
YA~UI II' IHAIIII
524,52
~OAH 1l0~~ATlI\A~
0,000
Importantl Retain This Statement For Tax Purposes
ACTXYXT'l FROI'I 01/03/95 '1'0 12/29196
Tranlllctlon Pnclt pit Ih.,. 8111n" hOld by
O.le T,anll(lIon dllc/lptlon omour1t O.dUCllcn. Nil amounl Shl'" 11,"1I1;1.1t
(In U.S. dollllrsl (In UB dellllll u. In YClJf accounl
1l/03l95 ~ALANCE FORWARD V'f5
11/05/95 IVIDEND PURCHASE ,70 ,70 21,947 ,032 7, 07
11/11/95 ~AYROLL DEDUCTION 5,00 6,00 2 ,804 ,2~9 7,636
11/11/95 COMP CONTRIbUTION ,75 ,75 2l'80~ ,0 4 F ,570
Jl/25/95 PAYROLL D~DUCTION 5,00 5,00 2 ,90~ ,228 7.790
H/25/95 COMP CONTRIBUTION .75 ,75 2 ,904 ,034 17,832
J2I08/95 ~AYROLL DEDUCTION 5,00 5.00 2~,000 ,20S l8'0~0
32108/95 COMP CONTRIBUTION ,75 ,75 2~,000 ,051 8,071
02122195 PAYROLL DEDUCTION 5,00 6,00 23,897 ,20r 8,2S0
02122195 COMP CONTRIBUTION ,75 ,76 25,897 ,03 18,311
03/00195 PAYROLL DEDUCTION 5,00 6,00 24,589 ,205 8,51~
03/08/95 COMP CONTRIBUTION ,75 .76 2~,5B9 ,031 lB,645
03122195 PAYROLL DEDUCTION 6,00 5,00 24,40B ,205 lB,780
03/22195 COMP CONTRIBUTION ,75 ,76 2~,408 ,031 IS,781
O~/05/95 PAYROLL DEDUCTION 5,00 5,00 26,9~7 ,193 18.914
O'd05/95 COMP CONTRIBUTION ,75 ,75 25,947 ,029 9,003
04/17/95 DIVIDEND PURCHASE ,93 ,93 26,564 ,056 19,039
NOTEI STATEMENT CONTINUED ON NEXT PAGE
_Q.'!JI"L~'!'_ _ _ _ _ _ _ _ _ _ _ ,- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - '
WAI;MART' & Flrel Chlelgo ',u.1 Transaction Form. use Ihlo on Iv when vou hove oddlllonBI buolnes,
\\.../.\I,I'I.\lJ<I(III/t S'iUJ.- Onllrnfllp Pllm
MOil thll 'orm 10: Flral Chicago Trust
P ,0, Boo 2~97
J....y City, NJ 07303'2~97
r".phone: 1,000,038,8278
0.t1"10I" Wllhdrlwnl
Vohm'."Y allh Contrlbullon
Mill' dllCll ':1)'11:1, 10: '-Iral Ch~';O TN" Ccm~.r
(Mu.lmutn U6.000 pI' YII'I.I"c'Io'~" Plyn:1I
$ ,'0'<1""'" VOl""", ,,,,'M'" I
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II )'ou "CliVI mOIl Ih,n on, 11I1.m.nl, or I' yOu
waulU Ilk"O d'l1lI\G' the "am'lIl (If I(Mlllnl1'l on
your account pl.... .:.11 FI"I ChlGlgo Tn,"I,1:
1.100-4=18"271
G.nUIIUI" Depotlt
I
C.!:OliItI'Il.numtlfc'lt'laru
(C'ttJ'IUIII.,.ne1cII"'1
IlIu' . ",tIIIul, ...,
forU'II,num/)1t ,....
el'''at'.
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I,.cUen"I"""
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5Igrl,luf. ll'jolnl.ccounll
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e'ltltll,number
ol,h,'1I
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I
My TII,phon. Number (
5.11,11'''''..
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Pl.... m.rll co. A/'Id compl.t, oth,r ..... 0
lid' ollorm ",
WAL-MART: !-Irst ChIcago Trust
II/til.Marl A.\'.\'ot'iar~ Srod; Oll'l/ashifl Plttl/
ACCOU~T NUM8ER 1273 18051-69664
,..llIltU iJ,I'~llJl.U"I,I"I"
corCl''''~'' ycut IICfoOIJI111Q
r'llI .....,......,v ""'"
Of" P"I N.tlon.1 PII,.
Mill fSull. 0'23
Chlr.lgo, I~ 10e70'012~
hllphon' . l'100"38,OR71
0012-U75
WILLIAM STANCAVAOE
2295 LAMIS OAP ROAD
E~OLA PA 17028
Gl.OIl/lO DATI
1212~/95
TOTAl. BHAIII/l
23,165
VAl.I/AnO/l PIIIOIE
22.250
VAl.1/1E 0' BHAIII/l
824.32
l.OA/I OOI.I.A'l'ItllAl.
0,000
Importantl Retain This Statement For Tax Purposes
AonVny ,I\OM 01/03/98 '1'0 lZ/29/95
r'."lIcllon I P'lell pat 1110.1. Bal,"(, hUhJ by
O.le rranllellon ducnpllcn amount O'CUCllen. "".1 amount 511.,.. "lr'lcl.d
(In U 5 delll") IIn US. dell"" uti" your .ccount
BALANCE fORWARD 5, 00 I 19.039
04/19/95 PAVROLL DEDUCTION 5,00 25,155 .199 19.230
04/19/95 COMP CONTRIBUTION ,75 ,75 25,185 .030 19.26B
05/03/95 PAVROLL DEDUCTION 0.00 5.00 23,692 .2p
05/03/95 COMP CONTRIBUTION .75 ,75 23,692 .0 2 ~un
05/17/95 PAVROLL DEDUCTION 5,00 5,00 24,B20 .201 9.712
05/17/95 COMP COIHRIBUTlO~ ,75 .75 24, G20 .030 9.742
05131/95 PAVROLL DEDUCTION 5,00 5.00 24,607 ,203 19.945
05/31/95 COMP CONTRIBUTION ,75 .75 24.607 .030 19.975
06/14/95 PAVROLL DEDUCTION 5,00 5.00 26 ,422 .189 20.16'.
06/14/95 COMP CONTRlaUrION ,75 .75 26,422 ,028 20.192
06/28/95 PAYROLL DEDUCTION 5,00 5.00 26,634 ,188 20.380
06/20/95 COMP CONTRIBUTION ,75 ,75 ~6.634 ,028 20,408
07/10/95 DIVIDEND PURCHASE 1. 00 j. 00 6,393 .038 20.446
07/12195 PAYROLL DEDUCTION 5.00 5.00 26.250 .190 20.636
07/12195 COMP CONTRIBurION ,75 ,75 26.250 .029 20.665
07/26/95 PAYROLL DEDUCTION 5,00 5.00 27,022 .LB5 20,850
_.~--
tlOrE, STATEMENT CONTINUED ON NEXT PAOE
_Q.It[ll!i.I,-h.!l~~_...... _ _ _ _ _ _.. _ .... _...... '..... _ _.................. _................ _.... .......... - _...........~.... ..... - _...~............. -......... .
WAI;MART' & Flr.1 ehleDgo TrUll Transaction Form. u~e Ihll only 'liMen YOU Mave Dddltlonal busln.ss
\\ ,1/. \"1" ,\, 1,'(lrJ/f fIL'r.l. O~~'lI fillip PI,tll
Mall U'IIS 101m 10: Flr't Chicago Tru&l
P,O, BOk 2697
J.,..y CIIy. NJ 07303-2697
hl.phon" '.BCO,431.127B
C.rtUlut, Wlthd'lw.1
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tMu.tmum 120,000 J:" Y"" . 1"(11,:1211 Pay,,:n
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OLOIXNIJ DATI
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TOTAl. lIHAlI1S
U.565
VALl/AnoN 'IIXCIE
U,250
VALl/IE 0' lIHAlllElI
524,32
1.0AtI COI.I.ATlIIAI.
0,000
Importantl Retain This Statement For Tax Purposes
Aonvnv '110/1 Ol/O~/n TO 12129195
.- ---- ... .-..---~.~~-.
n."III;III)/l Pne. pit ,haft elllnel hlld by
n.llt ',n"U,;Illllt 1111I1:1111111111 n,"lllinl C'IJIJt;IlC'" N.I .mount Shlfflltana,cl.d
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m~m ~llHWa~n 20,650
112./U 1:1I~' I:IIH NUl ION ,75 .75 27,022 .026 20,878
8/09/YK PA NlIll UfUIICTION 5,00 5,00 25,296 ,190 21,076
8/09/'18 CO~~ CONTRIIUTION ,75 .75 25.296 .030 21,106
0/23198 PA HlIll O~IIUCTION 5.00 5,00 25 , t 79 ,199 21. 305
8123/98 CO~P CONTHIIIITIO/ ,75 ,75 25, 79 ,030 21.3~5
9/114/95 PA ROLL U~nIlCTIOH 5.00 '.00 24.998 .200 21.535
'1/1I'/Y8 CU~~ CONTRIIUTIUN .75 .75 24 .998 ,030 21.565
91211/91) PA RULL U~nIlCTIUN 5,00 5.00 25.005 .200 21.765
9120/98 CaMP CIIN1NIBIITION .75 ,75 25 . 005 ,030 21.795
11/83/95 nIVIU~Nn PIIBC"A5~ ~.07 ~.07 2'. .646 .043 21.83e
1I/0~/'15 PAYNULL OeD CTIOtl ,00 ,DO 2~.940 ,209 22,O~7
1I/0G/98 COM~ CUNTNIIIITION .75 .75 2~.940 ,031 22,076
11/16/95 ~AYROLL nEUUCTIO 5,00 5.00 22.~81 ,219 22,297
11116/95 CUMP CII"INI8I1TION ,75 .75 22. 81 ,033 22,330
1/0 II" 5 PAYROLL DeUIICTIUN 5,00 5.00 22.075 ,227 22,557
1/01/98 CUMP CUNTRIBUTIUN ,75 .75 22,075 .034 22 591
ou..".. ___._
1/01E, STATEMENT CONTINIIED ON NEXT PAOE
Q,I'lh I'","
'_'_4WW_~_~__~_~_______________________________________"___________
NA~ MART' & .Irll Chlclgo TrUlt
Transaotlon Form. ule Ihl. on Iv when VOU heve eddlllonal bu.lne.1
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WAL-MART&' Flnst Chloago Trullt
IVal.,\1(//'I ..\J,Wd<l11! S,oL'i, UHlla,\'liip PIli II
ACCOUNT NUMBEH 1213 IB051-69664
Phil.. <JII,,.I 'Jl.lltlIIC'"
cr,r.c:,,,w . 'cut B((C!JIIl hI"
FilII I.:'\ICIOO Ttu41
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Chlc,go.IL 60670'0123
'"I"p"on.: ',600,.38,6271
0012-8175
WILLIAM 5TANCAVAOE
2295 LAMBS OAP ROAD
ENOL A PA 17025
OLonNlI DATIl
12129/95
'faTAL ISHAREa
2SOS65
VALI/ATlolI .RIOE
22.250
VALI/E OF ISHAREa
524,32
LOAII OOLLATlI\I\L
0,000
Importantl Retain This Statement For Tax Purposes
ACTIVITY FROM 01/03/95 TO 12129195
r,anuellcn O'OUCIIC"' I c"" ~tt ,h." I aallnCe h,ld t))'
Do" r'8"154(ll0n dlUCI1j::11cn IImcurl Nlfl,,"cl,Inl
Iln U.5 della'51 (In U.S, deUa,S) 5h.tlllranlllctlO Ulln yovr account
BALANCE FORWARD 22,591
11/15/95 PAVROLL DEDUCTION 5.00 5.00 23.725 .211 22.002
11/15/95 COMP CONTRIBUTION ,75 .75 23.728 .032 22.834
11/29/95 PAVROLL OED CTION 8,00 B.OO 24.384 .20B 23. 039
11/29/95 COMP CONTRIBUTION ,75 ,75 24.354 ,031 23.010
12113/95 PAVROLL DEDUCTION 8.00 5,00 23.S8 t ,2!2 23.202
12113/95 COMP CONTRIBUTION ,75 .75 23,85 ,0 2 23,314
12121195 PAVROLL DEDUCTION 8,00 8,00 22,919 ,21B 23,832
12127/95 COMP CONTRI8UTION ,75 .78 22,919 ,033 23,565
ANVONE NO LONGER EMPLOVED BV WAL-MART WHO CHOOSES TD STAY IN THE 1996 STOCK
PLAN WILL HAVE AN ANNUAL 825 FEE DEDUCTED FRDM THEIR ACCOUNT AFTER 2/16/96,
-~~~~~~-_..._--_.__.._._----------------_.--_.----._----------------.--------------
WAl;-MART' & FI.., Chlc.go nu.l Transaollon Form. use Ihll onlv when vou hev" eddlllonal bUllnOSE
,\'"/.1'",, ,\JJ.I(III/r Sl'~l J.: dlllrl.rl/llp fi,m
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PO, Bo, 2197
J....y C'Iy, NJ 07303,2197
'.'.~ho".: 1,800,'38,8278
ACCOUNT NUMBER 1273 IB051-69664
WILLIAM STANCAVAGE
2295 LAMBS GAP ROAD
ENOLA PA 17025
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GUIDELINES :=OR TR.~rI6ACTION FOR,'.I
C~RTlFIC.I TII IBSUAtlCr; C.rtlllcOloa WIll ~. r41'11.1I~ ," u,.
/1illrtU) :n ','/1'1':1' lhl dCCOur,' lIS mOlntalned ~" Firat CI~I":C'\ii?' t1tCQtiJIS.
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1"'I'!lIQ', ",.. TransBctlon FOlm 4nO make v~ur check pnYBt:llJ 10 F!rat
CI1Ic010 TI1I.1 Company, 801,,"10 IncluOe vour Scclol $,,:ul1'y
Nu".,t:~, qn ,cur ~her.k,
CEFlTIPICATe DEPOSIT '110 IU10051 you uSO "'jlll.red ."0 inou,od
fl':311 'NtHJn UndlnlJ ~tJrtll(r:.1I.ij /,:r tlllPOlSlllI'lo your Plan 11CCCUr.t.
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21
E1.el your Mod. 01 P.ym.nrln 5.ClloII. III .nd IV. II you are m.rrl.d, b. lur. Ihlll yeUl .pOUIO .Ign. the
lerm .nd hlv. II wlln....d by . NOlary {'ubllc In 5acllon V, You hlv" .11.111 30 d.y. .llar you r.e.lve
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31
C~mpl'"1he Foder.llncome Tu withholding 50cllon only If Ihe dlllribullon I. 1101 IlIglbl. lor rellov.r or
If \,ou w.nl mora Ihln 20% withheld Irom your dlllrlbullon,
\
Pu'AlII'U'MIT niE cOMruno fOAMS ~NO ~NV OUElI1ONe YOU H~VI TO nlf. ~T1INT1ON Ill' JIAHI B,1l1llA\'In,
kJrn, Prime .nd Fency Food, Ltd" 676 5l1v.r 5prlng. Ro.d, MechlnlcabUlll, PA 1701111
1~'/!C'hd'Nj.QENERAL INFORMATION . . ,;':;",,,~ .
PAllnc:"~NTN~MI William Stal1cnvag" O~noFBu'"lt
05/06/61
TmlollH~ T10H OA TI
07/06/90
SOCl~L SlwAllY
209-52 -la'l2
O~ II OF HIRE:
09/17179
P~nTlCll'~T1OH OATI
01/01/62
M~llJjoAoool!ls ,2295 Lamb'. Goo [hI.. Enolo. PA 17025
SPOUSE" NAMlI
5POUSE'. D~II OF BlAnil
50ClAL 51:WAllY
M~AIT~L 51~llJs:
511/016 0 M~M'D 0
SEbTlONllt~BI:NEFIT AMOUNTSI
$lO.448.n
The normel form of paymenl sholl be 0 lump sum. A partlclpanl who lermlnlle. Irom II/Vlc. Ind hi. I 'v. lIed 'Bcounl b.lanc.
gr.aler Ihll1 t3,500.00 Ihall havo Ihe rlghl to recolv. hi, er h.r benefllln Ih. lorm 01 . lump sum, or In In.I.llm.nl peym.nl'
ovor any perled mlexlendlng beyond or oxceadlng Iho Ilfeexpeclancy ollhe p.rtlclpanl Ind hi. Dr her beneficiary,
TOTAL DISTRIBUTION.
I SECTION III . MODE OF PAYMENT ELECTION
I heve read Secllon II describing my options for payment and underltand Ihel, II I am m.rrled, th. lump .um I. paYlble 10 ma
unless w. elecl .ome Ulhur opllon. If we elacleny olhor option, we ere r.'.ellng the lump lum .Iaollon,
o Lump lum dl'lrlbutlon, I hereby reqUUI paymenl 01 my .ccountln I lingle sum,
o Inslallmonl Option, I heruby mquesl paymonl ef my accounl Bccordlng to Ihe following opllon,
o Monlhly Payments (suggested minimum '501
o Annual Paymenl5 IIRC 457(dl minimum dlllflbutlonsl
I hereby requesllh311ha above leleclod Inslullmenl opllon ba paid over. periOd 01;
o
year~ (enler numberl 0 ___ lite expeclBncy of mYIBII and my bennflclery,
Karnl PrIme Inu Flncy Food, Ltd., Profit Shoring I-lln
Dletrlbutlon Requ..t
The .ltlched lorm. .r. Inl.nd.d 10 prevld. you wllh Imporllnl Inlorm.llon reg.rdlng lha benelll. due you Irom your reUllm.nl
pl.n. The .n.wall you provide on lhe.. form. will 'llIble lhe pl.n .dmlnl.Ir.lOr III pro",rly proc... YOUl benelll rique III
Ih4Irelor., pi.... re.d Ihelnmucllon. cer.lully und lupply cOl11pllle .nd eccuralllnfcrll1allol1,
11 Fill In .IIY unen.wer.d qlJutlonlln 6ecllun I, review 5ecIW,II call1ully,
21 E1acl your Mod. 0' P.ymenlln 5ecllen. III .nd IV, If you Ire mftflled, b. .Ulethll your .pou.. .Ign. tha
lonn .nd ""v. II wltne..ed by I NOllry {'ubllo In 5.ClloII V, You hav. 1111111 30 d.y. .,tar you rac.lvl
\hi. notlc. to decide whalhar you WIn! 10 dlrlOUy roll ov.r your p.ymlnl 0( have II plld to you, HoweYl/,
II you m.kI . ded.lon Iii I... lhen 30 dlY' .nd leI UI know In wrlung to whom you w.nl \he plyrnent
mid., w. will eon.ld.r thaI you hive wllv.d 11111 30-d.y Wilting ",,'cd,
31 Ccrnplat. tha fed.r.llncom. TIM wllllholdlng 5ectlon only If lhe dlllrlbl,rlJon I. nol .llQlbl. lor rollovar or
II ~ou w.nl more Ihln 20% wllhheld Irom your dl.lrllxJtlon.
\
l'UIIlIIIII\MIT 11. co""t.um 'Ojl"'l ~NO ~NY QUUllONe vou II~\I( TO lIlt! ~mNl1ON Of JuH<< B, tllllA\'lJl.
lClfllI PIIml .nd F.ncy food, lid" II 76 511Vef Spring. Ro.d, MechlnloabUto. PI. t 7066
~, '~,' ',,:Ill',Q, 'LNtl.-ll'N'F"O'\~M"A''r' "I-a' 'N' ',' ,'0;
~~I:RA r, . ,,' "'~~~"f;'t~:~'4",~"i~d
PMIICll'ANTNA.... Willi,um S tnncnvlIge 0~1I 01' BUlllll
Tl/IMIN~TlON O~11
07/0h/90
05/06/61
600AL 6lCUfIITY
O~ll Of' HIllE:
09/17179_ PA/lnaI'''TlON 0"11
01/01/62
209-52,.lJll2
M~IUNOADooiIl ,2295 Lumb'e Gup lId.. Enolu. Ph 17025
51'0\111" N~M11
51'0\1'"". O~ll Of BlAnH
6eOAL 6lCUNTY
M~"fT~L 5T~llJl:
GlNaLE 0 M~NlIfD 0
!.I:'!!\Ml)~i>t,.!"!l' ,,'fl', "i, .:", k" :,~~""
5tfl ",J~t"." 'I,....~D.4~1"f'ff,:,
The normlllorm of peymenl .hall be e lump .um, A panlclplnl who termlnltel Irom .eIVlce .nd hll . 'v.ll.d .ccoUrtt b,'enc.
greller Ihln t3.IiOQ,OQ lhall have Ihe rjghl 10 r.celv. hi. or her b.nelllln Iha lorm 01 . lump .urn, or In Inlllllm.nl p.ym.nle
ovcr Iny period not olendlng beyond or c.cccdlng Iha Ilfc opeclancy of Ih. punlclpanl .nd hi. or her beneficiary,
TOTAL DISTRIBUTION.
I SECTION III. MODE OF PAYMENT ELECTION
I have raad 5ecllon II delcrlblng my opllonl lor peym.nl and under. land Ihll, Ifl em married, th. lump .um I. p.yebl. 10 me
unleu w. elecl lome Olher opllon. If we elecl .ny olher opllen, w. Ir. rajeellng Ihe lump lum II.ellen,
o Lump .um dlatrlbullon, I hereby requell peymcnl of my ICCOUnt In I .Ingle .um.
o Inatallmenl Option. I hercby requcsl paymcnl of my account according 10 Iha following opllon,
()O" 'Monthly payrl1011IIs' IsuggeSted mln1mum $1i01'
1-' '.'.' ,,',
"
-, .. .. '. ~
o Annuol Paymellll IIRC 457(dl minimum dlllrlbuliollsl
I hereby rcquelt Ihallhc abovc IcleClod Inllolhncnt option ba paid over. perled of:
0___ d_'_.__ ycars lcnlcr numbcrl 0 ___ life c,poclallcy 01 myself and my bcn.lIclary,
l
Karn. Prima anu Fenov Food, Ltd., Profit Sharing t-..n
DI.trlbutlon Raquut
The lIt10hed lerm. .rl Intended 10 provide you wllh Irnpon.nllnlollnallon reglldlllQ Ih. b.nallll due you Irom yeur re\Jrem.nl
pl.n, The .n.wer. you provide on IMII lOll"' will en.ble lhe pl.n .drnlnl.lrller 10 propa~y pfee... YOUl b_1I1 ",que'lI
there lore, pl.... read Iheln'lrucllon. cerefully IIItl 'Ullllly COllllllolO .lId .ccurllelnlcrrn.lIoll,
II 1'11I111 .ny un.nlwered queallollllll 5eclloII I, flvlew 5ecllonll carefully,
21 E1eel your Mode 01 Plymelllln &eellon. "' I,MJ IV, If you lie m.rrl.d, be .ure \Jill your .pou.. .Ign. the
IOfm .nd hlvl II wltna.lld by . NOllry t'ubllo III HacUen V, You hive II lelll 30 d.y. liter you r.e.lvl
thI. nolJce 10 deold. whether you w.n110 dlrecuy roU OVIIf your plymenl 0' hlv.lt pald 10 you, HowlY.',
II you m.ke I d.el.lon III lell 111111 30 dlY' Ind leI u. know In w~lIng 10 whom you Wlnl tho p.yment
midi, we will cen.lder thll you hlvl w.lved Ihe 30-<l.y w.lllng p.~ed,
31 ~plele \he Feder.' Income T'N wllhholdlng 5~etJon only II lhe dlll~bu\Jo" I. nol IlIglble lor rOIlOVlf or
If ~ou w.nl mOfe thin 20'" whhheld Irom your dl.lrlbuIJon,
,
PLIlIlllUeMlT nil! COM"-ETllO fOflMS ~NO ~NY OUU11ON. YOU U~V1 TO lltl ~nlH11Ofj Of' JIANI II. SIMVIJI,
KI/l1I Prlml.nd F.ncy Food, Ltd., 676 511ver Sp~ng. Ro.d, Mechenle.butg, PA 1701111
l.J~.iti~I:'INFO)t~A~I~N.. ,:<.. ... , .~:;;:~,:~~;;!".;.;~~:\,;>,:';;;'~J/
PAA'I1Cll'~TN~MI Williom StOl1covogu D~lI <ll' DlflTItI
05/06/61
TfJ\MlN~ T10H DATI
07/06/90
SOCIAL 5I0JfIITV
209-52-1652
D~II<ll'HII1I!I
09/t7179
PAAnar~TlON O~1'I
01/01/62
M~llJjoAooM.. ......ll25 Lamb'. Gop Rd.. I!nalo. fA 17025
51'OUH" N~MI
5rousl" OAl1 Of' BlRntl
SOCIAL 5IcuRITV
M~AIT~L ST~11J'1
SINOL.l 0 M~NlIID 0
~... '~"'~i~i!If(!ir.._
. '. ' ,. T ' ,irym~..,.,.."~..._. '.'.'..".',.1",.>, ;,_ ;",_. ..'....,. ::"...,.. .,",_, n, n.',. . ...
The norm.llorm 01 peymenllhell be . lump .um. A participant who lermlnel81 Irom ,o""ce Ind hll . 've'led .ccounl bel.noo
greller Ihln t3,600,00 lhall have Ihe ~ghllo rccolve hi. er her bellelllln lhe lorm 01 I lump .urn, or In InalJllmenl plymsnll
over .ny perled nOle.lIndlng beyend or e.r.eedlno the 1110 ekpeclancy of Ihe pertlclponl end hI. or her benellcl.ry,
TOTAL DISTRIBUTION.
~ECTIONIII . MODE OF PAYMENT ELECTION
l
I hove read 5ecllonll describing my oplloll. lor peymenl end under'lend lhel, II , Sill mer~ed, lhe lump lum I. plYlble 10 me
unlell we el~cl .ome olher opllon. II we elecl "ny olher opllon, we .rl re/eeung Ihelump .um ellollon,
o Lump .um dlslrlbullon, I hereby requoll psymenl of my .ccounlln e .Ingle .um.
o Insrallmp,nt Opllon, I hercby requosI paymcnl 01 my ec.:ounl acoerdlng 10 tho loll owing opllon,
.,
0' 'MonllllyPsymenls' IlNgualled minimum f601
,
, .
,.. .' ',''', '; ., '., ,
o Annuol Paymel1ll liRe 4671dl minimum dlslrlbulionsl
I hereby requesllhallha abovo slIlocled Inslalhnenl opllen be paid ovor e period 011
o __ Lifo o.peclancy 01 mysoll ond my boneflclary,
SpecIal To Rule.
Notice
Special Tex Rules on Distribution
The Intarn.' Rllvenue Code provide. aovoral
complell rulu rel.tlng to Ih. 10llallon 01 the
Imounu you recelv.d In Ihle dletrlbullon, Thl.
nOllce meraly eumm.rlzu Iheee rulu, You
.hould promplly consull e Ilk _dvleor In deciding
Whll cour.. 10 lollow Wllh r..peOI to Ihl.
dlllrlbullon,
You oen roll over the plyment by peylng
II 10 your IRA or 10 anolher amployer plen Ihel
ecceple your rollover wllhln 60 doy. 01 receiving
Ihe payment, The amount rolled over will not be
IDlCed unlll you lok. II OUI 01 Ihe IRA or
omploYllr plen,
SUMMARY
" you wall I fO roll over 100% 01 Iho
payment 10 111 IRA or an employor plal1, ~
muet IInd olher money to reolace Ibe 20% Ihet
.wu....wJ1hbtJQ, "you roll over only the 80 %
Ihal you racelved, you will bo loed on Ihe 20%
Ihat wae wllhheld and Ihol Ie nOI rolled over,
A peymllnt Irom the Plan Ihat la eligible lor
"rollovIlr" can be laken In two woye, You can
hava all or any ponlon 01 your poymenl either
l' PAID IN A "DIRECT ROllOVER" or :II PAID
TO YOU. A rollover 10 e peymenl 01 your Pion
benellls 10 your Individual mllremont
err.ngemenl (IRA) or 10 Iln0lher employor pion,
Thl. choice will n"ecllhe tax you owo,
MORE INFORMATION
I, PAYMENTS THAT CAN AND CANNOT BE ROLL
If you choose a DIRECT ROLLOV.f.B
II, DIRECT ROLLOVER
III. PAYMENT PAID TO YOU
IV, SURVIVING SPOUSES,
ALTERNATIVE PAYEES
AND OTHER BENEFICIARIES
PAGE 5
PAGE 5
. Your poymenl will nOI be taxed In the
curronl yeer and no Incomo tox will be wllhheld,
Your paymenl will be made dlreclly 10
your IRA or, " you choose, 10 anolher employor
plan Ihat occepls your rollover,
PAGE 7
" Your payment will be taxed laler when
you lake II OUI of Ihe IRA or Iha employer plan,
I. PAYMENTS THAT CAN AND CANNOT
BE ROLLED OVER
If you choose to havo your Plan benefits
l!ALO.. TO YOU
Peyments from Ihe Plan may be 'ollglble rollover
dlslrlbullons. " This means Ihol Ihey con be
rolled ovor 10 an IRA or 10 onolher employer plan
Ihal accepls rollovers, Your Plan admlnlslrolor
should be oblo 10 tell you whal ponlon of your
poymant Is on eligible rollover dlslrlbullon. The
lollowlng Iypes of paymonls cannot be rolled
over:
You will recolvo only 80% 01 Ihe
paymanl, becousc I,he Plan o-Jmlnlslrator Is
required 10 withhold 20 % 01 Ihe paymenl and
eond II 10 Ihe IRS as Income lOll withholding 10
be credited agalnsl your loxes,
Non.IIIXllblll PllymtHIfs. In goneral, only Ihe
"Iallable portion' 01 your poymenl I. en eligible
rollover dlslrlblJllon. "you havo modo "after.
tax" employee contributions 10 Ihe Plan, these
conlrlbullons will be non-Ioxoble when Ihey ere
paid 10 you, and Ihey can no I be rolled over.
(Aflor'lox, employeo cont.rlbullons generlllly ere
coni,ibulrons 'ydu mode lrom your' own pilI' thot' ,
were olreody 10xed.1
Your paymenl will be loxlld In the current
year unless you roll it over, You moy
be oblo 10 use special lOX rulos Ihol could reduce
th,e. tax YO,! owe,. HQWllVe(, If, \:,ou i recelv~ ,t~e .
paymenl before age 69-112, you also moy hovo
10 pay an oddlllonall0% lOX,
4
Oller 100%, you musI find othor money wllhln Iho
eO.dlY period 10 conlllbulo 10 Ihl IRA or Ihe
employer plln 10 replace Ihe 20% Ihal was
withheld. On Ihl olher h&l1d, II you roll oller only
Ihe 80% Ihol you recelllud, you will bu lo~od on
Ihe 20% Ihol wes wilhheld,
Elllmple: Your eligible rolloller dlelllbullon Is
.'0,000, Ind you choose 10 hove It paid 10 you,
Vou will reclllle $8,000, Ind $2,000 will bu selll
to Ihe IRS 18 Incoml 10k wllhholdlno, Within 60
deys Iller rlcellllng Ihe $Il,OOO, you mlY roll ol'ler
the Inllre $10,00010 In IRA or employor plan, To
do Ihls, you roll oller Ihe $8,000 you rocellled Irol11
the Plln. end you will hlllO 10 find $ 2,000 Irol11
olher lourcel Iyour I8l1lnoe, I loon, atc,), In Ihle
case, Ih. enllre .10,000 I. nOI 10ked unlll you loke
It OUI 01 Ihl IRA or employor pion, If you roll ovor
Iho emlre .10,000, whon you lIIe your Incomo lak
relum you may 051 e rolund 01 Iho $ 2,000
withheld,
If, on Iho olher hond, you roll ollor only $8,000,
Ihe $ 2,000 you did nOI roll over Is lo~ed In Iho
yeor II W85 wllhhnld, When you IlIe your Incomll
(8)( relum you may oel I relund 01 porI 01 Ihe
.2,000 wllhheld, (Howeller, Iny re'und Ie likely 10
bllllrger It you roll oller Ihe entlro $10,000,)
Addlllonll' 10% TIIX If You Are Und", Age 69.112,
I' you recellle a paymonl boloro YOII rooch ooe
69.112 and you do nOI roll II Oller, then, In oddlllon
10 Ihe regullr Income lOll, you may hove 10 poy on
extra lox equal 10 10% 01 Ihe lo~oble portion 01
Ihe poymenl. The .ddlllonol 10% 10k does nOI
epply 10 your poymenl If II Is (1) pold 10 you
because you seporoto from sorvlco wllh your
employer during or ellor Ihe yoor you reocl1 oge 55,
121 paid because you rOllro duo 10 dlsobllllY,
(3) paid 10 you as equal (or olmos I oquol! poymonts
oller your 1110 or 1110 e~poctancy (or your and your
benoflclory's II110s or 1110 okpoclanclosl, or (4)usod
10 pay cortoln modlcol e)(ponsos. Seo IRS Form
6329 lor more Informollon on Ihe oddlllonol 10%
lOX,
Specllll Tn Tr8lltmont, If your ellolblo rolloller
dlslrlbullon 15 not rollod Oller, It will be laked In Ihe
yeer you recellle II. Howeller, If II quolllles 05 0
.'ump Bum dlstrlbullon,' II moy bo ollglble for
spoclalloll IreOlmen!. A lump sum dlslllbullon Is 0
poyment, within ono year, of your entire bolonce
.urujo( 11111 .,Plol,l ,(11M ,~ertoln. oll)or. slmllor plon:5"ol
Ihe employor) Ihot Is poyoble 10 you becouse you
hOlle rooched age 59.1/2 or hove separated Irom
servlco wllh your omployer lor, In Ihe ceee 0' e
ooll'employedlndlvlduol, becluse you helle ruchld
eoo 50., 12 or halle becoml dlubled), For e
poymenl 10 qUlllly 05 I lump Dum dlstrlbullon, you
mUal hIve been e perllclpenl In Ihe Pten lor II leeel
5 yoars, The spoclel tOk Ireelmenr lor lump sum
dlstrlbllllol18 II ducrlbod below,
Fllt.-Y.., AIt_glng, "you recellle I lump lum
dl8lrlbullon eller you Ire ege 59,1/2, you mey be
eble 10 meke e one. lime elecllon 10 IIgure Ihe tek
on Ihe peymenl by ullng o5'yelr Iverlglng,' five.
YOlr elleroolng 011 en reduces the lek you owe
beceuse It IreelS rhe p"ymenl much IS II It were
paid ovor 6 yelrs,
T...,.Y..r AIt_glng 1/ You W_ Bom B.f",.
J/JnUllry 1. 1936, II you receive I lump lum
dlslrlbullon and you woro born belore Jlnulry I,
1936, you con mlkl! 0 one-lime eleellon 10 flgurl
Iho (0)( on Ihe poymenl by uslno '10.yelr
Illlcroglno. (uslno 1966 IIX r018l)ln118ld 0' 5'yelr
avorlglno (uslno current 10 rel8ll, Uke Ihe !i-yeer
averllllno rules, 10.yur .verao'ng ollon reducll8
Iho tall you owe,
Ceplt/JI allln TrNlm...,t If You W_ Bom B.f",.
J/Jnu/Jry 1. '936, In Iddlllon, II you reclllle e lump
sum dlslrlbullon and you were born belore
Jonuary 1, 1936, you moy elocl to hIve Ihe part 01
your poymenl 11101 Is eltlibuleble 10 your pre.1974
portlclpallon In Iho Plan (II Inyl loed 88 10l\g'lerm
capitol ooln II 0 rllo 0' 20%,
Thera Ire other limits on Ihe special Ilk Irellmenl
lor lump Bum dlolrlbullons. For I!kemple, you con
gene rIlly elecl Ihlo epeelsl IIX trollmenl only once
In your IIlellmo, ond Ihs slecllon Ipplles 10 ell lump
sum dlslrlbullon Ihal you recellll In thaI lame year,
II you halle prelllously rolled over 0 poyment from
Ihe Plan (or cerloln olher similar plar,1 01 Ihe
employer), you cannot uso Ihls spoclal tall
Irealmenl lor 1010r poymenls Illlm Ihe Plan, II you
roll over your poymonl 10 on IRA, you will nOI bo
oblo 10 uoe Ihle opeclal lOX treolmenl for Iller
poymentl Irom Ihe IRA, Also, II you roll oller only
a porelon 01 your paymonl 10 Irl IRA, Ihll epoclll
10k Irootment II nOI ellolloblo for Ihe rOIl 01 Ihe
poymant, Addlllonol r06lrlcllons Ire described In
IRS Form 4972, which hIe more Inlormallon on
lump ~um dlslllbullon5 and how you olocl Ih"
special lOll IreOlment.
, , . "
Employer' Stock 0' S8curlfle.. Thero 'loa opeclal
rule for 0 poymenl from Ihe Plan thaI Includes
6
1,;.",~I;,~M'~!~::m G~lN,ll~'~IRM RIISIDENTIAtll~~,~,~AI!I L
CII,Y fJllJllt C"IIIII ClMllbul'j iIIld 1'1111, I'^ /1/1 C"", l'IO~~
ley.i1i!.icliJ~lo< 75)(200
!JvmoIJOt\!~'OIlI..Mk':l SblIICIIV'J!jll
Golo PIItI' Untu III !iulu
" -Lon'-I-;il/llgOSli:U/l(;Cb!il,lliti to he pni,i hy M!llto, $
'ill:: TII~" r5~~,46 . III' V'III 1')%
~~lIIioiiclI,ili ..' Will ilun H IIUICOVllUO
Alicll III II CI1V/Il II
lUC^'I011 IJlhllll /iulll,,11>1I1
'"liLT III' )( 'iI!!' /1>% il> 11>"',
lillllWlIllIMf IIIIi"~ lilllhlll
Plll)Ptlll V VAI.lJHi IiUlllllbil1U tllilllh!
IXMMlIJ//iUPPlY Sl!lJIlniju hllllltHIIl.lJ
MAIH<ElING 11M': 1111411'1 :1 MIlIi :1 Ii Mll'i
rnEtifNr IANlllliil ~~ IA,m Il:if ClIANlif 1'/11I)1)Mll/A~
. S'"Ulo fIlii", ~O N"III~"I, I X IIICCIJi'Aljey
H rnlllll, r, 1.i~'I, 111I~'iI" ! X I
M.llI,llUIllly ~) In fJlllfl!bb lUllalll I I 0, OOOllln
COIIIIIIOl,lnl Ii 111 VIl1nIlIIUI>"LI I ] 0, OllO""I'
" IlllkJ~lrlol 0 V,Ii:lIl1lllJ\I'r ,,',1"1 I I P,rtllllllllllll.1
VAtnlll!j $'10,000,00
Nulu: Ilnccllf Iho IllllnII)JtlIIHlbtll~~tlloUlI nlcllol [1"'hhll'1111111'lIl1hlu i1lljllilll'nllutll/lll
COMMENlfi l'l1:l!'l(!J."ly 11) ~'()I)VJ~II~, J.<J<;/lu'I111 ll1uhipIJIJI\l. uch<l<l.I., U1'llo\,III11lll alc.
ti,lll! I'lli'll
IIIIA 11M',
lInltl
1'04.11' 111111''''1101 _ Ml/lIlll'Uu "III1/11HI
1'11111'1111 V IIkilllli N'I'IIAI:irlJ MI)II\lIIU' lVII"
I X I'ml t)1I11111l1 I)lb[lJUIlI I'uilll!) '11Id lllhur COllcc66ltlll5
I 1l'IIlil'llUld PllhllJy ~1~lll'l .
t CIJIlIhllllUlKlll1 (IIUO/Y^, ,
Ilu MUIlIIlIti Pl/Il ~illUtlu
11111111 Nrllilllll~,IIIJOIl NIAIVlilli
IIIIIII't ,/)'11, IIHplll~'IIll!1I1 tililhlllty
hluw CIIIIVI!IUI't1l:U Iu 1IIIIIIiJY"II'111
llnUllIlllI CUII....l'IIII'llt8 h! :iIH.ljJ/llUU
0"'1" tlllpply Cun....I'IlIlltllll 10 llthuol!)
0....'" Ii Mil!, Alh~IIIIIIlY III flLJIllil; llHllhllmlnllllll
:)INtil.l' 'AMII.Y IIOIJ:lINti 1l1'I.'t'iIIlUlI fllLlhlll'li
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C21W/l.l N.mol ~.~l W/l.LAr. /l.30OC Ph~n.1 1~J.l~~1
~i)941 Nom" JOHN WI\!.AK J~,,&/lJ(Il PhonOI 9&1'J19~
o "JIM J Fhr.ntt I
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SETTLEME
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Pace attends real
estate course
l!meu K, Pia, hroku and cQ-{)wner
orCel1lury 21 PllCelPlICC,recen~ycom'
pl9l:d. seminar on COl11men:IBI Real
Es14lc Flnan~e and Feaslbllhy Tech-
niques,
The three-day COlll1le, held II lIie
Century 21 Oreot Lalcel, Inc, TraJnlng
Cemer hI KIna of Prus.lla, Ia one of .
rour'pllrlserles on commen:lalllllvest-
ment real estate,
A f1rm believer In continuing edu-
cation as a means or provldJng lIie
mOil Up-la-dale end prorculooal.er.
vlcQJ pclsslble, Puce holds the OR!
(Graduate REAL TORS Ins~lule),
eRB (Certified RealdentlaJ Broker)
and CREA (Certified Real Estate Ap.
praJl5U) designations.
He ~an be reached lIme Century 21
PacelPace MaIy,vllle om~e, locllcd
al 108 Soum SUIte Road, telephone
9'7.3866, 1'/ie IIrm IlIlO has I rran.
chllSC .1 9 Weal Maln SI, In New
Bloomneld,
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@
NATIONAL ASSOCIATION OF REAL ESTATE APPRAISERS
8383 E/Jat EV/Jna Road . Scoffada/8, AIIzon8 86:260 USA . (60g)940.8000 . FIJI:(60t1)998.lJOflt1
E-m/JII: nIJf88t!fJ18ml,o'(J , 1n/8m8' addf8u: hffp:lllaml,orQInar/J/J,html
E, Kenneth 7W1<:hell
)J-~...nIr"W
~eptember
26, 1995 -.,
Ernest K, Pace, RPM
Appraiser
Jack Ga'J';lhen Realtor
108 South State Road
Marysville, Pennsylvania 17053
Dear Mr, Pace I
Thank you for renewing your Membership in the National Assooiation of
(Real~Sta~e Appraisers~ Your official Membership Number remains as
oefore I ~nd your--'Membership records lndicate you are a Member in
good standTng7"
Now, more than ever, you will find your Professional Membership a
benefit, Having just retur.ned from our most successful Appraisal Expo
and Conference, attendees learned the latest on updated regulations,
guidelines and appraisal techniques. I had the opportunity to sit-in
and talk with most of the speakers and 1996 will be an important year
for Appraisers - different Valuation forms, updated policies from
Fannie Mae/Freddie Mac, new ways to service clients and much more,
Your NAREA Membership will keep YOlI current on all these items which
will affect your Appraisal business,
,-
I alBo wanted to r~mind you about the NAREA Internet listing
opportunity. Lenders and others whom hire Appraisers are accessing the
NAREA "Home Page" to locate Prafessional Appraisers, To get yourself
listed slile the enclosed br.~churp.
The Association is proud to have you as a Designated Member, If at
anytime, I or any of my staff can be of assistance, please call us,
Thanking you,
:ATlfiilWJii!iLr ESTATE APeRAI""
Executive Director
F.S. Enclosed is an address verification letter, Please make any
changes necessary and return it to our Association Headquarters.
Thank you for your assistance in keeping your records current.
CREA . C,ullfled Resl EsIsle ApprslsBr
CCRA . Certlflod CommBr<:/B' RBa/ Eslsle ApprB,'sB'
RPM . R81J'slerod Pro/Bss/on.' Member
.' "',.,,' '
ruHARRI.S~
D SAVINGS BANK
P,O, Jlox 171l
Ilaniabu..., hMI~lvanJa 11108
Phon'l 7l7me-4041
A#N;
c\'"n~~ t ~)(A <La...
j:"q.x* 967 ..1_/ 36~
~NNU~L LO~" 'T~TI"INT 101 1991
"0IT4~d' LO~N No, 010400416'
U I U IAN n~Ne~Y~DI IT~TI"'HT DHI "'.1/"
~LI(I ~ IILXI
II" L~"" d~' u '/0'/" lie XO w IAL~HC' 411,01
INOL' /A 17011
1/01/" LO~H IAL'"C' ",RU,"
TUN DUI TA DIU 'IIN, INTlHIT HCIOW OTllIA IICIOW IUHCIIAL
UTI D~TI CD COOl ~HOUHT ~"OUNT ~"OUN T ~"OUHT ULANC' IAL~HCI
_....~-- --.....-.-. " .._-.----~._....._--....--._-- .-----
,- ..-. '.~'..,'
1039' IX U \8,66 471,61 U,ln,S?
11795 aU191 AI ~'6.9' 95. 98 62, I 1 'n.79 13,011,46
11495 301 " H aU,44 92.41 da, I 1 191, '0 U,IU,QI
31495 ID 07 10a,95- 492,91 U,ln,OI
B ,." ID U 10',00- U7,9' 12,131.01
32195 401 " XI 119, " 90,90 62,11 110,06 12,615,03
~I 1 95 101 " IP 221,81 89.34 62, I I 4 \2, '7 12,191.41
11991 601 " IP 223.12 ey,77 6a, I I 474, as 12,165,36
70'" 70195 XI 224.70 16,19 62, I 1 136,39 ",943.dd
7219' 10195 XI aU,29 1',dO d2,11 195,'0 11,717. S?
12395 ID oa 430,11- 167,99 11,717, !7
12195 '01 " II a27,19 13.00 62,11 230,10 11,489,41
92'95 100195 XI aa9," 11,]1 62,11 292,2' 11,119.97
loa095 1 I 0195 XI 231.15 79,76 62, l' 114,32 11,011,14
111195 laOH5 AI a32,77 71,12 62,11 416,4] 10,796,07
1207" 10 96 101,U- 307,71 10,796,07
122'95 10196 XI 234.42 76.47 61.13 369,2& 10,161,65
12299' , .51 369,28 '0,"',07
12309' II 50 1,f7 J77,U 10,161,07
1"'01""' 'A. IN'OI"~'ION
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IN 1111! COUIl'r 01' aHQf PLP.M 01' CJtDB1U..AHJ) tnM'Y, pl!NN!lyr.vMIA
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UCTXON J: I INCOHl JUtD INSDRJ\NCS IlfFOIUlATIOlf
:u.,u"""..OlfS I THIS SICTJ:O'" IIIDlIT II FT1LLY COIlPr..JlTJlD. IV roo AJUI 110'1' "USBlrTLl'
B1lIPLOYJD). TUB llIlIPLOYIR Iln'OIlllll\TIOlf SHOOLIl R1J1'T.JICT IlJ\JUn1IIlIl :r:mrOIUD\TIOlf J'ROIII YOOR Ll\BT
JOB.
,INCOME, /h'l:' ..",1 L
Current Qr Lut KmplQy.rl .::JJW.L.~O~~(
PayrQll Mchelll
position Held, _ ltate ot Pay/frequancy ~
How Paid I (CIRCLll Oml) 4i.eklY'tblwul<ly/mont:hly/umi .monthly/otller VOJ\ 1V..tJ.~1L
It last job, Date lett :fCi1)'_ Rauon tor l....vin!]
OroBB pay per pericd, ~ -/.i' I " .
Itemi..d Payroll Deduction.. ~ ' '
Fedenl Wi thholding ~ ',' , ,
Social Security (& Medicare) ~. "11'
Lccal Wage Tax ,
State Inccme Tax . -
Mandatory Retirement (Required D1inimUll1 t
Health Ineurance
Other _~~~,~~i.ty!
..':.;:; .J" , ,I
,
,
,-
~ LI ,-'
-;-:!I'
Net Pay per Pay Period
-HI<I. :'\
OTHER INCOME, HlLllk ~ :au:
(Fill-rn-approprlate column)
............................... ......... .................. ........ ......... ......... ....... ...........
Interest
Dividends
Pension
Annuity
Sodal Security
Rents
Unemplo~ent Ccmp,
Workmen s Ccmp,
IRA
TiJ?
Al1mony (rec' d) 11."-'
PROPERT'( O~8' cd tiO~ ~~~wn'~'~i~
CheCking Acct., ~...~ ')1'. ~ l\ I... _ ~ _
Savinge Accts. - ~_l'.; f t-
Cndi!: Onion _____ : _ :
Stocks/Bcnds _____
Real Iistate _____ :::
Bulinell !: : :
TOTAL ~~o.b\L
TOTAL
M'. \ \ ,'5D
...........................................................................
INSURANCE (covering dependents in this ca.e) ,
cory;~d Claims Adche..
Hospital . a N'I/'
~~~:rcron . . ()~(jn~'/,/rhl(llttY
Medical '
Blue Shield
Ocher (lDl''''~~~U.\'()M.1 tl () ~~--'J~ VI~,....lJu.~h ~A~~~ t..J/''IJ.3
Heal th/Acddent
Dilal:llity
Dental 110 It II- \')( rfu}. \
OTIIER
-H_Husband, W-Wite; J_Joint/ C-Child
i.~~;if;.~h;~.~h~.;~;~;~~;.~d;.i~.~hi;.i~~~~;.~d.B~~~;;.s~;~~~;~~.;;~.~~~.;~d........
correct, I understand that talse .tatements herein are made subject to penalties of 19
PA.C.S. Section '90' rela ing t:o unsworn talsitact:ion to authorities,
LLet (J.
-Covera!]e
, Group It polir.y It H W C
IS fr~v;d..orJ IoLf Bills ltnf1~~
;J()Q.(;).J..I.'r(.:j~
J'~-!
:J(JfI-t;2 -If'i,J.. g X ~
I3IONATORS
DATE
;{-;',,-91
06790 9/1/95
(SEE ClVER)
~ .1C'l'XOlIf XI I aD>>PIJrliIllNT.I.f. r.......... .'I'.........lI'1'
~01I81 X. Itll7 AIUI 'lLJ"IDr..onu OR rp rot:7 AU 1ll7....TUl Ir A ItJllXIII.S OP..IIIIICB JW
AU 0WIIlIR XIf IIlIDLI OR %If 'JUr1', rot:7 IIIU ALIIO PILL an 'nIX' .aCTIOII. .'
1\. 'n1iai 'Orlll iii to 'Uled out by a .,....911 loheok 'one) /", ' ".
A. III ~ 9rl.ru.. a bu.UIe.. 01' P~1:1o.. a Pl'Ote..101l, 01' ,
- 2 0 1i11 . ..libel' U, . PutIle..,IUp 01' ~oiill: Wlltlln, 011'
2 0 ia a .1uu:.hol~1' 111 AIld 11 .alladed by a qlo.ed ClOl'pol'&tioll 011' e.i1SJ.1U' elltity
17 At a to thia .t.t_Dt a oopy 0' the 'ollowlng doc:lllllllllt. nlating tll the pU1:An.h.tp,
l11int venture, bu.ine.., PlI'o'...ioft, cOl'poratioD 011' .Lmilar .Iltil:y,
11 the lIIQ.t ncent re~ al XncalllI Tax IIetura, AND
2 the lIIQ't no.nc P I: All to. I:al: ilInl:' . ."'~... \
C, lIIIIe 0' lu.1 e " , . .v............-
AddI'... ,
0,
-
r.
/1,
'inanllial l'eCOlI'del
ua ncoma om u.ln..u,
11! How lllt.n i. income I'.ceive
~ 01'0" income p'lI' p..y p.riod,
'1. ~'" t: f."',=":."mll ~,.~ ~l\:" ~O::~.C'r1f
(4) Specltied d.duction., if any,
HOME
Mortgag./rent
Maint.nance
Utilities
Electric
Gal
Oil
Telephon.
wat.riJooJh &11
EMPLOYMli:~
Public transportation
Lunch
TAXES
Real as tat.
P.rscnal prop.rty
Income
I~,.~iJ,W1CA
Hom~owne t'I
Automobil.
Life
Accid.nt
H.alth
Other
AlJTOMOBILIl n ~ . I
Payment. CQ,fl XU(l.N
Fuel
Repair./m.intenance
MEDICAL
Doctor
Dentht
, Orthodontist
Ho.pital
Madicin.
Therapf
Sp.cia Nled. (gl.....,
br.c.., orthopedic
devices, etc.l
TOTAL EXPENSES
.:Ef),00
~c.r ~
EDUCATION
Private .chcol
P.rochi.l .chool
COlleg.
Rltligicus
PERSO::uu.
Clothing
Food/Groc.ries
S.rb.r/hairdresser
Credlt paym.nts
Cr.dlt c.rd
Ch.rg. .ccount
MamJ::erships
LOANS
Credi t Union
MO~Y ~rr~~:~
---
/ / , ()O
!j}:/~o .!la, 00 ?
--
ji.J,~'l[;
MISCELL.A:NEOt1S
Household h.lp
Child cars
P.ilers/blts. /mags,
Ent.rtairun.nt
P~y 'r:v
V.cation
Gitt.
Le'1al Fus
Ch.ritabl. contrib.
Oth.r child .uilPort
Alimony paym.nts
O'rnBR
"1n; I e9ff.. ~'1!M'W
tn <;
~Y.s :3
--.......-
I.f~.""()
--
-1~/~
II,
41.. "'.il.
13;(4,5x 4.'11.00
\,~~.(Conversion t.ctor weekly to monthly i. 4.345)
--
06790 '/1/95
d Tolal numb. 01 ill8mp~onl cl.lmld, . . . , . . . . , , . . , . , , . , , , . , . . , . , . . . . , , . . ., , , , , , , , , . . , "
7 Wagal, 11111111, I'p., .W, ~ll4ch FOllnt., w.a" , ",'" , , " ,"",'" , , , , ,""'" , , , , , , , ,
II Tuablllnl...1. ~Itach 5eh.dul. U " ov.. '~Oll. .. , , , , , , . , , , , , , , .. . , , , , , , , , , , , .. , , , , . , ,
b Tu....mpt Inl...1. DO Nor Include on IIna O. , , , , , , , , , , , , " L!I!J -1-
1 O,vldend ,ncom., ~Itach Schudulo U " ov. .~OO , , , , , , , , , , , .. , , , . , , , , , , , , . .. , , , , , . . , , , , .
10 Tillable rolund., f;1udilll Of o/l~Qld olllale Ind local Income 111181 In.tllnltrucllonll ' , , , , , , , . , , , 10
11 ~llInony loc,lv.d , " , , , .. ' , , " " .. , , .. .. .. .. '.. .. . .. " , .. , , .. .. , , .. " " , .. , , , .. , , II
la BU"nu"lneom. or (10"), Alloell Sch.dul. C or C-EZ, , , , , ' , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 12
13 C.pll1l g.'~ or ('O,,),IIIIQU,od, .1I0eh Sch.dul. 0.. , , , " """""""'"'''''''''''' 13
14 ,Olh.. go,n. or ~o".." ~Itar,h Form ~79" . , , . , , , " """""""."."""""""". ~_
n. Tolal IRA Ollblbullon., , , , , , , , " l Ua L L. J b r...bl. .mounl (1..ln.l.) Ub
Ie. TOlal pensions Ind 11111U1l1ul, . . ., J_~!.l L. b r...ble amount (..,Inlt.) lib
t 7 AQ/llallllal ulllo, ravalUea, prulnorllhlpa, 5 capOfaUO"I, truatal ele. AltAch Schldul. e. . , , , . . , , , 17
11 Fwm meDin' 0' (lou). Allach ScholJlJhl F . . . , , , . ., , . , , , . . .. . . , , , . . . . , . , , . , , I , , , , , , . , , , ,.
10 UIll.ll1lploVm8nl ~l)lt1p'"l'l.lIll" , , . . . . . , , . , . , . . . , , . . . , , . , " , , , . , , . , , , , , , . " I . , , , . , . , , , 1.
20. SlXlalaocurlly b'"011111 , . , . . . , ., L~~!.l U b ll)fobll .moun' (... Inll.) 2Gb
al Olh.'neomo, al
22 Add thl llmounla Inthl llU II hi column lor IIn.s 7 (tvQU h:Z 1. Thllls QlM' lolaf Incnml . . . . , . . ,Ill 22
231 'VOUl IRA d~ucUon (US hltilrUClJOI1I) , . . , . . , . , , " , , . , , , , , , ,. 23.
b SPOUI8'S tRA dlductlon (181 IIlIl1ucUonl), , . , . . , '" , , . . , , . , .. 23b
24 Moving 'IIPI"'''. Attdch FUtm 3003 or 3003~F . ." , , , , . , " , , , 24
:II Ontlwhltl ol..II~,,"plovm.nt \8). "\lach Schedull 5E . , . . . . . , . . 21
21 S.If~.mptoved he.lth (nnullco deduction (lSo.tnlll.), , . , , . " " , 21
a7 ~oogh & .ell-<lmployed SEP plan., " SEP, chock ~ 0 ' , '." , a7
II lU..JII'
"..<,Iu III '''6 21 Penally on '1I1V wtlhalwll 0' I14Wlij5 . . , , . , , , " , , , , . , . . , , . , 21
1"I'''W IV ~UU II 28 Altmon\l paId. Rectplenl'5 SSN .. 2.
ad'lhJ,!IIJllul ,
II., willi )'Iml. 30 Add Unes 231ttvough 29, . . , ,. . . . . . . . , . . . . , . ., . . . . . . . . . , .
~" II, I II''''
I.... lUll h' 31 Subhcllln.3O !Jomllnl 22, Thl5 II you, ~1UII'd grolllncom.
FIJr P,lv.cV Acllnd Plpl1WOfk n.ductJun Acl NnUc11 ue p.g. 7,
I
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1040
llb,1
llUljJ'U' II I
IIUUI.UIU
"'Li.t.
'1Il1'1"'1"
plrUI,_II,1
.,IUtl
"'.III.Jllllh.1
tllelloll Call1ll.IYII
Ibl'V_U.III
Filing SIDlul
1;IIH~ ')III)'
"It,llu.
E~e,"pllone
II IIIU,III,II II_
,1I".'"IIUI'.
.,.IIo'IIt,1I
lu IIIIIII~
Income
AII_h
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1996
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1':110ll1 l'f\ 17025
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n.X MIIII.e nllllg .eplI.lallh.", enl. 'POUII'I '00, .eo, no, .bov, & fUll "'''' h.. ~ Will iam Stanca va~::L
I~..d 01 hou.ellold (Wllh QUllllyll1Y p..on), (5" In.~ucllol",IIlIl1. qu.llfy1ng p..onl.. chid bul nol YOIl depend.nl,
,,,I.. 111'. clllld'. "'''' h., ~
au. II , widow. wllh dOIO"danl child ( '11 .pou.e diad ~ IY ), (BM 1I,,~ucUonl,)
Vou",U, II YOlM plllnlla 10llld0l11 ull') CAn claIm VUU II a dlpendGn' un hla Of 11., lax
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02 AlI1uU"lhUIIJ.""'311.lliulIUlI\jlUUI"~I"""I"""""""" .", ",' """"'" t'" -_Q..!-___lL.1?.1..._
n . CI",,;k II: [J You w... 00 II UhJIII, [J flll""i [) BpOUIlI..II 60 I' uhll., [) 1lI1,,",
Alld 1I!1"UlI1b.. 01 bo... ChICk.,! .huVI '''" 1111.. Ih.lol.1 h... ' , , , " """'" ~ 03.
bit YQU.,I mill II" rUIng IOfJII.tely .1111 yo I.., 'POllia 111,"1,., dltJUGUUII. a VOIJ W'"
. tJlJll~II.lul .llIn, 1..I/lI~IICUfJnl 'IIIJ ch..;k 11.. ' , , , . , ' , , , , ' , , , , , , , , , , , , , , ,.. 1I3b (J
i ",",I..d ".dIICUon. hOIJl 6<h"I"I. A, """ ~O, on I
114 Enhw ISlalldwd dlduclllJt1 IhOWllllltlfJW fIX ~QIM 'lUng 11.1111, Qui ...Ih.
Ih. IIlI"UCUQII. "you Clll.dltj '"Y "IJJ on Un. JJ. II b Of' IUIIlIunl
Iwu., C'" claim ~Oll ill dlpun.JIIIlI.
uf . UlnUh,... U,Ol)J . Mllllllld hllflU lolnUy 0' 1)lJlllfylnU V1ldowlw'.. 10,700 ' , ' , , , ,
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al 5ulJ~.ti Ilnl 3. "onll1l1.:lll , , , ' , , , , , , , , , , ' , , , , ' , , , , , , , . , , , , , , , , '. , , , , , , , , , ., , , , , , , . . ,
III 1111111 3Q II '86,476 01 I..., mulllply fQ,6~) hy Ihl 101.llIumblt 01 "olllpbo"l cl.lmld 01111111 Bd,
"Ih" 3211 0". 108,,06, "llhe w~"lhlttllllllh. 11111. 'lllh, '/JIounllo .nl. . , , , , , . . , , . , , , , . , . . 1M
07 TI..blll"COln", ~l/bb.cllI". 36 111111I11". :,",
III~l'~'I,ml,J' "nlln.JII.'III.,.o ""'""",."""""""""""".".." ~
III Till, ~..I"lbur.Uon., Cllock II 11I1e1I"cllldllll"y ta. hOIll . Ll Fallllllllll14 I--
b 0 Fam ~U7Q , , , , , ' , , , , , , , , , , , , " """""""""""""""""""""",.. III
III O.dllla c/lIl11 11101 d.p""d.,,1 c.,. .",.11..1, All, Fam Q~~1. , , " " ~. _
~O Oodllla Ih. oIdlllly OIlhl IIII.blod, Macll &:hellul. II " " ""', 40
4. FII.IU"I..ooIIII.AlllchFuIIIIII16 '''''''''''''''''''''''''' 41
42 Olhlll, CllIlCk 'I hUIII IIJ 1'11I11I 311OO b IJ ralll 0306 __'-'
c [J FIJIIII OIJQI d [J FIJII" Ilflll<"YI _ "~'h~_.._.._,___ 42
40 AIIII "nll au 1I00ugll 42 , , , , , , , , , , , , , . , , , , , ' , , , , , , , , , . , , , , , , , , , , ' , , , , , , , , , , , , , , , , , , , ,
44 5ubtraclllll' "J from Unl 36 rl IInu "3 II nUJ'1 Ihlll Unl 36, ."Ior .0., , . ' " ".""",.".,."...
41 51111-'lI1plo~mlllt r.lt. AIt, St;h, 51: ."" , , , ' , , , , , , , , , , ' , , , , , . ' , , . , , , , , . . , , , , , . , , , , , , , , , .
40 AJlJWnlU"1 rnlnlnlunl Lalt, .AltDch Fer 111 62151 , , , . , , . , , . , , , , . , , , , , , , , , , , . , , , , , . , , , , , , . , , , , . , .
47 Soclll ft1C1M11y Ind MetJlcl/,lax 0/1 U" lncom, nol IIPOI'lld 10 Improy.., AllIch For," 4137" , ., , . . ,
41 To OllllUIUllUtJ fll"8mlnl plllll, IIlCIUtJIIIU In.AI, II "qlJ~ld, .!Ilch Fo"n 63110, . , . , , , , , , . . , , . , , , .
4" Al.Iv"\C,, 1IIIllld IlIcomQ a81111 pa~l11u/ll, 11011I FOIllII) W-ll , , , , , , , , , , , , " , , . , . . , , , . , . , . , , . . ,
ISO HOIJI,hahJ lI,"plo~nllll\llalllfl, Alwch 6c:hutJUl8 II , , , , ' , , . , , , , , , , , , , , , , , , , , , , , , , , , , , , ' , , , . .
'1 Add IIn.1 H I'" ol/gh 110, rhll~l! 101111.. , ' , . , , , , , " , , , .. ' , , , , .. .. , , , , , .., ""..",..
13 FudwallnclJflle lax withheld hOIll FOIIII& W-2olltJ 1000, , '" , "" . , U 83
03 1006 ..Umah.d tax pa~mllnll and a/nolllll dPIJUud from IOOIS r.llMn " 1:1
U EIt".II In cum. credll. AII.cI' 5<ho"uI. ~IC " yuu h.YO I qU"ll)1nU
child, Nalll.ubl. ,,, nod Income: .mounl ... I l---.J
I"d lypI ~ 14 _
II Amount pahJ With Forll1 .4008 (loqllOIlI hx u~IBllalol1) , , , , , , . , , , , , , , ..
GI e.clu lot'"1 ,oclJllly end nnrA I.. "IIhl1.'" 1100 11111,1 ' , , , , , , , , , , II
17 Olh... plYlllenle, Chock II hom eO FIIIII 243U b 0 FOIm 413e , , , &7 .
GI Add """1 0211vouUh 17, Th..o III yo,,, 10111 PlIYmenll , , , , , , , , , , , , " , , , , . , , , , , , , , , , , , , , ,.. sa
.1 111111' 68 lIS mOle IhllJ VI" 61, &lJbtrad 11118 61 trOI1l Una 158, Thllll Ihu Imounl you OVeRPAID, . , , " ...!!_
Ie. ~lJIo.nl ollln. 5U YOIl Wlnl ReFUNOED TO YOU, , , , , , , . , , , , , , , , , , , " . . , , , , , , , . , , , , , , , ,~ .0.
. b RouUng numb... I~~._..__] c Typer 0 Chocking 0 Slvlngl
,I'___~_u__,_____ L
d Account "umbOI' L-
., Amollnl 01 line 50 you wlnl A""LI~O TO IOU' ESTIMATED TAN ~ 1\ .-1-
ft2 1111,," 51 'I 11I01. Ihollllnl 56, IUhb." line 56 hOlllllnl 01. Thll Illhl AMOUNT YOU OWE,
For detAil. on how 10 PlY Ind UISII Form f040..V, "' Inlll'ucllo"I, , , . i' , . , , , , . , , , . , . . , , . , 'I' , ...
.3 ElIllm.18d tax pe"alty, .Alao Include on UUle:?, , , . , , , , , , , , . , , , , . " I 13 I 56 I
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UnlJlI' p.n~H1.. ill plljur Y.,llJtC',fl 11111' 111\01 "'Inu,td IIlIl ,.IUln ,IIIJ I.:comp.n)'lng U/ltIM.. Inll tl.l.m.nlt, tnd 10 Ih. bill or",)' knq",lldg. In" IlIUtr,
Ihty II.I/U., cO'I'I:'I, ,noJ CumIJI.lt, O"'.lIlhmill ",.,,1I1r lelhl/It,," II)P'y"'" b'lId OIl'"11,lomtIIMoI '"hlch prlPllt, hit .n~~n~l'Illdg.,
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97
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Prtp.,.,'"oclllllc...lI)'no
181-32-3085
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17055
11.11I
2210
Underpllymenl 01
Esllmeted TOlC by Individual., Eslales, and Trust.
~ Sn IIp..,.ln.lIueUunl,
~ AlIlCh 10 fo,," 10.!!!..JOIOA, 'OliN" 1010NIt.1!l ." 1041,
n~. I111_1"I_Ol4l1
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1:,'.llj.,llh.,lIl1li....I~.
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1996
_lIuhm.nl 011
IlIquI/M.NI),
Idlnllf... ......
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Nol" 1111110" CUll, YOII dO nol lI..d 10 r"1 f..m ~~ Ill, rh. illS "'III nUl" IllY pOII.lIy Y"" OWl .lId o.m) \'011' bill, FII. f..m 2210 only II on. am...
lJu~"IIH PalllllPlJly II) you, It ynu dQ 11IJI"..cJ tQ nl, t=UUIl :l:l1Cl, VOu IIIIIIIIIV IJI.lllo flU I'" VUl)' pln.ny, Unl. Ihl ,muunl fro," Nn. IX) ~ Nne 30 an lh.
IJIIIlully 11111101 YUI. ,.11'", hul do nut Inaell t=ulIIlIllIO.
I J'!!!i]J Rle.on. lor FIling -- I' II, b, .. c h.,uw .ppll.. III YOII, you mlY he Ihl.lu 10"'. Ilf Ilhnllllll YOI. P'"II~I, Bill you MUST' ch..k Ih.
!Jo.....lh.'.Pllly Ind hi" FOl'II111:l10 wllh YUUI ha. "Il.n, It Id h.hJW 'PI1I1.111) you, check IhallJolI Inu hi. FOl'I" ;JlllO wHit YOI. 1..'llulI1,
..",.. ---.-.---.,-,-...-,.,.-....-..--.- ,.,-, - -,.,- _.__...._._--_..,-----~.._------~-.-p..
t l;h.,~ wh~hlv. 110... ."ply III nun. I"ply, GO. II.. Nol. 1110'0':
I U You 1IIIIlU,.' I WII~", In c..laln CiCU/IIst./II:el,lhl 11m will w.llJ', 'II lW plJlIII Ih,"utlIIlV. ~ju. Waiver 0' fI.nalty 011 pig. ~ Dr Ih.lnl_ucUonl.
b tJ Villi USU Ihl Il1t1UIUltd lncom.lnltlllm.nl ,"alhod, II YUI,,'lncmnu lJWIUlf IflMlnu Ihd yall, Ihllll1olhl3d mIVllduc.lh. Imounl 011l11' 0' !n0l.
Ili'llJlllnJ 1/lllaUnllfllll, 6111 pIUU" f)llh.It1I~UI;lllJlll,
e [J YIIII h.d FOd,..1'ncom.It. ",lIhhold ~om "'"U" "ltl, ". .ollmll.d ''',,,.po,.,, YOII bllllh. ",Ilhh.hllu II paid onlh. d.1I111 WII IclullIy
wllllhultJ, 111111Ul11 lJl III lI1uII llI1DUnl1 on Ih. PMVIIlIlll 11111. dlhJII, lHIlllh.lllnl1uctlonl 1t1 Un. ~~ OIlPIUI:),
~ U YIII' 1.1l"IUd InnuII "oYlllonttlln. 1311010"') "llU'." on YIII. IUU~ It. Ind you ".il.. lIellllng 1llIlnlloh.nlllf IIlh. IUU~ a IUOO bulnolla
tmlll V8WII,
L~~!n)] RequIred Annuel Plvmenl
,- .--._.--_._----_._-------~-_.-... - ,-_.- ._+~_.'----_.,--,--
2 Enlur your 10961')1; all..- audlt.s (10. paUI:l ollhlJ 1I15~uclJa/lI', , , " '" " , , , , . . , . .", " , , , , , , , , , .' , , , , , , , , , , , , ,
:) OlhOl IUIII (18. plUU ~ 01 11111 111111ucllunll, , , , , . , , . , , , , , , , , , , , , , . , , , , , , , " , , , , , , , , , , , , , , , , ' , , , , , , . . ,
4 AiJlJ Ilnol ;land 3, , , , , , , , . , , , , , , , . . , , . , . , , , , , , , , , , , , , , , , , , ' . , , , , , , . , , , , , , , , , , , , . ' . , . . . , ,
I f.'UIIHIIJ Inl;QlIle cu.dll""""""",. """".".,.,.., I--.J_ ___
. CI UIJllliJf FUIJ....1 hiM p.ltJ 1U!luull. , , , , . . , , , , , . , . . . . , , , , , , , , , , . , , . ., 0
1 /l.lhJ 1111016 .,1lJ 6, , , , " , ., .,'.'" . , , , , , , , ".., , , . , , , , , "" , , , , , . , , , , , " , , , " , , , , , .. , 1
. CIIHonl",lI,., 1&,.. Sublract IIno 7!r01l1 UlIg 04 , , . , . , , . , , , . , , . , . , . , . ., ,.,.""""""""""""",'.... ~_ _-1L!..'~~
I MulI'plyll".BbYOO""I.DOI"",..".."", ..,'"".,..",....""",'...."", I_,IJ___! 026
10 WllhhultJlnu 111I81, 00 l1ollncll.\!J. ,n)' Istun.ted la. pOYlllunll 0111111111"1 (1111 PDQI U ollh.lnltJudlol1l) , , , , , , , , , , , , , , .
II S\Jb~IlCllltlll 10 ItOIl1 IIn. 8.111011111." 1600, alop IUlfII; do nul campi. I. or fIIo IhIIIQlIl1. You do nul ow.lh, pll1all..., , , , , .
12 EtlllH Ih. IIIl1lhown 011 yo1M' 1095 I.. rollNn (110% ollhal_mounl II Ihl adlullad 0'011I1111;0'"" Ihown on Ih.1 rlllM'n lIS
lllUlU IhUII "00,000, allllllnllld flUno IOplllllulV lor 10Ulil 111010 Ih/ln '76,000), C.ullom SUI PUQI ;2 allhl h'IbucOol1s, . . , 1:1 1 04
13 ""qulred Innu.1 p.ymlnl. Enl.. Ih. ..nlll... ofll"o U ",line 12 , , , , " .. , , , , , , , , , .... , , , , , , , .. .. " .. , , " , " '" ,~ 1 , 02,
..-1!<<Jler II llllu 10 III Ul Ulllo a IYIOta Ihlnllll, 13. ~ll)fJ hUlI';~1J do 1101 OW" Iho "011011....1)0 nolll18 J-:offn :1210 unIon vou ch8(~.d bOil Id .blJvo,
L"_I-,t ilL Short Mellod (C.ullo", s.o ".Uo 2 01 11," 1,,,bllcl'"IJ'III IIiHj 0\J11I YIl\J CO" \Joolh. ,h..lm.lhod,1I YO\J c"..kld bo. Ib a c '" P.II I,
,;Ill Ihll Ilwllll~ go 10 PIIIIV,J
14 --E"IIUl-ij;-;;;;;OU1~ allYl ~-"1I1 Unu IOIIlOV~.,~':~~~~,..~,~-,~~.~~=D=~~
115 l:lller Ihe 10141 Imounll II sny, olluUrnal.dd 1.1111 pllynlfJr1I~ you /lllldo.""""....""".."., ~
16 Add Iinul I" 811tJ 16, .', , , . , , . . , , . , , , , , , , , . . . , ' . . , , . . . , " . , , , , . , . . , . , , " . , , , , . . , , . , . , , , , , , , . .
,
a
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10 8
.!L __---.-lLQ.~_
8.3
\I
0'
11 Total un!jtrpdvment fOf' Ve., Subl1lclU". 16 I1-om IIno 13. IIloro 0110111 Ilor' hBfIl; )'OU do nol OWl the pen.lIv, 00 nol
lilu FOIIll 2210 U"llI~lS you chuckod bOil Id ebovd , . , . , , , . , . , , , , , , , , . , . , , , . , , , , , , " , , . , , , , , , , , , , , , , . , , . , . . , , , '!_
1. Multiply Unu 11 by ,060'04, , . . , , , : , , , : , , . , , , . , , , ' , , , . , . , , , , , , , , , , . , , , , , . , , , '" . , . . , . , , , . , . . , , , , , , , , , , . , . 1.
1\1 . IIll1u qIllIlUI\' DllllnlJ 17 ~II fJdld on or .lIer A1I610/. ollldf -0-.
. 1I1I1U 1I11l0Ullt 011111111 11 wu paid be'ofl ""5IU/, IIlllt.S IhQ fOllowing complJlullon 10 Ilnd Ihu Imounllo .,,1.,. on 11"1 10.
Amount 011 Numb.. 01 dllys paid
11110 17 bolao 4/l6/Q7 . ,00026".., " " II
~o PENAl.TV, Sublraclllno 1011-0'" line 18, Enlor Illu rOlullllere IInd on FOlln 10040,
11/111 63; Farn IOAOA, Un, 3": For", 10040NHllln. 63; FCtln IOAONA~EZ. Une 26; or
FUIIIl 10"', IIn. 26 "."".,...,...,..,...".""..".""",..""""""".".,.""".." ""'.'... 20
F~' P.pllwo,k Reduellon ACI Nolie., lie pege , 0' "parele In.llucllon., -
91-
51
5r
'am 2210 I' '"
~I-A
SC~fEDUlE SE J
IFo,," 10401
U.tlWIIII.IlI ullh.I....~~
1,,1.'Il'IItI~'lIIIlUIlIfIU
;;;;;; III 11.,101111I1111 ..1f....luylMnt t"(PlII'I" .hu,,"onPlrm I(I~
Self-Employmont Tax
~~!:!~~
1996
. 8.. In.llucllon. tolf 8ch.dull 8111'OIm 10401.
. ~\IlCh 10 'OIm 1040,
,lllachmtnl 17
...."'.nu Hd,
Mt.Cll A,
Sl:ancavnqQ
r;OClill"Clltl~ nutnDW QI p"'OI1l11llh
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:.110-58-4133
Who Mu.1 File Schedul. BE
11.111 1I11HlI lltl tkhlt,lul, 51! III
· \ "" hu.J lIul III IIIIlQ' 'oll1l1l1'lIlIploYII1."1 .0111 olh.. Ihll. chlleh '''>ploy" 11"0""1"'" 4 01 8hol /lol1ldul. 58 '" 1111 40 0/ Long /loI>ldUII 86 I
uf '''OU Ul 11I1)11, OR
· Yo" h..J cllllcll 11I11l10YlllnculI1. 011llllU8 '" 1110', Inco"" Mo", ..vk:1I you p.II. med '1' mlnllla- "'. m.mb. 01 ,"lIglou. ",dill. I1<lI
1;111"l.:h Ifllploy..lncoml, 5.. pig. se..l,
Nol" H.." " you h.d "0" .. . Iln.N .mounl 01 IIlCOII\' Mo", ..1I-'lI\lllay",.nl, IIl1\ey b. Ie yo.. b.n,nllo nl. 8chodull 5& .nd UII all""
'0111101111 1I1.1I10U"In Pili" oll.ollQ &I1Idul. 8E, llH Il.g. 8H.3,
roupllon, "yo.. o"'Y .1I1-.lI\ploYII\."II,",o"" ".. MOII\ .lInlnOI II. ""N'IIi', m.",bll 01. rlllgloU' ..dll,'" CIw,.U.n IlctoIIllle ",'OurOflll, IIId you
"IoU Forll1 4J61 ""U 11<:.,..d 11\5 ,pp<o..' nolla b.lu.d Dnll'o.. 'IInlno., do nol hi. /loh.dul. 8E, In.lo.d, WIll. "II..",pl-'",m 4301" on '..m 1040,
~Il. .4fi,
Mav I Uso Short Behedule SE or MUST I UlIe long Schedule BE?
No
y..
--- ,- }
NI you II lIIH1lllerlII1ll11b. or. fIWgIQU. adw, 01
l;hlltlll.1I Selunc" P'lc~Uon. who fec-'vlld IRS Vel
opp'O".1 nul 10 b. la..\J on ..,nlngl fro," lhl" .OLX"...
lJul'rlJU ow"...lI-lIlIlpluym.nllu on 0111. '''"lnu.1
, -.---<---.-- ----_.-
W.. Ih. 101., 01 yo.. w.g.. I"d Up, lublacllo locl.1
'l<:lOlly .. "lIto.d IIbrlln.nl,.. plul yo.. ".1
.lInlllUI ~om .."-.mploy"""1 n,...lh.n 'U,7007
YII
No
/.. you u.lnu 0"" ollh. OflUOII.'molhodl10 hall. YOI,
IIllewnlnu. ('" pig. 5E-3)1
YII
No
JNO
11;lll you IUCUIV, ChLXCh .mploy..lncoml ,.pOlI.d on
fOil" W-2 01 1108 25 '" m",.7
- ---- -I No
[Y9U M~_Y U5E 5HORT 5CUI!OlU SI! BELOW
No
Old you ,oc:llv. hpl lubll<:llo locIaI '1<:1I11y '" M.dlca"
I.. Ih.1 you did nol "pOllio your .mploy.?
Y..
YII
YOU MU5T U51! LONG SCIlI!Oll.l! SE ON Till! B~CK
,
S~cllon A - Short Bch'edule BE, Csullom Road 4bov.10 ..." you c.n UI' 5hlll8cl1ldule 5U.
.
Nollwlll p,ofll or (101151 frOI11 SchodlJlu F,U". 36. ind lOll" pullnot5hlpll 5chldulQ K-1 (Fam 1085)11101 151 . .... ..'.
I N.IIlIO'" II (10'" ~o'" 5eh.dul' C, II~. 3'; Sched,," C-El, II". 3; '"d 8ch.dul. K-IIFOIm 1000&I, line 1&. (olhlllh.n
IUIIIII.IU). MI'\ltll"'lllld mllmlJUlI 01 ,.UgtOUlS Uf,JOIIIU811lltJd tif!~IIQr III10Unll to "pOII on Ihl,'ln., 5,. PIU' GI!..:r for
ollllJl hu;oll'" Ie,) ,.pud, , , , , '.' , . . , , , , , , , , , , , . , , ' , , , ' , . , , , . , " . . . . . . , . , . . . , , , . , , , , , . . . . . . ,.. . . , . , , . . .
:J Co.nbhllllllll' 1 and 2, . , , , , . , , , , . . , . . ,. . . , . , . . , , . . . . . , , , , " , , , , , , , , , . . . , . , , , , , , . , . , , , , ,.' , . . . . . . . ,
4 N.I..nlllg. "om IIlr...mploym.,,\, Mulllply """ 3 by 02,3&% (,623&), II I...lh.n I~OO, do nol hie Ihll ICh.dul.;
you lJu f1lJt OWl .aU-tulplov,nunlla. , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . . . , . . . , . , . , , , , , , . . , , . . , , . , . . . . . . . . ...
6 5.1f~.mploym.nllu.1IIh. amounJ,;on lint 411:
. $62,100 011.... mUlllp'y 11110 ~ by '0,3'" (,lb31, E"I,,'ho fill'" h.. .nd 9" Form 1040, IIn. 41,
. MOl. Ihon 162,700, mulUply "". ~ by 2,0'1\ (.0291, Thon, .dd 17,774.5010 Iha r'luil,
ErllOf thu lotal hili and on form 1040.11"' 45.
J ""..,,,,,,
I 8 Oti5
~ 8 Q..G 5
4 ., 448
I 1 140
, , . j;
o nlducllon lor on.-halr 0' ..II-.mploym.nllll. MUlllply "". & by 150% (,61,
t:llllif I/IU l06ull h8l'B Ind on FOfm 1040 lI"a 211 , , . . . ,.... , . . .,."", '.., .. .. , ." .
for P,p.,,,,olk R.ducUon ~cl Nollc., II' F"'m 1040 In.uucUon.,
570
8chldul. 81! I'orm 10401 ..II
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