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and separated July 20, 1996. They are the natural parents of
two children. Ann Marie. born December 8. 1983. and Elizabeth
'B., born October 21, 1985.
After considerable negotiations today the
Master has been advised that the parties have reached a
settlement with respect to the outstanding economic issues.
An agreement is going to be stated on the record in the
presence of the parties. The agreement as placed on the
record will be considered the substantive agreement of the
parties not subject to any changes or modifications except for
correction of typographical errors which may be made during
the transcription. The parties and counsel will return later
today to review the agreement for typographical errors. make
any corrections as required. and then affix their signatures
affirming the terms of settlement as stated on the record.
If the agreement is not signed by the parties. they are still
bound by the terms of the agreement when they leave the
hearing room today, the signatures being simply an affirmation
of the agreement that is going to be plaCed on the record at
this tiM.
After the Kaster has been provided a
c~l.t~ agreement he wl11 prepare an order vacating his
appoint:Mnt and C'oun..l will then be able to file a praecipe
tratl:llllUtting the record to the Court reque$tinq " final decr..
i.n dh"'r-c-~L IV. was.. ,
MR. WASS: If it may please the Master, the
agreement of the parties with regard to the distribution of
the marital and the non-marital property is as follows:
1. The husband, Mr. Reynolds, will retain that remaining
sum of the inheritance which he received post-separation as a
result of the death of his mother and from his mother's
estate.
2. Husband will retain the post-separation contributions
and value of his 40llk) account at Salomon Smith Barney.
3.
value
which
Husband will retain as his non-marital interest
in a Travelers Group Capitalization Accumulation
came to him following the separation.
the
Plan
4. Husband will retain a St. Thomas time-share acquisition
which he made subsequent to the separation.
5. On the other hand, any non-marital assets which had
been acquired by Mrs. Reynolds post-separation will likewise
be retained by her.
6. With regard to the division of the marital property,
the parties have identified actually six items which
constitute marital property.
A) They are the marital home which the parties have
agreed has a net marital value, that is its agreed market
value reduced by the current balance of the mortgage
obligation, and that net figure is $101.841.00. That asset
will be transferred to Mrs. Reynolds and she will assume the
responsibility of the existing ~rtgage. That transfer will
occur within five days.
B) Th. contents within that home had been appraised
and the appraised value has been accepted by both parties at
$9.H,.()O and the entiret)i' of thase personal property assets
within thi' hOllW sh.all L'enmle the ptoperty of Mrs, flt"}'T\olds,
Ci 1'11... part I'H~ h4ve cnnt inuO'd to Nintdin a jointly
,)..-ned t1l,iht a.f s\Hvivorship Hlv""~tl!\<<-nt aC(:01.lJH dt SdlOlllOfi
r","!!ith a.un.... flM t~ dal'" (Jf Ih~il <I",parat ion .md In", l!\\')lllt
ft'oC@nt vahtation that the part ,"',. Mve been able to aqre'e "p'n"l
<1S of lll.ltinl\lhr of l,ut nl\Jht. is tft4t th@fEi' is $I'H, UL In
t h.Jt "H>:mmt. \"""~nd inq ("'11 :,.,t.v'" t f>!ldl ng, It !lid>' qo up "
~~tt t..i fit ~t ~');' q<? ,;l(\'~-:. ~\ litt ~p tHt [tt.!t th~ r'".i[ti~ra h..l\~~
agreed that the entirety of that account shall be transferred
to the sole name of Mrs. Reynolds. That transfer will be
accomplished either today or at the latest by tomorrow.
D) The remaining items of marital property include
three items. There is an IRA account which has a value after
payment of taxes because of early withdrawal made by Mr.
Reynolds. current value is $25.888.00. Mr. Reynolds will
retain that,
E) There is a 40l(kl retirement account of Mr.
Reynolds maintained at Salomon Smith Barney. That account has
approximately $142.200,00 in it and that account will remain
the sole and exclusive property of Mr. Reynolds.
Fl There is finally a Deferred Compensation Plan
which Mr. Reynolds also maintains with his employer Salomon
Smith Barney and that Deferred Compensation Plan has
approximately $6.347.00 in it which is marital property but
which Mr. Reynolds will retain.
7. In achieving this agreement of distribution. the first
three items go to Mrs. Reynolds. the last three items are
retained by Mr. Reynolds. But in achieving this agreement.
the parties have also given appropriate consideration to the
following items:
Al There has been included in my recital an add back
of $15.701.50 which had been removed by Mr. Reynolds from his
IRA account: that is an after tax withdrawal and that sum of
money was utilized by Mr. Reynolds for personal purposes and
family expenses. but the add back of that has been calculated
as being divided in the recitals heretofore made. 60\ of it
having been included in the distribution being to Mrs.
Reynolds.
BJ The second item that has also been included is the
fact that Mr. Reynolds. as a result of an automobile accident.
has to replace what was then a jointly owned automobile and he
did GO by utilizing an insurance c~ny check which the
p4rt ies have acknOWledged w-as in the sum of $7. !lOO. 00 and he
acquired a new vehicle by use of that check. 60\ of that
$1.500.00 or in fact $4.500.00 was also incorporated in the
distribution of assets provided to be made to Mrs. Reynolds,
Cl l'in.Uy, the p..trties MV. also ..tc!m{..'Wledqed th4t
[MIe ed wt, an ind<tbt@'dn't'u to tn. p.ilrf!'nU of !tn. !'I.ynolds,
That in~bt..m(Hul is a"Hled to be in the llum of $~.OOO.OC and
the ooUl,lation of that i~btl!'dn.n MS blten a'\iIMd by tn.
p.lrt hi'll t() be llMrlilKl ~..aHy. an'tlnHI'I'Jlv $.L ~\70 .,),1 "f ttwlt
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$5,000.00 has also been incorporated in the amount of the
distribution provided to be made to Mrs. Reynolds. The
agreement is that Mrs. Reynolds would then be responsible for
the payment of that debt if in fact her parents insist that
she pays them.
In summary fashion then, the home, the furniture
and the entirety of that balance in the Salomon Smith Barney
investment account previously jointly owned by them now to be
transferred to Mrs. Reynolds effectively represents a
distribution of the total of the marital assets to Mrs.
Reynolds in the percentage of about 60% of those total marital
assets.
8. The parties have agreed to secure the obligation of
college expense for the two daughters and for the continued
support of the two daughters in the event of the untimely
death of Mr. Reynolds. and provision has been made by two
means. Number one. Mr. Reynolds currently maintains a
$100.000.00 death benefit term life insurance policy with his
employer. Secondly, he will secure a new policy of term life
insurance in the amount of $50.000.00. Mr. Reynolds will
thereupon create a trust instrument to take effect in the
event of his death which will designate the trustee to be Mrs.
Reynolds who is the natural mother of the two children. Mrs.
Reynolds as trustee will also be named as the beneficiary to
receive the proceeds of the life insurance policies in the
event of the untimely death of Mr. Reynolds and she is then to
utilize the funds so received to provide for the support of
the children and also to assist in the payment of any college
expenses incurred on behalf of both of those children with a
provision that the trust should terminate at the attainment of
the youngest child to the age of 23 years. If Mr. Reynolds
continues to maintain good he~lth and continues to live and
lives until his youngest child has attained the age of 2]
years. then this provision for the continued m.intenance of
both of the life insurance policies and the trust instrum&nt
as well. shall be rescinded and terminated and Mr. Reynolds at
that point can do whatever he wishes with regar~ to cancelling
the life insurance polil-iea or by naming any other beneficiary
of his choke.
'}, The last itE'!!l to whkh tt,O;! pdft I.lll MV~ r....ched an
"9t_nt is that Uw ('tir t<l'M ',rd>l1'[ of *\J~t>cn which t'xllltll in
the C~~~rland Ccunty ~~e~tic ~.l~ti~ns ofilee at docket ~;~
$ 199'1 shaH ccntim.le In full hH\:e dnd efftk:t lt~cHlcall'y,
tholt cnt.r '"'HH'I'lt t't' pf<wid....s th-lt Mt. J;.y1~,)ld;1 i5 to
("t,'\t'\{W'll':ijt. th~ sue nf i'i.lv;'t. ..~r ~'(~t,n f;{H- ~<h qf t!'-dt lil"\:\
(hl1(tr~\ or 4 t;;:rt.:tl of SZ..Q',}.(.:;' ;;\r~t;.1 (~'--ift~n'f ;)~ it- pf,)vtd...s
l!'-..At in Add!! In!, hOt .'S i.\bhq'l'\:I t.;, cnMrH~~t.. iH\<t ~'4y th.. 11'.~
,
of $2.000.00 per month as spousal support to his wife, The
dollars will remain the same but the only change will be the
designation of spousal support effective upon the issuance of
a decree in divorce will be changed to reflect that it is now
in the form of alimony.
The parties have further agreed that the amount
of alimony will be unchallenged by Mrs. Reynolds in terms of
its amount until one of two events occur. Number one. the
youngest child who is Elizabeth shall have attained that age
or level in life when she is no longer entitled to receive
support from her father. and that will be either on her
attainment to the age of 18 years or graduation from high
school whichever would be the last to occur. The second
reason that would enable Mrs. Reynolds to file for a change in
the alimony would be in the event it is ascertained that the
gross income from employment of Mr. Reynolds should reach the
level of $230,000.00 per year. Other than those two items.
either party otherwise would have the right after the youngest
daughter is no longer of support age to contest the amount of
the alimony. The alimony is to be indefinite in its term.
Alimony as provided will terminate upon the death
of either party, the cohabitation of wife or the remarriage of
wife.
10. It has finally been agreed that each party will pay
their own counsel fees and costs.
11, All property in the possession of either party at the
present time titled in their names remains their sole and
separate property. whether it is bank accounts. brOkerage
accounts or any other assets.
12. Except as herein otherwise provided. each party may
dispose of his or her property in any way and each party
hereby waives and relinquishes any and all rights he or she
may now have or hereafter acquire under the present or future
laws of any jurisdiction to share in the property or the
estate of the other as a result of the marital relationship
including without limitation. statutory allowance. widow's
allowance. right of intestacy. right to take against the will
of the other, and right to act as administrator or executor in
the other's estate. Each will at the request of the other
execute, acknowledQe. and ~li\~r any and all instrum-nts
which may be necessary Of advisable to carry into effect this
aut~l wai\~f and r.linquis~nt of all such interest. rights.
and claims.
MR. WASS: Bob, you are the Defendant in
this divorce action and you've heard me very methodically
identify the text of the agreement as I have discussed it with
you, as I have shared with you and as I have recited it. Is
your understanding of what I have said correct?
MR. REYNOLDS: Yes.
MR. WASS: And is it agreeable to you?
MR. REYNOLDS: Yes.
MR. WASS: Thank you.
MR. CONNELLY: Mrs. Reynolds, you heard Mr.
Wass place on the record the terms and conditions of the
agreement: is that correct?
MRS. REYNOLDS: Yes.
MR. CONNELLY: And that we have also talked
about the assets over the last several days in some detail: is
that correct?
MRS. REYNOLDS: That's correct.
MR. CONNELLY: Did you understand the
agreement as it was placed on the record?
MRS. REYNOLDS:
HIt, CONNELLY:
tenu and conditions?
HItS. REYNOLDS: Yes.
MR. ~Y: Do you under.tand that by
acknowlt'dQing on tn. f'e<'ord now that it COIIllpletH tn. Mtter
Yes. I did.
Are you in agr....nt with its
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J1MES S~ITH DURKI\ & CO\\ELLY
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TEL:"l' 5JJ 3280 .
P,002/005
MARY ANNE REYNOLDS,
Plaintiff
: IN THE COURT OF COMMON PLEAs OF
: CUMBERlANDCOUNTY,PENNSYLVANlA
v.
: NO. 96-5180
ROBERT M. REYNOLDS,
Def=dmt
; CIVIL ACTION. LAW
: IN DIVORCE
PLAINTIFrS AwrnAVlTOFCONS~NT
AND W A'VIlR OF COII1\J,UI.ING
I. A Complaint in Divorce IIIIdcr Section J301(e) of the Divorce Codo wu filed on
Sepla11bcr 18, 1996.
2. The marrtaac of tho Plaintiff and Defend-Ill is irrcuievably broken.1lld IIincty da)'I
bave cl"ted /Tom the dI&e ofboth the &m, and service of the Complaint.
] I COIlHlU to the clllfry of. final decree ofdivoree after eeMcc ofNocice oflnt"Glioa
10 reqIleIllllllry of the Dccrcc.
... J have been advised of the availability of marriqe ........AAI:"& IDlIllIldcnrUIlIlhat (
may request that tile Court nqIIire tba! my IpOlIIll IDlI I rarticipate ilI~. I ftmbcr
IIIlIScnQnd thaa the COIIIt mamtaina a list of marriacc coua.elon in !be PnlthoDotary. Of&e,
wbIch lilt is avlillbJe 10 me upon request. Beine 10 IlMad, I do IIOt r..- tItaIlbe Court reqain
that my IpaUII Md I pIrtidpaec ill CQ4' ... II.., prior 10 a diYllR:e deaee ....1IIDde:l dowa by rbe
COIIIt.
I Wlrit)o tba! tilt at -., IDIIdc lD tNa AJJI4mt ft1l1le Illd eoma. I ....rf"*--S IMt
!aile.. ~ lIereiza ft IDIde IUlljtct 10 Ibe ~ 0( II Pa. CSA ~ 49IM, w - ~. la
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JAMES S~ITH OURKI~ & CO~~ELLY
TEL'-I" 53j 3280
P,004/005
MARy ANNE REYNOLDS,
Plaintiff
: IN THE COURT OF COMMON PLEAS OF
: CUMBElU.AND COUNTY. PENNSYLVANIA
v.
: NO, 96-5180
ROBERT M. REYNOLDS,
DefClldant
: CMLACTJON-LAW
: IN DIVORCE
DF.FFNnANT'S AmnA \'IT 0' r~i:NI
ANn W AlVIi'fl OF Mt1NSF.r.
I, A Complaint in Divorce IIIlder SeClion 3JOI(c) ofllle Divon:e Code wu IDee! on
September 18. 1996.
2. The mmiage of the PwntitT and ~f~Ult ia irrelrie\-abIy broken, and ninety days
bave e!lp1Cd fi'om the date ofbolh thc filial and aervice o(tbe Complaint
3. I COIlSCZlt to the IIIltJy of a final decree or divorce after Icnice o(Notice ofrntentioa
to I'llq\IeIt CIlCI')' of the Decree.
4. r bave been adviIed oflhe availability ofmamace COtIft>>/"a. and unde.itllnd that r
may Nq\lell1Iw !be Court require that my IpOIlte and I ~ ill COIIIIIIIiIIa, J IIIrtber
IInd6A..d that !he ColIn mainuina I list of m.vriqe c:ounselon ill !be Protbov~. Oftice.
.hich list it avaiJabJe to me lIpOn tcqucIl Bana 10 Ill.. J do DOt IIqUat tIlat tbc Coan require
tbaI DI)' IpO\JIc lIIId I pIfticipatc in ...........Iirlc prior to I diVOft1C dca1e bcina bIlnded Ibm It) the
Coun.
I \'trity lllaI tbe --..... made 11\ dliJ AtIl4av1t 1ft InIc ... ~ I ~....t tNt
tiIw Rlk._IMnia..1lUIdrt aatIjed IDtIllt~of II PI. C,SA ~. ~ Nt.Icinc"
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IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. q~"lj)qo CIVIL 19
IN DIVORCE
STATUS SHEET
DATE:
ACTIVITIES:
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MARY ANNE REYNOLDS
IN TilE COURT OF COMMON PLEAS or
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO,
96- 5180
ROBERT M. REYNOLDS
CIVIL ACTION - LAW
IN DIVORCE
ORDER AND NOTICE SETTING HEARING
TO: Mary Anne Reynolds , Plaintiff
John J. Connelly, Jr. Counsel for Plaintiff
Robert M. Reynolds , Defendant
Carl G. Wass Counsel for Defendant
You are directed to appear for a hearing to take
testimony on the outstanding issues in the above captioned
divorce proceedings at the Office of the Divorce Master. 9 North
Hanover Street. CarlIsle. Pennsylvania un the
of June 2001 at 9:00
19th
day
a.m., at which
place and time you WIll be given the opportunity to present
witnesses and exhibIts in support of your case.
~ eT!'"
I. J. Q,.
President Judge
Date of Otder and
No ti ce : Jl2()" I
8y:
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Divorce Master
It' n:;u t)j} Nt'rt HAV,: ^ I..AWYU 011 CA.,,!'<tlT ,urnll!! (iNt, GQ TO OR
n:U:PttONf;. TilE orner. SF.T roRm BILOW!'.) ON!) OUT WHERE Yf,ll,! (AN
i,:n LtGAl. Il"LI'.
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MARY ANNE REYNOLDS,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Vs.
NO. 96 - 5180 CIVIL
ROBERT M. REYNOLDS,
Defendant IN DIVORCE
RE: Pre-Hearing Conference Memorandum
DATE: Friday, February 16, 2001
Present for the Plaintiff, Mary Anne Reynolds, is
attorney John J. Connelly, Jr., and present for the Defendant,
Robert M. Reynolds, is attorney Carl G. Wass.
This action was commenced by the filing of a
divorce complaint on September 18, 1996, raising grounds for
divorce of irretrievable breakdown of the marriage and
indignities. Counsel have indicated that the parties will
sign and file affidavits of consent and waivers of notice of
intention to request entry of divorce decree so that the
divorce can be concluded under Section 3301(c) of the Domestic
Relations Code. The complaint also raised the economic
claims of equitable distribution, alimony, alimony pendente
lite and counsel fees and expenses.
With respect to the alimony claim of wife,
counsel are going to determine if they can stipulate to an
alleged extra marital affair which husband had prior to
separation. If husband denies that such an affair occurred,
then we may have to take testimony on that issue and counsel
are to advise the Master if that is to be part of the
testimony at the hearing. Otherwise, counsel should provide
the Master with a stipulation to be made part of the record.
The parties were married on October 4, 1980,
and separated July ~O, 1996. They are the natural parents of
two children, Ann Marie, born December 8, 1983, and Elizabeth
B_, born October 21, 1985.
Wlte is 47 ~~.rs of age and resides at 6))~
Stephen's CrOS$lnq. Mechanlcsburg, Pennsylvanla. where she
lives with the two daughters. She ha, a tcur-y~af bUSiness
and finance degree and 1$ currently wer_Iog as a customer
serVl,e representative With Cc~erce Ban'. Her net ~ekly
lnc~~ from her current emplo~ent IS $~94.GG. Accnrdinq to
an order entered In the sUPf~rt Pf'~-~~I~q3, w.f.'~ tncoae
~t~lv w~s 15~e$$~~ ~t $l,I'~.I). Wlf, 1$ reCelYln1
S:.OCO_t0 . ~vnth 10 s~0u'.1 $~rPQrl A~~ $:.4Q0,00 in chil;t
support, She has not raised any health issues.
Husband is 46 years of age and resides at
4912 Jonestown Road, Harrisburg, Pennsylvania, where he lives
with a female friend, Husband has a four-year degree in
business. He is a stockbroker with Salomon Smith Barney and
according to the order entered in the support proceedings on
April 25, 2000, husband's net monthly income was assessed to
be $12,768.74. Husband has not raised any health issues.
The parties own real estate at 6335 Stephen's
Crossing, Mechanicsburg, Pennsylvania. Husband has suggested
that the market value of the property is $200,000.00; wife is
suggesting a value of $192,000.00. Counsel are going to
reserve the right to have an appraisal if it is necessary;
however, counsel have discussed the possibility of averaging
the two values if the parties agree. The property is subject
to a mortgage in favor of Chase Bank of around $100,000.00.
We will need an accurate mortgage payoff at the time of the
hearing. The monthly payment on the mortgage which includes
escrow for taxes and insurance is $1,223.07 pursuant to a memo
which wife provided her attorney lndlcating that the mortgage
payment had increased.
Listed on the inventory and appraisements of
the parties are various Salomon Smith Barney accounts.
Counsel are going provide updated statements as of the date of
hearing so we have current values and we wlll have to
determine whether or not any withdrawals were made
post-separation as well as any contrlbutlons post-separation
to determine the accurate value for those accounts.
With respect to vehicles, a jointly owned
vehicle was traded in for $7,500.00 and that money was used by
husband to purchase his current 1991 Volvo. HUSband,
therefore, received an advance an eqUitable distribution by
the receipt of those funds. Further, each of the parties
apparently received other advances on equltable distribution
cut of accounts ilnd c-ounsel ilre qQlnq to deterllune what those
amounts were and fro~ what dCC0unts that mChey was taken.
U!ltE'd en the pretrial statel!'ents are Vanous
It~ms of non~m.rlt.Z assets Includlnq a TrAv.lers Group fund
and a St. rh')l!\,,~ Ul"ot'j,hatl:' and an \nh."ntat,cl" fr,)::'\ I'l'JSb.\tlJ'S
~i,)thef.$ t,ll~~~t~~ 1 ~h<;,~~t{j d'li't~f~.tr\~ wh~tt,er('r ni]t w\~
~,e.~tt ~(~ c{:,~~l;,1t\l J.r:y f.f;\':rf'>Jl,~~ in valvf\ ;;"t thfl' fiL'!::"~artt.;al
.,l$$if'ts ft(\~ t.h~ 'iji!~f\ \:~'f- ~lc-q\l..~gltlO~. "i:tll",.;,mlh"; tf",If\"i ~P:-f,~
+\~L'_~l~lr~,;j d\.Jr-th,~:'; tte e",i.:rr!i':\l~ 4~.,-d _ti~r~ ~,t1~ f':it!! ~f";;, ".'l'1!~ llyt~~>~
t"~';l~,t-,t,;...t ~ t\'- !f:fi" \t,~! ~ ,'r ;;~r"l:'..tt F'~r-"..
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-
.
N~.?G '4.
MARY ANNE REYNOLDS
Plaintiff
vs.
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY. PENNSYLVANIA
NO. 96-5180 CIVIL
CIVIL ACTION - LAW
IN DIVORCE
ROBERT M. REYNOLDS
DEFENDANT - ROBERT M. REYNOLDS
PRE.TRIAL STATEMENT PVRSUANT TO RULE 1920.33(b}
I. ASSET!;l
A. Marital Prooertv
Valuation
Amt ~ 12m I.iID
1. 6335 Stephen's Crossing $200,000 Current Estimate Chase Bank
Mechanicsburg $100,000
2, Household fumiture and $15.000 Current Estimate None
furnishings
3, Salomon Smith Bamey $176.458 10120I2OOO None
Investment Account
4. Salomon Smith Barney $25.190 10120/20OO None
IRA Account
5. Salomon Smith Barney $43,658 1012312000 $5.000
401 (K) Account
6 SaIomor. Smith &.mey $7.313 1012312OOO None
DIferred Camp Account
B. Non..,...., ~ Of HuIIMInd
, I~ - Mother's $2SO,6tO April. 2000 None
eltW
,
2. Salomon Smith Bamey $112,374 10/23/2000 None
401(K) Account
3, Travelers Group Cap $99.838 10/2312000 None
Accumulation Plan
4. SI. Thomas Time Share $6,500 10123/2000 (Est.) None
II. EXPERT WIT~J:SSES
At the present time. Defendant does not anticipate the need to call any expert
witnesses.
III, NON-EXPERT WITNESS~S
At the present time. Defendant does not propose to summon any non-expert
witnesses, other than the offering of his personal testimony.
IV. EXHIBITS
At the pt esent time, the Exhibits wt1ich Defendant ptoposes to offer include:
Exhibit 1 . Salomon Smith Bamey account position summary of 10120I2OOO as to
jointly owned investment ac<:ount No, 724-81721-'.1-789, of the PIalntiff and
Defendant.
Exhibit 2 - SaIomol, Smith Barney eccount position statement dated 10120I2OOO
as to accovnt No, 724-68060-1-7-789. IRA account of Defendant
Exhibit 3 - Benefits_I"*" of the T,....I.rs Group 401(K) things pten of the
Defendant, account No 7247890. as of 1012312000
Exhibit 4 . BewIil!. "n~mtnt as to Travelers Group c.- ~ Plan
of the Defend8nt. as of 1012312000
.
Exhibit 5 - Benefits statement as to deferred compensation plan of the
Defendant as of 10/23/2000,
Exhibit 6 - W-2 form of the Defendant for calendar year 1997.
Exhibit 7. W -2 statements of the Plaintiff for the two calendar years 1998 and
1999,
Exhibit 8 - (To be supplied), Document verifying indebtedness of parties to
Joseph and Ann Boyer.
Exhibit 9 . 1999 Federal income tax return of the parties Qoint filing).
Exhibit 10 - 1999 Pennsylvania income tax return of the parties (joint filing).
Exhibit 11.1999 W-2 statements of the Defendant.
Exhibit 12 - Final pay stub of Defendant for calendar year 1999 (dated 12110199),
ITEM V. INCOME OF DEFENDANT. ROBERT. M, REYNOLDS
Robert M, Reynolds is employed by Salomon Smith Barney in the capacity of a
sales person of stocks, bonds. and other investment opportunities. His compensation
is based upon commissions received from his sales activity. The nature of his business
is that. in order to maintain his competitive position with other sales persons in the
investment market. he is required. personally. to expend sums of money for 'dient
nurturing' Reference to the December 10, 1999. pay stub of Mr. Reynolds will reveal
that his sales compensation for the entlre year was $157.443, This t\gunt 1S,In fact:. the
average amount of employment income which the Defendant IS able to generate on a
year to year baSIS An unusual aspect of Oefendant's empfoyment during 1999 was
that a 'retll'ement bonus- wasllCCOrded to Nm wh\(:l, thoogI'l he COOld not lran$f.ate Into
personal cash income without penalty, was, nevertheless, required to be included as
part of his gross compensation for tax purposes for 1999. In similar fashion. the
Cumberland County Domestic Relations Section also treated that "capital vestment" as
if it were a stream of income. In 1999, the figure for capital vestment was $50.413.
Defendant has indicated, upon his Income and Expense State. that his net
monthly income is $11,322. This calculation follows that calculation of Cumberland
County Domestic Relation Section, The calculation. however. does not exclude the
"capital vestment" figure, More realistically. Defendant maintains that his monthly net
income, absent the "capital vestment". is approximately $8.500 per month.
VI. INCOME OF PLAINTIFF. MARY ANNE REYNOLQS
Plaintiff is employed as a secretary in a Harrisburg law office, Her gross
eamings for 1999 were $15,900, Her net monthly income appears to be $1.200.
VII. PENSlONIREnR~MENT
The Defendant acknowledges that he has a reasonably substantial retItement
benefit program available to him through his empIoyment-telated 401(K) plan and a
personal IRA account, both of which ha~ been identified on the IrMlfltory and
Appraisement It is believed that the ~ has an IRA 8OO:lUt\t howtMtr, the
exIStence thereof and the value thereof ate not known to the Defendant,
VIII. COUNSEL.illS 6NO EXfJENSES
To the present date, Defendant has incurred counsel fees and expenses with
three different 8110rneys,totaling more than $14,000.
IX, m&elJTE AS TO PERSONAL !'ROP~8T'(
Defendant is unaware of any potential dispute as to the personal property
(household furnishings) of the parties. Defendant is residing outside of the marital
household and has no interest in receiving any of the household furnishings.
X OEQlS
Nature Date Initial Present
Cr:mt11Qf ofOebJ Incurred ~ Balance
, ChaM Bank Home mortgage 1986 $130.000 $100,00 +/-
2 Joseph and Ann Personal loan 1995 $5.000 $5,000
Boyet
XI
0eItIndant. Robert tot Re)I'lOIda, ~:I..lhIIlhent be... aside and .'-rerded
to .. PWlIift 1hit falIo.Mng'
....... Home .533S Stephen's ~
tSubted to IhiIting II~)
."~F~
$too,ooo
$ 15.000
P~ge: 1 Document Name: untitled
FBEC550 B E
FBEM590 TRAVELERS OR
S
NGS PLAN
EMPLOYEE NAHll: RIlYNOLDS, ROBERT M
EMPLOYEE 10:
401(11:) AS OF 09/29/00 P'llT1JRB EMPLOYEE "COMPANY
P'\JND NAME PCT' ACCOUNT ACCOUNT TOTAL BALANCE
---.......--------------------- --....... .. ......--....-..--- ...------.... --------..--..-
Citigroup Common Stock Fund 60' $122,927.36 $37,970.95 $160,898.31
Appreciation FUnd 10' $204.16 $0.00 $204.16
International Equity Fund 20' $39J.4J $0.00 $393.43
VltAC Emerging Growth FUnd 10' $458.42 $0.00 $458.42
~.............................................................................
TOTAL (EXCLUDING LOANSI
$123,983.37 $37.970.95
$161.954.32
" OUTSTANDING LOAN(SI (PRINCIPALI
CLOSING BA1.NICB (INCLUDING LOANSI
. VESTED ACCOUNT IlALANC'B (EXCLUDING LOANSI
Y PAGS
VERB TOPIC/SUBJECT
$0.00
$161,954.32
$161,954.32
PGE orr PCI BXBC
PI BJCMlC P2 I\ACJ( P3 A
P4 S
P5 BXBC
MAIL
IIOTY
P6 0lII (AI
RBCD
PSHP
ADVL
C"r ",,' \\"'~VL-
\()\'l~ lD~ ~
\S"\ ,0:'2.
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Page: 1 Document Name: untitled
.
,-. ..__...~.- _.~._'----- -~-".-'~ _....._._---~_..__.- ..-..----.-.-----
FBBC500 B B N E FIT S DATE: 10/23/2000
FBBM500 TRAVELBRS GROUP CAPITAL ACCUMULATION PLAN TIME: 09.43:55
RESTRICTED SHARES AS OF 10/15/2000
FCI SIGNON 10. 7247890
EMPLOYEE NAME: RBYNOLDS,ROBERT M EMPLOYEE 10: 202-46-7204
-------------------.----------------------------------------------------------
(1) .. (2)
'.. D~\
G ~SCOUNl' INITIAL 83B SHARIlS MAR1tBT
TB ",\ICB DOLLARS COST BAS IS ICTBD VALUE
07/01/2000 32. 184 29,186.39 0.0000 889 07/01/2002 45,300.69
D7/01/1999 24. 414 5.181. 58 0.0000 212 07/01/2002 10,798.85
01/03/2000 27 262 8,422.16 0.0000 302 01/03/2002 15,417.40
01/02/1999 .5039 10.288.17 0.0000 556 01/02/2002 28,321.52
.............
.........
.............
RESTRICT TatAL 53,078.30
NOTE: (1) \lIIIOLB SHARIlS ONLY
1,960 99,838.46
(2) VALUED AT PRIOR MY'S CLOSINa PRICK
INVALID REQUEST IlHTBRID
VERB TOPIC/SUBJECT
PRHT
F1 BICMIt '2 BACK IF3 A
PGE OFF Fe, EXBC
F4 S '5 laIC'
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BQTY
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Page 2
fOHll'i:<lllll't'1'11
34
34
3511
Amount from line 33 (adjusted gross Incomel . . . . . . . . . . . ..
Check It 0 You were 65 or older, 0 Bhnd, 0 Spouse was 65 or older, 0 Blind.
Add the number of OOllC5 check.ed above and enter the totaf here,. ... 35a
b If you are marned tIling separately and your spouse Itemizes deductIons or 0
you were a duaJ.slatus alien. see page 30 and check here . . . .. ... 35b
(01.. your ~.ml1ed deduction. trom Schedule A. line 28, OR .land.rd doduc1lon
shown 00 the left, But ..e page 30 to find your standard deduction n you checlled any
box on line 35a or 35b or n someone can claim you as a dependent, , . . . .
Subtractllne36lromllneJ.l , . . . . . . ('" ".' .' . . . '. . . .
If fine 34 is $94,975 or less. mull,ply $2,750 by the total number of e.emptionl claimed 00
line lSd, If line 34 10 0... $94,975, &88 the wor1<lheel on page 31 101 the IITlOImlID enter .
T..-Income. Subtract line 38 lrom line 37, If line 38 Is more !hen line 37, enter .Q.
Tu lM8 page 31). Check hny la...!rom a Oform(s) 8814 b 0 Form 4972 . . ~
CredIt lor _ and dependent care upenses, _ Form 2441 41
CIadillol the ~ 01 the disabled. AttacII Schedule R . .~ 42
.. ''1 '43
ChIld tIP credCt (,. page 331 . . . . . ':-'. -~f-:.... ~ - --
E4aI1on 01IdIts. Attach Form 8883 . ... . '. "',.. 44
Adoption cnldll Attach Form 8839. , . . . . .:'. "_. ,:45
Foreign lax credit. AttacII Form l11U required , ;' . ~ t : 45
Other, Check If from a 0 Form 3800 b 0 Fonn 8396
cO Form 8801 dO Fonn laPe<:rlyl ..~ '4'
Add _ 4t lhrough 47, These are y<u totaI..- ..'.
Subtract line 48 ~ Itntt 40 "line 48 is more than lJne 40. enter .().. .
Tax and
Credits
..
~
e 17L
Standard
Deduction
for Most
People
36
; 37
'38
SIngle
$4 300
Head at
househOld
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sa
13
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SoctaI ~ and !ledicara tax on tip """"'" I'd ropor1Wd 10 ~, _ Fonn 4137 w'
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MARY ANNE REYNOLDS ) IN THE COURT OF COMMON PLEAS
Plaint if f ) CUMBERLAND COUNTY, PENNSYLVANIA
)
vs, ) NO. 96-5180 CIVIL
)
ROBERT M. REYNOLDS )
Defendant ) CIVIL ACTION - LAW
) IN DIVORCE
INCOME AND EXPENSE STATEMENT
Q.E
ROBERT M. REYNOLDS
Defendant files the following Income and Expense Statement and
verifies that the statements made herein are true and correct.
Defendant understands that false statements herein are made subject
to the penalties of 18 pa.c, .S,'"M4,9, 0,41 re,la, ting to unsworn
falsification to authorities. \:_ '~" '\ \, (.
.,..\..(-' ~ \.~ '.", ,J-
-" Defendant ',J
Dated:
\\.~,-~)
INCOME:
E\!1pl oyer:
Address:
Type of Work:
Payroll Number:
Pay Period:
Gross Pay Per Pay
Salomon Smith Barney
11 N, 3'1 Street
Harrisburg, PA 17101
Stockbroker
19906
Monthly
Period: (Varies) During 199~.
$16,316.00 per month.
Itemized Payroll Deductions: ·
Federal Withholding
Social Security
Local Wage Tax
State Income Tax
Retif1!tllent
savings Bonds
Credit union
l.ife Insurance
Health Insurane.
Othu (~ify)
average was
· (Varies) During un, avenge wss
$4.994,00 per month
RT 'At I'D PAY rPlCO: Avera<;Je durill9 1999 Sll.lU.po
EXPENSES:
Week
AUTOMOBILE
Payments (Daughter's Car)
Fuel
Repairs
MEDICAL
Doctor
Dentist
Orthodontist
Hospital
Medicine
Special needs (glasses,
braces, orthopedic
devices)
EDUCATION
Private School
Parochial School
College
Religious
PERSONAL
Clothing
Food
Barber
Credit Payments
Credit Card
Charge Account
Memberships Friendship Center
LOANS
Credit Union
MISCELLANEOUS
Household Help
Child Care
Papera/Books./Magazines
Entertainment
Pay TV
Vacation
Gifts
Legal Fees
Charitable Gifts
Other Child Support
Alimony P,aymentl (Spousal!
OTHER
Busine.s E~n8e8
TOTAL EXFENSES
f'ROPIiJlTY OWNED:
$
I
-
Month
Year
200.00
130.00
2,400.00
1,560.00
33.00
400.00
167.00
333.00
29.00
366.00
2.000.00
4.000.00
350.00
4.392.00
21.00
250.00
25.00 100.00
500.00 6,000.00
83.00 1.000.00
250.00 1.000.00
250.00 1,000.00
42.00 SOO.OO
2.400.00 28,800.00
2.000.00 24.000.00
1,<;00.00 18,000.00
$
MARY ANNE REYNOLDS ) IN THE COURT OF COMMON PLEAS
Plaintiff ) CUMBERLAND COUNTY. PENNSYLVANIA
)
vs. ) NO. 96-5180 CIVIL
)
ROBERT M. REYNOLDS )
Defendant ) CIVIL ACTION - LAW
) IN DIVORCE
INVENTORY AND APPRAISBMBNT
Ql
DBPENDANT ROBERT M. RBYHOLDS
Defendant files the following Inventory and Appraisement of
all property owned or possessed by either party at the time this
actlon was commenced and all property transferred within the
preceding three years.
Defendant verifies that the statements made in this inventory
and appraisement are true and correct. Defendant understands that
false statements herein ar'e made subJect to the pen<'lt 1es of 18
Pa.C.S. 5 4904 r"htUl<) to unsworn falsihc..I.t ion to authorities.
,
.
\... )
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ASSETS OF PARTIES
Defendant marks on the list below those items applicable to
the case at bar and itemizes the assets on the following pages. If
an item has been appraised, a copy of the appraisal report is
attached.
Real property
Motor vehicles
Stocks, bonds, securities and options
Certificates of deposit
Checking accounts, cash
Savings accounts, money market and savings certificates
Contents of safe deposit boxes
Trusts
ute insurance policies (indicate face value. cash
surrender value and current beneficiaries)
Annuities
Gifts
Inheritances
Patents, copyrights, inventions, royaltIes
Personal property outside thp home
Businesses (list all owners, including percentage of
ownership, and officer/director positions held by a
party with company)
IX ) 16. Employment terminatlon benefits- . severance pay, workman's
compensation claIm/award
11. ProfIt sharln9 plans
18. ~mllion plans (indlclltE' e~loyee contnbutlon and date
plan "",,,slS)
19. l'letir...ment plans. IndiVidual rel lt~ent accounts
20. OUiiabdity pa)~nts
21. LHIg.\twn diU\l\$ ,!Mt\.lff'd ,\r,d ur.-turl"dl
22. MII,tilly/V.A, ~lletlt8
2 L tdw;~'H Ion t"l1!,;<!' fl ~.-
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LIABILITIES OF PARTIES
Defendant marks on the list below those items applicable to
the case at bar and itemizes the liabilities on the following page.
SECURED
X 1. Mortgages
2. Judgments
3. Liens
4. Other secured liabilities
UNSECURED
x
5. Credit card balances
6. Purchases
7. Loan payments
8. Notes payable
9. Other unsecured liabilities
( X
CONTINGENT OR DEFERRED
10. Contracts or Agreements
11. Promissory notes
12. Lawsuits
13. Opt ions
x 14 . Taxes
( l IS. Other cont.tnqent Ot' deferTe.:i liabllltiu
~
MARY ANNE REYNOLDS,
Plaintiff
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
ROBERT M, REYNOLDS.
Defendant
: CML ACTION. LAW
: IN DIVORCE
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: NO, 96-5180
PI.AI'TIFF'S PRE. TRI"-I. ST A TEl\IEI\T
Date of Marriage:
Date of SepandoD:
Dlvoree Complaint fdlng date:
October 4, 1980
July 20.1996
September 18. 1996
I. ASSETS
A. Marital Propert)'
See Plaintiffs InventOl")'
and List of Furnishings and PmonaIty
B. NOD-marital Propert)'
(Exhibit . ^ .)
(Exhibit . C* )
See Plaintiff s Inventory
(Exhibit -Aj
1. EXPERT \\1TNESSF.5
Plaintiff l;oows of no expert witnns4!'S at this time. HO\\'C\'Cf. Plaintiff mer'\'CS tht
nglrt to suprlement this iIIlS\\'Cf sOO\ild such becOlN: availabk,
~ NO~LX~T\\~L~D
Plaintiff ~1 of 00 n"ln-opc:n .,tness at this l\m( ..lIt nrqltlM 10 tht pIRies,
H<'\\'C\'cr. Plainllff men es tht riJN kl ~ lN1 __'Cf ~ 1IIeh ~
1,'lil4blt
MARITAL PROPERTY
Plaintiff lists all marital property in which either or both spouses have a legal or equitable
interest individually or with any person as of the date this action was commenced.
ITEM NUMBER DESCRIPTION NAMES OF ALL
OF PROPERTY OWNERS
1. Marital Residence Husband and Wife
633S Stephen's Crossing
Mechanicsburg. PA
Estimated S 192,000.00
3. Salomon Snuth Barney Husband Wife
Acc!. No, 724-81721-1-1-789
Marital Balance in account to
be Delermined
19, Salomon Smith Barney IRA Husband and Wife
Acct. No, 724-6&060-1-7-789
Marital Bahmce in account to
be Determined - Balance al
date of separalion
approximately S 113.000,00
3. I Salomon Snuth Barney 401(k) ,
Balance to be Determined i
19, I Salomon Smith lJarnev Husband and Wife
I Deferred ('ompensati~ Plan
I Balance to be Determined HIISband and Wife
3. ! Trndm Stock
i Nwnber ofSharn and Value
! to be Determined
9. ! Salomon Smuh Ilamey Husband and Wife
; Deferred ('(~ Plan
: BaJancc 10 be Detmnmcd
.---------- -,
MONTHI.Y YEARLY
(Fill In appropriate column)
Employment
Public Transportation
Lunch 553.30 5639.60
Car Phone 550.00 5600.00
Taxes
Real Estate
Personal Property
Income
lusuruce
; Homeo1Jl.ner5
,
I
I
j Automobile 5127.42 51,529.04
I Life
I
t A~ident
Health
j Other
I Automobile
I
, PaymentS $426.34 S$.H6.08
!
!
, Fuel 1255.00 13.060.00
I
l Repairs $1()U3 11.2$7.96
I
, l\IedkaI
I
1 Ooetof 511.15 SJ25.00
Dentist $41.J5 $49'.00
Tbcrapi$t $4(),OO S480.00
l'k..." (lida) $.t9..u WlU4
),bJiciM
$pect.JJ Ncott (.... ..... $4U: $W$.Q4
tnta.~ dmcft)
MONTHI.Y VEARt.V
(FIIIID appropriate columD)
EdueadoD
Private School 5200.00 52,400.00
Parochial School
College
Religious
Penonal
Clothing 5438.33 55,259.96
Food $650.00 57,800.00
BarberlHainlRsser 570.56 5846.72
Loan (parI:nts) 530.00 5360,00
Charge Accounts 53S0,OO 54.200,00
Memberships (YMCA) 537.00 $444.00
Loa..
Credit UniOCl
MIscdJutou
HouseboId Help 530.42 536'.04
Child C&rC (summer) 5 I 00.00 51,200.00
hpcriBoob'MapziDcs $3).00 $396.00
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\'Hadea $19$.13 S3~9.96
PIaH' 1R LM S 120J'O $1.440,00
[ltnnln'tNlar Adtfldn saUl 5969.96
...... 'tft s: IUD WIO,OO
n.atIUWrC1UI..th It W,OO SlOO 00
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TOTAl, t.UI~ S5.M1.11 m.m."
In the Court of Common Pleas or CUr.WERLA.I"iD Count~', Pennsylvania
DOMESTIC RELATIONS SECTION
MARY A. REYNOLDS ) Order Number 629 S 1997
PlaiD/iff )
VI. ) PACSES Cas: Number 427000075/iJ6Ct/:fO
ROBERT M. Rl!:YNOLIlS ) Docket Number 629 S 97
DefeDdanl ) Other State ID Number
ORDER OF COURT
li> FInal 0 Interim 0 Modified
AND NOW.
25TH PAY OF APRIL, 2000
.based upon the Coun's
determination thaI the Payee's monthly net income is $U99,12
and the Payor's
monthly net income is $ 1~, 768.74
. it is hmby ordered that the Payor pay to the
Pennsylvania State Collection and Disbursement Unit
FOUR THOO:>AND FOUR II'JNDRED AN:) XlC!100
Dollars ($ fo ,400 ,00
) a month payable
ION'I'HLY
as follows: fll'st payment due
011 Ol BIFORS nm 5TH OAY OF EA:H MONTH,
The effective date of the order is 0' /21 /9' .
Arr:ars set at S 10"0,00
as of A1'R:L ~S. 2000 art due in full
IMMEDIA TEL Y. All terms of this Order are subject to collection and!or enforcement by
conttmpt proceedinas. credit bureau reponing and tax refund offset ceniflCation and will not
be initiated as 10IlJ as obligor does not 0Il-e overdue support. Failure to make each payment on
time and in full _ill cause all amJrS to become subject to immediate collection by all tilt
means listed abcn-e.
For tile Support of:
::iIIIC
Rifth n...
MAllY" ~s
AJIll MUll ~s
n:uarnl ~s
OJ/01/U
lO/DalU
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REYNOLDS V. REYNOLDS
The defendant owes a total of $ 4 , 400 .00
PACSES Case NUlllber: 427000075
per month payable MON'I'HLY
also pay fees/costs as indicated below. This order is allocated and monies are to be applied as
follows:
fRqllOllO)' Codu:
PayJllClll AmowuI
Y:""<I'~""
$ 4,400.00
$ 2, 000 .00
$1,200,00
$1,200.00
$ O. 00
S 0.00
S 0.00
S 0.00
S 0.00
So.OO
S 0.00
S 0.00
S 0.00
S 0.00
S 0.00
S 0.00
S 0.00
S 0.00
S 0.00
S 0.00
S 0,00
for current support and $ 0.00
for arrears. The defendant must
I -One 111IIO B -BiWeekly 2 -Bi-IdOlllhly Id -Idondlly
5 -Scmi-AlIlIUaIIy S -Scmi-MOlIIh1y ^ -AMulUy W -Weeklj
Q - Quanod1
flto.hr TJV ~ptinn ~fiMlIIQI'
1M SPOUSAL SUPPORT MARY A, REYNOLDS
1M CHILD SPT ALLoe ANN MARIE REYNOLDS
1M CHILD SPT ALLOC ELIZABE'I'H REYNOLDS
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Said lDODey to be l\II1lIed over by lht PI SCDt! 10:
MAn A, II'nItIt.D$ . Payments lIlUIt be ... by dled or
I1lOIle)' order. All dlccb and **y orden muse be -* payable 10 Pa SCDlI aad mailed to:
PI SCOt'
P.O. 8M 69110
Ham... ... 17I06-\JIIO
PaJ1llllU mat ",,1u4t dlt clritftdlllt's PACSES MtJIlbtt Saber or Sotal SealrK) SlIftber
1ft oriIr \1\ br ..._..4, Oro I'Iat ttftd wh by &\Wi,
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REl"NOLDS
v. REYUOLDS
PACSES Case Number: 427000075
Unreimbursed medical expenses that exceed $250.00 annually per child and/or spouse
are to be paid as follows: 90 % by defendant and 10 % by plaintiff. The plaintiff is
responsible to pay the first $250.00 annually (per child and/or spouse) in unreimbursed
medical expenses. (i) DefenchnlO Plaintiff 0 Neither party to provide medical insurance
coverage. Within thiny (30) days after the entry of this order, the 0 Plaintiff
~ Defendant shall submit to the person having custody of the child(ren) written proof that
medical insurance coverage has been obtained or that application for coverage has been made.
Proof of coverage shall consist. at a minimum, of: 1) the name of the health care coverage
provider(s); 2) any applicable identifICation numbers; 3) any cards evidencing coverage;
4) the address to which claims should be made; 5) a description of any restrictions on usage.
such as prior approval for hospital admissions, and the manner of obtaining approval;
6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and
co-paymenu; and 8) five copies of any claim forms.
Other Conditions:
nus OIUlD IS BASED tlPOH AN AGUIMEN'I' OF '!'HI PARTIES nmotJGH THEta COllHSEL.
THE ANNUALIZIlD 'roI'rIOIil rOR THE TWO OlILDUN IS IJiCLlltlll) IN '!'HI StJPPOJtT OIUlIR.
PAKTIES AllB TO UPOIn' TO TIll tlCMESTIC uu:rIOlIS SE::TIOII WITHIN rIFTED nAYS
UPON RECEIPT or nus Olt:lU TO ESTABt.ISH A PAl'MDI'r Pt.AII FOil TIll L::QUIDAnOlf or
J.RlI.EARS ,
DefendaDt shan pay tilt foJlowilll fees:
F~ Tnbt
I S. DO
SU.II.0
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REYNOLDS
V. REYNOLDS
PACSES Cas: Number: 427000075
IMPORTA1\'T LEGAL NOTICE
PARTIES MUST WITHIN SEVEN DAYS INFORM THE DOMESTIC RELATIONS SECTION AND
THE OTHER PARTIES, IN WRITING. OF ANY MATERIAL CHANGE L"I CIRCCMSTANCES RELEVM'T
TO THE LEVEL OF SUPPORT OR THE ADMINISTRATION OF THE SUPPORT ORDER,INCLUDING.
BUT NOT UMJTED TO, LOSS OR CHANGE OF INCOME OR EMPLOYMEt.'T AND CHANGE OF
PERSONAL ADDRESS OR CHANGE OF ADDRESS OF Am' CHILD RECEIVING SUPPORT. A PARTY
WHO WIUJUUY FAILS TO REPORT A MATER/Al. CH.4NGE IN CIRCUMSTANCES MAY BE ADJUDGED IN
CONTEMPT OF COURT, AND MAT BE FINED OR IMPRiSONED.
PENNSYLVANIA LAW PROVIDES THAT ALL SUPPORT ORDERS SHALL BE REVIEWED AT LEAST
ONCE EVERY THREE m YEARS IF SUCH RE\lEW IS lEQUESTED BY ONE OF THE PARTIES. IF
YOU WISH TO REQUEST A REVIEW AND ADJUmlE.~'T OF YOUR ORDER, YOU MUST DO THE
FOLLOWING: CALL YOUR ATTORNEY. A..I/ U!\REPRESE!'.'TED PERSON \\'HO WANTS TO MODIFY
(ADJUsn A SUPPORT ORDER SHOULD CO!'.'T ACT THE DOMESTIC RELATIONS SECTION.
A MM"DATORY L"COME ATIACHME.~'T \\lLL ISSUE U!\LESS THE DEFE."DAl\'T IS NOT L"l
ARREARS IN PAYMENT L'I/ AN AMOUNT EQUAL TO OR GREATER THA." OSE MO!\'TH'S SL'PPORT
ORLlGATlOS AJIo1> (I) THE COURT m'DS THAT THERE IS GOOD CAUSE NOT TO REQUIRE
IMMEDIATE HI/COME ....lTHHOLDING: OR Il) A WRITIE."l AGREEMENT IS REACHED BETWEES
THE PARTIES WHICH PROVIDES FOR A.... ALTERNATE ARR.-\."GEME.~'T.
UNPAID ARREARAGE B,"LA."CES MAYBE REPORTED TO CREDIT AGENCIES. ON AND
,O\FTDl THE DATE IT IS DUE. EACH UNPAID SUPPORT PAYMD.'T SHALL CONSTll1lTE. BY
OPERATION OF LAW. A JUDGMEto.'T AGAINST YOL'o ,<\5 WELL AS A UEN AGAlNST REAL
PROPERTY .
IT IS FURTHER OWEllED that. upon payor's failure to comply with this order, payor may be
arrested and brought before the Coon for a Contempt hearing; payor's waies. salary.
commissions. andlor income may be attllChed in acconlallCe With law; this Order will be
increased without further hearing by 0 'it a month until all arrearages are paid in full. Payor
is responsible for COlIn _~"" \":' .
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c~ deUvmd III panics , .;J. oK)
Consented:
Plaintiff
Ddtndant
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ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 96-5180 CIVIL
OOriginal Order/Notice
State Commonwealth of Pennsylvania
Co./City/Dist. of CUMBERLAND OAmended Order/Notice
Date of Order/Notice 12/27/10 OX Terminate Order/Notice
Case Number (See Addendum for case summary) OOne-Time Lump Sum/Notice
RE: REYNOLDS, ROBERT M.
Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI)
202-46-7204
Employee/Obligor's Social Security Number
SALOMON SMITH BARNEY INC* 4997000037
C/O PAYROLL DEPARTMENT Employee/Obligor's Case Identifier
FL 5 (See Addendum for plaintiff names
125 BROAD ST associated with cases on attachment)
NEW YORK NY 10004-2440 Custodial Parent's Name (Last, First, MI)
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support
from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these
amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not
issued by your State.
$ o . oo per month in current child support
<- ]
$ o. oo per month in past-due child support Arrears 12 weeks or greater? Oyes {to
$ 0.00 per month in current medical support -nnr C= -
$ o.oo per month in past-due medical support =M MF
-
X n
$ o.oo per month in current spousal support :`
- rat
r-
TJ
1
$ o . oo per month in past-due spousal support C
? ?"
$ 0.00 per month for genetic test costs
$ 0.00 per month in other (specify) w
$ one-time lump sum payment
c?
CO
for a total of $ 0 . o o per month to be forwarded to payee below.
You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match
the ordered support payment cycle, use the following to determine how much to withhold:
$ 0.00 per weekly pay period. $ 0.00 per semimonthly pay period
(twice a month)
$ 0.00 per biweekly pay period (every two weeks) $ 0.00 per monthly pay period.
REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10)
working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of
withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work
state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of
the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding,
the following information is needed (See #9 on page 2).
Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is
ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has
a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections
and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE
42 000 00
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown
above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BY MAIL. ? _ -.0
BY THE COURT:
DRO: R.J. Shadday Form EN-028 Rev.5
Service Type M OMB No.: 0970-0154 Worker ID $IATT
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
M Ifheckefi you are required to provide a?opy of this form to your mployee. If yorr employee orks in a state that is
di event ftrom the state that issued this or er, a copy must be provideedpto your employee even if t?1e box is not checked
1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income.
Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting
agency listed below.
2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to
each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each
employee/obligor.
3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The
paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the
state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the
withholding order and forward the support payments.
4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against
this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow
the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent
possible. (See #9 below)
5. Termination Notification: You must promptly notify the Requesting Agency when the employeelobligor is no longer working for you.
Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 1124181910
THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0
EMPLOYEE'S/OBLIGOR'S NAME: REYNOLDS, ROBERT M.
EMPLOYEE'S CASE IDENTIFIER: 4997000037 DATE OF SEPARATION:
LAST KNOWN HOME ADDRESS:
LAST KNOWN PHONE NUMBER:
FINAL PAYMENT AMOUNT-
NEW EMPLOYER'S NAME/ADDRESS:
6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have any questions about lump sum payments, contact the person or authority below.
7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have
withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless
the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment,
refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law
governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit
Protection Act (CCPA) 0 5 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of
employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social
Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is
supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is
increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may
deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section.
Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the
employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts
allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of
the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the
CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health
care premiums in determining disposable income and applying appropriate withholding limits.
10. Additional info:
*NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state
that issued this order with respect to these items.
11. Send Termination Notice and
other correspondence to:
DOMESTIC RELATIONS SECTION
If you or your employee/obligor have any questions,
contact WAGE ATTACHMENT UNIT
13 N. HANOVER ST
P.O. BOX 320
CARLISLE PA 17013
by telephone at (717) 240-6225 or
by FAX at (717) 240-6248 or
by internet www.childsupport.state.pa.us
Page 2 of 2
Service Type M OMB No.: 0970-0154
Form EN-028 Rev.5
Worker ID $IATT
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: REYNOLDS, ROBERT M.
PACKS Case Number 427000075
Plaintiff Name
MARY A. BAYER
Docket Attachment Amount
96-5180 CIVIL$ 0.00
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
Addendum
Service Type M
OMB No.: 0970-0154
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
Form EN-028 Rev.5
Worker ID $IATT
ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT %-51'9L) EI V I
State Commonwealth of Pennsylvania XOOriginal Order/Notice
Co./City/Dist. of CUMBERLAND OAmended Order/Notice
Date of Order/Notice 01/03/11 0Term inate Order/Notice
Case Number (See Addendum for case summary) OOne-Time Lump Sum/Notice
RE: REYNOLDS, ROBERT M.
E mployer/With holder's Federal EIN Number Employee/Obligor's Name (Last, First, MI)
202-46-7204
Employee/Obligor's Social Security Number
SOCIAL SECURITY ADMINISTRATION 4997000037
STE 1 Employee/Obligor's Case Identifier
200 S SPRING GARDEN ST (See Addendum for plaintiff names
CARLISLE PA 17013 -2578 associated with cases on attachment)
Custodial Parent's Name (Last, First, MI)
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support
from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these
amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not
issued by your State.
$ o. oo per month in current child support t.
$ o . oo per month in past-due child support Arrears 12 weeks or greater? is nckA
$ 0.00 per month in current medical support
$ o. oo per month in past-due medical support
?rn
$ 2,000.00 per month in current spousal support
a
$ o. oo per month in past-due spousal support
$ 0.00 per month for genetic test costs 8--n
$ o. oo per month in other (specify) s o F3
$ one-time lump sum payment r -- C:)rn
for a total of $ 2,000.00 per month to be forwarded to payee below. -e
You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match
the ordered support payment cycle, use the following to determine how much to withhold:
$ 460.27 per weekly pay period. $ 1, ooo. oo per semimonthly pay period
$
(twice 920.55 per biweekly pay period (every two weeks) $ 2, 000.00 permonthly month)
pay p ay p
eriod.
REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10)
working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of
withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work
state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of
the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding,
the following information is needed (See #9 on page 2).
Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is
ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has
a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections
and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE
42 000 00
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown
above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BY AIL
BY THE COURT:
Service Type M OMB No.: 0970-0154 Worker I D $OINC
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
e ent fryou he state thrat issued the o?erpa ccopy must be p ovic?edpto your emp?oyee evoen if the box is not checked.
1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income.
Federal tax levies in effect before receipt of this order have priority. if there are Federal tax levies in effect please contact the requesting
agency listed below.
2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to
each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each
employee/obligor.
3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The
paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the
state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the
withholding order and forward the support payments.
4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against
this employeelobligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow
the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent
possible. (See #9 below)
5. Termination Notification: You must promptly notify the Requesting Agency when the employeelobligor is no longer working for you.
Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 8384100092
THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : ID THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: D
EMPLOYEE'S/OBLIGOR'S NAME: REYNOLDS, ROBERT M.
EMPLOYEE'S CASE IDENTIFIER: 4997000037 DATE OF SEPARATION:
LAST KNOWN HOME ADDRESS:
LAST KNOWN PHONE NUMBER:
FINAL PAYMENT AMOUNT:
NEW EMPLOYER'S NAME/ADDRESS:
6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have any questions about lump sum payments, contact the person or authority below.
7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have
withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless
the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
8. Antidiscrimination: You are subject to a fine determined under State law for discharging an employeelobligor from employment,
refusing to employ, or taking disciplinary action against any employeelobligor because of a support withholding. Pennsylvania State law
governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of
employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social
Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is
supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is
increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may
deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section.
Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the
employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts
allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of
the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the
CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health
care premiums in determining disposable income and applying appropriate withholding limits.
10. Additional info:
*NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state
that issued this order with respect to these items.
11. Send Termination Notice and
other correspondence to:
DOMESTIC RELATIONS SECTION
If you or your employee/obligor have any questions,
contact WAGE ATTACHMENT UNIT
13 N. HANOVER ST
P.O. BOX 320
CARLISLE PA 17013
by telephone at (717) 240-6225 or
by FAX at (717) 240-6248 or
by internet www.childsupport.state.pa.us
Page 2 of 2 Form EN-028 Rev.5
Service Type M OMB No.: 0970-0154 Worker ID $OiNC
d ,
Service Type M
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: REYNOLDS, ROBERT M.
Addendum
OMB No.: 0970-0154
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s): DOB
Form EN-028 Rev.5
Worker ID $OINC
R. J. MARZELLA & ASSOCIATES, P.C. ~ ;' ~- ~ ~; t~ `~f "'~,~r1-~ ,,
BY: Robin J. Marzella, Esquire
Pennsylvania Supreme Court LD. No. 66856 ' =' ~ ~ G~F~ `3 ~'~ ~: f i ~;
3513 North Front Street a or
~~;ll ~'fV~~ ~ ~ ~,~ ~,; ,;
Harrisburg, PA 17110 ~ d
Telephone: (717) 234-7828
Facsimile• (7171234-6883
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Mary Anne Reynolds
Plaintiff No. 96 - 5180 Civil
IN DIVORCE
v.
Robert M. Reynolds
Defendant
ENTRY OF APPEARANCE
Kindly enter our appearance on behalf of Defendant, Robert M. Reynolds, as
counsel of record in the above-captioned matter.
. J. M a Ass 'ates, P.C.
~,
By:
Robin fella, Esquire
Dated: p- Attorney Identification No. 66856
r f'`' ~ ~ ~ 'y'~
~,J ~'EPtN ~r`,3i[~ [,tali =i s.,_,
S Yl-V~"~ ~1~,
R. J. MARZELLA & ASSOCIATES, P.C.
BY: Robin J. Marzella, Esquire
Pennsylvania Supreme Court I.D. No. 66856
3513 North Front Street
Harrisburg, PA 17110
Attorneys for
Robert Reynolds
Telephone: (717) 234-7828
Facsimile• (7171234-6883
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Mary Anne Reynolds
Plaintiff
No. 96 - 5180 Civil
IN DIVORCE
Robert M. Reynolds
Defendant
v.
NOTICE TO DEFEND
YOU HAVE BEEN SUED IN COURT. [f you wish to defend against the claims set forth in
the following pages, you must take action within twenty (20) days after this Complaint
and Notice are served, by entering a written appearance personally or by attorney and
filing in writing with the Court your defense or objections to the claims set forth against
you. You are warned that if you fail to do so the case may proceed without you and a
judgment may be entered against you by the Court without further notice for any money
claimed in the Complaint or for any claim or relief requested by the Plaintiff. You may
lose money or property or other rights important to you.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A
LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH
BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
Taryn Dixon, Court Administrator
One Courthouse Square
Carlisle, PA 17013
(717) 240-6200
NOTICIA
LE HAN DEMANDADO A LISTED EN LA CORTE. Si usted quiere defenderse de
estas demandas expuestas en las paginas siguientes, usted tiene veinte (20) dias de plaza
al partir de la fecha de 1a demanda y la notificaci6n. Usted debe presentar una
apariencia escrita o en persona o por abogado y archivar en la Corte en forma escrita sus
defensas o sus objeciones a las demandas en contra de su persona. Sea avisado que si
usted no se defiende, la Corte tomara medidas y puede entrar una Orden contra usted sin
previo aviso o notificacion y por cualquier queja o alivio que es pedido en la peticion de
demanda. Usted pueda perder dinero o sus propiedades o otros derechos importantes
Para usted.
LLEVE ESTA DEMANDA A UN ABODAGO INMEDIATAMENTA. SI NO TIENE
ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN
PERSONA O LLAME POR TELEFONO A LA LF(CINA CUYA DIRECCION SE ENCUENTRA
ESCRITA ABA~O PARR AVERIGUAR DONDE SE PEUDE CONSEGUIR ASISTENCIA LEGAL.
Taryn Dixon, Court Administrator
One Courthouse Square
Carlisle, PA 17013
(717) 240-6200
Dated: ~~~~
,,,.,
R. J. arzella Asso ' s, P.C.
By: ~.
e
Attorney Identification No. 66856
R. J. MARZELLA & ASSOCIATES, P.C.
BY: Robin J. Marzella, Esquire
Pennsylvania Supreme Court I.D. No. 66856
3513 North Front Street Attorneys for
Harrisburg, PA 17110 Robert Reynolds
Telephone: (717) 234-7828
Facsimile• (717) 234-6883
~ Mary Anne Reynolds
Robert M. Reynolds
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiff No. 96 - 5180 Civil
1N DIVORCE
v.
Defendant
PETITION FOR MODIFICATION
OF AN EXISTING SUPPORT ORDER
AND NOW, Defendant, Robert Reynolds, by and through his attorneys, R.J.
Marzella & Associates, P.C., files this instant Petition for Modification of an Existing
Support Order and avers the following:
1. The petition of Robert M. Reynolds respectfully represents that on June 19, 2001,
an Order of Court was entered for the spousal support of Mary Anne Reynolds in the sum
of $2,000 per Month. (A copy of the Order is attached as Exhibit "A ".)
2. Prior to this order from 1996 until June 2001, Mr. Reynolds voluntarily paid
spousal support to Mary Anne Reynolds in the sum of $3,000 per month.
3. Mr. Reynolds has paid $2000 a month in spousal support from June 2001 up
through October 2008.
4. During the period in which Plaintiff was medically disabled and unable to work,
October 2008 through December 2010, Plaintiff paid $1000 a month in alimony which was
directly taken out of his distribution payments from his employer Smith and Barney.
5. Beginning in December 2010, Petitioner again began paying approximately $1,500
in monthly support which is deducted directly from his social security check, the exact
amounts for 2010 and 2011 are listed below.
6. Plaintiff has continued to make payments up through the present.
7. Per the Divorce Decree dated June 19, 2001, paragraph 9 states `The last item to
which the parties have reached an agreement is that the current order of support which
exists in the Cumberland County Domestic Relations Office at docket 629 S 1997 shall
continue in full force and effect specifically, that order currently provides that Mr.
Reynolds is to contribute the sum of $1,200.00 per month for each of the two children or a
total of $2,400.00 and currently it provides that in addition he is obliged to contribute and
'i pay the sum of $2,000.00 per month as spousal support to his wife. The dollars will
remain the same but the only change will be the designation of spousal support effective
upon the issuance of a decree in divorce will be changed to reflect that it is now in the form
of alimony.
8. Mr. Reynolds two daughters are now twenty-six (26) and twenty-eight (28) years of
age.
9. Petitioner is entitled to termination of this Order or in the alternative decrease of
this Order because of the following material and substantial changes in circumstances.
a. On or about June 16, 2009, Mr. Reynolds underwent an aortic valve
replacement surgery.
b. After a number of complications, on or about October 5, 2009, Mr.
Reynolds had to go in for another surgery at which time they removed the
aortic valve and placed a pacemaker due to the damage caused to his heart
by an infection.
c. Due to the severity of the infection, Mr. Reynolds suffered irreversible
damage to his heart and brain.
d. At the time of this incident, Mr. Reynolds was working for Morgan Stanley
Srnith Barney, previously known as Smith Barney located at 214 Senate
Avenue, 7th Floor, Camp Hill, PA 17011.
e. However, as a result of the damage to both his heart and brain, Mr.
Reynolds is unable to perform his work duties as a financial
consultant/broker,
f. On or about October 28, 2010, Social Security Administrative Law Judge,
Janet R. Landesberg, entered a Notice of Decision which. was fully
favorable for Mr. Reynolds to receive disability insurance benefits. (A copy
of the Notice of Decision is attached as Exhibit "B ".)
g. Judge Landesburg's decision stated that Mr. Reynolds has been disabled
under sections 216(1) and 223(d) of the Social Security Act since May 15,
2009.
h. On or about September 22, 2011, Dr. Deborah L. Wolbrette, a cardiologist
at Hershey Medical Center, entered a final report that noted even. if Mr.
Reynolds had full mental capacity he would still have difficulty performing
under stress and he would likely need to work shorter hours and be required
to take more breaks. (A copy of the Final Report is attached as Exhibit
«~/ ".)
i. Dr. Robert Fierer also evaluated Mr. Reynolds and noted that based on his
exam and his medical opinion that there is no chance that Mr. Reynolds
could perform his job as financial advisor. (A copy of the letter is attached
as Exhibit "D ".)
j. On or about October 10, 2011, Dr. Paul Edinger, a neurologist with
Hershey Medical Center, stated in his final report that based on his exam of
Mr. Reynolds and on Mr. Reynolds medical records he could not
recommend that Mr. Reynolds return to any form of competitive
employment at this time. He also stated the outlook for significant
improvement appears fairly dim. (A copy of the Final Report is attached as
Exhibit "E ".)
k. Mr. Reynolds and his current wife, Patricia Xenos Reynolds, file their
Federal Income Tax returns jointly. (A copy of the tax returns are attached
as Exhibit "F".)
1. On their 2008 Federal Income Tax Return the sum of their total income was
$1.31,297 of which $24,000 in alimony was paid out making their adjusted
gross income $107,297.
m. On their 2009 Federal Income Tax Return the sum of their total income was
$119,732 of which $13,596 in alimony was paid out making their adjusted
gross income $106,136.
n. On their 2010 Federal Income Tax Return the reported wages and salaries
amounted to $30,093. After adjustments which included $35,222 in losses
and $3,997 in taxable pensions and annuities, their total income was a
negative $1,132. Their adjusted gross income after paying $13,522 in
alimony amounted to a negative $14,654.
o. In 2010, Mr. Reynolds main source of income was from his social security
benefits in which he received $31,122.
p. For 2011 and 2012, Mr. Reynolds only source of income was from his
social security benefits.
q. Fur 2011, Mr. Reynolds social security benefits totaled $28,726.80.
r. Based not only on the fact that Mr. Reynolds income has been drastically
reduced, but also on the fact that his chances for recovery which will allow
hi.m to obtain adequate employment look fairly dim, petitioner is asking this
Honorable Judge to terminate the existing support order dated June 19,
2001.
WHEREFORE, Plaintiff requests this Honorable Court terminate the existing
order for support.
R. J~eTtaT~'a Associates. P.C.
By:
Dated: Attorney I en ification No. 66856
VERIFICATION
I, Robert Reynolds, do hereby swear and affirm that the facts and matters set forth
in the foregoing document are true and correct to the best of our knowledge, information
and belief.
We understand that the statements made therein are made subject to the penalties
of 18 Pa. C.S. § 4904 relating to unsworn falsification to authorities.
_-_
,,
I
Dated: ! ~'"'
Robert Reynolds
Exhibit A
MARY ANNE REYNOLDS,
Plaintiff
Vs.
IN THE COURT OF COP~iIOl~T PLEAS OF
CUMBERLAND COUI\TTY, PENl•TSYLVANIA
NO. 96 - 5180 CIVIL
ROBERT M, REYNOLDS,
Defendant IN DIVORCE
THE MASTER: Today is Tuesday, June 19,
200:1. This is the date set for a hearing in the above
captioned divorce proceedings. Present in. the hearing room
are the Plaintiff, Mary Anne Reynolds, and her counsel John J.
Connelly, Jr., and the Defendant, Robert M. Reynolds, and his
counsel Carl G. Wass.
This action was commenced by the filing of a
divorce complaint on September 18, 1996, raising grounds for
divorce of irretrievable breakdown of the marriage and
indignities. Counsel have indicated that the parties will
sign affidavits of consent and waivers of notice of intention
to request entry of divorce decree so that the divorce can be
concluded under Section 3301(c) of the Domestic Relations
Code. The affidavits and waivers will be provided today to
the Master who will file the affidavits and waivers with the
Prothonotary.
The complaint in divorce also raised
economic claims of equitable distribution, alimony, alimony
pendente lite, and counsel fees and expenses.
The parties were married on October 4, 1980,
and separated July 2Ci, 1996. They are the natural x.~arents of
two children, Ann Marie, born December 8, 1983, and E1_izabeth
B~, born October 21, 1985.
After considerable negotiations today the
Master has been advised that the parties have reached a
settlement with respect to the outstanding economic issues.
An agreement is going to be stated on the record in the
presence of= the parties. The agreement as placed on the
record wil]_ be considered the substantive agreement of the
parties not subject to any changes or modifications except for
correction of typographical errors which may be made during
the transcription. The parties and counsel will return later
today to review the agreement for typographical errors, make
any corrections as required, and then affix their signatures
affirming the terms of settlement as stated on the record.
If the agreement is not signed by the parties, they are still
bound by tl-ae terms of the agreement when they leave the
hearing room today, the signatures being simply an affirmation
of the agreement that is going to be placed on the record at
this time.
After the Master has been provided a
completed agreement he will prepare an order vacating his
appointment and counsel will then be able to file a praecipe
transmitting the record to the Court requesting a final decree
in divorce. Mr. Wass.
MR. WASS. If it may please the Master, the
agreement of the part:ies with regard to the distribution of
the marital and the non-marital property is as follows;
1. The husband, Mr. Reynolds, will retain that remaining
sum. of the inheritance which he received post-separation as a
result of the death of his mother and from his mother's
estate.
2. Husband will retain the post-separation contributions
and value of his 401(k) account at Salomon Smith Barney.
3. Husk>and will retain as his non-marital interest the
value in a Travelers Group Capitalization Accumulation Plan
which came to him following the separation..
4. Husband will retain a St. Thomas time-share acquisition
which he made subsequent to the separation.
5. On the other hand, any non-marital assets which had
been acquired by Mrs. Reynolds post-separation will likewise
be retained by her.
6. With. regard to the division of the marital property,
the parties have identified actually six items which
constitute marital property.
A) They are the marital home which the parties have
agreed has a net marital value, that is its agreed market
value reduced by the current balance of the mortgage
obligation, and that net figure is $101,841.00. That asset
will be transferred to Mrs. Reynolds and she will assume the
responsibility of the existing mortgage. That transfer will
occur within five days.
B) The contents within that home had been appraised
and the appraised value has been accepted by both parties at
$9,345.00 and the entirety of those personal property assets
within the home shall become the property of Mrs. Reynolds.
C) The parties have continued to maintain a jointly
owned right of survivorship investment account at Salomon
Smith Barney from the date of their separation and the most
recent valuation that the parties have been able to agree upon
as of midnight of last night, is that there is $174,114.00 in
that account. Depending on today's trading, it may go up a
little or it may go down a little bit but the parties have
agreed that= the entirety of that account shall be transferred
to the sole name of Mrs. Reynolds. That transfer will. be
accomplished eithe_Y today or at the latest by tomorroU~.
D} The remaining items of marital property include
three items. There is an IRA account which has a value after
payment of taxes because of early withdrawal made by Mr.
Reynolds, current value is $25,888.00. Mr. Reynolds will
retain than.
E) There is a 401(k) retirement account of Mr.
Reynolds maintained at Salomon Smith Barney. That account has
approximately $142,200.00 in it and that account will remain
the sole and exclusive property of Mr. Reynolds.
F) There is finally a Deferred Compensation Plan
which Mr. Reynolds also maintains with his employer Salomon
Smith Barney and that Deferred Compensation Plan has
approximately $6,347.00 in it which is marital property but
which Mr. Reynolds will retain.
7. In achieving this agreement of distribution, the first
three items go to Mrs. Reynolds, the last three items are
retained by Mr. Reynolds. But in achieving this agreement,
the parties have also given appropriate consideration to the
following items.:
A) There has been included in my recital an add back
of $15,701.50 which had been removed by Mr. Reynolds from his
IRA account; that is an after tax withdrawal and that sum of
money was utilized by Mr. Reynolds for personal purposes and
family expenses, but the add back of that has been calculated
as being divided in the recitals heretofore made, 600 of it
having been included in the distribution being to Mrs:
Reynolds.
B) The second item that has also been included is the
fact that Mr. Reynolds, as a result of an automobile accident,
has to replace what was then a jointly owned automobile and he
did so by utilizing an insurance company check which the
parties have acknowledged was in the sum of $7,500.00 and he
acquired a new vehicle by use of that check. 60o of that
$7,500.00 or in fact $4,500.00 was also incorporated in the
distribution of assets provided to be made to Mrs. Reynolds.
C) Finally, the parties have also acknowledged that
there exists an indebtedness to the parents of Mrs. Reynolds.
That indebtedness is agreed to be in the sum of $5,000.00 and
the obligation of that indebtedness has been agreed by the
parties to be shared equally, accordingly $2,500.00 of that
$5,000.00 has also been incorporated .in the amount of the
distributic>n provided to be made to Ntrs. Reynolds. the
agreement i.s that Mrs. Reynolds would then be responsible for
the payment of that debt if in fact her pax-ents insist that
she pays them.
In summary fashion then, the home, the furniture
and the entirety of that balance in the Salomon Smith Barney
investment account previously jointly owned by them now to be
transferred to Mrs. Reynolds effectively represents a
distribution of the total of the marital assets to Mrs.
Reynolds in. the percentage of about 600 of those total marital
assets.
8. The parties have agreed to secure the obligation of
college expense for the two daughters and for the continued
support of the two daughters in the event of the untimely
death of Mr. Reynolds, and provision has been made by two
means. Number one, Mr. Reynolds currently maintains a
$100,000.00 death benefit term life insurance policy with his
employer. Secondly, he will secure a new policy of term life
insurance in the amount of $50,000.00. Mr. Reynolds will
thereupon create a trust instrument to take effect in the
event of his death wh:i_ch will designate the trustee to be Mrs.
Reynolds who is the natural mother of the two children. Mrs.
Reynolds as trustee will also be named as the beneficiary to
receive the proceeds of the life insurance policies _i_n the
event of the untimely death of Mr. Reynolds and she is then to
utilize the funds so received to provide for the support of
the children and also to assist in the payment of any college
expenses incurred on behalf of both of those children with a
provision that the trust should terminate at the attainment of
the youngest child to the age of 23 years. If Mr. Reynolds
continues to maintain good health and continues to live and
lives until his youngest child has attained the age of 23
years, then this provision for the continued maintenance of
both of the life insurance policies and the trust instrument
as well, shall be rescinded and terminated and Mr. Reynolds at
that: point can do whatever he wishes with regard to cancelling
the life insurance policies or by naming any other beneficiary
of his choice.
9. The last item to which the parties have reached an
agreement is that the current order of support which exists in
the Cumberland County Domestic Relations Office at docket 629
S 1997 shall continue in full force and effect specifically,
that order currently provides that Mr. Reynolds is tc>
contribute the sum of $1,200.00 per month for each of the two
children or a total of $2,400.00 and currently it provides
that in addition he is obliged to contribute and pay the sum
of $2, OOC.00 pe-r month a.s spousal support t,o his Tsrife. The
dollars will remain the same but the only change will be the
designation of spousal support effective upon the issuance of
a decree in divorce will be changed to reflect that it is now
in the form of alimony.
The parties have further agreed that the amount
of alimony will be unchallenged by Mrs. Reynolds in terms of
its amount until one of two events occur. Number one, the
youngest child who is Elizabeth shall have attained that age
or level in life when she is no longer entitled to receive
support from her father, and that will be either on her
attainment to the age of 18 years or graduation from high
school whichever would be the last to occur. The second
reason that would enable Mrs. Reynolds to file for a change in
the alimony would be in the event it is ascertained that the
gross income from employment of Mr. Reynolds should reach the
level of $230,000.00 per year. Other than those two items,
either party otherwise would have the right after the youngest
daughter is no longer of support age to contest the amount of
the alimony. The alimony is to be indefinite in its term.
Alimony as provided will terminate upon the death
of either party, the cohabitation of wife or the remarriage of
wife.
10. It has finally been agreed that each party will pay
their own counsel fees and costs.
11. All property in the possession of either party at the
present time titled in their names remains their sole and
separate property, whether it is bank accounts, brokerage
accounts or' any other assets.
12. Except as herein otherwise provided, each party may
dispose of his or her property in any way and each party
hereby waives and relinquishes any and all rights he or she
may now have or hereafter acquire under the present or future
laws of any jurisdiction to share in the property or the
estate of the other as a result of the marital relationship
including without limitation, statutory allowance, widow's
allowance, right of intestacy, right to take against the will
of the other, and right to act as administrator or executor in
the other's estate. Each will at the request of the other
execute, acknowledge, and deliver any and all instruments
which may be necessary or advisable to carry into effect this
mutual waiver and relinquishment of all such interest, rights,
and claims.
NIR. 'n1ASS: Bob, you are the Descendant in
this divorce action and you've heard me very methodically
identify the text of the agreement as I have discussed it with
you, as I have shared with you and as I have recited it. Is
your understanding of what I have said correct?
MR. REYNOLDS: Yes.
MR. WASS: And is it agreeable to you?
MR. REYNOLDS: Yes.
MR. WASS: Thank you.
MR. CONNELLY: Mrs. Reynolds, you heard Mr.
Wass place on the record the terms and conditions of the
agreement; is that correct?
MRS. REYNOLDS: Yes. °
MR. CONNELLY: And that we have also talked
about the assets over the last several days in some detail; is
that correct?
MRS. REYNOLDS:
MR. CONNELLY:
agreement as it was placed on tl
MRS. REYNOLDS:
MR. CONNELLY:
terms and conditions?
MRS. REYNOLDS:
MR. CONNELLY:
acknowledging on the record now
That's correct.
Did you understand the
ze record?
Yes, I did.
Are you in agreement with its
Yes.
Do you understand that by
that it completes the matter
and any and all claims previously raised, having been ,,~~aived,
except as specifically provided in the agreement?
MRS. REYNOLDS: Yes.
I acknowledge that I have read the above
stipulation and agreement, that I understand the terms of
settlement as set forth herein, and that by signing below I
ratify and affirm the agreement previously made and intend to
bind myself to the settlement as a contract obligating myself
to the terms of settlement and subjecting myself to the
methods and procedures of enforcement which may be imposed by
law and in particular Section 3105 of the Domestic Relations
Code.
WITNESS:
Join J. ~`~onnelly, J'~':t~
~fAttorney !for laintff
^" '~ ~.
Carl G. ss
Attorney for Defendant
DATE:
~_-.....~ l~.r. l ~J
--- ~~
Mary ~; ~ e Reynolds
~" ~~ '; ~
~~ n
Robert M. Reynolds
O~i~i=r~~~~ioTICE TO ti~ilT~lxO>_D Ir~cO~tE Ft)f~ sul'~or~.r , , - `~
~~: ~~ , ,.~ i l
~,~,J;~,~, r-, ~e~.~,;~ti,e
State Comrr~onlvealth of Pennsylvania
CO./Clty/DISC. Of CUMBERLAND _ ~ArnendFd UrderlNotice
Date of Order/Notice 01/03/11 OTerrniot3re ordedNotice
Case Number (See Addendum for case summary) Oone-Ti,r.e rump Sum,~Notice
RE: REYNOLDS, ROBERT M.
Employer/Withholder's Eederal EIN Number. ~ ~ Employe/Obligor's Name (Last, first, Mp
202-46-7204
Employee/Obligor's Social Security Number
SOCIAL SECURITY ADMINISTRATIOiV
STE 1 4997000037
Employee/Obligor's Case Identitier
200 S SPRING GARDEN ST
(See Addendum for plaintiff names
CARLISLE PA 17 013 - 2 5 7 8 associated with cases on attachment)
Custodial Parent's Name (Last, First, MI)
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER 1NFORM,gT10N: This is an Order/Notice to Withhold Income for Support based upon an order for support
from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these
amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not
isstaed by your State.
$ o . oo per month in current child support
$ o . oo per month in past-due child support Arrears 12 weeks or greater? ,yes Q no
$ o.oo per month in current medical support
o . oo per month in past-due medical.support
$ 2 , o00 . oo per month in current spousal support
$ o . oo per month in past-due spousal support
$ o . oo per month for genetic test costs
$ o . oo per month in other (specify)
$ one-time lump sum payment
for a total of $ 2 , o 0 0 . o o per month to be forwarded to payee below.
You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycled not match
the ordered support payment cycle, use the following to determine how much to withhold:
$ 460.27 Per weekly pay period. $ i, o00 . oo per semimonthly pay period
(twice a month)
$ 920.55 per biweekly pay period (every two weeks) $ 2, o00 . oo per monthly pay period.
REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10)
working days after the date of this Order/Notice. Send payment within seven (~ working days of the paydate/date of
withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governi~;;g the work
state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of
the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding,
the following information is needed (See #9 on page 2).
Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is
ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has
a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections
and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE
42 000 00
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
JN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND THE PACSES MEMBER lD (shown
above as the Employee/Obligor's Case Jdentifier) OR SOCIAL SECURJTY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BYMA/L. ~ _ _ .~ d _ i ®-,
BY THE COURT:
Cts1cL:~td ~
Service Type ]~ OMB NO.: 0970-0159
Form EN-028 Rev.S
Worker ID $OINC
ADDENDUwt
Summar•~ of Cases on Attachment
Defendantr'Obligor: R1;Yr,oLDS, Ro~ERT r~.
PACSES Case Number 427ooo075 PACSES Case Number
Plaintiff Name Plaintiff Name
MARY A. SAYER
.Docket Attachment Amount Docket P,ttachment ,Amount
96-5180~CIVIL$ 2,000.00 ~ ~ $ 0.00
Child(ren)'s Name(s}: DOB Child(ren)'s Name(s):
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ o.oo
Child(ren)'s Name(s): DOB
PACSES Case Number
Plain*iff Name
Docket Attachment Amount
$ o.oo
Child(ren)'s Name(s): DOB
DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ o.oo
Child(ren)'s Name(s): DOB
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ o.oo
Child(ren)'s Name(s): DOB
___
Addendum Form EN-028 Rev.S
Service Type M ones No.: 09~o-oisa Worker ID $ozrrC
Exhibit B
~vsa~~'` SOCIAL SECURITY
°~~ I~~~~~~.~~j Refer 'to: 202-46-7204
~'ISTF-f'
ADMINISTRATION
8th Floor
2 North 2nd Street
Harrisburg, PA 17101
Date: October 28, 2010
Robert Michael Reynolds
478 Sweetbrier Terrac
Harrisburg, PA 17111
Office of Disability Adjudication and Revie«~
SSA ODAR Hearing Ofc
Notice of Decision -Fully Favorable
I carefully reviewed the facts of your case and made the enclosed fully favorable decision. Please
read this notice and my decision.
Although my decision is fiilly favorable, you have the right to an oral hearing and to examine the
evidence on which. I based my decision. Phase contact the office listed above if you 1~~atit to have
an oral hearing or examine the evidence in your case record.
Another office will process my decision. Tl~iat office may ask you for more infoiYnatiori. Ifyoti
do not hear anything within 60 days of the date of this notice, please contact your local office.
The contact information for your local office is at the end of this notice.
If You Disagree Vt'ith My Decision
If you disagree with my decision, you may file an appeal with the Appeals Council.
IIow To File An Appeal
To file an appeal you or your represe?~tat.ive must ask in ti~~riting that the Appeals Council review
my decision. You may use our Request for Review fo~Yn (HA-520) or tiz~rite a letter. The form is
available at ~~~ww.socialsectuity.gov. Please put the Social Security number shown above on any
appeal you file. If you need help, you tnay file i11 person at any Social Security or hearing office.
Please send your request to:
Tune Limit To File An Appeal
Appeals Council
Office of Disability Adjudication and Re~riew
5107 Leesburg Pike
Fa1Ls Church, VA 22041-3255
You must file your written appeal ~~~ithin 60 days of the date you get this notice. The Appeals
Council assumes you got this notica ~ days after the date of the notice uiiless you show you did
Fonn FiA-L76 (03-2010)
See Next Page
Robert Michael Reynolds (202-46-7204)
not get it within the ~-day period.
Page 2 of 3
The Appeals Council will dismiss a late request unless }you show you had a good reason for not
filing it on time.
What Else You May Send Us
1'ou or your represeiilative may send us a written statement about your case. You inay also send
us new evidence. You should send your written statement and any new evidence with your
appeal. Sending your written statement azid any new evidence with your appeal inay help tts
review your case sooner.
How An Appeal `Forks
The Appeals Council will consider your entire case. It will consider all of my decision, even the
parts with which you agree. Review can make any part of my decision more or less favorable or
unfavorable to you. The Hiles the Appeals Council uses are in the Code of Federal Regulations,
Title 20, Chapter III, Part 404 (Subpart J).
The Aanea.ls Council., ma;~:
• Deny your appeal,
• Return your case to me or another administrative law judge for a new decision,
• Issue its awn decision, or
• Disnuss your case.
The Appeals Council will send you a notice telling you what it decides to do. Ifthe Appeals
Council denies your appeal, my decision will become the final decision.
The Appeals Council May Review My Decision On Its Own
The Appeals Council tnay review my decision even if you do not appeal. If the Appeals Council
reviews your case on its own, it will send you a notice within 60 days of the date oftlus notice.
~'~-'hen There Is No Appeals Council Review
If 5rou do not appeal and the Appeals Council does not review my decision on its ovrn; my
decision F~~ill become final. A final decision can be changed only under special circumstances.
You will not have the right to Federal court review.
If You Have Any Questions
t~'e invite ~-ou to visit our website located at w«~~.socialsecurity.gov to find answee•s to general
questions about social security. You may also call (800) 772-1213 with. questions. If ~~ou are deaf
~.~;~•~ or hard of hearing, please use our TTY number (800) 325-0778.
Finn H.^t- L?6 (03-2010)
See Ne~~t Page
Robert I`~Iichael Reynolds (202-46-7204) Page 5 of 5
6. The claimant is unable to perform any past relevant work (20 CFR 404.1565).
The demands of the claimant's past relevant ~~~ork exceed the residual functional capacity.
7. The claimant was an individual closely approaching advanced age on the established.
disability onset date (20 CFR 404.1563).
8. The claimant has at least a high school education and is able to co~nmwiicate in
English (20 CFR 404.1564).
9. Tlie claimant's acquired job skills do not. transfer to other occupations witlun the
residual functional capacity defined above (20 CFR 404.1568).
10. Considering the claimant's age, education, work experience, and tesidual functional
capacity, there are no jobs that exist in significant numbers in the national economy that
the claimant can perform (20 CFR 404.1560(c) and 404.1566).
In determining whether a successful adjustment to other work can be made, the undersigned
must consider the clamant's residual functional capacity, age, education, and «7ork experience in
conjunction with the Medical-Vocational Guidelines, 20 CFR Part 404, Subpart P, Appendix 2.
If the claimant can perform all or substantially all of the exertional demands at a given level of
exertion. the medical-vocational rules direct a conclusion of either "disabled" or "not disabled"
depending upon the claimant's specific vocational profile (SSR 83-11).
Even if the claim~uit had the residual functional capacity for the full range of sedentary work,
considering the clai~ria~zt's age, education, and work experience, a finding of "disabled" wot.ild be
directed by Medical-Vocational Rule 201.14.
11. The claimant has been under a disability as defined in the Social Security Act since
May 15, 2009, the alleged onset date of disability (20 CFR 404.1520(8)).
DECISION
Based on the application for a period of disability and disability insurance benefits protectively
filed on January 19, 201Q the claimant has been disabled under sections Zlb(i) and 223(d) of the
Social Security Act since Iv1a.y 15, 2009.
Isl ~.a~7` ~l . ~~~
Janet. R. Landesberg
Administrative Law Judge
October 28, 2010
Date
Exhibit C
.0't~#I`lL~TATE HERSHEY
R~1 Milton S. Hershey
" Final Rep® Medical Center
September 22, 2011
Name: REYNOLDS, ROBERT M
HMC Number: 1171527
DOB: 09/28/1954
Date of Service: 09/22/2011
To Whom It May Concern:
R EYNOL~$~i I~RSI1(~'Y'1527
Heart and Vascular
Institute
* Final Report
Robert Reynolds has been followed in my Cardiology Clinic for the last 2 years. Prior to transferring his care to
Hershey Medical Center in 2009, he underwent a bioprosthetic aortic valve replacement due to severe aortic
stenosis. Postoperatively, he experienced atrial fibrillation which required him to be maintained on antiarrhythmic
drug, amiodarone, and he was also placed on Coumadin. Later he was found to have endocarditis of his aortic
valve, but it took a while for this. to be diagnosed. After he developed asymmetric facial paralysis, an MRI was done
which showed an embolic stroke. Once the aortic valve endocarditis was found, with a perivalvular abscess and
some dehiscence of the valve, he was taken back to surgery for a redo aortic valve replacement. As a result of his
second operation and the abscess, his conduction.system was damaged and he required adual-chamber
pacemaker for complete heart block. He is now completely dependent on his pacemaker. Mr. Reynolds is very slow
to regain his strength after his second surgery. He did participate in cardiac rehab and completed this; however, he
never regained his previous stamina. He tires easily. While at rehab it was discovered that he had an elevated
blood pressure, so additional blood pressure medication was started to control his hypertension. He has not had any
further episodes of atrial fibrillation since his pacemaker was implanted, so his amiodarone was stopped. Episodes
of atrial fibrillation can be monitored through his pacemaker. Due to his pacemaker he cannot have an MRI done in
the future. Mr. Reynold's echocardiogram done postoperatively showed his ejection fraction to be low normal at 50%
to 55%. The bioprosthesis is functioning well without.evidence of vegetation, stenosis, or regurgitation.
His current medications include warfarin as directed, metoprolol i2.5 mg b.i.d., lisinopril 20 mg in the a.m. and 10 mg
in the p.m., pravastatin 40 mg q.h.s., and Lexapro 10 mg daily.
Mr. Reynolds has his INR checked routinely through our.Coumadin Clinic and he has been tolerating his
anticoagulation. He has periodic visits to our Cardiology Clinic and to our Pacemaker Clinic. Mr. Reynolds has a
cardiac functional capacity of class II due to him being easily fatigued. He has not had problems with heart failure,
but is limited by problems with intermittent dizziness and vertigo-like symptoms which have not been determined to
Printed by: Wolbrette, Deborah L Page 1 of 2
Printed on: 9/28/201 i 11:52 (Continued}
Penn State Milton S. Hershey Medical Center • Penn State College of Medicine • Penn State Hershey Heart and Vascnlar Institute
M
Mail Code H047, 500 University Drive, P.O. Box 850, Hershey, PA 17033-0850 •+~
An Equal Opportunity University
.Of~t>~II'~~TATE HERSHEY REYNOLC~`~C$>~1~tRS1527
• Milton S. Hershey Heart and Vascular
` Final Rep Medical. Center ~ Institute
be secondary to his cardiac condition. He is undergoing evaluation by a neurologist for this.
I have interacted with Mr. Reynolds on multiple occasions in Cardiology Clinic. He speaks slowly and has to think
about answers to questions prior to speaking. He answers questions with very few words. He is emotionally labile in
that he appears anxious easily and is frequently tearful. After reviewing the expected functions of a financial
consultant which Mr. Reynolds easily performed prior to his surgery and embolic stroke, I have difficulty imagining
him performing those functions now. Obviously, I have not myself performed any neurocognitive testing. With full
mental capacity it would still be more difficult for Mr. Reynolds to perform under stress, than it was prior to his cardiac
events. If he had his full mental capacity, he would most likely still need to work shorter hours and require more
breaks than he had previously in his job. I would be happy to answer any further questions regarding Mr. Reynold's
cardiac status if needed.
488842
Signature Line
Electronic Signature on File
Sincerely, ~,
Deborah L Wolbrette, MD
Penn State Heart & Vascular Institute
Cardiology, MC H047
500 University Drive, Hershey, PA 17033
Phone: 717-531-3907 FAX: 717-531-4077
DLW /CO DD: 09/22/11 DT: 09/23/11 09:30
Author Signature Dt/Tm: 09/28/2011 11:48 AM
Result Type: .Outpt Ltr
Date of Service: September 22, 2011 00:00
Authorization Status: Final
Author or Import Date: Wolbrette, Deborah L on September 22, 2011 13:27
Verified By: Wolbrette, Deborah L on September 28, 2011.11:48
Encounter info: 16288516, Hospital Based Offices, Clinic, 7/13/2011 - 7!14/2011
Printed by: Wolbrette, Deborah L Page 2 of 2
Printed on: 9/28/2011 11:52 (End of Report)
Pena State Milton S. Hershey Medical Center • Penn State College of Medicine • Penn State Hershey Heart and Wascular Institute M
'\4ail Code H047, 500 University Drive. P.O. 13ox 850, Hershey. PA 17033-0850 -~4--
An Equal Opportunity CTniversity
Exhibit D
KANDRA, FIERER, KUSKIN, ASSOCIATES, LTD.
FAM{LY PRACTICE & INTERNAL MEDICINE
ROBERT R. FIERER. M. D.
LOUIS F. KUSKIN, M•D.
KIMBERLY A. KOWKER-WALKER, PA-C
1199 COLONIAL ROAD
HARRISBURG, PA 17112
PHONE 652-8436
FAX 652-8804
282 WEST MAIN STREET
ELIZABETHVILLE, PA 17023
PHONE 362-3371
FAX 362-4278
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Exhibit E
PENNSTATE HERSHEY PENNSTATE HERSHEY
Milton S. Hershey ~ Neurology
Medical Center
~` Final Report
Department of Neurology
Chairman, David C. Good, M.D. Name; REYNOLDS, ROBERT M October 10, 2011
BotulinumTozin Treatment HMC Number: 1171527
Phone: (717) 531.8697 DOB: 09/28/1954
Xuemci Huang, M.D., Ph.D.
Milind J. Kothari, D.o. Dates of Service: 10/06/2011 & 10/10/2011
Kevin Scott, M.D.
Thyagarajan Subramanian, M.D.
CcrebrovaacularDisease Stephen C. Ross, M. D.
Keratin Benermann, M.D.,Ph.D. Penn State Milton S. Hershe Medical Center
David Good, M.D. Y
Raymond K. Reichwein, M.D. PO BQX 850
Jacqueline Rohrbaugh, P.A.-~. Hershe PA 17033
Sandy Kerekgyarto, R.N., B.S.N. Yt
Clinical Ncurophysiology
Phone: {717) 531.5697 Dear Dr
Ross:
layant Acharya, M.D. .
Vinita Acharya, M.D.
AieahaAhmed,M.D.
Mili
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K
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i
D
0 Thank ou for referrin
Y g Robert Reynolds to the Neuropsychology Clinic for evaluation
n
.
ot
ar
,
.
.
MazLowden,M.D. and opinion. He presented first on October 6
2011
for interview and history as well
Kevin scat[, M.D.
zaohary Simmnna, M.D. ,
,
as initial h
p ase of neuropsychological testing and then returned on October 10, 2011,
Matthew Wieklnnd,M.D. for completion of the neuropsychological testing, with all results summarized in this
Cognitive Neurology single report.
David Gill, M.D.
]acqueline Rohrbaugh, P.A: C.
Epilepsy Program HISTORY OF PRESENT ILLNESS: As you know, Mr. Roberts is a 57-year-old
JayantAcharya,M.D. gentleman who first presented to your Walk-in Clinic in ear-y June 2011
with
Vinita Acharya, M.D.
Hana w. Pinkert, M.D. ,
concerns about unsteadiness and diplopia that he related to a stroke or strokes that
CtaireV.Flaherty-Crai„Ph.D.
C
th
M
N
CRNP
MS occurred Some ears rior and associated with cardiac disease. Based on our
Y p Y
a
ew,
y
c
,
G
N neurological exam and evaluation of his records, you determined that he was
eneral
eurology
Dav;dGi,I.M.D. presenting with sequelae from stroke that included ataxia
diplopia
and cognitive
Maz Lnwden, M.°.
Hans W. Pinkert. M.D. ,
,
d sfunction. The nature and extent of co nitive d sfunction was somewhat unclear as
Y g Y
Stephen C. Ross,M.D. Mr. Reynolds had not had any kind of formal cognitive testing althou
h his cardiolo
ist
Kevin R. Scott, M.D.
Richard B.Tenaer.M.D. g
g
were concerned about a change in his cognitive function. CT scan of the head on
Gary Thomas,M.D.
D
C ,June 13, 2011 was inter rated as within normal limits, and Mr. Re Holds has•
p Y
iana
onsols, P.A: C. continued follow-up care with physician assistant Diana Consofi who is currently
Movement Disorders
XaemeiHaang,M.D..Ph.D.
evaluating serologic testing to exclude any metabolic and infectious etiology to his
Mechelte Lewis, Ph.D. $ mr~toms.
Y M
Thyagarajan Subramanian, M.D.
Kala Venkiteswaran, Ph.D.
Jacqueline Rohrbaugh,P.A.-C. MEDICAL HISTORY:
Multiple Sclerosis Program Atrial fibrillation
Richard B. Tenser, M.D. .
GaryT"omaa,M.D. Dyslipidemia.
i+mhony P. 7Lrei, Jr., ivi.D.
Hypertension
Neuromuscular Program
AieahaAhmed,M.D.
A bioprosthetic aortic valve replacement June 2009, with second aortic valve
Milind l.Kothari,D.0. re lacement a few months later due to endocarditis with erivalvular abscess and
p P
Kevin R. Scott, M.D.
zachary S;mmona, M.D. dehiscence of the valve.
Matthew Wickland, M.D. Endocarditis.
Neuropsychology Program pacemaker im lantation in October 2009
p
Paul I. Edinger, Ph.D. .
Claire V. Flaherty-Craig, Ph.D.
Neurorehabilitation Unit Brain MRI was reported to have been undertaken prior to pacemaker and showed an
David C. Good, M.D. .
Thyagarajan Subramanian,M.p.
embolic-stroke. Dr. Wolbrette of the Cardiology Service has followed Mr. Reynolds
TranscranialDoppler since 2009, and has noted him to have become slowed in his thinking and in his
Phone: (717)531.8883 anxious
speech
emotionally labile
and at times teartul. Her opinion was that he
Raym°nd x. Reichwein. M.D. ,
,
,
would be able to handle his work adequately.
In further discussion with Mr. Reynolds and his spouse, they indicated that he
recovered relatively well after the first valve replacement, but has not recovered well
since the endocarditis and second heart surgery. They have noted particularly that
his memory, concentration, physical vitality and energy have ~ersistentlXbeen much
Pena State Milton S. Hershey Medical Center • Penn State College of Medicine
Department of Neurology, Mail Code EC037, 30 Hope Drive, P.O. Box 859, Hershey, PA 17033-G859
Scheduling: 717-531-3828 • Tel: 717-53~-8692 • Fax: 717-531-4694
An Egaal Opportunity University
I
_..
lower. They were also told that he had minor strokes as a cause for some of the cognitive changes.
Neuropsychological testing was requested at this time in order to more objectively evaluate his current
cognitive capacities.
MEDICATIONS:
Amiodarone 200 mg one-half tablet daily.
Lisinopril 20 mg 1.5 tabs daily.
Metoprolol 25 mg one-half tab twice a day.
Warfarin 5 mg, 1 tab daily.
Escitalopram 10 mg daily.
Pravastatin 40 mg daily.
Tramadol 50 mg p.r.n. for pain.
EXAMINATION: Mr. Reynolds presented together with his spouse and we were able to complete
extensive interview as well as neuropsychologicaltesting. He indicated that he completed high school as
well as a Bachelor's degree in Business Administration without difficulty and has been employed until he
went on short-term disability in December 2010, following the above-mentioned medical conditions. Mr.
Reynolds reported that he worked in corporate sales for a couple of years after college graduation and
then went into the brokerage business in approximately 1981, employed as a brokerand then associate
vice-president. He indicated that he eventually took a position with Smith Barney as a first vice-president
of investment, which he held for about 10 years before becoming avice-president of finances with
Morgan Stanley. He went on disability in December 2010, indicating that he found he couldn't keep up
with the work and was concerned about the accuracy of making investment decisions. He was handling
some 70 clients at that time.
Mr. Reynolds reports that his sleep is adequate particularly now that he is not working under the same
stress and pressures. He indicated that he often had disturbed sleep while working. His appetite is
reported to be normal with intact taste and olfaction. Energy levels have continued to be low since his
illness in October 2009. He describes this as feeling like he has been "hit by a truck." With regard to his
mood, he does indicate that he does feel depressed because he can't do what he once did. He
experiences a lot of frustration in his daily activities and from his inability to work. He has been trying to
find new outlets in terms of the arts and managing household and daily community chores. He has been
married for the past 10 years to his spouse, but together for the past 20 years. He indicates that he walks
daily with his dogs and that his home is a supportive setting where his mother-in-law has lived as well for
the past 5 to 6 years. He did indicate having a back injury from an auto accident. This occasionally gives
rise to significant back pain; however, he denied any loss of consciousness, traumatic brain injury, or
seizures related to the accident.
Mr. Reynolds participated well with the neurocognitive testing. His speech was fluent, non-paraphasic,
and well-articulated with functional range of verbal expression and comprehension. He was a man of few
words, seemingly having some struggles with word finding as well as describing his thoughts and feelings
in any detail. He was fully oriented to time, place, and personal information. He cooperated very well
with the neurocognitive testing and results were thought to provide reliable and valid estimates of his
current capabilities. Mr. Reynolds was focused on the testing throughout both sessions. He asked
clarification questions on occasion. He worked diligently with the materials and completed everything
presented to him. On the Victoria Symptom Validity Test, a measure of response effort, his results
indicated a valid profile of scores, suggesting adequate effort in testing. This score was consistent with
my own observations of his adequate efforts during testing as welt as his overall pattern of results.
Mr. Reynolds completed the Wechsler Adult Intelligence Scale and Wechsler Memory Scale (WAIS-111
and WMS-ill). His profile of scores indicated that he encountered fairly significant difficulties in
processing speed (21st percentile, low average range). In comparison to estimated premorbid
intelligence, performance IQ and processing speed index scores were low, and occurred among several
significant discrepancies of 21, 22, 24 and 33 points (all less than p=.05). These wide variations indicate
high risk for cognitive dysfunction.
Standardized measures of learning and short-term memory revealed scores that varied from low average
to average. He experienced significant problems with verbal learning, with all other scores (except
working memory) also below levels predicted from current intelligence. It is noteworthy that the
intelligence score is also below estimated premorbid levels to begin with.
On the Conner's Continuous Performance Test, his profile of scores was found to be highly similar to
individuals with sustained attentional impairments and consistent with self-report of daily attentional
difficulties on the Brown ADD Scales (total = 86)
Mr. Reynolds experienced difficulties on a measure of executive functions, particularly in abstraction and
shifting of response set on the Wisconsin Cord Sorting Test as well as in processing speed (trail making
part A). His trail making part B as well as verbal associative fluency measures were within broad normal
limits.
Word-finding on the Boston Naming Test revealed a score of 52/60 (2nd-5th percentile; borderline-
impaired}.
Self--report screening measures for symptoms of depression and anxiety revealed significant elevation on
both measures. On the Barkley Deficits in Executive Functioning Scale, there were highly significant
elevations in subscales sensitive to time management, self-organization and problem solving, self-
restraint, self-motivation, and self-regulation of emotions. These executive-behavioral difficulties were
confirmed on an informant version completed by his spouse.
IMPRESSION: Robert Reynolds is a 57-year-old gentleman who presents at this time for comprehensive
neuropsychological testing given his history of significant cardiac disease with development unfortunately
of endocarditis and cerebral vascular disease in 2009. He has been unable to return to his work in
investment and financial services, and is currently on a short-term medical disability leave.
Interview and results of neuropsychological testing are quite clear in indicating a gentleman who grapples
with rather significant cognitive, behavioral and emotional impairments as a result of his cardiac and
cerebrovascular illnesses. The profile of neuropsychological test scores, which is considered a valid
reflection of Mr. Reynolds' current cognitive capacities, reveals discernible deficits in sustained attention,
learning and short-term memory as well as in processing speed and executive functions. In addition,
behavioral inventories reveal extraordinary difficulties in everyday executive functions and attentional
regulation.
These findings portend rather profound risks and consequences should he be put in a position of having
to track complex and rapidly changing financial information over extended periods of time, comprehend
the implications of these data, and apply them decisively in order to provide investment decisions that
would be considered to be of professional quality and current standards of ethical brokerage services.
These findings were evident despite what appeared to be very good efforts on Mr. Reynolds part as well
as profile of scores that would be consistent with an individual who was trying his utmost. In addition to
the cognitive and memory difficulties, Mr. Reynolds also struggles with behavioral and emotional changes
related to brain disease particularly in the form of symptoms of depression and anxiety. He also has a
number of physical limitations in terms of his balance, vision, and general energy levels, which provide
yet another compounding set of symptoms that would jeopardize a safe and effective return to
competitive employment.
Based on available medical records and these exam findings, I cannot recommend that Mr. Reynolds
return to any form of competitive employment at this time. Given that these changes have been occurring
over the past 2 years, the outlook for significant improvement appears fairly dim particularly given the
recent neurologic evaluation and the lack of any clearly reversible causes.
Please don't hesitate to contact me for any discussion. Thank you for allowing me to participate in Mr.
Reynolds' care. I am glad to see him with regard to managing his current cognitive and behavioral
difficulties. Services an October 6, 2011 included 4 hours of Ph.D. neuropsychological testing and
3
services on October 10, 2011 included 4 hours of Ph.D. neuropsychologicai testing. Recommended
diagnosis coding includes cerebrovasculardlsease with cognitive effects.
CC: Robert R Fierer, MD
1199 Colonial Road
Harrisburg PA 17112
Pau stinger, Ph~S
Proles or and Clinical Neuropsychologist
Depts. of Neurology, Neural & Behavioral Sciences, & Pediatrics
Penn State Milton S. Hershey Medical Center
H037, PO Box 850, Hershey, PA 17033
PJE /CO DD: 10/10/11 DT: 10/11/11 17:56
4
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~ Department of the Treasury-Infernal Revenue Service 200
LL 1040 ~.s. Individual Income Tax Return 1 }v{ (99) IRS Use Only-Do not write or staple in this space
Label a
(See g
instructions E
on page 14.) L
Use theiRS
label. H
Otherwise, E
please print R
or type. E
Presidential
Electron Campaign -
1
Filing Status 2
Check only 3
one box.
6a
Exemptions b
C
if more than four
dependents, see
page 17.
Income
Attach Form(s)
W-2 here. Also
attach Forms
W-2G and
1099-R if tax
was withheld.
If you did not
get a W-2,
see page 21.
Enclose, but do
not attach, any
payment. Also,
please use
Form 1040-V.
Adjusted
Gross
Income
For the year Jan. 1-Dec. 31, 2008, or other tax year beginning , 2008, en
Your first name and initial Last name
ROBERT REYNOLDS
If a joint return, spouse's first name and initial Last name
PATRICIA XENOS REYNOLDS
Home address (number and street). If you have a P.O. box, see page 14.
4785 SWEETBRIER TERRACE
City, town or post office, state, and ZIP code. If you have a foreign address, see page 14.
HARRISBURG PA 17111
Check here if you, or your spouse if filing jointly, want $3 to go to this fund (set
Head of hou:
20 OMB No. 1545-0074
Your social security number
202-46-7204
Spouse's social security number
201-58-7380
Apt. no. You must enter .
S your SSN(s) above.
Checking a box below will not
channge your tax or refund.
14) - I I You n Spouse
Single 4 th ualifyin erson is a child but not your dependent r
Married filing jointly (even if only one had income)
Married filing separately. Enter spouse's SSN above
and full name here. -
eq gP
this child's name here. -
5 ~ Qualifying widow(er) with dependent child (see page 16)
X
X --_
Yourself. If someone can claim you as a dependent, do not check box 6a
......... .... ... .. ...
S ouse
.....
Dependents:
(1) First name Last name
(2) Dependent's
social security number (3) Dependenrs
relationship to
you (4} r if
qual. child
for child
tax cr. (see
pa e 1 )
d Total number of exemptions claimed .......................... ................................ .
7 Wages, salaries, tips, etc. Attach Form(s) W-2 . , .. , . , , , . „ . . . . . . . . . . . . . . . . .......................... .
8a Taxable interest. Attach Schedule B ifrequired ................. .......... ......................
b Tax-exempt interest. Do not include on line 8a ..... ... _ , . I 8b (
9a Ordinary dividends. Attach Schedule B if required
.... . . .... . . . . .......... .
......
b Qualified dividends (see page 2l) ,,,,,,,,,,,,,,,,,,,,,, ,, I 9b i 96
10 Taxable refunds, credits, or offsets of state and local income taxes (see page 22)
11 Alimony received
............................................
................................
12 Business income or (loss). Attach Schedule C or C-EZ . ......... . . . . .. . . . ........ . ...........
13
Capital gain or (bss). Attach Schedule D if required. If not required, check here -
...... Q
.....
14 Other gains or (losses). Attach Form 4797
.....................
................................
15a IRA distributions 15a b Taxable amount (see page 23)
16a Pensions and annuities 16a
b Taxable amount see a e 24
( P 9 )
1T ......
Rental real estate, royalties, partnerships, S corporations, trusts, e
tc. Attach Schedule E
18 Farm income or (loss). Attach Schedule F
..................... ................ .
...............
19 Unemployment compensation ........................ .
20a Social security benefits 120a I ~ b Taxable amount (see page 26)
21 Other income. List type and amount (see page 28) .... ... , , ...... .
22 Add the amounts in the far ri ht column for lines 7 throw h 21. This is our tot al income -
23 Educator ex enses see a e 28
P ( P 9 ) .............................
.. 23
24 Certain business expenses of reservists, performing artists, and
fee-basis government officials. Attach Form 2106 or 2106-EZ 24
25 Health savings account deduction. Attach Form 8889 25
26 Moving expenses. Attach Form 3903 26
27 One-half of self-employment tax Attach Schedule SE 27
Boxes checked 2
on 6a and 6b
No. of children
on 6c who:
• lived with you
• did not live with
you due to divorce
or separation
(see page 18}
Dependents on 6c
not entered above
Add numben on
lines above - 2
149,589
370
9a I 9 6
10
11
12 -15, 758
13 -3, 000
14
15b
16b
17 0
18
19
20b
21
22 131, 297
28 Self-employed SEP, SIMPLE, and qualified plans ... . . . .. . .... 28
29 Self-employed health insurance deduction (see page 29) .. 29
30 Penalty on early withdrawal of savings 30
31a Alimony paid b Recipieni'sSSN- 172-46-3627 31a 24,000
32 IRA deduction (see page 30) ....... .
...................... 32
33 Student loan interest deduction (see page 33) .... .. , ... 33
34 Tuition and fees deduction. Attach Form 8917 .... 34
35 Domestic production activities deduction. Attach Form 8903 35
36 Add lines 23 through 31a and 32 through 35 36
.....................................................
37 Subtract line 36 from line 22. This is our ad'usted ross income ............................ - 37
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 88.
DAA
24,000
107,297
Form ~ O4O (2008)
Forte 1040 (2006) ROBERT REYNOLDS & PATRICIA XENOS REYNOLDS 2 02 - 4 6 - 7204 page 2
............
TAX 38 Amount from line 37 (adjusted gross income) 38 10 ~ 7
, - - , , • . . . . . .. . . . . . ..... . . ......
~7+~ 39a Check You were born before January 2, 1944, 81ind. Total boxes
~ _ _
checked - 39a
Credits if ~ ^ Spouse was born befiore January 2, 1944, ^ Blind.
b If your spcuse itemizes on a separate return or you were adual-status alien, see page 34 and check here - 395
Standard c Check if standard deduction includes real estate taxes or disaster loss (see page 34} - 39c
Deduction 40 Itemized deductions from Schedule A} or our standard deduction see left mar in
( Y ( 9 ) 40 2 9 ,14 3
for- .......
41 Subtract line 40 from line 38
41
7 8 , 15 4
• , - , , , -
• People who 42 If line 38 is over $119,975, or you provided housing to a Midwestern displaced individual, see
checked any
box on line
500 by the total number of exemptions claimed on line 6d
multiply $3
Otherwise
page 36
42
7 , 0 0 0
39a, 39b, or ,
,
.
Subtract line 42 from line 41. If line 42 is more than line 41, enter -0-
43 Taxable income 43 ~ 1,15 4
39c or who .
..................................
can be Check if any tax is from: a ^ Form(s) 8814 b ^ Form 49'2
44 Tax (see page 36)
as
1 7 0
~
claimed as a .
................................
45 Alternative minimum tax (see page 39}. Attach Form 6251
45
1, 7 6 9
dependent, .................................
see page 34. ................ -
46 Add lines 44 and 45 as 12,239
„• „••-, • .
• Att others: 47 Forei n tax credit. Attach Form 1116 if re uired
9 q 47
Single or ...................
48 Credit for child and dependent care expenses. Attach Form 2441
48
Married filing
separately,
49 Credit for the elderly or the disabled. Attach Schedule R
49
$s,aso ...........
50 Education credits. Attach Form 8863
50
Married filing , • - • • • , . - • • .
51 Retirement savin s contributions credit. Attach Form 8880
g 51
jointly or • • • -
Qualitymg 52 Child tax credit (see page 42). Attach Farm 8901 if required 52 ' ~
widow(er),
soo
$1o
53 Credits from Form: a ^ 8396 b ^ 8839 c ^ 5695
53
, • • . • -
54 Other credits from Form: a ^ 3800 b ^ 8801 c ^ 54
Head of
nousenold, These are your total credits
55 Add lines 47 through 54 55
$8.000 • • . • , • . • • • • - - . , -
.
...............
56 Subtract line 55 from line 4fi. If line 55 is more than line 46, enter -0- . . ... . ....................
56
12 , 2 3 9
Attach Schedule SE
57 Self-employment tax 57
.
Other
58 Unreported social security and Medicare tax from Form: a ^ 4137 b ^ 8919 58
• - • - - • • • - -
Taxes
other qualified retirement plans, etc. Attach Form 5329 if required
59 Additional tax on IRAs 59
- . -
,
60 Additional taxes: e ^ AEIC payments b ^ Household employment taxes. Attach Schedule H 60
61 Add lines 56 through 60. This is your total tax . , . , , . • ... . . . .... . ...... ..... ........... - 61 12 , 2 3 9
62 Federal income tax. withheld from Forms W-2 and 1099 • - . • 62 18 , 3 21
Pa menu 63 2008 estimated tax payments and amount applied from 2007 return 63
If you have a 64a Earned income credit (EIC) 64a
qualifying b Nontaxable combat pay election 64b
child, attach
Schedule EIC. 65 Excess social security and tier 1 RRTA tax withheld (see page 61) 65
66 Additional child tax credit. Attach Form 8812 - • • • - .. - 66
67 Amount paid with request for extension to file (see page 61) - - • - • . 67
68 Credits from Form: a ^ 2439 b ^ 4136 c ^ 8801 d ^ 8885 68
69 First-time homebuyer credit. Attach Form 5405 • • - - . - . - • • • , , 69
70 Recovery rebate credit (see worksheet on pages 62 and 63) , - . • - • • • • 70
71 Add lines 62 through 70. These are your total payments - . - • , • . . . . . . . . . . .......................... - 71 18 , 3 21
subtract line 61 from line 71. This is the amount you overpaid - - - • . , , • ,
d 72 If line 71 is more than line 61
f
R 72 6 0 82
,
un
e
osit? 73a Amount of line 72 you want refunded to you. If Form 8888 is attached, check here - - . • • - - , • - ^
Direct de 73a 6 , 0 8 2
p
See page 63 - b Routing number 0 3 6 0 7 615 0 - c T e: ^X Checking ^ Savings
and fill in 73b,
73c, and 73d, - d Account number 610 0 6 4 816 8
or Form 8888. 74 Amount of line 72 ou want ap lied to our 2009 estimated tax - 74
Subtract line 71 from line 61. For details on how to pay, see page 65 -
ou owe
Amount 75 Amount 75
.
y '
YOU OWe 76 Estimated tax penalty (see page 65) • . . . . .... . ................... 76 .... .................................
Do you want to allow another person to discuss this return with the IRS (see page 66)? X Yes. Complete the followin No
Third Party
Personal identification number (PIN) -
Designee's
Phone no. -
Designee name - PREPARER
S I rt Under penalties of perjury, I declare that 1 have examined this return and accompanying schedules and statements, and to the best of my knowledge and
9 belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here Your signature Date Your occupation Daytime phone number
Joint return? STOCKBROKER
See page 15.
Keep a copy Spouse's signature. If a joint return, both must sign. Date Spouse's occupation
toryour
records. BUSINESS OWNER
Preparer's 5 ~
Paid signature ' ~~~~"i ~ ~ ~7~ v~ Date (y
~~% ~~ ~' / Check if
self-employed ^ Preparer's SSN or PTIN
P 0 0 6 3 3 2 2 5
Preparer's Firm's name (or HAMILTO ~'& MUSSER, PC, C A5 EIN 23-2113999
Use Only yours if self-employed), , 17 6 CUMBERLAND PARKWAY Phone no.
address, and ZIP code MEC$ANICSBURG __ PA 17 0 55 717 - 6 97 - 3 888
Form 1040 (zoos>
DAA
~
1040 Department of the Treasury-Internal Revenue Service I/~ Q
o0
~.s. Individual Income Tax Return f.
v {99) IRS Use Only- Do not write or staple in this space.
Labe! L For the year Jan. 1-Dec. 31, 2009, or other tax year beginning , 2009, ending , 20 OMB No. 1545-0074
A Your first name and initial Last name Your social security number
(See s ROBERT REYNOLDS 202-46-7204
instructions
on page 14.)
E
If a joint return, spouse's first name and initial -
Last name
Spouse`s social security number
Use the IRS L PATRICIA XENOS REYNOLDS 2 01- 5 $ - 7 3 8 0
label. H Home address (number and street}. If you have a P.O. box, see page 14. Apt. no. You must enter
Otherwise,
please print a 4785 SWEETBRIER TERRACE ~ yourSSN(s)above.
or type. ft
E
City, town or post office, state, and ZIP code. If you have a foreign address, see page 14.
Checking a box below Will not
Presidential HARRISBURG PA 17111 change your tax or refund.
Election Campaign - Check here if you, or your spouse if filing jointly, want $3 to go to this fund (see page 14) - You Spouse
1
Filing Status 2
Check only one 3
box. Single 4
X Married filing jointly (even if only one had income)
Married filing separately. Enter spouse's SSN above 5 ~
and full name here. - Head of household (with qualifying person), (See page 15.) If the
qualifying person is a child but not your dependent, enter this
child's name here. -
Qualifying widow(er) with dependent child (sae page 16)
Exemptions 6a
b X
X Yourself. if sorneone can claim you as a dependent, do not check box 6a
.....................
S ouse . . ........ . ........ . .. . . . . .
.......................................
......
...
~ Boxes checked 2
en 6a and bb
No. of children
c Dependents:
1) First name Last name
(2) Capendant's
social security number
(3) Dependent's
relationship to you (4) ~ i
goal chil
for Child
tax cr. ((s
page 17) f
d
ee on 6c who:
:lived with you
• did not live with
you due to divorce
If more than four
- or separation
(see page 18)
dependents, see -
page 17 and
check here - ^
- ooienteeed b ve
d Total number of exem tions claimed ......... . ....
............
.................................
. , ,
...... Add numbers on
lines above - 2
7 Wages, salaries, tips, etc. Attach Form(s) W-2
....................... DFC 4 , 0 3 5
...........................
..... 7
. 44 , 3 74
Income 8a Taxable interest. Attach Schedule B if required . . ..... . ........ . .
.... . ... . . . . .. . . ..... . ....... . . . Sa 12 5
Attach Form(s)
W-2 here. Also b
9a Tax-exempt interest. Do not include on line Sa
Ordinary dividends. Attach Schedule B if required
............. 8b
......... ......................
9a
attach Forms
W-2G and
1099-R if tax b
10 Qualified dividends (see page 2Z)
............. .
Taxable refunds, credits, or offsets of state and local income taxes 9b
(see page 23)
10
was withheld. 11 Alimony received
............................................
.......... 11
If you did not 12 Business income or (loss). Attach Schedule C or C-EZ .. . , 12 - 2 2 , 4 0 3
get a W-2, 13 Capital gain or (lass). Attach Schedule 0 if required. If not required, check here - ~ 13 - 3 , 0 0 0
see page 22. 14 Other gains or (losses). Attach Form 4797
.....................
............................. 14
15a IRA distributions 15a b Taxable amount (see page 24) 15b
16a Pensions and annuities 16a b Taxable amount (see page 25) 16b 10 0 , 6 3 6
Enclose, but do 17 Rental real estate, royalties, partnerships, S corporations, trusts, et c. Attach Schedule E 17 0
not attach, any
Al 18 Farm income or (loss). Attach Schedule F
....................
................................ 18
payment.
so,
please use 19 Unemployment compensation in excess of $2,400 per recipient (see page 27)
.........
............................... 19
Form 1040-V. 20a Social security benefits 120a I ~ b Taxable amount (see page 27) 20b
21 Other income. List type and amount {see page 29)
..........
................................ 21
22 Add the amounts in the far ri ht column for lines 7 throw h 21. This is our total income .. , , , - 22 119 , 7 3 2
23 Educator expenses (see page 29) 23
Adjusted
GtrOSS 24 Certain business expenses of reservists, performing artists, and
fee-basis government officials. Attach Form 2106 or 2106-EZ
24
Income
25 ..
Health savings account deduction. Attach Form 8889 .
25
26 Moving expenses. Attach Form 3903
.
.
.
.
..
..
..
. 26
27 ..
......
..
...
..
.
.
One-half of sett-employment tax. Attach Schedule SE 27
28 Self-employed SEP, SIMPLE, and qualified plans 28
29 Self-employed health insurance deduction (see page 30)
.........
. 29
30 Penalty on early withdraws( of savings 30
31a Alimony paid b Recipient's SSN - 17 2- 4 6- 3 6 2 7 31a 13 , 5 9 6
32 IRA deduction (see page 31)
.
..
. 32
33 ..
...........................
..
Student loan interest deduction (see page 34)
.
.
. 33
34 ................
.
Tuition and fees deduction. Attach Form 8917 34
35 Domestic production activities deduction. Attach Form 8903
.....
. 35
36 Add lines 23 through 31a and 32 through 35 36 13 , 59 6
37 Subtract line 36 from line 22. This is our ad'usted ross income . ... ... .. ... - 37 10 6 ,13 6
For Disclosure, P
DAA rivacy Act, and Paperwork Reduction Act Notice, see page 97. Form 1040 (2009)
,.. Dl1RL'D'T U&'vATr1T..TiC f~ UnTRTC'Ta XF:N(lC RF.VTTf1T,T)~
202-46-7204Page2
d 38 4mount from line 37 {adjusted gross income) 38 10 6 ,13 6
Tax an
Credits
Standard
Deduction 39a
b
40 , , .
Check You were born before January 2, 1945, Blind. Total boxes
if: ~ 8 Spouse was born before January 2, 1945, 8 Blind. ~ checked -
If your spouse itemizes on a separate return or you were adual-status alien, see page 35 and check here -
y g )
Itemized deductions (from Schedule A) or our standard deduction (see left mar in
39a
39b
0a
9 , 0 0 5
fcr-
• Peooie wno
checF: any
li a
b
49
If you are increasing your standard deduction by certain real estate taxes, new motor
ve~~icle taxes, or a net disaster loss, attach Schedule L and check here (see page 35) -
Subtract line 40a from line 38
40b
1
7 , 131
ne
box on
39a, 39b, or
40b or who
be
car 42 ... . ... . . . . .... . ................
Exemptions. If line; 38 is $125,100 or less and you did not provide housing to a Midwestern
see page 37
650 by the number on line 6d. Otherwise
multiply $3
laced individual
dis
42
7 , 3 0 0
,
claimed as a
43 ,
,
,
p
Subtract line 42 from line 41. If line 42 is more than !ine 41, enter -0-
Taxable income
43
6 9 , 8 31
dependent,
see page 35.
44 .
..........................
Check if any tax is from: a ~ Form(s) 8814 b ~ Form 4972
e 37)
Tax (see
a .......
as
9 1
r
• all others:
45 .
g
p
................. ......
Alternative minimum tax (see page 40). Attach Form 6251 .........
45
Single or
46 ............................
.....
Add lines 44 and 45 .........
..... -
46
9 r 8 31
Married filing
separately, 47 .............................................
Forei n tax credit. Attach Form 1116 if re uired
9 q ......
47 ...... .
$5,700
48 ...................
Credit for child and dependent care expenses. Attach Form 2441
48
Married filing 49 line 29
Education credits from Form 8863 49
jointly or
Qualifying
50 ,
............... .... .
Retirement savings contributions credit. Attach Form 8880
50
widow(er),
aoo
$11
51
Child tax credit (see page 42)
51
, 52 g 8396 b 8839 c 5695
Credits from Form: a j 52
Head of
household, 53 u
Other credits from Form: a ~ 3800 b ~X 8801 c ~ 53 1 , 7 6 9
$8,350
54
These are your total credits
h 53
47 throu
Add li
54
1, 7 6 9
55 g
.
..................................
nes
Subtract line 54 from line 46. If line 54 is more than line 46, enter -0- ... . .......... ...... .....
.....
55
8 , 0 6 2
56 Attach Schedule SE
ment tax
Self-em
lo 56
Other 57 .
p
y
^............Q ......
orted social security and Medicare tax from Form: a 4137 b 8919
Unre 57
Taxes
8
..
p
etc. Attach Form 5329 if required
ualified retirement plans
other
n IRAs
Additi
l t
........
58 -_
5
59 ,
q
,
ax o
ona
ayments b ~ Household employment taxes. Attach Schedule H
: a ~ AEIC
Additi
l t 59
60 p
ona
axes
Add lines 55 through 59. This is your total tax . .... . ... . ... . - 60 8 , 0 6 2
61 Federal income tax withheld from Forms W-2 and 1099 61 13 , 2 7 2
ments
Pa 62 2009 estimated tax payments and amount applied from 2008 return 62
y 63 work pay and government retiree credits. Attach Schedule M
Makin 63 8 0 0
h 64a g
Earned income credit (EIC) 64a
ave a
If you
qualifying b
child, attach
65
l
EIC ............... ......................
Nontaxable combat pay election 64b
Attach Form 8812
Additional child tax credit
65
.
Schedu
e
66 .... . .... . . .. .
.
Refundable education credit from Form 8863, line 16
66
67 .... ,
Attach Form 5405
er credit
First-time homebu 67
68 .. , ...
.
y
..
aid with request for extension to file (see page 72)
Amount 68
69 .... . . . .. . . . .
p
Excess social security and tier 1 RRTA tax withheld (see page 72) 69
70 Credits from Form: a ~ 2439 b ~ 4136 c ~ 8801 d ~ 8885 70
71 Add lines 61, 62, 63, 64a, & 65 through 70. These are your total payments . . . . . . .... . . . . ...... ............. ..... - 71 14 , 0 7 2
2 subtract line 60 from line 71. This is the amount you overpaid
more titan line 60
If li
71 i .... , .. _ . 72 6 010
Refund 7
73 ,
ne
s
.. _ ...
ou want refunded to you. If Form 8888 is attached, check here
nt of line 72
Am . - ~ 73a 6 , 010
Direct deposit?
See page 73
and fill in 73b,
73c, and 73d,
or Form as6s. a
- b
- d
74 .
y
ou
Routing number 0 31312 7 3 8 - c T e: ~ Checking ~ Savings
ACCOUnt number 5 0 0 6 2 8 2 7 6 9
Amount of line 72 you want applied to our 2010 estimated tax - 74
t
A 75 For details on how to pay, see page 74
btract line 71 from line 60
S - 75
moun
V.,. ~ !turn ~a .
u
Amount you owe.
Fctimaterl tax penalty (see oaae 74) .. . ... ......... I 76 ~ ~ . ,i
Third Part Do you want to allow another person to discuss this return with the IRS (see page 75)? U Yes. Complete the foll_ __ owing. U No
y Personal identification number (PIN) - 3 319 99
Designee Designee's
name - RICHELLE L RAFFIELD, CPA Phone no. - 717-697-3888
SI n Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief,
g they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here Your signature Date Your occupation Daytime phone number
,joint return? STOCKBROKER
See page 15.,
Keep a copy Spouse's signature. If a joint return, both must sign. Date Spouse's occupation
for your BUSINESS OWNER '
records.
~• Date _ Preparer's SSN or PTIN
Preparer's , ~,`~~~~`h~ Check if
Paid signature ,;ll ~~ g a y id self-employed L~ P 0 0 6 3 3 2 2 5
Preparer's Firm's name (or HAMILT & MUSSER, PC, CPAs
Use Only yours if self-employed),' 17 6 Cumberland Parkway
address, and ZIP code Meehani a sburg PA 17 0 5 5
DAA
EIN 23-2213999
Phone no.
717-697-3888
Form ~ X40 (2009)
1040
Name,
Address,
and SSN
See separate I
instructions.
Presidential
Election Cat
Filing Status
Check only one
Exemptions
If more than four
dependents, see
instructions and
check here -
Department of the Treasury-Im...,.a{ Revenue Service w 0 ~ 0
U.S. Individual Income Tax Return 1 (99)
p For the year Jan. 1-Dec. 31, 2010, or other tax year beginning , 2010, endin.
R Your first name and initial Last name
N ROBERT REYNOLDS
T if a joint return, spouse's first name and initial Last name
c _PATRICIA XENOS REYNOLDS
~ Home address (number and street). If you have a P.O. box, see instructions.
A 4785 SWEETBRIER TERRACE
R City, town or post office, state, and ZIP code. If you have a foreign address, see instructions.
v HARRISBURG PA 17111
i - Check here if you, or your spouse if filing jointly, want $3 to go to this fund . . . . . ............. -
Hea of household (with qualifying person). ((
4 ee
1 Single the qualifying person ~s a child but not your de per
2 X Married filing jointly (even if only one had income) child's name here. -
3 Married filing separately. Enter spouse's SSN above 5 ~ Qualifying widow(er) with dependent child
and full name here. -
6a X Yourself. If someone can claim you as a dependent, do not check box 6a .. . . ....... . . . . ... .
b S ouse ....................................... .......................................... ..
(a
c Dependents: ,~, Da......,, ~
ter ra,,..ant s ,~~ Da~ a-nr;
t.., r2n..° ;'~
for
social security number I relationship to you I tax
14 First name Last name
Boxes checked 2
on 6a and 6b
No. of children
~ if
' on 6c who:
I rhilri ,~ liyad tyith yng
chill
cr. (see • did not live with
e 1) you due to divorce
or separattan
1
(see Instructions)
Dependents on 6c
not entered above
d
Total number of exem lions claimed ..........................
.....................
................... Atltl numbers on 2
... lines above -
rm(s) W-2
h F
Att 7 3 0, 0 9 3
Income 7
8a ac
o
wages, salaries, tips, etc.
.......................
Attach Schedule B if required
Taxable interest ......................
......
. .............
sa
67
Attach Form(s)
Also
W-2 here
b .. . . . . . ..........
.
Tax-exempt interest. Do not include on line 8a ..... . ... . ..
Attach Schedule B if required
ds
di
id
di
O ....
.
.. 8b :::<: ri:;:>:
::;>:>:::>:::
-;>::<,.
9a
1
.
attach Forms
W-2G and 9a
b
10 en
.
v
r
nary
.....
Qualified dividends
..........................................
or offsets of state and local income taxes
credits
refunds
bl
T ......... ...........
9b
.. ..........
1
" '
10
1099-R if tax
l 11 ,
,
axa
e
received
Ali ....... . .... .. . . . . . . . . .. . . . 11
d.
was withhe 12 mony
Attach Schedule C or C-EZ
ss income or (loss)
i
B ..... ....... 12 - 2 2.19 3
If you did not
13
. .........
.
us
ne
check here -
If not required
Attach Schedule D if required
i
l
it
l
C
. . . . .. . . ... . ....
~
13
- 3 , 0 0 0
get a W-2, 14 ,
.
oss).
a
ga
n or (
ap
Attach Form 4797
ains or (losses)
Oth ..... . . ... .... . . . . . .. 14 -10 , 02 9
see page 20.
15 .
er g
IRA distributions
15a ..................... .....................
b Taxable amount ...........
15b
a
16a
Pensions and annuities
16a .
b Taxable amount ...........
16b
3 2
~
d
b
17 ......
S corporations, trusts, etc. Attach Schedule E
partnerships
alties
ro
ntal real estate
R . , , . , ... , ..
17
o
Enclose,
ut
not attach, any 18 ,
,
,
y
e
Attach Schedule F
r (loss)
i
F
18
payment. Also,
19 .
ncome o
arm
.....................
ensation
ment com
l
U ..................... .........
19
please use
20 p
nemp
oy
........ .......................
120a I 31, 12 2I
benefits
i
l
rit
S ......................
b Taxable amount ...........
20b
0
Form 1040-V. a
21 . , .
y
oc
a
secu
e and amount
List t
m
Oth
i 21
22 . . . .... . .. . ..........................
yp
er
nco
e.
Combine the amounts in the far ri ht column for lines 7 throw h 21. This is our total income - 22 -1, 13 2
23 enses
Educator ex
23
Adjusted 24 p
.............................
Certain business expenses of reservists, performing artists, and
Attach Form 2106 or 2106-EZ
overnment officials
fee-basis ..
24
GrOSS 25 .
g
Health savings account deduction. Attach Form 8889 2s
Income 26 Moving expenses. Attach Form 3903
26
27 One-half of self-employment tax. Attach Schedule SE 27
28 ....... ...
and qualified plans
SIMPLE
Self-employed SEP .. 28
29 ,
,
ed health insurance deduction
Self-em
lo 29
30 .... . ..... . .......
p
y
withdrawal of savings
on earl
Penalt .. 30
31 y
y
... ..
ient's SSN- 172-46-3627
id b Reci
Ali .
31a
13,522
a
32 p
mony pa
IRA deduction 32
33 ..............................................
Student loan interest deduction .. 33
34 ,,,,,,,,,,,,,,,
................
Attach Form 8917
Tuition and fees ,,
34
35 .
Domestic production activities deduction. Attach Form 8903 35
36 h3laand32through35
Add lines 23 throu 36 13,522
37 ...................
g
Subtract line 36 from line 22. This is our ad'usted ross income ....
.. . . .................
................. ...........
....... - 3T -14 , 6 5 4
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate Instructions. Form 1040 (2010)
IRS Use Only-Do not write or staple in this space
20 OMB No. 1545-0074
Your social security number
202-46-7204
Spouse's social security number
201-58-7380
Apt. no. -Make sure the SSN(s) above
and on line 6c are correct.
enter
Checking a box below will not
change your fax or refund.
You n Spous
DAA
For,,,lo40 (2010) ROBERT REYNOLDS & `ATRICIA XENOS REYNOLDS 2 02 - 4 6 - 7204 Page 2
'Tax and 38 Amount from line 37 (adjusts,. gross income) " • , " , " • " , .. , , 3g - ~ 4 , 6 5 4
C red ItS 39a Check (-
~f: 1 I n
tJ'i You were born before January 2, 1946, 8 Biind. ~ Totat boxes
Spouse was born before January 2, 1946, 81ind. checked -
39a
b If your spouse itemizes on a separate return or ycu were a dual-status alien, check here - 39b
40 Itemized deductions {from Schedule A;~ or your standard deduction (see instructions)
..
.. 40 3 6 , 5 7 $
41 Suhtract line 40 from line 38 , , " , ... " "
a1
-51,232
42 Exemptions. Multiply $3,650 by the number on line 6d 42 7 , 3 0 0
43 ...........
Taxable income. Subtract line 42 from line 41. If line 42 is more than line 4i, enter -0- ....................... ........
43
0
44 ....
Tax (see instr.). Check if any lax is from: a Form(s) 8814 6 ~ Form 4972 ....................... ........
44
0
45 ...
Alternative minimum tax (see instructions). Attach Form 6251
.... ......................
.....
...........
... ........
.
45
46
Add tines 44 and 45 ........................................... .
..
...................... .......
.... -
46
47 Foreign tax credit..Attach Form 1116 if required
..........
. 47
48 ...
.....
Credit for child and dependent care expenses. Attach Form 2441
48
49 Education credits from Form 8863, line 23 49
50 Retirement savings contributions credit. Attach Form 8880 50
51 Child tax credit (see instructions)
.......................
. 51
52 ...
.....
Residential energy credits. Attach Form 5695
52
53 Other credits from Form: a ~ 3800 b ~ 8801 c ~ 53
54 Add lines 47 through 53. These are your total credits 54
55 Subtract line 54 from line 46. If line 54 is more than line 46, enter -0- , . • . , . , " ..... , " . " . , • , . " .. " 55 0
Other 56 Self-employment tax. Attach Schedule SE 56
Taxes 57 Unreported social security and Medicare tax from Form: a ~ 4 137 b ~ 8919 57
58 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required 58
59 a ~ Form(s) W~2, box 9 b ~ Schedule H c ~ Form 5405, line 16 " • • • . • • • " 59
60 Add tines 55 throw h 59. This is your total tax - 60 0
61 Federal income tax withheld from Forms W-2 and 1099 61 9 0 0
Payments
82 ............
2010 estimated tax payments and amount applied from 2009 return
62
63 Making work pay credit. Attach Schedule M 63 4 9 0
If you have a 64a _
Earned income credit (EIC) 64a 4 57 ;,: ,,
qualifying
child, attach b Nontaxable combat pay election 64b
. • •
"
~
Schedule EIC. 65 Additional child tax. credit. Attach Form 8812
...................... 65
66 American opportunity credit from Form 8863, line 14 66
67 First-time homebuyer credit from Form 5405, line 10 67
68 Amount paid with request for extension to file • . • • , • • " . • .. • . • . • • • . " 68
69 Excess social security and tier 1 RRTA tax withheld 69
70 Credit for federal tax on fuels. Attach Form 4136 70
71 Credits from Form: a ~ 2439 b ~ 8839 c ~ 8801 d ~ 8885 71
72 Add lines 61, 62, 63, 6da, and 651hrough 71. These are your total payments • • • • , • • • . , . . ,
.................... -
... 72 1 $ 4 7
Refund 73 If line 72 is more than line 60, subtract tine 60 from line 72. This is the amount you overpaid " • • • " • • • 73 1 847
74a Amount of line 73 you want refunded to you. If Form 8888 is attached, check here • . • , • • .. - ~ 74a 1, 8 4 7
Direct deposit? - b Routing number 0 313 018 4 6 - c T e: QX Checking ~ Savings
see ~. d Account number 2 8 3 2 4 8 6 3 2 8
instructions.
75 Amount of line 73 ou want a lied to our 2011 estimated tax - 75
AmOU nt 76 Amount you owe. Subtract line 72 from line 60. For details on how to pay, see instructions - 76
...............
You Owe 77 Estimated tax enalt see instructions ` `'" ~ ~~' ~` " `"""• ' "" ' ` '"' ^'
Third Path/ Do you want to allow another person to discuss this return with the IRS (see instructions)? X Yes. Complete below. " ~ No...~..
Desi nee's Personal identification number (P1N) - 3 319 9
Designee name - RICHELLE L HAMBERGER, CPA Phone no. - 717-697-3888
Under penalties of perjury, I deGare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief,
Sign they are true, correct, and complete. Declaration of preparer (other than taxpayer) rs based on all information of which preparer has any knowledge.
Here Your signature Date Your occupation Daytime phone number
Joint return? STOCKBROKER
See page t2. ,
Keep a copy
for your Spouse's signature. If a joint return, both must sign. Date Spouse's occupation
records. BUSINESS OWNER
....
...... ~ •
PrinUType preparer's name Preparer's si ~ature ,'
~
~
~ Date Cneck ~ PTIN
•
Paid RICHELLE L HAMHERGER, CPA / ,
~ ~ ~`~ seH-employed P00633225
Preparer Firm's name - HAMILTON & MUSSER, PC, CPAS Firm's IN 23-2213999
Use Only Firms address - 17 6 CUMBERLAND PARKWAY Phone no.
MECHANICSBURG PA 17055 717-697-3888
Form ~d~{Q(2010)
DAA
A O A (' Depa~+rtment of the 7 reasury--Internal nue Service (99j
^
L
L 2011
'~ ^
-
7
'V IJ.J. Individual Ineo~ne Tax Return OMB No. 1545-0074 IRS Use Only-Do not write or staple in this space.
For the year Jan. 1-Dec. 3?, 2011, or other tax year beginning , 2011, ending , 20 See separate instructions.
Your Hrst name and iritiai Last name Your social security number
ROBERT REYNOLDS 202-46-7204
I` a joint return, spouse's first name and initial "east name Spouse's social security number
PATRICIA XENOS REYNOLDS 201-58-7380
Home address (number and street)- If you have a PA. box, see instructions. Ap(, no. . Make sure the SSN(s) above
4 785 SWEETBRIER TERRACE and on line 6c are correct.
City, town or post office, state, and ZIP code If you have a foreign address, also complete spaces below (see instructions). Presidential Election Campaign
HARRISBURG PA 17111 cne e jolntly~ want sa tog to this
rfflin
fund Checking a box below will
Foreign country name Foreign provincelcounty Foreign postal code not change your tax or refund
You Spouse
Filing Status 1 Single 4 Head of household (with qualifying person) (See instructions) If
the qualifying person is a child but not your dependent, enter this
2 X Married filing jointly (erven if only one had income; child's name here. -
".heck nnly nna 3 Married filing separately. Enter spouse's SSN above 5 I I Qualifying widow(er) with dependent child
boX. and full name here. -
6a
oxes c ecke
Yourself- If someone can claim you as a dependent, do not check box 6a 2
Exemptions b on 6a and 6b
S Ouse .. _ .. ........ . No
of children
c Dependents:
' .
cn~~d under on 6c who:
li
d
j
h
1
(2) DependenPs Y3) Dependent
s age ,7 qua, •
ve
w
you
t
social security number
relationship to you for child ~ did not live with
tax credit
(t) First name Last name (see instr) you due to divorce
If more than four MARCIA XENOS 578-40-2557 PARENT or separation
(see tnstrucbons)
dependents, see
i
t
ti
d
ruc
ns
ons an D
check here - n
otentered above
d Total number of exem lions claimed ....... , .. ,
.......................
........
..... Add numbers on
lines above -
3
7 Wages, salaries, tips, etc. Attach Form(s) W-2
................................
..............................
....
. 7 15 67 6
Income 8a Taxable interest. Attach Schedule B if required ... . 8a 356
Attach Form(s)
W-2 here. Also b
9a Tax-exempt interest. Do not include on line 8a
... ...............
Ordinary dividends. Attach Schedule B if required
_ _ . ... 8b
..
.
9a
1
attach Forms
W-2G and
1099-R if tax b
10 Qualified dividends
................................................
Taxable refunds, rredits, or offsets of state and local income taxes _
9b
..
.
...
.
..
..
..
.
. 1
..
10
was withheld.
11
Alimony received .
..
..
....
..
..
... ..
..
11
If you did not 12 Business income or (loss). Attach Schedule C or C-EZ
._ 12 21 415
get a W-2, 13 Capital gain or (loss). Attach Schedule D ii required. If not required, check here - ~ 13 -3 0 0
see instructions. 14 Other gains or (losses). Attach Form 4797
........................
....... .......... ........... 14
15a IRA distributions 15a 35 X00 b Taxable amount 15b 35 000
ROLLOVER 16a Pensions and annuities 16a 80 021 b Taxable amount 16b 3 g2 9
Enclose, but do 17 Rental real estate, royalties, partnerships, S corporations, trusts, et c. Attach Schedule E 17
not attach, any
t
Al
18
Farm income or (loss). Attach Schedule F
_ _ .. .
. .
18
paymen
.
so,
please use 19 Unemployment compensation 19
Form 1040-V. 20a Social security benefits ~ 20a ~ 28 , 727 b Taxable amount 20b 24 418
21 Other income. List type and amount MISCELLANEOUS
..............................................................
..... 21 125
22 Combine the amounts in the far ri ht column for lines 7 throw h 21. This is our total income - 22 97 920
23 Educator expenses 23
AdjUSted
GrOSS 24 Certain business expenses of reservists, performing artists, and
fee-basis government officials. Attach Form 2106 or 2106-EZ
24
Income 25 Health savings account deduction. Attach Form 8889 25
26 Moving expenses. Attach Form 3903 26
27 ..............................
Deductible part of self-employment tax. Attach Schedule SE ..
27
1
513
28 Self-employed SEP, SIMPLE, and qualified plans 28
29 __ _.
Self-employed health insurance deduction
29
30 .........................
Penalty on early withdrawal of savings
. ..
30
31a .................
...........
Alimony paid b Recipient's SSN - 172-46-3627 ..
31a
16
966
32 IRA deduction 32
33 Student loan interest deduction 33
34 Tuition and fees. Attach Form 8917
.
.
.
. 34
35 ............
.......
...
.......
Domestic production activities deduction. Attach Form 8903 . 35
36 Add lines 23 through 35
_. 36 18 4 7 9
37 Subtract line 36 from line 22. This is our ad'usted ross income. - 37 7 9 4 41
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
DAA Form 1040 (20„)
ROBERT REYNOLDS ?ATRICIA XENOS REYNOLDS 20 2-46-7204 Page 2
Farm to4o(2ott) ross income)
t
d
37
d
li
f 38 79 441
Tax and 38 jus
e
g
ne
(a
rom
Amount
Credits 39a Check You were born before January 2, 1947, Blind. Total boxes
if: { 8 Spouse was born before January 2, 1947, 8 Blind. } checked -
39a
b If your spouse itemizes on a separate return or you were adual-status alien, check here - 39b
Standard our standard deduction (see left margin)
le A) or
d
h
f
S
i 40 25 287
40 y
c
e
u
rom
ons (
Itemized deduct
Deduction
li
38
f 41 54 154
for- 41 ne
rom
Subtract line 40 11 100
number on line 6d
700 b
th
l
$3
l
i 42
• People woo 42 y
e
y
p
,
t
Exemptions. Mu 43 054
check any enter -0-
42 is more than line 41
If lin
41
42 f
li 43
box on line 43 ,
.
e
rom
ne
Taxable income. Subtract line 5 611
39a or 39b or a Form(s) b Form c 962
f
~ 44
who can be 44 rom:
Tax see inslr.. Check if an
elec.
( ) y 8814 4972
claimed as a Attach Form 6251
minimum tax (see instructions)
ti
Al 45
dependent,
see 45 .
ve
terna
~ - ~ ~
d 45
44
-
46 5 611
instructions. 46
47 _
_
an
Add lines
- ~ ~ ~ - ~ ~ ' ~ ~ ~ ~
Attach Form 1116 if required
n tax credit
Forei . .
47 _ _ .. ..
• All others
48 .
g
~ '
Credit for child and dependent care expenses. Attach Form 2441
48
Single or
Married filing 49 line 23
cation credits from Form 8863
Ed 49
separately
ss,aoo
50 ,
............................
u
Attach Form 8880
s contributions credit
tirement savin
R
50
.
g
e
Married filing 51 Child tax credit (see instructions) 51
jointly or
Qualifying
52 . ,
.................. .......,......
Attach Form 5695
Residential energy credits
52
widow(er)
soo
$t t
53 .
.... ...............
Other credits from Farm: a ~ 3800 b ~ 8801 c ~
53
,
Head of re our total credits
Th
h 53 54
household 54 ese a
.
g y .................... ..... .......
Add lines 47 throw
,
~ ss,soo I 55 Subtract line 54 from line 46. If line 54 is more than line 46, enter -0- . 55 5 611
h Schedule SE
Att
t t
l 56 2 630
56 ax.
ac
Self-emp
oymen
Other
and Medicare tax from Form: a ~ 4137 b ~ 8919
it
l
i
d
57
57 secur
y
soc
a
Unreporte
Taxes Attach Form 5329 if required
etc
lans
ed retirement
lif
th 58
58 .
,
p
i
er qua
Additional tax on IRAs, o
om Schedule H
f
t t
l 59a
59a axes
r
oymen
Household emp
Attach Form 5405 if required
ment
dit 59b
b .
repay
First-time homebuyer cre
tructions
in
f
d 60
60 s
rom
e(s)
Other taxes. Enter co 8 241
61 Add lines 55 through 60. This is your total tax . _ - 61
l income tax withheld from Forms W-2 and 1099
62 F
d 62 3 000
era
e
Pa ments 63 2011 estimated tax payments and amount applied from 2010 return 63
d income credit (EIC)
64a Ea 64a
If you have a
qualifying
child, attach rne
........... .........................
b Nontaxable combat pay election 64b
Attach Form 8812
65 Additional child tax credit
5
schedule Elc. _ . , . , . , , _
.
line 14
credit from Form 8863
ortunit
ri
an o
66 A 66
,
y
pp
me
c
line 10
er credit from Form 5405
time homebu
67 Fi
t
67 .
,
y
rs
-
aid with request for extension to file
68 Amount 68
_ .... . _
p
social security and tier 1 RRTA tax withheld
69 E 69
xcess
Attach Form 4136
federal tax on fuels
dit f
70 C 70
.
re
or
71 Credits from Form: a ~ 2439 b ~ 8839 c ~ 8801 d ~ 8885 71
7t Tn r total a ments - 72 3, 0 0 0
72 Add hoes 62, 63, 64a, and 65 through ese are you p y
Refund
Direct deposit?
See
instructions.
Amount
You Owe
73 If line 72 is more than line 61, subtract line 61 from line 72. This is the amount you overpaid .
74a Amount of line 73 you want refunded to you. If Form 8888 is attached, check here -
- b Routing number - c T e: ~ Checking ~ Savings
- d Account number
75 Amount of line 73 you want applied to your 2012 estimated tax - ~ 75
76 Amount you owe. Subtract line 72 from line 61. For details on how to pay, see instructions , , -
77 Estimated tax penalty (see instructions) ~ 77
Do you want to allow another person to discuss this return with the IRS (see Instructions)? X Yes. Complete below. U No
Third Party Personal identification number(PIN) - 33199
Designee Designee's
name - RICHELLE L HAM$ERGER CPA Phone no - 717-697-3888
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief,
Sign they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here Your signature Dale Your occupation Daytime phone number
Joint return? STOCKBROKER
See instr. ' If the IRS sent you an Identity
Keep a copy Spouse's signature. If a joint return, both must sign. Date Spouse's occupation Protection PIN,
for your
BUSINESS OWNER iseeri~ ~Qie
records.
Print/type preparer's name Prepa~er's signature _ j ~n Date s Check if PTIN
Paid RICHELLE L HAPffiERGER CPA I >~'"~~'t-
Preparer Firm's name - HAMILTON & MUSSER, PC,
Use Only Firm's address - 17 6 CUMBERLAND PARKWAY
MECHANICSBURG
~/ ~ ~f'~ /~ /•..~ .~~.? self-employed P00633225
CPAS ~ Firm'sEIN- 23-2213999
Phone no.
PA 17055 717-697-3888
Form 1040(2ott)
74a
7s I 5,241
DAA