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of thoSG existing bills or obligationn, HUSnAHO shall indonnlfy WIrE
therefor.
6. WIFE hereby assigns, conveys and sets over unto HtSBAHD any
and all of WIFE'S right, title and interest In and to a 1990 Geo
Prism and 1990 Ch.vrolet pickup truck titlad in HUSBAND'S nJm~ both
of which were owned frd9 and clear of all liens 3nd encumbr3n~e~ or
any interest WIFE m~y have in replacement vehicl~s obtained by
trading in either of the aforesaid vehl~les.
7. HI:SRA~O herebr assign., conver5 and Int. over unto WIFE any
and all of HUSIlArIO'S ri'Jht, t It,J" MId :ntnrest In i1nd to " 1990
Chevrolet Lunina titled in WIFf;'S nan"" .~nd which IS owned flee 0111<)
clear of all liens and encumbrances or any interest HUSBA~D ~ar have
in replacement vehicles obtained by trading in the aforesaid
vehicle,
8. Tll~ partie5 dcclar~ ttlat thny hnv~ ~~~lJr~!~ POS~~5S1'1:1 of
all personal pruperty separately and individually owned b,' ,",h'h
party and further that thl2Y h.we divided ,~ll' Jointly OWIl",-j r'Hsonill
property between them, except as may be touched upon and d~"crlbed
h'!r~in, and that they right, title and i,nterest; of <,ach of th<,
parties hereto in the Items of Jointly hald personal pro~erty now
poss~ssed by each party shall b" hereafter doemed th'! separate and
sole property of the possessor thereof.
9. IHf'( will, "I")lI l,,-cdl't Qf tl... P"l",,-,,:t t,~ "lOr ,'Sf ('Jlt" illl"ll,t~lill'h
131,.') Itc-Il'illllgn 1 D,~.~,) con'lcYlrq olll h'''' rl'-1ht, till.' ollld lr,ter..,::;t
in the p.:>rties fonneL' marita). residence sltuate in W"lk,lr' To'.tn.h1p,
ff~J~
Juniata County, Pennsylvania, to HUSBAND, as is mor~ fully sst forth
anJ described in document recorded in the Juniata Count, Re,-ordo!r' 5
Office in Deed Book Volume 127, at page 76. This property L~ trse
and clear of all liens and encumbrances.
10. fIUSBi\t1O h"reby sells, .:lnslgns and s~tr. O'lilr unt" WiFE ani'
and all of HUSBAND'S right, title and interest in and to any
Individual Retirement Account malntain"d by WIf'E at Merril t Lynch,
Pierce, Fenner' Smith, Inc., or any other bank!n'] instLtution.
ll, WIFE hereby sells, assigns and sets OVer unto IIU5LlJ\ND any
and all of WIFE'S right, title and interest 1n and to any
Individual Retirement Account maintained by HUSAAND at Merrill
Lynch, Pierce. Fenner' Smith. Inc.. or any other banking
institutions.
12. WIFE hereby sells, assigns and sets over unto HUSBAND any
and all of WIFE'S right, title and interest in and to Account
Bearing ~Iemb"r No. 1254 at Loc"l 520 U..\. Federal Credit UnIon.
1). WIFE hereby sells, assigns and sets over unto HUSAAND all
of WIFE'S right, title and interest in and to a Capital Builder
Account with Merrill Lynch, Pierce, Fenner' Smith, Inc. bearinq
~ccaunt No. 872 35556 ONLY UPON TilE FOLLOWING EXPRESS CONDITIONS:
11 J nUSB/\NO 1\110 WIFE SllAI.I. SIGN II.LL PAPf:nS NECESSARY TO
LIQUIDATE SO HUell OF TilE STOCkS /\NO OTUEn 1\SSETS DELD
IN TilE ABOVE ACCOUNT AS IS NF.CESSi\JlY TO DERIVE NET
PROCEEDS TIIEREFROH IN TilE AMOUNT OF ONE OUMDRED
Plli-
TWENTY-SEVEN TIIOUSNlO FIVE DUNDREO ($127,500.001
DOLlARS: /\NO
121 UPON LIQUIDATION OF TUE SUH SET FORTH HEREINABOVE
MERRILL LYNCH, FENNER, PIERCE, FENNER' SMITH, INC..
SIiAI.L RF.HIT Tnt: SUM OF ONE IIUNDRED l'WENTY-SEVEN
THOUSAND FIV.: IIlJNDRED ($127,500.001 DOLr,.ARS DIRECTLY
TO JANICE P. IUCII^,UlSON. C/O R1CIIl\IU) S. PRIEDMAN,
ESQUIRE, 600 NORTH SECOND STREET, FIFTH FLOOR, P. O.
BOX 984, 8ARRlSHURG, PA 17108.
HUSBAND and WIFE intend that the contents of thlS ^greem~nt can be
relied upon by Merrill C.ynch. Pieref'. F~nner & Smith, Inc.. for any
and all purposes related to accomplishment of the transfer on the
above express conditions and HUSBAND and WIFE do hereby expressly
authorize said firm to transfer title to any remaIning assets in
said ,lCCOUnt as of the date the .lforesllirl Slun is r.,mittcd to Jilnice
p, Richardson Into the name of Michilel L. Richardson singly. 80th
HUSA^~D and WIFE agree that they will promptly Slgn any and all
additional documents required by said organization to accomplish the
liquidation and transfer set forth hereInabove.
l~. WIFE hereby s.~lls. aSSigns and conveys lInto IIUSBMIIJ any
and all of WIf'E'S right title and intele~t in and to IIfJSfl.:UIO'S
ownership Interest in the Stratton Mutual Fund.
15. WIFE hereby generally and speCifically waives ~ny and all
cl..ins she m.1Y have In and to IIIJ$DAIID'S P"1I3ion. drlnu.lty. Or ,'ny
form of emplol'TT1ent b~M:it plan .ldmini~ter(!d Oil IfUSDAUD'S be!a,ll!
~~
thru PLumbers & Pipefitters Local Union No. 520.
16. HUSBAND hereby generally and specifically waives Any and
all claims he may have in WIFE'S pension, annuity, or any torm ot
employment benefit plan administered by the Federal Government or
any ot WIFE'S previous employers.
17. No moditicat~on or waiver of ,my of the terms hereof shall
be v~lid unless in writing and signed by both parties and no waiver
of any breach hereof Or default hereunder ohall be deemed a waiver
of any subsequent default of the same or similar nature.
18. This Agreement shall be construed in accordance with the
111\015 of the Commonwealth of pennsylvanl.,.
19. This Agreement constitutes the entire understanding of the
parties and supersedes any and all prior agreements and negotiations
between them. There are no representations or warranties, although
they and those expressly set forth hereIn.
20. The terms of this Agreement shall be incorpor3ted ~nto any
divorce decree which may be entered with respect to the parties.
The Court of Common Pleas which may enter such divorce decree ohall
retaIn continuing jurisdiction over the parties and the subject
mattlt"lr of the Agreement for the purpose:.; of ~~nforc.'m(:'nt o! ~ny of
the proviSions hereof.
21. Th~s Agreement shall continue In full torce and effect
after such time as a final decree in divorce may be entered with
respe~t to the parties.
0-
22. Except as otherwise expressly provided by this Agreement:
(Ill Each party her~by absolutdy and llnconditioll.~lly
releoses lInd forev..r di3charges the other and the
estato of the other for all purposes from any and
all rights and obligations which either may have
or ~t any time hereafter have for past, present
or future support or matn~cnanc~, alimony pendente
lite, alimony, equitable distribution, couns~l
fees, costs, e~penses and any other right or
obligation, economic or otherwi3e, whether
arising out of the marital relationship or
otherwise, inclUding all rights and bancfits
under the Pennsylvania OivorcQ Code of 1990,
its supplements and amendments, as well as
under any other law of any other Jurisdiction.
lbl Each party hereby absolutely and unconditionally
releases and forever dlscharges the other, his
or her heirs, executors, adminiztrators, assigns,
property and estate from any and all rights,
claims, demands or obli?atlons arising out
of or by virtue of the marital relationship
of th~ partlcs or otherwise, whether now
existing or hereafter arlsing. The abo':e
release shall be effective regardt~ss of
whether such cla1ms artsn out of any former
or future acts, contracts, enga9~m~nts,
or liabilities of the other or by way of
dower, curtesy, widows or wldowers rights,
family exemption or similar allowance, or
to take against the spouse's will, or the r1ght
to treat a lifetime conv~yance by the other
as testamentary, or all other r1ghts of a
surviving spouse to participate in a deceased
spouse's estate, whether arising undAr the
laws of pennsylvania, any state, commonwealth
or territory of the United States, or any
oth~r country. The partleS each waive and
release any and all riqht to reC~lve ln3urance
proceeds at the death of the other, whether 3S
named beneficiary or otherwise, as well as a~y
rtght to receive any legacy, bequest or residuary
portion of the e~tate o~ the other under his or
her wi t 1 Ii f e:<ecuted pr ior to the e:<ecutl.Orl date
hereof) or to act as personal represen~ative of
the cstate of the other.
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lcl Except for any cause of :l.ction for divorce which
either party may have or claim to have, each
party gives to the other by the execution of this
Agreement an absolute and unconditional rele~sa
and discharge from all causes of action, claims,
rights or demands whatsoever, in law or ~n e~uity,
Which either party ever hdd or now has against the
other.
ZJ. In the event that either parry breachas any provision of
this Agreement and the other party reta~ns counsel to assist in
enforcing the terms thereoi, the breaching party will pay all
attorneys fees, court costs and expenses (including interest and
travel costs if applicable) which are Incurred by the other party in
enforcing the Agreement. whether enforcement is ultimately achieved
by litigation or by amicable resolution, It is the spec~!ic
agreement and intent of the parties that the breaching or wrongdoing
party shall bear the Obligation of any and all costs. expenses and
counsel fees incurred by the non-breaching party in protecting and
enforcing his or her rights under this Agreement.
24. Within ten 1101 days after demand therefor. the p.uties
Will execute any and all written instruments, assi9nments, releases.
satisfactions, deeds, notes or such other writings as may be
reasonable. necesoary or desirabl~ for the proper ~ftectuation of
this Agreement.
25. In addition to such other remedies and sanctio~s available
under applicable law, the parties moy utill:e any remedies or
sanctions set forth in the l'ennsylvanir, Divorce Code. as amended. to
enforce any terms of this Ag~eemant as though it had been ~~te~ed by
an Order of. the Court.
~('f.
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26. Each of the partios has caretully read and tully
conoidored this ~greemont and all the statements, terms,
condition. and provisiono thereof prior to signing below.
27. For purposes ot contract interpretation and for the
purpose of resolving any ambiguity herein, the parties agree that
this ~greement was prepared jointly by their respective
attorneys.
28. The parties agree to elQct to have the provision. ot
Section 1041 of the Internal Revenul' Code apply to all qualifying
trannters of property atter Docember J1, 198J. The parties
understand that Section 1041 applies to all property transferrod
between spouses or former spouses in~ictent to divorce. rhe
parties turther understand that the ~ffects for federal income
tax purposes ot having Section 1041 "pply are that (1) no gain or
lose is recognLl:ed by the transferor spouse/ tOl'm'!r spous., as a
result of this tranSfer and (2) the basis of the transterred
property in the hands ot the transferee SpOuse/tormer spouse is
the adJustod basis of the property in the hands of the transreror
spouse immediately betore the tranefer, whethor or not the
adjusted basis ot the tranSferred property is loss than, equal
to, or greater than the fair markot value of the property at the
time of transter. 1he parties understand that if the transferee
spouse/former spouse disposes of the property in a transd~tion in
which gain is recognizod, the amount of gain that is taxable may
be larger than it would have been it this elect ion held not been
made.
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IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. l/~." '11.' CLV;" -r;.....,
JANICE P. RICHARDSON,
Plaintiff
MICHAEL L. RICHARDSON,
Defendant
COMPLAINT IN DIVORCE
COMPLAINT UNDER SECTION 33011dl
OF THE DIVORCE CODE
1. Plaintiff is Janice P. Richardson, who currently
resides at 82 B Hummel Ave., Lemoyne, Cumberland county,
Pennsylvania 17043.
2. Defendant is Michael L. Richardson, who currently
resides at R. D. #3, Box 364, Mifflintown, Juniata County,
Pennsylvania 17059.
3. The parties have been bona fide residents in the
Commonwealth for at least six (6) months immediately previous to
the filing of this Complaint.
4. The Plaintiff and Defendant were married on May 12,
1979, in Mifflintown, Pennsylvania.
5. Plaintiff avers that there are no children of the
parties under the age of 18.
6. There have been no prior actions of divorce or for
annulment between the parties.
7. Plaintiff has been advised that counseling is
available and the Plaintiff may have the right to request that
the Court require the parties to participate in counseling.
8. The marriage is irretrievably broken.
9. Neither Plaintiff nor Defendant is in the military
service of the United states.
10. The parties separated on May 24, 1994.
WHEREFORE, Plaintiff requests the Court to enter a
Decree of Divorce.
COUNT I
EOUITABLE DISTRIBUTION
11. The prior paragraphs of this Complaint are
incorporated herein by reference as though set forth in full.
12. The Plaintiff and Defendant have legally and
beneficially acquired property, both real and personal, during
their marriage.
13. The Plaintiff and Defendant have been unable to
agree as to equitable distribution of the said property to the
date of the filing of this ComplaInt.
WHEREFORE, the Plaintiff, Janice P. Richardson,
requests this Court to equitably divide all marital property.
COUNT II
ALIMONY PENDENTE LITE and ALIMONY
(under Sections 3701(a) and 3702 of the Divorce Code)
14. The prior paragraphs of this Complaint are
incorporated herein by reference as though set forth in full.
15. The Plaintiff is unable to sustain herself during
the pendency of the Divorce action.
16. The Plaintiff lacks sufficient property to provide
for her reasonable needs and is unable to sustain herself through
appropriate employment in accordance with the standard of living
established during the marriage.
WHEREFORE, the Plaintiff respectfully requests that the
Court enter an award of alimony pendente lite until the
termination of litigation and, at the appropriate time, enter an
order of alimony in her favor, pursuant to sections 3701(a) and
3702 of the Divorce Code.
COUNT III
COUNSEL FEES. COSTS and EXPENSES
(under sections 3104(a) (1), 3323(b) and 3702
of the Divorce Code)
17. The prior paragraphs of this Complaint are
incorporated herein by reference as though set forth in full.
18. The Plaintiff has engaged Friedman and Friedman,
P.C. to represent her in this cause.
19. The plaintiff is unable to pay her counsel fees,
costs and expenses, and Defendant is more than able to pay them.
20. Reserving the right to apply to the Court for
temporary counsel fees, costs and expenses prior to final
hearing, the Plaintiff requests that at the final hearing the
Court order Defendant to pay Plaintiff's reasonable counsel fees,
costs and expenses.
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ADMINISTRATIVE OFFICE OF THE UNITED STATES COURTS
EMPLOY~~6 PAIlNING6 STATU1(NT ')
003PAHPSCPAH 8111EI'KLY PAY Pf.I!IOO 15 ENDING 01l'Zl.196 if'53'"'tD
~fNNSYLV1NIA HIDOlE PR08ATIO~F1'tc~--- HARRIS~C
J
I
RICHAROSON JANICF P.-
CL 23/17 IIGl OUE IO/I~/96
3 16 ----,~nR[HCNT COO1:1..-
SAl~B.Y 22.969.00
l!AY
683.20
8e3.20
p
~fGULA'l
CROSS EARNINGS
o
4~ 13
.')0
5.00
6,182."0 \
6.182.1,0
no DEDUCTIONS
~9.49
1072.92
718.34
173.11
61.81
10.00
128.76
28.91
3.':i0
10.00
PAY PERIOD DEDUCTIONS DEDUCTIONS
rE~S RF.TlRI!"(NT 7.07
r reA .' ...' .', :,' 61.')6
FEDERAL TAX I<\S-S fXEMPT-OI If.. ,.. ,M:-ooqO,,: 102.62
SUTe TAX PI HS-S EXEMPT.Ol. .IIIA-OOO ',' 2~.n
'lOCAL TAX HARRISeURG /1$. ~:. : B.83
NON-RESIDENT EXEHPT-Ot ~ A~OOO
oce TAX HMlRI SBURC . ,
/lFALTH INSURANCE PLAN 104 , c,
CAI!RIEI! BLUE CROSS ANO~,' . SHIELO
GOYIY LIFE INS. PLAN BASIC ,'\t. :
,'..1' I
OPTION-A (SUNOAROI .::~ !
SAYINGS AlLOTMENTS III ~".~. ~L
Nt: T PAY .'~ \ . ~. ,~~.;<~ I~:~':'" ~
CUMULATIVE REHRE"~Nt~li'.J~TtON~! .
'.:,;~ .:
21.46
641. J 0
49.49
~~~j!J!l
MESSAGES :
THIS EARNING STAT~H~NT IS BEING PROVIDED TO YOU FOR OUR RECORD.
:>LEASE REVlf.W III INFORMATlO'lCARHUlIY t. NOrr"y THE HUHAN' ~l:SDURcr'S
OIVISION IN THE AO OF ANY DISCREPANCY. FAILURE TO N TIFY THE AO
HAY OBLIGATE YOU TO REPAY ANY SALARY OVFRPAYHENT TH T RFSUlTS.
TSP OPEN SEASON BEGINS MAY I~TH AND ENOS JULY 3t. 1
.f
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:..;.. "6"'91
ADMINISTRATIVE OFFICE OF THE UNITED STATES COURTS
EMPLOYEES EARN'NGS STATEMENT
003PA'FSCFA' ,B/klEKLY PAY PER/OC 23 fNtlNG 11/10/96
rlN~S~l~A~/A ~ICCLE PRO€ATICN CFflCE HARRISBuRG
o'~5T'1
RICHARCSC~.JAN/CE P.
~ Iq~-~e-2~~2
OIRECT OE:PCSIT
Cl 23/23 WGI OUE 0~/1~/?7
2J13~1116 RETIREMENT COOf K
S AI All Y
I\EGLLAH
GllesS [A~NINGS
80.0
q]o.~O
q30.~0
13.3~2./0
13,3~2.~0
FAY PERICC CfOUCTllNS
HRS RE T IHMEN r
f 10
FHEHAl TAX MS-S EXE~FT-Ol OTRA-OOOO
STATE TAX PA MS-S EXE~PT-OI EXTRA-OOO
LGeAl lAX ~ARRISEURG MS-S
NaN-RESICE~T EXEMPT-Ol EXTRA-OOO
Oce TAX .ARRISBURG
HEAlT~ I~SURANCE PLAN 104
CARRIE~ aLUE CRess ANa eLUE S~IELO
GC~/T LIFE I~S. FLAN eASIC
CPTICN-A (SIA~OARO)
SA~I~GS AlLOT~ENIS CI
DEOUCTIONS
7.44
11.IB
109.10
26.0~
'l.30
no OEOUCTIONS
106.19
1.020.64
1.553.46
313. ~9
133.3'7
1l.46
10.00
300.44
S ::2
o
4.~6
.~O
~.OO
62,61
1.~0
~o.co
/'oio T P A~
615.31
CU~UlATI~E RETIRE'ENT (EOUCTIONS
106.1?
MESSAGES:
THIS EAR~I"G srATE~ENT IS BEINC PRGVICEO TC yeu FOR yaup RECORD.
PLEASE REVIEW ALL INFORMATION CAREFUllY & NOTIFY THE HUMAN RESOURCES
OIVISICN IN T~E AO OF ANY DISCREPANCY. FAllURl TO N TIFY THE AO
MAY OBllGAIE YOU TC REPAY ANY SALARY CVERPAYMENT TH T RESULTS.
E1C NOTE: k-,\ CERTIFICATES EXPIRE C!:CfMPER 31. 1996. YOU !'lUST REFILE
ey JA~UARY 01. 1'791 TG co~rl~UF Te RECEIVE FIC PAYMENTS.
fEHe CPE~ StASO~ eEGI~S NUVEMBE~ II A~O ENOS OECEHRE 09.
ISP CPE~ SEASCN eEGI~S NCVEMBER 15 ANC ENOS JANUARY 31. 1991
C~~RE~T "-~ FOR~S ClAI~ING EXE~PT FeR FECERAL lAXES MilL EXPIRE
JANUARY 1. 1'197. NEW FORMS ro CONTI~UE THIS STATUS ARE REQUIRFO BY
FEl:lR~ARY I~, 1'1'11.
1'l91 SCCIAl SECl;RITY wAGE IlASt: .05,400
1'1')1 ~ECIC'Rf wAer l:lASU UNLlMIHO
.__J
4"".0/1t)
.;
PAY PERIOD OEOUCTIONS DeOUCTIONS
FERS RETIREMENT 7.44
FICA 11.16
FEDERAL TH MS-S EXEMPT-OI EXTRA-OOOO 109.70
STArt TAX PA M5-S EXEMPT-Ol EXTRA-OOO 26.05
lOCAL TAX HARRISBURG . MS-S Q.30
,,', '-"01't-~"tlt1'l""'''''''~1C'f M"''r'"-q1-~:'t'R~l)(l':''''''---' - - ':'~' ,
OCC lAX HARRISBURG '-'
.........,
HEAltHII'<SUHANCE I'LAN 104
CARRIER BLUE CROSs AND BLUE SHIELD
GOVIl L IFf INS. PLAN BASIC
OPTICN-l\ (STANOAPO~
SAVINGS ALLOTMENTS ~l
ADMINISTRATIVE OFFICE OF THE UNITED STATES COURTS
I!~PlOYEfR "'AnNlNA~ RTATr:r.ACNT
03PAHPSCPAt1 I\lwu:1([Y' PAY pERIOD 25 I.NnlNr.Tz7087~() -".-~31
L A -MTlnlLE PJrO~AT raN Orrlcr ..-'...trAlfRT58URG~ .
, ~------ ---------.--~':~:------------7--.-.
. .-':Ir.'-~, l')4-I,n-.V,62CLl3123 WGI Q\J,e 0"'1.',''11
, ------rtTJfLn~n'srr'21T1rm6.-------lff1'TREf1E NT "'tI'JIJrK
. ,_1" -.::..n'.---=:~=~=~J.ARY ZI,"Z90.00.
PAY P RIOO El\R~HNGS --.l!B.L.. ' . .~._~,--, ..-ll.lL1'ARNJN~
RECUL'AR 110.0 ' 930.40 15,203.2'0
GROSS €AR~INGS 930.40 15,203.20
YTO OEOUCTlONS
121.67
1,163.00
1,172.~6
425..,69
151.99
..ta.<t"~"""--,~."",,,,J'+;".l.
W'7".
I ()...~)Q .
343.36
21.46
.,; ::2
o
1,.46
.50
!l.OO
71.51
8.50
60.00
NET PAY
. 615.31
!1iJ;Ii1l!.'*IIl.U'lilll
. "Cu.r~~ATI;vr: Rn'IR(~ENT DEDUCTlClI'''S,' ;....;:..' . ";.
~E:~~~'Ei,"'i."':" .' ,,:..' " . '. ":".:':, .;:::.:"~;:::rt':I.""':' \.. .:' ,., ;'
TH(S~IRN1~G STATEH~NT 15 B((NGP~d~IOeo TO'YOUfO~ OU~ R~(ORU.
PLEA5E REVIEW ALL INFORMATION CAREFULLY ,&NOTlFY TIlE HUMAN RESOURCES
OlvrSION rN THE AO O~ ANY DISCREPANCY. fAILURE TO ~o .IFY THE AD
MAY OBLIGATE YOU TO REPAY ANY SALARY OVER~AYHENT THA "RESULTS.
HC NOTeI \01-5 CERTIFICATES EXPIRE oeCEM6ER 31,'; 1996. YOUIMUST REFI.t~E>
BY JANUARY 01. lQ97 TO CONTINUE TQ REtEIYE rrC'PAYHE~TS. ',:
, \. - ..... ..---
111 .61
FEHB OPEN SEASON OEGINS NOV~HRFR 11 AND ENOS DF.CFMB O?
"
.1;.... ,... -..,......,........._............... .._....~.....--,_....."io'ft. .... ... ?,.If .--'0............., ...,.,._I........_~....., ~~".,_ ...._,~_.~.. ........~.::. ..
TSP OPEN SEASON BEGINS NOVEMBER IS AND ~Nns J.NU^~Y 1. 1991
CURRENT W-I, FORMS ClAIrHNG EXEMPT FOR FFnFRAI TAXr,$ ILL- EXPIRE,
JANUARY 1. 1997. NEW FORMS ro CONTINUE THIS STATUS A E R~OUIRfO 8Y,
FEBRUARY 15, 1997.
1991 SOCIAL SECURITY WAGE !lASE '6fj,400
1991 MEDICARE WAGE BASEl UNLIMITEO
.'. ,
, 'J '
. '
~.,~ 1040
Labol
Uoo the
Inll
label.
a.p"''''.n' g' the Tfluwy-'ntaflla' "..11I1.. a.Met
U.S. Indlvlduallncomg Tux Roturn
Forlt\. ..tJln 1-0111: 'I, InS,orOlh.rts. ~e~n
199!)
lun,'~clhl
flllll 1"0 .... "Ill.,. -- Oil nlll "'''1. lit A'AIlII In In" '''It'I,
.
AU 194-~6-9750 Lg4-~O-2462 528
MICHnEL L " JntllCE P RIClinflDSOll
"f,J !i [JO;( ~(~.1
MIFFLINT')W'~ Prl 17(J~9'9lil.
3P
r.....ldcnU.,
BecUon Cllmp.'l11l11 ~
{!!Go p.q. " r
Alina
Stalus
(So. page 11,)
Che<:k only
onQl)Ox.
exemptions
(S.ep_ lZ-)
llmor.
lItan sUe
dGpend.nts,
see pege 13.
Income
e.
AUDch b
QopyBoly'out 8
t:.r-Tci' :'-d2. 10
1000,111,...... 11
12
13
1~
15<1
16a
17
18
19
flyou did no,
get a W-2,
.... pege 14,
Enclose. but
do not attach.
your payment
and payment
voucflar, See
poqe 33,
AdJusI-
menls
10 Income
22
23a
h
24
2S
20
27
28
z,
00 you want $3 to go 10 this Nnd? .
lie olnlroNrn do"" ur. OU!4wonl$3to o'olhl.fund?
61n9'0
Man1tId flllng /Olnlroturn (avon Ko~ono hadfncoml)
Married I1nngltUpllalO rot\lrn. ["hr 'POIl'.'. S$N abov., IIId f\lll n&m. h.rr, ~ ____........_____________...
H..d 0' hauI.hold (wtlh qlJ~n" paruon). (SOQ pllifi''' 12.) It qlJcrJiryh10per3CJfI hi 0 &::hHd bu, not your ClBpGnaonl,
onrorcl1lld'enameheno. ~ --.----____._n___...____________,.. ""--'-____n_____.._
Quail wi or w1thd ondllntchlld Oar. u..dled ~1D ,Soo a &12.
you"'".f. IfywrpNllnt (or.omeoM ah:o) ~.11 QhMmyou N .dopendd"'On t~:ior her
rtlllJrn, do nol chock !xlx Il<I. But be sure to Chock \he box on line 33b on page 2
1
2
3
.
5
6;0
~ ~pou.e
o Dependents:
(I) fir$! name
~~~
:l open 001 8 GO
rlty rJumbvr. If born
In 1e9~ . 13.
ust nama
d II you, 0""11 11141"'111". _llh )''i'II INtl, "~m.1I as )'Our 1I."."\I.nl unCI., _ pr'-IVI!) .grUm.n\, ChICk h.,.
o
7
Total number of e''"'lltlon' dlllmod
Wages, aaJarle3, tip.,atc. AlIach Fotm(e) W-2
------.......-----------
----.....----------
-----------
20a
21
Toxablo IntQrQ4llncomo (eeo plgo 16), AIlach Scho(M.. B II ovor $400
Tax-e.xemF1t inttrut Irlcomt(su p_gl 1S~ OON'T InClud. n" U",... I iIb I
Olvldend Inca""" Attach !lchIIdlllo B II 0_ C400
Tilllobl. ftf\md4, Gr.dit. fir 0,,;.\1 of .tl~.lItd k1c.allnCI)III, taq, f... P''ll' '!I
Alimony recerY9d
Buelno" Income or (/oss). AltacIt Schedule C or C- E2
Caplt" gain or Oo..)./Il'llqulrad, anocl1 SchedUle 0 (see pogo 16)
Otfltitr gaIn" or Oosse:s) AU&.;h ~ltn "TV'
Torel fRA distributions ~ -.--.J b r"""bl. .mounll....... ",
Tl)bl p,,",IClI1' .. ennuitl.. l..!!!J t b TuobhiJ amount',.. p.g. 141
nontaJ roll ~I.t.t.te, ro)/l3Itkml pDltner'$JllplJ. ~ corporaUul151 VUSlS. elc. Attacn sCnQdUle E
Farm Income or Ooss). Attach SchedulQ F
Unomploymonl oomponsallon (aeo page 17) .
E'.oclc.J 80CUrtty b~notlto 1:::1011 , ~"T&utJlo wnol.lnt{~Qt ilia. 15J
Other Income:
And 1h. f,mou ntII' In tho f(ll rlQht column tor 1Ir'l08 7 throu h Q1. Thl:t 10 cur tota' hu.ume
Your IRA deduction (soopag<l 1Q) . na
SpoUQQ','RAdeduction(aeep_19) 23b
Mnving fllqlans~ Anaeh Porm3900 o(~OO1-F 24
On.-h..'otself....-npiOymtntt.. . 25
Sall-employea Malll1lneuronoe <I<lOUCUon (.eo pogo ~1) 2fI
Keogh&I4l(-emploVeclSEPplans.lfSEP,ch<lCk ~ 0 ~7
~naftyonear1yw1t11drawaJo'e.vlngs 28
AJjJflony p.'~. A.Glpl"'f' 'IN .. 2'1
30 Add lines 23. Ihrou h 2fI. These are
AGI ". JII'''..' 11".10 'N'" 1M.:>> j hi . f.
~'ijkM 1040(1~5) 1'll1040-.
F""fI ,=.,llw""e ":up'/n<1"1 I'A'" H&~ BlolOM TtJ~ S.rvlc.., Inc.
ur lid lI""""'nto
lip-I ill....... ....."... I' I...,h." ,:ao.." ''':1.. ..toll..
, L.IU"'_,.",1t4Inp.nm." !:",tlh nn "..n. 21
" OMB NO. 1641HlO74
Vour aoc/ol seeIlJ1ly n"'~-
19':-46~9750
SpUU50'O .0cbJ .Icurtly no.
1911-48-2462
~"r Io',t..,.ey Aot .nq rapcrwork
Reductlon Act NoUee, .... , 7.
Yn9 No
Nolo:Ch.CklnU"V....
'Mil nql cnM\Jo your
11M a,,.owc. \tCll,jr
"fund,
NO. al 1M...
l:h'ck.~ an ..
_"deb
2
4 0 monttus
Iv.illn your
hotTlQln fe9~
No. of yaW
Ilhlldrwnon.o
WPlo:
. !tved with you
. cll.""1.........II"
)'lIUdll.tg
IINOn:. Ot
.....pU&ll."'(~..
p.o. 1 Ill)
O~.tnt'nu 0" 41Q
not.nt......,"boy.
..
~ Addn'ullblr'
;nttreoon 2
nll.bow
7 66,900.
I.
e 5
10 1
11
12
13
14
l!ih
llh
11
18
19
~Ob
70,602.
~
,to
30
31
,
Form In'0(10~~)
fOrn' 1010 MO~I
TalC 32
Compu- 33.
I.lJllon
(Seo pOijO
:3.)
II you WlInl
1I101A$1O
filllJl'IVOU'
.....-
. Q3~.
Credits
(:k>e poge
24.)
Other
Taxes
(So. p.O.
~.)
54
Payments 55
118
1fT
AltaCh
ForrnG W-2,
W-2G, llI1d
1ooQ-A 1:In
pag.ono,
5B
59
GO
51
Rofund or 62
Amount 113
You Owo 54
85
Sign
Haro
MICIIIWL r, Ilo JANICE P lUCllARDSON
34
Amount Imm linn [11 (odJuttod gro..I~) . 0' . . , . . . .
Chocktf, 0 VOUWlJ'OOOorOldor, U GUild; /ljIou~ow..ti~"'OldOf,
Add tho ll1.ImbOrol be'OIl_ad &bevt and onlOrlnolotal hotO
b II V'OUr garont (or 8Omeonu~SO) can dlllm yolJ ..,,, rlOf')f)flc~ml. <=hri hofo
C II yoU aro mM1O<J r~ln~ sopwlIlo/y ondyour llpoU:.8Itlllr/zco dodudionsor
yuuDfuu.1u~-VlatU5~8n,lMllp8{J0:l3"'dCnOCkhwV .......... 33C
Enlor [llemlzoddoducllonSlmmGcllOduIoA'DI102B'OR
~tan_d deduction .noWIl_W fOr VOU'fIIIng stawS. Ilulll you chocked
1110 .nv box on nn. 33a or b, 00. to PO. go ZlIlJ nnd Vou, lI10lldllTd doducUOIl,
1_'96r II you cl'M.....OIJ lYUI 3.3c; your 8l411dlltJ CJecJUcuon 131'010.
0' . Slnglo -- $3,000 0 MllITIOdnhnR Iolnllo, Qulll,Mnowidow(OI)'- $8./1.'10
your. 0 Holld 01 hou,.hold -- $5.7W . Monlodfll1ng 5QPerolOly 00 $3,2'10
OubllactUne:S4'lomUno3Z . , . ,
II Un. 321. $88,~5 OlIoS., ntJllJply S2 ,!500 I:Yi lito fOl" f1J_ of OlCOfTllllons do/mod on
nno 6O.lfine 321s0V"'~B8,(l;Ill, 100 tIIowol1<shoolonpogo :2:llo,Ih..,rounlIO ento,
Toxablo,noom.. 6UbltDc1'lne.:J1S trom Ano tJo. Ii loe 013 b more than une 3', urltur-o-
TW(.Choekn'rom . ~T4XTOblO. b o T..RIIlO&-.hodulos, e 0 G.1pIullGaJnTOl(Wo~"
.hoct,o, dO Filn11801~(o..pago21).AmountflOmForm(.)ee14 ~ e
Additton" tDIII. ~had( It from . 0 Form 4070 b 0 Fa"" 04D?U .
d 9
CrOd" 10' eluld 8I1d dopondont carD IIXpqnl8e. AUlICh Form 2441
Crodlt 10' th.. oldot1y or tho dlllbItld, AltN:h Soh.do'" R
Forolgnl4XC11Id1.AIlAlCh~1'16 '......
OllMlr CAdlIl (a.. pogo ~). CIIIlCl< n trcm . 0 ~orm 3800
b 0 Form 8386 eO Form 61101 d 0 Form
Addlnos41ttvough44 . . . . .
9ubtractW,.., ..orrom 110810, lflflO~l:lmon' UU1I1IIf11t40 IU1ter "0'"
Sel/-employmont llIx. AUach Sohedulo SE . .
Altom.Uve mnlmJm 1lIX. Allltch Fom1l1251 ......... .
"_lUrow....Checknfrom . 0 ronn4= bO I'ormOOI1 .0 forml102ll
Soct., !leCUrilyond Mod/clw IIX on .p InoomenolrGpoI1rid 10 oll1lloyot. AUach Form 4137
Texon qulllfted 'eIlromCIntpllns, including 1RAa.llrelJlinld,llUachFormll329
Advl1nt:ooamodlnoome QI"OdKpaymontll from Form W.Q .."
Hou..hold lln'j)I)ymIlnttaxes. AUoch Gchlldul. H
.
1:2 , 71l :
3.~ :57, 1191.
3~ 5 000.
~r
38 9,73.5.
as
40 , .
44.
~
,
.
o Blind.
. ~ 33.a
... ~~b
~.
3B
~7
38
38
40
.1
42
43
04
41
U
03
~
9 691.
44
46
4&
47
4B
48
60
51
82
113
Add IInet 46 tl'ltoUnhR.1, Thlsl!l I G
'.d'f'lllrH;Qm. till w1thhld. It u.,.1a fro. 'OtM(JIIOII. e".. ...
""5 IIumat.l!I ~ plly",ontlllld ."'.,,"t 19phG fralllllUil4 rtltin\
I::amlld Income Cf'tIdrt. Alllcll kh.dlllo ile I' YOII haVIII IlIJl'lfY'''D
chilli. NoMIXlb'l 'U"ICSlrtCO,"': '-"'4unl ..I
NO
andl)'PO ..
Amountpllld wfth Filrm 44&6 (extension ,.quost)
Exc"""$OcJ"'GoeurllY,lI1dRRTAtaxwllhhold(....p~32) . .
O''''''',oAym.n'l. cneCllffNm . Df'oflTl2438 bU fofm4'~6
Add IIn89 5e Ih(ou~h eo. Thoa8 oro vour_to,t11 paytll~ .
If SiI'l,'1" mor,thll1ll1' s.. IIJbtrlct un.S.ftol" 111.'1. Thi,It"" I1IIG',"lyou OVERPAIQ
Amountofll",,(j~youwantnr:FUNDEOTOVOU . . ., .
AMOII'" of ~no U YOU WlnIAPPU!'D TQVou" 19M UT/MA'lD TAX .. l.~. J __ _ _
Iflln8 ~41s morelh.n IIn. 5t,lItJbtrllC,lIn. 61 ~omllno 54. ThItr Is IhoAMOU/fTVOU OWl!,
For dalAi" on how 10 P*'I. And uta Fo"" iO.tO - v. r.ymont VO....ohOl', ctM pas- 3~
6S EntimOl.dIOl(DQn.IIV(_DaaO~).A1"!,lndudoonlnollll I se I
Under ponlluG. 01 D.'/ury, I d.cllf'll~1I1 1'1411. ."mined thl'''hlm",d ICOOml'MYlItf Ich.dul..."d at;u.m.ntl, Il'Id 10 "" bill af lIty _nowlld80 and
blll,r. tllGyu. ""0, I;Off.;\' and CO"'III"_. Of'lrill'lllCln 01 prlpu.r(Gtlltt' 'h~ YIlII.,.OI, bU'd IU' ,II Intormauon 01 'WhIch Dr'D".'"U 11\>, '"....,...,0..
0.10
YOUtoocupl1lon
LABORER
li.. Yourslgnal\lt8
Ko,p.oopy ,
01 this ,alum
foryour ~ SpC'lllr.'I'gslgnlftJro. Ulolnt,okJm. oonfmu!t~n.
rtCOnl9. [..
Paid Prep.,....
Ptop,uor's IIlgnatUIO See Attestation
Uso Only Flrm'8nlll'l8(OryotJ,!! ~
---1ro~;:FJoyod)~~HIPt!'l.INTOWIT, fl
Wi:M10IIQ(IQl51 mlCl4ll-'
~:~o 'W""C:OO#IOIII l!aU .1&R 1Il1c;'t"1l Tu S.,V101.,lnt.
Dote
Spouao'uOCCUpldOn
LABORER
o.t.
3 14/96
8,489.
"orm IdCO (10~~)
^",lch.."nl
Schedule O-Interllst and DIvidend Income .,,,on.'N..DI
._____ OMONa, 'lW'~OOl._
NAlM{II) chow" on F'onn 1040, I Your OOCIIiI lOOUrUy nUmber~
MICHAEL L & JANICE I' RICflAHDSON .. _.'_____,. _ ~~-9750
Part I Notv: Irvou hadoV8fS400lntl!Xllhl9.1nfnm~11nr.Orry~!.X!lli.'!.~!J~~~ry]JJ~...!!L-____ _~'_'
Interest t llll"1lnO uffJQYIH. It Ill')' IlllorC31 I" IlUllllI r.qIlUf -n.umc;oo nlJUnogo amJ U10 Amount
Incomo bUyGfusod U.. proporty.. I p"'$Onol ,ooldonr.." ."" P4()Q 0,,' and U'IIl,.
Inloro'la"SL AI"". .howthAl buy",-. 00",1\1 Oocurlty numOOr and addles. .. .,.______
II Add thUn-oounlSDn Une15 , .
7 Caprtol gain distr1budono. EIller horo and on Schedulo O' .
8 N0I1I,'!wnhl9dt8lJ1buUong, (S..lh.lncl. for Form 10"O.Une~.) ...
9 Add Hn.. 7 Ilnd 8
I U S"b~.clllno V !rom IIno 8. Entorlhe rasu" here and On Form 1 0<10. line 9
. If you do not nood ~chtldulQ 0 to repcnt .ny othQr gilln. Dr k)tJO()u, NO lho
II1$tructions for F0'1J11040. Une 13. on page 16.
Port III If you 11.,1I over $400 Of IntlnBtor CflVldends or had a for<!Jgn aCCOlJntor WGf'Q agrantor ot, Or a rranst.rorto,
Foreign .'Dr'lgnl/U$l.VOUO'lJS1C<l!!'llf~~II1I~l!!!L-___ .
ACCOunts 110 At any ~"'" during 1 g9~, did I'lu havo an IMI._ln Dr I 61gnalu,e or Dthor OUlhority over. ftnanelal .ocoun'
and In a 'or~rgn country, .uch ad a bank <<cCQunlt 3eUJrfdU8 JCCOum, orotl'ler rlnancfalaccount? s..pagca B-2
Trusts for exceptions .ndfifing r9lluiromtlnlS for Form TO F 9().'22.1
(See b 1f"Y",,'ontorlhenIlmeUflholorolgnoounl/y ~
pogo B-2,) 12 Worayou the vranrorof, or Itan"."" ru,. f"rotsn WOIUuUxl311!<l aunng 1V1/0, wl1e1neror noll'lu havuany -
-_ bQnefiCi"'n"""s1lnll1lf'Ye!l".l:!!~rn"Y,,~v.IOftleForTrl3i120.3m-~or92~
KIlA For P'PMWOrk R.dutUDII AIOt _e. _ Fann 1040 IIIWuo1lon..
(SclG
pagos 1~
andO.' )
Nott:lf)ul,J
received Q Form
101l9,ltofT,Form
100Q-()jO, or
oube!llUI.
....ternDnl from
. brokr<oge 11m,.
1st lhe firm's
n..-no'sth.
PllY1lr and onler
lIIe lowlnter.st
soownonthal
form
Part II
Dlvldond
Income
(S..
plg.110
and B-1,)
Noto: " you
rtoelvod.o. Fonn
t099-OIVor
.ubmllUle
.1.1lIrmnl from
a broker...o
fltm,lIellhe
nrm's name as
IhopayorMd
entAtlhQlot,,1
dlvldend..hown
on tn8tform.
---~._----------~----_._._----_._---...._--.._----.._-----
-..-----------------...------..- ------....- -----....------..
..-------.-.-------..-----.----.---------.---------
-----..---------.---------.--......-----------
-_.~----------------_.._-------_...
-....---..----------....------..----------....------
~-....-_._-----_._---_. ._~--------_.._......_--------
..------.....---.-------.----
...___w___________.._
.....----.------..--
_w__-------...___._.._____
......-----..----..---------.---...---...---......-----
--.----------.
.------
------------
..---------
---------------.-.-----.--
2 AddlhaamounleQnMrlO1. . , .
3 Excludable Inloro$ton eeries EE U.S. savIngs bond31s:suod alter tSSB from Fonn
U810,ino14. You MUST al!llch FormOo101O Form 1040 ,
.. !iublr.r.t nr14;l3, 'r'tImNnQ~, Ilntol' tho roeul' horo and on ronn 1CW)llfne 011 ~
Nole: "yOU hod OIlGt$400 In QJOG8 dlvtdend. and/or other dl3ll1butiD~ c.n .1Q.9!&lJ!1Jl!!1lI also CO
5 US1 nGnll/ of PIIY"'. Include gra... dMdendo IlId/or other dIoU1bullOnl on SIOOk herO. My
cmplt4.lgaJn dIstribution. and nontal(.bl. dl'ttributionewUl' ba dedU*d on In= 7,and 0 .
.l1P.liigg. LYNC[______ ______
2
3
4
Psrllll
Amount
2,059.
-....----
-_._._--------~._-- .----------..---....----
--------.. ------
....~-~-----------______M____~___.___...._
_......-.---..~._--------_._--------
----..-------....------------..---------..-----..
8
---------
..---------..---
-_._._._----..----.~_._----
------.....
..~-_..-...._---~~-
----------_...._-..._-_.~...._--
--...._----
---------....--
-----------~----_-___w_____________
--...--------------------..-.----------
7
8
2,059.
,.
59:"
X
Sch..sul. B (Form 1040) 1915
SCHEDULE B (19~5) mS-1
1'4"" ~..."...IWQ';'..'''I'nl 'ttl.' 114f'111111DC_ fa", 3~.i.T"e.
""m11118(1000)
MICHAEL L & ,1~~~ P RTr:11J\lm~ON
IPaifJ,1/ Agurtng tho Cledll
-_.._._----~...,-_._-~
· E""" lmOunllr<lm Una 8. Th'" b tho "".11 flJfolgn 1..0. pllld Of lU'.atlud lor
IhO C"">gOry ollncomo C"",,"ad Ibovo ",,"l . . .
10 CIltryback orcenyovor (ollAct""'LlMod CO"",ulDllon) 10
II Addlln.....nd10
II
t::l noduoUon In forelyn tolAUQ. &'0 pagv' ollllOln~tnJL"UOnlJ
12
13
14
SUblI'lICl11na12fiomllnOl1. Thlll4lf1olOWIInlUnfolloralgn"'01Ilvlllllll:l/olorcrodl\ . . . . , .
&r1lar amounl 'rom Iln. 7. Thtllo yvur wcable lneon.or QOSS) rrom
IOtJrooo OUllllda tho Unllod S1aIe<I (before adlYlI1mom.) fOlth8
ClI~oryol Income chockOd II>ovo PllfI I. Soepago7ollho
InctruQllon.. . . . . . . , . . , . . 14
Adjunnenf4IOUne14. SllOpage701lf1oinstnJcllonl. . 15
ComlJlnelhaMlOUnl>J on Unoe 14111d 15. Thlsla yournet fotlllgn eourea
.aubla InoorTlD, (If the 'HUII..:wt'O or 10M, you haw no tomlgn lQ cnttJll
for 1110 C<<Ulgoryoflncomeyou chod<od allove Part I. Sldp Un.. 17
trvouOh21.) . . . . . . . . . . . . . III
fndlVldual5: !nt<< .mourn liom F1lml1ll4O, UM 30.II)'Ou .....
nolVtlldont lilian, onlor lIIl1OullIlr<lm Fonn I040NR,lne34. LJ
!!allolo. .na 1IIllI1:I: EnloryourllllWllG Income wllhoUllho doduC1Ion
loryourllJ(Qrnpllon. . , , , . , . . 17 57, ag 1
c.uUon: If you figured YOIlrl<<ll ulllng If10nwdmumw ra/Q on ctplloJ Olllns, "'" paga 8 o. lh.lnlVWtlof1&
D!\oldaUno10llyU".,7.'""01018111Ol8I1l1nln017,lnwrtnerIgUlo".. . , . . . . . .
IndMduafe: I!nt8r amounlfromForm 1040, Dna 40, f.1lS any lIITlOUn1son Fonn 1040, a_41. 42, and
any mortgage InlerMl crudl\ (!rom f1>rm 11398) on "n844. II you IfO a noMl8ldofl1 ailen. anl<< amount
fI'om Foo" '040NR, line 01,.... O11)'''''U''' on ""'m l040NfI, Uno 40 III1Cl anymongage lntllIllS1r.:ttcln
(from Fonn sage) on IIno 42.
Ealiltaaand 11u.\e: Enler amounlfromForm1041, ScIIedulo G, Uno1C, or FonnOoo-.r, """38 end 37
Uulllplyllno'.byllno".ltJllOlftrumamouf'IlOlc:rwdlQ. . . . . . . . . . . , .
Emerthe lImOunrtrom llno 13 oraneOO, whIchev8rlumeJI'll', (If Wahl lhoOn/iFom11118you are
oompleting, skip an.o :22lhrough:zg and enllltlhls amount On """ 30. Olhorwi$e, oomplofa lI1e
8D11mf'lr1ateiln..'nPI"tv.) . . . . . . . . ~
mm Summary of Cledlls From a.pareto Pari. III (Soopou.oOftheln_cdon..)
15
18
17
11
1.
M
21
:22 Credit rOt laXU80n pesslvolncome
2:l Cledll for ""'" on high wtthholdlng lax Int__ . 23
24 CrO\Jlt for l~e' on nnanc;IJllIervtcos Income . 24
2.5 C"Oll1orl~on'"'pprngl_"", , 211
21 Credit fo, 1~81 on dlvldonClI from 0 DISC or former DISC 28
27 r.rodlt 1<0' ..... on cortaln dlo1r1butlono from a rllC or former roc. 27
--
2. er.dlltor_onlump'oumdlllll1bullonl. 2lI
29 C".t1tdl1 fn, IDn on gonorAllmlClIdon Incamo (ell oUt., Il'\OOme from
eourcesoulllckllhe Unllad Slllee) 29
30 Addin"ll2lhmugh~ . . . . . . .
31 R6duc1Ion OIOl8dllfar In1Ol'nl1lo"'" bojCOnoparatone. See Instruc1lone for Kne 12 on p~ 7. ,
32 SUbOllClUne31ImmUne30. ThI.r.yourlOrelQnWCredll EntorhereandonF1lnn 1040, IIno43;
I'olllll040NR 111041' '0""'1141, scllodutoO, a0021:0, Pormooo ~T."no GO.
FomI10(It9S) I'llIUe-a
'0"'" '4""'_' e._)'f'It"II"' ..an '....II T.... ","M.., ,"Go
l!14-4G-9750
11
20
21
~
31
,.. ~
'orm 1111 (19M)
P2.E..
82
0.0045
44
44
44
Fonn 2106-EZ
Unrclmbursod Employeo Business Expenses
OMI No. '....~'404'
0..,,,,,,,,,,,, Q' Tr.....ry
....t.,.~1 "h...,. SWett11l
Your namo
MICHAEL L RICHARDSON
~ See Inslruc:llon. on "AlI'" 2.
.. AlUch \0 fonn 1040 or Form 104O.T,
I Sod'" 8OCtJr1ly numb<<
194-46~9750
1995
~
~
ARu::.....'
s. I,.,.t:. Hit. 64A
OC;~ytI'bon6n ""Uch -lit,"'" w....~fAa
LABORER
Genoral InfOIlT\ilUOIl
You Moy Us. Thb fonn ONLY H All 01 tho Following Apply:
· Vou 110 an employeo dllduC1l"ll ,"",on.., lIIb1butabIe to your Job.
· Vou do nOlgfllr_"",d by)'OUrempIoYWforil.ny,"",s__(ll/1lOunl:!your~tayorlndudodlnbox, O'VOurfonnW-2aro
nol oonsld<nld rWroburaemonlS).
.IIYOUlll'Odo.lrringv9lllcle-.xp.~
. You own your vetvdo. and
b You IIRl u<lna Ulell1.ndll/d rnlal!l9 rale lor 1995 AND I/sQ uoed II far IhIl V<larvou llral plllC1ld the vehicle In servlco.
~~~ F1gurll Your ExpenSell
1
VeI'oI<:l. expanse uSIng IhIlSllndlrd nileogo IlIl8. Co/l'llletll PM IIIlnd rroltJply RIM 8& by '.3a
(.30). . . . . . . . . . . . . . . . . . . .
PIll1<Ing r.....IOIIS. and transp<lnauon, incjudlng trllln, bue. erc.,thal did nollnvolve o_nlght
"ovoI . . . . . . . . . . . . . . . . , . . . . ,
rRIVet """.nse wnllo .w"'trornhool1ll0~ Inctudlng /odgl"ll. Uplane, cor rental. tto.
Do nollncludo.....l' and enltrUilMVllll
I
6 280.
:z
;1
2
. . I . . . . .
3
4 Busln... ollPtns." nollnclJd.d on II"." I waugh 3. Do not Include lt1II/Il:Iand enlel1llnmonl
4
5 Mealund0l1leltalMWlllloxpens.:$ XIlO%(.llO) . . , . .
o Total "",,,,"-,. Add Inos l11vo<Jgno. fII1er here lIldon on line 20 olSohedul. A (Fonn 1040),
orForm 104a-T. SocUon8,llnen. (OIIaIllIed petloming onlslIlI1<l Inclvldu...wtIh dlllablllllee.
....1 I onsfor alrulMo lOenrerlhfsamount.
I
~ InformatIon on Your VeI1lclo. Conllloto thIspanONLYlfyou.....OIaImnOu.hlel.."".n...on"ne1.
e
6 280.
7 Whon 010 you plICO yaurv.hlduirl_tor _.-pu",....? (momh, Mi. yell')
~
1/1/95
o Ollne tulol numbw 01 mil.. you drovayourV8hld.dur1ng 'V9~. onterU1onumcerol mil"" you u...d yourvehldo for:
. Bu.JlnNI
20934 ___ IJConmJ~ng __
o OlIl$r _______!..~~~___
o 00 you (oryou,.pou,.) h.v. anothar vaNdlla...ailabte'orpeJlKJflaluse1
~ v. 0 No
~ V.. 0 No
pj V" 0 No
.~
Ponn 210e-E2U_)
10 WMyour vahkJ. avall8b'tfor ~ dwingolf-duty hool"l7'
11 a 00 you hd'la avld.nee to t1UppOr1 your deductlorn
b It"V~..lstl'llnvtd.n<:.~n? . .
KBA Por Paperwork Reduction Act HoUo.. H. IntllUoUona.
Form .IOfF-2: /ltllil I'll:IU'C-,
,.,. ',"wltt (d'1"OIiI ,ttlS H&A .'..ll Tu "M'''.'''o.
-..........-..,.. "~IULNI...Ul'n..y OrnctALUSF. ONLY
PA~OR INCOME TAX RETURN 1
'''YOU MU3T FILL DY MIONIGlrr MONDAY, A,'ntL 10. ,gOO'" 9 R
o n.c.. VileI' n., Doglnnlno __t t~ Endlna .1"W(j 9
Commonweollh 01 PonnllVl~n'. __-.E.A DopOl1monl 01 RQ,!onuo.-1L___ TYPF AI FR (Chod< Only On.)
194-46-9750
nrClIARUSON MICIIAI.!L L &
lQ4-40-2462
JANICE P
RR3 DOX JG4
MrFl?LINTOWN
MAKI:: C;O""~(; J IONS I:l~LOW
'rDU, SQtl., ~'Q.,I(ltv Ny,",>.,
r
N.".{l..., F....t.lI.. Mldd~ ""'."'1)
VA
17059
Oil'.'. ('i I
,,. N...b .. 'f I'lUflin .P....'.ly
,1'.11....
Str.,tAdd,...flncwdIllQ NI,l_hrJ
Apt. Nt,
"",.., Allult 0' Ptu OUle. g.n Nurnh,
-----~
'.
eO MO J13
SrNQLl MAnAlto JOINT
FllmG S'P"'I"V
l.;n.n 11"'011" II. ,.....ylNl nuld.tlt
'rum _ _ ill!.5to ."v,,~
-.- -NAMf. Oil THe" S.CHOOL OIUftlCT
JUN i:'l\Mt"'86D...m.. lI. '.U
r-O
~IN^1..
SCHOOL OIlJTRICTCCD~
I 34360 L
CHtCI\I'YOUWlLt. NOT~l!IO A
IIIIII"A TAJ( BOOKUT
[l:!
58,22~ 00
..l;;rl 00
Z;o5!(;;
00
C 00
60-;
1,
1,
00
ce
00
.1< 00
I~ -;;;;-
11ll 00
~,P~~.wIlOWMANY
"r.Hr ~~Q."!1f..Re'g 0
. of '0lWtIW-2
.ljl' 8C1\I1IU1.. VI! ..,.
'0'1;11'411"'.
. of IIc"'~", ., -:r
'1liI' 8011.4111., C -
'Q'~QhftKo-I ~
. af 8Chldl,j'" .. -
. ur 'Gh c~,.
. or 4~h.dllr.. 0 2"
,-
'.'0,"0.71 -
.., 8.h ,,"..,. -
rorSah,ltlllf.l: -
'OI.$ch.dIl'UJ -
.....,,, Q.,
~
.
ScheduleSI' 0
(C".CkOlllylfClIiming
tu'Oflllv."...,
..,e."'dlll.,a -
, of Sell'dul.. W -
1_09.J
18 00
-
00
DO
00
11IeTOTALoIUn,,""tllrou 19dMUSTE .1 Uno ".
ii<Mt Y.R.~,"~\T~rl~.Jt'ldZ~,~,~,I'~'1 ,9J~~f~''l' Ilw, if flurlIQ nllltty) d."",,.. I..,t I WI' h._ u."',,,.. '''i. ...t~'".I". d I'U .-....,.-J'l.., Mh.IlIUtll....d 'lo&~""r11"IIlCl tQ "I, be'l
111111.Ir SII'QIIolU 0.1. v,,,, 0...."."
~-- ~O~R
City J GlIt, lip Ced,
b GROSS PE;.NNSYLVANIA COMf'tNOATlON................. .1. r &7. O:'llIrYl
Ib UNREIMBURSEo EMPlOYE BUSINESS EXPENSES. . . . . . . . . . . Ib L. . 8 ,
10 TAXABLEPACOMPENSATlON.5ubtrlC1UnelbtomUn011...........,......:,... 10
2 TAXASL.EINTEI'lEST.COmplOlOPA6chedu4.A'.....CI.000,....................", z
3 TAXABl.ECIVlOI!NOS.CompIIllaPA5choduleBKOWl<$1.000....................... 3
4 NET INCOME or [LOSSjtrQmtha OPI!IIATlONofIBUSINEBS. PROFEBSIONOIPARM ,'.. 4
o NET GAIN 0' [lOSSj ft'Orn tho SALE. a;)(CHANGEo,OISPOSmONoJPROPP-RlY .
O. AMOUI-(!' 01 aAlN EXCUJoEO on PAScl1lldul9PA-'8.. .. .. .. .. .... r 00
· NET INCOME! 0' [lOS5j from RENTS. ROYALnES.PATVfTSOICOPVRIGHTS., . , . . .... 0
7 E5TATE ondTRUST INCOME , . .. , , ..' .. .. ......... . ........ .. ....... . , , , '.. 7
8 GAM9UNG ond LOTTEAYW1NNINGS .....................'.................. 8
, TOTAL'ATAXA!lLl!JNCOME.Aa<lUnllll0 2_3,40.8 7. indO. 00 NoIDlKfUClllo....., .. 8
10 PA TAX UABIU1Y. MulUply Une 8 b<.2.ll%rO,mal ...,. ."'.,, 10
11 TOTALPA TAXwrrHHELC . . . . . . .. ...... . ..... . . . ,.. ..... . .. . ........ . .. . . .. 11
IV'8 ESTli\1ATUI PAYME:HnI AND CIII!DITl5. ft.....lhllnavuctlons on P._ 20.
121 CAEOtTlrom 1894 PA TAX RETURN ...................... 121 00
1:zb IU8eESTlMATEOINSTAUMENTPAYMENn> ............. .1211 00
120 PAYMUNTwl'hl008EXTENSIONnIlQue.-,T............... .120 00
1:::d TOTALESTlMATEOCREorr.Ad:lUneal2lJ,12bll1dl2C ..........,..........".. h2d
TAX FORGIVl!N!!5S,from PA SCltellUlf: SP. R_1he Instruc1lons beglnnlnn on "..,. ~.
1:\.. HOOS'HOLD MliMIlElUH",m UnH. PIIr1I1. PA Gohedul. Of' . . . .10.
13b EUGI8IUTYINCOMElromUne1.pl/1l11,PAScheCJIo6P .,. ..131>
13. YOURTOTALlNCOMer"'mUno21.Slep8,SPWORKSHEET.,. .130
13d TAX FOROIVENESS Irom lJno ". PIIr1I11,PASohllduloSlP. ...........'..........,... Od
14 TOTAlCREOITlor TAXES PAID 10 O1lf ER STATES or COUNTRIES .....,............ 14
Ie EMPLOYMENrtNCJ;:NnVEpAYMENTSCRalrT......,.,.."...............,.., 15
10 TI">T" CRFnrrn .nrl PAYMEIfrn. AddU.... 11 120 Ud 14.nd1~ ...", ..... 1. 1, H11.
17 TAX DUE (IrUne1ols"",rollllnUno1l1,rolllltop"!lCl21lndOOmPloloPAPaYJJ1On1VoucheronpaM38\
II OVell'AYM~ (Un.. I." "",relhln lJno 10) ....,...................".,..... 18 r
111. AMOUNTofUNel810baREFUNoED....... ....."... ......,...,., "",..",..
191> AMOUNToIUNE: 1810beCREOrTEOto'fO\J"I1!leESTlMATEllTAXACCOUNT ......., ,.,........,..,.
10. AMOUNToIU,"E ,..... b.OONAT~DIoWlLDRESOURCECONSEF\VAJlONFUNU ........",....,.........
IUd AMOUNT 01 LINE t810b900NATEDto U.S.O~YMPlCCOMMrTTEE.PACMSION........... .......,.,...
.......'............
u...
X
l' 'VAl YOVIANOVOUA S~US'!!!.ON. CHfCKAU. MATH. ATTACH Al.L ~CH'OUL.U AND FORMS
............",....,H AND R Rl,OCl( ~J J
Ftltm 40R (11t5) PA4o-1
,.,"" e."",... <:""7'11)"" I'.' I""" CIIOc.1I T..II e.",..., lit..
100
I1f'
00
00
00
00
17
"^u
,..
lib
180
19d
01 "".hlt ho,...No.
s,ouq', Ocalp.tJl:"
LABORBR
~.P."'''.f.'' ""'.NO.
..\-40. ut.1(....) ALLOWABLE EMPLOYE BUSINESS EXPENSES
'"OlP.",."nNTO'"~V'NU' PA SCHEDULE UE-1 19Q5
N.....I "....,.few..... [......t! lUCIIl\RU30N-;-rn:CHl\EL L ,-'- "iiii:I!i4='l1i-97 50 ~
.-;:;:;:;-~.N'~' MCCL-umr-r.n _If 0191010(' ""."': HAlUUSBUHG i>^~~= E,;;p;;-~ 2F1420ub5
U,.CllDolh, dll'"'' tho ,41,1... whh;" "011 Im:allf,4 ,,,.., IlqIlnI.. .....kly.'.. Tel.pho... ..."'..".,
000)
000-0000
LABORER
PllliT ^- Unlon Ouoo, (Nomo .nd lIT",un'l PLUM1l1~HS uNTO
PIJIT 8, W.r1< Clolhos .nd Unlf.rms. (RoqUueU..... condition 0' omp~~ymont .nd I1<lt~~~dOY I~
t'AnT C. Smlllt Tool, and SUppllo,. (riequlrtt<J IL1 a ~ndldQn of on'P10'f"1Qrt' .nd not providod by 1M ~kJ~__
PART D. V<t..,...I....11 .It..... ".... ~,tgr&l",tfc,~,:""e..,,,d r1dd'V 00n4 PAmlu,"l. "'QIolIr,d U Ii Il:Q"4idon Df 'I'OU' om 10 PIlI"t
PART e. T"'WII."d Mlk' t. fro'" "d''''I'OI", 210' oRI,e",mi" IC'tuaI.. .nn',colllpl." putl b,lcwlndlM"f ,ht ...au"' II gill WI.....
Total !mp1.Y.llualno..l'-qlon....A<JU r_A1,voughEoNyKuolng Uno. 1.2.3 ""d~of F&dorll Form 21011.
Iln""h.,...nrlnnUne b. t/lnrwbo.oo otl1bsc~dulo. 1b
Pari E. "dUll Travol And MII..go f. on..s. o.-dolmedOnUnQ40Ironn2Ioe"....bo~_dInPortJo'lhIoo:chedUto
E1 TrlvoIOX1>Q058llawDY.'OJllhomoowmiglltkltlxlllln_-lndudelodolna;llrl31o;eOllontei:llIC............... E1
F~ BualllOS$MGal9 ""d.ntollalnmont awBY trom home ouernlghtlor bus!...., ..... .. ........ ,. ...... .... .. ' . E2
E3 P.rI<lng folll1, IOIIQ,locOIlronoportolJon (bUs,c.b.fllln.olC.)-COITTT1llG,'lI Iu 110' ollowablO ,......."., l!3
E4 ACl1JlllVohltlobp"".,,'lOmUno1 and q bOIowo,u..1ho Fedonll StanderdMUol9"Rllotrom Fonn210e ,'.... E4
E'5 TOUlTravel.nd Miklago E.><po--, Add U/llIlI E1 ""d1/ln)ughE4""d.ntotOnUneoabOvo ....,............ Ell
Gcn....1Infonnetlon.II m.re than ""0 vehlcl.. _ell _...at.heeto.
e OIl.\IOhl"law.untorDdlnlO'.rW:<o:mon1l~dllY/yeIll...,...".....................""''''''''''''
b ToI.lll1Gg~mll.., 35000 ",I... c 10ll5bur;ln...mI\o$: 20934 mte.
d Busl"""u""~.OMdounecbyban<lIUUndIo2<ledme1PI"-.......",,,...........,....,..
. Do you ha...o N\OUWlf .....nk:le fl')ryour perlonal use7 ........... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1 DldyouremplOyerprovldoyouwttl1ellOhlclo1........,......................,....................
II IIYoo.lDpe=noIuoopormlllld'l. . . ........ ..... ....,.... .... ... , ' , , . ., .,.....................
h t)DyoUh......uppol1lngdoctJm8n1Atlonlorlhorrilo.g...ntUOd.boV87......................,....".....
D...,Jallon M.mO<!. use lilY generolly IOC4Pl8d method orm. &am8mol/lOd on your Fedefoll'o,m 2100.
1 Ental 001llor oU\elbeol&oryo",vwt1lcl... ............, .",......,....................,..........
I MutIlpIyUnelbyt!10bUSIn691UIlOpel'llllnleilolromUnodebollO""donlerhol. ..,........................
k Entarthegel'lOi'allyOCl:OPlod dOprectellonmotllOdused Mdtl\Oporcenll(JG
I lloplQClldlOn axpense. Mul1lply Uno J by "'" Urwa k pornonUlQO. Enl'lr I\etQ ........,...................... II
Tolal ActueI Elq)on.os
m alUoano,ol.noplitS,vehldelnouraflCO.oln,lIornuno23ortorm2100...........,.,"",.............,.
n TO\lllvwhiGlol_whonYOUrowr",,,hldoorOT11>Ioyer'OIlOh/ClaWelnolavaloblo. ...............,...,.. ..
o Vllluoo! omploY'l"provldedvehlclQ only II 100% of IIlG 4lI1null lease IslndUded In yourFonnW-a. ........ . .....
P Total of Unes m, n ""d 0 . . . . . . . . . . .. . . . . .. .. . . . .. . .. .. . . .. .. . .. .. , .. . . , . . . . . . , . . . , .. . . . . . . . . .
9 TotaIAcut41E>q)~"o~.MultioIYUnenbYtheoeroenta fro Un9d. torheroB dlndu 0 ngE4above....
!'.1IRTF. Olft..O,Worl<Aroa ..sos. YournJS1~Allmr"" 8011'''''01 ur .n6Qllwll'IlOdt:llllowOd.
F1 eoos)'O\lremployet' I'1lqtJlro you 10 mllnroln o....lUIbI.wooi<_. ""'oyttomthooMlplny.(.Pl'1lrrUos? , ..... ..... YES NO
F2 l.thlo_rI< ...ethe p"ndPlliplar.Qwher1Iyoupor1onnthodutl"olyour~loymIInt? . . ' . . . . .., . . . . . . . . . . . YES NO
F3 18thl~Wor1<llIo.u.edrO\lUllll1yandel(dU.tvolylDpolIonntheduUGOolyour~ioyn1enrr................,... ViS NO
11 YOII OIlSW81od oil ~ to ALL "".. qu..llano. ""n~nuo,1I you onswemd NOID ony quostlon, you may not CleIm ofllcQ or wor!< 1r.'Oxp.nses.
A.lUal om.. or Worle NIl_ E'J<pon_. Enter ""p.n_1Or lhe entire Y.1r and 1/lOn Clll<;UllII9 d,. bu.._ portion,
D Oop"'oI01lon&f\en..(H.maownwUr/Y).................................,...................... ·
b R.oIl!l1ll1l/l Taxes. . . .. . . .. .. . . . . ... . , . . . . . ... .. . . . . . . , . . .. . .. . .. . . .... ... , , . ... .....'..... h
c MortgegolntorOlt(l'iome<lwner.only},.............. .' ..................,................... C
d Utllirlo~ . . . . . . _ . . . , . . . . . . . . , ' , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,. . . . . . . . . . . . . . . . . . . . . . d
1
2
3
4
.
1/1/9~
!'~
YES
YES
NO
NO
NO
NO
33
m
n
o
.
t
Property Insuranco ,..........................,....,..,.............................,...,
PropectyMQinten.I'\Ce.lt\i(l~lethotyp.and ,amount of maintenanoo expClnsee IOCUrNd .. .... . . .. ...
.
g
O\llorAllPo<1lonabloexp.n."'.U_1holy1:l.""oarrounl.lth......penOOe ..,....'.,
_u
:B
33-
h
Rent(Ronlorsonly), . . . , . . . . . , . . . . . ., . . . . . ' . .. . . . . . ' . . .. . . . . . , , . . , , . .. , ' , . . .
To'oI.AddUne<J_WoU\lhh Enter tlWallllnono ....,........",..,...."...'
!Iu.h~ 1""""'""9' 01 P",por1y. OMd.lho IllIaI sqU". f00llIgo 01 y'OJr work ore' by ll10 tllIaJ
oqu"elooll9"o1yourllllll"Pr~.RoundlOlWvdl;l1ll ... . ...,. . .... ........... . ... '...... .
ApPorUOnedElcpons...MulllplYUnelbytllBperoorugeonUnoj,.......,..,., ,..,...................
Totll OIIloo6uppllot, FntollhelOtaI 01 aupplae you purc~..od oxduelwlylot u..inyouroltleo
o'....rt<er... lI.m2"baIoW.
I
F4
k
I
,.
fot.1 O~OQ orWOrlt .'831 F't
Add Unoo k and I
PAUl!I-1
..~... "." ,..nnC"\
,8
E::
ci:
00
no
00
00
00
00
00
00
00
00
~
Ji:
%
~
00
00
PA~ch."ul.lJr"l(,...,.l)
P-ART G. Movfng EJ:p.!!'~,.. You mum IIn~r ALL 1f1reoauQStlOn!l or your ~.D&nSO' W11t bo ~IU'kJw~.~.
01 Old you wor1c lOrlhol.,,," ems>loyOt' bofore end altar moving?, ... ......... ....., , , . , ..., , , ,. '.-:".--0 YES 0 NO
G2 W",. you r.qulmd DVVOur """,1oyu'1O move tromonootndol duly lIladon 10 Il'IOlho<
eooonoruonofyuurvrnpIoYflw:tltT,.........,......,................",....,..",.,..,..... 0 VtO
03 OldyoumovooI1horoquos10Iyour"""'loyor1......,.., "...,..............................' 0 YES
lfyClU 'ntwer.d yeS 10 All. UUIlIO quO$tJona. eonUnu.. Uyou amJWW'r.d No to any quosUon, YQU mlynotclalrn moving .xp6n~OL
a ~lbIlIlIUIIU'JtJJ.Iwur'I.I~'('OmyolJrotdhonlG"")'ournowW'Orl<f.pl.oo ....,.......... .... ."... . .. ... . . . .
b [1I1erlhonurnfJcrofmlllklr,omyouroldhornotoyouroldworllplllCo ....,.............'".........
e SUblrOcILJnobfromUn..lllldemcrlhodllloronco......,................., ...... ,.
If IIn. 0 10 6Q mllM or ,"or., conUllu4.lfnolllt lGa.t 10 mil.., VO" MIV "n. dlllm moving ..P""...
G4 TronsponlllJolloxponooGlnmovlnghOU:MlholdgoodundporsonllloltOCl:l",.................,..........
~ T1aVlll,rno.l:andlodglng..pe"'14'.dUlinglhollClUoImowlromyouroldhomclloyournewhomo.......,......
a. ToblMovlnq~ n,..Adttl'"e.G4.ndGti ... ,...... , " ........
PAIlTH: I!du"","on I!xp.n..... You rrust 111IlWUI' A~ lhroo au..donl or your o>pon..1 wfl bo dIolllowad,
Hl WQ$lhl.lldUcllljon,"quirodbylaworbyyourO~loyoflor.laln)'OUrp_nlpoIIUonOI/0111,.,........,..... 0 Yt5 0 NO
ltyou In_wer YES. contfnu". rr vou anlwerod NO. vou tRaV not claJrn educ:aUon ..p.n..... ~
H2 OldyounflOdthlo.dueldonto~llheenlrylov\llorn1n1mum,equ~emonlOlOobtaln)'Ourjob1."..,..,..". 0 YES 0 NO
H3 WIUU11"Odu"'lJOn,~rM'lorF"u"'0:8llJayquaJlIy)'OURl<a'-llusl"....orpro'_uIl1""."..,...,.", 0 ~ 0 NO
II you .nswONd NO 10 bolll qu..Uo~ 112 .nd H3, conUnU..11 you answered YI!510 .llI1erquallon H~ or H3, you ""Y nol clal", ed"c.aUon ""'.......
. Nome otcqnogo. unlvorolly or oducldonall""tiIu~on
b CQuroe or way
H. Tuldoll or'". .......... , , . .. .. . . . . . . . . , . . . . . . . . .. . . . . . . . . . .. .. , , . . .. . . .. . . .. . . . . . . .. . . . . .
H~ Cournmlle~aI. .....' .. . ........... , .......... ....... ... ' , ...................... ..... . . . .
IfG rr.vet oxpef1'lo,. .., . . . . . . . . . ",. . . . . . . .. . .. . ... .. . . . . . . . . . .., , . , .... . . . . . . . . . .. . . . . . .
117 Tollll!dueaUon n......Ad<lUn..H4lhro hHu
PolUlT I. 0 reclaUon n... 00 ncllnclude vehlclO$ _ PARr
(0) (b)
RIcnARDSON, MICHAEL L
194-46'-975<1
.
B NO
NO
mil..
mile.
noIlo.
Q4
GO
GS
00
QO
00
H4
He
He
HT
00
00
00
00
OeocripUon of Proporty
, eoltor Othar R....
andotfloeorwor1clRl. u..PART .
Cc) Cd)
OoprtlCiatlon
Deduc
n....
Ce)
(l)
EJ<p"",e
Add d . ..
Doproelallon Mell'ICd
SectIon 1 T9 Elq).nSG
00
00 00
00 00
00 00
00 00 00
00 00 00
I' ToIaIOlPrecJoUonExp.nM4.ToI3lColumnCf).ndonlorh.,. ..........,............' 11
PART J. Ml4ccllanooWl Exp.nIM.llerrUe ll1el\'PG and omounl 0' GlCh..penoe.lnelud. omounts tram Unci 4 of F.deral F0m121 06 In
tflIsPln.
00
00
00
00
00
00
00
~____~~. 00
00
Jl TOIaI Mlletnanooul tna.. .... . ' , . .. .. .. . .. . ' , . . .. .. . , . ' , .. , , , , , . , , . .. . . , .. Jl 00
PolUlT K. Tolal Alllowable P.nnoylvanla Employ. au"ln_ !lep.n.... Add lho8Xpcln...rrom..cn Fin .nd Aeeounllor ralmt>u".menl..
i'.nv.
- ''S.r821l1--o.o--
K1 TotoloxpenSOe~omPar1SAUvoughJ.., ...........'........ ......', ,......... ..... ..........' Kl ~
t<2 Enter relmbursomenl, from your omployer.lnctuda rOllTlJrstments wnlcnyour employer 010 NOT fupon IJ.':S lax-
.hln W'O" on your H>rm W-2., .... ............. .. .. . .. .. ' .. , .. .. .. .. , .. . .. .. . .. K2
KJ Subtr.cIUnol<2fromU"eKl ...... ........ ...................'",'..., ............... K3 00
If Uno K2 Is MORE lhan lJne K1. inelUdoUl8 dlner,neeln Una t.. CrOM Penucsyluni.C<1n'P.Mollon 01 your PAlQ rtlUrn.
If Uno K11. MORE Ih.n Uno K2. .nl.rth.~lffertncoon Une1bL Unrelmborsed Employe Bullin_ ExPtI1MI on your PA ,.. rorum.
Form40R Vel (1995) I'AUI'II-.
r.~".. tOll'....lI.. ,;.,"'~','lh' If)Q6 HIIll Bloclt T.u 5.MC",'no.
,,'"'M..,v,nmNVt I'A TAXABLE_(f'JTEAE~T and DIVIQENDS _ . "1995
NfmQ" shown on PA--40R ~uiGJ Soourity NI.UIIUw _
RrCUARUSON M:r:CIW;L L &_ JANICE l' -----_'_J._ 194-46-9750.... __.
PA SCHEDULE A -' TAXABLE INTEREST PA SCHEDULE B - TAXABLE DIVIDENDS
"your Ponn:ly1v8nla IllXdbld Intorosllncamo I. ovo! $1,000, oom.
plotnlhl" schodu". SQG rho In.lruc1iono In YCLJ( 199:3 rA-.+on Wuhfnt
'or W"1lI mutt be .oported as blcablo Inl"'08IlnOlI11O, H .ddlll<Jnll
ace 15 noo nttach $ra.le II
NM10 of Ih.. Pllvnr ----.-~~unt
If your P.nnoylvnnlnl4>cftblo dMoon<llnoomo ill Ov.r $1.000. oom-
ph'lull1l3 OCflOOUlo, ~oo IlwllnlitnJcUo"" In your 1005 PA-40R boOklal
fOr what flIJS( bo Joporl(td ..... tolU~ dlVldttnrlll'l('orno. It additional
_~r.o io ,,~. *ftttch &cPNBJO ohe-ets.
Nc~nlQ ~ n\O Pavor Amount
l-miUfrLL LY'NC}1 -2-;0,
00
00
00
00
00
m
00
00
00
QQ..
00
00
00
00
00
00
00
'l2...
TOCllIlnt$I'eet Inoorrw
00
00
00
00
rolal Dividend Income
PA SCHEDULE 0
;r,m.':.~~:~~O"'VfNU' SALE OR EXCHANGE OF PROPERTY ~L
N'lmol u .hown on PA~R f$Odalllaourtty Number:
RICHARDSON, MICHAEL L __ L-- 194-46-9750
Enter all .ales, nchang.. or olllel..""",llIon. or...1 0' ".,.onaJ tangible _intangible propwty.
AmOUnb Iro", ........ 5che<llle 0 ""'y "011Ho _ for PonnayfVaII11 P_I Incom. Till purpos,",
Road .lIln_o"," In lIIe PA~R booklet
SPOUSES SHOULD FILE.;3EPARATE PA SCHEDUIF!'; D IfNLESS SEWNG JOINTLY OWNED PAOPEnTV
(I) (b) (e) (d) (e) (f)
D_b. 1110 ptopony o<>ld MOnlh/D.ylY.... MOllUl/DayIY_ Gross Salee Pr1cG COSl or Adjuallld GAIN or [lO~~J
(Exlmpltl: 100 shares of 'ABC" lhe propot1y Will the proporly WI., for the propeny Bum of th, (d) mI,\y, (.)
common stock or hOU.. II told purchlllGd or kls8 Il<pIlnSN of property sold ENTER [lOSSES]
... Main S' ........h... PA 000001 viifi.w.d oaIe 'N IRRACKETSl
1. 5b3' PRIN RETURN 08/17/95 lOUS 41 4. o. 00
.,. ----
00
-.--. 00
. I ----~ 00
00
.- --." 00
-- 00
.. 00
_. ._-~ .. 00
-, _. .( ~
2- N'E Oain or (lQSGI ((om 800VW Sales , 2-
-
3- Gain from PA ~hllduie(.) 0-1. Instill""'"' ~.l.. s. OD
4, r"".b1e Return of C""U.I OI.I71OOllon., Enlet tot.. dl!l1ribullon I s 00
Mlnu, Adlu:Sl8d Bleil I., 00.;; 4. 00
S. NlI GlIIn orll.o:!S1 trom PA ~hOOul. 0-71, !if.leof .-.1-71I'roDertY s. 00
-
!:... Net Oil" from PA Schedule PA-19, S.1o 01 I ~oonll ResidQnce. II I Il.ossl 8tIlllr (0). e. 00_
~Qol.' 0' ~e'l ,",m PII 90-''' !\K-1 7. 00
I. TOlal Nel <leln o'.lb<!ssJ, Add 1,1""" 2 ttwouoh 7. Enlotlho reou~ h.... Ind on LlJle.~, PA-<IO.F3. (
You mev on." OnlY your awn goJ... and ""-1. EmR NET L09SESS IN IIlRACKETSl .. 00
Fa"" 40fl A80 (1t9Sl PAABD-l
If".... ..........,. CO')'l'lfIU '.""t&" !II.... '..:J~... Iro...
. p~Di~:t..;~':-;'~'b.nrvrNur PA TAXABLE INTEREST and DIVIDENDS . -1995
llama .. .hown on PA <OR -.- ,-- _.~.,_ _.J . s;;d';;i <'\oc--;;;'ry Num....
PA SCHEDULE A - TAXADLE INTEREST PA SCIIEDULE D - TAXABLE DIVIDENDS
.
If your I'tnn:sytvCll1lolOXlllllo InIQl~ Inoomo I. UVI1r $1,000, com.
plolO Uli~ Gellodulo, Suo Ill. 1.....ucOOn. In your 190~ f'A'-IOH lXlokJOI
'\1I whnl rn.u.f b4 tnportad n!\ IlXat~ IntoroGt Jneomo. Ir .ddl~Or'l1J
..JlpaCG '" needl.l<l, nUach .~pnr010 809
Ncmo or Inu par!" Al1lOUlll_
U you, ronn-sytv.nl. I....ble dMdond Inoorm I. ovor $1,000. com-
ptol. UICI ""hooul.. t;eu 1/10 "mruCllOn.1n you, 100~ "A--IOR booklel
10' wllal IIIUll! bo ,""ortod .. "".blo dMdond ~'como. " .ddlUonal
....9lL~_ILn:w~. In.oh 5.".."0 5~
.t:'...!!!..'t6 ut UI6 PD'tef )Qum
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
ToW IntorllGllncofTlG
00
00
QQ.
00 ToW OIv1dGnd Inco"",
00
00
00
00
00
00
.1
.A..... 0 "..."
f!p. PIliPAFll""'t1't OF Ri.VIEN'tJli
Name as .hOwn on PA-4Of\
RICHARDSON, JANICE P
PA SCHEDULE D
SALE OR EXCHANGE OF PROPERTY 1995
Scolal Security Numbor
194-46-2462
Enter .11 uI-., ..ohanu., Dr oth.r dllIpOattfona of NaI or perconral tangtble DiIId Inbnglb'. proP<<tV.
Amoonte from ~raJ 5c:ll"'*-'1. D IRI'( not be ClOrrec:t for PonnsyIvOIlI. Pen...... (/lOOme Tax pU'll_
Read elllnll1nJcUona In tile PA-4OR booldeL
SPOUSES SHOULD FILE SEPARATE PA SCHEDULES 0 UNLESS SEWNG JOrtf1l.Y OWNED PROPERTY
(I) (b) (e) (eI) (e) (I)
Deoa1bo tho properly told MottWOaylY." MOUIn/OoylY"'" Gross Salms flrtce COOl 0' AdJu.ted I3AIN or [LOSS]
(Exompl., 100 ohMno of 'ABC" tho properly WII9 tho "ropertV w.. lor 1Il~ p,operty e...... of the (<I) minus (e)
cornnon stock or house at tOld purchaced or _ .xpen... of proporty IlOld ENTEA (LOSSES]
123 Main St.. A~O"', PA 999991 llCaulrfld .aI. I" IRA ar'KETSl
t.563 PRIN TURN 08/17/95 VARIOUS 41 4 O. 1M
00
I 00
- -
-.---. ---- --,,_.- 1-. . .-- _. ---- .99.
00
00
_. , '--'.-0- .--0 - 00
100-
00
- 00
2- Nol Gllln 0' (Lo..,) from !,bo". ..,.. 2- ( 00
3. Gotfn f'rO,." PI\ $9hoduIO((j) 0-1. 1,.1.nm8nt g.... :l- oa
4. T ""abl. ROlum 01 Capital DI:Itr1~no. .n,., tolai'dl3trlbuUon It 00
MinUS AClluAMd B...." I ., IV". 4. 00
s, flJ.tC Olln or CLoul freM PA ~d\OdIJIQ 0-71 SAIA of 8- '-71 Proo.rtv 5 100
6. Not Galn Irom PA Schedule PAo10. sm. 01. PmtIpaJ AMldenee, If a n.ossl enter (0) .. 00
7. Net Oaln Of [lo..llrom PA Schedu19 RK.1 {, 011
~~ No, ",'n Of [1.0.., Add u.- 2 IllrnlJnh 7. Enl..lIlo ,..ull Mr. end on Uno & 01 vou(~R .- r
)00 mav offset ontv your own Q..... and 110_1, ~R NET l.OSSI$S IN reRACKETSI e. 00
Po"" 40" 1000 (IOOSl P......SD-l
,.,. .."....,.. Copynghl ,~n H." Bloc" '"S'M"'! 1M.
Form 2106-EZ
Unrclmburscd EmployeE! Buslno5s Expenses
OMO Ho.I$4f..144'
1995
0.,.,'........, TrtlHtJ'
Int,mllll A..ln... 'trwl~ClflUn
You, nome
MICHAEL L IUCIIARDl'iON
!1j:)jj;i1-1/1I1 General In/I),m.Uon
You Mey u.. 1111. Fenn ONLV" AU 0' ..... FoUowtno Ar"P1y:
.. s.. .".trvdIofte Oft P-o-~.
~ AUoch to foorm 1040 or Form llMO-T.
3uclIlaocurity numl>...
194-4G-9"~iO
"...."....".
S. " nn Ho. S4A
~II'"'' In which ....1\1.. .", In"'nwcl
IJ\BORER
· You "0 an "",,,"'y" deduolng Ol'PO/lSGl aaril)(.ulble to YOII' job.
· You do not gut r~mbu...ltd byyour omployer tot anv ~.nHlI (NnnUntlt V'O"' ~va' Inuudnd In bc)): 1 of ynur Ponn w~a 8M
not cornidllf9d raimbunsemonll).
· II you IlIOclWngvahlcJoIIl<p.ntt,
. VlXI own your voNdo, .nd
b You IVO us1nq Ihoallndord rr/1e_'llbIlot189~ AND lllilO u!ltld Illor IheyearVOu !lmp/acad the WlI1lde In eeM(t.
f~,,)J Aguro Your Expenses
1
2
VehIdo OxpCMI ulling the Il.nd...d rriIIlagtl ,ate. CoR1l1e1e Pill III Ind n1JIIlply lne Bd by '.00
(.00). . .. ....... . . . .
ParI</lIg ,_. tolls. and VlnsnonOllon.lnclulllng 1I'1ln. bul. e1C..1hatdld not InvoMI owmlght
Irllvel . . .. '.. . . . . . . . . . . . . . '. .
TraYlIlllllponso whllo ~"I.om norm aY'llrTllgh~ '"'*'<1109 lodging. oirJ>l_.~.. ,.n"', 010-
Do nat Include '"""" and entlll1lll1rl'on
6 290.
2
3
3
4 I!Iuslnau mq>ermn not Inc;k.IfJItfJ on nnoo 111vough a, Do nallnQ4uda rreab and antertalnmenl
4
5 Meallandol1lOl1lllnmenlexpthsa:S XW%(.llO) . . . II
o Ta&.l........... AddU""" t II1RlUghO. Entorr.-IIndonon IIn. 110 af_....... A (I'D"" 1010),
or Form 1040-T. SeQlIon II,lIno n. (au.a.d pllr10rmng _1IId1ndMdu.WI1II dllabiuu.,
_tn.I.-.:tloM 'or spactllllUles on wIlerl to 8ntw1ltll amount e
&~ Information on Your VQh!cle. Complete thlapIl1OHLVWYOUlrlldalmlngvIlhlcJgOlCp4l,,"onDno,.
6 200.
7 Whan did you f1IGOO )'(Jyrvohlcloln.....,oefor bu""_ p~? (month, d-r. ~.,)
~
1/1/95
8 OtUlOlOtaJ numblr 01 mles you drOveyourvvhlcfo during 1995, enterlhe numbet 01 millS you ulCldYOIIr Whldefor.
a Bullln_ ___29.!L~__ b CornruUng
OOlher __.__)4066____
9 00 you (oryour,pOUSD) h...... anolh6tvohIdG ftVftilablft far ptll1IClnal u...,
~ Vaa 0 No
pj Via 0 No
~ Vo. 0 No
~
Form 210e-EZ (18M)
10 W~ yourvehlelo .vllll.bl.fo, use cfunngOIl-<luty hou~"
110 00 you Mveevfcfence10 suppo" your declucUon?
b ""Ve~.l.tho.vlnQnr."wri"en?
KBA I'or Paperwork Reduollon Act NoUoo, ... InaWOUons.
Form 2tllll'Z 11tH) 1'O:I1011!Z-t
'.''" ..,,"".,. c..1"'''' ,,,S ~'A 110.. T.. "Mn"I"',
~. C" ..
(,' ..:J
; i.;~ ,I',
I
'['
\. . ..
.~l "
l\':. Q.. .I
<,', :.'J
c'
"
u.,' I\!J
il. I !:l.
i
" ,...
U c..~
EXPENSES
W..klv ~onthl v v.arlv
Home
Mortgage/rent $ 575.00
Maintenance
utilities
Blectric 30.00
Gae
oil
Telephone 70.00
Water
Sewer
Employment
Parking 60.00
Public Transportation
Luneh 75.00
Taxes
Real Eetate
Pereonal Property
Mise. Taxes
Income
Insurance
Homeowners
Automobile .
Life
Accident
Health
Other
Automobile
Payments
Fuel $ 96.00
Repaire 71.26
EXPENSES
W..klv Monthlv Yearly
Medical
Doctor $ 34.25
Dentist
Orthodontist
Hospital
Medicine 23.11
Special needs (glasses,
brae'ss, orthopedic
devices)
Education
Private school
Parochial school
College
Religious
Personal
Clothing $ 25.00
Food 85.00
Barber/hairdresser 25.00
Credit payments 192.50
Credit card
Charge account
Memberships
Workout Plus 19.95
Hershey symphony
Orchestra Supporter 12.50
Loans
Miscellaneous $ 160.00
Other
Psychologist $ 71.25
TOTAL EXPENSES: $1,625.82
f':: ('I
., -"
,.. M . ,,~
~t' ':
",
[~; .J
'-- . ,...
j. ,-
<i'
, 'n .-,]
(l l.~
Lilt ,
...JI, II !J
u.. . " ""-
, .' )
" r- ,
u cr' ,.;
>- (")
c... -"
0
i~' (.~ ).q"
utI ..'.. .:
~, .
>.., <.I.. ~ :-j
~: ..
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