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Home My WebLink About00-00451 '" '" '" :f.'" :f. "':f. :f.:f. :f.:f. "'''' . , "'''' '" '" "':f."'''' . "'''' '" '" '" '" "'''' '" IN THE COURT OF COMMON PLEAS . . OFCUMBERLANDCOUNTY . . . . . STATE OF . . . ANGELA TOMASELLO . . . . . . VERSUS NICK TOMASELLO . . . . . . . . . . . . . . . . . . AND NOW, DECREED THAT . . . AND . PENNA. 2000-451 CIVIL TERM No. DECREE IN DIVORCE tA, ~~ c::r 3. '~3 fl.#!. JlX>/ , IT IS ORDERED AND ANGELA TOMASELLO , PLAINTIFF, NTC'K 'I'OMASF.T,T.O , DEFENDANT, ARE DIVORCED FROM THE BONDS OF MATRIMONY, . . . . . . . THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE BEEN RAISED OF RECORD IN THIS ACTION FOR WHICH A FINAL ORDER HAS NOT YET BEEN ENTERED; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J. . . . . . . . . . . . . ~r!!lr~, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - " <<"",,<,-';' 5.';)5".0/ M C'~ k;Ji./~4:~r 5;;;s--o/ '1(~ ~ d a!if ~ - ~. . !'<-<""'"'""'''-~".~ ',"."" ,'~~"~"~- r.~, """ .,,,,"j~~~ ~.< "~'. " ANGELA M. TOMASELLO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 2000-451 NICK T. TOMASELLO, Defendant CIVIL ACTION - DIVORCE PRAECIPE TO TRANSMIT RECORD TO THE PROTHONOTARY: Transmit the record, together with the following information, to the Court for entry of a Divorce Decree: 1. Ground for Divorce: Irretrievable breakdown under ~3301(c) of the Divorce Code. 2. Date and manner of service of the Complaint: Service of the Complaint was made acceptance of service by Defendant's Attorney on January 27, 2000. 3. Defendant executed the Affidavit of Consent required by ~3301 (c) of the Divorce Code on 2/13/01. Plaintiff executed the Affidavit of Consent required by ~3301(c) of the Divorce Code on March 9, 2001. 4. There are no related claims pending. 5. Date Plaintiff's Waiver of Notice in ~3301(c) Divorce was filed with the Prothonotary: March 16, 2001. Date Defendant's Wavier of Notice in ~3301(c) Divorce was filed with the Prothonotary: February 21, 2001. YOFFE, F E, ESQUIRE Attorney for Plaintiff 214 Senate Avenue, Suite 203 Camp Hill, PA 17011 (717) 975-1838 Attorney ID No. 52933 , ~~lIili!Iitil~g~~~";';'bi,*,-".~",,";;.J.ili."~:;;""" M - ,~" >~-, " ~":qlil\\~-''''''' -.... " o ~ < um n1\"T' ""7 '-,- ~c; S'~ ~2'~ ;::C_' ?c; ~C) rC <-'- :-< ~<,h " ". , C) -,. "w. ;!;:t.... r~.:.' ''0 .....;;~ ~- 'v c- -'" ~'- "' "~ Cl ";1 '--' (,-< ~: -< ,~" . ',I .' _"-< ;; IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW ANGELA TOMASELLO, Plaintiff : No. :24n-6. '+s I C:v.d J b- v. NICK TOMASELLO, Defendant : IN DIVORCE NOTICE TO DEFEND AND CLAIM RIGHTS YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fai] to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the Court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary, Cumberland County Co1U1house, 1 Courthouse Square, Carlisle, Peunsy]vania, IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. 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. Cumberland County Bar Association 2 Liberty Avenue Carlisle, P A 17013 (717) 249-3166 Le han demandado a usted a la corte. Si usted quiere defenderse en contra estas demandas expuestas en las paginas siguientes, usted tiene veinte (20) dias de p]azo aI partir de la fecha de la demanda y la notificacion. U sted debe presentar una apariencia escrita 0 en persona 0 por abogado y archivar en la corte en forma escrita sus defensas 0 sus objeciones alas demandas en contra suya. Se has avisado que si usted no se defienda, ]a corte tomara mediclas y puede entrar una orden contra usted sin previo aviso 0 notificacion y por cualquier que ja 0 alivio que es pedido en la peticion do demanda. USTED PUEDE PERDER DINERO 0 PROPIENDADES 0 OTROS DERECHOS IMPORTANTES PARA USTED. LLEVE ESTA DEMANDA A UN ABOGADO INMEDIATAMENTE. SI USTED NO TIENE 0 CONOCES UN ABOGADO, VA Y A EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. Cumberland County Bar Association 2 Liberty Avenue Carlisle, P A 17013 (717) 249-3166 AMERICANS WITH DISABILI'fIES ACT OF 1990 , i The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations availab]e to disabled individuals having business before the Court, please contact our office. All arrangements must be made at least 72 hours prior to any hearing or business before the Court. You must attend the scheduled Conference or Hearing. Cumberland County Bar Association 2 Liberty Avenue Carlisle, P A 17013 (717) 249-3166 , - ~ ~" "'~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CNIL ACTION - LAW ANGELA TOMASELLO, Plaintiff : No. 02 tnro - tf 6'1 Ct:x:i I.u- v. NICK TOMASELLO, Defendant : IN DIVORCE COUNT I COMPLAINT UNDER SECTION 3301(c) OF THE DIVORCE CODE AND NOW comes ANGELA TOMASELLO, by and through her attorney, Maryann Murphy, Esquire of Legal Services, Inc., who respectfully avers as follows: 1. Plaintiff is ANGELA TOMASELLO whose current address is P.O. Box 1039, Carlisle, Cumberland County, Pennsylvania. 2. Defendant is NICK TOMASELLO whose current address is 9 North Stoner Avenue, Shiremanstown, Cumberland County, Pennsylvania. 3. Plaintiff and Defendant have been bona fide residents in the Commonwealth for at least six months immediately previous to the filing of this Complaint. 4. Plaintiff and Defendant were married on January 1, 1996 in Schuylkill County, Pennsylvania. 5. There have been no prior actions for divorce or for '" c'. I" annulment between the parties in the United States. 6. Defendant is not a member of the Armed Forces of the United States of America or any of its Allies. 7. The marriage is irretrievably broken. 8. Plaintiff has been advised of the availability of marriage counseling and that she may have the right to request the Court to require the parties to participate in such counseling. Being so advised, Plaintiff does not request that the Court require the parties to participate in counseling prior to a Divorce Decree being handed down by the Court. 9. Plaintiff requests this Court to enter a Decree in Divorce from the bonds of matrimony. COUNT II CLAIM FOR EQUITABLE DISTRIBUTION OF MARITAL PROPERTY UNDER SECTION 3502 OF THE DIVORCE CODE 10. plaintiff hereby incorporates by reference all of the averments contained in Count I of this Complaint. 11. Plaintiff and Defendant are the owners of real estate, motor vehicles, bank accounts, insurance policies and other personal property acquired during the marriage which is subject to equitable distribution by this Court. 12. Plaintiff and Defendant have been unable to agree as to ,'. J' ~ ., "; an equitable division of said property as of the date of the filing of this Complaint. 13. Plaintiff requests this Court to equitably distribute the parties' marital property. COUNT III CLAIM FOR ALIMONY PENDENTE LITE UNDER SECTION 3702 OF THE DIVORCE CODE 14. Plaintiff hereby incorporates by reference all of the averments contained in Counts I and II of this Complaint. 15. Plaintiff does not have sufficient funds to support herself during the pendency of this action. 16. Defendant does have a sufficient source of income to aid Plaintiff in supporting herself during the pendency of this action. 17. Plaintiff requests this Court to grant her alimony pendente lite during the pendency of this action. COUNT IV CLAIM FOR ALIMONY UNDER SECTION 3701 OF THE DIVORCE CODE 18. plaintiff hereby incorporates by reference all of the averments contained in Counts I, II and III of this Complaint. 19. Plaintiff does not have a sufficient source of income or earning capacity at the present time to maintain the standard of - < ~ , -~"" . living enjoyed by the parties during their marriage. 20. Defendant does have a sufficient source of income and earning capacity to aid Plaintiff in maintaining the standard of living enjoyed by the parties during their marriage. 21. Plaintiff requests this Court to grant her alimony to enable her to maintain the standard of living enjoyed by the parties during their marriage. WHEREFORE, Plaintiff requests this Honorable Court to enter a Decree: a. dissolving the marriage between the Plaintiff and Defendant; and b. equitably distributing all property owned by the parties hereto; and c. directing the Defendant to pay alimony pendente lite during the pendency of this action; and d. granting alimony to Plaintiff; and e. for such further relief as the Court may determine to be equitable and just. Respectfully submitted, rphy, LEGAL SERVICES, INC. a Irvine Row Carlisle, PA 17013 (717) 243-9400 I.D. # 61900 Attorney for Plaintiff i'._ . AFFIDAVIT I, ANGELA TOMASELLO, verify that the statements made in the foregoing Complaint in Divorce are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsification to authorities. /- )tj~ 00 Date AN~:MA~ [1' . ~ " . ~w. J,~ ., . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW ANGELA TOMASELLO, Plaintiff : No. v. NICK TOMASELLO, Defendant : IN DIVORCE CERTIFICATE OF SERVICE I, Maryann Murphy, Esquire, do hereby certify that a true and correct copy of the wi thin ni vorce Complaint was mailed to the Defendant, NICK TOMASELLO, by first class U.S. mail, postage pre- paid, certified/restricted delivery, addressed as follows: Nick Tomasello 9 North Stoner Avenue Shiremanstown, PA 17011 Respectfully submitted, Maryann urphy, LEGAL SERVICES, 8 Irvine Row Carlisle, PA 17013 (717) 243-9400 I.D. # 61900 Attorney for Plaintiff lliliIIIIlmliIl_lIiaIilmll;lIl:li~i>>Iil'l;II>!~~_-'Wili;!illJJ!-'""""''''-'" ~~_..;..' . - -~ 0 0 0 " C 0 "TI <:;."- ,- ""Ufi5 7'" ;:::1 rrlp~i -- F"!l~ Z:JJ :Zr" N i~J.rn (l) ,~c' ..,"- :~}Q -<~...:.: ~::~,6 r:::C) e -0 ~r- "r; --,'" ~2;~ ,d.C' ~ -=0 6fn >c ~ Z -'"i W ):~ =< ...J :n -< ~ ~ ~ L ~;;' IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW ANGELA M. TOMASELLO, Plaintiff : NO. ;2 07J?} - ys1 {l;;y -r~ v. : IN DIVORCE NICK T. TOMASELLO, Defendant PRAECIPE TO PROCEED IN FORMA PAUPERIS To the Prothonotary: Kindly allow, ANGELA M. TOMASELLO, Plaintiff, to proceed in forma pauDeris. I, Maryann Murphy, Esquire, of Legal Services, Inc., attorney for the party proceeding in forma Dauperis, certify that I believe the party is unable to pay the costs and that I am providing i !' free legal services to the party. The party's affidavit showing inability to pay the costs of litigation is attached hereto. Maryann urphy, Esquire Legal Services, Inc. 8 Irvine Row Carlisle, PA 17013 (717) 243-9400 J.D. # 61900 Attorney for Plaintiff ~illlIIN!. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CML ACTION - LAW ANGELA M. TOMASELLO, Plaintiff : NO. c2-o-vv - 'IS? ~ I~ v. : IN DIVORCE NICK T. TOMASELLO, Defendant AFFIDAVIT IN SUPPORT OF PETITION FOR LEAVE TO PROCEED IN FORMA PAUPERIS 1. I am ANGELA M. TOMASELLO, Plaintiff in the above matter and because of my fInancial condition am unable to pay the fees and costs of prosecuting, defending, or appealing the action or proceeding. 2. I am unable to obtain funds from anyone, including my family and associates, to pay the costs of litigation. 3. I represent that the information below relating to my ability to pay the fees and costs is true and correct. (a) Name: ANGELA M. TOMASELLO Address: 9 North Stoner Avenue. Shiremanstown. PA 17011 (b) Social Security Number: 182-60-7453 If you are presently employed, state Employer: Country Meadows Address: 4837 E. Toodle Rd.. Mechanicsbur~. PA 17055 Salary or wages per month: $ 678.00 Type of work: personal care aide .""'"""'.,'I'-'~, If you 'are presently unemployed, state N/ A Date of last employment: N/ A Salary or wages per month: N/A Type of work: N/A (c) Other income within the past twelve months Business or profession: -0- Other self-employment: -0- Interest: -0- Dividends: -0- Pension and annuities: -0- Social Security benefits: -0- Support payments: -0- Disability payments: -0- Unemployment compensation and supplelllental benefits: -0- Workman's cOlllpensation: -0- Public Assistance: -0- C>ther: -0- (d) Other contributions to household support NC>NE (Wife)(Husband) Nallle: N/A the parties are separated If your (husband) (wife) is employed, state Employer: N/A Salary or wages per month: N/A Type of work: N/A Contributions from children: -0- (e) Property owned Cash: -0- Checking Account: -0- Savings Account: -0- Certificates of Deposit: -0- Real Estate (including home): little or no equity Motor vehicle: Make Hvundai Sonata Year 1993 Cost $7.000.00 Amount owed -0- Stocks; bonds: -0- Other: -0- (1) Debts and obligations Mortgage: $700.00 Rent: Loans: Monthly Expenses: approximatelv $1.500.00 (g) Persons dependent upon you for support (Wife) (Husband) Name: N/A I -- ilili(i~ . j; I I I ~~ I j "" Children, if any: Name: Rvan Age: 5 Name: Nickolas Age: 4 4. I understand that I have a continuing obligation to inform the court of improvement in my financial circumstances which would permit me to pay the costs incurred herein. 5. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. 4904, relating to unsworn falsification to authorities. Date:~~lj.\~t'o 0 ~-~~~ ~ AN LA M. TOMASELLO ~~~~iliHlilliialY\liQliIWiIlIIlilil~~diiilll>.lll'Ol~>tIl'IlWl~ ,~,' -~ ~, "-.- , ._~, - ~ , t, '\-> \.\2 .fft).... C' ;p :"b f6~ !Jjr... ",:?,',1 --.;;.,1:; <" r-~'" C0:J:c, ;:::;<,:,"" , -C'. ~; ::C-O :2:Ci e !$ . ~~~~ &.- 9 r.... I -~..Q ,,-{ ~ -"- ~ ,~~:'~~ ,.~~~ 'j-.J (j~'~~ ~:>(") (Sf!) j;j -:0 -- <:- t\) ::s? -~-,.. *' ANGELA M. TOMASELLO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 2000-451 NICK T. TOMASELLO, Defendant CIVIL ACTION - DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under ~3301(c) of the Divorce Code was filed on January 24, 2000. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final Decree in Divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this Affidavit are true and correct. I understand that false statements herein are made subj ect to the penal ties of 18 Pa. ~4904 relating to unsworn C.S. falsification to authorities. Date: ~ ~"~~ Jh/ol ANGE M. TOMASELLO tomasello\affidavit .., ~_" I _ !~:: H !:i '. ~ ,J !;\ i:~ "j '1 ; ~ '~ i ,,1 :'J :,J :J :! i,j ': ['J ii I: Ii I. II " " i' I ~ ,. " ;'j p :; i ~ """'1IlfIIl1iJ iB'~ "'. -. ''''"''''"~!lliiI;OC~!~'HiIll1&!l~k",........",." ~- -. _~o~~ ~~~.~ -...,"", - 0 c::' (~) c: --,-, s: :Jt -aCC' :,T.').lI> -~:"'1 mfT~ ;.<:J .~:~:~ !~fJ Z::C Zr;': 0', ~~ g(~i r;:C) T, ,- ;to> g'zq ?Z:o :Jl: =0 '? ;~.fTi PC: ,-, ~ ;-;' r'-' ~ ANGELA TOMASELLO, Plaintiff V. : IN THE COURT OF COMMON PLEAS :tUMOOlur.t:OUNTY, PENNSYLVANIA NO. ~~~~\ NICK TOMASELLO, Defendant CIVIL ACTION-DIVORCE AFFIDlI,VT';LOF CON.~ENT 1. A Complaint in Divorce under 53301 (c) of the Divorce 2. The marriage of Plaintiff and Defendant is ! ! ;~ :\ ~ Code was filed on January 24, 2000. irretrievably broken. and ninety (90) days have elapsed from the date of filing and service of the Complaint. , ., , 3. I consent to the entry of a final Decree in Divorce :'~ " after service of notice of intention to request entry of the decree. I verify that the statements made in this Affidavit are true and correct. I understand that false statements herein are made subject to' the perlalties of 18 Pa. C.S. 04904 re~~~ing to unSW~~8 falsification to authorities. 1: 1- a/ Date: -/0 :dkm TOMASELLO AFFCONSENT ~-. ~ ".,. ., ~, "'8' ""~""l'~~ ^ ,~ -" .' ~ ,",-, ~ ~~ (') c; C) c ";~ ?:":: -,-, ~ "D C':,' ,....".., rn j"''- ,,--;0 - Tc Z:'l:: -- Z ~~:~ ;",...) ~'J_~ cr:; , \"T" ;:'-.., /'. ,--., ',' ~ )::'^' '. ... ,", C ;:"''':' Z i........J ~ .-' )> r- 0 , i-I Z ~":l --j -< (j'i .~ ., . ,. I, ANGELA TOMASELLO, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 2000-451- CIVIL TERM NICK TOMASELLO, Defendant WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER s330l(c) OF THE DIVORCE CODE 1. I consent to the entry of a final Decree in Divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a Divorce Decree is entered by the Court and that a copy of the Decree will be sent to me ilnmediately after it is filed with the Prothonotary. I verify that the statements made in this Affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. s4904 relating to unsworn falsification to authorities. Date: 2--/~-O/ ~V2 N~ T ~lle, DeLendant ---- :dkm TOMESELLO NOTICWAIVER ~.~ JiIIili~_""""~ ,,~ ,,"'"~ ;, f "1 -" ~ -~'bI!Illiilll~a<Itilit~ . o C ;:"" -orj' rnl"t: ~%' <-- 7.'::C: ~;~~ Z -, -< "~ ~ " .:;) -n p'1 .",-' ~J " ~~ ~ '"I ;"0 :_!,~j~i "~;<(:} '., ',.-n ;0,-;(") ~:~~lTI -,.... ~2 ~? ::> (fl m "'"" ANGELA M. TOMASELLO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 2000-451 NICK T. TOMASELLO, Defendant CIVIL ACTION - DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER ~3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final Decree in Divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a Divorce Decree is entered by the Court and that a copy of the Decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this Affidavit are true and correct. I understand that false statements herein are made subj ect to the penalties of 18 Pa.C.S. ~4904 relating to unsworn falsification to authorities. Date: (~;... ~ ~"'~~""<;\dt._ :J11f/O/ ANG M. TOMASELLO I( tomasello\waiver i< " _,_ "'~, '"'""'''''',,~,.._,__ ";"~i11 "1'1 m:=~,""""". " ~ifiIll\i~' ........, ~~~ '1M .w. 0 0 0 c: '"[1 ;;:; :x -"I -oCt7 ;Colit ;:rifEJ m-rn ;;0 Z:D 'T;J'l! zr en ::,..J~--' ~=Z~ fj;~'~ ~C ". )>0 ::z: '~;;(J 20 S? C'5IT1 )>C -" ~ N ~ -, ~~-',,::<, '" '- '.. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LA W ANGELA TOMASELLO, Plaintiff : No. 2000-451 Civil Term v. NICK TOMASELLO, Defendant : IN DIVORCE AFFIDAVIT OF SERVICE I, Maryann Murphy, Esquire, depose and say: Peter R. Henninger, Jr., Esquire 4000 Vine Street Middletown, P A 17057 i-i ~ ' j )1 i!. i I ;1 "I ,I i I , 'I i'l !,I :1 I I 1 I " I i , 1 " 'I , 1. That I am an adult individual residing in Cumberland County, Pennsylvania. 2. That on January 26, 2000, I sent a true and correct copy of the Complaint In Divorce under Section 3301(c) of the Divorce Code to counsel for the Defendant, Peter R. Henninger, Jr., Esquire, by first class U.S. mail, postage pre-paid to the following address: 3. That on January 27, 2000, counsel for the Defendant personally accepted service of this Complaint in Divorce on behalf of the Defendant. The Acceptance of Service is attached to this Affidavit. Respectfully submitted: tho ~ Mary~ESquire LEGAL SERVICES, INC. 8 Irvine Row Carlisle, P A 17013 (717) 243-9400 1.0. # 61900 -~ t ~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW ANGELA TOMASELLO, Plaintiff : No. 2000 - 451 Civil Term v. NICK TOMASELLO, Defendant : IN DIVORCE ACCEPTANCE OF SERVICE I, Peter R. Henninger, Jr., Esquire, counsel for the Defendant in the above-captioned case, do hereby depose and say that, on behalf of and on the authorization of the Defendant, I personally received and accepted service of a true and correct copy of the Complaint in Divorce on the date written below. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating unsworn falsification to authorities. //91/00 , t9~ Peter R. Henninger, Jr., Esquire Date "I. .....i", , :: ;,: i~ I ! 'I :,j j j [I I] Ii ,I (! ~~ ~ ~f'''''''''''. "'~"~~lIll'" O"~-';'d,'Wrnili'~ " ,- "-'ff"'-"",,*"". ......"'~ .>- :~:,~;~ 'u'(? C')~:" i:J1!., c.- r- '<l- ,..;,.Cl [Hll >- ~.:;: :i:: o .0 V) '>- t:: / =-'5 ~::;' (~-) ::;;:.;: ;~~~3 -.~....-- ;~~~ ~-LJLU i\}tL "'-:> ~ o i\; ;;t:::. 0.. tn :,,-~ -~ .'^ . . " ~ . ~~~ ~ -. i-.'-; ) "," . - -~~--,. ". .. t i.MCIfLA 'r~~Llo l)Vn~f N\tt. ~~ftllO Pff~\ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW No.~Dm.. ~61 CIVIL 19 IN DIVORCE STATUS SHEET jj.-lti/oo ~ (, 1..{1..... 0 I 'ttJ --- ,If ..00 > ',,', in . . '~.--' "- ~ ANGELA TOMl\.SELLO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. NO. 2000 - 451 CIVIL NICK TOMASELLO, Defendant IN DIVORCE TO: Maryann Murphy Attorney for Plaintiff Defendan~ Peter R. Henninger Attorney for DATE: Tuesday, May 30, 2000 CERTIFICATION I certify that discovery is complete as to the claims for which the Master has been appointed. OR IF DISCOVERY IS NOT COMPLETE: (a) Outline what information is required that is not complete in order to prepare the case for trial and indicate whether there are any outstanding interrogatories or discovery motions. ,',',." .~. '_ c"',_:.,_. c;", ';".~" ,'~, '~' v .- (b) Provide approximate date when discovery will be complete and indicate what action is being taken to complete discovery. DATE COUNSEL FOR PLAINTIFF COUNSEL FOR DEFENDANT NOTE: PRETRIAL DIRECTIVES WILL NOT BE ISSUED FOR THE FILING OF PRETRIAL STATEMENTS UNTIL COUNSEL HAVE CERTIFIED THAT DISCOVERY IS COMPLETE, OR OTHERWISE AT THE MASTER'S DISCRETION. AFTER RECEIVING THIS DOCUMENT FROM BOTH COUNSEL OR A PARTY TO THE ACTION, IF NOT REPRESENTED BY COUNSEL, INDICATING THAT DISCOVERY IS NOT COMPLETE, THE DIRECTIVE FOR FILING OF PRETRIAL STATEMENTS WILL BE ISSUED AT THE MASTER'S DISCRETION. HOWEVER, IF BOTH COUNSEL, OR A PARTY NOT REPRESENTED, CERTIFY THAT DISCOVERY IS COMPLETE, A DIRECTIVE TO FILE PRETRIAL STATEMENTS WILL BE ISSUED IMMEDIATELY. THE CERTIFICATION DOCUMENT SHOULD BE RETURNED TO THE MASTER'S OFFICE WITHIN TWO (2) WEEKS OF THE DATE SHOWN ON THE DOCUMENT. , "'k '0 ,~,,~, ., ANGELA TOMASELLO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - LAW NO. 00 - 451 CIVIL NICK TOMASELLO, Defendant IN DIVORCE CONFERENCE WITH COUNSEL AND THE PARTIES TO: Maryann Murphy Angela Tomasello , Counsel for Plaintiff , Plaintiff Peter R. Henninger Nick Tomasello , Counsel for Defendant , Defendant A conference has been scheduled at the Office of the Divorce Master, 9 North Hanover Street, Carlisle, Pennsylvania, on the 7th day of November, 2000, at 1:30 p.m., with counsel and the parties to discuss the outstanding economic issues to determine if there is a basis of settlement of claims. If issues remain after the conference a hearing will be scheduled at another date. Very truly yours, Date of Notice: September 29, 2000 E. Robert Elicker, II Divorce Master ,- --, " .-1 -~ ANGELA TOMASELLO IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA . . v. NO. 00 - 451 NICK TOMASELLO : CIVIL ACTION - LAW IN DIVORCE ORDER AND NOTICE SETTING HEARING TO: Angela Tomasello JeffreyN. Yoffe Nick Tomasello Peter R Henninger, Jr. , Plaintiff Counsel for Plaintiff , Defendant , 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 on the 15th day of March 2001 at 9:00 a.m., at which place and time you will be given the opportunity to present witnesses and exhibits in support of your case. e~d' rge'E1t:Jr. 'mideo' 'udge Date of Order and Notice: 11/8100 By: Divorce Master 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. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE, PA 17013 TELEPHONE (717) 249-3166 ~ ,"'-=' IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW ANGELA TOMASELLO, Plaintiff : No. 2000-451 Civil Term v. NICK TOMASELLO, Defendant : IN DIVORCE PRAECIPE TO WITHDRAW APPEARANCE To the Prothonotary: Please withdraw my appearance as counsel for Plaintiff in the above action in Divorce. Respectfully submitted: ~.~ Maryann urphy, Esquire LEGAL SERVICES, INC. 8 Irvine Row Carlisle, P A 17013 (717) 243-9400 PRAECIPE TO ENTER APPEARANCE To the Prothonotary: Please enter my appearance as counsel for Plaintiff in the above action in Divorce. Respectfully submitted: effrey . Y offe, Esquire 214 Senate Avenue Camp Hill, P A 17011 (717) 975-1838 ~l$Ii(jJ_o;li1i<~~_iiIiii>tIH1l~'!l(j~lOffil-k,,:,,~I'"""ti'.JW"."-clEa~b;;l~tJill'-' ~~ .~ --~ > ...,~ f i'~ ,-~~ "1".,1 I 1':,1 !j 1:1 " !~ ji 0 0 (3 c: 0 "n s: z :::i -OW 0 nlrn < ',~ -n Z:n .,;--- zc I "'-\I~n '["10 (j) .,'c" 1'0 .---':, r ~...:"' :',~=[C) ,<0 'u '1-" ~c' ::r.: ~2-~ -(j 5>c r- '-' ~ ::> ~ 5:J N ...; f ,~ . . J, 1r ANGELA TOMASELLO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - LAW NO. 2000 - 451 CIVIL NICK TOMASELLO, Defendant IN DIVORCE RESCHEDULED PRE-HEARING CONFERENCE TO: Maryann Murphy , Attorney for Plaintiff Petter R. Henninger , Attorney for Defendant A pre-hearing conference has been scheduled at the Office of the Divorce Master, 9 North Hanover Street, Carlisle, Pennsylvania, on the 29th day of September, 2000, at 9:30 a.m., at which time we will review the pre-trial statements previously filed by counsel, define issues, identify witnesses, explore the possibility of settlement and, if necessary, schedule a hearing. Very truly yours, Date of Notice: 8/22/00 E. Robert Elicker, II Divorce Master , .... ~. ANGELA TOMASELLO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - LAW NO. 2000 - 451 CIVIL NICK TOMASELLO, Defendant IN DIVORCE NOTICE OF PRE-HEARING CONFERENCE TO: Maryann Murphy , Attorney for Plaintiff Petter R. Henninger , Attorney for Defendant A pre-hearing conference has been scheduled at the Office of the Divorce Master, 9 North Hanover Street, Carlisle, Pennsylvania, on the 23rd day of October 2000, at 9:30 a.m., at which time we will review the pre-trial statements previously filed by counsel, define issues, identify witnesses, explore the possibility of settlement and, if necessary, schedule a hearing. Very truly yours, Date of Notice: 8/10/00 E. Robert Elicker, II Divorce Master ~ ,-- . , - - -~- -,. -,.,. ..I .....'~"': , . ANGELA TOMASELLO, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 00~451 CIVIL TERM DR# 30,033 IN DIVORCE PASCES #512102641 NICK TOMASELLO, Defendant RE: SUPPORT AND APL APPEAL To whom it may concern: On behalf of my client, the Defendant/Respondent, Nick Tomasello, I hereby request a Hearing De Novo on the child support determination at PACSES No. 512102641, for Docket No. 00-451, Civil Term. The reason is that we believe the hearing officer erred and that the combination of child support and APL awarded to the Plaintiff/Petitioner is in excess of that as set by law. Sincerely, P Cc: Nick Tomasello Maryann Murphy, Esquire :sls TOMASELLO APLAPPEAL #16510 #16510 , . , . CERTIFICATE OF SERVICE A copy of the foregoing request for Hearing De Novo has been served upon the Plaintiff by sending a copy to her attorney of record: Maryann Murphy, Esquire Legal Services, Inc. 8 Irvine Row Carlisle, PA 17013 by depositing same in the United States mail, postage prepaid, in Middletown, Pennsylvania, this fJp /3 day of o~ , 2000. PANNEBAKER AND JONES, P.C. Attorneys for Defendant By: Peter R. Henninger, r., Esquire I.D. #44873 4000 Vine Street Middletown PA 17057 (717) 944-1333 ~""'''1lI1111ilrJi~ _Ili..-J_..J Il<b...." -~" ~'~olil:l~ ~.lo,"~_ ~" --IN' - .' (') " ~? :,":' ~~,~~? '~.c ~~.~ C~. :fjftJ _??C'~ ):; r~~; ~ -;;;; ~ -"!':""-. ~JC:) l~ ;>..~ .. ) ~-I (::J- \~.." ~. ,'fir {~).~-7 :--:__1' .:-_b";;::~J -::-::'-:-; ?-';... ':?i~f ;;;! "D --.;: _J:: - - .;::j (::;, () () ':::::. I' >' . ...... ~ <:> i,;;J 0 $' ~ ~ p g .) ~" p , 't' !, '. ""I"' . o,:..~, _'---', ,- -..~", '.,r,' , - .- OFFICE OF DIVORCE MASTER CUMBERLAND COUNTY COURT OF COMMON PLEAS 9 North Hanover Street Carlisle. PA 17013 (717) 240-6535 E. Robert Elicker, II Divorce Master West Shore 697-0371 Ex!. 6535 Traci do Colyer Office Manager/Reporter July 7,2000 Maryann Murphy Attorney at Law Legal Services, Inc. 8 Irvine Row Carlisle, PA 17013 Peter R. Henninger, Jr., Esquire PANNEBAKER & JONES, P.C. 4000 Vine Street Middletown, PA 17057-3596 Re: Angela Tomasello vs. Nick Tomasello No. 00 - 451 Civil In Divorce Dear Ms. Murphy and Mr. Henninger: I have received counsels' certification that discovery is complete. Therefore, I am going to proceed with the directive for the filing of pretrial statements. A divorce complaint was filed on January 24, 2000, raising grounds for divorce of irretrievable breakdown of the marriage. The complaint also raised the economic claims of equitable distribution, alimony and alimony pendente lite. No claim for counsel fees has been raised. In accordance with P.R.C.P. 1920.33(b) I am directing each counsel to file a pretrial statement on or before Friday, August 4, 2000. Upon receipt of the pretrial statements, I will immediately schedule a pre- hearing conference with counsel to discuss the issues and, if necessary, L I ;..;,1 . MS. MURPHY AND MR. HENNINGER, ATTORNEYS AT LAW 7 JULY 2000 PAGE 2 schedule a hearing. Very truly yours, E. Robert Elicker, II Divorce Master NOTE: Sanctions for failure to file pretrial statements are set forth in subdivision (c) and (d) of Rule 1920.33. THE ORIGINAL PRETRIAL STATEMENT SHOULD BE FILED IN THE MASTER'S OFFICE AND A COPY SENT DIRECTLY TO OPPOSING COUNSEL. FAILURE TO FILE PRETRIAL STATEMENTS AS DIRECTED BY THE MASTER MAY RESULT IN THE MASTER'S APPOINTMENT BEING VACATED. ^l ~ ~ _ "a ,I " --. '-~">> '~ -,< -,". -,,,. . -'" "."~-- .;." J"~<~'fr' I .k~c/ PANNlElBAKER AND JONES, P. C. FOUR THOUSAND VINE STREET MIDDLETOWN, PENNSYLVANIA 17057-3596 TELEPHONE 717.944.1333 E.MAIL ADDRESS TELECOPIER CARMEN CRI5T1Ni EICHMAN PETER R. HENNINGER, JR. DONALD L JONES JAMES B. PANNEBAKER pjpc@pannebaker#jones.com 717-944-4004 June 1, 2000 Office of Divorce Master 9 North Hanover Street Carlisle, PA 17013 RE: Tomasello v. Tomasello No. 2000 - 451 Civil Our File No. 16510 To Whom it May Concern: Enclosed please find Defendant's Certification in the above captioned matter. :dkm TOMASELLO L060100 cc: Nick Tomasello w/enclosure Maryann Murphy, Esquire w/enclosure CIVIL LITIGATION PERSONAL INJURY WRONGFUL DEATH AUTOMOBILE ACCIDENTS ESTATE PLANNING ESTATE SETTLEMENT BUSINESS LAW CORPORATE LAW FAMILY LAW REAL ESTATE MUNICIPAL LAW LAND USE INSURANCE LAW ENVIRONMENTAL LAW VISIT OUR WEB SITE AT: www.pannebaker-jones.com - c , " ,'" ,.- ~ "1 I , I I I I f' HAYS1. ANGELA TOMASELLO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. NO. 2000 - 451 CIVIL NICK TOMASELLO, Defendant IN DIVORCE TO: Maryann Murphy Attorney for Plaintiff Peter R. Henninger Attorney for Defendant DATE: Tuesday, May 30, 2000 CERTIFICATION I certify that discovery is complete as to the claims for which the Master has been appointed. OR IF DISCOVERY IS NOT COMPLETE: (a) Outline what information is required that is not complete in order to prepare the case for trial and indicate whether there are any outstanding interrogatories or discovery motions. l' . , , r' (b) Provide approximate date when discovery will be complete and indicate what action is being taken to complete discovery. 5' /J ;)tJO DATE ~'N~ COUNSEL FOR PLAINTIFF ( ) COUNSEL FOR DEFENDANT (J() NOTE: PRETRIAL DIRECTIVES WILL NOT BE ISSUED FOR THE FILING OF PRETRIAL STATEMENTS UNTIL COUNSEL HAVE CERTIFIED THAT DISCOVERY IS COMPLETE, OR OTHERWISE AT THE MASTER'S DISCRETION. AFTER RECEIVING THIS DOCUMENT FROM BOTH COUNSEL OR A PARTY TO THE ACTION, IF NOT REPRESENTED BY COUNSEL, INDICATING THAT DISCOVERY IS NOT COMPLETE, THE DIRECTIVE FOR FILING OF PRETRIAL STATEMENTS WILL BE ISSUED AT THE MASTER'S DI SCRE.T ION . HOWEVER, IF BOTH COUNSEL, OR A PARTY NOT REPRESENTED, CERTIFY THAT DISCOVERY IS COMPLETE, A DIRECTIVE TO FILE PRETRIAL STATEMENTS WILL BE ISSUED IMMEDIATELY. THE CERTIFICATION DOCUMENT SHOULD BE RETURNED TO THE MASTER'S OFFICE WITHIN TWO (2) WEEKS OF THE DATE SHOWN ON THE DOCUMENT. ,~ .~ & '-J ,_ I . . ~ . , ANGELA TOMASELLO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. NO. 2000 - 451 CIVIL NICK TOMASELLO, Defendant IN DIVORCE TO: Maryann Murphy , Attorney for Plaintiff Peter R. Henninger , Attorney for Defendant DATE: Tuesday, May 30, 2000 CERTIFICATION I certify that discovery is complete as to the claims for which the Master has been appointed. OR IF DISCOVERY IS NOT COMPLETE: (a) Outline what information is required that is not complete in order to prepare the case for trial and indicate whether there are any outstanding interrogatories or discovery motions. " .....~~, I, ".f' (b) Provide approximate date when discovery will be complete and indicate what action is being taken to complete discovery. II. 6//1()O / DATE ~p=' COUNSEL FOR DEFENDANT ( ) NOTE: PRETRIAL DIRECTIVES WILL NOT BE ISSUED FOR THE FILING OF PRETRIAL STATEMENTS UNTIL COUNSEL HAVE CERTIFIED THAT DISCOVERY IS COMPLETE, OR OTHERWISE AT THE MASTER'S DISCRETION. AFTER RECEIVING THIS DOCUMENT FROM BOTH COUNSEL OR A PARTY TO THE ACTION, IF NOT REPRESENTED BY COUNSEL, INDICATING THAT DISCOVERY IS NOT COMPLETE, THE DIRECTIVE FOR FILING OF PRETRIAL STATEMENTS WILL BE ISSUED AT THE MASTER'S DISCRETION. HOWEVER, IF BOTH COUNSEL, OR A PARTY NOT REPRESENTED, CERTIFY THAT DISCOVERY IS COMPLETE, A DIRECTIVE TO FILE PRETRIAL STATEMENTS WILL BE ISSUED IMMEDIATELY. THE CERTIFICATION DOCUMENT SHOULD BE RETURNED TO THE MASTER'S OFFICE WITHIN TWO (2) WEEKS OF THE DATE SHOWN ON THE DOCUMENT. _ ". r . ~, _ "~ ' w. .. , . "I~"~'.. 'd',- ,."" . , ANGELA TOMASELLO, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 2000-451- CIVIL TERM NICK TOMASELLO, Defendant MOTION FOR APPOINTMENT OF MASTER Nick Tomasello, Defendant, moves this Court to appoint a master with respect to the following claims: ( ) Divorce ( ) Annulment (X) Alimony (X) Alimony Pendente Lite (X) Distribution of Property ( ) Support ( ) Counsel Fees ( ) Costs and Expenses and in support of the motion states: (1) Discovery is complete as to the claimls) for which the appointment of a master is requested. (2) The Plaintiff has appeared in the action by her attorney, Maryann Murphy, Esquire. (3) The statutory ground(s) for divorce is ~330l(c). (4) Delete the inapplicable paragraph(s): (a) The actions is not contested. (b) An agreement has been reached with respect to the following claims: None (c) The action is contested with respect to the following claims: equitable distribution, alimony, alimony pendente lite. (5) The action does not involve complex issues of law or fact. (6) The hearing is expected to take four (4) hours. Date: (7) Additional information, if any, relevant to the motion: 'lP7,/u; ~ Peter R. Henninger, ., Esquire (Attorney for Defendant) AND NOW appointed claims: ORDER APPOINTING MASTER e ~Ck/0.;f: , , 2000, to the fOllOWing~ Esquire is ./'" :-l"\ I'd!) no j' I'. J ,,'I '" , \ 1'..,'1 (", /\UV.l.'---" jU -.--.",'-- "~' , "- -~" ~., ,-", '-,'. _. '_ ,0 <,;" "~-' ^" ~ ".' -",. CERTIFICATE OF SERVICE A copy of the foregoing Motion for Appointment of Master has been served upon the Plaintiff by sending a copy to her attorney of record: Maryann Murphy, Esquire Legal Services, Inc. 8 Irvine Row Carlisle, PA 17013 by depositing same in the United States mail, postage prepaid, in Middletown, Pennsylvania, this :1. 7 day of ~ ' 2000. PANNEBAKER AND JONES, P.C. Attorneys for Defendant By: Peter R. Henninger, Jr. LD. #44873 4000 Vine Street Middletown PA 17057 (717) 944-1333 squire > .~ " , ANGELA TOMASELLO, Plaintiff/Petitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NICK TOMASELLO, DefendantJRespondent NO. 00-451 CIVIL TERM IN DIVORCE DR# 30,033 Pacses# 512102641 ORDER OF COURT AND NOW, this 8th day of September, 2000, upon consideration of the attached Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before Rl Shaddav on October 4. 2000 at 1:30 P.M. for a conference, at 13 N, Hanover St, Carlisle, PA 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered. NOTE: This case and case 378102577 previously scheduled before Amy Ickes will now be heard by Rickie Shadday. YOU are further ordered to bring to the conference: (I) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by Rule 1910,111\) (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you IF you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest BY THE COURT, George E, Hoffer, President Judge ~,'.","""I , ,,'. I 'Ie ,I - --,'. :,,~i,~\!- "\ ~~;Wr,,-~o"J1 ' 9'8.00 to:' < Petitioner Respondent Maryann Murphy. Esquire Peter Henninger, Jr" Esquire Date of Order: September 8, 2000 YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY A VB. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 I, .....~ln k<r:,:~ , ~t!_'~ll!ii'&~~mw!ibl__;.!_I.<!'-"''''"*'''''',_~I.Ii_.,h!J,1...bJ<;I",,,~_o\l!l_liiIr''~ , , VII\!\l"Yl},S"i'\:N:Jd ). ! ',\:1'-1(':"'-1 i"..'"T"r::~---:!'\Jrl1""\ ,v_, "__".- ;.- ",,__ '[ ,IJ 01 :'1 iid 8- dS CO Alf/JC: 3~ ..!,.i()-<I:-ii.::! ~...... o..~""'~ ~-, '" . , IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW ANGELA TOMASELLO, Plaintiff/Petitioner . . v. No. 2000 - 451 Civil Term NICK TOMASELLO, Defendant/Respondent .. IN DIVORCE PETITION FOR APL CONFERENCE NOW COMES, ANGELA TOMASELLO, Plaintiff/Petitioner, by and through her attorney, Maryann Murphy, Esquire, of Legal Services, Inc., and avers as follows: 1. petitioner is ANGELA TOMASELLO whose current address is 7073 Carlisle Pike, Lot #207, Carlisle, Pennsylvania 17013 . 2. Respondent is NICK TOMASELLO whose current address is 9 North Stoner Avenue, Shiremanstown, PA 17011. 3. petitioner and Respondent were married on January 1, 1996 in Schuylkill County, Pennsylvania. 4. petitioner and Respondent are the parents of two (2) minor children, namely: RYAN TOMASELLO, born March 11, 1994; and NICKOLAS TOMASELLO, born May 16, 1995. 5. The parties separated in January of 2000. 6. On January 24, 2000, Petitioner filed a Complaint in ~ ..;.:;~ ,~..-~~-"~, ,~ '",."- ,-co ~', 1,!lI1--i , " , Divorce which includes a Count for Alimony Pendente Lite. 7. A DRS Attachment for APL Proceedings has been filed with the Court simultaneously with this Petition. WHEREFORE, Petitioner, through her counsel, requests a conference be held at the Domestic Relations Section to address her claim for APL. Respectfully submitted: By: Maryann Murphy, Legal Services, 8 Irvine Row Carlisle, PA 17013 (717) 243-9400 Attorney I.D. #61900 Attorney for Plaintiff/Petitioner ,00 .-J _c, ,_. I '" ~ _, -;""r._' ,,'" ,~. " I '-' 1"'"'\ 1 'i~~, . . . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW ANGELA TOMASELLO, Plaintiff/Petitioner . . v. No. 2000 - 451 Civil Term NICK TOMASELLO, Defendant/Respondent IN DIVORCE CERTIFICATE OF SERVICE I, Maryann Murphy, Esquire, do hereby certify that on the day of , 2000 I served a true and correct copy of the foregoing petition for APL Conference on counsel for the Defendant, Peter R. Henninger, Jr., Esquire, at the address set forth below, by placing a copy of same in the United States Mail, first class, postage prepaid. Peter R. Henninger, Jr., Esquire 400 Vine Street Middletown, PA 17057 Respectfully submitted, Maryan Murphy, Legal Services, 8 Irvine Row Carlisle, PA 17013 (717) 243-9400 LD. # 61900 "'-, ~~ "~_Hr.'. Itfflililill&~~tIlili5!:~~.m>iif;f<lll'..IilllI.... _' ,.,i. - <~ c_._ '" . (') S; ~R1 ZJ.! ~f:~ 0- l,;C~ LCJ Pc Z ~ , - ~- . ~.. .1 c...) (:J ~ G--; o 'n -.l ~I1 'r '--~' .1', -" ;' :e,'(.l-'; (:jiTl ~ :< 'v ::,0 .J en , " ~ ,I ''''::,; IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW ANGELA M. TOMASELLO, Plaintiff v NO. 2000-451 civil Term NICK T. TOMASELLO, Defendant IN DIVORCE INVENTORY AND APPRAISEMENT OF ANGELA M. TOMASELLO ( X Plaintiff Defendant files the following inventory and appraisement of all property owned or possessed by either party at the time this action was commenced and all property transferred within the preceding three years. ( X ) Plaintiff Defendant verifies that the statements made in this inventory and appraisement are true and correct. ( X ) Plaintiff Defendant understands that false statements herein are made subject to the penalties of 18 Pa. C.S. 4904 relating to unsworn falsification to authorities. ~c- /lIi f V"7rl'ALlQ Q}.~.r- ANGE A M. TOMASELLO ( X ) plaintiff ( ) Defendant -, ".., ~.'f_ ., :.; ; ,- ,,,,,-,,,=,J~':' '~i ~.,j I 1 ASSETS OF PARTIES ( X) Plaintiff below those items applicable to assets on the following pages. ) Defendant marks on the list the case at bar and itemizes the X 1. Real Property X 2. Motor Vehicles 3. Stocks, bonds, securities and options X 4. Certificates of deposit X 5 . Checking accounts, cash 6. Savings accounts, money market savings certificates 7. Contents of safe deposit boxes 8. Trusts X 9. Life Insurance policies (indicate face values, cash surrender value and current beneficiaries) 10. Annuities 11 . Gifts 12. Inheritances 13. Patents, copyrights, inventions, royalties 14. Personal property outside the home 15. Businesses (list all owners, including percentage of ownership, and officer/director positions held by a party with company) 16. Employment termination benefits--severance pay, workman's compensation claim/award 17. Profit Sharing Plans " __. ~ "-J',_ ~ ',i..-o ,"___ -'I I I i ! x 18. 401 K Plan x 19. Pension plan (indicate employee contribution and date plan vests) 20. Retirement Plans, Individual Retirement Accounts 21. Disability payments 22. Litigation claims (matured and unmatured) 23. Military/V.A. benefits 24. Education benefits x 25. Debts due, including loans, mortgages held x 26. Household furnishings and personalty (include as a total category and attach itemized list if distribution of such assets is in dispute) 27. Other '. b-_.,_, ,-" ,-,,--I. MARITAL PROPERTY: (X) Plaintiff ) Defendant lists all marital property in which either or both spouses have a legal or equitable interest individually or with any other person as of the date this action was commenced. ITEM NO. 1 DESCRIPTION:9 North Stoner Ave.. Shiremanstown. PA VALUE: $112,650.00 DATE OF VALUATION: March 2000 NAMES OF ALL OWNERS: Nick and Anqela Tomasello NON-MARITAL PORTION: N/A AMOUNT/NATURE OF ANY LIEN: (A) $88.400.27 principal balance as of Julv 2000 - Norwest Mortqaqe (B) $46.594.21 principal balance as of 2/14/00 - providian National Bank ITEM NO. 2 DESCRIPTION: 1993 Hvundai Sonata VALUE: DATE OF VALUATION: NAMES OF ALL OWNERS: Nick and Anqela Tomasello NON-MARITAL PORTION: N/A AMOUNT/NATURE OF ANY LIEN: N/A ITEM NO. 2 DESCRIPTION: 1992 Volkswaqen GTI VALUE: DATE OF VALUATION: NAMES OF ALL OWNERS: Nick Tomasello NON-MARITAL PORTION: N/A AMOUNT/NATURE OF ANY LIEN: N/A - ,'- .' ..< '~, ITEM NO.~ DESCRIPTION: Certificate of Denosit-Harris Savinqs Bank VALUE:$4,549.55 DATE OF VALUATION: date of senaration-January 2000 NAMES OF ALL OWNERS: Nick and Anqela Tomasello NON-MARITAL PORTION: none AMOUNT/NATURE OF ANY LIEN: N/A ITEM NO. 5 DESCRIPTION:Checkinq account - Harris Savinqs Bank Account number - 500066709 DATE OF VALUATION: July 2000 VALUE: $840.00 NAMES OF ALL OWNERS: Nick Tomasello NON-MARITAL PORTION: unknown AMOUNT/NATURE OF ANY LIEN: N/A ITEM NO. 5 DESCRIPTION: Checkinq account - Harris Savinqs Bank Account number - 500039569 VALUE: $1,703.06 DATE OF VALUATION: January 20. 2000 NAMES OF ALL OWNERS: Nick Tomasello NON-MARITAL PORTION: none AMOUNT/NATURE OF ANY LIEN: N/A ITEM NO. 9 DESCRIPTION: Life insurance nolicY-Monumental VALUE: face-$100.00.00; cash-$865.88 as of 12/13/99; beneficiary- unknown DATE OF VALUATION: January 9. 2000 NAMES OF ALL OWNERS: Nick Tomasello NON-MARITAL PORTION: N/A AMOUNT/NATURE OF ANY LIEN: none -, , , '," - _L~=~ '",i ITEM NO. 9 DESCRIPTION: Life insurance policy-Monumental VALUE: cash value - $50.00 DATE OF VALUATION: NAMES OF ALL OWNERS:_Anqela Tomasello NON-MARITAL PORTION: N/A AMOUNT/NATURE OF ANY LIEN: none ITEM NO. 19 DESCRIPTION: State Employees' Retirement System VALUE:$6.542.00 marital portion as per Harry Leister; vests in 2005 DATE OF VALUATION: March 20. 2000 NAMES OF ALL OWNERS : Nick Tomasello NON-MARITAL PORTION: taken into consideration by Harry Leister when determininq marital portion AMOUNT/NATURE OF ANY LIEN: none ITEM NO. 26 VALUE: DESCRIPTION: various items of household furniture DATE OF VALUATION: NAMES OF ALL OWNERS: Nick and Anqela Tomasello NON-MARITAL PORTION: N/A AMOUNT/NATURE OF ANY LIEN: N/A TOTAL VALUE OF MARITAL PROPERTY: '-- ... , b. 0". NON-MARITAL PROPERTY: (X) Plaintiff ) Defendant lists all property in which a spouse has a legal or equitable interest which is cla~med to be excluded from marital property. ITEM NO. 5 DESCRIPTION:Checkina account - Harris Savinas Bank VALUE: $25.00 DATE OF VALUATION: Julv 2000 NAMES OF ALL OWNERS: Anaela Tomasello REASON FOR EXCLUSION: opened after date of separation AMOUNT/NATURE OF ANY LIEN: N/A TOTAL VALUE OF NON-MARITAL PROPERTY: ~...o..-..I "' 'I , 1 I I I 0', " ;,' ~ ~_ : ," 0 . .~",;. u PROPERTY TRANSFERRED: ( X ) Plaintiff ( ) Defendant lists all property in which either or both spouses had a legal or equitable interest individually or with any other person and which has been transferred within the preceding three (3) years. ITEM NO. 18 DESCRIPTION: 401(k) Plan NAMES OF ALL OWNERS: Anqela Tomasello DATE OF TRANSFER: 1999 CONSIDERATION: $700.05 PERSON TO WHOM TRANSFERRED: Funds withdrawn and used bv the parties for family expenses. ITEM NO. DESCRIPTION: NAMES OF ALL OWNERS: DATE OF TRANSFER: CONSIDERATION: PERSON TO WHOM TRANSFERRED: ITEM NO. DESCRIPTION: NAMES OF ALL OWNERS: DATE OF TRANSFER: CONSIDERATION: PERSON TO WHOM TRANSFERRED: ITEM NO. DESCRIPTION: NAMES OF ALL OWNERS: DATE OF TRANSFER: CONSIDERATION: PERSON TO WHOM TRANSFERRED: TOTAL CONSIDERATION OF PROPERTY TRANSFERRED: ~~~ '-.!Q,"" """",,",,I, --1;;:: LIABILITIES: liabilities of of the date of ( X) Plaintiff ) Defendant lists all either or both spouses alone or with any person as separation. ITEM NO. 25 DESCRIPTION: mortqaqe NAMES OF ALL CREDITORS: Norwest Mortqaqe Company AMOUNT OF DEBT PRESENTLY: as of 7/2000 - $88.400.27 NAMES OF ALL DEBTORS: Nick and Anqela Tomasello AMOUNT OF DEBT AT SEPARATION: approximately $88.834.49 DATE DEBT INCURRED, INITIAL AMOUNT OF INDEBTEDNESS AND PURPOSES OF DEBT: approximately 1997: unknown: to purchase marital residence AMOUNT PAID BY DEBTOR SINCE DATE OF SEPARATION: unknown ITEM NO. 25 DESCRIPTION: mortqaqe NAMES OF ALL CREDITORS: proyidian National Bank AMOUNT OF DEBT PRESENTLY: as of 2/14/00 - $46.594.21 NAMES OF ALL DEBTORS: Nick and Anqela Tomasello AMOUNT OF DEBT AT SEPARATION: approximately $46.594.21 DATE DEBT INCURRED, INITIAL AMOUNT OF INDEBTEDNESS AND PURPOSES OF DEBT: 10/21/99: $46.929.00: refinancinq AMOUNT PAID BY DEBTOR SINCE DATE OF SEPARATION: unknown TOTAL AMOUNT OF LIABILITIES: """""'" ,'^, ;-~"" IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW ANGELA M. TOMASELLO, Plaintiff v NO. 2000-451 Civil Term NICK T. TOMASELLO, Defendant IN DIVORCE CERTIFICATE OF SERVICE .-c'. 1-_ ~'2' I, Maryann Murphy, Esquire, do hereby certify that on the ~. day of 0 Ii ~H ~ 2000, I served Plaintiff's Inventory and Appraisement, Income and Expense Statement, and Pre-Trial Statement upon Peter R. Henninger, Jr., Esquire, counsel for Defendant, by placing copies of same in the United States Mail, first class, postage pre-paid to the following address: Peter R. Henninger, Jr. 400 Vine Street Middletown, PA 17057 Maryann Murphy, Esquire LEGAL SERVICES, INC. a Irvine Row Carlisle, PA 17013 (717) 243-9400 l! Ii I:' ~ L,' ~ Ij r, " I;; ti ,,' " I' i, I r I, ~1 j~ "'ilIAlWBiii--_~~~I-~'-"~";"-~.'~'W " "~ ' ..- ~_. ::2 c_; U '1;;>1 '::,") ''', '-'-' =.:::r U-1 -< , , "~, , ._~ < - ", I,-~ " ,~d" ,_, ."b~'~' ,~I..:..,..' __<J '._, INCOME AND EXPENSE STATEMENT OF .J..vvv. LJeYl ANGELA M. TOMASELLO SSN 182 - 60 - 7453 DR# DATE July 28. 2000 THIS STATEMENT MUST BE FILLED OUT (If you are self-employed or if you are salaried by a business of which you are owner in whole or in part, you must also fill out the Su~plemental Income Statement which appears on the last page of thls Income and Expense Statement.) INCOME (a) Wages/Salary Employer & Address Country Meadows Job Title/Description personal care aide Pay Period (weekly, bi-weekly, monthly) bi-weeklY' Gross pay per Pay Period $609.01 Payroll Deductions: Federal Withholding .........$51.47 Social Security .............$45.22 Local Wage Tax ..............$ 6.09 State Income Tax ............$16.55 Retirement .................. $ -0- Health Insurance ............$ -0- Other (specify) AFLAC .....$27.41 disabilitv/accident/cancer... Net Pay per Pay Period.........$462.27 (b) Other Income N/A Month $ $ $ $ $ $ $ $ $ $ Year Week Interest/Dividends....$ Pension/Annuity.......$ Social Security.......$ Rents/Royalties.......$ Expense Account.... ...$ Unemployment Comp.....$ Workmen'S Comp........$ Separation Agreement..$ Other Income..........$ Total, Other Income...$ $ $ $ $ $ $ $ $ $ $ INCOME AND EXPENSE STATEMENT OF ANGELA M. TOMASELLO I verify that the statements made in this Income and Expense Statement are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. 4904 relating to un~sw rn falsifica~ authorities. Date: "7-.::19-= _~IL. -?r\. ..,r~ ~ ANGE M.TOMASELLO, Plaintiff EXPENSES Home Mortqaqe/Rent....... $ Maintenance......... $ Utilities............$ Lot Rent.............$ Household Month 192.25 10.00 175.00 269.00 Employment............$ 15.00 (transportation, lunches) Medical (with Husband's Keystone HMO) Doctor/Dentist/Orth..$ 25.00 Hospi tal. . . . . . . . . . . . . $ Special..............$ 50.00 (qlasses, braces, etc.) prescriptions........$ 25.00 Taxes Real Estate..........$ Personal Property....$ Income. . . . . . . . . . . . . . . $ Insurance Homeowners....... ....$ Automobile....... ....$ Life/Accident/Health. $ Other. . . . . . . . . . . . . . . . $ Automobile Payments. . . . . . . . . . . . . $ Fuel. . . . . . . . . . . . . . . . . $ Cell Phone.......... $ Education Private/parochial....$ College..............$ Personal Clothing... ........ ..$ Food. . . . . . . . . . . . . . . . . $ Other. . . . . . . . . . . . . . . . $ Credit-payments/loans$ Miscellaneous Household help.......$ child care Entertainment........$ Gifts. . . . . . . . . . . . . . . . $ Charitable contrib...$ Legal Fees.......... $ Other. . . . . . . . . . . . . " $ TOTAL EXPENSES....... $ 30.00 9.00 15.00 unknown 30.00 120.00 30.00 120.00 300.00 30.00 50.00 50.00 50.00 1,580.25 - I I I I I I I 1'1 j i'! Household Yearly $ 2.307.00 $ 120.00 $ 2.100.00 $ 3.228.00 $ 180.00 $ 360.00 $ 108.00 $ $ 180.00 $ unknown $ 360.00 $ $ $ 1.440.00 $ 360.00 $ 300.00 $ $ 600.00 $ 300.00 $ $ $ 1.440.00 $ 3,600.00 $ 360.00 $ 600.00 $ $ 600.00 $ 600.00 $ $ $ $ 18,963.00 t J I / PROPERTY OWNED DESCRIPTION Checking Accounts.Harris Savinqs Bank Checking Accounts.Harris Savinqs Bank Checking Accounts.Harris Savinqs Bank Certif/Deposit....Harris Savinqs Bank Savings Accounts... N/A N/A N/A Credit Union....... Stocks/Bonds....... Real Estate........9 N. Stoner Ave. Shiremanstown, PA Other. . . . . . . . . . . . . . N/A Total Property..... $ INSURANCE Company Hospital. . . . . Kevstone HMO Medical...... Kevstone HMO Heal th. . . . . . . AFLAC Accident Disability. . . AFLAC Other. . . . . . . . AFLAC Cancer Policy No. (*H-Husband, W-Wife, J-Joint, C-Children) . . '-,-,.- " .' I . .1 I I I I I I VALUE OWNERSHIP H W J $ 25.00 ~ $unknown ~ $1,703.06 ~ at DOS $4,549.55 ~ at DOS $ $ $ $112,650.00 ~ subject to mortgage $ Coverage * H W C -----L ~ -1L- -----L ~ -1L- ~ -----L ~ -1L- -----L -----L Iltl!ill!l-.""_Il:~M~~mlll;iIlOl;!HIM.M~"~J}_lilikW'l&i_~ii&M .~~--_. 0 (~; c: C) --,- ::;-;:" " cJ !Ti ? :,"'") -:7 , .7 0. .' r' " ~~: ~fi " - ~ ( ;1 -':... ....... ~ '-"j IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW ANGELA M. TOMASELLO, Plaintiff : NO. 2000-451 Civil Term v. NICK T. TOMASELLO, Defendant : IN DIVORCE PLAINTIFF'S PRE-TRIAL STATEMENT Plaintiff, ANGELA M. TOMASELLO, by and through her attorney, Maryann Murphy, Esquire of Legal Services, Inc., filed this Pre-Trial Statement in accordance with Pa.R.C.P. 1920.33(b ). 1. Assets: Inventory and Appraisement filed. (See attached). (i) Marital Property Plaintiff lists all marital property in which either or both spouses have a legal or equitable interest individually or with any other person as of the date this action was commenced. ITEM NUMBER - 1 DESCRIPTION OF PROPERTY 9 North Stoner Ave. Shiremanstown, P A NAMES OF VALUE ALL OWNERS Nick & Angela $112,650.00 Tomasello DATE OF VALUATION March 2000 NATURE OF ANY LIEN mortgages ITEM NUMBER - 2 DESCRIPTION OF PROPERTY 1993 Hyundai ITEM NUMBER - 2 DESCRIPTION OF PROPERTY 1992 Volkswagen ITEM NUMBER - 4 DESCRIPTION OF PROPERTY Certificate/Deposit ITEM NUMBER - 5 DESCRIPTION OF PROPERTY Checking account ITEM NUMBER - 5 DESCRIPTION OF PROPERTY Checking account ITEM NUMBER - 9 DESCRIPTION OF PROPERTY Life insurance NAMES OF ALL OWNERS Nick & Angela Tomasello NAMES OF ALL OWNERS Nick Tomasello NAMES OF ALL OWNERS Nick & Angela Tomasello VALUE VALUE DATE OF VALUATION DATE OF VALUATION VALUE DATE OF VALUATION $4,549.55 January 2000 NAMES OF VALUE ALL OWNERS Nick Tomasello $840.00 NAMES OF VALUE ALL OWNERS Nick Tomasello $1,703.06 NAMES OF VALUE ALL OWNERS Nick Tomasello $865.88 DATE OF VALUATION July 2000 DATE OF VALUATION January 2000 DATE OF VALUATION 12113/99 ,wI NATURE OF ANY LIEN none NATURE OF ANY LIEN none NATURE OF ANY LIEN none NATURE OF ANY LIEN none NATURE OF ANY LIEN none NATURE OF ANY LIEN none ITEM NUMBER - 9 DESCRIPTION OF PROPERTY Life insurance ITEM NUMBER - 19 DESCRIPTION OF PROPERTY Pension(SERS) ITEM NUMBER - 26 DESCRIPTION OF PROPERTY household items NAMES OF VALUE ALL OWNERS Angela Tomasello $50.00 NAMES OF VALUE ALL OWNERS Nick Tomasello $6,542.00 NAMES OF ALL OWNERS Nick & Angela Tomasello VALUE DATE OF VALUATION DATE OF VALUATION 3/20/00 DATE OF VALUATION :-:1 NATURE OF ANY LIEN none NATURE OF ANY LIEN none NATURE OF ANY LIEN none Plaintifflists all property in which a spouse has a legal or equitable interest which is claimed (ii) Non-Marital Property to be excluded from marital property. ITEM NUMBER - 5 DESCRIPTION OF PROPERTY Checking account NAMES OF ALL OWNERS Angela Tomasello VALUE $25.00 DATE OF VALUATION July 2000 NATURE OF ANY LIEN none ~ -,~ ~- "d 2. Expert Witnesses: Plaintiff knows of no expert witnesses that she will call at this time. However, Plaintiff reserves the right to supplement this answer should such become available. 3. Other Witnesses: Plaintiff knows of no witnesses at this time other than the parties. However, Plaintiff reserves the right to supplement this answer should such become available. 4. Exhibits: All exhibits will be submitted at hearing and are described as follows: (a) comparative market analysis from Jack Gaughen (b) comparative market analysis from Century 21 ( c) parties' 1999 income tax return (d) bank statements (e) mortgage information (f) 401 (k) statement (g) pension (SERS) valuation (h) life insurance policy statement 5. Gross Income: Income and Expense Statement filed. (See attached). 6. Expenses: Income and Expense Statement filed. (See attached). 7. Pension and Retirement Benefits: (a) Husband's SERS pension statement and valuation by Harry Leister reflect a marital portion of$6,542.00 as of March 20,2000. Husband is not vested. (b) Wife's 401(k) was valued at $700.05 as of June 30, 1999. However, Wife withdrew the funds from her 40 I (k) during the course of the marriage, and the parties used these funds for family expenses. ". 8. Personal ProDerty: Plaintiff's Proposed Distribution of Personal ProDertv To Plaintiff Wife: I. Toaster oven 2. Blender 3. Skillet grill 4. Hot dog maker 5. Toaster 6. Can opener 7. Fry Daddy 8. Snack cart 9. Sweeper 10. Mop II. Ryan's dresser 12. Nickolas' dresser 13. Sofa in front room 14. Washer and dryer 15. Recliner 16. Portable refrigerator I 7. Entertainment center 18. I VCR 19. Bedroom set - downstairs 20. Kitchen phone 21. Off-white portable phone 22. Her alarm clock 23. White outside chairs 24. Children's picnic table 25. TV trays 26. Tan trash can 27. Wood clock 28. Brown wooden end table 29. Blue clothes hamper 30. Patio chairs 31. Children's basketball net 32. Children's wagon 33. Black & white step ladder 34. End table lamp 35. Clothes closet 36. Filing cabinet , - ~ "'" "-,,, ',",-~l". . ." To Defendant Husband: I. Guns 2. Refrigerator 3. Dishwasher 4. Breadmaker 5. Coffee maker 6. Dining room table and chairs 7. Microwave cart 8. Microwave 9. Pantry cupboard 10. Oriental rugs in dining room and front room 11. Children's beds 12. Sofa and loveseat 13. Upright freezer 14. 2 color TV sets 15. 1 VCR 16. Bedroom set upstairs 17. Train phone 18. Black cordless phone 19. His alarm clock 20. Lawmnower 21. Trimmer 22. Gas grill 23. Picnic table 24. Swing set 25. 3 air conditioners 26. Fish tank 27. Steak knives set 28. Blue trash can in kitchen 29. Kitchen clock 30. Blue Hoover Quik Broom sweeper 31. Hand vacuum 32. Direct TV system 33. Video tape cabinet 34. Dehumidifier 35. Tan clothes hamper 36. Fire extinguisher 37. Video camcorder 38. train clock 39. clothes closet ~ , r ",: 9. Marital Debts: Inventory and Appraisement filed. (See attached). Amonnt as of 7/2000 $88,400.27 Amount at DOS $46,594.21 DATE INCURRED 1997 DATE INCURRED 10/21/99 INITIAL AMOUNT Unknown PURPOSE PAYMENTS SINCE DOS Unknown Mortgage on Marital home INITIAL AMOUNT $46,929.00 PURPOSE PAYMENTS SINCE DOS Unknown Refinancing 10. Proposed Resolntion: To Plaintiff Wife I. Household furnishings designated to Wife herein 2. 1993 Hyundai Sonata 3. Wife's Monumental life insurance policy 4. Sixty (60%) percent of the value of the Certificate of Deposit at the date of separation - $2,729.73 5. Sixty (60%) percent of the balance of the checking account at the date of separation - $1,021.84 6. Sixty (60%) percent of the marital portion of Husband's pension - $3,925.20 7. Husband to designate Wife as primary beneficiary of his life insurance policy with Monumental with a face value of $100,000.00 until the youngest child, Nickolas, reaches the age of 18 years or graduates from high school, whichever shall last occur 8. Alimony until Wife's cohabitation, remarriage, or the death of either party e- ---,;;, , '~ To Defendant Husband I. Household furnishings designated to Husband herein 2. 1992 Volkswagen GTI 3. Husband's Monumental life insurance policy with a face value of $100,000.00, designating Wife as primary beneficiary until the youngest child, Nickolas, reaches the age of 18 years or graduates from high school, whichever shall last occur 4. Forty (40%) percent of the value ofthe Certificate of Deposit at the date of separation - $1,819.82 5. Forty (40%) percent of the balance of the checking account at the date of separation - $681.22 6. Forty (40%) percent of the marital portion of Husband's pension - $2,616.80 7. The marital residence, with encumbrances, with Husband refinancing or otherwise removing Wife's name from the mortgages Respectfully submitted: Date:~ Maryann urphy, Esquire Legal Services, Inc. 8 Irvine Row Carlisle, PA 17013 (717) 243-9400 LD. #61900 Attorney for Plaintiff I~ ......i~IiBllia_ '~~'id~IillIilEirIliI~~<lIlf_ '-'--': ........-.-..... p Ci -;-i 7:..... ,.',-.1 'j: f",' C., , ,- ~_. " ,-" ',--. ANGELA TOMASELLO, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 2000-451 CIVIL TERM NICK TOMASELLO, Defendant IN DIVORCE INCOME AND EXPENSE STATEMENT OF DEFENDANT NICK TOMASELLO Defendant files the following Income and Expense Statement and verifies that the statements made in herein are true and correct. Defendant understands that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorit~ .. ~. ~--- Nick Tomasello, Defendant INCOME: Employer: Pa Department of Corrections Address: 2500 Lisburn Road, Camp Hill, PA 17011 Type of Work: Corrections Officer 1 payroll Number: 991102450000 Pay Period: Biweekly Gross Per Pay Period: $1255.20 ITEMIZED PAYROLL DEDUCTIONS: Federal Withholding: Social Security: Local Wage Tax: State Income Tax: Retirement: savings Bonds: Credit Union: Life Insurance: other (specify): Med Union Dues: $98.95 77.82 12.55 35.15 62.76 .00 .00 18.20 18.83 Net Per Pay Period: $930.94 ~-. ',-~;,-J OTHER INCOME: Weekly Monthly Yearly Interest: Dividends: Pension: Annuity: Social Security: Rents: Royalties: Expense Account: Unemployment Comp: Workmen's Comp: .81 Total $ $ .81 $ TOTAL INCOME: $ 2017.85 Per Month EXPENSES: HOME: Mortgage/Rent 173.20 750.53 9006.36 Maintenance 3.46 15.00 180.00 Utilities Electric 13.20 57.20 686.40 Gas 8.19 35.50 426.00 Oil Telephone Water 6.07 26.29 315.48 Sewer 1. 85 8.00 96.00 EMPLOYMENT: Public Transportation Income TAXES: Real Estate Personal Propery .19 .82 9.80 Income INSURANCE: Homeowners Automobile 9.35 40.50 486.00 Life 12.27 53.17 638.04 Accident Health Other AUTOMOBILE: Payments Fuel 11. 54 50.00 600.00 Repairs 4.23 18.33 220.00 EDUCATION: Private School Parochial School College MEDICAL: Doctor 1.15 5.00 60.00 Dentist Orthodontist Hospital Medicine 2.31 10.00 120.00 Special Needs 6.92 30.00 360.00 RELIGIOUS: PERSONAL: Clothing 11. 54 50.00 600.00 Food 46.15 200.00 2400.00 Barber/Hairdresser 1. 92 8.33 100.00 Credit Payments Credit Card 15.92 69.00 828.00 Charge Account Memberships LOANS: Credit Union Providian (2nd 118.04 511.50 6138.00 Mortgage) . '" MISCELLANEOUS: Household Help Child Care Papers/Books Magazines Entertainment Pay TV Vacation Gifts Legal Fees Charitable Contributions Other Child Support Alimony Payments OTHER: PCS One School Taxes TOTAL EXPENSES: 5.81 7.38 3.46 $464.16 :sls TOMASELLO INCOMEEXPENSE . " - ~ '-.''-' cl 'I .,"'-.' 1,--. 25.19 302.28 32.00 15.00 364.00 180.00 $2011.36 $24,136.32 "~ ,~ ~ ~ .- (') ~i -oCJ rTir-:--1 2....':1 2C~ ~~~~: ).-:;(~ Z J -,0 Pc Z :;! (-~ C5 .". ~..- 5 ~ ~-~~ ."h;:IJ ~1~ ') ,~-' ~"'~~ ?\:n :'7 C) ~i-n :D -< -.! "'~ :3:,: 9 :::> m ~. . ->, l... ~' S'~~D fG ANGELA TOMASELLO, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 2000-451 CIVIL TERM NICK TOMASELLO, Defendant IN DIVORCE PRETRIAL STATEMENT AND NOW comes the Defendant, Nick Tomasello, by and through his attorneys, pannebaker and Jones, P.C., and provides the following Pretrial Statement in accordance with Pa.R.C.P. 1920.33(b): 1. A list of all assets, marital and non-marital as attached her<eto as Exhibit "AN. 2. Plaintiff anticipates calling: (1) Harry Leister, Consulting Actuary Conrad M. Siegal, Inc. 501 Corporate Circle Harrisburg, PA 17110 A copy of the expert's report is attached hereto. .. I .. . (2) A representative of Jack Gaughen Realtors. A copy of the potential witness's report is attached hereto. 3. The Plaintiff expects to call as witnesses the following: (1) Nick Tomasello, 9 North Stoner Avenue, Shiremanstown, Cumberland County, Pennsylvania. Mr. Tomasello will testify regarding the circumstances surrounding the separation of parties, the nature and value of assets and liabilities, his employment expectations and benefits including, pensions of the parties and any other relevant matters that bears upon the claims of the parties. (2) Angela Tomasello, 9 North Stoner Avenue, Shiremanstown, Cumberland County, pennsylvania- as on cross/or on cross examination regarding her income, medical benefits, expenses, circumstances surrounding the separation, assets within her possession, both marital and non-martial, her rights to inheritance or .~ ,~ , "'..:.~""'-\ ' .' l~' (} I. , , , I 1 I: .. " .. . any other matters relevant to the issues between the parties. 4. The following is a list of exhibit that the Defendant intends to offer at the time of trial: (1) Mortgage statement from Northwest Mortgage. (2) Mortgage statement from providian National Bank. (3) Credit card statement from Chase Visa. (4) Credit card statement from CitiBank Visa. (5) Credit card statement from Mountz Jeweler. (6) Credit card statement from circuit City. (7) Credit card statement from Roaring Spring Water. (8) Copies of bills paid by Defendant since date of separation. (9) Copy of parties 1999 tax return. 5. For Defendant's gross income and deductions, please see federal income tax return and most recent pay stub attached. 6. A copy of Defendant's income and expense statement is attached. _L_ [( ... . " .. '. 7. For value of Defendant's pension benefits, see attached report of Harry Leister, Consulting Actuary. 8. Plaintiff claims counsel fees and Defendant disputes that claim,. 9. The parties hope to the distribute the marital tangible personal property between them at or about the time they physically separate and hope that there will not be any dispute regarding the division of this property. As regards to the value of the personal property they will be just estimates based on yard sales and the like. Each party will retain a vehicle at the time of separation. Marital debt is listed in Defendant's Inventory and Appraisement filed in this matter and attached hereto. 10. Your Defendant's proposed resolution of all economic issues between the parties is set forth in the letter of March 30, 2000, attached hereto. Most specifically the net assets of the parties with the exception of the personal property, which has a minimal value totals approximately $121,000.00, whereas the liabilities that Mr. Tomasello proposes to accept total at least $135,000.00, which under ,'. ", . '. ~~f if I: I:, !. : , , , , t I i I I I ,:; .-, :'l' i' I" "I i: Ii I: it_ j, ... '" . '" ' ""n'n "~ " .' r.- ',,-, J the circumstances seems to be a very, very fair proposal to the Plaintiff. :sls TOMASELLO PRETRIAL #16510 Respectfully submitted, PANNEBAKER AND JONES, P.C. Attorneys for Defendant By: Peter R. Henninger, J I.D. #44873 4000 Vine Street Middletown, PA 17057 (717) 944-1333 ,'~ '" __ I'. =~ ANGELA TOMASELLO, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 2000-451 CIVIL TERM NICK TOMASELLO, Defendant IN DIVORCE INVENTORY AND APPRAISEMENT OF NICK TOMASELLO Defendant files the following inventory and appraisement of all property owned or possessed by either party at the time this action was commenced and all property transferred within the preceding three years. Defendant verifies that the statements made in this inventory and appraisement were true and correct. Defendant understands that false statements herein are made subject to the penalties of 18 Pa.C.S. S4904, relating to unsworn falsification to authorities. Nick Tomasello '. --';'-1 ANGELA TOMASELLO, Plaintiff V. NICK TOMASELLO, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 2000-451 CIVIL TERM IN DIVORCE 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 items has been appraised, a copy of the appraisal report is attached. (X) 1. (X) 2. ( ) 3. ( ) 4. (X) 5. (X) 6. Real Property Motor vehicles Stocks, bonds, securities and options Certificates of deposit Checking account, cash Savings accounts, money market and savings certificates Contents of safe deposit boxes Trusts Life Insurance policies (indicate face value, cash surrender value and current beneficiaries) 10. Annuities 11. Gifts 12. Inheritances 13. Patents, copyrights, inventions, royalties, 14. Personal property outside the home 15. Businesses (list all owners, including percentage of ownership and officer/director positions held by a party with company) 16. Employment termination benefits-severance pay, workmen's compensation claim/award ( ) 17. Profit sharing plans (X) 18. Pension plans (indicate employee contribution and date plan vests) ( ) 19. Retirement plans, Individual Retirement accounts ( 1 20. Disability payments ( ) 21. Litigation claims (matured and unmatured) ( 1 22. Mi1itary/V.A. Benefits ( ) 23. Education benefits (Xl 24. 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U "' 0 '" U c- :;:UJ - " ~ 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 5. Credit card balances 6. Purchases 7. Loan payments 8. Notes payable 9. Other unsecured liabilities CONTINGENT OR DEFERRED 10. Contracts or Agreements 11. Promissory notes (.,) 12. Lawsuits 13. Options 14. Taxes 15. Other contingent or deferred liabilities . ~ " CERTIFICATE OF SERVICE A copy of the foregoing Inventory and Appraisement has been served upon the Plaintiff by sending a copy to her attorney of record: Maryann Murphy, Esquire Legal Services, Inc. 8 Irvine Row Carlisle, PA 17013 by depositing same in the United States mail, postage prepaid, in Middletown, Pennsylvania, this day of , 2000. PANNEBAKER AND JONES, P.C. Attorneys for Defendant By: Peter R. Henninger, Jr., Esquire 1.D. *44873 4000 Vine Street Middletown PA 17057 (717) 944-1333 , " .ItF , , ANGELA TOMASELLO, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 2000-451 CIVIL TERM NICK TOMASELLO, Defendant IN DIVORCE INCOME AND EXPENSE STATEMENT OF DEFENDANT NICK TOMASELLO Defendant files the following Income and Expense Statement and verifies that the statements made in herein are true and correct. Defendant understands that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. Nick Tomasello, Defendant INCOME: Employer: Pa Department of Corrections Address: 2500 Lisburn Road, Camp Hill, PA 17011 Type of Work: Corrections Officer 1 Payroll Number: 991102450000 Pay Period: Biweekly Gross Per Pay Period: $1255.20 ITEMIZED PAYROLL DEDUCTIONS: Federal Withholding: Social Security: Local Wage Tax: State Income Tax: Retirement: Savings Bonds: Credit Union: Life Insurance: Other (specify): Med Union Dues: $98.95 77.82 12.55 35.15 62.76 .00 .00 18.20 18.83 Net Per Pay Period: $930.94 OTHER INCOME: Weekly Man thly Yearly Interest: Dividends: Pension: Annuity: Social Security: Rents: Royalties: Expense Account: Unemployment Camp: Workmen's Camp: .81 Total $ $ .81 $ TOTAL INCOME: $ 2017.85 Per Month EXPENSES: HOME: Mortgage/Rent 173.20 750.53 9006.36 Maintenance 3.46 15.00 180.00 Utilities Electric 13.20 57.20 686.40 Gas 8.19 35.50 426.00 Oil Telephone Water 6.07 26.29 315.48 Sewer 1. 85 8.00 96.00 EMPLOYMENT: Public Transportation Income TAXES: Real Estate Personal Propery .19 .82 9.80 Income "" j ,~I" -, ~ii . , INSURANCE: Homeowners Automobile 9.35 40.50 486.00 Life 12.27 53.17 638.04 Accident Health Other AUTOMOBILE: Payments Fuel 11.54 50.00 600.00 Repairs 4.23 18.33 220.00 EDUCATION: Private School Parochial School College MEDICAL: Doctor 1.15 5.00 60.00 Dentist Orthodontist Hospital Medicine 2.31 10.00 120.00 Special Needs 6.92 30.00 360.00 RELIGIOUS: PERSONAL: Clothing 11.54 50.00 600.00 Food 46.15 200.00 2400.00 Barber/Hairdresser 1. 92 8.33 100.00 Credit Payments Credit Card 15.92 69.00 828.00 Charge Account Memberships LOANS: Credit Union providian (2nd 118.04 511. 50 6138.00 Mortgage) - MISCELLANEOUS: Household Help Child Care Papers/Books Magazines Entertainment Pay TV Vacation Gifts Legal Fees Charitable Contributions Other Child Support Alimony Payments OTHER: PCS One School Taxes TOTAL EXPENSES: 5.81 25.19 7.38 3.46 32.00 15.00 $464.16 $2011. 36 :sls TOMASELLO INCOMEEXPENSE c. i__ .~ 302.28 364.00 180.00 $24,136.32 NICK TOMASELLO BILLS PAID 1/14/2000 AAA Auto Club $ 89.00 1/14/2000 Providian Nat'l Bank $ 511.50 1/20/2000 Pannebaker and Jones $1,000.00 1/31/2000 Dr. Cincotta 5.00 1/31/2000 Bell Atlantic 26.83 2/1/2000 Roaring Spring Water 51.11 2/9/2000 Circuit City 90.00 2/11/2000 PA Water 28.72 2/14/2000 providian Nat'l Bank 511.50 2/15/2000 Chase Visa 328.02 2/17/2000 Dr. Cincotta 5.00 2/18/2000 Rite Aid-Prescription 6.00 2/17/2000 UGI Services 42.00 2/22/2000 PP&L, Inc. 69.09 2/24/2000 Dr. Cincotta 5.00 2/26/2000 BJ's Tire Service 191. 82 2/27/2000 Direct TV 75.17 2/28/2000 Post Office-PO Box 44.00 2/28/2000 Bell Atlantic 62.00 3/1/2000 Roaring Spring Water 51.11 3/1/2000 3/2/2000 3/3/2000 3/10/2000 3/11/2000 3/13/2000 3/14/2000 3/16/2000 3/17/2000 3/20/2000 3/23/2000 3/27/2000 3/27/2000 3/28/2000 3/30/2000 3/30/2000 4/01/2000 4/3/2000 4/3/2000 4/3/2000 Norwest Financial Citibank Dr. Cincotta-Nickolas Dr. Cincotta-Angie Circuit City PA Water Jiffy Lube Providian Nat'l Bank Chase UGI Gas Service The Marriage & Family Life Center-Nick Direct TV PP&L, Inc. Yearbook for Nicholas Dr. Cincotta-Nick The Marriage & Family Life Center-Nick Norwest Financial Rite Aid-Prescription Roaring Spring Water Citibank 750.53 82.89 5.00 5.00 89.61 26.29 36.02 511. 50 50.00 51. 00 20.00 74.12 78.44 3.00 5.00 20.00 750.53 10.15 51.11 s bo '<~ ~_ I 4/4/2000 4/4/2000 4/4/2000 4/4/2000 4/9/2000 4/12/2000 4/16/2000 4/17 /2000 4/17/2000 4/20/2000 4/26/2000 4/28/2000 4/30/2000 5/1/2000 5/1/2000 Dr. Cincotta-Ryan Cumberland-Perry AVTS April Preschool-Nickolas Pep Boys Waste Management Circuit City The Marriage & Family Life Center Chase Lower Allen Township Direct TV PP&L, Inc. The Marriage & Family Life Centert Dr. Cincotta-Nick Judy Prowell-Tax Collector Bell Atlantic Norwest Financial :sls TOMASELLO BILLS 4.00 15.00 122.31 31.71 ~ 10.00 60.00 26.40 74.12 57.20 10.00 5.00 9.80 48.14 750.53 . Prudential ~""~ -,-,> .' '.,,," "',";.,..~~ .;,-~:J"-- il_, j, "~"". - 111111111111111111111111111111111111111111111111111111111111111111111111:11111111111111111111111 PmdcntiaI Property and Casualty fnsurancc Company and Affiliated Companies Subsidiaries or The Prudential Insurance Company of America Pru-Matic Withdrawal Notice Automobile - This Is Not A Bill Notice Date: PO Box ~29 Hinsdale IL 60522 Insured's Name: Policy Number: Policy Period: Tomasello Nick T and Angela M 9 N Stoner Ave Shiremanstown PA 17011-6341 January 4. 2000 Tomasello Nick T and Angela M 281A150972 Feb 6, 2000 - Aug 6, 2000 Customer Service Office: To report a claim, please call: (800) 437-5556 (800) 437-3535 Your Prudential Representative: (717) 975-3625 ROBERT D FARABAUGH CLU CHFC LUTCF Paying Your Bill Billing Summary Your policy is on a monthly payment plan. You've authorized us to automatically withdraw each payment from your bank account. The withdrawal will be made no earlier than two business days after the billing date shown below, Each withdrawal will appear on your monthly bank statement. Please note that changes to your policy may affect future payment amounts and dates. Premium Current balance $312.00 $312.00 Billing Date Amoulllt January 14, 2000 February 6, 2000 March 6, 2000 April 6, 2000 - May 6, 2000 _June 6, 2000 Important Messages I st payment 2nd payment 3rd payment 4th payment 5th payment 6th payment $52.00 $52.00 $52.00 $52,00 $52,00 $52.00 This is your renewal payment notice. It shows tbe billing dates and monthly payment amounts for this policy term. We bope you'll continue to enjoy the ease and reliability of making your payments through our monthly payment plan. If you have a touch-tone telephone, you can reach us 24 hours a day, 7 days a week through our automated response unit. You can obtain policy information such as billing status, payment history. policy coverage, and request duplicate policy documents by calling the Customer Service Office Number listed on the front of this notice, Our Customer Service Specialists are available to assist you at the Customer Service Number on Monday through Friday between the hours of 8:00 a.m. and 9:00 p.m. and on Saturday from 8:00 a,m. to 12:00 Noon, PAC 2972l Ed, 4/97 AE 13.002 13 l See the back of this notice for additional messages, ~ ,. { , { ( ( ( ( ( ( ( <, D 20 fTl 3 n ~ ;u - - ~ 3 x '" "" .D ~ '^ '" 0' '0 n '" CJ " (,:1 " '" r) D :;0 ;;<; "'" "" cr " '" t" re' D20 t.J ~ '" cr ~ to .. '" ~, t" 0' toG) t.J 3-l "' '" <: a. '0 tofTl DO ,"".~ " ""'" 3 rt' n) (90r (9:;ot::l r) t::l r) C.) 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I;, [1;11 ,!I;,OL: :' :,11 "11,,1 " ,I ',' II ,Q,UJ ,'I! I 'I I j' 1 r;;:..:1~ ,J 'I' , lif:l: fli iJ110 II ~ i I I ! :.':I;',II!,~~t '1'1':, :'-:: "-fi.o.:' a::: , .:z ::> :i:J.J; 0 . rr ~... ~.. to 1.,.,,"' o-.j 0; ~:f ~ 'u ::> w ~l 1-00; <lO~ Cf .:t. ,,:,'.., f- '" C) i~ '..f.? ~\ l:. .... ." u:,o .' .." '. ~ -..-.,.,.......,..~-~-~---'----:--~~-...:-- .,~~; 1 ~"~~f1,.:t.,~,;;,~;~,:~.;":'~f.': ~:J ..- ---__:. ~ ." .0;" ~-'., ~'~ . .. '.R.CEII/ED FROM . / :g '~ 't~";;" 18 -A DRESS . ; ~ ~.,;~! ';:: .,JI. ,.;, ,0 A,~~ I .' ., ..'l~ ;-f.,; ',. "",j-' -.r., ;:~-,' ;\~:,/ ~ I,;:,' " ,__o:':~":;: '. "il ,}?i~l{ jJ~r~ i .:' '::! ",'i~'4~f~~~t~f(fr;~~~~r-> . "":~~~~~~\~~~1\t~~~~~~t'"~;" .;.".....' \ ----., -.--- - ._~ ---~---.--._------_._---_._-,--------------~ A. Cincotta, M.D. L1CH MC.Q18341-E (PA) Cfncotta, M.D. LICit MD.017634-E (PA) , ill. .Jame!1, ilI.o. LlCN MO.022884-E (PAl 0 ~1:\'Nart%., M..O. uc# MO..Q39532..E (PAl Wenner, D.O. LICit OS.OO5483-L (PA) Setzer, M.D. LiCit MD.062206--L (PA) I. Skurcenskl, M.D. LICit MD-D6858Q..L (PA) 1 A. Alwine, C.R.N.P. LICit VP-D01525-B (PA) !. Hough, C.R.N.P. UC# SP-D03098-B (PA) Polson, C.R.N.P. UCIt SP-003053-C (PA) Johnson, PA~C UCIt MA-000739-L (PA) iE ~ "-,,;-'.PHOt.Je:s.~:,:"':~~?~~r ,i;~ -.CW::SRENT .,' 'ZJJi) H 717 7'37 2':,11 INS, 0.0 ":'!Y! w 717 737-543 t GUAR et40 JARANTOIrS .~~':, : ,,:;"~~~ ''''''APQIjEsS Tomasello 9 North Stof!er PATlEN1" JIIl;M~ .::>;;i\<;POOI'itqoo'$ pCP Tomasello tomani 03 004 INS(jAfi;NdE(;OMPANY;N~'\! :,: ~stone Health Pia BOWMANSDALE FAMILY PRA-CTICE ~EPHEROSTOWI'! FAMILY PRACTICE 1 KACEY COURT, SUITE 101 :r ;~~o FISHER ROAD MECHANICSBURG, PA 17055 MECHANICSBURG. PA 17055 A (717) 591-0961 (717) 766-1795 ,:; i e-n.... It_as a $;;;; copay.. Appt. Time:? I' ()~oom -'\\~t~;~~r/::'J~ ,~,,_ 6.1-;"::99"~-'.::: <.$_1-; _1.?O, ,- .'~'~t2(}-*:':~)-:" 0.0 0.0 0.0' 0.0Q 121.0 0.0 0.0 0.0-. :,~;~,.:gi.~~~.~:\~- cl~i~T'-~~:>-: -~~<.:,_~~g"::<STAi:e.~' :~t?i~,_: 5::.- Ave ~hi~emanstowD,PA 17011 ',:REfERRIN.G~,:'" '";''' '^tiOB 'T. .~... Cincotta Janet F 11/23/7 ~ 1:l:i..NU I€.R.:<.9RQiJi'i'ltIMB~R';; 'REi"tq1rl$.. YWH2075035560 H 14055' SE f" 28203 { (" HHhl t' (' WHHf ~ t.. {" .. 10 lncision&Drainage_ , 85018 .H_ 206 Injection-Joint 84703 Pf8gn8llC'J.UriM 94684 """",,"do " S72:4(} KOHPrep. '20 Repafr-lacerntlOll ~ a7210 "'"'" - 45330 Sigmoid-AIlX. 87880 ~Strept 94010 """- 94000 VlfJbroncho 81003 OUA 810010UAwJMIcro I Pain 789.00 Carvical Strain 847.0 100M NIODM Hemorrhoids, Ext 455.3 Paripheral Vas. Dls. 443.9 Vaginitis, Candida! 112.1 PAP 795.0 Chest Pain 786.50 Controlled 250.01 250.00 High Risk Mad . V58.69 Pneumonia 486 Vir81 Syndrome 079.99 706.1 CAD 414.9 UncontroUed 250.03 250.02 HyperUpldemia 272.4 Post Menopausal 627.2 Warts 078.10 .,00 1 ADHD 314.01 CHF 428.0 . Neuro 25_0.61 250.60 Hypertension 401.1 Rectal Bleeding 569.3 N.M.!. P.E. w/fonn V70,3. :laction 995.3 C.O.P.D. 496 Ophthalmic 250.51 250.50 Hyperthyroidism 242.90 Shortness of Breath 786.09 Routine Gyn. '172-3 linitis 4n.9 Conjunctivitis 372.00 Renal 250.41 250.40 Hypothyroidism 244.9 Sinusitis - Acute 461.9 Routine Gyn. ~MC) '172-6 300.00 Coumadin Therapy 286.9 Dys. Ulerine Bleeding 626.8 Influenza 487.1 Sinusitis. Chronic 473.9 Adult/Adores. .E. V70.0 716.90 Counseling ~ F~1:l'- 780.79 IBS 564.1 Situational Stress 308.0 Infant/Child P.E. V20.2 493.90 Decen. Jt. Disease 715. ~ri1is 535.00 labyrinthitis 386.30 Smoker 305,1 Newborn P.E. '1:10,00 =:xtrinsic 493.0 epresslo Gastroenteritis. Viral 008.8 Menorrhagia 626.2 Sore Throat 462 Family HX: OM V18.0 724.5 I !::Iermal!~s "/692:6 GE Reflux 530.81 Obesity 278.00 Strap Throat 034,0 H1P:ertension V17.4 . Acute 466.0__ Dennatltis, Pfant Headache 784.0 Osteo~oroSiS 733.00 U.R.I. 465,9 CAD V17.3 . Chronic 491.21, Diarrhea , .... 787.91 Headache, Mj~raine 346,00 Otills adla ~ Vag'initis 599.0 Colon CA V16.0 impaction 380.4 Dizziness . 780.4 Hemorrhoids, nt 455,0 Otitis Extema 616.10 Screen Colon CA V7G,41 / ./ _1_1- Ihrn _,_,_- > Mo, Day Yr. Mo. Day ,YI; , LIMITATIONS ./ . INSTRUCTIONS: OKtoretumto{ ) Work ( } School I I , ./ Mo, 0 Yr, / UMITATIONS: " . . . / / " ~7_.Af ,Ie , , , "'- DOCTORS SIGNATURE . ''?'i,RtI 'EASON r DAY DATE TIME '" DAY. ~ \lING MAMMOGRAM 0 DIAGNOSTiC MAMMOGRAM WEEKS: ::1 ./; /14;...) I J4..A ""G~~~-;l;" MONTHS: 'lus_onG_dll...ln_acIvDlJCEliCy_oua(OutlllbI81okeep'y_ouraoDlJlntmllnl.~is$il!lUnapOOjolml!nlwinre_'W!tlnanottle.!l~ha~~~O.PV OffiCE VISITS ESTABUSHED 99211 Nurse 99212 Umited ~jnlerm:-' 99214 !;JIW!:lI,ll,l 99215 Comprehen SQ612 GYN(BS) G0101 GYN (Me) - 00091 C&H (Me) PREVEKnVE ESTABUSHED Med(MA) EPSOT erlyr. 99391 lJnder1yr. Irs. 99392 1-4ym. yrs. 99393 ~11ylS. 7yrs. 99394 12.UYrs.. gyrs. 993951a.39-yrs. .lyrs. 99396 4O-64yrs. ,over 99397 65&o.ver "RVlCES: ( ) HSH, Camp Hill ( ) HBG Hsp Oates; ----1--.J---.! To '---.J~ _ ;I 00 NB' - ;Bquent 9943S 1;Il(H1Pitb:llJ ;equent 99433 NBSub ;equent Mrge Heurs " ," ~ded preMn ,ISS) ,BEmerg. 'MElHOUSE CAlLS: IMMUN fiNd: 90471 Adm. Fee 0 1 904:72.___hdm.Fee 0203.04 90748 HI8JHepB -90700 DTaP 90113 OJPV 90712 0 TOPV 9O]Q7_ MMR 90744 HepB.5(G-l0yrs) 90745 HepB.5 (11.19yrs) 90746 HepBU(>20yrs) 90720 DPTIHIB 90665 Lymo 90716 Varicella 90718 OdT 90702 DpeddT 9065B lnlIuenza' 90669Pne~ 95115 AlIergy'D1 95117 AIIetgy 0203.04 86580 Mantoux ~ ,T1.neJesl . PROCEDURES: , , _.}~ ~ .;;. . 92552, AudiomaIi1' ;.. __ ~ 57454 Co~ '!'- 17_ -(W~l 58fOOEtxfcmetrial~ 93000- - EKG. wfth lnlelP~ . 11_Excislon~1.~ 82270 Hem:x:culi.ltx3 . . , PERFORMED BY: 0 HMG dSKBi. - OQuut i I it: i , I.~' I ,JL \(:: .... I UHH, .1 *' .1 "- j ".1 < T Ie 1 I I i I ! OPINN. O'SG 80049 BaslcMetabolic 80054 ComprehenslveMetabolic 80051 EIeclrclyteProfila, 80058 Hepatic Profile 80061 UpidProme ""'" AtT ""'" AST $5024' CBClDifllPlt.Ct. 82465 ChoIesteml B2947 Glucose o BIIfpatient le&for servlca 84703 84702 B3036 B870' 85010 84153 8505' ...", """ 02043 HCGBetaQl HCG Bela Quant HgbA1C HIVScreening ProTlmellNR- 'SA Sed..Rale.WesJer T4,F(8e-' TSH UF!~Mil:ro~in PATHOLOGY TO: '0 SKBl 877'R GenProbe 88150' PAP. r.... oPNi' O~ ': q~.;' O~- o Si!Il1&fenllee lor servic&_ IN OFfICE LABORATORY: 36415 Yenipu~JI1gerorhoolstick 02'" """'" C BBHf (. ( 1(.. I " " " Ie I liMn: --'!:' J? I l.... l. RTE 574 DEseR IPT ION INVOICE NO, 128()'; DATE 2/01/00 f~.GCT 1'.10 6G65-0G PRICE SLS TAX AMOUJ\. LEASE FOR FEBRUARY 48,22 :2 89 51, 1 '. / INVOICE AMOUNT PAy THIS AMOUN.T 51. 1:; *;,,********,.****,ij.******** ***** .. TERl'I$..~RENETCA;SH-. ....* "* rJ\{et;;~aE',5C.C:'{NQ.ONCl'iErK~ ~. ,***:l\'!!'H'****:ff,~H.*jO~Jt~~..(it'!t'***'l!;**" "';., " ..... :p:;~~~;'j;;~1"';~k~;~;iil;:;;~~1'~,~1~,L:t),'...,}...,.... 51. 1. _i, " .~ -., .,,~ - _I'.. ~~ Sunmarv of your aCcount Page 3 of 13 717 737-2411-111 38Y January 1, 2000 Charges fram last month Amount of your last bi II. . .. . .. .. .. . .. $43.14 Amount you Paj~ through Jan 5....... -43.14 Amount you still owe.................. ............ Charges for this month Our charges.......... .'............... $20.99 Call 1 800-660-7111 if you have a question Teleeom*USA charges ................. +5.78 Call 1 800-660-7111 if you have a question OAN charges......................... +.06 Call 1 800 926-0112 if you have a question Total for this month..... Due Date Jan 31 ...... . ... Total amount due A late payment charge of 1.25% may apply to any balance carried forward to next month's bill. ,1-- I~ $.00 $26.83 $26.83 Continued I.POSTING. .. DATE: '-i.. , . OE~~f~n9.~;.~~' ;U.,~.-:,i'>' .." ""',."". . ,"'" REfERENCE N\JM8~R -" :' ~UNT ;--'" CR~,cReorr PY-fW!MENT 170 VCR HOME 12-29 PROMOTIONAL PURCHASE 01-07 PAYMENT RECEIVED - THANK YOU , 12-29 372000994892130025940001 01-07 715230000101130515014171 , , , , OF, , , , , OF' , , , OMEONE YOU KNOW WOULD LOVE TO HEAR FROM YO THIS SEASON. SEND A BEAUTIFYL FR SH FLORAL RRANGEMENT. CALL aoO-aOO-SEND. USE YOUR IRCU CITY CARD AND MENnON CODE: DCOClRC. , , , r r r r 307.36 90.00PY YOUR PROMOTIONAL ,URCHA E OF 09/09/99 HAS ACCUMULATED DEFE~RED F NANCE CHARGES OF 030.35 WHICH WILL BE WAIVED IF THE PROMO PAYOFF BALANCE 0179.61 IS PAID 1 FULL BY 03/13/00. YOUR PROMOTIONAL URCHA E OF 12/29/99 HAS ACCUHULATED DEFE RED F NANCE CHARGES OF $3.31 WHICH WILL BE WAIVED F THE PROHO PAYOFF BALANCE 0307.36 IS PAID 1 FULL BY 02/04/01. .....-' " . ",i- ,,,,--, ,:'; , , , PERIODIC SEND INQUIRIES TO: CREDITUNE 1523003506197052 'R<VIOUS~' ~C!I.M~ES _~. PAST~~~~~OUS t.ATECHARaES,~- + , .00 ,,0 +MINIMUMDUETHISCYCl.E CREOITS" '..:, ';:-;':;:"" $ 20. 00 PA\'M~'-, ~:..:-'~ '" MINIMUM PAYMENT DUE .0 .00 90.00 .00 .. SEE ADDmOOAL EXPLANATION OF CODES ON REVERSE SIDE. Customer Account Information For Service To: Nick T Tomasello 9 N Stoner Ave Account Number: 24-0639416-3 Premise Number: 24-0377988 Billing Summary Billing Period & Meter Information Billing Date: Feb 11, 2000 Billing Period: Jan 11 to Feb 09 (29 days) Next reading onlabout: Mar 09, 2000 Rate Type: Residential ----Prior 8alaoc9---------' Balance 'rom 'ast bill , Payments prior Co Feb 11, '2000., Thanks! Total prior balance; Feb 11, 2000 --Current Water-charges Service Charge' " Water Volume 1$.004864 x 3,900) Total water charges, Feb 11, 2000 pO.40 -30.40 .00 ",,," 9.75 -1,8.97 28.72 -AMOUNT DUE ~ ~28. 72i Meter readings in current billing period: Meter Number N099014324 is a 5/8-inch meter. Present-actual 33000 Last-actual 29100 Gallons used 3!f'd' ~'" -., .-.--.,..,.....,.. '-~ ~- -.-. -' , ...._-"". --'~".'~ ,- - ,...~,' '-";':~ ::.;;-:'~ ,,;~,';.:.- :"if..:_'_:jj"~ .~-'t..t'~~:-in::J--?:' _.~. L ~'1IVater Usage Comparison ." ' ,',. '~,-~-,~~;~=-~~=-~ & " - Monthly Usage{nhundfsd_-gaI1ons. . ,.~:<_., :.::-;:.:f-~ ..,~.~~:~:~-}:!t:::':';i' "'. . ".~~' .,>' . '." ," '.~-'"" - ,~ ' .. ,,-.', ~,,,,'~'" :~'2 ~~~~'";-;f?;'~52 I:{~ '-",-~,,~;'~~~_~--=~j'.~' ,~",~-:ii.;:: -;,~.,;.:..:.:::-~1k; _ C _'. ,- --. .. ,_- ~ ~..:..::-~_'~,~~~-'---,~~:::::'.;,,~zl~,;;;' .-,~':4J. ..P ::~~~~i. --. _ - -_,.,,-"-;;":'~-'-'''-'_'-''cH ~~~~" :;:;: ,;,j~O'i'~,:}i~~ii~i::~;~~,~!~::,"~~~~;;':~~~i~~/ Messages to you from Pennsylvania - American . A penalty of 1.50% will be added to your unpaid balance on 3/07/00. . This bill reflects the approved rate increase, effective December 18, 1999. ;-" ,',,'".' Questions? Call 1-800-717-7292 Weekdays-8:15 am to 6:30 pm Saturday-8:15 am to 2:00 pm Emergencies: 717-774-2420 PAWC, 852 Wesley Dr., Mechanicsburg. Pa. 17055-4436 Intarnet: www.pawc.com @ l!iIl::I A1M , 1~B2 Loan Statement .";?~qY.ID!AN NP-;~Iqf'iAi;~~,g~~.:'-' ,',_~. . . n.";;:':;~.~~-=';::"_ - _.,-- ~"-L8AN---'t+E?A~T?1Er.i"'F:"":":_:::."1::.':3S;::,-;.~7'~~15'-. .:,~~~;~~~::=~.~---"--~- _ ., n._.,______ ~-T "..'.J.";~~t:~'D:~J'!:~':"?~~",':;':"'?":':::'~~~"7~?...'~="~'F:-=:~~~,~.=:',-~=. . ....;::":::;;;,'.';-- ~:~~;.~:;;==~~=7:rl~~~~~~i;ii~~;~~~'. , ..---."" .- .. .,- no" """,._____".__ .n"_'__._'__.._.~. ., ""-~ ..~ "".."". -""-' ~ ---. ..~..,-~,_._.__._..,- '~".""-'-_._' .. ,~" -'--' ~.~"'"'" ''''. -... ".,"~,,,. "~ , ",,""_,..r.___.,...,__uo'_."_. ._. ,.. ." _"_ - ==- .........- ............,.....:$~d:.~~FH...'; '"' .,'~.~.. ..::-~."~,~~~,~_" ."~~::~E~~-6.~~-r~~,;::~,~tJ~~~~~_,,_,, --," "',",-,-,,-, ".. ~:::..~_.~:;~:.::.::;::::;'"9Cl<f:'tsTQ~Iil::"'." ...~.~. ... ..m .~:'~~,~~~.~~~.tf~I"I":~~2~g:p'1'T'~~~:':-__.. __ ,,0,.--"- __... "...~'" ..-.-.., ,~,-,~,---"._."". -., -"~",..,,.-- . ~ . . _,~,. n' __,_,___.u ,_~,_".,.__.",,__ ,~, _,,_ ~_ . _"." ".."_,,..._._..'''.'' .._., '.""""'~'" ."'_ ,..__ .. 'n'_'._'''__._.''__,._ ___, ...,"'~- --'---'._'-"---"~"--'~'-'._--~ , - .,,- . -~,-, ~._.~-'._-'-_._-----"._.'.,.~, ,",-, -..- - ,_, ~"c~~ .. - -"-~ -,.."~,"..,_._._....,,,~,",-,.. ~._....,,,'. -. -_.~._.._..'" ---..,. ,- ~ .-. -. ,_. . .., ... .," ---,-,- - --,~" ~. ,,,_,_.,,,.'''..,,.,,_.,.,-,.'''.,... '-:-'.~'~":'::"::~'Gst: 1-04.'::- - .-'. ,--~._,--,~._,.,.--_..,~~- - "-,--"- _.~-- - ...~".,..,,'~.._,.. ......,.. .,,- ,.,'._"---,_..".. "".". n'''' 'C"".."'.'.,,,'" . " ..~,. _,"_."_""'".T""'..,."_,~,,,,,_ -' .""'~,,_,,___..___",_.,.,__'_,, ., ,,,,,_.. ....,,~... .'.,.,,_,_~,., '_"_...__U.'_'__ .'_,_~,._,~__~~ "^".______,_",,.,_ _ _.. _.....___,.___ .--~- ._" ~_.~.",~-.~",,,_. .' -._-,_._"-,-_._..._--------,-.._.._~.--,,,.._--,.._,_.._---,,~,,--". .-'" ~,~"."."-,., .,,,., ... .., ..." '""..",. .'...,-,_.- ,_.- ,-~ --, ,,,,.,,. - .. - ,.---"," ". .."- ,.~.~,,-,_.,.,~-,,----- _..~-'-'-_._..__._-_.__. ,---'~'. - ~. ------,--,-.- --."....-..-. .~ ..--...-""--.- -----._------,-. - .. . - -~..._~_._--- _,_,______U_~_"____ ~_____... ~~."_'" _" _ __,._. _,__.....'__"._______ .,,~_..___ _ _,~,_.~.___,,,.._.... .._..._,_.__ "",.._,,~,~_,,___,_.._ . '-'-"_._"_._..~"...". ,.'----_.._,~--~.,,,...,---,,.,,..,,.,~-_..,-_...,...._,. ... '.',.. 'u .,. "_'.."'.. ,._.,_~ ,,_ __._ ,"" _..,.._".__,__._."'~_,_.~._.__'_,_.~.' "_..".,~"'_'.. . ~__~____M,." ..,,,-,,.... ~'-'-'-"_._--~".""."--"----"'-'_.."~"'~'~"...,.,._--"'. ."..._-_.-'-".'."'-" ....,,-"...,., ,'" ,. .. _ _. . ,. __.,,,,_,,,"."""-...,,..M""'" , ,~, _"_.".~."_"'.".'~'''''_'''''''''''_'.''.'''~'''''.''''''.'.'' ,......'.',.,.,.,." ""."..."" . W_____ ._____~_________~___~.., ,M" . . ._..-._--,",-,-" . - - - -- -- - -'- -,- - - - - ----- - ----. -'- - - - - -'-- -"- -. - - -- -- -- --- - - - - -- ~"". , ....."""": o CHASE Your Chase Visa@ Account ACCOUNT NUMBER: 4225810590032697 NEW BALANCE $328.02 PAYMENT DUE DATE 02/16/00 STATEMENT CLOSING DATE 01/21100 DAYS IN BILLING CYCLE 31 TOTAL CREDIT LINE TOTAL AVAILABLE CREDIT $6,000 $4,671 Here is your Account Summary: CASH ACCESS LINE $6,000 AVAILABLE CASH $4,671 TOTAL Previous Balance $169.06 (-) Payments, Credits 80.00 (+) Purchases, Cash, Debits 234.04 (+) FINANCE CHARGES 4.92 i=i New Balance 328,02 Minimum Payment Due $10,00 Your charges and credits at a glance: TRAN. P DATE. DATE NO. DESCRIPTION OF rRANSACTIONS CREDITS CHARGES 01110 01/10. 9\IINK PAYMENT THANK YOU . ...' BO,OO 12/21 1212:!i;~N+".. CAPITALC.ITY.. .MAlL. ...cAM.J..HltL....PA 40,00 12/22 ,12122;', !lIJ)IX1;'; TEXACdINC14151~CAMpHILLPA 10.00 12130 :.;,;I2/3Oi':!l!I1;'~ . GIANfropD.110'S!8'CAl,le'!'IILL 'PA 128.17 1m1' .,'..121;1t:'.... ';~.; .... WEtS. MAR~II58'Sl:loMECIitANICSIlURG..P. A 36.80 01i02,'0'1JDZ) 2M'.' PETSMAmINC.0583:MEcHANICS8URG.PA"" 19.07 ..'j" 'C..' . , . .. .' Total of your credits and chmges BO.OO 234,04 " " ,'ii', _,' __, , '_ __, ' <,,,:', ",<~";,,, " , ,'''___;--,.J:'~ ENRO.Lt IN L1FEPLUSTOllAY...TliEPAVMENT PROTECTtOl,I'PtANTiiAT MAKESYOUR MINIMUM MONTHLY PAYMENT WHEN YOU CAN'T. " --' , :~ ',':::\::': ,';> :>",'.','," :::;;:(,":::,:::_;':',:':-'::' ,', :(:;,,:,.' --<:'-':'()' WHEN YOU NEED CASH ON n'IE.9POT THIS WINTER;"BESllRE TO KNow YOUR PIN CODE. CALL THE CUSTOMER SERVICE' ON YOUR STATEMENTTORESEtECT YOUR PIN CODEAND USE.ITWITH YOURCF/ASE CREDIT CARD AT AN ATM, __ __ ','"" ,) - "y ':.~ ' ' -", ,,- __; ", __,,,,..,:,N; /'___ 17,90% 0.00% - ...... ...... .- ~ ..... :g ........ ~ ..... ~ iiQiiiiiiiii; ~ i!i =1 _Ill ...... ~ =i ~ =t -IS ,; III 8 Iii -!!l _1 ~ -~ =1 -ill 2 !. iiiiiii """"'" Here's how we determined you..Fi~a"'ce Charl!~": AVeRAGE PBUODIC I MIN. TOTAL DAILY . DAILY FINANCE FINANCE PERIODIC RATE _e CHARGE CHARGE Purchases V 0.04904% $323.84 $4~92 $4.92 Cash V 0.05493% $0.00. . . $0,00 $0.00 . Please see reverse side lor balance computation method and other important information, Q Questions about your account? Credit Card lost or stolen? Call Chase Customer Service 24 hours a day, 7 days a week, toR-free, at 1-80Q.441-7681 or write POBox 15919, Wilmington, DE 19850-5919. Para Servicio al Cliente en Espanol: 1-800-545-0464. NOMINAL ANNUAL PERCENTAGE RATE 17.90% 20.05% ANNUAL PERCENTAGE RATE \ \Send Payments to: Chaee Visa, P.O. Box 15657, Wilmington DE 19886.5657. ***IMPORTANT: Don't forget to write your account number on your check or money order -- never send cash I Page 1 of 1 A. Cincotta, M.D. Cincotta, M.D. r fA. James. M.O. Schwart::z, M.D. Wenner, D.O. t Setzer, M.D. -I. Skurcenski, M.D. h A. Alwine, C.R.N.P. J. Hough, C.R.N.P. ?olson, C.R.N.P. Johnson, PA~C L1C# MD..o18341.E {PAl L1C# MO-D17634-E (PA) Lie. Ma.G22884.E (PAl uc# MO-039S32~E (PA..) LIe' OS-005483-l (PA) L1C# MO-D62206-l (PA) UC# Mo.o6858o-L (PA) LIC# VP..oo1525--B (PA) L1C# SP-D03098-B (PA) L1C# SP-D0305:3-C (PA) LIC# MA.o00739-L (PA) PHONE TE .J;"l H W JARANTOA'S NAME "';11:.1,-: ':. '-;1 i'-;'-;;"t:'" PATIENT NAME ACcOUNT CODE _"1;'''' J. \.."':' .; Gffi ': n.~ '~:.rl!, INSURANCE COMPANY NAME' , ", . ~ .:. : 0', '-~1 '. j -;:\ ',~' I..' <,:;,;;;1'r" I o BOWMANSDALE FAMILY PRACTICE 1 KACEY COURT. SUITE 101 MECHANICSBURG, PA 17055 (717) 591.0961 ~EPHERDSTOWN FAMILY PRACTICE - 2140 FISHER ROAD MECHANICSBURG, PA 17055 !\ (717) 766.1795 I"l ~ I Appt. Time: ~ /;" Room II: 91 -120 .120+ CURRENT INS. :.J",l GUAR k".. ADDRESS 31 -60 61-90 '.0. ,_il. " ..:"': ;/1" 30092 f' fj~f ( ':' ~) ~/J I,,:, '~'.~'tJ .~ ; ~ 'I'';' , . I,'.' ~~ E.LN. NO. 23.2933075 . TODAV'S BIWNG ( CITY STATE ZIP i,~: , PREVIOUS INSURANCE PREVIOUS PATIENT TODA'i'S CHARGES TOOAY'S PAYMENT ( '-~ '( .~:> : ,:.., J, .... :: .i'~'.- . ~"I ! DOB SEX '{.1" ..;/' < D CASH o CHECK D CARD ( ffk~ ( ~" PCP REFERRING DR. '.'.-' ,'GROUP NUMBER RELTOINS, '" I ..,-~, ( OFFICE VISITS ESTABUSHED 99211 NW'Se 99212----.J.1!!!L~ ~lliiOOned;:> . 99214 ~ended 99215 Comprehen $0612 GYN(8S) G0101 GYN (Me) Q0091 C&H (Me) PREVENTIVE ESTABLISHED " Med (MA) EPSOT ler1 yr. 99391 Under 1 yr. YIS< 993921-4yrs. lyrs. 9$3935-11yrs. ,Hyrs. 99394 t2-T7yrs. 39yrs. 993951&39yrs. ~4 yrs. 99396 4{J.04yrs. ,1 over 99397 65 & over lERVICES: ( ) HSH, Ga~ Hin ( ) HBG Hsp Dare5:--'---..I_ To----r'-------"_ ~ 9~1 ~ )saquenl 9~5 NB(H&PIDisdl] Jsequenl 99433 NBSub ~sequenl ,,,,,,. ,'Hours '''' ''l11ed ,ndad ~prehen '1 (6S) S8 Emerg. OMEII<<)USE CAU.S: ,1E: ,..:,':..o.L ..,. t nr"~ e:.: r; :(.: :::,e~r. ,., PERFORMED BY: 0 HMG OsKBL OCullll1: OPINN o PSG ( ( H~h ( , ( , I ~ I ( { I HHI: ( ( ( ( ~~f <. (. ( ( ~fif , " 1.0. NUMBER ~.I' ' ::-' 'l..,~ !-j .-:r ~.:'!..' " 80049 Basic Melabolic 84703 80054 Ccmprel1ensiveMetabo"e 84702 80051 ElectrolyteProliIe 831136 130058 Hepatic Profile 86701 80061 UpidProfile 85610 84460 ALT 84153 84450 AST 85651 85024 CBCilJilfIPItCt. 84439 824S5 Cholesterol 84443 82947 Glucose 82043 o Bill palient !eefor service HCGBetaQL HCGBetaQuant HgbA1C HIVSCI'eening ProTImellNA PSA Sed,Rale.Wester T4,Free TSH Urine MIao Albumin PATHOLOGY TO: 0 SKBL 0 PINH 0 HSH 87797 GenProbe 8S1SO PAP T""'. OQum OPSG o BlBpalientfeo!orservice IN OFFICE LABORATORY: 36415 VenipunctureJFingororheelstlclt 82947 GtUOJse 35018 Hemoglobin 84703 Pregnancy-Urine 87220 KOHPrep. 87210 Saline 87880 RapidSlrepl '.,no -'" 94DSO w/Ilroncho 81003 DUA 810010UAwlMiero ?-1 Pain 789.00 Cervical Strain 847.0 100M NIDDM Hemorrhoids, Ext 455.3 Peripheral Vas. Cis. 443,9 Vaginitis, Candida! 112.1 : PAP 795,0 Chest Pain 786.50 Controlled 250.01 250.00 High RiSk Med V58.69 Pneumonia 48B Viral Syndrome 079.99 706.1 CAD 414.9 Uncontrolled 250.03 250.02 Hyperlipidemia 272.4 Post Menopausal 627.2 Warts 078.10 -l-.OO I ACHD 314.01 CHF 428.0 Neuro 250.61 250.60 Hypertension 401.1 Rectal Bleeding 569.3 N.M.1. P.E. wlform V70.3 <eaction 995.3 C,O,?,D, 49B Ophthalmic 250.51 250.50 Hyperthyroidism 242.90 Shortness of Breath 786.09 Routine Gyn. V72,3 ~hinitis 477.9 Conjunctivitis 372,00 Renal 250.41 250.40 Hypothyroidism 244.9 Sinusitis - Acute 461.9 Routine Gyn. (MC) V72.6 300.00 Coumadin Therapy 286.9 I Dys. Uterine Bleeding 626.8 Influenza 487.1 Slnusitis- Chronic 473.9 Adult/Adoles. P.E. V70.0 716.90 Counseling V65.40 Fatigue 780.79 18S 564.1 Situational Stress 308.0 Infant/Child P.E. V20,2 493.90 Degen, Jt. Disease 715.90 Gastritis 535.00 Labyrinthitis aBS.3D Smoker 305.1 Newborn P .E. V30.00 . Extrinsic 493.00 Depression 29620 Gastroenteritis-Viral OOB.8 Menorrhagia 626.2 Sore Throat 482 Family HX: DM V18.0 In 724.5 Dermatitis 692.9 GE Reflux 530.81 Obesity 278.00 Strep Throat 034.0 Hypertension V17.4 s. Acute 466.0 Dermatitis. Plant 692.6 Headache 784.0 o p,vlJris -"=' l~ U.R.1. 465.9 CAD V17,3 s, Chronic 491_21 Diarrhea 787.91 Headache, Migraine 346.00 F8~tis Media t_L ~ a6,~, U.T_1. 599.0 Colon CA V16.0 1 Impaction 380A Dizziness 780.4 Hemorrhoids, Int 455.0 1ffiSE'Xfema 360, Vaginitis 616.10 Screen Colon CA V76.41 _1_1- thm _1_1- Mo, Day y,. Mo, Day Yr. ., UMITATIONS , INSTRUCTIONS: OKlo rerum 10 ( ) Work ( )School_I_I_ " Mo. D Yr. UMITATION$: ER'I ! ,- ~; '>;TIC " " ."'1' , ,', s I ' ' t ,<,. '. C;;',J. 1 'oo2toRs SIGNATURE RETURN REASON DAY DATE TIME AM DAYS: PM FNING MAMMOGRAM D DIAGNOSTIC MAMMOGRAM WEEKS: , MONTHS: i IMMUN IlNJ: 90471 Adm. Fee 0 1 90472 Adm.Fee 020304 90748 HIBlHepB 90700 OTaP 90713 LJ IPV 907120 TOPV 90707 MMR 90744 HepB.5(o-10yrs) g(j745 HepB.5 (11-19yrs) 90746 HepB1.0(>20yrs) 90720 OPTIHIB 90665 Lyme 90716 Varicena 90718 DdT 90702D?eddT 90658 Influenza. 90069 Pneumococcal 95115 Allergy' 0 1 95117 Allergy 020304 86580 Manloult 86585 TIneTost PROCEDURES: !l2552 57454- "- "'00 """ "- 82270 10_ 206_ 94664 120_ """ Audiometry CO_" Des\nIclIon(Warts) EI'ldomelrialAspiration EKGwilhlnlllrp. fu'cisiontLeslon) C1Il- HemoccultlllC3 Incision & Omllag9 Injection-Jolnt Futmonalde Repair-Lacemllontm_ Slgmold-Flllx. -'" 't!l ('1M r!~v in $ld...-Jl~JuHuJnableJ.o~_eo..YoJILl!Om1!!lll:rrem._MissmCl an_ajlJlointment will result in IIn olllee ctla1'Q9. t"_C:IIO_o!L,,"U'~J=_c..Q.p~____ HMGlSFP/9FP FOFlM ~1 (t 1199j 1lA4QI6 ~ -49S7CARLISLEPIKS !Ir:1Ti'1I "Mt.c.HANlaBURc.,~A \1055 ~ 04818 74936 DAW:O DAYS: 010 717 975-01 DEA:BR5642687 DATE: 02/18/00 NO REFILLS LEFT TOMASl!I:tO;1\lICKOlAS 9 N STONEIlAVE SHlIW'1ANSTOWN, PA 17011 717-737-24 TRIMOX 250MG/5ML SUSPENSION NDC: 00003-173'8-45 DR. SCHWARTZ, GARY M. MD. 2140 FISHEll. RD MECHAN1CZBUltCi, PA 1705$ PCS DOSE: LIQUIDS PRVD#: 3973749 N/R: N 10#: 207603656 elM REF: 022899 GRP: W7540013 PLAN: QTY: 150.00 RPH: JEH U&C: $ 16.:: ~l~" ~II~I ~I "" ~ ~~ PAY: $ 6.00 ~::f..,.. Billing Summary for Service to: NICK T TOMASEllO 9 N STONER AVE SHIREMANSTOWN PA 17011 Rate Classification: Residential Heating Billing Period: 12/22/1999 to 01/24/2000 (33 days) Estimated Read . Vour current charges include State taxes totaling $ 8.25. '^ ~~- ""., $ 80m -60,00 -29m -9.00 9.00 40,75 54.54 -3.75 -0,15 100,39 51.00 $ 42.00 Meter Reading Information Meter Number Previous Reading 127443B 170 (company) Present Reading 293 (estimated) ~ I~u~torner Number 12'19"70i'301000 If you have any questions, please call us at 717-232-1811, or write to P08X 13009. Reading. PA 19612-3009, Please contact us by February 17 ~.,."........, 'N~~l1e~l!l"'., '~ ' ':,' HI} "p 'f ~:__;:~:.'; " F~~~~~~OO NPN 219 702 3010 001 4.70 4,23 3.76 3.29 2.82 2,35 1.B8 1.41 0.94 0.47 0.00 Average CCF Per Day . . JFMAMJJASONOJ 1999 Months 2000 . ~ Estimated Usage Average CCF/day Daily temperature Last Vear This Vear 3.73 310F Past Bill Information - The account balance on your last bill was ................ Thank you for your payment of .."'''',..............''''''''''''.. Adjustments "'''''''''''''......'''........,..''''''''''''............'''..'''''' Vour balance as of 01/26/2000.."'.........."''''....''''''''', Current Bill Information - UGI Customer Charge .............................................................. Charge for gas used: First 50 CCF at 0,8150 per CCF .........,"''''..........'..''', Next 73 CCF at 0.7472 per CCF ,.."''''..,....'''.......''',''' PA State Tax Surcharge .."'...."'...."',........"'................... Pipeline Surcharges ..........."'..,.."'.."''''''''...........'''..''',''' Total Current Charges .."'.............."'................,............., EMP Amount (due by 02/17/2000) .............'''''''''''''.. Total Amount Due ........"'.."''''..'''..............''''''''''''......... CCF Used 123 Messages from UGI . EMP Summary for UGI charges Billed to date Used to date $ 102,00 $ 1 B0.46 . Help prevent pipeline damage. accidents and service disruptions, If you see someone digging near your home please call UGI. If you pay at a payment agent please take your entire bill. Make check payable to UGI. Keep this part for your records, Important information is on the back of this bill. "n~ ~,Inc. Electric Service For: NICK T TOMASELLO 9 N STONER AVE SHlREMANSTWN PA 17011 PG ENERGY POW Customer Service ' ONE PEl CEN1iER WILKES-BA~.;PA 18711,"':' , 1-888'699-PLUS, . i~:S~;,:::;';:{,,:/" ",.'"[ .ii, , ' , , \ II' ":'~I::'~-:> p p .!.~=-. " N Page 3 Your Bill Atx'ouut Number 24780-81008 Use when, C'ftUill' or wr till 1'olal frolll Lust Bill PaVllientReceivedJwl24... Tl,ank You! $ 64.51 $ 64.51 Billing Details Balance as of Jan 31,2000 $ 0,00 Current Charges Charges for - PG ENERGY POWERPLUS General Service Rate: PGPP for Dec 29 - Jan 27 874 kwh @ $ .03890 Total PG ENERGY POWERPLUS Charges 34.00 $ 34.00 Current Charges Charges for - PP&L. INC · Residential Rate: RS for Dec 29 - Jan 27 Distribution <''barge: Customer Charge 200 KWH at 1. 796000001l per KWH 600 KWH at 1.594000001l per KWH 74 KWH at 1.4720000011 per KWH . Transition Charge: 200 KWH atl.794274001l per KWH 600 KWH at 1.590757001l per KWH 74 KWH at 1.470032001l per KWH PA Tax Adjustment Surcharge at 0.46551700% Total PP&L, INC Charges 6.47 3.59 9.56 1.09 3.59 9.54 1.09 0.16 $ 35.09 !!iI" ".:. :....'..,;.>'.'liJ~,m,.r~&.i~) ."~,.-*j!i;l~.. :I'<~><>"'~'" ,'T m0eml1L ~~ Account Balance $ 69.09 General Information Next meter reading on or about Thank you for selecting pg energy powerplus as your electricity supplier. Call1'g energypowerplus at 888-699-7587withquestions about supplier charges Generation prices and charges are set by the electric generation supplier YOll have chosen. The Pu15lic Utility Commission regulales distribution ....... ........... ......,v. ........ ....". ".M"."" v.. .,....."'... , Joseph A. Cincotta, M.D. Janet F. Cine:otta. M.D. Geoffrey M. ,James. M.D. Gary M, SchllVartz. M.D. David R. Wenner, D.O. W. Scott S~er, M.D. Alison H. Sk...rcenskl, M.D. Elizabeth A. Alwine, C.R.H.P. Denise J. HoUgh, C.R.H.P. Mary E. Polsan, C.R.H.P. Terri L. Johnson, PA.C DATE -. . ,?,(~ H ...I,~' w GUARANtOR'S NAliff; -i '-:-. fl -::-'. .; ".~; 1. PATiENt Ni\M.i;' , '( '.) ~~} ':" ~ 1 j. '.J '" ~ L1C' MD-018341-E (PAl L1C. MOo017634-E (PAl LIC' MD-022884-E (PAl L1C. MOo039532.E (PAl LIC. OS-005483-L (PAl L1C. MD-082206-L (PAl L1C' MD-068580-L (PAl L1C. VP-001525.B (PAl LIC. SP-00309ll-B (PAl L1C. SP-003053.C (PAl L1C' MA-000739-L (PAl PHONE ~, 1. ~ - i ,_I ;: :+~. ! " ,.. .. :-..; ~. ..:.', . ~EPHERDSTOWN FAMILY PRACTICE 2140 FISHER ROAD MECHANICSBURG, PA 17055 (71 ~;laa--,795 ( j \ I ;J . Room ,\ ,/'1 - o BOWMANSDALE FAMILY PRACTICE 1 KACEY COURT, SUITE 101 MECHANICSBURG. PA 17055 (717) 591-0961 CURRENT ' INS. !?!.. :~y GUAR ;(1 . IAppt. Time: 31.60 '56'--;) 61.90 id~ ;i)t(. ~'l.. lili;;. '" .....', .~, , ? \ o ':), ~i CITY', ADD~, .~ :'L, ...."i": ~..,':; ,:'1- ~"'" ,,"c~~U@:COOE, PCP' t c. m .l;-' -,(?!:~, 'L.H,~(.!. INSU~Cj;[~~!,~, , """~" ;.'::CI-!,'" t'1e:l.l'i-;t\ 3~i.. ~ ~a~ ~ 15 {:O~'0 :::~',.. ,~ ~:il,"",: L ( .-:.: 'n ~l r, .._~~ 91 -120 120+ . ,1 ,. ,- .", , ','\ '--"J_ ""'1'''.. ;.l.. 'Re\'E!lRIN:G't!FI,; , "\i-:-;:, t t <:7t .' -:",r::2 G , A'''Oflj:)tJPNUMBER -.-~ :.;,;'t; t,.o.):IU~'B1;F\,;~",t,,~,.,; '. "/;..,JHc':Z! !::)IZl36:.~t:J~)'/ :,':'. }, '.~117 JZ', ::.).;, E,!.N, NO, 23-2933075 . TODAY'SBlLLlNG' " .'j.. -'" '" PREVIOUS INSURANCE PREVIOUS PATIENT TODAY'S CHARGES TOOAY'S PAYMENT -21,_ '1_'. ,]I h ":' ,--.. , tx. STATE ZIP 0( CASH o CHECK o CARO \\'::.."; -- Jl.;"l ;-,q "'?il.l! OFFICE vlsrrs ESTABUSHED !J9211 Nurse 1~ 99214 ndad 99215 Comprehen 50612 GYN(BS) G0101 GYN (Me) 00091 C&H (Me) ~EW PREVENTIVE ESTABUSHED N9630 Gen Med (MAl EPSDT 39381 Under 1 yt. 99391 Under 1 yr. '19382 1-4yrs. 99392 1.4yrs. 393835.11yrs. 993935-11yrs. 39384 12-17yrs. 99394 12-17yrs. 39385 1B-39yrs. 99395 18-39yrs. 3938640.e4yrs. 99396 4Q.64yrs. 39381 65 & over 99397 65&over HOSPITAl SERVICES: ( ) H5H, Camp Hill ( ) HBG Hap Dates:~~_ To~~_ ~922_ Inillal 99431 NB 39231 Subsequent 99435 NB(H&Poilisdl) 39232 Subsequent 99433 NBSub 39233 Subsequent 39238 Discharge '"W ,90S0 AflerHOlIfll /9201 Limiled j9202 Intermed J9203 Exlended 19204 Compreh9il 30610 GYN(BS) =BS 099058 ElT\erg. NURSING HOM!JHOUSE CALLS: IMMUM flNJ: 90471 Adm. Fee 0 1 904n Adm.Fee 020304 90748 HtSfHepB 90100 OTaP 90113 OIPV 901120 TOPV 90707 MMR 90744 HapB.5(0-10yrs) 90745 HapS.5 (11-19yrs) 9f)748 HepBf.0{>20yrs; 90nO DPTIHIB 90665 Lyme 90716 Varicella 90718 OdT 907020PeddT 90658 Influenza 9DS69 .Pllellinococtal 95115 Allergy 01 95117 Allergy 020304 86580 Mantoux 86585 "fineTeS! DOB SEX. OPINN o PSG HCG8etaQL HCGBetaQuant HgbA1C HIVScreening ProTrlTlllllHR PSA Sed. Rate,Westflr T4,Free TSH Urine MIcro Albumin Pleasalnlormus~nedayinadvancelfyouareunabletOkeepyoureppointment.M~lnganappointmantwillresulfinanofficechsrga. INSURANCE COpy PROCEDURES: ;::::'J :'"l R~','t(}iNS' . ~.{~:-, j, :<.~~ i~.~ t. PERFORMED BY: 0 HMG OSKBL o Quest Oa_ OPSG Meds I oME: 10_ IncIsIon&DJainage 85018 Hemoglobin 2116_ InjeCtlon-Joint 134703 Pregnancy' Urine 9.... Pulmonakle 87220 KOHPrep. 120_ Repair-laceratfoncm_ 87210 Saline 45330 Sigmoid-Flex. 87880 RapidSlrept ""''' Spirometry 94060 wlbrondTo """' OUA 81001 0 UA wMcro Abdominal Pain 789,00 Cervical Strain 847.0 100M NIODM Hemorrhoids, Ext 455.3 Peripheral Vas. Dis. 443,9 Vaginitis, Candidal 112,1 Abnormal PAP 795.0 Chest Pain 786.50 Controlled 250.01 250.00 High Risk Mad V58,69 Pneumonia 486 Viral Syndrome 079.99 Acne 706,1 CAD 414,9 Uncontrolled 250,03 250,02 Hyperlipidemia 272.4 Post Menopausal 627.2 Warts 078.10 ADD 314.00 I ADHD 314.01 CHF 426,0 Neuro 250.61 250-.60 Hypertension 401,1 Rectal Bleeding 569,3 N.M.!. P.E. wlform V70,3 Anergic Reaction 995.3 C,Q,P,O, 498 Ophthalmic 250.51 250,50 Hyperthyroidism 242.90 Shortness of Breath 786.09 Routine Gyn. V72,3 Allergic Rhinith3 477.9 Conjunctivitis 372.00 Renal 250.41 250,40 Hypothyroidism 244.9 Sinusitis. Acute 461.9 Routine Gyn. (MC) V72.6 Anxiety 300,00 Coumadin Therapy 286,9 Dys. Uterine Bleeding 626.8 Influenza 487.1 Sinusitis - Chronic 473.9 Adult/Adoles. P.E. V70,0 Arthritis 716.90 ~uns~Ii.~gn=. ~~~.~ Fatigue 780,79 IBS 564.1 Situational Stress 308.0 Infant/Child P.E. V2Q.2 Asthma 493,90 Gastritis 535,00 Labyrinthitis 386,30 Smoker 305.1 Newborn P.E. V30,00 Asthma. Extrinsic 493,00 sslon 296.20 Gastroenteritis ~ Viral 008,8 Menorrhagia 626.2 Sore Throat 462 Family HX: DM V18.0 Back Pain 724.5 Dermatlls 69'l.9 GE Reflux 530,81 Obesity 278,00 Strep Throat 034,0 Hypertension V17.4 Bronchitis - Acute 468,0 Dermatitis, Plant 692,6 Headache 784,0 Osteo~orosls 733.00 U,RL 465,9 CAD V17,3 Bronchitis. Chronic 491.21 Diarrhea 787,91 Headache, Mi~raine 346,00 Otitis edia 382.00 U,U 599.0 Colon CA V16.0 Cerumen Impaction 380.4 Dizziness 780.4 Hemorrhoids, nt 455,0 Otitis Externa 380.10 Vaginitis 616.10 Screen Colon CA V7B.41 rHER: _1_1- thru _1_1- Mo. Day Yr. Mo. Day Yr. ] CONSULT LIMITATIONS ONLY INSTRUCTIONS: OK 10 ret1Jm to ( ) Work ( )School_I_I_ i CONSULT & Mo. 0 Yr. TREAT LIMITATIONS: 1 SPEC SEAV I MRR ~tJ OIAGNOSTIC STUDIES DOCTORS SIGNATURE LAB RETURN REASON DAY DATE TIME A" DAYS: P" SCREENING MAMMOGRAM o DIAGNOSTIC MAMMOGRAM WEEKS: , i PTEO MONTHS: / ./1 ,/J, J,../ ,I / ; j\..l . 92552 57454 17_ 58100 93000 "_ "270 AudlomelYy _scopy OestnJct1on(Warts) Endometria/AspIratIon EKGwItt1lntelp. Excision{Leslon)~ Hemoccultllx3 80049 Basic Metabolic 84703 80054 Comprehensive Metabolic 134702 80051 ElectrolyteProfiIe 83036 80058 HepalicPmfile 86701 60061 UpidProflfe 85610 84460 ALT 84153 844SO AST 85651 85024 CBCJDiffIPR.Ct. 64439 82485 Cholesterol 84443 82947 Glucose 82043 o Bill patient tee for seMce PATHOLOGY TO: 0 SKBl 0 P1NN 0 HSH 87797 Gen Probe 88150 PAP r",,,, o 8111 patient lee for service IN OFFICE LABORATORY: 36415 VeoipuncturelFlngerorhee!stick 82947 Glucose HMGlSFP/BFP FORM '1 (11199) ~' .. STAPLE RECElil HERE CENTER 993003 REV.7t99 MEMBER # 6;:).5 CXo'b'?:>'> 1 MODEL lie ;)de. 'pP} /.):; tI STREE ) ADDRESS: CITY I STAT ZIP CODE: MEMBER TELEPHONE: MAKE \lOUC.S. YA. <71 ODOMETER I-:/. -.,.1-~ 0 MEMBER COMPLETELY FILLS IN ABOVE AND SIGNS BELOW ,AM!'t 4 6 II 'il" I i-- ~. 2796646 DATE: TIME IN fEB 26 'e0 A"10:16 TIME OUrEB26'e0A"11:17 D,O,T, #'8: 1. 2, REGISTER VALIDATION ~ :, '" ...,.--..... 3, 4, TIRES PURCHASED 5 BRAND: IIp, SIZE: I 135; { (." 0' I ( l TIRE BAY SERVICES QTY STYLE # UNIT TOTAL PRICE WHEEL DEAL PLAN 3 883093 HIGH SPEED BALANCE -::z.. 080365 TIRE ROTATION 556572 TIRE RECYCLING :2, 523070 MOUNT I DISMOUNT 804940 TIRE REPAIR 586331 WHEEL' LUG NUT 804959 . MOUNT NEW TIRES '5 FREE NEW RUBBER VALVE <- FREE TOTAL VEHICLE CONDITION I DESCRIPTION MISSING DAMAGED RUSTED .L I H.CAPS @ !5/) C.CAPS B-RINGS .- @ L -NUTS NONE MISSING 0 lONE D/R 0 I CD BLACKWALL OUT IN 0 TIRE MANAGER ON DUTY NOTESlSPECIAL INSTRUCTIONS: QUALITY CHECK 0(\ LUG NUTS TIGHTENED TO MANUFACTURER'S SPECIFICATIONS SECURED HUB CAPS ~1>~ PROPER TIRE INFLATION VALIDATED PICK UP SLIPS & D RECEIPTS TO MATCH INVOICE REVIEWER X ~\ ~- AM TIME CHECKED OUT: PM YOUR INSTALLER IS Or; inal Tread De th Chart 4..323132213211t.l20132913281327132 BAY NO, Z-- 313292100 2/328391100 1/3275 82 90 100 013267 73 80 89 100 . .8 ,. PerclmlageofUsaDleTfeadAllmaining 4132100 ,~ < ~ ~~ ' -I . BJ! S bl~"\~i..e)ALE CLUB 3805 H~FTZD~LE DRIVE CAMP HILL. PAl GA'3H~1 0025 C03 S:6~'2 02/2o/-':'~' :01 O?;44:0~ MEMBERSHIP ID, 0254068J3:: MEMBERSHIP EXPIRES ON 03/0C U6699694j~ TrA 1856014 --.. i~ 49,99 149,?7 ENVIRON. TAX N .J .,; 1,00 :;,00 833093 WHEEL DEAL ::: !! 9,95 N 29,:35 ITEM TUTAL .5 SUBTOTAL 18:,32 '?A STATE TAX &;: '1 r,^ , ,"Vv TOTAL 1?LG2 \JISA CARD 44?liOO0057XXXX EX? NICK r TOMASELLO AUiH MERC~ANT ~ 67461100257 191,3: 01/0J 060977 S~VE RfCEIPT FOR REFUND M E r,j r,!"" :-, C 0 F' '{ ,L Bill Issue Date 02107/00 Page 1 of } for: NICK T TOMASELLO ACCOUNT NUMBER DATE DUE ACCOUNT SUMMARY Previous Balance (~) Payments and credits (+) Charges and taxes = AMOUNT DUE 01/28/00 205-208978 02/10/00 01/25/00 01/06/00 01/04/00 12/09/99 01/03/00 322-844101 02/08100 01/29/00 01130100 DESCRIPTION Previous Balance Payment ~ Thank You SUBSCRIPTIONS 03/09/00 MONTHLY TOTAL CHOICE DIRECT TICKET PAY PER VIEW WILD WILD WEST 1/22 INSPECTOR GADGET 1/26 BIG DADDY 12/27 ADL T2 CH 401 ADL T2 CH 401 SUBSCRIPTIONS Additional DSS Receiver Authorize Additional Receiver DIRECT TICKET PAY PER VIEW WILD ATTRACTION ADL T2 CH 598 Sales Tax AMOUNT DUE 4.99 2,99 7,99 4.26 $75_17 CUSTOMER SERVICE 1-800-531-5000 000103% 142285 A 2 0001 07 01204010-01 002"" A -. -........................ ......... ........... -. _ -. --. -.............................._.- _ _ _ _ _ _ _ _ _ _ _ _ _ _ -.... _ _ -.. _ _ -. _ _ _ _ -. _ _ _ -. -.- _ _ -- -... - - - - - -. Always show your P.O. Box No. end ZIP Code in your return address Received Post Office Box/Caller Service Fees From: (Name of Customer) Infonnation on your For9i 1093, pplication fOf Post Office Box or Caller Service, must be updated if it has changed. For regulations pertaining to P.O. boxes, see rules for use of Post Office Box and Caller Service on Form 1093. Box Number(s) 327Y D For one semiannual payment period gfor Annual payment period D Res.erved Number Fee Ending (Date ':2..~~~( Thank you PS Form AU9, 19891538 I'. ...;....:..,,1 W1' o Amount /1 . p-Q (Dating Stamp) " __ J., , - .~~~ L - Nii..'-' ;.;;;,~~ ~-"-"""", ,.. ,-','.:m?J SUnunary' of your account Page 3 of 14 717 737-2411-111 38Y February 1, 2000 Charges from last month Amount of your last bill.............. . $26.83 Amount you paid through Feb 3...... -26.83 Amount you sti II owe.............................. $.00 Charges for this month Our charges.......................... $57.23 Call 1 800-660-7111 if you have a question Telecom*USA charges ................. +4.77 Call 1 800-660-7111 if you have a question Total for this month.....Due Date Feb 28 ......... Total amount due A late payment charge of 1.25% may apply to any balance carried forward to next month's bi II. $62.00 $62.00 Continued . COntinued I' tii ""',j, " . Sf'~.iNQWA:~~ SItR'nC;~$ . "4a~:. .....:.......... ...... .;;0'~;;O~:;~r5~.& . :i~~i~i')-:; f'1;Y'''' ~'?4 6FSCFi, If'T LON HNOI\:E. NO,. 13Q9;7 GATE 3/01/00 (:;;:CT NO. t~Q6'5-CO "'(1 ICE SLS TAX AMOU~r. -,-'-.-.-...-,- ....------,. L~Ff'~SE FOR MARCH 48,2;:, ;2, )3"9 ~t'."1 :t '.....7""'"'-"-""':,....-~" {NV.OJCE: AMOUNT . l1'1.. 1 i .:'-." ,:.- MORTGAGE STATEMENT ...... ..... NORWEST MORTGAGE; I.... .~.., Corre.pondence Addro..: Norwest Mortgage, Inc. Corres?C!ndence Resolution X2501-01T 1 Home Campus Des Moines 104 50328 Customer Service Phone #: (800)262-5294 Fax#: (515)237-7070 TTY Deaf/Hard of Hearing #: (800) 945-0399 Account Information: LOAN NUMB~R: Statement Date: Interest Rate: N~XT PAYM~NT OU~ OAT~: Cu"entPaymen~ 03/01/00 Past Due Payrnenr(s) Late Chargers) Other Chargers} 5291292 01/24/00 7.250% 03/01/00 $750.53 $ .00 $ .00 $ .00 AWELLS FARGQCompany fiBWNDXCT #6880005291292010# 003602 TOTAL AMOUNT DU~ Where to Send Payments: R&gulorMail: Box371393. Pittsburgh,PA 15250-7393 Overnight Moil: 666 Walnut, MAC N8200-0U Des Moines. IA 50309 $750.53 NICK T TOMAS~LLO ANGELA M TOMASELLO 9 N STONER AVENUE SHIREMANSTOWN PA 17011-6341 1.,.111",11I,,,,,,11.,,11,1/,,,,11,,/,,1,,,11I1,,,1,1,,1.,,11 Property Address: 9 N STONER AVENUE SHIREMANSTOWN PA 17011 Description - : -_: Prindp~I' '~.77 'In~e>~,~_:"" . Mbcellaneo<~s ,",'-,.'-, '"'J:::::',,' ActivI SlnceYourLGstStatement, Oate ':' Eserow :. Late Charge .'.To~l. .: 01/24 PYMIIT TIfANK ,YOU 01/04 I'MI/FHA INS .,.~~?,z~", .,$i~:~~- ':",( :::::::?t{1.~t::'~:}:,:,;,:;,.::'.:::: . HUo RISK-BASED 'PrUic'f" at Balance * _' . Interest Paid ,- . As__o ,01/24/00__ -, . Year to Date $88,919,78 '. ,,' $537.74 * This is your ,prinCipal' Balance only, .' . Escrow Balance,' As of 01/24/00' $781.29 not 'the amount requ i red Taxes, Paid , Year to Date $ ~oo to pay your 1 oar:- In fUll. ,\~\~ .;.~~ ::~i~ -;;~:;?t>~~i ":",'f,r'-,~ ":';"~;" ~~ ". '~. '::.,:.;~ _"./' . ',,: ~:~ , ~ "':'\ Important Messages .. Protect Your Investment! January is National Crime StoPRers Month. To deter burglars from entering your home, take these precautjo~s: (1) make sure external doors have a sturdy, well- installed dead bolt lock; (2) install a peephole or wide-angle viewer in all entry doors so you can see outside W)ithout opening the door; (~) install outside lights and keep them o~ at night; (4 prune back shrubbery so It doesn't hide doors or windows; and (5) consider joining or starting a Neighborhood Watch group. {Keep upperpottion for YOUf Il3cords.j Ctl942S13-MBINW.685 ...',.,'';''; ,'~fl ';r1~ "'11 :!ril 169131l~ 1,_ . W"_ AccC'lllnl rJIJmber 4128 0036 7739 6007 PAYMENT DUE DATE 03/02/2000 Stalp.rn~nVClosing Date Total Cret:lit Line 02/11/2000 $3800 Sale Dale Poat Data Reference Number Cash Advance Limit New Balance $900 $82.89 ActfVlly Blnce Last statement- For Customer Service. call or write 1-800-950-5114 BOX 6500 SIOUX FAllS, 571I7 Available Credit Line $3717 SD Tllr.porlbllll"g...or._wrll~ tolhl.add...a:call'"IIWill nlltp......v.)'OU..illhts eitibank Platinum Select SM Available Cash Linllt $900 "-{l. Amount 1/24 44399082 PAYMENT THANK YOU 2/01 2/01 F9010001 SOFTWARE USA 2/01 2/01 F9010001 SOFTWARE USA 888-692-3766 CA 888-692-3766 CA -334.51 -10.05 -39.95 65.00 21. 40 24.75 6.00 15.74 1114 1129 1130 1131 1131 1/14 ROL7Q6LJ STERLING OPTICAL CAMP HILL PA 1/29 KZBW4*9F PERKINS FAMILY RESTAURANTLEMOYNE PA 1/30 5JDIYLB7 WHITAKER CENTER HARRISBURG PA 1/31 3KTTF*PO RITE AID 4818 MECHANICSBURGPA 1/31 QYID9NT2 FRIENDLY RESTAURANT f1202CAMP HILL PA If you have not received your new card, please call the Customer Service number on this statement. The Progressive Jackpot Sweepstakes winning number is 36.62! Check each purchase or mail in from 11/1 to 12/31/99. If the last 4 digits match 36.62, be among the first 2000 to call 1-800-366-7833 starting 2/18 for a chance to win. Rules at citibankcards.com YOUR CREDIT LINE HASCHANGEDT---~'-- Please note your new credit line shown above. **Take control of Your Personal Finances!** Save $$$ on tax preparation fees. mortgage services. financial planning and more. Invest in your future.! Call 1-800-889-7835. mention code CTB99 to enroll in Personal,~airis(R). a pr~gram offered by Memberworks' ~ {}r.::' ,~ -,':i;';;;, ;. ~'i--. PreVio~ Balance (+)Purchases (-) Payments & Advances (-)Credlts (.) Finance (+) late Charae Charges (",)New B^alaric:e- ~hli8iiS ~~i1i,um-Du. ~..Mf~~DU. :Am~ntov.rCrodltUr19 '20.00 Purchases 334.51 132.89 334.51 50.00 82.89 F... AdVances Pu.tOU_ Total 334.51 132.89 33....51 50.00 82.89 MlnlrnumArftountO_ 20.00 Rate Summary Purchases Advances Numbe~ of day<; this Billing Period 29 Calculation Method Daily Daily Periodlt Rate .03671:( .05476:( Noml~ Annual Percentage Rate 13.400:( 19.990:( AnnUAl Parcentaae Rate 13.400:( 19.990:( Balaoc, SUbject:to Ananee Charge SEND ~AYllENTS TO: CITIBANK P.O. BOX 8109 S HACKENSACK. NJ 07606-8109 iOl26S Make C:heck or money order payable in U.S. dollars on a U.S. bank to Cltibank. Include account number on check or money order. No cash please. Y M. ames, .. , Schwartz, M.D. i. Wenner, D.O. :t Setzer, M.D. -I. Skurcenski, M.D. Ih A. Alwine, C.R.N.P. J. Hough, C.R.N.P. Polson, C.R.N.P. Johnson, PA.C TE ,:.~':) H W UARAIltTORfS ~ME L1C. MD-<l39532-E (PA) LIC. OS-005483-L (PA) LIC. MD-082208-L (PA) LIC' MD-08858o.L (PA) L1C# VP-001525-B (PA) L1C. SP-003098-B (PA) LIC' SP.003053-C (PA) LIC. MA-000739-L (PA) PHq :ii, 7.....7 ..-r o BOWMANSDALE FAMILY PRACTICE 1 KACEY COURT, SUITE 101 MECHANICS BURG. PA 17055 (717) 591-0961 : ,,-\ I Appt. Time: \~ - CURRENT INS. I;~ ':'1,., GUAR (:~, ;/.1' , INSU. .':'.::ne ."',~:;.lt OFFICE VISITS ESTABUSHEO 99211 Nurse ~'.., 13 rmed ",,"do' 99215 Comprehen 80612 GYN (BS) G0101 GYN (Me) 00091 C&H (Me) PREVENTIVE ESJABUSHEO 1 Moo (MA) EPSOT ler1yr. 99391 Under 1 yr. yrs. 99$92 14yrs. lyrs. 99393 5-11yrs. 17yrs. 99394 12.17yrs. 39yrs. 993951ll-39yrs. 34yrs. 9939640-64yrs. 1. over 99397 65 & over ,ERVlCE& ( ) HSH, Camp Hilt 1 ) HBG Hsp Dates:_....______.1~/~To.~_....______.1~ al 99431 NB lsequent 99435 NB(H&PJUisdI) 'sequent 99433 NBSub ..sequent :harge };\ t irHours ,'oo <moo ;;nded nprehen 'I (BS) 58 Emerg. Pl.:3. he .t;;.: L'..' _.i CO pa'/ , i , lMMUN f INJ: 90471 Adm. Fee rtI1 90472 Adm.Fee D2D3J 90748 HIBIHepB 90700 OTaP 90713 DIPV _90712 D. . PV 90707 MMR , . 90744 HepB.5(Q-1Q,yrs) I'~.." 90745 HepB.5 (.1'.%' 19yrs) 90746 HepB1.0~~Yrs) 90720 DPTIl-iIB ~_/ 90665 Lyme _:if 90716 Varlce!@S ;! 90718 OdT;~t 90702D~dT E1!i!€B'! 0 304 86580 Mantoux 86585.." ;;;t"URES: . 57454 CoIposcop i 17~ Oestru (Warts) :: ~m:f~I~' 93t1Oo E wiII1lnterp. -;:, 11-~./Excision(Lesion).'_ si27V' Hemoccult II x 3 ~lncision&Dralnage 206~lnjec1ion-Joint 94664 Pulmonaide 120------=-t',Repair-laceralion~ 45330 .gmoid-Flex. 94010 irometry 94ll wlbroncho 847.0 100M NID~ Hemorrhoids. Ext 786.60 Controlled 250,01 250:01 High Risk Mad 414.9 Uncontrolled 250.03 250. Hyperlipidemia 428.0 Neuro 250.61 250. Hypertension 496 Ophthalmic 250.51 25~:~ Hyperthyroidism 372.00 Renal 250.41 25~.~ Hypothyroidrsm 286.9_ Oys. Uterine Bleeding 626.8 Influenza V65.40 Fatigue 75358l?',~7.: IBS 715.90 Gastritis ~.~ Labyrinthitis 296.20 Gastroenteritis - Viral 008.8" Menorrhagia 692.9 GE Reflux 530.8 Obesity 692.6 Headache 7~.~ Osteoporosis 787.91 Headache. Migraine 34~.':'1 Otitis Media 780.4 Hemorrhoids. Int 455.0 Otitis Extema :-j,,' . J I Jl A i i .FI .Ii"'" I ~ iVt" ~~~J~~8NS' /' ../ / r JME/HOUSE CALLS: E, ! Pain PAP :.00 / ADHD "action ,initis 789.00 795.0 706,1 314.Q1 995.3 4n.9 300.00 716.90 493,90 493.00 724.5 466.0 491.21 380.4 ::xlrinsic . Acute - Chronic mpaclion CelVicaJ Strain Chest Paln CAD CHF C.Q.P,Q, Conjunctivitis Coumadln Therapy Counseling Degen. Jt. Disease Depression Dermatitis Dermatitis. Plant Diarrhea Dizziness u 0/'- <;-J , " ~IC liNG MAMMOGRAM l' i . RETURN DAYS: REASON o OIAGNOSTIC MAMMOGRAM WEEKS us ontl day m adVance If you are unable 10 keep your appolnlmenl. Missing an appolntm entwill resull in an office charge. MONTHS: INSURANCE COpy HMGlSFP/BFP FORM ,<11 (11199) J' \ ------ -'_.'--'~-- - -- i SHEPHERDSTOWN FAMILY PRACTICE 2140 FISHER ROAD MECHANICSBURG. PA 17055 (717) 766-1795 ~ J, 31633 ("~ -- \.'jl I Aoom #: . EJ.N. NO, 23-2933075 T BILLlt(Iii'":'"i;,- 71 ,i'!.' I~~G~~~ I '-';:. 1; P::.x~~s TODAY'S CHARGES TODAY'S PAYMENT 91 -120 '*, set: jll~/ l t:" I'r REL TO fNS(?: ~^ -~..> .:fJ2155 .,.0 CASH o CHECK o CARD PERFORMED BY: D HMG DSKBL Dauest DPINN DpSG 84703 HCGBela QL 84702 HCGBelaQuant 83036 Hgb'A1C 86701 'HNScreening 85610./ ProTimeflNR ~t53 PSA /85651 Sed. Rate, Wester /84439 T4,Free / 84443 TSH , 82043 Urine Micro Albumin 80049 BasiC Metabolil:: 80054 Comprehensive Metabolic 80051 ElectrolyteProIi!e. B0058 Hepatic Profile B0061 Lipid Profile 84460 AlT 84450 AST 85024 CBCiDifffPlt.Ct. 82465 Cholesterol 82947 Glucose , / D Bill patient fee for selV.iz / p'THOLOGnO, J1'Kt. 0 P"," 87797.'~ Gen Pro \. 88150 PAP /; l:;. .' r Tisstfe .' DHSH Dall8St DPSG OBiII~enlfeefor~ce IN OFFICE l.ABORATOfl\ 36415 VenlpunchJrelFlnger or heel stick 82947 Glucose t 85018 84T03 87220 87210 "880 81003 , Hemoglobin Pregnancy. Urine KOHPrep. """' RapldStrept o UA BfOO1DUAw/M'lCro r. 455.3 V58,69 272.4 401.1' 242.90 244.9 487,1 564.1 386.30 626,2 278.00 733.00 382.00 380.10 Peripheral Vas. 9!'~ 443.9 Vaginitis, Candldal 112.1 Pneumonia i 486 Viral Syndrome 079.99 Post Menopatf.' 1.2 Warls 078.10 Rectal Bfeedl .3 N.M.1. P.E. wlform V70.3 Shortness of - reath .09 Routine Gyn. V72.3 Sinusitis - ACUte 1.9 Routine Gyn. (MC) V72.6 Sinusitis - Chronic .7. 3.9 Adult/Adoles. P.E. V70.0 Situational Stress .0 Infant/Child P .E. V20.2 Smoker '305.1 Newborn P .E. V30.00 Sore Throat Family HX: DM V18.0 Strap Throat .0 Hypertension V17.4 U.A.1. .9 CAD V17.3 U.T.1. .0 Colon CA V16.0 Vaginitis 6.10 Screen Colon CA V76.41 1 /~ lhru _1_1_ ~ cay- 1) Mo. Day Yr. OK to retum to ( )Work ) School _1_1_ Mo. /"/ Yr. / i L1MITAnONS: DAY /" '\ <~>;;:id-e':vd ~/ OOCTORS SIG~ DATE TIME -,- {' ( hY~ ' r C" ( ( ll~WII (' 'c ; -( ( ~U"8 C ~ l( I j< (' ~Wqj ~ ~ ( ~ Hh41 \.. AM PM '-,. .,"~"- "LoIJIL." -, \. Cincotta, M.D. Cincotta, M.D. M. James. M.O. Schwartz, M.D. Wenner, D.O. Setzer, M.D. . Skurcenskl. 1III.D. I A. Alwine, C.R.N.P. . Hough, C.R.N.P. :)olson, C.R.N,P. lohnson, PA~C L1C. MO-Q18341-E (PAl L1C. MO.0171l34-E (PAl LIC. M0-022884-E (PAl L1C. MD-D39532-E (PAl L1C. 05-0ll5483-L (PAl LIC# MlHl62206-L (PAl L1C' MO-Q665J1O.L (PAl L1C. VP-oG1525-B (PAl LIC' SP-D0309ll-B (PAl L1C# SP-003053-C (PAl lIC. MA-Q00739-L (PAl m BOWMANSOALE FAMILY PRACTICE 'f-' 1 KACEY COURT, SUITE 101 MECHANICSBURG, PA 17055 (717) 591-0961 o "E I.~ :' :'1'\ ,t0ne 20750365602 .le0t has a $5 copay. .~,~~- SHEPHERDSTOWN FAMILY PRACTICE 2140 FISHER ROAD MECHANICSBURG, PA 17055 (717) 766-1795 140650 SP ..L . ~ B 13909 " I ( ( { HHYf (" ~. ( c- um ~ OFFICE VISITS ESTABUSHED Haurs t99211 Nurse ed 99212 Umiled med ~e mt8rm~ nded ::J:J"I'f l:Xlended prehen 99215, Camprehen 1(85) __ 50612 GYN{BS) is Emerg. 00101 GYN (Me) QOO91' C&H (Me) PREVENTNE ESTABUSHED Mod IMAI i . /" E1$ql" er1yr. 9939t Und&t1,yr. Irs. 99392 1-4!t l;~ ___r ' =: ~~r& "gyrs, 99395j~,Y,1s. ,4 yrs. 99396. 4O-M ~lS. ,over -_99S9-765lter '"VICES, ( ) HS11, Camp HII ( )"'0 Hsp' Dates:~~--,--- To__L._~J_ 11' '9943t NB,.:. ' sequent 99436: N9(t1AIWIsdII sequent 99433 NBSub sequent h~" IMMUN I INJ: 90471 Adm. Fee 0 1 90472 Adm.Fee 020304 90748 HIBiHepB 90700 Olaf 90713 DIPV 90707 MMR 90744 HepB.5(lHOyrs) 90745 HQpB.5 (1-1-19yrs) 90746 HepB1.0(>2ltyrs) '--:""" 9072,0 DPT/,HIB '-')~-'''' , ( / ,'. '~/..wfla /~ 9071& OdT 90_ ~ .... - .~~.' 9&115 Allergy 0 t 95Ul' Allergy. D2:0304 ,..~",".~ Mantoux 86685 TInli,Test 907120TOPV ''; t.; 907020PeddT PRGCEOURES: .' ""'_ A- ~ 51454~, 1-1_ Des\tuCIIon-(WaJ!s}, 58100 EndcmebiaIAspIraIion 93000 EKGwilhlntelp;- t,.-___Ellcision{~CIlL...:....... 8227G Hemoccufllb3 '. lMElHOUSE CAllS: 1 liS ons day In actvance il you are unabie!o keep your appolntmenl. MlssirIgan appointment wjUIV,SU/t.\n,~olllcechacge. PERFORMED BY: 0 HMG Basic Metabolk: ComprehensiveMelabolic EIectroIyteProfile ".' """,,p-/I l.ipictPmlile Al.T AST . ="/7(, 82947 G,Iucose. o BlIlpa11entfe&lorseMce 80049 80054 80051 80056 80061 ..... 84450 e,.,. 82... ([CASH " '<.J o CHECK o CARD ~ OSKBL D..... DPINII DPSG 84703 84702 .... B6701 1l561O 84153 _1 ..... ,..... ..... HCG ... 01. HCGBelaauant. HgbA1C iJ HIV"""'t'no Pm_ PSA .'~ Sel1RBte,Wester T4..Free TSH .____' U"""",,~', . '. .,. '.. \, O~,OPl\G ",,"OLQO..,", 0..... 0_ D!ISH aPs7 GIlnProbe 881m P.AP r_ 0, 6iIf patient lee for: seMce IN OFRCE LABORATOI!IY: 36415 venipUflclure/FIngerorheels1lck _7 _ { I I ( I ~ ( llYtif i ~ It .;....',.:' INSURANCE COpy E, 1.0-,----- II'ldsIpn&Draioag:e, 85018 """""""" ilO6~.-""'" 64703 ....... - .... . ....... PuI_ """ KQKPrefI. ""- """""""""' ""---- 87210 "'" 45330 Slgmold-"'" B18BO """'..... '. . . 940:10 """"'" 94000 w/broncho 81003 OUA 810010UAwlMlcro ., I Pain 789,00 CervicatStrain 847.0 100M NIDDM 'Hemonhold8, Ex! 455.3 Peripheral Vas. D1s. 443,9 Vaginitis. CancRdal. 113.1 PAP 795,0 Chest Pain 788.50 Conlrolled 250.01 250,00 High Risk Med V58,89 Pneumonia 488 Viral Syndrome . Q19.99 706.1 CAD 414,9 Unconb:oDed, 250.03 250.02 ~ernpldemia 272.4 Post: Menopausat 627.2 Werts 1Il8.10 kOO I ADHD 314.01 CHF 428,0 Neuro 250.81 250,80 Hypertension 401.1 Rectal Bleeding 089.3 N,M.!. P.E. wlform ItlQ,3 ~action 995,3 C.D,P,O, 496 Ophthalm~ 250.01 25G..0 Hyperthyroidism 242.30 Shortness of Breath 788,09 Routine Gyn. '112,3 linitis 477.9 Conjunctivitis 372,00 Renal 250.41- 250,4(j Hypothyroidism 244.9 Sinusitis ~ Acute 481.9 Routine Gyn. (MC) '(l2,6 300.00 Coumadin Therapy 286.9 Oys. Uterine Bleeding 828.8 Influenza 487.1 SinUSitis. Chronic 473.9 AdultlAdoles. P .E. VJO,O 716.90 Counseling V85,4(j Fatigue 780.79 IBS 584.1 Situational Stress 308.0 Infant/Child P.E. V20.2 493,30 Degen. Jt. Disease 715.30 Gastritis 535,00 Labyrinthitis 386,30 Smokef 305.,1 Newborn P.E. V30,OO Extrinsic 493.00 Depression 298,20 ~astroenteritis . Viral 008.8 Menorrhagia 525.2 Sore Throat 452 Family HX: OM \'18.0 724.5 Dermatitis 892,9 GE Reflux 530,81 Obesity 278.00 Strap Throat 034,0 Hypertension V17.4 . Acute 468,0 Dermatitis, Plant 892,8 Headache 784.0 Osteo~orosis 733.00 u~ ~ CAD V17,3 . Chronic 491.21 Diarrhea 787.91 Headache, Ml~raine 346,00 Otitis edia 382.00 ~. " Colon CA V18,0 Impaction 380,4 Dizziness 780.4 Hemorrhoids, nt 455.0 Otitis Extema 350,10 Vaginitis 618.10 Screen Colon CA . V76.41 ,,"'" _1_I_lhru_I_I_ MOo Day Yr. Mo. Day Yr. UMITATIONS .>'ldI INSTRUCTIONS: OKtoretu~t-r--schOOI'~.t-.:..:..:..-I_ , ~,'" ,\ Mo. D" Yr. .. UMI7A7IONS: No4- . t..b N>-" 't.J. , " " ()-...-'" .' - I f >:,J1. I, f.. '. 'Ie .. -) \ DO ORS' I NA 7IlRE RETURN REASON DAY ) 04TE \J TIME AM DAYS: , 'M "NG MAMMOQRAM o DIAGNOSTIC MAMMOQRAM WEEKS: MONTHS: HMOISPPI8i=P FOAM,1 (tllQ8) ( c- I ie i OWN! ( I I { I (, h(.. W~i1' ( ,. " iif''', 02-09 PAYMENT RECEIVED "'-,~ ___c:.o;: -~--'"."';"":'-;.ci.,,~ ~;c '-,A ,- "1,"' YOUR PROMOTIONAL $33. ~O ~ WHICH lI:m': BE -WAivED- . .")'$89'~l,~ l'~pI .._' .; \. youll PROHOi:i:p~!. ~ ,. "~,,,.', - '.;' '.~.~'; :" '''','':-', , , , * SEEAOOmONAL EXPLANATION OF CODES ON REVERSe: SIDE, NOTICE: SEE REVERSE SlOE FOR IMPORTANT INFORMATIO' CUstomer Account Information L. Simng Summ,ary For Service To:' NickT Tomasello" " . !',Jff:.., <".IW~rJ:I..I~!'AA: '.; i.,:, 9 N StonerA,ve.,.:)V8alancafromlastbiJl" '... 1~c'1o,!"t~~mf>i>r::24,:06!3941!?~:;:\ .,. ','!lr;.j;,.I?<lYlJle{/ts priortOMai:13, :?gqQ-.i!lia.ti/(s!.. '. ,i~~~.i,",;,'.~~~~:~~:~~~~I~:~;::r~:!~;;.:);"i;,;>1}~1\J:~\P~~~~~i~:f,1~~~~~?'~,.:~",'., ,Billing Period,&'Memr Infimnation: ,';,i;;;,,"'Serviee Charge j;, !'i,~i\%'1,;;'l+t0,",,"(- ..;', Billing oa!';:Mar13:~ooo":; .... ..,.. ..... .;;;'r:Wate': VOlume(f.oEi~iM.f<~~1P#j3T.;',{",' Billing P~~i.O<J:, Ee~ 09!~l1Aar 09 (29 days). . .!} ; Total. walerc;~arJl".s. Mar 13; :1'd~Il' NextrealbngQ.nlabo.ut:Apr,1.t.2000:..,,', '.;, '.' .;. ._'.' '. Rat'; Type:R~<fenti~1 . ...<;.;~. '. c. .. '. -AMOUNT DI!'E ;;/i,. "~:::;~:!~:'~~9~~~~:~~f~~fi~eter~;:::;:~,.\i:; "'.c'" '.' ";hiiJ'~ftf~~"~tj', ,:;:, Present-ac!U,d' . :36400,:, ". . '. "('': . ,". , :;.\X;'i~~it;~~@. '33060 ',"'.'." I " . $28.72 ! -28.72 . i .00 I 9.75 16.54 26.29 I $26.291 I ! . , I , l , .;- Messages to you from Pennsylvania - American . . Ani' portion of this water biH which /s not paid as of 4/10/00 will be subject to a 1.50% penalty, . Thlsbill rei!ects the approved rate increase, effeclive December 18, 1999. - "::~ . 'QuestiClns?Caill-iloo~t17-7292Weekd~Y~~:15am to 6:30 riiT1'. t...... i:~Wg;~1~:~~6i~~~~~~lc;~t~~t~~~~~1~4~~~~~4~~;,~!' .'....~;;('i'... . ~i:):~~~~':1~~:ro;2~;~~~~~~~.f,~:?jii:~,~~~:i}1:~~~~~~~~~;J[tW~;~':.:~' ;;.'b.;,~'-::~'i~:j~~iSilir1i..;~: i~t,~\-i; ";;...~:s,..~~~~~~~:.;-.:.'-~'n~"b':'iAr""L.t':1a"i!.:.: ~'~I:'_ ,:;..:,,:e, .~~~'.::I.~t~ :tl'i..::~~,~;..,.... ',",":''-__0 -.,....; ,'>"'''''' ~~~i!,~~;;~ ,Ji ffy Lub" *~ [,20 ',.JEST BA~jh LUBES, r~lc. 4958 CARLISLE PIKE MECHANICSBURG, PA 17055 (717) 7S1-€'.5QJiZI DATE 1213/14/121121 08, INVOICE NO. 420 41414 BAY1 TRANSACTION NO. 000314,0121041414 EMPLOYEES AJB42121 JAE420 KRW+2Gl PCR420 jiffy lube") NI Ch TOMASELLO '3 N STONER AVE SHIREMANSTOWN, PA . YEAR 1992 MAKE VOLKSWAGEN MODEL RABBIT IGOLF ENGINE 4-1780 1. 8L LICENSE PLATE PA-ARR3178 ALTERNATE ID MILEAGE 11214,478 17011 SOHC DATE MILEAGE SERVICES 03/14/00 104,47E FS WB' 112\/18/99 10121,851 FS 02/19/99 97, 7S~l FS Cl-l LGT QI 06/12/98 94,45,: FS ttlTs QI .::; 08/15/97 . 91, 509 FS QI '. 04/1 ''3/97 89,807 FS AF 'FIe .' 0 " Recommend next service on June 12, 201210. or WORRIED ABOUT FUEL ~lIL.AGE?? HAVE YOUR FUEL CL.EANED VISA '+ 128003677396007 0012 AP360263 d;/~ ~ ~ ./ AUTHORIZED & RECEIVED BY Cardholder acknowledges receipt 01 aoods tIInQlor SGNlcO$ln the amount of the totII shewn hereon lltIct agrees to perform the obligations set forth In !he Cardholder's agreement whh the lauer. C Jl~ Lube lnlemallonal, lnc.. ~~R~h~l~:=d, CUSTOMER -< --.-.-----.------:-._._______,________ ------y~,--r__----. -.- --- ---,--- - -__- 041414 . '~ - -- - -- -.- --- - ~.- - -- ~ ---- -- - -- --_.~-_.- ---~--~._--- Loan Statement .,.$ - .,."m ~~-------~- ---- _.~._---'"_...._..,._.._". ..-.- __n__ ... "'__~_'__'___""~_~. ____ -,-------"-,, '""'''....__._---------~'''- ~----~----.._-,.__.- ... "..---,-,- ,,,,,..,,,,..,,,,,---,,--------'----'-. ----------.--.. .-..--------.-- ..--- --- - .~.. --'--..,,-.-,-..--.-.----....,,--.-- ----,.....,.."..,..".."..;;,..-..'''.-------.. ~ -"-'-"---"'''- '-- .."'"'.".....,..."...-..... ------ ':='~----_.''''''- ::~ ..." '" "/,"M,l" "'Je,," o CHASE Your Chase Visa@ Account ACCOUNT NUMBER: 4225 8105 9900 3665 PAYMENT DUE DATE 03/17/00 STATEMENT CLOSING DATE 02121/00 OAYS IN BILUNG CYCLE 31 NEW BALANCE $2,010.00 CASH ACCESS UNE $6.000 AVAILABLE CASH $2,990 TOTAL CREDIT UNE $6.000 $2 Here is your Account Summary: TOTAL Previous Balance $0.00 (-) Payments, Credits 328.02 (+) Purchases, Cash, Debits 2338.02 (+) FINANCE CHARGES 0.00 =i New Balance 2010.00 Minimum Payment Due $40.00 Your charges and credits at a glance: DATE' DATE NO. ~RIPTION OF TRANSACTIONS . CR~IlI!s 02Ill9 02Ill9 XFRl PAYMENTTHANI<YOU. ." .,'. 328.02 ,.,. g:~ . 00210::131 ~." ....... =~~=~'r.1~~c:&s:FuR~ ..., ..',. .,.:.:..,...........;..=.....,~.oo...02l1l1... "." 02113 .,en GI.OBALCHRlSTIAN:.NlWRK.702-82!l6611.NV . "... '. '..... ..........i.> ";,{';{""';'('. Total of yell,r credi~~ct~~;;"'~:ali"~~ 0000 NEWSI A<;CEPT.OUR BAlANCETRANSFEROFFE'itIiNOYOU MAYBE ELlGIBI.ETO. RED\JCEYoUR DAlLYPERIOOO RATE YOUR ~~~~_r:~:~n.L'~~~<" ,_"~;~2,:,?,~i;;&tJ':_;'X:;!_;;~~~iiXi?":~~~t(i,,,~i:~~"~t~;,:; -,,' -:, :," _ ",:"\:,:~:;>-'~" o~i;:~'i:~:-;;}~~~:::;~~ -:;~::,:;;~:~~", ,'~, -'''. NOW CU'~EBRINGS'.YOU A NelI/iWA'kTO:$A\lEfVISlf,:liIS''ElllllNE,...t .WWW.CHASE.COMICReDOT............FF OFFE~~~TPURN6W.C.~:.~~~~OJ.\O~C$;I<'~OFrEN:NEW6FF~~~~ '.. . . :,,--''','o/"'.,} ,", ;,t'.\~" '>;'~'r_" "; ,,_;~,;~, --.:.::;)<<-,,~~,~0~-T' .c;,\: ;~::;'{!_;l<~'~X:;'/p_::-,\',,"~':/, "~,,, .',' . ;,--''', "",~' ,: ,,' 'o''1;:F{1f',;::'4, ':":" \" -:\w;~~,,~~~~;\;' SHOP;; GUcK.: ",NO::'SAVE.:l:iNr:HtOUsANDs:OF0tTEMs;'INClUOING OUR WeEKi.V 's'PEc~"\Ni)i::BP:r! 'MNW.d1AS~Qp~cQM -' <:~:!i:~-?-~ ""<,~>'-:: ",,>-';,,~~>::_'--'::"::'~~?;~;:"~" -, '-: -'- ,- :,_/ ,; :.::: - ,,,'- . "'-'-" "''', -;,~:,,;'g;{~:.:,..;.;.'.:.;-.~.";.:.<:.' .......'..,::......, ...., ,\"-;;--.,,,/.'.<,":--:" " ' ,'1$~"t ',1~~g: ,\y~~. ~===='~ .11 ...~ '~ Here.~hCl~ w.e. . dete.. ~iD..'" 'eiiY'~..~'iiji~~e.(:llarg~fr: . .'.:'i',:riJ:~J::"~1f~.i.'...'.' ... .' ..! ,'_ "", ,-," "",-.,.0","'"',,_'- , "', "', ",_;,,' ,;' --' "",' -"'-",'.1,">-= ~ ;~i:1~E.~=~Rl'F&Z;~_1.J~.i;;~' . ..~ ~:'~RATe :'{;~E CftARGE CHARGE',.RAl'E':",;""'IfA'E.4i~; I Purchases .N().04904% $0.00' . $0.00 $O:OG 17.90%.,0:'60%:' I CashVO.05493% $0.00$0;00 $0.00 2G.05%0G,00% . Please See reverse' side for b8tance 'compul8uon.method arid 01l1er importantlnfonnation. Q QuestIons 'about your acco.lInt? Cred~. Card lost or stolen? Call Chase Customer Service 24 hours a day, 7 days a week, toll-free, at 1.800-441.7681 or write PO Box 15919, Wilmington, DE 19850-5919. Para Servicio al Cliente en Espanol: 1-800-545-0464. ~ ~ ~ ~ _l\ --- 1 tl ~ - - - - --- ~ Send Payments to: Chase Visa, P.O. Box 15657, Wilmington DE 19l186-5657. "'IMPORTANT: Don' forget to write your eccount number on your check or money order -- never send cashl Pags 1 of2 ~ tw.::!.". Billing Summary for Service to: NICK T TOMASELLO 9 N STONER AVE SHIREMANSTOWN FA 17011 Rale Classification: Residential Heating Billing Period: 01/24/2000 to 02/24/2000 (31 days) Company Read 'Vour current charges include Stale taxes totaling $ 9,18. Past Bill Information - The account balance on your last bill was ",,,.....,..',, Thank you for your payment of .....""'...."'....,...."'""",, Vour balance as of 02/25/2000 ..".................",,,,,,,,.... Current Bill Information - UGI Customer Charge "',........"'................."'........................... Charge for gas used: First 50 CCF at 0.8150 per CCF ..........."'....,........".... Next 91 CCF at 0.7472 per CCF ................................. PA State Tax Surcharge ...."',...."',...................."'........... Pipeline Surcharges "'.......................''''''',...............,''''.., Total Current Charges ..............",.................................... EMP Amount (due by 03/20/2000) ......................'..... Total Amount Due ..,.........,"'........................................'.. $ 42,00 -42,00 0.00 9,00 40.75 67,99 -5.89 -0.17 111.68 51.00 $ 51.00 (! r...'...'.,....+.".,'".'... .... .... i.,.. '-~'^' He" -~<" --, > I, ~Bll~~!1er I, 219702 301000 'i If you have any questions please call us at 717-232-1811. or write tc POBJ( 13009. Reading, PA 19612-3009. Please contact us by March 20, April 24. 2000 NPN 219 7023010001 5.70 5.13 4.56 3.99 3.42 2.85 2.28 1.71 1.14 0.57 0.00 Average CCF Per Day . . FMAMJJASONOJ F 1999 Mlmtbs 2000 . = Estimated Usage Average CCF/day Daily temperature Last Vear This Vear 4,55 30'F Meier Reading Information Meter "um~ Previous Reading 1274438 293 (estimated) Present Reading 434 (company) CCF Used 141 Messages from UGI . EMP Summary for UGI charges 8i11ed to date Used to date $ 153.00 $ 292.14 . Help prevent pipeline damage, accidents and seNice disruptions. If you see someone digging near your home please call UGI. . If you pay at a payment agent please take your entire bill. Make check payable to UGI. Keep this partlor your records, Important information I. on the back of this bill. -- The Marriage & Family Life Center 10 East Main Street Shiremanstown, PA 17011 (717) 737-5200 Bill For: Nicholas TOMASELLO 9 NorthStoner Avenue Camp Hill, PA 17011 Date TransactiOn Session CharQa Total OWed Previous Balance -$O~OO 0311412000 Family Psyehother.tpy $85.00 $W..0ll 0312312000 Family Psychotherapy wlo Patio $85.00 $10.00 03/2312000 Payment {$2O.00) $170.00 $D.OD Please Pay this Amount: I $0;001 Next Appointment <.0/. _--fJ or_A f1:A." =::3-~ 2..:6>0 ~~ / Sally J. Tice Ph.D. Licensed Psychologist License Number: PS..o0304f-L Employer I~ .2.5-167-82.6.Q ,- Ie > i!i.~; c ACCOUNT SUMMARY Bill Issue Date 03/07/00 Page lof I for: NICK T TOMASELLO Previous Balance (.) Payments and credits (+) Charges and taxes = AMOUNT DUE DESCRIPTION Previous Balance 02/23100 Payment ~ Thank You 205-208978 SUBSCRIPTIONS 03110100 04/09/00 MONTHLY TOTAL CHOICE 322-844101 SUBSCRIPTIONS Additional OSS Receiver Authorize Additional Receiver 03108100 02120100 02115100 02129100 03/03100 02110100 .o2l.19j09 DIRECT TICKET PAY PER VIEW ADL T2 CH 598 SEXUAL OUTLAWS AUDITIONS FROM BEYOND ADL T2 CH 598 ADL T2 CH 598 , EROTIC CONFESSIONS:SEX & SCANDAL Sales Tax AMOUNT DUE \ CUSTOMER SERVICE 1-800-531-5000 " 0>3Z> A PP&l, Inc. Electric Service For: NICK T TOMASELLO 9NsrONERAVE,' "<, SHlREMAN~"TWN PA. i 7011 PG ENERGY POWERPLUS : Customer Service ONE PEl CENTER . . WILKES-BARRE, PA 18711 . 'l-888-699-PLuS . PPL Utilities' . '.Customer Service 827 H3usman Rd. . Allentown, PA 18104-9392 . . 1-800-342-5775 www.ppl~inc.conl <' , '\1. . "':'~I::I.-:> pp )=:', , " ...., ~T11 Page 3 Your 8m Account N~r 24780-81008 U w en C'rtllin or writin Total from Last Bill Payment Received Feb 8 - Thank You! $ 69.09 $ 69.09 Billing Details Balance as of Mar 3, 2000 $0,00 Current Charges Charges for - PG ENERGY POWERPLVS General SelV ice Rate: PGPP for J an 27 - Mar 1 1010 kwh @ $ .03890 39.29 Total PG ENERGY POWERPLUS Charges $ 39.29 Current Charges C1tar~es for - PPL UTILITIES ' Residential Rate: RS for Jan Z7 - Mar 1 Distribution Charge: . Customer Charge 200 KWH at 1. 79600000(t per KWH 600 KWH at 1.59400000(t per KWH 210 KWH at 1.47200000(t per KWH Transition Charge: 200 KWH an.79800000(t per KWH 600 KWH at 1.59400000(t per KWH 210 KWH at1.47300000(t per KWH PA Tax Adjustment Surcharge at 0.50000000% Total PPL UTILITIES Charges , -- ~- --'-'--- 6.47 3.59 9.56 3.09 3.60 9.56 3.09 0.19 $ 39.15 ,~a~',~.,~~MRfirJl~~1Ili~n~ll!'n#:~~~~;~~~~:wa~\~l~'# Account Balance $ 78.44 General Information Next meter reading on or about 'Thank you for selecting pg energy powerplus as your electricity supplier. Call pg energypowerplus at 888-699-7587 withquestions about supplier charges Generation prices and charges are set by the electric generation supplier YOll have chosen. T1je Pubric Utility Commission reg!llates ~li~tributioI). '" " / \ .. " _ A I " > ~ ""lS\ ~~,:'" \ !~-=c ii" Rece!l'edof ". ..' 1,' ,? ~'€.-e -<;J;n;~ ;1 ',tt ;~8l; ~ 'be ,.;~ \AJ 1Jl-,-- p' Dollars l,. '1 ".0 0 $ 0, TOPS' ~4161 __ow _"'~".. , "-,i' >," - 841.0 " '~":">~1'.!,;;ecloOLf1J~ 78&:50 ~"2$!nilii 414:9' ,~. ~~"250; 428;0 . N_ ; 25J1>al"25O. 496 "',' ap_ ,250;1&1,.' 372:00 ~o .'.250.41 250: 28M i,t .Ily$'llIOrino Bleeding V65.:40 F~ue; ,'1/ '.~~ 7 G_~",," _Onlsrilfs-Viral OQlt, GE:-l;lettux,. :i!>.t;:",c"~,;j ~ H~h8 ,;!~,; I; ,:___ 'HeadaChe; Migraine "-'"346:00 Hemollhoids, In! 455.0 "oM '-. ':; "-'l.;.t .~ ~:i ,~: u P<;~}' ... ESTABUSHED No.. :;.~ Extended Comp','"'' GYN{BSJ GYN (Me) C&H (Me} .ESTABLISHED !?:PSDT l,Jndet1yr. t-4yrs. !i-l1yrs. WA7yrs. 18-39yrs. -"" 65&ov91 iSOHsp -1.-.-1- NS NIl (H&PID9:h) NBS"" :al Strain . Pajn 'D. I"lctMtis ad!n Therapy ;eling I. ssro , .titis, Plant ,. ,"55 692.6 ' 787,91 780.4 AR VWH;~:0"/50JtJ5S00 IMMUH IINJ: 90471 Adm. Fee 0 1 90472 Adm.Fee 020304 90748 HlB1HepB 90700 OTaP 90113 0 IPV 90712 0 ropv 907111 """ 90744 Hep 8.5 (().IOYlS) 90745 HapS.S (11.19yrs) 90748 HepB1.0t>20yrs) 90720 DPTIHIB 90665 Lyme 90718 Varicella 90718 OdT 90702 0 Ped dT 90658 Influenza 90889 Pneumococ:cal 95115 Allergy 01 95117 Allergy 020304 88580 Mantoux 86S85 l1neles1 PROCEDURES: 92552 AudIometly 57454 Colposcopy 17_ Dutruction.(Wads) 58100 Enllom$al AspIralIon J(i.-. 93000 EKG ... ',""". 11_ ~,{lesilm~ an......---- 82270 He~ltlix3 10_,lnclslp~,&DraInage 206_~ :-r.'. 94684.'Pu~,_ :- f20--'-"'"'II!!II~~. ~.,~,~ ,,~ , "'94Q1D--'~''''''''''94OIjO\IIlbmricha.. -,' . ,;'-!{~!~ /if..il:i -~'-- lJMITATlONS INSTRUCTIONS: "-- r;i CASH I D . CJ'(j o CHECK o CARD (I7......fl :;5.00 'r-V iSo1'f1I~ k'o L. it'S PERFOAMEDSY: OHMG DSKBL OPINN Daunt DPSG HC1-4-Q!:5C f......'" ClC 80049 BasieMetabol1a 60054 Comprehensive Me!llboliC aoos1~PfOlfte 80058 HepatlcProfile 80061 UpidProffle ..... M.T 84450 AST 85024 CBClDifflPn.Ct. 82465 ChoIes\9rol 81947 Glucose o Bill patient fee lor seMca 84703 HCGBeteOl 84702 HCGBelaQuant 83036 HgbA1C 86701 HIVSCreening 85610 ProTirneJJNA 84153 PSA 85651 Sed. Rate, Wester 84439 T4,Free """ TSH 82043 UrlneMJcroAlbumln r PATHOl.OGY'TO:., DSKBL DPINH OHSH DQlIeSf OPSG 'm97 Gen Probe 88150 PAP r_ DBln~~,tor$l3lYic1i IN 0!fICE lABORATORY: 364tS,". Ven#i_reIFInger or heel stick 82947 GIIIcos8 ""~.~ 84703 ~.Uline 87220 KOH'~~ 872t!?:, Salin8-:.'., 8788Q: RapklSfrept 'i\.r, .,~,,__~.1~ - ., q~A.~::; ",~1~1)TJ"~... ',", - . ' "~ ., " I ,"; I ' thru,'. f '>&" I , i ~ cay --y;:- '1.iD."" cay --y;:- OKtorelumtol )Wo"'1 )School_I_I_ Mo. 0 Yr. LIMITATIONS: REnJAN DAYS: \GNOSTIC MAMMOGRAM WEEKS' MONTI"lS: ReASON , ;' , / ;?, ,.) INSURANCE COPY HMG/SFPIBFP FOFlM M1 (11/99) to kaep your appoinlmenl Missing an apPOlntmenl wifl resllll In an office charge, DOCTORS SIGNATURE DATE TIME T: r ~} i: (" >>li~H (, ( C d"" '/"I,' " ~, t'; " W' ) it I ("1 . AM PM .' ~U - - '--~,- - -"-- - --~ '- -- _.~ -- -- -- --- ~ - - -.----' -.-'-- ._-~ - - --'-" _1- The Marriage & Family Life Center 10 East Main Street Shiremanstown, PA 17011 (717) 737-5200 Bill For: Nickolas TOMASELLO 9 North Stoner Avenue Camp Hill. PA 17011 Date . Transaction session Charge Tolal'OWed 03130/2000 03130/2000 Previous Balance Family Psychotherapy w/o Pati, Family Psychotherapy $85.00 $85.00 $170.00 $0.00 $10.00 $10.00 .$20.00 Please Pay this Amount I $20.001 Next Appointment Lf-- C; 1.f~'eO Sally J. Tice Ph.D. Licensed Psychologist License Number: PS-003041-L Employer 10: 25-167-8260 - MORTGAGE STATEMENT "." ~MORrGAGE ..... ..~.. " COFreapoflldsnceo A.ddlr'olS~ Norwed M~:lrlg:(l9.(~r Inc. Corre~pondaf'jce Re'.ioiuHon X250 1-0 1 T ] Home CamplJ'So Des Moine$ iA 50328 Account 1 "formation: LOAN NUMBER, .'. WEL.I..:5 }1:A.R(}() '~""l!II',"; StrJfe,';W.'lt Dww' !nter~'st Rau:: 5291292 02/10/00 7,250% 04/01/00 $750.53 $ ,0<) $ .00 $ .00 c".t..",... S..rvi... !'h..".. It: (800)262-5294 Fax It: (5151237-7070 TTY Deaf/Ha.d of H..a.lng #: (800)945-0399 NEXT PAYMENT DUE DATE, Current f\l}'mcm: 04/101/00 P!L~l Due Pdynu:'nf(5) Laff: Chllrge(~') Othf!f Chluge(j:,i /,'BHNDXCT #6880005291292028# n03158 NICK T TOMASELLO ANGELA 101 TOMASEl.LQ 9 N STONER AVENUE SHIREMANSTOWN PA 17011-6341 1",111,..111",."11",11,11""11.,1,01,,,1111,,,1.1,,1,,,11 TOTAL AMOUNT DUE Where to Send Paym.nts~ Reguk.!r-Ml,']H: BcJlt 37t393. Pitt!;huryh, P'A 15250-7393 Overnight Mail~ 666 Waln!}f, MAC NBZOQ-OM O~." JI,~tlif1~t, !A 50309 $750.53 Property Addf'en: 9 N STONER AVENUE SHIREMANSTOWN PA 17011 ,:,Y,:':~_r~~~~.,;"r:~j!R?~;;'(tF","';:,'~~~8~i~~~~::',,.,.,,,,,: * 1;hls. I" yOtir';ir1halpal 'liiO,iiilc:oe.QnlY; '.MotJtie ..lIIDLii>ti"equlr~::tcp.y ImporlanfMelscig..." . . ..... ... '. . .' .. ...... ,.... ,......, "'" On Acpril 17, Norwe5t Mortgagll, Inc., will change its name toWel!s Fargoflomia' Mortgage, lne.. to reflect Ihe strengths and heritage of our parent, Wells Fargo & Company. Only our name is changing. We remain committed to providIng tl)e' , ' super.or customer service, convenience, and new product and service offerings on wh,eh you already depend, Please continue to make payments payabl", to/l!orw.est Mortgage, Inc.. until Apri! 17. . . . ..... .... :'-':'- .:~, {l<eI~ l~W~ r.o:lrtlon ftll' yeur 11""'<;>:~l>.J . CW4~'~~ l~f.lOO.t .. >'_"1 . - "" ~I .......ii, -. -------~_.__._---,-- ~," 71~t';o~~:;Ji... ~~'i'>:_.,',',~-_"i)~- DEA:BR5642687 DATE: 04/03/00 I: ; ~ Em ~stB~RLISLEPIKE qJ MECHANICSBURCi, PA 17055 0481880548 DAW: 0 DAYS: 030 REFILL 3 TIMES 717-737-2411 TOMASELL 9 N STONER AVE PAXlL 30MG T NDC: 00029-1 DR. CINCOTTA ZI<lOFlSHEUD PCS DOSE: TABLET 10#: 207603666 GAP: W764001 3 17055 N/A: N QTY: 30.00 RPH: JCS U&C: $ 92.98 ',:C III~:~I~ """llm~ 0S~~f;;'~<~)~:~~~~' :;,,' ,..".".!l'A!'Y~',!i10..15 L "" ~,. '0' RTE 574 . DESCRIPTION., PRICE ..~_________.....__..::.o...-~________________ LEASE fOR APR XL - '--- 48. 2;'< INVOICE NO. 1,3384 . . "DATE . . '4103/00 ACCT NO. b065-00 SLS TAX AMOUNT ------- ---~--- 2. S9 ':fl. t: --"""------ 51.11 ';'~1 itl ~',-....;.~;..:::-l .". ,. ,'.;' " =, embank Platinum Select '" AceolJrrt NlJl'f'.ber 4128 0036 7739 6007 PAYMENT DUE DATE 64/63/2CO@ SmfernenttG1Qsmg rJ!l!~ 'fotal Cr~lfllil1e Cash AtMmce limit 03;14;2000 $3300 $900 /",. '_.~.' ~~ tI1"ft' -",~~'~~~'?'.;.;'r~';)'p':..o for C,,~lt:lfltll/r S~f\~lil't, C<l~ r.;t Write 1-300-950-5114 80X 6500 SIOUX FAllS, SD 57117 . Aw1~ C?'edtt /Jr<e , $3351 N~w 8nl<'lfICe- $448. 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AvaimbUt Cuh ll:l1~: $900 2/22 455355114 PAYMENT THANK YOU -,82.39 21'11 21'12 OMRFY2F5 OFFICE MAX 00000398 MECHANICSBRG PA 52.93 21'16 21'16 5MM3MF40 SUPERI'ETZ 1227 MECHANICSBURGPA ,.....,10.73 21'17 21'17 9IXlF2C3 WILLOW MII.L 'In HOSPITAL MECHIUIICSBURGI'II \),1611.50 21'17 21'17 lllfDQ3'15 P C 5 ONE CAMP HILL; I'A '. ,;';',;::;':'62',54 2-'23 2/28 liFJYPSU USPS 41;~41170091 CAMP H-ILU I'll !;~t;J~i:U 3/10 3/10 8181RR60 SUIlOCO NEW.,ti!!lfl:E I'll 3/11 3/11 MGNYZHOF ELEcrs BOUTIQUE 1125 ~~~III~i~l!R I'A '~'58";21 ..3~,U ;",11 QQDD4Hil7 THE ITAlIAN 011 EN _..!!f ME FA 32.15 . . .. ... .e~!,li~i~;f;~15~lr~i~I~~~:~~~i~~1~, .',. ..n""l-800,.8.&'l;,'1835..'(i)tIi....lihn "..d...".CT1UIO.'j:.....ni"ol'I in ""2";''-'''I'....",,,n..l B..'i!l'ili'CRl, ."'Pr..al'.... off....ed bY,.Jole...b..rwo..k..... .,-.... "',.'.~:,:". "::"S:,O',:,'", '~.. .., .. ...,'"'' "......, .. ,. .. ,"::;:,,:,,-:":';":', ',C': :->.'. "'., DON'T BET .STUCK.Wmi;;L~~GE AUTO REI'AIIl.'BIL(S! Get ..nAut.. .HarrantY)~#i:i'~....ci:Y"u ~"Il .'bonk.lIn f..o.. ,Interstate Natiolla1.DiOilor S"rvi~..s ,"- Insuo;..dby Gulf In"u..e""e Group; . C;,1l1~lJ8a-'13fj-'47211,t"sp....k ',' ....:witl) '''"::''''~''~~''n~j'';!; (!!..4~ri ty_~;l;i>~oii,; '311l!),,':';;1,:.if,;',...,<,;::..,.. ,-::.':: , :'-,:'7':':'~'" -::; '" " . ......".,..,."... "-.: ,:.'.".'_:.:Tl~~':';:''J~.~,'':'''~.;V-.:<f';,rL',;,:,:C:fYfi bank c:~~.~~~{:. , .o....,.liil.;'With 'c.l!I;1V,!>ackani;f)( Go'tQ"'W!iiw. clickic<~ t. co,"'."d yo".. Click Ci ti",~'t...ti"u," s,..[.;; ,_"" -n, annual fee ~.",..-,r,~1:,~~r~:):;~~;~:;~tj~:~~: ,'" "., ,'::;'_'::~,,:,,:".i",.:,:,'..!"r~ ,,",'II. . ..... r. ... H.........& , , -, ,- ,. "" "" -',:, ;: :..'.:; ::,:;~~:i:~;:~h,:}M:;~~~~)~]~W~~~~[i~~~::~~ag~~~~1~r' ""ll. . ~:;;''';'d.'~-, ~'..:;;i.i.',~---.;.",:;,,:.i~',-,~'!:,.:.0.;:."::'_~_~ . .""""".'-_~'" .0-':'__ ...".;..:", _'~_'''':'-'-..::_ :_'_'-'''-'-''':_C"-"_",,,';';'';:;::'~:;~",,~__ ~." ' - ;:.;' "": :',::"; ~_~: ___ _ ..,,__ "_..:~-::._ ____.__ """ '._ _~~ :.: _, .il,~;'lI.::.~":', - " I LIC' MD-017834-E (PA) UC' MD-022884-E (PA) UC' MD-039832.E (PA) UC' Os.oOS4B3-L (PA) LIC. MD-0822D8-L (PA) LIC# MD-081ll18O-L (PA) LIC. YP-oOI525-B (PA) UC# SP-0G309I1-B (PA) UC# SP-0D30S3-C (PA) UC# MA-ooD73II-L (PA) ~~,I ~ C UHW' 34916 (, { (" Cincotta, M.D. M. James, M.D. Serb .D. Wenner, D. . 0' BOWMANSDALE FAMILY PRACTICE ~PHERDSTOWN FAMILY PRACTICE 1 KACEY COURT. SUITE 101 2140 FISHER ROAD MECHANICSBURG. PA 17055 MECHANICSBURG. PA 17055 A (717) 591-0961 (717) 766-1795 /. I Appl. Time, Is'" '1' Room', . Skurcenskl, M.D. 1 A. Alwine, C.R.N.P. . Hough. C.R.N.P. .;)olson, C.R.N.P. johnson, PA-C 'E C' YWN~ << ( ."lent n2S a .~ copay. OFFICE VIsn'S ESTABLISHED 99211 Nurse ~ 99214 Extended 99215 Comprehen S0612 GYN (68) 60101 GYN (Me) 00091 C&H (Me) PREVENlWE ESTABLISHED Aed (MA) EPSDT '1 yr. 99391 Under 1 yr. "S. 99392 1-4.yrs. lrs. 99393 5-11yrs. yrs. 99394 12-1:ryrs. yrs. 99395 lM9yrs. ,yrs. 99311S,4lJ.64yrs-.. over 99391 85,&over AVlCES; ( ) HSH, Camp HOI ( I.HBGHsp Oates: ___L_---1_ T(1.---1---1'_ 99431Na.- 99435 rtI:(Il&-Ml&c:h)' ..... NIlSW> If,lYUN IINJ; 90471 Adm. Fee 0 1 90472 Adm.Fee 020304 90748 HIBJHepB 90700 DTaP 90713 OIPV 90712 0 TOPV 90707 MMR 90744 HepB.5(G-10ym) 90745 HepB.5 (11-19yrs) 90746 HepB1.0(>20yrs) 90720 OPTIHIB 90665 Lyme 90716 Varicella 90718 OdT 907020Peddt "'" """"'" 90669 PrletJInQc:occa' 95115-. AUe/gl 0,1- 851-11 AIIeIgY. 02'-0304 B6580 Mantoux 86585 Tlne-Test PERFORMED BY; 0 HMO OSKBl 00U0tl OPlNN 0... ( -lours , ;e' d" rehen ,as) 1 Emerg. HeG Beta QL HCGBetaOllllllt HgbA1C HIVSCreenlng Pro'TIrrIWI~R 'SA ....-- T4;Free TSH UrineMl!:ro,AbIInIrt/' '/J. 60049 BaslcMetabollc 84703 80054 CompretlensiveMetabolic 84702 80051 Elecb'lIlyteProlIle 83036 80058 HepaticProfjle 86701 80061 UpIdProlile 85610 S4460 ALl 84153 84450 AST 85851 85024 CBCIOIfI/PIt.CL 84439 82465. Choleslllrol 84443 82947 Glucose 82043 o BHlpallentfeeforservice ( YHHh ( i Ie I.L- I :.~ 1,< I j BWH~ . ~. 0_ 0...., j:lATHOLOGYTO: .0 SICIIl 0 PINN- 0 fISH 87797 GepPrdle 88150 PAP T..", , ','~;- PRoCEDURES: 92552' Audiometry. 57454: Co/poscopy 't7_DeslJucIIon,.{WartB)' 58100: EndomelriaMsplrallon- 93000 EKG ....1.....' 1.t~Excision(LesiQn)'an~ 82270 Hemoc:cuItlllt3' . ~,~~, lqll&nl ~quenl ,quant ... o BlIIpallentfeelorservice IN OFFICE LABORATORY: 36415V~oiheel-sIi:k 82947 G11lCQl1ll- IElHOUSE CAllS: , '<L- IncIsIcn&OraiJlage BOO" ",,,,,,,... "- Pregnancy,-Urine I ~ ,- ,847110 ..... PuJrnonaide. 87220 KOH..... 120 Repalr-Lacelation~ 8721. ...'" 4533ll - 87880 -SlMpt 14O1O - 94060 w/broncho 81003 O:UA 810010UAwJMIcro Pain 789.00 Cervlcalstrain 847,0 100M NIOOM Hemorrhoids, Ext 45S.3 ' Peripheral. Vas. Dis. 4<\3.9 Va91n1t1a. Condidol 112,1 'AP 7llS.0 Chest Pain. 786,50 eoimolloll 25Or01 250,00. ,High RIal< Mod V58.69 . Pneumonia 486 Viral Syndrome 079.99 706.1 CAD 414.9 Uncontrolled 250.03 250,02 klypefllpidemia 272,4 Post Menopausal 627.2 Warts lI18.10 JO I ADHO 314.01 CHF 426.0 Neul'l) 2S0.61 250.60 ' Hypertension 401.1 Rectal Bleeding 569.3 . N.M.J.. P,E. wlform \170.3 . lction 995.3 C.O.P.D. 496 Ophlltolm~ 250.51 250,SO Hyperthyroidism 242,90 Shortness of Breath 786.09 Routine Gyn. V72.3 nitis 477.9 Conjunctivitis 372.00 Renal 250.41 2S0.4O H~lhYroidism 244.9 Sinusitis - Acute 451,9 Routlne Gyn, (MC) 1172.6 300.00 Coumadin Therapy' 286.9 Dys. Uterine Bleeding 626.6 In uenza 487.1 Sinusitis - Chronic 473.9 AduIVAdol.., P,E, 1170,0 716,90 Counseling V65,4O Fatigue 780,79 IBS 564,1 Situational Stress 308.0 Infant/Child P.E. .. V20,2 493.90 Degen. Jt. Disease 71S.90 Gastritis 535,00 Lahyrinthitis 388.30 Smoker 305,1 Newborn P.E. Y3O,00 xtrinsic 493.00 ~pression 296,20 Gastroenteritis - Viral 008,8 Menorrhagia 626,2 Sore Throat 462 Family HX: DM V18.G 724.S Dermatitis 692.9 GE Reflux 530.81 It "'e Strap Throat 034.0 Hypertension V17.4 Acute 466.0 Dermatitis, Plant 692.6 Headache 784,0 U.R.L 465.9 CAD V17,3 Chronic 491,21 Diarrhea 787.91 Headache, Mi~raine 346.00 I~ U,T.I. S99.0 Colon CA V16,0 npaction 380,4 Dizziness 780,4 Hemorrhoids( nt 455,0 xtoma .......,. 0.10 Vaginitis 616,10 Screen Colon CA V76,41 _1_I_thru _1_1- Mo. Day Yr. Mo. Day Yr. LIMI'TATIONS INS"I'RUCTlONS: OK to relum 10 ( ) Wori< ( )School_I_I_ Mo. 0 Yr. UMTrAllONS: , " \:>, tl, tl.u.-:o DOCTORS SIGNATURE RETURN "EASON DAY OATE TIME '" DAYS: PM NG MAMMOGRAM o DIAGNOSTIC MAMMOGRAM WEEEKS: MOf'.lTHS: (:' ( ( "Uhf ( l. ( { UWh~ , lIS one day In llllVance ilyou are unable lO keep your appolnlmelll MlssinganappolntmenlwillfllsuRlnanolllcechBrg e. HMa/SFPIBFP FORM,1 (11189) INSURANCE COPY .--"-'---,-.-'-------.--- _.._._-~._----_._----_. - _.___-J .t r ~ CUMBERlAND-PERRY A.Y.T.S. 110 Old Willow Mill Road Mechanicsburg, Pennsylvania 17055 (717) 697-0354 C'.J:',1(Qm&l's, Ord~r f'b I Phon..l ~o .-"' . I/k~ Y ~ttt ( ') , I)"~ -II.~, .... Dat. r Ii! I'U SoJdtc Address '"'' rlJ~-I'~.~"';" :~ l tl-~ J ,f- .- itRJ ..):5"..+""., 'V "l"t.. \1 t~ . '$-&"'F ;;"'l.j . ~.---1--~.." ! po! . v14.L.. I I r-lec'd ,.'chda!mo and rolurno<i_dsMlJlIT ba ~nl.<l by lhi& /lillo, ----__.______._._..._._.._....___.._._.._.~._._;e:;:;~~.._......._._..._.._~_. Hi' a!!mll(f3R -~~E"C<;:l,tl"'t' Gtlll<lltln'J~, lrt~. 1~10 Prmlr,qmL!SA /flpBOYS$ Pet::,~ #21 61aerc;ARL1SLE P1KE MECHANICSBURG. PA ( REG #t Gi\SH I ER # '\ 842 TRX itlB4372 04/C4/00 13:21 **>1': On:ier :\!:1103341. Tomasello, T[CfrrEJI Me BEG AND ALTER I (:lS PREM!UM'-24/84 MO 41~7:~ 1 Cor'e -.1 Care CORE ALLOWANCE 1 BAT: PROTECT! ON SRve 'wi 1 REMOVE BROKEN BOLT *** ORDER END *** 4. i tel\"i~. SlJbtot,1I1 Tax rota I U* CHARGE *** CaSF1 Change CARD: V1SA ACCT: 4491100005713603 AUTHORIZATrON n: 206714 AUTO EXP. DATE: 01/31/03 TOTAL CHA,RGE AMOUNT: Nick *** 43.20 T ,49. 99 T 7.00 T 7.0Q...T 5.89 r 16,20 T 115.38 6.93 122.31 122.31- .00 122.31 (~flD HOLDER ACK~NWLEDGES RECEIPT OF GOODS A~IQ/OR SERVICES IN THE ,\MOUNT OF TOTAI_ SHOWN ,ABOVE ANDAGREEll TO PERFORI~ THE OBLlGArlONSSET FORTI~ IN mE CARD HOLDER'S AGREEMENT WiTH THE ISSUER. ThANK YOU FOR SHOPPING AT ~~r-'---(' .~.-~.,,,.. ~ ."12.....2...6 ~.,~.._"".,.~:,..,.-:,-':-,_-' --.~.'::,.1F:~-~.,. "'~':':':~-:::._,,'_ .,"'- \-. , . I Hi\..'D ICE l;;;, OO(;!l C (i'<I.. 1 :;,LEi: F' ,: 1M,. ICf'Ui."i.3, PI~ \ ) b~? 1-0~U~V j:'.1 :'t (! .:,"~ ~ t '::!','i::}:~;, C. ;:)2-~1 :L :L0334":~ GREG PI ECHAF:'D - ." , "-~r:-..OOtlSl1A!'E* . -'~jm/OOLF i'., .... "92l';;" ,'. ~~''i!: ..'... -. ~ tllR:ii78 '''i\1~~~5----;-'--' ------'I"H~~'" RIlTf:o'^H v"~W~RBllll!i<~03?,,23 4-1780 1.fll. SllIlC ',:,";.""" !:19F* 1 ~~~~ ~~l:mlAQE r~I-i:~RGE.~:S: I.r "'"\.1t :~..~r ;;;'m;;(IM,::n"~Il..~:'~';;;;:;:;;~;';'kNii\~ .tal!"! OU) f'Ar-fl'S ,':l.EaJ..!F.'sTE':D B'l' Cu.$T<.iMEW' :~ 00'"", ,Jlltlt :i':'M~?i!gf"'-I1'"~ rW;!.I!')'. CUI\' ,..:;>ft'iprl\'.ted, $rw(l(i'iJ") dlilllwl;l!\ ""il Hcr ~~;-~" j:~;~1~i~f.~;~lJ_~:~~::~I~;i:~~~~h;~~~, ~:'~ s(c' ':::,':;'~ ,-;-~ ~~;;7;:..~~.-.;t~ .~:_~ 'N~:r:wMTTi~T;~,:-~;;-;~~:i:!w~~--' f.i '":,,,I-::U: ,.", ':lc:mr ~Ml1W..' ;( PIC,"~'j~ X ,t , 7 ',/-,;A. ~, ::~~~(~J,;:~::T ~:~~~t\1 :1::::::~::::~~::'li~r4~~~;~r~;~~~;::~ ,SOl'; $ IIt;S.CQ} - U'tJiJ /~ : 1m NACiEfl: F(SO~.~-=~~~t"~1l ~.~_--=~~=~ ~!,~~/~.~:~_I,ll:.aM~=~,_.. ~~:~ER _~~ " -~ . '", ',,"" -if~_~' ..-;.., _" ; - " ,"I , EST IMATE'flwH lCI-! IS SIGNE!) BY YOU AND TliE ., ',,' :E AUTHOIHllEll AND BEGUN. I ACKNOWLEDGE' '"' " " ilNrR):,f~~~CJ~~ nils oI'Ul:!Ilf~LgsT~l'!i1!IE!)..,.~.f;lCg~;;..; ;,,;1':;'" i~~:~L~i~&0' , ~~..__:;i~:. ';':-' 'c' . _ . ,:::',;'>., ,~':c:",,~[': ..1-,,-, ,.. '.,'\.";;:{ , -:t~ ,~:,~ ". .:1> T '(t" t .'" W WASTE MANAGEMENT OF CENTRAL PA 4300 INDUSTRIAL PARK RD CAMP HILL, PA 17011 ' 17171 232.{l878 800 642-8850 717 783-8153 (FAX) INVOICE Acct No: 611-21634 Invoice No: 0061-0476901 04104I2OOO Page: 0001-0001 811-21834 NICK T TOMASELO 9 N STONER AVE SHIREMANSTOWN PA 17011-6341 Se~vice Period Description: APR MAY JUN 2000 0061-0476901 04/04/2000 Service Location 611-21634 TOMASELO, NICK T 9 N STONER AVE 1.00 CURB SERVICE 1.00 RESIDENTIAL RECYCLING 31. 71 .00 31. 71 31. 71 $31. 71- $31. 71 NET 10 DAYS UPON RECEIPT TO ITECElVE PROPER CREDIT. RETURN BOTTOM PORTION WITH YOUR PA YMENT IN THE ENCLOSED ENVELOPE ( ~'~""-"-'~"'-"-=""""""--""--!1'- '~IT;i!f!iJ/if!j .u.~."" '-'-~"'. ~t::~i"}"~:~;:R~~ J.~~i:~?~~m)~:",:'._...;~".~~~,:~~~' ~A" ~_1~~~~}~~'- I 03-08 PAYMENT RECEIVED - THAlli( YOO USO 03' 111523000069115000651712, ! YOUR PROKOTIONAL "URC ~E OF 12/29/99 ~ I HAS ACCtlttULA TEn DEfERRED f~NANCE CHARGES OF" I $14.79 WHICH WILL DE WAIVED 1F T E IPROHO PAYOFF BALANCE OF: I $307.36 IS PAID IN FULL iBY 02/0"/01. , dIIIE VGUIlSELF PEACE OF 11100, SEE THE Eill:I..'/ C~EnIN~ERT AND SIIlN UI' fOR THE :CHA I I'ROTECTIOfl PLAII TODAY. .IU~T ONE IIORE WAY Tn SEWE YOU DETTE:! ':'. "H a9~61p\1 EGARIl FLUS . -,,:"',-'~':,.'- ,-,,:.,' .... ,"-:i-:;.' ,-..:.:,,':,",..:.:-- ",,,-:~,,,\'.,:,,:.- ,," '.__3,q,6....9.L", ,__"........_....'O.IL_. .,.,.,.,.,.,._.._.,.,.....11.11,., .,.__.._..,'~oo ..,.,.,.,.,.,.,.,.,_..89.,..6.L, -.-.---.....--..---. ""~O,O,.,...., . SH; Ao~:;m{Ji'M:' E."rU,~J.\1'I0N (J!: ('(.'\]1;;;; (';I, EEVEiRSE Slct NOTiC,' SEE m.:vrl1siC SlDE F'OR !MPOfiTANT INFQB1MT;O~7 .......-.......,......--.'$ ..._,~_ __.....-~...,_,__.,..-_........~."-"""'.,"""'"'W-,.....,:,,...,..""_~,......'~ -"~."""__~,..__ The Marriage & Family Life Center 10 East Main Street Shiremanstown, PA 17011 (717) 737-5200 Bill For: Nickolas TOMASELLO 9 North Stoner Avenue Camp Hill, PA 17011 Dale Transaction Session Charge TolalOWed 04/12/2000 04/1212000 Previous Balance Individual Psychotherapy Payment $85.00 $0.00 $10.00 ($10.00) $0.00 $85.00 Please Pay this Amount: I $OoQOI Next Appointment </-/t? 'f~C)O Sally J. Tice Ph.D. Licensed Psychologist License Number: PS-003041-L Employer 10: 25 117 1260 o CHASE PAYMENT DUE DATE NEW BALANCE 04116/00 $2,018.61 MINIMUM DUE $40.00 Po", ~NewAdd~" ch':3:: ~d tek5phone numbor: Telephone ( 0399V NICK T TOMASELLO 2 PO BOX 3274 SHIREMANSTOWN PA 17011-3274 1...111..,111,,,,,,11.,,11,,11,,,1.11,,,1,1.,111,,,11,,,,1.,1 422581059900366500201861000040005 o CHASE NEW BALANCE $2,018.61 PAYMENT DUE DATE 04f16fOO TOTAL CREDIT UNE I TOTALAVAlLABLECREDIT I $6,000 $2,981 Here is your Account Summary: TOTAL P....vious Balance $2010.00 (-) Paymonts, Credits 50.00 (+) PUrchasos, Cash, Debits ,. . 2S.00 (+) FINANCE CHARGES 29.61 New ce 2018.61 Minimum payniorit Duo $40.00 ,". ~..' .-^-,..-, ~ '-~..': ,.'-~~'~:"(;.;.~~>..;;..:~,b:;';__,~_,:~'.. ~,,:;. -'.-' ;,,;,:1; y our ~l1arges a,nd cr~!i~tsat a.glance: R. ',REF~ DAm DAm NO. " .. 7,~ w ACCOUNT NUMBER: 4225 8105 9900 3665 Entor Amounl Enclosed In Boxos Solow $ DDD[h][QJIil] Please make check or rTIOl'I$y order payable to: CHASE VISA. Enn:l11Tll!/l i1 optIcIrml UfoPlu1. cre<:lllnSlll'J:nce.l~cknowJecJg. tNt insuunc./$ notleQlJkW ro olJbIin clOtH .net my d<<islon wh<<hor to purcMH tnsuunc. Is not oil factor In Cha~'s ~ ilPPfOwl. I have reld line! understand (lull ur.Plus c......~~an<lr2t s may YoIryby suro zs dlst:1o!lIdOll rM MWI~.' rlO y tOrrt'lacocDUrlf.lmaycar1cetatanytiM.(ECMl ~ IAL R 0 L1FEPlUS BirU1datlt P.O. BOX 15657 WILMINGTDN DE 19886-5657 1,,,111.1,,1,,1,1,,1.,11..,1,1,,11,,,1,1,1,,,1.1,1,1,,,1,,11.1 v\Lff1iD- . . _ _ _ P1e~e Qe!8CQ. ~ perfor.a.!.ion aflC;1 retum.wi1h your payment Your Chase Visa@ Account ACCOUNT NUMBER: 4225 8105 9900 3665 STAmMENT CLOSING DATE 03122100 DAYS IN BILUNG CYCLE 30 CASH ACCESS UNE $6,000 I AVAILABLE CASH $2,981 DESCRIPTION OF TRANSACTIONS , CREDITS' CHARGEs' PAYMENTTHANKYOU - ""', 50.00 MOBIL:, 09951914 > . '. 14.00 GLOBAl CHRISTIAN mwRK 702-8296677,Nlf . 15.00 '. .. ./_ ,,:'\".t; . :;irOlal 01 your credits and ch~;; . 50.00 '29.00 ENROLL IN UFEPLUS TODAY. THE:~~Y~EN~~PROT~.IQN P~ THA~-~MA~_ YO.UR UINI~UMMO.~HI..: PAYME~, ~E~ YO~.CAN,'T ~. "-:', EFFECTIVE APRIL 1.2000. YOUR TRAVEL ACCIDENT INSURANCE 8ENEFLT WILL BE UNDERWRITTEN BY AMERICAN NATIONAL INSURANCE COMPANY. QUESTIONS AND ClAIMS WILL BE HANDLED AT l.aoo.735-1408 (M-F 8AM-9PM ETl . 03AJ9 Q3,I)ll 03113 03AJ9 Q56Q Q3,I)ll. S101 03113 VZSM Here's how we determined your Finance Charge*: 'Q =1 ---; N ~ ~ 6 - iiiiiOOOi iiiiiOOOi - = -~ =6 :l ~ ~ I ~ ll: ~ ~ ,; NOMINAL AVERAGE PERIODIC I MIN. TOTAL ANNUAL ANNUAL DAilY DAILY FINANCE FINANCE PERCENTAGE PERCENTAGE PERIODIC RATE BAlANCE CHARGE CHARGE RATE RATE Purchases V 0,04904% $2012.98 $29.61 $29.61 17.90% 17.90% Cash V 0.05493% $0,00 $0.00 $0.00 20.05% 0.00% . - - iiiiiOOOi - iiiiiOOOi 1r Pleasa SGa reverse side for balance computation method and other important information. Q Questions about your accounl? Credit Card losl or slolon? Call Chase Customor Service 24 hours a day, 7 days a week,lolI-/reo, al1-800-441-7681 orwrito PO Box 15919, Wilmington, DE 19850-5919. Para Sorvicio al CIionle en Espafiol: 1-800-545-0464. iiiiiOOOi == ~ ~ ~ ;'.. .. ~ " ~ - - - - - Sond paymonts to: Chase Visa, P.O. Box 15657, Wilmington DE 19886-5657. ......IMPORTANT: Oon't forget to wrfte your acc;ounC number on YO<<.Ir check or money order -- never iS4iind caGhl Pago 1 of 1 r I I I PP&L, Inc. Electric ". Service..... ';' "',' . ~. . ":". .;:',"<-,' For: .' . . .N1CKT'I'OMASEl.tO, Y.9N'SrQNERAVE ..' . '. "SIlIREMANSTWlfPA riuu " ~\~;;,i,~iff~t . ~.~.t~""t;,i);t.t,-. .e:-:>;-,-s;;:'y..--,."" '.":', ".. , .' :' ~~,"-~ r~.,,:~i:-i;i~:~ j:'~,;.~;~~-~;, . . . ' uestions.aooilt . . . bill?, Please' . ., l~I~~i.~#gO" ~'to:~;;:~' . _,..JI!.er~~"" ~H:i."""'''p'n Rd.. '.' '. enlOwn. :A . . 8104-9392..". ,!~~~~Pl-~i~~: . i?:.Electnc ,),";'U"~-- . "'i.,', se --.' . "" ~ :; ...'.'f!ij; grnph.shows <.",yo!l!.electrjcl)Se . .... OVer the lasU3. . pl9'nt~. . J'ypes of Meter Readings: Actual _ Estimated _ Customer D " , 'llf' '....\...l:../~/ , , I'" pp J( "', n. Page I ".:. ': :-:+. :.Your' Bm Account- Num 24780-81008 ::-:-:....-:.:-..:..>:.Use'when:eaDfu. :or. writin ,'j Summary Page Balance as of Mar 30, 2000 $ 0.00 fg~d ENERGY POWERPLUS Charges $ 27.35 Total PPL UTILITIES Otarges $ 29.85 Total Charges $ 57.20 -~ Account Balance $ 57.W KWH - Average Per Day Meter Rcading Information Vlcter Mar 29 Mar 1 28 Davs 98694 97991 -----w3 2000 48F 25 Actual Actual KWHHlIled Average.. Mar Tem1!erature KWH Per Day 1999 39F 88 Yearly Use: Apr 1998 - Mar 1999 Apr 1999 - Mar 2000 Total Average Use Monthly 17478 1457 1098 I 915 MAMJJASONDJFM C. re /> ; 'I N'1-~ Months 2000 ( l{PD -(; 7)--- )48 ---------------------------------------------------~---------------------------------~-----.,------------------------------------------------"'---.. Other important information on baek -+ NICK T TOMASELLO PO BOX 3214 SHIREMANSTOWN, PA 17011 DfREC'IV . P.O. 80:<9001009 LOUISVILLE. KV 40290-1009 1,..llI,..II!..""II",!III",! !,I"I!I"",!,II,!"II,..,..IIIi""!I..I.!,..ll,,!,I,,,I,,11 0000000000000000010590915 4 0028 00007412 00007412 5 ~I - -- -- --- --~ -~ --~ -- -_.~ - ----- ---- - ~ ----- ~.-'-- '-- - -- ----- - -- -.--- --.-,-- -- -.- - ---- -- -- ~'- - --, . , , LOWER ALLEN TOWNSHIP 1993 HUMMEL AVENUE CAMP Hill, PA 17011 TBl3'HONE: 717/975-7575 BilLING PERIOD: PROP. LOCATION: BILLING DATE: . 0-4/0:IJOo THROUGH '~06/30/qO <1 . N.. STONER AVE ....., . .. .' . 04/0t/OO<PAY GROSa,.Af"TERtft,iIS ". 'c' ",' DT 05/01/00 .,] '--+.' ,"'",>"~"'" ,;.,; -,.,,-' .~.:~,.',~., GRO~S ~6.40 ACCOUNT NO ;01-3620.30() SEWER r"'''''' '-.", f~l;- *** TOTAL DUE :?"6.40 *: ,,~. ''''';':''''''.>''_' :~:':Af~ - ;', '?~ ,;. NICK TOMASELLO ANGELA TOMASELLO 9 N STONER AVE SHIREHANSTOWN PA 17011 . -'~"": " 5_\' _ A 1~ENALTY 9~ SEWER AND A10%PENAlT" O~~EfUSEI:':mD~D IF FULL PAYM~~S ~o~ll~~ITHIN~ DAYS'OF BIlJ.ING;d- A. Cll1COtta, M.D. Clncona. M.D. I M. James, M.D. Schwartz, M.D. . Wenner, D.O. t S~er. M.D. -1. Skl..lrcenskl, M.D. h A. .Alwine, C.R.H.P. J. Hough, C.R.H.P. Polson. C.R.H.P. Johnson, PA.c TE ',s""_ :~.~':;' " /'ZI0 , ., ~"~"'" L1C' MD-01834l-E (PAl LIC' MD.017634-E (PAl LIC. MD-D228B4-E (PAl L1C# Mo.o3953Z-E (PA) LIC' OS-005483-L (PAl L1C' MD-082206-L (PA) LIC' MD.Q6659Q-L (PAl LIC' VP.Q01525.B (PAl L1C.SP.Q03098.B (PAl UC# SP-D03053-C (PAl L1C# MA.Q00739-L (PAl !::t:/'tici!lI~;~~f;,,,. ~ti.nt has a $5 copay. OFFICE YJSJTS ESTA8J.JSHED 99211 Nurse ~ed' 99214 Extended 99215 Ccmprehen 80612 GYN (00) 60101 GYN (Me) QOO91 C&H (MC) PREVENTIVE ESTABUSHED en Mecl (MA) EPSDT ncier1yr. 99391 thulfI,1yr. -4yrs. 993921-4yrs. -11yrs, 99393 s,11'yrs. 2.17yrs. 99394 12-17yrs. B.39yrs. ~ 1&39yrs. 0-64yrs. 9939,(140-64yrs. S&over 99397 85 & ovel-' . SERVICES: ( .)- HSH, Camp HiII_ ( i H~ Hap Dates: __.L_.....J~ To__1-_-1_ litia1 ' ~t~' _ :>ubseqlJenl 994as NB(H&PIll$:h) ,ubs9ljll8nt 99433 NBSub ,ubseqlJenl )ischarge terHollrs llited 'ermed (telldeCl ""',,,,'''' 1N(BS) ~058 B:rrierg. HOMSJHoUSE CALLS: JME: ~" ~ o BOWMANSDALE FAMILY PRACTICE ~PHEROSTOWN FAMILY PRACTICE 1 KACEY COURT, SUITE 101 ~ 214'0 FISHER ROAD MECHANICSBURG, PA 17055 MECHANICSBURG. PA 17055 A (717) 591-0961 (717) 766-1795 , - ~ (' IAllWNJIHJ: 904-71 Adm.Fse 01 90472 Adm.Fee 020304 90748 HIBlHepB 90700 OlaP 90713 DIPV 00707 MMR 90744 HepB.5(G-10yrs) 90745 HepB.5 (lH9yrs) 90746 Hep.B 1.0 (>20yrs) 90720 DPTn-lIB .,... Lyme 9Ol16 Varicella 90118 oisr 907020Pedcp' ~ ........ -- 95tt5 Alfergy 01 95117 A\lerw -02 0304._ """ ,""""" ...... 'l'T'" l c.~ PEAFORMED SY: 0 HMO OSKBL OQ_ 37155 ( 9071~ 0 ropy 80049 BasicMetaboIic 84703 80054 ComprshensIvsM6tabalic 84702 80051 ElecIrolyteProliIe 83036 80058 HtlpaIIcProfIIe 88701 80061 UpidProll1e 85610 84460 ALl 84153 84450 AST 85651 B5024 C~.Gt 84439 82495-~ 84443 82947 GlUcose ~ QBiBpaIi$leelor~ { HHH ~ -er t (' PA~r(t DSlCBL:/'ORtot OHSH. ,8ns7.GenPn:lPe . .~150 PAP< . TISSUe O,Bu..-_irtf~:fqrseNice. iii omc.e lAIlIiIlATOIlV'. . 36<l-15Ven~orheels1ick ~t G.... c'. 8llQi18 Hemoglcbin 84703 PregRanc:y-Urine """ KOfi"". 87210 salioe . ""'" -.... 81003 OUA 810010UAwJMiao CASH CHECK CARD ( " PI!lPC~U~ -~ . ~454~ ,;, 17_lJestiuc:IIonlWi(ts~' " 58100 ~~,~tralio:n 93000 EKG_wifh(n~ "5", "- ......(-~ ~ ~ HemocctiItDl:3 , 1Q_looision&D~ 't 206_I11PI'l-Jolnt' , 94664 Pulmo.1lBIde 120 RepeIr-L.acera,tio(l~ 4S33O Slgmoid-F~ "1 94010 Spirometry, 9406O~!broncbo OPINN 0... C HHR C , HCG Beta Ql HaG Beta Quant Hub A1C HIVScreening ProTim&JlNR P5A Sed. Rale,WesIfl T4.F~_ TSH ~ririe""_' ~,~_,-.,,~c,::. t ( D~ 'GP.$G ~':,< /( " ( ( H ~ <.. ( ", , ( t. I Wf i Inat Pain 789.00 Cervical Strain 647,0 100M NIOOM Hemorrhoids, Ext 455.3 Po"'*eta1 Vas. D~, 443,9 Vaginitis, Candtdal" 112,1 lal PAP '795.0 Chest Pain 786.50 Conlroll>d 250,01 250.00 !llgh Aiok Med V58,eg P~ 486 Viral Syndrome 079.89 706.1 CAD 414.9 UncontroUed 250.03 250.02 per1ipldemia 272.4 PosI M.no~ 627,2 Warts 078.10 314.00 I ADHD 314.Q1 CHF 428.0 Neuro 250.61 250.60 ypertenslon 401.1 Rectal BleQd11l9 58as N.M.!, P .E. wlform '170,3 Reaction 895.3 C,Q,P.O, 496 Ophlf1aJmlc 250,51 250.50 Hyperthyroidism 242.90 Shortness of 8i'eath 766.09 Aoulina Gyn, '172,3 Rhinitis 477.9 Conjunctivitis 372.00 Renal 250.41 250.40 Hypothyroidism 244,9 Sinusitis - Acute 461.9 Rou1Ine Gyn. (Me) V72.6 300.00 Coumadin Therapy 286,9 pys. Uterine Bleeding 626,8 Influenia 487.1 Sinusi,t1s ~ Chronic 473,9 Adult/Adoles. P.E. '170,0 716.90 Counseling V65.40 Fatigue 780.79 IBS 564,1 Situational Stress 308.0 InfantlChild P.E. V20.2 , 493,90 o en. Jt. Disease 715.90 Gastritis 535.00 Labyrinthitis 366.30 Smoker 305,1 Nawbom P,E, V;lO.OO [ - E~nsic 493,00 Gastroenteritis - Viral 008,8 Merrorrhagia 626.2 Sora Throat 4B2 Family HX: OM Vf8.0 ain 724.5 a 692:6 GE Reflux 530,81 Qbeaity 278,00 Strap Throat 034.0 HypertensiQll V17.4 ilis - Acute 466,0 Dermatitis, Plant Headache 784.0 . Osteo~orosis 733,00 U.RJ. 486,9 CAD .' V17,3 itis - Chronic 491.21 Diarrhea 767,91 Headache. M~r~ne 348.00 Otitis edia 382,00 U.T.J. 599.0 Colon CA V18,0 ~n Ill1paction 360,4 Dizziness 780.4 Hemorrhoids, Int 455,0 .tis Extema 380,10 Vaginitis 616.10 Screen Colon CA V7il.41 _1_1_ thfU _1_/----..:.. Mo. Day Yr. Mo. Day Yr. ULr LIMITATIONS INSTRUCTIONS: OK 10 retum to ( ) Work ( )SchooI_I_I_ ULTll: Mo. 0 Yr. , SEAV LIMITATIONS: IOSTIC '" ,ENING MAMMOGRAM D REASON RETURN DAYS: o DIAGNOSTIC MAMMOGRAM weeKS, MONTHS, :? 101m us ohe tIlly InSdvllliCllllyOl,lIll6Un_lOkllellyourappoinlment. Mi&sIngan~lWIIwlllleaultinanotflt8.cl'Wge. AM PM I ~: ,! HMGlSFPIBFP FOAM _I (11199) _________ __,.-J;- Bill For: Nickolas TOMASELLO 9 North Stoner Avenue Camp Hill, PA 17011 - The Marriage & Family Life Center 10 East Main Street Shiremanstown, PA 17011 (717) 737-5200 Date Transaction Session Charge Total OWed Previous Balance $0.00 04126/2000 Family Psychotherapy $85.00 $10.00 04/26/2000 Payment ($10.00) $85.00 $0.00 Please Pay this Amount I $0.001 Next Appointment Sally J. Tice Ph.D. Licensed Psychologist License Number: PS-003041-L Employer ID: 25-167-8260 ---. -..' "~ O~I~atE :ESC , ~AXES i:)1Jf . ~NO i~VABLE 1"liOM: ! '"' coo. ,oma:. j HOURS: I F.NClOSE ~ ** TAX COLLECTOR . . ~.~..':~i:;;th COpy ,!!.,*,~~~~ JUDy C. PROWELL 211 E. CHESTNUT STREET SHIREMANSTOWN, PA 17011-6763 JOB TITLE POLICE CTL 37 1771 SSN 207-50-3656 TOMASELLO, NICK T. 9 N; STONER AVE. SHIREMANSTOWN PA 17011 3/1~"5/1 TUES 7PM-9PM THURS 1-3PM &7PM-9PM << 4/28 7PM-9PM MAY TO NOV 1 THURS ONLY 7PM-9PM AFTER 11/1 BY APPT ONLY PHONE 737-2193 F ~Rt.:lf=j:~J:f\_' :': -:ILL-DATE 3/01/2000 2000 PERSONAL TAX NOTICE COUNTY OF CUMBERLAND ' BOROUGH OF SHIREMANSTOWN' UNPAID TAXES SUBMITTED TO EXTRA COPY $1. 00 PER COPY VALUE 300 " ASSESSED VALUATION DESCRIPTIONOF ~ .. CNTY pic ;. MUN pic 5.00000 5.00000 . ~ .: CNTY PIC .. MON Pic 2.0% 10.0% 2.0% 10.0% BILL NO 1118 --'-~--... DELINQUENT COLL 12/15/00 4.90 4.90 9.80 DISCOUNT 3/01/2000 TO 4/30/2000 5.00 5.00 10.00 FACE 5/01/2000 TO 6/30/2000 5.50' 5.50 11. 00 PENALTY 'I AFTER . 6/30/2000 I "r.",,"", .~~". . '.>l\t't , -- , ""I ';' ~ -_I, -JJ Page 1 of 7 717 737-2411-111 38Y Please make Di'!',IIlE!t\t"to. BeHAtla,nt,l,~~" AP~j.l. 1,2000 H:,:~'. 'and return'thfll:"D8ge"wlth your- Da,ymerJl',,';:.':>;;e>/. ,':,..."., " .:;,>;,,' , . ";1': '. ';,~, . Due Date May 1,.2000 . . . . . . . . . .. ., j):. . . '. :$48:14 "ie. ..'. ..... ..... . >,$. .F~1);,l~l . LIST 'OF SERVICES INCLUDED)' Fill i~~tP'lttd S~.'~.;;:;~:. F..,~~""'.."'f{1r~ "'&~l.fII. W L+J PO BQx28000 ehighVly. PA 18002-8000 NICK T TOMAsELLO 9 N STONER AVE CAMP HILL PA 17011-6341 1,..11I11I11I11I..,11..,11,11....11..1..111I1111...1,1..111I11 f~ lD9717D73724111~~28~~ ~ r L [~I DDDbDDDDDDDDDDDDDODOD4814DDDDDD R21 028 J .., ___~--A. MORTGAGE STATEMENT ...... ..... NORWEST MOr.rn"iAGE' ..... ....,... COJ"'l'esp&W'Tdenc4t Addre.ia: NOl'west MortglJgt~! [nc:. Correspondence R0SiC!utio!1 X2S0 I -01 T 1 H~:ll'ne (amplE-; Ds.. McitH~':. It.. 50:3'28 Account Informafion: LOAN NUMBER: Stakmt'?tl Datt': 5291292 03/09/00 7.250% 05/01/00 $750.53 $ .00 $ ,00 $ .00 :. \,'itfiTI..l'::'i FJ\_H(K)\.,""'".>r', Imn!,'!it Hi~U: Customer 5..."1...1'11,,,,.. It: (8001262-5294 Fox #: (5151237-7070 TTY DoafIH".d of He"rlng #: (8001945-0399 NEXT PAYMENT DUE DATE, Currou PI.1.rmf!nt, 05/01/00 Pas! Due Payment{s) t.l.te Clw."',ge{s) Oiher Charge('s) jlBWNDXCT #6880005291292036# NICK T TOMASELLO ANGELA M TOMASELLO 9 N STONER AVENUE SHIREMANSTCWN PA 17011-.8341 1",111,,,111,,,,,,11,,,11,11,,,,11,,1,,1,,,1111,,,1.1,,1.,,11 009745 Ton.L AMOUNT DUE Where to Send Pa ym.nts~ Regular Moil, Bod71393. Pin,burgh. FA 15250-73Q3 Ov.might Moit 666 Wolnol, MAC NBZOO.,044 D~"i Moines, IA .50309 $750.53 Proporty Addr'l\tu: g N STONER AVENUE SHIREMANSTOWN PA 17011 Actlvl Slnce'll'Qur Last Sta...m nt Dot.:-' .- ::-r1~lcrf~it~"~;: ":':"";".'''':'fri~'ai''''<.,,:-.,, ... 03/Olt. P'/IlNTTliAl<< roo 00/03 PMIIFIIlI IllS ',".C'.-,,' .,'" . ..~ ,":;":"" '.C",,-,',',,_,"_:.'. ~ ":"nlidju.tl Balrm,ce * :;'5,- -of 03/09/00 .,': $'1111; 7411. 5S . This Is If""" .1"uer:~1'- Paid ,:,::,:::~it$(:~ati;-:naian;:e:':: :":".-,:- -"- ," Yeaf leVa,. .. ..... :':'M'Of:P3/Q<1/00 .' ". . ,51;811 ~fl7 . .. '.' ..' $'1l811;n Prlnc'lpal Balance only, not the' amOunt' rooqt,lrGld 1a..i!$"i>aid." ": .Yciii.t"Pilu" .:s,';~..,. ..,...' to p.aYYOUI" loan Iti fuTl. . Impt)rtant Menage. '.' '. .... '.. . . Next month, on April 17, Norwest Mortgage, Inc., will change its name to Wells Fargo Home Mortgage, Inc'j to reflect the strengths and heritage of our parent, We 1 Is F ar'go & Company. On 'lour name i" chang i 1'19. We rema i n comm; t ted to providing the Sllper..,r customer serv;ceL convenIence, and new product and service offerings on which you already depend. rlease continue to make payments payable to Norwest Mortgage, IIlC" unt i 1 Apd 1 17. . ." . (Kmltp ~~ppf.<f pt.rtwn llJf t.;:.ur t~~l,d.~.) COO42.~Me..~,v.aa~ tI'WWMl'lIXlll 0002406 394J;J;3UlJuuuUUUUlJUUU l>UUUJ. 't ~~:~fJ~~;:,=~:m.~~CJll~_ 2() East Union 51 Wilkes S''''T'', Pa. 18701.2715 f)V' Fot Servic" To, 9 N SteHle' AV'f/-x:...J1CiL f\)l1 ~\.; ./....) rrU ,)1 AMOUNT PAlO \ L \ tV'V' I 1...IIi...m......i1"'II.,li...I.n...I.I..m..:JI..I"I.I. IJ / le,3se mlum Ihis p. ",lion will, clWCK or 7~ I. mo,wy ",d", paY;Jble /0 PAWC Hick r Tomasello i)' PO Box 3274 Pennsylvania-American Water Co ShirE,mal1"lown, PA 17011.3274 PO Box 371326 Pittsburgh, Pa.15250-7:l26 4CCOUNT NUMBER 2!,-()63941.6-3 AMOUNT DUE $1. 00 DUE DATE May 133, :lOOO L..)I- (l-C,(; ___ 1...11,1.1...1.1.1,1.11...1...1..11...1.1.11..1,1..1 -- --- /: elliJi~!ii::j ct1!,;.<<>A n",lUJ;O <lad r.:..oU;~r EII"J.i'W' ;:ontfroolion te, yvlJf wonlNy I:'~I! ........1 or f.::;. eJKlllgf) )'",lUf .,uk)rt1'i>S Of liih'liif.ih<m,;; ,mmbOf, o!<.1d ptinf ml1:m~tKm on r,"v,.)fse side. Customer .Account Information FOI'.Service To: Nick TT<ll""""Uo . '. .' .... " c.>9 N SIO""I' AVa, ' '.' \\(foounfNo.iii<b0t:24;~!l i)Pf..ijj"'/ifiiomwiZ4,~ '. . ,..8ii'ing smn,m!2' .... "i".\;,i;,;~i;~~~il"(Si'2~1"'. ..,-, . .-.,- -. .- - ---. '~:""-'~---, $26.29 I -5?.!..;H! -26.29 9.75 _p~?.l 27.26 ---".Q;1 .03 '--:--=-~}_:_~1 . , : - , . . . . Hi- - , "-" -,,-", , ., ,_. ':,:"-"" ',.' ._, . c:.L~l . .~, . 1",' l. '-~~J ~' p..,; ..... r CclnttoI_ --. ' ,0 .r2 fi . OMS No. 1546-0008 b~ldIntiftcatJon_ 23-2934299 · Employ.... name, $ddr_ and ZIP .- Genda~me Investigations -&300 Aubtirl1' I:h'lv~ M~C,h,~~ I fsb~r,~., ,Pa. V:()~~ '.- ,~. ~. " " -~-(H '"j.'" -iC'<- '. "..., "-" . -~i d' EmI>Ioyee's_~I1llII1ber"." "c, ,;c.,':":"" 0':,# .0,', n ,'fl)'1'''150'.li3fi.5i6'oo,< ': "Be',; i<'~S',,, .);.! . eEma/avM's "'8dGl'osi, aiwt' ," ..,,. .. ,0... .J8I.s:;or~;"~."i' "'t)it.' .~JA. ~'~,*,:J-"i C~;, 'i-o,';;;,'? ;:~or :';'d'1~ 91".0$1:'0 ;)/.91dsm V~'" ,':tlICi.i;!liW cuT .~ .db'! tll'La a"o~:lIJtta"i. 4lJJ>C i '0' "N.. Sto"erAi;~ftlm'JfJ"". . . '.' . $Ill~...nst~.b;. .,.- '1,,~.:t1t),tt. . -.' "~~l'A~t~:~7~~:it~j,,,."";"" -~'-'~t.\~;;, ::'rt.~~j~<';:~;'~i~j'i3:i.~;.i~~~:~l;~-'i~';...~'~~~~;;":" . . "..~ ". ..;" '. ',~-.,,;- . '. '/, ~ -". '!W~2 w.,... TlIll statement " ~' -,>.,.,,..-.,..;1.',,1:...,-, v.o::.'~ oM!""..", ,~ .' .J :;.....: ;/:~ ..t '-..'. -- , , , .;....r.\i'._ ;.. ,.~"~ 3 Social security __ ?68 no 5 ___.anclllpa l68 ;00-:,' . 7 SociaJ ~ t4>a ~ 4 Sacialoecurily lao\wjtl1jloId . MedIcate Iaxwllllhold :, '(' ,. '-. ~~. ~,' r" ....~:tlp;f:;I.:- .;.,.... . .~ . :8'...'br'~ .~;";\ ~.:,'n. ." -lfr;~-::U';~ '(';0:r;:j' .'1f> ..,.,~:. ...")y :.)~.: .~-u 14. '~8~~'~'~ -;-'Ei '!J(~'": ;1 ,-,,/.:..; j!;j' m!6K:: ",t;.. 'r ':,!,)r~ ~'U '''';-'. 1~ r-t _____.................. "J; _I..__',_"':~ _ o CORRECTED (if checked) o CORRECTED (if checked) PAYER'S name, street address. city, state, and ZIP code 1 Gross distribution SUS;j:.JE;<4~li.,'" ilM4C;iMb:~ -~tS ~~r~/~~UITY A~~ i4 ~ORT~ CeC~~ ~TRE~r U UHf i"!:Ni.;,t~~M.r oil. 1150....~ S 100.;) 2a Taxable amount $ 700.0~ .. -.,.,.".,. <~'-;-;i~' :~'~'- .~> 2b Taxable amount not detelT!llo!'P 0 . 3 Capital gain' (included in box 2a)' PAYER'S Federal identification number 13-Z 7'18219 RECIPIENT'S idonlification number ' . 1 ilZ-t,,)-HS Jo $ :RECIPIENT'S nome. stnlol address [lIlCludlng apt no.), city, stale. and ZiP code 5 .0 $ Employee contributions 6 or insurance premiums '.........1 I OMS No. 1545-0119 Distributions from Pensions, Annu:ities, Re~~reme:nt or !Profit~Shmii1g P~1ans, ~RAs, ~nsur'ance Form 1099-R Contracts! etc. Total distribution ~ 4 Federal income tax withheld CALENDAR YEAR l'i'9~ Copy C For Recipient's Records 14 Name of locality $ $ $........................................ .......................................... $............................-. .Q!e~!!!!'_~.t ..QfJ:he Treasury - Internal Revenl!e Service . Form 1099-R IKeeD for your records.) " . L '< ~::: , ( ; W.2 ~;:t'::.r'" 1999 'fit' ,..lnq Act.... ~ -....cu. act..uce ......-.u iftItrucUont ~.... Ill140 l\wrtellftt.f _ fr_7-lftt.-1I81 __ Senllu .... 1...... tCllltl'ol,..,.. T 22222 T ....1. "'''''' 001166 o ....0ftI, copy 2, FILE NITB STATE IIETUIIH bpi..,..... WlnU'1crthIl ..... 1 ...... u... tUlIr -u... If.....I~tllldtllMl. 23-23626" 10 Z33.IoS 160.29 _I'''''' ..... ........ .. u, c* S hoWIl .....ltJ .... " s.c1rIllal;IWltJtllllIlttllleJ. COUNTIIY IIEADlIU AlISOC 10,233.105 262.107 HERSIIBY PA 17033 I..."CII'..........~ , 1MlcIr. t.. II1ttNJd It)233.''5 61.101 (.1.....' _1111 UCUI'!tJ .... - r-"I.....' dbtr1lllrt1_ codI 1 seclll_1tJtuS . AUMetM u.. 182-60-71t53 ~1"",,""(f1rtt.ddlIl'.IA1t1eJ.J_) , ...,...IJClIQMlIt II DIMIldInt __ "-Uti 11 ......l1flN.l_ II ....UtI1llC1IldHln...l IS SM Instn. fer ... LS 14 - AHllBLA II TOlIAllBLLO AHllBLA TOlIAllIILLO 9 NDII!II 8TOIIEII AYEIlUI SRIIEIIAIIImIIlK PA 17011 IS_ - ...... "". ,,-.. ...,- ". ... - , ~JO>>M" ...... ... ZD ... ,,- \E-I...... nau I.D. ... 11 ~ ..... un. lite. 1tS~w..ta l' ~q hIM .Loca1......t1fI..tc. Il.oal!nl:OM ta PA 23-2362679 10,233.105 118.53 NSTBBD 10,233.105 102.310 - . ----- ---- - N'''j"~. "P'. "In~, c.omp. , F".!.,.,! '"COm9 ,... ..'lhh.hl I 1.715.,33 70,93 Social "~UI,'IY ".'1'" . SacI.1 S"cu,ltyt.. ",ilhh.ld , 1.905.S5 11S,18 "'.d.ca."...,,'l'" and liP' . Medic... t". withh",ld 1.905.S5 27.82 Conlrol numb., I Depl. Co,p. I Employ.. un lInly 24915 ::mploy.'" rI.m", "dd,gn. ". ZIP cod. lEIS MARKETS IN~. :000 S. SECONO S .. P.O. BOX 471 ;UNBURY. PA 17801 Emo'oy.", FED 10 numba. d E,"ploy.'$ SSA "lImbu 24-0755415 182-60-7453 $oc,..I.IICUfi'yl;ps . Alloc,ft.d lips "-d".rlco EIC lI"ym"nl 10 Oopond"nt can boulits Nonqualiliodplans 12 a.nlllin inl:ludlldinboll I Su In.t,s. for bOll 13 " Othe, 190.52 I) ,$t.. .mo. I O..n_ r -.'; Orb 1.0,"1 'OIl. f o.I."t4X ~m.. 'f Employ.....' IIam_, addren, and ZIP code ~GELA M TOMASEL~O 1 NORTH STONER A ENUE SHIREMANSTOWN PA 17011 6 Stat,,!EmploYlr'S Slatlil ID 17 Stall wagn, lips, .t~. R! >A 24-0755415 1 905. 5 8 Slalo incam. 1.011 1 ~1I~~~ity ~unll 53 35 W T RE TAl( .v Laca wagr' 905 :185 " Loca Incoma tax 19.06 Employee Reference Copy W 2 Wage and Tax 1999 - Statement :opy C for employee's racords, OMB No, 1545-0008 ",J- ',~ ',,: 1999 W-2 058-01-05392 ANGELA M TOMASELLO 9 NORTH STONER AVENUE SHIREMANSTOWN PA 17011 Wagn, tips, other camp. 2 Feder.1 income tall withheld 1 Wagn, tips, othar compo 2 Fadaral inlloma tall withhMd 1,715.33 70.83 1,715.33 70.83 1 Social sacurity wagas . Social Sacurity tlla wiIIlhald , Socilll security ..agn 4 Socilll Sacurity 11IX wilhhald 1,905.85 118.18 1,905.85 118.18 i Madicara wagas and tips . Medicara tax withhald 5 Madieara wllgas lInd tips . Madie.ra t.x withh.ld 1,905.85 27.82 1,805.85 27.82 . Control numb.r I Oepl, C.... I Employ.r usa only , Control numb.r I Olpl, Carp. I Employarullonly 24915 24815 \ Employar's nama, addrau, lInd ZIP code , Employer's nam., addras$, and ZIP cod. WEIS MARKETS INC. WEIS MARKETS INC. 1000 S. SECOND ST'1 P.O. BOX 471 1000 S. SECOND ST'1 P.O. BOX 471 SUNBURY, PA 7BOl SUNBURY, PA 7BOl b Employar's FED 10 number d Employ.a's SSA numb"r b Employa,'s FED 10 numbar d Employ..'s SSA numbar 24-0755415 182-80-7453 24-0755415 182-80-7453 I 7 Socill ueurity tips . AlloCllad tips 7 SOCilllllluritytips . AlloClltld tips I 9 Advanca EIC paymant 10 Dapandant cara bln.lits 9 AdvlnCI EtC pllymant 10 Dopondllnt carl bUlfits I 1 Non'lualifi.d plans 12 aanalitsinllludadinb.ox 1 11 Nonqualifiad pltlns 12 atlnafits includlld in box 1 " Su Instn. for box 13 ,. Oth.r " SOIIlnstrs, for box " " Olhar 190.52 0 180.52 0 'S$IOI.",. lllK....,lp-'~I>I.R """"_ I OIIt"ocIX""'''' "Shlt.",JI. ]Oeca.....l""'..;..... L.,.I..... I Ool'''ocIX<<l'''''' ~/t Employu', nlml, IddrlS\, IRd ZIP coda all Employll." n.mll, IddrlSS, Ind ZIP cod. ANGELA M TOMASEkLO ANGELA M TOMASELLO 9 NORTH STONER VENUE 9 NORTH STONER AVENUE SHIREMANSTOWN PA 17011 SHIREMANSTOWN PA 17011 , 6 SIII.Il;.~ployar" SIlt. ~1,I.. If ::.1.1. waglS, lipS, tie, !..1S.Slatale~ploy.r'S SUI. 10 I St.t. WlIgllS, lips, ate. PA 24-0755415 1 905.85 PA 24-075541S 1 905.85 18 SUI. ,ncoma tn: 1':j. Locality n.m. lS Stll. inlloma I.. il~..Localjty n.m. 53.35 WEST SHORE TAl( 53.35 WEST SHORE TAX ZU L~c.1 ....'T' 9()S :'85 Local ,nllom. I... ZO Loul wa91s, 905 :t85 I.~CII ,ncorn. ". 19.06 19,08 Federal Filing Copy State Filing Copy W-2 W~:t:~~~:X 1.~e~ W-2 W~:t:~~~:X 1.~e~ C"PV ~ l<I ba Iliad .Jik .liIjllo.y..'1 Fli.OERAl Inco"'. Tn "aturn Copy 2 to ~'__,!jl!d ~jt~_ .rnp'!oy.'" ST~TE."If\~orna Tn. Allurn ~, - .~ . .........J~ -~'M"i Employer's,ldentPlic,tlon Number ( Irol Number 1 Wage&, t-ips, 01h.r C1ompensr" "'l 2 F.dlllfal income '" wilhh.la 23-21'12'299 I 011-04403 . 32.454.15 .... 2,774,10 '.' Employe,'!! nalTte, address, and ZIP code 3 Social security wages 4 Social security ta. witl'theld COMMONWEALTH OF PENNSYLVANIA 34.145.04 2,117.02 DEPARTMENT OF CORRECTIONS S Medicare wages and tips , Medicare lO. wltl'lheld HARRISBURG PA 17120 34.148.04 495.09 employee's Social Security Number 9 A.d'ltllncG E.le Payment 10 Dependent ellre benefits 207-50-3858 . .' '. , Employee's name lfirst, middle, last! 11 Nonqualifilld plans 12 Benefits ,nCluded in 80x 1 NICK T TOMASELLO ............................................................................................................................................. 13 Sa. lnstrs. fo, Bo. 13 IS Deceaud Pension Deferred 9 N STONER AVE Plan Compensation SHIREMANSTOWN 0 l2J 0 E.l:i\\Oy.1.7PIJd'." and ZIP code r 6 Statel Emplover's 10 No. 17 State wages. liP. etc. 18 State income ta. '9 Locality name 20 Local wages. tips. etc. 21 Local income ... I..........'...............,.................. -... ............................................. ..._..............N..................... ................................................................ ................................................. ...................................... PA I 23-2172299 34.148.04 958.01 SHIREMANSTOWN BORO 34,148.04 341.45 .. ..arm W..2 Wage and Tjlx Stat_nt 1999 COPY 2 - TO BE FILED WITH EMPLOYEE'S STATE Department ot the Treasury. Internal Revenue Service INCOME TAX RETURN OMB No. 1545.D008 This information is being lurnished to the Internal Revenue Service Employer'S Identification Number 23-2172299 Control Number 011-04403 i.~li~I!;!~1:i~~ii2'~;;, :ii-~il~li~llllilll~illl;.. Employer's name, address, and ZIP code COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF CORRECTIONS HARRISBURG PA 17120 3 SOCial security wages 34,148.04 5 Medicare wages and tips 34,148.04 4 Social security tax withheld 2,117.02 6 Medicare tax withheld 495.09 Employee's Social Security Number 207-50-3658 10 Dependent care benefits Employee'S name lfirst, middle, lastl NICK T TOMASELLO 12 Benefits included in Box 13 See Instrs. for Box 13 15 Deceased Pension Plan Deferred Compensation 9 N STONER AVE SHIREMANSTOWN E.l:i\\Oy.1.7PIJdr... and ZIP .od. 13 State Employer's 10 No. 17 State wages, tip, etc. 18 State income tax 19 Locality name ..............1...........................__... 23-2172288 ...............34.:.148~04'..... ...-..............-tis8.:.01...... .sH'i'iliiwisTOWN'..BORii...........,.. .............,.....-34:..;.46:04.... .............341.:.45..... o l2J o 20 Local wages, tips, etc. 21 Local income tax PA Fo,m W-2 Wage anc:l TjIIlC Stat_nt 1999 Department 01 the Treasury. Internal Revenue Serric. COPY B - TO BE FILED WI1'H EMPLOYEE'S FEDERAL TAX R~t~J:-~atiOnISbeingIUml=::th~':i:::IRevenues.rvic. 460431 056207 011 103 36539 207-50-3656 , - SUMMARY OF EMPLOYE PAYROLL OEOUCTIONS FOR CALENOAR YEAR 1999 ( " .- , Your payroll record for the calendar year 1999 shows that you had the following deductions from your gross pay. The amounts shown are a year-to-date total for each deduction type listed. DEDUCTION TYPE FED WTH TX SOC SEC/MED TX LOC WG TX-RES RET P/U CON Instructtons: IAlso... Notice to Employ.. on back of COpy BI lox 1. Enter this .mount on the wage. line of your 'llIt return. 80. 2. Enter this amount on the Federa' income f'X withheld I ine of your tlx return. , lox'. Enter thi, amount on the advance earned income credit prime"ts I ine of your Form 1040 and tOaOA. 80x 10. This amount i. the total dependent elf. benefit. your employe, paid to you or incurr.d on your behe" Iincluding amounts from I ..ction 125 (ute.ari" planl. Any emount oyer $5.000 al.o is included in box 1. Vou must complete Sc:hedule 2 (Form 10404) or Fo"" 2441. Child and Depandant Car. Expens.s. ~o compu~e any ta.able and nontaxable .mounu. 80. 12. Thi' amount i. tha tlxlbl. fringa banafitl included in box 1. You may ba abla to daduct a.pan'a. that .ra relatad to trin,. banaflts; ,.a tha For'" tNO I"ttructionl. YEAR-TD-DATE AMOUNT 2.774.10 495.09 341.45 1.691.89 DEDUCTION TYPE SOC SEC TX STATE WTH TX DCC PRIV TX UN DUES lox 13. The following list Ixplains the codes shown in box 13. You may nead this informltion to complete your tax raturn. E - Electivl d,terral. to a section 4031bl .alary reduction a,raamant G - Electiva Ind nonalactiYe dafarrlla to a .action 4571b) d,f.rred compansation plln P - ElCCludlble moving expense reimburs.ments paid directly to ,mployl. tnot includld in box 1) Q - Militery Imploye. basic tlousinll. subsistence. and combat lona companution tusa this emo,,", if you qualify for EIC) 101 15. If the "Pansion plan" box is checked. splcial limits mlY apply to ttle amount of traditional IRA contributions you may dlducl. If thl "Oef,rr,d compansation" box is chackad. the elective d.f.rr.ts in box 13 lcodas E and G) Itor .11 employa,.. .nd for ,II such plans to which you balong) era ,anarllly limited to S10.000. EIIC1lvI dafarral. for ..ction 403tb) contrac.. aUI limi.ed to S10.000 C$13.000 in some c....; Sll Pub. 57ll. Th. limit for .~c1l0n 457(b1 pl.na 'il S8.000. Amounts YEAR-TD-DATE AMOUNT 2,117.02 956.01 ~QO . 437.33 . "~ ovar the$8 limits must be included in income. Se. "Wage" Salaries Tips. etc.: in the Form 1040 instructions. !C._a C:ttDV c: af Form W~2 for at I.." 3 v.ars aftar tbe due dati far fllino your inclMII* tax ra:urn. However. to helD DrOtect Your sacl. secur1t -'beMnts te, Co, C until you aD n flce.vlng soc.a .ecufl1Y ene ItS. Jul1 In CIS' In.,. .. a qua.tlon aD,out yo:ur work racCM'G anGIor earnlnas ,.n a oartlCUlar YeDr. SSA .uaa..ts YOU con'lfm your work record Wt,l'l '.em fram Ii..... ta time " llfIIiIilr.~' ( 1999 TAX RETURN CLIENT COPY Prepared for: NICK T. AND ANGELA M. TOMASELLO 9 N. STONER AVENUE SHIREMANSTOWN, PA 17011-6341 HOME: 717-737-2411 i ~ ; I': " " , I " I:' I , , I ~, Ii Client: 412 Prepared by: DAVID S. BABO IAN , CPA DAVID S. BABO IAN , CPA, PC 3525 COUNTRYSIDE LANE CAMP HILL, PA 17011 (717) 763-8044 Dme: FEBRUARY 24, 2000 Comments: Route to: Declaratioil Control Number (DeN) @E]-~-~-@] ( IRS Use Only _ Donol wrlle IJf staple In thJS space. Depilrtment of the Treasury Interl1al Revenue Service Your fJrsl name and JOihaJ U.S. Individual Income Tax Declaration for an IRS e-file Return For the year January 1 - December 31, 1999 ~ See Instructions on back. OMB No. 1545_0938 Fo,m 8453 1999 Use the IRS label. Otherwise, please print or type. L A NICK T. TOMASELLO B If a JOint return. spouse's first name and Initial E L ANGELA M. TOMASELLO last name yOU' social sectlUy number 207-50 3656 Last name Spouse's social secwity number Horne addren (number and street). If you have a P.O. box, see Instructions. ApI. no. 182-60-7453 .... IMPORTANT! You must enter your SSN(s) above, Telephone number (optional) .... H E R City. town or post office. slate. and liP code E 9 N. STONER AVENUE SHIREMANSTOWN, PA 17011-6341 717-737-2411 Tax Return Information (Whole dollars only) Total income (Form 1040, line 22; Form 104OA, line 14; Form 1040EZ,line 4) ,.., , , , . , , . , . . . , . , , . . . . , , . . . , ' , 1 Total tax (Form 1040, line 56; Form 1040A, line 34; Form 1040EZ./ine 10), ' . . , . . . . , . . . . . , . . , , . , . . , . . , . . , , , . 2 Federal Income tax withheld (Form 1040, line 57; Form 1040A, line 35; Form 1040EZ, line 7) ................... 3 Refund (Form 1040, line 66a; Form 1040A, line 41a; Form l040EZ,line l1a)......,..,....".... . , ,.. ""'" 4 Amount au owe Form 1040. line 68; Form 104OA, line 43; Form 1040EZ, line 12 ........,...,........,..... 5 :r,ii1\Jf'!' Declaration of T a er (Sign only after Pari I is completed.) 39,429 1,204 3,145 1,941 6a 0 1 consent that my refund be directly deposited as designated in the electronic portion of my 1999 Federal Income taxnturn. If I have filed a joint return, this is an Irrevocable appOintment of the other spouse as an agent to receive the refund. b 1&11 do not want direct deposit of my refund IX J am not receiving a refund. e 0 I authorize the U.S. Treasury and its designated Financial Agents to Initiate an ACH debit (automatic withdrawal) entry to my flnanciallnstitutlon account Indicated for payment Of my Federal taxes owed, and my financial Instltutlon to debit the entry to my account. This authorization is to remain In full force and effect until the U.S. Treasury's Financial Agents receive notification from me of the termination. To revoke this payment authorization,l must contact the U.S. Treasury I=lnancial Agent at 1-881 353 4537 no later than 2 business days prior to the payment lselflemenl) date. J also authorIZe the fl1lanclaJ institutions involved In the processing of my electronic payment of taxes to receive confidential Information necessary to answer inquiries and resolve issues related to my payment. If I have flied a balance dueretum,l understand that If the IAS does not receive full and timely payment of my tax liability, I wlllremaln liable for the tax liability and all applicable Interest and penalties. If I have flied; joint Federal and $tate taxretum and there Is an error on my state return, I understand my Federal return wlll be rejected. Under penaltles of perJury. I declare that the information I have giVen my ERO and the amounts in Part I above a!Tee with the amounts on the corresponding lines of the electronic portion of my 1999 Federal income tax return. To the best of my knowledge and belief, my return is true, correct, and complete. I consent to myERO sendIng my return, this declaration, and accompanying schedules and statements to the IAS. I also consent to the IRS sending myERO and/or transmitter an acknowledgment of receipt of transmission and an Indication ot whether or not my return Is accepted, and, if rejected, the reason($) for the reject/on, and, if I am applying for a refund antlclpatlonloa:n or similar prodUct, an indication 0' a refund Offset It the proceSSing of myretum or refund is delayed, I authorize the IRS to disclose to my ERO and/or transmitter thereason(s) fer the delay, or when the refund was sent. ~~~ ~ Yau"'g..'". Oal. ~ Spou"''''g..'''', If a jo'n".lu<o, BOTH mu.' "gn. _di'ljlt{l Declaration of Electronic Return Originator (ERa) and Paid Preparer (See ins~ucUons.) I declare that I have reviewed the above taxpayer's return and that the entries on Form 8453 are complete and correct to the best of my knowledge. If I am only a collector, I am nol responsible for reviewing the return and only declare that this form accurately reflects the data on the return. The taxpayer will have signed this form before I submit the return. I will give th~ taxpayer a copy of all forms and information to be filed with the IRS, and have followed all other requirements in Pub. 1345, Handbook for Electronic Return originators of Individual InCome Tax Returns. If I am also the Paid Preparer, under ~enaltles of perjury I declare that I have examined the above taxpayer's return and accompanying schedules and statements, and to Ihe best of my knowledge and belief, they are true, correct. and complete. This Paid Preparer declaration Is based on all informatlon of which 1 ha.ve any knowledge. Date ERO's .... signature, Date Check!f also paid preparer Ill! Check If self- employed 0 ERO's SSN or PTIN ERO's Use Only Firm's na.me (or yours if self.employed) and address ~ 2/24/00 DAVID S. BABOIAN, CPA, PC 3525 COUNTRYSIDE LANE CAMP HILL, PA P00133645 .,N 25-1848232 ZlPood.17011 Under penallles of perjury. 1 declare that I have examined the above taxpayer'srelurn and accompanytngschedUles and statements, ana to the aest of my knowlttdgtt and belie', theyare trlle, correct, and complete. This declarallon JS based on alllnlormatlon of which I have any knowledge. Paid Preparer's Use Only Preparer's ... sIgnature , Date Check Preparer's SSN or PTIN if self- 0 employed Flrm'Sname(oryours ~ if self-employed) a.ndaddrl!lSs .,N 21Pcode For Paperwork Reduction Act Notica, see back. Form 8453 (1999) e 1-, 0 1040 OepMtment of the Treas..-y _ Inlemal Revenue service 1999 I R U.S. Individual Income Tax Return M (99) IRS Use Only - Do not write or staple In this space. Label For the year Jan. 1 _ D~c. 31, 1999. or other tax year beglnrllng . 1999. ending I OMB No. 154S~OO7" Your first name 'lnd Imllal Laslname yOU" social SOCl6lty numb. (See L NICK T. TOMASELLO 207-50-3656 Instructions A If a Jotnt return, spouse's first name and Initial Lastn",me Spouse's social soctrlty numb..- on page 18.) . E ANGELA M. TOMASELLO 182-60-7453 USlIlhe IRS L label H Home address (numoer and street). If you have a P,O. box. see page 18. ApI. no. IMPORTANT! OtherWise, E .... .... please pnnt R 9 N. STONER AVENUE You must enter orlype. E Cily. town or POst office. slale. and ZIP code. If you have a foreign address, see page 1 a. your SSN(s) abov., Presidential SH IREMANSTOWN , PA 17011-6341 Yes No Nole: CheckIng "'~s. ElecUon Campaign ~ Do you want $3 to go to this fund? .................................................... X will not changa ycur taxorraducayolS (See page I e.) It a ioint return, does vour scouse want $3 to 00 to this fund? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X refund. 1 "x Single Filing Status 2 Married filing joint return (even if only one had income) I---"- 3 f-- Married filing separate return. Enter spouse's soc. sec. no. above & full name here .. Check only 4 HMd Of household (with qualifying person). (See page 18.) If the qualifying person Is a child but not your dependent, onebol(. enter this child's name here ... I---"- 5 Qualifvlna widowler) with deoendent child Ivear soouse died ~ 19 ), ISee oaoe 18.l Add numbers entered on d Total number of exem tions claimed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. lines above .. 7 Wages,lSalarles, tips, etc. Attach Form(s) W-2 . . . . .. . . .. . . . .. . , . . . . . . . .. . . .. . . .. .. . . , 38 , 671 8a Taxable interest Attach Schedule B if required. .. . . . . . . . . . . . . . .. . . . . , , ' . . . . . . . . . .. .. 38 b Tax-exempt interest 00 NOT include on line 8a. . . . , . . . ., 8b 9 Ordinary dividends. Attach Schedule B if required.. . .. . . . . .. . .. . . . ... ... . , . . .. . .... . . 9 10 Taxable refunds, credits, or offsets of state and local income taxes (see page 21) . . . . . . . . . . .. 10 11 Alimony receiVed. . . . . . . ... . . . .. . .. .. . .. . .. ... . ... . . .. . .. . .. . .. .. . . .. . ... .. ." 11 12 Busines$ income or (loss). Attach Schedule C or C-EZ . . . .. . . . . . . . . . . . . .. . . . .. . .. . .. ., 12 13 Capital gain or (loss). Attach Schedule 0 if required. If not required, check here ~ D. . . . .. .. 13 14 Other gains or (losses). Attach Form 4797 . .. . ' . .. . . . . . . . . . . .. . . . . . . . ' . .. . . .. . . . . . .. 14 15a Total IRA disbibutions.. . .. . ~ U b Taxable amount (see pg. 22) 15b 16a Total pensions and annuities D..!!J D b Taxable amount (see pg. 22) 16b 17 Rental real estate, royalties, partnerships, S corporations, Irusts, etc. Attach Schedule E ' . . , . .. 17 18 Farm income or (Joss). Attach Schedule F . , . . . . , , . . , . . . . . , . , . . . . . . . . ' . , , . . . . . , . .. . . 18 19 Unemployment compensation. . . . . . . . . . . . . .. . .. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .. 19 20a Social security benefits. . . . . ~ U b Taxable amount (see pg. 24) 2Gb 21 Other income. 21 22 Add the amounts in the far ri ht column for lines 7 throu h 21. This is our total Income . . . .... 22 23 IRA deduction (see page 26) ..............".,....... 23 24 Student loan interest deduction (see page 26) . . . . . . . . , , ,. 24 25 Medical savings account deduction. Attach Form 8853. . . . .. 25 26 Moving expenses. Attach Form 3903 . . . . . . . . . . . . . . . . . .. 26 27 One-half of self-employment lax, Attach Schedule SE ' . . , " 27 28 Self-employed health insurance deduction (see page 28) . .. 28 29 Keogh and self-employed SEP and SIMPLE plans. , . , . . . .. 29 30 Penalty on early withdrawal of savings. . . . . . . . . . . . . . . . .. 30 31. Alimony paid. b Recipient's SSN ~ 31. 32 Add IInas 231hrough 31a .,.....,., ,.. .. ..,., ,.. .."., ... ,.. ,.. ,.,..... ,.. ..,., . 33 Sublractline 32 from line 22. This is our ad usted ass Income. . . . . . , . . . . ' . . . . , . . . . . . KFAFo( Disclosure, Privacy Act, and Paperwork Reduction Act NoUce, see page 54. Exemptions If more than siX dependents, see page 19. Income Attach COpyBofyoll" Forms W-2 and W-2G hEn. Also attach Fain 1099-R If tax was withheld. If you did not getaW-2. see page 20. Enclose, but do not attach any payment, Also, please use FonIt ICHO-V. Adjusted Gross Income 6a 181 Yourself. If your parent (or someone else) can claim you as a dependent on his or her tax return, do not check box6a. ............................................... } b IllI SpoUse.".,....,.,............,.....,........,................................ c Dependents: (2) Dependent's social (3) Dependent's (4) Chk If qualifying child fot' child tax (1) First Name Last name security number relationship to you credit (see page 19) RYAN A. TOMASELLO 162-78-9133 SON X NICKOLAS T. TOMASELLO 172-76-5048 SON X 75 No. of boxes checked on 6aand6b No. of your children on Bcwho: . lived with you 2 . did nolllve with you due to divorce or separation (seepage 19) 2 Dependents on Bcnot entered above 4 20 700 39,429 75 39 354 Fo<m 1040 ('...) "~ Form 1040 Tax and Credits Standard Oeducllon fa-Most PlIople Single: $4.:300 Head of household: $6,:350 Married fihng jOlntlyor Qualifying wldow{er~ S7,200 Married filing separately $:3,600. other Taxes Payments Refund Haveit dIrectly deposited! See page 48 and fill in 66b, 66c, and 66d. Amount You Owe Sign Here .. .- . ,~ .J .- t999 NICK T. AND ANGE. . M. TOMASELLO 34 Amount from line 33 (adjusted gross income) ......".,..,.". . . . . . , , . . . , . , . . . . . . . . 35 . Check if: 0 You "Nere 65 or older, 0 Blind; 0 Spouse was 65 or older, 0 Blind. Add the number of boxes checked above and enter the total here. , , . . , , , . . , , , , . . .... 35a L b If you are married filing separately and your spouse itemizes deductions or you were a dual-status alien, see page 30 and check here. . , , , , . . . . . , . , . , , , . . . , , . , . . , . ... 35b 0 36 Enter your Itemized deducUons ~om Schedule A, line 28, OR standard deducUon shown on th~ left. But see page 30 to find your standard deduction if you checked any box on line 35a or 35b or if someone can claim you as a dependent. . , . , . . . . . . . . . . , . , . , . . . . 37 Sub~act line 36 ~om line 34. . , , . ' . . . . . . , , , . . . , . . , . , , , . . , . , , . , . , , . . . . , , , ' . , . . , . . , , . , . , . 38 If line 34 is $94,975 or less. multiply $2,750 by the total number of exemptions claimed on line 6d. If line 34 is over $94,975, see the worksheet on page 31 for the amount to enter,., " . .. . , .. . .., " . 39 Taxabfe Income. Subtract line 38 ~om line 37. If line 381s more than line :31. enter -0- . . . . . . , . .. . , . . , . . . , , . . . . , . . , . . . . . . . . . . , . . , , , 40 Tax (see page 31). Check if any tax is tram .0 Form(s) 8814 b 0 Form 4972, . . . . . . . . . . . . . , ... 41 Cre<llt for child and dependent care expenses. At!. Form 2441 ".,. 41 42 Credit for the elderly or the disabled, Attach Schedule R , . , . , , . , .. 42 43 Child tax credit(see page 33), . , , , . . . . . . . . , , , , . . . , . , . . . . , , .. 43 44 Education credits. Attach Form 8863 ... . . . , . , . . . . , . . . . . . . . . ,. 44 45 Adoption credit Attach Form 8839 . . . . . . . . . . . . . . , . . , . . . . . . . " 45 46 Foreign tax credit. Attach Form 1116 jf required. . . . , . . , . . . . , . , .. 46 47 Other. Check if from a 0 Form 3800 b 0 Form 8396 c 0 Form 8801 d 0 Form (specify) 47 48 Add lines 41 through 47. These are your total credlls. . . .. . . . . . . . . .. . .. , . . . . . . . , . . . . .. . . . . , . 49 Subtraclline 48 from line 40. If line 48 is more than line 40. enter -0- . .. . .. . , . . . . . . . . . . . . . . . . .~ 50 Self-employment tax. Att. Sch. SE.. . . . . . . .. . . . . . . . . , .. . . . ... .. ... .. . . . .. . .. . . . . . . . , . .. , 51 Alternative minimum tax. Attach Form 6251 ............................................,., 52 Soci_i security and Medicare tax on tip income not reported to employer. Attach Form 4137 ......,., 53 Tax on IRAs, other retirement plans. and MSAs. Attach Form 5329 if required. . . . . . . . . . . . . . . , . . . , . 54 Advance earned income credit payments from Form(s) W-2. . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . , . 55 Household employment taxes. Attach Schedule H. . . .. . . . . . .. . . . . , .. .. .. .. , ' . . . . . .. . . . . . . . . 56 Add lines 49 throu h 55. This is our total tax . . . . . . .. . .. .. . .. .. . .. .. . . . . , . .. . . . .. . . .. . .... 57 FederaUncome tax withheld from Forms W-2 and 1099 .......... 57 3, ~45 58 1999 estimated tax payments and amount applied from 1998 return. 58 59 : ::.:::::~~:~~~: ::: E~ I' you have a qualif}4ng U' ;llll and type ~ NO 59_ 60 Additional child tax credit. Attach Form 8812 ..........,........ 60 61 Amount paid with request for extension to file (see page 48) . . . . . . . .. 61 62 EXceSS social security and RRTA tax: withheld (see page 48) . . . . . . . .. 62 63 Other payments. Check if from a 0 Form 2439 b 0 Form 4136 " 63 64 Add lines 57. 58, 59a, and 60 throu h 63. These are our total manls. . . . . . . . . . . . . . . . . . . . . ... 65 If line 64 is more than line 56, subtract line 56 from line 64. This Is the amount you OVERPAID ....... 66. Amount of line 65 you want REFUNDEO TO YOU. . . . . .. .. .. . .. . , . . . . .. . . . . . . . . . . . . . . . . . ... ~,OOO b Routing number .. c Type: 0 Checking 0 Savings 207 -50 -3656 Pa _ 2 34 39,354 14,150 25,204 11,000 14,204 2,134 48 49 50 51 52 53 54 55 56 1,000 1 134 70 1 204 Ir(l~fl ~~:i~1f:~[~[i :::~:~tMt '.::::~:;m.~::. ~.~:.~:~.;.:.~; lilll:li ::t1M::;: .:.:.:.:~.:.:.. 64 65 66. 3,145 1,941 ~,941 d Account number 67 Amount of line 65 you want APPLIEO TO 2000 ESTIMATED TAX ~ 67 68 It line 56 is more than line 64, sub~act line 64 from line 56, This is the AMOUNT YOU OWE. For details on how to pay. see page 49 .....................................,............ 69 Estimated tax enal . Also include on line 68 .................. 69 Under penalties 0' perjury, I declare that I have 9xamined this return and accompanying schedules and stalements, and to the best of my knowledge and belief, they are true, cOrTect, and complete. Declaration of preparer (other than taxpayer) is based on all Information of which preparer has any knowledge!. ~ Your signature Dale Your occupation Daytime telephone JOlntreturn7 CORRECTIONS OFFICE number (Optional) Seepage 18. Keep a copy ~ Spouse's signature. If a jOint return, BOTH must sign. Date Spouse's occupatlon for your 717-737-2411 records. PART-TIME 0'1'1 : Preparer's SSN or PT1N Preparer's ~ Checklf 0 POO133645 Paid signature 2/24/00 .."..mploy.d Pre parer's DAVID S. BABOIAN, CPA, PC EIN 25-1848232 Use Only Firm's name (or yours ~ 3525 COUNTRYSIDE LANE If self_emplOyed) and ZIPcode address CAMP HILL PA 17011 Form 1040 (1999) ~' k,~' "-'~ ;CHEDULES A&B Form 1040) Sc ;dule A - Itemized Deductici ; OMS No. 1545_0074 . Attach to Form 1040. 1999 Attachment 07 SIlIquIlInclll No. yOU' social aecw1ty numb_ J<:lpartrnenl of the Trlllasury llern<l.lRevIlInuIlIServlce (99) ,amefs/shown on Form 1040 NICK T. ~edlcal .nd Jental :.xpeoses faxe$ You Paid S.. :JageA_2.) Interest You Paid (See page A-3.} Note: PersOnal Interes1is nol dedu~lible. Glfllllo Chatlly \f y04 made a gifl al'ld got a benefit for It, see page A-5. CaSUally and Theil Losses Job Expenses and Most Other Mlseellaneous DeducUons {See pag~ A-5 for exp~nse$ to deduct h6f"e.) Other Miscellaneous Deductions . See InstrucUons lor Schedules A and B (Form 1040). AND ANGELA M. TOMASELLO 207-50-3656 Caution: 00 not inClude expenses reimbursed or paid by others. 1 Medical and dental expenses (see page A-l) . , . . . . , . ' . , . . , ' , . , , . , . 2 Enter amount from Form 1040, line 34 . . . . 2 3 Multiply line 2 above by 7,5% (,075). . , , . . , . , , . . , . , . . . , . . , , , , , , ' , . 3 4 Sub~act line 3 ~om line 1. If line 3 is more than line 1. enter -0- ,'.".,...".........'",.,.." 5 State and local income taxes.. .. .. . .. . . .. . .. . .. .. . . .. . .. .. , .. .. 5 1 , 541 6 Raalestata taxes (see page A-2) .. . . . .. . . .. , . .. .. . . .. ' .. . , .. , .. , 6 926 7 Personal property taxes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 8 Other taxes, list type and amount . OPT ]>@'@~'fA2[ _ _ _ _ _ _ _ 8 418 9 Add lines 5 throu h 8. . . . , . . . , . , . . . . . . . . . . . ' . . . , . , . . , . . . , . . , . . . .. . . . , ' . . . . . . . . .. . . , . . . 10 Home morlgage interest and points reported on Form 1098 . STM. .. 1 10 10, 742 2 885 o . 11 Home mortgage interest not reported on Form 1098.1f paid to lhe person from whom you bought the home, see page A-3 & show lhat person's name,lD no. & address 11 12 Points not reporled on Form 1098. See page A-3 . . , .. .. . .. . . . . . .... 12 13 Investment interest. Attach Form 4952, if required. (See page A-4) ... .. .. . . . .. . . ... .. . ... . ' . .. .. .. .. ....... . '" 13 14 Add lines 10 throu h 13. . '" . . " . .. .. . , " . ., . . .. .. . . . . .. . . , . . . .. . . .. . '" . . . . . . . , . .. , ' . 15 Gills by cash or check. 11 any gift of $250 or more, see pg. A-4. S.T. . . a 15 3 0 16 Other than by cash or check. If any gift of $250 or more, see page A-4. You MUST attach Form 8283 if over $500 . S.TATEMENT. . .. . ...3. 300 17 Carryover from prior year . .. . .. .. . ' .. . . .. . .. . . . . .. .. . .. . . . . . '" 17 18 Addlines 15throu h 17............................................................... 19 Casualty or theft loss(es). Attach Form 4684. See a eA-5. ...................................................................., 20 Unreimbursed employee expenses -job travel, union dUBS. job education ?~::;:~:;;?~ ete. You MUST attach Form 2106 or 2105-EZ if required. (Sae page A-5.) . . SUPPLIES 55 UNi FORMS- - f'17 UNiFORMS - 163 ~@ =& ]>@~@:@l[~ @'@ _ = -Q 7 21 Tax preparation fees. . . . . .. . .. .. .. .. . . .. . . . .. .. .. .. . . . . . . . . . . , 22 Other expenses - investment, safe deposit box, ete. List type and amount . 14 10,742 llllll :~~~it~1I~ 18 330 o 23 Add lines 20 through 22......,..,..,.....,...............,..., 980 24 Enler amount ~om Form 1040, line 34 ...' 24 39,354 25 Multiply line 24 above by 2% (.02) . ' , . . . . . . . . . . . , .. . . . . . . . . . . , . ,. 25 26 Subtract line 25 from line 23. If line 25 is mOl'e than line 23. enter -0-............... . . .......... . 27 Other - ~om list on page A-6, List type and amount . 193 o Totel 28 Is Form 1040, line 34, over $126,600 (over $63,300 if married filing saparataly)? ItemIzed IE No. Your daduction Is not limited. Add the amounts in the far right column Oeducllons for lines 4 through 27. Also. anter this amount on Form 1040, line 36. }............. o Yes. Your deduction ma be limited. See a e A-6 for the amount to enter. o<F4 For PaperwOrk ReducUon Acl NoUce. see Form 1040 Instrucllons. Schedule A (Form 1040) 1999 " .'~ ;,\j ( ';chedules A&B (Form 1040) 1999 ~ame(sJ shown on Form 1040. 00 not enter name and social sl!Icurlly numlJer II shown on other side. OMB No. 1545_0074 Fl'age 2 VOAI social s8Cwlty numb.. NICK T. AND ANGELA M. TOMASELLO Schedule B - Interest and Ordinary Dividends Nole: If you had over $400 in taxable interest you must also complete Part III 207-50-3656 AttaChment Sequence No. 08 Part I , Interest Amount 1 List name of payer. If any interest is from a seller-financed mortgage and the buyer used the properly (See page a-I as a personal residence, see page B-1 and list this interest first. Also, show that buyer's social security and the number and address .. Instructions for ------------------------------------ ~orm 1040, ~1~.IE_~~~IpgS BANK 5 line 8a.) ---------------------------------- MONUMENTAL LIFE 33 --------------------------------------------- --------------------------------------------- --------------------------------------------- -------------------------------- ------------ Note: If you received a Form -------------------------------------------- 1099-1NT,Form --------------------------------------------- 1 1099-010, or substitute --------------------------------------------- slatementfrom acrokerage firm, -------------------------------------------- Hs! the flrm's -------------------------------------------- name as the payer and enter --------------------------------------------- the total Interest shown on that --------------------------------------------- form. --------------------------------------------- --------------------------------------------- -------------------------------------------- 2 Add the amounts on line L ................................................................. 2 38 3 Excludable interest on series EE and I U.S. savings bonds issued after 1989 from Form 8815,lIne 14" You MUST attach Form 8815. . " .. ... .. . . .., . .. ... .. . .. .., .. . . . .. ".. . . .. . . .. . . . . . . . .. . , , .. . . . 3 4 Subtract line 3 from line 2. Enter the result here and on Form 1040,lIne8a...,.".."..".....,.........~ 4 38 71 At any time during 1999. did you have an interest in or a signature or other authority over a financial account in a foreign country, such as a bank account, securities account, or other financial account? See page B-2 for exceptions and filing requirements for Form TO F 90-22.1 "'".."."."'"'""'.,.".,..""","""""""".,..""......",..""....",."",."..""" b It "'Yes," enter the name of foreign country iii-' _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 8 During 1999, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? If "Yes," au ma have to file Form 3520. See a e B-2 . " . " " " " . . " . " , . " . " " . " . " " , . " " " . . " " . . " . . ' " . . . . . " . . " , " . . . " . . , X For Paperwork ReducUon Act NoUce, see Form 1040 InstrucUons. Schedule B (Form 1040) 1999 Part II Ordlnaly Dividends (See page B-1 and the Inslructlonsfor Form 1040, line 9.) Note: If you received a Form l099-DIVor subslltute statement from a brokerage firm. IIs1 lhe firm's name as lhepayer and enter the ordinary dvidends shown on that form. Partlll Foreign Accounts and Trusts (See page B-2.) KFA Nole: If you had over $400 in ordinary dividends, au must also complete Perl III. Amount 5 List name of payer. Include only ordinary dividends. If you received any capital gain distributions, see the instructions for Form 1040,IIne 13. ~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . 5 -------------------------------------------- -------------------------------------------- -------------------------------------------- -------------------------------------------- -------------------------------------------- -------------------------------------------- -------------------------------------------- -------------------------------------------- -------------------------------------------- o 6 Add the amounts on line 5. Enter the total here and on Form 1040, line 9 ' . , . ' . . " . " . . . . , ' . " . ' . . . "' . . "~ You must complete this perl if you (a) had over $400 of interest or ordinary dividends; (b) had a foreign account; or (e) received 1 distribution from, or were a grantor of, or a transferor to, a foreign trust. 6 ,. ",",,~j '--.; Fo,m 5329 ( Additional Taxes Attributable to IRAs, Other Qualified Retirement Plans, Annuities, Modified Endowment Contracts, and MSAs (Under SecUons 72, 530, 4973, and 4974 01 the Internal Revenue Code) ~ Attach to Form 1040. ~ See separate InstrucUons. OMB No. 1545-0203 1999 Department of the Treasury Infernal AevenueSerVlce Fill in Your Address Only II You Are Filing This II. Form by Itsell and Not r With Your Tax Return Home address (number and street). or P.O. box II maillS not dehvered 10 your home Attachment Sequence 11I0. 29 I YOII' social soclllty numb. 182-60-7453 Apt. No. Name Of Individual subject to additional tax. (If mamed riling 10lntly. see page 2 01 the Instructions.) ANGELA M. TOMASELLO CIty. lown or post office. state. ancl ZIP code Ilf this is an amended return. Check here ~ 0 If you are SUbject only to the 10% tax on early distributions. you may be able to report this tax direcfJy on Form 1040 without tiling Form 5329. See Who Must File on page 1 of the insb'uctions. [.Aa6JI Tax on Early Distributions Complete this part if a taxable disb'ibution was made from your qualified retirement plan (including an IRA other than an education IRA). annuity contract, or modified endowment conb'act before you reached age 59 1/2. If a disb'ibution was correcUy indicated on Form 1099-R as an early disb'ibution (no known exception to the additional tax), or you re- ceived a Roth IRA dis~ibution, see page 2 of the ins~uctions. Note: You must includelhe taxable amount of the dls~lbution on Form 1040, line 15b or 16b. 1 Early distributions included in gross income. For Roth IRA dls~ibutions, see page 2 of the ins~uctions .. ... 1 700 2 Early dis~ibutions not subject to additional tax. Enter the appropriate exception number from page 2 of the instructions: .. .. .. . .. .. '" .. .. .. .. .. . .. .. .. .. 2 3 Amount subject to additional tax. Sub~act line 2 from line 1 .. .. .. .. .. 3 700 4 Tax due. Enter 10% (.10) of line 3. Also include this amount on Form 1040, line 53 .. .. .. .. .. 4 70 CauUon: If any pari of the amount on line 3 was a dls~ibution from a SIMPLE retirement plan, you :~ll'll~tlllrIJltl"'dlilfl~i h v t % e 2 ofl ~ may a e 0 Include 25% of that amount on line 4 Instead of 10 . See pag he Ins uctions. :tRlittJfM Tax on Certain Taxable Distributions From Education (Ed) IRAs Complete this pari if you had a taxable amount on Form 8606, line 30. Note: You must include the taxable amount of the dls~lbution on Form 1040, line 15b. .:,:~,:".".~,.,'~.:B;:::;.,.:.~~~:~~::;:<<~~;.:.:::~...:.:.>:<< 5 Taxable dls~lbutions from your Ed IRAs, from Fcrm 8606, line 30. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 5 6 Taxable dis~ibutions not subject to additional tax. See page 2 of the ins~uctions. . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 7 Amount subjoclto additional tax. Sub~actline 6 from line 5. . .. . .. .. . . .. .. . .. . .. . . .. . . , . . . . . . . . . . . . . ... 7 8 Tax due. Enter 10% (.10) of line 7. Also include this amount on Form 1040, line 53. . .. . . ' . . . . ,. . . . . .., .. .. . , 8 !:PiiitilJM Tax on Excess Contributions to Traditional IRAs .f:.;::.... ;...t.. t 9 Enter your excess con~ibutions from line 16 of your 1998 Form 5329. If zero, go to line 15 .................... 9 10 11 your ~adltionallRA con~lbutions for 1999 are less than your maximum I aDowable con~ibution, see page 3; otherwise, enter -0-. . . . . . . . . . . . . . . . . . . . 10 11 Taxable 1999 dis~ibutions from your ~aditionalIRAs. . . . . . . . . . . . . . . . , . . . . . . 11 12 1999 withdrawals of prior year excess con~ibutions Included on line 9. See page 3 ...................................................... 12 13 Add lines 10, 11. and 12.....,.,.........,.........,....,........... ...,.................. ...'. 13 14 Prior year excess contributions. Subb'act line 13 from line 9. If zero or less, enter -0- ........................ 14 15 Excess conb'ibutions for 1999. See page 3. Do not include this amount on Form 1040, line 23.. . . . . . . . . . . . . . . . . 15 16 Total excess conlributions. Add lines ~-g,....,....,....,...,........."....,................. 16 17 Tax due. Enter 6% (.06) of the smaller of line 16 or the value of your tradltionallRAs on December 31, 1999. Also include this amount on Form 1040, line 53 ..................................................... 17 Complete this pari If you con~ibuted more to your traditionallRAs for 1999 than Is aDowable or you had an excess contribution on Dne 1601 your 1998 Form 5329. For ):laperwork ReducUon Act Nollce, see page 4 01 separate Instrucllons. KFA F"'m 5329 I"..) -.., . . ....,j-, \' 1999 FEDERAL STATEMENTS PAGE 1 NICK T. AND ANGELA M. TOMASELLO 207-50-3656 STATEMENT 1 SCHEDULE A, LINE 10 HOME MORTGAGE INTEREST REPORTED ON FORM 1098 FIRST PLUS FINANCIAL ....................................... $ NORWEST .................................................... PROVIDIAN .................................................. PROVIDIAN POINTS ........................................... TOTAL $ 2,765 5,823 787 1,367 10,742 STATEMENT 2 SCHEDULE A, LINE 15 CONTRIBUTIONS BY CASH OR CHECK QUALIFIED CHARITIES ........................................ $ TOTAL $ 30 30 STATEMENT 3 SCHEDULE A, UNE 16 CONTRIBUTIONS OTHER THAN CASH SALVATION ARMY - CLOTHING .................................. $ 300 TOTAL $ 300 ,- ~ ---.J PLEASE I DO NOT USE VO",,i LABEL 9900113151 ( 1999 PA-40 PAGE 1 OF 2 .'~ , ',~, L 207-50-3b5b TO 182-bO-7453 EX 0 RS R TOMASELLO NICK T A 0 FS J ANGELA M FY 0 9 N. STONER AVENUE SC 21b50 SHIREMANSTOWN PA 17011 PN 717-737-2411 1A 40553.00 18 832.00 1C 39721.00 2 38.00 3 .00 4 .00 5 .00 b .00 7 .00 8 .00 9 39759.00 10 .00 11 39759.00 12 1113.00 --------------------PLEASEFOLDPAGEALONGTHIS-CINE-------------------- LocallnlormaUon. Enter where you lived as of 12/31/99. School District: MECHANICSBURG School Code: 2165 0 County: CUMBERLAND Municipality: SHIREMANSTOWN BORO Residency Status (Mark the Correct Space) R X Resident NR Nonresident P Pari Vear Resident From: MM/DDIYY To: MM/DDIYY Extension, (Mark This Space) Amended Return, (Mark This Space) Fiscal Vear Flier, (Mark This Space) Type Filer. (Fill-in only one choice) 5 J X M F D Date of Death: 1a Gross Compensation, from PA Schedule W-2S, or your Forms W-2 or other statements. . . . . . . . . . . . .. 1a 1b Unrelmbursed Employee Business Expenses, from PA Schedule UE . ... . . .. ... .. .. .. .. . .. . .. . . .. 1b 1c Net Compensation. Subtract line 1bfrom la............. ................................... 1c 2 Interest Income. Complete and enclose PA Schedule A if over $2,500 . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2 3 Dividend Income. Complete and enclose PA Schedule B if over $2,500 . . . . . . . . . . . . . . . . . . . . . . . . . .. 3 4 Net Income or Loss from the Operation of Business, Profession, or Farm. . . . , . . . . . . . . . . . . . . . . . . . .. 4 5 Net Gain or Loss from the Sale, Exchange, or Disposition of Property.. . .. . . .. . .. .. .. .. . . . . . . . . . .. 5 6 Net Income or Loss from Rents, Royalties, Patents, or Copyrights .......................,....... 6 7 Estate or Trust income. Complete and enclose PA Schedule J. .. . . .. . . . . . .. . . . .. . . . . .. . . . . . . ... 7 8 Gambling and LOlleryWlnnings...............,...............,.,..,...........,.......,. 8 9 Total PA Taxable Income. Add only the positive income amounts from Lines lc, 2, 3, 4, 5. 6, 7, and 8. DO NOT ADD any losses reported on Lines 4, 5, or 6. . . . . . . . . . .. .. . . .. . . .. . . . . .. .. . , . . . . . . . .. 9 10 Contributions To Vour Medical Savings Account. See the instructions. . , . . .. . . . .. . . ' . . . . . . . . . ,. 10 11 Adjusted PA Taxable Income. Subtract Line 10 from Line 9............ ,........,............. 11 12 PA Tax Liability. MulUply Line 11 by 2.8% (0.028). Also enter on Line 13, Side 2. .. .. . . .. . . . . . . . . .. 12 EC FC L IT] ITIIIIJ IT] 9900113151 Single Married, Flllng JolnUy Married, Flllng Separately Final Deceased MM/DDIYV 40,553.00 832.00 39,721.00 38.00 .00 .00 .00 .00 .00 .00 39,759.00 .00 39,759.00 1,113.00 R 9900113151 -3 - -.l 13 16 19 21 24 27 30 33 36 9900213159 L 1999 P A-40 PAGE 2 OF 2 NICK T 207-50-3656 1113.00 14 1135.00 15 .00 .00 17 .00 18 .00 .00 20A 00 208 00 .00 22 .00 23 .00 .00 25 .00 26 .00 .00 28 1135.00 29 .00 22.00 31 22.00 32 .00 .00 34 .00 35 .00 .00 37 .00 TOMASELLO 13 Total PA Tax liability. Enter your tax' liability from line 12 on Side 1 .,.......,.............................,.......... 13 14 Total PA Tax Withheld from W-2 PA Schedule W-2s. or your Forms W-2, or other statments. , .. . . . . . . . .. 14 15 Credit from your 1998 PAlncomeTaxReturn.........."..............., 15 .00 16 1999 Estimatad Installment Payments......,......,....... ....".......16 . 00 17 1999 Extensi~n Payment. . , . .. . . . . . . . . . . .. . ' . . . . .. . . . . . .. . . . . . . . . . , . 17 . 00 18 Nonresidentljax Withheld on your PA Schedule(s) NRK-l ...,..,...........18 .00 19 Total Esllmated Payments and Credits. Add Lines 15, 16, 17, and 18 . . . . . . . . .. ,. . . . .. . . . . . . . . . . .. 19 Tax for9iveness Credit. Complete Unes 20a, 20b, 21, and 22. Read instructions. 20. Filing Slatus: Unmarried or Separated Married Deceased ... . . . . . . . . . . , . . . . . .. 20a 20b Dependents, Part B, Line 2 PA Schedule SP .. .. .. . .. . . .. .. . . .. .. . . . .. . . .. .. . .. .. . . .. . . . . .. . .. 20b 21 Total Eligibility Income, Part C, Une 11, PA Schedule SP. . . .. .. . . , . .. . . .. . . . .. .. . .. .. . . . . . . . . .. .. 21 22 Tax Forgiveness Credit from Part 0, Une 16, PA Schedule SP. .... .. ... . . . .. . ..... . .. .. . .. . . . . . ... 22 23 Total Credit for Taxes Paid to Other Slates or Countries. Enclose your PA Schedule G or RK-1 . . . . ., . . '" 23 24 PA Employment Incentive Payments Credit. Enclose your PA Schedule W, RK-1 or NRK-l ........................................................ '" 24 25 PA Jobs Creation Tax Credit, from enclosed certificate or PA Schedule RK-l or NRK-l........,........ 25 26 PA Waste Tire Recycling Investment Tax Credit, from enclosed certificate or PA Schedule RK-l or NRK-l.. .... . . . . . . .. . . . .. .. . . . .. ........ . .. . . , . .. .. ..... . .. . . . . .. . .. 26 27 PA Research and Development Tax Credit, from enclosed certificate or PA Schedule RK-1 or NRK-l .........................................,................. Z7 28 TOTAL PAYMENTS and CREOITS.Add Lines 14, 19and 22 through 27............................ 28 29 TAX DUE, If Une 13 is more than line 28, enter the difference here. .. ... . ... . . .... . .. . . . . .. . . . . .. .. 29 30 OVERPAYMENT. If Une 28 is more than Une 13, enter the difference here. . . . .. . .. . .. .. . .. . ... . . . '" 30 31 Refund-Amount of Line 30 you want as a check mailed to you ........................... . Refund 31 32 Credil- Amount of Line 30 you want as a credit to your 2000 estimated account. . . . . . . . . ' . . . . . . . . . , .. 32 33 Donallon - Amount of Une 30 you want to donate to the Wild Resource Conservallon Fund . . , . . . . . . .. 33 34 Donation - Amount of Line 30 you want to donate to the United States Olympic Commlllee, PA Olvlolon. 34 35 Donation - Amount of Line 30 you want to donate to the Organ Donor Aw.eness Trust Fund. . . . . . . . .. 35 36 Donation - Amount of Line 30 you want to donate to the KoreaIVletnam Memorial, Inc. .. . . . . . . . . . . . .. 36 37 Donation - Amount of Une 30 you want to donate to the Breast and Cervical Cancer Research. . . . . . . " 37 The total of Lines 31 through 37 must equal line 30. Under penalties of perjury, I (we) declare, I have examined this return, including all accompanying schedules and statements, and to the best of my (our) belief they are true. correct and complete, 1,113.00 1,135.00 .00 00 00 .00 .00 .00 .00 .00 .00 .00 1,135.00 .00 22,00 22.00 .00 .00 .00 .00 .00 .00 Oatil Your Occupa lion CORRECTIONS OFFICER Date Spouse's QccupaUon PART-TIME Date Telephone Number 2/24/00 (717) 763-8044 YOlJr Signaturl1 SPouse's Signa!url1, llllling jolnUy Prtlparer or Company Name (Please PrInt) 2 5 - 18 4 8 2 3 2 DAVID S. BABOIAN, CPA, PC Slgnalure of lhe Preparer (OpliClnal) L 9900213159 9900213159 ~ ~.~~ . ,-I "'L -.-J WAGE STATEMEN. SUMMARY 9901212154 PA Schedule W-2S (09199) PA OEPARTMEt.rr OF REVENUE Name(s).s shown on YOlJr PA taxrl5lurn: 1999 OFFICIAL Use ONL-f SOCI.l Security NumDer: NICK T. TOMASELLO 207-50-3656 In.trucUon.. Instead of sending your paper Forms W-2 with your PA tax return, or photocopying them to a sheet of paper, you may write the necessary information below. Keep YOLlr original Forms W-2. Important. Your PA compensation may be different from your federal wages. Caution. If you believe that a PA amount on your Form W-2 is incorrect, you must submit your actual Form W-2 with a written explanation from your employer. You must submit other statements for amounts you are reporting as compensation on your PA tax return. Informallon From Each Form W-2 Number of Form(.) W-2 I 4 I If you need more space, you may photocopy this schedule or prepare your own schedule in this format. (a) (b) (c) Enter the total on Line la (d) Enter the total on Line 14 Employer Identification Number Federal wages from PA taxable compensation PA tax withheld from box B box 1 from box 17 from box 18 1. 23 2172299 $ 32,454 $ 34,146 $ 956 2. 23 2362679 $ 4,234 $ 4,233 $ 119 CauUon. The 3. 23 2934299 $ 268 $ 268 $ 7 Department 4. 24 .:~.:.:.:.: 0755415 $ 1,715 $ 1,906 $ 53 reSQrVes the rtght :::JI!i!,::: 5. $ $ $ to require your 6. iril $ $ $ actual Forms W-2. 7. q~~H $ $ $ 8. ~~::;:::;:: $ $ $ :~~'::: 9. .~~.;;:~: $ $ $ ~::~:::; 10. &;.~ $ $ $ 11. :~Z~~ $ $ $ 12. t$~ $ $ $ 13. ~J#~ $ $ $ 14. ;@ $ $ $ 15. f@;;% $ $ $ 16. li~ $ $ $ 17. ~g $ $ $ Total. Add the amounls in column (c) and (d). 40,553 1 135 L 9901212154 9901212154 -.-J ~ . I .~ --.J INTEREST AND DIVIDEND INCOME 9901213158 ( PA Schedule A & B (09_99) PADEPARTMEHTOFREVENUe Narne(s)as shown on your PA lax return: 1999 OFFICIAL USE a~L-f Social Security Number: NICK T. TOMASELLO 207-50-3656 If you need more space, you may photocopy these schedules or prepare your own schedules in this format. Caution. Federal and PA rules for taxable interest and dividend income are different. Read the instructions. Filing Ups. If either your PA interest income or dividend income is $2,500 or less, you do not need to submit a schedule. If Bither your interest income or dividend income is more than $2,500. you must submit a schedule. Filing options: 1. You can submit a copy of your federal schedule, or you can just enter your federal interest income and/or dividend income. The Department can venfy the amounts you reported on your Federal Income Tax return. 2. Otherwise. list the name of each paver and the amount of PA interest and dividend income you received in 1999. PA Schedule A - PA Taxable Interest Income Filing option 1. Enter the amount from your Federal Schedule B (Form 1040) ar SChedule I (Farm 1040A). 1. $ 38 Filing option 2 PA Taxable Interest Income Read lhe Instructions $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 2. Total PA Taxable Interest Income. Add the amounts above and enter on Line 2 of vour PA tax return. 2. $ PA Schedule B - PA Taxable Olvldend Income FlUng opUon 1. Enter the amount from your Federal Schedule B (Form 1040) or Schedule I (Form 1040A). FlUng opUon 2 PA Taxable Dividend Income Read lhe InslrucUons 1.1$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ . $ $ $ $ $ 2. Total PA Taxable Dividend Income. Add the amounts above and enter on Line 3 of your PA tax return. 2. $ Important. capital gain distribution. are dividend Incoma fer PA P"PDalls. even though youraport tham on SChadUla 0 fer Faderal pt6pOlla.. L 9901213158 9901213158 ---.J , ~ I. ~ 9901713157 ( PA SCHEDULE UE Allowable Employee Business Expenses PA-40 UE (09-99) 1999 PA DEPARTMENT OF REVENUE OFFICIAL USE 0 NL 'f If you incur expenses from more than one JOb. you may make photocopies of this schedule or make your own SChedules In this format. Name of Taxpayer Claiming Expenses: Social Security Number: NICK T. TOMASELLO 207-S0-36S6 Employer's Name: I Employer's Address: Employer's Federal 10 Number: COMMONWEALTH OF PA [HARRISBURG PA 17120 23-2172299 Describe the duties of the job in which you incurred these expenses: Employer's Telephone Number: CORRECTIONS OFFICER PART A. Employee Business Expenses. Caution. You may not use Line 4 of Form 2106 or Form 21D6EZ. You must itemize these expenses in Part G of this schedule. Vehicle expenses. Standard Mileage Rate. Filing Tip. If you do not file Form 2108 or 2106EZ, enter your total business miles _ and multiply by the federal standard mileage rate $0. Enter the result on Une 1. 1. Enter the amount ~om your Form 2106 or Line 1 of Form 2106EZ, ,.,., ,.., .,., ,.,., '.,.,., ....., ., ,., ,... 1.1 Vehicle Expenses. Actual Travel and Mileage Expenses. 2. Enter the amount from your Form 2106. Make the following adjustments:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2'1 3. Add back the Inclusion amount. This adjustment does not apply for PA purposes.. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. 4. Depreciation. You may use any generally accepted method. If not using your Form 2106. enter YOIJr depreciation expense & complete Line 5 4. IJ B 5. Depreciation Method. 6. Actual Travel and Mlleege Expenses for PA Purposes. Total Lines 2, 3, and 4. . . .. ,. . .. .. .. . . . , . . . . . .. . , . . 6. 7. Parking Fees, Tolls, and Transportation. Enter the amount from your Form 2106 or Form 2106EZ.. , . . . . . . . . . . , . , . 7. 8. Away From Home Overnight. Enter the amount from your Form 2106 or Form 2106EZ. .. . " . . . , . . . . , .. . . .. .. . . 8. 9. Meals and Entertainment Expenses. Enter the amount from your Form 2106 or Form 2106EZ.. . . . . . . . . . . . . . . , . . , 9. 10. Tolal Exoenses lor Par! A. Add Lines 1 or 6 and 7, 8. and 9. . . .. . .. . . . . . . . . , . .. .. . .. .. .. . . . . . .. . . , . . , . . 10. PART B. DlrectEmployee BUslness Expenses. 11. Union Dues. List Union name(s) and amount(s) paid. Enter total. Attaoh additional sheets, if needed. Name 01 Unlon(s) and amount(s). AFSCME 12. WOrk Clothes and Unllorms. Requ~ed as a condition of employment and not suitable for everyday use. OescrlpUon: UNIFORMS 13. Small Tools and Supplies. Requ~ed as a condition of employment and not provided by the employer. OescrlpUon: SUPPLIES 14. Prolesslonal Ucense Fees, MalpracUce Insurance, and Fidelity Bond Premiums. Required as a 11.1 12.1 13.1 4370 1630 SSO condition of your employment. DescrlpUon: 14. I I 15. Tolal Expenses lor Par! B. Add lines 11. 12, 13, and 14.. . .. . . . . . . . . .. . ... . ... .. .. . ." . .. . . . . . . .. . .. . . . 15. 6SS I I PART C. Olllce Or Work Area Expenses. Vou must answer ALL three questions or the Department will disallow your expenses. D2.NO C1. Does your employer require you to maintain a suitable work area away from the employer's premises? . . . .. . .. . .. Cl. 0 1. YES C2. Is this work area the prinoipal place where you perform the duties of your employment? . . .. , . " . .... .. . . . . .. . . C2. 0 1. YES o 2. NO Ca. Do you use this work area regularly and exolusively to perform the duties of your employment? . . . . . . . . . . . . . . . . . C3. 0 1. YES D2.NO It you answer YES to ALL three quesUons, continue. II you answer NO to ANY quesUon, you may not claim at home expenses. Actual Olllce or Work Area Expenses. Enter expenses for the entire year and then calculate the business portion. a. Depreciation Expense (Homeowners only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a. i b. Real Estate Taxes . . . . . . . .. . , , . . . . . . . .. . .. . , . . . . . . . . . . , . . . . ' . . , , . . . , . .. . . . , . . . .. . ' , . . . . . . .. .. . . b. I I Mortgage Interest (Homeowners only). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C. I C. d. Utilities,...,...,........,...,.,........,.,..,..,..,.................................,.....,. . d. e. Property 1 nsurance ............................................................................ e. I. Property Maintenance. Itemize the type and amount of maintenance expenses incurred: I. g. Other Apportionable Expenses. Itemize the type and amount of these expenses: g.1 0 ~. Rent (Renters only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~: I I~ I. Total. Add Lines a through h. Enter the total here .................................................... I. Business Percentage. of Property. Divide the total square footage of your work arEla by the total J. % square footage of your entire property. Round to 2 decimal places. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . k. Apportioned Expenses. Multiply Line i by the decimal on Line j . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . k.1 0 I. Total Office Supplies. Itemize supplies you purchased exclusively far use in your office or work area. 1~: \ B Total. 16. Total Expenses lor Part C. Add Lines k and I. , ..................................................... L 9901713157 9901713157 ~ ., .' j. " , --.J 9901813155 PA SCHEDULE UE Allowable Employee Business Expenses PA-40 UE (09-99) 1999 PA OEPART"ENT OF REVENue Nan,e or Taxtlayer Claiming Expenses: OFFICIAl. USE ONL'r Social Security Number: NICK T. TOMASELLO Part D: Moving Expenses. a. Enter the number of miles from your old home to your new workplace. , . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . .. 8. b. Enter the number of miles from your old home to your old workplace.. . ... . ..... ..... . '" ... .. . . ...... .. b. c. Subtract Une b from Line a and enter the difference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . .. c. If line c is 50 miles or marl!, continue. If not at least 50 miles. you may not claim moving expenses. 17. Transportation expenses in moving household goods and personal effects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17. 18. Travel, meals, and lodging expenses during the actual move from your old home to your new home. . . . . . . . . . . . . . . . . . . 18. 19. Toll!l Expenses for Part D. Add Lines 17 and 18.... ,....,..... ... ..." ,..., ..... """ ..., ......., ,... . ,. 19. Part E: Education Expenses. You must answer ALL three questions or the Department will disallow your expenses. El. Did your employer or a law require that you obtain this education to retain your present position or job? . . . , . . . . . . . . .. 0 1. YES 0 2. NO If you answer YES, continue. If you answer NO, you may not claim education expenses. 1:2. Did you need this education to meet the enby level or minimum requirements to obtain your job? . . . . . . . . . . . . . . . . . . . E3. Will this education, program or course of study qualify you for a new business or profession? .. . . . . . . . . . . . . . . . . . . . . If you answer NO to both questions, continue. If you answer YES to ..ther question, you may not claim education expenses. 20. Name of college, university or educational institution 21. Course of study 207-50-3656 miJes miles miles i I I o I.VES 0 o I.VES 0 2.NO 2. NO 2~. Tuition or fees .. .. . .. . . . . . . , . . .. . . .. . . . .. .. .. .. . . . . .. .. . . . . . . . . . . . . . . . . .. . . . . . . . , . . . . . . . . ' . .. . . . . . . 22. 23. Course materials. . . .. . .. . . .. . . . . . . . . . . . . ... . . . . . . . .. .. . . . ... . . . . . . . .. . .. . . . . .. . . . ... . . . .. . .. . .. . . . . 23. 2~. Travel expenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24. 2$. Toll!l Expenses for Part E. Add Unes 22, 23, and 24. . . .. . .. .. . .. . . . . . .. . . ... , .. . .. .. . .. . . . .. . . . .. .. . . , . . . . ~5. Part F: D_ecJaUon Expenses. Do not include vehicles (use Part A) and office or work area (use Part C) expenses. (a) Description of property (b) Cost or (c) DepreCiation (d) Depreciation (e) Section 179 (I) Expense other basis method deduction expense Add (d) + (!!) 26. Toll!l Expenses for Part F. Add column f.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26.1 Part G: Miscellaneous Expenses. Itemize the type and amount of your additional expenses, including expenses from Form 2106 or Form 2106-ez. a. a. b. b. c. c. d. d. e. e. 27. Total Miscellaneous Expenses for Part G. Add Lines a through e.. . . .. . . . . . . , . .. . , , .. . .. . . . . . , . . . . .. .. . . ' , . . . 27. Toll!l Allowable PA Employee Business Expenses. You must also account for reimbursements. if any. ~8. Total expenses. Add Lines 10, 15, 16, 19, 25. 26, and 27. . . . , . . . . .. . . . . . . . . . . . . . .. . .. . . . . . . . . . , . . . , . .. . . . . , . 28.[ 655 [ ~9. ~~~u:::~~y~~:~~e~m~~~.e~.e.n~ ~~t.~o.u~.e~~'.o.y~ D.'~.N~~re:.~~ ~~. .... ............................ . 29'1 I 30. Net Expense or Relmbursemenl. ..........,.......,...,...,.....,........,..,..,.....,.........."... 30. 655 If Line 28 Is MORE than Line 29, enter the difference on Line 30 and include on Line 1 b, Unreimbursed Employee Business Expenses, on your PA-40. If Line 2918 MORE than Line 28, enter the difference on Line 30 and include the excess in Line 1a, Gross PA Compensation, on your PA-40. L 9901813155 9901813155 .--J Page 2 I PA SCHEDULE UE' 9901713157 ~ Allowable Employee Business Expenses PA,-40 UE (09-99) 1999 PA, DEPARTMENT OF REVENUE OFFICIAL use ONt y It you incur expenses from more than one job, you may make photocopies of this schedule or make your own schedules In this formal Name of Taxpayer Claiming Expenses: Social Security Number: ANGELA M. TOMASELLO 182-60-7453 Employer's Name: I Employer's Address: Employer's Federal 10 Number: COUNTRY MEADOWS I HERSHEY, PA 17033 23-2362679 Describe the duties of the jOb in which you incurred these expenses: Employer's Telephone Number: PART-TIME PART A. EmploY~e Business Expenses. Caution. You may not use Une 4 of Form 2106 or Form 2106EZ. You must itemize these expenses In Part G of this schedule. Vehicle expensea. Standard Mileage Rate. Filing Tip. If you Cia not file Form 2106 or 2106EZ, enter your total business miles _ and multiply by the federal standard mileage rate $0. _ Enter the result on Une 1. 1. Enter the amount from your Form 2106 or Une 1 of Form 2106EZ......... ... . ..... ....... ... .. . ....... ... 1.1 Vehicle Expense~. Actual Travel and Mileage Expenses. 2. Enter the amount from your Form 2106. Make the following adjustments:. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . " . . 423:'1 3. Add back th~ Inclusion amount. This adjustment does not apply for PA purposes., , . , , . . . . . . . . . . . . . . . , . . . , . . . . 4. Depreciation. You may use any generally ae;e;epled method. If not using YOW" Form 2106. enter your depree;iatlon expense" complete Line 5 5. Depreciation Method. [J B 6. Actual Trav~1 and Mileage Expenses lor PA Purposes. Total Lines 2. 3, and 4. . . . . . . . . . . . , . . . . . . . . . . . . . . , ' 6. 7. Parking Fees, Tolls, and Transportation. Enter the amount from your Form 2106 or Form 2106EZ., . . . . . . . . . . .. , . . 7. 8. Away From Home Overnight. Enter the amount from your Form 2106 or Form 2106EZ. . ,. " ,. . , . . . . . . . . . . . , . . . 8. 9. Meals and Entertainment Expenses. Enter the amount from your Form 2106 or Form 2106EZ.. , , , . . . . . . . . . . . . , . . 9. 10. Total Exoen$Os lor Part A. Add Lines 1 or 6 and 7, 8, and 9. . . . .. . , . . , . , . , , . ' . .. , .. .. . . . . . . . . . , .. . .. . , , 10. PART B. Olrect Employee Business Expenses. 11. Union Oues. List Union name(s) and amount(s) paid. Enter total. Attach additional sheets, if needed. Name 01 Unlon(s) and amount(s). 11. I 12. Work Cloth~s and Unilorms. Required as a condition of employment and not suitable for everyday use. Description: UNIFORMS 12.1 13. Small Tools and Supplies. Required as a condition of employment and not provided by the employer. Oescrlption: 13.1 14. Professional License Fees, MalpraCtice Insurance, and Fidelity Bond Premiums. Required as a condition of your employment. Description: 14. 15. Total Ex e"$Oslor Part B. Add lines II, 12, 13. and 14..........,..................................... 15. PART C. Olllce Or Work Area Expenses. You must answer ALL three questions or the Department will disallow your expenses. Cl. Does your employer require you to maintain a suitable work area away from the employer's premises? . . . . . . . . . . . . Cl. 0 1. YES C2. Is this work area the principal place where you perform the duties of your employment? . . . , . . . . . . . . . . . . . . . . . . . C2. 0 1. YES C3. Do you use this work area regularly and exclusively to perform the duties of your employment? . . . . . . . . . . . . . . . . . C3. 0 1. YES II you answer YES \0 ALL three questions, continue. II you answer NO \0 ANY question, you may not claim at home expenses. Actual Olllce or Work Area Expenses. Enter expenses for the enlire year and then calculate the business portion. a. Depreciation Expense (Homeowners only) . . . .. . . . . .. . .. . . . .. . .. .. . . . . . . . . .. " .. . . . .. . . . . . . . . . . .. . . . a. b. Real Estate Taxes ., , . . , . . . . . .. . . . . . . .. .. , . . , , . . . . .. .. . .. . . . , . .. . . . . . . . . . . .. .. . . . . . . . . . . . . .. . . , b. c. Mortgage Interest (Homeowners only). . . . . . . . .. . . .. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c. d. Utilities. . , , . . . . , . . . . . ' , . , . . , . . . . . . , . . . , . , . . . ' . . , . . . . , . . . . , . .. . . , , . .. . . . , . . , . , . . , . . . . , , . . . . , . , d. e. Property Insurance ............................................................................ 1. Property Maintenance. Itemize the type and amount of maintenance expenses incurred: g. Other Appottionable Expenses. Itemize the type and amount of these expenses: h. Rent (Renters only) .... , . . . . . . . . , . . . ' . . , .. , . . . ' . . . . , . , , . . , .. . , . . . . . . . , . , . , . , . . . . , . . ' . , . . . .. . , . I. Total. Add lines a through h. Enter the total here ,.,.. ' , . . .. . , . . . . . . ' , . . , , , . , . . , . , . , . . , . . . . . . , . . , . . . . J. Business P$rcentage of Property. DiVide the total square footage of your work area by the total square footage of your entire property. Round to 2 decimal places. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . k. Apportioned Expenses. Multiply Line i by the decimal on Line j . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. Total Office Supplies. Itemize supplies you purchased exclusively for use in your office or work area. Total. 16. Total Expenses lor Part C. Add Unes k and I. ' . , . ' , ' , , . . . ' , . , , . , . , . . , ' . . , , . , , . . . , . ' . , . . . . , , . . . , . . , , L 9901713157 o 1770 o 177 D2.NO o 2. NO o 2. NO g. I o I~ h'l I. ). k. I "" o B 1~: \ 9901713157 .-J ., < ......~ I "0<_ -.J 9901813155 PA SCHEDULE UE Allowable Employee Business Expenses PA-40 UE (0"99) 1999 PA DEpARTMENT OF REVENUE Name of Taxpayer Claiming Expensos: O~l=lcrAL USE ONt" Social Security Number: ANGELA M. TOMASELLO 182-60-7453 ParI 0: Moving Expenses. a. Enter the number of miles from. your old home to your new workplace. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 8. b. Enter the number of miles from your old home to your old workplace. ' . ' . , . , . , , . , , . . , , . ' , . . . . , , ' , . . . , . " b. c. Subtract Une b from Une a and enter the difference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " c. If Une c is 50 miles or more, continue. If not at least 50 miles, you may not claim moving expenses. miles miles miles 17, Transportation expenses in moVing household goods and personal effects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17. 18. Travel, meals, and lodging expenses during the actual move from your old home to your new home. . . . . . . . . . . . . . . . . . . 18. 19. Tolal Expenses lo~ Part D. Add Lines 17 and 18. .. . , ' . . . . . . . . . ' . ' . . . . .. . . . . , . , . . . . . . . . . . . . . . . , ' , , . .. . ' . . , 19. Part E: Education Exp~nses. You must answer AlL three questions or the Department will disallow your expenses. E1. Did your employer or a law require that you obtain this education to retain your present position or Job? . . . . . . . . . . . . . . If you answer YES, continue. If you answer NO, you may not claim education expenses. E2. Did you need this eduoatlon to meet the enby level or minimum requirements to obtain your job? . . . . , . . . . . . , . . . . . . . E3. Will this education, program or course of stUdy qualify you lor a new business or profession? . . . . . . , ' . . . . . . . . . . . . . . If you answer NO to both questions, continue. If you answer YES to either question, you may not claim education expenses. 20. Name of college, university or educational institution 21. Course of study o 1. YES 0 2. NO o 1. YES 0 2. NO o 1. YES 0 2. NO 22. Tuition or fees 22. 23. Course materials 23. 24. Travel expenses. 24. 25. Total Expenses lor Part E. Add Unes 22, 23, and 24. 25. ParI F: OepreclaUon Expenses. Oil not include vehicles (use Part A) and office or work area (use Part C) expenses. (a) Description of property (b) Cost or (C) DepreCiation (d) Depreciatton (e) Sectian179 (I) Expense other basis method deduction expense Add (d)+{e) 26. Total Expenses lor Part F. Add column f.. . . .. ... ... ,.. . . ... ...... .. .. .. . . ... . ... . . . . .... . ... . .. ... , . .. 26. I ParI G: Miscellaneous Expenses. Itemize Ihe type and amounl of your additional expenses, including expenses from Form 2106 or Form 2106-EZ. a. a. b. b. c. c. d. d. e. e. 27. Total Miscellaneous Expenses lor Part G. Add Unes a through e.. . . . .. .. .. . .. . .. . . . , . . . . . . . . . . . . . . . . . . . . . . . . 27. Total Allowable PA Emp~oyee Business Expenses. You must also account for reimbursements, if any. 28. Total expenses. Add Lines 10, 15, 16, 19, 25, 26, and 27. . . . . . . . . ' . . . . .. . . . . . . . . . . .. .. . . . . . . , . . . . . . . .. ' , . . .. 28.1 177 i 29. Reimbursements. Enter reimbursements that your employer DID NOT raporl as lal(N able wages on YOlur Form W-2. .......,..,....................,.,.........,....,....,..,......,..... :'1 177 ! 30. el Expense or Rembursemenl. ...,...............................,...,......,....,..,...,.......... '. . If LIne 28 is MORE than LIne 29, enter the difference an Line 30 and include on Line lb, Unreimbursed Employee Business Expenses, on your PA-40. If Line 29 Is MORE than Line 28, enter the difference on Line 30 and include the excess in Line la, Gross PA Compensation, an your PA-40. L 9901813155 9901813155 -1 Page 2 1. W-2 EARNINGS (Anach W-2's) .. 2. EMPLOYEE BUSINESS EXPENSES (Altach State SctMKIUIe UE.1 and Required AtIachmenII) .K.K...."".............."."..._..._..............._.............. 3. TAXABLE W-2 EARNINGS (Subtract Line 2 trom Line 1) ,. 4. OTHER TAXABLE EARNED INCOME (No lnt&reat. DI\IId8ndt or Unemployment BenefIts. AIt8ch SupportIng Documents) ..................... 5. TOTAL TAXABLE EARNED INCOME BEFORE NET pROFITS (Losses) FROM SELF.EMPLOYMENT ....... (Add Lines 3 and 4) 8. NET LOSS FROM SElF-EMPLOYED BUSINEss. PROFESSION, OR FARM ........,.....u...:.."_;..;;.".K...::~.:..:....:.K._"._...,,_........."K..m......._........... 8. (Use Une 8 for any Net ProRIa) (Attach AppropriPIe IRS Schedules) ," 7. SUBTOTAL (Subtract Line 61rom Line 5) IF LESS THAN ZERO, eNTER ZERO .......................................................................... 7. 8. NET PROFIT FROM SElF-EMPLOYED BUSINESS, PROFESSION, OR FARM::."..___K:.K."~...".."".......:~:.._.:..~...__._.._........................... 8. (Use Una 8 for any Net 1..o88e8) (AItadI AppropriII8IRS'Scheduleal': -~ .-:':-",:~:;:::..':ii>~:';>';;j;;;q.;,::~:'.~,'. .:-:__...- ." . 9. TOTAL TAXABLE EARNED INCOME AND NET PRofiTS (Add Une 7 and 8) ........................................................ ................................ . 9. 10. TAX LIABILn'Y 1% OF UNE,9 (Mulllp/y Une 9 by .01) ....."."..K"~..':"':.~'.+::{"....~:.K."":""...u.".~:~~i:..~;.~~~::7:~~~i~~......."K........"....._......."......... 10. 11. CREDITS: A. ENTER TOTAL 1% TAX WITHHELD Bt( EMPLOYER .........._............................................................................. 8. ENTER aUARTERL Y PAYMENTS MAOE ,TO THIS BUREAU .."................... .................... .......................... . 11, 12: IF UNE 11C IS LARGER_:ntAN UNE 10, ENTER REJruND'DuE H~~:.1'.i;:~-,; ,'~~j~';;.;~;.;:.~~~':f'""',;~~:~.....-................................ 12. (If lea8 ~,$1~i enter,Ze~)'- , -, 'Y~" .., ~~'!::;:t~,~"i'it~~~~i:~~&::i~i):" ,.~:@~,;::;;..~i;i,,,' . 13. IF 10lNE 10 IS LARGER THAN loINS 11C. PAY UNPAID BAlANCE BY APf'UL 15 ........................................................._............................................... 13. (It Less than $1.00. Enter Zero) 14. ADQ lNT$e~ AND PENAL~,Q~~~,:~~~,:~L_Jk~:I!~IE;~.:.-_,:.-;:!"'.__....,'4. 15. PAY BALANCE DUE WITH THIS RETURN (Une 13 plu. LIne 14) ................................................................................................................................15. OLD MAIUNG ADDRESS LIST MOVING I FORMATION FOR 1999 TAX YEAR BELOW TWPJBORO PERIOD UVED HERE TO CENTER TOfAL 100 TAX CREDns (Line 11A plus Line l1B) CURRENT MAIUNG ADDRESS (IF NOT THE SAME AS BELOW) TWPJBORO 207-50-3656 TAX BUREAU COPY 1999 FINAL RETURN FOR EARNED INCOME TAX WESTAB FORM 531 (REV. 11/99) RE EAENCE NO. ************** ECRLOT ** C-032 0-197-ij51 OUR RECORDS IIIDlCATETHAT YOU ARE A RESIDEIIT OF: NICK T TOIlASELLO 9 N STONER AVE SHIREIlANSTOWN FA PSO ~, "~ ,I ~ '" 1. ,3"0 rf I'f - b"SS- 33(7SCj 2. 3. 4, ,. 33,7::'"-1 33,7S'7 33,7SCl ~3"i3 31f./f 3<t'f 6 . 073 SHIREIlANSTOWN 17011-63ij1 011810 ( 1 '/V-2 EARNINGS (Attach W.2's) 2. ~PLOYEE BUSINESS EXPENSES (Attach Slale Schedule UE-1 and Required Attact1rnents) .~..._..._.".............~..............,._........... 3. TAXABLE W-2 EARNINGS (Subtract Line 2 from Line 1) .. 4. OTHER TAXABLE EARNED INCOME (No Intereet. OiYldend8 or UnemplOyment BenefIts, AI!ach SUpportIng Oocuments)..__mm..........__....... 4. 5. iOTAL TAXABLE EARNED INCOMe BEFORE NET PROFITS (Losses) FROM SELF-EMPLOYMENT ............................................. 5. (Add Unes 3 and 4) 6. NET LOSS FROM SELF-EMPLOYED BUSINESS. -PROFESSION. OR' FARM-~.._~_-:~~:....;.:.~_~~... ..__......_.................... 8. (UselineQforanyNetProtits) (ArtachAppropriateIRSScheduIes)"..':.. ',.:-, -,'?',_;_::,:':::_'.,<_~,;-. 7. f;UBTOTAL (Sl.lbtract Une 6 from Line 5) IF LESS THAN ZERO. eNTER ZERO ..................................................... ......................... ..................... 7. 8. NET PROFIT FROM SELF.EMPLOYED BUSINESS, PROFESSION: ofi:'PW: "....~~::;~~;;:-::;;2::i.~~:~~- :;;;;.;.4~~".""....-................... 8. (Use Une I) tor any Net Loesea) lAtIach Approprfate IRS ScheduIeIt ',' -. .' . ~, ,~.. , "'-;-'-",' '\.;;,' _,' '" . .'It- ." 9. IOTAL TAXABlE EARNED INCOME AND NET PROFITS (Add Una 7 and 8) ........... ....................................................... ......................... 9. 10. lAX UABIUTY 1% OF UNE 9 (Mulllp/y Une 9 by .01) ....~.-:.~--,-:~"".~k~~~.~~;...,;:.~~.-:...:..............~.,.::....;....~,........._............._.._........ 10. 11. CREDITS: A. ENTER TOTAL 1% TAX WITHHEW BV EMPLOYER ...............................................................................m.......................... B. ENTER QUARTERLY PAYMENTS MADE TO THIS BUREAU .................:....................................................................... 11. 12. IF U~E~ ~=~Ze~E 10. ~ REfUND Dur;-'HERE,:,)F--' ;.....,...~~ip.::L.~~:;;~:~;.~r~.:,~~._,~_'~::.._........_._........_..._...12. 13. IF UNE 10 IS LARGER THAN LINE 11C, PAY UNPAID BALANCE BY APRIL 15 ........ .......................................................... .. 13. (If Less Ihan $1.00, Enter Zero) 14. ADD INTEREST AND PENALTY OF 1% PER MONTH OF LINE 13-~~:~RJl15';':",:.._._.."..:.........:_;..::.-,.......:..~...........................:.................14. 15. PAY BALANCE DUE WITH THIS RETURN (Une 13 plua Une 14) ................"...................................... OlD MAILING ADDRESS UST MOVING INFORMATION FOR 1999 TAX YEAR BELOW C ENTER TOTAL Fo TAX CREDITS (lme 11A pius line ItB) CLJRRENT MAILING ADDRESS (IF NOT THE SAME AS BE~W) 182-60-7~53 TAX BUREAU COpy 1999 FINAL RETURN FOR EARNED INCOME TAX WESTAB FORM 531 (REV, 11/99) RE ERENCE NO. ************** ECRLOT ** C-032 0-256-707 ANGELA ~ TO~ASELLO 9 N STONER AVE SHIRE~ANSTOWN PA 17011-6341 PSO " >-, ~ ..........I~, "~ 2, 3, 6, 1.91 - /77 ~-;1 6' ;). $(762- ,5; 'i([~ 67762- €;o 6f 6/ / OUR REtaRDS INDICATE THAT YOU ARE A RESlDENT OF: 073 SHIREMANSTOWN --I .0 -h;_ ( ( David S. Baboian, CPA, PC 3525 Countryside Lane Camp Hill, PA 17011 (717) 763-8044 /V,'C. IT. Attached is your 1999 Local Earned Income Tax Return. Please follow the instructions below: SIGNATURE: Sign and date Page 1. AMOUNT DUE: $ Make check payable to: WESTAB / CTCB / CDAITO LCTCB / MATCB / YAEITB Write your Social Security Number and "1999 Income Tax" on your check. REFUND : $ 6 Will be refunded to you. CREDIT: $ Will be applied to your 2000 estimated tax. WHEN TO FILE: Mail on or before April 17, 2000. WHERE TO FILE: Envelope attached. I recommend the use of certified mail to provide proof of timely filing. Please contact me if you have any questions. David S. Baboian, CPA ~ - t...i~i, , , 1999 PENNSYLVANIA FILING INSTRUCTIONS NICK T. AND ANGELA M. TOMASELLO 207-511-3556 FORM TO FILE: FORM PA-40 - 1999 PENNSYLVANIA INCOME TAX RETURN SIGNATURE: THE TAXPAYER AND SPOUSE SHOULD BOTH SIGN AND DATE FORM PA-40 AT THE BOTTOM OF PAGE 2. PAYMENT: NO PAYMENT IS REQUIRED. REFUND: YOU WILL RECEIVE A REFUND OF $22. WHEN TO FILE: ON OR BEFORE APRIL 17, 2000. WHERE TO FILE: PA DEPARTMENT OF REVENUE REFu~/CREDIT REQUESTED 6 REVENUE PLACE HARRISBURG, PA 17129-0006 1999. . ( FEDERAL FILING INSTRUCTIONS NICK T. AND ANGELA M. TOMASELLO ELECTRONICALLY FILED: FORM 1040 1999 U.S. INDIVIDUAL INCOME TAX RETURN THE ABOVE TAX RETURN HAS BEEN ELECTRONICALLY FILED WITH THE INTERNAL REVENUE SERVICE. PAYMENT: NO PAYMENT IS REQUIRED. REFUND: YOU WILL RECEIVE A REFUND OF $1,941. "' _k~ 207-50-3656 "'"!Lit< ( THIS INFORMATION IS BEING FURNISHED TO THE INTERNAL REVENUE SERVICE COMMONWEALTH OF PENNSYLVANIA ~ AA"RS OMB No 1545-0120 De:PARTMENT OF REVENUE ,~, FORM 1999 ac:1drll$$.ZlP l099-G HARRISBURG, PA 17128 -,WI Statementfo. ,-.> R8Clpl8l'llsof Copy' ldenllficalicn Certain ForRel;i~I'$ FEDERAL 1.0, # 23-6003112 THIS IS NOT A BILL ~- Government """'"" Payments llCipient's ldenunc;mon Numt:ler 1.lm::om.ax~yment Z.OI'TaxTlllll" 3. I.H1SIII'lefund 207-50-3656 $15.00 1998 $15.00 4. Clediw.d to Estimatecf """M NICK TOMASELLO $0.00 ANGELA TOMASELLO - 9 N STONER AVENOE 5.Dona\ll)nS I SHIREMANSTOWN PA 17011-6341 1:0.00 i STATE TAX OVERPAYMENT FOR 1999 FEDERAL INCOME TAX REPORTING REQUIREMENTS Under federal law the PA ~ent of Revenue must provide you with this record of your overpayment approved in calendar year 1999 and provide a copy to the IRS. you included the amount shown in Box 1 as an itemized deduction on your 1998 federal Income tax return, you must reportthl$ overpayment as income on your 1999 federal ineometax return. (If you have any questions, please caD 717-787-8201.) INSTRUCOONS TO RECIPIENT BOX 1. Shows the total amount of overpayment in 1999 from your original to another year's estimated account or to an existing PA tax liability fat or amended PA income tax return. another tax year. BOX 2. Shows the taxable year of the overpayment In BOX 1. BOX 5. Shows that ALL or the portion of your overpayment which you BOX 3. Shows that ALL or a portion of your overpayment was a cash requested was donated to the crganization(s) specified on your return . refund. BOX 4. Shows that ALL or a portion of your overpayment was credited PLEASE CHECK YOUR RECORDS BEFORE CONTACTING THE DEPARTMENT ABOUT THIS FORM. ", '.'c ( USAGroUP Loan Services' USA GROUP LOAN SERVICES INC PO BOX 6179 INDIANAPOLIS IN 46206-6179 ~II mlll~IIIIIIIII11III"lllmlllmlllllllll WIIIIIIIIUlIII~1 NICK T TOMASELLO 9 N STONER AVE SHIREMANSTOWN PA 17011-6341 JANUARY 10, 2000 Account Number: 207-50-3656 THIS IS NOT A BIll Dear NICK T TOMASELLO: This is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return. a negligence penalty or other sanction may be imposed on you if the IRS determines that an underpayment of tax results because you overstated a deduction for student loan interest. The IRS is provided the amount of interest paid on your student loan during tax year 1999 only if that amount is $600 or greater. Instruction for Borrower A person (including a financial institution. a governmental unit. and an educational institution) that is engaged in a trade or business and. in the Course of such trade or business. received interest of $600 or more on a student loan in the calendar year must furnish this statement to you. You may be able to deduct student loan interest on your income tax return if the interest payments were made durin9 the first 60 months the interest payments were required. However, the interest reported on this statement may be different from the interest you may deduct. See Pub. 970, Tax Benefits for Hi9her Education or consult your tax advisor for more information. IRS forms may be ordered by callin9 (BOO)829-3676. To ask IRS questions directly - call (800)829-1040. Box 1. Shows the interest received by the lender during the year on this student loan. Should you have any questions regarding the amount of interest paid during this calendar year. you may contact USA Group Loan Services Inc at the following address/telephone number: USA Group Loan Services Inc PO BOX 6179 INOIAHAPOLIS IN 46206-6179 (800)883-4551 WWW.USAGROUP.COM o CORRECTED (if checked) USA Group Loan Services Inc PO BOX 6179 INDIANAPOLIS IN 46206-6179 (800)883-4551 OMB No. 1545-1576 AECIPIENrSJLENOER'S name, address, and telephone number ~@99 Student Loan Interest Statement Fo"" 1098-E Copy B For Borrower RECIPIENrs Federal identillcalion no. 1 Student loan interesl received NICK T TOMASELLO 9 N STONER AVE SHIREMANSTOWN PA 17011-6341 This is important tax information and is being lurnished 10 Ihe Internal Revenue Service. If you are required to lIIe a return, a negligence penally or olher sanction roay be imposed on you if the IRS determines that an underpayment of lax results because you overstated a deduction lor student loan Interest. BORROWER'S name and address Account number (optional) Foim 109l1-E , (lS~!lP tor Y9W r~c9r<;I~,) Cap.rtment oj the Treasury. Inlernal Revenue Servuce L _ ~ _~,~ ( NICK T TOMASELLO FIRST PLUS FIIWlCIAL LN . 2012111194' ............................................................ ............................................................ .. .. u YOUR 1'" IIII1TGAGE INTEREST STATEIlEIIT IS S_ .. .. 8ELOlf. PLEASE DETACN AND RETAIN FOR YOlIR RECORDS. u .. - - .. . ............................................................ -............................................................ [' " , DETACH AT PERFORATION MORTGAGE iNTEREST STATEMENT , 52:: "IE'J:RSE 3,:<:" =CA \lPCRT,l,NT 'NFC;:l~,1,.l.i!CN Copy B For Payer . OMS No. 1545-090 1 Form 1098 Dept. Of The Treasury -IRS NICK T TOMASELLO ANGELA N TOMASELLO , IIIITH STOllER AVEIlUE SHIRENANSTOWN PA 17011 TELEPHONE: 1-1100-1122-1986 TAll 10: 74-2424505 FIRST PLUS FINANCIAL P.O. BOX 36668 DALLAS TX 75235-1668 TAXPAYER IDI 207-50-3656 LN 2012111194' REMAINING . BALANe \I .- M T G , G .. - -- .- ~'-" .. ""... ~ f"; RECIPIEN1'.S/LENOER'S nama, 11."t add,u:I. ",II', llata,( IP"ada 0 CORRECTED Ii( .eckedl Norwest Mortgage. Inc, 'C.utlan: Th.OlllOlln'lhown MORTGA IIIG)' no' b. fully dedudibl. by)fOll. OM8 No. Correspondence Resolution X2501-0lT limi" bared on Ifl. loan amount and 1545-0901 1 Home Campu s tft.eoJfand...alnolffl.I-':lIred INTERES Des Moines. IA 50328 property may apply. AJso.)fOll may 1999 Phone #: i800~ 262-5294 Ol'Ilyd.dllr:f;n,.'.dfolft....,.ntit STATEME Fax #: i5 5) 37-7070 wal incurred by)fOll, octualJy paid by TTY Dea /Hard of Hearing (800) 945-0399 you. and not r'lmbu".d by dnotfte, pe.lQIn. Form 109S RECIFIENT'S Fada,al ,dantll'Cilltlan no. PAYER'S ,,,clIl lIcu.,ty numb.. , .""'j' '"'''''' "''"Vi: I..m oy pavar!!/bo,'"willds). Copy B 95-2318940 207-50-3656 ,$5.823.0 For Payer , PAVER'SiaORROWER'S nillma. iIIddran. and ZIP ~ada 2 p..,nu plld an jlu.chan. rlnCI 'nldane, 8027 (s..a... Z..nback.l $.00 Th, 'nformallon ,n bOll8' 1, 2. and 3 '. Important lall 'nformallon and ,$ 3 Rafund of ..v.rlllld ,ntarnl b.,ngfu,n,sh.dtoth. NICK T TOMASELLO (S..Ba.3<lllbackJ $.00 InUlrnal ROII.nu. SarI/ICO. ANGELA M TOMASELLO I'\,oua'or.qult,dto flloa.aturll.anagltganca 9 N STONER AVENUE --'~ ponalty or atha, Unc:tlOIl SHIREMANSTOWN PA 17011 4 Real Estall Ta..! Faid '$925.97 ) may bo Imposod on \,ou If tho IRS d.t.rm,nl$ lhat an undorpillymo.nt of tlX rlsulls / blcluSlyouol/lrstatada Offic.i------ d.ducllon for thl! mOrlglga Account numb.r (..ptlonall Illt.rast or for tnasa pomts 5291292 or !:Ioc:aus. \,ou did not 685 report thl$ r.fund of ""taraston you,retl.l,n. GE T NT form 109S SEE BACK SIDE FOR IMPORTANT INFORMATION (KlIlIp f.., VllU' "cords.) Ollparlmll/lt of thm T,usurV . Inlerul ROIIll/lUO SO'ViCCl 13.2678063 Please consult a Tax Advisor about the deductibility of any payments made by you or others. $508.57 $1,761.84 $438.06 $217.00 $925.97 $689.38 BEGINNING BALANCE + DEPOSITS - MORTGAGE INS PAID - HAZARD INS PAID - TAXES PAID "ENDING BALANCE $90,128.95 BEGINNING BALANCE $1,124.40 PRINCIPAL APPLIED $89,004.55 ENDING BALANCE $750.53 TOTAL CURRENT PAYMENT $128.02 ESCROW PORTION OF PMT PROPERTY ADDRESS: 9 N STONER AVENUE SHIREMANSTOWN PA 17011 " HELD FOR DISBURSEMENTS DUE NEXT YEAR ----------------.--------- 1999 INTEREST DETAIL --------------------------- TOTAL INTEREST APPLIED 1999 $5,823.00 1999 MORTGAGE INTEREST RECEIVED FROM PAYER/BORROWER(S) $5,823.00 Section 329 of the Cranston Gonzales National Affordable Housing Act requires that mortgage companies provide their customers the notice provided below describing the requlrements that the customer must fulfilL upon prepayment of the mortgage. T~e issuance of this statement is an annual requirement of federal Law. It necessitates no activity on your behalf, and does not require you to payoff your loan. You do not need to respond. FHA N: 441-544783 Annual Disclosure Notice to Mortgagor Date 01/07/00 This notice 15 to advise you of requlrements that must be followed to accomplish a prepayment of your mortgage. and to advise you of requIrements you must fulflll upon prepayment to prevent accrual of any interest after the date of prepayment. The amount listed below is the amount outstanding on the loan for prepayment of the 'ndebtedne~s due.under your mortgage, This amount is good through 02/01/00. (The amount is subject to further account1ng adjUstments, Also. any mortgage payments received or advances made by us before the stated expiration date will change the prepayment amount,) S90,305.38* You may prepay your mortgage at any time without penalty, However, in order to avoid the accrual of interest on any ,prepayment after the date of prepayment. the prepayment must be received on the installment due date, Otherwlse. you may be required to pay interest on the amount prepaid through the end of the month. If you have any questions regarding this notice. please contact our Customer Service Department toll free at 800) 262-5294. .Pl.... r....b.r that the ..ount listed on this nottc. above .ay not corr..pond wtth your curr.nt princtpal bel.nca. It .ay tnclud. tnt.r..t .nd oth.r charge8 a.80ct.tad wtth the payoff of your mortgage loan. ~~.....; &< ]98LOOOOZ540.1 PROVIOIAN NATIONAL BANK P.O. BOX 269 Tll TON NH 03276 FOR ASSISTANCE CAll: (800) 537-4332 lOAN SERVICING RECIPIENT'S FEDERAL IDENTIFICATION NUMBER 02-0118519 PAGE 1 THE INFORMATION IN BOXES 1, 2. AND 3 IS IMPORTANT TAX INFORMATION AND IS BEING FURNISHED TO THE INTERNAL REVENUE SERVICE. IF YOU ARE REQUIRED TO FILE A RETURN. A NEGLIGENCE PENALTY OR OTHER SANCTION MAY BE IMPOSED ON YOU IF THE IRS DETERMINES THAT AN UNOERPAVMENT OF TAX RESULTS BECAUSE YOU OVERSTATED A DEDUCTION FOR THIS MORTGAGE INTEREST OR FOR THESE POINTS OR BECAUSE YOU DID NOT REPORT THIS REFUND OF INTEREST ON YOUR RETURN. 1999 MORTGAGE INTEREST STATEMENT FORM 1f/911. COpy B. FOR PAYER OMB No, 1545-0901 NICK T TOMASELLO ANGELA M TOMASELLO 9 N STONER AVE CAMP HILL PA 17011-6341 PAYER'S SOCIAL SECURITY NUMBER 207-50-3656 ACCOUNT 1. MORTGAGE INTEREST 2. POINTS PAID ON 3. REFUND OF OVERPAID REFERENCE NUMBER RECEIVED FROM PURCHASE OF PRINCIPAL RESIDENCE INTEREST PAYER(S)/BORROWERlS) ... (SEE INSTRUCTIONS BELOW) (SEE INSTRUCTIONS BELO'N\ 2 15266290028 00001 CY ./. -........... I 1,367.00 " ~ 0.00 JO-~1-''\ ISyV"'\ . CAUTION: THE AMOUNT SHOWN MAY NOT BE FULLY DEDUCTIBLE BY YOU. LIMITS BASED ON THE LOAN AMOUNT AND THE COST AND VALUE OF THE SECURED PROPERTY MAY APPLY. ALSO, YOU MAY ONLY DEDUCT INTEREST TO THE EXTENT IT WAS INCURRED BY YOU, ACTUALLY PAID BY YOU, AND NOT REIMBURSED BY ANOTHER PERSON. INSTRUCTIONS FOR PAYER/BORROWER ~ par.:;or, (lll.;l~dlny ;] flnanclill il"!:titution, a governmental unit, ",Iud.. ccoperativo! llousing corporation) who is engaged in a tr3d'!.' or b'J~ine~s end, in the course of such trade or business, received from you at least $600 of mortgage interest (including certain points) on anyone mortgage in the calendar year must fUrI'Ilsh this statement to 'Iou. If you received this statement as the payer of record on a mortgage on which there are other borrowers, please furnish each of the other borrowers with information about the proper distribution of amounts reported on this form. Each borrower is entitled to deduct only the amount he or she paid and points paid by the seller that represent his or her share of the amount allowable as a deduction for mortgage Interest and points. Each borrower may have to include in income a share of an)' anwunt reported in NO.3. If your mortgage payments were subsidized by a government agency, you may not be able to d~uct the amount of the subsidy. I. Shows the mortgage interest received by the interest recipient durin~ the year. This amount includes interest on any obligation secured by real property, including a home equity, line 01 credit, or cred>>' card loan. This amount does not include points, government subsidy payments, or seller payments on a "'buy-down" mortgage. Such amounts are deductible by yOU only in certain circumstances. Caution: If you prepaid interest in 1999 Ihat accrued in full by January 15, 2000, this prepaid Interest may be Included in No.1. However. you cannol deduct the prepaid amount in 1999 even though it may be Included in No. 1.1f you hold a mortgage credit certificate and can claim the mortgage interest credit, see Form 839B, Mortgage Interest Credit. If the interest was paid on a mortgage, home equity, tine of credit, or credit card loan secured by your personal residence, you may be subject to a deduction limitation. For ~ample, \f a home equity loan exceeds $100,000 ($50,000 if married filing s.paratel~) or, together with other home loans, exceeds the fair market value of your home (such as in a high loan-Io-value loan), your interest deduction may be limited. For more i"formation, see Pub. 936. Home Mortgage Interest Deducllon. 2. Not aU points are reportable to you. No.2 shows points you or the seller paid this year for the purChase of your prinCipal residence that are required to be reportp.rl to you. Generally. these points are fully deductible in the year paId, but you must subtract seller-paid poInts from tne basis of your I'1!Isldenc&. Otr.ef points not reported In NO.2 may also be deductible. See Pub. 936 or your Schedule A (Form 1040) instructions. 3. Do not deduct thl, amount. It is.1 refund (or credit) for overpayment(s) of intarest you made in a prior year or years. If you itemized deductions in the year(;.) you paid tne interest, include the total amount shown in NO.3 on the "Olhl!lr Income'" line on your 1999 Form 1040. However, do not repor1 the refund as income~' you did not item~z' deductions In the yeart!) you paId the interest. No adlustment to 'lour prior yearts) tax return{s) I" naeessayY. For mare. Information, S88 "Recoveries" In Pub. 525, Taxable and Nontaxable Income. L__ """"-', ( ( LOAN YEAR-TO-DATE ACTIVITv AS OF 12-31-99 p Ar~E r\~iJ, 1 Rj::;O;)\/IDrAN NATIONAL BANiA., ~DAN DEPARTMENT t 888-237-8815 _. SOX 269 TILTON, NEW HAMFSHIRE 03276 ACCOUNT NO. 15266290028 LOAN NO 00001 INTEREST RATE 10. 250000 _._------------------,------------- FOR THE ACCOUNT OF: YTD INTEREST FEES PAID 787, 43 1!367.00 TOTAL PAYMENT AMOUNT 511. 50 N r CK T TOrw1ASELLO ANGELA M TOMASELLO 9 N STONER AVE CAMP HILL PA 17011-6341 :JST ~TE EFF DATE DESCRIPTION TOTAL PRINCIPAL INTEREST ESCROW .00 ro..r, . V'~ 46,929,00 46,929,00 ,00 1,367.00 .00 0'-' OTHER FEE 1!367.00 511. 50 110,65 400.85 .........., . .........' 511. 50 111. 59 399.91 * . QO 46,706.76 n.~, ~D OF PREVIOUS YEAR BALANCES }/27/99 10/27/99 NEW LOAN )/27/99 10/27/99 FEE PAYMENT 1/29/99 12/02/99 PAYMENT 2/29/99 01/02/00 PAYMENT ,'<DING BALANCES * - INTEREST REPORTABLE THIS YEAR: 386. 58 396LODDD2S40.1 PROVIDIAN NATIONAL BANK P.O. BOX 269 TIL TON NH 03276 FOR ASSISTANCE CALL: (800) 537-4332 LOAN SERVICING RECIPIENT'S FEDERAL IDENTIFICATION NUMBER 02-011B519 PAGE 1 THE INFORMATION IN BOXES 1, 2. AND 3 IS IMPORTANT TAX INFORMATION AND IS BEING FURNISHED TO THE INTERNAL REVENUE SERVICE. IF YOU ARE REQUIRED TO FILE A RETURN, A NEGLIGENCE PENALlY OR OTHER SANCTION MAY BE IMPOSED ON YOU IF THE IRS DETERMINES THAT AN UNDERPAYMENT OF TAX RESULTS BECAUSE YOU OVERSTATED A DEDUCTION FOR THIS MORTGAGE INTEREST OR FOR THESE POINTS OR BECAUSE YOU DID NOT REPORT THIS REFUND OF INTEREST ON YOUR RETURN. 1999 MORTGAGE INTEREST STATEMENT FORM 1098. COpy B, FOR PAYER OMB No, 1545-0901 NICK T TOMASELLO ANGELA M TOMASELLO 9 N STONER AVE CAMP HILL PA 17011-6341 PAYER'S SOCIAL SECURllY NUMBER 207-50-3656 ACCOUNT 1. MORTGAGE INTEREST 2. POINTS PAID ON 3. REFUND OF OVERPAID REFERENCE NUMBER RECEIVED FROM PURCHASE OF PRINCIPAL RESiDENCE INTEREST PAYER(S)/BORROWER(S) . (SEE INSTRUCTIONS BELOW) (SEE INSTRUCTIONS BELOW) 2 15266290028 00001 787.43 1,367.00 0.00 . CAUTION: THE AMOUNT SHOWN MAY NOT BE FULLY OEDUCTIBLE BY YOU. LIMITS BASED ON THE LOAN AMOUNT AND THE COST AND VALUE OF THE SECURED PROPERlY MAY APPLY. ALSO, YOU MAY ONLY DEDUCT INTEREST TO THE EXTENT IT WAS INCURRED BY YOU, ACTUALLY PAID BY YOU, AND NOT REIMBURSED BY ANOTHER PERSON. INSTRUCTIONS FOR PAYER/BORROWER A person (Including a financial institution, a governmental unit, and a cooperative housing corporation) who is engaged In a trade or business and, in the course of such trade or business, received from you at least $600 of mortgage interest (including certain points) on any one mortgage in the calendar year must furnish this statement to you. If you received this statement as the payer of record on a mortgage on which there are other borrowers, please furnish each of the other borrowers with information about the proper distribution of amounts reported on this form. Each borrower is entitled to deduct only the amount he or she paid and points paid by the seller that represent his or her share of the amount allowable as a deduction for mortgage interest and points. Each borrower may have to include in income a share of any amount reported in NO.3. If your mortgage payments were subsidized by a government agency, you may not be able to deduct the amount of the subsidy. 1. Shows the mortgage interest received ~ the interest recipient during the year. This amount includes interest on any obligation secured by real property, including a home equity, line of credit, or credit card loan. This amount does not include points, government subsidy payments, or seller payments on a "buy.down" mortgage. Such amounts are deductible by you only in certain circumstances. Caution: If you prepaid interest in 1999 that accrued in full by January 15,2000, this prepaid interest may be included in No.1. However, you cannol deduct the prepaid amount in 1999 even though it may be included in No. 1. If you hold a mortgage credit certificate and can claim the mortgage interest credit, see Form 8398. Mortgage Interest Credit. If the interest was paid on a mortgage, home equity, line of credit, or credit card loan secured by your personal residence, you may be subject to a deduction limitation. For example, if a home equity loan exceeds $100,000 ($50,000 If married filing separately) or, together with other home loans, exceeds the fair market value of your home (such as in a high loan-to.value loan), your interest deduction may be limited. For more information, see Pub. 938, Home Mortgage Interest Deduction. 2. Not all points are reportable to you. No. 2 show~ points you or the seller paid this year for the purchase of your principal reSidence that are reQulrEtd 10 be reported to you. Generally, these points are fully deductible in the year paid, bU1 you must subtract seller-paid points from the baSIS of your residence. Other points not reported in NO.2 may also be deductible. See Pub. 938 or your Schedule A (Form 1040) Instructions. 3. Do not deduct Ihis amount. It is a refund (or credit) for overpayment(s) of mterest you made in a pnor year or years. If you Itemized deductions in Ihe year(s) you paid the interest, include the lotal amount shown in No.3 on the "01her Income" line on your 1999 Form 1040. However. do not report the refund as mcome if you did not itemize deductions in the year(s) you paid the interest. No adjustment to your pnor year(s) tax relurn(s) is necessary. For more Information, see "Recoveries" in Pub. 525, Taxable and Nontaxable Income. o 8 E ,~I '""'~~ ( DAVID S. BABOIAN, CPA, PC 3525 COUNTRYSIDE LANE CAMP HILL, PA 17011 (717) 763-8044 r February 28. 2000 NICK T. and ANGELA M. TOMASELLO 9 N. STONER AVENUE SHIREMANSTOWN, PA 17011-6341 FEDERAL FORMS Form 1040 Schedule A Form 5329 Form 8453 1999 U.S. Individual Income Tax Return Itemized Deductions Additional Taxes on Retirement Plans Declaration for Electronic Filing PENNSYLVANIA FORMS Form PA-40 Schedule W-2S Schedule AJB Schedule UE Schedule UE Spa 1999 Pennsylvania Income Tax Return Wage Statement Summary Taxable Interest & Dividends Allowable Employee Business Expenses Allowable Employee Business Expenses FEE SUMMARY Preparation Fee Federal electronic filing MFS report $ 129.00 19.00 10.00 I $ 158.00 Amount Due ""' =-~" ( ( Competitive Market Analysis Completed For: 9 N. Stoner Ave. , Shiremanstown I I ADDRESS II STYLE 11# DR 11# DA IISQ.FT. II OTHER FEATURES IIMT IILIST PRICE ilSALE PRICE' I IE] 11 Stoner Avenue l~ape_~jEJ~ 1~295 J!patio, Fence, Fireplace 11951\$109,900 1~204,~~0 ' I ~ ' Shiremanstown 11# 2: 924 Thorton Drive Icape cOdlEJl2 :11200 :INew Carpet, New paint IE] $114,900 !1$114,000 I ; Mechanicsburg , ' i : ll# 31 2604 Rosegarden Blvd B[][]11572 : Seller help, New carpet & vinyl, [OJ '~ i i : Mechanicsburg ape :: garage $115,900 i $114,900 ' ____J__ _ ~ ~, - -- ----' ----, . - -- - -- --- --- __.._._.___....__...__.J ..______ ...._......". : 1#41 1 009 Apple Drive Icape cOdl[][]11596 I New heat, roof, baths, electric, 11611$119,700 I , Mechanicsburg kitchen, plumbing, windows $119,000 i Settled Properties competing Properties I ADDRESS II STYLE IlnR II#BA IISQ.FT. II OTHER FEATURES 1\ MT IILIST PRICE I EJ 2200 Parkside Rd. !cape Cod IEJ011680 1 Screened porch, CIA, hardwood floors, EJ $111,900 I Camp Hill Fireplace, new roof and windows 1#21 510 Mt. Allen Dr. Icape Co~ IEJDI1200 1 New electric, doors, windows, roof, CIA, siding EJ $114,900 I Mechanocsburg rJ 16 Railroad Ave. Icape Cod IDDIII041 EJ109,000 1 Shiremanstown ~ 122 Sixteenth St. Icape Cod JDDI11751rew windows, carport and garage 16 $112,900 i Camp Hill Suggested Price Range: $107,900 to $112,900 This analysis has not been perfonned in accordance with the Unifonn Standards of Professional Appraisal Practice which require valuers to act as unbiased, disinterested third parties with impartiality, objectivity and indeperldence and without accommodation of personal interest. It is not to be construed as an appraisal and may not be used as such for any purpose. lACK GAUGHEN = REALTOR E RA ~...,j -,c~, I. i' ! ( Loan Statement ?:=:::J"..: r::::.I Ai.i NATIONA:... BAN:::. ~_n~\:-~ r:-=:p t..:=; l:-1E.N"i ......-- --- ---- :::Jt10-'::"':; ..-:::::_t:'- . ...t. 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T T::JMAS1;~.LO-.-...~~=~~~_=__=.~_~:-. ~rl~ELA ~ TQ..lf.1A~4:Lr.;i1F;:..:~_~:.~..: ~ ~~ STDNER AVE -" -" '=AMf' HiLL PA !70tf"''a34f: '"._-'~'---'-'~----'''-'--'-- ,..-, -----. ---......... -.----.. ,- .- -,- ..- .. - .. .". --"..- -- ~ ,----,,---.----- -..-----.., J=:pr .,,-..,,---...... ._-"..__."-,,_.,, '-...- . ---------_.._..__...__._--_...._-_._._---,-~. ...--._~-----.---~--~._..._--------- -,._""--,, -~_.... "'"'--~--'-'--'" --.-----.-.,,- ....-.. 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MlRItIE5T MOflTr3AGE ...- -~.. . Nonwst Mortgage, Inc. 1 Home Campus MS 122539 Des Moines IA 50328-{)OO1 PAYOFF STATEMENT FIGURES MUST BE VERIFIED 24 HOURS PRIOR TO PAYOFF February 16, 2000 (000)000-0000 Nick T Tomasello Angela M Tomasello 9 N Stoner Avenue Shiremanstown PA 17011 Mortgagor: Property Address: FHA Case No. Sec: . Loan No.: 5291292 Nick T Tomasello 9 N Stoner Avenue Shiremanstown PA 17011 441-54478341203 Loan Type: FHA Region 685 o FUNDS MUST BE RECEIVED AT THE ADDRESS LISTED ON PAGE 2 OF PAYOFF STATEMENT BY 3 P.M. CENTRAL STANDARD TIME FOR SAME-DAY PROCESSING o ALL FIGURES ARE SUBJECT TO FINAL VERIFICATION BY THE NOTEHOLDER This loan is due f9r the April 01, 2000 payment. The current total unpaid Principal Balance is : Interest at 7.25000% from 03-01-00 to 03-01-00 Pro Rata MIP Recording Fees . . TOTAL AMOUNT TO PAY LOAN IN FULL . . $ This figure is good to March 01, 2000. Funds received after March 01, 2000 will require an additional $ 536.71 per Month. A late charge of $ 30.02 will be assessed 15 days after a current payment is due and should be added to the payoff total, if received after that time. The current escrow balance is $ 873.20. Issuance of this statement does not suspend the borrower's contractual requirement to make the mortgage payments when due. $ 88,834.49 .00 72.22 14.00 88,920.71 ,.~ , .' ll.. ;...." I k Pg: 2 RE: Nick T Tomasello Tax Amount Disbursed $ Insurance Amount Disbursed $ Region 685 Loan Number: 5291292 685.73 Last Date Disbursed 08-05-99 217.00 Last Date Disbursed 07-05-99 Figures may be adjusted if any check/draft previously credited is rejected by the institution upon which it is drawn. Unless you notify us otherwise, if you fail to remit funds sufficient to pay your mortgage loan in full. we may, at our option, apply funds from your escrow account to complete the payoff. We must receive funds to cover a deficiency on the following business day. Interest will continue to accrue until we receive full payment. Send payoff funds to: Norwest Mortgage . ATTN: Payoffs, MAC X2501-01D 1 Home Campus Des Moines, IA 50328 Wire payoff funds to: Norwest Bank, Des Moines, IA Norwest Mortgage RTR: 073000228 Acct: 3002183852 To further Credit: 5291292 Mortgagor: Nick T Tomasello Sender's Name and Phone Number DO NOT PLACE A STOP PAVMENT ON ANY MONTHLY PAYMENT ALREADV MADE. ANY OVERPAYMENT WILL BE REFUNDED. Escrow disbursements will continue to be made as they become due. Any request to stop a disbursement for a tax or insurance payment must be made in writing prior to the date of payoff. The lien release document will be mailed in accordance with state law and the loan documents. The lien will not be released if: 1) any funds previously received are rejected by the institution upon which it is drawn; or 2) an insufficient amount is received to payoff the loan in full. FHA NOTICE ON 235 RECAPTURE LOANS: In order for HUD to release the second lien, a copy of the final settlement statement must be sent in with the payoff funds. XP033-055/KVE ~~ ,',,_ 1-. ~,- ,,",--l, '--, Pg: 3 RE: Nick T Tomasello Region 685 Loan Number: 5291292 -------~----------------------------------------------------------------- PLEASE DETACH AND SEND WITH PAYOFF FUNDS PLEASE PRINT OR TYPE Loan No.; 5291292 Nick T Tomasello Angela M Tomasello 9 N Stoner Avenue Shiremanstown, PA 17011 CURRENT OWNER'S NEW MAILING ADDRESS - Providing this address will ensure our customer receives the escrow balance, year-end interest statement and other documentation, if applicable. THE SATISFACTION OF MORTGAGE WILL BE MAILED TO THE COUNTY RECORDER. XP032-036/KYE , ' MORTGAGEE NOTICE TO MORTGAGOR (In response to prepayment inquiry. request for payoff or tender of prepayment in full) February 16, 2000 Nick T Tomasello Angela M Tomasello 9 N Stoner Avenue Shiremanstown PA 17011 Region 685 Loan Number: 5291292 FHA Number: ~~1-5~~7B3~/203 This is in reply to your inquiry/request on February 16, 2000 for payoff figures or offer to tender an amount to prepay in full your FHA-insured mortgage which this company is servicing. This notice is to advise you of the procedure which will be . followed to accomplish a full prepayment of your mortgage. Norwest Mortgage will: A. accept the full prepayment amount whenever it is paid and collect interest only to the date of that payment; or x B. accept the prepayment whenever tendered with interest paid to the first day of the month following the date prepayment is received. C. consider that we have received notice of your intended prepayment and the 30-day notice began to run on NOTE: It is to your advantage to arrange closings so that the prepayment reaches us on or before (as close to the end of the month as possible) the first work day of the month. If you have any questions regarding this notice, please contact me at. Sincerely, XP031/KVE '-' =--. .L '. ,_ "~"~~ - '. i f / ' /SEl'I.RCH C',RITERIA: AREA MARKET SURVEY n1/Z1/00 12:36 PM (CMA CRITERl AND (AREA=6) AND (PROP TYPE(' ) AND (ll=SHIREMANSTOWN); AREA= 6 - FRVW Twp & E OF SS/MIDD, SMID/MONR ACTIVE LISTINGS List Price Range * Listings Avg Days on Mkt $80,000 - $89,999 1 62 $90,000 - $99,999 1 30 $100,000 - $119,999 2 20 $120,000 - $159,999 1 13 For the 5 Properties: The median price is $109,000. The average price is $105,049. The highest price is $123,900. The lowest price is $84,549. The average market time is 29. PENDING LISTINGS List Price Range $120,000 - $159,999 * Listings Avg Days on Mkt 1 53 For the 1 Properties: The median price is $159,900. The average price is $159,900. The highest price is $159,900. The lowest price is $159,900. The average market time is 53. -(~SETT LISTINGS /t SETT Price Range $80,000 - $89,999 $100,000 - $119,999 * Listings 1 1 Avg Days on Mkt 62 95 For the 2 Properties: The median price is $104,000. The average price is $92,000. The highest price is $104,000. The lowest price is $80,000. The average market time is 78. EXPIRED LISTINGS List Price Range $100,000 - $119,999 $160,000 - $199,999 $250,000 - $299,999 * Listings 1 1 1 Avg Days on Mkt 78 187 126 For the 3 properties: The median price is $163,900. The average price is $177,033. The highest price is $257,700. The lowest price is $109,500. The average market time is 130. ~~ """ ~ ~, . '5~~ q 1: -,(\ '\~\ \ q ~~\i; ~. ~I "'" , r' I II " V Ii / \'o~ . / r .~' / l;j . \0, . oj~; I \\~ ~~ l'? . / X ') t)fA. ~\ I' Ii I, \'[ j~ " 11 N STONER AVENUE $ 104,000 MLS t 10045273 Mun SHIREMANSTOWN SchDist W SH Dev Dir SIMPSON FERRY TO SHIREMANSTOWN,TURN R/STONER AVE TO HOME ON LEFT LotSz 46.10 X 154.20 Acres 0.16 Totsqft 001295 Source APPRAIS* Rooms S Bedrooms 4 Baths,Fu11 1 Half 0 tFirep1 01 Warnty N YrB1t+/- 1950 Fee Lvl-Bth:FullM Half Style CAPE COD Exterior ALUM,BRICK Taxes 1210 Yr 1999 LR 15 X 11 LVL M WOOD FLOOR DR S X 11 LVL M WOOD FLOOR FR 12 X 26 LVL L WALL TO WALL CARPET DEN LVL KIT 12'10X7'6 LVL M VINYL FLOORING,WINDOW TREATMENT MBR 13'7X13'S LVL U WALL TO WALL CARPET BR1 9'4X12'5 LVL M WALL TO WALL CARPET BR2 S'SX11' LVL M WALL TO WALL CARPET BR3 S'4X9'5 LVL U WALL TO WALL CARPET BR4 LVL OR1 LVL OR2 LVL OR3 LVL Fin ADJUSTABLE,CONVENTIONAL,VA,FHA,C* Api RANGE,MICROWAVE,DISHWASHER,DISPO* Equip SMOKE DETECTORS,CABLE READY IntF SOME WINDOW TREATMENTS,ROUGH-IN* Rooms BREEZEWAY ExtF EXISTING STORM WINDW,PATIO WtSw PUBLIC SEWER,PUBLIC WATER LOVELY ALL BRICK CAPE COO OFFERS A FOUR BEDRM IN CONVENIENT LOCATION. COVERED PATIO, LRG FENCED YARD, LRG FAM RM W/FP IN LOWER LEVEL. HWOOD FLRS, OIL HEAT, PUBLIC WATER & SEWER. PLAYGROUND ONE BLOCK. PUBLIC TRANSPORTATION ONE BLOCK. CLOSE TO SHOPPING. BLINDS IN KITCHEN & 2ND FLOOR WINDOW TREATMENTS REMAIN. SELLER TO PAY $1,000 BUYERS CLOSING COSTS. LO HOME 763-7500 LA KING, HAYDEN 761-6340 INFORMATION THOUGH BELIEVED ACCURATE IS NOT GUARANTEED RADIATORS, BASEBOARDS, ELECTRIC, OIL Heat Cool Bsmt FOLL,PARTIALLY FINISHED,CONCRETE * Prkg ON STREET Ameni PLAYGROUND LtDsc LEVEL " .... ~'-<-:: .-" 03/21/00 12'38 Comparative Market Analysis (Set U) Page: 1 Active Sinq1e Family-Detached Listings ( ( S i,ist No Address Price L-Ofc AR tRm BR F/p Styl Yblt Reft - --------- ------------------------ -------- ------ A 10050515 12 N STONER AVE 84549 GAUG1 6 5 2 1/0 CAp* 1 R 10051527 '418 E MAIN ST 92900 RMREAL 6 8 3 1/1 CAp* 1957 2 N 10052361 16 RAILROAD AVE 109000 GAUG2 6 6 2 1/1 CAP * 3 A 10051677 404 E WALNUT ST 114900 CBHSG2 6 6 3 2/1 TRA* 4 N 10052353 106 W GREEN ST 123900 THOMp 6 0 3 1/1 RAN* 5 SF Active Listings: 5 Average List Price: 105,049 Average Market Time: 29 Expired Single Family-Detached Listings S List No Address Price L-Ofc AR OffMktDt MT BR F/P Reft - -------- ------------------------ -------- ------ -------- X 10047830 308 E MAIN ST 109500 BROWN 6 12/31/99 78 3 1/0 6 X 10043258 306 BELAIRE DR 163900 DETWE1 6 12/09/99 187 4 2/1 7 X 10045756 102 W MAIN ST 257700 GAUG1 6 12/13/99 126 4 2/2 8 SF Expired Listings: 3 Average List Price: 177,033 Average Market Time: 130 Pending Single Family-Detached Listings S List No Address Price L-Ofc AR OffMktDt MT BR Styl Reft - -------- ------------------------ -------- ------ -------- U 10049591 306 BELAIRE DR 159900 CBHSG2 6 02/10/00 53 5 TRA* 9 SF Pending Listings: 1 Average List Price: 159,900 Average Market Time: 53 Sold Single Family-Detached Listings S List No Address S-price L-Ofc AR SettDate MT BR Sty1 Reft - -------- ------------------------ -------- ------ -------- S 10048445 63 SUSSEX RD 80000 RMREAL 6 02/24/00 62 3 RAN* 10 S 10045273 11 N STONER AVENUE 104000 HOME 6 12/10/99 95 4 CAP* 11 SF Sold Listings: Average Market Time: 2 78 Average Orig Price: Average Sale Price: 97,400 92,000 ****************************** SUM MAR Y *********************************** Total Listings 11 Avrg Total MT: 67 List Price: Sale Price(Solds): Fin Square Feet: LP/SQFT: Sp/SQFT(Solds) : High Value 257,700 104,000 o o o Low Value 83,900 80,000 o o o Average Value 128,186 92,000 o o o Criteria: (CMA CRITERIA) AND (AREA=6) AND (PROP TypE=SF) AND (11=SHIREMANSTOWN); ~ lOCC.~ - 1\(1. 9.JD ..A.~ \"NSUt ~ 8 \\ LI/'~ w ~ , , '" 12 N STONER AVE $ Mun SHIREMANSTOWN SchDist MECH Dir E.MAIN IN SHIREMANSTOWN, R/N.STONER LotSz 44X150 Acres 0.15 Totsqft 000720 Rooms 5 Bedrooms 2 Baths:Full 1 Half 0 iFirepl Fee Lvl-Bth:FullM Half Style CAPE COD Exterior BRICK LR 14.LK10.8 LVI. M WALL TO WALL CARPET DR 11.2X8.2 LVI. M WALL TO WALL CARPET ER 19. 7Xl2. 8 LVL I. VINYL FLOORING DEN LVI. KIT 10.1X6.5 LVI. M MBR 16.9x10 LVI. U BRl 11.IXI0.3 LVI. M BR2 LVL BR3 LVL BR4 LVL ORl 1l.3X7 LVL I. VINYL FLOORING CR2 LVL OR3 LVI. 84,549 MLS * 10050515 Dev Source PUBLIC * 00 Warnty N YrBlt+/- 0000 Taxes 949 Yr 1999/* VINYL FLOORING,PANTRY WALL TO WALL CARPET WALL TO WALL CARPET Fin SALES AGREEMENT ApI Equip SMOKE DETECTORS,CABLE READY IntF ELEC. STOVE CONNECTION,WASHER C* Rooms ExtF EXISTING STORM WINDW,EXISTING S* WtSw PUBLIC SEWER,PUBLIC WATER ALL BRICK CAPE COD IN CONVENIENT LOCATION. EXTENSIVELY REMODELED INCLUDING NEW KITCHEN AND BATH IN 1986. NEWLY PAINTED, SOME NEW CARPET, NEW KITCHEN FLOOR IN 1999. PURCHASE SALES AGREEMENT ONLY 15 YRS AT 7%. MUST COVER ALL COSTS. CALL AGENT FOR DETAILS. OIL HEATERS IN BASEMENT WILL STAY. STORAGE AREA IN BASEMENT. LO GAUGl 761-4800 LA EBERLY, MARY 766-7292 INFORMATION THOUGH BELIEVED ACCURATE IS NOT GUARANTEED ......:c:;~>~~.......-.....'L . ," .,.~ ~-~,. -- - - RADrATORS,HOT WATER,OIL Heat Cool Bernt FULL,PARTIALLY FINISHED,CONCRETE * Prkg ON STREET Ameni LtDsc LEVEL , " , .-.~ ':o~F / ~. xlJ. I ~ '~k--< Y.r/ ~.~ ~ ~ ~ X ~lA./\. ~ (. -J-- 8 418 E MAIN ST $ 92,900 MLS # 10051527 Mun SHIREMANSTOWN SchDist MECH Dev Dir CAMP HILL: W/TRINDLE,L/ST.JOHNS RD,PROP ON CORNER E.MAIN/ST. JOHNS LotSz 84X85X104X50 Acres 0.00 Totsqft 001200 Source APPROXI* Rooms 8 Bedrooms 3 Baths:Fu1l 1 Half 1 #Firepl 00 Warnty YrBlt+/- 1957 Fee Lvl-Bth:FullM Half M Style CAPE COD Exterior ALOM,BRICK Taxes 1125 Yr 1999 LR 14.8X15.4 LVL M WALL TO WALL CARPET DR 9.6 X 11 LVL M WALL TO WALL CARPET,DINING AREA FR 14 . 7 X 26 LVL L WALL TO WALL CARPET DEN 11.9 X 17 LVL U WALL TO WALL CARPET KIT 12.6X12.6 LVL M SKYLIGHT,CEILING FANS , WOOD FLOOR MBR 10.3X10.9 LVL M WOOD FLOOR BR1 LVL BR2 10.5 X 11 LVL M WOOD FLOOR BR3 16.9 X 17 LVL U WALL TO WALL CARPET BR4 LVL OR1 LVL OR2 LVL OR3 LVL Fin CONVENTIONAL,VA,FHA Apl RANGE,DISHWASHER,DISPOSAL Equip SMOKE DETECTORS,CEILING FAN,CA* IntF WET BAR,SKYLIGHT,VAULTED CEILIN* Rooms ExtF PORCH,STORAGE SHED/OUT BLDG WtSw PUBLIC SEWER,PUBLIC WATER NICE CAPE COD W/MANY RECENT IMPROVEMENTS: NEW FURNACE & H/W HEATER (2.5 YRS), NEW CARPET,FRESH PAINT; NEW RANGE & D/W (2 YRS); NEW SPOUTING (2.5 YRS). NICE KIT W/SKYLIGHTS,LOTS OF CABS,BKFST BAR,WOOD FLOOR. FINISHED LL W/FR & WET BAR. UL HAS 2 LARGE ROOMS: OFFICE/DEN & BR. CONVENIENT LOCATION AND SHOWS WELL. CALL STEVE NORFORD, 730-5569! LO RMREAL 761-6300 LA NdRFORD, STEVE 730-5569 INFORMATION THOUGH BELIEVED ACCURATE IS NOT GUARANTEED , ! Heat FORCED AIR,OIL Cool Bsmt FULL,PARTIALLY FINISHED Prkg CARPORT Ameni SHOPPING/MALL,PUBLIC TRANSPORTAT* LtDsc CORNER,LEVEL --,_. ~ "~ ;J~!;l~~~~;,;;' '. ,tt}~~",. . ..': iff~~f.~~:':: ~~~~[~1i~~i!~~~'~~0g~~~~~~';l~i;;'~ .. .."""'!""J"....~..~ . .. -~,;,'~: tv' I /~J.. AYJ~ \~~ .\ ~ \ \'^" 16 RAILROAD AVE Mun SHIREMANSTOWN Dir W ON MAIN ST, LotSz Rooms 6 Bedrooms Fee Style CAPE LR DR FR DEN KIT MBR BR1 BR2 BR3 BR4 OR1 OR2 OR3 $ SchDist MECH SHIREMANSTOWN, T/L ON RAILROAD AVE. Acres 0.29 Totsqft 001104 Source APPRAIS* 2 Baths:Fu11 1 Half 1 #Firep1 00 Warnty Y YrB1t+l- 0000 Lvl-Bth:Fu11 Half Exterior VINYL COD LVL M LVL M LVL LVL LVL M LVL LVL M LVL M LVL LVL LVL LVL LVL Fin CONVENTIONAL ApI NONE Equip IntF Rooms ExtF wtSw SEWER IN STREET A LOVELY STARTER HOME, LARGE LOT, APPROX. .29 109,000 MLS # 10052361 Dev Taxes 1335 Yr 1999 Heat FORCED AIR Cool NONE Bsmt EXTERIOR ACCESS, PARTIALLY Prkg Ameni PUBLIC TRANSPORTATION LtDsc CAPE COD HOME, 2 BEDROOMS, WITH ACRES. LO GAUG2 697-4673 LA KIKER, TOM 697-8840 INFORMATION THOUGH BELIEVED ACCURATE IS NOT GUARANTEED FINISHED - I . '-.- '. " ~-- --~:',; ,.:ft_~':: ---]~..>,_.7~11'; . ill!t~l^I.. .-' "-,: .~ "', '''''1;1'1 . ',.\, ',',:,." -=1111 ~ . .. ...'~":.:j,4~'t.,-. 404 E WALNUT ST Mun SHIREMANSTOWN Dir E MAIN ST TO SOUTH LotSz Rooms 6 Bedrooms Fee Style LR OR FR DEN KIT MBR BIU BR2 BR3 BR4 ORl 01'.2 01'.3 TRADITIONAL LVL M LVL M LVL LVL LVL M LVL U LVL LVL U LVL U LVL LVL U LVL LVL $ 114,900 MLS i 10051677 SchDist MECH Dev STONER L/E WALNUT HOME ON RIGHT Acres 0.00 Totsqft 001654 Source PUBLIC * 3 Baths:Full 2 Half 1 iFirepl 00 Warnty N YrBlt+/- 0000 Lvl-Bth:FullU Half M Exterior Taxes 1583 Yr 99 Fin CONVENTIONAL,CASH Apl RANGE,DISHWASHER Equip OTHER IntF MASTER BATH Rooms OFFICE/COMPUTER RM E"tF DECK WtSw PUBLIC SEWER,PUBLIC WATER PC5038- LOCATION .. SHIREMANSTOWN BORO WONDERFUL THREE BEDROOM 2 STORY W/1 CAR GARAGE,2.5 BATHS & DECK OFF DINING ROOM OVERLOOKING LARGE YARD. TERRIFIC HOME NO THROUGH STREET. Heat ELECTRIC Cool WINDOW UNIT(S) Bsmt CRAWL SPACE Prkg ATT Ameni LtDsc LEVEL LO CBHSG2 ~.o .~::..:..~~...." '0""" 106 W GREEN ST $ 123,900 Mun SHIREMANSTOWN SchDist MECH Dir W/MAIN ST SHIREMANSTOWN, Lis EBERLY, Rlw GREEN LotSz Acres 0.00 Totsqft 001232 Rooms 0 Bedrooms 3 Baths:Full 1 Half 1 iFirepl Fee Lvl-Bth: FullM Half M Style RANCH Exterior ALUM,BRICK LR 21'6X12' LVL M WALL TO WALL CARPET DR 12 X 11 LVL M WOOD FLOOR FR LVL L WALL TO WALL CARPET DEN LVL KIT 12 X 9 LVL M VINYL FLOORING MBR 13'9Xll'2 LVL M WOOD FLOOR BRl LVL BR2 10'7X9'2 LVL M WOOD FLOOR BR3 14 X10'5 LVL M WOOD FLOOR BR4 LVL OR1 LVL OR2 LVL OR3 LVL MLS i 10052353 Dev SHIREMANSTOWN STREET Source APPROXI* 00 Warnty N YrBlt+l- 0000 Taxes 1513 Yr 99 Fin CONVENTIONAL,VA,FHA,CASH ApI RANGE,DISHWASHER,REFRIGERATOR,WA* Equip SATELLITE DISH,SMOKE DETECTORS IntF SOME WINDOW TREATMENTS,MASTER B* Rooms FORMAL DINING RM,PANTRY ExtF PORCH WtSw PUBLIC SEWER,PUBLIC WATER BRICK RANCHER ON QUIET STREET W/3 BR & 1 1/2 BATHS. SEE-THRU FP BETWEEN DR & LIVING AREA. HARDWOOD FLOORS IN DR & ALL BR'S. HALF OF BSMT FINISHED FOR FR. NEW ROOF & NEW WINDOWS EXCEPT BAY WINDOW. OIL HEAT & ELECTRIC CiA. SHOWS WELL. 1-CAR CARPORT & LEVEL YARD. ALL APPLIANCES STAY & WATER SOFTENER. LO THOMP 761-8353 LA ZODY, BILL 697-0497 INFORMATION THOUGH BELIEVED ACCURATE IS NOT GUARANTEED Heat FORCED AIR,OIL Cool CENTRAL AIR Bsmt FULL,PARTIALLY Prkg CARPORT Ameni PARK LtDsc LEVEL FINISHED .......... L.," :,, ..- "~-", .1_t7PROVIDIAN .=-, Financial r PO. Box l)120 Pkasanton. California 945M-9] 20 February 16. 2000 \1, \'J Nick T. Tomasello 9 North Stoner Ave Shireamstown. PA 17011-6341 Dear Nick T, Tomasello: Providian National Bank Application Number: 0004700130 Thank you for your interest in a Providian custom credit account We have already begun processing your application and hope to welcome you soon as a new customer, This account gives you a low interest rate, low payments, and in most cases, tax savings you just can't get from credit cards! Many of our customers save hundreds, even thousands of dollars, in interest and taxes the first year alone. Please consult your tax advisor for your potential tax savings, Plus, a Providian account is better than most other loans, Whether you're using the account to pay off bills, make home improvements, or however you'd like, you'll find that we offer benefits that give you maximum flexibility and convenience: · No Out of Pocket Costs - we don't charge any application fees or closing costs! . High Credit Lines - we offer high credit lines to meet all your financial needs! · Fast and Easy Process - we take care of everything so you can get your money fast! You're on your way to saving money with your Providian custom credit account! For your reference, enclosed is a federal disclosure that we are required to send to anyone considering these types of loans. As always, please call us at 1-800-695-0044 if you have any questions. Sincerely, ~~ '-I'Yl~ Gordon Morris Providian R8888 SEE REVERSE SIDE FOR IMPORTA:-.lT INFoRMAnnN ~. -; __0"" ,;..~~J f NOTE Oc:ober 21,1999 [Dalel Tilton [Cityl NH [SIllle) 9 North Stoner Avenue Camp Hill, PA 17011 [Property Address) 1. BORROWER'S PROMISE TO PAY In return for a loan that I have received. I promise to pay U,S, $ 46 929.00 "principal"). plus interest, to the order of the Lender. The Lender is Providian N~tional (this amount is called Bank . I understand that the Lender may transfer this Note. The Lender or anyone who takes this Note by transfer and who is entitled to receive payments under this Note is called the "Note Holder," 2. INTEREST Interest will be charged on unpaid principal until the full amount of principal has been paid. I will pay interest at a yearly rate of 10.25%. The interest rate required by this Section 2 is the rate I will pay both before and after any default described in Section 6(B) of this Note. 3. PAYMENTS (A) Time and Place of Payments I will pay principal and interest by making payments every month. I will make my monthly payments on the 2nd day of each month beginning on December , 1999 . I will make these payments every month until I have paid all of the principal and interest and any other charges described below that I may owe under this Note. My monthly payments will be applied to interest before principal. If, on November 02,2014 , I still owe amounts under this Note, I will pay those amounts in full on that date, which is called the "Maturity Date." I will make my monthly payments at Providian National Bank C/O Mortgage Processing P.O Box 269 Tilton, NH 03276 or at a different place if required by the Note Holder. (B) Amount of Monthly Payments My monthly payment will be in the amount of U.S. $ 511. 50 4. BORROWER'S.RIGHT TO PREPAY I have the right to make payments of principal at any time before they are due. A payment of principal only is known as a "prepayment." When I make a prepayment, I will tell the Note Holder in writing that I am doing so. I may make a full prepayment or partial prepayments without paying any prepayment charge. The Note Holder will use all of my prepayments to reduce the amount of principal that I owe under this Note. If I make a partial prepayment, there will be no changes in the due date or in the amount of my monthly payment unless the Note Holder agrees in writing to those changes. 5. LOAN CHARGES If a law, which applies to this loan and which sets maximum loan charges, is finally interpreted so that the interest or other loan charges collected or to be collected in connection with this loan exceed the pennitted limits, then: (i) any such loan charge shall be reduced by the amount necessary to reduce the charge to the pennitted limit; and (ii) any sums already collected from me which exceeded pennitted limits will be refunded to me. The Note Holder may choose to make this refund by reducing the principal I owe under this Note or by making a direct payment to me. Ifa refund reduces principal, the reduction will be treated as a partial prepayment. 6. BORROWER'S FAILURE TO PAY AS REQUIRED (A) Late Charge for Overdue Payments If the Note Holder has not received the full amount of any monthly payment by the end of 15 calendar days after the date it is due. I will pay a late charge to the Note Holder. The amount of the charge will be $ 24.00 . I will pay this late charge promptly but only once on each late payment. (B) Default If I do not pay the full amount of each monthly payment on the date it is due. I will be in default. MULTISTATE FIXED RATE NOTE -Single Family fit}191003199041 pagelof2 ELeCTRONIC LASER FORMS. INC. . (000)327..Q545 Irlltials: - "~ " (C) NOlice of Defaull If I am in default. the Note Holder may send n:e a wdtten notice telling me that if I do n~t pay the overdue amount by a certain date. the Note Holder may require me to pay Immediately the full amount of principal whIch has not been paid and all the Interest that I owe on that amount. That date must be at least 30 days after the date on which the notice is delivered or mailed to me, (D) No Waiver by Nole Holder Even if. at a time when I am in default, the Note Holder does not require me to pay immediately in full as described above the Note Holder will still have the right to do so if I am in default at a later time. . (E) Payment of Note Holder's Costs and Expenses If the Note Holder has required me to pay immediately in full as described above. the Note Holder will have the rioht to be paid back by me for all of its costs and expenses in enforcing this Note to the extent not prohibited by applicable la;. Those expenses include, for example, reasonable attorneys' fees. 7. GIVING OF NOTICES Unless applicable law requires a different method, any notice that must be given to me under this Note will be given by delivering it or by mailing it by first class mail to me at the Property Address above or at a different address if I give the Note Holder a notice of my different address. Any notice that must be given to the Note Holder under this Note will be given by mailing it by first class mail to the Note Holder at the address stated in Section 3(A) above or at a different address if I am given a notice of that different address. 8. OBLIGATIONS OF PERSONS UNDER THIS NOTE If more than one person signs this Note, each person is fully and personally obligated to keep all of the promises made in this Note. including the promise to pay the full amount owed. Any person who is a guarantor, surety or endorser of this Note is also obligated to do these things. Any person who takes over these obligations, including the obligations of a guarantor, surety or endorser of this Note, is also obligated to keep all of the promises made in this Note. The Note Holder may enforce its rights under this Note against each person individually or against all of us together, This means that anyone of us may be required to pay all of the amounts owed under this Note, 9. WAIVERS I and any other person who has obligations under this Note waive the rights of presentment and notice of dishonor. "Presentment" means the right to require the Note Holder to demand payment of amounts due. "Notice of dishonor" means the right to require the Note Holder to give notice to other persons that amounts due have not been paid. 10. UNIFORM SECURED NOTE This Note is a uniform instrument with limited variations in some jurisdictions. In addition to the protections given to the Note Holder under this Note, a Mortgage, Deed of Trust or Security Deed (the "Security Instrument"), dated the same date as this Note, protects the Note Holder from possible losses which might result if I do not keep the promises which I make in this Note. That Security Instrument describes how and under what conditions I may be required to make immediate payment in full of all amounts I owe under this Note. Some of those conditions are described as follows: Transfer of the Property or a Beneficial Interest in Borrower. If all or any part of the Property or any interest in it is sold or transferred (or if a beneficial interest in Borrower is sold or transferred and Borrower is not a natural person), without Lender's prior written consent, Lender may, at its option, require immediate payment in full of all sums secured by this Security Instrument. However, this option shall not be exercised by Lender if exercise is prohibited by federal law as of the date of this Security Instrument. If Lender exercises this option, Lender shall give Borrower notice of acceleration. The notice shall provide a period of not less than 30 days from the date the notice is delivered or mailed within which Borrower must pay all sums secured by this Security Instrument. If Borrower fails to pay these sums prior to the expiration of this period, Lender may invoke any remedies permitted by this Security Instrument without. further notice or demand on Borrower. WITNESS THE HAND(S) AND SEAL(S) OF THE UNDERSIGNED. Nick t Tomasello SSN: 207-50-3656 (Seal) .Borrower Angela M Tomasello SSN: 182-60-7453 (Seal) .Borrower SSN: SSN: [Sign Original Only] fi4 :}191003 ,-, Page2cf2 I l I f I I i , i I i ! (Seal) -Borrower (Seal) -Borrower " ( ADDENDUM TO NOTE This Addendum to Note is made as of October 21, 1999 by Nick T. Tomasello, Angela M. Tomasello ("Borrower") in favor of Providian National Bank ("Lender"). Borrower executed a Note of even date herewith in favor of Lender in the principal amount of $46,929.00. Borrower and Lender desire to modify the Note in certain respects. NOW, THEREFORE, the parties hereby agree as follows: Quality Service. To ensure quality service on Borrower's account some calls may be monitored and/or recorded. Personal Information; Documents. Borrower authorizes Lender to make or have made any credit inquiries Lender feels are necessary. Lender may get such information from others, including credit reporting agencies, and provide Borrower's address and information about Borrower's account to others. Lender mav also share such information with Lender's affiliates. However. Borrower mav write to Lender at anv time instructinl!: Lender not to share credit information about Borrower and Borrower's account with Lender's affiliates. In addition, Lender may also share credit information with independent auditors, consultants or attorney's, and/or a party outside Lender's affiliates, such as a vendor or service company that Lender hires to provide support or services for one or more of Lender's products. These vendor or service companies agree to safeguard Lender's confidential information about Borrower. Borrower will promptly give Lender information about Borrower's financial affairs if Lender asks for it. If Borrower does not fulfill any of Borrower's obligations under this Agreement, a negative credit report reflecting on Borrower's credit record may be submitted to credit reporting agencies. Fee. There will be no fee if Borrower pays more than Borrower's minimum monthly payment amount and pay down Borrower's balance faster. However, there will be a $2,500.00 fee if Borrower closes Borrower's account within three years. This fee will not be assessed as long as Borrower's account is open. AP3796 ADDENDUM (CLOSED,E:-ID) Aug 06. 1999 Page I "^ i ( . . BY SIGNING BELOW, Borrower accepts and agrees to the tenns and covenants contained in this Addendum to Note. Dated: Nick T. Tomasello Dated: Angela M. Tomasello APl7% ADDENDUM (CLOSED-END) Aug 06. 1999 P3ge 2 ~ CCAH....d M. Siegel, Inc. ( i Actuaries/Benefit Consultants -. - 7'.. . 501 Corporate Circle .: =..:::.. 7": ~ ~ P.O. Box 5900 .::.. -=: ~ ':. = I:"-J Harrisburg. P A 1711 0-0900 __II. (717) 652-5633 ~. I Fax (717) 540-9106 March 20, 2000 p~CEIVE' _ '. 2000 Conrad M. Siegel. F,S.A. Hany M. Leister, Jr., F.S.A. Brian S. Sann. F.S.A. Clyde E. Gingrich. F.S.A. Earl L. Mummert. M.A.A.A. Robert J. Dolan. A.S.A. David F. Stirling, A.S.A. Robert J. Mrazik. F.S.A. David H. Killick. F.S.A. Jeffrey S. Myers. F.S.A. Thomas L. Zimmerman. F.S.A. Glenn A. Hafer. F.S.A. Kevin A. Erb. F.S.A. Frank S. Rhodes. F.5.A.. A.C.A,S, Charles B. Friedlander, F.S.A, Holly A, Ross. F.S.A. John W. Jeffrey, A.S.A. Denise M. Polin. F.S.A. Thomas W. Reese. A.S.A. Janel M. Leymeister, CEBS Mark A. Bonsall. A.S.A. Jonathan D. Cramer, A.S.A. Peter R. Henninger, Jr., Esq. Pannebaker and Jones, P.C. Four Thousand Vine Street Middletown, PA 17057.3596 Re: Nick T. Tomasello Dear Mr. Henninger: You provided me with the following information concerning Nick T. Tomasello: 1. Date of birth - November 29,1971. 2. Date married - January 1, 1996. 3. Date separated - On or about January 1, 2000. 4. Data with respect to his status under the State Employes' Retirement System as follows: a. Years of service as of December 31,1999 - 4.97. b. Normal retirement date - November 29,2021 (age 50). c. Final average salary as of December 31,1999 - $31,337. d. Accumulated contributions plus interest as of December 31,1999 - $7,305. e. Accumulated contributions plus interest as of December 31,1995 - $819. Currently, Nick T. Tomasello is 28 years of age (age nearest birthday). The State Employes' Retirement System (SERS) is a defined benefit pension plan. The pension benefit provided upon retirement is based upon the final three-year average salary and the years of service. Ai; previously indicated, Mr. Tomasello's normal retirement age is age 50. A member of the SERS "vests" after at least 10 years of service. If a member does not have 10 years of service and terminates employment, the only benefit provided is a refund of the employee's accumulated contributions plus interest. ~._> h_. .. ( ;-J Conrad M. Siegel, Inc. ( ( Peter R. Henninger, Jr., Esq. March 20, 2000 Page 2 As of December 31, 1999, Mr. Tomasello had completed 4.97 years of service. Thus, he was not "vested." If he had terminated then or for that matter if he terminated as of the current date, he would be entitled to a refund of his accumulated contributions plus interest. As previously indicated, Mr. Tomasello's accumulated contributions plus interest amounted to $819 as of December 31,1995, and $7,305 as of December 31,1999. Thus, during the marriage, the accumulated contributions plus interest increased by $6,486 ($7,305 less $819). Accumulating this figure of $6,486 with interest at the rate of 4% per year from December 31 until the current date provides for an accumulated amount of $6,542. My suggestion is that you use the figure of $6,542 as the value of Mr. Tomasello's pension attributable to the marriage. If you have any questions, please call. With best regards, Yours sincerely, ~~J-L~@' ~~. Leister, Jr., F.S.A. Consulting Actuary HML:kad UJ .u i tL '" 0: c. ..... a:: o D.. W a: ..J <( ::) 2 2 <( W LL - ..J ..J <( CJ) a: w > Z ::) :rl as ~ ~ ~~ ~ '" '" '" '" , ~ ~ ~ ~ , '" N ~ '" '" , ~ ~ , N ti o '" w .. ~ '" o .. w '" '" '" '" ~ , ~ ~ , N ~ w ,.. " o w o on ~ o ~ on N , t;;~ "'N ..~ ,..N .. o "'''' .. 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COMMONWEALTH OF PENNSYLVANIA STAf .:MPLOVEES' RETIREMENT SVs(- .M 30 NORTH THIRD STREET - P,O. BOX 1147 HARRISBURG. PENNSYLVANIA 17108-1147 1999 STATEMENT of ACCOUNT for NICK T TOMASELLO 9 N STONER AVE SHIREMANSTOWN PA 17011 96,211 The State Employees' Retirement System (SERS) is pleased to provide your annual Statement of Account. Vour Statement lists calculations based on information reported to your retirement account through December 31, 1999. These calculations are subject to final audit by SERS in accordance with applicable law and regulations, SERS has undergone significant change since its estl!blishment in 1923. You may be interested to know that you are one of approximately 109,000 active contributing members and today, ] 07 employer agencies participate in SERS. The following observations were made regarding our members in 1998: . The average age of a new retiree was 63. . The average monthly benefit was $1,550 for those members who retired in 1998 and had reached superannuation (normal retirement age). By comparison, the national average monthly benefit for '. Social Security recipients was $783 in 1998. . Our 86,000 retirees and beneficiaries received more than $1 billion in retirement benefits. Explanatory information is included on your Statement under the headings of SPECIAL CONDITIONS, IMPORTANT INFORMATION and TERMS & DEFINITIONS. Be sure to review your Statement carefully and retain it for future reference. If you feel there may be omissions or discrepancies in your Statement, you may telephone your SERS Retirement Counseling Center toll-free at 1-800-633-5461. YOUR STATEMENT CONTAINS PERSONAL AND CONFIDENTIAL INFORMA TION ABOUT YOUR SERS RETIREMENT ACCOUNT WE RECOMMEND YOU MAINTAIN THIS STATEMENT WITH OTHER IMPORTANT FINANCIAL INFORMATION - ~~ ~ - c '-. I =_,g .' 1999 STA.EMENT of ACCOUNT For: NICK T TOMASELLO Your statement contains three sections: SECTION I: BASIC DATA SECTION II: ESTIMATED RETIREMENT BENEFITS AS OF DECEMBER 31, 1999 SECTION III: ESTIMATED RETIREMENT BENEFITS PROJECTED TO NORMAL RETIREMENT ~ ~ SECTION I: BASIC DATA Personal Data Social Security Number: 207-50-3858 Sex: MALE Birth Date: 29-NOV-1971 Coverage Type: FULL Contribution Rate: 5.00% Counseling Center: HARRISBURG Nonnal Retirement Date: 29-NOV-2021 Final Average Salary: $31,337.27 1999 Retirement Covered Earnings: $33,837.88 Total SS! Non-Covered Earnings: Joint Coverage Conversion Amount: Mandatory Debt: Service Credit as of Dec. 31, 1999" Class Years of Service Class Years of Service A-50 4.9891 TOTAL SERVICE 4.9B91 Princioal Beneficiarvlies)** ANGIE M TOMASELLO . SPECIAL CONDITIONS Due to the following reason(s), special conditions apply to your benefit estimates or estimates have not been calculated: You have insufficient service credits to qualify for a regular benefit. You have insufficient service credits to qualify for a disability retirement benefit. Account Balance Regular SSI Contributions Contributions Dec, 3 1, 1998, Balance $5,366.13 Contributions $1,691.89 Lump Sum Payments Arrears Payments Credited Interest $247.05 YTD Adjusnnents ~~ !)ec. 3], 1999,~ance $7,305.07 TOTAL DEDUCTIONS S7,305.07 Arrears Balance as ofDce. 31,1999 Regu]ar S81 Taxable Breakdown of Your Account~~ Taxab]e Contributions $6,707.69 Previously Taxed Contributions Credited Interest (Taxable) $597.38 Dec. 31,1999, Balance S7 305.07 -If you are eligible to purchase creditable state and/or non- state service, contact your Retirement Counselor for information on purchasing service, All requests to purchase service must be filed while you are an active, contributing member. H Information filed on a Nomination of Beneficiary(ies) form before 1993 or since Dee, 31, 1999, or involving special circumstances (such as the designation of an estate or trust as your beneficiary) may not appear, A maximum of 10 beneficiaries may be shown here; however, you may have more beneficiaries in your retirement record, Keep your beneficiary nomination current, You may change your benejiciary nomination at any time by JIling a new Nomination of Benef'reiory(ies) form wiJlt SERS. Forms are OI1/lihlble from your agency Personnel Office or your regional SERS Retirement Counseling Center. Please contact us if you do not want your benejiciary(les) listed on future Statements. ~YTD (Year-To-Date) A4iustments reflect corrections to your account for which you already have received notification. ~. .'SERS is a defined benefit plan under Internal Revenue Service Code Section 401 (a), '"'~" ~ ~~ ( :. 'SECTION II: ESTIMATED RETIREMENT BENEFITS AS OF DECEMBER 31, 1999 This section provides an estimate of your Monthly Pension only if you have at least 10 years of credited service or you have reached your Normal Retirement Date and have at least three years of credited service. Maximum Sin Monthly Pension Accumulated Deductions \ Monthly Pension Present Value Option 1 Option 4 (Adjusted for Withdrawal of Accmnulated Deductions) Adjusted MSLA Monthly Pension Adjusted Option 1 Monthly Pension Adjusted Present Value Under Option 1 I Disability Retirement Monthly Pension (if you qualify) Death in State Service I~, . - ;ki~, ( SECTION III: ESTIMATED RETIREMENT BENEFITS PROJECTED TO NORMAL RETIREMENT DATE This section provides Monthly Pension estimates, projected to your Normal Retirement Date. if you have at least 10 years of credited service, Estimates are provided for the same options as listed under Section II. Normal Retirement Date: 29-NDV-2021 Maximum Sin e Life Anuui Monthly Pension Accumulated Deductions I Monthly Pension Present Value Option 1 Option 4 (Adjusted for withdrawal of Accumulated Deductions) Adjusted MSLA Monthly Pension Adjusted Option 1 Monthly Pension Adjusted Present Value Under Option 1 IMPORTANT INFORMATION . Benefit Estimates are provided for: . Maximum Single Life ADDuity (also known as Full Retirement Allowance) - Monthly Pension payment made to you for life; beneficiary(ies) receive(s) Accumulated Deductions, less Monthly Pension payments you received and any lump sum you received under Option 4. . Option 1 - Monthly Pension payment made to you for life; beneficiary(ies) receive(s) Present Value, less Monthly Pension payments you received and any lump sum you received under Option 4. . Option 4 - At retirement, you may withdraw an amount equal to all or any part of your Accumulated Deductions. You may elect to receive this withdrawal in up to four installments. If you elect this option, you must also elect a Monthly Pension payment plan. . Disability Retirement - You must have at least five years of credited service (except State Police and Enforcement Officer-category employes, who have no minimum service requirement) and be certified by SERS Medical Examinets as physically or mentally incapable of performing current job duties. Only active, contributing members or those on leave without pay may apply for Disability Retirement. You cannot withdraw your Accumulated Deductions if you take Disability Retirement. . Death in State Service - If you are vested and die while an active employe, it will be assumed you retired under Option 1 the day before your death. The Present Value of your annuity will be payable to your beneficiary(ies). If you are not vested, your Accumulated Deductions will be payable to your beneficiary(ies). . Benefit Estimates assume: . Your future earnings will be the same as in 1999. . You continue in your present class of service as a full-time employe. . Retirement tables and factors remain the same as those in use on Dec. 31, 1999. . Any Arrears Balance will be paid (exception - those membets who are currently vestees or in a furlough status). . Your earnings will not exceed the federal Social Security taxable wage base after 1999. . Joint Coverage is converted to Full Coverage prior to or at the time of retirement. Continued on back page -~ -.'"',......" 0' . Any Mandatory Debt, with appropriate interest, has be~n actuarially reduced from the Present Value of your account. Note: If you have credited service as a Multiple- Service member (service in both SERS and the Public School Employes' Retirement System [PSERS]), your estimate does not include your PSERS contributions. Your service may be overstated if in any calendar year you have Concurrent Service. ~- -I ,'__ ( . Other Monthly Pension plans (not estimated here) are: . Option 2 and Option 3, which are based on your date of birth and the date of birth of your designated survivor. The younger your survivor, the lower your Monthly Pension amount. Following your death, Option 2 provides your survivor the same Monthly Pension you received, while Option 3 provides your survivor one- half the Monthly Pension you received. Contact your SERS Retirement Counselor for payment estimates under Option 2 and Option 3. TERMS & DEFINITIONS Following are definitions of terms used in your Statement of Account. For more information, refer to your SERS Member Handbook or visit our Website at http://www.sers.state.pa.us. Accumulated Deductions: Total of contributions plus Credited Interest earned on your retirement account. Al:tive Member: An employe for whom contributions are being made to the Fund or who is on leave without pay. Annuity: The pension benefit paid in monthly installments. Arrears Balance: The balance owed to your retirement account for which you are making payroll deductions. Bilneficiary(ies): The person(s) or organization(s) you last designated in writing to SERS to receive any remaining pension benefit upon your death. Concurrent Service: Service in SERS and the Public School Employes' Retirement System (PSERS) for which you contribute to both systems at the same time during any year of membership. Credited Class of Service: A-60 - Normal Retirement Age of 60; A-50 - Normal Retirement Age of 50; C - Normal Retirement Age of 50 as a State Police Officer or enforcement officer whose service began prior to March 1, 1974; D-3 - Normal Retirement Age of 50 as a member ofthe General Assembly whose service began prior to March I, 1974; E-l - Normal Retirement Age of 60 for members of the Judiciary; E-2 - Normal Retirement Age of 60 as a District Justice; PSERS - Service with the Public School Employes' Retirement System; SSI-60 - Normal Retirement Age of 60; S81-50 -Normal Retirement Age of 50. If you have any creditable State or nonstate service not included, contact your SERS Retirement Counselor for information on purchasing such credit. All requests to purchase service must be filed while you are in an active pay status. Credited (or Statutory) Interest: Member account interest set by law at 4 percent per year, compounded annually. Final Average Salary: The average salary of three non-overlapping periods of four consecutive calendar quarters. Typically, this is the average of the highest three years of compensation. Full Coverage Member: Any member making regular member contributions who joined SERS on or after July I, 1964. Joint Coverage: For members who joined SERS between May 28, 1957, and June 30, 1964, elected Social Security coverage and paid a reduced retirement rate into SERS. Mandatory Debt: A debt to be satisfied at the time of retirement through an actuarial reduction to the Present Value of the member's account. Normal Retirement Date/Age: Also called superannuation age, normal retirement age for most members typically is age 60 with at least three years of credited service or any age upon attaining 35 years of credited service, whichever occurs first. Age 50 is normal retirement age for a member of the General Assembly, an enforcement officer, a correction officer, a psychiatric security aide, a Delaware River Port Authority policeman, an officer of the Pennsylvania State Police, or a member of any other membership group stipulated by legislative revision of the Retirement Code. Present Value: The total value of a member's retirement account that funds annuity payments over his or her lifetime; this also is the amount paid to a vested member's beneticiary(ies) when a vested member dies in State service. SSI (Social Security Integration) Contributions: For eligible members who elected SSI coverage, the total contributions on earnings exceeding the federal Social Security tax base for all years of SSI coverage since Jan. I, 1956. VesteeNested: Eligible to receive a SERS monthly pension. Keep your Statement in a safe place. There is a $5 charge for each duplicate Statement. 'C.~ "~ . r. - ~ J! COMMONWEALTH OF PENNSYLVANIA J"~ATE EMPLOYES' RETIREMENT SYSTEM STATa T OF ACCOUNT AS OF DECEMBER 31, 19(' Annually the. State ~IOY~Sl Retirement System (SERS) provides each IlI8lN)er with current reti.rernent accOW'It information which should be helpful 1n underst:anchng the beneflts provided by the retlrernent plan and in doing hnancial planning. ThiS stat-.t was prepared us 1 ng. the data recorded 1" your retirement account as of DecentMlr 31. 1995. and is subject to final audit by the SERS '" accordance w1th aPl)licable law and regulations. PLEASE REFER TO THE REVERSE SIDE FOR IMPORTANT INFORMATION ABOUT YOUR STATEMENT. PREPARED FOR: NICK T TOMASELLO 9 N STONER AVE SHIREMANSTOWN PA 17011 55.: 207-50-3656 Dat. of Bi.th: 29-NOV-1971 Sex: M Region Code: 04 Normal Retirement Date: 2g-NOV-2021 Credited Service as of 12-}1-9!; ~'-ag~ 5~9'61i' lliYill ..ill Coverage Type Contribution Rate Final Average Salary 1995 Retirement Covered Earnings S5I Hon-Covered Earnings Joint Coverage Conversion Amount Mandatory Debt FULL ACCOUNT BALANCE 5.00% NOT DETERMINED $16.146.44 Balance as of 12-31-94 19" Activity Contributions Lump Sum Payments Arrears Payments Adjustments* Credited Interest Balance as of 12-31-9S Arrears Balance as of 12-31-95 - *Ad1ustmentS reflect C:orrections to your account about which YOU have been notified. $807.33 -----TAXABLE BREAKDOWN OF ACCOUNT----- $11.89 $819.22 + + Tax-Deferred Contributions Previously Taxed Contributions Credited Interest Account Balance as of 12-31-95 .>807.33 $11.89 $819.22 Benefit estinates are prepared for mentMlrs who have reached H~l Retirement Age and for members who have at least 10 years of credited Service for Regular Retirement and at least 5 years of credited service for Disability Retirenent (State Police and Enforcement Officers have no minimum service requirement for disability retirement). If you terminate priol'" to attaining eligibility for monthly benefits, that is prior to becoming vested, you would be entitled to receive your account balance minus any debts to the ConInonwealth as of yOUr' date of termination. BENEFIT ESTIMATES Current as of 12-31-95 Projected to Noral Retirement FULL RETIREMENT - Thl,S option provides the maxinun monthly benefi ts to you for 1; fe. If you die before receiving your total accLIDUlated dec:tuctions, the balance will be paid to your beneficiary(ies). ClPTION 1 - This opti~ ~rC'..ides rec!uced mlmt!'tly ber.efits to you for life. All monthly benefits are reduced from the Present Value. Any balance remaining at your death will be paid to your beneficiilry(ies). PRESENT VA~UE - Death Benefit under Option 1 or a death in state serVlce. OPTION 4 - You may receive all or a portion of your accumulated deductions (contributions and interest) in a lump sum or installment payments and receive reduced monthly benefits under one of the other retirement options. Option 4 ;s available only at the time of retirement and may not exceed your accumulated deductions. FULL RETIREMENT AO~USTED UNDER OPTION 4 OPTION 1 AO~USTED UNDER OPTION 4 AO~USTEO PRESENT VALUE UNDER OPT:ON 1 WITH OPTION 4 MAXIMUM DISABILITY - Vou ....st be me Medical Examiners tc) be physically or mo. performing your current job dutie~ WITHDRAWAL IS NOT AVAILABLE WIT, RETIREMENT . -REFER TO CODES A THROUGH R ON THE REVERSE AS THEV APPLV TO VOUR BENEFIT ESTIMATES: 'ly certified by SER5 1y inca~ble of OPTION 4 , DISABILITY SlOE OF THIS FORM FOR AN EXPLANATION OF THE ,:~LOWING CODES L M 0 ADDITIONAL RETIREMENT OPTIONS ARE AVAILABLE. PLEASE TELEPHONE YOUR SERS REGIONAL RETI~,'~~~ COUNSELOR TOLL-FREE (1-8oo-B33-54BO FOR QUESTIONS CONCERNING YOUR BENEFIT RIGHTS OR THIS STATEM::r,: .. ACCOUNT. ... ~ WE' "ARKETS. INC. RETIREMENT SAVING( \.AN STATEMENT OF ACCOUNT AS OF 06/3011999 FOR ANGELA M TOMASELLO 01101/1999 Investment Fund D6J:l0/1999 Vested Account Contrlbutfon GelnILoss Forleiture. WRhdrawal. Transfers Account Amount AGGRESSIVE EQUITY FUND 401 k e'e. $ 467.76 185.49 46.80 0.00 0.00 0.00 5 700.05 $ 700.05 employer 45.95 0.00 3.84 0.00 0.00 0.00 49.79 0.00 Rollover 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Total $ 513.71 185.49 50.64 0.00 0.00 0.00 $ 749.84 $ 700.05 GRAND TOTAL 401k e'e. $ 467.76 185.49 46.80 0.00 0.00 0.00 $ 700.05 $ 700.05 employer 45.95 0.00 3.84 0.00 0.00 0.00 49.79 0.00 Rollover 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Total $ 513.71 185.49 50.64 0.00 0.00 0.00 $ 749.84 $ 700.05 Vesting Percentage.: 401k e'ee 100%; employer 0%: Rollover 100% aU "" the electIGn. on thll .t...mlnt. Contributlonl and 'und tr.nl"~ rllIRt your etecttona .. rlCOnltd'or thl .....ment~. It you haft any que on. conee nt you mUlt notify Ih. PlI" Admlnletrator wtthln 30 clap. In Ihl IVlnt.ot . dIHrl~ncy. .ctUII bene"" will... determined lCCorcllnl to thl Plan prowIllone. , . ,.. -",. --- , A. SETTLEMENT STATEMEN'l U. S. ID~PARTMENT OF HOUSING ------1 AND URBAN DEVELOPMENT OMB No. 2502-0265 I B. TYPE OF LOAN j 1. 0 FHA 2.0 F_ 3.1i1 COIIV.UNINS. 6. File NUlt>er: 7. Loan NUlt>er: 8. Mortgage Insu.ance Case NUlt>er: 4.0 VA 5.0 CONV.INS. 063669 9926600016 C NOTE This form is furnished to give you 8 statement of actual settlement costs. Amounts paid to and by the I . : settlement agent are shown. Items marked "(p.O.C)" were paid outside the closing; they are shown here for informatlonal'p nPOses and are not inclUded 1" the totals. D.NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER/TAX 1.0.: F. NAME AND ADDRESS OF LENDER: Nick T. Tomasello REFINANCE Angela M. Tomasello Providian Bank 4940 Johnson Drive Pleasanton, CA 94588 9 North Stoner Avenue Camp Hill, PA 17011 . H.SETTLEMENT AGENT: SERVICE LINK PLACE OF SETTLEMENT: 724 Edison Rd. Dauphin, PA 17018 J. Sl.M'<IARY OF OORRCMER'S 'IRANSACl'ICN K. Sl.M'<IARY OF SELLER'S TRANSAcrICN 100. GROSS J\lVDUNI' OOE FRCM OORRCMER: 400. GROSS l\MOUNT OOE TO SELLER: 101. Contract Sales Price ~ 401. Contract Sales Price . 102. Personal Drooertv 402. Personal D'ooertv 103. Settlement charoes to bo"ower (line 1400) ~"4,' _4, 403. 104. 404. 105. 405. Adjustments for items oaid bv seller in advance Adlustments tor items oaid bv seller in advance 106. Citv/town taxes to 406. Citv/town taxes to 107. COW"Itv taxes to 407. County taxes to 108. Assessments to 408. Assessments to 109. 'l'HRIT 11 '^" '^^ 20 _ 497 _ 57 409. 110. 410. 111. 411. 112. 412. 113. 413. 114. 414. 120. GROSS J\lVDUNI' OOE 420. GROSS l\MOUNT OOE FRCM OORRCMER 4" Q~ Q . n n I TO SELLER 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: I 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. DeDOsit or earnest money 1501. Excess decosit (see instructions) 202. PrincioallllllO\J/1t of new loonls) 4" Q~Q_nnI502. Settlement choroes to selle. (line 1400) 203. Existina loan(s) taken subiect to 503. Existina loan(s) taken subiect to 204. 504. PaYOff of first mortoooe loan 205. 505. PaYOff of second mort.o.e loan 206. 506. 207. 507. 208. 508. 209. 509. Adiustments fo. items unoaid bv selle. Adjustments for items unaaid bv seller 210. Ci tv/town taxes to 510. Citv/town taxes to 211. COl.Xltv taxes to 511. County taxes to 212. Assessments to 512. Assessments to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOI'AL PAID BY/FOR 520. 'l'<JI2\L REI::KJ:TICN J\lVDUNI' OORRCMER 4" Q? Q . nn DUE SELLER 300. CASH AT SEITLEMENI' FRCM/TO BQRROOER 600. CASH AT SEITLEMENI' TO/FRCM SELLER 301. Gross amount due from borrower (line 120) .4~ Q?Q. nn 601. Gross amount due to seller (line 420) 302. Lessamountsoaidbv/fo. bof'ower<line 220) 46.929.00 602. Lessreductionsin8lllOuntdueselle.(line520 303. CASH( 0 FRCM} (0 TO}OORROOER 0.00 603. CASH( oTO) (OFRCMI SELLER I have carefully revi~wed the H~D~1 Settlement Statement and to the best. of my knowledge. and belief it is a true and accurate st8t~nt of at receIpts and dl1bursement8 made on my account or by me 1" thlS transact10n. I further certify that I have received a copy of the HUD-' Settlement Statement. G.PROPERTY LOCATION: 9 North Stoner Avenue Camp Hill, PA 17011 I.SET1LEMENT DATE: 10/21/99 Disbursement Datel . '" I \ Borrowers Sell~rs The HUD-' Settlement Statement which I have pre~red is a true and accurate account of this transaction I have caused or will cause the funds to be disbursed in accordance wfth this statement. . Settlement Agent pate ~g~Oi2'io~tcL~ 'n~[~ ~of~~wLR8IY~~I~~,.st'6F"ar.flitg 19~:U~if~ ~Ao~?~.oe.agi~egfigRY1a~,i~~ ~gE~io~e~8\6~es upon , . { . , /~ -?- " ~.,~ - .. L. SETTLEMENT CHARGES I . . i 700. TOTAL SALES/BROKER'S COMMISSION PAID FROM PAID FROM I based on orice $ @ %- . BORROWER'S SElLER'S Division of comnission (line 700) as follows: FUNDS AT FUNDS AT SETTLEMENT SETTLEMENT 701. $ to 702. $ to 703. commission oaid at Settlement I 704. 800. ITEMS PAYAFlLE IN CONNECTION WITH LOAN 801. Loan Oriaination Fee 3. nnn % Dr~,,~"bn lIT".... ,1 "'l>. 1 '';7 no 802. Loan Oiscount % 803. Aooraisal Fee to . 'bn 1IT"H~n=' "'=nk ~~ DIY' a04. Credit Ronnrt to 805. lenders Insoection Fee 806. Morto8ae Insurance Aonlication fee to 807. ASSLnDtion Fee 808. 809. Flood Determination Fee to ~1 ~ "n Dr_ ."' ,n N"','~no1 ,,,,, 00[' a,o. 811. 812. 813. 814. 815. 816. 900. ITEMS REOUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest from to 6l$ Iday 902. Mortaaae Insurance Premium for months to 903. Hazard Insurance Premium for vears to 904. Flood Insurance Premium for vears to 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance months li)$ nPr month 1002. Mortaaoe Insurance months 6l$ cer month 1003 City nronPrtv taxes ~ths 6l$ rwr month 1004. County o.ocertv taxas months 6l$ cer month 1005. Annual assessments months 6l$ oer month 1006 Flood insurance months iil$ nPr month 1007. months 6l$ cer month 1008 ADDreDate Adiustment 1l00. TITLE CHARGES 1101 Settlement or closinD fee to ~?~~ .." ~..r"~"'.. 1~nk DO[' 1102 Abstract or title search tn 1103. Title examination to 1104 Title insurance bindl:1or to 1105 Document nr~ration to 1106. Notarv fees to 1107 Attornev's fees to Cincludes above items IllII'bers: , 1108. Title insurance to (includes above ft- nl.lltlers: I 1109. lender'S coveraae $ 1110. Owner's coveraDe $ 1111 Endorsements 1112. Exoress Fee to 1113. 1114F=~.. 'inn ~~~ .." ~"T"~"''' '~nk Dn(' 1115h~" 525 ..~ a..ru~"'.. 1ink DO[' 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordjno tees: DeM $ :Hortoaoe $ 31 SO :Reteases $ P()[' 1202 Citv/countv tax stall'lr\fl!: Deed $ :Mo.t.ao. $ 1203 State tax/sta~: D.ed $ :Mortoaoe $ 1204. . 1205. .. 1300. ADDITIONAL SETTLEMENT CHARGES 1301",,,, ~~ N" 4 0~0 nn 1302",,,, n=u~FF . "h1" "'=n" ROR.OO 1303"" -- "..",h~ . I_L ?4';.00 1304",1" -- ['i.'''' ,'- V~~" ? 0';7 nn 13051"1" ~. 1",,,n 933.00 1306"" ('r..,.H. ..~ ra" N" 440 nn 1307",1" .. ' ,. 11.463.43 1308",1" n=u~FF T1~= T.~=n q.. 1 74" 00 1309"'''' ~ou~H 1 401 nn 1310. 1311. 1400. TOTAL SETTLEMENT CHARGES'ent.. on lines 103 Sect J and 502 Sect Kl ~,; 4., 4' - , ==--...I~ , .' CERTIFICATE OF SERVICE A copy of the foregoing Pretrial Statement has been served upon the Plaintiff by sending a copy to her attorney of record: Maryann Murphy, Esquire Legal Services, Inc. 8 Irvine Row Carlisle, PA 17013 by depositing same in the United States mail, postage prepaid, in Lj.tb. day of ~ ' 2000. Middletown, Pennsylvania, this PANNEBAKER AND JONES, P.C. Attorneys for Defendant By, ~..<.~ Peter R. H nninger, Jr., Esquire I.D. #44873 4000 Vine Street Middletown PA 17057 (717) 944-1333 ANGELA TOMASELLO, plaintiff IN THE COURT OF COMMON PLEAS ~UMBERLAND COUNTY, PENNSYLVANIA V. NO. 20~O-451 CIVIL TERM NICK TOMASELLO, Defendant IN DIVORCE INVENTORY AND APPRAISEMENT OF NICK TOMASELLO Defendant files the following inventory and appraisement of all property owned or possessed by either party at the time this action was commenced and all property transferred within the preceding three years. Defendant verifies that the statements made in this inventory and appraisement were true and correct. Defendant understands that false statements herein are made subject to the penalties of 18 Pa.C.S. s4904, relating to unsworn falsification to authorities. ~~~ Nick Tomasello . ~ ~ ~~. ^ "^.,~"' '^=.~ "'..0' ANGELA TOMASELLO, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 2000-451 CIVIL TERM NICK TOMASELLO, IN DIVORCE 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 items has been appraised, a copy of the appraisal report is attached. Real Property Motor vehicles Stocks, bonds, securities and options Certificates of deposit Checking account, cash Savings accounts, money market and savings certificates Contents of safe deposit boxes Trusts Life Insurance policies (indicate face value, cash surrender value and current beneficiaries) Annuities Gifts Inheritances Patents, copyrights, inventions, royalties Personal property outside the home Businesses (list all owners, including percentage of ownership and officer/director positions held by a party with company) Employment termination benefits-severance pay, workmen's compensation claim/award Profit sharing plans Pension plans (indicate employee contribution and date plan vests) Retirement plans, Individual Retirement accounts Disability payments Litigation claims (matured and unmatured) Military/V.A. Benefits Education benefits Debts due, including loans and mortgages held Household furnishings and personalty (include as a total category and attach itemized list if distribution of such assets as in dispute) Other ~ ~"-' > _0', ,', ~, ~ ., ~_ 'i -u I~" c' OJ M 0 0 0 0 c: c: .0 0 0 0 0 :< :< m +' 0 0 -i-J c: >, 0 N cO 0 c: c: .rl Q) +' 0 " C- O "" "" ;:J H -rl 0 cO ro cO c: c: t:r H " '" " " " tJ' cO '" OJ '0 u Q) N +' OJ I '" +' H 0 Q) '" 0 c: Q) M OJ m ~ c: b1 <U OJ 0 .rl M 0 H +' -0 Q) '" .rl <U '" 'd Q) ,. <U M :< 0 ;;: 0 c: H H OJ "' Q) 0 '" ,. c: -rl Z m '" M m ~ ~ ~ ~ ~ ~ 0 c-m ...... ...... ...... ...... ...... .rl Q) 'H m...... 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Ul Ul '" C ~ 0 ..c: +-> 'M +-' ~ >,'" +-> rl 0 0 +-> u r-- 0 0 0 0 .Q .rl "M '0 '" 0 0 0 0 0 III +-' rl C 0 0 IZI '- IT> 0 0 0 0 0 Eo< '" '0 ro U") 0 0 0 0 H "M '" +-> ro '" 0'1 rl 0 N N H '-< Ul rl '-< C '" OJ .rl '-< '" H ..c:..c: 'H " 01 +-> ~ +-'+-' 0 U '" Ul 0 "rl C 0 '" 0 H OJ OJ +-' "M C 0 H +-' C '" 0 IT> 0 0 0 'H '" " C ~ 0 N 0 0 0 '0 0 '" 0 IT> 0 0 0 Jl~ 0 0 '" 0 0 ro 0 0 U IT> '" r-- 0 N Ul OJ <f} <f} 0 0 rl '" N OJ ..c: .rl +-' +-' .rl 'H '0 rl 0 '" .rl '" '-< .Q Ul +-> '-< r-- IT> 0 0 IT> IT> ro '" " IT> IT> 0 0 IT> IT> IT> '" '" 0 0 IT> IT> 0 0 IT> IT> IT> .rl C rl rl N N rl rl rl rl H rl rl 'H Ul '" 0 H 0 Ul '"+-' ~ ~ +-' 01.0 '" '" '" '" :r: :r: :r: :r: :r: :r: :r: Ul ZO .rl Ul rl '" H tJ> ~ '" +-' '" [J] rl >, H ~ Ul tJ> H '" +-' '" <1l 'H H +-' -" ~ :> ~ 'M +-> '0 0 0 H <: <: [J] '" U '" ~ +-' 0 '" '" H -" r, ~ OJ '" "M :.: ".-1 PO :> C +-> tJ> 'H 01'0 '0 '" N ".-1 C tJ> '" '" +-' ..-1 rl '" .0 +-' " ".-1 <: OJ Z H Ul ~ - Ul ".-1 C 0 H "M 0 U '" 0 +-> '" +-' " H '" H ~ H '" ..c: ..-1 0 "M 0 P. H '" Z U u :.: u ~ [J] 0 Z '0 <: <: '0 '0 '0 '0 '" 0 H H H H "M '" '" '" '" +-' '" '" U U U U 0 P. tJ> tJ> H Z ".-1 '" '" +-' +-' +-> +-> '" H tJ> tJ> "M "M ".-1 ..-1 H C 01 0 +-' +-' '0 '0 '0 '0 '" +-> '" Ul H H '" '" '" '" +-> 'H +-' '" 0 0 H H H H '" 0 H 0 rl :.: N :>:: 0'1 U '" U U") U '" U r-- ~ [J] .~."~ ~~"". ~ =.i 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 5. Credit card balances 6. Purchases 7. Loan payments 8. Notes payable 9. Other unsecured liabilities CONTINGENT OR DEFERRED 10. Contracts or Agreements 11. Promissory notes (. ) 12. Lawsuits 13. Options 14. Taxes 15. Other contingent or deferred liabilities ,'- """'<''''.'-'';''.'A' ~, """,~I.,' _j CERTIFICATE OF SERVICE A copy of the foregoing Inventory and Appraisement has been served upon the Plaintiff by sending a copy to her attorney of record: Maryann Murphy, Esquire Legal Services, Inc. 8 Irvine Row Carlisle, PA 17013 by depositing same in the United States mail, postage prepaid, in Middletown, Pennsylvania, this /7.ft, day of ~ ' 2000. PANNEBAKER AND JONES, P.C. Attorneys for Defendant By: Pete R. Henninger, 1. D. #44873 4000 Vine Street Middletown PA 17057 (717) 944-1333 . "~ 'Ill 1ilI~ ~~""",~~-' . li:1iiBillilIi -' (') 0 0 c: <:::> " ~:: ~ ,-.-< ""ODJ -',' mn G) ~+:;F1 Z:.TJ ~L{8 ZC;::: _...J ~2: SC} C::l.7 "J:.."" ;~:~{~ 5' -'r''' 20 -.0 a <-", ,fl J>(-~ '-~ ~ ,;:,:) 5P 'l"' ~ '" .~ _~I ~L....,,,,,, l DR 30,033 PACSES In 512102641 ANGELA TOMASELLO, Plaintiff/Petitioner vs. : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : DOMESTIC RELATIONS SECTION : CIVIL ACTION - LAW NICK TOMASELLO, Defendant/Respondent : NO. 00-45 I CIVIL TERM ORDER OF COURT AND NOW, this day of, , based upon the Court's determination that Petitioner's montWy net income/earning capacity is $per month and Respondent's montWy net income/earning capacity is $per month, it is hereby Ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit, $a month payable -weekly as follows; $for alimony pendente lite and $on arreaTS. First payment due. Arrears set at $. The effective date of the order is. This Order is based upon the fact that husbandhas a child support obligation for the parties'stwo children under C#378 102577, docketed at 741 Support 2000. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C.S.g 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and its discretion make an appropriate Order, including, but not limited to, commitment of the Respondent to prison fOT a period not to exceed six months. Said money to be turned over by the P A SCDU to: Angela Tomasello. Payments must be made by check or money order. All checks and money orders must be made payable to P A SCDU and mailed to: PASCDU P.O. Box 69110 Harrisburg, P A 17106-911 0 Payments must include the defendant's PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. ~.I Lb.-;;:;,. Respondent is to provide medical insurance coverage for wife. This Order shall become final ten days after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. DRO: R. J. Shadday ~l~d copies .~~ 'o/'tJr~iJ?IJ'w: .. <;: Petitioner Respondent Maryann Murphy, Esquire Peter Henninger, Jr., Esquire BY THE COURT, cQ~,,~ Edgar B. Bayley 1. ~~ifUJ!lII-;jII....;..~~_~l>->>^,""'1_",...,J"~.d'V.l"~~""'_1'l"""r ~~"=1lli1llo1_ ~ _.. o c: ? "OC;', IT! .... _ frr Z::o z-- &~~; ~O ~O .Pc: ~ 'U , a Cl w n -i I c.,;, o -" "'; ;~Ti?] .~~~ f;~ ~~ d~n ~ :n -< -n :31; l.- ::> (J'l . - I , "' r "- ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT pi "10' S ~o rv\ 0 .. 10 d /N . State Commonwealth of Pennsylvania 11 77 \!0 rlglna r er otlce Co./City/Disl. of CUMBERLAND 1ge5f5 3-?!?' 10;;L5'.. . ....0 ~,:"ended Order/Notice Date of Order/Notice 09/28/00 :!)/c. C)..99'7,? IJDd. tJO:!I5/QPlIiJO Terminate Order/Notice COU rt/Case N umber (See Addendum for case summary) ~ 6 7 dl D){pt..f / V'C- 30v3.3 ) RE, TOMASELLO, NICK T. ) Employee/Obligor's Name (Last, First, MI) ) ) ) ) ) ) ) EmployerlWithholder's Federal ErN Number COMMONWEALTH OF PA EmployerlWithholder's Name C/O PAYROLL OPERATIONS EmployerlWithholder's Address PO BOX 8006 HARRISBURG PA 17105-8006 207-50-3656 Employee/Obligor's Social Security Number 8136100607 Employee/Obligor's Case Identifier (See Addendum for plaintiff names assodated with cases on attachment) Custodial Parent's Name (Last, Firstl Mf) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMA TlON: 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. $ 606. DO per month in current support $ 35.00 per month in past-due support Arrears 12 weeks or greater? o yes Q1) no $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 641.00 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: $ 14 7. 92 per weekly pay period. $ 295.85 per biweekly pay period (every two weeks). $ 32D. 50 per semimonthly pay period (twice a month). $ 641.00 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 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 pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDUl Employer Customer SeNice at 1-877'676-95BO for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS 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. DRO: RJ S xc: def /D '03,00 8iJ ~fJt.-<;;ltib 1J, [BBS "'H~'lJ~~ Date of Order: Edgar B. Bayley JUIX;E Form EN-028 Worker ID $IATT 5eNice Type M OMB No.: 0970-0154 Expiration Date: 12131/00 , I 'i 1 '.,1 j Ii ii !I II 1j il :, !i \. ~. ._., f7ted I'r\ pro+hofiJi:((Y Ot+\<'9- Qc.10btr 3. JOOO j<ll.At,""~_ IflOrED - _"..._~_I,j ,,.,,...,...~ \'!!Iffi'l!l"~"l?!;=,,,,,""'WPc~=,y~,,.,,,,,_,,-.::;q""""I~~tgI~~~!~~11~__lJ1IlI'!!l!~11l!~1ml~~ ~....~ -,~'" ~~....... . '~:''''""''Ji\i' ( " ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS o If checked you are required to provide a copy of this form to your employee. 1. Priority: Withholding u'nder 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. * RCpOl1illg tL<:: P-aydate/Date ofVJitl.l.oIJ;I,g. '.(Otl.llust Ic..t:<oll tLe payJ<:itddate of Hitl.l.oIJ;,15 vvl.eh sehdihg tl.o:; t-'oylllellt. Tl.e f:JayJate,'d~te of vvitl,l.vldil,g if, tLe date VII vvLid. ohl0UJlt no::> vvitl.I.c..IJ filii.. tLc.. 1o.'.,.ployec.'3 vvages. 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 employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 2321722990 EMPLOYEE'S/OBLlGOR'S NAME: TOMASELLO , NICK T. EMPLOYEE'S CASE IDENTIFIER: 8136100607 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: 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 shouid 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 (15 U.s.c. !i1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 10. '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. If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240--6225 or by FAX at 1717'1 240-6248 or by Internet @ Requesting Agency: DOMESTIC RELATIONS SECTION P.O. BOX 320 CARliSLE PA 17013 Page 2 of 2 Form EN-028 Worker 10 $IATT Service Type M OMS No.: 0970-0154 Expiration Date: 12/31/00 ( ... ~""~ ADDENDUM Summary of Cases on Attachment Defendant/Obligor: TOMASELLO, 378102577 ptJc?7>f DOB .... .......... ...i.i6~~t~k:~ dl;~~~~~~~,;:~:;e required to enroll the child(ren) ..... ... ....... ..... identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB D If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB If checked, you are required to enroll the child(ren) above in any health insurance coverage available the employee's/obligor's employment. Addendum Service Type M OMB No.: 0970-0154 Expiration Date: 12/31/00 NICK T. PACSES Case Number 512102641/3LJ033 Plaintiff Name ANGELA M. TOMASELLO Docket Attachment Amount 00-451 CIVIL $ 146.00 Child(ren)'s Name(s): DOB . dl/~~~~~~~,y~~~;~;~~uired to enroll the child(r~~;i/ identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): D08 D If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB dli~~~~~~J,;~~;;~;~~~ired to enroll the child(ren) .. ..... identified above in any health insurance coverage available through the employee's/obligor's employment. Form EN-028 Worker 10 $IATT ~lc." ~-i f ( DR 30,033 PACSES In 512102641 ANGELA TOMASELLO, Plaintiff/Petitioner vs. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : DOMESTIC RELATIONS SECTION : CIVIL ACTION - LAW NICK TOMASELLO, Defendant/Respondent : NO. 00-451 CIVIL TERM AMENDED ORDER OF COURT AND NOW, this 4th day of October, 2000, based upon the Court's determination that Petitioner's monthly net income/earning capacity is $1,175.33 per month and Respondent's monthly net income/earning capacity is $2,290.79 per month, it is hereby Ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit, $146.00 a month payable bi-weekly as follows; $60.46 bi-weekly for alimony pendente lite and $6.92 by-weekly on arrears. First payment due next pay date at $67.38 bi-weekly. Arrears set at $262.00 as of September 28, 2000. The effective date of the order is August 17, 2000. This Order is based upon the fact that husband has a child support obligation for the parties' two children under C#378102577, docketed at 741 Support 2000. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C.S.s 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and its discretion make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the P A SCDU to: Angela Tomasello. Payments must be made by check or money order. All checks and money oTders must be made payable to PA SCDU and mailed to: P A SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the defendant's PACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. , -~. ~.,~ ~ .L~~ ~,.c I '. Respondent to provide medical insurance coverage for wife. This Order shall become final ten days after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo befoTe the Court. DRO: R. J. Shadday Mailed copies on ItJ'{rt:O to: < 9f BY THE COURT, Petitioner Respondent Maryann Murphy, Esquire Peter Henninger, Jr., Esquire cQ?J~~ Edgar B. Bayley J. O!........_IlMj&Ji:~~~~__'_;/<b;,';"';;j"""=~""'".;oI~~.~' ~ -~~~'-~lllllII'''''' - ~.. ... \ 0 = C c....~ ::;::"'. c:) U C'"' n1 rn "') "'"1" Z :X.' --I -c', --- Z , I :", cq~~'--: ~..c> - __"_,.i CS-c. (-=--J ;..-- c:.~ -, j;; C) :it .:c; Z(~, C) Pc 1'0) nl '"_.~ Z .-.-' -' -.... (JJ ,_co. -< \D ~D ,< !!l' - 'I, ~..,...j .....!...._, . ANGELA M. TOMASELLO, Plaintiff DR 29,978 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. DOMESTIC RELATIONS SECTION CIVIL ACTION - SUPPORT NICK T. TOMASELLO, Defendant 741 SUPPORT 200 ANGELA M. TOMASELLO, Plaintiff DR 30,033 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. ~vIc'IVIL ACTION - LAW NICK T. TOMASELLO, Defendant 00-451 CIVIL TERM IN RE: FINDINGS OF FACT AND NOW, this 21st day of December, 2000, after hearing, we make the following findings of fact: 1. The parties have stipulated that the support order for the children as previously computed by the Domestic Relations Office is appropriate. 2. There was a change of circumstances effective October 14, 2000, in that Defendant became disabled from performing his job at the State Correctional Institution at Camp Hill. 3. Defendant is receiving monthly disability payments in the amount of $897.61. This is a net figure. 4. The Defendant is able to receive those ....- " ~V""'I .. , disability payments and still work at a job in which his disability does not affect his performance. We find that he has an earning capacity of $7.00 per hour, 40 hours per week gross. 5. There is no reason to justify a deviation from the guidelines. 6. The parties still have 50/50 custody of the children. The Domestic Relations Office is directed to prepare a guideline calculation based upon these findings of fact so that we may enter a modified order effective October 14, 2000. By the Court, .~ ~ 0" \j(,Y ~ Edward E. Guido, J. Jeffrey N. Yoffe, Esquire For the Plaintiff Peter R. Henninger, Jr., Esquire For the Defendant DRO :mae w~ ~ '"'- illlil.ua~~' . ~~~< ~. " . "~., """~"lli!~i'i:!wh~W;~ ~ ~~ , , _. ~~ ......,~ ,. '^ lii, .. , , I!\ 'L!'-'} (""'1\ IN- , Vii'4v/\' \()I\:r ::!d ^.Li\!n"'~, n 'd" ':Y^'I\'n" , ',.!'J \...." !<:',~'!>/l; l.j " ,^, J :5 I :~~ h?J ":';;) t;0 v.... -J,.." .......} },!:j';ii! -~ . ,J 6~? o. -,<.! , ,,'" - ~.' i , .. ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT ~ '7'11 $di5lJO State Commonwealth of Pennsvlvania A9/9<;f<; :3 7!? /0.)-577... ..' .... .... ...... .' .' .... . ....@originaIOrder/Notice Co./City/Di5t. of CUMBERLAND ~I<. &'r97f j/tb,t%J-'/Sy(!;1!7L '.0 Amended Order/Notice Date of Order/Notice 01/04/01 NI,;.,/,'l 5/;UO+(f:,l/1 0 Terminate Order/Notice Court/Case Number (See Addendum for case summary) '-'71::::' <; , 61<.. 30033 ) RE: TOMASELLO, NICK T. EmployerlWithholder's Federal EIN Number ) Employee/Obligor's Name (last, First, MI) STATE EMPLOYEES RETIREMENT OFF ) 207-50-3656 EmployerlWithholder's Name ) Employee/Obligor's Social Security Number 30 N 3RD ST ) 8136100607 EmployerlWithholder's Address ) Employee/Obligor's Case Identifier HARRISBURG PA 171Dl-1703 ) (See Addendum forplaintiffnamesassodaledwith casesonattachmenlJ ) Custodial Parenfs Name (Last, First, Mf) ) " , " !' i; I II ! I " i'l li See Addendum for dependent names and birth dates assodated with cases on attachment. ORDER INFORMA TlON: 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 dedud these amounts from the above-named employee's/obligor'5 income until further notice even if the Order/Notice is not issued by your State. $ 6D6. 00 per month in current support $ 35.00 per month in past-due support Arrears 12 weeks or greater? <Dyes 0 no $ 0.00 per month in medical support $ O. DO per month for genetic test costs $ per month in other (specify) for a total of $ 641.00 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: $ 147 92 per weekly pay period. $ 295 85 per biweekly pay period (every two weeks). $ 320. 5D per semimonthly pay period (twice a month). $ 641.00 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 dedud a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee'5/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Colledions and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for in5trudion5. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106.9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER 10 (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. ':\j"'3l.' R"'11 '::!1ft DRO: RjfJSBadday ~ xc: defendant /-IO-fJl dJ Date of Order: January 5. 2001 Fdward E. Guido .JULCE Form EN-028 Worker ID $IATT Service Type M OMB No.:0970-D1$4 Expiration Date: 12/31/00 .~c: I ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS o If checked you are required to provide a copy of this form to your employee. 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, separateiy identify the portion of the single payment that is attributable to each employee/obligor. 3.* Repoltihg tLe Paydaoc.lOQtt vfVJitl,l,oldillg. You Jlltbt 1<;;~vlllLe paydateJdate of vv;1l11Ivld;1I5 vvlleh sehdill5 tll.., 1--~f1l1ellt. Tile paydatefdate.. of nitllllvlJ;1I5 is tile date 011 vvllkL QlIlVUlIl vvas vvitl,l,eld flOl1! tile e..11I/:,loY':"':" vvages. 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 foilow the law of the state ofemployee'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 employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 4687100063 EMPLOYEE'S/08L1GOR'S NAME: TOMASELLO , NICK T. EMPLOYEE'S CASE IDENTIFIER: 8136100607 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: 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 (15 U.S.c. 91673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 10. "NOTE: If you or your agent are selVed 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. Requesting Agency: DOMESTIC RELATIONS SECTION P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by Internet @ Page 2 of 2 Form EN-028 Worker ID $IATT SelVice Type M OMBNo.:0970-0154 Expiration Date: 12131/00 , ADDENDUM Summary of Cases on Attachment Defendant/Obligor: TOMASELLO, NICK T. PACSES Case Number 5121026413<::)033 Plaintiff Name ANGELA M. TOMASELLO Docket Attachment Amount 00-451 CIVIL $ 146.00 Child(ren)'s Name(s): ,... ~ ,~ " , I PACSES Case Number 378102577/aC)Cr78 Plaintiff Name '/ v ANGELA M. TOMASELLO Docket Attachment Amount ooms 2000 $ 495.00 Child(ren)'s Name(s): ~i;6~s:]ilil1)tIM':~j:ji:;6t DOB ............................. O~/g/91 :,::,:iX':t"):"(,"::':':ttt:':X'X6!l/:illflt!l ::."",.;"::::,::::,.:::,.,::::",.:..,'::::"::::::,'::::.::::::;'::',:,.::,::,::::::,,::::::::::::'::.::.:,::'.::".::'::,::'::::'::'::":'..:'.:::':::::'::::.:::,.::::.::".:.:,:,:.:,::.:,:,..,:..:,:,:,.:...,." Olf~h~~k~d:"~~.~'.'~;;;;~~i;~d;~;~;~II.';h~'~hild(;~~; ..,. .... identified above in any health insurance coverage available through the employee's/obligor's employment PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB o If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): D08 If checked, you are required to enroll the child(ren) above in any health insurance coverage available employee's/obligor's employment J DOB tsli~~:~~:~:;~~~;:;:~~~;~~:;~:~;~II;~~:~iIJ1;:~i'i".'.... identified above in any health insurance coverage available through the employee's/obligor's employment PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB o If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the empioyee's/obligor's employment PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB D If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Service Type M Addendum Form EN-028 Worker 10 $IATT OMB No.: 0970-0154 Expiration Date: 12131/00 " ~lllIIiIIilildlIlIII8l/l~oil~~~~_...,Il"'.'"mt;1lO_~.;u,,,-,,,o,,,",,, ^ ~ ~-'--~~-~ -_...~.-...... (') f;'; ~p UJ,.~': c.::-; to, ~~ ii[5 2~ ^cJ -<;, - 'II ~ \ o 9 " ::,.~~:> C'..} ^~ -;:-;; ~- ::::> Co ='1 -< 'or': :1 " i " 'I :1 [I I .! 'I I, II !J :j I ~ ~ ,I ~ ~ ,~ il 60~ ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT f:,li. 7L/ / .s 02fJtJ1) . . . State Commonwealth of Pennsvlvania ,l)jfe[,f5 37!! Itv-577 Q anginal OrderlNotlce Co./CitylDisl. of CUMBERLAND !J;e, ;?(tJtl7 f .. ~. ..Q, Amended OrderlNotice Date of Order/Notice 01/04/01 12,/(j,./)O-L/5/ 11I/4@ Terminate OrderlNotice COU rtICa5e N um ber (See Addendum for case summary) 1IM5f5 $7;; I O~ (ptf / )1<. 3003,3 ) RE: TOMASELLO, NICK T. ) Employee/Obligor's Name (last, First, Ml) ) ) ) ) ) ) ) EmployerlWithholder's Federal EIN Number COMMONWEALTH OF PA EmployerlWithholder's Name C/O C/O PAYROLL OPERATIONS EmployerlWithholder's Address PO BOX 80D6 HARRISBURG PA 17105-80D6 ...... 207-50-3656 Employee/Obligor's Social Security Number 8136100607 Employee/Obligor's Case Identifier (See Addendum for plaintiff names ilssoaated with cases on attachment) Custodial Parent's Name (Last, First, Mil See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMA TION: 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'5/0bligor'5 income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current support $ D. 00 per month in pa5t-due support Arrears 12 weeks or greater? Qye5 G9 no $ D. 00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 0 .00 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: $ O. OD per weekly pay period. $ 0.00 per biweekly pay period (every two weeks). $ 0.00 per semimonthly pay period (twice a month). $ 0 00 per monthiy 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 the allowable amount. The totai withheld amount, and your fee, cannot exceed S5% of the employee'51 obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on pg. 2). If remitting by EFl/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDUr P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER 10 (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH B~A~L~.. 'SIIft DRO: RJ Shadday ~ /-/0-01 <%7 Date of Order: January 5, 2001 Service Type M OMB No.: 0970-0154 Expiration Date: 12/31/00 ~'"~ Edward E. Guido JIUIX;E Form EN-028 Worker 10 $IATT "'-~. I ~~ --<;j:",:: "" ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS o If checked you are required to provide a copy of this form to your employee. 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.* RepoI1i1.g tile PayJahdDa-te ofV,{itLI,oIJil.5. \'vu IIHASt lepolttl.e payda.tefJa~ vf nitl.l.oldillg vvl.el. S61.J;1I6ll.c: pay I lIeht. TL"" paydil.te/Ji!tk vf nitl.l.oldil.g is tl.e cia&.. VII nl.id. alIlOUl.t nCl.S ~vitl.l.o..:.IJ hVII. lLc: C:II.ployee's ~Vdge.... 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) S. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S 10: 2321722990 EMPLOYEE'S/08L1GOR'S NAME: TOMASELLO , NICK T. EMPLOYEE'S CASE IDENTIFIER: 8136100607 DATE OF SEPARATION: LAST KNOWN HOM~ ADDRESS: 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. [fyou 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 (15 U .s.c. 91673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxesi and Medicare taxes. 10. ONOTE: If you or your agent are seNed 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 re5pecl-lo these items. Requesting Agency: DOMESTIC RELATIONS SECTION PO. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contad WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (7171 240-6248 or by Internet @ Page 2 of 2 Form EN-028 Worker ID $IATT Service Type M OMBNo.:0970"0154 Explration Date: 12131/00 , '''UM1 i1Ii1il11lWiIlil""'~.'~ ~""""-""""'''''_l!IlI~I,.~,,!J8.j''li'''''~.....~- -~_...~~ ......~- ~~-_.~.. _......0_'.- 0 0 .~~ c: ? C_ -orf1 [nt~, ~;::oe. z...., :::'.": z:~"' (l' '.., C' -<Z " C.' ~ " .J> n :3: " J 58 ( - ::..',) ':.J nO, Z :.n ~:x;l :;! ID =-.t""J -~ .# \ ''t,' ~~ ~ ~.~.. ~ ,~ '~"--~=. - ~ I ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT q ~.....7fiW$~ State Commonwealth of pennsvlvania )'Jlte?'fl'37iI6.)-c5-77 OOnginalOrder/Notice Co./City/Dist. of CUMBERLAND })Je. ;?(lJt{7 f t1 0 Amended Order/Notice Date of Order/Notice 01/04/01 bl:i.. {)[).L;:<;/lltl/L@ Terminate Order/Notice Court/Case Number (See Addendum for case summary) ft}(l5fC; 51;}IO,!Xfp<l/ lJl?. 3ct?33 ) RE: TOMASELLO, NICK T. ) Employee/Obligor's Name (last, First, MI) ) 207-50-3656 ) Employee/Obligor's Social Security Number ) 8136100607 ) Employee/Obligor's Case Identifier ) (See Addendum for plaintiff names associated with cases on attachment) ) Custodial Parent's Name (last, First, MI) ) EmployerlWithlmlder', Federal EIN Number COMMONWEALTH OF PA EmpJoyerM'ithholder's Name C/O C/O PAYROLL OPERATIONS EmployerM'ithholder's Address PO BOX 8006 HARRISBURG PA 17105-8006 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'5/obligor'5 income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? 0 yes G9 no $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 0 .00 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 biweekly pay period (every two weeks). $ 0.00 per semimonthly pay period (twice a month). $ 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 the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee'5/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDUl Employer Customer SelVice at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCOU Send check to: Pennsylvania SCOU, P.O. Box 69112, Harrisburg, Pa 17106.9112 IN ADDITION, PA YMENTS 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. DRO: RJ Shadday Date of Order: JanllaIy 5, 2001 .n~ El:Iward E. Guido JlJLGE Form EN-028 Worker ID $IAT'r SelVice Type M OMB No.: 0970-0154 Expiration Date: 12/31/00 ~~-~. " ,~" -.'- . ~ . .,u ".~ ~ - ~..~,,,,,,,,.,I'lIllIi<i~"'~' .. . ADDIT/ONAllNFORMATlON TO EMPLOYERS AND OTHER WITHHOLDERS o If checked you are required to provide a copy of this form to your employee. 1. Priority: Withholding under this Order/Notice has priority over any other legai 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, * Repol1ilJg tile:; Pa)'dQle/DAte ofV/itl,l,oldihg. YvJ IilUSt l~pOlt tilt;;; ""a)'Ji::tteJ'dare of nitl,l,oldillg ul,el, 3elldil'5 tile payllJellt. TIre -paydatefdate.A yy;lLLolJillg i!. tLe dAte vi. yvl,;d, allluulit ..M vvitl,l,eld flOln tllt:' t;;;U1plo)'ree's vv8.6d. 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 OrdersINotices to the greatest extent possible. (See jj9 below) 5, Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 2321722990 EMPLOYEE'S/08L1GOR'S NAME: TOMASELLO , NICK T. EMPLOYEE'S CASE IDENTIFIER: 8136100607 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: 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. It you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the OrderINotice 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 Statel in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are jubject 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 (15 USe. 91673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory dedLlctions such as: State, Federal, local taxesi Social Security taxes; and Medicare taxes. 10. 'NOTE: If you or your agent are 5eNed 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. Requesting Agency: DOMESTIC RELATIONS SECTION P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240,6225 or by FAX at (717) 240-6248 or by Internet @ Page 2 of 2 Form EN,028 Worker ID $IATT SeNice Type M OMBNo.:0970-0'5~ Expiration Date: 12131/00 '.' "" '~"' ., 6J~_~IIilIIHU~" .mJ - ~ I .1] 1"-4,illl-:<~';~Jil('I.","^,"j.=n,,,,,,,,,,,,..iioi~.wJl _.""""~~_. -<~ ~''''''''''''IiM,i'''-~ ,....w ".....,...r . Q ~::;.: < tJ 5.~ O}f2'"' "c.........:.." 21-- ~).:~' r~ $ ~~ -l -< c;. i._ ;::;-i~ o ,'1 ~:i: :e..' :r. <0 . " C) -'-:j-) :;:"~ ::-q -, -;. ".."i'h ~'" , -I - ~a';, .] ANGELA M. TOMASELLO, Plaintiff DR 29, 978 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS. NICK T. TOMASELLO, Defendant DOMESTIC RELATIONS SECTION CIVIL ACTION - SUPPORT 741 SUPPORT 200 ANGELA M. TOMASELLO, Plaintiff DR 30, 033 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NICK T. TOMASELLO, Defendant CIVIL ACTION - LAW 00-451 CIVIL TERM PROPOSED FINDINGS OF FACTS 1. Plaintiff/Obligee is Angela M. Tomasello. 2. Defendant/Obligor is Nick T. Tomasello. 3. By Order dated September 28, 2000, for child support, Nick T. Tomasello was directed to pay to Angela M. Tomasello the monthly sum of $475.00 plus $20.00 on arrears - effective date of Order, August 17, 2000. 4. By Order dated October 4, 2000, for alimony pendente lite, Nick T. Tomasello was directed to pay to Angela M. Tomasello the monthly sum of $131.00 plus $15.00 on arrears - effective date of Order August 17, 2000. 1.'"",.-", ' < ....', ;'." ',. ~'"~ ,I~ 5. Both Orders (child support and alimony pendente lite) were appealed by Nick T. Tomasello. 6. There was a hearing held on December 21, 2000 in front of the Honorable Edward E. Guido resulting in certain findings of fact and a direction to the Cumberland County Domestic Relations office to prepare a guideline calculation based upon said findings of fact. 7. The Domestic Relations office did prepare a guideline calculation and since the undersigned is unsure whether the same has been filed of record, said guideline calculation is attached as Exhibit "An to Mr. Yoffe's proposed finding of fact. 8. The parties agree (and represented to the Court on December 21, 2000) that the Court should make its determination as to child support based on the facts presented at the December 21, 2000 hearing and the parties agree that the Court can, if it so chooses, use the calculations of the Domestic Relations office to assist the Court in making its Order for child support. 9. Where the parties disagree is the Order for alimony pendente lite effective from August 17, 2000 forward. 10. In reference to alimony pendente lite, the parties do stipulate to certain facts which are as follows: ~ " " " ~ .. I'A A. The first effective date of any order for alimony pendente lite should be August 17, 2000 and the Court should modify the Order effective October 14, 2000 in consideration of the disability of Nick T. Tomasello as found by the Court; B. Effective August 17, 2000, the monthly net income of Angela M. Tomasello is $1,175.33 and the monthly net income of Nick T. Tomasello is $2,290.79; C. Adding child support ($475.00/mth) plus A.P.L. ($131.00/mth) to the monthly net income of Angela M. Tomasello and subtracting it from the monthly net income of Nick T. Tomasello results in the following: ANGELA NICK $1,175.33 Net Income 475.00 Child Support 131.00 A.P.L. $1,781.33 Revised Net Income $2,290.79 Net Income (475.00)Child Support (131.00)A.P.L. $1,684.79 Revised Net Income D. The difference between $1,781.33 and $1,684.79 is $96.54. E. Angela T. Tomasello agrees with the September 28, 2000 and October 4, 2000 Court Orders (the end results of which are set forth in paragraph 10C above) and is not challenging the same. ~~ .-I - -, F. Nick T. Tomasello challenges the October 4, 2000 Order claiming generally that in a shared custody situation, the amount of A.P.L. that Nick T. Tomasello is required to pay should not be so high such that the amount of money he has left over every month after paying child support and A.P.L. is lower than the amount of money Angela M. Tomasello has each month after receiving child support and A.P.L. As illustrated in paragraphs 10C and 10D above, this difference (for the time period between August 17, 200 and October 14, 2000) is $96.54 per month. It is the position of Nick T. Tomasello that his monthly payment of A.P.L. should be reduced by one-half of $96.54, or $48.27, since A.P.L. is based on need of a party to have equal financial resources to pursue divorce proceedings. See Litmann v. Litmann, 449 Pa. Super. 209, 673 A.2d 382 (1996). Strict application of the support guidelines defeats this purpose in a pure 50-50 custody situation. G. Taking into consideration the recommendation of the Domestic Relations office, the calculation set forth in paragraph 10C above, changes effective October 14, 2000 to that set forth below: .....1." ANGELA NICK $1,175.33 Net Income 398.34 Child Support 53.66 A.P.L. $1,627.33 Revised Net Income $1,972.02 (398.34) (53.66) $1,520.02 Net Income Child Support A.P.L. Revised Net Income H. The difference ($1,627.33 less $1,520.02) is $107.31. I. Angela M. Tomasello agrees with the recommendation of the Domestic Relations office. J. For the same reasons set forth in paragraph 10F above, Nick T. Tomasello takes the position that this monthly amount of A.P.L. should be reduced by $53.66 which is one- half of $107.31. PANNEBAKER AND JONES, P.C. BY: PRH/cse TOMASELLO ProposedFindsOfFacts.doc ~ H. ~ w. . CERTIFICATE OF SERVICE A copy of the foregoing Proposed Findings of Facts has been served by sending a copy to Defendant's attorney of record: Jeffrey N. Yoffe, Esquire YaFFE & YaFFE, P.C. 214 Senate Avenue Camp Hill, PA 17011 by depositing same in the United States mail, postage prepaid, in Middletown, Pennsylvania, and by telefax (717) 975-1912, this /66 day of -J<l. Vlv<< '/ , 2001. PANNEBAKER AND JONES, P.C. Attorney' for Defendant By: Peter R. H 1. D. 44873 4000 Vine Street Middletown PA 17057 (717) 944-1333 ....' N "...~,....--~' i'~lllOi1l!lioo-~~" ~h . " III ;-::: :;z C':~ -- i~;:, 5~") ~ ~I I I c.> " c c; :".,.) (::J- --$;<.' ANGELA M. TOMASELLO IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ) , ?, I , I , V. NICK TOMASELLO : NO. 2000-0451 CIVIL CIVIL ACTION - LAW IN RE: ALIMONY PENDENTE LITE BEFORE GUIDO, J. AND NOW, this ORDER OF COURT ")/- ~ fJI'~ day of JANUARY, 2001, for the reasons set forth in the attached opinion, it is hereby ordered and directed that defendant pay to the State Central Disbursement Unit $82.73 per month as Alimony Pendente Lite. Said oTder is to be effective from August 17,2000, to October 14,2000. Effective October 14,2000, this order for APL shall be and is hereby suspended until further order of court. Arrears, or credit, shall be determined by the Domestic Relations Section. Any arreaTs shall be paid at the Tate of $10.00 per month until paid in full. Any credit balance shall be applied to the arrears on the child support order enteTed at No. 741 SUPPORT 2000 (DR# 29978). The defendant shall not be responsible for any of plaintiff s unreimbursed medical expenses. Plaintiff to provide her own medical insurance. Jeffrey N. Yoffe, Esquire Peter R. Henninger, Jr., Esquire E_dEGu;do,J. ~ t~ O\'~ Domestic Relations ~"".... ~~~~lil!l/i.b:~ : Ill.'::,J.f", ~~<'~,L~" " ~ '"'Iili>1.1~"'",!l<-)j;;~~" ~~.~ YINVAlASNN3d AlNnO:J Q~~\;f),y':J8f'ilnO 'IS :01 ~iV 92 Nllf 10 1U\.JiC':';,':"",:,: 1\0 v..!. '\\J, .,_~ .J.., j~lU:!(J'{;J'lH '0 :'il , "._,. ,,~" ""'> ."" ,". d".~. _,"~",<' - .."" . -" " ~ "....~ ,-,-~~ ~ - . ~ ~'" ~ , . J .c' , ANGELA M. TOMASELLO: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. NICK TOMASELLO : NO. 2000-0451 CIVIL CIVIL ACTION - LAW IN RE: ALIMONY PENDENTE LITE BEFORE GUIDO. J. OPINION AND ORDER OF COURT On October 4, 2000, pUTsuant to the recommendation of the Domestic Relations Office, this Court ordered defendant to pay alimony pendente lite to plaintiff in the amount of $131 per month phis, $15 on arrears. Defendant filed a timely request for a hearing de novo which was held on December 21,2000. Defendant's request for a hearing de novo in connection with a child support order entered at No. 741 SUPPORT 2000 was consolidated with this matter for hearing purposes. At the conclusion of the hearing we made the findings of fact which are attached hereto as Exhibit 1. Although the caption indicates that the findings of fact apply to both the APL and child support actions, they were meant to apply only to the child support action. The parties were hopeful of reaching a stipulation of facts for purposes of the APL action. Unfortunately, this was not to be accomplished. We adopt all of the findings offact contained in Exhibit 1 attached hereto, except number 5. W~ make the following additional findings off act: .< . , ~ .' ~. Lo 2000-451 CIVIL TERM (APL) ADDITIONAL FINDINGS OF FACT (1.) The plaintiffs net monthly income is $1175.33. (2.) The defendant's net monthly income was $2290.79 until October 14,2000. (3.) Effective October 14,2000, defendant's monthly income/earnings capacity decreased to $1972.02 per month. (4.) Defendant was obligated to pay plaintiffthe sum of $475 peT month for child support until October 14,2000. Thereafter, his monthly child support obligation was reduced to $398.34. (5.) The 50/50 custody arrangements is sufficient to justif'y a deviation from the guideline. (6.) The effective date of any order is August 17,2000. DISCUSSION Applying the guidelines, we have calculated defendant's APL obligation to be $192.13 prior'to October 14,2000. The calculation is as follows: $2290.79 1175.33 1115.46 475.00 640.46 x.30 $192.13 - defendant's net monthly income - plaintiffs net monthly income - defendant's child support ,obligation - difference APL Defendant's guideline APL obligation after October 14, 2000, is $119.50, calculated as follows: 2 ". , 2000-451 CIVIL TERM (APL) $1972.02 - 1175.33 796.69 - 398.34 398.35 x .30 $119.50 - defendant's net monthly income - plaintiffs net monthly income - defendant's child support obligation APL obligation In Litmans v. Litmans, 449 Pa. Super. 209, 673 A.2d 382, (1996) the Superior Court discussed the purpose ofAPL, i.e., to level the economic playing field fOT the parties to a divorce action. Quoting from its prior decision in DeMasi v. DeMasi, 408 Pa. Super. 414, 597 A.2d 101 (1991), the Litman Court reiterated: APL is based on the need of one party to have equal financial resources to pursue a divorce proceeding when, in theory, the other party has major assets which are the financial sinews of domestic warfaTe. APL focuses on the ability of the individual who receives the APL during the course of the litigation to defend her/himself, and the only issue is whether the amount is reasonable for that purpose, which turns on the economic resources available to the spouse. (citations omitted) 673 A.2d at 388. Ifwe were to oTder APL in accordance with the guidelines, plaintiff would end up with a greater monthly income than defendant. In view ofthe pure 50/50 custody arrangement, this result would not only be unfair; it would be contrary to the purpose for which APL is intended. Therefore, we will deviate from the guidelines to enter an order of APL in the amount of$82.73 per month effective August 17,2000, through October 14, 2000. Thereafter, the order of APL shall terminate.! I The net effect of this order is to equalize the household incomes of the parties. Prior to October 14, 2000, when the child support and APL are added to plaintiffs income and subtracted from defendant's income each party's net monthly income is $1733.06. After October 14,2000, the revised child support figure equalizes the parties' income. 3 ~ , .~~; 2000-451 CNIL TERM (APL) ORDER OF COURT AND NOW, this 26TI1 day of JANUARY, 2001, for the reasons set forth in the attached opinion, it is hereby ordered and diTected that defendant pay to the State Central DisbursementUnit $82.73 per month as Alimony Pendente Lite. Said order is to be effective from August 17,2000, to October 14,2000. Effective OctobeT 14, 2000, this order for APL shall be and is hereby suspended until further order of court. Arrears, or credit, shall be determined by the Domestic Relations Section, Any arrears shall be paid at the rate of $10.00 per month until paid in full. Any credit balance shall be applied to the arrears on the child support oTder entered at No. 741 SUPPORT 2000 (DR # 29978). The defendant shall not be responsible for any of plaintiff s unreimbursed medical expenses. Plaintiff to provide her own medical insurance. By the Court, /s/ Edward E. Guido Edward E. Guido, J. Jeffrey N. Y offe, Esquire For the Plaintiff Peter R. Henriinger, Jr., Esquire For the Defendant Domestic Relations :sld 4 ANGELA M. TOMASELLO, Plaintiff DR 29,978 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. DOMESTIC RELATIONS SECTION CIVIL ACTION - SUPPORT NICK T. TOMASELLO, Defendant 741 SUPPORT 200 ANGELA M. TOMASELLO, Plaintiff DR 30,033 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION - LAW NICK T. TOMASELLO, Defendant 00-451 CIVIL TERM IN RE: FINDINGS OF FACT AND NOW, this 21st day of December, 2000, after hearing, we make the following findings of fact: 1. The parties have stipulated that the support order for the children as previously computed by the Domestic Relations Office is appropriate. 2. There was a change of circumstances effective October 14, 2000, in that Defendant became disabled from performing his job at the State Correctional Institution at Camp Hill. 3. Defendant is receiving monthly disability payments in the amount of $897.61. This is a net figure. 4. Th~ D~fendant is able to receive those ~. ' 1t. ~. disability payments and still work at a job in which his disability does not affect his performance. We find that he has an earning capacity of $7.00 per hour, 40 hours per week gross. 5. There is no reason to justify a deviation from the guidelines. 6. The parties still have 50/50 custody of the children. The Domestic Relations Office is directed to prepare a guideline calculation based upon these findings of fact so that we may enter a modified order effective October 14, 2000. By the Court, Edward E. Guido, J. Jeffrey N. Yoffe, Esquire For the plaintiff Peter R. Henninger, Jr., Esquire For the Defendant ~RO :mae _.t.. ._ I ~ """"""""'~""_I.w"" "~ .~"-, I _ ,~~ ". _"."._~~ ~~~ -~ , ~-_~L''-''''''d>Oil'~_ ...................... ~ i"tS!tb"i} .. .... '. "i..; '~gt)P;i;;~ ~ I ~il;III;Mem~~~iil,~~::~ij~Eg~~nsijs.';.} ~~~~~I.~1~~~~}g~;~ni.. M6~e~!!lII~i!i! 3136100607 Jii; NIC~T;.TdM~S~LLd.;'.ll..:~..I..IIII. ..,...:..........,..........'.....,.'.,';..'...........':'!':'t':'}".'. );'FWi;...\....~M .i;&mp~tOf..EXemJfjBrs: I 41:::rax iYear;.......,' .ii 200111;':; LS!f!leIW~~~~tW}; 2. 80:W~~iijliTa~}Rat~:.LL!.lmnO!'! ...EIGlikR~tE\; 1.1 ~ . ..... t~~..Jili.j~~~&.~~. ...... slT;f~~~rl~i.il,;;I,. 33. 91 ';"i~/ M;:}: .' ..... . "~~1;'?1n\ .... L1T'+9(i;4!f:i~!li... . .... ""II;II:'.; 12. 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"""" ,", ' , ""', ":. ~~~~imf~I;~~;~r~!;IJ~ltljjj"IiI~",lT' IMI 11.., In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Plaintiff Name: ANGELA M. TOMASELLO Defendant Name: NICK T. TOMASELLO Docket Number: 00741 S 2000 PACSES Case Number: 378102577 Other State ID Number: Fax: (717) 240-6248 Please note: All correspondence must include the P ACSES Case Number. SUDDort Guideline Calculation CHILD SUPPORT Defendant Plaintiff 1. Number of Dependents in this Case 00 02 2. Total Gross Monthly Income $ 1,972 . 02 $ 1,175.33 3. Less Monthly Deductions $ 0.00 $ 0.00 4. Monthly Net Income $ 1,972.02 $ 1,175.33 5.' Combined Total Monthly Net Income $ 3,147.35 6. Basic Child Support Obligation $ 986.00 7. Net Income as Percentage of Combined Amount 62.66 %- 37.34 % 8. Each Parent's Monthly Share of the Basic Child Support $ 617.83 $ 368.17 Obligation 9. Adjustment for Shared Custody $ -219.49 10. Adjustment for Child Care $ Expenses 11. Adjustment for Health $ Insurance Premiums 12. Adjustment for Unreimbursed $ Medical Expenses 13. Adjustment for Additional $ Expenses 14. Total Obligation with $ 398.34 Adjustments 15. Less Split Custody $ O.OD Counterclaim 16. Obligor's Support Obligation $ 398.34 Form OE-O 19 Service Type M Worker 10 21005 --. .6 _-I ANGELA TOMASELLO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. NO. 00 - 451 CIVIL NICK TOMASELLO, Defendant IN DIVORCE ORDER OF COURT I'^ (l<-- AND NOW, this ~4. day of ~/ by counsel that all , 2001, the Master having been advised outstanding issues in the above captioned case have been resolved without the need for a marital settlement agreement or a hearing, the appointment of the Master is vacated.* BY THE COURT, ~J cc: Jeffrey N. Yoffe Attorney for Plaintiff Peter R. Henninger, Jr. Attorney for Defendant * See letter from attorney Peter R. Henninger, Jr. dated February 6, 2001. 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