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HomeMy WebLinkAbout00-00471 ~ ~ " . . '. . , , . . . . , . . . . . . . . . . , . , . . . . . . , , , . i'. .0- ,-" ,- ~' , " - ( .. , , , , , , , :t: Of. :t::f. "';Ii . , IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY , PENNA. STATE OF , . , ERIC S. PEIFFER, , , Plaintiff No. 7000-471 CTVTT, TERM . VERSUS , FAY T PFTFFFR, np.fp:nr1~nt . AND DECREE IN DIVORCE NOW,V~ "1 20010 IT IS ORDERED AND . . ERIC S. PEIFFER , PLAINTIFF, DECREED THAT . . . FAY J. PEIFFER , DEFENDANT, AND 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; None. It is further ORDERED, ADJUDGED and DECREED that the terms, provisions and conditions of a certain Marital Settlement Agreement between the parties dated November 1, 2001, and attached hereto, are illcorporated ill thIS Decree m DIvorce by reference as fully as If the same were set forth herein at length. Said Agreement shall not merge with but shall survive this Dec ' , PROTHONOTARY BY~E COU .', " ATTEST: "" . , , . , . ....;;'" . . , Ii i~ i; !; !~ Ii' Ii , . . , , . . , . , . . , , , , , . J. . , , , , . . . .. " ~, ~ 7 /.21'1f / J;; -, .tJl 7 . '" - __" -_"..;V~_ ~'__'~_-~__"'""~"",,,,~, ~ =~"" ..,+, ~" " {k;I- ~, ~ -d d~ 4. Ii 11~ ~ -;{; dj'~7 . ~~""~, ~~ ~~~ _ .........M~. ~" "-' lllHiIi!llj- ,,!"'!!llllll, " ~~ , , f . II MARITAL SETTLEMENT AGREEMENT BY AND BETWEEN ERIC S. PEIFFER AND FAY J. PEIFFER Cindy S. Conley, Esquire HOWETT, KISSINGER & CONLEY, P.C. 130 Walnut Street P.O. Box 810 Harrisburg, P A 171 08 Telephone: (717) 234-2616 Counsel for Eric S. Peiffer Michael L. Bangs, Esquire 302 S. S. 18th Street Camp Hill, P A 17011 129 Market Street, P.O. Box 335 Telephone: (717) 730-7310 Counsel for Fay J. Peiffer :" - ......J "f_1 f ( . . MARITAL SETTLEMENT AGREEMENT THIS AGREEMENT is made this ~ day of IV ~ t...v" _ , 2001, by , and between Eric S. Peiffer, of Cumberland County, Pennsylvania, and Fay J. Peiffer, of Cumberland County, Pennsylvania; WITNESSETH: WHEREAS, Eric S. Peiffer (hereinafter referred to as "Husband"), social security number 187-50-3162, was born on September 5, 1962, with a current mailing address of 120 Parkview Road, New Cumberland, Cumberland County, Pennsylvania 17070, WHEREAS, Fay J. Peiffer (hereinafter referred to as "Wife"), social security number 175-48-4005, was born on January 12, 1955, and presently resides at c~') CJ () .'..(1 . c _ , l21 R~ ~~~ ~~ '?~ L". __'] ~,~,\ ,1 WHEREAS, the parties hereto are husband and wife, having been lawfull~m:;)!riel'B:m :'1']: rJJ --! ~" 1....-' C,) October 3,1992 in Boiling Springs, Pennsylvania; ~~) ~ ~p. ""'0 - ~ >c ..- ~ WHEREAS, the parties have lived separate and apart since on or about Septe~er 9t ~ 1997; WHEREAS, no children were born of the marriage between the parties; WHEREAS, the parties hereto are desirous of settling fully and finally their respective financial and property rights and obligations as between each other, including, without limitation, the settling of all matters between them relating to the ownership ofreal and personal property, the support and maintenance of one another and, in general, the settling of any and all claims and possible claims by one against the other or against their respective estates. 1 ,,~- , -,,' "",,,--I, ~'ii I . · NOW, THEREFORE, in consideration of these premises, and of the mutual promises, covenants and undertakings hereinafter set forth, and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged by each of the parties hereto, Husband and Wife, each intending to be legally bound hereby, covenant and agree as follows: 1. ADVICE OF COUNSEL. Each party acknowledges that he or she has had the opportunity to receive independent legal advice from counsel of his or her selection (Cindy S. Conley, Esquire for Husband and Michael L. Bangs, Esquire for Wife). Each party fully understands the facts and his or her legal rights and obligations, and each party acknowledges and accepts that this Agreement is, in the circumstances, fair and equitable, and that it is being entered into freely and voluntarily, and that the execution of this Agreement is not the result of any duress or undue influence, and that it is not the result of any improper or illegal agI'eement or agreements. In addition, each party understands the impact ofthe Pennsylvania Divorce Code, whereby the court has the right and duty to determine all marital rights of the parties including divorce, alimony, alimony pendente lite, equitable distribution of all marital property or property owned or possessed individually by the other, counsel fees and costs of litigation and, fully knowing the same, each party hereto still desires to execute this Agreement, acknowledging that the terms and conditions set forth herein are fair, just and equitable to each of the parties, and waives his and her respective right to have the Court of Common Pleas of Cumberland County, or any other court of competent jurisdiction, make any determination or order affecting the respective parties' rights to alimony, alimony pendente lite, support and maintenance, equitable distribution, counsel fees and costs oflitigation. 2. DISCLOSURE OF ASSETS. Each of the parties hereto acknowledges that he or she is aware of his or her right to seek discovery, including but not limited to, written 2 ,~ 1-- { . . interrogatories, motions for production of documents, the taking of oral depositions, the filing of inventories, and all other means of discovery permitted under the Pennsylvania Divorce Code or the Pennsylvania Rules of Civil Procedure. Each of the parties further acknowledges that he or she has had the opportunity to discuss with counsel the concept of marital property under Pennsylvania law and each is aware of his or her right to have the real and/or personal property, estate and assets, earnings and income of the other assessed or evaluated by the courts ofthis commonwealth or any other court of competent jurisdiction. The parties do hereby acknowledge that there has been full and fair disclosure to the other of his or her respective income, assets and liabilities, whether such are held jointly or in the name of one party alone. Each party agrees that any right to further disclosure, valuation, enumeration or statement thereof in this Agreement is hereby specifically waived, and the parties do not wish to make or append hereto any further enumeration or statement. Each party warrants that he or she is not aware of any marital asset which is not identified in this Agreement. The parties hereby acknowledge and agree that the division of assets as set forth in this Agreement is fair, reasonable and equitable, and is satisfactory to them. Each of the parties hereto further covenants and agrees for himself and herself and his or her heirs, executors, administrators or assigns, that he or she will never at any time hereafter sue the other party or his or her heirs, executors, administrators or assigns in any action of contention, direct or indirect, and allege therein that there was a denial of any rights to full disclosure, or that there was any fraud, duress, undue influence or that there was a failure to have available full, proper and independent representation by legal counsel. 3. PERSONAL RIGHTS. Husband and Wife may, alall times hereafter, live separate and apart. Each shall be free from all control, restraint, interference and authority, direct or indirect, by the other. Each may reside at such place or places as he or she may select. 3 ''''''-~ J~ ~'~: . . Each may, for his or her separate use or benefit, conduct, carry on or engage in any business, occupation, profession or ernployment which to him or her may seem advisable. Husband and Wife shall not molest, harass, disturb or malign each other or the respective families of each other, nor cornpel or attempt to compel the other to cohabit or dwell by any means or in any manner whatsOever with him or her. Neither party will interfere with the use, ownership, enjoyment or disposition of any property now owned by or hereafter acquired by the other. 4. DIVORCE. It is the intention ofthe parties, and the parties agree, that by this Agreement they have resolved all ancillary economic issues related to the dissolution of their marriage and thus any divorce action with respect to these parties shall be limited to a claim for divorce only. The parties acknowledge that on January 25,2000, Husband initiated a divorce action under, inter alia, the no-fault provisions ofthe Divorce Code by filing a cornplaint docketed at number 2000-471 Civil Term in the Cumberland County Court of Common Pleas. The parties acknowledge that the ninety (90) day waiting period provided for under S3301(c) of the Divorce Code has expired. Therefore, contemporaneously with the execution ofthis Agreement, each party will sign an Affidavit of Consent to Divorce and Waiver of Notice of Intention to Request Entry of Divorce Decree and deliver same to counsel for Husband, who shall promptly submit said affidavits and waivers to the court, along with a Praecipe to Transmit Record, Vital Statistics Form and any and all other documents necessary to precipitate the prompt entry of a divorce decree. 5. EOUITABLE DISTRIBUTION. (a) Marital Residence Proceeds. The parties acknowledge that after their separation they sold their marital residence located at 1735 Weatherbum Drive, New Cumberland, Cumberland County, Pennsylvania. The parties further acknowledge that since the 4 ,!.--~,- ~~ '.~ I.", , . . sale date of said residence that the proceeds of sale have been in an escrow account at M&T Bank in account number 1500420985470 titled as follows: "Howett, Kissinger & Conley, P.C. escrow agent for Eric S. Peiffer and Fay J. Peiffer". The parties further acknowledge that as of July 26, 2001, the balance of said account was Ten Thousand Eight Dollars and Fourteen Cents ($10,008.14). The parties agree that the proceeds of said account shall be withdrawn and payable to Wife and shall become her sole and separate property free and clear of any right, title, and or interest of Husband. (b) Furnishinl?:s and Personalty. (1) The parties agree that they have divided by agreement between themselves all their furnishings and personalty including all furniture, furnishings, antiques, jewelry, rugs, carpets, household appliances and equipment. (2) Husband shall retain, as his sole and separate property, free of any and all right, title, claim or interest of Wife, all of the personalty and furnishings currently in his possession. Notwithstanding the foregoing the parties agree that Husband shall return to Wife, simultaneously with the execution of this Agreement, the parties' marriage certificate, Wife's wedding ring, the drawers for the entertainment center, the cushions for the sofa, Wife's birth certificate, Wife's newborn hospital identification bracelet, Wife's book stand, Wife's clothing removed by Husband from the Marital Residence prior to its sale, and the binoculars originally owned by Wife's father. (3) Except as otherwise set forth herein, Wife shall retain, as her sole and separate property, free of any and all right, title, claim or interest ofHusbaRd, all of the personalty and furnishings currently in her possession. Notwithstanding the foregoing, the parties agree that Wife shall return to Husband, simultaneously with the execution of this 5 ,"'" ~" ,-J..~ ~,- --~_I , . . agreement, his record album collection (LP's) per itemized inventory, the black filing cabinet, the wooden cabinet containing the record album collection, Husband's birth certificate and birth announcement. Moreover, Wife will provide Husband with liberal access to all photographs and corresponding negatives that were at the Marital Residence at the time of separation. Husband shall be entitled to have duplicates made of any such photographs at his expense and then shall return the originals to Wife. (c) Motor Vehicles. (1) Husband agrees that Wife shall retain possession of and receive as her sole and separate property the 1997 Honda Civic autornobile currently titled in her name, along with all rights under any insurance policies thereon and with all responsibility for payment of any outstanding indebtedness pertaining thereto and insurance thereon, free of any and all right, title, claim or interest of Husband. Wife shall indemnify and hold Husband and his property harmless from any and all liability, cost or expense, including actual attorney's fees, incurred in connection with any vehiele belonging to Wife by virtue of this subparagraph. (2) Wife agrees that Husband shall retain possession of and receive as his sole and separate property the 2001 Honda Accord, currently titled in his name, along with all rights under any insurance policies thereon and with all responsibility for payment of any outstanding indebtedness pertaining thereto and insurance thereon, free of any and all right, title, claim or interest of Wife. Husband shall indemnify and holdWife and her property harmless from any and all liability, cost or expense, including actual attorney's fees, incurred in connection with any vehicle belonging to Husband by virtue of this subparagraph. (3) The parties agree that they will cooperate in effectuating the transfer of titles and insurance to accomplish the purposes of this subparagraph. 6 I~ ',,1 , .. . (d) Life Insurance. Except as provided for herein, the parties acknowledge and agree that each shall retain as his/her sole and separate property, any and all life insurance policies in his/her name, free of any right, title and interest ofthe other party. (e) Pension and Retirement Benefits. Except as specifically set forth below, Wife and Husband each hereby specifically releases and waives any and all right, title, claim or interest that he or she may have in and to any and all retirement benefits (including but not limited to pension or profit sharing benefits, deferred compensation plans, 401(k) plans, employee savings and thrift plans, individual retirement accounts or other similar benefits) of the other party, specifically to include a waiver of any spousal annuity benefits and/or beneficiary designations thereunder. The parties agree that they shall execute any documents pursuant to the Retirement Equity Act or any similar act that rnay be required from time to time to accomplish the purposes of this subparagraph. Notwithstanding the above, the parties agree that Husband shall take all steps necessary to rollover the sum of Twenty Seven Thousand Four Hundred One Dollars ($27,401) from his Government Thrift Saving Plan ("TSP") to a retirement account in Wife's name via a Domestic Relations Order. Counsel for Wife shall take all steps necessary to prepare the Dornestic Relations Order in a form acceptable to Husband's counsel. Once said Domestic Relations'Order is prepared in acceptable form, both parties shall corporate in taking any and all steps necessary to implement the Domestic Relations Order in order to effectuate the rollover. (1) Equitable Distribution Payment. Simultaneously with the execution of this Agreement Husband will pay to Wife as and for equitable distribution the sum of Seven Thousand Two Hundred Dollars ($7,200). 7 "-~ . .iio:6t1~ , (g) Miscellaneous Properly. As of the execution date of this Agreement, any and all property not specifically addressed herein shall be owned by the party to whom the property is titled; and if untitled, the party in possession. This Agreement shall constitute a sufficient bill of sale to evidence the transfer of any and all rights in such property from each to the other. (h) Property to Wife. The parties agree that Wife shall own, possess, and enjoy, free from any claim of Husband, the property awarded to her by the terms of this Agreement. Husband hereby quitclaims, assigns and conveys to Wife all such property, and waives and relinquishes any and all rights thereto, together with any insurance policies covering that property, and any escrow accounts relating to that property. This Agreement shall constitute a sufficient bill of sale to evidence the transfer of any and all rights in such property from Husband to Wife. (i) ProDerty to Husband. The parties agree that Husband shall own, possess, and enjoy, free from any claim of Wife, the property awarded to him by the terms of this Agreement. Wife hereby quitclaims, assigns and conveys to Husband all such property, and waives and relinquishes any and all rights thereto, together with any insurance policies covering that property, and any escrow accounts relating to that property. This Agreement shall constitute a sufficient bill of sale to evidence the transfer of any and all rights in such property from Wife to Husband. (j) Liability Not Listed. Each party represents and warrants to the other that he or she has not incurred any debt, obligation or other liability, other than those described in this Agreement, on which the other party is or may be liable. A liability not disclosed in this Agreement will be the sole responsibility of the party who has incurred or may 8 " - ~ , ~~ ~l.-...";",, hereafter incur it, and such party agrees to pay it as the same shall become due, and to indemnify and hold the other party and his or her property harmless from any and all such debts, obligations and liabilities. (k) Indemnification of Wife. If any claim, action or proceeding is hereafter initiated seeking to hold Wife liable for the debts or obligations assumed by Husband under this Agreement, Husband will, at his sole expense, defend Wife against any such claim, action or proceeding, whether or not well-founded, and indemnify her and her property against any damages or loss resulting therefrom, including, but not limited to, costs of court and actual attorney's fees incurred by Wife in connection therewith. (I) Indemnification of Husband. If any claim, action or proceeding is hereafter initiated seeking to hold Husband liable for the debts or obligations assumed by Wife under this Agreement, Wife will, at her sole expense, defend Husband against any such claim, action or proceeding, whether or not well-founded, and indemnify him and his property against any damages or loss resulting therefrom, including, but not limited to, costs of court and actual attorney's fees incurred by Husband in connection therewith. (m) Warranty as to Future Oblil!ations. Husband and Wife each represents and warrants to the other that he or she will not at any time in the future incur or contract any debt, charge or liability for which the other, the other's legal representatives, property or estate may be responsible. From the date of execution of this Agreement, each party shall use only those credit cards and accounts for which that party is individually liable and the parties agree to cooperate in closing any remaining accounts which provide for joint liability. Each party hereby agrees to indemnify, save and hold the other and his or her property harmless 9 .-.~~"' .- . ~u '- , c..., , from any liability, loss, cost or expense whatsoever, including actual attorneys fees, incurred in the event of breach hereof. 6. ALIMONY. ALIMONY PENDENTE LITE. SPOUSAL SUPPORT. Husband and Wife hereby expressly waive, discharge and release any and all rights and claims which he or she may have now or hereafter by reason of the parties' marriage to alimony, alimony pendente lite, spousal support and/or maintenance or other like benefits reslllting from the parties' status as husband and wife. The parties further release and waive any rights they may have to seek modification of the terms of this paragraph in a court oflaw or equity, it being understood that the foregoing constitutes a final determination for all time of either party's obligation to contribute to the support and maintenance of the other. Accordingly, Wife shall take all steps necessary to terminate, effective the date of execution of this agreement, the support order currently in force through the Court of Common Pleas of Cumberland County, Pennsylvania, Domestic Relations Section docketed at number 00996 S- 1997 PACSES CASE NO. 264100005. 7. COUNSEL FEES. COSTS AND EXPENSES. Each party shall be solely responsible for his or her own legal fees, costs and expenses incurred in connection with their separation and/or the dissolution of their marriage, and the preparation and execution of this Agreement. 8. WAIVER OF INHERITANCE RIGHTS. Unless otherwise specifically provided in this Agreement, as of the execution date of this Agreement, Husband and Wife each waives all rights of inheritance in the estate of the other, any right to elect to take against the will or any trust of the other or in which the other has an interest, and each of the parties waives any additional rights which said party has or may have by reason of their marriage, except the rights 10 ."~~ . i - ,_.,~J. , ""I saved or created by the terms of this Agreement. This waiver shall be construed generally and shall include, but not be limited to, a waiver of all rights provided under the laws of Pennsylvania, or any other jurisdiction. 9. WAIVER OF BENEFICIARY DESIGNATION. Unless otherwise specifically set forth in this Agreement, each party hereto specifically waives any and all beneficiary rights and any and all rights as a surviving spouse in and to any asset, benefit or like program carrying a beneficiary designation which belongs to the other party under the terms of this Agreement, including, but not limited to, pensions and retirement plans of any sort or nature, deferred compensation plans, life insurance policies, annuities, stock accounts, bank accounts, final pay checks or any other post-death distribution scheme, and each party expr€ssly states that it is his and her intention to revoke by the terms of this Agreement any beneficiary designations naming the other which are in effect as of the date of execution of this Agreement. If and in the event the other party continues to be named as beneficiary and no alternate beneficiary is otherwise designated, the beneficiary shall be deemed to be the estate of the deceased party. 10. RELEASE OF CLAIMS. (a) Wife and Husband aclrnowledge and agree that the property dispositions provided for h€rein constitute an equitable distribution of their assets and liabilities pursuant to 93502 of the Divorce Code, and Wife and Husband hereby waive any right to division of their property except as provided for in this Agreement. Furthermore, except as otherwise provided for in this Agreement, each of the parties hereby specifically waives, releases, renounces and forever abandons any claim, right, title or interest whatsoever he or she may have in property transferred to the other party pursuant to this Agreement or identified in this Agreement as belonging to the other party, and each party agrees never to assert any claim to 11 - -j ", ~-J .....""~i:: said property or proceeds in the future. However, neither party is released or discharged from any obligation under this Agreement or any instrument or document executed pursuant to this Agreement. Husband and Wife shall hereafter own and enjoy independently of any clairn or right of the other, all items of personal property, tangible or intangible, acquired by him or her from the execution date ofthis Agreement with full power in him or her to dispose of the same fully and effectively for all purposes. (b) Each party hereby absolutely and unconditionally releases and forever discharges the other and the estate of the other for all purposes from any and all rights and obligations which either party may have or at any tirne hereafter has for past, present or future support or maintenance, alimony pendente lite, alimony, equitable distribution, counsel fees, costs, expenses, and any other right or obligation, economic or otherwise, whether arising out of the marital relationship or otherwise, including all rights and benefits under the Pennsylvania Divorce Code of 1980, its supplements and amendments, as well as under any other law of any other jurisdiction, except and only except all rights and obligations arising under this Agreement or for the breach of any of its provisions. Neither party shall have any obligation to the other not expressly set forth herein. (c) Except as set forth in this Agreement, each party hereby absolutely and UI'lconditionally releases and forever discharges the other and his or her heirs, executors, administrators, assigns, property and estate from any and all rights, claims, demands or obligations arising out of or by virtue of the marital relationship of the parties whether now existing or hereafter arising. The above release shall be effective regardless of whether such claims arise out of any former or future acts, contracts, engagements or liabilities of the other or by way of dower, curtesy, widow's or widower's rights, family exemption or similar allowance, 12 or under the intestate laws or the right to take against the spouse's will, or the right to treat a lifetime conveyance by the other as testamentary or all other rights of a surviving spouse to participate in a deceased spouse's estate, whether arising under the laws of Pennsylvania, any state, commonwealth or territory of the United States, or any other country. (d) Except for the obligations of the parties contained in this Agreement and such rights as are expressly reserved herein, each party gives to the other by the execution of this Agreement an absolute and unc0nditional release and discharge from all causes of action, claims, tights or demands whatsoever in law or in equity, which either party ever had or now has against the other. 11. PRESERVATION OF RECORDS. Each party will keep and preserve for a period off our (4) years from the date oftheir divorce decree all financial records relating to the marital estate, and each party will allow the other party access to those records in the event of tax audits. 12. MODIFICATION. No modification, rescission, or amendment to this Agreement shall be effective unless in writing signed by each of the parties hereto. 13. SEVERABILITY. If any provision of this Agreernent is held by a court of competent jurisdiction to be void, invalid or unenforceable, the remaining provisions hereof shall nevertheless survive and continue in full force and effect without being impaired or invalidated in any way. 14. BREACH. If either party hereto breaches any provision hereof, the other party shall have the right, at his or her election, to sue for damages for such breach, or seek such other remedies or relief as may be available to hirn or her. The non-breaching party shall be 13 ,.- - ~~ _....-,1 . . entitled to recover from the breaching party all costs, expenses and legal fees actually incurred in the enforcement of the rights of the non-breaching party. 15. WAIVER OF BREACH. The waiver by one party of any breach ofthis Agreement by the other party will not be deemed a waiver of any other breach or any provision of this Agreement. 16. NOTICE. Any notice to be given under this Agreement by either party to the other shall be in writing and may be effected by registered or certified mail, return receipt requested. Notice to Husband will be sufficient ifmade or addressed to the following: Eric S. Peiffer 120 Parkview Road New Cumberland, P A 17070 and to Wife, ifmade or addressed to the following: Fay J. Peiffer Notice shall be deemed to have occurred upon the date received by the recipient. Each party may change the address for notice to him or her by giving notice of that change in accordance with the provisions ofthis paragraph. 17. APPLICABLE LAW. All acts contemplated by this Agreement shall be construed and enforced under the substantive laws of the Commonwealth of Pennsylvania (without regard to the conflict oflaw rules applicable in Pennsylvania) in effect as ofthe date of execution of this Agreement. 18. DATE OF EXECUTION. The "date of execution" or "execution date" of this Agreement shall be defined as the date upon which the parties signed the Agreement if they 14 ~="" . -~- . ,,~,;...I~ "~i-, . . do so on the same date, or if not on the same date, then the date on which the Agreement was signed by the last party to execute this Agreement. 19. EFFECTIVE DATE. This Agreernent shall becorne effective and binding upon both parties on the execution date. 20. EFFECT OF RECONCILIATION. COHABITATION OR DIVORCE. This Agreement shall remain in full force and effect and shall not be abrogated even if the parties effect a reconciliation, cohabit as husband and wife or attempt to effect a reconciliation. This Agreement also shall continue in full force and effect in the event of the parties' divorce. There shall be no modification or waiver of any of the terms hereof unless the parties in writing execute a statement declaring this Agreement or any term ofthis Agreement to be null and void. 21. HEADINGS NOT PART OF AGREEMENT. Any headings preceding the text of the several paragraphs and subparagraphs hereof are inserted solely for convenience of reference and shall not constitute a part of this Agreement nor shall they affect its meaning, construction or effect. 22. AGREEMENT BINDING ON PARTIES AND HEIRS. This Agreement shall bind the parties hereto and their respective heirs, executors, administmtors, legal representatives, assigns, and successors in any interest ofthe parties. 23. ENTIRE AGREEMENT. Each party acknowledges that he or she has carefully read this Agreement; that he or she has discussed its provisions with an attorney of his or her own choice, and has executed it voluntarily and in reliance upon his or her own attorney; and that this instrument expresses the entire agreement between the parties concerning the subjects it purports to cover and supersedes any and all prior agreements between the parties. 15 ~ , I . ~ . This Agreement should be interpreted fairly and simply, and not strictly for or against either of the parties. 24. MUTUAL COOPERATION. Each party shall, on demand, execute and deliver to the other any deeds, bills of sale, assignments, consents to change of beneficiary designations, tax returns, and other documents, and shall do or cause to be done every other act or thing that may be necessary or desirable to effectuate the provisions and purposes of this Agreement. If either party unreasonably fails on demand to comply with these provisions, that party shall pay to the other party all attorney's fees, costs, and other expenses actually incurred as a result of such failure. 25. AGREEMENT NOT TO BE MERGED. This Agreement may be incorporated into a decree of divorce for purposes of enforcement only, but otherwise shall not be merged into said decree. The parties shall have the right to enforce this Agreement under the Divorce Code of 1980, as amended, and in addition, shall retain any rernedies in law or in equity under this Agreement as an independent contract. Such remedies in law or equity are specifically not waived or released. IN WITNESS WHEREOF, the parties hereto set their hands and seals on the dates of their acknowledgments. ~~ ERIC S. PEIFFER WITNESS fILM} I ;J/ WITNESS IIi FA~/~ 16 ~~ ~ , ; . COMMONWEALTH OF PENNSYLVANIA COUNTYOF \)lI.f ~ ,',.., ) ) ) BEFORE ME, the undersigned authority, on this day personally appeared ERIC S. PEIFFER known to me to be the person who executed the foregoing instrument, and who acknowledged to me that he executed same for the purposes and considerations therein expressed. GIVEN UNDER MY HAND AND SEAL OF OFFICE this \JO\,lf VYlbt/ ~'r ( day of ,2001. ~~ g- {~~~Lr Notary Public in and for Commonwealth of Pennsylvania Typed or printed name of Notary: M 17 - ~"~~ " '..J~ - ~' . . . . COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~JeA. W ) ) ) BEFORE ME, the undersigned authority, on this day personally appeared FAY J. PEIFFER known to me to be the person who executed the foregoing instrument, and who acknowledged to me that she executed same for the purposes and considerations therein expressed. G1[J UNDER MY HAND AND SEAL OF OFFICE this ~iD1Jt( ,2001. :::xJ:ay of , C/w-b-to Notary Public,' and for Commonwea of Pennsylvania Typed or printed name of Notary: My commission expires: NO!Af!i.ot.!. U4II. WENDY S. CHESIllO. NMHy I'\:W: lDwet ....... Twp.. ~ c:a..my My Comminloft ExpIreo Hi:r( 10. 2003 18 . -~ _I ERIC S. PEIFFER, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. NO. 00 - 471 CIVIL FAY J. PEIFFER, Defendant IN DIVORCE ORDER OF COURT AND NOW, this rJ 7 ~ day of 'h-tuA'1f~ 2001, the economic claims raised in the proceedings having been resolved in accordance with a marital settlement agreement dated November 1, 2001, the appointment of the Master is vacated and counsel can file a praecipe transmitting the record to the Court requesting a final decree in divorce. BY THE COURT, Ge J. cc: Cindy S. Conley Attorney for Plaintiff ;1(' aJJ LJt~~Yr Michael L. Bangs Attorney for Defendant ~iiIil&st1I--Iloi&li._.-' :$ -", , ,.-, '":"l__\l~-rn~ ~l ""- ,',,'"-=, ~" ,.,~t- .~<":I IIINWilASNN3d ALNnQ:) (1',iVlig2llllnO 21']:5 ~!11 1.2 lION 10 A\:NKi!\C:, v .. < .:; .ii, " ,\.. _i\.J - , " "",~-,-~,~, - ~ ~ . " .. .~" M""i v=: -") F,.....c.<..,Q. uw,1\- ~.. 0 ~. ~ ~~~ .. ... MARITAL SETTLEMENT AGREEMENT BY AND BETWEEN ERIC S. PEIFFER AND FAY J. PEIFFER Cindy S. Conley, Esquire HOWETT, KISSINGER & CONLEY, P.C. 130 Walnut Street P.O. Box 810 Harrisburg, PA 17108 Telephone: (717) 234-2616 Counsel for Eric S. Peiffer Michael L. Bangs, Esquire 302 S. S. 18th Street Camp Hill, PA 17011 129 Market Street, P.O. Box 335 Telephone: (717) 730-7310 Counsel for Fay J. Peiffer ..~ -~ ~_..~- -" ~" - ~",.,- .. ., MARITAL SETTLEMENT AGREEMENT THIS AGREEMENT is made this 1:c day of lI)h..I~ ,2001, by and between Eric S. Peiffer, of Cumberland County, Pennsylvania, and Fay J. Peiffer, of Cumberland County, Pennsylvania; WITNESSETH: WHEREAS, Eric S. Peiffer (hereinafter referred to as "Husband"), social security number 187-50-3162, was born on September 5, 1962, with a current mailing address of 120 Parkview Road, New Cumberland, Cumberland County, Pennsylvania 17070, WHEREAS, Fay J. Peiffer (hereinafter referred to as "Wife"), social security number 175-48-4005, was born on January 12, 1955, and presently resides at WHEREAS, the parties hereto are husband and wife, having been lawfully married on October 3,1992 in Boiling Springs, Pennsylvania; WHEREAS, the parties have lived separate and apart since on or about September of 1997; WHEREAS, no children were born of the marriage between the parties; WHEREAS, the parties hereto are desirous of settling fully and finally their respective financial and property rights and obligations as between each other, including, without limitation, the settling of all matters between them relating to the ownership ofreal and personal property, the support and maintenance of one another and, in general, the settling of any and all claims and possible claims by one against the other or against their respective estates. 1 ~'-"'~- ."~~ -. ~I ~ .., NOW, THEREFORE, in consideration of these premises, and ofthe mutual promises, covenants and undertakings hereinafter set forth, and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged by each of the parties hereto, Husband and Wife, each intending to be legally bound hereby, covenant and agree as follows: 1. ADVICE OF COUNSEL. Each party acknowledges that he or she has had the opportunity to receive independent legal advice from counsel of his or her selection (Cindy S. Conley, Esquire for Husband and Michael L. Bangs, Esquire for Wife). Each party fully understands the facts and his or her legal rights and obligations, and each party acknowledges and accepts that this Agreement is, in the circumstances, fair and equitable, and that it is being entered into freely and voluntarily, and that the execution of this Agreement is not the result of any duress or undue influence, and that it is not the result of any improper or illegal agreement or agreements. In addition, each party understands the impact of the Pennsylvania Divorce Code, whereby the court has the right and duty to determine all marital rights of the parties including divorce, alimony, alimony pendente lite, equitable distribution of all marital property or property owned or possessed individualiy by the other, counsel fees and costs of litigation and, fully knowing the same, each party hereto still desires to execute this Agreement, acknowledging that the terms and conditions set forth herein are fair, just and equitable to each of the parties, and waives his and her respective right to have the Court of Common Pleas of Cumberland County, or any other court of competent jurisdiction, make any determination or order affecting the respective parties' rights to alimony, alimony pendente lite, support and maintenance, equitable distribution, counsel fees and costs oflitigation. 2. DISCLOSURE OF ASSETS. Each of the parties hereto acknowledges that he or she is aware of his or her right to seek discovery, including but not limited to, written 2 1!,~I:;;{.'?3{~G - ._1__. \. ... interrogatories, motions for production of documents, the taking of oral depositions, the filing of inventories, and all other means of discovery permitted under the Pennsylvania Divorce Code or the Pennsylvania Rules of Civil Procedure. Each of the parties further acknowledges that he or she has had the opportunity to discuss with counsel the concept of marital property under Pennsylvania law and each is aware of his or her right to have the real and/or personal property, estate and assets, earnings and income of the other assessed or evaluated by the courts of this commonwealth or any other court of competent jurisdiction. The parties do hereby acknowledge that there has been full and fair disclosure to the other of his or her respective income, assets and liabilities, whether such are held jointly or in the name of one party alone. Each party agrees that any right to further disclosure, valuation, enumeration or statement thereof in this Agreement is hereby specifically waived, and the parties do not wish to make or append hereto any further enumeration or statement. Each party warrants that he or she is not aware of any marital asset which is not identified in this Agreement. The parties hereby acknowledge and agree that the division of assets as set forth in this Agreement is fair, reasonable and equitable, and is satisfactory to them. Each of the parties hereto further covenants and agrees for himself and herself and his or her heirs, executors, administrators or assigns, that he or she will never at any time hereafter sue the other party or his or her heirs, executors, administrators or assigns in any action of contention, direct or indirect, and allege therein that there was a denial of any rights to full disclosure, or that there was any fraud, duress, undue influence or that there was a failure to have available full, proper and independent representation by legal counsel. 3. PERSONAL RIGHTS. Husband and Wife may, at all times hereafter, live separate and apart. Each shall be free from all control, restraint, interference and authority, direct or indirect, by the other. Each may reside at such place or places as he or she may select. 3 ,~~ ~_.~. ~ ~~ J~. - .....J_......., , . ~ Each may, for his or her separate use or benefit, conduct, carry on or engage in any business, occupation, profession or employment which to him or her may seem advisable.. Husband and Wife shall not molest, harass, disturb or malign each other or the respective families of each other, nor compel or attempt to compel the other to cohabit or dwell by any means or in any manner whatsoever with him or her.. Neither party will interfere with the use, ownership, enjoyment or disposition of any property now owned by or hereafter acquired by the other.. 4. DIVORCE. It is the intention ofthe parties, and the parties agree, that by this Agreement they have resolved all ancillary economic issues related to the dissolution of their marriage and thus any divorce action with respect to these parties shall be limited to a claim for divorce only. The parties acknowledge that on January 25,2000, Husband initiated a divorce action under, inter alia, the no-fault provisions of the Divorce Code by filing a complaint docketed at number 2000-471 Civil Term in the Cumberland County Court of Common Pleas. The parties acknowledge that the ninety (90) day waiting period provided for under 93301(c) of the Divorce Code has expired. Therefore, contemporaneously with the execution ofthis Agreement, each party will sign an Affidavit of Consent to Divorce and Waiver of Notice of Intention to Request Entry of Divorce Decree and deliver same to counsel for Husband, who shall promptly submit said affidavits and waivers to the court, along with a Praecipe to Transmit Record, Vital Statistics Form and any and all other documents necessary to precipitate the prornpt entry of a divorce decree. 5. EOUITABLE DISTRIBUTION. (a) Marital Residence Proceeds. The parties acknowledge that after their separation they sold their marital residence located at 1735 Weatherbum Drive, New Cumberland, Cumberland County, Pennsylvania. The parties further acknowledge that since the 4 .. ,,~, " ,_I . .. sale date of said residence that the proceeds of sale have been in an escrow account at M&T Bank in account number 1500420985470 titled as follows: "Howett, Kissinger & Conley, P.C. escrow agent for Eric S. Peiffer and Fay J. Peiffer". The parties further acknowledge that as of July26, 2001, the balance of said account was Ten Thousand Eight Dollars and Fourteen Cents ($10,008.14). The parties agree that the proceeds of said account shall be withdrawn and payable to Wife and shall become her sole and separate property free and clear of any right, title, and or interest of Husband. (b) Furnishinl!s and Personaltv. (1) The parties agree that they have divided by agreement between themselves all their furnishings and personalty including all furniture, furnishings, antiques, jewelry, rugs, carpets, household appliances and equipment. (2) Husband shall retain, as his sole and separate property, free of any and all right, title, claim or interest of Wife, all of the personalty and furnishings currently in his possession. Notwithstanding the foregoing the parties agree that Hllsband shall return to Wife, simultaneously with the execution of this Agreement, the parties' marriage certificate, Wife's wedding ring, the drawers for the entertaiument center, the cushions for the sofa, Wife's birth certificate, Wife's newborn hospital identification bracelet, Wife's book stand, Wife's clothing ternoved by Husband frorn the Marital Residence prior to its sale, and the binoculars originally owned by Wife's father. (3) Except as otherwise set forth herein, Wife shall retain, as her sole and separate property, free of any and all right, title, clairn or interest of Husband, all of the personalty and furnishings currently in her possession. Notwithstanding the foregoing, the parties agree that Wife shall return to Husband, simultaneously with the execution of this 5 "".~ - ._L...._", , ~ ~. agreement, his record album collection (LP's) per itemized inventory, the black filing cabinet, the wooden cabinet containing the record album collection, Husband's birth certificate and birth announcement. Moreover, Wife will provide Husband with liberal access to all photographs and corresponding negatives that were at the Marital Residence at the time of separation. Husband shall be entitled to have duplicates made of any such photographs at his expense and then shall return the originals to Wife. (c) Motor Vehicles. (1) Husband agrees that Wife shall retain possession of and receive as her sole and separate property the 1997 Honda Civic automobile currently titled in her name, along with all rights under any insurance policies thereon and with all responsibility for payment of any outstanding indebtedness pertaining thereto and insurance thereon, free of any and all right, title, claim or interest of Husband. Wife shall indemnify and hold Husband and his property harmless from any and all liability, cost or expense, including actual attorney's fees, incurred in connection with any vehicle belonging to Wife by virtue of this subparagraph. (2) Wife agrees that Husband shall retain possession of and receive as his sole and separate property the 2001 Honda Accord, currently titled in his name, along with all rights under any insurance policies thereon and with all responsibility for payment of any outstanding indebtedness pertaining thereto and insurance thereon, free of any and all right, title, claim or interest of Wife. Husband shall indemnify and hold Wife and her property harmless from any and all liability, cost or expense, including actual attorney's fees, incurred in connection with any vehicle belonging to Husband by virtue of this subparagraph. (3) The parties agree that they will cooperate in effectuating the transfer oftitles and insurance to accomplish the purposes of this subparagraph. 6 - ~ ~". -L..._ , . (d) Life Insurance. Except as provided for herein, the parties acknowledge and agree that each shall retain as his/her sole and separate property, any and all life insurance policies in his/her name, free of any right, title and interest of the other party. (e) Pension and Retirement Benefits. Except as specifically set forth below, Wife and Husband each hereby specifically releases and waives any and all right, title, claim or interest that he or she may have in and to any and all retirement benefits (including but not limited to pension or profit sharing benefits, deferred compensation plans, 401 (k) plans, employee savings and thrift plans, individual retirement accounts or other similar benefits) of the other party, specifically to include a waiver of any spousal annuity benefits and/or beneficiary designations therell11der. The parties agree that they shall execute any documents pursuant to the Retirement Equity Act or any similar act that may be required from tirne to time to accomplish the purposes of this subparagraph. Notwithstanding the above, the parties agree that Husband shall take all steps necessary to rollover the sum of Twenty Seven Thousand Four Hll11dred One Dollars ($27,401) from his Government Thrift Saving Plan ("TSP") to a retirement aCCOll11t in Wife's name via a Domestic Relations Order. COll11sel for Wife shall take all steps necessary to prepare the Domestic Relations Order in a form acceptable to Husband's cOll11seI. Once said Domestic Relations Order is prepared in acceptable form, both parties shall corporate in taking any and all steps necessary to implement the Domestic Relations Order in order to effectuate the rollover. (f) Eauitable Distribution Payment. Sirnultaneously with the execution of this Agreement Husband will pay to Wife as and for equitable distribution the sum of Seven Thousand Two Hll11dred Dollars ($7,200). 7 .- ~ ~ _.J , (g) Miscellaneous Pronertv. As of the execution date of this Agreement, any and all property not specifically addressed herein shall be owned by the party to whom the property is titled; and if untitled, the party in possession. This Agreement shall constitute a sufficient bill of sale to evidence the transfer of any and all rights in such property from each to the other. (h) Pronerty to Wife. The parties agree that Wife shall own, possess, and enjoy, free from any claim of Husband, the property awarded to her by the terms of this Agreement. Husband hereby quitclaims, assigns and conveys to Wife all such property, and waives and relinquishes any and all rights thereto, together with any insurance policies covering that property, and any escrow accounts relating to that property. This Agreement shall constitute a sufficient bill of sale to evidence the transfer of any and all rights in such property from Husband to Wife. (i) Pronertv to Husband. The parties agree that Husband shall own, possess, and enjoy, free from any claim of Wife, the property awarded to him by the terms of this Agreement. Wife hereby quitclaims, assigns and conveys to Husband all such property, and waives and relinquishes any and all rights thereto, together with any insurance policies covering that property, and any escrow accounts relating to that property. This Agreement shall constitute a sufficient bill of sale to evidence the transfer of any and all rights in such property frorn Wife to Husband. G) Liabilitv Not Listed. Each party represents and warrants to the other that he or she has not incurred any debt, obligation or other liability, other than those described in this Agreement, on which the other party is or may be liable. A liability not disclosed in this Agreernent will be the sole responsibility of the party who has incurred or may 8 _1__"",," . hereafter incur it, and such party agrees to pay it as the same shall become due, and to indemnify and hold the other party and his or her property harmless from any and all such debts, obligations and liabilities. (k) Indemnification of Wife. If any clairn, action or proceeding is hereafter initiated seeking to hold Wife liable for the debts or obligations assumed by Husband under this Agreement, Husband will, at his sole expense, defend Wife against any such claim, action or proeeeding, whether or not well-founded, and indemnify her and her property against any damages or loss resulting therefrom, including, but not limited to, costs of court and actual attorney's fees incurred by Wife in connection therewith. (I) Indemnification of Husband. If any claim, action or proceeding is hereafter initiated seeking to hold Husband liable for the debts or obligations assumed by Wife under this Agreement, Wife will, at her sole expense, defend Husband against any such claim, action or proceeding, whether or not well-founded, and indemnify him and his property against any damages or loss resulting therefrom, including, but not lirnited to, costs of court and actual attorney's fees incurred by Husband in connection therewith. (m) Warrantv as to Future Obli2ations. Husband and Wife each represents and warrants to the other that he or she will not at any time in the future incur or contract any debt, charge or liability for which the other, the other's legal representatives, property or estate may be responsible. From the date of execution of this Agreement, each party shall use only those credit cards and accounts, for which that party is individually liable and the parties agree to cooperate in closing any remaining accounts which provide for joint liability. Each party hereby agrees to indemnify, save and hold the other and his or her property harmless 9 ~~ ~_I, W' "~~H__ , from any liability, loss, cost or expense whatsoever, including actual attorneys fees, incurred in the event of breach hereof. 6. ALIMONY. ALIMONY PENDENTE LITE. SPOUSAL SUPPORT. Husband and Wife hereby expressly waive, discharge and release any and all rights and claims which he or she may have now or hereafter by reason of the parties' marriage to alimony, alimony pendente lite, spousal support and/or maintenance or other like benefits resulting from the parties' status as husband and wife. The parties further release and waive any rights they may have to seek modification of the terms of this paragraph in a court oflaw or equity, it being understood that the foregoing constitutes a final determination for all time of either party's obligation to contribute to the support and maintenance of the other. Accordingly, Wife shall take all steps necessary to terminate, effective the date of execution of this agreement, the support order currently in force through the Court of Common Pleas of Cumberland County, Pennsylvania, Domestic Relations Section docketed at number 00996 S- 1997 PACSES CASE NO. 264100005. 7. COUNSEL FEES. COSTS AND EXPENSES. Each party shall be solely responsible for his or her own legal fees, costs and expenses incurred in connection with their separation and/or the dissolution oftheir marriage, and the preparation and execution of this Agreement. 8. W AlVER OF INHERITANCE RIGHTS. Unless otherwise specifically provided in this Agreement, as of the execution date of this Agreement, Husband and Wife each waives all rights of inheritance in the estate of the other, any right to elect to take against the will or any trust of the other or in which the other has an interest, and each of the parties waives any additional rights which said party has or may have by reason of their marriage, except the rights 10 ~ If ,,__..J saved or created by the terms of this Agreement. This waiver shall be construed generally and shall include, but not be limited to, a waiver of all rights provided under the laws of Pennsylvania, or any other jurisdiction. 9. WAIVER OF BENEFICIARY DESIGNATION. Unless otherwise specifically set forth in this Agreement, each party hereto specifically waives any and all beneficiary rights and any and all rights as a surviving spouse in and to any asset, benefit or like program carrying a beneficiary designation which belongs to the other party under the terms of this Agreement, including, but not limited to, pensions and retirement plans of any sort or nature, deferred compensation plans, life insurance policies, annuities, stock accounts, bank accounts, final pay checks or any other post-death distribution scheme, and each party expressly states that it is his and her intention to revoke by the terms of this Agreement any beneficiary designations naming the other which are in effect as of the date of execution of this Agreement. If and in the event the other party continues to be named as beneficiary and no alternate beneficiary is otherwise designated, the beneficiary shall be deemed to be the estate of the deceased party. 10. RELEASE OF CLAIMS. (a) Wife and Husband acknowledge and agree that the property dispositions provided for herein constitute an equitable distribution of their assets and liabilities pursuant to 93502 ofthe Divorce Code, and Wife and Husband hereby waive any right to division of their property except as provided for in this Agreement. Furthermore, except as otherwise provided for in this Agreement, each of the parties hereby specifically waives, releases, renounces and forever abandons any claim, right, title or interest whatsoever he or she may have in property transferred to the other party pursuant to this Agreement or identified in this Agreement as belonging to the other party, and each party agrees never to assert any claim to 11 - -I. said property or proceeds in the future. However, neither party is released or discharged frorn any obligation under this Agreement or any instrument or document executed pursuant to this Agreement. Husband and Wife shall hereafter own and enjoy independently of any clairn or right of the other, all items of personal property, tangible or intangible, acquired by him or her from the execution date of this Agreement with full power in him or her to dispose of the same fully and effectively for all purposes. (b) Each party hereby absolutely and unconditionally releases and forever discharges the other and the estate of the other for all purposes from any and all rights and obligations which either party may have or at any time hereafter has for past, present or future support or maintenance, alimony pendente lite, alimony, equitable distribution, counsel fees, costs, expenses, and any other right or obligation, economic or otherwise, whether arising out ofthe rnarital relationship or otherwise, including all rights and benefits under the Pennsylvania Divorce Code of 1980, its supplements and amendments, as well as under any other law of any other jurisdiction, except and only except all rights and obligations arising under this Agreernent or for the breach of any of its provisions. Neither party shall have any obligation to the other not expressly set forth herein. (c) Except as set forth in this Agreement, each party hereby absolutely and unconditionally releases and forever discharges the other and his or her heirs, executors, administrators, assigns, property and estate from any and all rights, claims, demands or obligations arising out of or by virtue of the marital relationship of the parties whether now existing or hereafter arising. The above release shall be effective regardless of whether such claims arise out of any former or future acts, contracts, engagements or liabilities of the other or by way of dower, curtesy, widow's or widower's rights, family exemption or similar allowance, 12 ~~. ~ "; or under the intestate laws or the right to take against the spouse's will, or the right to treat a lifetime conveyance by the other as testamentary or all other rights of a surviving spouse to participate in a deceased spouse's estate, whether arising under the laws of Pennsylvania, any state, commonwealth or territory of the United States, or any other country. (d) Except for the obligations of the parties contained in this Agreement and such rights as are expressly reserved herein, each party gives to the other by the execution of this Agreement an absolute and unconditional release and discharge from all causes of action, claims, rights or demands whatsoever in law or in equity, which either party ever had or now has against the other. 11. PRESERVATION OF RECORDS. Each party will keep and preserve for a period offour (4) years from the date of their divorce decree all financial records relating to the marital estate, and each party will allow the other party access to those records in the event of tax audits. 12. MODIFICATION. No modification, rescission, or amendment to this Agreement shall be effective unless in writing signed by each of the parties hereto. 13. SEVERABILITY. If any provision of this Agreement is held by a court of competent jurisdiction to be void, invalid or unenforceable, the remaining provisions hereof shall nevertheless survive and continue in full force and effect without being impaired or invalidated in any way. 14. BREACH. If either party hereto breaches any provision hereof, the other party shall have the right, at his or her election, to sue for damages for such breach, or seek such other remedies or relief as may be available to him or her. The non-breaching party shall be 13 . ~.. . ~ . entitled to recover from the breaching party all costs, expenses and legal fees actually incurred in the enforcement of the rights of the non-breaching party. 15. WAIVER OF BREACH. The waiver by one party of any breach of this Agreement by the other party will not be deemed a waiver of any other breach or any provision ofthis Agreernent. 16. NOTICE. Any notice to be given under this Agreement by either party to the other shall be in writing and may be effected by registered or certified mail, return receipt requested. Notice to Husband will be sufficient ifmade or addressed to the following: Eric S. Peiffer 120 Parkview Road New Cumberland, PA 17070 and to Wife, ifmade or addressed to the following: Fay J. Peiffer Notice shall be deemed to have occurred upon the date received by the recipient. Each party may change the address for notice to him or her by giving notice of that change in accordance with the provisions of this paragraph. 17. APPLICABLE LAW. All acts contemplated by this Agreement shall be construed and enforced under the substantive laws of the Commonwealth of Pennsylvania (without regard to the conflict oflaw rules applicable in Pennsylvania) in effect as of the date of execution of this Agreement. 18. DATE OF EXECUTION. The "date of execution" or "execution date" of this Agreement shall be defined as the date upon which the parties signed the Agreement if they 14 ,~~~~ ~".1 , do so on the same date, or if not on the same date, then the date on which the Agreement was signed by the last party to execute this Agreement. 19. EFFECTIVE DATE. This Agreement shall become effective and binding upon both parties on the execution date. 20. EFFECT OF RECONCILIATION. COHABITATION OR DIVORCE. This Agreement shall remain in full force and effect and shall not be abrogated even if the parties effect a reconciliation, cohabit as husband and wife or attempt to effect a reconciliation. This Agreement also shall continue in full force and effect in the event of the parties' divorce. There shall be no modification or waiver of any of the terms hereof unless the parties in writing execllte a statement declaring this Agreement or any term ofthis Agreement to be null and void. 21. HEADINGS NOT PART OF AGREEMENT. Any headings preceding the text of the several paragraphs and subparagraphs hereof are inserted solely for convenience of reference and shall not constitute a part of this Agreement nor shall they affect its meaning, construction or effect. 22. AGREEMENT BINDING ON PARTIES AND HEIRS. This Agreement shall bind the parties hereto and their respective heirs, executors, administrators, legal representatives, assigns, and successors in any interest of the parties. 23. ENTIRE AGREEMENT. Each party acknowledges that he or she has carefully read this Agreement; that he or she has discussed its provisions with an attorney of his or her own choice, and has executed it voluntarily and in reliance upon his or her own attorney; and that this instrument expresses the entire agreement between the parties concerning the subjects it purports to cover and supersedes any and all prior agreements between the parties. 15 --.~ ~r ~~ - ~~I - . . This Agreement should be interpreted fairly and simply, and not strictly for or against either of the parties. 24. MUTUAL COOPERATION. Each party shall, on demand, execute and deliver to the other any deeds, bills of sale, assignments, consents to change of beneficiary designations, tax returns, and other documents, and shall do or cause to be done every other act or thing that rnay be necessary or desirable to effectuate the provisions and purposes of this Agreement. If either party unreasonably fails on demand to comply with these provisions, that party shall pay to the other party all attorney's fees, costs, and other expenses actually incurred as a result of such failure. 25. AGREEMENT NOT TO BE MERGED. This Agreement may be incorporated into a decree of divorce for purposes of enforcement only, but otherwise shall not be merged into said decree. The parties shall have the right to enforce this Agreement under the Divorce Code of 1980, as amended, and in addition, shall retain any remedies in law or in equity ll11der this Agreement as an independent contract. Such remedies in law or equity are specifically not waived or released. IN WITNESS WHEREOF, the parties hereto set their hands and seals on the dates of their acknowledgments. o if!:- ~/~' ERIC S. PE FER FAy~/< 16 ~- ~ ~.~ ,.I . . . COMMONWEALTH OF PENNSYLVANIA COUNTY OF DA lA.~A'i "'"" ) ) ) BEFORE ME, the undersigned authority, on this day personally appeared ERIC S. PEIFFER known to me to be the person who executed the foregoing instrument, and who acknowledged to me that he executed same for the purposes and considerations therein expressed. 1>1- GIVEN UNDER MY HAND AND SEAL OF OFFICE this day of No'J-{ \M. \,p......- ,2001. _O~M ~, ~~ Notary Public in for Commonwealth ofPeunsylvania T . eo m DONNA J KNISR\ NOTARY PUBUC HARRISBURG DAUPHIN COUN6TV2 . IRES FEB. I My commission expires: 17 ~~- _I Q , - COMMONWEALTH OF PENNSYLVANIA COUNTY OF G ;yJA. J it" A / r>>fl1/ ) ) ) BEFORE ME, the undersigned authority, on this day personally appeared FAY J. PEIFFER known to me to be the person who executed the foregoing instrument, and who acknowledged to me that she executed same for the purposes and considerations therein expressed. G"'rUNDER MY HAND AND SEAL OF OFFICE ""' ,)r;- day of lJ a :tuber, 2001. CIv () and for Commonwealt fPennsylvania Typed or printed name of Notary: My commission expires: NOTARW. SEAL Wl!NDY S. CHE$8IlO. NcIuty PuWic ~ ....... Twp.. CumIlolrIancI Olunly My Coinmlollon &pINs M:q 10, 21m 18 <".~~_..... ,~~-...I~ ' .&f.f- . , IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ERIC S. PEIFFER, ) Plaintiff ) ) v. ) NO. 2000-471 CNIL TERM ) FAY J. PEIFFER, ) CNIL ACTION - LAW Defendant ) IN DNORCE 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 S3301(c) of the Divorce Code. 2. Date and manner of service of the complaint: Service accepted by Michael L. Bangs, Esquire on February 16,2000; Acceptance of Service filed on February 24,2000. 3. Date of execution of the affidavit of consent required by S3301(c) ofthe Divorce Code: by plaintiff, November 1, 2001; by defendant, November 15, 2001. 4. Related claims pending: All claims resolved by Marital Settlement Agreement executed by the parties on November 1, 2001. 5. Date plaintiffs Waiver of Notice in S3301(c) Divorce was filed with the prothonotary: November 19, 2001; date defendant's Waiver of Notice in S3301(c) Divorce was filed with the prothonotary: November 19, 2001. Date: Cindy S. Conley, HOWETT, KISS 130 Walnut Street P. O. Box 810 Harrisburg, P A 171 08 Telephone: (717) 234-2616 Counsel for Eric S. Peiffer ~H.tJiI~I:li1i!1ltil'i1!'~M*:i~lIi~ij;;j;~,~-;;W<Il;Willi~f,ji;;{j'ilill/&~Bi1i!i!~lrilil!!tl..- ,~-,~ 1 - . ,< ~ -,. 0 C' C ;;;: - -Uc;::; 0 nlr';"j .,," , 2:1) N ~~" . Z~ - <::b ,.;:0 '~l~~ :;:::c: :!'.-,. . " )> ::.K t~~ ~8 '!? -l 2 :SC> =< Q"\ :D -< " ,.. 80lLI VINVA1ASNNiId '~lll1ijSImIVH 018 X01l3:>IddO.LSOd .L33lI.I.S lIlN'IV hi. OEI ';)'d 'A:!l'INO;) 1flll:!lDNISSDI 'l..L:!lM.OH , :10 S3;JId:lQ 1\\ V'1 " " . , ", _. ":I ~ ~~; ~ 1< (l li?;-< <: 'UUl ~~~8 :I: . f-" H Hl[il PJ ~ [il ~i ,.... 'U '" iHl ~ ~3 ~ Iii "CI.... '" 0 '" :j $~ c: '" 0 .... '" .... ~ ~. ~~~ ;> 0 > ~ - ".. .... ci ij~ '" .. Z z 0 c: .. .. ~ t'11 ~ n ... '" '" '" ~ ~ 0 ~ 00 > >< '" 0 ! QI ~ I .. ~ ;; ~ ; O;;:Ul'U ~ ~~~ 0 '" ~~ -""1 (") c- ~: vcr rnf-:-. ~~ci :.- ' ,- 4Q t=-""-L; ';'>C Z ~ ..,:,:~ -: '? ::i.:_ f"-J '.0 l:.9 CT> " ~ 0- - ~~~.- ,.~. -.J ~ ~~I ' ~"n IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ERIC S. PEIFFER, ) Plaintiff ) ) NO. 2000- 47/ v. ) CIVIL TERM ) FAY J. PEIFFER, ) CIVIL ACTION - LAW 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 fail to do so, the case may proceed without you and a decree of divorce or annuhnent rnay 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 Courthouse, 1 Courthouse Square, Carlisle, Pennsylvania 17013. 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 Telephone: (717) 240-6200 AMERICANS WITH DISABILITIES ACT OF 1990 The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our dffice. 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. . '-"l,;I"''''~' ~l...~...c~ "---~"""""'...."."'-'>. ~ ~ ~ ...J-__lJ" IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ERIC S. PEIFFER, Plaintiff ) ) ) ) ) ) ) NO. 2000- "171 CIVIL TERM v. FAY J. PEIFFER, Defendant CIVIL ACTION - LAW IN DIVORCE COMPLAINT IN DIVORCE AND NOW comes Plaintiff, Eric S. Peiffer, by and through her counsel, Howett, Kissinger & Conley, P.C., who sta~es the following in support of the within Complaint: 1. Plaintiff is Eric S. Peiffer, an adult individual whose current mailing address is 120 Parkview Road, New Cumberland, Cumberland County, Pennsylvania, 17070. 2. Defendant is Fay J. Peiffer, an adult individual who currently resides at 210 North Enola Drive, Enola, Cumberland County, Pennsylvania, 17025. 3. Both the Plaintiff and the Defendant have been bona fide residents in the Commonwealth of Pennsylvania for a period of at least six (6) months immediately preceding the filing ofthis Complaint. 4. Plaintiff and Defendant were rnarried on October 3, 1992 in Boiling Springs, Pennsylvania. 5. Neither Plaintiff nor Defendant is in the military or naval service of the United States of its allies within the provisions of the Soldiers' and Sailors' Civil Relief Act of the Congress of 1940 and its amendments. 6. There have been no prior actions for divorce or annulment ofthe marriage instituted by either of the parties in this or any other jurisdiction. w_. ~"..~.............. .-eo'- J_ '1!ll!lml'o 7. Plaintiff has been advised that counseling is available and that Plaintiff may have the right to request that the Court require the parties to participate in counseling. 8. The parties have lived separate and apart since in or about September 1997. COUNT I - DIVORCE PURSUANT TO &3301(c) or (d) OF THE DIVORCE CODE 9. The prior paragraphs of this Complaint are incorporated herein by reference thereto. 9. The marriage of the parties is irretrievably broken. WHEREFORE, Plaintiff respectfully requests the Court to enter a Decree of Divorce pursuant to g3301 ofthe Divorce Code. COUNT 11- EOUlTABLE DISTRIBUTION 10. The prior paragraphs of this Complaint are incorporated herein by reference thereto. 11. Plaintiff and Defendant have legally and beneficially acquired property, both real and personal, during their marriage, which property is "marital property." WHEREFORE, Plaintiff requests the Court to equitably divide all marital property. Respectfully submitted, Date: I? V, ;2aJr} Cindy S. Conley squire HOWETT, KI INGER & CONL 130 Walnut Street P.O. Box 810 Harrisburg, P A 17108 Telephone: (717) 234-2616 Counsel for Plaintiff Eric S. Peiffer . ~ -~ . ._.........=~. .-..."~ _I -- _1__,,- VERIFICATION I, Eric S. Peiffer, hereby swear and affirm that the facts contained in the foregoing Complaint in Divorce are true and correct to the best of my knowledge, information and belief and are made subject to the penalties of 18 Pa.C.S. g4904 relating to unsworn falsification to authorities. Date: J"""'''1j 1'7.1 d{)OO ~# Eric S. PeifflH" 80lLI VINVA"1ASNN3:d'mmgSOOIVH 018 XOH3:JlddO~SOd B311~S HlN'IV N1 on ';)'d 'A:>l'INO;) 191I:>l~NISSDI '.1.1:>lMOH .m S::I::lI.i.iO AW'1 ,. ;! t>;j 'ZClClH ", OH~Z ~ H . < Cl H"">-3 '-< Nt'"t>;j:I1 ~ [J) o "'t>;j :t o>t'" >1j OCl>Cl > t>;j >1j I>-3Z0 " " ~ H t>;j tj'=';i3 ~ cg ~ H ":! ZCl>-3 c: '" t'" t>;j ":! 1 0 " ... ~ '='", ." >1jt>;j t'"c::o " 0 '" . . H'" >Z":! .. ." 0 ~ H> Cl . :<:>-3 '" ." '" '" .... ~Cl Z - Z ('J '" 0' 0' - 0 ~ '" r; ~ P- H' ClH>1j~ " '" " III .... <;; 0 ~ 0 (:l 0' H> HZtJ:jO > >< '" H' H> < Z'Z z '" ~ H'=''Z ;;: c: t'"H[J)>1j - <~'t'" ~ >-30t'"~ 0 t>;j",< '" ggCl>[J) t>;jZ HO >"':1 t:J rt ~ V) ~ ~ & ~ ....... -( ~ o ~ ~. I " o (y ( u ~ ~ & i CQ - ~ , '--1 D o c: < "'Dc' U)[2:,~ '.?-._.;_J 2'T' OJ 1"-_ '~2-:j J>(') ZCJ 5c: Z =< I Ct o C) ;;-:,; ":-1 '~~ () N (J; ~~o :.JC ( \ _~T' :~,,';C) ::..::.;-;'1 u ;~ 5.:' -< ~J c:> ,.,.-'~ '~.. -- ,...L......b . , , IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ERIC S. PEIFFER, ) Plaintiff ) ) v. ) NO. 2000-471 CNIL TERM ) FAY J. PEIFFER, ) CNIL ACTION - LAW Defendant ) IN DNORCE ACCEPTANCE OF SERVICE I, Michael L. Bangs, Esquire, hereby accept service ofthe Complaint in Divorce on behalf of Defendant Fay J. Peiffer. Date: 2-lb~60 "~2 .~/J Michael L. Bangs, Esqui 302 South 18th Street Camp Hill, P A 17011 Telephone: (717) 730-7310 Counsel for Defendant Fay J. Peiffer SOlLI VlNVA1ASNN3d 'mUl'aSnntYH 018 XOH 3:Jld.<!0 LSOd L33l1.LS l.flN"IV In Of!' ( ~,.;)'<I 'A:iI'lNO;) 'l? U:ilnNISSDI '.L.L:ilMOH 11.0 S3:Jld.:IO M v'1 ., , ,--", . == > "':I t<j nZCJH HO~Z 0 (') > '" <. ~ (') "" H H to>'3 t<j (') I:""Nt<j t'1 ~ '-< O"'~ >'3 . (f) > 01:"" t<j :J: >-3 > (')0>(') > .>-3 Z ~ >'3IZ0 ~ (') t<j ., ~ H""'''''c: ~ '" el t<j H t<j 0'-1 '" ~ "':I H Z>->(') ~ 0 0>'3 c <n' '" t'" 0 "':I :::J ~ >-l, '" "':I t<j I(')C:O " 0, .... ~ ""'" ~t<j HZ "':I '" "" :;;;0: 0 (f) ro - f-'''' 1:""<>'3 '" ",,' C'l t<j H, III - >H~CJ Z t'" .. '" ro ,... ,,-:: 1:""- 0 z n t'1 .. ~ '" " < ::l ::l H>'3~~ "' '" := '" H 0- ct >3 0 ~ (') III ,... Zt<jt<jO > >< l1,o 0 t<j ::l H, "'ZZ .. Z <>0 ct H, ",,::s:Z :; 0 rl H (f)~ ~ 0 < ""I:"" ~ :;;;0: 0 I:""t<j 0 '" <> <>0 I"" (') >(f) t'1 t<j Z -< HO 1-cI >"':1 1; "G "'1 rn ',", .~, , <J / ,",,'~ t,,) , " U) - "~. r.: "'::,. .. [,," C-7 ~:-'.; /, c.:: :.<] :;,~ -; '~ -<c fv ';:I"':'~... " lj: . , , . '. . - I. 1 F' '. ij, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA I,' I" h, !: ERIC S. PEIFFER, ) Plaintiff ) ) v. ) NO. 2000-471 CIVIL TERM ) FAY J. PEIFFER, ) CIVIL ACTION - LAW Defendant ) IN DIVORCE I I;' :;i '1, ~; j; PLAINTIFF'S AFFIDAVIT OF CONSENT I. A complaint in divorce under S3301(c) of the Divorce Code was filed on January 25, 2000. 2. The marriage of Plaintiff and Defendant is irretrievably broken, and ninety 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 ofthe decree. WAIVER OF NOTICE OF INTENTION TO REOUEST ENTRY OF A DIVORCE DECREE UNDER &3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if! 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 above are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. 94904 relating to unsworn falsification to authorities. Date: I AJ() v' 0 I ~~ Eric . eiffer, Plaintiff liIIliir' ''''~''''':I..lii.~''''';';I' ;",;, . '^ ""'-""'- ~" - ~'~ '" iliiilIM ~ . - u -'"', ~, " " ."", ',"c, ~" " ~ '~" 0 c.' C, C -'1 ~ Z <:lee c:> " cp,rr. "'" 4-. ::D ,.., fTl Z;::-~' \;0 :'".'1) en,,:; -</- '~.~Cl ~C' V -.., I. Po ~~~ Zo :PC CJ . --I Z 0 ~ ~ U"I -< ~ A .. I "., . ~ ' , <,.- . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ERIC S. PEIFFER, ) Plaintiff ) ) v. ) NO. 2000-471 CIVIL TERM ) FAY J. PEIFFER, ) CIVIL ACTION - LAW Defendant ) IN DIVORCE DEFENDANT'S AFFIDAVIT OF CONSENT 1. January 25, 2000. 2. The marriage of Plaintiff and Defendant is irretrievably broken, and ninety 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 requ~st entry of the decree. A complaint in divorce under 93301(c) of the Divorce Code was filed on W AlVER OF NOTICE OF INTENTION TO REOUEST ENTRY OF A DIVORCE DECREE UNDER &3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if! do not claim thern 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 above are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. 94904 relating to Unsworn falsification to authorities. Date: ilJ15/0J { F'Y~D~ -- '" WilIIi_' <~ ,., ,~~- -, - -""""""'=- ,~ W'~iliiiiiII " , . ., .. ." '-~ ,..,,'e .-~.~ ')1 () 0 0 c:.: -"1 ~ 23 ~:;i ." r.o g;;JrT; """ ~", , 'j-."::::. ~::G --rn 2:S; 1.0 :L~o \f)_.::: 0(":., -<~~,:.. r-c:::' ~ -0 -'--"-l"j ::l;: ;,"'~-n z.() ~O )>0 - (SfTl ~ " bi =< :::> :i3 -r=- -;; Ii' ""-,,,I " ~l'~ ~" ~,~ I HtnNriW IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VB. ~~1~ CIVIL ACTION - LAW 1D:::o- NO. ~\ CIVIL 19 IN DIVORCE STATUS SHEET DATE: aJ. '" 'DO M-Q:;jO r__J.L- 'I . a,~. L.DT \KI~, Ir lu/~l -- I - ;~'- 'j I ... . 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 Traci do Colyer Office Manager/Reporter West Shore 697 -0371 Ex!. 6535 July 17, 2000 Cindy S. Conley Attorney at Law HOWETT, KISSINGER & CONLEY, P.C. 130 Walnut Street P.O, Box 810 Harrisburg, PA 17108 Michael L. Bangs, Esquire 302 South 18th Street Camp Hill, PA 17011 RE: Eric S. Peiffer vs. Fay J. Peiffer No. 00 - 471 Civil In Divorce Dear Ms. Conley and Mr. Bangs: Attorney Conley has returned the certification document indicating that discovery is complete. Her document was dated May 12, 2000. I do not want to delay a directive for filing pretrial statements even though we have not heard from Mr. Bangs. Consequently, I am going to proceed. A divorce complaint was filed on January 26, 2000, raising grounds for divorce of irretrievable breakdown of the marriage and the economic claim of equitable distribution. I assume that the parties will sign and file affidavits of consent and waivers of notice of intention to request entry of divorce decree so that the divorce can be concluded under Section 3301(c) of the Domestic Relations Code. '~ , :, - -:,., - -- '1I1.~"J... H.: ", ~ ... . MS. CONLEY AND MR. BANGS, ATTORNEYS AT LAW 17 JULY 2000 PAGE 2 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 18, 2000. Upon receipt of the pretrial statements, I will immediately schedule a pre-hearing conference with counsel to discuss the issues and, if necessary, 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 V ACA TED. ~!<'-"P 11' ....-~ 1, - ~-, ,'" ',I ,-, . , '~'. --~' ERIC S. PEIFFER, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. NO. 2000 - 471 CIVIL FAY J. PEIFFER, Defendant IN DIVORCE TO: Cindy S. Conley Attorney for Plaintiff Michael L. Bangs , Attorney for Defendant DATE: Tuesday, April 25, 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- I --~ .., ", ,',-', -'. -- ". -"~<-' -, - , (b) Provide approximate date when discovery will be complete and indicate what action is being taken to complete discovery. \ 'Q. mC1 i9.60() DATE COUNSEL FO 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. ._~'- -- ~ ( "' I ~. ~'-1'" ,', ERIC S. PEIFFER, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. NO. 2000 - 471 CIVIL FAY J. PEIFFER, Defendant IN DIVORCE TO: Cindy S. Conley Attorney for Plaintiff~ Michael L. Bangs Attorney for Defendant DATE: Tuesday, April 25, 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 --., , , . .'- ._~-- ,-- . (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, ~NDICATING 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. ,'---.,'. " ~~ ' ""-, ' ~ "~'_;2;--; -c"> ,__ -, .';."H-i t,i LAW OFFICES OF HOWETT, KISSINGER & CONLEY, P.c. 130 WALNUT STREET POST OFFICE BOX 810 HARRISBURG. PENNSYLVANIA 17108 JOHN C. HOWElT, JR. DONALD T KISSINGER CINDY S. CONLEY DARREN J. HOLST (717) 234-2616 FAX (717) 234-5402 DEBRA M. SHIMP Legal Assistant November 19, 2001 Traci Jo Colyer, Office Manager Office of Divorce Master 9 North Hanover Street Carlisle, PA 17013 Re: Eric S. Peiffer v. Fay J. Peiffer No. 2000-471 Civil/Divorce Dear Traci: Enclosed please find two copies of the Marital Settlement Agreement in the above matter. - I[i'''~/( a M. Shim~ C:=--C!/lfl/lQ-- " ,--c:::::::- Enclosures _ ,'_'_ ~ -~O-'.-- ,..,,:~-. c- ,,~,"f..- ,'- "A"" _+ --""'''''wt" ,.- ,,~:_'" , ,,-" ,-, LAw OFFICES OF HOWETT, KISSINGER & CONLEY, P.C. 130 WALNUT STREET POST OFFICE BOX 810 HARRiSBURG, PENNSYLVAMA 17108 JOHN C. HOWETT, JR. DONALD T. KISSINGER CINDY S. CONLEY DARREN J. HOLST (717)234-2616 FAX (717) 234-5402 DEBRA M. SHIMP Legal Assistant October 26, 2000 Ms. Traci Jo Colyer Office Manager/Reporter Office of Divorce Master 9 North Hanover Street Carlisle, P A 17013 Re: Eric S. Peiffer v. Fay J. Peiffer No. 2000-471 Civil/Divorce Dear Traci: As per our phone call earlier today, Attorney Conley has requested a continuance ofthe pre-trial conference scheduled before Mr. Elicker for Monday, November 6, 2000 at 9:30 a.m., and Attorney Michael Bangs has agreed to this continuance. Sincerely, r cc: Michael 1. Bangs, Esquire Eric S. Peiffer "I,.' ... '" ,--,' ,- \ -"~, <~.' .....J ERIC S. PEIFFER, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - LAW NO. 2000 - 471 CIVIL FAY J. PEIFFER, Defendant IN DIVORCE NOTICE OF PRE-HEARING CONFERENCE TO: Cindy S. Conley , Counsel for Plaintiff Michael L. Bangs , Counsel for Defendant A pre-hearing conference has been scheduled at the Office of the Divorce Master, 9 North Hanover Street, Carlisle, Pennsylvania, on the 6th day of November, 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: 8/24/00 E. Robert Elicker, II Divorce Master , '"~ '. -i,.....,_~,~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ERIC S. PEIFFER Plaintiff vs. FAY J. PEIFFER 2000-471 Civil Term NO. 19 Eric S. Peiffer a master with respect to the (X) Divorce ( ) Annulment ( ) Alimony ( ) Alimony Pendente MOTION FOR APPOINTMENT OF MASTER (Plaintiff) (~a!aKaK~), following claims: moves the court to appoint 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 claims(s) for which the appointment of a master is requested. h r (2) ~he defendant (has) ~l\!K'lD<m:1!!') appeared in the action ([Y"v~l\J<.;'\.~ (by ~ attorney, Mlchael L. Bangs ,Esquire). (3) The staturory ground(s) for divorce.(is) (are) 93301(c) (4) Delete the inapplicable paragraph(s): (liJXnlOOClUl!WJW:JOOij[~. (}[XXXDXUn~~~~Q(!X<<dX\XimXnllIiinXnX~ l'fo1i~lQC1JCmlC claims: DIVORCE and DfstRIgnTIBNt3f~~~ested with respect to the following (5) The action (~~~~ (does not involve) complex issues of law or fact. (6) The hearing is expected to take (7) Additional information, if any. one (l'1bM'S') (day'S"). to the motion: Date: April 12, 2000 Cindy S. Con Attorney for (Plaintiff (~MYAt\~ // ' " ORDER APPOINTING MASTER AND NOW C;;l..,&u..l / Lf ' ,I![2OOJ , '>;' ~ is appointed mas fer with respect to the following claims: E.iu/~ aU Esquire, J i@j~~~i6ililllii>.ll'Il.ffi!jg~iiifiiOCilli!'i!~i~.i!iII!j""li:Il;i1t&-;c,''';'~''T!#'-'Ai",--''I''~_i!i' ~--" ~~_., ~" . ,"~,~ .~- ,,~.. ~~ ,"'" -," -1I'~'17ii<;_- ~--"1Jl (') ~ --D~J~' fT\fT' ~(.-: f:fJ ~::~, 2--e''''': ~,.".. ):>C'. ;z:6 ).> 1..:: z =< c~ C) = "D ;;u ~ ,." (,,) '"'(J " --, ::J ::.>C2 '-.~: \ ' 1 V ~ :< r;? U1 --l \.i'N\i\l'\'8NN:!d vII '!I\ ,\\;.l,-'"'r"lI!\1r'\f) 'l'l"nn 'I "0 ,\-1}-, I'd ,~ ,\ \ \1 ~-..- ..j \,,,: : -- -, ,--'''' -,.' ..,c .7 Iii '1 \ udi 00 (.It,.- 'v"" AB\/iO;\[,\-U.cd ~__. . -jN \_\n-.rl-~ \"~\ :.,jlj-..... ',~ -' ;.-' In "~ . - 1,,1~~ -~<>M. LAW OFFICES OF HOWETT, KISSINGER & CONLEY, P.C. 130 WALNUT STREET POST OFFICE BOX 810 HARRlSBURG, PENNSYLVANIA 17108 TO: Office of Divorce Master 9 North Hanover Street Carlisle, P A 17013 May 12,2000 DATE: RE: Peiffer v. Peiffer We enclose the following to keep you informed of the progress of this matter: Certification executed by Cindy S. Conley, Esquire. -I. For your review/records D For your signature D Kindly return D D D Please call upon receipt Per your request Call for an appointment Please call us if you have any questions. ~, - , , -" - ,~~ ,,' . ~ ' ,---,-- , , " :;;JJJ.>::-'~,,,-, ,~J-~ MICHAEL L. BAN6S ATTORNEY AT LAW 302 SOUTH 18TH STREET CAMP HILL, PA 17011 PHONE 717-730-7310 FAX 717-730-7407 or 717-730-7374- E-mail: bangslaw@paonline.com July 18, 2000 E. Robert Elicker, II, Esquire Cumberland County Divorce Master 9 North Hanover Street Carlisle, PAl 70 13 RE: Eric S. Peiffer v. Fay J. Peifftr No. 2000-471 Civil Dear Mr. Elicker: Tracy advised me that I had not responded to the Certification of Readiness. I apologize. I must have misplaced the forms sent. I certify that there is no further discovery needed and that the case can proceed at this time. Very truly yours, 1 , mkz cc: Cindy S. Conley, Esquire Mrs. Fay J. Peiffer " .. -, ~ > -~,,;,"c,~-,, ~ n_ , d','""~ LAw OFFICES OF HOWETT, KISSINGER & CONLEY, P.C. 130 WALNUT STREET POST OFFICE BOX 810 HARRISBURG. PENNsYLVANJA 11108 JOHN C. HOWETI, JR. DONALD T. KISSINGER CINDY S. CONLEY DARREN J. HOLST DEBRA M. SHIMP Legal Assistant Robert E. Elicker, II, Divorce Master 9 N. Hanover Street Carlisle, P A 17013 Dear Mr. Elicker: August 17,2000 Re: Peiffer v. Peiffer ,- ,-~~,-' - ",{"'- ,', , nfll (717) 234-2616 FAX (717) 234-5402 Enclosed for filing please find Plaintiff s Pretrial Statement Pursuant to Pa. R.C.P. 1920.33(b). Thank you. Very truly yours, c~;d?- CSC/slc Enclosure cc: Michael L. Bangs, Esquire (w/encl) Eric S. Peiffer (w/encl) , ,( ERlC S. PEIFFER, Plaintiff NO. 2000-471 - CNIL TERM ~'~o IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v. ) ) ) ) ) ) ) CNIL ACTION - LAW IN DIVORCE FAY J. PEIFFER, Defendant PLAINTIFF'S PRE'I'~~~!~!:EMENT PURsUANT TO PA. R.C.P. 1920.33(b) I. ASSETS "'~'" , A. MARITAL ASSETS ..' DATE OF ANY PORTION LIENS OR # ASSET VALUE V ALUA TION NON-MARITAL ENCUMBRANCES 1 Marital Residence $9,650.18 7/25/00 No No Sale Proceeds 2 Increase in value of H' s $75,055 Date of No No Retirement separation (9/97) 3 Increase in value ofW's $24,831.33 Date of No No Retiremeut separation (9/97) 4 1996 Honda Accord (H) $6,000 Current No Current -0- Approximately $5,000 as of 10/92 5 1997 Honda Civic 0Nl $6,000 Current No Current - unknown Approximately $5,000 as of 10/92 6 Increase in value in H's $2,203 Date of No No Life Insurance separation (9/97) 7 Increase in value in H's $3,299 Date of No No stock portfolio separation (9/97) 8 Second Stock Portfolio $344.25 8/11/00 No No Stock portfolio 9 Harris Certificate of Approx. Current No No Deposit $359.00 10 Personal Property Unknown N/A No No B. NON-MARITAL ASSETS # ASSET VALUE DATE OF LIENS OR VALUATION ENCUMBRANCES 1 H's Retirement acqnired before $98,619.00 Apri130, 2000 No marriage and after separation 2 W's Retirement acquired before $32,257.98 2000 No marriage and after separation 3 H's Life Insurance acquired $4,005.00 3/26/2000 No before marriage and after separation 4 H's stock portfolio acquired $12,262.00 7/31/2000 No before mamage and after separation 5 H's PNC checking acquired $17,436.50 8/t 1/2000 No before marriage and after separation 6 H's PNC savings acquired before $8,661.22 8/11/2000 No marriage and after separation 7 H's Harris Savings Account $3,848.54 7/31/2000 No acquired before marriage and after separation 8 W's post separation accoWlts _ Unlmown, NIA Unlmown information in W's possession II. WITNESSES A. Expert Witnesses. Phriptiff cioes not anticipate calling any expert witnesses at this time. However, Plaintiff reserves the right to call rebuttal expert witnesses in the event Defendant chooses to call expert witnesses. B. Other Witnesses. Other than the parties themselves, Plaintiff does not anticipate calling any other witnesses. However, Plaintiff reserves the right to call unidentified rebuttal witnesses. III. EXHIBITS Plaintiff anticipates submitting the following exhibits at trial: (a) Statement evidencing the balance ofthe proceeds of sale of the marital residence; (b) Various retirement plan statements evidencing the increase in value of Husband's retirement plan during the marriage; ~ '&..... -'-""''',0=''' - , ~\t<o-< ~- . ..I'>'=~J.__"__ 'J ~~-L~",;;;, (c) Various retirement plan statements evidencing the increase in value of Wife's retirement during the marriage; (d) Letter from life insurance cornpany evidencing the increase in value of Husband's life insurance policy during the marriage; (e) Various statements evidencing the increase in value of Husband's stock portfolio during the marriage; (f) Various statements evidencing the value ofthe stock portfolio acquired in Husband's name during the marriage; (g) Various statements evidencing the balance of the Harris Certificate of Deposit in Husband's name acquired during the marriage; (h) Various statements evidencing the balance in Husband's PNC Checking Account at the date of marriage and at the date of separation; (i) Various statements evidencing the balance in Husband's PNC Savings Account at the date of marriage and at the date of separation; (j) Various statements evidencing the balance in Husband's Harris Savings Account at the date of marriage and at the date of separation; (k) current pay stub; Husband's most recent, Federal, State and Local tax returns as well as (I) Wife's most recent Federal, State and Local tax returns as well as a current pay stub. IV. PLAINTIFF'S GROSS INCOME See attached 1999 joint federal income tax return including W-2s for both parties as well as attached July 21, 2000 pay stub for Plaintiff. _~i' ~-"'''_'d'' ........_~,""-_....o ;I(~"<'_, ...~~ ..""= ~""J<'f!IW V. EXPENSE STATEMENT OF PLAINTIFF (Fill in Appropriate Column) EXPENSES WEEK MONTH YEAR Home Rent $168.69 $731.00 $8,772.00 Maintenance N/A, included in rent Utilities Electric $11.50 $50.00 $600.00 Gas N/A Oil N/A Telephone $12.23 $53.00 $636.00 Water N/A,included in rent Sewer N/A, included in rent Employment Public Transportation N/A Lunch $50.00 $217.00 $2,600.00 Taxes . Real Estate N/A Personal Property N/A Income Total projected $234.00 $1,014 $12,167.00 for year 2000 Per Capita/Occnpational $7.65 $33.17 $398.00 Insurance Homeowners N/A Automobile $12.33 $53.42 $641.00 Life $11.54 $50.00 $600.00 Accident N/A Other Automobile 8500 miles as of August 2000 Payments N/A Fuel $16.15 $70.00 $840.00 Repairs $11.20 $48.50 $582.00 Medical Doctor $8.46 $36.67 . $440.00 Dentist $2.50 $10.83 $130.00 Orthodontist N/A VI. PENSION/RETIREMENT BENEFITS. See MaritaI/Non-Marital Assets Charts above. VII. PERSONAL PROPERTY. The parties have already divided their personal property to their mutual satisfaction with the exception of Husband's pre-marital record collection and filing cabinet which is in Wife's possession and which Husband desires returned. VIII. MARITAL DEBTS. EVIDENCE AMOUNT OFFERED AMOUNT INITIAL PURPOSE AND DATES IN DEBT OF DEBT AS DATE AMOUNT OF OF PYMT. SUPPORT DEBT OF D.O.S. DEBT OF DEBT DEBT SINCE D.O.S. OF CLAIM INCURRED Car $0 $5,000 During Unknown Car Paid off by Statement Loan marriage purchase Husband 1996 Accord Car Unknown $5,000 During Unknown Car Unknown Statement Loan marriage purchase Misc Divided To Mutual Satisfaction of the parties credit card debts "-" - ,^' ~ " Jlltl'l~"__ ~. '"" ~-.J_~o IX. PROPOSED ECONOMIC RESOLUTION. Husband proposes that the marital estate be divided on a 50-50 basis after providing him with credit for paying the mortgage associated with the marital residence from December, 1997, through the date of sale of the marital residence, October, 1999. Moreover, Plaintiff proposes that neither party pay the other . alimony, or alimony pendente lite and that both parties be responsible for their own counsel fees and costs. Date: f7 {).IIr ()<XxJ Respectfully submitted, (: Cindy S. Co ley, Esquir HOWETT, KlSSINGE & CONLEY, P.C. 130 Walnut Street P.O. Box 810 Harrisburg, PA 17108 Telephone: (717) 234-2616 Counsel for Plaintiff, Eric S. Peiffer -, . ~ u~ wu_" ,~" . . ~m~" .." I ........"""--'-- I ConIrol.-.ntMr l'w-=so-"3i62........ I OMINo.l~SoCIOOI , CSD111995 b~Id<<1IIfic.nonrunbllr , tW.Q...IIp..~c~iDn '1 Federlllroc_luwitl\held 57-0717652 48933.86 8985.04 c [mpIoyw"........ lIdIk""..nd lW codt 3,.,.,......c~lIIlIO". 4Soc11lSKW'JI)'IUWI!hh.Id DFAS OPLOC-CHAS (ZGT) 54342.90 ,3369. :a6 1545 TRUXTUN AVENUE SUITE C $Medk.......-dllp'l 6 -.ck.. IJIlt WlO1hMl CODE P 54342.90 787.97 CHARLESTON SC 29405-1968 7 S.,.,""..CI61lYIIp. I .uoe..d 11IM 0.00 0.00 .~',MI'W.~s,lWWIZitl'~ IlAdY_. EiCp.,.,. tO~c:..lMrMItII. twIll_ 0.00 ERIC S PEIFFER t21_flI.i'>cludedonbo.t 'I4S..instrs.forbaxM 120 PARKVIEW RD X 10.00 NEW CUMBERLND PA 17070-1733 13 S..onstrs. 'fDrball t3 D 5409.04 "0= 0- fiJ~ O:-.:ro Iil~~r...., "$I.. ~s...LD.no. 17 ... wagon, tip$, ~ 1I...__IU t."'~_ ZO Local..... tips,-. 21 Lcit.I inc:orM IU PA M3.,6216540 54342.90 1521. 54 HAMPDEN 54342.90 .. .543.49 .............. .........-................................ ..... ..........__ ........n.... ......... ............................... ............................ _.................-................ ................................... 0.00 0.00 HAMPDEN 0.00 0.00 Fonn W2 Wage and Tax Statement 1999 Department of'" Treasury. Internal Revenue Service (I + o 1. W.2 EARNINGS (Anach W-2's) ....m......................................... .m..................................._. ,. 2. EMPlOYEE BUSiNESS EXP9ISES ~ S1a1e Sd\eduIe UE-1 and ~ AItac:hmentI) ___.....__.__________.___......____. 2. 3. TAXABlE W-2 EARNINGS (Subtract Line 2 from Line 1) ...........,...... 4. OTHER TAXABLE EAANED INCOME (No tntet9Bl, CMdends or UnarnpkYyment Benefits. AIIach SUpporUng Documents) .................__._......... 4. 5. TOTAL TAXABLE EARNED INCOME BEFORE NET PROFITS (Losses) FROM SELF.EMPLOYMENT 5. (Add Woes 3 and 4) 6. NET LOSS FROI.t SflF..EMPt.OYED BUSINESS, PROFESSION. OR FARM _................_..._____.......~..__._~_.___._..._..___._.__ 6. (\I$O.......""NeI_) (AlIacI1_'RS_1 7. SLJBTOTAL (Subtract Line 6 from Une 5) IF LESS THAN ZERO, ENTER ZERO 7. 8. NET PROFIT FROM SIa.F-EMPlOYED BUSINESS, PROFESSION. OR FARM .___...__.._..._.._......_ ......._._....._......................._......__. 8. (Use Line 6 for any NeI Losses) (AtIach AppropriaIe IRS Schedules) 9. TOTAL TAXABLE EARNED INCOME AND NET PROFITS (Add Une 7 aocl 8) ................. .................................................m................... 9. ~ " o '. . 10. TAX UAB8.ITY 1'.4 OF LINE 9 (MAIipIy U1e 9 br .01) __w._._._.__.__.:.._~____~....___.._.____. 10. ~!i:~l 11. CREDITS: A.. ENTER roTAL f~ TAX WITHHELD BY EMPLOYER............ B. ENTE8 QUARTERLY PAYM~NTS'MAOE TO THIS BUREAU CENTER TOTAL 1"-0- TAX CREOlTS llme l1A plus lme 118) 12. IF LINE 11C IS LARGER THAN L!NE 10. ENTER REFUND DUE HERE ........ (If L.ess than $1.00. EnterZeto) 13. IF LINE 10 IS LARGER THAN liNE 11C. PAY UNPAIO BALANCE BY APRIL 15.. {ff less Ina1l $1.00. Enter Zsto} 14.. ADD INTEREST AND PENALTY OF 1% PER MONTH OF UNE 13 AFTER APRIL 15 ..._.._.______...____.._ 14. .......................12. .............._...........__13. 15. PAY BALANCE DUE WIlli THIS RETURN CUne 13 plus Une 14) ..'...m..._.............._........._.....................................................m............................. 15. OlD MAlUNG ADDRESS UST MOVING INFORMATION FOR 1999 TAX YEAR BELOW TWP IBOAO PERIOD LJVEO HERE TO CURRENT MAILING ADDRESS OF NOr THE SAME AS BELOW) 181-50-3162 ..ltJ TAX BUREAU COpy .. A 1999 FINAL RETURN FOR EARNED INCOME TAX WESTAB FORM 531 (REV. 11199) REFERENCE NO QQQQQQQQQQQQQQ FCRLOT QQ C-006 0-101-561 IlUR RfCORDS lNDICATf rHAT YOU AIlE A RESlDENTQf ERIC S PErryP.R 120 PAR1\'VIEW RD NEW CU"BEllLA'D PA ~s:: 3. S4j~ .1f0 S4-3q.a. ,~ SLl34-a.,a S''fj'fJ... ,~ 11. S'q.3tj~. 'tD 5"113.1/-3 Slf3. '1-1 ~.,,~ 066 MEW CUMBERLAND 1.1070-1733 0898621 1_... ...,1,..."..; ~ c..,.I1 [..~ ~~ Copy 2 To Be File<lWrth Employee's Stat.. Cily. or L"""llncome Tax Return ) , + o " .'i [] '. - I - w ~, -""""'=""""""'''', .'''' - H~ "'" ~, ~ I" """.~, r' ~..>U~' 'VSSfJ:...ti?-S'0_3J~~ ERIC PEIFFER 3183 (717) 774-1897 1735WEATHERBURNORIVE 1/1,fJ. [L~ .1:) .-,,,^,, 60-12,73/313114' r NEW CUMBERLAND. PA 17070 o.m~ PA,runlL I - r Ro.VD~ D I $ I IXIX OWeRc" ~_ -,Yc.. . 10. 't-I'P Six f>~ - OOLLARSm~:i;;:;''''''''. PNCBANK . 00......... , PNCBaoIt,N.A. 040" ChOice ~ CeDlrlll PA Plan r; RlR 11?--c5l>"3/~ - PATIt>Ce1 ~~ ~';. '" 1:0 3 ~ 3 ~ 2? 3BI: 3 ~B 3 II' 5 ~ 1.,02 20:\ :\ h' .~ ____--.J 187-50-3162 PE PEIFFER ERIC S PEIFFER FAY .J 1211 PARKYIEIII R>> NEId CUI1BERLAN>> PA PA PAYMENT VOUCHER For use with your 1999 TeleFile or PA-40EZ Tax Return. 900914 ENTER THE AMOUNT OF YOUR PAYMENT. 175- 48- 4005 DO NOT USE CENTS. ENTER WHOLE DOLLARS PA-V (09-99) 1999 PA.V Commonwealth of PA Department of Revenue $ ".00 1711711-1733 Make check or money order payable to the PA Dept. of Revenue DO NOT WRITE IN THIS SPACE L 3001811875031b200075199912310000000000000001 ... Fonn W2 Wage and Ta. Stalement 1999 Department of ... Treasury. ......., Revenue Service Form W2 Wage and Tax Statement 1999 Department of... Treasury. lntllmal Revenue Service ~.., -,~~,~"~"~,. ,,-""~ ~J~"*.~.,, -~ ~-,- ~-,,~ - '~-~,~"- .C_roI~ I d 1mployH'. .ociII..curlryflUlflb.- I OMI No. tWs.4lIOI CSD109021 , 175-48-4005 b impayw """'MlWO IU10IMr tw..,.......al'-<::~ 2F.....__luwill1tM6d 57-0717652 28226.09 ,4036.88 C EmpJoy.". _.Iddr..... tnd Zll" "odD 3Soo:011luc:...-y....... 4 SociaIuc..nvlU: dhMld DFAS OPLOC-CHAS (ZGT) 30994.09 1921. 63 1545 TRUXTUN AVENUE SUITE C SIIMN:_.-gD.....t. II "'-dIc..I_wiIht1Ml CODE P 30994.09 449.41 CHARLESTON SC 29405-1968 7Soc1l11..c....,.~1 , AIoe.-IId.. 0.00 0.00 . ~'. 1tMW, ....... ww121p CocM 'Adv_.ElC~ to o.p.ndMll:.:.. '*-fh csalft021 0.00 FAY J PEIFFER 12 ..,... nc:tudM ~ box 1 143..inltrl.fcwbo.W 210 N ENOLA DR FL 2 X 10.00 ENOLA PA 17025-2247 13 SM IMVS. for box 13 0 2768.00 " c:::I= 0- IXJ=- O~ [jJ~~, tI... Empfayw'-$ ...lp. ..,. 17........... Mo:. 1....-..w tllLoully_ 2GLoaIwages.lIps,<<c. 21 LoaI__... PA M3-6216540 30994.09 867.87 HAMPDEN 30994.09 309.89 ................ .........._-....-.................................. .----..-............-................-- ........--.......--............. ............................ ........-........................... .._....._..........._........_d._ 0.00 0.00 HAMPDEN 0.00 0.00 Copy 2 To Be Filed With Employee's State. City, or Local Income Tax Return . Cot<<roI nwnDw Id187-So:-'3i62- I OMBNo. t54$4OO1 CSD111995 bEmplayeriderClfk:atiorlf\UrrJbw tWIlgK,____cDflllMlftS8lion 2FIdenIln-tuwtlhtMold 57-0717652 48933.86 8985.04 c~, twM,lldI*.,.. andZlP' cPCk 3Sodl1lSKUfity.,., 4 Soc:iIItseariywwilHMld DFAS OPLOC-CHAS (ZGT) 54342.90 3369.26 1545 TRUXTUN AVENUE SUITE C 5~...andlips ....... tp ~ CODE P 54342.90 787.97 CHARLESTON SC 29405-1968 1 Social MCY1Iy lips I~NIips 0.00 0.00 . EmpIayH', MIM. ~ and Zip ~ t Actnnce EIC ,..... 10 o.p.ndsnI c.. tMnMh 0.00 ERIC S PEIFFER 12...... indudod... bel. t t4SHinIfr&bba.t4 120 PARKVIEW RD X 10.00 NEW CUMBERLND PA 17070-1733 t3 s.. men. few bet. 13 0 5409.04 "~ 0- 1x1~"'" n,- ......, IXI~ , tlSI.. ~s_..LD.no. t1 ShI...... tips,.rc. tISl..___ t.LoaIily...... 2OLacalWlIgll.....*- 21Laca1n:-tu: PA _..~~:::~.?.1..6..s..~Q._.............. 54342.90 1521. 54 HAMPDEN 54342.90 543.-49 ........................................ ................................ .......-................... ..................................... .................................... 0.00 0.00 HAMPDEN 0.00 0.00 Copy 2 To Be Filed With Employee's Stale, City, or Locallncome Tax Return PA.40 . 1999 Pennsylvania Income 'all Retum PA Department of Revenue, Harrisburg,. PA 17129-0006 PLEASE PRINT IN BLACK.INK. ENTER ONE LETTER OR NUMBER IN EACH BOX. FILL IN OVALS COMPLETELY. Ya:ur Social ~ecurity ~umber Spouse's Social Security Number [ c=J Extension. See instructions, t- : Amended Return. Fill in this oval jf ! c:::::l you are amending your 1999 PA return. ~~"",. - ...J '1'100110017 I~7 S0 ~'r-' . ~I 1a7-S0-31b2 PE 17S-4a-400S -' ...i I PEIFFER ERIC S l:fl PEIFFER FAY J j I 120 PARKVIEbl Rb -:1 NEW CUMBERLANb PA 17070-1733 (.).1 ell .... .... L-_......".......... .......~_~~....._.__.~._ 4-g 40~S --, . 3 1 10 ~ 175" I I I I I I I ..____-"--~..,...._-,..JI ',:' , <" t ~ L:"",A,,,,~,,;_~_~~_"',L~ : ",,,,,L,, .,:"'''_t~-i,~"in<.L.~_t" .#"~<f;"'"'~,-=<<t""l*~,,:j,'><* ,~,','O, ' Fl1lltline 01 address. P.O. Box; Apartment Number. Suite; RR No. . n applicable '.0'-',~M~"""O :,'~, -00 ~- . "'-'r.''''l<-~-'''"'"~'":'''''''''-}~-'.'''----;~'' ,'A' o>>;,+,-~^...- -/""'.o-""''''~>i ~f. 25* '3 U E :: ~ c J; 'E = ::J :e ,,,," ~"O.Q - ~ " . (3'- ::;"'" .- '" ~.95 w () ~ ~.Q- W ~N >"" 0"" .. .. $econd-line of address. Street Address 'j ~ 0, .. PAR I< V I EW C"rty or Post Cifiice ROAD State ZIP Code NEW c. U M B E.'R L It AJ I> Daytime Telephone Number I '7 0 ? eJ PA School Code I'- ~ 1 q.e 0 .-'I CJ CJ .-'I .-'I CJ CJ II"' II"' 74-8'1 7/7 770 Name of scIloo!dislrict where you lived on 12/31/99. County where you lived on 12/31/99. was e CllM6 L./WD . _I ~ii = Fiscal Year Filers, Fill in this oval. FY beginning --1 --.19g & ending --1_i_ ResIdency Status. Fill in only one oval. _ R Resident c::> N Nonresident = P Part-Year Resident from _1--199 to --1_199. Type Filer. Fill in only one oval. . - = S SIngle _ J Married, Filing Jointly = M Married. Filin9 Separately c::> F Final Return, Indicate reason: ! i = D Deceased. Date of death --1--199 identification Label Change. ;=> Fill in this oval if the label you received with this booklet is not completely correct, or iI you did not file a 1998 PA tax retum. Do not make corrections on the label - DISCARD IT. Municipality where you lived on 12/31/99. NEwUlMB~LhN1) la. Gross Compensation, from PA Schedule W-2S, or your Forms W-2, or other statements. . . ... . .. la. Do not use cenls Enter whole dollars lC. Net Compensation. Subtract Une lb from Une la. . . . .. . ... . .... . . . .. ....... . . .... . .... lc. 2. 8S337tJtJ ~3'f e~ 8S/03 tJ0 371 00 7;).QJ~ , 't, 6 ~ V> 0~ '1 b. UnreimbiJrsed Employee Business Expenses, from PA Schedule UE. . . . . . . . . . . . . . . . . . . . . . .. 1 b. 3. Dividend Income. Complete and enclose PA Schedule S. if over $2.500. 2. Interest Income. Complete and enclose PA Schedule A, If over $2.500. ..................... 3. 4. Net Income or loss trom the Operation of Business, Profession, or Farm. - 4. 5. Net Gain or Loss from the Sale. Exchange, or Disposition of Property. ,..............,. c:J 5. 6. Net Income or Loss from Rents, Royalties, Patents, or Copyrights. . . . . . . . . . . . . . . . . . . .. = 6. 7. Estate or Trust Income. Complete and enclose PA Schedule J. ........................... 7. 8. Gambling and LoneI)' Winnings. . .. .. . . . . . .. . . . . . .. . .. . .... .. .. .. .. .. . . . . . .. . . .. .. . 8. g. Total PA Taxable Inccme.Addonly II'e positive inl:ome8JMU!1ls from Unes lc, 2. 3. 4. 5, 6, 7, and 8. 00 NOT ADO any losses reported on Unes 4, 5. or 6. . .. .. . . . . .. . . . .. .. .. .. .. . .. .. .. . ,10. Contributions To Your Medical Savings Account. See the instructions. ... 11. Adjusted PA Taxable Income. Subtract Une 10 Irom Une 9. . . . . . . 12. PA Tax Liability. Multiply Line 11 by 2.8% (0.028). Also enter on Line 13, Side 2. Side 1 EC L 9900110017 9. 8SS-I.f" 00 10. 11. g S Stf b 00 <<3<iS f;0 12. FC '1900110017 --I """'~..b.!~~ J",~~ ~._C= ---' PA~40 ~ 1999 Social Security Number 9900220014 I I L-- , 87 S0 3 I 10 d.. YourName ~IC. S. Pc.IFf~ 13. PA Tax Liability. Enter your tax liability from Line 12 on Side 1. ... . . . . . . ....... . . . . . . . '" . ~3<<tS t>0 0138' 210 o e 0 " (00 0a.0 ," '~,/A,t~'r:-,1> ,'_,~. ..l:..'.~;"h..'-;L't<~<__ j : i jJ;r. ~riJ . - -;0 S6;!:i%;; -\-}~;'_;:ot-.-;;;<:';:S~~t" . ) l ~0 ~~~~w;..'09: o~' ^J.,o:,~;: Tax Forgiveness Credit Complete lines 2Oa, 2Ob. 21. end 22. Read instructions. .l".;$( 2oa. Filing Slaws: .. M~=':3 Of = Married = Deceased . ~~~~; Part B,Line 2 PA Schedule SP. W.;.~ 21. Total Eligibility Income from Part C, Lin_, PA Schedule SP. . . . . cmn:~/J2j;!r;l/)' 0 . ,''-.- -'"^-~'fW---'''''-J """.r'''''''e~~_~,~__ 22. Tax Forgiveness Credit from Part 0, Una 16, PA Schedule SP. ....,...."....,..""..... 22. -{ 13. 14. Total PA Tax Withheld. from PA Schedule W-2S, or your Forms W-2, or other statements. ....:.. H.. 15. Credit from your 1998 PA Income Tax Return. ........................................ 15. 16. 1999 Estimated Installment Payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16. 17. 1999 Extension Payment. .........:,.:..;'........'.....'....................."".. 17. 18. NonresidentTax Withheld on your PA Schedule(s) NRK-l. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18. 19. Total EsUma1ed Payments and Credits. Add Lines 15. 18, 17, and 18. .................... 19. , .. 23. Total Credn lor Taxas Paid to Other States or Countries. Enclose your PA Schedule G or RK-l. .... 23. 'jIi;(\' '0'iitp~ ",r-, .1, -':'c t. I> ~~ 24. PA Employment In""ntive Payments Credit. Enc~ roorPA Sch!'dule W, RK-l or NR,K'I. . r . . ;. 24... 25. PAJobs Creation Tax Credit. from enclosed certificate or PA Schedule RK-l or NRK-l. . . . . . . . .. 25. . , . . 26. PA Waste r.. Recycling Investment Tax Credit. from enclosed certilicate or PA Schedo/e RK- t or NRK- i. ... 26.' - 0\' , . . :r M C C ru ru c c II:' ~I 27. PAR~.and.DevelopmenlTax Credit, from encIosedcertificato Of ~ASchedule RK-J or NRK-l. .... 27. -- . . ~. . 29. TAX DUE. if Line 13 is more than Line 28, enter the difference here. .. . . . . . . . . . . . . . . . . . . . .. 29. ~-;J~~.' ty_,,^ to,.,:L,_ ~3 S q 00 ~ tJ 0 28. TOTAL PAYMENTS and CREDITS. Add Lines 14, 19. and 22 through 27. . . . . . . . . . . . . . . . . . .. 28. 30. OVERPAYMENT. If Line 28 is more than Line 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 tax account. .......... 32. 33. Donation - Amount of Una 30 you want to donate to the Wild Resource Conservation _.....................................................................- '34. Donation.. Amount of Line 30 you :ant to donate to the United States Olympic Committee, PA Division. ....................................................... 34. '35. Donation - Amount of Line 30 you want 10 donate to the Organ Donor Awareness Trust Fund. ...................................................................... 35. 36. Donallon - Amount of Line 30 you want to donate to the KorealV1etnam Memorial Inc. 36. 37. Donatlon .. Amount of Line 30 you want to donate to the Breast and Cervical Cancar _.....................................................................~ The total of Lines 31 through 37 must equal Une 30. Under penalties of perjury, I (we) declare that I (we) have examined this return. Including all accompanying schedules and statements, and to the best of my (our) belief the .ra true, correct, and eam e '4'11J~oaol~",,~ ~pEuM.I.sr I..' ". . '.,., ...."-....-.--..-..-...-..-..-..-...-- I 'II? / 2o.~':o.,.Lf.:..':o:::.,[~~.'!.,-'q, 7*(:;,~."~QL__. co,. .. .c'" .....;o,.P'".-. .. ~.'f:t-'-t' /( , p:epa~er;' ~pan~ ^ ,,' ~~.~ _ taxpayer(s) L 9900220014 r;;L::.;.3E;:jI) roC; C':"~i.. .:.3-':':U--:' <>,,- r',:,::y ,'.':; .":::':;;:":- . 9900220014 .-J Side 2 ..I.<< " - <" --1......_" ---1 WAGE STATEMENT SUMMARY PA Schedule W.2S (09199) 1 999 PA DePARTMeNT OF REVENUE OFFICIAL USE ONly Narne(s) as shown on your PA tax return: Social Security Number: ERIC S." FAY J. PE-IPI= IS? -s -3/ba. ~ns ruet.ions. Instead of sendinQ ~our paper orms W-2 with your 'A tax return. o~ photocopyin.g them to a sheet of paper. you may write the necessary information below. Keep your angIna! ~orms W-2. Important. Y~ur PA compensation may. be dlff~renl 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 wntten explanation from your employer. You must submit oth~r statements for amounts you are reporting as compensation on your PA tax return. Inf()rmatlon From Each Form W-2. Number of Form(s) W-2 (a> Employer Identification Number from box B 1. G <;l $ 2. (/) $ 3. $ 4. $ 5. $ 6. $ ~ $ Tollll. Add the amounts in column (c) and (d). PA Schedule A &,J! (09.99) PA DEPARTMENT OF REVENUE Nallle(s) as shown on your PA tax return: 9901210014 If you need more space, you may photocopy this schedule or prepare your own schedule in this format. (b) (c) Enter the total on Une 1a (d) Enter the total on Une 14 Federal wages from PA taxable compensation PA tax withheld box 1 from box 17 from box 18. :ot $ $ $ $ $ $ $ $ $ 'nterest and Dlyldend 'ncome - Caution. The Department reserves the right to require your actual Forms W-2. 1999 Social Security Number: 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 tips. I~ either'YDur PA interest income or dividend income is $2.500 or less. you do not need to submit a schedule. If either your interest income or dividend income is more than $2,500. you must suomit a schedule. Filing options: 3" 1. You can submit a copy of your federal schedule. or you can just enter your federal interest income and/or dividend income. The Department can verify the r"'=I amounts you reported on your Federal Income Tax return. a 2. Otherwise. list the name of each payer and the amount of PA interest and dividend income you received in 1999. ::;: PA Schedule A - PA Taxa~le fnt~rest Income IlJ Filing option 1. Enter the amount from your Federal Schedule B (Form 1040) or Schedule I (Fonn 1040A). 1.1$ M c:J Filing option 2. PA Taxable Interest Income. Read the instructions. IT' IT' $ $ S . $ $ $ $ - $ S $ 2. TOlal PA Taxable Interest Income. Add the amounts aboVe and enter on Une 2 of your PA tax retum. 2. $ PA Schedule B - PA Taxable Dividend InCllme Filing option 1. Enter the amount from your Federal Schedule B (Fonn 1040) or Schedule I (Fonn1040A). Filing option 2. PA Taxable Dividend Income. Read the Inatructlons. 1.1$ $ $ $ $ $ $ . S S S S 2. Total PA Taxable Dividend Income. Add the amounts above and enter on line 3 of your PA lax return. 2. S Important CapItal gam distributions are diVIdend Income for PA purposes. even though you report them on Schedule 0 for federal purposes. L 9901210014 9901210014 --I =~" .'", ~I~'"_UII......J~~_."< . __".L~.."",; -I PAI'SCHEDULE SP SpeC,'al. Tax Forglvenas. Crodll PA-40jSPj09i-99) 1999 PA DEPARTMENT OF REVENUE Nam~srZ" oog.ur PA~E:~tF~ Spouse's Name (e~en if filing separately): FftY J. PC-1Ft=€./( Part A. Type Flle~ for. Tax Forglvenea.. _ UNMARRIEO. Fill in :1I1is oval and II1e Unmarried or Separated oval on PA-40, Une 208. Also fiU in II1e appropnate oval below that descnbes yoor situation. c:::> Singl~..Unmarried on December 31, 1999. Fill in this oval if divorced. c:::> Singl~ and daimed as a dependent on my parents' PA Schedule SP. Enter your parents' Seeial Security Numbers and names. SSN: _ _ _ Nama: SSN:_'_'_ Name: _ SEPARATE!). Fill in, lI)is oval and 1I1e Unmairied or Separated oval on p...-4p, Une.208.1I ~ are separated pursuant to a \\Tillen agreemen~ or ~arried. but separated and living apart for the last. six months ol1999. . , c::::> DECEASED. i Fill in this oval II filing for a decedent: AlSo, fill in the Deceased oval on lihe 20a of your PA-40. c::::> MARRIED. Fill in thi.s oval and the Married oval on PA-40, line 2Oa, Also fill In the appropriate oval below that describes your situation. c:::> Married and. daimirig Tax Forgiveness together with my spouse. c:::> Marriild and filing separate PA tax returns. Enter spouse's Socia' Security Number and name above. c:::> Married with.a spouse who is a dependent on his or her parents' PA Schedule SP. Enter spouse's parents' Social Security Numbers and names. SSN: -, Name: SSN: == ,=, == ,Name: c:::> Married with a spouse who is a dependent on ine Fodera/Income Tax retum of another person. Enter 1I1e Social Security Number and name of II1e person claiming yoor spouse. SSN:_,_,_ Name: c::> Separated and living apart from my spouse. but for less than six months of 1999. Enter spouse's Social Security Number and name above. 9901120015 OFFICIAL USE ONLY Seeial Security Number: , 1'6? - 0'0 -3/~~ Spouse's Social Security Number: I?S -lfg - 4(1~S Part B. Dependent Children. Provide all the Infonnatlon for each dependent child. Attach addillonal sheets if needed. LIl .-'l C C N .-'l .-'l 2. Number of dependents for PA Schedule SP. Enter on PA-40. line 20b. ......................................... :i:! Part C. Eligibility Income. It filing as Unmarried, Separated, or for a Decedent. use the Your Income column. Q"'" If filing as Married, use the Your Income and Spouse Income columns. Add the totals and use the JOINT Income total. I Your Incom~ Spouse Inco~ 1. PATaxable Income from your PA-40. .................. 1. Sq.3q~ ~ CJ Report,income that is not taxable for PA purposes on Lines 2 through 10, See the instructions. 2. Nontaxable interest. dMdends, and gains. . . . . . . . . . . . . . .. 2. /1) 0 3. Alirnony. ........................................ 3. 00 4. Insurance proceeds and inheritances. . . . . . . . . . . . . . . . . .. 4. IJ 0 5. Gifts, awards, and prizes. ........................... 5. IIJ 6. Nonresident income. . .. . . .. . . . . . . . . . . . . . . . . . . . . . . .. 6. 0 01> 7. Nontaxable military income. Do Not Include Combat Pay. ... 7. 0 0 rJ 8. Nontaxable Gain from the sale of a residence. ........... 8. " OJ 9. Nontaxabie educational assistance. ................... 9. 0 0 0 10. Cllllh receipts, for personal purposes, from cutsIde your home. 10. 0 I'> 11. Tolal Eligibility Income. Add lines 1 through 10. Total Enteron PA-40, line 21. ............................ 11. Part D. Calculating Your Tax Forgiveness. 12. PA Tax Liability from your PA-40. Line 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 12. 13. Less Resident Credn from your PA-40, Line 23. ................................................... 13. 14. Net PA Tax Liability. Subtract Line 13 from Line 12. . . . . . . . . . . . . . . . . . . . . . .. ................ . . . . .. 14. 15. Peft:entage ofT.. Forgiveness using yoor dependents from Part B. Une2 and your Eligibility Irccmefrom PartC.l.i1e 11 -1/J.. . t> 16. T.. Forgiveness Credit. Multiply Line 14 by the decimal on Line 15. Enter on PA.40, Line 22. ........ 16.1 1. Dependent's Name Age Relationship Seeial Security Number Total Income . , , , , , . , Important: Only claim a child that you claim as your dependent on your Federal Income Tax return. 2.~ If filing as Unmarried or Separated or for a Decedent, use Eligibility Income Table 1. If filing as Married use Eligibility Income Table 2. ~ Total L 9901120015 9901120015 -..J ,~.~~. "',_J~--~ ~i'lIllII ~c PA SCHEDULE UE Allowable Employee Business Expenses P..40 UE 109-991 1 999 PA DEPARTMENT OF REVENUE ' OFFICIA_L USE ONLY ~ you incur expenses from more JI1an one job. you may make photocopies of this schedule or make your own schedules in this Ionnat Name of Taxpayer Claiming Expenses: Social Security Number: . F Y J. EL 6.1< /?s - g :"'4eeS Employer's Name: Emplo er's Address: p Employer's Federal 10 Number: OFAS ~PLOc..-C.H S ~.. TRl),cTVN Me;'\l)I~';COOI 57 - 07/7 S. Describe the duties of the job in which you incurred these expenses: Employer's Telephone Number: PR.OC.\J~fME.N-r TEe ,,)IC-14/J (?l ) "~o-SS38 Part A. Employee 'usiness E,xpensll!s. Caution. You maynotuse Line 401 Form 2106 or Form 2106EZ. You must itemize these expenses in Part G 01 this schedule. Vehicle Expenses. Standard Mileage Rate. Filing Tip. If you do not file Form 2106 .or 2106EZ, enter your total business miles _ and multiply by the federal standard mileage rate $0. _ ~nter the resu~ on Line 1. 1. Enterthe amount from your Form 2106 or Line 1 of Form 2106EZ. ..................................... 1. I Vehicle Expenses. Actual Travel and Mileage Expenses. 2, Enter the amount from your Form 2106. Make the f~lowing adjustments: . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . ., 2. 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 your depreciation expense and complete line- 5. ......,......,......................................... 4, 5. Depreciation Method. 6. Actual Travel and Mileage Expenses for PA Purposes. Total Lines 2, 3, and 4. .......................... 6. 7. Parking Fees, Tolls, and Transportation. Enter the amount from your FQnn 2106 or Form 2106EZ. . . . , . . . . . . . . .. 7. 8. Away From Home Ovemight. Enter the amount from your Form 2106 or Form 2106EZ. . . . . . . . . . . . . . . . . . . . . .. 8. 9. Meals and Entertainment Expenses. Enter the amount from your Form 2106 or Fonn 2106EZ. ................ 9. 10. Total Expenses for Part A. Add lines 1 or 6 and 7, 8, and 9. ......................................... 10. Part B. Direct Employee Business Expenses. lTl 11. Union Dues. List Union name(s) and amount(s) paid. Enter total. Attach additional sheets. if needed. 8 Name of Union(s) and amount(s). At: G E- o 12. Work Clothes and Uniforms. Required as a condition of employment and not suitable for everyday use. ~ Description: .-'I 13. Small Tools and Supplies. Required as a condition of employment and not provided by your employer. ~ Description: a'" 14. Professional License Fees, Malpractice Insurance, and Fidelity Bond Premiums. Required as a condition of YOLlr employment. Description: 14. .15. Total Expenses lor PartB. Add Lines 11.12,13, and 14. . . . ... . . . . . . . . . . . . .. .' . . lS. Part C. Office Or War!< Atea Expenses. You must answer ALL three questions or the Department will disallow your expenses. C1. Does your employer require you to maintain a suitable work area away from the employer's premises? ....... C1, ~ 1. YES C2. Is this work area the principal place where you perform the duties 01 your employment? ................... C2. c:::> 1. YES C3. Do you use this work area regularly and exclusively to perform the duties of your employment? . . . . . . . . . . . . .. C3. c:::> 1. YES If you answer YES to ALL three Questions. continue. If you answer NO to ANY Question. you may not claim at home expenses. Actual Office or Work Area Expenses. Enler expenses for the entire year and then calculate the business portion. a. Depreciation Expense (Homeowners only). ....................................................... a. b. Real Estate Taxes. .. .. . . . . . .. . . . . . .. .. . . . .. .. . . . .. .. . .. . .. .. .. . . . . . . .. . .. .. .. .. .. .. .. . .. .. .. b. c. Mortgage interest (Homeowners oniy). ........... _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. c. d. Utilities. .. _ . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .. d. .e. ~roperty Insurance. _...,.................................................................... e. f. Propeity Maintenance. Itemize the type and amount of maintenance expenses incurred: --I 9901710013 D B D ~3lJ IQQJ D D ;J3'f ~ 11. 12. 13. c:::> 2. NO c:::> 2. NO c:::> 2. NO f. D ll- Olher Apportionable Expenses. ~emjze the type and amount of these expenses: I~ g. h. Rent (Renters only). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. h. i. Total. Add Lines a Ihrough h. Enterthe total here. .................................................. i. j. Business Percentage 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. ................................ j. k. Apportioned Expenses. Multiply Une i by the decimal on Une j. ........... . . . . . . . . . . , . . . . . . . . . . K. I. Total Office Supplies. Itemize supplies you purchased exclusively for use in your office or work area. % I::=J B Total. I. .16. 16. Total Expenses for Part C. Add Lines k and l. L 9901710013 9901710013 --I Side 1 - ^ ........J~~ ~,.wi,~'~~~I'.........u""'I,._ ~. ~...til..k,,,,' PA SCHEDULE UE Ajl~~a'b'~e,!~~'ployee Business Expenses PA'40:UE':I09'99) , 1999 PA DEPARir"MfN;r!OF:REVENtJE Name of T(;lxpaye"!Clai~ing::Expenses: FAY -l,AE:Ir:-PCi. Part D. Mo~in9Expej:l~e$. . a. Enterfhe rit.i~be.r of iTIi1e~ from yo~r ol~ ~ome to your ne~ w~~p'la.c~. : . . . , . '.' .: . ... . . . . . . . . . . . . . . . . . . . ,. a. b. Enter. the nurober of mUes from your old home. to Y.oW.ol.d workplace. .. '. ".:. . , ".' : . . . . . . . . : . '. " . . . . . . . .. b: c. Subtract Une b rrom Une a and enter the difference. ............................ . . . . . . . . . If Une" c is 50 miles:or., more., cootinue. If not at least 50 miles. you may not claim moving _expenses. 17. Tran.'sportation ex.p. e~ses 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. To,,!' Exp~n~es;for Part D. Add Lines 17 and 18. ........................;....................... 19. Part E. E;ducatlj)ri'!!:xP1lnses. You must answer ALL three questions or the Department will disallow your expenses. EI. Did you,r e~pfoy~r :'or' a law require that you obtain this education to relain your' present position or job? . . . . . . . .. c::> 1. YES If you ans~er YES, co~ti'f'lue. If you answer NO, you may not claim education expenses. E2. Did ~ou need this education to meet the entry level or minimum requirements to obtain your job? . . . . . . , , . . . . .. c:::> 1. YES E3. Will jthis edueatio'ri 'prOgram or course of study qualify you fer a new business o:r profession? ,........,....... C=> 1. YES 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. 22. Tuition or fees. .............................................".....,..................... 22. 23. Course materials. ................,.....,.....,........................................... 23. 24. Travel expenses. ,..........................,..............,......................,...... 24. 25. Total Expense~for Part E. Add Lines 22, 23, and 24. ........ . . .. . .. .. ' . .. .. . ' . . . . .. .. . .. . . . .. ... 25. Part F. Depreciatioll Expenses. Do not include vehicles (use Pari A) and office or work area (use Part C) expenses. o ..... o o I'\J 'Cl ..... o II'" II'" .....J 9901820010 OFFICIAL USE ONLY, Social Security Number: 17S-Lf~ s miles miles miles c. B c:::> 2. NO c:::> 2. NO c:::> 2. NO .(a) D.escription of property (b) Cost or (c) Depreciation (d) Depreciation (e) Section 179 (n Expense other basis method deduction expense Add (d) +(e) 26. " To~1 Expenses for Part F. Add column f. ............................. ....... ................. 26. Part G. Miscellaneous Expenses. Itemize the type and amount of your.add~ional expenses, including expenses from Form 2106 or 2106-EZ. a L ~ ~ ~ c. ~ ~ e. e. 27. Total Miscellaneous Expenses for Part G. Add lines a through e. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 27. Total Allowable PA Employee Business Expenses. You must also account for reimbursements, if any. 28. Total expenses. Add Lines 10. 15, 16,19,25,26,and27. .......,................................, 28.1 :13'1- em 29. Reimbursements. Enter reimbursements that your employer DID NOT report as taxable wages on your Form W.2. '" , . . . . . . . . . . . , . . . . , , . . . . , , . . . . . . , . . . . . . , . , . . . . .. . . . . . . . . . . . . .. . . . . . ,. 29'1 =urn SO. Net Expense or Reimbursement..... . . . .... . . . . . . . . . . . . . . . . .... . . . . .. . . .... . . . .... . . . ..... SO. ;l31Fllli If Line 28 is LESS than Line 29, enter the difference on Une 30 and include on Une 1 b, 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 Une 1 a, Gross PA Compensation. on your PA-40. L 9901820010 9901820010 ....J Side 2 -"",_..~"~d.olllllWill~ ...~"'-~~~= . "~ "" .-.-J_~, ..:....J PA-40 C (() , Profit or' LQS8 from !;lulln... or Profession (SOLE PRO~RIET0F\SHIP) PAo4O C (09';97) , PA DEPARTMENT O,F Aew:N~E Attach 10 form PA-40, PA'$5 or PA.41 Name of ProprIetor" lihovin on PA: tax return. FAY Plu:; 9703110024 '*' 19qq oA:.lClAL USE ONLY SCHEDULE C A Di~ B Business Name ~ I Po S JtJ o Business address. (nu~r and stieet) ..Rl.~...N.<<~:r.~..~9.I.Al1&IY.~.i2nJ...fJ..o.~. City,StateandZJPCode:~ EN L. P ~S' E Method(s) used 10 value clO$lng inventory, fill.ln the approprtate oval: (1) C) Cost (2) c::l Lower, of cost or market (3) c::l O1her [~ other, attach explanation) F Accounflng method, fiU.1n thtI approprtate oval: 1) _ Cash (2) c::l Accrual (3) c::l 01her (specify) ~ ..................................... Yes No Social Security Number of Proprietor ; product or service ~ c c G Was there any change in delennlnlng quanflties. costs or valuations between opening and closing InvenlOty? _................................... If "Yes" attach explanation. H Did you ded!'cl ~~,for ~ p\fice In your home? ...,-..................-...;.........-........-..........................;...c.;.;..."........;.........-.- :T '\J ~ ~ -'I 8 -'I TI 9 ~ :'- 10 rfl 1 a GrOss rec8ipts:'Oi~I. ....~_.~.~....._.................:...~...~...............:...1 a b Returns and allowances ................................................................ lb () O/) c Balance (subtract line 1 b from line 1 a) .............................................................................................._ 2 Cost of goods sold and/or operations (Schedule Col, line 8) .........................._......................................... 2 3 Gross profit (subtract line 2 from line lc) .............................................................................................._ 3 4 Other Income (attach schedUle) I~ude Interesl from accounts receivable, business checking accounts, 4 and other business a~nts. AIs~ Include sales of operational assets. Se<j, InstructIons BooIdets. TO!aII~e(adQ",l!nE!!l,:3.i~ ~l. +:..........,.~.........;'..;.i..;.".;;,-;.;.."""..;,il.;.........,,;;.,...............-.......-~ ,t. t, . ~ .. .. I I" II , Advertising ..._______________._________._..._.....______ Atnortization ____......_.__._........~...__._________... Bad debts from sales or services .._____.______._ Bank charges .......................................... - Car and truck expenses ..........,___________....... Commissions ........_.._..._.______~_..________._____ 31 Wages .m................................... 32 Other expenses (specify): a.............................................. b.............................................. 12 Depletion ..____.__________.._..........__________._..... 13 Depreciation (explain in Schedu'- C.2) __...0000.. 14 Dues and publications _____00............_________... 15 Employ.. benefit programs _Illan on Uno 22 18 Freight (not included on Schedu'- 0-1) ...._.... 17 Insurance ..____.____._....__..........__.____...60.... 18 Interest on business indebtedness mu__un..... C.............................................. d e f 9 h 19 Laundry and cleaning ..u.________,_____........_.... 20 Legal and professional _ ................... 21 Office suppfles ....__._00____.........._._______...... 22 Pension end p",fit.sharlng plena fo< employees _ 23 Postage ................................................. 24 Rent on business property _..._~...m...____..... 25 Repairs ................................................. 28 Supplies (not included on Schedule C.l) ........ 27 Taxes __._.......___________.__........,__._____......._.. 28 Telephone ........._____.._____......~..__._______...... 29 Travel and entertainment ._.......,___._____......... 30 34 35 j .............................................. k I m .............................................. n .............................................. o .............................................. Utilities ........__...............__.... ___._.....__00____ Total deductions (add amounls In columns for Uoes 6 lhrou h 32r) and deduct Une 33. ___.00___._.........._..___.................._..... 34 Net profit 01 loss (subtract Une 34 from Une 5), Enler lotal here and on the appropriate line of PA tax relum. = If a net loss is shown. fill.in the 0\'81 and enter on the a r riate line of the PA tax return. _... .. ___............. ....___ _..._...... .35 p .............................................. q .............................................. r .............................................. RecLoe llllpOllSOS by Ihe lolaI business aed- 33 its_(for_.~ Ir<l!fllive PaymenlS CIedil} on your PA-lO, L 9703110024 9703110024 ...J ,....~~".""k-l.""'""",L>......~.....J....~Wi~I-", 1...., ",," "~ :lllil"",-J~" ~ SCHEDULE C ( I) PA-40 C .(094l7) Pol DEPARTMENT OF REVENUE 9703210022 I SocIal Security Number OFFICIAL USE ONLV I ""',' Inventqry at beginnlllg of year (If different from last year's closing Inventory, attach explanation) a Pure""",,s ........................................___..___.....___...__.................. 2a b Cost of Ilems w1ltldrawn for personal use ___......___._____...........___.___ 2b c Balance (subtract line 2b from line 2a) ..........________............____________...........___............___......___.______...... 2c 3 Cost 01 labor (do not Include salary paid to yourself) ..............__.........______.................___.......___...___.......___..__ 3 4 Materlals and supplies 4 . ' .________4.........______4~._......_._.~___.___4....__________._...._...44__44._~__._.........._.___.~..~~.__~__.__.~ 5 Other costs (all8ch sChedule) ............................___...................................._...___...........________........._....... 5 6 Add lines I, 2C, 3, 4 and 5 ....___.........................................___.......................___.............____...................._ 6 7 Inventory at end of year ........_.....................................___...........................................___...................____ 7 8 Cost of jlOQdS sold ~or OI"'ratlor)s,(~ub1raCI"Il~ ! f""" I/n~ ~), ~ter.~'! and !l" Pari '1. line 2"'-T"'~ . J. DoscripIion of property (a) (b) 1 Total additionlll first.year depreci'\tion (do nollncl.ude In illlms ~1oW) ;'" ,'" "I', "I ,I '\J '\J :J :J ~ '\J "r1 :J ---........................................- :"- 2 Other depreciation: Buildings ........._.______....4.... Furniture and fbctures ._m....... Transportation equipment..____. Machinery and other equipment OtIlar (spacify) ......__............ r .__...4........._.........___.....___.____ 3 Totals 3 4 Depreciation clalmed in Schedule 0-1 ........_........................_.___....................____..........................._....._ 4 5 Balance (subtract line 4 from line 3). Enter hera and on Pari II. line 13 ......................-.................--..-... 5 SCHEDULE C-3,' Expense Information I II you incur any of t/le expenses described belOW. unlllr lI1e amount of Ihe expense and describe lI1e kind. of COS1lllncurred and lI1e business purpose. Ex n_ Amount A. Entertainment facility (boat, rasotl, ranch. etc.) $ B. Living accommodations (except employees on business) $ C. Vacalions for yourself, your employees or tneir tamilie.. $ L 9703210022 9703210022 --.J Fonn W2 Wage and Tax itatement 1999 De.._ of... Treasury. ......., Revenue Service Fonn W2 Wage and Tax Statement 1999 De.._ of... Treasury. Internal Rev8nlHl ....... ...."'"""-,~ " .C~~ IdEmPO.......MC:IIIIHC.....,.1llftIb<< IQII.No.t~5-OOOI CSD109021 175-48-4005 . b ImpGyer idM'wdk:.ian numIMr t W"lI"o tips, lMtMr c.,.,...,.., 2 F..,.. __ fa. 1II1lhtMld 57-0717652 28226.09 4036.88 c~.rv.m..<<M"......wI~""'" ]~.IIC"""no-. 'SOc-'.lK:urlytuWlUlhHl DFAS OPLOC-CHAS (ZGT) 30994.09 1921. 63 1545 TRUXTUN AVENUE SUITE C 5 ....... WlIQH MId lips ......l..~ CODE P 30994.09 449.41 CHARLESTON SC 29405-1968 7 SOClIIfSRlPytlps . Aloe..... 0.00 0.00 ,~."ruam..__....lfldllpCooM IAdY_.Ell:pey9IW'I ta~c..tMndI. 0.00 FAY J PEIFFER Ua-llt.klduOIdlnboltt t. s.. NIn. far bolt t4 210 N ENOLA DR FL 2 X 10.00 ENOLA PA 17025"'2247 13SMiNlrs.fcrllPt3 D 2768.00 15 DSlIMWY 0......... 1iJ~ 0..... 1iI- ..- ~s"'.LD.1IlL 17 II.. ngn, tips..cc. 11 sra.incanw_ tI LodIly_ 20 LomI..... ... .. 21 LocaI-.n.W PA ...~~::-_ti~.1._ti_?_~_Q...__.__._._... 30994.09 867.87 HAMPDEN 30994.09 .............~Q.~.'-.!1.L ................ ........................................ ............-................... ..-........-............ .-.................................. 0.00 0.00 HAMPDEN 0.00 0.00 aConrrolilumlMi- Idi8'7-s0-"316'2--- -F-t~ CSD111995 b Employer ~""1UrJb<< tWagu,tips,OIhercllfflplnSltion 2 FMelWincllfNlIUwiltINtld 57-0717652 48933.86 8985.04 c &npIopn..... ---. and M.o:odII 3SCK:ia1S!1C\ri:y.... 4Sac:i11sec:urcytuwitl1hllld DFAS OPLOC-CHAS (ZGT) 54342.90 3369.26 1545 TRUXTUN AVENUE SUITE C 5 ........ .... Ind tips .......tu:~ CODE P 54342.90 787.97 CHARLESTON SC 29405-1968 7SOcl11MCUrily... .~.. 0.00 0.00 . EInpIayH'. nem.. ...... and Zip codII IAdot_ac:~ 10 hp...s.n: cw. bMdIs 0.00 ERIC S PEIFFER 128-*.indudldinbo.t t4$Hinstrs.fvrbo1it4 120 PJUu{VIEW aD X 10.00 NEW CIlMBERLND PA 17070-1733 tJ,S..instrs.kwballt3 D 5409.04 15[]: 0......... 1iJ~""'" O~ 1iI~ -:z tISt.. Ernpoyer, .If. LD. no. t7 $rill. wages. Iip$..c. 11 SI..inconMt.. 111 Loo:lily_ 20 Lacalwages,lips. lICe. 2tLoc:a1incOfMlu PA ..l9.:::~.?~~?~.Qnn__...... _n..5..~}~.?,};lQ.. 1521. 54 .~E'J:l~!i'_..... n._......5.~}~.?,.~Q 543.49 ...........m.. ..m.......... ---.......... ..................... 0.00 0.00 HAMPDEN 0.00 0.00 --1..-",-,. . Copy B To Be Filed With Employee's FEDERAL Tax Return This Intormdon Is being furnished to thelntemal Revemie Service. Copy B To Be Filed With Employee's FEDERAL Tax Rl!tum This information is being fllrnJShed to the Internal RevenUQ: Service. ~ 1040.: u:5."in"di~id~~-;oJ;;;Re= ~@99 FOf tM 'f8'II Jan. 1-0.::.31.1990. or other tax year boQlnni1a ** ECRLOT ** C-006 Ql 528 10 ERIC 5 & FAY J PEIFFER 120 PARKVIEW RD NEW CUMBERlND PA 17070-1733 Label (See instructions on page 18.) Use the IRS label. Otherwise; _ please print' 0< type, . Presidential Elecllon,Campalllll II. See a e 18..: r Filing Status'\~):J~ .l'll". . , ,..~-,;;~ . . -~'IJ~:S'" . .-~.:l,o\: Check only . '~~:i ~l~,. one box.. !.\~;i ~ d Total nomt:ier of:ex'em ions clatined ._". . ,:7:iW~-.llps.i.tc.~Form(s}W-2'~',f\:r}:, ,')"\V";;;~< . , Sa Taxable interest. Attach Schedule B If required . . b Tax-exempt interest. DO NOT include'oo nne sa . 9 Ordinary dIvidends. Attach Schedule B if required 10 Taxable refunds. credits. or offsets of state and focal income taxes (see page 21) 11 . A1imonY- . . , , . .... . . " .... . . .. . . . . .12 .' BuSiness income or (loss). Attach Schedule C Or C-EZ . . ..... . . . . . ., rJr~;;;'Csp/ta! ~ or\k>SS~Altach Sched~\, HI~Uired.1f not~eii~~.~ 0 ..-J~,...9'J1er~orO<>ss!'s).AIla.cl)FOITTI47n"._. .'.' . ,....... :,..; . . . . 15a i':'taiiRA'distnt.roons. ~ U bT~8mount{seepage22) 1& Total pensions and annuities l!~!-' U b Taxable amount (see page 22) 17 Rental real estat.. roya~ies. partnerships. S ""rporati'1'1". trusts. etc. Attach ~hedul. E 18 Fsrm Incom& 0< 0088). Attach- Schedule F. '~...:. '. '; , .;. .;. . . ; .'. .'. "... ..... . ~ 19 UoernpJoyn1ent compensation ., _ '..~ ... _' .. ..".... ....~. -4 -:..,. JO ._.. .. . :aOa SodaI oecu1ty beneflls . I 20a J J ' , I b Taxablunounl (see plIgO 24) ". . , "- , ,........,5T. '.'IIIlIfIll"" . 2.1., .flIll'!"lllCQffi8.L.isttypeaodamount,iseepag.24} "..-,r..'.!"... ..............~.. . .22'g;Adc:I~sinounlsinth.far htCOliiMforllnes7 . 21. 'RllS1s totallncome ~ ..'.. . <.".L"".:.' .. ~'..~1'~~" . ..7~"..,.. 23 ..'.~" ,~..(see page 26)~~V-:'-:'f;'~,"'" . --'-r.'~~ ."!'if': 24'''.' s!i&nt;.;." '!irterest ded~ Cs8e.tJl!e 26): 'y'~h<;; 14 211 Medical savings account deduction. Attach Form 8853. 25 26 Moving expenses. Attach Form 3903 .. . ... 26 27 O<"'chali of seH-<lmployment tax. Attacl\ Schedul. SE. 27 28 Self-employed heaJth insurance deduction (see page, 28) 28 29 K~h and self-employed SEP and SIMPLE plans 29 30 Penalty on early withdrawal of saving.s . 30 31 a Alimony paId b R~IOlent s SSN II- 31 a 32 Add lines 23 through 31 a, . 33 Subtract line 32 from line 22 TfJls IS ' our a.djusted gross incom.e For Oisclosure. Privacy Act, and Paperwork Reduction Act Notice, see page 54, , . exemptions If more than six dependents, see page 19. Income Attach Copy B of your Forms W-2 and W-2G here. Also attach Fann{s} l099-R If faX was wilIlheld. : If you did not get a W-2, see page 20, Enclose. but do not staple. any payment. Also. please use Fonn l040-V. Adjusted Gross Income '\0 '" .... '''~' , ~ ~ ,-'. ~ - I R 5 .",. 1",11I...11I...1...111......11I",1..11,..11...1,11I,..1,1..1 . Do ye.; want S3 to go to this fund? ;... . ..... '." ~~. Last name . (2J Ilepen<Ieo1rI IOCIaJ securIly oornbet . . .:' !M.~._'~.(:,: :c'/.,'j'j;" q, jo,.J. cfInll!':fl 011 k -, j'::~i c:b1dfofchildtn ." '-""0: ,~.."" , crtdIt see 1 -. l~wD'" o . lid aol 1In_ o yoo d.. tV dl..... D . or ..,.!>U.. , C.....Jl'9.1t) o D.p.ncflats 011 Ie D. not'tldiIrell above - Add ....b... ~ _ .ntare' 81 CI\ . L~~.; .1lI1i-ahYt_ ~ 8b o 9 10 11 12 13. 14 15b 1Gb 17 18 19 20b 21 :i2 D tJO ~ 32 33 o OD o 1040 \19'J'4J Cal No 12:)~<';G FCrnl ~, '',~~1:~c;t}rtmfs801.~d'" tfFoml .- . "':'-''',_..,~:.:. -7.~ ~':.' ,~. <. 48 Aiklii~<41ttiroL9h'47.~;Vq'~tOial';;~~$i:uJ.:;';~~1tfe~;i.. ,', .-49 SubimCiii";,r48from1lne40, tfiOO48'ISm6....thai>l(r1e'<40~(,i,j;;<;t~~... '. _ .__ _ ,. _._ .,' - ,_.. ,r,..._._ _,~ .-..._._ ~ , ___..".' , 00 Self-employment faX. Attach ScIiedul6 SE.. .' . . . " 51' Alternative minimum tax. Attach Fonn 6251' ... , 52 Social securfty and Medicate tax on tip iI)come not reported to emp!oy9r. Atta<;h Fonn 4137 53 Tax On IRAS~ other retirement Plans. and MSAs. Attach Forrr;' 532S if ~ . 54 Advance earned income croon payments from Form{s) W.2 ., 55 HouseI101d employment taxes. Attach Schedul<f H. :..,. .. 56 AQdrlf18S49 h 55. This is total tax. . ."" P!lyments. I)7.F~~~.~f)'omFonnSY':2~1099 .'..-_ .'f!t: . ."~ . Ss" 199!i~I..rtaxP8Yn- i1<l1.....i;f~~ffCtii199siiiitm' :~..li8 59a Earned Income credit. AlIach Scl1. ElC ~ i'OO have a qualifying child. b Nootaxablewnedincome:amounl . . ~ , . . r r and type ~ ...__.........__........m.._...m.m..m..._.. 60 Additional child tax credit. Attach Form 8812 . . . . . 61 Amou.nt. paid.wIth request for extension to file (see page _48) .62 exce;.;,soclaI. Security and RRTA tax withheld (see page 48) 63Olhei,~Ct.ecIr~from :aDFoon 2439 bD Foon4.1.36:' 64 Add 1lIies. 51. .58: 593. and' 60 63. TheSSare our to!liI Havetl directly deposited! .... b Routing number See pall" 48 and fin 1TI 661>." d Account number . . 66c. and 66d. 61 Amount of "no 65 Want APl'LIED TO YOUR 2000 ESTIMATED TAX .. 61 Amount 118 .. n IWM! 5615 m6fe'.iJW, fine 6.4;'~~ 54 ~Ii".; ~.Thls Isu;,; AMOUNT YOU oWE. . Y O. ...'~"~. For:;,;..:.J'~...."t...:.:.:.1 '''''' 49..'~.?'~.~',... '...:):..~.~~:~....; :;:<;fg':~',;.:~':r-.I,.~,:~'J"'.' ....:~. OU we ....~~i. ~,IoCl!'....onllVW opay~seepoge ~. .':jO"~' .:f.,'~"~"""""",...'~,,,,,,,,,~_,,,,,-;-;~,,, ~ iJfi .~'t<ix" .AisO'lncJudeonBnee8 ~'. : ::,t~.::.~. ,...... ''''.'.'-' .""" Sign u.-"..,...,. of l*IlnY.'- _,..... ~ this....., and ...i:oc.,;...,yIi1O ocl>OdufOSinl._.aOdt6 ...~cl mi'1iJiowledge'irid ' """.they ....._. corrnct, and "",""",,". 0ecIatati0n of P<.".,.... (other l11an _Is based on aI WonnalIon of which _ has any ~ Here yOur signature Your oCcupation . Daytime 'l~;epho~' ~~~~~ ~~ rreco~~rpadZs:.:o~~. sooos:'~a.~u~o ~ti~IAt.1S .;",. "'; .. ..... ".,.,. ,Jf.:.,. f.;.. P(lX:.uf'v,"..;,fC-r;,/,,) ~:an Preparer's SSN or PTIN Fonn 10<0 (1999) ,ax and Cr~dits Slandard Deduction for Most . People Single: $4.300 Head of household: $8.350 Manied. filing jointly or . auanry;ng . ; widow{er): ., $7,200 :~."'. 'separately: ~~~. ~~ .. '~.~:'. ,- Other Taxes Refund Paid Preparer's Use Only ..."..... . f.".'. .~~ ~,~ . ". ".." .......,;[;Z.'.2.. ." ,>i~:;:;'~, ~~".;:\~~~"" r~~ .-:;. , '.. 34 35a b 36 37 38 '" ,~, . " . .~.. ' :. '.,;.; :.~ ,~ ... ... 13C>d~ l>O Db () 65 66a ." .........,. If line 64 is more than nne 56, subtract line 56 ~m line 64. This ~ the'-~~t"You OVERPAID Amount of line 65 you want REFUNDED TO YOU" . . ." '" Prep8fer'S. ~ ' Slgnatur~ , FlfrT' '3 nar.e (or yours ~ If self'errPlo'/~) anfj a<:J(:lr~ss EIN ZIP code Check If S-elf-employ8'd LJ Fo"r'rrl' 1040 (1999) @ Prffl,od on nteYt;fod p/lpor .;; U.S GPO 1999 4SQ.536 'M~~""" _"""""""'-'-"-"-.''""~'",-,--.". SCHEDULES Ala (Form 1040) ~" " '" - ,-~" ~J.."<....", I Schedule A-Itemized Deductions OMB No. 1545-0014 '. '~@99 Attachment' Sequence No. 07 -Vour!socieI security number Ig'?:S-~:31(,~ OeoartlTl8f1t of It18 Treasury Intemal Revenue Service (P) Name(s) shown on Form 1040 ~RIC $. (Schedule a is on back) .. Attach to Fonn 1040. .. See Instructions lor Schedules A and B (Fonn 1040). Medical and 1 Dental 2 Expens~lI 3 '. .4 Taxes You S Paid .':-" .6. ..t ..~ .7 (See .~ : _A-2.)' 8 9 Interest., , . 10 You Paid. '.11. (See page A-3.) Note. Personal interest ~ . . not deductible" . . Gifts to Charity If you made.. gilt and got a benefit for it, see page A.4. Casualty and . Theil Losses .19 Job Expenses 20 and Most Otl1er Miscellaneous Deductions (See page A-5 for expenses 10 deduct here.) 23 24 2S 26 Olher 27 Miscellaneous Deductions Total Itemized Deductions tl"J FAY j. PE)FF~R Caution. Do not include expenses reimbursed or paid by others. Medieal and dental expenses (see page A-I . . . . Enter amount from Form 1040, Une 34. 2 00 Multiply line 2 above l;>y 7.5% (.075). . . . . .. 3 Subtract line 3 from line Vlnine 3 'ismdre th<in ilne 1, enter cO" State and local income taxes . .:'. I': .' '.' : .' S R6alestate taxes (see pageA-2) :.<.:>,:~: '."'.'. ,'6' . - . _' 't......-'1.::,",.,:....,>.,...I...'...~J-'~ '7 =::~~rtrtY~e:ndr,,'.irn;..,;~l~~ . YM_/~IM!~lit......~c.,..i~..jM.~1 Add1l!te$ S throu h ir. ... . . . . . . .'. . lfOineinOrtg3ge interest and points reported to you oIi Fol!!i.l09\l 10. HOiite iiK1rig.ge Interest not rSported to you on Form 100&. p8id . to the person from whom you bcught the _. see page A.3 and show that person's name, identifying no., and address ~ 12 Points not reported to you on Form 1098. See page A-3 for special rules. . . . .'. . . . . . . ., 12 Investment interest. Attach Form 4952 if required. (See page A-3.) . . . . . . . . . . . . . .. 13 Add line$ 10 through 13. . . . .'. . . . . . Gifts by cash or check. If you made any gift of $250 or more,seepageA-4 . ; .,. . . . . . . . Other than by cash or check. If any gift of $250 !Or more, see page A-4. Vou MUST attach Form 8283 if over $500 . Carryover from prior year Add lines 15 throuoh 17, . . . . . . . . . . .. ~1.f6' lb' 13 14 15 16 17 1B Casua or theft IO$$(es). Attach Form 4684. (See page A-5.) Unreimbursed employee expenses-job travel, union dues, job education, etc. Vou MUST attach Form :?106 or 2106-EeZ if.required. (See page A-5.).~ u..uuuu,u 21 22 Tax preparation fees . . . . . . . . . . . . Other expenses-investment, safe deposit box, etc. Ust type and amount ~......................................... QS7 00 o Addlines20through22. ... . . . . . Eritei amount from Flinn 1040, line 34. 24 Mu~iply line 24 above by 2% (.02) . . . . . 2S Subtract line 25 from line 23. If line 25 is more than line 23, enter -0- Other-from list on page A-6. List type and amount. ~ .............................. For Paperwork Reduction Act Notice, see Form 1040 instructions. ~fH 2B ..........................----.......--.....--...................---......,...--..............-- D e, Is Form 1040. line 34. over $126,600 (over $63.300 if married filing separately)? is! No. Your deduction is not limit. ed. Add the amounts in the far right column } ! for lines 4 through 27. Also, enter thiS amount on Form 1040, line 36. ~ 28 o Yes. Your deduction may be limited. See page A-6 for the amount to enter. 97g~ IQJ0 Sat No_ '~61'3Z Schedule A (Fonn 1040) 1999 ~'-~"r- _..~< ~~ ~ '. 1 - - ~ ,.,-""""""".J.,.;,,,,,",,m,,,.,'" ~ ,~ _A..... - ~'-..!ilJ;"""' Schedules A&B (Form 1040) 1m Name(s) shown on Form 1040. 00 not eo~er name and social sec:urity number if shown on other side, OMB No. 1545-0074 Page 2 Your soeial security number .: 7a At any time during 1999. did you have an intetest in or a signature or other authority over a financial account in a forei9n country. such as a bank account, securities account, or other financial account? See page B-2 for exceptions and filing requirements for Form TO F 90-22.1 b If "Yes," enter the name of the foreign country ~ ... ...... .. ....... ......... ...... ...... ....... 8 Durrng 1999. did you receive a distribution from. or were you the 9rantor of, or transferor to, a foreign trus:? If "Yes," you may have to file For'" 3520. See page B-2 . . . '. For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule 8 (Form 1040) 1999 @ Pnntt1d on reqcl~ paper Part I Interest (See page B-1 and the instructio~ for Form 1040, line Sa.) Note.lt.y<l\I received Herin. .' . 1099-INJ'ti'orin' ;. l09$-0ID. Or' . SubStItule',. - stat..;,.;"t from a bo'okerag<o firm. . rlSlthe firm's name as the payer and linter the total interest shown on that form. Part II Ordinary Dividends (See page El-l and the instructions for Form 1040, line 9.) Note. If you received a f:orm 10gg-DIV or substitute statement from a brokerage finn. list the firm's name as thEt payer and enter the ordinary cflVidends shown on that fonn. Part IH Foreign Accounts and Trusts ISee page B-2,) Attachment Sequence No, 08 Schedule B-Interest and Ordinary Dividends Note. If ou had over $400 in taxable interest, you must also complete Part III. 1 List name of payer. If any interest is from a seller-financed mortgage and the buyer uSed. the . property as a personal residence, see page B< 1 and list this interest first. Also, show that blJY8r's sO"ejal\Security number and address ~ Amount '. :::~N':'~~"~:fi;~4!"&li~t.i:~:~b~1l;:fA:::::::::::::: ...~~"j1t~..~~i!tI/.,4}'b*,!lI""'A"'''''''''''''''''''''''''''''' ..h. .. ..,h .-.~-~~..tJ.~~,"#,P.1A""'~':-""'''''''''''''- .Jl--___~.":I' .~r1'r.J.~. 1.f;I. -'-. 'J.~ -_.....:...:.-.:'T-. ..'.....11.......'... ..S~4. .,r.~"U~~_'. 1 . ,,~..P.II!'IJI:JIJot'''.,.~,...,..._,- : ::: :~: ::: :::: ::~~::: ::::::::::::::: :5:1~~~:i::~::::::~:::::: :::~:~: ::::~:::::: ~::::: . ';' . i_ ~~~~'~ r"'~'. ~h~ ~ ~'~ ~ ~:t.:-o..- -. -. -.-.. ~- - u - -- -- -~ _;_';_::o.u.. -.;.:-~ .... ------~-~ ,1.:"--- -.- -. -.. - --.. -- _.'._--- - -.... - ~ ~- -' -."......:..-. ..0;." -- - -.. - - ~_. ~.. ~-;: :;:;,;~..... -... -.... .~.:~-~ .~-.'; -: ~..-....~.....;.. --....... 1 ;1';.,...'1,-, -.r"" ~\.~ -. ~. ;;,." -,' ""~~, ._~ ....... _....... _.... _.. - _.. _.,,,,.,.0... _...... _.. ~ _.... ~ ~_....... _... ~..... "," _. _..... ~_..... _...................._ ........-...--..---..............-;..........----.---..._---_.........-..---..-.....--_..... ........___..._...____.h.............._...............__._......................_...______.. 2 Add. the amounts on line 1 . . . . . . . . . .'. . .'. . . . . 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 . . . . . . . . 4 Subtract line 3 from line 2. Enter the rBSU~ here and on Form 1040 line Sa ~ Note. If you had over $400 in ordinarv dividends, you must also complete Part III. 5 List name of payer. Include only ordinaIy dividends. If you received any cap~al gain diSiributions, see the instructions for Form 1040, line 13 ~ u... u......... 2 3 4 Amount . :: Ri;}~ -WN..::Giiif: :L:(:;;~ :'nWSM;: M;o::::::::: ::::: ::: ::::::::: ::!la:tJI .-.......... ...- --.......... -. -.. -.... -. ----.. -.- --~.... - -.- -.- -.... -- --. -. -. ____A. ._.______ . . 5 ..._u..~__................._._..._..._._.....I._...._.................___......._.........__ -.... ..... -.. -........... - ---....... -. -...-. .-- - -.... -.... - .-..... -. -. ---... ._~... -... ... -.. -. ---- -- --.. -... -..... -... -.-.-... - -.... -- -.. -. .---.. -.. .'- ... -. -- -.-.. .~._--~.._- - -. -... .... ...........____.__.......______...___.__....__......__._.....__..__-----.-.u.-.---------~--. - . ----------: "." --- -,-------...---- - .... .--- -.-.. ...-: -?------ -. .....- --_._-~...-.-._..-_._-_.. .. ... - ___ - - ... _..... .______~. _' ____ ._~__. ____....... .......... .... __ ____A. "'_'0" _.. ......... 6 Adci.iIieamoii;,i;;or..iine.5...E,;i;,~.itieioiaiiie~ea,;do;;Fo~;;i1.040:.li;,e9....~ 6 '7 a I x You must complete this part if you (a) had over $400 of interest or ordinary dividends; (hI had a foreign Yes No account: or lc) received a distribution from, or were a grantor of, or a transferor to, a foreign trust. . , r.' ''1-:-, ~:'::;-~}1:1 Profit or Loss From Business (Sole ProprietCl(sIlip) .... Partnerships. joint vef'mJl'es, etc., must rile Form 1065 or Form 1065.6, . II\tLal;:hnenl .. Attach to Form 1040 or Fonn 1041. ... See Instructrons for Schedute C (Form 1040). Secuence ....0. 09 Social security numbet (SSN) I S 0~S B E.nter code 'rom pa es C -, Ir 9 ~ S ~0 o Employer 10 number (UN). if any _"'h-"--'~'- >~ ~-~ '-"" ~" """""R"iI'lW' SCHEDULE C (Form 1040) :)""...tr-er-'~I"o:l'~."""y lrll:'ral ~~YE'''l;l' Sc'VItl' J. PE.IF':E./< Ei GoI'I'A~Y E Gross receipts Of.saIes Caution:" this it7come was l'e(Xltted to you on Form W.2 and the "Statu/a)' 0 employee" box on that form was checked. see page C-2 and check here . . . . . . ... 2 Returns and allowances . . 3 Subtract 6ne 2 from line 1 4 Cost of goods sold ffrom line 42 on page 2) 5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . 6 Other income. including Federal and state gasoline or fuel tax credit or refund (see page C.3) 7 ; Gross income. Add lines 5 and 6 . Elt nses. Enter ex nses for bUSiness use of 9 . ~ home on . on line 30. 19 Pens;on af1CI 1701. .shairg plans 20 Rent Ot lease (see page C-4): a Vetlcles. machinery. aoc ec~ _ b Other business 170perty _ Z1 Repairs and maintenance . 22 Su~es (r1tt irdu:led ir1 Part 10 23 Taxes and licenses. . . 24 Travel. meals. and enlertainmenc" a Travel. . . b Meals and en- tertainment . c ~nle- naocecuct. tlIe amounl in. cluceconine24b IseeP'!1eC.,) _ d Suarad Ii"a 24c !fern line 24b 25 Utilities . . . . . . 26 W;qs "ess mdoyner! credi:~ 27 Ot~er expenses ~rom line 48 on page 2) 8 Advertising....._ 9 Bad debts 'rom saleS or setvices (see page C 3) . _ '0 Car and trUck expenses (see page C- 3). . . Commissions and fees Depletion . . . . Depreeia.., and section 1 79 eApen5e OOdJdon (not included in Par111~ (see page C-ll . _ 13 '4 Employee benefit progams (other than on line 191. . _ Inslf"aoce {other than health) . Interest: . !b1gag> (paid to baOO. etc_) _ bOther. . . . . . 17 Legal and professional services .... 11 18 Office ex ense. . . 18 28 Total expenses before expenses for business use of home. 9 11 12 13 10 11 12 15 16 14 15 168 lib Add lines 8 through 21 in coumns Teftl8tNe profit {bssJ. Subtraclline 28 from line 7 Expenses for business use of ywr home. Attach Form 8829 Net. profit or (loss). Subtract line 30 from line 29. . ~ a prof.. emer on Form 1040,1ine 12, and ALSO on Schedule SE,1ine 2 (statutory employees. see page C.6). EstaOls and IJ1JSlS. enter on FOtm 1041. ~ne 3. . If a loss, y<xJ MUST go on to line 32. 32 tf yOJ have a loss. check rhe box that ~ibes your investment in thi<!; activity (see page C-6). . If yoo checked 32a, enter the loss on Form 1040. line 12. and ALSO on Schedule SE. line 2 (statutory employees.'see page C.GI. Estates and trusts. enter on Form 10,41. line 3 . if yoo checked 3ib. yCXJ MUST attach FormS19S. rot Paperwork Reduction Act Notice. see Form 1040 instructions. 29 30 31 Cat. '~o. ',33-'P . .. } } ,~ ---1,"-,~".; OU6 'Iu 1~4~.OOI4 <;'@99 U~) . 1 2 3 4 5 S 7 00 19 200 ZOb 21 22 23 24. 2ad 25 26 27 29 29 30 31 32a 5i:I All investment is at risk. 32bO Some investment is nor at risk. SChedYfe C (Form 10401 1999 ,~" -~~ " ~"~- " -' ~"""""",c, " Sche-ClJe C (fOln 'C4C) '999 to rmm Cost of Goods Sold (see paqe C-6) Poge Z 33 Melhod(s) usm 10 value clos'"g Invemo')' a 0 Cost Wa~ there any changQ III dclerm1nlllg quantities. costs. nycs. ~ allach explanatIOn . _ b 0 lower of cost or market c 0 Other fattach ~xPlanalion) or valuallons between opening and closing inventory'" If . . . . _ DYes D No 34 35 Inventory at begmnill9 of year, If diHerent from last year's closing invernory. attach explanatiOn 35 3& Ptlchases less cost 01 items withdrawn fOl' persooal use 36 31 Cost of lab<<, 00 nOl inclucle any amounts paid to ycusetf 37 38 Materials and supplies . 38 39 Other costs . . . . 39 40 Add Iilles 35 twoogh 39 40 41 Inventory 8t end of ye2f' 41 Cost of sold. Subtracl line 41 from line 40. Enter the result here aod On " line 4 42 Information on yOU' Vehicle. Complete this part ONLY if you are claiming car or truck expenses on line 10 and are not required to file Form 4562 for this business. See the instructions for line 13 on page C-3 to find 0L4 if you must file. 43 When did you place 'JOt.If >Jehicle in service for business purposes? (mooth. day. year) . .. _.. I ............ 44 Of the total number of miles you drove 'j04S vehICle during 1999. enter the number of mdes you used your vehICle for: a Business ..........._..........__........... b Commuting .........._...................... c Other 4S 00 you (or 'JCU spouse) have anoU1ef vehicle available for personal use? . _ Dyes DNa 48 Was pIf vehICle available for use wing o{f.duty hours? _ DYes DNa Ir "Yes." is the evidence written? . . . . . Other Ex s. Ust below busiress ex _ Dyes _ DYes S no! included on lines 8-26 or line 30. DNa 478 Do you have evlClence 10 support your deductIOn? D No 48 Total other expenses. Enter here and on p. . 1. lillC 27 48 Schedule C (form 1040) 19" @ ~I"'.""."",,,~~~ '",~,!..-'",,",'~- """"""<^.~ ~,~ ~ """",~L,,"~:,,, -'~...~ ~~~..........""." ,~ -'..' ~<<~~~ltI!ti~"-""""""'-' ~ , . DEPARTMENT OF DEFENSE ' ~<OV ~E. ~O ["0 . . CIVILIAN LEAVE AND EARNINGS STATEMENT 07/15/00 ~ ~<OV 0"'1 Visit the DPAS Web Site at www.dfas.mil . . 07121/00 lJ'lA"( 4 ~Av PlAHiGaAOE/SHP \ IlIlUIllVIDAt~~ ... TI 6 '''SIC or .Art , 'ASIC .<O~ ~oe<Ollh "OJ <oO....\.(OIAiIC.. PEIFFER ERIC S GS 12 06 28.03 27.36 54780.00 3714.00 58494.00 I SOC SIC '<<l 'lOC<o.,TY'>., 105U<oC",T(QOIIV 1 I $CD ~("vt .~ ....... .1...Y( eAJ'lIV 011(. I.J l(~(l Y;~1I3f;O 1 187-50-3162 6.78 E 08/19/83 240 14 ~1"-....cIAl '''-SflTUTICN .~, ... IS "J'lAN(:IA. INSr.rUT'OOl . "~lor"€J'lr ., 16 ',J'I....c....~ IJ'lSTlTUToC". "UO'''!NT U PNC8ANK. NA "TAl( MUIT..., ("tMPTIONS "'OO'l 18T"''' .....R"A. E"E"~TIOJ'lS '00' TAI(I-'iG "'UTIfO~,ry " CU"Ul"'TIIIE ~HI.!"E,,-r ~a MlllT"_V O!.CS" sr..TU5 STATU5 FEO S 1 421080 S HAMPDEN TS PA FERS: PA S 1348.12 " CURRENT YEAR TO DATE " GROSS PAY 2242.40 33953.60 TSP DATA EARNINGS FOR TSP CALC (CURRENT) TAXABLE WAGES 2018.16 30600.08 101: 2242.40 NONTAXABLE WAGES G FUND: 451: TAX DEFERRED WAGES 224.24 3353.52 F FUND: 101: DEDUCTI ONS 909.90 13770.96 C FUND: 451: EARNINGS FOR TSP CALC (YTD) AEIC 33535.20 NET PAY 1332.50 20182.64 CURRENT EARNINGS TYPE HOURS/DAYS AMOUNT TYPE HOURS/DAYS AMOUNT TYPE HOURS/DAYS AMOUN T REGULAR PAY 80.00 2242.40 DEDUCTIONS TYPE CODE CURRENT YEAR TO DATE TYPE CODE CURRENT YEAR TO DA TE FEGLI Yl 9.48 141. 43 FEGLI OPTNL BC 12.14 181. 50 MEDICARE 32.52 492.33 OASDI 139.03 2105.12 RETIRE. FERS K 26.91 399.23 TAX. FEDERAL 380.39 5797.61 TAX,LOC OCC 421080 10.00 TAX. LOCAL 421080 22.42 339.48 TAX, STATE PA 62.79 950.74 TSP SAVINGS 224.24 3353.52 LEAVE TYPE PRIOR YR ACCRUED ACCRUED USED USED DONATED/ CURRENT USE.lOSEI BAI.ANCE PAY PO no PAY PO YTO RETURNEO BAI.ANCE TERM DATE ANNUAL 240.00 8.00 112.00 42.00 310.00 174.00 SICK 1477.00 4.00 56.00 1533.00 RESTORED 8.00 8.00 01/12/02 COMPENSATORY 36.00 5.00 8.00 17.00 GF COMP TIME 1.00 1.00 HOLIDAY 8.00 32.00 REMARKS ENROLL IN TSP - DEADLINE 31 JUL IF YOU HAVE NOT DONE SO. PLEASE CUSTOMizE YOUR E/MSS PIN. TEMPORARY PINS ARE ONLY GOOD FOR 120 DAYS. IF YOU DID NOT RECEIVE A TEMPORARY PIN. CALL 1-800-390-2348. NEED TO CHANGE YOUR HOME ADDRESS? USE E/MSS. 16.00 COMPENSATORY TIME j ..,,/", ... THIS REPORT CONIAI"lI !"rl.Jl$l!.Iell~!! :10011;.\,1 ll,,! ."" ~F'I""'Io' "'10' OJ' 'j''''''.; ..-............ "'-~...,~'''~.-~''''~,._~~ -~ " ~. ..,~,.J.'~.;f~-',,,~, . ~ ~ ~ . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ERIC S. PEIFFER, Plaintiff v. ) ) ) ) ) ) ) NO. 2000-471 - CIVIL TERM FAY J, PEIFFER, Defendant CIVIL ACTION - LAW IN DIVORCE CERTIFICATE OF SERVICE I, Cindy S. Conley, Esquire, counsel for Eric S. Peiffer, Plaintiff in the above-captioned action, hereby certifY that a tIDe and correct copy of the foregoing Plaintiff s Pretrial Statement Pursuant to Pa, R.C.P. 1920.33(b) was served upon Michael L. Bangs, Esquire, counsel for Defendant, Fay J. Peiffer, by depositing same in the United States mail, first class, on August 17, 2000, addressed as follows: Michael L. Bangs, Esquire 302 South 18th Street Camp Hill, P A 17011 Date: '7 ~ o?aJO Cindy S. Conle squire HOWETT, Kl SINGER & CONE Y, P.C. 130 Walnut Street P.O. Box 810 Harrisburg, P A 171 08 Telephone: 717-234-2616 Counsel for Plaintiff, Eric S. Peiffer " , c-.- " , .--0"'.' "~ -,; '~_.', .- Eo _. ~"' _I ~;.;., , MICHAEL L. BAN6S ATTORNEY AT LAW 302 SOUTH 1STH STREET CAMP HILL, P A 17011 PHONE 717-730-7310 FAX 717-730-737f E-mail.:bangsllaw(a)oaonlline.com August 21, 2000 E. Robert Elicker, II, Divorce Master Office of the Divorce Master 9 North Hanover Street Carlisle, P A 17013 RE: Peiffer v. Peiffer No. 2000-471 Civil Dear Mr. Elicker: Enclosed you will fmd Defendant's Pretrial Statement. I will supplement this with Defendant's Expense Statement upon receipt. A true and correct copy of this document has been provided to opposing counsel as of this date. IW:: y Michael 1. Bangs wsc Enclosure cc: Mrs. Fay J. Peiffer Cindy S. Conley, Esquire PEIFFER PRE-TRIAL STATEMENT { AUGUST 18, 2000 IDlSK 25 . < vs. ) ) ) ) ) ) ) ) ~I ~~/OU[(, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ERIC S. PEIFFER, Plaintiff NO. 2000-741 CIVIL TERM FAY J. PEIFFER, Defendant CIVIL ACTION - LAW IN DIVORCE DEFENDANT'S PRETRIAL STATEMENT PURSUANT TO P A RC.P. 1920.33(b) I. ASSETS Marital Assets Value 1. Marital residence; sale proceeds $9,650.00 2. Increase in value of Husband' s retirement $75,055.00 3. Increase in value of Wife's retirement $24,831.00 4. Husband's 1996 Honda Accord $6,000.00 5. Wife's 1997 Honda Civic $6,000.00 6. Increase in value of Husband's life insurance $2,203.00 7. Increase in value of Husband's stock portfolio $3,299.00 8. Husband's stock portfolio acquired during marriage $4,067.00 9. Husband's Harris certificate of deposit acquired during marriage $2,300.00 10. Personal property Unknown Date of Valuation Current Current Current Current Current Current Cu..rrent Current Current '" PEIFFER PRE-TRIAL STATEMENT I AUGUST 18, 2(KIO I DISK 25 1 I I . , II. WITNESSES A. Fay Peiffer B. Eric S. Peiffer Defendant does not intend to call any expert witnesses but reserves the right to do so. III. EXHIBITS Defendant anticipates stipulating to many ofthe values but in the event that stipulation cannot occur, then appropriate exhibits will be presented. IV. DEFENDANT'S GROSS INCOME In 1999, Defendant's gross income was $30,994.09. She has received a cost ofliving increase this year. V. EXPENSE STATEMENT OF DEFENDANT Will be provided. VI. PROPOSED RESOLUTION Defendant is to receive the house proceeds and sixty (60%) percent of all other assets and Plaintiff is to receive forty (40%) percent. Defendant to receive alimony for a period of five years in an amount of $680.00 per month. ~L MICHAEL 1. BANGS Attorney for Defendant/ 302 South 18th Street (/ Camp Hill, P A 17011 (717) 730-7310 Supreme Court ID #41263 " >- " ~- - .-, ". -<- -.- _ _ '0'_ ~_~" _ .. _ .. ,. ~.. 'I 'J ~ PEIFFER PRE-TRIAL STATEMENT I AUGUST 18, 2000 I DlSK:aS .... > , , I I II t:1. i CERTIFICATE OF SERVICE I HEREBY CERTIFY that I have this day served the foregoing Defendant's Pretrial Statement by depositing a copy of same in the United States mail, postage prepaid, at Camp Hill, Peunsylvania, addressed to the following: Cindy S. Conley, Esquire Howett Kissinger & Conley Post Office Box 810 Harrisburg, P A 17108 DATE: ~ ,. , ~ , Ii 'I j;, " ~j 11 [I ~ -" - --.~ 's;'_-._ ,,' -" - -" ~-',.- _ '.-""'''' ..1,-;", ,.,;-' h.' "j I i:i I, , ;': ]'1 'I LAw OffiCES Of HOWETT, KISSINGER & CONLEY, P.C. 130 WALNUT STREET POSTOmCEBOX 810 HAItRISBURG, PENNSYLVANIA 17108 !,I :! JOHN C. HOWETI, JR. DONALDT. KISSINGER CINDY S. CONLEY DARREN J. HOLST (717) 234-2616 FAJ< (717) 234-5402 l' , , 1 , ;-1 :'1 DEBRA M. SHIMP Legal Assistant August 24, 2000 rl 'I :,! :-, 1 " , Robert E. Elicker, II"Divorce Master 9 N. Hanover Street Carlisle, PA 17013 I , :i ;! Re: Peiffer v. Peiffer Docket No. i I I i 1 I II , I ! I I , 'I I Oil ;] Dear Mr. Elicker: Please be advised that in the expense portion of the Pre-Trial Statement I filed on behalf of my client, Eric Peiffer, in the above-referenced case there is a typographical error. I indicated that the milage on Mr. Peiffer's vehicle is 8,500 when in fact the milage is 85,000 as of the date contained thereon. I apologize for this error. By a copy of this letter to Michael Bangs, Esquire, Ms. Peiffer's attorney I am likewise advising him of this error. Thank you for your consideration of this matter. I look forward to receiving a notice of a settlement conference. Very truly yours, ~C- CSC/slc cc: Michael L. Bangs, Esquire Eric S. Peiffer - , . c ~.~. ". -. - ~, = ~ ~^" , '''',,",,'x- ~ ".-'~ -, "4__ 0'" - iiilliIiil ,,' ',,", ";j ,.. PEIFFER QDRO f APRIL 9, 2002/ DISK 44 r , . . ,~ .." FAY 1. PEIFFER, ) IN THE COURT OF COMMON PLEAS Plaintiff ) OF CUMBERLAND COUNTY, ) PENNSYLVANIA vs. ) ) NO. 2000-471 CIVIL TERM ERIC S. PEIFFER, ) Defendant ) CIVIL ACTION - LAW ) IN DIVORCE ) DOMESTIC RELATIONS ORDER AND NOW, this ~ day of f.)~ , 2002, it is hereby ordered and J directed as follows: I. This Order creates and recognizes the existence of an Alternate Payee's right to receive a portion of the Participant's Thrift Savings Plan (hereinafter referred to as "TSP"). It is intended to constitute a Court Order acceptable for processing by the Federal Retirement Thrift Investment Board. 2. The Participant's name, mailing address, Social Security Number, and date of birth are: Eric S. Peiffer 120 Parkview Road, New Cumberland, P A 17070 SSN: 187-50-3162 DaB: 09/05/1962 3. The Alternate Payee's name, mailing address, Social Security Number, and date of birth are: Fay 1. Peiffer Post Office Box 484, Sunnnerdale, P A 17093-0484 SSN: 175-48-4005 DOB: 01/12/1955 4. The Participant is the owner of a certain TSP account as a result of his employment with the United States Government. 1; "* ,'- . il......... '" ",_ -",q ';' -'-'-'"~ "--' C" ,--~. . . ~i 'tl- ~f ~p l>)~ , , ~~ .. ,.- , ~." ,. -~' '.- ... , '. t! - PEIFFER QDROI APRIL 9, 2002 {DISK 44 " , . . ,. j" 5. This Order relates to the provision of the marital property rights to the Alternate Payee as a result of a Marital Settlement Agreement dated November 1, 200 I, which was incorporated by reference in the Decree of Divorce dated December 4, 2001, said terms incorporated herein by reference. 6. The Alternate Payee is entitled to receive $27,401.00 from the Participant's TSP. 7. The Alternate Payee, who also is a government employee and is the owner of a Thrift Savings Plan, is to receive the $27,401.00 from Participant's TSP directly as a rollover from his TSP into Altemate Payee's TSP. 8. The Court shall retain jurisdiction with respect to this Order to the extent required to maintain the status of the Court Order acceptable for processing and the original intent of the parties as stipulated herein. Further, the Court shall retain jurisdiction to enter such further orders as are necessary to enforce the award to Alternate Payee of the Participant's TSP as awarded herein. J. -- ~: ::~l': ~~~; ~~,~' L., C) -, C UJ ;-;....il' ,-- tL o a'l IJ: -- ;::~. .s,. 0.:! ~.~ ..:.::;: :;:~ ;") -:'12 (~j aJ ~~~CL. -:J b n ,...,- L) CJ "4 C> =,o,~,~_>" . - . ... , ':.. ., .,., " PElFFERQDROI APRlL9, 2002/DISK44 ," : , FAY 1. PEIFFER, Plaintiff ) ) ) ) ) ) ) ) ) IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. ~IDV=2000-471 CIVIL TERM ERIC S. PEIFFER, Defendant CIVIL ACTION - LAW IN DIVORCE I I, ~ I ~ ! fi I n i'I Ii I ! I I i i1 ,! :1 " I ! I, ,j I 11 ~ i ~ '~ STIPULATION The parties hereto, by and through their attorneys, hereby stipulate as follows andrequest that the attached Order be entered as a Domestic Relations Order in accordance with the following: 1. The parties entered into a Marital Settlement Agreement dated November 1, 200 I, which was incorporated but not merged into a Decree of Divorce dated December 4,2001. 2. Under the terms of the Marital Settlement Agreement, the parties agreed that Plaintiff/Wife Fay 1. Peiffer is to receive the snm of $27,401.00 from the Thrift Savings Plan (hereinafter referred to as "TSP") of DefendantlHusband Eric S. Peiffer. 3. The parties agree that the attached Domestic Relations Order accurately and completely reflects their agreement and request this Court to enter that as an Order so that the TSP may be transferred to Wife. IN WITNESS WHEREOF, the parties hereto have executed this Stipulation the j / II--- day of r 'CO ~..--q .:::~o !_~::;~'l (~S8 ..... = C~ ....... U, f'T1 "D C:l;:;:;'1 c;P'I~ 0:0 ;:~~ P1 :J> M_.';D w <=' w -,,'~-"," -, ~-~ (n r.' ~~~"^ , "' ~-~ -......... ,. , ". " () CJ ~ c:: r" ~ <::> ~:j "1Jc:r_~ ("J .;;Q fflrl1 '--I 'f", 2::0 i<,on :;;<'C- CJ ~~~ -";.-~- ',~;C"~ r-'e' '" ~~i~ ~f~ ::1::;: )>c .:y -7 cO".,) J~'" ?:J ~~ (fl -<