HomeMy WebLinkAbout00-04314
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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
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STATE OF
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Peter A. DeLorenzo
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Plaintiff
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VE;RSUS
DeBBie I YelgrsRzg
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Defendant
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AND NOW,
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PENNA.
No, 2000-4314
DECREE IN
DIVORCE
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DECREED THAT
Peter A. DeLorenzo
, PLAINTIFF,
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AND
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DpT,ol"pn7.0
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, DEFENDANT,
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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.
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The Marital Settlement Agreement, dated March 7, 2003, is incorporated
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herein by reference but is not merged i
Decree.
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PROTHONOTARY .
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NUUUTALSETTLEMENTAGREEMENT
THIS AGREEMENT, made this 1 day of ~/LJ.003, by and between
I PETER A DELORENZO, hereinafterreferred to as "HUSBAND", and DEBBIE L
DELORENZO, hereinafter referred to as "WIFE",
WITNESSETH, That:
WHEREAS, the parties hereto are husband and wife, having been lawfully joined in
marriage on June 19, 1976, in Westbury, New York;
WHEREAS, two (2) children were born of this marriage being Lauren A DeLorenzo,
born June 19, 1986, a minor residing with Wife, and Jason S, DeLorenzo;
WHEREAS, it is the intention of the parties to settle fully and finally their respective
financial and property rights and obligations as between each other arising out of the marriage
relationship or otherwise, including without limitation (1) the settling of all matters between them
relating to the ownership ofreal and personal property; (2) the settling of all matters between
them relating to the past, present and future support and/or maintenance of HUSBAND and
WIFE; (3) the settling of all matters between them relating to the past, present and future support
or maintenance of their minor child, and (4) the settling of all matters between them relating to
any and all rights, titles and interests, claims and possible claims in or against the estate of the
other.
NOW THEREFORE, with the foregoing recitals being hereinafter incorporated by
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I reference and deemed an essential part hereof in consideration of the foregoing recitals, the
, mutual promises, covenants and undertakings herein set forth, and for good and valuable
consideration, receipt 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:
SECTION I
GENERAL PROVISIONS
. 1. ADVICE OF COUNSEL
HUSBAND and WIFE declare that they have each had a full and fair opportunity to
I obtain independent legal advice of counsel of their selection, WIFE has been independently
I represented by Barbara Sumple-Sulliv!ln, Esquire, HUSBAND has been independently
, represented by Edward 1. Weintraub, Esquire, Each party further declares that they are executing
this Agreement freely and voluntarily, having obtained such knowledge and disclosure of their
legal rights and obligations, Each party acknowledges that this Agreement is fair and equitable
and is not the result of any fraud, coercion, duress, undue influence or collusion,
Both parties further acknowledge and agree that each has fully disclosed their respective
financial situations to the other, including their assets, liabilities and income, Each of the parties
acknowledge and agree that, after having received such information and with such knowledge,
this Agreement is fair, reasonable and equitable and that it is being entered into freely, voluntarily
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and in good faith and that the execution of this Agreement is not the result of any duress, undue
influence, coercion, collusion and/or improper or illegal Agreement.
2. PERSONAL RIGHTS
HUSBAND and WIFE may and shall, at all times hereafter, live separate and apart, Each
shall be free from all control, restraint, interference or authority, direct or indirect, by the other in
all respects as if she or he were unmarried, except as may be necessary to carry out the provisions
of this Agreement. Each may reside at such place or places as she or he may select. Each may,
for his or her separate use or benefit, conduct, carry on and engage in any business, occupation,
profession or employment which to him or her may seem advisable, This provision shall not be
taken, however, to be an admission on the part of either HUSBAND or WIFE of the lawfulness
ofthe causes which led to, or resulted in, the continuation oftheir living apart, HUSBAND and
WIFE shall not molest, harass, or malign the other or the respective families of each other, nor
compel the other to cohabit or dwell in any manner with him or her, nor in any way interfere with
the peaceful existence, separate from each other.
3. FINANCIAL DISCLOSURE
The parties have fully disclosed to each other the extent of each other's income, assets,
liabilities, holdings and estate, Each party warrants that the information provided has fully and
accurately described the extent of his or her holdings, Each of the parties acknowledge that he or
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she is aware of his or her right to seek discovery including, but not limited to, written
interrogatories, motions for document production, depositions, and other means of discovery
available through the Pennsylvania Rules of Civil Procedure. The parties acknowledge that they
have had the right to have property fully appraised, Each party is fully satisfied that no additional
information is necessary for the execution of this Agreement.
4. MUTUAL CONSENT DIVORCE
The parties intend to secure a mutual consent, no fault divorce pursuant to the provisions
of Section 330l(c) of the Divorce Code of 1980, as amended and will execute the documents
necessary to effectuate a divorce under those provisions concurrently with the execution ofthis
Agreement.
5. SUBSEQUENT DIVORCE
A decree in divorce, entered by the court of Cumberland County, shall not suspend,
supersede or affect the terms ofthis Agreement. This Agreement, and the terms and conditions
contained herein, as well as the enforcement of said terms and conditions, shall not be contingent
upon the granting of a Divorce Decree to either party by the Court of Common Pleas of
Cumberland County, Pennsylvania, or any other Court of competent jurisdiction. This Agreement
shall remain in full force and effect even if the parties reconcile, cohabit as HUSBAND and WIFE,
or attempt a reconciliation. This Agreement shall continue in full force and effect and there shall
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not be a modification or waiver of any of the terms hereof unless the parties, in a writing signed
by both parties, execute a statement declaring this Agreement or any term of this Agreement to be
null and void, Both parties hereto agree that this Agreement may be incorporated by reference
but shall not be deemed merged into any judgment or decree for divorce obtained by either party,
6. OTHER DOCUMENTATION
HUSBAND and WIFE covenant and agree that upon request of the other party, they will
forthwith execute and deliver to the other party, any and all written instruments, assignments,
releases, satisfactions, deeds, notes or such other writings as may be necessary or desirable for the
proper effectuation of this Agreement.
7. MUTUAL RELEASES
Except as otherwise expressly provided by this Agreement,
A 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 may have or at any time hereafter have 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, agreements and obligations of whatsoever nature arising or which may arise
under this Agreement or for the breach of any provision thereof. Neither party shall have any
obligation to the other not expressly set forth herein.
B, 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 or otherwise, whether now existing or hereafter arising, The above release shall be
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effective regardless of whether such claims arise out of any former or future acts, contracts,
engagements or liabilities or the other or by way of dower, curtesy, widow's rights, family
exemption or similar allowance, 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 or the United States, or any other
country, It is expressly understood, however, that neither the provisions of this release nor the
subsequent entry of a divorce decree are intended to defeat the right of either party to receive any
, insurance proceeds at the death of the other of which she or he is the named beneficiary (whether
the beneficiary designation was made prior or subsequent to execution hereof), nor to defeat the
right of either party to receive any legacy, bequest or residuary portion of the other's estate under
I his or her will, or to act as personal representative or executor if so named by the will of the
, other, whether such will was executed prior or subsequent to this Agreement.
C. Except for any cause of action for divorce which either party may have or claim to
I have, and 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.
8. SUCCESSOR'S RIGHTS AND LIABILITIES
This Agreement shall, except as otherwise provided herein, be binding upon and inure to
the benefit of the parties hereto, their respective heirs, executors, administrators, successors or
I assigns,
I 9, SEVERABILITY
If any provision in this Agreement is held by a court of competent jurisdiction to be
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I invalid void or unenforceable, the remaining provisions shall nevertheless continue in full force
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and effect without being impaired or invalidated in any way.
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10. ENTIRE AGREEMENT
HUSBAND and WIFE do hereby covenant and warrant that this Agreement contains all
of the representations, promises and Agreements made by either of them to the other for the
purposes set forth in the preamble hereinabove; that there are no claims, promises or
representations not herein contained, either oral or written, which shall or may be charged or
enforced or enforceable unless reduced to writing and signed by both of the parties hereto.
11. BINDING EFFECT OF AGREEMENT/W AIVER
This Agreement shall remain in full force and effect unless and until terminated under and
pursuant to the terms of this Agreement.
The failure of either party to insist upon strict performance of the provisions of this
Agreement shall not be construed as a waiver of any subsequent default of the same or similar
nature, nor shall such failure be construed as a waiver of any other term, condition, clause or
provision of this Agreement.
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12. BREACH
If either party breaches any provision of this Agreement, 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, and the party breaching this contract shall be responsible
for payment of reasonable legal fees and costs incurred by the other in enforcing their rights under
this Agreement.
13. CONTROLLING LAW
This Agreement shall be construed and governed in accordance with the laws of the
Commonwealth of Pennsylvania,
14. TAX RETURNS
The parties agree that in the future if any penalties or interest or any liability for failure to
I declare income or the wrongful claiming of any deduction shall be assessed by the United States
I Internal Revenue Service or the Commonwealth of Pennsylvania, or any other state as a
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I consequence of the parties' Federal and State income tax returns which were filed jointly by the
I parties, said tax, penalties or interest shall be the sole responsibility of HUSBAND, inasmuch as
he was the sole wage eamer, and shall be paid solely by him. HUSBAND hereby covenants and
agrees to hold WIFE harmless from any penalty, interest or liability for such reason arising out of
the filing or failure to file any past tax return.
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SECTION II
EQUITABLE DISTRIBUTION
During the marriage, the parties have accumulated various assets and liabilities, the
disposition of which is intended as follows:
1. ASSETS
A. PERSONAL and HOUSEHOLD PROPERTY
HUSBAND and WIFE do hereby acknowledge that they have heretofore divided the non-
marital and marital personal and household property, including but without limitation, jewelry,
clothes, furniture, and other assets, HUSBAND agrees that all assets in possession of WIFE shall
be the sole and separate property of WIFE and, WIFE agrees that all assets in the possession of
HUSBAND shall be the sole and separate property of HUSBAND. The only exception thereof is
that WIFE shall make available to a representative of HUSBAND, within thirty (30) days of the
date of this Agreement, for his pick up at the marital home, the following additional items of
personal property which shall include:
Oriental Rug;
Secretary;
Liquor Cabinet; and
Charcoal Picture by Husband's Brother.
In the event HUSBAND's representative does not pick these items or take possession of
these items within the allotted time period, HUSBAND forfeits his rights to said property.
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Each of the parties do hereby specifically waive, release, renounce and forever abandon
whatever claims, if any, he or she may have with respect to any of the above said items which are
the sole and separate property of the other. This document shall constitute a bill of sale for said
sole property,
B. REAL ESTATE
The parties jointly own property at 1830 Signal Hill Drive, Cumberland County,
Pennsylvania, Said house is encumbered by a mortgage held by Waypoint Bank (Account No,
005008718), WIFE desires to maintain said home and reside therein. HUSBAND agrees to
convey all his rights, title and interest in this real estate to WIFE, HUSBAND agrees to execute a
Deed concurrently with execution ofthis Agreement for recording, WIFE shall be fully
responsible for any past, present and future principal, interest, penalties and costs as well as any
; taxes, insurance and/or any debts associated with the real estate, WIFE hereby agrees to
indemnify and hold HUSBAND harmless for any and all liability as a result of non-payment ofthe
mortgage or any other obligations as enumerated above associated with the real estate, WIFE
shall have HUSBAND removed from the mortgage obligation through release, refinance or sale of
the property on or before December 31, 2004. For 2002 and pending refinance, WIFE shall claim
all mortgage interest paid,
The parties acknowledge that they have in the past maintained life insurance to cover the
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mortgage indebtedness in the event of either's passing. Both parties agree to maintain coverage
on their lives sufficient to cover the outstanding mortgage amount. Each party shall designate the
mortgage company or the other party as beneficiary on their respective policy, with his or her
estate listed as additional beneficiary to receive any proceeds in excess of the amount then
outstanding on the mortgage at the time of death, Proof of existence of this coverage shall be
exchanged between the parties annually on the anniversary of this Agreement and up until
HUSBAND is released from the current mortgage, Each party shall pay the costs of each
respective individual policy,
C. MOTOR VEmCLES
There is one vehicle which is jointly owned by the parties, Said vehicle is a 1995 Chrysler
New Yorker. Said vehicle is not encumbered. The parties acknowledge that WIFE shall retain
sole possession of said vehicle. HUSBAND agrees to cooperate to effectuate transfer of the title
of said vehicle to WIFE.
D. MARITAL FINANCIAL ACCOUNTS
At the time of HUSBAND's separation from the marital home, the parties had the
following accounts:
PNC, Account No. 50-0081-1666
PNC Account No, 50-0093-5693
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PNC Certificate of Deposits - 31600171783
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31200172000
Harris Savings/Waypoint, Account No, 320300216
These accounts have been closed and divided between the parties, Each party shall be the
sole owner of such sums in their possession at that time of execution of this Agreement
Additionally, each party shall keep as their separate asset all interests generated on these cash
accounts since date of separation.
E. RETIREMENT AND EMPLOYMENT BENEFITS
1. 401(K):
HUSBAND has earned certain employment and retirement benefits through his
employment at Rite Aid Corporation. This includes a 40l(K) Plan, HUSBAND agrees to
execute an immediate rollover of the sum of ONE HUNDRED THOUSAND DOLLARS
($100,000,00) from the 40l(K) account to WIFE. This rollover shall be made by a Qualified
Domestic Relations Order drafted by counsel for WIFE at her cost The sums shall be transmitted
to WIFE's qualified account. However, HUSBAND agrees to give WIFE inunediate notice of all
communications he may receive from Rite Aid concerning the timing of distribution of her
separate account
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2, Miscellaneous Accounts:
The parties additionally had the following accounts:
MFS Union Brokerage, Account No. CPS-000479574;
Evergreen Funds, Account No, 825-1008289344; and
Prudential Discovery Select Annuity Plan.
The parties agree that these accounts shall be the sole and separate property of
HUSBAND, WIFE releases and waives any claims thereto,
3, mAs:
Each party has an IRA account with PNC Bank Said accounts (WIFE's Account No.
7400004401 and HUSBAND's Account No, 7200004489) shall each become the sole and
separate property ofthe respective account holders. Each party waives any and all claim to the
other's account.
4. Social Security Benefits:
The parties agree that subject to the rules and regulations of the Social Security
Administration, each of the parties shall continue to be eligible for social security benefits to
which he or she would be qualified as a party to a divorce after a marriage often (10) years or
more in duration.
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F. STOCK OPTIONS:
During the marriage and prior to the parties' separation, HUSBAND had acquired certain
stock options for the Rite Aid Corporation, the value of same is speculative. These options
consist of fifteen thousand (15,000) shares at FIVE DOLLARS and 375/100 ($5.375) (issued on
or about November 12, 1999), If Rite Aid determines whether to issue cash or stock
automatically, The procedure for division of the asset between HUSBAND and WIFE shall be as
follows: If Rite Aid provides cash, HUSBAND shall deliver to WIFE her one-half (1/2) of the net
profit, together with the supporting documentation, within ten (10) days of his receipt of the
money, If Rite Aid issues stock, HUSBAND shall either (1) sell the stock within thirty (30) days
at its going market rate and deliver to WIFE her one-half(1/2) of the net profit, and supporting
documentation, within ten (10) days of the date of sale; or (2) elect to hold the stock for which
HUSBAND agrees to forward the cash equivalent of WIFE's one-half(1/2) of the net profit and
supporting documentation within ten (10) days of his declared intention to retain the stock. In all
occasions, WIFE shall receive fifty percent (50%) of the net profits realized from the stock option
after the calculation that provides for an equal sharing of all applicable taxes. Net profits is
defined as the amount due after payment of all applicable taxes. WIFE shall receive one-half (1/2)
of the net profit in all cases.
G. EE BONDS:
The parties have also accumulated certain savings bonds, These bonds shall be the sole
property of HUSBAND. WIFE shall deliver said bonds within twenty (20) days of the date of
execution of this Agreement.
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H. CASH PAYMENT TO WIFE
HUSBAND agrees to pay to WIFE the sum of TWEL VB THOUSAND DOLLARS
($12,000.00), HUSBAND shall make said payment to WIFE within twenty (20) days of the date
of this Agreement.
I. INSURANCE
Each party shall retain ownership of any life insurance policy in his or her name, It is
further agreed that HUSBAND shall maintain a life insurance policy in the sum of not less than
THIRTY-TWO THOUSAND DOLLARS ($32,000,00) on himselffor the benefit of WIFE and
the parties' minor daughter. WIFE shall be named as irrevocable beneficiary up to and including
July 1, 2004 when her alimony and child support payments actually end in accordance with this
Agreement. HUSBAND shall provide WIFE proof of the existence of this insurance and her
designation of beneficiary upon execution of this Agreement and each anniversary date thereof
2. DEBTS
Each party represents that they have not contracted any debt or liability for the other for
which the estate ofthe other party may be responsible or liable except as otherwise provided
herein, and that except only for the rights arising out ofthis Agreement, neither party will
hereafter incur any liability whatsoever for which the other party or the estate ofthe other party
will be liable, Each party agrees to indemnity and hold harmless from and against all future
obligations of every kind incurred by them, including those for necessities.
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To the best of the parties' knowledge, the parties affirm no other joint debts exist and all
joint credit cards are terminated.
SECTION ill
CHILD SUPPORT, ALIMONY
1. CHILD SUPPORT
HUSBAND shall pay child support consistent with the terms of the Order entered by
Agreement of the parties dated July 22,2002, which incorporates the memo dated June 27, 2002
of the HUSBAND's counsel. This requires HUSBAND, inter alia, to pay as child support, the
sum of ONE THOUSAND DOLLARS ($1,000.00) per month. HUSBAND shall also pay within
ten (10) days of receipt of any bonus, fifteen percent (15%) of the net bonus received or earned
by him until June 25, 2004. HUSBAND shall notify WIFE in writing of the actual receipt of any
bonus within ten (10) days thereof WIFE retains all her current rights to enforce any failure by
HUSBAND to make the bonus payment through Domestic Relations and the Court of Common
Pleas of Cumberland County. HUSBAND shall also provide to WIFE's counsel a copy of his last
pay stub for 2003 and July 30, 2004, to verify the reporting of any bonuses earned or received.
HUSBAND shall carry health insurance on the minor child and pay eighty-five percent
(85%) of all unreimbursed medical, dental, prescription and psychological expenses for the child,
HUSBAND's obligation to carry health insurance for the child shall continue until her nineteenth
(19th) birthday or until age twenty-three (23) if she is enrolled in post high school education,
whichever is later. If she is enrolled in college or other post high school education in conformity
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with HUSBAND's insurance company's bylaws, HUSBAND will provide insurance until she
drops out, fails out or graduates before age twenty-three (23),
In addition to basic child support, HUSBAND agrees to pay sixty percent (60%) of all
costs incurred for extracurricular costs of the parties' minor child, including car, social or other
necessary expenses, which expenses are incurred by joint written agreement of the parties and
which expenses are reasonably necessary to allow the parties' daughter to enjoy the standard of
living which she experienced prior to the parties' separation. At the time Lauren reaches the age
of eighteen (18), all requests for additional assistance on extracurricular costs of the daughter
shall occur directly between her and HUSBAND,
2, ALIMONY
HUSBAND agrees to pay to WIFE the sum of ONE THOUSAND DOLLARS
($1,000.00) per month as alimony through July 1,2004, This award shall be non-modifiable in
amount or duration. This amount shall be paid through Domestic Relations of Cumberland
County and shall only terminate in the event of HUSBAND's or WIFE's death.
3. CUSTODY
Custody shall be consistent with the terms ofJudge Oler's Order dated May 10, 2000,
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4, COLLEGE EXPENSES
Both parties shall use their best efforts based on financial resources and income to assist
their children with their post high school education,
SECTION IV
1. CONDITION PRECEDENT TO THE AGREEMENT'S EFFECTIVENESS
The parties acknowledge that this Agreement shall become effective when actually signed
by both parties. ~
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COMMONWEALTH OF PENNSYL V ANlA
COUNTY OF \O(ll."-0-~
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Before me, the undersigned officer, a Notary Public in and for said Commonwealth and
County, personally appeared PETER A. DELORENZO, who being duly affirmed according to
law, deposes and says that the facts and matter set forth in the within and foregoing Marital
Settlement Agreement are true and correct to the best of his knowledge, information and belief.
Affirmed and subscribed to before me this 1;3 +-'" day of fY\o. vcl, , 2003,
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NOT YP LIC
My commission expires:
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Nola rial Seal
Misty [l, Lol1m"", Nole-ry Public SEAL)
Harris,bu,rg, Dauphin County
My Commission Expires Aug, 2, 2004
COMMONWEALTH OF PENNSYL V ANlA
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COUNTY OF CUMBERLAND
Before me, the undersigned officer, a Notary Public in and for said Commonwealth and
County, personally appeared DEBBIE I. DELORENZO, who being dilly affirmed according to
law, deposes and says that the facts and matter set forth in the within and foregoing Marital
Settlement Agreement are true and correct to the best of her knowiedge, information and belief.
scribed to before me this ~day of ~ Ad--
,2003,
(SEAL)
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PETER A, DelORENZO
Plaintiff
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IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO, 2000-4314
.
.
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.
.
DEBBIE I. DelORENZO,
Defendant
.
CIVil ACTION. lAW
IN DIVORCE
.
PRAECIPE TO TRANSMIT RECORD
To the Prothonotary:
Transmit the record, together with the following information, to the court for entry of
a divorce decree:
1. Ground for divorce: irretrievable breakdown under Section 3301(c) of the
Divorce Code.
2. Date and manner of service of the complaint: Acceptance of Service signed
by opposing counsel July 13, 2000.
3. Date of execution of the affidavit of consent required by Section 3301 (c) of
the Divorce Code:
by plaintiff: March 13, 2003.
by defendant: March 13, 2003.
4. Date plaintiff's Waiver of Notice in Section 3301 (c) Divorce was filed with the
Prothonotary: Signed by Plaintiff March 13, 2003 and sent for filing via mail on March 17,
2003.
5. Related claims pending: None.
6. Plaintiff and Defendant have signed a Marital Settlement Agreement dated March
7,2003.
WHEREFORE, the Court is requested to enter a Final Decree in Divorce in
compliance with Section 3301 (c) of the Divorce Code and Pa. R.C.P. 1920.42(a)(1) and
to incorporate the terms of the Marital Settlement Agr e in accor nce with Section
301 (a)(1) and (4) and 401 (b) of the Divorce Code.
Dated: 5!lq fro
PLAINTIFF'S SOCIAL SECURITY NUMBER: 067-44-6901
DEFENDANT'S SOCIAL SECURITY NUMBER: 110-48-6944
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PETER A, DelORENZO * IN THE COURT OF COMMON PLEAS
Plaintiff * CUMBERLAND COUNTY, PENNSYLVANIA
* NO, .;{Ooa -4'311..\ c./v11
vs, *
*
DEBBIE I. DelORENZO, * 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
annulment may be entered against you by the Court, A judgment may also be entered
against you for any other claim or relief requested in these papers by the Plaintiff, You
may lose money or property or other rights important to you, including custody or
visitation of your children.
When the ground for the 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 Court House, 1
Court House Square, Carlisle, Pennsylvania, 17013-3387.
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 LAWYER REFERRAL SERVICE
2 LIBERTY AVENUE
CARLISLE, PA 17013
(717) 249-3166
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PETER A, DelORENZO
Plaintiff
*
*
*
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PlENNSYlVANIA
NO. .:2<J-ov - '1.3 / 'I ~ -r.P-<-
vs,
*
DEBBIE I, DelORENZO,
Defendant
*
*
*
CIVIL ACTION - lAW
IN DIVORCE
COMPLAINT UNDER !i3301
OF THE DIVORCE CODE
1. Plaintiff is Peter A. Delorenzo, who currently resides at 531 Bedford
Road, Mechanicsburg, Cumberland County, Pennsylvania, 17055,
2. Defendant is Debbie I. Delorenzo, who currently resides at 1830 Signal
Hill Drive, Mechanicsburg, Cumberland County, Pennsylvania, 17055.
3, Plaintiff has been a bona fide resident of the Commonwealth of
Pennsylvania for a period of more than six (6) months immediately preceding the filing
of this Complaint.
4. The Parties were married on June 19, 1976,
5. Neither Plaintiff nor Defendant is in the military or naval service of the
United States or its allies within the provisions of the Soldiers' and Sailors' Civil Relief
Act of the Congress of 1940 and its amendments.
6. There has been no prior action for divorce or annulment instituted by
either of the parties in this or any other jurisdiction,
7. The 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.
. ~
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COUNT I.
REQUEST FOR A No-FAULT DIVORCE
UNDER ~3301 (c) OF THE DIVORCE CODE
8. The prior paragraphs of this Complaint are incorporated herein by
reference thereto.
9. The marriage of the parties is irretrievably broken.
10. After ninety (90) days have elapsed from the date of the filing of this
Complaint, Plaintiff intends to file an affidavit consenting to a divorce. Plaintiff
'believes that Defendant may also file such an affidavit.
WHEREFORE, if both Parties file affidavits consenting to a divorce after ninety
'(90) days have elapsed from the date of the filing of this Complaint, Plaintiff
I
I respectfully requests the Court to enter a Decree of Divorce pursuant to Section
'3301 (c) of the Divorce Code,
COUNT II.
REQUEST FOR A No-FAULT DIVORCE
UNDER ~3301 (d) OF THE DIVORCE CODE
11 . The prior paragraphs of this Complaint are incorporated herein by
reference thereto,
12, The marriage of the Parties is irretrievably broken.
13. The parties are living separate and apart and at the appropriate time,
Plaintiff will submit an affidavit alleging that the Parties have lived separate and apart
for at least two years as specified in Section 3301 (d) of the Divorce Code,
WHEREFORE, Plaintiff respectfully requests the Court to enter a Decree of
Divorce pursuant to Section 3301 (d) of the Divorce Code.
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COUNT III.
REQUEST FOR EQUITABLE DISTRIBUTION OF MARITAL PROPERTY
UNDER ~3323, ~3501, ~3502 and ~3503
OF THE DIVORCE CODE
14, The prior paragraphs of this Complaint are incorporated herein by
reference thereto,
15, Plaintiff requests the Court to equitably divide, distribute or assign the
martial property between the parties without regard to marital misconduct in such
proportion as the Court deems just after consideration of all relevant factors.
WHEREFORE, Plaintiff respectfully requests the Court to enter an order of
equitable distribution of marital property pursuant to Sections 3323, 3501, 3502 and
3503 of the Divorce Code,
COUNT IV.
REQUEST FOR APPROVAL OF ANY SETTLEMENT AGREEMENT
AND INCORPORATION THEREOF IN DIVORCE DECREE
UNDER SECTION 3104
OF THE DIVORCE CODE
16, The prior paragraphs of this Complaint are incorporated herein by
reference thereto.
1 7, The public policy of the Commonwealth of Pennsylvania encourages
parties to a marital dispute to negotiate a settlement of their differences,
18. While no settlement has been reached as of the date of the filing of this
Complaint, Plaintiff is and has always been willing to negotiate a fair and reasonable
settlement of all matters with Defendant.
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19, To the extent that a written settlement agreement might be entered into
between the parties prior to the time of hearing on this Complaint, Plaintiff desires that
such written agreement be approved by the Court and incorporated in any divorce
decree which may be entered dissolving the marriage between the parties.
WHEREFORE, if a written settlement agreement is reached between the Parties
prior to the time of hearing on this Complaint, Plaintiff respectfully requests that,
pursuant to Section 3104 of the Divorce code, the Court approve and incorporate such
agreement in the final divorce decree.
BY:
EDWARD EINTRAUB, ESQUIRE
2650 North Third Street
Harrisburg, PA 17110
(717) 238-2200
10#17441
Ca L~ eD
Date:
ATTORNEY FOR PLAINTIFF
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VERI FICA TION
I, Peter A, Delorenzo, hereby swear and affirm that the facts contained
in the foregoing Complaint for Divorce are true and correct and are made subject to the
penalties of 18 Pa. C.S. Sec. 4904 relating to unsworn falsification to authorities.
Date:
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PETER A, DeLORENZO * IN THE COURT OF COMMON PLEAS
Plaintiff * CUMBERLAND COUNTY, PENNSYLVANIA
*
VS, * NO, 2000-4314
*
DEBBIE I. DeLORENZO, * CIVIL ACTION - LAW
Defendant * IN DIVORCE
AFFIDAVIT OF CONSEffi
1. A Complaint in Divorce under Section 3301 (c) of the Divorce Code
was filed on June 26, 2000.
2. The marriage of Plaintiff and Defendant is irretrievably broken and
ninety (90) days have elapsed from the date of the filing and service of the Complaint.
3. I consent to the entry of a final decree in divorce after service of notice
of intention to request entry of the decree.
I verify that the statements made in this affidavit are true and correct. I
understand that false statements herein are made subject to the penalties of 18 Pa.C.S.
Section 4904 relating to unsworn falsification to authorities.
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Barbara Sumple-Sullivan, Esquire
Supreme Court #32317
549 Bridge Street
New Cumberland, P A 17070
(717) 774-1445
PETER A. DeLORENZO,
Plaintiff,
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYL VANIA
v.
NO, 2000-4314
DEBBIE L DeLORENZO,
Defendant
CIVIL ACTION - LAW
DIVORCE
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under Section 330l(c) of the Divorce Code was filed on
June 26, 2000,
2, The marriage of the Plaintiff and Defendant is irretrievably broken. Ninety days
have elapsed since the filing and service of the Complaint.
3. I consent to the entry of a final decree of divorce after service of notice of
intention to request entry of the decree.
4, I understand that I may lose rights concerning alimony, division of property,
lawyer's fees or expenses in do not claim them before a divorce is granted,
5. I verify, that the statements made in this affidavit are true and correct. I understand
that false statements are made subject to the penalties of 18 Pa, C.S,A. Section 4904 relating to
unsworn falsification to authorities.
DATE:'~~~~~
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DEBBIE L DELORENZO
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PETER A, DelORENZO . IN THE COURT OF COMMON PLEAS
Plaintiff . CUMBERLAND COUNTY, PENNSYLVANIA
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VS, . NO, 2000-4314
.
DEBBIE I, DelORENZO, . CIVil ACTION - lAW
Defendant . IN DIVORCE
WAIVER OF NOTICE OF INTENTION TO REQUEST
ENTRY OF A DIVORCE DECREE UNDER SECTION 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 I do not claim them before a divorce is granted.
3. I understand that I will not be divorced until a divorce decree is entered
by the Court and that a copy of the decree will be sent to me immediately after it is filed
with the prothonotary.
I verify that the statements made in this affidavit are true and correct. I understand
that false statements herein are made subject to the penalties of 18 Pa.C.S, Section 4904
relating to unsworn falsification to authorities.
Date: 3\13 \t>}
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Barbara Sumple-Sullivan, Esquire
Supreme Court #32317
549 Bridge Street
New Cumberland, P A 17070
(717) 774-1445
PETER A DeLORENZO
Plaintiff,
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYL VANIA
v,
NO. 2000-4314
DEBBIE L DeLORENZO,
Defendant
CIVIL ACTION - LAW
DIVORCE
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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 I do not claim them before a divorce is granted,
3, I understand that I will not be divorced until a divorce decree is entered by the
Court and that a copy of the decree will be sent to me innnediately after it is filed with the
prothonotary.
I verifY that the statements made in this affidavit are true and correct. I understand that
false statement herein are made subject to the penalties of 18 Pa.C,S, 94904 relating to unsworn
falsification to authorities.
DATE ?:Jd-'4\O~
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DEBBIE I. DELORENZO
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PETER A, DeLORENZO * IN THE COURT OF COMMON PLEAS
Plaintiff * CUMBERLAND COUNTY, PENNSYLVANIA
*
vs, * NO, 2000-4314
*
DEBBIE I. DeLORENZO, * CIVIL ACTION - LAW
Defendant * IN DIVORCE
ACCEPTANCE OF SERVICE
I hereby C1ccept service of the Complaint in Divorce on behalf of my client
Debbie /, DeLorenzo, which was filed on June 26, 2000, to the above referenced term
and number, and certify that I am authorized to do so,
DClted:~7rlJ)
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Keirsten Davidson, Esquire
RECEIVED
"Ill 1 2 2000
JOHNSON. DUFFIE
STEWART AND WEIDNER
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HUSBAND'S SOCIAL SECURITY NUMBER: OCol - \.i L{ - ~qa I
WIFE'S SOCIAL SECURITY NUMBER: , \0 - Y<6 ~ loCi '-ILl
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Plaintiff
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DEBBIE I. DELORENZO,
Defendant
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IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 2000-4314
CIVIL ACTION - LAW
IN DIVORCE
ORDER OF COURT
AND NOW, this ~6~day Of~~
hereby made into an Order of Court.
, 2000, the attached Agreement for Support is
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By: Keirsten W. Davidson
J.D. No. 78243
301 Market Street
P. O. Box 109
Lemoyne, Pennsylvania 17043-0109
(717) 761-4540
Attorneys for Defendant
PETER A. DELORENZO,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 2000-4314
v.
CIVIL ACTION - LAW
DEBBIE I. DELORENZO,
IN DIVORCE
Defendant
AGREEMENT FOR SUPPORT
Plaintiff, Peter A. DeLorenzo, by and through his attorney, Edward J. Weintraub, and Defendant,
Debbie I. DeLorenzo, by and through her attorneys, Johnson, Duffie, Stewart & Weidner, hereby enter into
this Agreement for Support and agree as follows:
1. Plaintiff in the above-referenced divorce action is Peter A. DeLorenzo, hereinafter referred to
as HUSBAND. HUSBAND is currently residing at 5260 Simpson Ferry Road, Mechanicsburg, Pennsylvania
17055. HUSBAND'S Social Security Number is 067-44-6901.
2. Defendant is Debbie I. DeLorenzo, hereinafter referred to as WIFE. WIFE is currently
residing at 1830 Signal Hill Drive, Mechanicsburg, Pennsylvania 17055. WIFE'S Social Security Number is
110-48-6944.
3. HUSBAND is employed with Rite Aid Corporation and has a net monthly income for support
purposes of $5,313.12.
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4. WIFE is unemployed and has been for the past approximately 14 years of the parties'
marriage. WIFE, however, is certified as an RN, and the parties have agreed that her earning capacity is
$900.00 per month for support purposes.
5, The parties are the natural parents of one (1) minor child: Lauren Ashley DeLorenzo, age 14,
wh9se date of birth is June 19, 1986.
6. The parties agree that HUSBAND shall pay child support in the amount of Nine Hundred and
Twenty Eight ($928.00) Dollars per month until Lauren turns 18 years of age or graduates from high school,
whichever occurs later.
7. The parties agree that HUSBAND shall pay spousal support in the amount of One Thousand
Fifty ($1,050.00) Dollars per month pending the issuance of a final Decree in Divorce.
8. In addition to the above-referenced support figures, the parties acknowledge that WIFE is
entitled to a mortgage contribution from HUSBAND, which shall be $159.00 per month.
9. In summary, HUSBAND'S monthly support obligation shall be as follows:
$928.00 I mo. - child support
$1,050.00 / mo. - spousal support
$159,00/ mo. - mortgage contribution
$2,137.00/ mo.
10. HUSBAND shall pay the above support amounts to WIFE on a biweekly basis ($986.00 /pay),
coinciding with each of his 26 pay dates, but no later than two (2) days after his pay date. For example, if
HUSBAND receives his paycheck on Thursday, he shall make the above payments to WIFE no later than
Saturday. All payments shall be made directly from HUSBAND to WIFE, and WIFE agrees that no wage
attachment shall issue. In the event that HUSBAND is delinquent for a period of 10 days, he shall be in
contempt of this Agreement and WIFE shall have the ability to enforce this Agreement through either the
Domestic Relations Office and/or the Courts of Common Pleas of Cumberland County.
11. In addition to the above, HUSBAND shall pay to WIFE 30 percent of all net bonuses and
stock option proceeds he receives within 10 days of his receipt of the same.
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12. The parties acknowledge that HUSBAND carries health, medical, and dental insurance for
the parties and their two (2) children. HUSBAND shall continue to maintain such insurance for WIFE until
the divorce is finalized, and for the parties' children for as long as they are eligible. Any and all
unreimbursed health I medical I dental I orthodontic I psychological expenses I prescriptions and co-pays
shall be allocated between the parties in proportion to their net incomes. HUSBAND shall be responsible for
85% of such unreimbursed expenses and premiums, and WIFE shall be responsible for 15% of the same.
WIFE shall submit receipts for such expenses to HUSBAND at the end of each month and HUSBAND shall
reimburse WIFE for 85% of the expense no later than the fifteenth (15'h) of the following month. For
example, WIFE shall submit all September receipts to HUSBAND no later than the last day of September.
HUSBAND shall reimburse WIFE for 85% of those expenses no later than October 15'h.
WIFE has accumulated several such unreimbursed expenses since the parties separated at the end
of March 2000, which bills total $1,183.09 and are attached hereto as Exhibit "A". With the exception of the
orthodontist bills for the parties daughter which total Four Hundred ($400.00) Dollars, the parties agree to
defer allocation of these bills until equitable distribution. HUSBAND shall provide WIFE with 85% of the
orthodontist bills, or $340.00 no later than December 15, 2000. Payment shall be made directly to WIFE.
13. This Agreement shall be effective immediately. There are no arrears other than those
specified in Paragraph 12 above.
14. The parties agree to file a joint tax return for the year 2000 and further agree that any refund
be used to pay the parties local taxes first, and then any remaining balance should be equally divided
between the parties. Any and all liabilities should be allocated in proportion to the parties' net incomes, 85
percent belonging to HUSBAND, and 15 percent belonging to WIFE. The parties specifically reserve the
right to seek a different allocation of liability (if there is any) at equitable distribution. If WIFE fails to file a
joint tax return for the year 2000, this Agreement shall be retroactively amended as an unallocated order of
child support and spousal support I APL, thereby enabling HUSBAND to deduct all payments to WIFE and
requiring that she report all payments to her as income.
15. Commencing in the year 2001, if WIFE is not employed HUSBAND shall be entitled to claim
both children as dependents for income tax purposes. If WIFE is employed, the parties shall each claim
one child as a dependent for income tax purposes.
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16, The parties intend that this Agreement shall be made into an Order of Court,
~!1/4~fc1
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DeObie I. Delorenzo
'vi. ~ /I/~I/OO
Date
:137810
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S~P-B1-00 87:49 AM CONNER APICELLA ASSOC.
717 6'97 7584
P.02
Financial Detail
* Conner-Apicella Orthodontic Associates *
Report Date: 09/01/00
Patient Name: Delorenzo. Lauren A
Address: 1830 Signal Hill Drive
Mechanicsburg, PA 17055
Account iI:
Balance:
Due Now:
12141
400.00
.00
Date
Description
SP Payments
Charges Pay Method
---------------------------------------~----------------~-----------------------
03/11/99 Starting Records 1 195.00
03/30/99 Dr. A case discussion 1 .00
06/03/99 Payment: 1833 1 -195.00 Check
06/16/99 VISA/Me PAYMENT 1 -545.00
06/16/99 Phase II 1 1985.00
08/09/99 Payment: 1872 1 -80.00 Check
09/13/99 Payment: 1897 1 -80.00 Check
10/11/99 Payment: 1909 1 -80.00 Check
11/05/99 Paymen t : 1932 1 -80.00 Check
12/07/99 Paymen t : 1951 1 -80.00 Check
01/11/00 Payment: 1976 1 -BO.OO Check
02/08/00 Payment: 2000 1 -80.00 Check
02/29/00 Payment: 2019 1 -80.00 Check
03/27/00 Paymen t : 2035 1 -80.00 Check
05/12/00 Payment: 1'024 1 -80.00 Check
12.'141'9-1 Payment: 1043 r./IZ/co 1 -80.00 Check
07/14/00 Paymen t : 1058 1 -80.00 Check
OB/10/00 Paymen t : 1075 1 -80.00 Check
_____M__________________________________________________________________________
TOTALS 1235.00 1635.00
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DATE: 04/19/00
DAW: 0 OAYS:~ ;q'O"REFILLS LEFT
DELORENZO;.QEB'BIET'. ....'
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RPH: JEH
U&C: $ 43,69
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Cashier #48186369 4/07/00 6:41PM
1 SCA~IiiIPHARMACY
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Register #1 Transaction #109571
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RITE REWARD SAVINGS
Customer 10: <Associate~
1 DIMETAPP ELIXIR 40Z 4.79
Re ula 1 1 5.99
at Rite Rewards Disc 1.20,
1 SCANNED PHARMACY 8.00
RX# 93477
1 SCANNED PHARMACY 8.00
Subtotal 20.79
l Tax .00
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1 'PAID BY DEBIT' 20.79
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4957 CARLISLE PK
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Register #1 Transaction #104175
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4957 CARLISLE PK
MECHANICSBURG, 17055
(717) 975-0199
Register #1 Transaction #110426
Cashier #48189940 7/11/00 11:56AM
RITE REWARD SAVINGS
Customer 10: <Associate>
1 CITRACAL ECONOMY SIZE200
Regularly 1/12.99
Tot Rite Revards Disc 2.60-
1 RA TALL KITCH BAG 30CT13G
Regularly 1/3.29
Tot Rite Revards Disc 0.66-
1 RA DISP LADY SHAVER '10CT
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1 STAYFREE MAXI UL THN LNG
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1 CREST SMTH MINT TART GEL
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ADD 3V,,{}J,I ADHD 3'14 Q'I CHF 428.0 N~un~ 250.0'1 25\1.BO HYPil'Jrl.;;nsil:ln 401,'1 Ret,tal 2Im;;dl,i'] bGt~.8 NfI,~! FE w/forff! 1/70,3
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Atdr~mimd P"un 7B9.00 C,,,rJical S!r",i!', 847,0 lDDM ,N!ODM Hem(~rrhc:jd$, Et.t 455,,2 Pl<l:'!phcm.d Vas. 0:5, 443.9 V,~glni!is, Candida! 1[2,1
Abrormal PAP 71;0$.0 Ch~)ct rain ?8e,BrJ C,')nt!'ClJte~ 250.Q~ 2S0,0{) Hi-gh Hisk Msci '158,69 PnetJmonj.1 4,30 Vlra! S~'fldl'()l"fIe 079,99
li(':ne 706.1 GAD 414_9 UliCt:l11trcllcd 2:50,03 250,02 Hyp,"'tilpldfsmkl 27:2.4 PO(.t MHI"IDpaIJiil,! 52?,:;! Wmro 078.10
AnD- r:H-4,OQ i :~DHD 314,01 CHF 42f::.o Nt;.uro ~SO.6j 2SG.60 Hyp,.rtiJns!o:-n 401,1 R~;da! Blf3tu!no 569,3 NMI PI: w/form V1C,3
A_ne~rc.RfJaJ::l!on 995.;;\ COPD 4g6 \ Opiltt:a!rr.ic 250,51 ;~SG,50 HYPQrthVtJ!dIS111 z42.S-'O Shortnes'& cf Breath 786,09 RQutin(~ Gvn V72,3
J~.lt!;lro!c Flhlrili!s 4n,g ,;111'J'J,. ;)7;;' CO I Bulla! 2Si),4j 250 4D Hyr.Y,)al~ro!d.,m 244,9 SimmHls" Ac.tlle. 461,9 Routine G)1J1 (Me) '17(:1.2.
Anxiety 300,OQ 28-69 DY5 iJtrHVI() 81N1dlflg 626 a 'ntl(j\~n:m 487.1 Si1~ur,Jtls . Chronic 473,9 Mull/MeiGS. PE V7{1,O
r\rthnt!s "16,$ ~'(;S 40 FdtiglJe ISO;9 JElS 5G4,1 5ituallcnal Strqss 308,Q Inl.-t/1l1CNrcl PC 'V2Q,2
Astl1ma. 498.BO 715 &0 I Gastrll,$ 52f, on L,I).t\Yll!1~hltl~ 3fJ€,30 'Slnclker 305.! Nawbom PE V30,':!(J
Mt~lma - E'<1nnslc 493,00 :tS',/,rQ tGa5tl'f.erlt!"r'll~ Vlf,~l 1.108.8 I Ma-noirll",gi(~ u~6..2 I SC~6 rhrcat 462 Fal1lil~/ HX;DM V1fW
Bc.;ck Pain. '124.5 '392.9 GE R\j~ux 5;,081 l otw~.lity 278 DO I Str\~p ;-t\1( <~t 08.4,0 HypmjerJ,iGr~ 1/1 ,?,-'\.
Bronchitis. Acute 466,0 ~'rll~\ 6'326 He:;cm:h. /840 'lO';tell'l0DSI1' 7~3~tOO URI 465,9 C/\D V't7.3
I3mnchibs .. Chronic 491 ,21 787,9~ Hel:id.'ch~J., Mlgrz'u1e ,;<i.6,OO DUllS Mor:lta JE2 fiO I UTI 559,0 \ CO:Ol1 CA 1/10,0
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GuJdahcH Associates of Pennsylvan1ia
4 i '2: 'Er~oTC:\ P.oad
Camp Hill, PA 17011
Phone (7'!7) ?32-2917 Tax ID#23,2038594
Contact us \vith any address or' insurance CHAtJGES~ Thank you
DEBBIE! DELORENZO
'1830 SIGNAL HILL DRIVE
MECHANIGSEUF~G, PA HiJ55
statement Date,,,..: 08108/2000
Page Numb"'........: 01
ST/l..TCr,!;EHT FOR PF{OFESSIOr~f\L SERVICES
CHAHGES OR P..'l,_YMENTS t~FTER ABO\iE ST,.:\TEMENT DATE !NIL!.. il.,PPEi",f~ ON YOUR NEXT STATr::r-.AENT'
~;i8~:~,~~i3EHC!T"i;~~~;.iZ::Ii';:'?iDi',;-P~~ER~~Efj,sHrF:','O:'r'TU?;:D,":~~:E,';:r;;I9A6[~~~;iHi.;f~r~~?=~~jZIJ
.... ID: 1701 DEBBIE I DElORENZ~ r _ I
0313'1/2000 Psychotimrapy 45-50 minutes 3/::l'I/OO, Elaine McKmma, MSN, FtN, 25,00
es, (Fen $100(0), charoed to Patient
03/3112000 (Patient) Cash (Credit $2500) applied to 31:WOO, Elaine McKenna, 25,00
MSN.RN,CS
04104/2000 (Patient) Cl'ieck# 2040, (Credit $20.00), applied to 4/04100, Elaine 20,00
McKenna, MS~J, FN, CS
0410412000 Psychotherapy 45-50 minutes 4104/00, Elaine McKenna, MSN, RN, 25,00
CS, FAXED TX PLAN 4/5, (Fee $'100,00), charged to Pal.ienl
Cl411212000 Psycllotherapy45-50 minutes 4/'12/00, Elaine McKenna, MSN, i~N, 25,00
CS, (Fen $100.QO), charged to Patient
04/'12/2000 {paUt.mt) Chock.# 2045, (Credit $26,QO}, npplied to 4/04/00, E~arr1e 5,00
McKenna. MSN, RN, CS
04/1212000 ... applied to 4112/00 for Patient 20,00
0412012000 Psychotherapy 45-50 minutes 4/20100, ElaimJ McKenna. MSN, RN, 25,00
es, (Fee $100,00), chm'ged to Patieni
,""'" ,. """'_,__,_..'",.,....................,................, '.............................................'...._...'..'_.._''__.____ __",_....,.._.,__, ____,______....i
riy;~0j3~~~~:'S~:[!;]I~:Z'.'-[t'~!'S:~~~~]~~:]'[~[-..:-~~'-~..~Yo~~~::~;J;:~;;::~:}~S(~[f~~it:~:,_.=E~-[-=~~~i~:'~:~~;~:':[:L-i
.,.-.-...-.., Return tl~i:s porUorJ with your paymf~H1t ..........................----..-------..
~,;~t,!~'!r::bf:Jl' "" ~'..,==,[[,==-=][~L..t~':~L;~~;:;:[[[=:=[:===[==::=:[:;:==' u._===..'.
'l'Str;t~;;;~;~i'D~!~.'II.'.-..."'....-lr'N~;,;;;;t}~~,,;;D~~ ']r--"'" ., ... '1!:'N;~~;;~YE~;6;;~~d;' 1..........'......-....-.-......'.1
~_..~~,~"_..~_.__.,L_..__._.___uu____...,'"~,..""''',..",............,.,.......,..,,".__.....,......................,.."......,..,........."..........1,__........................"........__....__
Please r!1aKe check p,'Wi3bfe to:
Guidance i'I:;sociatf'!s of Pennsylvania
4 '1 2 Erford Road
Camp Hi!!, PA ',7011
Phon., (7 i 7) 732-2917 Tax m#23.20:lB694
Contact us 1Nith ar:y address 01" insurance CHANGES- Tllar~k you
DEB:3IE I DELORENZO
'1830 SIGNP,l HILL DRIVE
MECHANICSBURG, PA 1 i'055
Staten'on! Datn"...: 08i08!2000
Page Numbf.~r""...,: 02
STATEMENT FOR PROFE,SSIONAL SEFMGES
CHARGES OR PAYMENTS AFTER ABO\/E STt.TEMENT DATE. WILL APPEAR or,1 YOUR NE.XT STt..TEMENT
5,00
04/20/2000 (Patient) Check# 1003, (Credit $25,00), applied to 4/12100, Elaine
McKenna, MSN, HN, CS
04/2012000 '" applied to 4/20100 for Patient
04/28/2000 J (Patient) Check# 1010, (Credit $25,00), applied to 4120/00, Elaine
McKenna, r'-ASN'I RN~ CS
04/~:8/2000 ... applied to 4/28/00 for Patient
04/28/2000 PsychothEm?py 45-50 minLites 4/28/00, f::laine Mcl<:enna, MSN, RNI
eG, (Fee $'100,00), charged to Palient
05/09/2000 Psychotherapy 45-50 minutes 5/09100, Elaine Mcf<;,mna, MSN, RN,
.I CS, (Fee $1 OO,OOj, charged to Patient
05/091<~000" (Patient) Ch<1ck# '! 021, (Credit $25,00), applied to 4128/00, Elaine
Mcf<;enna, MSN, RN, CS
05/09/2000 '" applied (0 5/09100 for Patient
OS/23/2000 '(Patient) Check# 1028, (Credit $25,(0), appiied \0 5109/00, Elaine
Mc!~~enna. MSN, HN1 CS
20,00
:;,00
20,O(J
25,00
25,00
5,00
20,00
5,00
.----....,....."-.---------------------..........................................., Return this pod;\on with yc.ur payrnent .....-.-----........-......-..........--------
[~~~(:~ilii;R~~!J:~:::~:~:::::::::::::::::::=][~~'-~~;;i~:".:-][_..__..,_=::..,'__=~=::=---=~--~---------:=:'==']
[~~i~~f~El.~iEl[ ......... ][}~.~?~,;.E~l(~~i:][=_==:=:=:Ji_",~~~\~f!fSEE~~][::::::=-=:::=:::::::::::::=1
P!e3se make check payable to'
GuJd'arlce Assoclates of Pennsylvaqia
4i2 Edon:'l Hoad
Camp Hill, PA 1701 'I
Pllone UHj 732-2917 Tax 1i:l#2:J-2038694
Contact us v./rth any address or insurance CHAHGES~ Thank you
DEBBIE I DELORENZO
18:,0 SiGN,A,L HILL DRIVE
MECHANICSBUI,G, PA ':70!55
Statement Date,....: 08/08/2000
PaQ9 Nurnbr::;['," "".. 03
STATeMENT FOR Pf;:OFESSIONfI.L SERVICES
CH}\F~GES OF~ PAYMENTS AFTEF::: ABOVE ST ATEMENT DATE ViiLL APf;)EA!;: ON YOiJR NEXT SrA TEME~JT
f""\'5ATE3iFl-'-;:-;:;c:':;-i-;:'c:"cc",-r-:--:;'---::'-"oEcR7i;:rlo~r,-;-7:;"--T-::"::---':':'::-".'..'('T-':-CHARGES-.' U:::Ti'PAYivi'ENfs": ':--"j
[~~::.::_._"::::L:.~.,~.I:.}..;~~...~.L):;,:..::~':~:,.::~~~;':,.1~:~;_.:"::~:;;';':;;.:'~1':.'.:.~'~,:.:..L'~'...;.:;;:~.":....;.;...'.".,.~;;...:....,.~,~~~~.:'::'~...:...~~.:;~.",.,~.~..;~;~':'::.:~:.~::__l.:~l.:.~L.;"::;',",..:"..:_".;;..,;.;:~,".;.~2.;:;.l.:.,;.;.:::;:_'.:.;~,;;::..;_._.;..."L..:~__.:~~J
. 0512312000"'." applied to 5125100 for Patient 20,00 I
OS/2512000 Psycholllerapy 45,50 minutes 5123/00, Elaine McKenna, MSN, HN, 25,00
CS, (Fee $100.00), charlled to Patient
OS/251;!()OO TP.EATMEtH PLAN SUB!AITTED ti12e100, Elaine Md<enna, MSN,
RN. CS, (Fee ), charged to Patient
06/0'1/2000 Psychotherapy 45,50 minutes 6101100, Elaine McKenna, MSN, RN,
CS, (Fee $100,00), charged tc! Patient
06/0112000' (Parient) CI1(lck# 1037, (Credit $25,00), applied (0 6101100, Elaine
McKenna, MSN, RN, CS
06/0 112000,,, applied to 610 1 100 fOl' Patient
06106/2000 '(Patient) C!mck1l1038, (Credit $25.00), applied (0 1310(0100,
Nuct'1Hnart VenbrLlXj MD
06/0S12000 Diagnostic Evaluation 6106/00, Nuchanart Venbrux, MD, (Fee
$150,QO), charged to Patient
0"115/2000 j F'sycholherapy 45.50 minutes 6/1 5100, Elaine McKenna, MSN, HN,
CS, (Fee $l()(),OO). charged to Patient
25,00
20,00
5.00
25,00
25,00
25,00
L.___._..................__......______
--.--.---'.'---".,-.-,-.",-,-.--.-",-.-'."'.'."'.'.'....................................................................................-.......-........................--..........................-..........--.-.
RIi-;tum this por~:icn wlth your paytTH:.'r'l1: ----.-.--..---...-.-....................-.--------------.--.--...-----.-
ro-"---:--~-'-~~--~:'- ,-., --,
t. ,f;cct,r'lq'pb",i.' ,Ii
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'''7~.':",:'-~.'~~-~07'''.',:'":-.'':-~''' r..-.-.-----. .
L~!~~::T,:r~t.9!:~~jl_
Plea5e make f:l1f~ck payab('8' ::::r
--,._.....~-'------..,----.,-------~I..
Il":.:;AmoLg'ot f\Jo;"_Due' "',j
_____..l,,,,_,,,,_____c...___________,.,.
-----o------..,-JC- ... -,,--_...-,...
.-Amou~ii Eficfo'secl-:-"
;.......,~...,;;:...~,..~":~.,~:;.~-~..._~ ' -----,.....
Guida/we AssoGJates ~)f Penl1syh,rania
G:\ 2 t2..r''O'id ?aac
Camp Hili, PA '1701 i
Phone (7Hi 732-29',7 Tax ID#23-20:lB6[14
Contact us with any address or insurance CHAJ\jGES~Thank. you
DEBBIE I DELORENZO
'1830 SIGNAL HIL.L DRIVE
MECH!\~JICSB:.JRG, PA '17055
Statement Date....: 08!O81<~OOO
Page Number........: 04
STATErvlENT FOR PROFESSIONAL SERVICES
CHARGES OR P/WMr:NTS AFTEHA80VE S"TI,TEMGNT D.!l.TE. WIL.l..APPEAR ON YOUR NE>::r ST,I~TEMENT
[1!~~E!-~Ji:~I:_j;;;:.:J~;__;I:__:SS:.__j:t(_._,:~::E~[~C~ipfiQN-2-:IE~DZ-I:m~X:-:'-"-II__:'s8~~GES____I~;;__~'~Xt?~0IIjclj
I 06/1612000 (,patient). Che~~:# 1044:\Credlt $25,00), applied to 5/23/00, Elaine 5,00 I'
i f,10l<enna, MSN, RN. CS
. 06/1612000 .., applied to 61'15/00 for Patient 20.1lC! '
06/27/2000 (Patient} Check#- "1048, (Credit $12.50), applied to 6/27iOO, 12,50
. Nuchanart Venbrux, MD
06/27/2DC!O ,,. Pharmacotherapy 1'5-20 minute 6127iOO, Nuchanart VenbrLlx, MD.
,(Fee $75.00), char,)ed to Patient
06/3012000./Psychotl1erapy 4!3,50 minutes 6130/00, Elaine Mcl';enna, MSN, Rr,j,
CS, (Fell $100,001. charged to Patient
OG130/2000 (Patient) Check# 1Or51.. (Credit $25,(0), applied to 6/3()/OO, Elai'le
/ ~,..1cKenna. MSN ~ RN, CS
0711812000 (Patient) Check# 1059, (Credit $30.00), applied to 6/15/00, Eiai!le
McKenna, r',1SN, RN, CS
om 812000 ..' appli"d to '//18!OO for Patient
07/1812000 Psycl10tilerapy 45-50 minutes 7/'18100, Elaine McKenna, MSN. RN,
i CS, (Fee $100,00), dlarged to Patient
l__.._______________.___________..__..__....'..'__________,__.._____...__.________..,..______________________________________________________________________________________________________________..____..._...______________________________________..,..______..,_____..,_._.._____....
'i2.50
25.00
25.00
5,00
25.00
2e.,oo
i
...J
[;~=t?:i~G~H~~t~::~~!..--~[;..~..:~:-;;'~~l;~~i~=~:::E~~~~~'~=~::=:=~=~=F~~;~:::!::=~~~,:jl::_:\:+____::::;::;:~:~~:~~i1\i~--f~..:~:~:j
Retum tJlis portbn "'/ith yeur payrr~ent
[~:~;CrjOFb6~I'[=~~=~===='===..=] r:.........:j;;;~~~~;-]I_.._.._....."..-;:~=====___..
[~t~~rij~hrp~;~":11............--"':....'I[t~;lZ~~tf.l6;~.Di;'''1[..--:::=-~~=-:=~][i:n:?~r:t.f~~~~~d.I[-
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---------------1
Pl8as~"~ rn8ke c:h~ck payable 1.0:
GuJda,1ce Associates of Pennsylvania
4 i 2 Eriord R.oar.l
Camp fiili, PA 1701 'I
Phone (717) 732-2917 Tax ID#23-20:,S604
Contact us <1J\l1th any address or insurance CH.bl.~,JGES-Thank you
DEBBIE I O[LORENZO
1830 SIGN,I\L HILL DRIVE
MF-CHAN!CSBURG, PA '1705[;
Statement Date,....: 08/08/2000
Page Nl:rnber,......,: 05
STATEMENT FOR PROFESSIONAL SERVICES
CHAEGES OR PAYf'.,.1ENTS Af~TEf.;. ABOVE STATEr.j:E~'JT DATE WILL. .A.PPEAt~ ON YOUH NE)-:-;- ST.lI,TE~1Fi'{r
EP~I~~~;;~i::B.;,;;I2;Jli[I;E;;,!E;::::3;i;;0n;::R~'~SRI~f'9fJ';F7~';:T",;:",,:;3L:;[JE~:f1~~9.~~ITi[:::~~'?E~{ilr':E;n
I 08/02/200!J" Psychotherapy 45-50 minutes 8/02/00, Elaine Mci<enna, MSN, RN, 25,00
CS, (PeEl $'100,00), charged to Patient
08102/2000 (Patient) Check# 1069, (Credit $25,00), appli80 to 8/02/0l\ Elaine 2[;,00
~'v'kKenna, MSf\!, RJ\!; CS
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.-. F<{.;turn thi,:; pcrti!:)n v.~th ~;()ur ;:layrmmt -..-
[i~i,:!:~~T,~E::]!,,';:!~~::::::::::::===:=':=:]-..ficyEE:=,:JI'~t,BBIE~,[:~~~~~~~:i~,?","'_"...".._,..
L$fcit~;~~;;~~~~]i'08108i2r~~o . .,.I[~.?1~i~~\::,E~:..]I:::::==_~=~1~~~][T~[[~~~:i;:[:~~~l~~~IJ!:-".==:.:':...._===:::
PIC<:iS~ make cheer; pa/ab[~ te,; GuidmlCe'.o l\ssociatcs of PennsylvanIa
412 Erford Road
Camp Hill, PA 17011
Phone (717) 732w29'17 Tal. ID#;23..20:H3691.~,
!NSUFU\NCE Pf...TIENTS PLEASE NOTE: If expected iI-;SUr2I1Gt1 payments i3:'e denied)
those charges wilt be added to )foLlr co~paymellt balance in future billinfJ.
.'
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Guidance Associates of Pennsylvania
412 Erfore Road
Camp Hi!!, PA 17011
Phone (717j 732,2917 Tax ID#23-203B694
ContaGt us with any address or insurancfJ CHANGES-Than~. you
DEBBIE I DELORENZO
1830 SIGNAL HILL DRIVE
MECHANICSBURG, PA 17055
Statement Date.....: 08/3012000
Page Number...,..,: 01
STATEMENT FOR PR.OFESSIONp,L SERViCES
CHARGES OR PA~'MENTS AFTER ABOVE STATEMEerr DATE W!LL APPE'AR ON YOUR NExr !irlATEMENT
.-. ID: 1701 DEBBIE I DELORENZO Dx: 309.28
08/0812000 (Patient) Check# 1071, (Credil $12,50j, applied 10 8116100, Elaine
McKenna, MSN, RN, CS
08114/2000 DISCHARGED 8123/00, Nuchanart Venbrux, MD, (Fee ), ,,;,argEld to
PatiOi'll
08116/2000 Psychotherapy 45-5() minutes, Elaine McKenna, MSN, RN, CS, (Fee
$100,00), charged to Patient
08116/2000 (Palient) Clleck# 1078, (Credit $12,50), applied lo 8/16/00, Elaine
McKenna, MSN, RN, CS
0812212000 Pharma<:oIherapy 15-20 minute, Nucllanarl Venbrux, MD, see below,
(Fee $75,00), chargBd to Patient
0812212000 (Patient) Clmck# 1080, (Credit $12,50), applied to 8122100,
Nuchanarl Venbrux, MD
12,50
25,00
12,50
'12.50
12,50
O,OO! 0,00
--.-.__.~--_._._._._._._._._._._._----.__.--,------_._..._..._------~._._-_.-
-------.---.....-,--, l~etwn thiS portion wiU, ycur payment
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Please make cheGk payable to: Guidance Associates of Pennsylvania
4 '12 Erford Hoad
Camp Hill, PA ir01i
Phon!) (/17) 732..291)' Tax ID#Z;l'20~381394
iNSURANCE PATIE~nS PL.EASE NOTE: If expected insurance paymer,ts am deni"d,
those charges will be adder! to your co-payrnent balance in iuture biiiing,
::..: "7'" .;..,,~.., ,.'""~.!.~ \':'~"'::J:, ".":" '".,J..'-':! I ~~,:~t..S"..~~_
Attending Doclor's Statement
Central Pennsylvania Oral 8.
Maxillofacial Surgeons
4700 Union Deposit Rd.
Suile 260
Harrisburg. PA 17111
717.540.1777
Date
Palient ID
04/10/2000
6266
Proce>dl.1!'e Code Di:."5cription NoeJJtler Tooth pas T05 Units
..........-............-"...".-.,---..--...........-.-~---_.................~-_.__.._._--
09310 Off Cons, New/Est 60
Patient Payment: aleck #. 2044
Signature:
232262979
_.__."_...,._~--_.........._........_...~---_.._..~~...
DSO'1984GL
Den Lie.
Tolal
$
96,00
Dr, Harry P Meyers O,D,S_, FICO
Tax I,D,
Mea Lie.
Compldr; the patient information section of your insurance claim,
Attach a copy of this fonn and mail directly to your insurance company,
It is not necessary for this ortice to fill out the insurance company form,
Attending Doctor's Statement
Central Pennsylvania Oral &
Maxillofacial Surgeons
220 Cumberland Parkway
Suite 5
Mechanicsburg, PA 17055
717-795-9340
99243 09310 Ot!' Cons, Newl!:;' 40
Pabent Payment: Check #" 1023
Date
Patient ID
05/1012000
6266
Signature: _..._,..,__._,_..____._,.._._...___.._...__.______..__2.:::2.?_(~?:91'9,....._,_..____.._
Dr, Harry P Meyers D,D,8" FICO Tax I.D. Med Lie,
DS019840L
Den Lie.
Total $
67,QO
Complete tl"lEl patIent information section of your insurance claim,
Attach a copy of this form and mail directly to your insurance company.
It is not necessary for this office to fill Qut the insurance company form.
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Attending Doctor's Statement
-"'''.~,.:,(
Central Pennsylvania Oral &
Maxillofacial Surgeons
220 Cumberland Parkway
Suite 5
Meehanicsburg, PA 17055
717-795-9340
Date 07/06/2000
Patient 10 6266
Procedure. Code.. Description
20245 07285 Biopsy bone, deep
1:1442 07431 Exc lesion 1.1-2cm
00170 General Anesthesia 50 min
Patient Payment: Check #1054
Modifier
. Signature:
Dr, Larrypepper D,M.D.
232262979
Tax 1.0. . Med Lie.
05020731 L
Den Lie.
Total '$
915.00
Complete the patient information section of your insurance claim.
Attach a copy of this form and mail directly to your insurance company.
It is not necessary for this office !o fill out the insurance company form,
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TAX X;D.' NO.:, 232189809
DATE
THE ARLING'1'ON GROUP
1'0 BOX' 65()7' 80S SXR THOM
~ISBURG, PA17~12
7171652-9ll15.
DR WOODS
2:15PM
72547/:t.:
29979
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70551 MIll BRAIN
70552 HRI BRArN KIM COftRASr
70553 MRI BRAIN COMBINED
71550 HRI CEtBS'r
72141 MRZ CERV NO COHRASf
721.42 MRI CERV CONfRAS'r
72156 HRI CERVICAL COHBZNBD
72146 NRI WlOR NO CON'ZR
72147 MRI !'SORACIC CON'l'RAS7!
721.57 MRI UORACIC COMBINED
72148 MIll LUMBAR NO COlWRAS!l'
721.49 NRI LUMBAR. CONTRAST
72158 MR.I LI1NBAR COMBINED
721'96 JIRI PELVIS
73220 MHI UPPER SX'r OI'S !l'HAN n
7322J SRI ANY ,Jr UPPER Bzr
73720 MRI LOW BX1: O!rIlEli !l'H .n
737:" )Du ANY ,no LOW EX'l'
74181 JrlRI ABDOMEN
70540 NRI ORBI!l'.. FACE AND NBCK
75552 CARD MRr 1fOUR WID COftR
75553 CARD MRI HORPR WICON'Elt
75554 CARD DI FOR FUlfC COHPL
75555 CARD DI FOR FUNC un.eD
75556 CARD MRZ FOR VEL now MAP
76093 HRI BRl'ASI' NI'NO CO~ UNIL
76094 .HRJ;',. BREAS1' NINO COln'R BIL .
76400 MR.I BORB MARRON BLOOD SUP
r715S .MHI CIlES'r "11:8 CO.N!l'RAS'r
17156 HR.I Cll1!1S1' CoMBINBD
17220 MRI PBLVIS "I!l'B CONl'RAS7!
r722~ MRI PELVIS 'COMBI1IBD
r132~ ,DI UB O!l'8 7!BAN J1' Nlcoe
17323 MRI UB orrs !nl on COMBINED
r732C MRI ANr J'E UB "ICON'J!RAS'J!
1732$ MIlt ANY .n us COMBINED
1737~ DI LB 01'R !l'B .n filCOftRA
r737:.) Il1lI LE 01'B J!l' COHBtNED
r737f: MRI ANY n LE WICONDAS!r
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r7411J DI ABDOMEN f(I'rB COftRAS!E'
PA'J!ISNl' NAME
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70541 lIRA lIBAD "/ffO CON'lRAST
71555 MRA CUSl' NINO COM
72159 HBA SPINAL CNL W/NO CO~
72198 MRA PELVIS w/rro CON1'
73225 HRA UPPEJR EJK~ ,,/f((} CONTIl
73725 MRA LOW BX!l' ,,/NO CONTR
74185 NIlA ABlJ ,,/wo CONTR
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DELORENZO, DEBBIE
RESPONSIBLB PAR'1:Y
DELORENZo,DEBBIE.
DIAGNOSIS
I!fSrJRANCB. CARRIER J.
US HEAI:$HCARE.MBWZ8020
'r- .,SE
~08;0710(j
S!MBB!I! ADDRESS
1830 SIGNAL HILL
S!I!REB!I! ADDRESS
1830 SIGNAL HILL
REFERRING PHYSICIAN
WOODS, MICHAEL DO
IINSU~cs ~ISR 2
"bll.OCA!1'ION OF SSItVICB
PA 17055
Sl'Al'.! %I~ CODE
PA 17055
TOTAL
, BALANCE FORWARD
PAYMENT .
.. BALANCE DUE
IAS.SIGNHBN!1' I FEE "AID
I OrES . Dao OrES
CIrY
MECHANICSBURG
CI7!r
MECHANICSBURG
..I~,..us
..
STA!I!: ZIP CODE
PHONE
717/732-4243
PHONE
717/732-4243
0.00
Dao
PHYl;ICIAN'S srQNAfURB
DA~
.DATE
PA!rIEN!I!' S s:tGNP3URB
JUf'JL..FJ'ELD MAGNET
COMMUNITY IMAGING ASSac:nf,l'i!i::r 06/04/1955
PO BOX 6507
805 SIR THOMAS COURT
HARRISBURG.. PA 17112
717/652-16:>2
3:00 PM
72547/1
29345
TAX I.D. NO.: 232516297
tAl Suite 201 "AmericanOmceCenter
, '1 Carl Brol'litsky,MD, FACOG 423 Nort1121"S!reelo C.mp Hill PA 17011
Gyo,cololi:J' & Ob,"',,,,, (717) 763.%7~F;'\.>( ('17>163.9356 '
I<.K. ~ Norman Navarr<j M.
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Barbara Sumple-Sullivan, Esquire
Supreme Court #32317
549 Bridge Street
New Cwnberland, P A 17070
(717) 774-1445
PETER A. DeLORENZO,
Plaintiff,
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYL VANIA
v.
NO. 2000-4314
DEBBIE 1, DeLORENZO,
Defendant
CIVIL ACTION - LAW
DIVORCE
PRAECIPE TO WITHDRAW APPEARANCE
Please withdraw my appearance on behalf of DEBBIE I. DeLORENZO in the above-
captioned matter.
Respectfully submitted,
Dated:~,2001
~w~
Keirsten Davidson, Esquire
JOHNSON, DUFFIE STEWART & WEIDNER
301 Market Street
Lemoyne, P A 17043
(717) 975-5500
Supreme Court !.D. f)~3
PRAECIPE TO ENTER APPEARANCE
Please enter my appearance on behalf of DEBBIE I. DELORENZO in the above-captioned
matter.
Dated: /(J-~
,2001
arbara umple-Sullivan, Esquire
549 Bridge Street
New Cumberland, P A 17070
(717) 774-1445
Supreme Court I.D. 32317
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Barbara Sumple,Sullivan, Esquire
Supreme Court #32317
549 Bridge Street
New Cumberland, P A 17070
(717) 774-1445
PETER A. DeLORENZO,
Plaintiff,
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO. 2000-4314
DEBBIE 1. DeLORENZO,
Defendant
CIVIL ACTION - LAW
DIVORCE
CERTIFICATE OF SERVICE
I, Barbara Sumple-Sullivan, Esquire, do hereby certifY that on this date, I served the
foregoing Praecipe to Withdraw Appearance and Praecipe to Enter Appearance, in the above-
captioned matter upon the following individual by first class mail, postage prepaid, addressed as
follows:
Edward J. Weintraub, Esquire
2650 North Third Street
Harrisburg, P A 1711 0
Keirsten Davidson, Esquire
JOHNSON, DUFFIE, STEWART &
WEIDNER
30 I Market Street
Lemoyne, P A 17043
Dated: October II, 2001
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Respe91fUll s
6';L_l~Wli_ E~Wre
549 Bridge Street
New Cumberland, PA 17070
(717) 774-1445
Supreme Court 1.D. 32317
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Supreme Court #32317
549 Bridge Street
New Cumberland, P A 17070
(717) 774-1445
PETER A. DeLORENZO,
Plaintiff,
v.
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 2000-4314
DEBBIE I. DeLORENZO,
Defendant
CIVIL ACTION - LAW
DIVORCE
PETITION RAISING MARITAL
CLAIMS UNDER. THE DIVOR.CE CODE OF 1980
AND NOW, this ~ day Of~ 2002, comes Defendant, Debbie I.
DeLorenzo (hereinafter referred to as "PET~ by and through her attorney, Barbara
Sumple-Sullivan. Esquire and files this Petition Raising Marital Claims Under the Divorce Code
of 1980 and in support thereof states as follows:
1. A Complaint in Divorce was filed on June 26, 2000.
2. Petitioner is the Defendant in the above action.
3. Petitioner requests the Court to enter an order granting alimony to your Petitioner as the
Court deems reasonable pursuant to Section 3701 of the Divorce Code of 1980, together with any
amendments thereto.
4. Petitioner requests the Court order Plaintiff to pay alimony pendente lite. reasonable
counsel fees, costs and expenses of Petitioner in this action pursuant to Section 3702 of the
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Divorce Code of 1980, together with any amendments thereto.
5. Petitioner requires reasonable spousal support and maintenance of medical and life
insurance policies to adequately maintain herself in accordance with the standard of living
established during the marriage.
WHEREFORE, Petitioner requests your Honorable Court to enter an award of alimony,
enter an award of alimony pendente lite, spousal support. interim counsel fees, and maintenance
of medical and life insurance policies, costs and expenses until final hearing, and thereupon award
such additional counsel fees. costs and expenses as deemed appro riate and enter an award of
Barbara Sumple-Sullivan, Esquire
549 Bridge Street
New Cumberland, PA 17070-1931
(717) 774-1445
Supreme Court I.D. 32317
Attorney for Defendant
alimony.
DATE: January f , 2002
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Barbara Sump Ie-Sullivan, Esquire
Supreme Court #32317
549 Bridge Street
New Cumberland, PA 17070
(717) 774-1445
PETER A. DeLORENZO,
Plaintiff,
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYL VANIA
v.
NO. 2000-4314
DEBBIE 1. DeLORENZO,
Defendant
CIVIL ACTION - LAW
DIVORCE
VERIFICATION
I, DEBBIE I. DeLORENZO hereby certify that the facts set forth in the foregoing
PETITION RAISING MARITAL CLAIMS are true and correct to the best of my knowledge,
information and belief. I understand that any false statements made herein are subject to penalties
of 18 Pa. C.S.A. S4904 relating to unsworn falsification to authorities.
DATED: ;!.3/0:J-
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DEBBIE I. DeLORENZO
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Barbara Sumple-Sullivan, Esquire
Supreme Court #32317
549 Bridge Street
New Cumberland, PA 17070
(717) 774-1445
PETER A. DeLORENZO,
Plaintiff,
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
. NO. 2000-4314
DEBBIE I. DeLORENZO,
Defendant
CIVIL ACTION - LAW
DNORCE
CERTIFICATE OF SERVICE
I, BARBARA SUMPLE-SULLIVAN, ESQUIRE, do hereby certify that on this date, I
served a true and correct copy of the foregoing DEFENDANT'S PETITION RAISING
MARITAL CLAIMS. in the above-captioned matter upon the following individual by first class
mail, postage prepaid, addressed as follows:
Edward J. Weintraub, Esquire
2650 North Third Street
Harrisburg, PA 17110
/
Barbara Sumple-Sullivan, Esquire
549 Bridge Street
New Cumberland, P A 17070
Supreme Court J.D. No. 32317
(717) 774-1445
Attorney for Defendant
DATED: January L, 2002
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Plaintiff, * CUMBERLAND,PENNSYLV ANIA
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VS. * NO. Oo-I./3tlj ~ov;(
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DEBBIE I. DELORENZO, * CIVIL ACTION -LAW
Defendant. * CUSTODY
CERTIFICATE OF SERVICE
I, Misty D. Lehman, Legal Assistant to Edward J. Weintraub, Esquire, hereby certifY
that on January 16, 2002 I served a true and correct copy of the Petition to ModifY Order of
Support upon Barbara Sumple-Sullivan, Esquire, counsel for Defendant, by depositing same,
postage pre-paid, in the United States Mail, Harrisburg, Pennsylvania, addressed as follows:
Barbara Sumple-Sullivan
549 Bridge Street
New Cumberland, P A 17070
Date: -bit Q - ()~
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· IN THE COURT OF COMMON PLEAS
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NO. 00-4314
.
DEBBIE I. DELORENZO,
Defendant.
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CIVIL ACTION - LAW
DIVORCE
ORDER
AND NOW, this d l,). day of ~, 2002 this matter is referred to
the Office of Domestic Relations to schedule a conference on Plaintiff's Petition to
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PETER A. DELORENZO, * IN THE COURT OF COMMON PLEAS
Plaintiff, * CUMBERLAND COUNTY
* PENNSYLVANIA
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VS. * NO. 00-4314
*
DEBBIE I. DELORENZO, * CIVIL ACTION - LAW
Defendant. * DIVORCE
PETITION TO MODIFY ORDER OF SUPPORT
AND NOW, Plaintiff, by and through his attorney Edward J. Weintraub, Esquire, files
a Petition to Modify Order of Support, and in support thereof, avers the following:
1. Plaintiff in the above-referenced divorce action is Peter A. Delorenzo,
hereinafter referred to as Husband. Husband is currently residing at 5260 Simpson Ferry
Road, Mechanicsburg. Pennsylvania 17055. Husband's Social Security Number is 067-44-
6901.
2. Defendant is Debbie I. Delorenzo, hereinafter referred to as Wife. Wife is
currently residing at 1830 Signal Hill Drive, Mechanicsburg, Pennsylvania 17055. Wife's
Social Security Number is 110-48-6944.
3. At the time the within support agreement was negotiated and entered directly
with the Court, Plaintiff/Husband and DefendanUWife were filing a joint tax return.
4. Commencing in 2002, Husband will be filing separately, as a consequence
of which his tax liability and withholding of taxes have both increased substantially.
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WHEREFORE, Husband seeks to modify the within support agreement
consistent with the current guidelines of the Supreme Court.
submitted:
Edward J. Weintraub
ATTORNEY FOR PLAINTIFF
2650 North Third Street
Harrisburg, PA 17110
(717) 238-2200
1.0. #17441
Date: l
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VERIFICATION
I, Peter Delorenzo, hereby swear and affirm that the facts contained in the
foregoing Petition to Modify Order of Support are true and correct and are made subject
to the penalties of 18 Pa. C.S. Sec. 4904 relating to unsworn falsification to authorities,
Date:
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DEBBIE I. DELORENZO, * CIVIL ACTION - LAW
Defendant. * CUSTODY
CERTIFICATE OF SERVICE
I, Misty D. Lehman, Legal Assistant to Edward J. Weintraub, Esquire, hereby certify
that on January 25, 2002 I served a true and correct copy of the Petition to Modify Order of
Support and Order dated January 23, 2002 upon Barbara Sump1e-Sullivan, Esquire, counsel
for Defendant, by depositing same, postage pre-paid, in the United States Mail, Harrisburg,
Pennsylvania, addressed as follows:
Barbara Sump1e-Su1livan
549 Bridge Street
New Cumberland, P A 17070
Date: -' - ~ ") - () "()--
Misty D. Lehman
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Plaintiff,
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYL VANIA
v.
: NO, 2000-4314
DEBBIE I. DeLORENZO,
Defendant
: CIVIL ACTION - LAW
: DIVORCE
QUALIFIED DOMESTIC RELATIONS ORDER
Based on the foregoing, the Order is intended to satisfy all requirements to be a
Qualified Domestic Relations Order, as defmed in Section 414(p) of the Internal
Revenue Code ("Code") and Section 206(d)(3) of the Employee Retirement Income
Security Act ("ERISA").
IT IS HEREBY ORDERED that Debbie I, DeLorenzo shall be entitled to a share
of the retirement benefits of Peter A. DeLorenzo, as follows:
1. The retirement plan subject to this Order is The Rite Aid 401(k) Plan
("Plan"), which is a qualified plan under Section 41O(a) of the Code and an employee
pension benefit Plan under Section 3(2) of ERISA.
2. Peter A. DeLorenzo is the Plan Participant to whom this Order applies,
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a. The Participant's current mailing address is:
931 North Front Street, Apt. 403
Harrisburg, PA 17112
b, The Participant's Social Security number is: 067-44-6901
c. The Participant's date of birth is: November 13, 1953
3. Debbie I. DeLorenzo is the Alternate Payee under this Order, as the term is
defmed in Code Section 414(P)(8) and Section 206(d)(3)(k) ofERlSA.
a. The Alternate Payee's current mailing address is:
1830 Signal Hill Drive
Mechanicsburg, PA 17050
b. The Alternate Payee's Social Security number is: 110-48-6944
c. The Alternate Payee's date of birth is: June 4, 1955
4, References to the Participant's "interest" or "benefits" means all amounts
allocated to the Participant's account under the Plan from all sources, including any
employer contributions, employee contributions, forfeitures, rollovers, and transfers, as
adjusted for earnings and losses of investment, in accordance with the terms of the Plan.
Unless otherwise specified, the term "account" refers in the aggregate to all
recordkeeping and/or segregated accounts maintained for the Participant under the Plan.
2
5, In accordance with all other terms of the Order, a portion of the
Participant's interest in the Plan is hereby assigned to the Alternate Payee as follows:
a, The Alternative Payee's share shall receive ONE HUNDRED
THOUSAND DOLLARS ($100,000.00), provided that this amount does not
exceed the value of the Participant's accounts as of the Plan valuation date that
coincides with or next follows the date that this Order is received by the Plan
Administrator.
b. The shllIe assigned to the Alternate Payee shall be deemed
attributable to the different types of Plan contributions that have been made by
or for the Participant, and earnings on such contributions, on a pro rata basis,
in the same proportion as the Participant's interest in the Plan, determined as of
the valuation date referred to in subparagraph (a) above.
c. As soon as practicable after the Order is determined to be a QDRO,
the Alternate Payee's share shall be withdrawn from the Participant's account,
on a pro rata basis, and invested in accordance with the Plan as a sepllIate
account of the Alternate Payee. On and after the date the Alternate Payee's
account is established, the Alternate Payee shall have the same ability to
3
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designate the investment of those amounts as the Participant would otherwise
have had with respect to those amounts. All amounts so assigned to the
Alternate Payee will separately share in the gains and losses of the Plan in
accordance with Plan terms, once the Alternate Payee's account is established
and until the date of payment of such assigned amounts,
6, The Alternate Payee may elect to receive payment of the share awarded by
this Order as of any date that is on or after the date Administrator determines this Order is
a Qualified Domestic Relations Order, by filing an election with the Plan Administrator
in accordance with Plan terms. This shall include the right to roll over the entire balance
to another qualified account held by a third party. Actual payment shall be made as soon
as administratively feasible thereafter. Notwithstanding the foregoing, the Alternate
Payee shall not be permitted to obtain a loan from the Plan or take any hardship
withdrawals from the Plan. If the Alternate Payee has not elected an earlier beginning
date, the Alternate Payee's share will begin to be paid as of the earlier of the date as of
which the Participant begins to receive a distribution of the Participant's share, or the
latest date permitted under Section 401(a)(9) of the Code.
7. Once the Alternate Payee's beginning date has been reached pursuant to
Paragraph 6 the following shall apply.
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a, The Alternate Payee may elect to have the Alternate Payee's share
paid in any form permitted by the Plan, by making the appropriate election
with the Plan Administrator; except that the qualified joint and survivor
annuity form shall not be available to an Alternate Payee,
b. Upon the Alternate Payee's death, and if appropriate to the form of
distribution elected by the Alternate Payee, any remainder of the Alternate
Payee's share shall be paid to the Alternate Payee's designated beneficiaries.
The Alternate Payee's beneficiary designation shall be governed by the terms
of the Plan that apply to Participant designations, with the following limitation:
if the Alternate Payee has remarried, the Alternate Payee's subsequent spouse
shall not have the spousal rights provided to the spouses of Participants under
the Plan, although the Alternate Payee may designate a subsequent spouse as a
beneficiary, lfno beneficiary designation is in effect at the Alternate Payee's
death, any remaining amount of the Alternate Payee's share shall be paid in
accordance with the Plan rules that apply when no beneficiary designation is in
effect for a Participant.
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8, If the Alternate Payee dies before beginning to receive benefits under the
preceding provisions of this Order, the Alternate Payee's share shall be paid to the
Alternate Payee's beneficiaries.
9. The assignment of a share of benefits to the Alternate Payee in accordance
with the foregoing provisions of this Order shall not be reduced, abated or tenninated by
the Participant's death, regardless of when the Participant's death occurs. However, the
Alternate Payee will not be entitled to any survivor benefits attributable to the remaining
portion of the Participant's benefits under the Plan unless the Participant, independently
of this Order, has designated the Alternate Payee as a beneficiary. However, if the
Participant remarries, any such designation would be subject to the spousal rights of the
subsequent spouse provided by ERISA, the Code and the terms of the Plan.
10. None of the provisions of this Order shall be construed to require the Plan:
a. To provide the Alternate Payee with any type or form of benefit not
provided under the Plan (other than any right given to the Alternate Payee to
elect payments as early as the Participant's Earliest Retirement Age);
b, To provide benefits in excess of the value of the Participant's
account; or
6
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c, To provide benefits to the Alternate Payee that are required to be
paid to a different Alternate Payee under another order previously determined
to be a Qualified Domestic Relations Order.
11. The assignment of the Plan interest in this Order shall be permanent. From
the date of this Order and thereafter, the Participant shall have no further right or interest
in the portion of the Participant's accrued benefit under the Plan which is assigned to the
Alternate Payee pursuant to paragraph 5 above, and, except as otherwise provided in
paragraph 9 of this Order, nothing in this Order shall restrict the Participant's ability to
obtain a distribution under the Plan or designate a beneficiary under the Plan, with
respect to the Participant's remaining accrued benefit determined after the assignment to
the Alternate Payee.
12. The Participant and the Alternate Payee shall each be personally
responsible for the payment of all taxes levied or assessed on their respective benefits
under the Plan. The Plan Administrator is hereby directed to provide the Alternate Payee
with the tax and other information appropriate for the distributions being made to the
Alternate Payee. The benefits paid to the Alternate Payee shall neither be taxable income
to the Participant nor a deduction on the Participant's income tax returns.
7
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IT IS FURTHER:
ORDERED, that the Participant and Alternate Payee shall execute any documents
and take any steps necessary to have this Order determined to be a Qualified Domestic
Relations Order; and it is further
ORDERED, that in the event any subsequent Treasury Regulations (or other legal
changes) impose requirements that are not met by this Order, the Participant and
Alternate Payee shall promptly take all steps necessary to obtain an Amended Order
which will meet the changed requirements; and it is further
ORDERED, that the Plan Administrator shall take such steps as are required to
implement and give full effect to the provisions of this Order; and it is further
8
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ORDERED, that this Court shall retain jurisdiction to amend this Order for
purposes of establishing or maintaining its status as a Qualified Domestic Relations
Order; and it is further
J,
Signed at ~ I p~
on the J".f'\o. day of ~ ,2003
ENTER:
JenV\l L..hieche-ll€. Esquire
Attorney for]}
f)uJI t ~
DEBBIE I. DeLORENZO
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/ Barbara Sumple-Sullivan,
Attorney for Defendant
sqUIre
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Barbara Sumple-Sullivan, Esquire
Supreme Court #32317
549 Bridge Street
New Cumberland, P A 17070
(717) 774-1445
PETER A. DeLORENZO,
Plaintiff,
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYL VANIA
v,
NO, 2000-4314
DEBBIE I, DeLORENZO,
Defendant
CIVIL ACTION - LAW
DIVORCE
NOTICE OF INTENTION TO RESUME PRIOR NAME
NOTICE is hereby given that Defendant in the above-captioned matter, having been
granted a final decree in divorce on the 1 st day of April , 2003, hereby intends to
resume and hereafter use the previous name of Debbie I. Newman and gives this written notice
avowing her intention in accordance with the provisions of the Act of 54 Pa. C.S, 9704,
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Debbie I. DeLorenzo p
TO BE KNOWN AS:
!Jdrt.;J,/ &M~
Debbie I. Newman
COMMONWEALTH OF PENNSYLVANIA
: SS.
COUNTY OF CUMBERLAND
On this, the 4th day of April ,2003 before me, a Notary
Public, the undersigned officer, personally appeared Debbie I. DeLorenzo, known to me (or
satisfactorily proven) to be the person whose name is subscribed to the within instrument, and
acknowledged that she executed the foregoing Notice ofIntention to Resume Prior Name for the
purposes contained therein,
S WHEREOF, I hereunto set my hand and official seal,
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