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Home My WebLink About97-01690 '" ~ ~ I . II) .11) ~ ~ .,,::,);,'.,:.,~, '".(, ,,/,,::, ....;.. r _..~." A~!...:.~.~ ~'.;;;,-~ ....'..,. ." :"- <:) ~ ~ '., (b) Date Plaintiff's Waiver of Notice in ~3301(c) Divorce was filed with the prothonotary: November 1, 1999 (delivered to E. Robert Elicker, II, Divorce Master) , Date Defendant's Waiver of Notice in ~3301(c) Divorce was filed with the prothonotary: November 1, 1999 (delivered to E, Robert Elicker, II, Divorce Master) . 6, Plaintiff's Social Security number is 181-36-9273 and Defendant's Social Security number is 102-44-6713. Date: g !JOt!. (7~' MARTSfiIOLF & BRA TON ~ By Bruce F. Bratton, Esquire Attorney I.D. No, 23949 2515 North Front Street P. O. Box 12106 Harrisburg, PA 17108-2106 (717) 236-4241 Attorneys for Plaintiff 2 '- If) b; j:~ f lJ.f:-' (.~ <> ~~: ~ c:.: n , , C.,: c' .. lll' u, li..:1 C 0 f L! -.. Cl C:-, LOt ,.J proceder sin usted y decreto de divorcioo anulamiento puede ser emitido en su contra por la Corte. Una decisi6n puede tambi6n ser emitida en su contra por cualquier otra queja 0 compensaci6n reclamados por el demandante, Usted puede perder dinero, 0 propiedades u otros derechos importantes para usted, Cuando la base para el divorcio es indignidades 0 rompimiento irreparable del matrimonio, usted puede solicitar consejo matrimonial. Una lista de consejeros matrimoniales estii disponible en la oficina del Cumberland County Courthouse, One Courthouse Square, Carlisle, Pennsylvania. SI US TED NO RECLAMA PENSION ALIMENTICIA, PROPIEDAD MARITAL, HONORARIOS DE ABOGADO U OTROS GASTOS ANTES DE QUE EL DECRETO FINAL DE DIVORCIO 0 ANULAMIENTO SEA EMITIDO, USTED PUEDE PERDER EL DERECHO A RECLAMAR CUALQUIERA DE ELLOS. US TED DEBE LLEVAR ESTE PAPEL A UN ABOGADO DE INMEDIATO. SI NO TIENE 0 NO PUEDE PAGAR UN ABOGADO, VAYA 0 LLAME A LA OFICINA INDICADA ABAJO PARA AVERIGUAR DONDE PUEDE OBTENER ASISTENCIA LEGAL. ., [ !" . Court Administrator 4th Floor, Cumberland County Courthouse Carlisle, PA 17013 Telephone: (717) 240-6200 Date ~~ ~ P7 By / Bruce F. Bratton, Esquire Attorney I,D. No, 23949 2515 North Front Street P. O. Box 12106 Harrisburg, PA 17108-2106 (717) 236-4241 """"\. Attorneys for Plaintiff 2 v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. q 7 - It. 91:) twd ~ IN DIVORCE W, SCOTT BLISS, JR., Plaintiff PAMELA S. BLISS, Defendant COMPLAINT UNDER SECTIONS 3301(cl AND (dl OF THE DIVORCE CODE ~ I 1. Plaintiff is W. Scott Bliss, Jr., who currently resides at 145 Bryce Road, Camp Hill, Cumberland County, Pennsylvania. 2. Defendant is Pamela S, Bliss, who currently resides at 145 Bryce Road, Camp Hill, Cumberland County, Pennsylvania. 3. Plaintiff and Defendant have been bona fide residents in the Commonwealth for at least six months immediately previous to the filing of this Complaint. 4. Plaintiff and Defendant were married on or about August 17, 1979 in Jamestown, New York. 5. There have been no prior actions of divorce or annulment between the parties. 6. Plaintiff has been advised of the availability of marriage counseling and that he may have the right to request that the Court require the parties to participate in counseling. 7. plaintiff avers as the grounds upon which this action is based: I VERIFICATION I verify that the statements made in the attached pleading are true and correct, partially upon personal knowledge and partially upon my belief; to the extent language in the attached pleading is Date 3ht~7 I relating that of my attorneys, I have relied upon my attorneys in making this Verification. I understand that false statements herein are made subject to the penalties of 18 Pa. to unsworn falsification to authoriti /' 1-s b: en ?:: f" c .., IV) ..:!. .- .. "<1: ~q - i)~ M - .... '.):{ \\ '~~ ,-; ~ '") ?;j ~~ '.:>- V', 0 N :.'.....'l ::l~ I ',2' ~~ ~ 0: ,'-,(5 ~t (i:Y' a... ; .JU,. F oCt -- ~< u_ r- :J I..tl \ . 0 17' U r-V) - ~ W. SCOTT BLISS, JR., Plaintiff v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 97-1690 CIVIL TERM PAMELA S. BLISS, Defendant IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under Sections 3301(c) and (d) of the Divorce Code was filed on April 2, 1997 and served on April 26, 1997. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a Final Decree in Divorce after service of Notice of Intention to Request Entry of the Decree. 4. I understand that I may lose rights concerning alimony, division of property, attorneys' fees or expenses if I do not claim them before a divorce is granted. 5. I have been advised of the availability of marriage counseling, understand that the Court maintains a list of marriage counselors and that I may request the Court require my spouse and I to participate in counseling and, being so advised, I do not request that the Court require that my spouse and I participate in counseling prior to the divorce becoming final. 6. I am not a member of the armed forces of the United States of America nor any of its allies. I verify that the statements made in this Affidavit are true and correct. I understand that false sta ents herein are made subject to the penalties of 18 Pa. C ion 4904 relating to ::::'" ,:;:/~';"O" to '","0'''' t: ~ ~ it; -:\" >- tr. '-, ;::: N ~-1..4' . ,'-' t... -. l. c)" ::;: ~ .' 0, ~:i( .::;_J D '('"J i~:' ~1j:". . . -,"- r~ ~,. ~~ , li(, ... : ~ t';'" t... I' e) :j 0 0' u W. SCOTT BLISS, JR., Plaintif f IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 97-1690 CIVIL TERM v. PAMELA S. BLISS, Defendant IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under Sections 3301(c) and (d) of the Divorce Code was filed on April 2, 1997 and served on April 26, 1997. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a Final Decree in Divorce after service of Notice of Intention to Request Entry of the Decree. 4. I understand that I may lose rights concerning alimony, division of property, attorneys' fees or expenses if I do not claim them before a divorce is granted. 5. I have been advised of the availability of marriage counseling, understand that the Court maintains a list of marriage counselors and that I may request the Court require my spouse and I to participate in counseling and, being so advised, I do not request that the Court require that my spouse and I participate in counseling prior to the divorce becoming final. 6. I am not a member of the armed forces of the United States of America nor any of its allies. 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. {d,~1- , .( {ft.-.... Pamela S. Bliss, Defendant Date: //-/-re; , " , ,I ~ -:\' ~ :c. LJ. . ,- oo '-')/ UJ0 ~ 0'" _4'-) ~~: : I '..'. 1"' I - .) , l. ' {.J ,- ..-"- " G, ..l Cl tf' LJ W. SCOTT BLISS, JR., Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 97-1690 CIVIL TERM v. PAMELA S. BLISS, Defendant IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REOUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final Decree in Divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not b~ 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. on 4904 related to Date ,,/, /~'i unsworn falsification to authorities. Er. .- r ~ tr. t'- ts ? & :-) n , 11-' ~ . O. - r.: ~.... (... .J~~ <:""ll. . ~~:~ C:.. 1.~ I . ..:;..: ~ J I :- ! ~ ' I G~ 1 L , : ; ~.l- \, I.'. G' ..J 0 (J' U >- -~. :- n- lJ: r..: ~.? 1--: ~~I " IJ C; " : , -, o' r . (j ..~& l:-_j , - ;-/) -,' . .. 1._.- 17;1 .-..... [l I ", .'"Irtj " ~" .J:.l.. "- " c"\ :.i u u"\ {-! W. SCOTT BLISS, JR., Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. CIVIL ACTION - LAW NO. 97-1690 PAMELA S. BLISS, Defendant IN DIVORCE AFFIDAVIT OF SERVICE COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF DAUPHIN AND NOW, this 2nd day of May, 1997, personally appeared before me, a Notary Public in and for the State and County aforementioned, Bruce F. Bratton, Esquire, who, being duly sworn according to law, deposes and says that a copy of the Complaint in Divorce in the above-referenced divorce action was served on the Defendant on April 26, 1997, by certified mail, Certified No. P 649 937 761, return receipt requested, restricted delivery, as evidenced by the return receipt card attached her~~ade 1 V 'Vi Bruce F. Bratton, Esquire part hereof. Sworn to and subscribed to before me this,~ day of , /II,~,/ , 1997. / ~I}' N~c(~) P~b' ti~ (' 1" ,-<" ""- NOTARIAL SEAL NANCY E, ROACH, N.tary Public Harrilburg. Oouphin CGllnty, PA My Commh&Jon Expinu Jon. 29, 2001 5, Rocet,ed By: (Print Nsme) 937 7,{./ ):l' Certlfied III .& . " 15 - ~ ss (Only II request ! , :i :1 II 5 i , .CoqlleI.~ ,_..Z""odcIlIonII_, _eomptt, ItImI 3,." and 4b. .~)'OIM' f\Il'M n Idd,., onlht,....... oflNl torm 10 IhIt weean r.h.m IN. . to = _to tho ""'" 01 tho molIpioco," on tho bod< K _ _ not . r\to.R..... Roco/pI ~od' on tho meJpioco bIlow tho._....,."." . Ret\M'T1 Receipt wi. show lo.oom 1M artId. WI' dI~ tnd the dati -- 3, Ar1Ide Addressed to: ,/lis, h,<(f'LA .s. 6us .5 1"/5' .o,<!w'p AA,j {lI'JA(~ ;/'u./ /'-4 /701/ >- 0 "- f_.. cr, e, -. ~: N :5..... r )d: t.. .......~~ ~- ,-, ~ ~ u... ~. --I ;:.j c.:. .~ 'D ; . Cf) ,.. . ) /.: 6.' I J~Z '" ~ .1llU ~ \!.I(l.. :l!: ~ u. r- ':1 0 CJ' U \ ( . I J i \ . I l . - PRE HEARING CONFERENCE MEMORANDUM - May 10, 1999 W. SCOTT BLISS, JR" Plaintiff IN THE COURT OF COMMOll PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v, NO, 97 - 1690 PAMELA S, BLISS, Defendant CIVIL ACTION - LAW IN DIVORCE Present for the Plaintiff, W. Scott Bliss, Jr, is Attorney Bruce F, Bratton, and present for the Defendant, Pamela S. Bliss, is attorney Steven J, Dzuranin. A divorce complaint was filed on April 2, 199/, raising grounds for divorce of irretrievable br"i1}; down OJ the marriage. Counsel have advised that the paJ'ties will sign affidavits of consent and waivers of notice of intention to request entry of divorce decree to conclude the divorce under Section 3301(c) of the Domestic Relations Code. However, counsel did previously file an affidavit under Section 3301(d) after a two-year separation (the date of separation of record has been disputed) but in any event the parties will have been separated two years using either date of separation so the divorce can conclude, if necessary, under Section 3301(d), The complaint raised no economic issue~; the Defendant filed an answer and counterclaim on September ~c, 1998, raising the economic claims of equitable d istribut i l'll, alimony, alimony pendente lite, and counsel fee~ and expenses, Counsel have indicated that they wilL let the Master know if they need to have a separate hearing for (Ii.te of separation issues, and also whether or not they want to have a separate hearing on marital misconduct. Counsel will advise the Master on these two issues within a month of today's date, and if they request a hearing on either or both issues, we will use the hearing date set today for the testimony required to address date of separation ilnd marital misconduct, The parties were married on August 17, 1979, anu separated according to husband on June 30, 1996 and according to wife on July 11, 1997, The parties are the natural parents of three children, Walter Scott Bliss, III, born October 1, 1981, Hillary S, Bliss, born June 27, 1985; and Andrew L, Bliss, born November 9, 1987. The children are in the primary custody of wife. '17 (lL,~ ~ Husband is 46 years of age and resides at ~ Charles Road, Mechanicsburg, Pennsylvania, where he lives alone. He has is a high school graduate with several years of college. He currently works for CTR Systems, Inc. as a vice-president of sales. The 199B gross income as shown on the W-2 form for that year is 121,496.66, On February 4, 1998, the support office entered an amended order stating his monthly income at $5,902,00 net. He is currently pnying support for the children in the amount of $1,597.00 per month and support for wife in the amount of $78u,OO per month. He has not raised any health issues, Wife is 46 years of age and resides at 145 Bryce Road, Camp Hill, Pennsylvania, where she lives \Iith the three children. She J.s a high school graduate, ..nd has i1 bachelor of science degree, She is currently working for Moorefield Communications, Inc. as a manager of sales administration, Her gross income is around $27,000,00 annually, The amended support order on February -I, 1998, showed her net monthly income at $1,701.00. Sh" has not. raised any health issues, The parties own real estate at 145 Brjce Road, Camp Hill, Pennsylvania, where wife lives with the childrell. The property is subject to a mortgage in favor of Harris Savings Bank with the payoff between $210,000.00 and $225,000.00. Counsel are going to get information regarding the payoff of that mortgage, The house is also subject to n lien in favor of Pennsylvania Housing Finance Agency with a payoff of currently around $6,900,00. The hOUSE \{as appraised a few months ago for $283,000.00. Counsel are satisfied to accept the value of the property as stated ,,~; of the date of the appraisal. According to wife she contributed $25,UOO.00 Irum an inheritance from her grandmother toward the purchase of the property where wife is currently living, The down payment, according to her, consisted of $10,000.00 from tlw prior home, and the $25,000,00 from her grandmother's estate. Husband disputes this information and counsel are going to try to verify the facts as their clients are presenting them so that we know exactly what the source of funds were for the purchase of the present home. There is also an issue with regard to \':hether 01" not the 1993 GMC Safari van has any value for purposes of distribution. Counsel are going to review the tr;jde-in value of the van and other expenses associated \'Iith the Viln, including the payoff on the lien, to determine \'Ihether or not we will use any value for that asset in the equitable distribution computation, Husband had a 401(k) plan with Horizons/CMS Healthcare Corporation, which was cashed in leaving a net or around $3,000,00 which he claims was used for e>:penses ill the custody case, Wife says that only around $JU5.00 benefited her, and counsel for husband is going to provide an accounting of the disposition of the funds pulled out of that 401(k), There is a 401(k) plan with CTR Systems, Inc., which had a value as of March 31, 1999, of $31,100,00, Counsel for husband has indicated that no contributions hilv" been made in that 401(k) since the date of sepa~iltion so \'10 can use the date of distribution statement as representative of the value of that asset, There is a list of household tangible personal property which wife claims husband removed from the property at separation; if there is an issue about the value of property in each party's possession, counsel should arrange to have the property appraised. Also listed in the pretrial statements are a number of creditors. The Master has raised a question ilbout how we could accomplish distribution since there is no cash for payment from either party to the other, and provide [o~ an assignment of debt to husband, without allocilting any or the debt to wife. Counsel for husband is concerned that if he assumes the debt, he should be given some consideration on the claim of alimony being made by wife. This request is not unreasonable; however, the Master is not prepared to terminate wife's alimony claim. Along the lines of the comments that hiwe been made regarding the fact that there is no cash to be paid from one party to the other, (the only cash is in the 401 (k), which would require penalty and tax con,;,,,quences) , wife's decision to keep the real estate where she is paying $1,938,00 a month is a financial decision which will impilct on how we devise a settlement of the assets and the alimony claim. The Master did point out to counsel that if the parties decide that the house should be sold, it should be listed immediately so that the parties will be 'lharing the costs of sale. Wife is forewarned that she should not appear at the hearing, and at that time decide that she wants to list the house for sale, and then expect husband to pay some speculative amount of money toward the costs of that sale, A hearing is scheduled for Thursday, lIovember 10, 1999, at 9:00 a.m. Notices will be sent to coulls~l and the parties. E. Robert Elicker, II Divorce Master ee: Bruce F. Bratton Attorney for Plaintiff Stephen J. Dzuranin Attorney for Defendant W. SCOTT BLISS, JR., Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. NO. 97 - 1690 CIVIL PAMELA S. BLISS, Defendant IN DIVORCE ORDER O~OURT AND NOW, this' day Of~, 1999, the economic claims raised in the proceedings having been resolved in accordance with a stipulation/agreement dated November 1, 1999, which has been signed by the parties and made part of the record, 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, cc: Bruce F. Bratton Attorney for Plaintiff P.J. Stephen J. Dzuranin Attorney for Defendant vf.ttpwJJ J))'u'L 1I'3-?9 RLK W. SCOTT BLISS, JR., Plaintiff v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 97-1690 CIVIL TERM PAMELA S. BLISS, Defendant IN DIVORCE STIPULATION OF SETTLEMENT The parties to the above-captioned divorce action, W. Scott Bliss, Jr. (hereinafter "Husband") and Pamela S, Bliss (hereinafter "Wife") hereby stipulate and agree as follows: 1. The parties each are signing, simultaneously with the execution of this Stipulation, Affidavits of Consent and such other documents as may be required to obtain a Decree in Divorce. 2. The terms of this Stipulation shall be incorporated into the Decree in Divorce by reference but shall not merge in such Decree. Enforcement of the terms of this Stipulation may be had under the applicable provisions of the Pennsylvania Divorce Code or under contract principles as the non-breaching party may determine. 3. The marital real property at 145 Bryce Road shall remain titled in the name of both Husband and Wife until Wife obtains a release of Husband from any and all liability for the Harris Savings Bank mortgage loan, having an approximate remaining principal balance of $224,000.00, for the PHFA mortgage granted by Wife alone and having a balance of approximately $6,200.00, and for any other liabilities, debts or the like for which title to the property is pledged or subject to mortgage or other lien. Wife shall obtain such release or payoff all such liabilities in full by means of a completed refinancing of such debts no later than July 1, 2002. Wife shall hereafter be solely and exclusively responsible for payments of all taxes assessed on such property, for maintaining insurance in an amount not less than the total debts secured by mortgages upon title to the property and for full, timely performance of all obligations under any such debt, note and/or mQrtgage. Wife hereby agrees to and shall indemnify and save Husband, his heirs and assigns, of and from any and all liability, losses, dam3ges, claims, suits, actions or causes of action to which Husband may be exposed by reason of Wife's failure to pay, when and as due, each obligation with respect to the marital real property assumed by her, including the obligation of Wife to pay such reasonable attorneys' fees Husband may incur in defending against such claims. Wife shall provide to Husband written evidence of the payment of all such mortgage payments when and as due each month hereafter upon the reasonable request of Husband, not more frequently than two times per year. The foregoing notwithstanding, Wife shall, immediately upon receipt thereof by Wife, provide to Husband copies of all notices of default, notices of intention to foreclose or notices of tax claims or municipal claims with regard to the real property or any mortgages, liens or taxes related thereto. Wife shall be entitled to exclusive possession of the former marital residence and, upon Wife's full performance of all obligations assumed by Wife with regard to the real property and all debts/mortgages in this Stipulation, including refinancing on or before July 1, 2002, Husband shall execute and deliver to Wife a quitclaim deed assigning all of his right, title and interest in such real estate to Wife. 4. On or before December 1, 1999, Wife shall deliver to Husband a payment of the total sum of $8,700.00, by cashier's check or certified check made payable to Household Credit Services, Inc., for appication to the joint credit account of the parties, Mastercard Account No. 5407-0410-2201-4726 being otherwise assumed by Husband as hereinafter provided. Husband shall forward such payment to the said creditor and shall simultaneously provide evidence of such forwarding to wife. 5. Wife hereby assumes as her sole and exclusive responsibility and liability the marital debt to Hecht's Department Store, Account No. 118-909-160, having a balance remaining of approximately $830.00 and hereby agrees to and shall hereafter indemnify and save Husband harmless of and from any and all liability, losses, damages, claims, suits, actions or causes of action to which Husband may be exposed by reason of Wife's failure to pay the full balance of such account, when and as due, including the obligation to pay such reasonable attorneys' fees Husband may incur in defending any such claim or claims. 6. In the event Wife should (a) fail to deliver to Husband the amount required to be paid by her when and as provided in Paragraph 4 hereof, (b) fail to pay any and all mortgage payments or other obligations with respect to the real property as provided in Paragraph 3 hereof, or (c) fail to perform any other material obligation undertaken or assumed by her under this Stipulation and to cure any defaults or breaches within ten (10) days of Husband's written notice to her of such breach or default (such notice to be 2 I ,awJ - , oL,jvJ,1 J fr~ ~ VJ i-tr 10f iS~kt"} ..t4~ U' ,,,It .11' a.c1v.J/'( (ee ~ivr./ ~r W trt v.IoJ Jw.....d lur (' ,.,.... fJ 1.~1I .,sy.- forwarded via u.s. Postal Service, certifie or registered mail and shall be deemed to have been given when m~i18e t~ Wife at the address of the marital residence), then, any other provision of this Stipulation to the contrary notwithstanding, the obligation of Husband to execute and deliver a quitclaim deed to Wife shall terminate and the parties shall immediately execute a contract to list the real property for sale with a real estate broker of Husband' 8 choosing at an initial listing price of $283,000.00. Said listing contract shall, however, also provide that the listing price shall be reduced by a sum of $2,000.00 on the date 60 days from the date the listing contract is executed by Husband and Husband's broker~and that the price shall also be reduced by an additional $2,000.00 each month thereafter until the property is sold to a bona fide third-party purchaser. Upon sale of the real property, such amount of the proceeds, less costs of sale, payoff of mortgages and liens, settlement charges, brokers commissions, transfer taxes and other usual costs of sale, as may be necessary to satisfy Wife's obligation under Paragraph 4 hereof, if not already satisfied, shall be distributed to Husband for forwarding to the appropriate creditor, and the balance, if any, shall be distributed to Wife. 7. Husband hereby assumes as his sole and exclusive responsibility and liability the marital debts to visa /l.ccount No. 4271 3821 3852 6401 (formerly 4271 3823 1466 9819), having a date-of-separation balance of approximately $7,842.00. to Mastercard Account No. 5407-0410-2201-4726, having a date-of- separation balance of approximately $8,600.00 and a current balance of approximately $11,600.00 (except for the amount to be paid by Wife as provided in Paragraph 4 hereof), and to American Express Account No. 3728-882387-41001, having a date-of-separation balance of approximately $5000.00, and, except for the amount to be paid by Wife for application to the Mastercard Account as provided in Paragraph 4 hereof, hereby agrees to and shall hereafter indemnify and save Wife harmless of and from any and all liability, losses, damages, claims, suits, actions or causes of action to which Husband may be exposed by reason of Husband's failure to pay the full balance of each such account, when and as due, including the obligation to pay such reasonable attorneys' fees wife may incur in defending any such claim or claims. Husband shall provide Wife with evidence that the Mastercard Account has been closed and that Wife is not a signatory on nor liable for the amounts owing on the Visa Account or the American Express Account. 8. All amounts held for the benefit of Husband in the 401(K) Profit-Sharing Plan at CTR Systems, Inc. shall hereafter be and remain the separate property of Husband free of any and all claims of Wife whatsoever. 3 9. All furniture, furnishings and personal property of any kind whatsoever in the possession of either Husband or Wife, whether acquired during the course of the marriage or not, shall hereafter be and remain the sole and separate property of the party in possession, free of any and all claims of the other party whatsoever. 10. The current Support Order dated September 16, 1999 shall terminate as to spousal support and mortgage adjustment payments, effective October 31, 1999. Husband and Wife agree that Wife shall make no future claim to entitlement to any payments for mortgage adjustments under the provisions of Pa. Rule of Civil Procedure 1910,16-6(d) or otherwise, the full obligations with respect to such mortgage payments being assumed solely by Wife herein. Husband shall pay to Wife as alimony the sum of $948.00 per month, commencing November 1, 1999 and each month thereafter through October of 2000; for the period of November 1, 2000 through October of 2001, Husband shall pay to Wife as alimony the sum of $500.00 per month; and for the period of November 1, 2001 through October of 2006, Husband shall pay to Wife as alimony the sum of $400.00 per month. The obligation of Husband to pay alimony shall terminate upon the death of either Husband or Wife, Wife's remarriage or cohabitation with a member of the opposite sex who is not a member of the family of Wife within the degrees of consanguinity, but shall not be modified or modifiable except as herein otherwise expressly provided. 11. Child support shall remain unmodified by this Stipulation but shall remain subject to the jurisdiction of the Domestic Relations Section of the Cumberland County Court of Common Pleas and may be modified in accordance with Pennsylvania Support Guidelines. 12. costs and by either Each party shall bear his or her own attorneys' any such claim with regard to counsel fees and party is hereby waived and withdrawn. fees and expenses 13. In the event of a breach of any obligation by a party hereto, the non-breaching party shall be entitled to recover from the breaching party the reasonable attorneys' fees, costs and expenses incurred by the non-breaching party in enforcing the terms of this Stipulation or seeking to recover for damages sustained by virtue of such breach or default by the other party, 14. Wife acknowledges that she retains as custodian three accounts in the H. J. Heinz Company dividend reinvestment plan for the benefit of the parties' child, Hillary Bliss, two such accounts for the benefit of the parties' child, W. Scott Bliss, III, and one such account for the benefit of the parties' child, Andrew Bliss, 4 and shall continue to maintain such accounts until each child attains the age of 18. 15. has made matters, nature. The parties represent and warrant to each other that each a full and complete disclosure of all material financial including income, expenses, assets and liabilities of any 16. The parties accept the provisions hereof if full and final settlement of any and all claims for distribution of property, alimony, alimony pendente lite, counsel fees, costs and expenses and any and all other claims arising from the marriage of the parties, whether raised in these proceedings or not, all such claims as have been raised being hereby exp y withdrawn. ]ofJ: III, /~ ~ # fj)Jc.I : "I' ! 99 Jr., Plaint ff -DA., (r< f , ~ela SJ. B~~ Defendant 5 W. SCOTT BLISS, JR. Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. NO. 97 - 1690 CIVIL PAMELA S. BLISS, Defendant IN DIVORCE THE MASTER: Today is Monday, November 1, 1999. This is the date set for a Master's hearing in the above captioned divorce proceedings. Present in the hearing room are the Plaintiff, W. Scott Bliss, Jr., and his counsel Bruce F. Bratton, and the Defendant, Pamela S. Bliss, and her counsel Stephen J. Dzuranin. This action was commenced by the filing of a divorce complaint on April 2, 1997, raising grounds for divorce of irretrievable breakdown of the marriage. The Master has been provided affidavits of consent and waivers of notice of intention to request entry of divorce decree signed by the parties and dated today. The affidavits and waivers will be filed by the Master's office with the Prothonotary. The divorce can be concluded under Section 3301(c) of the Domestic Relations Code. No economic claims were raised in the complaint; however, the Defendant wife filed an answer and counterclaim on September 28, 1998, raising the economic issues of equitable distribution, alimony, alimony pendente lite, and counsel fees and expenses. The parties were married on August 17, 1979, and are the natural parents of three children, none of whom are, at this time, emancipated. The Master has been advised that the parties and counsel reviewed a stipulation prepared by counsel setting forth the agreement and understanding of the parties with respect to a resolution of the pending economic issues. Counsel are going to make the agreement/stipulation part of the record. Mr. Bratton, at the request of the Master, is going to give a brief summary of the content of the stipulation and then the parties will be asked by their respective counsel if they understand the terms of the stipulation and are in agreement to have the stipulation resolve the outstanding economic issues pending in these proceedings. Mr. Bratton. MR. BRATTON: Thank you, Mr. Elicker. The stipulation essentially, as you said, is intended to settle all economic issues currently pending under the terms in a summary fashion: The marital residence at 145 Bryce Road, Camp Hill, Pennsylvania, is to remain solely and exclusively occupied by wife. She is being granted an opportunity until July 1, 2002, to obtain refinancing or release of liability in favor of Mr. Bliss as to Harris Savings Bank mortgage of about $224,000.00 and a PHFA mortgage on the property having a balance of somewhere in the neighborhood of $6,000.00 to $6,500.00. If she does in fact refinance within that time frame, then the property will be quitclaimed to her and she will have sole title to it. In addition, the parties are dividing between themselves certain marital debts, including wife taking as her exclusive responsibility obligations with respect to a Hecht's Department Store account, a payment from Mrs. Bliss toward an obligation to a MasterCard account and Household Credit Services. Mr. Bliss is retaining sole obligation for a Visa account and an American Express account and the balance of the MasterCard account over and above the amount of the contribution by Mrs. Bliss. There are provisions in the divorce settlement agreement as well providing that the personal property of the parties stays in the possession of the person who currently has possession of it. Mr. Bliss will retain as his sole and separate property his interest in a 40l(k) plan at his employment at CTR Systems, Inc. The child support remains unmodified and is still subject to the jurisdiction of the Cumberland County Court where there is a current order pending. The support order which had most recently been modified and is dated September 16, 1999, will terminate as spousal support and its provisions regarding mortgage adjustment payments effective November 1, 1999, and in lieu of those payments Mr. Bliss is agreeing to pay alimony at the sum of $948.00 per month for one year, beginning November 1, 1999; starting November 2000 through October of 2001 at the rate of $500.00 per month; and from November 2001 through October 2006 husband would pay alimony at the rate of $400.00 per month and then the obligation ends. It would also terminate as provided by statute in the event of death of either party, the wife's remarriage or cohabitation with someone not a member of her family within the prohibited degrees of consanguinity, but otherwise, the alimony provisions will be unmodifiable. There are provisions as well regarding what happens if there is a default under the terms of the mortgages which the wife is undertaking as her sole responsibility providing for a potential rapid listing of the house for sale and the distribution of the proceeds. I believe that in essence summarizes the terms of the agreement. All other claims for counsel fees, equitable distribution, alimony, alimony pendente lite, or other economic issues are expressly being resolved by this stipulation and in lieu of further litigation. THE MASTER: Is that correct, the statement that Mr. Bratton has made of the outline of the agreement? MR. DZURANIN: Yes, it is. MR. BRATTON: The parties have executed this morning there is a small change that has also been initialled by the parties on Page 3 of the stipulation, and I am presenting the stipulation to you, Mr. Elicker, to be made part of this record. Mr. Bliss, you've read the stipulation dated today? MR. BLISS: Yes, I have. MR. BRATTON: And you've initialled the changes that were made this morning? MR. BLISS: Yes, I have. MR. BRATTON: And you've signed it? MR. BLISS: Yes, I have. MR. BRATTON: By that action, do you agree that this stipulation constitutes a satisfactory resolution of all economic claims which have been raised in these proceedings, could have been raised in these proceedings, and in lieu of the litigation through the Master's hearing process? MR. BLISS: I do so agree. MR. DZURANIN: Mrs. Bliss, have you read the stipulation of settlement that Mr. Bratton has summarized? MRS, BLISS: Yes, I have. MR. DZURANIN : Do you understand what it says? MRS. BLISS: Yes, I do. MR, DZURANIN: Do you agree with the terms contained in it? MRS. BLISS: Yes, I do. MR. DZURANIN: Do you agree that this settles all claims raised in the divorce proceedings? MRS. BLISS: Yes, I do. (STIPULATION IS ATTACHED AND MADE A PART HEREOF. ) " Mr. Bratton and Mr. Dzurnnln, AlIorncys lit Lllw 12 Octobcr 1999 Pngc 2 thc apprnlsalllccomplishcd until now. Pcrhllps thlltls hccnus(~ of wife's reluctance to respond to scttlement proposllls which hnve hecn proffered previously. Perhaps wifc's delllY in letting hushllnd know if settlcment is not possible has resultcd in husband's necd to havc an appl'llislllllt this time. In any event, I would suggest to counsel thllt thc CIISC he rClldy for trial in all respects for the hellring on Novemher I, 1991). , :I ! Vcry truly yours, I~. I~obert glicker, II Divorce Master E. Robert Elicker, II, Esquire October 8, 1999 Page 2 Master's hearing, I will be reque/ltJng that the hearing transcript remain open pending conclullion ot tho ilppraisal report and adding it to the record. ll(~caU/lfJ it ilppl!ilr/l to have been Mrs. Bliss' failure to cooperate in illlowtng th" in/lpection/appraisal, I will be requesting that the auuitiol\ill contu and expenses of any extension of the Maull)r' Il h'!ilr I /lfl pl'oc:ellll be assessed against her. Please call l11e it YOII hilvI! ilny qllulltionll. V('I'y,~__I.ql Y y, rs, . / ) I I // J/(()- U{II<:IJ F, Bratton BFB/ner cc: Stephen J. Dzuran in, I':uqlll rl! Mr. W. Scott Blisll, Jr. Martsolf [1 Bratton ATTORNEYS AND COUNSELORS AT LAW 2515 NORTH FRONT STREET P,O, Box 12106 HARRIS6URG, PENNSVLVANIA 17108,2106 TELEPHONE (717) 238.4241 I I TEL.ECOPIER (717) 233.G7G1 F.R. MARTSOLF DRUCE F. BRATTON FILE NO. February 8, 1999 VIA HAND-DELIVERY E. Robert Elicker, II Office of Divorce Master 9 North Hanover Street Carlisle, PA 17013 RE: Bliss v. Bliss Dear Bob: Per your letter of January 19, 1999, I enclose herewith the Plaintiff's Pre-Trial Statement. I am simultaneously mailing a copy of this letter to Mr. Dzuranin along with a copy of the enclosure. ~ .: Please call me if you have any questions or comments. I look forward to your scheduling of a conference. BFB/ms cc: Stephen J. Dzuranin, Esquire (w/ encl) W. Scott Bliss (w/ encl) (B) An agrecmcnt haB BeeR rcachcd I..ith reBpeet to the felle....iFlg elaimB. (c) The action is contested with respect to all claims. (5) The action does not involve complex issues of law or fact. (6) The hearing is expected to take four (4) hours. (7) Additional information, if any, relevant to the Motion: Plaintiff has filed his Affidavit pursuant to Section 3301(d) of the Divorce Code and has caus~d such Affidavit to be served upon counsel for Defendant. Defendant's last-known address is: 145 Bryce Road Camp Hill, PA 17011 Respectfully submitted, Date I) JIJ~ ff MARTS~LF ,,~7r By M- """'" Br ce F. Bratton, Esquire Pa. Attorney I.D. No. 23949 2515 North Front Street P. O. Box 12106 Harrisburg, PA 17108-2106 (717) 236-4241 Attorneys for Plaintiff w. SCOTT BLISS, JR" Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v, NO. 97-1690 CIVIL TERM PAMELA S. BLISS, Defendant IN DIVORCE COUNTER-AFFIDAVIT UNDER ~ 3301(4) OF THE DIVORCE CODE 1. Check either (a) or (b): --- (a) I do not Oppose the entry of a divorce decree, -i- (b) I oppose the entry of a divorce decree because (Check (i), (ii) or both): ~ (i) The parties to this action have not lived separate and apart for a period of at least two years, --- (ii) The marriage is not irretrievably broken, 2. Check either (a) or (b): --- (a) I do not wish to make any claims for economic relief. I understand that I may lose rights concerning alimony, division of property, lawyers' fees or expenses if I do not claim them before a divorce is granted. -i- (b) I wish to claim economic relief which may include alimony, division of property, lawyer's fees or expenses or other important rights. I understand that in addition to checking (b) above, I must also file all of my economic claims with the prothonotary in writing and serve them on the other party. If I fail to do so before the date set forth on the Notice of Intention to Request Divorce Decree, the divorce decree may be entered without further delay. I verify that the statements made in this counter-affidavit are true and correct, I understand that false statements herein are made subject to the penalties of 18 Pa.C.S, ~ 4904 relating to unsworn falsification to authorR~s" 0 A_ r' 9~o ~ DATE: ((-l.. ~ rl\" ~'-'~' __~ ~ \~ Pamela S. Bliss, Defendant NOTICE: If you do not wish to oppose the entry of a divorce decree or you do not wish to make any claim for economic relief, you should not file this counter-affidavit. .:\sjd\domcstlcrcIDtlons\bllss.2co W, SCOTT BLISS, JR" Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA f I I v. NO. 97-1690 CIVIL TERM PAMELA S, BLISS, Defendant IN DIVORCE CERTIFICATE OF SERVICE I hereby certify that the foregoing Counter-Affidavit was sent by first class, postage prepaid mail this day to the following: Bruce F. Bratton, Esquire Martsolf & Bratton 2515 North Front Street P,O. Box 12106 Harrisburg, PA 17108-2106 WIX, ~t~~! &)W~DNER I ,l'~'-l;1 ! J ) I), \ " By:./ ;ll/I../.....,J! i}_ .-/ It!... /Z.~....~.. ,/stephen J I DZ,utanin, Esquire 508' NortH' Second Street P,O, Box 845 Harrisburg, PA 17108-0845 (717) 234-4182 DATE: October 1, 1998 i I Ii I I' I ' , r I, ! W. SCOTT BLISS, JR., Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v. NO, 97-1690 CIVIL TERM PAMELA S, BLISS, Defendant ': IN DIVORCE ANSWER TO COMPLAINT IN DIVORCE WITH COUNTERCLAIMS ,. ~ I ,. AND NOW, comes the Defendant, Pamela S, Bliss, by and through her attorneys, Wix, Wenger & Weidner, and files the within Answer to Complaint with CounterClaims, averring as follows: . . Answer to Complaint Under section 33011cl and Idl of the Divorce Code 1. Admitted with clarification, As of the date of this answer, the Plaintiff resides at 4706 Charles Road, Mechanicsburg, Cumberland County, Pennsylvania 17055 Plaintiff has lived at said address since July, 1997. 2. Admitted, 3. Admitted, 4. Admitted. 5, Admitted. 6, Admitted on information and belief. 7. Admitted in part and denied in part. (a) It is admitted that the marriage between the parties hereto is irretrievably broken, (b) It is denied that the parties have lived separate and apart since June 30, 1996 and strict proof thereof is demanded. 8. Admitted. WHEREFORE, Defendant requests this Honorable Court to deny the Plaintiff's request for a Decree in Divorce pursuant to section 3301(d) of Divorce Code and to grant such further relief as this Court deems appropriate, COUNTERCLAIMS Count II - Equitable Distribution 9. Paragraphs 1 through 8 hereof are incorporated herein by reference. 10, During the marriage, Plaintiff and Defendant have acquired various items of marital property, both real and personal, which are subject to equitable distribution under Section 3501 of the Divorce Code. 11. Plaintiff may have owned, prior to the marriage, property, real and personal, which property has increased in value during the marriage and/or which has been exchanged for other property, which has increased in value during the marriage, all of which is "marital property." 12. Plaintiff and Defendant have been unable to agree as to an equitable division of said property to the date of the filing of this Answer, and portions of said property are in the exclusive control of Plaintiff. VERIFICATION I, Pamela S, Bliss, Defendant in the foregoing Answer to Complaint with counterclaims, have read the foregoing Answer and hereby affirm and verify that it is true and correct to the best of my personal knowledge, information and belief, I verify that all of the statements made in the foregoing are true and correct and that false statements made therein may subject me to the penalties of 18 Pa,C,S.A. section 4904, relating to unsworn falsification to authorities, C) C P . '-\ l\ /0"'-': Q~'l.- :j, )J._L.-:) Pamela S. Bliss, Defendant DATED: september~, 1998 c:\sJd\domrels\blfss.sns . - CERTIFICATE OF SERVICE , I r I hereby certify that I today served a true and correct copy of the foregoing Affidavit under Section 3301(d) of the Divorce Code, by placing the same in the U.S. mail, postage prepaid, addressed to: Stephen J. Dzuranin, Esquire WIX, WENGER & WEIDNER 508 North Second Street P. O. Box 845 Harrisburg, PA ''1f{iI-~ Bruce F. Bratton, Esquire Date 1'1 .hI/' 1 fd I WIX, WENGER & WEIDNER I\I['II""UII. \lilX '1110MA'il. \l,l~N(jEll !lEAN A WElUNFK S'mVEN C WIIJ)S 11lEIlESI\ I. SIIAn!! WI.'\ . llt\\'HlH..ClIrrZ SIH'IIEN J. IlZUItASIN CilRAIU> I!. Rlt'KAIU>S t S'IT:VHN It WIIJ.IAMS KEVIN S. 1II.AN'lllN (IIlAUU!\' U. AIJ.ISON A 1'111 WESSIONA1. ('OIU'OIIATION ,\TI'OIINEYS AI' I.AW \lIK NOli'll I SITONIl STIIEET I'OST OI'I'ICE 1I0X K,II IIAIUUSIIIJlW, I'ENNSY1.\'ANI,\ l71l1K,I>>l~1 -1M nmm S'I1tEBT IIAH.RISIIlJltn,ll^ 1111>>-.11'19 (1l1JhlHI.I5S (717)m'~IK~ TEI.E(,OI'IEII (717) ~.IH~~~ 1'L1!ASH REPLY1U Ul1lm s111EHT OHICH I ) . AI"1 Mrmhcr M.:a._'hutC'lIlll1r t CtnirJC',J CAil Tritl AIh'l(.;Jlt, N.:aI~)fI;aI(lo>.ardnITri.:aII\.h,I!;"'l February 5, 1999 E. Robert Elicker, II Divorce Master Office of Divorce Master Cumberland County Court of Common Pleas 9 North Hanover street Carlisle, PA 17013 RE: W. Scott Bliss. Jr. v. Pamela S. Bliss No. 97-1690 civil In Divorce Dear Mr, Elicker: Enclosed is the original of the Defendant's Pre-Trial statement and Inventory in the above referenced divorce action. We understand you will immediately schedule a pre-hearing conference with Mr. Bratton and myself. If you have any questions or comments please do not hesitate to contact the undersigned. Sincerely yours, WIX, WENGER & WEIDNER By:~1'8 ~w'td-A~v(k~ Stephen J. Dzuranin \bsh Enclosure cc: Ms, Pamela S. Bliss (wjenclosure) Bruce F, Bratton, Esquire (wjenclosure) W, SCOTT BLISS, JR., Plaintiff v, PAMELA S. BLISS, Defendant , IN THE COURT OF COMMON CUMBERLAND COUNTY, PENNSYLVANIA PLEAS NO. 97-1690 CIVIL TERM I i IN DIVORCE PRE-TRIAL STATEMENT OF DEFENDANT. PAMELA S. BLISS AND NOW COMES Defendant, Pamela S. Bliss, by and through her attorneys, Wix, Wenger & Weidner, and files this Pre-Trial Statement in accordance with Pennsylvania Rule of Civil Procedure No, 1920.33(b). PLAINTIFF: 1. 2, 3. 4 . 5. 6, 7. 8, DEFENDANT: I. BACKGROUND INFORMATION Name: Address: Age: Date of Birth: Educational Background: Health: Occupation: Employer: 1. 2, Name: Address: 3. 4. 5, Age: Date of Birth: Educational Background: 6. Health: 7, 8, Occupation: Employer: CHILDREN OF THIS MARRIAGE: W. Scott Bliss, Jr. Charles Road Mechanicsburg, PA 17055 46 August 8, 1952 High School Diploma and several years of college. No health problems/issues have been raised. Vice President of Sales. Keystone Medical systems, Inc. Pamela S, Bliss 145 Bryce Road camp Hill, PA 17011 46 August 9, 1952 High School Diploma and Bachelor's Degree in Science. No health problems/issues have been raised, Manager of Sales Administration Morefield Communications, Inc. 1, Walter Scott Bliss, III (d.o,b. October 3, 1981) - 17 2, Hillary S, Bliss (d,o.b. June 27, 1985) - 13 3. Andrew L, Bliss (d,o.b. November 9, 1987) - 11 MARRIAGE INFORMATION: 1. 2, 3, 4, 5, Date of Marriage: Place of Marriage: Date of Separation: Date Action Commenced: Issues Raised: August 17, 1979 Jamestown, N,'{, July 11, 1997 April 2, 1997 Divorce, Equitable Distribution, Alimony, Alimony Pendente Lite, Counsel Fees II. INCOME 1, Husband is employed as a Vice President of sales at Keystone Medical Systems, Inc. with an annual gross income of in excess of $100,000,00. 2. Wife is employed by Morefield Communications, Inc. as a Manager of Sales Administration, Her gross income from such employment was $27,117,43. A copy of the Defendant's 1996 and 1997 tax returns and her 1998 W-2 statement are attached hereto as Exhibit A. III, ASSETS A. Real property 1. The parties jointly own property at 145 Bryce Road, Camp Hill, Pa, which was the marital residence of the parties from August 1995 until the date of separation, July 11, 1997, From that time to the present, the Defendant has continued to reside there along with the three children. The house was purchased in August, 1995 for $268,000,00, The downpayment of $35,000.00 was made from the proceeds of the sale of the parties' previous home (approximately $10,000,00) and an inheritance from the Defendant's grandmother (approximately $25,000.00). The property is subject to a first mortgage with Harris Savings Bank in the original amount of $233,000.00, with a current balance of approximately $225,000.00, and a second mortgage taken out by the Defendant with Pennsylvania Housing Finance Agency to help cure arrears on the first mortgage (which was subject to foreclosure action) with an initial principal amount of $7,900.00 and a current principle balance of $6,900.00. The Defendant claims the $25,000.00 from her inheritance to be non-marital property and the remaining value of the marital residence and both mortgages to be marital assets and liabilities, 2 VI. WITNESSES A. Expert Defendant may call a pension evaluator regarding the Plaintiff's 401(k) plans, an appraiser for the marital residence and an appraiser of the tangible marital assets, Defendant reserves the right to supplement this provision to include experts necessary at the hearing, B. Fact ~ other than Pamela S. Bliss, the Defendant does not intend to call any other fact witnesses. However, the Defendant reserves the right to supplement this provision to include other witnesses necessary at the hearing. A VII, EXHIBITS ~, 1. statements verifying Defendant's income and expenses including, without limitation, Defendant's 1996 and 1997 income tax returns and 1998 W-2 form. - " 2, statements verifying ownership of marital and non-marital assets. 3, statements verifying values of real and personal property. 4. statements verifying balances of marital liabilities during applicable time periods. 5. statements of legal fees incurred by the Defendant in the instant Divorce action. Defendant reserves the right to supplement this list of Exhibits to include other Exhibits necessary at the hearing. VIII. COUNSEL FEES The Defendant will present documentation of attorney fees incurred to support her claim to counsel fees in this matter, 5 INCOME AND EXPENSE STATEMENT OF PAMELA S. BLISS Employer: Address: Type of Work: Payroll Number: Pay Period (weekly, bi-weekly, etc.):BI-WEEKLY (everv two weeksl Gross Pay Per Pay Period: $ 1.189.51 ITEMIZED PAYROLL DEDUCTIONS: Federal withholding social Security Local Wage Tax State Income Tax Retirement (401kl PA UC Tax Union Dues Life Insurance Health Insurance Other (specify) Short Term Ois $ 107.81 $ 72.73 $ 11.73 $ 32.85 $ 46.92 $ $ $ $ $ 3.73 NET PAY PER PERIOD: TOTAL MONTHLY PAY: $ 914,37 $ 1.979.61 OTHER INCOME: WEEK MONTH YEAR Interest $ $ 0.00 $ Dividends $ $ 0.00 $ Pension $ $ 0,00 $ Annuity $ $ 0,00 $ Social Security $ $ 0,00 $ Rents $ $ 0,00 $ Royalties $ $ 0,00 $ Expense Account $ $ 0.00 $ Gifts $ $ 0.00 $ Unemployment Comp $ $ 0.00 $ child Support $ $ 1,598.17 $ Spousal support $ $ 780.85 TOTAL INCOME . . . . . . . . . . . $ 4,358.63 EXPENSES WEEK MONTH YEAR HOME Mortgage $ $ 1,953.35 $ Rent $ $ $ UTILITIES Electric (PP&L) $ $ 95.00 $ Telephone $ $ 70.00 $ Water $ $ 70.00 $ Sewer/Trash $ $ 33,00 $ Gas $ $ 105.00 $ SUBTOTALS . . . . . . . . . . $ 2,326.35 WEEK MONTH YEAR EMPLOYMENT Public Transport $ $ $ Lunch $ $ $ TAXES Real Estate $ $ $ Personal Prop. $ $ 19.58 $ 235,00 Income $ $ $ INSURANCE Homeowners $ $ 24,75 $ Automobile $ $ 158.33 $ 1,900,00 Life $ $ $ Accident $ $ $ Health $ $ $ AUTOMOBILE Payments $ $ 221. 34 $ Fuel $ $ 100.00 $ Repairs $ $ 50.00 $ MEDICAL Doctor $ $ 100.00 $ Dentist $ $ 30.00 $ Orthodontist $ $ 110.00 $ Hospital $ $ $ Medicine $ $ $ Special Needs $ $ $ SUBTOTALS . . . . . . . . . . . $ 814.00 WEEK MONTH YEAR EDUCATION Private school $ $ $ Parochial School $ $ $ Religious $ $ $ PERSONAL Clothing $ $ 300,00 $ Food $ $ 900.00 $ (housshold of four) Barber/ $ $ 40,00 $ Hairdresser Credit payment $ $ $ CREDIT CARDS Hechts $ $ 30.00 $ MEMBERSHIPS Cumbo Valley $ $ 50,00 $ spiralette LOANS PA Finance $ $ 150,00 $ Agency MISCELLANEOUS Household Upkeep $ $ 100.00 $ Child Care $ $ $ Papers/Books/ $ $ $ Magazines Laundry/ $ $ 20.00 Dry Cleaning Entertainment $ $ 20,00 $ Educational/ $ $ 150.00 $ Extracurricular activities for children Internet Access $ $ 21. 95 $ SUBTOTALS . . . . . . . . . . . $ 1,781.95 WEEK MONTH YEAR Pay TV $ $ 25.00 $ Vacation $ $ $ Gifts $ $ 10.00 $ Legal Fees $ $ 200.00 $ Charitable $ $ $ Contributions other child $ $ $ Support Alimony Pmts $ $ $ Other (specify) $ $ $ SUBTOTALS . . . . . . . . $ 235.00 TOTAL EXPENSES . . . $ 5,193.30 CURRENT H W J PROPERTY OWNED/DESCRIPTION VALUE Marital Residence $ 283,000,00 X CTR Systems Retirement Account $ 26,423.18 X Delta Airline Skymiles $ Unknown X 1993 GMC Safari Van (sold) $ Unknown Horizons/CMS Health Care Corp $ 5,000.00 X 401-K Plan (cashed in) Household goods and $ 10,100.00 X furnishings (see attached itemization MONY Life Insurance Policy $ Unknown X Keystone Company Life $ Unknown X Insurance Policy TOTALS $ Unknown ATTACHMENT TO INCOME AND EXPENSE STATEMENT ITEMIZATION OF HOUSEHOLD ASSETS IN POSSESSION OF PROPERTY DESCRIPTION/VALUE: li.1fQ Husband Oriental Ruas !': 2 000 00 X Crvstal shotalasses 50.00 X Mexican naintina 100.00 Sma 11 framed etchina 50.00 Tina Madotti black & 50.00 X white framed artwork Librarv of books 2 000.00 x CD collection 1 500.00 X Photonranhv enuinment 1 000.00 X Couch (whitel 100.00 X Couch {familvl 800.00 X TV 800.00 X Treadmill 100.00 X Lawnmower 50.00 X Washer 100.00 X Drver 75.00 X Refriaerator 300.00 X Leaf Blower 25.00 X Miscellaneous household 1,000,00 X furnishinas TOTAL $ 10,100,00 . ~".1d40 Lobol UIOIh. IRS Iab.L (III Ih .. Only - Do nat writ. or .tapt.l" thl. 'DIU. ,l.,e.lnd!", ~'OMBNo.'~5.oo14 You, .0elallOeullly number 181-36-9273 Spou.... ooelal.ocullly number 102-44-6713 10' h.,p Ilndlng IIn. nltrucUonl,I'1 pig.. 2.nd3Inlh.bookl.L Yes No X D.partm.nt of thl rtluur.,. ..In''.....1 R.y,nll' S.rvict U.S, IndivIdual II Jme Tax Return 1996 'otth. .,,''''' '.0.11 ", till. Groth"tu....., bI lIulln WALTER S BLISS JR PAMELA S BLISS 145 BRYCE RD CAMP HILL, PA 17011 ~ Flllng 1 2 Status 3 Choclc only 4 ono box. 5 ExomptJons 8. IIrno,elhonalx dependents. ....the InolrtJc:1Iono 'o,Dnolle. Income 8. Allaeh b Copy B 01 your 9 Form. W-:!, W-:lG. .nd 10 lD99-R he,o. 11 12 13 14 15. lea EncIo.o. bur do 17 nolonoch.any 18 poymenL Also. ple.,.enclo.o 19 Form lD4D-V 201 ('lKIlho 21 InslrtJctJono 10' IIno 52), llyou did nol goIIW-2, _lhe InolrtJC1lono Io(Bne7. Adjusted Gross Income II11n031I. undor$28.~95 (undor$9,50D III child dldn'l Dvewllhyou). soo Iho Instructions for nneS4. KBA I Hal.: CheCking ...... wtnnalchltlg')1II" tllorr.4uu)'1Iur '''und. Do you wonl $:llo go 10 thl. lund? lIa Inlrlturn. dODS OU'SDOUSDwantS:Jlo Q to this fund? Single X MlIIl10d filing )olnlrellJrn(evonllonlyonl hId Ineomo) Married flllng sopal'sl. 'eturn, Ent., 111011.... aSH .bo.... .nd fulln.m. h.,.. ... Hood 01 OOu...hold (wil~ qtJalltylng person), (Seo In.lrtJc:1Ions,) litho qualllyfng plrson Is I chUd bul nol you, dlpenden~ enlor this chUd's namo hilI. __ Ouallfvln widow Ir withdeolndlnlchnd ear. ousodlld __19 ,lSeolnSlrtJcllons, YoursoU. II your porlnl (or .omoonl 01.1) can claim you IS I doplndenl on his or hI"" 'llUm.donolcheckbox5l, , . . .. ....,. b Soule o Oopondlnts: It) Flrot namo lJI.lnamo WALTER S BLISS III ANDREW L BLISS HILARY S (2) Depondlnruoclal .ocunlV numbo"II born In Oed. 109B see Inst 076-66-0518 SON 202-68-7969 SON 6- U (3) Doplndenr. ,e'allon.hlp 10 u, (4) No,olrmnlho Ifvld In your OOmolri1998, 12 12 12 22 Add1hlamounlllln1hlfarri hlcolumnlorline.1throu h21, This I. 23. You, IRA deductlon (.eo In.lrtJcllon.), , , b 5pou,o'sIRAdeducUon(.00In,trucUon.1. , , , 24 Movlngoxponso5.AnochForm:1903or:1903-F. . 25 Onl-half 01 .01f-omploymonllax,An.ch Schedulo 5E 28 Soll-omployod hlalth In.uroncl doducilon (.eo in",) 27 Koogh &solf-omployod SEP plln.,II SEP, chock, ~ 0 21 PonoJryonoDllYWllhdrowlllofsavings 29 Alimony paid, Rociplonl'. SSN ~ 3D Addllnl.2Jllhrough29, "',"" 31 Subtract II no :10 from IIno 22. Thi515vour.:ad usled res! In coma Fer PrIvacy Act and P.:aperwork Reduction Act Notice. see page 7. d Tolo/numberol.. Ilonsclalmod 7 Wagos. .o/Ilrios. tlps.ltc,AnlchFonn(.)W-2 FORM 2106 2,760 TaxablolnlcroslAnochSchlduIIBlfove,S400, , . , . . , . . , . . . . . ~:~:~:~t~:~~efR):D: :~. Taxabloro ~ 0 sots'1J~o'mUx~(so~cY~b tS. AIIrnonyrocolvod . . . . . , . , , , Busln",'ncol1l8 or (10..), Anach Schedule C 0' C-EZ Capllo/ gain 0' (10..).11 requlrod, anach Schldull 0 , Othor galno 0' (Iossos" AnechFonn4?97 . . , . . . . . . Toto/IRAdI.lributlon. . . .~J I bT...bll."..,unl(.lKIln.l) TolalpenolonoMdlll1nultlos .l.!!!J ' b Toxlbllamounl(.lKIlnot.) Rlnlal,oo/ DSIIIO, royo/tlos. pDl1nesshlp.. ScorporIUon..lrtJsts, ole, Anach Schedull E . Form Inco"," 0' (10..), Anach Schldull F , . . . . . , . , Unomplc t","n: compln.ltlon, . . , , , . Soclal.DClJrUy b.'nlnls . . ,~I Olhl' Inco",", U!1 typl and amoun1- slKIln.lrtJc:1Ions . I 'b ':ax;bll'~U~I('~I~Sli ourtolallncome 21. 23b 24 2S 2B 27 2B 29 , , ,~ ,~ Form 1040 (1996) FDID4D-IV I. lOB For'"'oll....,. COll.,'lQI'II ttlJ5 It&n OIOCk Tu S.,,,'cn. tPlc. No. or bo... chlChd on In.. 2 'undlb No.o'rour chlld"n on m. Icwflo: . .....d wllfI you . dIdn'tin wilt, rou du.lo dlvoru cr .."aravon 1....n.tnlc1Icn.1 _ 3 O.p.nd,ntJ0" Ic: nol.nl.ud.bo...._ Addnu".b." 'nt.nd on 5 In...bo.... 104,658. 104,658. 104,658. Form 10~O (I99B) WALTER S JR & PAMELA S BLISS Form1040(1996) t, . 32 Tax Compuo; 33.1 Iallon nBII~d" ,. 331 181-36-9273 P.12 ~ 104,658. II you w.nt thl IRS 10 ngure your lax, SGO the In'1nJClIon. fornnl37. Credlls Other Taxes 51 Payments 52 53 54 Anach Forms W-2. W-2G. and 1099-Ron page on.. Refund HllVoII..nl ~~h~ lCCOunll 588 Ins!. Ind mlln 6Ob,c,andd, 61 Amount 62 You Owe Amounl fromlln. 31(.d, .dgro..ln""n;!!!l .'""". Chock II: 0 YouW8r.~oroldar. U Blind; 0 Spou..w..~oro1dor. Add the numbo,o' bo,o. chack.d lbeV. Ind .nlOrlho 10lal horo, , , b II you 110 maniod filing ,0Plllloly .nd youllpou..Uornzo. doductlon. 0' you 1101 dual-.1.tu. allon, .oeln'1nJctlon. and chock horo , , . , ,. 33b 0 34 Enlor nlm/lld d.ducUona komSchoduloA.lln026. OR Standard d.ducUon .hown bolowforyour nllng .I.tu., But .00 Iho Ih. /n'lrllctlon.llyau chock.d .ny bexan IIn. 33. or b or ..moano '..g.r c.nclalmyou.. .depond.nL af I Slngl. -- $4,000 I Mani.dnllng jalnttyar Oualllylngwtdow(or) -- $6,700 your: I H..dof hou..hold -- ".900 I Mani.d OIlng ,.plI.loIy -- S3.3:lO Sub~.C\lIn.34kom/ln'3~, , . . , . , . , . , , , , , . . . II IIn. 321. $88.476 or I.... multlply $2.650 by Ih.lolal num~.r af .'amptlon. c1a1mod an IIn. 6d,II IIn. 321. ovor $88.476, .881h. work.h88l1n Iho In51.lor th. amounlla .nl.r Taxabl. Incoml. Sub~.cllln. 36 kam IIn. 36,lIlIn0361. maro Ih.n IIn.36. .nl.r -0- , Tax. S..ln'lrllctlan., Chock II lolallncludos Iny IIll ham I 0 Farm(.) 6914 b Form 4972 , , . . . , , , , , , , '. "," er.dll for child and d.p.nd.nl car. .'p.n..., An.ch Form 2441 39 Cr.dllforth..ldorfyarlh.dl..bl.d.An.chSchodul.R.. 40 Foru!gnIIllCf.dIl.An.chFarm1119 . . , . . . . 41 Othar.Chockllham "8 Farm3BOO bD Farmll:J99 00 Farm6l101 d Farm(.poclfy) 42 Addlln"39ttvough42 . . , , . . . . . . , . 5ub~.C\ IIno 43 ham line 36,11 IIn. 4315 mare thin IIno 38, onl.r-o- Soll-amplo . A1lom,llvo m I, n.c a Soclalsecu a I In""mo Irepan c Taxon qualln.d rellre"",nl plln..lncludlng IRAs,lIroqulrod, .n.ch Farm 5329 Aclvanc. .arn.d Incomo Cf.dll p.yments ham Form(.) W-2 Hou..hold employmentllll". An.ch Sch.dul. H 43 48. . ... 13,100. 45 46 47 48 49 50 13,100. 26,341. 35 35 78,317. 37 35 12,750. 65,567. 13,148. 39 40 41 42 43 ... IS 48 47 48 49 50 &5 58 57 58 59 ' 801 Addlln.....throu h50, ThIs I. urlolallax Fedorall amF 2 18, 1998..11m I dt n nd I dh Earn.d In a Sch I child. Nantox.bl. .em.d Incomo: amounl. I andtyp. . NO Amounl paid with Farm 4068 (."'.nolan r.qu"I). Exc......d.hocurfty.ndRRTAIlllwithhold(.oeln51.). . . . Othorpaymoms.Chackllfrom "0 Form 24:19 bD Farm4138 Addlln"62ttvou h57. Thosoar.vourlotll I .nls linn. 501. mara th.n Pn.61. sub~aC\Pn. 61 ham IIn. 50, ThI.I.lho omaunlyou OVERPAID Amounloflln.69yauw.nl REFUNDED TO YOU, bRautlngnumbor 03130184 cT 0: Os.ving~ dAceountnumbor 032071334 Amounl a' IIno 69 you wont APPUED TO 1997 EST/MATEO TAX . 81 IInn061 l.marothonlln05O..ub~.C\lIn058hamlln061, ThI.ISlhoAMOUNT YOU OWE. FordOlailsonhowtopayandusoForm 1040-V,scolnstructfons . . . . . . . E.llmolod lax ponaltv, A1.a Includo an IIno 62, , , , , , , , Il:J 18,990. ,890. 5,890. 63 SIgn Und,' plnalli.. of pI'JU'Y, I dle"'llh.11 h.", ulmlnld thl' ,.llIrn .nd .ecompl.n.,..nOlch.dlll.. I.nd .tl.I!rn.nll,l.nd to thl bllt 01 my IlM.lldOI &lid Here b.III', thlY "ltruI, co".c1.l.nd cornpl.I.. Q.clul.llon of plllllr" loth,r thin IUllly.rll, bl.l.d on IlIlnlor"'IUOn 01 whIch pr,pI,., hu .ny Ilno.l.dO'. Keop ocapy aflhlsroiUrn '0' yoUr records. PaId Preparer's Usa Only KOA ~ Yourslgnaturo 'Information onl - Do not fil ~ Spouso's aignoturo. If a Joint rOlurn, 80TH must sign. 'Information onl - Do not fil Preparer', .Igno,uro Flrm'.nomo(oryaurs ll.. H AND R BLOCK ~~~~f;:~Playod,ond rLEMOYNE, PA OUfO Youroccupatlon VICE PRESIDENT spouso'ooccupaUon HOUSEWIFE Check if Prepare". .acloJ .ocurlty na, 180-28-2913 43-1632899 17043-0000 Form 1040 (19GB) Oalo OUIO 4/8/97 PREMIUM Form 1040 (199B) FDI040-2V 1. lOB For", SOIl.....III CoPyrIO"IIUS H&R Dlock Tn S"""CII. :nc. Cnlld and Dependent Care Expenses ~ Alllch 10 Form 1040. ... See seplralelnlwctJona. " Form 2~41 D.p,"I'I'''' ,f th. T'.UUfY Inl.mal ",,,,nul a.rviu 1111 H.",,,.).hOWft on Form 1040 WALTER S JR & PAMELA S BLISS OMB Na,l~5-OO88 1996 Anachmonl SoquoncoNa, 21 Your aaclal aocurlly numb.r 181-36-9273 You need 10 undo,,"and 1holallawtng lorms 10 camp'ola Ihl.larm: Qualllylng Po..an(.). Dep.ndont Cart Bononta, Qualln.d Expon.... and Earnod Incam.. 5.0 Important Tormo on pig. I 01 the Form 24041 In'lrucllan., I'PiIrlTI Persons or Organlzallons Who Provided Ihe Care-Yaumullcampl.lothl.pll1. , II uneedmorelSPIC8,uHthlbonomolpI 02. (a) Caro pravldo(. (b) Addra.. 1 nomo (numbor. .ueeL apL no.. cl . '1G10. Ind ZIP codo) 3715 KOHLER_~I:___________ CAMP HILL PA 17011 POBOX P NEW CUMBERLAND PA 17070 KENDER CARE BEST FRIENDS 2 Addthoamounlalncolumn(djalRnel . . . . . . (c) Idonlltyfng number (SSNarEIN (djAmounlpold .eeln.lrucllan. 63-0941966 58. 23-2418962 180. 2 238. 3 Enlerthenumboralqu:lUylngpo..anacarod'arln1000. .~ 2 I @rBltFY"00fL:W'::7::: Caution: litho carl w.. provldod In your homo. you may owa employmont t..... 500 Iho In'lrucllon. lor Form 1~0. IIno SO. IElilrtml Credit for Child and Dependent Cars Expensss 4 Enler tho amounl 01 qua/lnod oxpena.. you Incurrod and paJd In ::~;::=.~i5fcOlKtD)1T · 5 EnlorYOUR..rn.dlncomo . . . . . . . . . . . , . . 5 e llmarrfodnllng o jolnlIOlUrn. onlorYOUR SPOUSE'S oarnod Incomo ~1.lUdonl or dlsablod..ee tholnotruc:1lon.); all ath.... onlorlhoamounltromUne5 . . . . , . . , . , , . . , e 7 Enlotthoomall..taIUn04.5.or8 . . . . . . . . . . . . 9 Entor on IIno 0 tho doclmaJ amount.hown bolow 1hol appll..lo Iho amounl on IIno 8 Ulln08l.- Ulln.al.-- Decimal Bulnot amaunl Butnal Over over I. Over over SO --10.000 ,30 $::0,000 --22.000 10,000 --12.000 ,29 22,000 --24,000 12,000 --14,000 ,28 24,000 --20.000 14.000 --18,000 ,27 26,000 --28,000 18,000 --18.000 ,20 28,000 -_ No limll 18.000 --20,000 ,2~ 10 Mulllpty IInll 7 above bylho decimal nmounton lino 9, Enlor lho rcsull. Than, SCD IhDinslruclions for IheamountofcrodilloentcronForm1040,lIn0:19. . . . . . . . . . . . . . . e Enlor tho amounllram Form 1040. Uno 32 . . . . . . . . . . KBA Far PaperwarkReducUan ActNaUce. seG sepilrate InslrucUan,. Form 2441 (1996) FD2441-1V I,J4 Form Soflwatt CoPyrtQIII1US HIR OloC_ T~I SIIVlC". ll'lc. e 4,148. ft~%~~~ }X' ;:~_-,.' $nP .'W}:!: t."~j ) ',- '-~. fih; tfti~ #tK' >::"'~~i-", ~f~t ~J.t11 . . . . . . 7 238. 104,658, X. 0.20 DecIma' ilmount I. ,24 ,2J ,22 ,21 ,20 fO 48. Form 2441 (1096) F~nn210tl(1098) WALTER S BLI,cc: JR IRiIrfirl Vehicle Expenses (5., Jucllon.lonndoul"hlch.octlon.10compl.,.,) Soctlon A - Gonerallnformotlon 11 enlOl Ih. dal. v.hlcle "IS placed In.olVico 12 TolJl mil.. v.hlcle WIS drlv.n du~ng 1008, 13 Bualnmniltslnc!udodon8ne12 14 POlc.nlol bualne" u.., 0lvldelln.13 byUne 12. 15 ,Averlgeda/1y,oundlr1pCOlM1Ullngdl.lanc.. , 15 CoIM1U8ngmil..lncludedonUne12. . , . 17 Olhot pmonal nil.., Add 8n.'13 .nd 18 .nd .ubUcllhe 10111 ~om Dna12, , , . . , , . . . . . . , . , , . 11 Do you (0' your .pou..) h.v. anolhot v.hlc1e Ivlillbl,'or pl""nal purpo...? 181-36 - 9273 Plqe2 (I) V.hlcl.l (b)V.hlcle2 11 7 26 89 12 16000nil.. mil.. 13 13400mll.. nilts 14 83.75 \', % 15 5 mil.. nil.. 18 1250ml1.. mI.. 17 1350mll.. 1. II your.mployot provldod you wiIh. v.hIcI., I. p.rsonal u.. du~ng oil-duly hours po,,",nod? Dy.. DNo ~ Nol ""pllelbl. 20 00 you h.v. .vld.nce 10 .uppon your d.ductlon?, , , . . . . ~Y.. DNo 21 IIoy....lslheovldencolVlltt.n? Section B - Slandard Mlloa 0 Rata (U.llhluocllono II uo"nlh.~.hlcle,) 22 Multiply Dn'13 by 31 conti (,31). Emit tho ,,,uII hOtI Ind on Dnl1. (Rural moll clll1....oo. lns1nJcIIon..) SecUon C - Actual Ex anses 23 =::~:;~~a1~. v~.. 23 );\;:ji;~;~';iij~Gf.I:()\! 2.1 VlhIcI.ronlal.. . . . . . . 241 'b InclualcntlT1OUnl(.OOlns?C o Sub~IClDne24b~omlna2 " 25 VaJul01 omployer-provld vohlcle (""pDo, only II l00"~ 01 annual 10158 value w..lncluded on FonnW-2-ll88Ins1nJcIIon.). Add In.. 23. 24<:. and 23 , . . Mulllply Dna 2B by 1he pOltOnl8geonDnell rOD 28 Ooprudlllon. Entor tIT10 IromUne3B bolow,. . 29 Addlnn27and2B,Enfllrl0lal hereandonDnel 29 2,532. Sactlon 0 - De roc/aUon of Vehicles (UselhlsllOCllononlyll u own lheVohlcle,) (.)VohlclOl ~ (I Vohlcle 1 22 (bIVehlcl02 3,023. \!j;~:~:1~;~j~;:;;j~H~~:4 25 27 r:."""''''J...,'t'." "",'v'/"''''''-'1 {":>:'~ ~\,\,j('>r;~'l ~:'."'~)': ;,::Y;'f~ll:;t;<:' {i;ft ':f~J." .I,'; ~. I ,,;iK,. < -\-;,':' h.~.,}t.I(,-. ,..._,~; l_! 25 28 3,023. t/ji1 i~~i:i~)~~f~j 'n!'\,{,;l'l"~ tl,<,('>'hj;..'-"!~ Wi]- ~ .1'JI\~~~W,.i(tt{'tf.f.:~,: '-.' ': ',' :'y~'.A... r"" ..,,l"'{ "v,t. ,~. "'fW",U"'$ kb.'ti~YJ;'~i~1;<.;r~~~\':,~ ''l,,:t~>~f~'i,i ,,:~,.~1S\ :1~}?, ")?:U(,""bL,fr~-'~\ ( ,;,0 i ~;*?tbi;v~;~~li.?;}tthL:f~ l~;;tfPV'~tt~-:-iW\~l;}~; , ,:wfo f ",.. ,'"'!it,~ :i~ (b)Vohlcle2 "v~'I"'I' fI"M'M- :'~"'"-Vj:,",, .v.i. ~-&~'':',-l,~;~ tRiii1' - _~__;' "::dr>>,; jJ4f~t.tt~Qt' '<ljW;}:'. ~n~~~:. 30 Enter cost oroiher b.... ('00 lns1nJcIIons) , . . . . 30 31 EnlllttlT1OuntolBllClIonl?O doducllon(.ooln.tnJcIIon.) 31 32 MultlplyAne30byDneI4(.oo InstnJcIIon.lfyou olected Ihe allC1lon 170 deduCllon). , , 32 33 Enter doproclltlon molhod end porconlag.(.ooln'lnJcIIon.) , 33 34 Mul8ply Un. 32 by Ihe percont.go onUne33(.ooln'lnJction.) 34 35 Addllne.31lnd34 35 :U' EntDr lho limilation amount Irom rho rablo In 1holin. 3B Instruction, ~8 37 MulUplylln03Bbyth. perconlago on IIno'4 37 31 Enlerthasmlllllrolllno3Sor IIno 37, AI.o. o",o"hl. smaunr on IIn. 2B .bovo 31 KBA For Paperwork Reducllon Act Nollcll, "llnsll1JcUons. Form 2108 (1091) F02f06-2V 1.35 FO'IItSQltw.t. CUrtlll"lllU tUFt Bloc~ Tu ~'h'C'I, lilt. r~~~:[t~~~~~{~f!i[~~~)1 Yf;h~~:t:;\~';-{~~{l'~tn~it";q [r_l~j Form2108(1geB) _'_"_v .,...~-,....."......,'~"(:;:'......,......'1-..~'~.'lf.."'~..,.,_<,._'..:.'.r......_.~A,...../1--...1"'.....,....-m-! ',.".',",',~,".",',,""",'.."",' I,,'.',' """1..'.'."j ,..." ',' ,.,',..,,";'"'',''' ',.."""'.I^"",","'l"....,,' ."'" " 'N'SY""'A'Nt '" NC' lIE':A)( n~u ",",' ~'";\NP N ,Loll', ",~\t ,;'0 " '''''i ;;Htj"<~Y()IIMUsrFILEllVMIDNIl:ilrr.TUI(SD"VAPRIl;IJit99 ,~~.t 1. f-%;;~t :1'/:.:~''''ltt.}:\~~-i~it,>J 'ilY>;~,~k,;:~;(,';/~,",1~':''P_:~:;:{<,~1/'!'h~''?V'~~.;,~:-::(.'W~\t~~:;5.:-~;'(~~l;;~~;la~,';;~~"'$'Jm~Q )-;?;.-~f:.-',<;:~~{:t'_:_,., '"-",',,,,, ~ijlt: ::>'~-:-,<: ...~~-,-;::.{ ,),,: ','jj;f.;',,';<_ '.:.. ~", <~:" -~~ /:.:;~ ':~":~'~,: '~1it:''i:,'::'':' ~<1"'<r >t,~~~.,-~ '~,::. ""2!c!':"~~."v"fhC.''''':~u..",,.' 9 ','."..,..".. ,," '''''''''I'''''''''J'',,' iCOii1rnonw<laltlto M1n "''''''''.\d,/,,(''{il},. ~AD/l IItnon 01............ P rJ~7" ' ::,._';'-~,::''';''':' A >>'v'..., ih'401, .~ "Y')' . ,_1.~. - . .,.".' .....' itk~~i'->{i"". 4 \:1$.tLJXb OFFICIAL USE ONLY PA--40tOl.111 o FISCAL YEAR FILER From to lYPE FILER (Chock Only Ono) 50 MO J ~ Slngl' Mlw.1t MllII.d FllngS'Patal,ly FIUna JOlnUy If ch.d.Jng boa F b.cauu Ii'll LaIPlr"I, d'ClU.d, .nt.r th. 011. af O.ath RESIOENCY Sf A TUS (Chock Only Ono) R~ NRO pO A'"d.nl Nonftlld'''' Part.,.I,r.lld,,,t Ent., lh.lIm, you W,t.. PA'"ld'"I: trom 10 NAME OF SCHOOL DISTRICT CUMBERLAND VALLEY SCHOOLDISTRICTCOOE 21160 FO Flnll Review 011 1ho propnntod Inlonnollon on your labor .nd pl.cell In tho nomo ond .ddT... 8100. Mako any nocosslII)'conoctJon"o your la""'.nd chock 1ho SSN/NAMEJADDRESS Chongo "". ""low, n oudonoth.v.. r. rlntedlabel.ente..UlnformaUon- I.... rlnL YOUR SOCIAL SECURITY NUMBER SPOUSE'S SOCIAL SECURITY NUMBER. IV.. II "',' UP""'" 181-36-9273 102-44-6713 LeI Nomo Ann nomo and InlUoI - Includ. apou..'. nam.. n nllng 10lnUy BLISS WALTER S JR & PAMELA S Home Addro.. 145 BRYCE RD CltyorPo.lol1lco CAMP HILL o SSNINAMElADORESSCHANGI! If AHYof U\I.bov.lnhumatlon I, dIU".nl tram your 1115 PA La.nMn. eft.elllhl, BOL U ,our .ddr... ehang.d. Ilu proYldl the ",m.and Zip Cod, 01 11'1. dIY.lo.n'hill. borough 0' munlClPIUY wh'n)'Ou h'd o/lIlI1I"1. Nomo 210 C<ldo 1. GrossC<lll'4'on.a1lontromW-2fonm.ndothorw.goSl.,omonl:l "....,....,.,....,. ,1. lb Unrolmtll".odE1rl>loyooBusfn...Expon...lrllmPAS<:hodUIOUE......,.,.....,.., .1b 10 NotPA T..abloC<lll'4'on"1Ion,Sub~aC1Dne lblrllmDnola ..,.,",...............,.......,..,........ .1C 2 PAT...blolntoreot(C<lll'4'lotoondonachPAS<:hodUloAlfoverSl,OOOj .........,..."................,...2 3 PA Toxoblo Olvldond3(COll'4'loloond aUach PASchodulo BnovorSl,OOO) ....,..,...,......"...........,.3 4 NotJncomo or [l.ossJ tromlhe Opera1lonofaBu.lnoss. Prolosslon or Farm. .,...".,......""..",..,...,..4 5 NetGoInor[l.ossJlrllmlheSoIe. ExchongeorOI.posfuonoIProp.rty ,.,...,...,.."......""""""", ,5 5a AmountofGoInExclud.dlromPAS<:h.duloPA_19.""..",......"....",..". .ea 8 NetJncomo or [l.osoj Irllm R.nts. RoyolU... Pal.nts .ndC<lpyrlghts ,."...."....,..........,............ 8 7 Estato ondTItlB1lncomo , .. . .. . . . , . .. , . . . .. . , .. . , , , , . , . .. . , . .. , , .. .. .. , .. . , .. .. . .. . . .. . .. . . . . .. 7 .8 GembDng and LonoryWlnnlng. .......,....,......",..,...,..."...,..,...,.........",......,.8 9 TOTAL PA TAXABLE INCOME Add Dnm 1c,2, 3, 4, 5, 8, 7 and 8, 00 n01'1I bnct allou, report,d on 0'" or 1lI0re'''" 9 'tom the profit, Incom, or gal" on any Olh"lneom,'n.. Nor can ,pou'l.ofl"lueh oth,,.,lncolll' and llo....1.van U on Ill, ..m,'"" 10 PA TAlC UABIUTY Multl inoO 2.8% O,02B .........,..".......................,.............10 11 TOlolPAT..W11hheldfromW-210nm,.Ic."""....",...........".....,...,.... ........,."",,11 124 Credit fram 1111S PA Tu R.hltn I B 12c Parmln' with '"' Eat.naion . . . . . " . . . . " . . . . 12b t'lI. E,tlmll,d P.ym,nll . 12d Honft.ld.nt TuYt1lhh,ld ftolll Pa Sch,dlll" HAK,...' 120 TotolEsUmatedP.ymen13ondCrodItaAddUneo12..,2b,12cOnd12d .................,..""..........,120 13. Hou..holdMemborolrllmPAS<:heduleSp. PlII1JJ.Dn04 ,.......,.....,.....",..., .13. 13a Youmu.tnreb'f 13b Your EllglbllltylncomotromPAS<:hodulo SP. Perl III. IIn.2 ..,......,.,...".....,.. .13b 13b AprlI15,1997. 13c YourTolollncomolrllmPAS<:hoduloSP. PlII1III. Dno I ...."..,................,., .13c 13c AI...rty,lIyoucan. 13d T..Forgtv.n... CrodllFromPAS<:hodulo SP. pon III. IIno 7 ..,.......,......",....,...............,... 13d 13d 14 Total CredlllorT.... PoIdto OlherSI.Ill3orCrlunfrieolrllmPAS<:h.dulo(.) G. ....,',..,..".."..,.,...... .14 14 15 E1rl>loymentlnc.ntlvoP.ymenl:lCrodlllrllmPAS<:heduloW"..,...." ......,,'. ..... ,..",.,.".,... .1e 15 18 TOTAl. PAYMENTS AND CREDITS Addlln..11. 12e. 13d. 14.and15 ,..".,',..,'""..,..""..",.." IB 2,97 18 t7 PATAlCDUEUnol01,rnorethanllno18 ."...,..,...",........,..,.......,..,17 7 17 Seeln'lnJctIon.for MBi<ochock oavoblolO PA DEPT. OF REVENUE USE YOUR PA-V. HOW TO PAY 18 OVERPAVMENTUnu16IsmorothanUnD10................................... .18 18 CIleekln'f'OurcalcuLalion' IMPORTANT: Tho 10101 olUno 19a1hrough 10d mu".quollln.l0, i ...... ....I&ii.l.a.l.....;,,;;;;j I;;;ul.;;m~.li;;ji..ii! 18a Amounlofnno 18youwonl...R.'und Chockmllil.dtoyou ,..,............,......................... 100 19. 19b Amounlo'"n.18youw.nl Credll.dloyourl097 E,Uma,.dTaxAccounl ......,...;..........,....,.."" lOb 19b 190 Amountollln.18youw.nllo Don.lelo1h.WildRe'ourc.Con'orv.UonFund,..""""",.....,:"., ,'.. ,19C 19c 19d Amounl01 IIno 10 you wenllo OonatolO Ih.USOlvmplcCommlno., PA Olvlslon .. , .. , " .., ...., .., .. , , .. .. , ,10d 19d ION YOUR RETURN, Una" p.nlmll or "ur I !W'I! hI'"g 10fnllYI ellCII,. IPllIllw" hi"" .lIAmlnld Ihf' "lurn,lnClUelln,alllCcompln)'1ng .en'elllln anelllll'",.n",lnd 10 1P1, 51010 PA 21p C<lde 17011 108,75 10 2 3 4 S ~I Donoladdord'ductln,Sa 108,75 8 7 8 9 Your Slgn.runj X Spou.o', Slgn.ruro (II filing jolMy) X 0010 OaytlmoTelophon. Numb., (717) 737-4686 BE SURE YOU (AND YOUR SPOUSE) SIGN Your OCCUp.Uon VICE PRESIDENT Spouse's Occupltlon HOUSEWIFE .OQUOl CHf:CIf.All MAtH". OalO Pnp.,., or COmOlny Nlm.. olh., Ihln tl.p,y'r('I, blUd on IoII'n'Ofllllllon 01 whICh 11'1. PftDlft' ha'ln, 'no",l.d;l. H AND R BLOCK PREMIUM 17043 NEXTYEAR, ouwill also bo ablato mako adonalJonof .311 or PA-40/'996) PMO-1V 1,4 Fo,m 50 Iw", tODrll;h' 19" Il&" Oroc' TAl S"'Ilc".lnl:. Oalo Preparer', Tolophono Number 4/8/97 (717) 737-6778 .11 01 our OVOI 0 monllo Iho ORGAN DONOR AWARENESS TRUSTFUNO, PA-40Chockll.t I . Form(.)W-2 _ PASch.dul.(.)A A PA Schldul.(.) B + PASch.dul.(.)C A PASchldulo(.)C-F C PASchedul.(.) 0 H PASchldul.(.) 0-1 A PASchldulo(.)D-7t t PASchedulo(.)PA-l9 PASchldul.(.)E W PASchldull(.)F 2 PA Schldul.(.) G PA Schedull(.)J F o PASchlduil(.)NRK-t R PASchedulo(.)NRH ~ PASchedule(.) RK-' PA Sch1dul.(') UE-l H PASchedulo(.)UE-2 E R PASchldulo(.)W E F.derIlSchedule(.) K-l F.derIlSchedulo(.)210B _ Olher_ Inachllsl. PA.SPlO...., . . ."'..... ownon)'o...' 3 PA-UE-' "I BLISS PA SCHEDU' - UE-2 181-36-9273 PADEPAI ,NrO_REV'NUE ALLOWABLE EMPLOYE.. .JUSINESS EXPENSES 1996 NemoolTaxp.yor C1a1rr1ng exp.n....: 501:111 SOCUIlly Numbot 'I Employors Namo Employor'.Addr... T.lophon. Numb" D..cr1b.lh. duUo. ollh.joblnwhlchyou Incurr.d lho.. ..p.n... :",'';DOIlOTUSECI!H'/'S,/:':': RoullOTtiWtiOill iiOU1iiil PART A: Union Du... Ust Union nome(.) .nd amounl(.) poJd, EnlorlolaJ, An.ch .ddlllonll.hoeto," n..dld, AS 1 1 PART B: Worll Cloth.. .nd Unllorm.. R.qulr.d... condiUon 01 your .mploymenl and nOlouh.bl.'orevorydI'fU'. BS PARTC: Sm.II Tooll .nd Suppll... Roqulr.d.. .condiUon 01 your .mploymenl and nol provld.d by Ih. .mployer C S PART 0: Pro'.../on.1 Uc.n... F.... M.lpllcUc.ln.u",nc. and Fld.lIly Bond PlImlum.. R.qult.d...condillonol ourOO1l>lo nl OS PART E: Trav.1 and Mllugo. U.oyour Form210B, Itclalrrln .ClUIIIlX1lO..... comoi.loa PA Sch.dul. UE-t ES Total Emp/oy.. 8u.ln... EJp.n.... Add PlIIl3A Ihrough E. Ent.r hereandonlnllbol urPAlur.tum Sep."'tl PA Scheduleo UE mJst be m.d "you have mor.lhan ono ocouplllon andlor" u,"pouse 11oo II1CUI'lI unr.imbursed .mplo eo buolnoso OXD."". PA SCHEDULE SP SPECIAL TAX FORGIVENESS CREDIT " f'lurn: oa. ''''tll., UmDtr PART I. CtrtlncaUon or E1lgiblllly: L SocUon A: Allng u S. Single or M. Mamed Altng Sep.",t. R.tum. 1. 0 I clll1lly Ih.tl porsoneJly provided all..., one-half 01 my own TOloJ Support and I am .Dglbl.'or lAX forglv.n.... It Mng.. M. .ntoryour Spou..'.Namo andSSN .1..pou..nnng.PASch.dul.SP? 0 YES 0 NO :z. 0 / certlfy Ihall am. d.p.nd.nl 0'. p.rson who I. oIIglbl.'orlax lorglv.n..., I am being c1oJmod... d.p.nd.nl on Ih. PA laX IOturn of: Namo .ndSSN . Vou may noJ claim dep.nd.nts. StcUon 8: Allng as J. Mamed Allng JolnUy. and Cl.lmlng Tax Forglven_ Jointly :J. 0 land my.pousecertlfylholw. ora each eligible forIAXforgfv.n... and oloette 11Io ejolnt PASchodulo SP, AI.o u.o!hls 'latu. II you lIIe jolnlly. bul onlyon. .pou.. qua/lll.. for lAX forglvon... and Ih. olher spou.. to. d.pondonlwllh no taxablolncomo, SacUon C: Allng u F, th. FInal PA Retum for a docoaaed IndivIdual I certlfy Ihall have r.ad 1h.'nS1nJe1lon. for Ih'" Mng Slalll. and lhaUh. dtcedenl named above II .ltgibl. for lax forglv.n.... 4. Thodeced.nt"'an bl.dalmanloran. Ibled/lll.nd.nllorlaXfo ..... u 0.... PART II. Number of HOUlehold Members for Tax ForgIven... PulpOIU: Entorlhelnlormallon loryourselt, yourspousoand oach dopendent chlJd. Uat all dep.ndonl chltdren. It u aro not man1ed and have no dopondents, go te Part Ill, Hou..hold Mlmblrs for Tax Fo von... A I SSN Totallncom.. trom ourSPWorksheo~ IIno21 1. Vour Nam.: S'am claim UI. N.m.: S SpoUI. '" 11II sapar.t don I N.m .): RelaUonlh A I SSN TOlallncom..'fan . Who"'dolrri .achd endentchlld? S lam M 5 u..'" S I am M Spou..l. S lam M 5 u..'" S lam M 5 u.ol. S I am M Spou.ol. 4. Hou..hold Memb.rs, Vou. yourspous. (111I1Ing jolnUy or ~your dopondonl) and only lh. depondonl ch~dron you ar. doJrrI on Ihi. PA Schedulo SP, Enler herundon IIno13aolvour PA-40or IInOBa 01 our PA-40EZ. 4. PART III. Calcul.Ung Vour Tax Forgluenus ClIdll: ,DONOTUSECENTS.ROUNDTOWHO~EDOI.1ARS ,i 1. TOTAL INCOME fromlln. 21 ollh. SPWork.heel.ltmarriod onlor1hoJOINT llITlOunl ovon It filing soparately, 1t.lngl..u.oYOURamounl, EnlorTOTALINCOMEonlln.,3coIPAo400rlln08coIPA-40EZ """""",."", 1, S I [J 2. VOUR ELIGIBILITY INCOME. IIl11lng SlngloorMarriodFillng Sopll/Dlely us. tho amounlflomllno 120lVOUR Columnol SPWork.hoOl.lll1ling .Jolnl Roturn (vou andyour spou,o ..DOlICh ollg'blo). US.1ho llITlOun11rom llno 1201lhoJOlNT 2 S COlumnolyourSPWork.heol,Enlorl1er.ondlino13boIYOurPA_400rlln08bolyourPA-40EZ '",..,..""""" ' 3. PA TAX UA8tUTY lromllnolDolyourPA-400,lln050IyourPA_40EZ ..,.."..,"',.."""".."""".., 3, S I. LESS RESIDEKT CREDIT Iromllno 14 olyour PA-40, TIII.crodil doo. no1.ppiy lor PA-4DEZ .., , , , , , , , , , , , , , , , " 4, S 5. NETTAXLlADlUTY.Subtrocllln04Iromllno3ondonlorh.lo ..,"""""',..".."""""""""".. 5, S 8. PERCENTAGE 0' TAX FORGIVENESSlrom1hoEllg,billlylncomo Tablo, U..lln02Irom1hl'Pl1f1and Ih. HousaholdMombersfromPartll,EnlOrlhOPOrconlDgohoro ~~.andlhodocjmaJoqUjvalo"tonllno8....... 8. D 7. TAX FORGIVENESS CnEDITfrom PA Sch.dul. SP, Mulaply Ime S by IIno 8 and onlor ho,o .nd PAo'1.'ll~~0ImWourPA-400rllnoOdo/.YA'~~~P~~VZI:4"."".""""'.'."'.'."'" ,.."."."""", 7, 51 0 'IU'" Sol"..,. COllrtlOll1UII Illn Block hi 5",,'ell,'nc. 2, 3 2,53 83,750 % YES NO YES NO YES NO YES NO B % o 3.02 3,02 2.53 c, d. a, f, g, Olhar Appor1lon.blo Expan..., lI.mlZ.1h. typo .nd omounloI1h... a'p.n.." g, S h, S I. S J, .. ,. k, S I 0 I, S F4,S h I, I, k, I. R.nl (R.n,.,.. only) , , , , , , , , .. .. , , , .. .. .. , , , .. , .. , , , , , , .. .. , , , , .. , .. , , , , , , , ' , , , , , , , , , .. , , , , , , , TeOloJ,Addlln...lhroughh, En'orlh.lolalh.r.,..",..,...."".."",."..""...,..,..",..""" uslnau Pefcontago of Proporty. Otvldulho 101111 squQlo loolago olycur work 4104 by tho lotal sQU8IofoolagaofyouronlJropropony.Roundlo2docimalplacos ....................,.................. Appor1lon.d Exp.n..., Mull!pry IIn.1 by Iha p.re.nr.g. on IIn./ """",'"",..""",..""""""., Total cmco Suppllos.lIomlzo ISUpplJOS you purchasod DllClusivory for usa In your olneD or work olrno, Enr.r1halo1al Tolll OIf1co or Work AIB. Exp.n..., Add IIn.. k .nd I F4. PA-ue-l (lBBS) PAUE1-tV l,J8 '0'''' Soll_"1 COllrlli:lht 'lte tlln 010t_ Tu ~""'IUI. tnt. 00 ~OT USE CENH. qOUNO TO WHOLE OOLLAR! BLISS, WALTER S JR I PAS.h.llul. UI!-l (P.g. 2) Part a. Moving I!xp.n.... Vou IrAlII.nllWOf ALL Itvoo quostlon, oryour oxpon,oswm bodl,allowod, al. DldYouwor1l;orlhuomoIllJ1lIoV"'bolo'und.normovtng?,........,............... ..,........,... 0 VES 0 NO G2. W",. you ,.qultod bV your omplovor 10 mov.lrom on. olfldal duly ,Iaoon 10 .nothor ...condlllonoIVourlllJ1lloymant? ..'"""""."""'..."""",.""""""",, ,'.'.",., 8 VES 8 NO 03, Dldyoumovlltlh..oqua,'olvouromplovor7 ",.....,..:......."...,........"....,.. .......... VES NO II you .n.w.red VES \0 ALL thro. quuUon.. conUnu., II you .nawor.d NO 10 .ny qu..Uon, you m.y not cl.lm moving up.n.... I. Enlllthlnumbotolmlo.~omyouroldhomotovournawwor1<placo .......'.'""""""........ mllo. b, En1lfthlnumborolrr/loslromvouroldhomo10vouroldwor1<placo .','.....,.','."""",.,.,.,. milo. c, Sub~.C1Hnlbfromllnll.ndonlllthodmoronco,..,..............,.........".",.."..".., mllo. If IInl a I. ao mll'l or mar_, conUnu.. I' not It IUlt 50 mil". you may nat claim moving expenses. a4, T'an.pon.oon..p.n.os'nmovtnghou.oholdgoodSlndpa""'nalollocts...".,.".,.,.""........"", a4,$ QlI, Tr.vel,moaJSlndlodglng.xp.n.osdurlngthOLc1UaJmovollomvourold homotovournowhomo, ,. .,. , , " ., " a~. $ G8. Total Movln Exp.n.... Add Uno.G4andG~ G8. $ P.rt H. EduClUon I!xp.n.... Vou lrAl.t.nawor ALL Uvoo quo.lIon, orvour oxpon.o.wiU be dl,allowod. HI. W..th1soduc.oon'oqu~odbylaworbyyouromplovorloro,ainvourpro'ontpoaJlIonor JOb? .'.....",.",'.. 0 VES 0 NO II you Inaw.r Y1!S. conUnu.. II you .n.wored NO, you m.y not cl.lm .duClUon up.n.... H:z. Dldyounoodthlsoduc.lIonlomoGllhoonllyl..olormlninllm,oqulromonlllloob1ainvourJob?...,'.,.".". 8 VES 8 NO H3, WiIIth1soducatlon.programorcou..ool'tudyqualllyyouloranowbuaJnossorprofosaJon?..,...",....,... VES NO II you .nSWIred NO 10 both qu..Uon. H2 and H3, conUnul. II you an.wored Y1!S \0 .Ither qu..Uon H2 or H3. you m.y nol cl.lm eduClUon up""'" I. NomoolccUogo. unlvorsltyoreduc.lIonall".1ftullon b, CoUIII 01 stUdy H4. Tulllonorfoes.......,.......,.,....",...".... ......",.,.,...'".,.....""....'....".,. H4.$ H!, COulllmatartals....................................,..........................."......... H!, $ H8. Tr.voIexponsas ..... .., ,'.......",...", ..,.,...""., ".. ,. ....." ,. '. '.. ...,.,.., '. ..,. H8, $ H7. Total EduClUon Exp.n.... Add Unes H4lh,ough HB , " " "" , H7. $ PutL 0 rocl.Uon an.... Donollncludovohlclos u,oPartElandolflcoorwor1<aroa(u,oPan ex on,o.. (a) Doscrfpllon (b) CO'lor (c) Doproclaoon (d) Dopreclaoon (e) SBCllon 179 olProp Olhorbasb Melhod Deduction onsa 181-36-9273 I DO HoT ueil ctinS; RoONe TO WI.idLR rii>t.iJ.Rls I (Q $ S S S S S S S S S S S S S S S S $ S S S S S S $ S S S S S S S S S S S 11. Total Deprecl&Uon Exp.n.... TotalColumn(Q andenlorhora ..... ,...,.,....,... ..........,......., 11. S Part J. MI..an.n.ou. Exp.na... IllllTizolho typo and amount 01 each o.pon.o,lncludo lIITlDunlll from Ilno 4 01 Form 210B In this part. GIFTS DUES 14 26 S S $ $ $ S S $ $ Jl. Toul Mlac.U.n.ou. EJp.n..., , .. .... , .., .. , , ..' , .., , .. .. , , , , , , .. , .... , , , , , , .. , , , , , , , , .. , , " JI. $ Plrt K. Tobl Allowable Pennsylvania Employee Bu~rne" Expenses. Add ltlQ expanses lrom oach Part You must also accounl 'or rolmbursomonts, if InY,lnthls Pnrt. KI, TQlalo.pon.o,',ompan,AlhroughJ "..,..",..".."", , '" "," ..", '" , "'..",, "",..., Kl, S I K2. Entar ralmbursomonls from your omployor.lncluda rClmbuf!icmonls which your omployor 010 NOT ropor! aslaxlblewlgosonyourW-2form .......................................,................... K3. Sublncl IInl K2 from line KI , , , .. , , , , , , , , , , , , , , , , ' , , , , , , , , , , , , , , , , , , ' , , , , , , , , , ' , , , , , , , , , , , , , 40 2,94<(] nUne K2ls MORE than IIno K1,Includo lho difforenco in Ii no 1 iJ. Oross PA Compensation of your PA lax rolurn. lIlIno K11s MORE than IIno K2, onlor tho diNoronco on Ilno , b, UnrOtmtu~od EmployeD Businoss E.lCponses on your PA lax rclurn. PA-UE-l (199B) PAUEl-2V 1,38 Form SOIl""II' COP)"IQ"t UU Hill Olotk T.I_ 5"",ICII, l!'Ie. Oocllla~on~\!!5!;!L, , [il9]-~ LITTI-[L] IRS U.. 0"1.......00 n I. 01 lu.pl,lnthl. 'Oltl. Uulh. IRS label. Olhorwl.e, pie... prinlo' type. O,pattm,ntolthtrrIUl,IfY l"l"n.IR....."u.S.MCI L A B E L You, IIrI1 nlll10 and Inl~aJ ALTER S. BLISS JR II alolnlroturn, .pou.o'a IIral name and Inl~aJ PAMELA S. BLISS U.S. Individual Income Tax Declaration for Electronic Filing FOrlhoyoarJanuaryl--0ocomber31.1998 ~ SlIlnalnlclJona leI nlll10 'OMBNo:l~~-093a Fonn 8453 1996 Home addro.. (numbor and '~"I),1I a P,O, box. aOO In'blJC~ons, 145 BRYCE RD ApL no, Your aoclal alCu~ly number 181-36-9273 SI'.u.... .oclal..cu~ly no. 102-44-6713 Tolophon. numbor(opllonaJ) L4st nlll10 Clty,lown Dr pOll olnco. .1010, and ZIP codo AMP HILL, PA 17011 :Pait'l: TIIX Return Informal/on (WholodoDaraonly) 1 TOlallncomo (Fonn 1040, Uno 22; Fonn 10-4lJA.IIno14; Fonn 10-4lJEZ. Uno~) . 2 Tolall.. (Fonn 10-4lJ, IIno ~1; Fonn 1 040A.llno 20; Fonn 1 O-4lJEZ.llno 10) . 3 Fodorallncomo l..withhold (Fonn 10-4lJ,IIno 52; Fonn l040A,lIno29a; Fonn 1040EZ.llno 7) 4 Rotund (Fonn 10-4lJ, IIno 6Oa; Fonn 1 040A,lIno 31 a; Fonn 10-4lJEZ, Uno 118) . 5 Amount u OWO (Fonn 10-4lJ.llno 82; Fonn 1040A.lln033; Fonn 10-4lJEZ. ono12) Piitt,1I Direct De osll 01 Refund (Opllonal-Seolnatruc1lon.,) Allach Copy B 01 Fenno W-2, W-2G, 7 Accounl number and l09t-R her.. I Typo 0' account Chocking Saving. Paft! II Declaral/on of Tax a er (S no a1torPartllscomplolOd,) 9 I f,,,..,,1tha' myutund b. (1I'lc1l)' dtpOIU.d U dllfgnll.d In Pat1I1. and d,cw.lhlt Ih, inlllrmatlon thown on II".. 1 IhlOU;h 'II con.c1. If I hlY. mid. Jalnt flhlm, thl". an 1"IYDcabl. Ippoln1r"'nt 01 Ih. 011'., IpOUI. U In ';'1'1 to 'lcllvl thl rlrund, ForPap.rwcrll RtduclJon Aet NoUee, ...lnltructJons. 1 2 3 4 5 104,658 13,100 18,990 5,890 a Roudng numbor The "raltwo d1glla ollhe rouUng number mu.tbe Ollhrcugh 12 or21lhrough 32. o I do not want dlrlct d.po.11 a' myrlrund aramnotrlcelvlnganrund, If I haVllllld. ~lanCI d"lnwrn.1 undlr.Land thatl' thllAS do.. notncllYI lullllld tfmllypaymlntal m)' tul.lbllty,l wllltlmaln labl, 'or the tu "b1It)'and an'PP'cabl,lnl"ul&IId pln,IU...11 I h'YI m,d 'Iolnl F.d"II&lld .1111 tu IItvrn and Ih".I. In I",oron my IIItl nhlm,l undtr.t&nd my F.dlt,l"tum Mil b.nl.cI.d. Undtt ptt'l,ltlu or p"Jury,1 dlclarl'hal th.lnformaUon I han ;ivln my ERa &lid th'amounllln Part labovl '0"1 with Ihl llIlountl on thl ""upondlng In.. 01 th.,IIC'Uonlc portion or my 1nl Flderallncaml II."wm. To thl but 01 my knowlldOI and blh', mynturn I,w', corrlct,and complll..1 C:O/llut to m)' ERa 'Indlno "'y"l\Im,lhl. dlclar. n,&IId acumpanylng .ch.dulullld .IItlmlnlllo th, IRS, 11110 connnl to thllRS .endlng,"y ERa andlottnn.mln"anaCknowl,dg.mlnlor l1an.milllon and an Indication 0' whllher ornol lIIyrlhlrn 1.lcnplld, and. If rlJlctld.lhl flUOn(I' lot IhlnJlc1Ion.11 thl proClllingo r n or r~"'ld~ authonll IhtlRSlo dl,clonla my E dlortranlrnlner Illlnuon( rthl d'lay, o,w'onlh"",,'wumC ~ (~0 . ~~r: ~ CJ1f ( ~,,~ '7 ~ ...u....~;n.tu' ,.lntratum.BoTHmu.UI",1 Part IV Declaral/on 01 ElectronIc Return Orl Inator ERO and PaId Pre arer I dldltt thlll han"~I",.d thl aboYI "'UPIYlr'. rlhlm and Ihlt thl 'ntrill on Form un arl complltland corrlct to thl bill 01 my knowlldO" It la", ontya colllctor, rim nOlrupon,lbll 'or "'WIlwinO thlnhlrn and only dlCtatl thltthll 'or",accurallly"f1lcu till dill on Ihl "tvrn. Thl taxparar Mn hlYl ,lgn'd Ihl,'orm bltofl I ,ubnul thl fltum.1 wlllg/YII"I tnpaytt 1 copyo' III 'arm. and In'ormallon 10 bl tll,d wllh thllAS,and hlVt 'ollowld alloth., ttqulflmlnlJ In Pub. 1345, Handbook for Ellctronlc FIT.,. 0' IndMdulllncoml Tu Rltvrn' (TuV.ar 1111). If 11m 11'0 Ihl Plld PrlP"", undtt PI"lltl.. 01 p.rjury,I dlclar, thlll hhl ulmi".d thl abovl \I.pIYlr', nlurn Ind IccomplnyTno .chldur.. a"d IIItlm,nt',lnd to thl but 01 my knowl'do.,nd b,I", Illlyarlhu., cor"ct, and co,"pl,ll. Thl. d,cwluon i. band on 11I1,,'orllllllon a' which I hlVI Iny knowlldg.. ERO', ~ VOl,lrlocJll.ICUfllynumbtt ERO's Use Onl 180-28-2913 [IN 43-1632899 ZIP",. 17043 -0000 Undtt p,nllli.. 01 p"lury, 1 dlct"'llh'll h'YI ..aminld thl ..bo....I..Ply.r'. ,.lu,n Ind ,ccomp..nY'no ,ch.dulll,nd ,llllmlnl..lnd 10 Ihl b..1 0' my knowl'dg, Md hltr,thly,re trUI. carr. ct. and CO,"pllll. Thl. dlCIUlllon I. b..ud on 'II informlllon 0' wPltch I ",n 'ny knowlldg.. 0'11 Ch.ck 0 UUI'- I,"olond Preo.."r', .... ,"~""h,H' , F"m'.n","I(o'youn UIIll-,molOYldl ..nd.dd,," PrIP"Ir'.,oaal.lcurUyno, PaId Preparer's Use Onl KBA Fonn I4S3 (1096) FormI4S3(1996) F004S3-tV 1,43 Form SOllw11I COPY'lgPlI1J9!1 1'1&" BlaCk T.. 5"'o"CII,'''C, r. , . .~~~:.:., ~::.;'.~~... ,... 0:: '::':. ...~ . '. " ",.:,' ;~. ;;. : . ;-'1:''': .~:. "l': .' ..... . " 0, ..'." . " " , ,<'~ ....._,.-;.. .:.. . ' . . . . -. . ~ .. -. .., -of... I' '[.... .1 " ,.'~'..,; ',',' _ \...._ ~...'.:,.....J'~,,_ ".. .,1_, <.4'~",;" ':', ... ':'. '~..'., 1..., to.. .'..&0 1 :t~ .".....~..J,.~.. IHI..... i - - . C<rCroI_ 000013. 0M8 No. 1545-0001I Copy 8 To lie Fled WIth Employ"', FEDERAL Tax RatIA'll oga.llpI. - ... 21111.41 1I12.S' I SocIIIIIC1d1_' . _ -.rI1l1X....1lOId 21117.0 1111.21 I .,_ wagoI and ~ . ModcMIlP _ 21111..3 3U.U 7 SocIII_1IIy ~pI . -.lllpl 0.00 0.00 '"'" poymo'" 10 lleptrd... .... -. 0,00 0.00 11 /lot'qJoII1od plant 12 __lnboa1 0.00 0.00 11 s.. I1U'S. 101 bO. 13 ,. 0Uw C 7.'3 0,00 0.00 0.00 0,00 0.00 11_ - - ':I' -.. - ... ~ ~ ~Idotdca__ 231117S5S1 c ~,--.._...., liP codo MDrat1a1.cl ( . -t.1.oIw, %Dc. 3S .. 31t11 .t. ea.p a111,~ 11011- d ~'.IOOII-.iJ""""" lo2-~'-I1U . EtnQ/OyH', Nfl'll, ICtCnSS. and tiP code v-la I. au.. us kyce _ c_ 1111.'" 11011 11 M E~'II"IO.no. 1'sa...... 11SL&tftCOfNLII ...~~..l.............................. ......~~~~!:.~.. ........',~~:~~.. 0,00 0,00 11LOCIIJ:tl'lltnf lOuu...,n._1lL ZlL<<11IftQftlClI ,AtO 2110..10 211.0' ............... .................... 0,00 0.00 IW-2 Wage and Ta. Statement 1998 ~nt 01 ChI Tf'MIU")'-Itll.N1 ~...... Sr-tice Tho ,--..lobWog \.mOIlOd......I_-"O__ ASSETS OF THE PARTIES Plaintiff marks on the list below those items applicable to the case at bar and itemizes the assets on the following pages, (X) 1, (X) 2 , ( ) 3. ( ) 4 , ( ) 5, ( ) 6, ( ) 7, ( ) 8. (X) 9. ( ) 10. ( ) 11- (X) 12. ( ) 13. ( ) 14. ( ) 15. ( 16. ( 17. ( 18. (X) 19. ( ) 20, ( ) 21- ( ) 22, ( ) 23, ( ) 24. (X) 25. (X) 26, Real Property Motor Vehicles stocks, bonds, securities and options Certificates of deposit Checking accounts, cash savings accounts, money market and savings certificates Contents of safe deposit boxes Trusts Life insurance policies (indicate face value, cash surrender value and current beneficiaries) Annuities Gifts Inheritances Patents, copyrights, inventions, royalties Personal property outside the home Business (list all owners, including percentage of ownership, and officer/director positions held by a party with company) Employment termination benefits - severance pay, worker's compensation claim/award Profit sharing plans Pension plans (indicate employee contribution and date plan vests) Retirement plans, Individual Retirement Accounts Disability payments Litigation claims (matured and unmatured) Military/V,A. benefits Education benefits Debts due, including loans, mortgages held Household furnishings and personalty (include as a total category and attach itemized list if distribution of such assets is in dispute) other MARITAL PROPERTY Plaintiff lists all marital property in which either or both spouses have a legal or equitable interest individually or with any other person as of the date this action was commenced: ITEM NO, 1 DESCRIPTION OF PROPERTY: Camp Hill. PAl NAMES OF ALL OWNERS: W. Scott Bliss, Jr. and Pamela S. Bliss Marital Residence (145 Brvce Rd.. VALUE: $ 283.000.00 DATE OF VALUATION: NON-MARITAL PORTION: None LIENS OR ENCUMBRANCES: Harris Savinqs Bank ITEM NO. ~ DESCRIPTION OF PROPERTY: 1993 GMC Safari Van NAMES OF ALL OWNERS: W. Scott Bliss. Jr. VALUE: $ Unknown DATE OF VALUATION: NON-MARITAL PORTION: None LIENS OR ENCUMBRANCES: Societv/KevBank VALUE: $ Unknown DATE OF VALUATION: ITEM NO. 9a NON-MARITAL PORTION: None LIENS OR ENCUMBRANCES: None ITEM NO. 25 -- ITEMIZATION OF HOUSEHOLD ASSETS IN POSSESSION OF PROPERTY DESCRIPTION/VALUE: Wife Husband oriental Runs <: 2 000.00 X Crvstal shotalasses 50,00 X Mexican naintinn 100.00 Small framed etch inn 50.00 Tina Madotti black & 50.00 X white framed artwork Librarv of books 2 000.00 X CD collection 1 500.00 X Photonranhv enuinment 1 000.00 X Couch (whitel 100.00 X Couch (familvl 800.00 X TV 800.00 X Treadmill 100.00 X Lawnmower 50.00 X Washer 100.00 X Drver 75.00 X Refriaerator 300.00 X Leaf Blower 25,00 X Miscellaneous household 1,000.00 X furnishinas I i i ; TOTAL $ 10,100,00 NON-MARITAL PROPERTY Defendant lists all property in which a spouse has a legal or equitable interest WhlCh is claimed to be excluded from marital property: Item Number 1 Value: $25.000.00 Description of Proper tv Reason for Exclusion Inheritance from Grandparents Date of Valuation: 6/1990 Liens or Encumbrances: None LIABILITIES Item Number 1 Description of Property Marital Residence Names of All Debtors W. Scott Bliss and Pamela S. Bliss mount of Debt as of Date of Se aration: to be royided In1 1a Amoun 0 De an Pur ose: 233 000 0 urc ase orne Date Initial Debt was Incurre : 8 1995 Paymen s ma e S1nce Separa 1on: 0 e prOY1 e Names of All Creditors Harris sayings Bank 2 Mastercard W. Scott Bliss 5407-0410-2201-4726 and Pamela S. Bliss mount of Debt as of Date of Se aration: 9 005.00 In1 1a Amoun 0 De an Purpose: open cre 1 accoun Date In1t1al Debt was Incurred: unknown Payments made S1nce Separat1on: unknown 3 citibank W. Scott Bliss 4271-3823-1466-9819 mount of Debt as of Date of Se aratio : 5 000.00 In1 1a Amoun 0 De an Purpose: open cre 1 accoun Date In1t1al Debt was Incurred: unknown Payments made S1nce Separat1on: unknown 4 Keybank 00213298032 Amount of Debt as of Date of Se aration: 5 200.00 In1 1a Amoun 0 De t an Purpose: purc ase ve 1C e Date In1t1al Debt was Incurred: Payments made S1nce Separat1on: pa1d off from van sale W. Scott Bliss 5 W. Scott Bliss and Pamela S. Bliss Amount of Debt as of Date of Se aration: 990.83 Inlt1a Amoun 0 De an Purpose: open cre 1 accoun Date In1t1al Debt was Incurred: unknown Payments made Since Separat1on: to be prov1ded Hechts 118-909-16 6 W. Scott Bliss and Pamela S. Bliss Amount of Debt as of Date of Se aration: 7 900.00 In1 1a Amoun 0 De an Pur ose: 7 900.00 s OP orec osure on ouse Date Initial Debt was Incurred: 1997 payments made S1nce Separat1on: $1.000.00 PA Finance Agency -- :'~'';(Rfij'.'''''_'i:'ii~-'-4'U'''''--''('~'1'-~~'- -- """~I'f-.%t~2jr:t~~';~~i~t~~'t!>'",-';;,.'fifj~VtJ:l~;."-~;.:/~-"'t:Tl't\t~!f~}Iy,~t~*.>;iE"- - t&J.i~]~~~~~(~'~ ;Jf~~. ;~<,,_pf.{ _.~ --."r.I~~1~~r,t~~}f~~:t~~5_\.\"~,~rl2 _t~,-fr:;:';~tJrt5i~'-~.J',fl~(;'R~~_tf> :"M"~~i:T"~' "'-""\t:;!:;r..;:;.~~'~'f.-.;;~iit; ,,'''~:'':1,._tc'_.._''':y.-,1'''''''''''' ,....... ..- '.' .,....', '..,' ',- W. SCOTT BLISS, JR., Plaintiff v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 97-1690 CIVIL TERM PAMELA S. BLISS, Defendant IN DIVORCE PLAINTIFF'S PRETRIAL STATEMENT I. Assets of Parties: A. Marital Assets. 1. Residential real estate: 145 Bryce Road, Camp Hill (Hampden Township), PA. Purchased 9/27/95 for $268,000.00. Mortgage to Harris Savings Bank from 9/27/95 with approximate payoff balance of $209,000.00 at time of separation; Additional mortgage financed by Wife alone to PHFA in 1/98 for $9,000.00, when Wife failed to make mortgage payments while living in the home post- separation. Appraised 11/24/98: $283,000.00. 2. CTR Systems, Inc., 401(k) plan, Husband's prior employment (only partially vested) . Date of separation vested value approximately $19,800.00. 3. Keystone Medical Systems, 401 (k) plan, Husband's current employer. Date of separation value approximately $5,000.00 (This plan was liquidated, net after tax penalty, etc., for $4,300.00, with full knowledge and consent of spouse to provide source of payment of custody evaluation/counseling sessions and the like related to custody proceedings.) 4. 1994 GMC van (Husband's name). Value at time of sale on 4/15/98: $6,500.00. Security Bank auto loan payoff at time of sale: $2,840.21. Costs of post-separation auto loan payments, repairs of vehicle after Wife's use of vehicle for about 5 months post-separation, and costs of sale of vehicle exceeded net proceeds of sale. I , I 5. Contents of home, furniture, furnishings, etc. Value: Unknown. Subj ect to appraisal prior to hearing, Plaintiff estimates value of such items to be approximately $15,000.00 to $20,000.00 B. Non-marital Assets. 1. All employee benefits of any type earned post- separation. Those accrued by Wife, including cash value in life policies, IRA's, etc., have values unknown to Plaintiff. ~ " 2. H. J. Heinz Company stock in DRIP of H. J. Heinz Company, held by parties hereto as custodians under the Uniform Gift to Minors Act in the names of the children. Total value approximately $25,000.00. F II. Expert witnesses. Plaintiff expects to offer the appraisal report or testimony of Philip F. Grow, of Affiliated Appraisers & Consultants, 1002 Bridge Street, New Cumberland, PA 17070 as to the value of the marital real estate. (Copy of appraisal report is at tached. ) ... " III. Other witnesses. No other witnesses are anticipated other than such witnesses may be required to rebut Defendant's testimony - - to be determined upon review of Defendant's Pretrial Statement. IV. Exhibits. Other than appraisal report and copies of statements concerning 401(k) plans, credit card bills and the like (not all of which are available to the Plaintiff at the present time), no other exhibits are anticipated. V. Plaintiff's gross income. 2 , , Copies of most recent pays tub and of 1998's W-2 forms for Plaintiff's employment at Keystone Medical Systems, Inc. are attached. ,I " , VI. Expenses. Plaintiff/Husband's expenses are not expected to be a significant issue in this divorce action. VII. Pension values. None requiring actuarial valuation. 401(k) plans existed and the valuation is established by statements which will be offered in evidence at the time of hearing. VIII. Counsel fees. No claims pending by Plaintiff. IX. Tangible personal property and disputes. Plaintiff has not yet had an appraisal of the contents of the marital home. Plaintiff's estimate of value of such furniture, furnishings and the like is included above. If Defendant/Wife is to retain marital home and custody of minor children there, Plaintiff anticipates she would wish to retain such assets with the home and the children. The negative net value of the only vehicle titled in the name of the parties at the time of separation was established by bona fide sale to third party about which Plaintiff will offer testimony. X. Marital debts. A. Visa Account No. 4271 3821 3852 6401 (formerly 4271 3823 1466 9819). Balance at separation: $ 7842.00 Purpose of debt: Household expenses and the like. Any and all payments on such debt since separation have been made by Plaintiff. B. Mastercard Account No. 5407-0410-2201-4726. Balance at separation: $8600.00 Purpose of debt: Household expenses and the like. Any and all payments on such debt since separation have been made by Plaintiff. C. American Express Account No. 3728-882387-41001. Balance at separation: $5000.00 3 Purpose of debt: Household expenses and the like. Any and all payments on such debt since separation have been made by Plaintiff. D. Hecht's Account No. 118-909-160. Balance at separation: $2000.00 purpose of debt: Household expenses and the like. Any and all payments on such debt since separation have been made by Plaintiff. XI. Proposed resolution. Plaintiff proposes the Master distribute marital property of the parties as follows: Plaintiff to retain his 401 (k) plan assets from prior employment. Marital real property to be sold and, after payment of mortgage created jointly at acquisition of such real estate, Defendant to retain such amount which, taking into account value of furnishings also retained by Defendant, will result in 55%-45% division of total marital assets in favor of Defendant. With the cash assets available from sale of real property and reduced and more reasonable housing costs, Defendant's need for support should be substantially lessened. Plaintiff has been paying to Defendant/Wife (or making payments for her benefit) in an amount of over $1100.00 per month for more than two years and proposes paying alimony post-divorce in the amount of $400.00 per month for a period of two years from the date of the Master's Hearing, subject to modification and/or termination as provided in the Diyorce Code. Date&r;hu~ ~p By 17108-2106 Attorneys for Plaintiff 4 , 1 Keystone Medical Systems, Inc. DATE: 1O"DII,1 PAY PERIOD ENDED; U~9Dll>1 SUPERVISOR: ~LUH C r.OMrr.NSATION RECORD AND NOTIFICATION OF I'AYROJ.I. IlEPOSIT Ol\'/IIIID" : riA'-": I aQattell1 Gl can r.ftl'O I 001 INP" I H scarr ILISs JR 47DI A CH~RLES Ra MECHANICSIUNO r~ l1D5S IS 1(0.1 GIlAP' uvn , "'01 Tlnll T,U"'ATUI' 111-5."273 ODG~ MCOPI!I WO"IC.IJ:T,I "Ie I Q7.&..2 v P SALES t1 IIIH(PJlC"' I aOOI"O""1. ,al."T.I UP I 5 Ir_fll .00 PA 5 .00 TillS HanCE Of DEPOSIT IS TilE fIRST OH! fOR un. "lNY CHANGES MER! rROCEssEO ON TltIS NOD. PLEASE cHfC~ YOURS C1REFULLY AHD RErDRT lNY ERRORS InnEDUTELT TO 'OUR IfR DErT .M-2S MILL IE "~ILEa IT JAHU~RY 511. 19... HOURS AND EARNIHGS TAXES LEAVE INFORMATION PI':II::IIIIl11CJH HQURI CUPIIIlIQ'".,,"ua l,u..'iIlPl ON .,.,.D fA" j 1'''01 CUIIIIHNT 'U,hlUUT ,.,.p A"lOI"~t RECULAR rD L SCH HOLlaAY Iq.OO 8.00 8.00 5,OGI.16 Slo.77 300.77 5,OQI.U sao.77 58D .17 sac SEC FED TAM STATE TN LOCAL TX 236.DB 711.D6 ID6.02 5A.oa AFTER TAX DEDUCTIONS U.IO 6.5. 1,057.55 1&.21 256.0B 111.01 lDI.6Z 51.01 "EDlCAL DENTAL DARNISH "EDICARE 45.60 6.51 I,Dn.55 1&.21 AFTER TAX REIMBURSEMENT 011C"1"110/l 'AID L(/wt nV^lI.AILf I H.DD ," LV UUP "IP 'CIIJPULJP I O,OQ U UCH[PUUP I .00 liCit LU.~( .VAltA,Lf I .aD .~ .\1 uno 'ffD SCIIHIUUD I .00 U tUH1DlIU;P I .00 l.lIiPAIP UAVt: UUD, ICHlDULED I .DO INICHIDULf,D I .DD APMI" UAUrl .DD , OUTSTANDING BALANCES ,a.ov. W~ar;$: . aD rliRM TMV.~ : .Da DEPE~DENT CARE. .DD EPUC:ATiC/1 AD\I, : . ao BENEFITS FLEXIBLE SPENDING ACCOUNT CUllf<ENT NET PAY DISTRIBUTION 'URRUT y+n CUIlUMT ,,+p AMOUNT ftMnllNT AMnllNT A DUNT EARNINCS: MtPI~"LI NOT SELEcTEa ru:TI'A'(1 I.S46.H WELLNESS .Da .aD IUDI/CTIOH I .DD .00 Y- YENURE IENEFIT .aD .DD flfUUlUf\Sr:MliH'1 .aa .DD , nVnlLI .DD DEP011IJl. REDUCTIONS, rfllOp , "VAIL I .00 "EDICAL .00 .DD CD"~ERCE "HI( ~upr MEDICAL .DD .DD lCCr R &120Qq441 CAHCta .DD .DD DEHHDt:NJ CAllE I NOT SELECTED 1.&~6.H DENTAL/VIS .00 .DD '''H:n.'~f1DlIl .aD .DD HEX SPENDIHG .00 .00 "f.IMaU":u:~n:"T I .DD .00 PREF SUG rL. OY, .OD .00 , ""-II-, .DD 4al IXI. 001; .OD .Da r"ID" I AVAil., 1 .PD Ufulllla, IlENtflTS IA1(Allt.' WAl4'& L~r;, lAin J.'U Olt). PLUG REIP.-A. Ii!!r P^V ~UnAtH' J.D07.7D .aD 3.107.70 1.0'6.84 1.164.7D .DD 1.5_1.16 ,.,.0 5.U7.7D .ap 3,101.10 1,DQ".84 1 .164 . 7D .aD l,S.., .lE. ..,.,,1111", ~"",,--'-"'. UNIFORM RESIDENTIAL APPRAISAL REPORT Fllo No 11 017118 Pron."" Add"" 141i Brvce Road CIN Camn Hill Si,l. PA II,eode17011 llOll O..cn,lIon Lot 111 Section 6B Point Rldoe Farms Hamnden Townshlo countvCumberland AIIt"n(, Pm" No. 10-1 q-l liq8-14 TIX YOIr q8 R E. Tt". s1. Oq7. 28 Sotcl., A.",.menl..none knwn N/A "ur"nl (),ynar BlI ss Scott & Pamela OCCUDlnl: I X Il)..vn., r I T"IOI r -1 VICIOI P hi' ''""I..d I YI roo Slmnl. I I ,....hold I Pro'ec' Tvn. r PliO n Cond,mlnlllm rHUDNA onlv\ HOAt N/A/t.4o .. C,noU. T"clll" N.lnhbOlhood or Pro',,1 Nlm. Point Rld~e Farms t.41O Rei""" ADC q F 10 S.I.Pn"S N/A Olltol 5,1. N/ A DOIcnnli" IOd S .mounl 01 lOIn chlr",/eonc...I,,, 10 be nold hv "II" N/ A l"dar/cllenIBruce Bratton Addr",2515 N. Front Street. Harrlsbur~ PA 17070 Ano"I.., Ph I 10 F. Crow AddrOl' 1002 8r Idoe Street New Cumber land loc.lIon ~ Urban oX Suburban Rur.l Predominant Slngl. tamlly houllng Pru.nt land un " Land un chang. OVar 75X 25-75X Undar 25X occupancy PRICE AG~ On.llmlly qO ~ Nolllk.ly 0 llk.ly Buill up ~ Owner 11000' br. Growth ,ale >- Repld Sltbl. Slow 120 low 10 2-411mlly 0 In process Property vatu.. >- Incrllllng SI.bl. Declining ~ Tenlnl 1liO Hi'h 11i t.4~Hlmily 0 To: DemlOd/lupply Shorllg. k\ bliInat OVe, IlWt Vlwl (1)-5X) Predl'lminanl Commerclll Ii >- t.4"k'lInn lime Under 3~, 3-6mos. Over6mos V'ClIII!c.tr5'l1 200 20 vacant I Ii Hote: RacI and the racial composition of the n'lghb~~:OOd are not appraisal factorl. N.lghborhoodbound.n..endchtltclarl.II,,: The sub ect nelahborhood Is bounded bv the Carlisle Pike to the south . and by the Conodoaulnet Creek In other directions. . F.clo," Ihlt.lleotlh. mtrk.llblllly ollh. proparll"ln Ih. n.lghborhood (proxlmlly 10 .mploymenl end .menIIiOl. .mploymenl.l.blllly. .pp..llo mtrk.l. .Ic.): " , The subiect Is located In an established residential nelahborhood comorlsed nredomlnantlv of . s I na le fam 11 v houses The nelahborhood Is well located with resoect to most amenities. Access - . to Routa 11. shoppln~. and most services is within a few minute drive. Emolovment centers are n within a ten to fifteen minute commute. t.4ark.t condlUoOl In !h. ,ubject n.lghborhood (Including .uppon 10' Ihe .bov. eonclu,loOl ,,1.I.d 10 Ih. I"nd 01 proptrly v.lu". d.mend/lupply. Ind mlrk.llng 11m. - - .uch.. dIll on comp.lll1vl prop"lI" 10' Sfl. In Ih. n.lghborhood. dOlc,lpllon ollh. prev.l.nco 01,,1.. end II"nclng concollloOl. Ilc.): Consistent with other nel~hborhoods In this area homes In the subiect nelQhborhood have exoerlenced moderate aooreclatlon In recent vears. Conventional FHA and VA flnanclno are readllv available with occasional sales concessions. Interest rates remain favorable. Project Information for PUOI (1IIppllcabl.)... "'1, the de~eloper/builder in conltol ollhe Home OWners' Associalion (HOA)? DYES DNO , Approxlm.,.loltl number 01 unll. In Ih. .ublecl prolecl N / A Approximate lolal number 01 units lor sale In the subjecl project N I A Otscrlbe common elemenls and recrulionallacllilies. NI A Dimen.loOl 121i X 1 Ii Ii Topogllphy aentlv slonino 511. trO. 19375 Sa. Ft. or .44 acre Cornerlol 0 y" Lx] No Size tvnica1 for area Speclllc zoning cl...III"II" end dOl"lpll" resident la1 suburban ShIp' rectanoular Zoning complllnce (Xl l.gll legalllll1CXll\l)<I1ing(Grandltteredw) U lII.g.' U 110 zOning Drainage annears adenuate Hlnhesl & best use as lmnroved: Present use ~r~fOlher use te)(nl.in' View averaoe for area UtlIlU.. Pu~c Other Off.lItelmprovemonh Type Public Private Landscaping tvnlcal Eleclrlclly ~ 200 Amn 51,,,1 macadam ~ 8 O,i~eway Surlacl macadam , Gu ~ Curb/guller none Apparenl easemenls of record Wal.r !J. Sidewllk none - ~ FEMA Special Flood HUlrd Area U Ves lXJ No Sanilary sewer ~ SJr"tllghl' none = = FEt.4A Zone X t.4lp DII.-'1/2/<l1 Storm sewer Iy AII.v none FEMA t.410 No. 420160 Commenls (IPPltenlld~'f5e easements. encrolChmenls. .pecilluseuments. slide Irea., i111gll or legal noncontorming zoning. use. etc.); No annarent adverse easements or encroachments were noted. GENERAL DESCRIPTION EXTERIOR DESCRIPTION FOUNOA TION BASEt.4ENT INSULATION No. 01 Unll. 1 Foundation cone block Sllb 0 ,. A"a Sq.F1. 1686 Rool ~ No. 01 51011.. 2 Exlerlor Wall. brk & alum CnrMSpaCll 0 ,. % Flni,h.d qO C.illng Cncld. Typ. (Del/Alt) detached Rool Surflce asoh shlna Ba..menl 100'. Ceiling suso. tile Wall. Cncld. De,lgn(SIyI.) 2 storv Gullm & Ownopl'. aluminum Sump P\Jmp none WIll. drywall Floo' Cncld. (Xl Exl.llng/Propo"d ex 1st Ina Window Type wood 0 H Dlmpn", none noted Floor caroet None 8 n Age (YII.) 10 +/- Storm/Screens yes/ves S.III.menl no evident CM.lde Enlry no Un~f\OWn -I <1I"-lIv" A"' Yr- \ 12 Manufaclured Hous" no Inre.lllinn no aonarent n lIvlno - ROOMS Faver Olnlno KUehen Den Famllv Am Aee,Am Bedrooms , Balhs Laundrv Other Ar.. Sn FI . B.1semenl 2 1 1 1 1 686 : l.vel' 1 1 1 1 1 .Ii 1 1 686 . '.v.l? 4 2 1 - '148 " Finl.h-d .r-. "b'wo "raA~ conlalM. 8 Room . 4 Redrnnm ., 2.Ii ,Ihr.,. '1_ 014 <~". F.., 01 Gro'" Ivlnn A'" . INTERIOR Materials/Condition HEATING KITCIIEN EQUIP. ATTIC At.4ENITIE5 CAR STORAGE: Ftoou Cnt Hd.Wd.lad Typ. FHA Helrigeralor @ None @ Flreplace(,)' L- ~ None 0 . Wall. dr""all/oood Fuel aas Reng./OVen Slairs Pollio 14 X 14 CXJ Garage , clelts Trlm/Flnl,h wood/nalnted Condilionunknown Disposal 0 Drop Slair ~ Deck 0 Allach.d 2 !lith Floor ceram. T Ile/od CoolIIIG Dishwasher CXJ Scuttle Porch 3 X 14 ~ Delached !lilhW.lnsc,' ceram. Tlle/ava Cenl,,1 ves Fan/Hood ~ FloOt Fence ~ DuitHn DoOlS 6 oane1/aood Other no Microwave Healed Pool Carport vinvl kitchen floor C:ondlhol'lunknown WI'her/ONer n Finished OtlveW3" Add,lio",,,..lur.. (.peelll energy elliclenlll.m...'c.): See Attached Addendum. CondiUon 01 the Imptovemenls, depreciation (physical. lunction..I, and exlernal), tepair. needed. qualily ot conslluction, remodeling/addillons, ele.: The home Is In avera~e to ~ood condition and has been well maintained. No functional or external : Inadenuacles were observed. . Ad~erse en~ltonmcnlal conditions (such IS, but not Iimiled 10. hazardous wastes. loxic subslances, elc.) ptesenl in the Improvements. on the sllll. or In Ihe Immedlll. vlclnlly ollhe ,ubl.ct properly: No adverse env I ronmental condl t Ions noted. However the annralser Is not an exnert In this field and makes no claims as to the existence of undesirable conditions f"UotUtefor..10 "\lJ PAGE I OF 2 ,... ""'.. .......b.l.. I.. ...._. (_.~_,.... ..,......0 1\.I.l.kIA hJ'lnl.UuForlllltw:l4 '-IJ _.<<In' . FlloNo.ll01708. . ...., 1M" TED SITE V"LUE . . S II/A Comm.nll on Co.1 "pp,oech (.ueh II. .ou,e. 01 COIl IIlImll.. ESTIMATED REPAOOUCTION COST-NEW OF IMPROVEMENTS: III. vllul. IqUIIIlool csleullllon Ind lor HUO. V" Ind FmH". th. !>N.lling Sq.FL'S . S 0 ulimll.d romllnlng 'CDnomle III. ollh. properly): Becausa the Sq. Ft.. S . 0 aoe of the orooertv makes estlmatlnn eccrued . . depreciation extremely speculative. the cost : CIorago/Carport _ Sq. Fl. . S . annroach Is considered unre11eble and has TOIaIElllmllldcoIINIj" .. ~ I...... . . $ 0 not been develooed. L.II PhY11e11 Funcllonll Exlern.1 . DopracllUon ~o $0 . S Ooproclllld Vllul ollmp,ov.m.nll . . S .".-11' Vllu. 01 SII,'mp,ov.menl. . . .... . $ INDICATED VALUE BY COST APPROACH . ~ II/A ITEM I SUBJECT COMPARABLE NO.1 COMPARABLE NO 2 COMPAIIABLE NO.3 145 Bryce Road 115 1I0rthgate Drive 110 Pelham Road 6220 Westover Drive Add,... Camn Hill Camo Hill Camn Hill Mechanlcsburo Pro)(lmlk. 10 Sublecl 2 blocks I ~ blocks 1.<; miles 5.1.. Prlc. ~ II/ ~ 2~4 000 ~ 111 000 ~ 260 000 Price/Gross Uv, Are. ~ o OOil 101.20il . I. 110.81il I~ 10<;.<;2il. . '. Oala Ind/ol Inspection multi-list multi-list multi-list V.rlllclUon Sources REDI e1ata REDI eIa ta REDI e1ata VALLEAMJSTI.fJITS DESCRIPTION DESCRIPTION 1.,."......,_, OESCIIIPTION 1.,.,'.... ,_, DESCRIPTION I.,."....~I_I Salll 01 Flnlnclng .... conventional conventional . conventional . . . . . . Concessions ... closed sale . closed sale . closed sale . Oal. 01 Sal.lTlm. N/A . . 8/98 . 4/q8 . 17198 . . . . Locallon suburban suburban . suburban , suburban . L....t1lidiF.. Si....... fee slmnle fee slmole . fee slmnle . fee slmole . . . Sile .44 acre .4Q acre : .48 acre . .29 acre . .~ 000 . . View averane Iaveraoe . averaoe . averaoe . Desln" and Anneal 2 storv/avo 2 storv/avo . 2 storu/avo . 2 storv/avo . , . OJaIi"oIComInJclon avo-brk& alUl lava-aluminum . .~ 000 avo-aluminum . .1 000 avo-brk&vlnvl: . . Ace I ~o vears ./- similar . 14 uears . -10 000 24 vears . -1.000 averaoe-oood similar . sunerlor : -<; 000 similar : Condition , Above Grade Tol.,'8<lIIII" TolIl' IIdflllt' 9.1111 . Tell" lIdrlllt' 8.,h1 . Tel.,' Sdffl'll' 811M : , 8ith. . . Room Counl 8: 4: 2.' 8 : 4 : 2.1;: 8: 4: 2.<;: 8: 4 : 2.<;: Oross L1vlna Are. ~ 0':\4 So. Fl. 2.<;10SoFt : .1<;.700 2.806 So. Ft. . .6 800 2 464 So. FI : .17 100 . Bmmenl & fin/ailed full full . full . full . . . . . . unfinished . .5.000 finished . Rooms Below Orade finished finished , . Functional Utility averalle !"verane : averaoe : averaoe c Hellino/Coolina frced alr/CA forced alr/CA: forced alr/CA: forced alr/CA: . solar . tunlcal . tVrllcal tvnlca1 . . Enerav Elficlenlllems Oafloe/Carnor1 2 car attache 2 car attachd: 2 car attachd: 2 car attachd: Porch. Pilla. Deck. porch,patlo similar , superior . -5,000 similar : . FiI"lac.I.I.,c. 1 f I renlace h f I reo1aces , -~ 000 1 flrenlace . 2 flreolaces : -1.<;00 , . . : Inllround 0001: -~OOO Fence Pool elc. none none . none : . , . , tI.IAdL (101.11 .'. . 11xl. rl- :$ 1<;.700 n. Ixl- '$ <;.200 rXl. n- '$ 12 600 Adju.led Sales Poco '.' .... iGross: g.5 Cross: 11.2 Cross: 12.2 01 ComDarable . . .... Inet. 6.; $ 260_700 Net. -1 7 $ ':\0<;.800 Net. 48$ 272 600 Commenl. on Salll Compaoson (Including Ih. .ubJecl prop.rty.. complllbillly 10 Ih. neighborhood. "c. ): See Attached Addendum. ITEM SUBJECT COMPARABLE NO.1 COMPARABLE NO.2 COMPARABLE NO.3 Oil.. Poco Ind Dill 110 sales Uo sales during past 110 sales during past 110 sales during past Source lor prior sales during past twelve months twelve months twelve months witt'inwarofaooralsaJ vear Analysis 01111)' curflnllgreemenlol sale. option. or lislingol the subject property and analysis olal1)' prior sales 01 subject and comparables wilhin tine yearol the dale 01 apprai~l: The sub1ect is not currentlv listed for sale nor has It sold durlnll the cast vear. It last transferred on 10/0~ for ~268 000. INDICATED VALUE BY SALES COMPARISON APPROACH $ 28, 000 . INOICA TED VALUE DY INCOME APPROACH (II Appllcabl.) E.limaled Mark.1 Renl $ N I A /Mo. )( Gross ~nl Multiplier N/A . $ N/A This appraisal I! made lXJ -.s Is. U subject 10 the repairs. alletations,lnspections orcondltions listed below ~ subject to completion per plans and specifications. CondIbonscIAppral.." Personal oronertu Is not Included In the valuation. This Is a comn1ete summaru reoort. Final ReconclllallonAll three aooroaches to value were considered. However the market area lacks an adeauate number of rental sales to use the Income annroach. The cost aooroach was not develoned . due to the aile of the subiect. The sales comnarlson annroach Is considered reliable. The purpose ollhls appral5l1 is to estimale the market value ollhe rul property thai Is the subject 01 this report. based on the above condItions and the certllication. contingenl _ and IimiUng CDnchUon.. .nd ma",.1 value deliniUon lhalore .laled In Iho ollacl'<d Fredd" Mac Form 439/Fannie Ma. Form 10048 (Revised 6/93 ). I I (WE) ESTIMATE THE MARKET VALUE, AS DEFINED. OF THE REAL PROPERTY THAT IS THE SUBJECT OF THIS REPORT. AS OF 11/24/98 i IWHICHISTHEDATE;mOH~ECTlVEDATEOFTHlSREPORT)T08E$ 283.000 . . APPRAISER: rr:; SUPERVISORY APPRAISER (ONLY IF RECUIREO): Slgnalu'l <> --,. Signa lure o Did OOidNol Ilam. Ph III P F. Crow Name In.pecl Properly Oal. Report Signed 11/30/98 0.1. Repoll Sign.d Sill. C.rtillelfion' CA-000053-L Sial. PA Slate Cerlilicalion' Sial. 0, Sill. Licon.. , Sial. Or 51.1. L1cenll , Sial. UNIFORM RESIDENTIAL APPRAISAL REPORT PAGE20F2 ,.. 'If... "'........1.. Iftf_, U-'l_'..'f'I'''1IO.) Ut.LlWI hnnltUuFOlmlC041/11 AFFILIATED APPRAISERS & Consultants