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NOVEMBER 16, 1997
DEAR M[CHAEL,
[ AM SUBM[IT[NG TO YOU COPIES OF THE CURRENT MEDICAL AND
DENTAL EXPENSES ON THE CH[LDREN FOR YOUR RE[MBURSEMENT,
9-22-97 THREE SPRINGS $5,00 MCW CHECK-UP
9-23-97 GIANTS 6,00 MCW MEDS
[ 0-9-97 DR, CANTOR 65,00 MCW BRACES
10-26-97 CVS 6,00 MCW MEDS
[ [-6-97 DR, CANTOR 65,00 MCW BRACES
PLEASE PAY YOUR SHARE OF 50% WITH[N THIRTY DAY AS AGREED,
CONCERNING MY LEITER TO YOU DATED, SEPTEMBER [4, 1997, YOU SEEM
TO DISAGREE WITH SOME OF TH[S AND DON'T FEEL SOME OF THE
CHARGES AND REIMBURSEMENTS TO YOU ARE CORRECT, AS I STATED
IN THE LEITER AND I QUOTE, "IF YOU HAVE ANY QUESTIONS, OR CAN
DOCUMENT ANY PAYMENTS ON ANY OF THE ABOVE PLEASE CONTACT
ME." I FURTHER GO ON ANY STATE, " PLEASE SUBM[T DOCUMENTATION
FOR ANY BILLS YOU FEEL YOU HAVE PAID TO SUPPORT YOUR CLAIM ",
INSTEAD YOU HAVE HARASSED AND THREATEN ME AND ONCE AGAIN
HAVE NOT MADE ANY PAYMENTS, I AM NOT SA YING THAT I AM PERFECT,
I CAN MAKE MISTAKES, BUT YOU HAVEN'T MADE PAYMENTS ON MEDICAL
AND DENTAL BILLS FOR MONTHS, AND THEN YOU PICK AND CHOSE WHAT
YOU WANT TO PAY AND WHAT YOU DON'T WANT TO PAY,
MICHAEL IT IS BLACK AND WHITE, PAY WHAT YOU OWE, AND IF YOU
FEEL YOU HAVE ALREADY PAID A PART[CULAR BILL THEN SENT ME THE
DOCUMENT A TION, I'M SURE WE CAN WORK [T OUT, [N FACT AFTER
REVIEWING MY RECORDS, I DO SHOW A PAYMENT FOR $[ [2.00 IN APRIL OF
1997, BUT THAT IS THE LAST PAYMENT I SHOW,
PLEASE TAKE CREDIT FOR THE $112.00 AND SEND ME THE BALANCE YOU
OWE WH[CH [ SHOW AS FOLLOWS;
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E. MICHAEL WHITE,
Petitioner
vs.
}
} IN THE COURT OF COMMON PLEAS OF
} CUMBERLAND COUNTY, PENNSYLVANIA
}
} civil Action - ~'- 11" /J
} No. q7- 27W= ~
}
MARY RAE PITTENGER WHITE,
Respondent
APPLICATION FOR REGISTRATION OF FOREIGN JUDGMENT
PURSUANT TO UNIFORM ENFORCEMENT OF FOREIGN JUDGMENTS ACT
TO THE HONORABLE JUDGE OF SAID COURT:
COMES NOW, E. Michael White, Petitioner herein, and
respectfully requests this Honorable Court for Registration of a
Foreign Judgment and shows:
1. In an action in the Superior Court of the State of Arizona
In and For the County of Graham, No. 13817, styled E. Michael White
vs. Mary R. pi ttenger White, a divorce action , Petitioner as
Plaintiff obtained a decree of divorce. The stipUlated decree of
divorce incorporated by reference the property settlement agreement
of the parties.
2. The JUdgment was entered on April 29, 1992. A duly
exemplified copy is attached hereto and marked Exhibit "A" and by
reference made a part hereof.
3. Respondent, herein, Mary Rae Pittenger White, is a resident
of Cumberland County, residing at 15 Brian Drive, Carlisle, PA,
where she shall be served with process.
WHEREFORE, E. Michael White prays that the judgment of Graham
County, Arizona be registered in Cumberland County, Pennsylvania in
accordance with the provisions of 42 Pa.C.S.A. 4306 and 23
Pa.C.S.A. 3705.
IN THE SUPERIOR COURT OF THE STATE OF ARIZONA
IN AND FOR THE COUNTY OF GRAHAM
STATE OF ARIZONA )
)ss
County of Graham )
Cause NO. 13817
I, AMELIA SAINZ, the duly elected, qualified
and acting Clerk of the Superior Court in Graham County,
State of Arizona, and having official custody of the Court's
records, do hereby certify and attest the foregoing to
be a full, true and correct copy of the original:
STIPULATED DECREE OF DISSOLUTION OF MARRIAGE (WITH MINOR CHILDREN)
on file and of record in my office, and I have carefully
compared the same with the original, all of which I have
caused to be authenticated according to the act of Congress
(28 USC, Sec. 1738) and the Ar' na Rules of Idence.
(SEAL)
Clerk
Court
BY:
Deputy
STATE OF ARIZONA )
)ss
County of Graham )
I, DUDLEY S. WELKER, Judge of the Superior Court
in Graham County, State of Arizona, do hereby certify that
said Court is a Court of Record having a Clerk and Seal.
That Amelia Sainz, who has signed the foregoing certificate,
is the duly elected, qualified and acting Clerk of said
Superior Court. That said signature is her genuine
handwriting, and that all her official acts, as such Clerk,
are entitled to full faith and credit.
And I further certify that said certificate is
in due form of law.
IN WITNESS WHEREOF,
in my official capacity as
seal of said Court, this date:
have hereunto
Judge, and
13 1997
./
~
,/----- Judge of the Sup rior Court
&. . .
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APR 2 9 1992
1 C. Robert Pursley
P.O. Box 668
2 Safford, AZ 85548
(602) 428-3620
3 Arizona Bar #003214
BY ClERKAI' /.I
GRAHAM COUN SUPERIOR CP'1f r
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Attorney for Respondent
IN THE SUPERIOR COURT OF THE STATE OF ARIZONA
IN AND FOR THE COUNTY OF GRAHAM
In re the Marriage of: )
) No. 13817
E. MICHAEL WHITE, )
) STIPULATED DECREE OF DISSOLUTION
Petitioner, ) OF MARRIAGE
) (With Minor Children)
and )
)
MARY R. PITTENGER WHITE, )
)
Respondent. )
)
This matter having come before the Court, both parties
being ~epresented by counsel and having stipulated to the terms
and conditions contained herein, and good cause appearing, the
Court having heard testimony and taken evidence, finds as follows:
The parties hereto were residents of the State of Arizona
for more than ninety days immediately preceding the filing of
the Petition for Dissolution of Marriage herein; the marriage
between the parties is irretr.ievably broken and the provisions
for conciliation either do not apply or would not prove effective;
this court has jurisdiction to decide child custody, support and
24 visitation since the minor children reside in this county; the
25 parties have reached an agreement regarding the division of
26
27
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1 their debts and assets, a copy of which is attached hereto and
2 incorporc:ted herein by this reference; '.he agreement referred
3 to is found to be fair and reasonable under the circumstances.
4 WHEREFORE, IT IS HEREBY ORDERED:
5 1. That the marriage between the parties is dissolved;
6 2. That custody of the minor children, COURTNEY RYAN
7 WHITE and MICHAEL COLBY WHITE, is awarded to Respondent with
8 Petitioner granted reasonable visitation as more fully set forth
9 in the agreement referred to above;
10 3. That child support, a division of community debts and
11 assets and other property settlement provisions are also taken
12 care of in this agreement, all of which are confirmed by this
13 Decree of Dissolution of Marriage;
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4. That no spousal maintenance is awarded;
5. That the Petitioner shall be responsible for legal ex-
penses incurred herein by Respondent, including attorney's fees
as set forth in the agreement.
DATED this "Z.!!.-day oi \::)t'12 I C- , 1992.
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Judge of th~perior Court
Approved:
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~~rney for Petitioner
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Attorney/for Responden~
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SETTLBKEKT AGRIZKIHT
IN COKTBKPLATION OF
DISSOLUTION OF KARRIAGI
THIS AGREEMENT is entered into this /6'\ll day of
February, 1992 by and between MICHAEL WHITE and MARY RAE
WHITE, man and wife, and evidences the following Facts
and Agreements:
FACTS
A. MICHAEL WHITE (hereinafter "Husband") and MARY
RAE WHITE (hereinafter "Wire") were married on December
15, 1984, in Odessa, Texas.
B. The parties have two (2) minor children, namely:
COURTNEY RYAN WHITE, born January 1, 1982 (natural child
of Wife and adoptive child of HUSband), and MICHAEL COLBY
WHITE, born January 16, 1987. Wife is not now pregnant.
C. Irreconcilable differences have arisen between
the parties and the marriage is irretrievably broken.
D. The parties hereto now desire to amicably
resolve all matters relating to the Dissolution of their
Marriage by the mutual agreement as expressed herein.
E. Having settled all their differences herein, the
parties intend that the Dissolution of Marriage action on
file as Graham County Cause No. 13817 shall proceed as a
Default or Consent Dissolution.
AGREEMENTS
NOW, THEREFORE, in consideration of the promises and
agreements contained herein, these parties agree as
follows: ......"
1. Incorporation: The Facts herein shall be
considered a part of this Settlement Agreement and these
Agreements, as if fully set forth herein, and the parties
ratify and acknowledge each of the facts.
2. custody: Husband and Wife each agree that Wife
shall have custody of the two minor children and that
such an arrangement would be in the best interests of the
minor children.
. 3. Child Support: Husband and Wife agree that the
present income of the parties and the guidelines of the
State of Arizona provide for child support payments by
Husband to Wife in the sum of Nine Hundred Thirty Dollars
($930) per month, said amount to be subject to
modification in the future consistent with the income and
support guidelines of the State of Arizona in effect at
that time. Husband shall make such payments, along with
court costs of $1.15 per month, by wage assignment
through his employer ami payable to the Clerk of the
superior Court of Graham County, Arizona.
4. Visitation: Husband shall be entitled to
exercise liberal visitation rights due to the distances
of separation anticipated. Providing at least 72 hours
notice is given, he shall be entitled to visit the
children whenever possible. All costs of visitation
shall be borne by Husband.
S. Medical Expenses: Husband shall provide medical
and dental insurance coverage for the two minor children
initially and, in addition, shall pay all non-covered
medical expenses until Wife is gainfully employed, at
which time said costs will be split equally between the
parties. During this initial period no elective medical
or dental procedures shall be performed upon the children
without the express written consent of the husband. At
such time that coverage is available through Wife's
employment, the parties will determine the most
advantageous method of insurance and whether or not
coverage will continue under Husband's employment and, if
provided by Wife, all non-covered medical and dental
expenses shall be split equally between the parties.
6. Life Insurance: Husband shall maintain life
insurance for the benefit of the children so long as he
is financially able. Husband may name the children as
beneficiaries or may name his brother, Thomas Alan White,
as Trustee for the benefit of the children or may name
his estate in which case the funds shall be administered
by the Personal Representative of his estate. If husband
is not able to provide life insurance he will notify wife
of his intention to terminate life insurance coverage.
7. Children's Accounts: The parties agree that all
present savings accounts, bonds, stocks, etc. designed
for the childrens' educations shall remain untouched and
shall be placed in both parents I names for administrative
purposes. Any savings bonds purchased in the future for
the benefit of the children by either parent shall be in
both parents' names. other savings programs shall be
discussed between the parties to determine the most
effective way of assuring their use for the children's
future needs.
8. Spousal Maintenance: Neither party shall pay
spousal maintenance to the other.
9. Division of Assets and Liabilities: The
parties hereto have divided the community debts and
assets and that division is set torth in detail on pages
one through tour ot Exhibit A attached hereto and
incorporated herein. The division is acceptable to both
parties and represents a tair and equitable division ot
community assets and debts. Each shall receive the
property set torth in Exhibit A as his or her sole and
separate property.
10. Wite, in assuming the debt on the 1992 Toyota,
will attempt to have Husband I B name removed trom the debt
thereon, but cannot guarantee that will be done. Each
party will execute the appropriate documents to remove
their name from title or deed ot ownership or accounts as
set torth herein.
11. Income Taxes: Husband shall be entitled to
claim both ot the minor children as dependents for tax
purposes tor the tax years 1992, 1993 and 1994. Atter
that, each parent shall be entitled to claim one child
with Wite claiming Courtney and Husband claiming Colby.
12. Housing Allowance: Husband agrees to pay Wite
the sum ot Three Hundred Seventy Dollars ($370) per month
housing allowance to assist in her move with the children
to a new locale. These payments shall continue until such
time as the Husband and the Wife agree that they are no
longer necessary or for a period of no more than thirty-
six (36) months, which ever comes tirst. Payments shall
be made by personal check by the fifth (5th) of each
month.
13. Travel Expenses: Husband will assist Wife in
travel expenses involved in one (1) trip to Pennsylvania
for job interview purposes and the move of the family
form Arizona to Pennsylvania as a permanent move. This
assistance will not exceed $1,250 in total with Wife
being responsible for the remainder ot expenses.
14. Home: Husband will assist in the purchase ot
a home for Wife and children by allowing his income and
name to be used only for the purpose of obtaining
approval on a mortgage for that purchase; the residence
will be held in the name of both parties. All purchase
money will be provided by Wife and all payments will be
made by her and she will be entitled to all equity built
up in the residence. Husband, for his part, will be
allowed all tax benefits from owning the home and
associated deductions for a period of not less than three
(3) years. At the end of three years, Wife shall have
the right to receive a Quit Claim Deed from Husband
transferring ownership of the property into her name
alone. During the three year period following this
agreement, Wife shall send the monthly payments, along
with the payment coupon, to Husband who will, in turn,
forward the monthly mortgage payment in a timely manner.
Husband shall, at the end of the three years, be provided
by Wife with documentation guaranteeing that his name has
been removed from the mortgage. If this documentation
cannot be provided and Husband's name cannot be removed
from the mortgage the residence shall remain in both
parties' names and Husband will continue to be allowed
all tax benefits and associated deductions rising from
ownership of his fifty (50) percent share of the
residence. Upon request, Husband will provide Wife with
proof of payments. If Wife fails to make any monthly
payment and Husband is required to make the payments
himself, and the delinquency continues for thirty (30)
days, Husband shall become sole owner and Wife shall give
Husband a Quit Claim Deed to residence allowing Husband
to dispose of residence as he sees fit and ~usband shall
be entitled to all equity built up in the residence.
15. Husband shall file the parties' 1991 income tax
returns and shall be allowed any and all refunds which
the parties are entitled for 1991 or, if the parties owe
taxes for 1991, Husband will be responsible for payment
thereof.
16. Attorneys' Fees and Costs: Husband agrees to
pay all costs, including attorneys' fees, incurred herein
in accordance with the arrangement set forth in Exhibit
A.
17. Release of Claims: Subject to the provisions
of this Agreement, Husband and Wife hereby release each
other from all further claims, rights, liabilities or
obligations arising out of their marriage, the
dissolution of their marriage, or the division of
property and obligations expressed herein.
lB. Modifications in Writing: Both parties agree
that any changes in the terms of conditions of this
Agreement, to be effective, must be in writing executed
by both parties or their designated counsel, and shall
become a part of this original Settlement Agreement and
approved by the Court.
19. Entire Agreement: This settlement Agreement is
intended to be a full, complete and final Agreement
between the parties herein and supersedes all prior
understandings or agreements, whether oral or in writing,
pertaining to the subject matter contained herein.
20. Voluntariness and Advice of Counsel: This
Agreement is made and entered into voluntarily by both
parties, free and clear from any duress or influence on
EXHIBIT A
DIVISION OF PROPERTY SMI2t'g2A
'SETllE AGREEMIHrr PER RAE AtIOMICHAEL'
2:o:! g2
--
irrEM DISPOSITION
, MICHAEL RAE
fI~!ASlER BEDRC2.OM SUIT 1000 11.1lOO
~:!'1C:1UR:S IN MBR X
:l.lAMPS IN MBR X
'4'NJSWERiNG MACHINE (GIFTIE X
S:lELEPHOIIE IN MBR . X
6,PIC1UR: OF CRIMC IN HALL X
7.0nIENTAL PICllJRES AND PRltml X X
B.COLBY'S BEDROOM SUIT X
9:COURTNEY'S eeOOOOM SUIT X
10, LOUNGE CHAIR IGIFT TO EMWl , X
11, lV IN MBR IEMW BFORE RAEI X
12,EN1ERTAINMENT CENTER '1.500
13,lV IN UVINGAOOM 1500
14,STER:O lEMW BFOR: FW:I X
15IfvINGRooM SOFA 1500
16,LOVE SEAT '000
17,COFFEE TABLE 1200
16,CR:DENZA 1300
19,END TABLE lISO
20INING ROOM lAMPS X X
2I.NIC-NACS (D~COAlTIVE ITEMSI X X
22,K1TCHEN TABLE/HUTCH '1.000
23.DESK .HIO
24,MICAOWAVE/STAND '300
25.FeFRIGERATOR SBOO
26,K1TCHEN UTENSILS.'APPLIANCES X X
27,COOKWARE X X
26, STONEWARE X X
29,CORlAN WAR: X X
::lO,FlAlWAFE X X
5f:CHiNNCRYSTAUSILVERWAR: X X
1~,~EZER (EMW BFOR: FW:I X
:l:l,WASHER'DRYER I'EMW BFOR: RAE SOOO
34,CORDLESSPHONE (G1FTTOEMWI X
35.SILVER TRAYS AND MISC, ITEMS X X
36,PATIO FURNmJRE (3SETSI X X
37.GAS GRILL 1200
38, YARD TOOLS X
ii9,CHRISTMAS DECORATIONS X X
4O:100e COLEMAN POPUP CAMPER SI.4SO
41 ,EXERCISE BIKE 1200
42,PEFlSOrlAL fTEMS X X
~LOT fI'95S ANGEL FIR:. N,M~ S7.000
4<4,1002 TOYOTA CORROLA 112.000
45,12" DIA. ABOVE GROUND POOL SEUJSPUT ~ASH
.16, TfW.1POUNE X
47,GARAGE SHELVING X X
.iii:TOO"LS-HANDANDPOWER IEMWl X
'MICHAELGETS OR:SSER
"RAE MICRO/MlCWCL BTAND
"MlCWCL 4 PLC SEmNGS
oMICHAEL 4 PLC SEmNGS
oMlCWCL4 PLC .3EmNGS
"mADE FOR CFEDeNZAANDENTCRTAINMENTCE :
&J Z//4/rz
DIVISION OF PROPERTY
.SETTLE AGREEMEr-rr PER RAE AND MICHAEL.
O'EM DISPOSITION
MICH.ACL RAE
X X
9,eoo
2/03,'Q2
PAGE 2/8
411,MISCELlEANEOUS fTCMS
5o,ME'S IRI\ APPROX.
51.MICHAEL'S IMAPPROX,
52,2390 PALM DRIVE RESIDENCE
53,HIGH BACKCHAlR
54,DIN"j;~G Ff.1 TABLE:CHINA CABINE
55,SEARS VCFVCM1ERI\
58,GUNS MW BFOFE RAe
57,35mm C ERAS (EMW BFOFE
5B,ADDING MACHINE .tW BFOFE ME
59,SWING SET
6O,ARE PROOF LOCK BOX M
8t .ALE CABINET W BFOFE RAe
82,
83,
84,
TOTAL ESTIMATED V LUE
Sl:l,424
S84,OOO I
S300
S3,000
5500
X
X X
X
X
X
X
S1011,574
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30,300
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
E. MICHAEL WHITE
.
.
:
v.
No. 97-2745
:
MARY RAE PITTENGER WHITE
.
.
.
.
CIVIL
PETITION FOR ORDER OF COMPLIANCE
TO THE HONORABLE JUDGE OF SAID COURT:
COMES NOW, E. Michael White, Petitioner herein and files this
his Petition for Order of Compliance against Mary Rae Pittenger
White, Respondent herein and for cause of action would show this
Honorable Court the following, to-wit:
1. Petitioner, E. Michael White filed his Application for
Registration of Foreign Judgments pursuant to Uniform Enforcement
of Foreign Judgments Act of May 22, 1997 with the Prothonotary of
cumberland county, Pennsylvania.
2. Respondent, Mary Rae Pittenger White received a true and
correct copy of the Application on May 22, 1997 when the same was
sent to her certified mail. Attached hereto as Exhibit "A" is a
true and correct copy of the receipt with the signature of
Respondent thereon.
3. Petitioner's request was that Pennsylvania give full
faith and credit to an Arizona Order of Divorce and the parties
agreement which had been incorporated therein.
4. The date of the settlement agreement was February 18,
1992. A true and correct copy of the Agreement is attached as
Exhibit "B."
5. The date of the decree of divorce was April 29, 1992. A
true and correct copy of the Decree is attached as Exhibit "C."
6. Pursuant to Paragraph 14 of the Agreement, Petitioner
assisted Respondent in the purchase of a home located at 15 Brian
Drive, Carlise, PA 17013, by executing a mortgage with Fleet
Mortgage corporation.
7. As seen in Paragraph 14 of the Agreement, Petitioner
"will be allowed all tax benefits from owning the home and
associated deductions for a period of not less than three (3)
years."
B. Paragraph 14 goes on to say that, "Husband shall, at the
end of the three years, be provided by Wife with documentation
guaranteeing that his name has been removed from the mortgage. If
this documentation cannot be provided and Husband's name cannot be
removed from the mortgage the residence shall remain in both
parties' names and Husband will continue to be allowed all the tax
benefits associated deductions rising from ownership of his fifty
(50) percent share of the residence."
9. Peti tioner on his own and through his counsel have
requested repeatedly since June 27, 1995 that Respondent refinance
the mortgage.
10. Respondent has for two (2) years refused to refinance the
mortgage.
11. Respondent on her 1996 Federal Income Tax Return further
breached the agreement by taking the interest deduction on the
income tax return. Attached hereto as Exhibit "D" is a true and
correct copy of her return showing the deduction of $5,611 on
Schedule A - itemized deductions.
12. Attached hereto as Exhibit "E" is a true and correct copy
of the letter dated July 23, 1997 requesting Respondent, Mary Rae
Pittenger White to comply with the agreement.
13. As of the filing of this Petition neither Respondent nor
her counsel have responded to the request of Petitioner to
refinance the mortgage.
14. As a result of Mary Rae Pittenger White's breach of the
parties agreement and her failure to take appropriate steps to cure
the breach, Petitioner has been required to prepare and file this
Petition and has incurred attorney's fees of $500 and anticipates
incurring additional fees of at least $1,000.
WHEREFORE, your Petitioner, E. Michael White, respectfully
..
SETTLEMENT AGRBZHBHT
IN CONTEMPLATION OP
DISSOLUTION OP HARRIAGB
THIS AGREEMENT is entered into this I e,-$ day of
February, 1992 by and between MICHAEL WHITE and MARY RAE
WHITE, man and wite, and evidences the to1lowing Facts
and Agreements:
FACTS
A. MICHAEL WHITE (hereinatter "Husband") and MARY
RAE WHITE (hereinatter "Wife") were married on December
15, 1984, in Odessa, Texas.
B. The parties have two (2) minor children, namely:
COURTNEY RYAN WHITE, born January 1, 1982 (natural chile!
of Wife and adoptive child of Husband), and MICHAEL COLBY
WHITE, born January 16, 1987. wife is not now pregnant.
c. Irreconcilable ditterences have arisen between
the parties and the marriage is irretrievably broken.
D. The parties hereto now desire to amicably
resolve all matters relating to the Dissolution of their
Marriage by the mutual agreement as expressed herein.
E. Having settled all their differences herein, the
parties intend that the Dissolution of Marriage action on
file as Graham County Cause No. 13817 shall proceed as a
Detault or Consent Dissolution.
AGREEMENTS
NOW, THEREFORE, in consideration ot the promises and
agreements contained herein, these parties agree as
follows: ' ~.-
1. Incorporation: The Facts herein shall be
considered a part of this Settlement Agreement and these
Agreements, as if fully set forth herein, and the parties
ratify and acknowledge each of the facts.
2. custody: Husband and Wife each agree that Wife
shall have custody of the two minor children and that
such an arrangement would be in the best interests of the
minor children.
. 3. Child Support: Husband and Wife agree that the
present income of the parties and the guidelines ot the
State ot Arizona provide tor child support payments by
Husband to Wife in the sum of Nine Hundred Thirty Dollars
($930) per month, said amount to be subject to
modification in the future consistent with the income and
support guidelines of the State of Arizona in effect at
that time. Husband shall make such payments, along with
court costs of $1.15 per month, by wage assignment
through his employer and payable to the Clerk of the
superior Court of Graham County, Arizona.
4. Visitation: Husband shall be entitled to
exercise liberal visitation rights due to the distances
of separation anticipated. Providing at least 72 hours
notice is given, he shall be entitled to visit the
children whenever possible. All costs of visitation
shall be borne by Husband.
s. Medical Expenses: Husband shall provide medical
and dental insurance coverage for the two minor children
initially and, in addition, shall pay all non-covered
medical expenses until Wife is gainfully employed, at
which time said costs will be split equally between the
parties. During this initial period no elective medical
or dental procedures shall be performed upon the children
without the express written consent of the husband. At
such time that coverage is available through Wife's
employment, the parties will determine the most
advantageous method of insurance and whether or not
coverage will continue under Husband's employment and, if
provided by Wife, all non-covered medical and dental
expenses shall be split equally between the parties.
6. Life Insurance: Husband shall maintain life
insurance for the benefit of the children so long as he
is financially able. Husband may name the children as
beneficiaries or may name his brother, Thomas Alan White,
as Trustee for the benefit of the children or may name
his estate in which case the funds shall be administered
by the Personal Representative of his estate. If husband
is not able to provide life insurance he will notify wife
of his intention to terminate life insurance coverage.
7. Children's Accounts: The parties agree that all
present savings accounts, bonds, stocks, etc. designed
for the childrens' educations shall remain untouched and
shall be placed in both parents' names for administrative
purposes. Any savings bonds purchased in the future for
the benefit of the children by either parent shall be in
both parents' names. other savings programs shall be
discussed between the parties to determine the most
effective way of assuring their use for the children's
future needs.
8. Spousal Maintenance: Neither party shall pay
spousal maintenance to the other.
9. Division of Assets and Liabilities: The
parties hereto have divided the community debts and
assets and that division is set forth in detail on pages
one through four of Exhibit A attached hereto and
incorporated herein. The division is acceptable to both
parties and represents a fair and equitable division of
community assets and debts. Each shall receive the
property set forth in Exhibit A as his or her sole and
separate property.
10. Wife, in assuming the debt on the 1992 Toyota,
will attempt to have Husband's name removed from the debt
thereon, but cannot guarantee that will be done. Each
party will execute the appropriate documents to remove
their name from title or deed of ownership or accounts as
set forth herein.
11. Income Taxes: Husband shall be entitled to
claim both of the minor children as dependents for tax
purposes for the tax years 1992, 1993 and 1994. Atter
that, each parent shall be entitled to claim one child
with Wife claiming Courtney and Husband claiming Colby.
12. Housing Allowance: Husband agrees to pay Wite
the sum ot Three Hundred Seventy Dollars ($370) per month
housing allowance to assist in her move with the children
to a new locale. These payments shall continue until such
time as the Husband and the Wife agree that they are no
longer necessary or for a period of no more than thirty-
six (36) months, which ever comes first. Payments shall
be made by personal check by the fifth (5th) of each
month.
13. Travel Expenses: Husband will aSDist Wite in
travel expenses involved in one (1) trip to Pennsylvania
for job interview purposes and the move of the family
form Arizona to Pennsylvania as a permanent move. This
assistance will not exceed $1,250 in total with Wife
being responsible for the remainder of expenses.
14. Home: Husband will assist in the purchase of
a home for Wife and children by allowing his income and
name to be used only for the purpose of obtaining
approval on a mortgage for that purchase; the residence
will be held in the name of both parties. All purchase
money will be provided by Wife and all payments will be
made by her and she will be entitled to all equity built
up in the residence. Husband, for his part, will be
allowed all tax benefits from owning the home and
associated deductions for a period of not less than three
(3) years. At the end of three years, Wife shall have
the right to receive a Quit Claim Deed from Husband
transferring ownership of the property into her name
alone. During the three year period following this
agreement, Wife shall send the monthly payments, along
with the payment coupon, to Husband who will, in turn,
forward the monthly mortgage payment in a timely manner.
Husband shall, at the end of the three years, be provided
by wife with dOCUMentation guaranteeing that his name has
been removed from the mortgage. If this documentation
cannot be provided and Husband's name cannot be removed
from the mortgage the residence shall remain in both
parties' names and Husband will continue to be allowed
all tax benefits and associated deductions rising from
ownerShip of his tifty (50) percent share of the
residence. Upon request, Husband will provide Wife with
proot ot payments. It Wife tails to make any monthly
payment and Husband is required to make the payments
himselt, and the delinquency continues for thirty (30)
days, Husband shall become sole owner and Wife shall give
Husband a Quit Claim Deed to residence allowing Husband
to dispose ot residence as he sees tit and~usband shall
be entitled to all equity built up in the residence.
15. Husband shall file the parties' 1991 income tax
returns and shall be allowed any and all refunds which
the parties are entitled tor 1991 or, it the parties owe
taxes for 1991, Husband will be responsible for payment
thereof.
16. Attorneys' Fees and Costs: Husband agrees to
pay all costs, including attorneys' tees, incurred herein
in accordance with the arrangement set forth in Exhibit
A.
17. Release of Claims: Subject to the provisions
of this Agreement, Husband and Wife hereby release each
other trom all further claims, rights, liabilities or
obligations arising out of their marriage, the
dissolution of their marriage, or the division of
property and obligations expressed herein.
18. Modifications in Writing: Both parties agree
that any changes in the terms of conditions of this
Agreement, to be effective, must be in writing executed
by both parties or their designated counsel, and shall
become a part of this original Settlement Agreement and
approved by the Court.
19. Entire Agreement: This settlement Agreement is
intended to be a full, complete and tinal Agreement
between the parties herein and supersedes all prior
understandings or agreements, whether oral or in writing,
pertaining to the subject matter contained herein.
20. Voluntariness and Advice of Counsel: This
Agreement is made and entered into voluntarily by both
parties, free and clear from any duress or influence on
DIVISION OF PROPERTY
'SETTlE AGREEMENT PER RAE AND MICHAEL e
SM12!?92A
2:00 92
--. I DISPOSITION
,ITEM
. MICH,ACL ME
1I~~SlER BCD~CM surr S:lOO S l.llOO
~!'.!.C:1UFeS IN MBR X
:I.lAMPS IN MBR X
'~NJ.~':!ERiNG MACHINE IGIFTIEMWl . X
5.1ElJ:PHOIIE INMBR . X
5.PIC1UFe OF CRIMC IN HALL : X
7.0nIENTALPICTURES AND PRltml I X X
ii.COLBY'S BCDROCM surr I X
9.COURTNEY'S BCDROOM surr I X
10. LOUNGE CHAJR (GIFT TO EMWI . X
II. TV IN MBR rEMW BFORE RAE) X
12.EN1ERTAINMENT CENTER SI.5OO
l:l.TV IN UVINGROOM S500
14.STEil:O MW BFOil: RAE) X
15.iJVINGRooM SOFA S500
IS.LOVE SEAT SOOO
17.COFFEE TABLE S200
IB.CFEOENZA SOOO
19.END TABLE SISO
20.UVING ROCM lAMPS I X X
21.NIC-NACS (O~CORrrlVE ITEMS) X X
22.KJTCHEN TABlJ:/HUTCH SI.OOO
2:1.CESK SISO
24.MICROWAVEISTAND SOOO
25.FEFRIGERATOR SBOO
2S.KJTCHEN UTENSILS.'APPLIANCES X X
27. coo KWAAE X X
28. STONEW ME X X .
29.CORIAN WAil: X X
:lO.A.A TW Ail: X X e
3~CHINNCRYSTAIJSILVERWAFE X X e
!~.FR:EZER (EMW BFOFE RAE) X
:l3.WASHEP.'DRYER rEMW BFOil: R,AC SOOO
34.CORDlJ:SS PHONE !GIFT TO EMWl X
:l5.SILVER TRAYS AND MISC. ITEMS X X
:l6.PA no FURNITURE /3 SETS) X X
37.C'lAS GRILL S200
58.YAAD TOOLS X
59. CHRISTMAS CECORATIONS X X
40.1008 COLEMAN POPUP CAMPER SI.45O
it .EXERCISE BIKE S200
42.PEnsOllAL ITEMS X X
~-:LOT #955 ANGEL Flil:. N.M.~ S7.ooo
404.1992 TOYOTA CORROLA S12.ooo
45.12" DIA. ABOVE GROUND POOL SEWSPUT t;ASH
46. TAAMPOUNE X
47.GARAGE SHELVING X X
.ia. TOOLS. HAND AND POWER /EMWl X
. .
eMICH.ACL GETS DRESSER
.JW: MICROt'MICH.ICL STAND
MICH.ACL4PLCSETnNG8
MICHAEL 4 PLC SETnNGS
MICHAEL 4 PLC SETnNG8
rmAOe FORCR:CENZAANDENTERTAIt-lMENTCE
&J Z//4/~
IN THE SUPERIOR COURT OF THE STATE OF ARIZONA
IN AND FOR THE COQNTY OF GRAHAM
STATE OF ARIZONA )
)ss
County of Graham )
Cause NO. 13817
I, AMELIA SAINZ, the duly elected, qualified
and acting Clerk of the Superior Court in Graham County,
State of Arizona, and having official custody of the Court's
records, do hereby certify and attest the foregoing to
be a full, true and correct copy of the original:
STIPULATED DECREE OF DISSOLUTION OF MARRIAGE (WITH MINOR CHILDREN)
on file and ot record in my office, and I have carefully
compared the same with the original, all of which I have
caused to be authenticated according to the act of Congress
(28 USC, Sec. 1738) and the ArO na Rules of idence.
(SEAL)
Clerk
Court
BY:
Deputy
STATE OF ARIZONA )
)ss
County of Graham )
. I, DUDLEY S. WELKER, Judge of the Superior Court
in Graham County, State of Arizona, do hereby certify that
said Court is a Court of Record having a Clerk and Seal.
That Amelia Sainz, who has signed the foregoing certificate,
is the duly elected, qualified and acting Clerk of said
Superior Court. That said signature is her genuine
handwriting, and that all her official acts, as such Clerk,
are entitled to full faith and credit.
And I further certify that said certificate is
in due form of law.
IN WITNESS WHEREOF,
in my official capacity as
seal of said Court, this date:
I have hereunto set my hand
suc Judge, and affix d the
MA 13 1997
"./
Judge of the Sup rior Court
AP~-18-97 FR I 10:37 AM
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Credits
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60
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Paymenls 82
53
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I' line 32 " See.H9 or less. mulilply 52.950 by Ihelo'.1 nllmber 01 ..e"'pllon. Cl.\mld on
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Credil fo' Ihe eldlrly 0' 'h. d:"bled. AII.eh Sehldule R .. 40
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.. b Roulln~ number DJ:IIJ:TITI c Ty".: 0 Ch,ok..g 0 Savings
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82 Iflinr 51 is morn Iha~ linft ~!. sul:lr.1l:llil"le' 58 fromlil1!\ 51. "'i, is II'" AMOUNT YOU OWE.
Fer dllftil, on hnw 10 r.tty ~nd un Form t0040.V. ~tfll Inlllructions. . . . . . . ~
63 estima\~d 1'1 C:l:!'I1ally. AlsO Include on fj"c 62. . . ., 63 ~~*~'i,,~'t~~~~,~~\~~
Un:l,r PlNlll;U el rlt'IV', 1 eccL,.. ,nlll"~wt tnrfltnrd 1!\lS "II)11'j '":1' tlce~~,,"'Y"'9 ..eheau1n '"0 l'II,m,'IS. and 10 Ihe Df,' 01 ""J kn'JVilCtdgt ",no
~~~lt'. 111"" OUt l'vt. CC""', 11''1:1 &;,;",.."~I~. \)"'/.'''''111..." "I ,....,.."".. 11,0.1.... 11\\1' U\~.'J't.l., hnrJ'l1 M~' Irllc'~.l'.," C\I__-h'rh 1'I'''I'IIt." h:u. P1~ ~"OWl~.
~ 3~u :i!E.J,.L '~~/\~. ~'~~:.s:':J1
~ SO""" ,'n ",,,:rii. ,"'''''''1.''. ~"III.~." '0" (1".
""Ci7~';:K.
~r~~~',. ('(::':111":11111-'''
r'IfII"l.1"'" ~
'1~""I...tl ,
- -......--....
r:ill"lI"""It'!: V'loIf~ ~
.1'"...."''''1'''..-..1'..1.. ..-.-..
atl:f't..o:
"""fl.""" ,.t'l~...,1 '..,."",\, ""
~.'I.
CI\t"t~ .,
U'~~rllt)o,e1
D.
.
-!!!.!...-....---.:...-..----,..
,IP rl"l:ltl-
... ... I... ......... ....
SCHEDULES A&B
(PDrm 1040)
0.".."........ :t!1P<. '11\,'\'_y
.ll"~ "...."'.... !M\'Ct (10)
N''"fl,) ,roC"''" ft~ '~I'" 'O.aO
Medical
and ,
Dental 2
Expenses 3
4
Taxes You 5
Paid e
(5.. 7
089' A.I.) 8
9
Inlerest 10
You Paid 11
(S..
page A.1.)
Nale:
P.rso~1 12
Inltre,t II
nol
d,dtJclible. 13
14
Gilts to 15
Charity
d ~u ",ed.. le
g; end gol .
btncfil 10111. 17
SII pege A.3. 18
Casually and
Thall Lossas 19
Job Expenses 20
and MDSI
Dlher
Miscellaneous
Deducllons
21
(S.e 22
o"go A.4 'nr
".ptl'~e~ to
deducll'c'e.)
23
24
25
25
Other 27
Miscellaneous
Deducllons
Total 28
itemized
Deductions
'oJ 1..1 II,"" 'oJ I I ...n...
1111\ u...... 1'1 L..'tv vL."....
~'.
.-.
Schedule A-Itemized Deductions
IScll.dule e I. on bOCk}
.. AUach ta 'Ofm 1040. ... See Inltructlans laf Schedulu A Ind e (Form 1040).
h \ te..,
Ciullo": C:o nor Incl\.l~1 e1t:fnStS rtlmbur!!d er p.,jd byolt"', :;~~
Medlc.1 aod den!>1 ..pens., (... peo' A.' I. . .. 1
Enle, Imoun'lr~m forn, IO~O. Ii"e 32. 2 ~1t
Mulllply line 2 abov, by 7.5% (.075). . . . . ., 3
Sublractline 3 Irom line 1. 11 line 3 Is mD,e lhen Une' .nle, .0.
State and leeallncom. \3xeS . . 5
Real eslate lax.s (see page A.2). . . . . . .. 5
Perlonol properly laxes. . . . . . . . . .. 7
Other laxos. L1sllype and ameunt .. .................... ~~~~
,
8
Adcrlin..'s' ihio~o'h '8':":"':":''':'':'':'' .:..:. ..: ..:....
Ho,"! mortgagelnl"elt I"d poinlS ,epolled 10 you on Fo,m 109B
Ho"" "'ell gag; "'Ielesl IIDI reported Ie you on Fe,m 'OoB.llpald
to the persen Irem ..ho", you boughl Ih. heme. s.e pag' A.2
and show IhAt pe<son's name. Idenlllyino no.. and add,ess ..
................................................................
...............................................................'
................................................................
Points nel reporledlO you on Fo,m ,098. S.e pag. A.3
lor special rules. . . . . . . . . . . . ., 12
InveSlmenllnteresl. If reQuired. allach Form 4952. (See
pag. A-3.) . . . . . . . . . . . . . .. 13
AcId lines 10 \lIrou h 13. . . . . . . . . . .
GIfIS by cash or check. If you made any gift of $250 or
more. Boe page A.3 . . . . . . . . . . . .
Olher Ihan by cash or chee~. II any gill of $250 0' more.
sea page A.3. If over $500. you MUST allach Form 8283
C'''Yover I,om prior year . ., .....
Add lin.s 15 th,ou h 17. . . . . . . . . .
o A.4.)
'~
I
~
~~
20
21
I
22
................. ............,.............................
Add lines 20 Ih,ough 22. . . . . 23
Enl!' amour.llro'" Fo,m \O~O. lin! 32. 24 },~
Mu\lipl\' line 24 a.bove b)' 2% (.02). .... 25 '?:> I ~
Subl,ec\ line 25 ',om line 23. If lin. 25 Is more lhan line 23. enler .0.
OIlier-fro'" Iis\ 0" pag. A.d. Lis' type and amou"' .. ..............................
Casualty or thell loss(es). Allach Form 4684.
Unrelmbursed employee IXpenses-lob t,avel. union
dues, lob e':lueatlon, elc. If reQlJir.d. you MUST allacll
Form 2,06 or 2,06.EZ. (5e,\ page A.4.) .. ..............
.......~.\.c~...~!.~.~..................
................................................................
Tax prepa,atlDn le.s . . . . . . . . . . . .
Olher "PenaRs-inv.s\"'enl. sale deposit box. ole. LIst
Iype end amount ...........................................
...............................................................................................
IS FD,m '0.10.1in~ 32. over 5117.950 (ovor S~8.97511 mnrried1iling separal.'yl?
NO. Yeu, d~duc\ID" Is nollimiled. Md "'e amDu'llS in '~e far ,ighl column )
Ic' lines d th'ough 27 AlSO. ooter en Form 1040. line 3( Ihe larger 01
1his :J'""unt or your :i!and3rd d"duc!if)"'.
YES. Your dod'JCl'O" ",oy ~e l,m'led. Sa. pnge A.5 lor "'e omou,\llo enle'
for P'I'erwork Reductlcn Act Nolle.. .e. Fcrm 1040 inslrur.:llanl.
(::U.II1II,'I"iX
1. 1.1'1
OMS ,~~. 1'''5.Q074
.~@96
5;;1.
00
-(.) -
97Lfo 00
.. 28
""fu~" ~tt\~~"~"<
~~~~~_\~\1
Schedule A (Form '04el '996
..
1111\ ~u oJl 11\. IY'J;; nil
-
\JUIICi \.III V[\U
rMh 11V. III c:qU O~qO
r. U~
Sct'ttdvtu Me IfQlm I040119~5
..,.tN(11 f,no"," en rOlm IO~O Co "01 '"'" "'"", 1"'(1 M:..II,eu'I!1 ",......1)., .1 ,PlOw" 0'" .,tht' tiel..
OMS NO. 15t!i.COU PI;t 2
YO\If tocl.1 ItIclI"Itv "umb"
i. :'
lla At any lime during 1996. did you I,ave ~n inle,esl in or a SlgMlure or other authority over a financial
acccunl In a fo.eign counlry. such a5 a hank aceollnt. sqcurilies accounl. or other nnanclal
accounl? See page Bd for .xce~lions nnr1 Fling reC\lI;.em.nls fo' r-orm 10 F 90.22.1 . . . .
b II "Yes," enter Ih. name ollhe lor.lgn eo,'nlry ...... ....... ......... ................. ............... ~~ ~
12 Ou,lng 1996. did you .eceive a disttlbllllon fro.n. or were YOll 11'$ g,.nlor of or "anslaror 10. a..... "'.'"
ferel n lrusl? II "Yes: see oaoe B.2 lor olher forms eu mav hove Ie !lie . . . . . . . .
Far Paf1erwork Reducllon Act NoUe_, It. 'orm 1040 Inllruc:Uot\~. Schtdult 8 (Form 1().t0) 1990
Part I
Inleresl
Income
IS.. o.g. B.I.)
Nole: II you
recl1vld Q Form
logS.INT. Form
1099.010. Dr
.ub.lilule
stDlemonl frOln
I btokereg. fir"l,
Ilsllhe n.m'.
nama os lhe
PRY" and enl.r
lkt tOlall"'"".
1hown an lhat
foun.
Part II
DivIdend
Incom.
(S.. oago e.l.)
NOlo' II you
,ecelved " For",
1099.DIY",
sub.lilule
slalemenl ',om
. brokerage
nnn. Osllhe
lirm's nlUT18 ..
Iha p'yer and
Intar the 10 Ie'
dividends
shown en !hal
form.
Part III
Foreign
Accounls
Bnd
Trusls
IS..
~'p' e.!.)
Schedule 8-lnterest and Dividend Income
.1I.c","...t
Sell"""" No. 08
Note: tt yoU nsd aver ~"OO in ra.rab/I tnt,fut inccm.. au mv:r II/SO e~mp'ell Part Iff.
1 Uat name or pay". If any Inleresl Is from a saller.nn.nced mortgnge end Ihe
buyer used Ihe preperty a' a oersonal ,u1denee. soe paga B.' and IIs1 Ihl.
IntereSH'''1. Also. show Ihal buyer's social securily num~er snd ,d~re"" .
.......r::':~l':\ n.o......~:~J.r" ...Er.Y.lp.. .9~ +.....~\.~.N
Amount
5 8"1 00
............................................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
2
2 Add the amounts on ~ne 1 . . . . . . . . . . . . . . . . . .
a. E~clud.br.lnlerul en series EE U,S. savings bonds Issued after 19991rom Form
9615. IIn. 14. Vou MUST .ttach Ferm 991510 Ferm 1040 . . . . . ., 3
4 Subtracl IIna 3 from line 2. Enler the resuft here end on Form 1040 line 9a .. 4
Nola: If u h.d OVIIT S400 In lOSS dMd.nds atIdler orhar dlstriburions on sreck. muSI ~.o como'ete PIlIlIII.
Amounl
5 USI name 01 payer. Include gross dividends ondler olher diWlbullons on slock
here. Any capital geln dlslributlons .nd nonlaxable dlslribuUons will be deducted
on line. 7 end 8 .. .....................................................................
............................................................................................
............................................................................................
.............................................................................................
............................................................................................
.............................................................................................
............................................................................................
5
.............................................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
............................................................................................
B
~"
';,~
~~~
9
10
9 Add Ihe amounts en line 5 . . . . . . . . . .
7 Capilel gain disl,lbuIIO^s. Enler he.. and en Schedule O' .
8 Nonla..ble diSlrlOO!ic".. (Seethe in,l. for Fc.", 10~O. tine 9.)
9 Add line. 7 and 8 . . . . . . . . . . . .. . . . . . .
10 Subtraclllne 9 Irom line 6. Enler Ihe result here and en ferm '()40. line 9 . ..
'11 YOIl do nol need Schedule 0 to r.porl any of her ga,ns 0' losses. Set rhe
(nslruclions lor Form 1040. line 13.
You must complete lhis pari if you (al had OVef $noo of Inle.esl or dividends; (bl had ~ lorelgn aecounl; or
(c) received a distribution Irom, or we.e 3 g.anlor 01. or a I.ansl.ror te. a lo.elgn Irusl.
V.. No
~~'1: ~~
~~
.~~... "'.....
--.
,,~
A il ~~"'~i~~' ~~ 0' r' '''''0''~'9.0'O~UCI 0' ,.'
..kQ'Y\lT\.l r"O&tn . :!ll~
C BU'JIIl~!I' ruan_e. 11110 SfI)l1'i1Il1 1Ju,itlf"~ unlUp, hlDve l,l;ll"k.
t'ront or Loss From Business
. 1501, PrOPllttlOnhlOI
.. pOltn,rshlp" Jalnt v.nlu'", ole., mUll rue FaIn' 1OG5.
Allaeh"""l
.. AU:sch 10 Form 10.0 or Foun 1041. .. 5.. Instructions for Schedull C fForm 1040). ~l.Iu,uc, No. 09
Socl" ltcurlty "'''TIber (!ISH)
~09 ! 40:
t1t,.\U Ho ".~,oo"
SCHEDULE C
(Form 1.0401
1!@96
UIP..rl"'f''' d II'" 1I"1I1"Y 10
~,,,,,,,,'lt''''''''' $,..<_ ()
f1;t"..fllp:'lr"'"tnf
VQ.te.raf\S
o EmplOy" 10 numb., (~INJ. II ""y
E Bu,I"... "'d.." lU.c1udl"9 ,."it. O'"l0'" "01 ~ .............................................................................................
ca.,.. lown or uo:1 ollle.. ItO:!!. :amJ ZIP code
, AcCO",.,1"9,n,"'od: PI !:S.C"" (210 ^ce'u.1 (~) 0 Oil'.' IIp.eilYI ~ .................................................
Q Old )'C1U .,nal"l,,".,. pn1tlcl,,:.I." Illlh.. apt'l'IIIQI1 of thio llU11Ilc~' L1ullllO 19RG' II "Nu: ~ee tlng' Co2'''' lillli1 on losn~. .10 Vet 0 No
H U ';'OU ~tolr1ed at QC:JullltJ lhis bUllnun dUlln 1996. t;heck her. . . . . . . . . ." -
Income
- ----
I Gran 'Ice:pls at !\nl~. Co1uUon: 1I1111S ;.1C;UtlU, won! 'el/a"ud'f.1 )lUll all FOI/II W.~ ;llItl "I~ "Slnfula'y ~O~ IV>
Imp/oye"" be.. 011 "I~r fUll" W.1.S chtc.:&.lJu, see I,-'ge C.2 :111I' tI'ec" ""I! . ~ 0 ~
2 Rftlwll, "ue) nllow:1l\1:n . . 2 -. .:) -
~ S\lhlrtlct U". , f'(.IwlllI" , . . ~ I c:;o<; Oq
. C05l 0' Roods $Old (1'0111 Ihlft .12 (Jlllln\lc :11 . 4 -0
5 GrolS prom. Sublt~cllillo ., "UUt lit'e 3 . 5 I :;"(").<; DO
.
5 Oll.er inCOIIII. Incll/dlng rDtJotnl :n,t! slplt y"'OlllllJ or fuet In1l clcdil or ,.ltJIld Is.. pn~" C.2) . 8 -0 -
7 Groos Income. AtJd lines 5 allY G . . . . . . .. ......... ~ 7 I~()~ ICo
Exnen5es. Enler expenses lor business use 01 ~our home onlY on line 30.
8 Ad.ertl.lng 8 19 Petl$ion :uwJ ptnril.sllll1ing "Inns n
.
9 B=,d d,bls ho", sales or 20 n.", 01 leall (s.. ~"g. C.41: ~
...ylo.. (... ~"9' C.~) 9 . VeIUcl.... ....cl"'''l'. and eqv\lm"" . :lOa
10 C., .nd huck 'lfp~n:les .l.Wa '.:1. b Olh~r bu,;"ess proj')et1y 20b -
(... P~D. e.~) . . . 10 Z1 Hll"ll'lIs l'"d 11lU;.'tt'........:.. . ?t
11 COlllllriSSIOftl ;\lId 'HI 11 22 S,~.plol (nollncludtd In P., nl) 22
12 O~pllt'ion . . . 12 - - 2~ T"1I11 31ld lh:."~es . 23
. . .
I~ Otfl,,,cl,,lIon "rod IfClton 179 24 l'lv\:'. ll1eal~. ;tlld ent.rlaluluenl: .~ I 1"12
tJpon'~deduclic" (1'01 Inc:Wed . j'Plvtl . . 24. tlC
I.. PD~ III) (5M poge C.3) 13 b Mc;\IS l'nd ~. ~ 1(1)..31.,
14 Emctoylc befll!!liI progta,.ll ler1"IrHnenl
(olher Ihlll 011 IIn. 19) . . 14 c Entet SOli .1
15 ,,,suranCI (u'h~r ",,,., he;lIlh) . 15 ';"e 21b subjecl I /.cO. 18
10 f;mil.1IiO"'
18 lnltl(~sl: ~~. lot. ~'g' C.., . f ft,l'
0 MOllg~9C IDfllid Ie honks. el=.l . 180 d $!.lblliJtllin. 2.1e ham ~II' 20ib 2.d il
b Olher. 15b 25 Ulilili~ 25 -
17 L.O~' and "'D'CS~lon~1 25 W"i'JI (less ptl'r-klyl1lcnl 'r,dil~l . 25 -
serlllr.PI . . 17 27 Olher ~1I"1"I1'~' (110'n lillt ~S 011
-
18 Olllce exD'll!ie . 15 pogo 21 27
25 lollll oap.nlt' t)efofl upr.no;p,1\o 'or bu~lne~~ L1,a 01 hOllle. ^dd Il",,~ B l"rOIl;h 27 in c:I\Jfnns ~ 25 \I:./""IC". I ,~I,
2ll lrnl:1livll ,,'olit llvl"). SubV:u:llillC!'8 (ranI Llle 7 29 - 1-
.
~O eJllI't!n~l!$ Inr l:llsinp~", It"'" Cd V'tUr hOIllf]. AUnch FO'"1 ee2li1 ~O - , ...
~1 NIl prom ar (lou1. SlIhh:lt' 1~:U',:1n 'ron\ linQ '!).
. 11 11 ('\lnlit. enhu 011 Farm 1040, Ihllll t2. :1"d ^LSO (11\ Schedule SE. IIn., 2 bl:tluIO,V efllllloy('e~. .- " .-
SC(l "'"J'" C.~), E~ll'1lr.s ;J'111 hll~I,. ,..,11" l.I \ '1'"'' 10"'. "111\ 3 31
. 11 ~ 1M". yeu MUsr po oHln hn" :-,.
~:z II ~r'/ll h~\I" " Inr.~. thee!. lh.. htJ, "':'II dlll!'thbnr. ymll 1r",,"'''\l1I~1l1 ." !hi, :u:li"ily (~Ptt l~iU"~ C.5)
. II V"', r.hlllf~krd :'I~n. ~"tr.1 lh~ In~." on Farnl t040. line n. ~ll(t ^LSO (\11 Sch-:dull SE, nn, :z
(4.1:'UIII..,,;, ~1l'1,lnv"r.s. "~r 1~:ttJ" C ~I f~l:tle' ",1ll11111"1~ ''1,lr' UIl r'J"'l HI.1t ri't" 3
. II you ohock.~ ~2b. ~ou MUST .11.<1, f.,m B198.
For P:1l'1lrwolk nlc1ucUon ^CI NoUet. Set Fan" 1<)otO Inlhucllant (:,,\ ,,,; "3lotr
}
}
~2. 0 ^" ill\lnhlll"1I1 i\:11 .i~.\.
~2bO Sltll.e u''''''hll'....'1 i'\ '"1'
;1llisk.
5eh.dul. C (Fo.m ,040)'990
E!; '" E
~ lr..
.
, c
:' I
,
- . I"
'-. '. '"
I L....
",. r- :.)
(.) t"i.. I:"";'