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Home My WebLink About97-02814 ~ .v .. ~ ~ ~ ~ .tJ , .' ,- <,' '\\ (~ " .;"f.; , ,:,l'~~ .'~' :<..r :YD - ~-)~ "::,;f , .~ < ",':;.,''i ~~ -,;_.' ,',' ,,'~\"j-~ ','; . .,.'< ,"-{" ~ i~ { :<. I~ ,', " r:.... < ,\':;~ ,,'.: [;{ OJ ';\: , , I l '~ " '. ./: ) / -;.- <, ~, , . ,.; .,', -f '. :".~ '~~ ":'J ,-::" .. ~ .. -:':..: i,.~~.~); -;o.':Y .~ ...~ .. _:~;~E!j 'P~ "'<'1" --r.& .. .~~' .:~:;~ -~;. .. . " ,. ',,'.."- :r '.0\ . . '.':+:' .:+:,' .:+:. ':+:' .:.:,' .:.:. .:.:.. '.:.:, ,:<<.'.:+:, .:+:. .:+:. ':.:' .:+:. .:.:,.:.:. ':.:' ,:t:, .:.:' ':.:":-":.:':~':.:-::':':'::':.:"-':.> .:.:' .:.:, <c-::o:+Y:l ,'. --.-- t. . , , ~ ~ : IN THE COURT OF COMMON PLEAS : w ',' ~ ~ ~" ~ ~ .', ~ ~ ,,' ~ :,' ~ " ~ OF CUMBERLAND COUNTY ~ . ~ ~,' ~ ',' $ STATE OF PENNA. ~ ',' w ',' DOUGLAS M. PATRICK, Plaintiff N 1l,.97."2B14,, ,.....,.,.., 19 ..... II ~ ~ , " ^ \' ~ CI'stlS ~ DENISE D. PATRICK, ',' S Defendant ~ ',' " ~ ,', ~ DECREE IN Cl DIVORCE AND NOW, ' , , ,.)DA ~, ,~, , '. 19 ,9~" it is ordered and V;otGLAS M. PATRICK , , decreed that ,....,"""""",..""""....""..""..,..,. plamtlff, ond , " " """'," ",~~~~,S,~ ,?:, ,~~~~,~~~, ,',',' "" " """. defendant, are divorced from the bonds of matrimony, ~ ,', ~ ~ ,0, * ~ " W :'~ w ~,' ~ ',' The court retains jurisdiction of the following claims which have been raised of record in this action for which a final order has not yet been entered; ~))~ The parties' Agreement dated August 12, 1999 shall be incorporated hu't 'no' 'mer-geld 'In't'ci 'i:h'is 'b'fvcii:ce 'Decree:' , , , , " , " , " '" , '" , " " , , . .., ..".,.,., ...", ." ,..., ,.,. ,." , .",."",.",.,., w ~" ~ ~ :>. ;<l ~ :>. ,-----,._--- < -. '---'.'<' ,...... -< ..<, ~~~~~*-~~-***~~***** Prothonolary " ~ " ,,' ~ ~ ~ .~ ,', ~ ~ ',' a " ~ ~ y ,,~ ~ ,', ~ ~ ~~. ~ ,,~ ~ .'~ ~,; ~ ,;, ~ s w ~.~ ,', ~ W ~.~ w ~.' $ ~ ,', ~ $ $ * ~ J, ~ 1~ ,.. \ ' I.', (~ I,:, .. ,.. , ' !'~ ~ i' . .'.' .: ':. . ~ -. .' ._,'. .. -.... .'~ ....' ..... ..." '.... '...' '...' '...' '.... ..... '.... . DOUGLAS M. PATRICK, Plaintiff : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA v, : NO: 97-2814 DENISE D. PATRICK, Defendant CIVIL ACTION - LAW IN DIVORCE PRAECIPE TO TRANSMIT RECORD To the Prothonotary: Transmit the I ecord, together with the following information, to the court for entry of a divorce decree: I. Ground for divorce: Irretrievable breakdown under ~3301(c) of the Divorce Code. 2, Date and manner of service of the complaint: United States Mail, Certified Mail, Restricted Delivery on June 5,1997. 3, Date of execution of the affidavit of consent required by ~ 3301(c) of the Divorce Code: by Plaintiff: August 12, 1999; by Defendant: August 12, 1999, 4, Related claims pending: All matters have been resolved pursuant to the Marital Settlement Agreement reached by the parties dated August 12, 1999 and incorporated, but not merged into the Decree, 5, Date Plaintiffs Waiver of Notice in ~3301(c) Divorce as filed with Prothonotary: August 12,1999, Date Defendant's Waiver of Notice in ~3}oj Divorce was filed with Prothonotary: August 12, 1999, / D>to!' Au"",,,,~ 1999 ~ Omb", S,mp".s,n;"". , 'co 549 Bridge Street New Cumberland, P A 17070-1931 (717)-774-1445 Supreme Court ID #323 I 7 Attorney for Plaintiff ~ .... f~ ~ b: C': 0., , ::I I" ro :-1;,~ n ~ 5 ~ s ~ 'JI LU.:; o~ " , f'" .. :. ~: '''; :,; , . . ..- ~.; VI ::l J\ "r" -,....J ~ 6( .<- l' -- .., ... en - - ~.) -- - " " ,~ lfiL N "'- .,-". .. r'" ;.- . i(11 It 1..< ...: .) w.. I' ... l.I. ,...... J ! c:. c." ~ %> ~ r . . "-.. '. .. . .' -. . ~ '" .. ~ d z S ~ ~ - < oJ _ oJ Z :11;;< Ul..:i ::J iii 0: >- U .J Iii III ii: 0.. w Z ~ ~ g ffi ~ :I iii II. :l Ul : 0 <(..z o:"j <( 0: m III 0: m <( :E m 1l ~ z . . . . ~ '" ~ ... '" ~ <~ ~ ..... .:I ". ." .,,~ .. ~ '; ~~ - .' -( :.J", ::r.: i.J~ oe, ;.~,~ ~~ ."S:;: u \J) 'fIn q. l~ L., 15" -I" ;z: ?: :::J c9l:e -j ." lL. ,... 3 Q 01 . . , " ., ~ .' ; " r 01 ~ o z S ~ ~ - :S :l z :It;~ :l II} II! ;J u lIJ Ii ~ L&: ..J iii Z .. D. " Z o ::l: a w ~ :l ~ Do :5Ulmci <(~z 0: liS <( II: lD W 0: ED <( ~ lD il ~ z ~. -. .. BE 0 R: -3 .CompIet. itams1 ard'0I 2101 IddltioNl 1tr.1Ce1. .. .Compi...ittme3,....and4b. I _Print your, nama and Idd,"' anlh. rt'tlrll ot ItVI form 10 that.. can ,..umlN. Clrd 10 you. . U,nach 1N,lorm 10 thll~ of IhI fNIlpiKe, Of on IhI back Ilaplce don not porml, II _Wnl,'R.tum Rtceipf RlQlIf.tH' on 1M m&lIpiece below thI.rtldl numbet. = -The Return Recllpl WllshOW toYJf'lom 1M .nidi WI' dlllY,f,d and IhI dill e dllivtrM1 o 'll li "ii. E II 3'~Bdt~, !1.twt.-,(' itJl/ fMI kJ~.51- SA;u.l7Mi4.'~'1 /a I ,/t11/ ~ " o '" .!! PS Form 3811, DBCBmbBr 1994 - ~ '"" I\J <It .lI <(I tr' LI1 I\J :r : ~ 11. ) S '_,1 , I /'1 _~\\II'" \ II 1 'Ii. U a: E a u ~CBl1iftBd ';, oS " " ~ 2 " o '" (Only il roquBstad ':! ~ Domestic Return Receipt ~ ,l') ~ , -- ." , i 0 ...... .'..r"'_~~., . ;., '.... "...,. , ../ -~. . \,.., ~ .....'1 JIt ...~.:~ -., .. S Ii. ::")'.' ~ I n it :t: ~;{:,; I ~ Uh J ~ I J un ~ J S661lPdy '0081: WJo~ Sd C) ~, b: , - t:; ~;, , , ') ~._',' ) ;~~..:( '- -.:1 ~ ,:'...} :n \ , ~;,~ ::'2 ::~~ ~, .~ ,-- , , fn ~l (. , ~':'"'. '.) " ~. .;1' r , " r- ~ - ~~~ 1:"'. ~ :-.:J , .I'V) " I '--,'" c.:. '} i~tJ ,<~ !1.L. .~... ::.' , :'," " . .:..:,..., (.) 0 I , -- i'J. ., ~~ -' 0 , . '- -' . -' :-. :--.J '- ; ~"',I I.) , -, ~ !:',. (:.' .:{.ij ~o... -.. .~.: ,; r:' " <.:) 4;', , () ~~4 ~ DOUGLAS M. PATRICK, Plaintiff . . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No. 97-2814 CIVIL TERM vs. . . . . DENISE D. PATRICK, Defendant : IN DIVORCE RE: Pre-Hearing Conference Memorandum DATE: Friday, February 5, 1999 separated parties. names and Present for the Plaintiff, Douglas M. Patrick is attorney Barbara Sumple-Sullivan, and present for the Defendant, Denise D. Patrick is attorney Rebecca R. Hughes. A divorce complaint was filed on May 28, 1997, raising grounds for divorce of irretrievable breakdown of the marriage. Wife will not agree to sign an affidavit of consent; husband is going to file an affidavit under Section 3301(d), averring separation in excess of two years, within a month of today's date so the divorce can be completed under Section 3301(d) of the Domestic Relations Code. The complaint also raised the economic claim of equitable distribution. No other economic claims have been raised of record; however, the Defendant wife, according to her attorney, is going to file a petition for alimony and counsel fees and costs. With respect to the alimony claim, counsel for wife is going to let the Master and opposing counsel know if she is going to raise any marital misconduct issues as the factor of marital misconduct affects the alimony claim. Ms. Hughes will advise the Master and opposing counsel within a month as to her intentions regarding her testimony on marital misconduct. The parties were married on March 12, 1983, and January 19, 1997. This is a first marriage for both They are the natural parents of four children whose dates of birth are set forth as follows: Christopher, August 31, 1983; Jonathan, July 20, 1985; Amy, May 13, 1988; Rebecca, May 13, 1988. . The children are in the custody of the mother. Husband is 34 years of age and resides at 116-C Umberto Avenue, New Cumberland, Pennsylvania, where he lives alone. According to wife, husband has a Bachelor's degree, although his counsel needs to verify whether or not he has any education beyond high school. He is currently a transportation supervisor with sysco corporation. His gross annual income is $46,000.00. Husband is currently paying support for his wife and children, which is unallocated in the amount of $1,165.67 per month. Husband has raised no health issues. He does have health insurance for the family. Husband is directed to file within a month an income and expense statement and provide a copy of his 1998 income tax return to opposing counsel and the Master. Wife is 38 years of age and resides at 404 East Walnut street, shiremanstown, Pennsylvania, where she lives with the four children. Wife has a Bachelor's degree and currently works as a daycare worker earning approximately $21,000.00 annually. She does not have any health insurance currently except through husband's employment, but counsel for wife is going to inquire as to whether any health insurance is available through her employer upon the entry of a divorce decree. Wife has not raised any health issues. She is directed to file an income and expense statement within a month and provide a copy of her 1998 income tax return to opposing counsel and the Master. It is perhaps likely that the parties will file a joint return so they will both have information regarding the respective incomes, but that income tax return should be made part of the file along with the income and expense statements. The parties own real estate at 404 East Walnut street, Shiremanstown, Pennsylvania, where wife and the children are living. There is some question about whether or not wife wants to remain in the premises or has an interest in selling the property. Counsel is going to inquire of wife as to her intentions and let opposing counsel know her decision. If the house is going to be listed for sale, it should be done so as soon as possible; otherwise, counsel for husband is willing to allow wife to remain in the premises and will try to work out a settlement which will allow that to happen. The home, according to husband, has a value of around $110,000.00; wife has not at this time suggested a value. If the parties cannot agree on a value, then the house will have to be appraised. The property is subject to a mortgage with ACCU Bank, Inc., with a payoff of approximately $75,000.00. The monthly payment, which does include taxes and insurance, is $808.35. ~ Wife has in her possession a 1993 Ford Aerostar, and the parties will try to agree to a value using a blue book. Husband has a 1997 Ford F150, which is leased. The parties distributed the monies in the checking and savings accounts on January 19, 1997, representing funds in PNC Bank and CAFCU. Husband received $535.76 of the total funds and wife received $1,389.78 of the total funds. Husband has a profit sharing and 401-K plan with his employer, Sysco Corporation, and at the date of separation, the amount of money in that account was $18,811.00. The marital portion should be updated using an interest factor to the date of hearing. Husband also has a retirement plan with Sysco corporation, which is a defined benefit plan, and counsel for wife is going to have that plan valued using Pension Appraisals. Most, if not all, of the tangible personal property was left with wife and the children when the parties separated. Husband had to incur debt of around $10,000.00 to furnish his apartment. He is going to suggest a value for the personalty so that he can be given some credit for what was left in the marital residence and to see if wife will agree with his suggested value. If the parties cannot agree to a value, then the property should be appraised. The Master has pointed out that the children's furniture and any specific items that are used by the children should not most likely be included in the appraisal of the personalty. Wife does not have a pension plan. There has been raised an issue regarding wife's earning capacity since she has a Bachelor's degree and could possibly teach. Her counsel, however, says that she needs to take some courses in order to be certified, and Ms. Hughes will inquire of her client as to just what would be required for her to be able to search for a teaching position. The only marital debt of the parties is a Visa card with a balance of $320.72 as of January 15, 1997. The card has a substantially higher balance now, but that is because, as noted, husband had to buy furnishings for an apartment when he separated. LAW O'''CIS BARBARA SUMPLE.SULLIVAN D"O DRIDOE STREET NEW CUMBERLAND, PENNSYI.VANIA 17070.1 g3 1 PHONE (717)'17...1...&11 'AX (717177".7080 THII II A TRUE CORRICT COf'V 0' THI ORIGINAL ~!-- DOUGLAS M. PATRICK, Plaintiff : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYL VANIA : NO: 97-2814 v, DENISE D. PATRICK, Defendant : CIVIL ACTION. LAW : IN DIVORCE NOTICE TO DEFENDANT If you wish to deny any of the statements set forth in this Affidavit, you must file a Counter.affidavit within TWENTY (20) DAYS after this affidavit has been served on you or the statements will be admitted. PLAINTIFF'S AFFIDAVIT UNDER SECTION 3301 (D) OF THE DIVORCE CODE I. The parties to this action separated on or about January 19, 1997, and have continued to live separate and apart for a period of at least two (2) years, 2. The marriage is irretrievably broken. 3, I understand that I may lose rights concerning spousal support, alimony, division of marital property, attorneys' fees or expenses if! do not claim them before a divorce is granted, I VERIFY THAT THE STATEMENTS MADE IN THE FOREGOING AFFIDAVIT ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE, INFORMATION, AND BELIEF. I UNDERSTAND THAT FALSE STATEMENTS HEREIN ARE MADE SUBJECT TO THE PENALTIES OF 18 PA. C.S,A. SECTION 4904 RELATING TO UNSWORN FALSIFICATION TO AUTHORITIES. DATED: z //"1 199 Irtf~~TRlCK " . * tD.>,~\o. S M, R:r\nc.. '<. Plaintiff : IN THE COURT OF COMMON PLEAS OF :CUHBER.LJIND COUNTY, PENNSYLVANIA . . V * t:x:,""i~e.. b, fb+nc...\c. Defendant :CIVIL ACTION - LAr., ~NO. d g \ '-\ CIVIL :CUSTODY/VISI-TATION 19'1., " ORDER OF COURT AND NOr." this (datefl/<l.L.j /'11, upon consideration of the attached complaint, it is hereby directed that the parties and their re~p,,:ctive counsel appear befo{:e .t:ii.r.h~ I ,-:. &,(',~' F'~~. , the conc~hator, at ~(')d..S, \R-\11...."\-~~."'""\~___ on the \ \ day of ~("'0e N""\'c\('> r , 9C:q , at \ A" M., for a Prehearing Custody Conference. At such conference, an effort will be made to resolve the issues in dispute; or if this cannot be accomplished, to define and narrow the issues to be heard 'by the court, and to enter into a temporary order. Either party may' bring the child who is the subject of this custody action to the conference, but the child/children's attendance is not mandatory. Failure to appear at the conference 'may provide grounds for entry of a tempC?rary or permanent order. FOR THE COURT: By: ~~t~~; ~~il-nPc,~~' YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. OFFICE OF THE COURT ADMINISTRATOR COURTHOUSE, FOURTH FLOOR CARLISLE PA 17013 (717)240-6200 ell ~ z ci l) ~ r- ~ ::i ~ -' z :l t ~ Ul .. is W e ;J >- In -- ~ u; .,,: f, u -' ~": E D.. .. Z l.lJC~ ~.:: . 0 " " ffi " <. ,.... ~ :l ii: Do r~~' : LO... Ul .. ci '_I'r" '..'j co >Je .. 0( .. Z T.'" , 0: 11 j .1: , U2 ~.. : ;"-', ~:; 0( a: r!t;; ~-! m bJ .~ .~ I" I':'\.. 0: m 1- .. ::.~ 0( :E II. r- ,:'J m :l 0 0' 0 0 ~ z " , ." . ~JUL 1 7 1997 DOUGLAS M. PATRICK, Plaintiff : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA NO, 97-2814 v. DENISE D. PATRICK, Defendant ORDER OF COURT You, DENISE D. PATRICK, Defendant, have been sued in Court to obtain custody, partial custody or visitation of the child(ren): CHRISTOPHER. JONATHAN. AMY AND REBECCA PATRICK. You arc ordered to appear in person at on at O'clock for: [ ] a conciliation or mediation conference [ ] a pretrial conference [ ] a hearing before the Court If you fail to appear as provided by this Order an Order for Custody, partial custody or visitation may be entered against you or the Court may issue a warrant for your arrest, YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. OFFICE OF THE COURT ADMINISTRATOR COURTHOUSE, 4TH FLOOR CARLISLE. PA 17013 (717) 240.6200 6, The parties separated on January 19, 1997. 7. Plaintiff seeks partial physical custody of the following children: NAME ADDRESS DOB Christopher M. Patrick 404 East Walnut Street 8/31/83 Shiremanstown, PA Jonathan M, Patrick 404 East Walnut Street 7/20/85 Shiremanstown, PA Amy M. Patrick 404 East Walnut Street 5113188 Shiremanstown, PA Rebecca M. Patrick 404 East Walnut Street 5/13/88 Shiremanstown, PA The children were not born out of wedlock. The children are presently in the custody of MOTHER who resides at 404 East Walnut Street, Shiremanstown, Cumberland County, Pennsylvania. During the past five (5) years, the children have resided with the following persons and at the following addresses: PERSONS ADDRESSES DATES Denise D. Patrick 404 East Walnut Street Shiremanstown, PA 1119197 to present Denise D. Patrick Douglas M, Patrick 404 East Walnut Street Shiremanstown, PA prior to 1/19197 The mother of the children is DENISE D. PATRICK, currently residing at 404 East Walnut Street, Shiremanstown, Cumberland County, Pennsylvania, 2 provider. This schedule shall occur for three (3) times. Thereafter, this schedule shall change so it occurs on an every weekend basis. This alternating weekend schedule shall begin October 5, 1997. B. Every Thursday evening from 6:00 p.m. until 8:00 p.m. 3. The parties shall alternate the major holidays, those holidays being defined as Thanksgiving, Easter, Memorial Day, Fourth of July, and Labor Day, These periods of partial custody and visitation shall occur from 9:00 a,m. until 10:00 p.m, This alternating schedule shall begin with Mother having Thanksgiving in 1997. 4, Father shall have the children every Christmas Eve from 9:00 a,m. until 10:00 p.m.; Mother shall have the children thereafter through Christmas Day until 10:00 p.m, 5. Mother shall have the children on Mother's Day and Father shall have the children on Father's Day from 9:00 a.m. until 10:00 p,m. 6, Each party will be entitled to four (4) weeks of uninterrupted vacation with the children. The parties shall provide each other with thirty (30) days advance notice as to when they intend to exercise these periods of exclusive custody. .. ,. In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC REL...TIOSS P.O. BOX 310, C"'RLlSLE, P.... 11013 Phone: (717) 240-6215 Fax: (717) 240-6248 Plaintiff Name: Defendant Name: Docket Number: PACSES Case Number: Other State ID Number: PI.... aotel AD cDmspoadlllCe mast blcJude the P"'CSES Case NlIIDbcr, Income and ElCDense Statement TInS FORM MUST BE FILLED OUT (If you arc self-employed or if you arc salaried by a business of which you arc owner in whole or pan, you mUSI also fill out the Supplemental Income Slalement which appears on the last page of this income and expense statement.) INCOME STATEMENT OF DENISE D. PATRICK I verify that the stalClllClllS made in this Income and Expense Slalement arc true and CO[[ctt. I undcrstaDd that faIsc stalements herein arc subjctt to the criminal penalties of IS Pa. C.S. fi 4904. relating to unsworn falsification to authorities. Dale INCOME: Employer Plaintiff or Defendant First Church of God Address 28 E. Main Street, Mechanicsbur2, PI. 17055 TypeofWor\c Dav Care Director Payroll No. Gross Pay per Pay Period $ 840 Pay Period (wkly.. bi-wkly.. etc.) Bi-Weekly Itemized Payroll Deductions: Federal Withholding Slale Income Tu $ 26.3 Social Scturity $ 13. 52 Retirement ~~. $ 12. 18 Ufe Insurance $52.08 Local Wage Tu $ 8.40 $33.60 Savings Bonds $ $ Health Insurance $ $ $ Other Deductions (specify) Net Pay per Pay Period $ 683.88 Service Type M Form IN.ooS Worker ID 21205 Income ami Expeosc Slalement PACSES Case Number 348100635 OTHER (Fill in Appropriate Column) INCOME WEEK MONTH YEAR Interest $ $ $ Dividends Pension Annuity Social Securily Rents Royalties . Expeosc AcCOUDI Gifts Unemployment Compensation Workmen's Compensation IRS Refund Other Other TOTAL $ $ $ TOTAL INCOME 1$ (Fill in Appropriate Column) . " EXPENSES nt-Weekly WEEK Mt1Nl1H YEAR Home MongagelRenl $ $397.50 $ Maintenance 50,00 Utilities Electric 56.00 Gas Oil Telephone 10.50 Page 2 of6 Form IN'()()8 Service Type M Worker 10 21205 In~ume ane! Expense Statement PACSES Case Number 348100635 (Fill In Appropriate Column) EXPENSES B~ (continued) WEEK YEAR Waler $ $ 21. 75 $ Sewer Employment Public TlIIlSpOttation $ $ $ Lunch . Taxes Real Estate $ $ 3.75 $ Personal Property 16.00 Income Insurance Homeowners $ $ $ Automobile 17,75 Ufe 13.00 Accident Health Other . AutomobUe Payments $ $ 20.00 $ Fuel Repairs Medical DoclOr $ $ 30.25 $ Dentist Orthodontist Service Type M Page 3 of6 Fonn 1N'()()8 Worker ID 21205 Incume an~ Expense StalemeDI PACSES Case Number 34 9100635 (Fill In Appropriale Column) EXPENSES B~y (continued) WEEK YEAR Hospllal Me~lcinc Special needs (glasses, braces, onhopedic devices) Education Private School $ $ $ . Parochial School College Religious Personal Clothing $ $ $ Food 275,00 BarberlHairdresser Credit PaymentS: Credit Card Charse Account Memberships Cable 4.25 . LoIIDS Credit Union $ $ $ VISA 23,25 Pa Nat'l 120.50 MIscellaneous 120,00 Household Help $ $ $ Child Care PaperslllookslMagazinc Enlenainment Pay TV Vacallon 25,00 Service Type M Page 4 or6 Fonn IN.oo8 Worker ID 21205 Income and EJpense Slalel!ll:n\ EXPENSES WEEK (conllnl/ed) Gifts Legal Fees Charilable Contributions Other Child Support Alimony PaymcnlS . Other '. Instrument $ ri t a TOTAL EXPENSES $ PROPERTY OWNED Checking AcCOUDIS Savings AccounlS Credit Union StockslBoods Real Estate Other TOTAL INSURANCE PACSES Case: Number 348100635 (Fill in Appropriate Coluom) MONTH $ $ DESCRIPrION COMPANY Hospital Blue Cross Other Medical Blue Shield Other · H - Husband W - Wife C - Combined J - Joint Page 5 of 6 Service Type M 23.25 4.75 25,00 $ $ VALUE POLICY # YEAR $ $ Ownership · H W J Coverage · H W C Fono IN.Q08 Worker ID 21205 >- ,... ~ S? C'; % 6 N -.J ~.,.. o~ .~ ':.J ;;; rr:~., .... ::.~ II.,.! ~ .:t ;:i Oei N ?:;;i; or;( u. I ..2l% ~'U It~7 - l'"J U::.C - fJ IJ .u: 'no. r::: ~ =: lL CO a 0 O'l / , >- 1..0 C c::; -= ~ -. .. "'- lu0 ('"l ::1._ We, -. :{~ ,I_*r ,:I.. r}f::, - c' >-" ,-::Or: -=:> ", i)) l.t.:.._. C"? .'J;~ i1! I ~ . 0_ 'r:~- !! it:] l-''':''' lu :n.:!.. cr. ...-; h- e-; 25 r.:, (J. U ASSETS OF PARTIES . Plaintiff marks on the list below those items applicable to the case at bar and itemizes the assets on the following pages. [.1 1. [J 2. [ ] 3. [ ] 4. [.{ 5. [if' 6. [1' 7. [] 8. [i( 9. [ ] 10. [ ] II. [ ] 12. [ ] 13. [ ] 14. [ ] 15. [ ] 16. [{ 17. f~ 18. 19. [ ] 20. [ ] 21. [ ] 22. [ ] 23. f} 24. 25. [] 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] MilitaryN.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 LIABILITIES '. Item Description Names of Number of PropeJ1y All Crediton 1. Marital Residence Accu Bank Inc. Mortgage 2a. 1993 Ford Aerostar PA National Bank Car Loan 2b. 1998 Ford F150 PA National Bank Car Lease First USA VISA Credit Card Debt Balance as of 1/15/97 $320.72 Current Balance is $10,599.82 Names of All Debton Joint. Wife paying. Joint. Wife paying. Joint. Husband paying. Joint, Husband paying. 4 ASSETS OF PARTIES Plaintiff marks on the list below those items applicable to the case at bar and itemizes the assets on the following pages. [.1 1. [J 2. [ ] 3. [] 4. [.{ 5. [if' 6. [1' 7. [] 8. [i( 9. [] 10. [] 11. [] 12. [ ] 13. [] 14. [] 15. [] 16. [{ 17. f~ 18. 19. [] 20. [] 21. [] 22. [] 23. f} 24. 25. [] 26. Real property Motor vehicles Stocks, bonds, securitie.> 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] MilitaryN.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 LIABILITIES Item Description Names of Names of Number of Property All Crediton All Debton 1. Marital Residence Accu Bank Inc. Joint. Wife paying. Mortgage 2a. 1993 Ford Aerostar PA National Bank Joint. Wife paying. Car Loan 2b. 1998 Ford FI50 PA National Bank Joint. Husband paying. Car Lease First USA VISA Credit Card Debt Joint, Husband paying. Balance as of 1/15/97 $320.72 Current Balance is $10,599.82 4 INVENTORY & APPRAISEMENT Item Description Names of Number of Property Value All Owners Lien I. Marital Residence Joint Amount Unknown 404 E. Walnut Street Shiremanstown, PA 2, 1993 Ford Aerostar Joint Amount Unknown 3. 1998 Ford FI50 Joint (Leased) 4. PNC Checking $336.03 Joint 5. PNC Savings $ J ,458.69 Joint 6. CAFCU Savings $130.82 Husband 7. Contents of Safe Deposit Box Joint 8. Life Insurance Policies 9. Sysco Corp. Savings Incentive Plan $18,811.00 Husband 10. Sysco Corp. Retirement Plan Husband 11. Personalty Joint DEBTS I. VISA $320.72 I I , f . " g ~ Ii - " 3 i w 0 " .. J!; ~. ,. <: .. !!! 0 :. '!! '.' i!: . ! , I i I , . I i I /, - l'l Cl - :z d ~ ~ :; ~ -J ZII :Jt;~;: cn..,.....o !!I Jir!';~"" i1-JIii~~~ ~, a. III Z t: ,.. ~:S~i5;:E ~ :J" II. ~ .. jln"C'''- <h~~ ~lIjE" ia ffi ~'m < ::E m a ~ Z .0,'. ~ , .' I o.Oll1mtnlol h TfNlW)' - Intima' Rtvtnw StMee Form 1 040 u.s. IndivIdual Income Tax Return For Ih. .ar Jan 1.Dec 31.1998. or olh.r lax .ar b. Imln Yu 'nlName .. LastNMnt SHIREMANSTOWN PA 17011 .. Do you want $310 go 10 lhis fund?..... ............. .................................... II a olnl r.lurn. do.s ur s us. wanl $310 010 this fund?.................. ........... 1 ~ Single 2 Marrl.d filing Joint r.lurn (.ven II only one had Inceme) 3 Marri.d filing s.paral. r.turn. Enl.r spous.'s SSN above & full name her.. .. .. 4 X H.ad 01 hous.hold (with qualifying person). (S.. Inslrucllons.) lItho qualifying p.rson Is a child but not your d.pend.nl. enl.r this child's name her. . . . .. 5 n auali I wldow.r with d. ndenl child .ar s us. di.d .. 19 .. inslructions. 6a X Yoursell, II your par.nt (or som.on. .Is.) can claim you as a d.p.ndent on his or } No..,..... D h.r tax r.lum. do not check box 60.......... ............. ................... ...... =1....... 1 b Souse ......................................................................... ....01.... (2) Depend.nl's (3) D.pend.nl's (4) · =.. D c Dependents: social s.curily r.lalionship...._..1eI ..... 4 number 10 you '" chid lU -you.... . Ct'Idit(stl .6tnotltwt 1nstNctiant) MIh )'OU ... to X -.....,. r---l X ::=:I..L---1 X _- X =-~.....CJ Add ........ d Tolal number olexem lions claimed.. ..... ...............,................................. =::::. . .. 5 7 Wag.s.salari.s.lips..lc.AllachForm(s)W.2......................................... 7 21365. SlTlllIbl. int.r.sl. Attach Sch.dul. B it r.quir.d..................... .................... 8. 38. b Tax-exempt inler.st. Do not includ. on lin. Sa. .. . . .. . .. . .. . 8 b 9 Ordinary dividends. Attach Sch.dul. B II required.. .. , .. .. .. .. .. .. . .. .... .. .. .. .. .. .. .. 9 10 Taxabl. refunds, credits. or offsets 01 slal. and local Income laxes (se. Instruclions)..... 10 " Alimony r.celv.d ...... ........... ............................... .................... 11 12 Busln.ss income or Qoss). Attach Sch.dul. C or C.EZ. ..... .............. .... .. ........ 12 13 Capllal gain or Qoss). Attach Schedul. 0 .............................................. 13 14 Other gains or Qosses). Attach Form 479? ............................................. 14 15. TolallRA distribulions......~1 I b Taxabl. amounl (s.. inslrs).. 15b 160 Tolal pensions & annuilies .00 b Taxable amounl (se. Inslrs).. 16b 17 R.nlal r.al .slal.. royalti.s. partn.rships. 5 corporalions. trusts. .Ic. Attach Sch.dule E. 17 18 Farm incom. or Qoss). Attach Sch.dul. F................................ .............. 18 19 Unemploymenl compensalion..... ..... ................. ..................... ......... 19 20. Social securilybenelils...... ~I I b Taxabl. amounl (s..lnslrs).. 20b 21 Olhorincome.Usllype&amounl-setinsln ________________________ 21 22 Add th. amounls In th. far rl hI column for lin.s 7 Ihro h 21. This Is ur total Income" 22 23 IRA deduction (se. inslruclions) .. .. .. .. .. .. .. .. .. .. .. . .... 23 24 Slud.nlloan inleresl d.duction (s.. Instructions). . ..... . ... 24 25 M.dical savings accounl d.duclion. Attach Form 8853... . ... 25 26 Moving .xp.ns.s. Atlach Form 3903 .............. .. ....... 26 Xl On..hall 01 s.lf.employm.nt tax. Attach Schedul. SE .... ... Xl 28 S.If..mploy.d heallh Insuranc. d.duclion (se. instruclions). 28 29 K.ogh and self.employed SEP and SIMPLE plans. . . ..... . .. 29 30 P.nally on .arly withdrawal 01 savings.. . .. . .. .. . .. .. .. .... 30 31. Alimony paid. b Recipienrs SSN ... .. 31 . 32 Add lines 231!voogh311 ................................................ ,................. 32 33 Sublraclline 32lrom lin. 22. This is ur.d usted lOSS Incom..."................... 33 BAA For Disclosure. Privacy Act, .nd P.p.rwork R.ducUon Act NoUce. see InstrucUons. fDtA0112 11102/98 Label (S""'hctia'll,) Usa the IRS I.bel. Olh.rwis. . pleas. prinl or typ.. PresldonUol Eloctfon CampoJ~n (Sol i\m.<ticnJJ flUng Status Ch.ck only on. box. Exemptions If more than six d.pend.nls. see instructions. Income Attach Copy B 01 your Forms W.2, W.2G, .nd 1099-R hore. If you did not gel a W.2. see Instructions. Enclos.l bul do nol stap ., any paymenl. Also. please use F'onn lQ4G.V. Adjusted Gross Income If lin. 33 is und.r $30.095 (und.r $10,030 if a child did nol live with you). s.. EIC In Ih. instructions. 1998 . 1998. .ndln ....... -OoftOl_rtaOt ltaM6ft "IO~. 19 _"'.15<5_' V-_s.curorN_ 209-50-8967 .,.......Iod..IocurtIr_. OENISE II. Jotnt RIll.m, Spol.M.' finlNaml o '" PATRICK ....,"- Home Addrtu (mrntw... Itr"O,lt you....... P.o. Bolo Sn lmlrul:tlons. 404 EAST WALNUT STREET CIty, Town 01 Poll OffIcI." You Haw. FOtIIQft AddtIU, SIt' Ins1r\dlonl. ............... . Importantl . You must .nler yout social s.curily numbor(l) above. YIS No _. X ,..,,~ Yf1II"'fJI~ 1''''''- Stall ZIP CodI First name CHRISTOPHER PATRICK JONATHAN PATRICK REBECCA PATRICK AIMEE PATRICK Last name 184-64-0945 169-66-5189 161-70-4864 161-70-4974 Son Son Oau Oau hter ter 13 988. 227. 35.618. 35 618. Form 1040 (1998) Form 111411 199 Tax and Credits Standard DaducUon for Mosl People Single: $4.250 Head of household: $6,250 Married filing JoinllY.or Qualifying widow(er): $7.100 Married filino separalely: $3,550 Other Taxes Payments AUach Forms W.2 and W.2G 10 page 1. Also aUach Form 1000.R if lax was wilhheld. Refund Have it directly depositedl See instructions and fill In 6Gb, 66c, and 66d. Amount You Owe Sign Here Joint return 7 See inslruclions. Keep a copy for your records. Paid Prepare"s Use Only DENISE D PATRICK 209-50-8967 34 Amount from line 33 (adjusted gross income) ..... ...............................,...., 34 !S. Check If: 0 You were 65/older, 0 Blind; 0 Spouse was 65/older. 0 Blind. Add the number of boxes checked above and enler the lotal here.....,...... ~ 35a b It you are married filing separalely and your spouse tlemiles deductions or you were. duel.slalus elien, see instructions end check here............. ~ 35b 0 36 Enler lho lara" of your Itemllld deducUons from Schedule A. line 28. Or standard deductfon shown on the left. But see inslructlons 10 find your standard deduction If you checked any box on line 35a or 35b or It someone can claim you as a dependenl... ....... ............... ............ ............................. 36 'n Sublraclline 36 from line 34........................... ............................... 'n 36 II line 34 II 193.400 or lal, mulUpIy $2.700 by the lot1l number 01 exemptions claimed on Iina 6d. II line 34 11_$93,400, lee the worIcsheel,n lI1ainslruc1lons for the Il!IOUnt 10 enlM ............................ 36 39 Taxable Income. Sublract line 38 from line 37. It line 38 is more lhan line 37, enter .0,... !9 40 Tax, See inslructions. Check if any lax from. 0 Form(s) 8814 b 0 Form 4972 . . ... ~ 40 41 Credilfor child and dependent care apensa. Albdl Form 24.11 .......... 41 42 Credit for the oIder1y or the disabled. Atlach ScheduleR ................ 42 43 Child lax credit (see Inslrucllons) .......................... 43 44 Education credits. Attach Form S863....................... 44 45 Adoption credit. Attach Form 8839 .... .................. ... 45 46 Foreign lax credil. Attach Form 1116 if required............. 46 C Olhor. Check It from.... . B Form 3800 b 0 Form 8396 c 0 Form 8801 d Form (speclly) 47 48 hld1i1ltS41lhrouQh47. These"'JOII'lllblcredlb ............................................. 48' 49 Subtract line 48 from line 40. It line 48 Is more Ihan line 40. enter .0., . . ... . . . . ... . . ... ~ 49 50 Selt.employment lax. Attach Schedule SE . .. ......... .... .. .. ..... ....... .. . ....... ... 50 51 Altemalive minimum lax. Attach Form 6251....... ........ ............. .......,.. ...... 51 52 SocIal security and Medicaretu on Up Income not reported 10 emplO)'el. Alt4dI Form 4137 . ... . . . . .... . ... .. 52 53 Tax on IRAs. other retirement plans. and MSAs. Attach Form 5329 It required............ 53 54 Advance earned Income credil payments from Form(s) W.2. . ... .... ..... . . . . . ... . ...,.. 54 55 Household employment laxes. AUach Schedule H...................................... 55 56 Add IInaeg.55. ThlIII lobi tax ............................................,......... ~ 56 ~ Federal income tax withheld from Forms W.2 and 1099...... ~ 698. 58 1998 aUmal!d tu payments and amounlapplied from 1997 retum '" . .. .. 58 591 limed Income endit. Attach Schedule EIC if you ""'" a qualifying child. b Nonlaxable earned Income: amount.. ~ and type.. ~ _ __ _ _ ______ _ ___ __ __ _ __ 59a 60 Additional child lax credit. Attach Form 8812................ 60 61 Amounl paid wilh Form 4868 (request for extension~ ... . .. .. 61 62 Excess social security and RRTA tax withheld (see instrs~ . .. 62 63 Other payments. Check if from.. ... . 0 Form 2439 b o Form 4136.......................................... 63 64 Add lines 57, 58, 59a, and 60 Ihrough 63. These are your total ents .............................................,...................... ~ 64 65 II line 64 is more ltIan line so. lubtract line 56 from line 64. Thil is the amou,l IllU Overp.ld ......... . . . . .. 65 66a Amount of line 65 you want Refunded 10 you..........................,............. ~ 66. · b Routing number. . . . . . . . .. c Type: 0 Checking 0 Savings · d Account number ....... fj] Amount of line 6S you want A!lplled to Your 1m EstI...ted Tax. .. . . .. ~~ 68 If line 56 is more than line 64. subtract line 64 from line 56. This is the Amount You Owe.Fordelails on how 10 pay, see instruclions ......................... ............ ~ 68 69 Esllrnaled tax nal. Also Include on line 68 .. . ... ... . .. .. 69 Undtr penaltia of perp..y, I decWIIlNt I haw .1Itnined 0'iI rUJm and accompanying scf1eduln and ItItlments. and to hi bill crI my IlnawrrIodOt and beticl. ...., 11'I N, conllCt. and CCl'nII"te. Dedarabon 01 pt~r (otter I\an~) IS baled on all infomIaUon of Mtdt ~ hal'" knCrwIedQ.. YlIU'Signatur. Dati Yru OccupItion Daytime T.I.ctloM .. -(....... r TEACHER SpclUSI" S.gnat...... II. .loll'll R.ILm, 80th Must 'IOn. Date Spouu', ~ 1 541. 59. P. .2 3S 618. 11 832. 2 86. 13 500. 1 86. 1 541. 1 541. O. o. 757. 757. 757. lL,:::~.~:l..~: ... Pr.p.,.,.. Soaal s.a.lly No. ~~~ ,....".sNamt (ot,...,' .....mploytd) ""-... Check "self-emp d Se - re are ~ EIN liP Cod. FOtAOl12 1111I191 Form 104G (1998) Schedule A ItemIzed Deductions CMINo.l1l<54l14 (Form 1040) 1998 ~I of.,. r'laaury (99 . Albch to Form 1040, InWr\U RI'I'eIM Serva ) · SM Instructlonl lor Schldull A (Form 1040). 07 NAmt(1) ~ on'onn 1040 I:V-- ......,- DENISE D PATRICK 209-50-8967 Medical CluUon: Do not Include "pinus reimbursed or paid by othlrs. Ind 1 Medical and denial expenses (see Ijlruc\IOnS). ......... . .... . . 1 Denial Exptnstl 2 Enlar IIIlOIlnl from Form 1010, IInl 34 ..... 2 3 Mulllply line 2 above by 7.5% (.075)...... ......... ...... ...... 3 4 Sublract line 3 from line 1. II line 3 Is more than line 1. enter .0... .. .. .. .. .... . .... .. .. ..... 4 Tax.. You 5 Slale and local income laxes ................................. 5 813. Paid 6 Real eslale laxes (see Inslrucllons)................ .. .. .. .. .. .. 6 1 939. (Sea 7 Personal property taxes .... ...... ........ .................... 7 inslrucllons.) 8 Olher laxes. lIsltype and amount. .9.!:l1.eLtaJC!L__________________<t21.:. 8 422. 9 Add lines 5throUQh 8........ ................. .............. ........................ ..... 9 3,174. Inlll'lst 10 Home mortQaQIlnllrOlt and points I!POItod III jOU on Form 1098 ........,... 10 7 348. You Paid 11 Home = Inlarest not rapoNd III jOU on Form 1098.11 paid III 1!11 penon rom whom JOU boUQht 1!11 hOmo, 'OIlnslr\lctions and ,haor Fruee ltut penon', name, Identifyil1Q number,and address . nslrucllons.) ------------------------------- ------------------------------- Note: ------------------------------- 11 Personel 12 Points 1101 reported III you on Form 1098. SOIlns1nIeIions tor 'peeIalllliOl. .... . 12 Intereslls 13 Investmentlnlerest. Allach Form 4952 II required. not deductible. (Seelnslrucllons.) .. ........ ...................... ........... 13 14 Add lines 10 throUQh 13...... ...... ........... .............,............................. 14 7,348. Gifts to 15 Gifts by cash or check. II you made any gift of $250 or more. Chanty see instructions....... ............ ...... ................ ..... 15 1 310. II you made 16 Olher than by cash or cheek. II anf gill of $250 or more. a ~Ift and Pco a benefit see Instructions. You Must attach orm 8283 if or It. see over $500 ................................................... 16 Inslruclions. 17 Carryover from prior year.. ........ ..... ........,............. 17 18 Add lines 15throuoh 17................. ................................................. 18 1 310. Cuualty and Casuallv or theft lossles\. Atlach Form 4684. (See Inslruclions.l. ....... .. . . .. . . .. .... . . .... Thlft Lossts 19 19 Job Expenses 20 Unreimbursed employee expenses - job travel. union dues. and Most job educallon. etc. You Must atlach Form 2106 or 2106.EZ Othar Mlscellanlous If required (See Instructions,) . Dlductlons -------------- ------------------------------- 20 21 Tax preparation lees.......... .... ............................ 21 22 Other expenses - investmenl. ..fe deposit box, etc. Lisl Fruee type and amounl . nslructlons ------------------- for e~enses ------------------------------- 10 de ucl 22 ------------------------------- here.) 23 Add lines 20 through 22.... ........(..'1'..... ............... 23 24 Enlar I/11Oll1ltfnlll1 Form 1040, IInl 34 ..... 24 2S Mulliply line 24 above by 2% (.02). ........... ....... ....... ... 2S 26 Subtract line 25 from line 23.11 line 25 Is morelhan line 23. enler .0........................ 26 other 'Z1 Other - from list in the inslrucllons. List type and amount . _ _ _ _ _ _ _ _ _ _ _ _ _ MiI<ellll1lOlIS Oeductiona ------------------------------------------ 'Z1 ToW 28 Is Form 1040. line 34, over $124,500 (over $62.250 if married filing separalely)7 nlmlnd Daductlons No. Your deduction is nollimlled. Add the amounls in the far right column for 1 lines 4throUQh 27. Also. enler on Form 1040. line 36. the lalllero' this 11 832. amount or your standard deduction. .28 VIS, Your deduction may belimiled. See instructions for the amount 10 enler. BAA For Paplrwork Reduction Act NoUce, Sit uparatl instructions. FOlAOlOl O!lI27m Schedule A (Form 1040) 1998 Schedule C (Form 1040) DENISE D PATRICK Profit or Loss from BusIness (SoIl Proprlltorshlp) .. Partnlrshlps, Joint ventur.., Ilc, must ntl Form 1065 or Form lQ65.B. .. AUach to Form 1040 or Form 1041, .. SlIlnstructfons lor Schldull C (Form 1040) 09 So.Io/s-tlyO_(1'N) 209-50-8967 B rnt" .... Cod, Irom 1n.tNdSont <MI No. 1S45.Ql7' 1998 ~of"'T,..wy """"'I RMnUlI Stmel .................. A PnrciClll But.,." 01 ProIeWon. Includlno Product Of s.rvict (Nt inslndions) AVON REPRESENTATIVE C s.......g Name. If No S'PltI. BuaIl"ilU Name. Leaw Blank. .. 454390 D ......""'100....."(1111),11.., E _.........._"...,roomno.) "404 EAST WALNUT STREET c.tv. T""'.,P..'OIftce........Z1PCodo siifR-EMAN-STOWN:-P-A-i'701i'- -- - - - - - -- - - -- - -- - - -- - --- - -- --. Accounling method: (1) ~ Ca.h (2) 0 Accrual (3) OOth.r (.pecify) .. Old you 'mat.rlally partlclpete' In the operation 01 thl. busln.ss during 1998111 'No,' s.. In~tr;,dl;n~ fO~I~ii ;ni';;;'s. -;-I&f Yes No II u start.d or a ulr.d this busln.ss durin 1998. check h.r.......,........................................ .............. .. X Income 1 Gross rec.lpts or sal.s. CluUon: If this Income was reported 10 you on Form W.2 end the D 'StatutOI)' employee' box on thol form was check'd, see the instructions IIId ch.ck hers.... . . . . .. .. 1 2 R.tums Ind allowanc.s ...... ......... ...... ............ ....... ........................... ............. 2 3 Subtract line 2 from Iin.1 .............................................................................. 3 4 CosI of goods sold (from line 42 on page 2).............................................................. 4 1 034. 1 034. 633. 5 Gross prom. Subtract Iin. 4 from Iin. 3.........................................................,........ 5 6 Oth.r incom., including I.d.ral and sIal. gasolin. or ru.llax credit or r.lund ......... ......... ....... ..... 6 401. 7 Gross Incom.. Add Iin.s 5 and 6........ ........... ....... ....... .............. ..... .................... 7 Ex enses. Enl.r.x .ns.s lor busin.ss us. of our home ani on Iin. 30. 8 Adv.rtising.................... 8 19 P.nsion and profit.sharing plans... .. .... 19 9 Bad d.bts from sal.s or 20 R.nt or I.as. (s.. Inslructlons): s.rvic.s (s.. instructions). . ... . 9 I V.hicl.s. machin.ry, and .quipm.nt. . ... 20 I 10 c.r and truck apenses (seelnslrs) .... lab Oth.r busin.ss prop.rty.. .. .. .. .. .. .. ... 20 b 11 Commissions and f..s .. .. .. ... " 21 R.pairs and mainl.nanc. ......... .. .... 21 12 Depl.lion..................... 12 22 Suppli.s (nol includ.d in Part III) .. .. .... 22 13 D.pr.cialion and s.ction 23 Tax.s and lic.ns.s .... .... .. ..... .. .... 23 179 .xpens. d.duclion 24 T I '. (nol includ.d in Part JII) rave , m.als, and .nl.rtalnm.nl. (s..instructions).............. 13 aTrav.1 ................................. 241 14 Employ.. ben.fit programs b M.als and (oth.r than on Iin. 19)......... 14 .nt.rtainm.nt.......... 5 I th the c Ent.r 50% of Iin. 24b 1 nsuranc. (o.r n h.alth)... 15 subject 10 Iimitalions 16 Int.r.st: (see instructions) ...... I MortQaQe (paid to banks, etc) ........ lal d Subtractlin. 24c from Iin. 24b .......... 24d bOth.r......................... lab 2S Utiliti.s ................................25 17 L.gal & prof.ssional s.rvic.s, .. 17 26 Wag.s o.ss .mploym.nt cr.dits)... . .. .. 26 18 Offic.., ns................. la 'IJ Other es from line 48 on 2) ......... 'IJ 28 Tolll expenses before exp.ns.s for busin.ss us. of hom.. Add Iin.s 8 through 27 in columns. . . . .... . . . ." 28 401. 6. 168. 174. 29 T.ntativ. profit ooss). Sublracllin. 28 from Iin. 7....................................................".. 29 ~ Exp.ns.s for busin.ss us. of your hom.. AUach Form 8829.. .............. ... ............ ... ... .......... 30 31 Net proOl or ooss). Sublract line 30 from Iin. 29. · If a profit. .nt.r on Form 1040,IIne 12, and also on Sch.dul. SE,IIne 2 Cstalulory .mplov.es. s.. instructions). Eslat.s and trusts. .nt.r on Form 1041, Iin. 3. 1 . If a loss. you must go on to Iin. 32. 32 II you have a loss, ch.ck th. box that d.scrib.s your inv.slm.nt in this activily (s.. instructions). _ · If you ch.cked 32a, .nl.r th. loss on Form 1040, line 12, and Ilso on Schedule SE,IIne 2 l (slatutory .mploy..s, s.. instructions). Eslal.s and trusts, .nt.r on Form 1041. Iin. 3. _r . If you ch.ck.d 32b. you must attach Form 6198. BAA For PlperwOrk Reductfon Act NoUc., s.. Form 1040 Instructfons, 227. 31 227. O All investment is 32 a at risk. Sam. Inv.stm.nt 32b 0 is not at risk. Sch.dul. C (Form 1040) 1998 FOIZD112 1Q12S198 r,i1N,~I.' Your IOCIaJ 1<<:ur1tynumberh... . :1~ZLt,O:qgS5 . Spou..'lsoclal IKwtty numb<< 1 2() :So: 8%:7-; '.....,.itf~~5.r~~,... .. ,!.! ~"'_:..VoiJmuatenter"''''. ..l '\~~Ui- SSNf.) 8bciv~, :r.1~'j 't.. ~..,. _, \'" .11..". . dYes' .Ne)" HOt.:'~~.~ 1 -~ ~ '. >< !y.,'dnot~I~.1 . Election Campaign OoyouW3!lI$3,I~goto,.t,~I~.!u,:q7.. ',_ .,.:'t-.~~ )~l" ,'"i.'."l'fO ':.' .',~'l'.:.dr,..~~:lt. ~QI. )'OlR".ta.Ct7:,': , S~e a e 18) .. ;-If a 10lnt retum. does your spouse want 53 to 0 to. thIS fund? . . . . _ .. .' :(ldUce1P<'~ 1 S,' I ' . . I I ' . ",. " ;J,:' -. ,"\'. ,..'."~..l('t'. ':'0.,''<),'. Filing Status ._~g_!_-:..---:--.-..~; II':.'; ,~l' ii:i-f1., .i:'>IIl~'~.\r;. ~dl:) L...~.\hVll.SJ'~,~ ~~t;'O~,~~t~: ; "\:;'''':~llO., 2 ,~llfI2~,~h~g.l!!.."l'..!.~t!!!'l.tev,,!, If. only 9!t~Md ,InCO!!'.hlwl:,;.~ ""~:.'\,I..,;",Ji oi:11""'-'Jo,::...~, ,,(_~.. 3 ~~ fiI!~_"!,patate ren.m.;Enter SllOU..... social .securilY. 00, ~!'IId 'l!1~,hOr~~';:~ Denll<. D. Pc-3rlc!:: 4 , !:lea.~ 01, house~~qi~~ qualifying person). (See page 18.) !lJhe q\J'lli!Yi!1g P~Jl~ ~ f!Jil!ilirt!i'Qfv9ur d.p~;ni, I enter this child's name here, ... ! 5 -OUalifvin -'wlifow(er)wilh-dcnendent child (vp.ar !'il'louse dj~d .. 19 . {See 3 0'18. :.. I ........: ~ : 6<1 t& 1'ourS'en. If your' par cOt' (of'so~eono e~se) ca~ ~!a}.m you i1;S.~ d~~~n~~J o~_his..~r ~~~!~.: .:c.Ho. ol.bolll . relum, do not check ball; 601. . . . . . . . .. . .. . .. . ..... cflecull an _ _~_____:.:_ .. .._.. .____._ ',. 1'.-: ,,' 1 .. ~ ., '.:t!~, m:.Q.t I "eland Ib Spouse. . . . . . . . . ... . . -' .. ... "N " .~.. o. your .'--'c Depend,ents: . ,." .~,,(2IOtpendMrS .. (3)Degendenrs 141 1I.~"r:o.J"cfIl1dr..aftIC ~ '.socQISlcunrynum,bcr -. '. rel1llonsl'llPIO. Chk1lotcMSw._ who ",-- . 11)firslname-- ~stn3me au cncir'SH '9'.'~. ~.~ . ..fI".llridwllb,au,_ o . "itl'" dldl10111".IUI""~. o . ,:"',.Jou~u~lQdIYarcl :r~::~ O ~r ",,,,Uan .. - ;(,~I'" "1'111 ; 0 '."';'j;l,Dopi;d,n'"n.. . .,~:.O "';"':'~ci..~.I~I:_I~~ldlbOYl- ..... 0 '. "..' tbJ.MlII_umb'rs r"fl . :... .~:.: .nla~ll an -..-1...L.J . .. ,. ..... ,lIner.aboYl'" o -- d Total nUlnber cit elC."emptions dailTlcd 7 WageE!,Eatanes~~ps. e~c..A!!acl1 FoRO(s) W.2. '. Sa Taxable interest. Attach Schedule B if requi~ed b Tax:exempt interest. 00 NOT include on line Sa . . - ..~... ~ 9 ' Ordinary dividends. Attach Schedule B .f required ." . ,- -', . 10 Taxable refunds. credits. or offsel~ of state and local income taxes (see page 21) ~.ir"'- 11 Alimony ~~iv~d_ . . . . . . . . " _'.':':~ .T.;(l-'.' .'.' 12 '.BusjncSSin.comeOltlos.s):At_t:lch~cheduleCorC-EZ .' '. "'.; :.... . If I!., 13 Cap,tal gain or (loss), Attach Schedule 0'. .. . '. . . . '. .. 14 Other gains or (Iossesl. Attach Fonn 4797. . . . . . . . .> .... . . . _.~5~ . -Total IRA disinbulions. ~ U b T~abl~'~m~~nt (~ee p;ge 221' 16a Total pellS01S and 3IlnUlllCS ~ U b Taxable amounllsee page 22) ..- , 17 Rental real estate, royalties, panner~hips, 5 corpomtions, trusts. etc. A.ttac~ Schedule E 18 ,Farm Income or (Io~sl"A!!a.ch Sched~,Ie'F _' , ,', '., . ._. . , . . '.,. 19 Unemployment compensation '. ':' . . . . .. ,. -:.. . 20a Social~~unty ~n~,iits.,'I, 20a I I b Taxable amo';"l (...-page 24) : 21 Other income. List type and amount-s_ee page 24 .....................u................ <:- 22 Add the amoUnlsin thetai right column for lines 7 throu h 21. This is our total Income ... 23 lRAdeducllon(seepage25)....'. .,. " ,_",:,,~. , 23 7'24 : Studentt;,;;;;'I;,I~;~stdedu~,i~~ (~~e p;g-; 27).": ',"i' 24 25" Med'iCaJ~~~i~9S acc~nt.d~uction:.Aii3dhi=o~'8ss3 .' 25'" '~'~26 . Moving expenses'. Attach Form 3903 .!'. 26 27 One.half olsell.employment Ii,. Attach Schedule SE .'..' 27 11 hn~ 33 .s und~r - 530.095 (und~r 28 Self.e~pioyed h;ailt~ in~urance deducilon (se~ Pilgc 2Bl 28 $10.030,1 a ch,ld' '29 Keogh and sell.employed SEP and SIMPLE plans 29 did nel live wIlh ...--..-. ... _..~.- --, ... ..--. _. . -- .,-- O I S EIC . 30 Penalty on early withdrawal of savings. . . . .. 30 Y u, ee ,...., 7. 0 " ' ~ "S"9 ' 1 31 Insl, on page 36 31a AlirrvJflV.~" b Recipienl's SSN ... '1 : ~ C: tl. a -32" ,Addilnes2iihrOugh31a:: . . . . . . . -. . . . . . . . "33 "Subtract line 32 from-line 22. This is your adjusted gross in como .~:-.: ..: .- .~ ~ '-" . - ., . . For. Disclosun;,'PnvaCy Act. and Paperwork 'Reduction Act Notice, !Ice page 51. ColI. No 11320~ . ]1040 label IS... In51""cllon5 on page HI.) Use the IRS label. Olherwisf!. please prInt or type. Presldenllal Check only one ball:. Exemptions II more than SIX dependents. see page 19. Income Allach Copy B of your Forms W.2. W,2G. and 1099.R here. II you did not gel a W.2. see page 20, Enclose. but do not ~taJ:Je. an.,. payrnt!nt. Also. please use Form 1040.V. Adjusted Gross Income -. - '-,' . ..,...., "-"'.~'" ,'" ~P't:".... .,' f.--..'...,.""...,.~l~-otll1'~..rt Ii.!!'....,. ":..: ,:-'1.""'" ..-t'J\....'f~u.~-.l" ,. .~:'........t.. :";"'!:~V"~"~~ ....:6 ' ,..: ~~~ D!.':h- Tf!8surr;-~~!~~ .n~ ~~~...r~G1f6'\9 ~'.. fU.S:-lndlvldual-lncome'TalC'RelUrn-;;UiW .' '-. " '. ECRLOT ... S28 ... . . . 1I11 L . e E L KN DOUGLAS M PATRICK 116 UMBERTO ST APT C NEW CUMBERLND PA 17070-2626 I R S H E R E 1."111",111",1",111"",1,1,11,,,,1.1,11,,1.1,,1 b -L .' ...., ~..;, '.. .'. 8b ... 9. 10 11 12 13 14 .151> lab '17; ~ 00 I Y 5'2.Co 00 ~ ..."'.... ~: '-""" -Fo,m 1040 (19981 l .~ ""'.- ..",.. 11 ,- 'oJ - ouoHrc a /OSled ax anul '. 'l'j;!"';-' .'...,~ '.~Io."~ ",';'lI' , credits-."~~~~f~!~.':!'~~~~.~E,, ..',:;.. .~~!!t!~~~m':"~lo .... .' ~: '!~~'" a Ule ~ber.of boxes checked abcivo and enter the total here.J: . . ~.!' .~~~;i~~~!~~;a'ruiA"l{sePa~t~ly~ah'd"y~~i't~~~ld~I~t6n& 1 ~rd ,..:'~~~~~~P.~U..~I~~I~!U~all~'S.~P~.g~29_~~~~J(,~':.~;.~~~ _'.. : Deduction' :' =!6:: Enler,/ho larger of your nomlzei:! deductions from 5chedure A,'line 28-,-5!!!~~ ~ 'or Mosl -: ....~!"fli#Oi..thoWn..P.n:,I!(.,e";-aUlSOep,igO~~OJO_fiD!fyooT..!~il1I!id~~,y!'9,;;;~ People .... =W~~.~,~y box on hryo ,~5a ~r 35b o~ if someo!16 can claim you ~~a~ep~en~.:':..'! i,.;-"'~ .5ingla: 1I,37'1i"S;)\,lracllfn036-fromline(l4. '. . . . . .~_-;--:-:- ......:'~llr!..i..N;."~,..37- $4250' ,.,t:a~'...t',."l '):IJf"J.a~:.""''\('1''''1C~~'''Il.IJOlfII..atlt>:'''IS'bhi''.idIloJ~ol ' H.'oo 01 ".... ;W,~' !~;;J.1 '{ $93.400 or less. mulliply $2.700 by thelolal number 0' exemp.ti~ ~1!"~ed,Of1,' . household: .,. f$lne 6d.~]f. !',,!e ~.I~,~~,,~,4>~..~ ~~ wO.rk$h~t "~'P8~~ f~t~ arro~~t .. .,~ $6.250 . '39-Toxablolncome. Subtract line 3D from lino 37. ~ line 3D Is moro"tli!ui un"3~:$.:?~~ Manied filing '4J..,...T~. s.J Page' 30, ChOck ~ any ~'';';~~ID~F~.i'lI8i'4'-=-'''tf-g..''F~~972 jQ1W6' ~ jOintly or ..~.~..". ,4.....~."'. ....,.........., ..". '. , :.. ...... ..,:;".! '.. .;.". .'.'" " I.;' _ ...~...~_._.,..._,.<o_ OuaUfying. ; ~1.~):p~....f~~.~ty~.~:'!,~~~~.t,~~...ex~~. t-~.f~,~.~1, :: , 41 )':' , wldow(er). , ,42 '?Cred~ for the e1derly'or'the dlsabled~Attili:h'sd,eaul.R.~'!"'" 42' 'r ..,I~" , . $7,100 ...1"3~(\I;CIi-~d'ta?r~':i;~~.,:;' '.. 1\~3-1)"Yd.G~::cn vfm~ ~Ol! i'~-w..hi, r43! '"., :,; c,".1 ' Manied . _ ~ W~I~\.eepage ..... ....'. ". . . . . ,. ; filing' "44~~Ed.biti6.}:;r.;;rrts~Aiia'dlFinrlSB63,:,~,.et.(r"';."'lI'lW!j, "44' ,'/, or' .separately:.. ~.~Ptfon'~L~tt.chF~8839. : :',.: . :.:._~:~~.,4t5r :'.r~.l;.t. , $3.550 )"~~\"~I ...!"<\...,.....-,ol-", r"'pr'~ 1"Ier.;~ .......:111. ~r.c:....1 ~:..=- :"'}:v~~&.: ,.." ""\."'''.' ~,.~l'orel!Jn)'!"credit.-~"ach Form'1-1161~reqUlred . . . . .46. '.. .",___ " '4i',r:''other7Cii''etk"i(fr-oOi'' :rO'Fon;; 3800'(,': Il'"til O'Fo,;n'9300-:"" ., .,. ;;~~.cq Fonn:~aiil.''d 0 Fe;,." (spOOly) , . .. -':<J "47' .' ',:,1 :~ trAddUneS.41.through 47 ..~These aro your total credits -:",,~-"-':"-i--.:-.=-I. ..' ~1l;~~. 48 49",H'Subtr3'Ctlihe48 frOm'iiiia'f40. ii'lin'e 48 Is 'more thari line 40. enter.()... .... :'. ~~"')i.:~ .;'49 ....... ..._.;....:..,;1 .... '1 .-.....,.. ~-~ ~ '1....'.,." .,.....1;:.. .50 : lSe~-ernployment tax ,AttaCh Schedule 5E . -,- ...._._.._--C-....: .__ _._.. .50 . ''', '. "1 t I' . . . . , . . . . . . . . . . ','si~-"Aiie~;iiV&t rplnimum tax..Attach F:mn 6251'-"~-;-',~,~,;-;---., . . . . . -51 ""''-0''" ,..'_. " . .5,2:i;"SoCiol security and Medicare lax on lip income not reported to employer.-Attach Form 4137 '_', 52 .. ....' '.~'I \.. t I,:, . ;,5:3,~~~ ,~,I'~i ~~~?f retirement pl~.and'M~As., ~ttach Form 5329 if required~-;-...-..- ,53 . 54'11 Advance earned income credit poyments from Form(s) W-2 .. _________. 54 I' ~--._. .... t I .. . . . . . .' . . . 55 ,.,,- ~oUs:ehoid employment taxes. Attacn.Schedule H'. _.__. =._. ._._.' , ..._ '__ ~_ __.__ _ 55 ~-~:. 'r"1 ." I . I . .. .. .58 ....Add fines 49 through 55..This is our total tax. ,.... _...._...:__ _ ... ._.,.__'__ .._.-._ _56 Payments 'SZ~iF~"!.al'l~come taxwithheld.'romForms W'2'and"~99 :'-." :51' ,58 ~'"l99S esFmaled lax paymen15 and alOOUflt applied lrom 1997 "';'Iuin:" 58: 59a ,- ea'mOd r:.c;,;.;. crOdiL Al1ach Schedulo ElC if you ha", " qiJaliIyi.g !I .<<....-) I . ",. I I I I child b Nontaxable earned income: amount. .... '. -and.tYP~ .~' .....'.......~.:.................................... (II 60 -Addlli;,.l./child ia."credil.'A<<ach FormS8l2 'fi "''' ":J':" '60 61 -- Ali.o\k,t 'paid wilh Form 4868 (requestlor oxten.lon). . .' 61 . "r I .. _. ,.' 82 -- Excess,.oclal .ecurity and RATA tax withheld (see page 43) " 82 63._0lherPaYmenls. Check illrom 00 Form 2439 b 0 Form 4136" 83 '84-~ dd lines 57. 58. 59a. and 60 throu h 6::? These are ourlotal payments "~ .:;., ,:,....:. .- . ... .I. Refund ~Jin. 64 Is moro thon lino 56, subtract fine 56 'rom line 64. ThIs i. the amount you OVERPAID . --_tt .~I~ I . . . '. '" '., ". 66B;tAmount of line 55 you want REFUNDED TO YOU. . - . ".... . '. . . .'. ." ~::~~ u -::r:;-2!'.t'iJ . .... _1 '..., :....",. ,:;":::.~,' .,'.'~.,: f:'".' ','J:':' depoSIted! .. . ,b ._Routing number. .. c Type: Checking, 0 Savings '. See page 44 r "' : 0 0 0 2 2 and fill In 66b .. .d -~Account number 66c, and 66d: 67 Amoulifo/line 65 ou wonl APPUED TO YOUR 1999ESTIMATED TAX .., 87 Amount 68, ,II lin~56 Is more than line 64, subtract lino 64 from line 56. 'Thi.ls the AMOUNT YOU OWe.' You Owe ___2'For details'oo noY;iO~pay: seO~pago'44':'. ';:~;:,::_:__..;:: :.. .:'-:;~~:':;.: ~.:"~"..~;:7l~tI;~r...~ :.68. 69 EstimatEid tax 'penalty. Also include'Cn'line 68. . . .. 69 ,:: Uncler pen"alties C!' peq~rf. I d~br! ~~r Lha,-!. w.nined this return and accompanying schedules and ~tements, and to.the best of my knCwtedge ancr belief. ~~1.~' co~~:.~~~omplel~~Jf~of~~~~f.(~.~~~~'~lez~1~~~1~~:r~!1fW:~~e[~s ~~~~~ YOUt signature .,.. J Oala Yo;r' oC.cupa.t~..., '. '. DaytuM telephone . I ~ . .. . number (optIOnal) '. ;:::...---- , . 11,. . pause's sig"illUle, II ,] Jornt relurn. 80TH musl sign. ",." r'11712~2-JI/I' Joint return? See page 18. Keep a copy for your records. Pal'd P'ep",e'" It.. slgnJlUle , I Preparer's 'F;rm"I1iU11.(~';"U" It.. Use Only i~d~:~;,m",~ed),and r Other Taxes A"ach Forms W.2 and W.2G on the front. Also attach Form 1099.R if tax was withheld. Sign Here ';"'. ,'. , ....(,.,':1 .. .1' r . I' ~ ; ..;; .I " " I I I I' Dale Prepare,', SClCI.lI security no. Check i; . , ""..motovea El .. " EIN ZIP code ....;" -:.-.. _...~.. --"~'"'.''' ..-.----:... -':'". -- -:-~'-~:"-~,~"""l~ I.AW OPPlGllS BARBARA SUMPLE-SULLIV.AN "40 IllllDOll STUllllT NllW GUHIIBlILAND. PllNNSYLVANlA 17070-1001 PIIONIl (717) 7....\448 l' AX (7.7) 774-70ftO August 3, 1999 E. Robert Elicker, II, Esquire Divorce Master 9 North Hanover Street Carlisle, PA 17013 Re: Patrick v, Patrick No. 97-2814 Dear Divorce Master Elicker: Pursuant to your leller dated March 8, 1999, the hearing scheduled in this mailer for August 12, 1999 is for the purpose of taking testimony on the factor of marital misconduct as that factor may affect Mrs, Patrick's alimony claim, Since Mrs. Patrick will be the only witness testit)ring concerning marital misconduct and in the interest of judicial economy, the parties have agreed that the hearing scheduled before you on August 12, 1999 not only will address marital misconduct but the balance of the issues. It is anticipated that any testimony concerning marital misconduct will be addressed in each party's direct testimony, Please contact me if this is not acceptable. Thank you. BSS/lw cc: Rebecca R. Hughes, Esquire Douglas Patrick , . DOUGLAS M. PARTICK, IN THE COURT OF COMMON PLEAS OF Plaintiff . CUMBERLAND COUNTY, PENNSYLVANIA . . . vs. . NO. 9? - 2814 CIVIL . . . DENISE D. PATRICK, : Defendant IN DIVORCE ORDER OF COURT ~ AND NOW, this ~ day the parties and counsel having entered into , 1999, eement and stipulation resolving the economic issues on August 12, 1999, the date set for a Master's hearing, the agreement and stipulation having been transcribed and subsequently signed by the parties and counsel, the appointment of the Master is vacated, and counsel can conclude the proceedings by the filing of a praecipe to transmit the record with the affidavits of consent of the parties so that a final decree in divorce can be entered. BY THE COURT, P.J. cc: Barbara Sumple-Sullivan Attorney for Plaintiff - C'~JJ 17>......6.( 1111 3/ 'I' . .oS. p. Rebecca R. Hughes Attorney for Defendant DOUGLAS M. PATRICK, Plaintiff vs. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 97 - 2814 CIVIL DENISE D. PATRICK, Defendant IN DIVORCE THE MASTER: Today is Thursday, August 12, 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, Douglas M. Patrick, and his counsel Barbara Sumple-Sullivan, and the Defendant, Denise D. Patrick, and her counsel Rebecca R. Hughes. A divorce complaint was filed on May 28, 1997, raising grounds for divorce of irretrievable breakdown of the marriage. Although an affidavit under Section 3301(d) was filed on February 23, 1999, averring a two year separation, counsel have indicated that the parties will sign and file affidavits of consent and waivers of notice of intention to request entry of divorce decree so that the divorce can be concluded under Section 3301(c) of the Domestic Relations Code. When counsel and parties return later today to review the draft of the agreement, they will provide the Master with signed affidavits and waivers. The parties were married on March 12, 1983, and separated January 19, 1997. They are the natural parents of four minor children, all of whom are in the custody of wife. The complaint that was filed on May 28, 1997, raised the economic claim of equitable distribution which is the only economic issue currently pending before the Master. The Master has been advised by counsel that after negotiations this morning the parties have reached an agreement with respect to the economic issue of equitable distribution. An agreement is going to be placed on the record in the presence of the parties. The agreement as stated on the record will be considered the substantive agreement of the parties not subject to any changes or modifications except for correction of typographical errors which may be made during the transcription. The parties and counsel will return later today to review the draft of the agreement for typographical errors, make any corrections that are required, and then affix their signatures to the agreement by way of affirmation of the terms of settlement which are being placed on the record at this time. Following the receipt by the Master of the signed agreement, the Master will prepare an order vacating his appointment and counsel can file a praecipe transmitting the record to the Court requesting a final decree in divorce. Ms. Sumple-Sullivan. MS. SUMPLE-SULLIVAN: Thank you. This represents the agreement of the parties in regards to full settlement of the marital issues between Douglas M. Patrick and Denise D. Patrick. 1. REAL ESTATE: The parties own a home at 404 East Walnut street, Shiremanstown, Pennsylvania 17011. All rights, titles, and interest in that real estate shall be vested in wife. Wife agrees to pay all expenses, costs incident to that property including but not limited to taxes, insurance, mortgage payments, and shall indemnify and hold husband harmless for all of those expenses. The home is currently encumbered by a mortgage with Mellon Financial with an approximate balance of $76,600.00. Wife agrees to pay in a timely manner that mortgage obligation. Additionlly wife agrees to immediately attempt to refinance that mortgage obligation in her sole name. In the event that wife is not able to immediately refinance that, she will have a period of up to two years to effectuate that refinancing. If the refinancing is not completed at the end of two years, the house shall be listed for sale. Pending refinancing of husband of the mortgage obligations, husband's name shall remain on the deed to the marital home. Husband shall execute and provide to counsel for husband a deed which will be escrowed by counsel for husband to be released at the time of wife's refinancing. In the event wife should die prior to the time of effectuating the refinancing, husband's deed shall be released for recording upon her estates' satisfaction of the outstanding mortgage. 2, ACCOUNTS: At the time of separation the parties had a marital checking account with PNC with a value of $336.03; a savings account with PNC with a balance of $1,458,69; and a federal credit union account with a balance of $130.82. The parties have amicably divided those accounts, with wife receiving distribution of $1,389.78 and husband receiving distribution of $535.76. This shall constitute full distribution of the marital accounts. 3. VEHICLES: The parties have two vehicles, a 1993 Ford Aerostar van and a 1997 Ford F150 truck. The 1993 Ford Aerostar van shall become the sole property of wife. That Aerostar van is currently encumbered with a loan to Pennsylvania National Bank and wife agrees to assume the obligation to satisfy that loan in full and to indemnify and save husband harmless against such debt. Husband shall cooperate with transferring all title and interest . I in that van to wife and sign all necessary documents necessary to effectuate that transfer. The 1997 Ford F150 truck shall become the sole property of husband. That is a leased vehicle. Husband shall be solely responsible for the lease payments incident to that vehicle and shall indemnify and hold wife harmless for any obligation on that lease arrangement. 4. PENSION: Husband has accumulated a value in an employment pension plan known as the Sysco corporation Retirement Plan. Wife waives all rights, title, and interest or any claims to said benefit, and said benefit existing with the Sysco corporation Retirement Plan shall be the sole and separate property of husband. Husband also, as an employment benefit, has a benefit in the Sysco Corporation Savings Incentive Plan, SIP. Husband agrees that wife shall be entitled to receive $12,000.00 from the existing balance of the sysco Corporation Savings Incentive Plan. It is the intentions of the parties that that transfer shall be done in a tax free nature to either party and that wife shall arrange for the transfer into a retirement or other qualified plan which would effectuate the transfer being tax free to the parties. Counsel for wife shall take the necessary steps to implement the division of the $12,000.00 from the savings plan to the account of wife. 5. PERSONAL PROPERTY: All personal property that is in the possession of each party shall be their sole and separate property and each party waives claims on any property that is in the current possession of the other party. 6. MARITAL DEBT: At the time of separation there existed one marital debt, being a VISA, in the amount of $320.72. It is acknowledged that husband has paid that debt and there are no outstanding marital obligations. 7. Additionally, the parties have agreed that they will stipulate for entry at the Domestic Relations Office for a child support order, effective September 1, 1999, in the amount of $930.00 per month. It is further stipulated between the parties that for future calculations of child support payments, the sum of $200.00 per month shall be added to wife's gross income for purposes of calculating child support obligations between the parties for a period of three and a half years from September 1, 1999. 8. Except as herein otherwise provided, each party may dispose of his or her property in any way and each party hereby waives and relinquishes any and all rights he or she may now have or hereafter acquire under the present or future laws of any jurisdiction to share in the property or the estate of the other as a result of the marital relationship including without limitation, statutory allowance, widow's allowance, right of intestacy, right to take against the will of the other, and right to act as administrator or executor in the other's ostate. Each will at the request of the other execute, acknowledge, and deliver any and all instruments which may bo necessary or advisable to carry into effect this mutual waiver and relinquishment of all such interests, rights, and claims. MS, SUMPLE-SULLIVAN: Mr. Patrick, you've been present in the hearing room today when I recited the terms of the settlement agreement relative to your divorce; is that correct? MR. PATRICK: That's correct. MS. SUMPLE-SULLIVAN: And you've heard the terms that I have indicated. Are you in agreement that those terms represent the accurate statement of the terms that you agree are appropriate to settle this matter? MR. PATRICK: Yes. MS. SUMPLE-SULLIVAN: Do you have any questions about those terms? MR. PATRICK: No. MS. SUMPLE-SULLIVAN: Do you understand that by acknowledging this agreement today, that you waive any and all claims to have any of those issues litigated? ~i I&< .,.'r ~~~~ O!j~ >!l, 1.11' .... ... II~~~ 1& . :::l i:l III "'...~~:W '" I tl a ... '3 ~l!l~l!l rl] ~CI) 0"-" 1~"llpl . GI O!:j t,l... ~ ~~ ... 8 0 ra. tCJt:= ij'" ~ o~ ~l:l ~ 5;! lil. 08oi1l~l:l ;~ :s \, I ~. ,;d II~~~ '" :J -=1 . . I~I~ ~ ill:;t lI: I> . ;1 !:l i ' CJOI i . , ~~ ra:I It' , '" 15 ~"'~ ;'~ ~, !:l .. .c'.< LAW OFFICES '~f'fil, .It. :%'tjhl &. ;yt:yhfJ . NOV 2 4 ~,\) "'I' \ '. Plan as of the Plan valuation date immediately preceding the date of this Order, adjusted by a pro rata allocation of earnings and losses in accordance with Plan provisions and that the Alternate Payee shall have no interest in the balance of the Participant's entire Account in the 401 (k) Plan not awarded to Alternate Payee. 2, The Trustee of the 40 I (k) Plan shall pay to the Alternate Payee the 40 I (k) Plan benefits awarded to her adjusted by a pro rata allocation of earnings and losses in accordance with Plan provisions, in the form of a single sum payment entirely in cash at the earliest time payment can be made under the terms of the Plan after the Committee has determined that this Order is a qualified domestic relations order within the meaning of Section 206{ d) of the Employee Retirement Income Security Act of 1974, as amended, and satisfies the requirements of Section 414(p) of the Internal Revenue Code of 1986, as amended (the "Code"). The Alternate Payee shall be entitled to payment of the 40 I (k) Plan benefits awarded to her only if the Account is or becomes vested under the terms of the 40 I (k) Plan. 3. To the extent that the Trustee of the 401{k) Plan erroneously pays to the Participant any benefits that are payable to the Alternate Payee under this Order, the Participant shall be deemed to be a trustee holding the amount of such benefits in a constructive trust for the benefit of the Alternate Payee. The Participant is ordered to pay such amount to the Alternate Payee within five days after he receives such amount. 2 4, To the extent that the Trustee of the 40 I (k) Plan erroneously pays to the Alternate Payee any benefits that are payable to the Participant under this Order, the Alternate Payee shall be deemed to be a trustee holding the amount of such benefits in a constructive trust for the benefit of the Participant. The Alternate Payee is ordered to pay such amount to the Participant within five days after she receives such amount. 5. The mailing address of the Alternate Payee is 404 East Walnut Street, Shiremanstown, Pennsylvania, 170 II, her birth date is June 10, 1960, and her Social Security number is 209-50-8967. 6. The mailing address of the Participant is 116C Umberto Avenue, New Cumberland, Pennsylvania, 17070, his birth date is December 4, 1964, and his Social Security number is 162-60-9835. 7. This Order shall not require the 401{k) Plan to provide any type or fonn of benefit, or any option, not otherwise provided by the 40 I (k) Plan; nor require the 40 I (k) Plan to provide increased benefits (detennined on the basis of actuarial value). 8. This Order does not require the 401{k) Plan to provide benefits to Alternate Payee that are required to be paid to another Alternate Payee under another order previously detennined to be a qualified domestic relations order. 3