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AGREEMENT
, THIS AGREEMENT made thls.QL day of March, 2000, by and between Paul
G, Davenport, of 8630 82nd Street, Apartment 101, Pleasant Prairie, Wisconsin 53158
(hereinafter referred to as "Husband"), and Helen p, Davenport, of 21 Stone Ledge
Road, Newville, Pennsyl~anla 17241 (hereinafter referred to as "Wife"),
WITNESSETH THAT:
WHEREAS, Husband and Wife were lawfully married on February 29, 1964, at
Winston Salem, North Carolina;
WHEREAS, three children have been born of this marriage, all of whom are
adults;
WHEREAS, differences have arisen between Husband and Wife in consequence
of which they have lived In separate residences since August 1, 1997;
WHEREAS, Husband and Wife desire to settle and determine their property and
marital rights and obligations, including rights to support, alimony pendente lite, alimony
and counsel fees and costs;
NOW, THEREFORE, the parties, Intending to be legally bound hereby, do
covenant and agree as follows:
1, SEPARATION: It shall be lawful for each party at all limes hereafter to
live separate and apart from the other party at such place as he or she may from time
to time choose or deem fit. The foregoing provisions shall not be taken as an
admission on the part of either party of the lawfulness or unlawfulness of the causes
leading to their living apart,
2 INTERFERENCE: Each party shall be free from Interference, authority,
and contact by the other, as fully as If he or she were single and unmarried except as
may be necessary to carry out the provisions of this Agreement. Neither party shall
molest the other or allemptto endeavor to molest the other, nor compel the other to
cohabit with the other, or in any way harass or malign the other, nor in any way Interfere
with the peaceful existence, separate and apart from the uther, and each of the parties
hereto completely understands and agrees that neither shall do or say anything to the
children of the parties at anytime which might in any way influence the children
adversely against the other party.
3, ~'S DEBTS: Except as otherwise set forth herein, Wife represents
and warrants to Husband that since the separation she has. not contracted or incurred
and in the future will not contract or incur any debt or liability for which Husband or his
estate might be responsible and shall Indemnify and save harmless Husband from any
and all claims or demands made against him by reason of obligations Incurred by her,
4, HUSBAND'S DEBTS: Except as otherwise set forth herein, Husband
represents and warrants to Wife that since the separation he has not contracted or
incurred and In the future he will not contract or incur any debt or liability for which Wife
or her estate might be responsible and shall Indemnify and save harmless Wife from
.2.
any and all claims or demands made against her by reason of debts or obligations
Incurred by him,
5, MUTUAL RELEASE: Subject to the provisions of this Agreement, each
party has released and discharged and by this Agreement does for himself or herself
and his or her heirs, legal representatives, executors, administrators and assigns,
release and discharge the other of and from all causes of action, claims, rights, or
demands, whatsoever in law or equity, which either of the parties ever had or now has
against the other, except for: (a) any or all cause or causes of action for divorce; (b)
any or all causes of action for breach of any provisions of this Agreement.
6. HOUSEHOLD GOODS AND TANGIBLE PERSONAL PROPERTY:
a, Husband does hereby transfer, assign and set over to Wife all of
his right, title and Interest in and to all household goods and tangible personal
property that is In the possession of Wife as of the date of this Agreement, with
the exception of an antique wooden canoe that is the property of Husband and 15
currently stored at 21 Stone Ledge Road, Wife agrees that the canoe may
remain at 21 Stone Ledge Road until Husband or his designee is in a position to
take possession of it, or until Wife sells the home, whichever first occurs,
However, Wife may require Husband to remove the canoe at an earlier date
upon 60 days written notice to Husband.
-3.
Husband and Wife, Wife has not yet deposited the check she received
from Husband for her share of the proceeds, If the check Is not accepted
~y the bank, Husband agrees to write a new check to Wife for her share of
these proceeds,
8, REAL ESTATE:
a, 21 Stone Ledge Road, The parties currently own In Joint
names the property located at21 Stone Ledge Road, Newville,
Pennsylvania, Husband agrees to and shall execute a deed transferring
to Wife all of his right, title and Interest In said property. Wife agrees to
and shall indemnify and hold Husband harmless from any and all liability
with respect to said property, Tille to said property shall be transferred to
Wife at the time of execution of this Agreement. The property is
transferred to Wife subject to the mortgage to First Nationwide that is
secured by said property. Wife shall be solely responsible for payment of
. the mortgage and shall Indemnify and hold Husband harmless from any
and all liability regarding the mortgage, Wife shall not be obligated to
refinance the existing mortgage or to obtain Husband's release from the
mortgage, Wife, however, agrees to cooperate with Husband in the event
Husband, at his sole expense, seeks to obtain his release from the
mortgage, Wife shall not be required to accept any mortgage terms upon
.5.
Husband, Wife shall be entitled to recoup all such sums she pays to the
Insurance company or companies that were or are the obligation of
Husband pursuant to this Agreement and, In addition thereto, shall be
entitled to collect an addltlona/15% of all amounts paid by her and shall
be entitled to collect actual legal fees Incurred In obtaining reimbursement
from Husband, Husband shall have no obligation to pay Wife's portion of
the premium, and If Wife defaults so that the policy or policies lapse,
Husband shall have no further obligations under this Paragraph. Each
party hereby agrees to make arrangements for the payment of his or her
share of the premium payment by way of an allotment from the military
retirement pay that shall be apportioned between Husband and Wife
pursuant to Paragraph 15 below.
b, Any and all other life Insurance policies shall be and are
hereby assigned to the party currently owning said policies,
10, CASH, MONEY MARKET, SAVINGS AND CHECKING ACCOUNTS:
a, Wife does hereby transfer, assign and set over to Husband
any and all Interest In any and all cash, money market, checking, savings
accounts in the name of Husband as follows:
1) Navy Federal Credit Union Account No, 2060454705;
.7.
2) Navy Federal Credit Union Account No, 0135554-
004; and
3) Navy Federal Credit Union Account No, 013554-707.
b. Husband does hereby transfer, assign and set over to Wife
any and all Interest In any and all cash, money market, savings or
checking accounts In the name of Wife as follows:
1) PNC Bank Savings Account No, 508-0130587; and
2) Navy Federal Credit Union Account No, 0135554-103,
11, CUBIC CORPORATION 4011Kl ACCOUNT: The entire balance of the
Cubic Corporation 401 (K) Account No, 150-30-4016, Plan No, 007850, currently In the
name of Husband shall be transferred to Wife pursuant to a Qualified Domestic
Relations Order or other required documents so that there will be no tax consequences
to either party as a result of the transfer. Husband shall prepare the required
Stipulation for the Entry of a Qualified Domestic Relations Order and provide it to
counsel for Wife on or before April 15, 2000, The balance in the 401(K) account as of
February 2, 2000 was $34,935,70,
.8-
12, IRA ACCOUNTS:
a, Husband does hereby transfer to Wife any and all Interest he may
have In Wife's Oppenheimer Funds IRA Account No, 70070037924554,
b. Wife hereby transfers to Husband any all Interest she may have In
Husband's Oppenheimer Funds IRA Account No, 7007003792426,
13, SEP~RATE PROPERTY OF THE PA~:
a, All non-marital assets of the respective parties shall be
retained by the party who currently owns them, except that Husband
acknowledges that the entire balance of the Cubic Corporation 401 (K)
plan shall be transferred to Wife, Including the contribution made to the
plan after separation,
b, 'Mfe hereby specifically transfers, assigns and sets over to
Husband any and all right, title and interest that she may have In the
property at Griffin Road, Indian Lake, New York, and any and all other
property received or to be received by Husband from his mother's estate,
c, Husband hereby specifically transfers, assigns and sets over
to Wife any and all right, title and Interest that he may have in all non-
marital property of Wife,
-9-
14, MILITARY RETIREMENT:
a, Husband Is retired from the United Slates Marine Corps, He
Is currently receiving retirement benefits, A copy of the retiree account
statement as of February 1, 2000 is attached hereto as Exhibit "A", The
following provisions apply to the military retirement.
b, The parties agree that the portion of the retired pay
represented by the VA waiver, which on Exhibit "A" Is the amount of $813
per month, Is a disability component of the retirement and Is not marital
property and not subject to equitable distribution,
c, The parties agree that the marital portion of the remaining
pension, after deducting the VA waiver, is 90,23% (representing
$3,669,95 based on Exhibit "A"), based on Husband beginning active duty
service on March 15, 1961, the parties' marriage on February 29, 1964
and Hu~band's retirement from active duty on July 1,1991, (328 months
of service while married and a total of 363.5 months of active duty
service), The parties further agree that 9.77% (representing $397,35
based on Exhibit "A") of the remaining portion of the pension is the non-
marital property of Husband, Any increase in the retirement shall be
allocated pro rata based on the above percentages,
-10-
b, Husband has made the $1,357 payment of alimony
pendente lIIe/spousal support pursuant to the above referenced Order to
the Support Office for the month of March 2000, With such payment
mode in March 2000, the parties agree that Husband's alimony pendente
lIIe/spousal support obligation pursuant to the above Order has ended
and that no further payments are or shall be owing 10 Wife pursuant to the
Support Order dated January 12, 1998, as amended on February 5,1998,
On or before April 20, 2000, Wife, through her counsel, shall file the
necessary documents with the Support Office to terminate the Support
Order effective March 31, 2000,
c, Husband agrees that beginning with the receipt of his
military retirement pay for April 2000 and for each month thereafter until
50% of the marital portion of the retired pay is allocated and actually paid
to Wife pursuant to Paragraph 15 above and the contemplated Military
Retirement Benefit Division Order, Husband shall pay to Wife promptly, by
the 5th day of each month, upon receipt of his monthly retired pay in April
2000 and each month thereafter until the contemplated Order becomes
effective 50% of 90,23% of the gross retired pay received by him after
subtracting the VA waiver, but before any withholding for taxes. All such
payments made by Husband to Wife shall be treated as alimony and
.12-
considered as taxable Income to Wife and deductible by Husband
pursuant to the provisions of the Internal Revenue Service Code,
d. Except as set forth In subparagraphs (a)-(c) above, no other
alimony shall be paid by Husband to Wife or by Wife to Husband.
16, REPRESENTATION AND WARRANTY OF FULL DISCLOSURE: Each
party hereby represents and warrants to the other that he or she has made a full and
fair disclosure of all of his or her Income and assets, Each party shall furnish to the
other party their federal Income tax returns through 1999,
17, A rrORNEYS FEES AND EXPENSES: Each party shall be solely
responsible for payment of their respective attorneys' fees and expenses,
18, MEDICAL INSURANCE COVERAGE: After the entry of a divorce decree,
each party shall be solely responsible for his or her own medical insurance coverage,
19, WAIVER OF ~LAIMS AGAINST ESTATES: 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,
dower, curtesy, statutory allowance, widow's allowance, right to take in intestacy, right
to take against the will of the other, and right to act as administrator or executor of the
other's estate, amI each will at the request of the other execute, acknowledge and
-13-
deliver any and allln6truments which may be necessary or advi6able to carry Into effect
this mutual waiver and relinquishment of all such Interests, rights and claims,
20, ASSUMPTION OF MARITAL DEBTS:
a, Husband hereby agrees to be solely responsible for the payment of
the U,S, Department of Education loan for Nancy Davenport with a remaining
balance due of approximately $19,000, Husband agrees to Indemnify and hold
Wife harmless from any and all obligation with respect to said loan,
b, Husband agrees to be solely responsible for all outstanding credit
card obligations that existed as of the date of separation, and agrees to
Indemnity and hold Wife harmless from any and all such obligations, The credit
card accounts outstanding are as follows:
1) USAA MastercardNisa Account No, 5416300832070503;
2) Visa Account No, 4428-9600-0303-8628;
3) Visa Gold Account No, 4445302248039245;
4) Visa Gold Account No, 4445320161208654; and
5) MBNA Account No, 4264292436000216.
21, DIVORCE: Husband has instituted a divorce action to No. 97-4546 Civil
in the Court of Common Pleas of Cumberland County, Pennsylvania. Nothing herein
contained shall be deemed to prevent the parties from proceeding in the said suit for
absolute divorce against the other and In the said Court, and the parties agree to obtain
-14-
a divorce by mutual consent pursuant to Section 3301(c) of the Divorce Code.
Affidavits of Consent to a 3301(c) divorce shall be signed on or prior to the closing date,
22, BREACH: If either party breaches any provision of this Agreement, the
other party shall have the right, at his or her election, to sue for damages for such
breach or seek such other remedies or relief as may be available to him or her, and the
party breaching this contract shall be responsible for payment of reasonable legal fees
and costs Incurred by the other In enforcing his or her rights under this AgrE1(IIIl~nt
23, BDDITIONAL INSTRUMENTS: Each of the parties shall from time to time
at the request of the other execute, acknowledge, and deliver to the other party any and
all further instruments that may be reasonably required to give full force and effect to
the provisions of this Agreement. Such consent will not be unreasonably withheld,
24. VOLUNTARY EXECUTION: The provisions of this Agreement and their
legal effect an. fully understood by the parties, and each party acknowledges that the
Agreemel')t is fair and equitable, that it is being entered into voluntarily with full
disclosure of assets, and that it is not the result of any duress or undue Influence.
25. ENTIRE AGREEMENT: This Agreement contains the entire
understanding of the parties and there are no representations, warranties, co'.pnants,
or undertakings other than those expressly set forth herein.
26, MODIFICATION AND WAIVER: A modification or waiver of any of the
provisions of this Agreement shall be effective only If made In writing and executed with
-15-
the same formality as this Agreement. The failure of either party to Insist upon strict
performance of any of the provisions of this Agreement shall not be construed as a
waiver of any subsequent default of the same or similar nature,
27, ACCEPTANCE BY PARTIES: Husband and Wife accept this Agreement
In lieu of and In full and final settlement and satisfaction of all claims and demands that
he or she may now or hereafter have against the other for support and maintenance, for
alimony, alimony pendente lite, counsel fees, costs and expenses or any other charge
of any nature whatsoever,
28, REVIEW BY COUNSEL: Husband and Wife acknowledge that the terms
and provisions of this Agreement have been reviewed by their respective counsel and
the Agreement Is being executed upon advice of and after consultation with counsel.
29, APPLICABLE LAW: This Agreement shall be construed under the laws of
the Commonwealth of Pennsylvania,
30, INCORPORATION OF AGREEMENT INTO DIVORCE DECREE: The
parties agree that the provisions of this Agreement shall be Incorporated Into but not
merged into the divorce decree to be entered into by the parties and shall be
enforceable by court order,
-16-
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No notice or document shall be deemed to be given to the Plan unless such notice or
document Is sent by certified mall, return receipt requested, to the above address,
6, The Court finds that Participant's Plan accumulated account balance
during the period of Partlclpant's marriage ~o Alternate Payee such that the Participant's
Interest In the Plan Is part of the marital property of Participant and Alternate Payee;
end
7, IT IS HEREBY ORDERED that one hundred percent (100%) of the value
of the Participant's Plan Account No, 150-30-4016, Plan No, 7850, determined as of the
date of this Order, plus earning gains or losses thereon from such date, Is allocated and
assigned to the exclusive benefit of Alternate Payee. For this purpose, In determining
the value of the Participant's account on such date, the balance due (of Interest and
principal) on any existing loan to the Participant will be Included. However, the
Participant Is allocated all of the outstanding balance of any loan at all times for all
purposes under this Order and the Plan,
The Plan Administrator shall establish a segregated account for Alternate
Payee's assigned share of the Participant's Plan account. The Plan Administrator may
treat Alternate Payee as a Plan participant under the Plan, to the extent provided under
the Plan and as further determined by the Plan Administrator,
,.3-
8, The amount In the Plan allocated to the Alternate Payee in Paragraph 7
will be paid upon the election and In the form chosen by Alternate Payee pursuant to
the terms of the Plan and In accordance with applicable law.
The Alternate Payee shall have no rights with respect to election of form
of payment on Participant's portion of benefit not allocated to Alternate Payee.
g, Notwithstanding the above, if the amount allocated to the Alternate Payee
Is less than $3,500, the amount will automatically be paid out in a single lump sum
payment to the Alternate Payee pursuant to this Qualified Domestic Relations Order,
10, If Alternate Payee dies before Alternate Payee has received the full
amount due under Paragraph 7, the balance or amount, if any, of Alternate Payee's
Plan accounts which Is payable after Alternate Payee's death, shall, to the extent
permitted by the Plan and in accordance with applicable law, be paid to Alternate
Payee's beneficiary, or If there is no beneficiary, to Alternate Payee's estate or as
otherwise provided by the Plan.
11, Alternate Payee shall promptly provide such written requests for payment,
consent to payment, receipt of payment, and other information as the Plan may from
time to time request or require,
12, The Participant, the Alternate Payee, and the Court intend this Order to
be a Qualified Domestic Relations Order within the meaning of Section 414(p) of the
-4-
Internel Revenue Code, In the event any Order submitted to the Plan Administrator of
the Plan Is held not to be a Qualified Domestic Relations Order within the meaning of
Section 414(p), the parties shall submit to and request a Court of competent jurisdiction
to modify the Order to make it a Qualified Domestic Relations Order in such a manner
that will reflect the intent as herein expressed and thereafter to enter an Order
modifying the Domestic Relations Order entered pursuant thereto,
13, The Court shall reserve jurisdiction to make any other Orders relative to
the Plan that are necessary herein to carry out the terms of this Qualified Domestic
Relations Order,
IT IS FURTHER ORDER AND ADJUDGED that Alternate Payee shall be solely
responsible for all income taxes on the Plan monies awarded and distributed to
Alternate Payee herein and shall indemnify and hold Participant harmless from any
liability for such taxes,
IT IS FURTHER ORDERED that nothing in this Order shall be construed to (a)
require the Plan to provide any type or form of benefit, or any option, not otherwise
provided under said Plan; (b) require the Plan to provide increased benefits
.5.
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AGREEMENT
THIS AGREEMENT made this g I day of March, 2000, by and between Paul
G. Davenport, of 8630 82nd Street, Apartment 101 , Pleasant Prairie, Wisconsin 53158
(hereinafter referred to as "Husband"), and Helen p, Davenport, of 21 Stone Ledge
Road, Newville, Pennsylvania 17241 (hereinafter referred to as "Wife"),
WITNESSETH THAT:
WHEREAS, Husband and Wife were lawfully married on February 29, 1964, at
Winston Salem, North Carolina;
WHEREAS, three children have been born of this marriage, all of whom are
adults;
WHEREAS, differences have arisen between Husband and Wife In consequence
of which they have lived In separate residences since August 1, 1997;
WHEREAS, Husband and Wife desire to settle and determine theil' property and
marital rights and obligations, including rights to support, alimony pendente lite, alimony
and counsel fees and costs;
NOW, THEREFORE, the parties, intending to be legally bound hereby, do
covenant and agree as follows:
1, SEPARATION: It shall be lawful for each party at all times hereafter to
live separate and apart from the other party at such place as he or she may from time
to time choose or deem fit. The foregoing provisions shall not be taken as an
admission on the part of either party of the lawfulness or unlawfulness of. the causes
leading to their living apart,
2, INTERFERENQE: Each party shall be free from Interference, authority,
and contact by tha other, as fully as If he or she were single and unmarried except as
may be necessary to carry out the provisions of this Agreement. Neither party shall
molest the other or attempt to endeavor to molest the other, nor compel the other to
cohabit with the other, or in any way harass or malign the other, nor in any way Interfere
with the peaceful existence, separate and apart from the other, and each of the parties
hereto completely understands and agrees that neither shall do or say anything to the
children of the parties at anytime which might in any way Influence the children
adversely against the other party,
3, WIFE'S DEBTS: Except as otherwise set forth herein, Wife represents
and warrants to Husband that since the separation she has not contracted or Incurred
and in the future will not contract or Incur any debt or liability for which Husband or his
estate might be responsible and shall indemnify and save harmless Husband from any
and all claims or demands made against rim by reason of obligations incurred by her,
4, HUSBAND'S DEBTS: Except as otherwise set forth herein, Husband
represents and warrants to Wife that since the separation he has not contracted or
incurred and in the future he will not contract or Incur any debt or liability for which Wife
or her estate might be responsible and shall Indemnify and save harmless Wife from
-2-
any and all claims or demands made against her by reason of debts or obligations
Incurred by him,
5, MUTUAL RELE~, Subject to the provisions of this Agreement, each
party has released and discharged and by this Agreement does for himself or herself
and his or her heirs, legal representatives, executors, administrators and assigns,
release and discharge the other of and from all causes of action, claims, rights, or
demands, whatsoever in law or equity, which either of the parties ever had or now has
against the other, except for: (a) any or all cause or causes of action for divorce; (b)
any or all causes of action for breach of any provisions of this Agreement.
6, HOUSEHOLD GOODS AND TANGIBLE PERSONAL PROPERTY:
a, Husband does hereby transfer, assign and set over to Wife all of
his right, title and interest in and to all household goods and tangible personal
property that Is in the possession of Wife as of the date of this Agreement, with
the exception of an antique wooden canoe that Is the property of Husband and Is
currently stored at 21 Stone Ledge Road, Wife agrees that the canoe may
remain at 21 Stone Ledge Road until Husband or his designee is in a position to
take possession of It, or until Wife sells the home, whichever first occurs,
However, Wife may require Husband to remove the canoe at an earlier date
upon 60 days written notice to Husband,
-3-
Husband and Wife, Wife has not yet deposited the check she received
from Husband for her share of the proceeds, If the check Is not accepted
by the bank, Husband agrees to write a new check to Wife for her share of
these proceeds.
8. REAL ESTATE:
a, 21 Stone Ledge Road, The parties currently own In Joint
names the property located at 21 Stone Ledge Road, Newville,
Pennsylvania. Husband agrees to and shall execute a deed transferring
to Wife all of his right, title and Interest In said property, Wife agrees to
and shall Indemnify and hold Husband harmless from any and all liability
with respect to said property. Title to said property shall be transferred to
Wife at the time of execution of this Agreement. The property Is
transferred to Wife subject to the mortgage to First Nationwide that Is
secured by said property, Wife shall be solely responsible for payment of
the mortgage and shall indemnify and hold Husband harmless from any
and all liability regarding the mortgage, Wife shall not be obligated to
refinance the existing mortgage or to obtain Husband's release from the
mortgage, Wife, however, agrees to cooperate with Husband in the event
Husband, at his sole expense, seeks to obtain his release from the
mortgage. Wife shall not be required to accept any mortgage terms upon
-5-
Husband, Wife shall be entitled to recoup all such sums she pays to the
Insurance company or companies that were or are the obligation of
Husband pursuant to this Agreement and, In addition thereto, shall be
entitled to collect an additional 15% of all amounts paid by her and shall
be entitled to collect actual legal fees Incurred In obtaining reimbursement
from Husband, Husband shall have no obligation to pay Wife's portion of
the premium, and If Wife defaults so that the policy or policies lapse,
Husband shall have no further obligations under this Paragraph, Each
party hereby agrees to make arrangements for the payment of his or her
share of the premium payment by way of an allotment from the military
retirement pay that shall be apportioned between Husband and Wife
pursuant to Paragraph 15 below,
b, Any and all other life Insurance policies shall be and are
hereby assigned to the party currently owning said policies.
10, CASH, MONEY MARKET. SAVINGS AND CHECKING ACCOUNTS:
a, Wife does hereby transfer, assign and set over to Husband
any and all Interest in any and all cash, money market, checking, savings
accounts In the name of Husband as follows:
1) Navy Federal Credit Union Account No. 2060454705;
-7-
12, IRA ACCOUNTS:
a. Husband does hereby transfer to Wife any and all Interest he may
have In Wife's Oppenheimer Funds IRA Account No. 70070037924554,
b, Wife hereby transfers to Husband any all Interest she may have In
Husband's Oppenheimer Funds IRA Account No. 7007003792426.
13, SEPARATE PROPERTY OF THE PARTIES:
a, All non-marital assets of the respective parties shall be
retained by the party who currently owns them, except that Husband
acknowledges that the entire balance of the Cubic Corporation 401 (K)
plan shall be transferred to Wife, Including the contribution made to the
plan after separation,
b. Wife hereby specifically transfers, assigns and sets over to
Husband any and all right, title and Interest that she may have In the
property at Griffin Road, Indian Lake, New York, and any and all other
property received or to be received by Husband from his mother's estate,
c, Husband hereby specifically transfers, assigns and sets over
to Wife any and all right, title and interest that he may have in all non-
marital property of Wife.
.9-
14, MILITARY REIJREMaa:
a, Husband 15 retired from the United States Marine Corps, He
Is currently receiving retirement benefits, A copy of the retiree account
statement as of February 1, 200015 allached hereto as Exhibit "A", The
following provisions apply to the military retirement.
b, The parties agree that the portion of the retired pay
represonted by the VA waiver, which on Exhibit "A" Is the amount of $813
per month, Is a disability component of the retirement and is not marital
property and not subject to equitable distribution,
c, The parties agree that the marital portion of the remaining
pension, after deducting the VA waiver, is 90,23% (representing
$~,660,95 based on Exhibit "A"), based on Husband beginning active duty
service on March 15, 1961, the parties' marriage on February 29,1964
end Husband's retirement from active duty on July 1, 1991, (328 months
of service while married and a total of 363,5 months of active duty
service), The parties further agree that 9,77% (representing $397,35
based on Exhibit "A") of the remaining portion of the pension Is the non-
marital property of Husband, Any Increase in the retirement shall be
allocated pro rata based on the above percentages,
-10-
d, The parties agree that one-half of the marital portloll of the
pension after subtracting the VA waiver (one-half of the 90,23% set forth
In (c)) shall be allocated to Wife pursuant to a Military Retirement Benefit
Division Order In a form satisfactory to the Defense Finance and
Accounting Service, Based on Exhibit "A", one-half of the marital portion
Is $1,834,83, Wife shall be solely responsible for all taxes on the portion
of the retired pay allocated to her, and Husband shall have no obligation
with respect to any tax obligations as to the portion of the military retired
pay allocated to Wife pursuant to the said Order, Husband shall
cooperate with Wife to submit the required forms and Information to the
Defense Finance and Accounting Service on or before the closing date.
Any Increases In the retirement shall be allocated pro rata based on the
above percentages,
15, ALIMONY PENDENTE LITE/SPOUSAL SUPPORT:
a, Husband has been paying alimony pendente lite/spousal
support to Wife in the amount of $1,357 per month pursuant to a Support
Order dated January 12, 1998, as amended on February 5, 1998, and
entered to Docket No, 931 S 1997 in the Domestic Relations Section of
the Court of Common Pleas of Cumberland County,
-11.
b, Husband has made the $1,357 payment of alimony
pendente lite/spousal support pursuant to the above referenced Order to
the Support Office for the month of March 2000, With such payment
made In March 2000, the parties agree that Husband's alimony pendente
lite/spousal support obligation pursuant to the above Order has ended
and that no further payments are or shall be owing to Wife pursuant to the
Support Order dated January 12, 1998, as amended on February 5, 1998,
On or before April 20, 2000, Wife, through her counsel. shall file the
necessary documents with the Support Office to terminate the Support
Order effective March 31, 2000,
c. Husband agrees that beginning with the receipt of his
military retirement pay for April 2000 and for each month thereafter until
50% of the marital portion of the retired pay Is allocated and actually paid
to Wife pursuant to Paragraph 15 above and the contemplated MIlitary
Retirement Benefit Division Order, Husband shall pay to Wife promptly, by
the 5th day of each month, upon receipt of his monthly retired pay In April
2000 and each month thereafter until the contemplated Order becomes
effective 50% of 90.23% of the gross retired pay received by him after
subtracting the VA waiver, but before any withholding for taxes, All such
payments made by Husband to Wife shall be treated as alimony and
-12-
considered as taxable Income to Wife and deductible by Husband
pursuant to the provisions o~ the Internal Revenue Service Code.
d, Except as set forth In subparagraphs (a)-(cl above, no other
alimony shall be paid by Husband to Wife or by Wife to Husband,
16, REPRESENTATION AND W8RB8l':ITLOF FULL DISCLOSURE: Each
party hereby represents and warrants to the other that he or she has made a full and
fair disclosure of all of his or her Income and assets, Each party shall fumlsh to the
other party their federal income tax returns through 1999,
17, ATTORNEYS FEES AND EXPENSES: Each party shall be solely
responsible for payment of their respective attorneys' fees and expenses,
18, MEDICAL INSURANCE COVERAGE: After the enlly of a divorce decree,
each party shall be solely responsible for his or her own medical insurance coverage.
19. WAIVER OF CLAIMS AGAINST ESIAIE.S: 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,
dower, curtesy, statutory allowance, widow's allowance, right to take in intestacy, right
to take against the will of the other, and right to act as administrator or executor of the
other's estate, and each will at the request of the other execute, acknowledge and
-13-
.'
deliver any and all Instruments which may be necessary or advisable to carry Into effect
this mutual waiver and relinquishment of all such Interests, rights and claims.
20, ASSUMPTION OF MARITAL DEBTS:
a, Husband hereby agrees to be solely responsible for the payment of
the U,S, Department of Education loan for Nancy Davenport with a remaining
balance due of approximately $19,000, Husband agrees to Indemnify and hold
Wife harmless from any and all obligation with respect to said loan,
b, Husband agrees to be solely responsible for all outstanding credit
card obligations that existed as of the date of separation, and agrees to
indemnify and hold Wife harmless from any and all such obligations, The credit
card accounts outstanding are as follows:
1) USAA MastercardNisa Account No, 5416300832070503;
2) Visa Account No, 4428-9600-0303-8628;
3) Visa Gold Account No, 4445302248039245;
4) Visa Gold Account No, 4445320161208654; and
5) MBNA Account No, 4264292436000216,
21, DIVORCF;: Husband has instituted a divorce action to No, 97-4546 Civil
in the Court of Common Pleas of Cumberland County, Pennsylvania, Nothing herein
contained shall be deemed to prevent the parties from proceeding in the said suit for
absolute divorce against the other and in the said Court, and the parties agree to obtain
-14-
a divorce by mutual consent pursuant to Section 3301 (c) of the Divorce Code,
Affidavits of Consent to a 3301 (c) divorce shall be signed on or prior to the closing date.
22, BREACH: If either party breaches any provision of this Agreement, the
other party shall have the right, at his or her election, to sue for damages for such
breach or seek such other remedies or relief as may be available to him or her, and the
party breaching this contract shall be responsible for payment of reasonable legal fees
and costs incurred by the other in enforcing his or her rights under this Agreement.
23, ADDITIONAL INSTRUMEIIIIS: Each of the parties shall from time to time
at the request of the other execute, acknowledge, and deliver to the other party any and
all further Instruments that may be reasonably required to give full force and effect to
the provisions of this Agreement. Such consent will not be unreasonably withheld,
24. VOLUNTARY EXECUTION: The provisions of this Agreement and their
legal effect are fully understood by the parties, and each party acknowledges that the
Agreement Is fair and equitable, that it is being entered into voluntarily with full
disclosure of assets, and that it is not the result of any duress or undue influence.
25, ENTIRE AGREEMENT: This Agreement contains the entire
understanding of the parties and there are no representations, warranties, covenants,
or undertakings other than those expressly set forth herein,
26, MODIFICATION AND WAIVER: A modification or waiver of any of the
provisions of this Agreement shall be effective only if made in writing and executed with
-15-
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the same formality as this Agreement. The failure of either party to Insist upon strict
performance of any of the provisions of this Agreement shall not be construed as a
waiver of any subsequent default of the same or similar nature.
27. ACCEPTANCE BY PARTIE.S: Husband and Wife accept this Agreement
In lieu of and In full and final settlement and satisfaction of all claims and demands that
he or she may now or hereafter have against the other for support and maintenance, for
alimony, alimony pendente lite, counsel fees, costs and expenses or any other charge
of any nature whatsoever.
28. REVIEW BY COUNSEL: Husband and Wife acknowledge that the terms
and provisions of this Agreement have been reviewed by their respective counsel and
the Agreement Is being executed upon advice of and after consultation with counsel.
29. APPLICABLE LAW: This Agreement shall be construed under the laws of
the Commonwealth of Pennsylvania.
30. INCORPORATION OF AGREEMENT INTO DIVORCE DECREE: The
parties agree that the provisions of this Agreement shall be incorporated Into but not
merged into the divorce decree to be entered into by the parties and shall be
enforceable by court order.
-16-
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OFFICE OF DIVORCE MASTER
CUMOf-RLAND COLJN TV
COUnT OF COMMON PII:AS
9 North flnnovor Slroul
Cnrll5lo, PA 1701:1
(717) 240.6535
E. Robert Elicker, II
Dlvoreo Mo.'or
Trecl "0 Colwer
Ollleo ManogorlRopor1or
Delano M. Lantz, Esquire
McNEES, WALLACE & NURICK
100 pine Street
P.O. Box 1166
Harrisburg, PA 17108
RE: Paul G. Davenport vs. Helen P. Davenport
No. 97 - 4546 civil
In Divorce
We.l Shore
697.0371 Exl. 6535
August 4, 1999
Ruby D. Weeks
Attorney at Law
10 West High Street
Carlisle, PA 17013
Dear Mr. Lantz and Ms. Weeks:
I am in receipt of Mr. Lantz's letter of August 2, 1999.
Mr. Lantz is writing on behalf of the Plaintiff and enclosed a
copy of an affidavit under section 3301(d) which he filed
averring that the parties separated August 1, 1997.
Consequently, grounds for divorce do not appear to be an issue.
The only economic claim currently pending before the
Master is equitable distribution.
Attorney Weeks entered her appearance for the Plaintiff
but I point out that the caption which she used on her praecipe
is incorrect and that she should probably enter a praecipe
correcting the previously filed praecipe on May 20, 1998. Ms.
Weeks represents the Defendant, as I understand it, and the
caption is appropriately referenced as above, not Helen P.
Davenport vs. Paul G. Davenport as noted on the praecipe filed
by Ms. Weeks.
Mr. Lantz has requested that we ~roceed with the
directive for filing pretrial statements. I am directing,
therefore, each counsel to file a pretrial statement in
accordance with P.R.C.P. 1920.33(b) on or before Friday,
September 10, 1999. Upon receipt of the pretrial statements, I
will immediately schedule a prehearing conference with counsel
V, PLAINTIFF'S GROSS I~COME FROM ALL SOURCES
Attached as Exhibit "D" Is a statement from the Defense Finance and Accounting
Center dated August 12, 1999 Indicating Plaintiffs retirement Income, Also attached as
part of Exhibit "0" Is a copy of a letter from Terabrldge Technologies Corporation dated
September 7, '1999 offering Plaintiff employment on the terms and conditions set forth
In the letter, The employment Is "at will",
VI. fLAINTlFF'S EXPENSES
N/A
VII. PENSION AND RETIREMENT BENEFITS
A. Plaintiffs retirement benefits from his military service are attached as part
of Exhibit "0", The VA waiver of portion Is not subject to equitable distribution under
federal law.
B. Plaintiff Is a participant In a 401 (k) plan sponsored by Cubic Applications,
being Account No. 150-30-4016, The amount in that account as of June 30, 1999 was
$29,482.70, The account statement Is Included In the exhibits.
C. Plaintiff has an IRA at Oppenheimer Fund. Its value at June 30, 1999
was $3,593,17.
VIII. COUNSEL FEES
Plaintiff does not make any claim for counsel fees.
-2-
IX, PERSONAL PROPERTY AND HOUSEHOLD GOODS
The parties have divided scme Items of personal property and household goods,
Plaintiff anticipates that the parties will be able to resolve any remaining disputes
regarding household goods and personal property,
X. LIST OF MARITAL DEBI
Attached hereto as Exhibit "E" is a list of the marital debts,
XI. PROPOSED RESOLUTION OF ~IC ISSUES
Plaintiff proposes the following resolution of all economic Issues:
A. The marital home shall be assigned to Defendant, subject to the existing
mortgage, and Defendant shall be responsible for the payment of the mortgage and all
real estate taxes and expenses relating to the property, and shall Indemnify and hold
Plaintiff harmless from any and all liability with respect to the property,
B. Defendant shall receive the Dodge Caravan.
C. The marital portion of the military retirement (excluding the VA waiver)
shall be divided equally between Plaintiff and Defendant.
D, Plaintiff and Defendant each retain the $5,632.46 of net proceeds each
received from liquidation of the Putnam High Yield Trust.
E. Plaintiff and Defendant each retain the $150 of net proceeds each
received from sale of 1988 Dodge Caravan,
F. Defendant shall retain the 1984 Dodge Aires,
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EXHIBIT "B"
Z, Beneml
The Complny may provide you wilh ouch iruwunce pllns, hoopilAlizalion plans, relllemenl planl and other
ben.OII lIual are gen. rally provld.d 10 .mployeeo of th. Company and for which you are .ligibl. under th.
lerma and condilions Ih.reof, T.I.Hub Conununicalions Corporalion provid.s its .mploY..1 wilh a
bimonthly B.neOI Suppl.m.n!. You may be .ligible 10 r.ceiv. up 10 $2192.00 or $4575.00 or $6395,00,
anmaUy, 10 b. appli.d loward your own, youn and on. <l.p.nd.nl'o or your familY'1 m.dical, dental
&neVor vision car. premjum., r.s""ctiv.ly. You will r.ceiv. a lunulUlry of curr.nt Company b.n.Ols onc.e
you report 10 work, Th. bcn.flu or. subj.ct 10 chang. as d.t.mun.d n.c.ssary by T.I.Hub
ConununlcBhol15 Corporation.
3. Elpenses
T.raBridge T.chnologi.s Corporation will r.imburs. you for r...oDJIbl. and n.c.,sary .xp.nsel iocurred
by you In furth.ranc. of our bu. in.... Certain cal.gori., and a,noWlI, of ex""nscs may r.quir. itemizalion
and/or lubmi..ion of a receipl in accordance with Company policy,
4. AI-WlIIl!:mployment StatuI
It i& the policy of TeraDridge Teclmologies Corporation wt employment is "at-will." TIus means lhallf
you accepl our otTer of employmenl, you have Ihe right 10 t.nninate your employmenl at any time, wilb or
without advance notic., for allY or no r...on, Similarly, TeruBridg. Teclmologies Corporation has lbe
option of ending your .mploym.nt with u. at any time, with or withoul caU.le or prior nolice,
Your at-will employmenl SlAtus caMol be ch:mged by ..Dy slAtemen~ promise, policy, and coune of
conduct, writing or llUlnWlI unless except Ihrough a written agreement sign.d by both the Pre.idenl of
TeruBridge Technologies Corporation and you.
5. Severablllly
ElIch provilion of this agreement shall be consid.red ,ev.rable and if for any r.a,on any promion which is
nol essential to the .ff.ctuation of the basic purpos., of lbe agr..ment is determin.d by a court of
competenljurisdiction 10 be invalid or un.nforceable and contrary to existing or future applicable law, such
invalidity shall nol impair the op.ration of or atTecI those provi.ioll5 of this agr..m.nl which are valid. In
WI case, this agreemenl shall be cOlUtrued so .. 10 limit any term or promion so as to llUlke it .nforceable
or vaUd within the requiremenu of any applicable laM, and in lbe evenl such term or prom ion cannot be
$0 limited, this agreemenl shall be cOlUtrued to omil ,uch invalid or Wlenforceable provisions.
6. Olher l'ernu and Condillons of Employmenl
Terms and conditions of your .mploym.nt not set forth in this otT.r I.tt.r will b. govem.d by th. policies
of T.maridg. T.clmologi., Corporalion and TelcHub Corrununicalions Corporation. T.raBridg. may
change th.se polici.s al any lime, How.ver, your "or-will" .mploymenl slAtus i.l not and caMot be
chang.d, modified or Iimit.d by any current or future policies ofT.ralJridge.
Normally, your fllSt day WIll include an orienlAtion. At thai lime, we will give you an Employee Handbook,
employmenl and benefit .nrollment fonns and other inforllUllion concerning SlAnd.rd polici.s and benefits, Pleas.
bring wilh you, on your fllSI day, Iwo p,.ces of id.ntification (..g., a valid driv.r's Iic.nse, birth c.rtificale. original
social securily card or a pa&Spon.)
In accordanc. wilh 5IAndard T.raIJridge T.chnologies Corporalion policy, Lbis off.r is conlingent upon your
completing and executing an Employm.nl Acknowl.dgm.nt and Acc..plAnc., an Invention Assignmenl and
Confidentiality Covenant and slandard n.w .mploye. documents,
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~lf TIll con'll 0' COlOlOlf PLIAS 0'
l:OMIIlIlLAlfD COUNTY, PIlflfSYLVIUtIA
CIVIL ACTION - LAW
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10 waS'll BIGB STU'"
CARLI8L1, PA 17013-2'55
717-243-12,..
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....................... .. .. - . 'leI\. Milt l4 _Il
HIl.EH Ol\..VEHF'OIl'l' hI' "''''II'''' )IS - ,~ G .1)0 15 ,1\0 1 n ,II
116........... ~.dl Will I,"
6/14/99 1)O.'l.''HlZ ....~~:~~ 0,00 au... ItAU M/n I,n
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6/21/99
1I1~11l CAVllll'O~~
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TOTA~ IA""I 1I0BI
TOTA~ CIDUCTIONII
HItT PAY I
............
211."
27,)1
aU.n ....
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27."
n.ol
16.24
'.0'
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..................................................:....................-.........:.........................................................
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7112/99
1I1~11I CA\IIIII'O.T
HO-54.51l2
Jtft'iJ Waq.. ,S.lS 0,00
~5,25 0,00
TOTA~ lEAMINtlS I
, TOTAt. CtDucrtOHB I
HIeT PAYI
Ii ,"0 lOI.U ,ICA WIH
............ ~odL Will
ISoI.n rd M/H
ItaU WI"
IAcal WIH
101,1]
97.11 II.....
tn.)O ..
." ........,..............-
6,5,0 )I;.U riCA WIlt
............ ~odl IIIIt
IU, U '001 IIIIt
IUU W/M
Local WIM
IU.U
15'7.'7' c.....
)o1..U ..
22.21
5.21
16."
10.0'
J.n
.........-.....
n."
.............................................................................r...........................-...........~....................................
I...
HILIN OAVlHPORT
:UO.54.5lJ2
bg wIIgltfI
16. 7~ 0,00
..............................................................................................................................................................-......
LU
7/26/..
16,715 Q.OO
TOTAl. EAAHlNOB I
TOTAl. DIDUcrtONSI
NET P~'tl
rtIrIoIrbIrlJJ....:::.:.:.:.:.:........:.:..-.:..._...::_.:.::.:,:::.:::::.._.::.::.:::::::~':.:_..:'-:"'.""."'..."""."."
Ino
ItILIII CAVINPo.~
2)0.54'~lU
".q ""9'"
Ov.rtt.m.
110.00
L2~
O.QO
0,00
lU
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11),25 0.00
TOTAL EMIHtl!l!1
TOTAl. OEOUr:-rtOt/r,
NF:T f'^Y
6.1$0 ...... riCA W/M
............ Midi W/M
." . II rid WIN
IUtt "/H
Lo<.l IIIIt
......
'4.')".1 ..........
404.14 ..
4,!S0
',75
520.00
II,"
riCA WIN
Midi W/M
rid WIN
IUU "1M
Loe.l W/M
55), .,
551..69
10".11
oil.....
442.911 ..
n.tJ
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.!I.st
15."
5.52
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ttl t ch." IlhllPp'
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p.,.cnpUlJn
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Pl'c:'.
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b..crlptlon Amowlt
Ch.~k . EmpLoy I.D. Imploy.. Ham.
DIU Dltpt .
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...................................................................................."........"......................................
LIIL .L1 HILIH OAYIHI'D~T 'R'9 W4911 14, SU 0.00 ',&0 ...,2& 'ICA H/H )0.0:1
./&/" no.ISt.lnn ......... ......... . . . . . . . ~ . '.' M04L H/II 1.03
14,&0 0.00 ".,2& '04 HIH )I.U
.tat. ./N U,U
l.o.oL H/H 4.14
.... ~. ......
'l'lTAL I_IHD., "4.211
toTAL DIDUCTlOH8, '0.1'7 c. . .. ~ '0.1'7
tilT '~Yr JI).U ..
....................M.................~....................~~~~:~~;:;;::::::::::::::::::::::::::::::::::
415050 0.00
6,10 421.15 rICA WIN
............ Modi HIH
U5.n rid WIH
.tatl NIH
l.o.oL H/H
at.tO
..17
n.n
n.n
..26
LLI
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HILIH OAYIHPO~T
lJO.!4.SLJ2
RI' Wao.. 41.50 0.00
TeTM, IARHUIQII
TOTAL DIDUCTIONI,
HIET PAY,
4U.n
15.40 C".6O
110.'1 ..
'71.10
...................................................~....................~...........................................................
.................................... .................~.............. ~................. .......,......,.."..~.-...... ........,.......__.--...-......--........~.
LU. U. HILIH OAYlHFD~T Rig Wag.. 'l.1S 0.00 6.50 nl,u FlCA H/H :21."
SOl" nO.S..SUl ......... ...... . . ~ ............ ModL H/H 1.11
'l,JS 0.00 nl,1L rod H/H 22.51
Btat. M/M 11.15
Locel N/M J.9I
. - ~ - _......-
TOTAL EARNINGS r "'.U
TOTAL PEDUCTIONSr ".0' c.. ~.. ~
NE.T pAYr no.o. ..
,..................................
1111 LL' HELIH OAYlHFDRT Req )la9" U.QO Q.uO 6.50 21'.10 FlCA HIH n.n
'ILU" 110.$4.SL11 ......... ......... .............. HedL M/H 4.05
41.00 0.00 2,7'. SO rod ./H 4.11.
Itate "1M 1.1)
Local WIN 2.'0
.~...-......
TOTAL lAJUnNOS I 2".150
TOTAL DEDUCTIONS I U.12 C. .... 1&.12
NIT PAYl 212,'" ..
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HUEH O"YlHFDRT,
2]1).154.5132
Reg W1981 80.00 0.00 8.~O no,oo riCA HIH n."
overt1me 1.00 0.00 , '.15 U,2S Madi HIH ..n
......... ........- ............ rooJ HIM 51,OJ
11.00 0.00 "1.25 nata W/M U..,
""'01 ./H 1.11
.......-......
TOTM. r.I\Ptlltlll/l,
TOTAL OEOUM'lOUS,
NF.'r PM'
nl.2!5
lll.l1 c~""
469.11 ..
n., JI
1998
Federal Income Tax Summary
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.-....-....---.........-............................... ..,.....-"..",....................... ...,......,.-..",
Client 04011
Helen P. Dlvenport
INCOME
Wages, salaries, tips, etc
Interest income
Dividend incomo . ,
Alimony received
Business income , .
Capital gain or loss
Total income . . . ,
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ADJUS'I'MENTS TO INCOME
One-half of solf-employment tax
Total adjustments . . . .
Adjusted gross incomo . , . , .
. . . .
. . . .
. . .
ITEMIZED DEDUCTIONS
Taxes ..........
Interest . . . . . . . . .
Total itemized deductions
. .
, , .
, .
'l'AX COMPUTA'l'ION
Standard deduction . . . . . , . . . . ,
Larger of itemized or standard deduction
Income prior to exemption deduction . .
Exemption deduction . .
Taxable income . . , .
Tax before credits
CREDITS
Total credits
Tax after credits
. ,
OTHER TAXES
Self-employment tax
Total tax
" .
. . . .
PAYMENTS
Federal income tax withheld
Estimated tax payments , .
Amount paid with extension'
Total payments . . . . . .
. .
. . . .
. .
. . . .
REFUND OR AMOUNT DUE
Amount you owe .
. . . . . . . . . .
TAX RATES
Marginal tax rate
Effective tax rate
. .
. ,
230 114 1132
1998 1997 DiU
11,690 4,774 6/916
64 105 -41
777 926 -149
16/284 0 16,284
2/987 1/622 1,365
-1,054 0 -1/054
30,748 7,427 23/321
211 115 96
211 115 96
30/537 7,312 23,225
2,074 192 1,882
6,216 0 6,216
8,290 192 8,098
3,550 0 3/550
8/290 192 8/098
22,247 7,120 15/127
2,700 2,650 50
19,547 4,470 15,077
2,929 671 2,258
0 0 0
2,929 671 2,258
422 229 193
3,351 900 2,451
785 138 647
2,000 0 2,000
0 500 -500
2,785 638 2,147
566 ;!62 304
15.0\ 15.0\ 0.0\
17.1\ 20.1\ -3.011I
PAUL G, DAVENPORT,
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO. 97.4546 CIVIL
HELEN p, DAVENPORT,
Defendant
IN DIVORCE
",'/
"
1..
NOTICE TO THE DEFENDANT
I
".
If you wish to deny any of the statements set forth In this affidavit, you must file a
counteraffidavlt within twenty (20) days after this affidavit has been served on you 'Qr
"
the statements will be admitted,
PLAINTIFF'S AFFIDAVIT UNDER
~3301 (d) OF THE DIVORCE CODE
1, The parties to this actio,", separated on August 1, 1997 and have
continued to live separate and apart for a period of at least the time period specified In
~3301(d) of the Divorce Code,
2. The marriage is irretrievably broken,
3, I understand that I may lose rights concerning alimony, division of
property, lawyer's fees or tl:qJlHl3tlS if I do ,.,ot c1din I t1ltlll1 btlf.:;r.. a divorce I" granted.
I verify that the statements made in this affidavit are true and correct. I
understand that false statements herein are made subject to the penalties of 18 Pa.
,-
.. r ,.--.
C,S, ~ 4904 relating to unsworn falsification to authorities,
Date: August 1, 1999
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MeNlle, WALLACI . NU"'CK
100 'INI IT".IT
'.
I' 0 .011 II..
HAnNI"U"". 'A 1'101
'I
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,
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OCT 2 2 199$ib
6. Plaintiffs monthly payment obligation on the Caravan was Included In his
Income and expense statement and discussed at the conference. However, the
support office did not provide him any credit for the monthly automobile payment.
Defendant refused to make any contribution toward the obligation,
7, Since the support conference, Plaintiff has attempted to work out an
arrangement with Defendant where Defendant would have a vehicle available for her
use, but which would result In a lower monthly out of pocket cost for Plaintiff, To that
end, Plaintiff arranged to lease a Subaru Forester for Wife's use so that he could sell
the Caravan and eliminate the monthly payment.
8. Plaintiff entered Into a lease for the Subaru Forester which required a
monthly payment of only $329,99, A copy of the lease Is attached hereto as Exhibit
"B",
9. When the registration became due on the Caravan, Defendant requested
Plaintiff to sign the registration so that she could renew It for another year, Plaintiff
refused on the basis that she was not contributing to the monthly payment on the
Caravan, he was receiving no credit for It and his cash flow did not permit him to
continue making the large monthly payment on the Caravan. A copy of the letter from
Plaintiffs counsel to Defendant's counsel dated June 24, 1998 Is attached hereto as
Exhibit "C",
-2-
NAVY @
FEDERAl.
CltlDlT UNION
STATEME/'lT OF ACCOUNT
--
-
P.J. el1
T ~ ~
Fm," f}1 P) 'if)
'hll'llll h I1Y.Il!'18
~. l T
21)60""",00:'-
PAUL G DAVENPORT
"
I Otllll\1IItd1tomp"vIOIIt;IlIl_'
('lIlI'lI
~CA PTl9!L~,- . :
C"nSlllll~r Lllan ACClIUlll.. 111)2 MOllthly Paym~ll
07.31 DIRECT DEPOSII
08.18 TRANSFERFROUSf'ARES 12012
08,19 ENDING BALANCE, (OOES ~Or INCLUDE FINANCE Cf'ARGE DUEl
O'tt';f I'jltpOSIt tn'Suttlel"..... to cow, monl"'Y ~o1vmlf"1
. PRill ~
Pili
51511
0671
Shar~dl~k Account.. 7c)~
Joint Owner..NONE
i.ll1ITE TIlANSACTIONDESCRIP110N
07,'9 BEGINNING BALANCE
07,20 TOTAL SHARECHU(S) P~ID
01.23 A~~N ~EE WITHQAAWAL
SEE LEGENOBHOW
ATM WITHDRAWAl ~QE76 60.00- 173.62
07,29 TOTAL Sf'ARECHEKIS) P~IO 640. 167.22
0].31 DIRECT DEPOSIT C 3,000,00 ~ 3,167.?2
TOT AI. SHAREO'EK(s) PAID 4.05. 3,163 17
DIVIDEND ~ 3.16508
08,C3 DEPOSIT ~ 3.864.3~
AFFN FEE. Wllf'DRAWAL fCET6 0.75. 1.89360
ATM WITHDRAWAl fOE76 40.00. 3.643,60
08.05 PAID TO MASSUUTUAL 236.32. 3,607.28
TOTAl Sf'ARECf'EK(SI PAID 67040. 2.93688
09,06 TOTAl sf'ARECl<EK(s) PAID 429. I O. 2.501 18
08.07 TOTAlSf'ARECHEK(S) PAID 354.76. 2, 153.02
08,'0 PLUS ~EE. WITHDRAWAL iNsOS 075. 2.15227
ATM WITf'ORAWAl iNS03 10000. 2.05227
TOTAlSHAREC!;E~(s) PAID 427 17. 1,625 10
08." DEPOSIT c-::-rillO") 1.746.10
TOT A.. SHARECHEKls) PAID - 29825:- 1,447 85
08,12 TOTAL sHARECHEKI5) PAID 595.99. 85186
08,14 TOTAe Sf'ARECHiKIS) PAID 31617. 53569
08.17 TOT Ae Sf'ARECHEK(S) PAID 29488. 2010 a 1
08.18 TRANS'FR'ROUSHARES ~ 300.00) 54081
TO"AI ,"'ARfC"'EK(S) PAID 64 83. 47598
OQ,'8 ENDING8ALANCE .\7598
YI)UI aeeO'J'" ."'''1It11 SI qT. Wlth."in J.n~u.,1 pllttr..nl'''J. Vleld urnltd of 2 'n-.... lor 11'1, QjV'dlfnt1 PIf'IOCJ Irem 01.0 ,.ga Ih'~~9'"
~7.31.')e
.~~, :"'; ':. .".:; : ':: ~;:':'. ,-.. ~ ..
AM j
A
~CE7~
6053.
0.75.
294.90
234.3/
233 62
Sharc~hcks (',IIU
Numbor A"'tJ nl I. ~hJmbl" Amoll r ..- ,11 Numbltr Amount .,1.
00'71 rlO ~:l O78O'9~ 002~j 16j 81 OR.O/,~8 on~91 Fl19" OR, 1 7.~1l
OO?73 64i 21; O~. S.') oO,?,... 46 .17 118,10.')8 f)f)2'J2 200 oil O~ 14,98
f)1l~7,J ~ 40 o ,')').'JH nn~~ 1 000 OR.0I;,')8 On~l):J J'}q ')9 08. I~-91l
00 75 23 14 08~5,'l8 OO')~S ;~m 8A.'2'lR 011294 593< OA-l, .98
002,'!3 4 U5 0l,3PH OO~ 6 , ~.lI''lH ()1);'?'!5 53 3~ 081/.98
00277 11)4 10 I1H'U~ 'IA OO.Q1 11 ,12,')8 ()Irlt)fl "71') Il~ IH-98
"llF9 16500 OR ()G-9~ l)r"'~f3 81,} 17 08.1..')8 OC)~l)' 374,\ 08 1 A.~8
n()~ ,'lO 21 &5 08.01.~q nO)fi'I ill/JOO flH- I;?lJ>> OO;1r)A 119 F;!l OH.17 !lA
OO~el 10') ) 08.01.9~ 001.3') 21 00 OA. 14.~H ATMO ~o 1)0 01;n.~8
[.::m[[J['[' "^Il
RETAIL LEASE AGREEMENT
~!2B198-.._. .___ -
. -----------------
LEASE NUMBER
--_.-_.__._--_._~--
ATE OF LEASE
1. PARTIES
A, LESSEE:
..L;;;;N;;;-- ~ -~--
.--------.~h.._ cay ....-.-----.-
II _wJ'''T-_.clli.JRCILSt.____ _____.F.llIi.l!ORX.
5;;:;;-t,.... e/f)'
.....
NV
.....
2.WL-lL_OJ..'LElll'iJaL___
,I l..... NiWl.
_____._n_~._.__.__~u___~_.__ .._---
8, LESSOR:
~.INYill'l'
-----J
~ U'lA-----l
,;Ml~;;;;;---.-~---.---..-----.--.---.-"-.---~~-- --"- -----.-.....- ----~----------- IS.... llrtI -------1
'I A"80RTEL ~OTO!!J:.AILIJjE 6327 ROUT.E 96 V ICIQR NY 14:564 .
C. AGREEMENT: In UHS lust. the "",olds ~I~, "me-, "my. or .our. 'eler 10 the lltssee(s), "You. .Jnd ~~olJr~ reler tQ the Ltlssor and, 3rter .151ilunment, Ihelusor's ilSSIQnu,
Subilru Le.nlna C'lIp. PO SO.l 6000, Cherry HIli. N J OB03"'6000. and/or ,Joy other 35S11J1ll!lt By SIQOIlIQ below. I 301.110 !e3SQ Irom you the VehlCllt dl!!Scnbed below on Ihe
ferrns and conlJlllOl1S In thiS ll!asl I 30ree 10 pay aU amounts due under IhlS Lllase and any olher charon disclosed in IhlSluSll, Incluulno all offIClillll!l!S. liI):IS, ellpCnSeI and
Insur:lOce prertllUI1lG retiltll19 to the Vl!hlcle, The ljl!5lqflilllun Me. lOdlcallHi all esltlnafe
2, DESCRIPTION OF LEASED VEHICLE (lh.'V'hlCl.')
t:AA MAt<E MOOt1. OOQV Snt.f CnJNDIRS COlOR
9/:1 Sl,/eARlJ FOREST:::1l . SUB" 4 GR/OY
rlcfudlno factory ilnd distributor IOslJlled equIpment and the lollowUlQ dealer lnslall.d equipment and acceS$ontl:
lthe VehIcle is a demonstr3tor or J lJsed Vehicle. the odometer reading is
mil..,
!I
3. FEDERAL CONSUMER LEASING ACT DISCLOSURES
IA. Am..nt 0.. .1 31. MItllllIy """,,.nll :\C. OlMr el',,1I (nol part of my monlhly paym.nt)
lO.l. Sllnlng .r o.a..ry My IInl monlhly paym,nl 01 S ~~9 99 I. due Olsposltion Fee (III do
(11'mlzedbelow)' on iU/28/98 .. followed by nolpun:hmIhfVlhlcll)
--il~ paym'nls 01 S 329. 99 due on Ihf (')
.8 of .ach month, .BEILBi:NEWAL
Th. lolal 01 my monlhly paym.nls I., 11879. 64. ToW
'"._Uo..I Am_II 0.. It II' Ignl...r O.I..ry
3F. H.wllll Am.unl Ou. .1 Lilli Sllnl.. or D.llnry will 110 ,.I~'
Net Irad~ln ~Iowanet ,
R.bal.. and noncash credits S
,
Amount 10 b. paid In cash ,
Total ,
$
1725.36
,
,
L_2~
,
lIA
3E. Am.unl Ou. II LIII. Signing., O.llnry
CapllalU.d Cosl reo1uction
First monthly payment
R,lundabl. ..cumy d'po,U
Tillefus
Registration lees
SALES TAX
DOC/NYSI
, Nt.
,~29. 99
, 3!l0. e0
$ NA
S 65.00
, 950,37
,--30:00
Toral S 1725.36
My lllOIIll" ,_1111 iIot.nnl_" II alt..n b.low,
3G, Grou copllallzld .0It. Th. aoreed upon valu. of Ih. V.hlclo (, 22~?--,.~__J and any II.m. I pay 0'"' Ihf L....lerm
(such as SI!Viet conlracts, Insurane.. and oul'landlno prior ClC<lU or I....llalanc.), . . . ..
" I want an rt.mlz:ltlon 01 this amounl, 1 have chockod IIIls box, 0
3H. Copltallzltl..1t ,,'ucUa.. Th. amount 01 any net lrad~ln _nce.l'lIbafl. noncash crodM. or cash I pay lIIaI'roduce.1hf
oro.. capilallzed cost "
31, Adluat.. capIIlU,,' .0It. Th. amount used In calculallno my bast monlllly payment. ,
'3J. R.II.... YlI... Th. valu. of 111. V.hlcl. allh. end 01 Ih. L.... u.ed In calculallno my bast monll1ly paymenl. .
! 3K. O"l'IClltlon ..... any Imartln" ImHnII. The amount charged lilr the Vehlcle's dedlne !n vatue thrOuoh normal use and for other ihms
i paid over the Lease term.
13L. R.ot ell."., Th. amount chatlJ.d In addition 10 111. d.preclation and any amortUed amounts.
3M, Talll., b11' m.ntIll, p.ym..... Th. d.preclallon and any amortized amounts plus Ihf renl chatlJ..
3M. Lt... Tlrm. The number of months in my lease.
30, 1.1. m.nlllly plymlnl.
3P, Monlhly sal.s!ulO tax
. .
. ~. ';.
EXHIBIT "B"
30, ToIIl manthly p.yml"1.
3D. roll. II """'11I
(T'heMlNf'......1Jr1hl
.... 11I......1
$ 129:50.01
HA
If.
l?2!'t.36 .
l?'2!'t.36
.
s22757, e:e
.. ~ . of ... ... ' . ..' I
~"("'" "".
""-l:i)' ,."
.~ ,~k'."~1
I--~ ".,b '"
s U;/~/. .i::' i
,1~.J5 i
,:&871.6:1.
, *7.~
,11679. 64,
---:Jo.1Ml
,_ J29..p
, IIA
S ItA
,
, J2~.99
.
.
.
+
+
.
.
.
Ellly T.nnln.lIon. I mlY hav. la P"' . sullll.nUII.hl"." 11tllI1Il1I L.... ""', no cII.... mav II u.la ......llb....n. d.".... TbI Ictu.....". will III,... .. wII._
Ih. L....III Th. ..rllar I.n~ III. L.II., Ill. g......IIlII.b1".III"." '.1.,
wt WII' .nd UII. I may barged for exCl!S51~e wear baSld on your sbndards lor normal use .lnd lor mileage In ellceS5 of M 15000
ral 01 _~__I per m,I..
Pure ..... EnJ 01 L..I. TI . I have an opllon 10 pun:haso lhe V,hlCl. alth. ond 01 Ih. Leas.lorm lor-'l5.813.5,.=!5
The purchase option pnc~ does not include officiallH$ such as th05l1 for was, taqs, licenses i1nd r!Qlsfration.
OUter Importlft' rlrml. I Will see my tlla~ documenls lor .1ddrhon.aJ inlOmlanon on earl'1tefminahon. purchJse options, malntenancl1 rl!sponsibIllHes. WJrr.lntlas.lall 'and default
_~arolS, l~s.~~~:_~.,~n~_J~y_~~~_~~~~r~.t, It applicable
and a pun:llase option 'oo 0' ll~~.
m,1os per year" 1M
'l\1"II.Uon, bUt Ind l.un Udl 111' 1'"1101 relU' 'Ubi ....nfln., ulllut!." Wllln ~')III ,tll]llll"~ p,~III,nh
" .......d OIhtIWO" I _.lt6::i..:3.7
5. LATE CHARGES: limtI5Ihllu'Il'f ollnl. Lrat.f Th., mUII~ Ih.t I 'Ill III Ilr'~ljn II IlJlll1Ut
plrfann my ~.Ullln und.r It,,, lU~1 when th.y III tjll~ II VillI do I!QI It-em' lJi)'m.nlltl IlllI 1)1
~..P'vmtnt Gut undllll\15l18u wrthUll0 day, al"r II!. dut lialt, I ~~Iff II) IJ~'" Il.al, (h.a'~lllllJl
',Ii or IS'. of Ih'put "UI "",Junt, \lrl1lCn.v.r III 11""' II you h..~, lllt..l! 1)/ nJntall nil hI ~1)1I.tl
my latl PlYm.nt~. you un l;l1IfU' nil hH you. f;ottHlII)!l (ll~I~. II PIIlIlII1.,1 by I....
II. SECURITY DEPOSIT: I h,).., lJrQu,1l'4 .....Iltl YIllJ h)lUy In, !;rlUflt} "'11')"" ',I1II"'U ~hl)\I' ,11
111m 3 III PI" olin. -"mlllJllI OUt al Luu S'UnUllJ 01 U'II""Y' VI)IJ 1II11! I"l/Ill 01 111'1111 !11 Ill. lh.
ltcunry d'~l Illhl !Ild iJI Ih! Leu. r.,," liJI '11) t)telllllull 01 lh. Luu '~Ilttf, tJr .HI /!alt)'
lennirllbon 01 Itll' lun II I hhllLllly I1l,lunnrtJ mV LULl! 'lblrll'IUll111 U I IjullU lJ~1 ~IIV ~"lIllmt due
tJr Om.rWlW d.llull IJl1dp;'r lhllllu~, vou n\.!) olplJl)' Ill) ~1!(UI1t't "'P'I~ll hl ~m()jJnl~ 1'lWI )llU Allh.
Ind 01 theluse T.rm, Yl)U 111'", hup 1"'1 pt1'lllllhl! ~"(IjI1f)' d'PU~II"'IIU Ullnlilll! hI h, Ill!t"1l1l1o plV
Illy tlJr:lI wndlll. unplJUllllll 01 ol!\Y~ 'IIJI/lM IhlVl!hldllJllllr lu~. t1t J tim, whl!ll I 'II'l)ljll.!
be rllpcmllbw 10' ",,'" You hlVI no OOll\lltuffl hI pol.,. Illl! .all)' IIIlmM InCllliltl' Ilr P"lltl'l IJ/l lit)'
5ItlUny dlpout. You holv. no Ildllmry obll\lalllJII wllh 115PI!(1 10 Illy dfpO~ll
7. WARRAHTlES: Unll!r.!, Itl. bo) !>t1111/11111 d11!t:~~, 1tI. Vllluc:lr.. ~lJbJtl.1 III ~t.1nd.lll.l t1\.a11ulal."furfr',{
WUTInbIa, roudlf'lQ WllTlnbu 'eQolrdu'Q ~rWI tQUlIl/1lI/lI, !\ur.h.u hl~ Ul1l1lltlllllu~ Illlr'J1\lIlo1l~,
you ~n fD IN tlo tn. r-lelll lhfy all ~nlblrl all you, l'IlJhts ~\II IP.1I11~11IeS ulldl!1 watrillllle5
~ IN YIhkit Unln.s prohlbrtld I1y law, YOU MAKE NO WAAIWWfS ~)'PHf 55 OH IMPllE I), QF
MERCHAHTABIUTY OR FITNESS HJf~ U~ WITH RESPECT TO 111E VElilCt[
Q If thll bo. II CheclW. Ihe Vrtucl" 15 not sublllcl 10 .ny e).prns wirunlll!s
e. REQUIRED INSURANCE: I .aQt" 10 lJ/ovldr .and m.al"lJrn Il'Ie IllHal'flng !,\,pes .1nd ;amounl III
lnlurlnct on the VehlClt dUflng Ihllu~ Term unlll I relurn Ihr Vehlcl.
A. Bodlty Injury. $100,0001300,000 01 combml!d slnl,llr IImll r:ovmge 01 $300,000,
B Prolll"Y 011I1I9'. $50,000~. ~'
c. $1.000 (01' tBssldlductlble CoUl!\.! Ind /
D, '1.000 (or "SIll d~uctlble Co,""r "SM, Including fill ind then. ~
PHYSiCAl OAMAGE OR LIABILITY INSURANCE COVERAGE FOR 100lLY INJURY AND
PROPERTY OAMAGE CAUSED TO OmERS IS NOT INCLUDED IN ThiS LEASE,
II any addiUOI\Il tnliUrance (Illher in kind Of Imollnllls f!Qulre4 by ~w, I "'111 .a150 prQvldl! and mamlJln
auen Iddlllon&! Inluran", hch policy Wilt prowj, you with pnmary coverage as all ;additional Insur~
and Iou ~Y" on all coverages, I will lumish you wrth wIl.1t\'er prool 01 co~mor you teQunl before
ltl. Vet\icl, il cJtilvelld 10 m., No C.Jntelllllon or m.almill challQn In any required InsuranC! w"11I tM .
eNottivo ",.p' upon 30 d.y. ."'"n noflco 10 you I UNDERSTAND mAT IF MY INSURANCE ,.
IS CAHCELlDl, I AM IN DEFAULT UNDER mls lEASE. I UNDERSTAND T1iATIF TIlE
vtHICLE IS STOLEN OR OESmOYEO AND mls LEASE IS ENDED, PROCEEDS FflOM MY
INSURANCE POUCY MAY NOT IE SUFACIENT TO SATISFY MY OILIGATIONS TO YOU ON
EARLY TIIIMINATION, mls LEASE PROVIDES ME WJTIt NO INSURANCE COVERAGE;
C .
My Inlu/IOCI company, policy number and aoenl are as follO'W'S'
INSURANCE COMPANY. USAA ' I
POLICY NUMBER: ~53.4.4B2U?10B~ ,4
AGENT USA/, I ' TElEPHONE Gilil-531-&111
SIGNATURE OF lESSOR REPRESENTATIVE VF,RIFYING INSURANCE COVERAGE
;.',1,
VcnlltJllon Numbllr
9, OPTIONAL MAINTENANCE/SERVICE CONTRACTS: I n", In, "lion 10 ,un:nose '"
an .lCIende4 s.tMCl! tontract \lrhich covc" the rcparr or certun meth,rllCJI brukdowns and relaled
"pen"s and/or (I)) a malnlenance conlract which cove~ cen_m $cheduleiJ marnlenilnce S8f'VlCes olniJ
prOVtdelS fOldSlde illS1isUnCl! The canlr.Jct(sl wr1l be provldrd by'
B.A_ Ptill
U MllllllIWSlU Clll1l1i~1 ('lIlIS .. ..~A_ I'lal1 ___________
10. MAlNTIlWlCl, OPEJlAnHG EXPtHSES AND STANDARDS fOR WEAR AND USE:
I Mil mllfl~lIllnd !.I!I'IIlte IN "'rhICI. tJulIIIII trlr lUll. T.,m III 1I!(I)IIunen,led 111 Ih.Vehlcle owner~
",..nUilllld.' nHll~ hi ~UlllllI\ uoOlJ "~'t1hIlU (tlluJll1l1n Ir,t "0111 Ilh,alt.11 ,IIJl1'l,l~ t wdlll.y.all
'1Ilff'lIn", nplfl~" 11)1 Ihr ""rllll, dUIUlU 111' l !lMl Itrlll, Int!ijlllllU Ihl (<al of 011, illS, IlJbllUhlln
pillli IIbOI, ,Iotll,l'. pllt-lI1l1, IUWUll,l 10115..',1 all 1)111" l;oMIi n~'}';lalell 'IIllh Illlt't.aIIIlO lhl Vl!hu,:11!
VIII) h,v, 110 IJllllgallllllllllllU~IIJI! I rflllal.l!lI1l!l11 'Ifl1ltl, Illh. Vrhltle 11l1)'lt III SlI'o1(f It" an~ leJIiQrl
II .llhl .nd olllla lu~, lerm ~ou d,trrll\1I1r lhillhe Vehlcl. hali fll!en /iljl)lecllo I!).t'~1i 'il'ur and
Ii~' I 11I111 p,.,. 101 Ihc <:lllil .)1 1t~IlH1nu II', Vrhlcll! 10 Iflr teQIJIIl!l1 cQI11111lUn ~tilIllJ.al<Hl JIlllhUb1t In
IlltermUuIlVlh.llhrVlll1ltl,hUbunsuhll!\;lIOnCI!IiIiWUlalHlIJPtI!arr
lA) Th"Iunuf'C'Ullll'JlniUlll!nloce 1chl!IlIJI, h.l/i nol bUIlm,1
Ill) The VlI1cillWl flul ~ ~'V 1i~!WI1!t'; 'If 1!11\Mkl11!\ 1fl5CAA11011.eVlflII bUl.J1l1llipol.1lof116 I1lI!n flol dur
Ii;) Ihl V.htde rjOt!\ /101 hlV' 4 IJIldIJ1lIUa1 nlo11chlng htes (nu 1l'lrulls) III oll\llnal equlpmenl
QU,Ur-, wrlh illltnl 118111 Illch Ilud at It~ lownl p.)UlI, .andllll! !>olmr 1)1 ~ljmpalable eQuipment
indlcc~50f1U,lnwOI"lnllllld" ~5Intlllll'dlldl!lrvery.
(Ill lhe.. II' np., IUI~, bUlnr., foQllIl\\l 'lr oce~51'" 'II'ur 111 Ihe (.;IIOfl. liutS, dOOl:i, hudlUltr.
dWlbQ&rd()lIr\Jn~ar..u
IFI The.. III ~I.althes, 1',ll111 Illls, Il/l,l "ur., n1l$nlllthe~ 01 p~1J11 Of cricks In lhe frrlder~,
1>urnptIr.. g,... houd, mill" roolOl l'oJIX:i, 01 blxty dilllalJe IN. would CQ5! rOQl1lIhan S50 10 lepalr,
(~) Th. VehKl. hil been Ifpaulfed III utfm lhln ID IlIIglnal tlllof. Qr the" arc ~nv sprc'al
Id,ntlhr..lllllnr. Of rnalklllUS allPUllnv Inywherl! on or In tIIr Vlllllc!e.
(G) The rtlUlllf, <JIM If311l, or olher m,lh:lntul. ~h:ty, all1leletlllc.11 palts do not Qperate propell)',
(Ii) 1h, WindOWS Ienr..u Olllllhts.1I C/ac~rlJ I'Jlo~en, ptlled Of !\ct.alched
(IJ The VtlJlde IlII bun dn....n In Utt~ ollhe Telmln;atlQn Mlluge srllOllh In polrll,lraph 12 O.
(J) O~. his 'nulle<l Irmn nGOd, hili, und, Utawve un, mISU!il, abu!\I, nlOligence or Iwdcnt
I may 0lN.tn IIlht l!f1d of me ll!l51 Tllm al my upen5oll, a plOlesslonll Ipptllsal 01 lhe amounl
leqUIll'd 10 rlt1lllr w replace pins or thr Imount lrr' whldllh. UCISS WUf Ind un reducl5lhe valuc
!lIthe V.hlde This prOleSS1QNI ipprals.al must Dr per10rme4 by an Independl!nl 3rd party agreed 10
by .~ uMl by you, wtllch IDPf'I~1 Wilt Ile hAAl .nd hrndllllJ no m. and you
11. PURCHASE OPTfOH: ( hI'lIf an opllon 10 Ilurchilse ffle Vehltlr al ffle I!nd 01 the le.ase Tllnn
!II dloo~. I /Ny pun:hue !Ill! V.hICle bV p')'Ino the purthaSr opllOn pllce Ind purchasc apuan Ice
shOwn ibov, In lIem J, plus .arly offiCllt l.llS and wn IIQullcd to be p.ald upon Ihe '>.lIe 01 Ihe Vehlclr
,. To Urrtl51 11'11 I/urchast apflon, I muSl gIve )'ou wnMl!rl nQllte lh.all '11'111 buV the Vehicle .and pay you
m. purchne pncll bdorr Iht rod ollhe Leasll Tenn You I;.1n, In your dlscreUon alone. gl'llr me Ihe
lll\b9" 10 pUlchase the Vehicle en urty lefmrn,ltlon ollhls lease II I deslfe 10 purchascthe Vehicle al
'nr't1rnfll)rlofe lhe end of thelusr Telm, I can notIfy you In wntlng and you are nol reqUired 10 but
. can thoo~ 10 sl!lI lhe Vrhlelr 10 me_ II you choo~ 10 srft mr tilt VehICle, tile $ile pnce al Ur1y
tennl/\llion W111 bfl the same ;amounl ilS Ihe eilfly lennlnallon thillQl!5 deswbe<l below In lIem , 2,A
12. TERMINATION:
A, EARLY TERMINATION BY ME: Early lermlnatlon may require me 10 pay a
lubllantlll charge, I have the right 10 lermlnale Ihls LUll volunlarlly al any
time III am In lutl compllanc. wllh Ihe lennl ollhls Luse and III sallsly my
early lennlnallon abllaallons. To lrrTmnalcltul LlI.ls.e, I mu!t gIVe ~ou 10 diy$' wMen noflcr,
dellvef the VehlCk 10 'tOIJ and pay )'ou II onee thc amount tJlCulalM aCCOrdino 10 thl nut senlenCll I mU51
PilY yoo: (II) ltM dlftefllOCe. If any, belWten (il t1\r adlusled c.1plUlll!Kl CObt and (iI) the sum of all
dtpr8Qill)On amounts accrued lhrOtlQh.l1le dalr 01 urty tl!lmlnallon and I1lr r&aJlzed value or ttlI Vehicle al
termt/\lm, and (b) all olhl!r amounts lhen due under ttus luu. InduOlno unllald monthty chargl!S .and
of1iaal lee5 and tDes You calCulate 1f1e !Jeprecloluon amounts accrued lhrooOh ltle dale 01 tatty
lemunlbon, USlnQ the .const3nl yWI melhod. "Constanl y.rld mrtl1od- means. in the cue 01 a montnt)'
piymlInt 1eJ.s.e. tnr ~od 01 dl!lrrmlnlnfJ the rent ch.\rQc portion ot each base monttlty paymtnl. untJer
wtlldllhe rent cJ\a1'Qe lor e.ac:h rt'lOnth tS eJmed In ,ld\ilnCf. by multlplYIIlO the cor,stanl rate Impllcll in tht
lll.l5e llmes IhI! bllancI! sublKllO fent cl1.1rQr as rt dedlllM dunng me lus.e Term. AJ any Oiven llme
dU1l1lQ1tlI! lease TIrm, Itle billanCe subtoCf 10 ~III Ch.1I1,lCIS llle dlffenmCl be~n the adjusted capltlll1e4
cost and ItlI! sum ot (IJ all drpm:IJllOn .imoonfS accrul!t1 dunng!hC prevtous monthly PfIn0d'5, lJld (il) tht
I\rstba$l moolhl\l~Ymt!n1
!n lhl! w. 011 smgle or allvan,e pilymenl liaR "constanl yield method". muns the method 01
delefmlnmo the l/frlOOIC urnlno 01 renl chdlQes. under whiCh lhe letll chafoe lor rar:h r:ompu~tlonal
II I purchl~ I conlract. you Wilt lS5)Qn your I1UII!s under the conll'3tl to mr I have I~lewl!d any 01
th.tOnlractJlrlet110purch.ase..ndhaVt'feceivedacopyoleilChtompleledconllJct
I chooll 10 purcllase t1le lollowlng conl~rs and pay Ihe c.1!\h pnce alluSl! slQnlllQ or dell"'l!1)' or
THE TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS LEASE ARE PART OF THIS CONTRACT.
IN WITNESS WHEREOf, the parlin have execuled this Lease on Ihe dale shown below.
Wamlng: Important consum.r protections may not apply" this agreement indicates thlt 11m lusing tht Vehiel, prlm.rlly lor Igrlcultural. ~usin'" or commen:111 use,
NOTICE TO LISSa: 1. Do not .Ign tills Ill,..mont belo.. ,,,,,..011"""" contalns.ny bl.... IlI'CI. 2. YOII... ontJn.d Il>. compl.tely n"od In COllY 01 till. .g...m.n. when 'OIl .Ign",
Ilctnowl.d,. d.llv.ty hl me ala copy ollhll lun,
UVMORTEL tlOTORCAR IHe 'H'jff.~/i'DfVENPORT
BV: ___DArE _0~/-2~~~~~;;~......~, 04!28~~ LESSEE SlGHATURE:.___DATE:__(SEAI.!
By ~gnlng alXwe ttlet DttIlIP.f'It,~SlS()' ac,:epl5 Ihl! ttn11l5 am' OI'lIIl)1l1111115 Ollhl!lll!a~ and dl}f'~ 10 In!! LIt!>....or s A.')!)lClnm...,! on Ih~ ro~~I'la 51111)
Th. V.hlcle will be used primarily lor: ':..l business purposes: i.J agricultural PU'lloses; t,J personal, lamlly or household pU'llosn, INITIALS
LESSEE 1'W.lE:
LEASE GUARANTEE
I Q~ranl'c and promlsr It) makr JIII1' Iht polyf'llf!nlt Jnd IQ pllllmm JlIlh'le~~;H s oHm IlbhQ.Ulons ,1.'i SPf!Cllutd III 1M .an()~e le.l!.1' U~ I'.lnlhf)' '5 primary .11\<1 WIlt nul b~ JHllclcr1 fly Jny se!t1ernclll tw11nslOn
f1ntwll, usagnmenl or rnOOIII~llon (lllfw lea'.e by lhf r1lr,chan.le 01 leleily. ot llle Le~i~l!l! Ii oblJgal10n'i wl\ethflf 01 nol b~ opl!rahOn o! law or by Inf !.a~lnQ Ilr rllleue 01,u1<l1110nal QIW':J11101'i 01 SlIcunly lor th,
Pfr10rmanCl of ltIe lU!\e I 'N.)rYP, In!! oght!. to Ilt'!~.dnlml!llt dl!mand m flOrltl! ot ,Illy hind and ffle IlOht to t101/lrlllht lll~~.or 10 Ilrocnd '0011n5l thl! Le~f,1I11 or 10 PU"IJP' In\l [)the' I~all.llle 1WII1C~ UnIC!5
Prol'ubftld by ft. I sholl! pd~ olnom!!'; s let"i ,lllll ~t1 '1Ih..r UDI!M/!5 0' 1.1!~~lH IIlCIJtl/!l1ln lhl! /!nlllrte~nl 01 lhls UUlr.lJllf!f Thrr. guaranl!!e InlJl1!slo t1le /JInllhl of l11.l/!55or!> .1551gn1
GUARANTOR
Dilte
'M.ITf "llH,f,J'\)II'A:;INf,r:<),U> ':'lI''f r~f'f t.1J~;ft)Mt,j.l(:<)P'r PINM flfAlrlll:np'l'
GUARANroR: ._...
Date:
.._~_........--w..-......~""__..___ .-.
....... '. .-._".:"
lleftCd6 Ulnedn .lll'f.1ntl! o~ lI1yllipl)1I1~ 11'1' (C!1~I.1nl 1.111! 11111,:11(11 _II th, ll!.ju !lInu lht billill'(r ~ylllrd 10 Ilnl tNIlJl J~ .1 ,n(rril~n Ihlllll~ lh. ~(htdlllttllfil6'
Telm AI JJI) 11111. JYlltllj !h, tcl1l11ulrll ll!.)5' Telnl III J ~ln~11! ,.1 Jd'f.1nce P.1~II'"lllI!JR Ill. b"I.1l'rl Wblfel 10 flJlI (hill~e 16 I!rl,rmHlrd IW ~YbIUllU'9 hom Ih.
1611111.1led IUI/JU.11 'fQIUl Ii'll! h,1IJI lell1 (/'lallI' ~llltljylrll III bl t.1"lI11 'l~tI Ihl lUU tHln.1t1lJ JlllllluJ 10 th, <litl'ltnu .111 Il!flllhilt~I', Inllll!l! IJUIIIIlJ Ill. p.t{l!lIll11J
'ell1llul.1IIlJrl.1IP'"0115
In Ii'll (351 .,;ll!lt/'lI!'l)llll 'll I!JH Ih.\lt.'tllll( IIIlt Cr!JI<l1 (.1llljl.jtll:ns .II' bJ',ttJ 'In Iht n~ulII~luln Ih.1II'UlJ "".It l'lrl~'I\/"II)lIHlt~ llJ~nllfl'~ 'lIllhll. I!~JlI ,JUI 'Jiltt6
JIUJlhilllhlluu,;onllnuu'Q. Ihl lull ll!.151 fl!lm
Thl! r'lll.ed /l1llle' iI1r.u15 'hi 13U rl\~I~rl Ji,hdn.1l, /31l11! ,;1 Ii'll! '/~111(!l! .l~ll!l!tl 10 by I':U JIllJ 1111! II ,1)11 JIllJ I I)lllll)1 Jlj'u L;rr Ihllt.1UII!Il ',alrlt I fllily ')1:1.1111 ""llhul
10 JJ',~ .ll my 'l",n UllrJl51! '''llll i1n "1lItlltfhJrIl13td \lalr/.llllH'J!:le 10 /Ulj J lllcrr~~llln.l1 ,11l1l'JI~JI'll thr ~hQIH,.jI!! ,3111' r)/Ihl 'Jl!hl{l. Ji,hl(tl ':Ol)hl ~lt'uh;rll JI
~Jflf fnt JI:j:lJI~l!tJ ,alII!! ~hJII Ihrn ~I! IIH'JI~ HIe 'fJllj~IJ ,j1hJI! 'I thl! ,.1111' 'lt I~t 'Jehlclr ,5 111)1 'Jl!rl!lfl1ll1l!tJ by JIJltl!rr'I!fll .:1 JllIlIJIf)JI IhllItJlrll!tJ.."lu' /tlll!lt thll
JIl'Cllf'l ,<:1/ 'pcr,'.!! 'JIl,:n 11'1, JtlUJ! ~Jle ,:1 '11M "1!11IlII .11 Ithllll!tJIl! r~5 ,lf1~ IJJI!~ fl'll':tl!fl ')Il thll ~all!
B. EARLY TERMINATION BY YOU: Early lerll1lnallon may require me 10 pay a subllanllol charge. I.,,, "''Y """"",,,"" "''' II" ."'"".
111r 'i~"ll:t' 'a,l "l "'J~I! ,ll1~ llJ\II'1!1\1 '1I1"r/ \/115 ll!.l~t Ithl!fl I ,!i ,llJI! I,ld III ~l'rll JI'~ ,:thu J~'trmer1t '1I11l!!llh" lu~, ~I JII~ ';Ihl!l 'ItI0ll;t11151I!tl ,II Ilrlll Zot ,)(tUI' hrn
I ,1:11 l.1~1! tJJ(1l 'f11! "chiC' I must ~tdl P,l'; JI ,;f'C:! !ht 'IUIll L;! 'JIIl"rlll!l!l~IIC:1 I Jn~ crlWrrn thlt J\!luMetJ f,Jpll,lIIWJ ':1.:51 11'1) Ii'll! Jllllllmt '1lllJ It(tI\1 upcn ult Illlht
'Jcl11C'e II ,'''r.;le~.lle 'e55.]f1y I..~I!S mt':~I!'f ';11 Ii'll' ~JII Jl1d 'hI .111 'llt'I!' JIl\i)IJl1ls lhl!l1llLJI! UI111tllh'5ll!.1~t lilli/51 J1511 IlJ~ Jlll!Jprlllieli VIJIJ pay hJ I!nhllU ',Olll 11011111
'Jj"ltlll'l_6 r..1!3~1! .!l;'lj"II1I) "J~cnJl:11! Jnl;II1l'~ 'I!tS .IS pl!!ll1l11e,1 b~ law ,11l1! JI1~ '!JIl1Jljl!~ .:auulj 10 /llU b~ my IJelJulI 'r'OIJ m,lV ~ltrl tl'lt '/thlel, alpll!lllt OlplMlt y,1t ...,llh
:1 ""I/1r;~t "<;tICt III "1t
C. TERMINATION AT END OF LEASE TEAM: AI lilt ~11d .)1 lht leJ~t Ttllll ,]t .Illy 1!)lrll~jQn r;llh, lI!3~' rtllT1 I ",illp.1V yllu Jny 11f6 'It l.).In ImplNlJ 011 tht
.en,CI! 1I~'} rIel ,Ill IlJ'iJ I ,~III JI~,.; "'.1/111 ~~(I!~S CnJI~t pl!. mile J5 set IUllh 'II :ttlll 12 0 plu~ 3ny I!JCl5S NU' Jnd IjU Chill';!!~ 'JUI un/Jl!llllm 10
D, EXCESS MILEAGE CHARGE: I J(l'~lIlhJt!he '/thl(!e 11111 t::t <JIMn ~J(h /w d Ihlll!JSl! IHl '!lere Ih.1r1 Ihl! 'lUll1t~1 d Illllu ~hoWI\ .Ioo.,.e rn Iltm J nUll amounl
611'11! lllnllJI 1l111!!Jr,1! ,]II,:wJJ1ce 'h~tl1lhl! least's lelmlllat!!ll Ihl! 'lerrlllllJIlcn lT1lleJ~I!' 'Ii CJlculJh!lJ bv .1I\I/JlnQ Ii'll! .lrlnu~1 lT111t,l0" aUol/fance oy 12 ~nlJ fl1lJltl!:IyInQ thl!
Il!sult 0'/ 'he 11l;ll'I;tr Qt Il1c"lh~ '(CIJnIr11~ J IlJlllJIIllOl\Ih as J/t't1cll! 'nClllh) fllJmlctJay to Ii'll! IJ~It IhlleJ~e IlIttflT1Ul.)tel! ~I 11'111 IWflIn,lllon IT1I!t!aQ' Iii ~Il!atlr INn Ihi
J(!ual rl'1"lJ~e 5111;\\I1I;n Ii'll! '/rf1IC:1! s 0110flll!lt/, l"'lllpa~ "Oil lhe pt! mile chJI~' shown .lllo'f' In Ilem 3 10f each tHUS mill!
13, FINES: I ,\fll !:J~ Jny lint. peI1JI"'. IWlle ,rekel, p,lr~1J10 Ilcket or COlJrl prOCr5$ If',suetJ In conntctloJ1 wllh ust oltM 'Jthl(11! (feterrl!\! 10 J~ 'linn- In Ihl$ Itlm), You
I\Jloe no Il!s!:cnf',l!:illly 11)1 Jny lllll! II 'IOU lecer'fl .lIlV JSSe~smelll 01 J li1lt 'IOU >*rIll. Ilprlml"l!d by law, lell !hl COlJlt 1"011 r musl p.1y thl line, I Will pay VOlJ J str'o1Ct chirOI
cl up to $20 to CO~ff Jny or 'iour eosls .l1currellln lhl ploce5slnQ Jndior pJYlno 01 3ny rlne 1111.)1110 piy at Sf"I, ;my 1\111, yQu IflJV pay 111m m., I wllIlelrnDlJl'V vou on
1frNntJ ]rv II"'! 'jr:u NII1 Illhe :'JI1511lctl()n .1' "w!lrchl"t Vehtcle IS /e\1151eIPlllTlalntJII1~1 prIJ~.3m IN J~~~~~I/'IO lint! J\1~'/'I~t 'e~~ees or lny I)lhel 'fllhlCht o"rl1l('~ who ale
not 'Ienlcll O.....Il~l~ 1....111 pay Jny ChJI~e$ Ilrpo~e\! lly lhl IUllslllcllOn IOf '.lour P3rtlClpJlron In the pro!J'JI1l
14. TOTAL LOSS OF VEHICLE: Iltha ythltlall dlmagld. 110111' 0' 1011 and II dumtd I tolll Iou by my Inauranu company and my inluranl' complny
0' 3rd party /I1Y' 10 m. 0' to you 1111 "10111111' m.ntl Vllul- ollhe Vthlcle'l Iht Urn. oltht 10lallon,IhllluII will and and 1",111 nlll ba lI.bll 10' Ihl amounts
In iI,m 12..A; ONLY IF I p.y to you lilt lollll",lng amounts: (I,any PIOCltdl I IlCtlYl 110m my Inluranu company 0' 3td party up 10 Ih, ~lol.ll.i, mll"t '11lu'"
oltha Vlhlcl., (bl 111. Imounl 01 any "d.due"bla. und.r Iho inlUllnn pullcy 11111 paId 101 Iht lolal ron 0111'1. V.hlcl, ,nd IC) any amounllll.n du or put dUI und.,
IhlllulI. Th, "Illlalllll mllktl valu," 01 In. Vlnlell on Ilolalloll il UII .mounl alllt.d 10 by you, ma. ud my InlUlann tomplny 01 3rd party." 1 comply
",lth thi,Utrn II will not b. dumtd 10 bt d.laulI by ma und" lI.m 24 Ind wtll nol IUb]ICI ma to addUlonalllablllty lIndu IItm 20.
15. DELIVERY OF VEHICLE: HII~ l~asl! 15 eHecll'f1 h'l'lrn I Jccepl IJI!Ii~'rr/ 01 \/'I~ '/ehlcl!! Jl1l1'lllU ,1cCtpt alld ~~ecu'e the leJse You JIP. flot fla!lle to me II tnl
Vehlc!1 ,s flat dtll'feled I JCkflO\\lell~e lhalthe 'Iehlcll compll~s ....111'1 my sPl!cllical!Ons
16, RETURN OF VEHICLE: Upon early I)t s,hedultd l,w,e termmatlOn. I Will "nrnetJialely "Iuf(l the VehlcllllO 'IOU. al J placa and lime you t.!es:onal', fh. placa
01 relUf(l Mil ncllle .In uflteJ50naOll iJl51.1flCI! flom the place wllt/e I tOOK lleli'fer, 1)1 the 'Iehlcle, II! Keep lhl VehlCII.1Mef the <Jml 011hlll!a5' ferm, I'Hlll be dlltmld
10 Oe hOliJlnO ovtr the leilse on ~ monlh.to.monlh OasIS, 5ublecllo Jlllea~e lerrm. Ineludlnq my oOOoatlon to conllnu. milKI110 my monlhly paymtnts, Howlvlr. nOlhino
In lhlli l.useh'11I tJlJ conSllued 3S QI'flno me Jny IIOhll0 kerp !lle 'Iehlell .Iller Ihe I!M 01 thelr3se Ttlm, III rad to relurn Ih. Vehlel. as fl!qutred, you may rltCov'r Ihe
'Jehle:e 31 my ~~r::eflse !o thl! 1!~llnl pel miMed !ly lilW You m,w notify Ihe Deall!f !rom whom I lOOK delivery or th. Vehicle or 3ny othlr Suoatu Ouler ollh. oltll!nClt 01
thiS Luse JM Ihe seheol;leo lelmlllatlon tJate 01 tl'll5 le.1se Rl!turfllJr the '/p.hlclll iJees flOt, 'n It~ell cOnslltute.1 termmJtlCfl ot !hIli leasl, IJJlless 'foU ha'f' allPloved lhll
retufn IJI tM 'Je/1lc~e Jnd the ~fllll)l the le3~e in .....,IIln~ 311111 have palll aU sums dUI ulldtr Ihl' lease
17, EXPENSES, FEES, AND TAXES: I ....,Il pil~ all openses. leI'S and IJ)r, eMl'led lor Inlll.11 aM suO~equent arlnll31111 anVI Vlhlcle tllllno, IIcenSlflQ.lnSpetUOn
3M reqlSlrJtlon JlllJ .III sales use, pmell.)i property Jnll other la,es Ofl thl 'Jehrele 1M lea~e or -/ehlcle use I undmland tllat Ihe IClal 'or orflclal Fees and Tun shown
,n Item ~ rellects \hl lates JM JIl'IOUfltS ;n eHecl ill the trrne I slqfled !hlS ll!Jse II those fates or JlT10UfltS Inr;reJse dUrlflQ the leasl flfm. I '11'111 ha'f!! 10 pay 111 amount
qrealer tMn lhe 1I;lal snown In l!em4
18. VEHICLE USE: The Vehrcle 11'111 !:e used rJnly ror lawllll pllrposes Within lh. United StJtes n compllanCl With slatl and l"llmllilws hupl rOt OCca5UJno1l and
I"Cllunlal use oy elhers Nlth my pefmlSSlon, I Wilt relaln possesSion 01 the Vehlell I AM THE PERSON USING THE VEHICLE AND MAKING ALL THE
PAYMENTS OUE UNOER THIS LEASe, I WILL NOT SUBLEASE THE VEHICLE, "". "" ", 'en"" .,11"01 D' uso' 10 ",""on ,'odS or ptOpl,
lor hire, and thaI ,I NLlI nolbe opelJlel) by ilnv persofl rIO! dilly IIcen5cd ,lnl1 QlIallllrd.ls .10 ooeralor I mllsl 00t31/1 your NrIHen permIssion 10 makl Jny thatIQIS 10 or
'fl$IOlIl any I!QUloment on lne 'I"hIClt II lfly chaflotS Jre l11adlt .JI Jdllltloflal ~QlJlpmentl5 ,nstallp.tj I '11'111 nJvllo llJY YOII IOf 1M coSI to return Ihl V!!hlell 10 Its orllJln.11
condlliofl even ,I IOU Jcpto~e lhe ChJfll)" IJr InstJltJllr.n 01 P.QUlPIT1()fll You may Illsp~cl tne '/enlcle on ll!Qut~1 ,It Jny l!!asCflabll! !Ime
19. lIABILITY FOR INJURY, DEATH AND PROPERTY DAMAGE: I Jm 'Iallle 'Of In', '11IU1', .leJth Jllllill' plop~rr, dJm,ll)e reSlll1ln1) directly ot Indlrw!y
from thl! IJPtIJtlcn l11ollnlenance, uSt IJr P05S~,)WJlllJr Ih!! "~nle:e ,II JII IIIl1I!S lltll}!!! _ felulfl I~." 'M1If.'P.!0 you I UNDERSTAND THAT THE PROCEEDS OF
ANY INSURANCE POLICY MAY NOT BE SUfFICIENT TO PAY THE FULL AMOUNT OF MY LIABILITY ,,,II ,""","n.1I '" II,""""",, ,",,'"
Ihe '/p.hIClt \0 lOIJ the IIlSUlall~e 'JesClIllf!d In Ilem 8
20. VEHICLE CONFISCATlON, lOSS, THEfT, DAMAGE, DESTRUCTION: f,cl!llr .1~ ll'fl'fulp.t!1I item 1~ I lS5ume .111 fI~K 01 Vehlr,le Jamilqe.loas or
tnet1 DJ/tlal ';r ~amplf!le frcmllly ';iluse If the '/!!hle!e IS ~QIl'ISCJII!IJ I)', ,lfly <)C'felnment Juthofl~, iC~jl ',rolell, IlesIIC~p.I! r;r 'Jamal)ed lleyond IlpOlrr, ! WIll ptompl1y
flotlf'f /Oll il sllcn JIl ~~efll .~t~II'~ f!lCell' .IS PIQ~llll!tJ In 111!1T1 1.1 lllll Inay r!pclarl! Ihl5 L~.l~e III I)e ;n IlI!tallll JnlJ /1)1l 11'111 t1JVI .111 rlmtdlll$ SII fOflh ,n Ilem 24 or
other,~I~t ol!/mlMed 1y ,1pOllcable law AllY InSul,lllCe P/llC!!!!lls ,p.ceIVp.I] Jy lOll /jlll oe JO\lllell tOllO'Jul1lS I .)\\l! iJncl~l IhlS Lp.Jse, e,cepl as prl)'flotd In tllm I" I
UNOERSTANO THAT THE PROCEEDS OF ANY INS'JRANCE MAY NOT BE SUFFICIENT TO PAY THE FULL AMOUNT OF MY LIABILITY,
rile 'ack 'll flSlI/.l/'ce:QVi!11ql .'I.II"Gr f!lCI/Sa ,Illy IrJtllh~i' may I1,1'I1! Ji',1P.1 \hl~ ~~.1~~ I 11'111 <:1;nCl!r.lll! Illrly IIlth l'lIl ,1I1iJ .'Illh Ihe 11l3uranct f,Jf/ler In connKtlon 'Hlln
]11'1 f!'IP.nt ...nlcn ~Ou'll fl!Slllr ,fl I c,au'l JIlII>!r .jll'/'!1slJIal1(1! !lOIIl",
21, INDEMNITY: I ,';111 'llll(lll.llInle'j$II;11 /')Ijr HJ1!11I', WII ~mpll1.,,""; IrOIl1 l(1.tl'l./IW.1 ,ill', wrl III 'I)',,, 1,1I11JI;I! Jll.} ~ID~ll','lllr.llJrllfl'lII!QJI ~lPl!flSl, al any kind
1l1">"I., 'fr;m '/'1I11(:e ,j"e ':Ofl'IIIICI1 'lflf,IUIJIIHI NIII'1(]III lllflllJ!lIln !,lrent IIIIJ Jlh~1 lp.lfcr'j~l1l!lh~f 'll IIr,l ,11..crl~nlhll!!I'I Ic.n 'If <lD~r.1tllln I rna~ f,onllol 1111 d,lense 01
,In'/ "'Jr.h ::.11111 T~.lsIlIJell1lll~/ .'/111 conrllllJl! ,(1 ~rll!ct ,lt ,111 II1IIes f!V~fl ,II ',lrrrf!'lll~1 Ihl! Ip'!1Ir.:" ')1!1"IP. :111! ~(lt! ,)1 !he I,~.l~e felm
22, REMOVAL OF VEHICLE FROM STAn: Wllht:ul /'lljl ,~rln~n pf!rrlll',',H:11 I IIilll'.;1 rf!lT:fj',P.:1'!lt "ehlf,lp 110m 111'1 ..IJr" rlr r"Sldflnee ~hOwn In 111m I 101 iI
Dl!rlCIJ ;1 time )' ';ltll!r'NI')e '1IlII"r i)IICI,III',t.lnr.~'j IhJl ""I]ulll 'P']IJ'''! ,,,hlr.lf! 'P.')f',II,llll;n .Jf '1(,,11'.11111 ,II .lI'y IJt~l!r ~IJlI!
23, NO ABATEMENT OR SET. OFF: 'lUll'" I 'lwe 'lllll~l '/'I'j :.".1'." ,II" 111:! ';IJIllf!f,1 10 _lll',' '1,,1,,1I',1! ~I!I .)11 .;r,ljl1ll!lf,!,Wl1 'll Il!r.cuprnl!nl Dte,lu~l! 1111 'JlhlClll IS
:lJI".I'jf!rl 'r:~r ..tew' 'l/ ,1""lrO',1!11 1r n"clU.." fJI lIl'l nll!flljpllnn fl II!111(1P. I';" )~I~r,I!I<11l 11 Pr)','.P.",',ICI1
lUU ,')Ij 1I1l/bl nnll m.. 'lIJlIC' '11 ~Jnll'll.)IIU11 ",1)1/ ')1) \U!:llul 10 tI', '11.1 \.111..11(1 I 0'1111 h~1 tt111l~~1 II) UUl~IJlt Ihl~ If!J~' J~ !:")'olllrd III !ll' 1\1;11(11 b~ !:.l)Hl~
,11 p..~IIIUt 1I11,nlhIV p.~rn'1111 IlItr f,n JI'1l alnt' JmCllnl5 'Iut ulld.r IIlI~ It.l~1l Jill) ,1111. V.IlIC!t n,1$ nUll 'rlll)~5U5r'l ,11'" (1)51$ III IflllJIU$5IUrl, 'hJIJ~1 Jnd
III11'I)OlllnQ In. ~'.h.cl., pllll, ,I ,'JII ,nCUI llltrn ,'~Uf 'rJ~C'1"QII JIIOln'}5 t,n lil Ih. ~~III1II)'''MII!j!ly I.lW .lUll (ClIII (ll~15 II I 'tl/l~t.II. Ihlll ltJU 1/1 th/IS '"ilnnlf,
I mly COI1IUIII' II'llll It'lll luu n ,I 1111 1).l)1I11111 !jtlJIlII lIi1tJ ')Cll/llld, bull >\'111 1'II..tlh. /llJllllQ 'tlll~I.llllhlllIJbl ,11 11115 "'Jllnl' 1)1l/) I lUll' tJljlln~ Ih.luu rum
I "",II h..... no "IIl'till'lll.nlll~III,1 I 11.1.)1111 10' Illy '"ncn '1llIlIlhill fllllllfl'O 11'.lk' my lI11ll1ll1ly j)t)'1l1.nl lJlhll....'~r I ""111), 'II ,jrlJIIII Unllll thlll lrJ~1 ,I I l;all II) ply
oIny JUlounl n JIHJ 'hlltn 'JlI' I folll to pl/hnm .1Il~ ,;1 iII~ 'JlIlr' ploml~tI 01 obliqllllJn5 <Jl1!jU IhQ lr,,~, J J.IJllllol;CIJ!', 'JfIIlrl J"~ 'HI'" lun <JI Jql~~ml/1t I "ilvl
SIIJII.d Of ~ullt.nII!tO <JrT bthillf cl Jn~ ()Ih., p,'~~n pJrtn"~hlp. 'JI ~Olp.JIJIlllfll tJle, .1m 'Il(JrUliltlG <JllIe(Omel'~JII~ 'n(cm~e!enl tll, ltJ~"l/ V.ll1CI, '5lr3n511!III!O
b~ 'JpllallQn cl law ')I by (lllll' <J/l.11/ 'lr lh. '/rhl(llt.~ /';11'11.1], conhsc.:llelJ Jl1atll.ll ~elZrll 'JI such J(IU)I!.5 IIl'fJtl!,'t(J 1(0111111;' p.:Iy Illy ,1.bts.)5 fhe~ (cmlt <Jill I
bl'OIl1, ,n501..Inl. I)r J IltCCt1]lI11 'I orl,lIr, J(filil1M IIlr un')tl JII~ 5Iillrll~~I...llcy ~1.11111.. Ih, 'I"lIcl, 15 IQ~I ~Il)/.!n or ')~tIJt~tJ lJy 1 pl'l~cn LJIlJC(tptJt:lr to you, Jlld II
nol IICa..III111 'lr "lurn,tJ .."IIM 30 o.lll)5 lhl '/lhl(l. '5 50 llJlnillJrd !hilt m ',Oul ludQrnlnl.1 [Jnnol be ',pJII'I) Wl/H)I1tll:Jlly Jlly 'lllllJntCll)tlClrl IIlII leJSt 15 '0 lle/1I1111
lQ IOU Jlllll IUPfttllll ,lily 'Jbh~JIICtl <Jl'lrlJ b~ III' 'luJIJnll;f to (QIj, 'n(IUllln~ III, <;Uilfilntu ':1 11l'5lrau I hJ';' IIlJll' Jny IIlJ!el',111ll1~"plr5,nIJtuJtIri 'II Illy JpI)ItCJlIO/1
101 Ihll~ lti151 'Jr In)thul~ ".lPCt111$ hhl[II/ClIlfJ6(;llilbly C'lIt'" ,n qootJ IJlth /JIll fl1(I'119.1 the 5.ecUllty /011(" ar ~t1"'(IJI)IIit)' ,;llhlf "!III~le
111'111 In IJtIJijl1 UIlO" !hI5lfJ~1t ;Cll '''.:Iy '10 .lilY')' .III ,)I Ih. fOlhl""'Ilq tlIJI311 nolplcnlbllelJ b~ 11* 111111111.111 Ih,~ l~J~t JI'd JIl) emef 'rJU <11 JqrurIl..nllhall ho1~1
Itqn,,, ()Il btll.tll llf ~I <JUJllnl~tIJ lilt Jny atllll ll~I~CIl p.:Iltnenn,p 1)' CU'lllJIJhcn, tJ~e ~II(II JUlon leu 'JrW' ntce~"JI'; 'If J1I11111pll~le ,,1 lJldtt III prQlect. Illest'....
ll' Qth"'NIU Ule~uJld 11111 '/In'~'1f IJ~e PO~U5~U.l/l 'II l/lll "l'hl(I, II'IIh l)r ....,lhlJlJIIUdICI~lllllJ(Umn05 'Y'IIJ I"I~ com" 'mlo my prfJprrt)' III IJ~' th. '/elllcl, .tno olll"
COllillltJIl. l)r let}lIutlllill ( I.turn !h, 'I,hlcl. !o ;1)11 ~lflllht "rhltle JI I llllbhc 01 llll~JII 1.111/ NllOO1I1 111'th" f\lJtlCl f.) 111' ,I!:I:'Y III 'Il~ lrJU I)bhq,lllons tn, $ltu,'1Y
1'P"5I1U) '" p,oce.ds '"lln Iht 5Jte 'JIIIl, 'I,hlc!, "'lullt <1",,1.01111 pl)lI1enlOr tll. IrlUlunts 'PKIII'l) ," Iltrn 12 B '('lll ,'1,,1 pI(l';ldll 11QIIC' 01 .tn~ 'llch JellOn 11101.1
.Ire "QlIlltd b~ law 10 tJo ~l)
25, INTENT: THE PARTIES INTEND THAT THIS CONTRACT IS A LEASE AND NOT A SALE OF THE VEHICLE, , .gl" tho! , 'co"," n.
ownll~hlp. lilt. P'Olll!lty r!~IIl<l1 'nlffltsll(Jr Jn~ l)llllllrllhell!(Jllullh. V.lllcl. r~(.pl 'elely J~ ltu.. IjtHJu Ihls lUSt All 'ef."nen ,n thll lun to the lU5Qt $11111
Include 11111 OfltJlr.:U l~!5C)r ,ny J~51~I1U <Jllhe lJfUJII1illlf55CI Jnll 5vbuQlIrnl huhWs III thl5 lU5I
26. ENTIRE AGREEMENT; ThiS ltJStS lJu' I'nl'" (onl'Jet An~ rnolJlllCJIlon mUfilb. Willi'" Jill) SIr.ntiJ by ~l.lth ,)1 'JS I may /lol il1510n, Sill Qr Itanliltr any
Inlerflt ,n llle 'Jellu;le 01 Ihl5 leJ~e ,'Illhcul ;I:ur ""'Itltll (Onunt I "",II nOI pledOI mllt1qJQ" 01 olMtwlU p.nclImber Jny 1I0hl!Jt ,olerull ha~1 In Ihl '/ellltll or undtr
!hla ltJ~e You IllJy JS~I~f\ Jn~ cr all !JI ,0(Jf rIQIlI~ 10 !Jrn thl! v.n,ct. or toe leas. .11 Jn~ liml. Thl hUillll1J5 !llrllllQhOul !hlli leau JIl! u5td fOl r"lr,nCI PU'PIlIIlli
Jnl3 COO~l!nll!llCl! !Jnly, .trl!j JIl! nct 10 bl! <:on5Uu.tJ JS limlllng ,n Jn~ Nay Ihl P'OV1511)n101 Ihe leonl
27. TITLE AND REGISTRATION: rh~ Vrhit!1! 'JIlltb. U'l151I!I~d Jnd lllled 1M IMllaml! 'SuDIIU luslnQ C<llp.. 2235 W. Marllcn PI~'. Chlt'Y HIli. N.w Jrrs.y 08002'
0' as 'tOil 01h..ro'Y161 m,ly 1"111)11_ (Wilt 13~e 111 IIr(t~~.:Iri ~lfll5 10 '1la~' ~U" Inri !t!. Vthlcte '5 InllUJly 3nd conltnuillly reQI51erec ,)nQ Illlld as reqUire" by law 1 'NIII ~''I
101 allllle c051s. fees Jnd uprn~t5, ,neludlng tun. lJue on subuQu,nllltllng or Il!QllItallon. If 1 mov.IO anothulun5dicllon and lhe Velllc!e mUll be r.U::td l1nd
ImQlsle,.d 10 such .llurl~Olcllcn llUIIOQ Ih. LI3se ferm, I i,llI llil~ lor all co\l5, leu and open"s, lMeludlllQ liLJ:tS due on IlllmQ Ina tlQISlrJIlOn QIIhe V.hiellln Ihl
new IUlllilJICIlOf\, I will .:1150 p~y ,ou 01 tre of $20 lor ,(JlIr Il!cord ~"plng 31111 el.tlcal,Jp.nSl!I$ In tOlln,cllon wlln 3 cnanQe 01 tltllnO and reglliltallOn
28. REPRESENTATIONS AND WARRANTIES: I repftunl,Jnd wartanl Ihal all 51allmelltl mild. In my JppUcill10n lor lhlli lust wert. .nd umaln. !rUI olnd
carreel, I lepmenl Ihalllle lessee 15 nOI ,} Qownmellt uOlt, ,} forelOn person Ot .nllty.lfIlnl.rnallon.1l orqanl13110n. an agenC'i or InSIrumenlallty 01 Jny tll the 10rloomg
p.rsons or enlllle5. 3 IJ.~',mmr.1 entll'/, 01 panne/Shlp ot otnlt pau'lhru enllty II1VII1Q "ny ollh,'ortgolno pellionli Qr elllllllli as a member. Ot.1 lhntllnlilllullOn, I
reprnenl3fld 'o'Y3/tJnl Ihall Will ncl u5e Ihe 'Uhlc)e p/fllQmlllatllty Inlh. Iud. or bUllnUl 01 tile lutllIShlno Ot 5"1. 01 publiC 1I111lly mVlen at Ploducts, or 10 eonnleMo
wlIIl the ~~rnl5!lII1Y at opmtlOn tll 01 10dQlnQ !ICIlIly. IneludlnQ JIl Jpaf1m.nl hOU6..
I undersl.1nd 11'1011 ,eu hil~e J51c.lJ fer CIIt.1111 01 Ihue reprnen/llIons In order 113 mak. sur. lh, ,JpIl'oprlll' m.lllIJd 01 deplecllllOIlI$ uUd In lhus l.aS!. II my
rellllUllliltlons Jnd WJtt,lnllt5 In thiS ~.CUon JII falst. ,and ,au "' required 10 Ul' 0111" methodl al d.pteClillon, I lor.. lhal ,au may adiustlh. paym.nlS due uoott
Ihls Luu 10 ptovld. ,au WIth lIle bene Iii 01 llle deprrClallon mltll1Qd you Olntrwlll1 would havI bftll .nhtled 10 UISI.
29. JOINT AND SEVERAL LIABILITY: IllIlert 1$ mO'1t than ani Lmll, 01" oblloallons und" Ihlll.as. "" )Qinl o1nd st~.t,,1
30. NOTICE: Any nOIIC! rrlill!no to 11115 lust Will be wrll1en and sellt 10 In. addll$s ~llIJwn 10 Ittm I or 10 such olher "ddr.SS as,} Pilrty may e1l5lgnall in wrltlno.
Nolle.s J s.nd ,^,llIbe eHeell~e when you ffCl!I~e Illem NOllr,e5 you send Will bIIlHec!lV..1S 01 UlIllatllh.y JII sent
31. SEVERABILITY: II Jny prO'o'l510n 01 Ihl5 LeJst IS to ally ot.nlln~alld Or untnlorcl!Jble 11M! rlmalnlJet 01 Ih. LeJ~' Will be 'Ialld all" enfQrteabl1 10 III. full'll
eJ!.nlpetmrnedby1i1w,
32. NO WAIVER: Thllallure or etlner party 10 InSI51 on IlIe pltlormance 01 any or Ill. lerms, COVtnanls 01 condlllons 01 tillS lU6I WIll not be CQn5trued as WIll/ino
In Ihe lulure $lIch lerms. co...nanI5, nohls or prlVlI'QlIs, wfllcll Will rernam in lull lottl as II no waivtf !\ad OCcurred
lessor's Assignment
Dealer/Les~or sells and assigns to the assignee named herein or below ("Assignee"). all 01 ils right. lille, and interest In this Motor
Vehicle Lease Agreemert ("Lease") and the related motor vehicle ("Vehlcle'l. ThiS Assignmenl is sub lee I to all the terms and
conditions 01 a certain Dealer Agreement made b..tween Dealer/Lessor and Subaru Leasll1g Corp. ("Agreement"). This Assignment
is without recourse to Assignee. e,cept as provided under the Agreement or a separale wrillen agreement between Dealer and
Assignee with respect to thiS Lease. The ASSignee is Subaru Leasing C~rp. unless anolher Assigneo is named below:
, ..
PAUL G. DAVENPORT,
Plaintiff
v,
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - I,AW
HELEN P. DAVENPORT,
Defendant
NO. 97-4546 CIVIL TERM
ORDER OF COURT
AND NOW, this 4th day of November, 1998, upon
consideration of Plaintiff's Petition for Special Relief ReI
Dodge Caravan, and pursuant to an agreement reached in open
court between the parties and their respective counsel, it is
ordered and directed as follows:
1. The consumer loan from Navy Federal Credit Union,
Accoun~ No. 2060454-002, will be paid in full using joint funds
from the Putnam fund account, No. AOD-1-150-30-4016-BBB-S, which
account is in the names of both husbani and wife. The balance
on the loan as of August 18, 1998, was $8,951.16.
2. The title to the 1996 Dodge Caravan currently being
held by the Navy Federal Credit Union will be transferred from
husband to wife when released by the Navy Federal Credit Union.
3. Husband will cooperate in the transfer of the title
to wife and in having the Dodge Caravan registered in wife's
name. Husband will pay the costs for the transfer of the title
and registering the vehicle in wife's name, and wife will
cooperate in signing the necessary documents to transfer the
title and obtain the registration in her name.
4. The parties will accomplish the transfer by no
later than November 30th unless there are unforeseen
circumstances that arrive.
~
...
5. After the transfer of title, wife will be
responsible for the maintenance and insurance on the Dodge
Caravan,
6, By November 30th, husband will provide ,to wife a
statement for the payments on the Naval Federal loan account
referred to above showing all the payments made from the
beginning of the loan to the time it was paid off.
7. This is not intended to be a partial settlement of
any marital property issues, and the property transferred, as
referenced above, and the payoff of the debt wi 11 be taken into
account by the Master and the Court when the equitable
distribution proceedings take place in this action.
By the Court,
Delano M. Lantz, Esquire
100 pine Street
P.O. Box 1166
Harrisburg, PA 17108-1166
Counsel for Plaintiff
~qu.~ f')',.\.~,d'fL
II/S/'1f.
.,l,.'6",
Ruby D. Weeks, Esquire
10 West High Street
Carlisle, PA 17013
Counsel for Defendant
:srs
, ,
(') I,
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I
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1,'1;
XII 'l'IIJI COURT or COIOlON PLllA8 or
CUIIB.RLAIID COUNTY. PI1I1f8YLVAlfXA
CXVXL ACTXON - LAW
I
1\;
"., ,
XN DIVORC.
n-uu
CIVIL T.U
'I:
PAUL G. DAv.NPORT.
\,
Plaintiff
"
v..
DLIIlf P. DAVJIlfPORT.
"
"
Defendant
i ~
t.~R~ "1m APP..TglnmIiI'I'
...oz_
DUIN P. DAVlDlPORT
,.
RUBY D. nn8. UQIJIU
10 n8T BlaB 8TUIIT
CARLI8L.. Pol 17013-2955
717-2U-129.
,[
.,
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"
.,
D,O,M. 2/64
0.0,6. 8/1/97
BUKHARY or PRIBINT VALUIB
trom HU.band'./W1te'. InventorY , III:lDrahal
ITEM "AllIl- AI' INWIH'S IN IllJSIIAhl)'S
"It! SI'1'\1 IIC)SSI'SSIlIN 1'(I!'ISlssItIN
\'AUT AI
U^"lol.
SII'i\ltAIItJ1'\
Mllrilil1I'lO""rt'
Morital Rc.iaJcllce 21 Slone lcJ~t: Om!:. Nt:~\llh... S4~.12111~1 IICI\loCt:1I X
l.un;hllfSl'aJ H/26/HM lor 51} I.OOll.l)O, Or;~il1l1ll1li)It~Il~c '42,171}C}W
Amount \M I ,1)00,00 blllll"~C JUI.' un 1II1)rl~lIl1l' 7/1(1, ')7 LInd
7J7KO.00 S4",17'IHK
S 112,I}C)O,t){) ~ lth lIIill1hllUIIl "',Hk JOIII.' S II S,tJOO,OO
"lIh 601111: "ork dOlle, Ioloith full "ork dllllc S II 1i,IIOn,HO
('umnl hlllulI~'c JUl: WI C!I'IY \70 720.1,12
111M" t>tKJUI! Arlcli ScJUII Irotllili:n:J 10 duuuhlcr . S~I)O.()O S5CllJ,l)O
Jo~nl chcl.:kintc accounl Nay)' hllcrul Credit Ullillll S'"M.M H/311')7 ,
OlJ\ JlS54. 707 S"MMi
lIufSbnnll'li Member'! fcJl.'ral Credit Union ^CCllUlIl " $S2 .)H C1\llicd 1lJ/27,'}7 X
ISlO9K bllluru:l.' nllimc or
dUliilU1 SI~'1,Ot)
Joint so....inji511l:ClIUnl NIl\l)' h:Jc:ral Credit Union SIH22.lJ2 elm!.'d 'Jilt-,tn
hullll1Cculdllhillg
$:!l)l)l)()
lIu&band's ~\lin1C5Iu:F.:oUnl NII\')' Federal Cf\:\hll1nioll Unkllllwn 10 .... ife lJnkmJ\\dlto wili:
NOIH54.1)()4
Wife's 511vln~5 Betounl Nov)' feJeral Crelllt Union /I IV II} ,In S".HIM.2M
$2,2JH.'15
Husband's r.:hcckinH ul.'counl Nu...y Fcdt:rJ' Credit Uniun
NO IJ5S4. 707
Joint Putnam High Yield Trust ('l-A S\lH\tJ~Ol) ('hIlled IO,2hll)H X X
Balance 6/30/911 S21 ~72.J4, ulicd SH,9's1.16 10 payoff S5kl2Atl SS.6J2.4~
Nov)' Fedcrnl Crcdillolll1 per cuun order. RCll1uilJ1I1~
funds wert di...idcd between the partiu nlld phh:cd in
seoarulc accounts
Husband's life Insurun('!: Mass, MuluaI1l9751)')4 . unkl1tJ\o,n 10 wife: ullknm..n In ....ife X
aiullBblc Icon. $450000.00 face: value:
lIuBband'. Amll:d Fon:e!l Uf\! Insuranl.:e polk>, un UnNlltlWn 10 wife unknuwn Itl wile ,
lIursband'slife
(nee ,;olue $41) 000.00
Veteran. A"lmhll1111rulion Icnn inllunmec. fal.:!: IUIIOUlll Unknowlllll wili: lJnknm~lltu "",fl: ,
$100')0.00
TROA Acclde:ntal death & dhmll:mbcrl1lentlll!lllranl.:e. Unknowlllllwife UnklUl\\oI1lO wifu ,
roo.., ,~.~
HELEN P. DAVENPORT
Page 2 of ...17
October 4, 1999
IIHI \AII'I' AI IN WII'I's IN 11I'~II^"..Il'
I'~I !rrlH'\1 I'O\SI !-ShIN II(IS\I-"ION
VAl lll. AI
I)AII-I/I'
SI'I'^"^IIIIN
Iluhhulld'.l'uhh: h'\:h (lNI\! Slulflllll ~ 1IM.Ill Un~IIIl"" hI \10 IIi: ,
11JI,In
Ilulihl1l1d'. C:uhll: ^111Ihl:L11101l~ 4tll K II,hl111 11,.\1),111( ,
Il,Il7H4l
l"t(~Clll hulun.;.:
Illll.nm..nIII \Ioirc
IIUtlhlllld'.lll:l~lIhC FIlllllll:l.' I'ClIlIlUII . III Puy frlluluII ,
S"7n~_l.I0 lIIU1l1hl\' Vrtllto
Iluhblllll1'l Of1II~'lllllmll"r I:Ulldli II~A "70071)0.17111421, 2....J1J.7~ (II 12,llK ,
72.b2~ .hUftIlUlilll"IJI12197 2.1124"'4
I'rl.'~cnl \UIUl:
unl.nll\\.lllu "IIi:
Wlli:'.OPllcnhcinu:r fUIIII.lltA I17l)U 7l)()J11J2"~~" 24"'}7S 11112,ln\
72.fl25 ,hllrelllli tlflJI12,97 l'IN"'4
('rcliclIl \olllu!:
un"-nu\Iorllu ....ire
Rolcll wBlch nun:llIlM:lI b\' hUliblllld llrlknll""hI "i'", l/nknll""IU\lllli: ,
Ounllllnd r\'lolldinal: equipment J.501l,l)() ,
pre\iiou~l~ di...hJed wilh "ifc, cllchllll~ed li.n ".Ife
rt!;'ei\iinlZ klh:hell !;'lmlenli
Kill:hell conlcnll.llrc",'ioull)' d'''''lded ",1111 hUllhand, J,.5UI)I)() ,
uchBn~cd for hUlibllnd rL'\:ei...iny: ~U"1i nnd rdulldlll~
eLlllinemenl
Wlfc'slel.l.t'lrv 290.00 J.\O,l)l) ,
MiKclluncou$ ncnonlll nronen\i .Sc:c II1111d1Cd armrni~1I1 llnknm,," hI ....ife ,,(WJ,f)f) ,
11)96lbhzc CBruvun lJnknl)\,l,oll hI wife 1301l.00 ,
Incrcalic in mBrllial ""lIlue, lfu~bIlIlJ'1i nWlhers nil).! .1411UO
Incrcll!c in marilial ....alue, blltllnc!: uf Ilu~bIlIlJ'S Unknlll.l.ll10 wil'c Unknu.....n 10 "ife:
inheritancc
TOTAL MARITIAL PROPERTY S I 00.661.87 5110.306.94
NON-MARITlA!. PROPERTY,
IIUSBANO'S
1,8 Coral diamond sllhlalrc nng' Inheriled frolll111lul's 1991) 2i4ilJlJ ,
mother 12191),00 l~flOH..5()
2 anlique calloes, Ihese ore: beiliU: ~Itlrcd Illlhe 8urnge for Unklltl'Wlllo'Wifc Unkn!)wn III wife ,
lhc husband
II) owncr'!'hin ufclIbin in New York Unknuwn III "ifc lInknll'Wn lu ....ife ,
Palek Phillint walch. inherited fmm his mol her 2l00.lX) lInknmlo" llll.l.ifc ,
Uusband'l 12 Plote scllilllz McrlinllSil\icr I1UIWllrc lJnknllWl110 ""Ifc lJnknlJ'Wlllu Wife: ,
En". Slo'~ . 212 .h..., ''''MIV' 11,"o~".'o w;,.
HELEN p, DAVENPORT
Page 3 0 f ... 17
October 4, 1999
I1HI VM_UI' AI INWIH'S INIILJsIIAN/)'S
IIIU'S!.Nr Ifi)SShSSIIIN 1~ISSI.MiIIIN
\'AIIII. AI"
IMII-OF
SH'All^llIlN
TOTAL NON.J\IARITIAL PIWPERTV 54,668.62 655,949.93
IIUSBAND'S
NON.J\IAJUTlAI. I'JHlI'EIHY. WIFE'S
Nn\')' Federal ('n:t!H lJlllun . prol'CI1)' n.'L:CI\C\llllkr 2L\1 ,
ru:ncrnlilJI1
1/4 cum I dilllllllJld t1t1l1 UnkIHl"lIlll....ilc UnkllO\ldlliJ \111ft." ,
fulllcnulh "enl ~klll fur (lllll Unktlily,ntuy,ifc Unkllll\\dl h) "ife ,
TOTAL NON.J\IARIT AL PROPERTY 12190.00 15608.50
WIFE'S
PROPERTY TRANSFERE[)
111M I)Ulhzc ^jn:~ Scdun (In1mlcn,'ll ~t) dau\/hlcrl ,501),00 500.00
19HH [)tJJ~c ('llnl\aJl 2000.00 5/9K 11000 110.00
300.00
232 lih:&rc, of Exxon ~lock lJnknownlu wife 9/1J7 ,
\4200.00
Hu"bunds 11OI1S 10 husband 1'1\1 1I1.1rCCllIclll J Sllo.no X
Wife's Kih:hcn contents lu wife b... l111rcCll1cnl 3.S0n,On X
," ':} "ll
JrnTAL PROPERTY TRANSFJ:RED 14200,00 , '11
UAOII,I'fIl:S Qt' TIn: p.~lnll:S R.:SI'ONSIIII..: PARl'V
lIlonll:ullc-Fir;.;t Natiollwide n1nrilal residC:lllo:c 7)7HOJ6 lJnkno\l!tltn wil~ ,
Visa 42IPJ6(1).030)-Hh2H 71 I 6/I}H ,
lJH4.77
Wirehl!licHS
present hnlall(c
-0.
US Dcpt. Of Educotion loan for t.lllu~hter lJi2Jil)7 7/21ilJH ,
t1usband hM OIWIl\l8 nlliJ ItJ~34,67 191M.II}
Viso GolJ 444~ J022 4HOJ tJ24~ 7/22fl)H x
21M
USAA Federal SIl~in~8 Bank Milsterl:ordlVi!m 7/1/1)11 x
1416 JOOH J21l7 OIIlJ 1)1}21),21)
Viso Gold 444~ 3201 6120K654 6/11/911 ,
4lJ2.~,50
MONA 42M 2924 )600 0216 711};~~1" x
HELEN P. DAVENPORT
Page 4 of .,,17
October 4. 1999
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091011~999 0914~
'1777~4E71
:Jj;'/fJH'"
~ ROWE:~~=
R, D, 4, Boa 116I- Cullllt, PA
24..11T7 148-1178
AUCllltoll1l Adioll Call "ROWE"Por Soti.(adioll
Auqun all, "lIII
TOI Keltn D.venport
2' Stoneledqe Road
NeWVille, Pa, 1724'
FROM I aenny I. Rowe
Auctioneer/Appra1eer
2505 Ritner K1qhway
CarU81., Pa, 17013
REI p.r.onal Property Appr'~.al at the current Auction
lllarket value.
DINt~G !!Qm!
Oval antiqued walnut d1nin9 room table
v/2 leaves. Bcared
Ii dinin9 room .ide chair., leather
(or vinyl) (3 broken), Vinyl damaged
2 d1n1n9 room armchair., one leather,
one vinyl
Marble~topped J-drawer chaet
3-piace etacking table .et, Oritntal
Japaneee .ilver cheet
Oil painting, river ecene (1970)
Wooden hanging Norwegian candl.holder
Pi.r. Browne York.hire a11klcreen,Bmaller
Japanea. calligraphy han9ing from Jane O.
Dani.h cry. tal punchbowl
Ii Swedith eryatal Christmas trte.
Windchime, braaa and wood
Pair of Norwegian pewter candl.holdera
w/;la.e hurricane shade.
angliah bra.abound typeettor', drlwers
w/elontllntl '
,.oriel place~ata and napkins
. 45.00
35.00
10.00
275.00
30.00
95.00
35.00
5.00
6.00
8.00
10.00
15.00
5.00
12.00
45.00
5.00
Pi~,i. 05
DelDll;eee De14~
'1711.4.77
:J/lVENPCP'
DINI~ ~ CONTINUID
G
12 In;l~.h gameb.rd plac.m.t.
6 Engli.h dry fly plleemlt.
12 Pimpernel co.ateru, .almon fl~e.
A..orted napkin rin;e
R.ed and Barton Francia I .terling flatware,
eervice for 12 (14 .alad forka,
12 ~inn.r forka, 12 dinner knive.,
13 tea.poona, 6 cream aoup apoona,
2 oval .oup.poona, butter knife,gravy
ladle, .erving .poon, augar .poon)
. demit.a.e 'poone, Franci. Firet
pie .erver, Francia tiret
5 a.eorted aterling teaepoone
2 pertorated .ijgar apoone, ailver plate
2 bondhendled ~ngliah at.rling fork.
Norwegian mormor .terling .ugar spoon
Engliah .terling euger tongs
Handwrought .terlinq cak. .erver
One re~tengular sterling napkin rin9
Ona eterling baby fork
One ailverplat. ~rea.ing .poon
One eilverplate b.aded .erving apoon
(Uncle Bill)
One aterlinq ~ngli.h .erving spoon,
monogrammed BM
One silverplate handled Norwegian
cheese eUcer
One antique pierced Norwegian ladle
I .terling?)
One Norwegian .terling (Telemark)
patit-tour eerv.r
Eleven Norwegian d.mitaaa. epoona
(TelemarkJ
One sterling Norwegian shallow serving apoon
ITelemerkl
One Norwegian sterling bonbon aerver
Two Norwegian aterling pickle forka
One eee eilverplate flatware
C.ervice for 61(1964)
One oval .te~11n9 photograph freme,
lllonogralMled Ll'R
PerU Necklace, '8", Stirling cJ.a.p
Norwegian Pendant, Ball w/tinka,
24" atlrling chain
'4K Gre.n Jade Ring. Oval 3/4 X ~"
W/emall cultured ~earla,
Norwegian crvetal ring, i" X lie"
StarUng aUvlr
Japan... Brown topaz r in9 3/4" X ,", Hk
Sterling Silver Earrings
Norw.gian copPer rin9,ha~d crafted
Norwlgian Broach, midevil,aeerling ellver
. "
tlA'lLJ
tl
. 6,00
..00
8.00
12.00
420.00
20.00
12.00
25.00
3.00
10.00
6.00
8.00
12.00
11.00
~.OO
2.00
2.00
11.00
3.00
12 .00
8.00
12.00
'.00
7.00
12.00
20.00
15.00
35.00
30.00
110.00
40.00
40.00
30.00
20.00
25.00
PAlO!:. u.
, NID11;ee~ O~lll
'ljl1'=...,,"
!.'(,'JUIFI.IJ'
fJ"'\lJ~ lL~
~~
("I" \
Cl'~l \,'l"p"'. )
I'I'P"'" 'oil'
. -...., ..,- --"- --- ~--.-
Item V.lije Really N~~oliable Don't Inherilante I
---~ ._, WIlI!!. WlIIlt "'~
Randall kn\veo --
-~-_... .-." ..--.-,. 1----
Other knl\es ..-.-- -. - ---
~.- . u,_._,-" _.
~ly..~.. -
.-..-..------i" .. _. -
Orvis fly rod .. '_"'___h_-t -I- _...._n + -'-
fl\' reels
U1L~5))lnll vest u _...._. .~._ --.
.....-+-----
J!Lflshlnl bSll i .- -
wooden fly tying kit w c11l."p....___ ---r- 1-
n.w mouselllld ,
1 tW'ke\ decoy i .--
~~ walchJJ2~2.1L___... '---- , ..
LL Bean llI'een cllwwle!!b.!!..!iJ!1l1e ___. . ~.-- j.. -.,.
.. " halljlllH bat! I
-.--t ...- .--.
.. " com pUler J!!L.
32 LV recordJ -.,-..----... .. I ..
----.-
~~ ---..----- ~-------
30 cantlie!
Bi. ammo bIl" With reloadl.I}U'2';d~r l',,"x9 -
I .. ...-.-.
2 fibclldass dOlllhioolnll kenllels (extll larae) ,
J_mCl!1~~1I of du<:k deco~'~ze"1) ----
elClllrlC compressor - .. ---
2 mer.\ fillna cabineb
J1~c!!!tY llara~e jllCk ..
camelr1el1' III ijC c1amos
I wild Mlmll trio --
,
2 DeDe "'Tenchcs . -
2 coleman IllnlcnJS
flrenlACft lools -----
Ihio's wheel barometer -. -.-.
s/uo's wbeel clock _.
2 v\llwnes TCll4S Wild Flowers "."-
DeWIer Vilunlillcttor opener -..-._~ .---
.-
3 bo~es assorted awards &: mementos -.
2 slDOls _..'_h
u__._______ .....-.---
.ccordlon In CIS' ,
cui iron oaintcd Lsbr.dor S11lJ\ ---
-
Italian wood weslher forecaster board --...
8 mm movie orolector camera'" screen -
ma'-''''to
2 WIlod &: canvas canoes , -
-
climbina oitons and hammer
3 fliaht 1000boo~ ---
,
-.--..
calCijlalor
-. ..
~~---- -- --_... --. .
:010111999 09138
'1/1If,48'1 ,
L!l\vUlPU'"
f'''.~ Oil
mounlelfDfke l1ead - -, ~ .... ._o---~ -----...
- I -
'Ilal
11100\101 iac:kel I ...
- --_.-
r.lt IIW1'td mllllle :
.
Xmu Ilockinll :
NRA bueball taD .--
I
On
I PO:l' radio
rcloadinR dies and tarJll!IS ~
Llbrador llllwine .
Kaithness DaDel'V\'etllhl .--.. I
5 dOli traininR videos
..Ink ""reel.in &; melll vas.: , - .
Ilftioll wetllhll ,
inlaid wooden pc~il boll
"""'elain IlllIle llll\ln!ine -
-
I'mall Bible I
3 female I1ll1lles___=___ --
boll of mUll I: IIlass -;";wler norcellin
2 Iml VII
-
I
boll or.i1ver from DfD: COISlen, tray, 2candle - -
I
hoolden, bonbon dllh, dJnner bell, .ijllU bowl, 2 I
creamers. round Ira't. lea IlOI I
I
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:1:1. T8I COURT or COIOfON Pl.DS or
, I CMfIlal.MD COUNTY , PINNSYl.VAlfIA <l
CIVIl. ACTION . WlIf
.1, IN DIVORCI '~
n-u", CIVU TIM I
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., L]
"
PAUL O. DAVlNPORT, .~
Plaintiff II l
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va. 'j',
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OLIIN P. DAVlNPORT, >,
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.,
D. fenc1an t I 'f' I, i,j
PlaIn tifT's l're."JrJalStatement
, ~
In Aeeorda.w:udth..J>a...R.C.l'J21O.33(b) ,
,
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,
RUBY D. lfIIlltS, BSQlJIRI I,
10 lfIIST BlOB STRIIT
CARLISl.I, PI. 17013-2955 ,.
717-2U-12" I'
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,
For 33 yeurs she wus u Murine wife. She supported her husbund's cureer und run the
household, us wel: us rnising three children with Iillle help from her husbund, since his job
required him to be uwuy the mujorily of the time. The Husbund wus onen out of the country for
the mujority ofu yeur. The Husbund's cureer required tllUtlhe purties move uround u greut deul,
due to husbund's employment with the U.S. Murine Corp.
b) Hu~band; Husbund wus born October 25,1938 in Brooklyn, New York, he is
sixty-one years old, u retired Colonel from the United Stutcs Murine Corps with 31-yeurs active
service, who retired in 1991 and nOW works as a privute contructor and consultant to companies,
such as Cubic Applicutions. Inc., Logicun R & D Assoc., and Smurt Writers, Inc., providing
war games to the Anny, Navy and Marine Corps. His monthly gross income is presently
unknown to the wife, who believes that Smartwriters, u New York corporation ubout which Wife
has been unable to obtain informution and which is alleged by Husband to be owned by his
girlfriend with whom he lives, is actually an effort by Husband to shield his income from Wife.
Husband has leased an office, with a wrillen lease according to his answers to interrogatories, at
II W Church Street, Fairport, New York 14450, from Barbara D. Stewart. Howeve r Husband
has asserted that there is no lease lor his apurtment rental at II West Church SI., Fairport, New
York. Husband has assr.rted he has no ownership interest in SmartWriter's Inc. and that he has
only a verbal agreement as to his employment there. Prior to separation, he lived ....ilh the wife
in the marital home. Husband received a Bachelor of Arts in economics from Cornell
University in 1961 and an M.A. in International studies from George Washington University
(and the US Naval War College. Newport Rhode Island) in 1973. He obtained this laller degree
2
while in the military at the govenlmenl'S expense through V.A. reimbursement. lie has
government secret security clearunce. Wifc hus no currcntlnlormullon ubout his income from
his consulting with Ihe vurious corporulions, but in Muy I 99!1, SmurtWriters Inc. billed $21 ,!l50
for his services.
Husbund relired from1he mililury in 199 I und pcrsuuded Ihe wife thut il wus in both their
best intcrests nolto clcct survivor's benelits lor Ihe Wife. The Wife ucceeded to Husband on
this and now thaI Husband has decided he wishes 10 end the murriage, she Is without such
benelits. Further, Husband hud, shortly after sepurntion, begun 1he process 10 rceeive a
Veternn's disubility. ending up with a 40% sel'Vice-relllled disubllity, making his retirement
benefits of $4609.00 gross per monlh (Ihe ligure on July 25,1977, the lasl dute for which Wife
has infonnation), 40% related to his disubility.. These uctions by Husband were very much to the
detriment of Wifc, who was as involved in Husband's military carecr and promoting it as he
was.
. B LegaUssucs
1. Both parties request equitable distribution of the marital assets; wife seeks s 35-
65 distribution, In her favor.
2. Wife seeks SI50,000.00 Iifc Insurance policy, to compensate her for the loss of
survivor's benefits.
3. Wife seeks alimony.
4. Wife seeks disclosure from husband as to the true status and ownership of,
Smartwriter's, and its financeS and payments to him.
S. Wife sceks counsel fees and court costs.
3
C. List of Assets:
BUHHARY or PRIBINT VALUIB
f~om Huaband'a/Wif.' a Inventory i Appr.ia.l
'T~M V AlllI' AT INWIH:'S IN IIUSIlANIl'S
1'llI'SI'NT l'ossr,SSlllN "()SS~SSlllN
v AIlII' AT
IlArI'.<)f
SH'AIIATION
MurilUI ProDcrtv
Muritul ReliidclIl.:C 21 Slone Lc:d~C' nri\c, New\illt:, S41,llO.0I1 Bctwccn X
l.urthBIiL'11 H/2b/HH lor S9I,OOO,OO, Origlnnll1llJrtguM-C S4l,17'I.OK
umounl SH I ,~Of).l)O bulull\:e due un IIlUI'1I1UI!I.' 7/1 fiN? And
7J7HO,OO S4K,17'I.OK
SI12,900.00 w'ilh lIIimill1UIII work dOIle: SII S,900,l)()
with IiOI1lC .....ork donc, wllh full "ork done SIIH,900,00
MOrl)l;lIKC 1I11lUUnl1l5 ufl'J1I flIlJI) S70 720,1}2
19M4 lludll:e Arie~ Sellllll.lrumfc:rcJ 10 Juullllll.'r S~OO(jl) 511)0,01)
Joint dlCl:king 11"011111 Nu...)' I-'cdcml Credil Uniun 57"" H/JIII)7 .
00 1 JlJl4.7<l7 $464,6H
lIu~bBnJ'1i Member', federal Credit Union A"uunlll 51l0K l'loKed IO/27/lJ7 X
IllO'lH bulnn&:c II11illlC or
dUliin", 51.59,00
JoinlslI\lillgs ll,ctlunl Nav)' hJcnal Crc..JilUnillll 5102l.'Il ('lnlied'mHI1)7
bahUlce al cloliing
S2lJO,OO
lIu~bllond'li ",u..'inij~ oClo:oUI1I No...)' Fedcml CmlilUnilJn lJnkllowlllu",ile: lJnknuwnlu\\oirc:
001J1l4.()()4
Wire's sa...ingli accounl No...y Fcdeml Credil Uniun II HII'I,!}7 54,H 1 K.lK
51~JH.71
Husband's cheding accounl No...)' Fedeml Credit Ulllon
001J514.707
Joinl Putnam lIigh Yield Trulil Cl.A SI91'N5,OO Clllsl:d 1l)/26f11K X X
Bulnnce 6/30/9K S21 5'12.34, used SK,1J5 1,1610 pay olT SI,6J2,4~ Sl.6J2.4S
Na...y Federal CrcdillOlUl per court order. Remollling
runds were d....idcd between Ihl: panIcs and phlcl:J in
~enamte aCCtlunlS
fluliband's Lire In~uran'c Mass. MUluu11t975131J4. unknnwn tu wile unknllwn In wire X
uiuslable Ie"". S450 ()(J()OO race \falue
HUllban!I's Amled Force~ Life Inf'turance pulle)' un unknllwn In ",ili: unknown hi wire .
lIusband'slirc
r:let ...alue $49 000.00
Veterans AJminulllraliun lenn in8urancc, race al1lnllnl UnknuwntoVrili: UnknuWl1lo wife: .
<10 "10 no
4
IIlM VALli I' AT INWlmS IN IllISIIANll'S
1'llI'SI'NT I'OSSI'SSION I'OSSI'SSION
V AUII' AI'
llATI' 01
SH'AllATION
TItOA AI:\.'hlL'1l11l1 JlIlllh & lllllll1l:lIIht:t111IlIlIIIlIlUtlllll:l:, lJtI~nu~lllu ....ill: Ullk"U\~" In "IIi: ,
IBi:l:lllllllUI1I SIUI)t}I)(),041
Ilu~hlllld'l!i {'ubi\.' Tv!:h I'flll\1 Slllllll1~ S71H.l.75 UnktlU'Ml !u \\, I Ii: ,
.'I.ll,l17
Ilullhul1J'1!i ('ubi!: APll!lI'ullullb 401 K 11,1012.21 'J!30,lJK ,
15,07HAJ
11n:t>lInl bllllllll:e
Unknil\l,1I10 ....ili:
lIuKbund', nC(t:IlM: fhllltlt:e I'ellbioll . in I'")' t>lIiIUK ,
S470.5,I)() mum hi\' Uroll5
lIuhbllnJ'1i OpPL'lIhcillu:r FUIIJK II(A 1171107UO.l71)H2h 2.4l}l} 7.5 6112i9t1 ,
72.62.5 Iihlll1:S llli 0(911211)7 2,'/2444
Iln..~elll ..lIhll:
ullklltl....nlu ....ire
Wirll'h Oppct1hc~lIler funds II(A ff70{) 700J71}245.54 2491).15 bl12NK
72.625 .hun:1i UK o('1/12N7 2924.....
I)n:bllllt nihil:
unkllmHI!O ....1Ii:
Roh:.ll. \\iDIl:h nun:hUlicJ by hu!\hllllJ Un\..nuwl1 hl\'l,lc Unkllm..n III wife ,
GUIlIi Bnd rclondin" equipment .'.~OO,O{) ,
pre\liou~ly Ji\liJcJ with "Hc. C::'1dlllll~c:J for "ife
rccd\lin\l'.kitchcll contcnts
Kitchcn contents. "rc\iitJu~ly Ji\lltlcJ wllh hu~hlllllt. J,500I)() ,
(lIchunged fur hu~hllnd recei\ling gUl1l1und rclouding
(oulncmcnt
WlfC'liie"clrv 290.00 3JI),tlO ,
MiscclllllleoulIllerstJllul "runerl\l .Set: llllllcheJ nnnrlliMl1 lJnkno"1l tll ",-ife 40"9,00 ,
IIN6 Oodtlc Curu\'lln lJnkntJ"'-lllo "'-ili: 1302.5.00 ,
Incrcn~c in nlllriliul \lIII1C,lIu~hllnJ's II1Lllhcrs ntH! 14llUO
Incn:usc ill muntiul \alue, halullce of llushUllJ's Unknn\\.11 tll "jli.' lJnkno"11 tll VIiii.'
inhcrilalh:c
TOTAL MARITIAL PROPERTY 5100.662,87 SilO 306.94
NON-MARITJAL I'IHWERTY,
IIUSBANI)'S
I.K Caral diamolld Ml!llllirc nll~' lIlheritcd frllm (I,ml's Ilj9l) 214,C)9 .
mulher 121'}OOr} I ~6mUO
2 alltique CIUlUCS, Ihese IIrc hcin~ slon:d in IlIe llllrnge lilr lJl1knll",1l III wil~ lJnkl1ll\..n 10 wili: .
Ihe hushlll1d
'il , N"" ,"n.' "",,,,. .,''',.~ I ,..IHt Wfl I., wil~' .
5
IIUI VAlIII'^1' IN WII'I"S IN IIIISII^NIl'S
l'IlI'SI.N'1 l'OSSI'SSIllN l'IlSSI'SSION
V ^l.lJl' M
Il^".()i.
SI.I,^,lMlllN
l'ul(k I'tullll)t ~uh:h . Illhctllf.'lllhllll hth Illllth...r HOfl,I)1) l!llkllt}~lIlil "'lit ,
1I1111bulbt'1I12 PIli!:!: IIcllinu IIlcdillil MIH~r Ihll""tc 1,IUktltJ\"Ulu "III: l!nknu"IlIU "\I'c ,
Hu.on Shll.'k. 2.'2 hhlltl;'lI SI.Ul)l)lJl) l'I11."II"n hi "ll~
TOTAL NON-I\IARITIAL I'ROPEIHV 54,668.61 655,949.93
HUSBAND'S
NON-MAltlTlA" \'IWI'EIH'V. WIFE'S
Nu..~ h:llclul Cn:Jn LII\IlIIl- PWPCll) rC~'CIH'd aller 2.\..11 ,
IIClCmlllll1
114 .;urIlIJlulIl,llh! lUlU UnklhlVolJ hi ",Ii: lIn\..nO\\n hi ",l'c ,
rulllclllllh hcal sl..ll1 fur ~'IHll tJnh'lLJ""I11 ",Ie lJn\..IlIl\loIlIU "lie ,
TOTAL NON-MARITAL PROPERTY 11\ 90.00 15608.50
WIFE'S
PROPERTY 1'1~ANSI'EREJ)
\ilK4 ll,K.ll1t Airel' Sedan llransli.'rcJ hlllulI"hh:r\ ~OO.OO 500.00
\'IHH Dod~c('Urll\lln 200(01) ~ilHI IlO.nO IlO.on
JOO.OO
2J2 IIharcsorFlI.:\tlll slo\'k UnkrUlVoll III ",fc 1}(I)7 ,
1..20n,oo
Husbands "uns 10 hushulhl h... IlIHCClIlcnl .uoo,OO X
Wi(c:'~ Kit.:hcn (tllllcnls III ~irc hv ll"rcclI1cnl .UllO,Of) X
TOTAL'ROPERTYTRANS'ERED 14200.00 ,
L1^HII.lTII:S lit' '1'11I: P^RJ'II:S RI:SI'ONSIHI.I: P^IlTY
mOr1"i1"c.rir-ol NlllhlllwlIle, maritnl rc~idcl1'c 7J7HO,Jb lJl1kllllWl1lllWlf~ ,
Visa 42H.l)t'JI)(l.f)JOJ.lI.fllH 71]llil}lI. ,
5.111.",77
Wife bclicH~s
pn.'selll hulull":
.(j.
US I>cpl. 01 hluculioll l,ulln for dnll~hlcr 9/21,1)7 7/21/11H ,
lIu!ihund hos olwuys noill 1"~J4.b7 19IM,P)
ViKa Guld 444.5 )022 4HOJ 1}24.5 7/22i~~ I)" ,
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ITUM VAWI'M IN WWU'S IN 1I11SIIANIl'S
l'IlI'SI'.NT l'llSSI,SSION I'OSSI'SSION
VAlliI'M
IlATI' Of
SI'I'AIIA'IION
US^^ fcJcrul Sll\oln~" Ullllk MII'II.'n:utLllVi~1l 7/1/9" ,
1410 lOOK llO7010l 'N2'J.2IJ
VI" Clol44441ll01 0llOKOl4 h/llNK .\
4~ll.IO
MIINA4ll\4l~14lOl)<Il)lIO 7tl3/9M ,
MlllH
SUbllfU l.culiin Co lj(~~II)O ,
TOTAL LIABILITIES OF THE 73780.36 68,877.71
PARTIES
D. Witnesses;
I. Expert Witnesses: Wife docs not anticipate calling any expert witnesses, except the
realtor who has listed the marital residence for sale, because she cannot afford them. She docs,
however, reserve the right to call such experts as may be necessary to refute or rebut any expert
testimony offcred by Plaintiff or which may be necessary to value the assets of the parties.
2. Fact Witnesses: Wife will testify, and she reserves the right to call any other witnesses
who may be necessary to rebut or refute evidence or testimony offered by the Plaintiff.
7
E. El\hibilij
I. f1uKhlll1d'K AnKwcrK to Wilc'K IntcrruguturicK
2. StulemcntK It) Wilc'K pusscKslun cum:crning Kome uf IluKhund'K prevlouK pUYlllenlK
from SmarlWriter's, Lugicun, ('ublc for hiK consulting work for 1996, 1997, and
1998.
3. Cumberland County Court of Cumlllun Pleas Cour1 Order of Novcmber 4th, 1998,
regarding Peti110n fur Spcdul Relief
4. Current firstmortgagc luan bl\luncc (when avuilable) and at date of separation
S. Real Estatc Listing Agreement proposed by Wife for Illarital residencc
6. Estimates from con1ractors and realtor's asscssmcntlisting ofrepulrs necessary to
makc marital rcsldencc salcublc
7. Market Analysis, Jack Guughcn Rculton, ERA, suggcstlng $112,900 listing price for
house with no work done; $115,900 with minimum work necessary to scll; and
$118,900 with full list of rcpuirs accomplished
8. Correspondence from Ncw York Dcpartmcnt ofStatc with the rcglstration
information they have available on SmurtWri1cr's Inc.
9. Essex County N,Y, Surrogate's Court documents on Husband's Inheritence from his
mother's estatc and her last will and testament (if needed).
10. Such documentation us is in Wife's posscssion as 10 each itcm listed in her Inventory
and Appraisemcnt
11. Wife reserves the right to prcscnt such other cxhibits as may bc neccssary to rebut or
refutc evidence or tcstimony offered by the Plaintiff
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IlAUL G. DAVENPORT.
1)lainHll'
IN TilE COllRT OF COMMON PI.EAS OF
CliMBERt.ANI) C<)lINTY,I)I~NNSYI.VANIA
v.
CIVIl. ACTION " I.A W
HELEN I). DAVENPORT. :
Delendant
NO. 97.4546 CIVIl. TERM
()!~DER OF COllin
AND NOW, this 17" day of August, 200 l. upon eonsideraHon of Plalntltl's
MoHon for Relief To Not Appear in Person Ii.Jr September 12, 200 I lIearlng In Court
Room No. I at Carlisle, Pennsylvania. the motion is granted and Plaintiff shall be
permiued to participate and testify by telephonc at thc hcaring sehedulcd for September
12,2001, at 2:30 p.m.
BY THE COliRT.
Paul G. Davenport
c/o Busnauer II of Gasthof
AM Schattwald 2
70569 Stuttgart, Gcrmany
Plaintiff: Pro Sc
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Paul G. Davcnport
I1Q USEllCOM
CMR 480, Box 647
APO AE 0912l!
Plaintill Pro Se
C"f'"
Ruby D. Wecks. Esq,
10 West High Street
Carlislc, PA 17013
Attorncy Ii.lr Defcndant
:re
AGREEMENT
THIS AGREEMENT made this Q1 day of March, 2000, by and between Paul
G. Davenport, of 8630 82nd Street, Apartment 101, Pleasant Prairie, Wisconsin 53158
(hereinafter referred to as "Husband"), and Helen P. Davenport, of 21 Stone Ledge
Road, Newville, Pennsylvania 17241 (hereinafter referred to as "Wife").
WITNESSETH THAT:
WHEREAS, Husband and Wife were lawfully married on February 29, 1964, at
Winston Salem, North Carolina;
WHEREAS, three children have been born of this marriage, all of whom are
adults;
WHEREAS, differences have arisen between Husband and Wife in consequence
of which they have lived In separate residences since August 1, 1997;
WHEREAS, Husband and Wife desire to settle and determine their property and
marital rights and obligations, including rights to support, alimony pendente lIIe, alimony
and counsel fees and costs;
NOW, THEREFORE, the parties, intending to be le~ally bound hereby, do
covenant and agree as follows:
1. SEPARATION: II shall be lawful for each party at all limes hereafter to
live separate and apart from the other party at such place as he or she may from time
to time choose or deem fit. The foregoing provisions shall not be taken as an
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admission on the part of either party of the lawfulness or unlawfulness of the causes
leading to their living apart,
2, INTERFERENCE: Each party shall be free from Interlerence, authority,
and contact by the other, as fully as If he or she were single and unmarried except as
may be necessary to carry out the provisions of this Agreement. Neither party shall
molest the other or attempt to endeavor to molest the other, nor compel the other to
cohabit with the other, or In any way harass or malign the other, nor In any way Interlere
with the peaceful existence, separate and apart from the other, and each of the parties
hereto completely understands and agrees that neither shall do or say anything to the
children of the parties at anytime which might In any way Influence the children
adversely against the other party,
3, WIFE'S DEBTS: Except as otherwise set forth herein, Wife represents
and warrants to Husband that since the separation she has not contracted or Incurred
. and In the future will not contract or Incur any debt or liability for which Husband or his
estate might be responsible and shall indemnify and save harmless Husband from any
and all claims or demands made against him by reason of obligations incurred by her,
4, HUSBAND'S DEBTS: Except as otherwise set forth herein, Husband
represents and warrants to Wife that since the separation he has not contracted or
incurred and in the future he will not contract or Incur any debt or liability for which Wife
or her estate might be responsible and shall Indemnify and save harmless Wife from
-2-
any and all claims or demands made against her by reason of debts or obligations
Incurred by him.
5. MUTUAL RELEASE: Subject to the provisions of this Agreement, each
party has released and discharged and by this Agreement does for himself or herself
and his or her heirs, legal representatives, executors, administrators and assigns,
release and discharge the other of and from all causes of action, claims, rights, or
demands, whatsoever In law or equity, which ellher of the parties ever had or now has
against the other, except for: (a) any or all cause or causes of acllon for divorce; (b)
any or all causes of action for breach of any provisions of this Agreement.
6. HOUSEHOLD GOODS AND TANGIBLE PERSONAL PROPERTY:
a. Husband does hereby transfer, assign and set over to Wife all of
his right, title and Interestlr and to all household goods and tangible personal
property that 15 In the possession of Wife as of the date of this Agreement, with
the excepllon of an antique wooden canoe thai is the property of Husband and 15
currently stored al21 Stone Ledge Road. Wife agreesthallhe canoe may
remain at21 Stone Ledge Road until Husband or his designee Is In a position to
lake possession of it, or until Wife sells Ihe home, whichever firsl occurs.
However, Wife may require Husband to remove the canoe at an earlier dale
upon 60 days written notice 10 Husband.
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Husband and Wife. WIfe has not yet deposited the check she received
from Husband for her share of the proceeds. If the check is not accepted
by the bank, Husband agrees to write a new check to WIfe for her share of
these proceeds.
6. REAL ESTATE:
a. 21 Stone Ledge Road. The parties currently own In Joint
names the property located at 21 Stone Ledge Road, Newville,
Pennsylvania. Husband agrees to and shall execute a deed transferring
to Wife all of his right, title and Interest in said property. WIfe agrees to
and shall Indemnify and hold Husband harmless from any and all liability
with respect to said property. Title to said property shall be transferred to
WIfe at the time of execution of this Agreement. The property Is
transferred to Wife subject to the mortgage to First Nationwide that Is
secured by said property. Wife shall be solely responsible for payment of
the mortgage and shall Indemnify and hold Husband harmless from any
and all liability regarding the mortgage. Wife shall not be obligated to
refinance the existing mortgage or to obtain Husband's release from the
. mortgage. Wife, however, agrees to cooperate with Husband In the event
Husband, at his sole expense, seeks to obtain his release from the
mortgage. Wife shall not be required to accept any mortgage terms upon
-5-
Husband, Wife shall be entitled to recoup all such sums she pays to the
In'surance company or companies that were or are the obligation of
Husband pursuant to this Agreement and, In addition thereto, shall be
entitled to collect an additional 15% of all amounts paid by her and shall
be entitled to collect actual legal fees Incurred In obtaining reimbursement
from Husband, Husband shall have no obligation to pay Wife's portion of
the premium, and If Wife defClults so that the polley or policies lapse,
Husband shall have no further obligations under this Paragraph. Each
party hereby agrees to make arrangements for the payment of his or her
share of the premium payment by way of an allotment from the military
retirement pay that shall be apportioned between Husband and Wife
pursuant to Paragraph 15 below.
b. Any and all other life insurance policies shall be and are
hereby assigned to the party currently owning said policies.
10. CASH. MONEY MARKET. SAVINGS AND CHECKING ACCOUNTS:
a. Wife does hereby transfer, assign and set over to Husband
any and all Interest In any and all cash, money market, checking, savings
accounts in the name of Husband as follows:
1) Navy Federal Credit Union Account No. 2060454705;
.7.
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2) Navy Federal Credit Union Account No, 0135554-
004; and
3) Navy Federal Credit Union Account No, 013554.707.
b. Husband does hereby transfer, assign and set over to Wife
any and all Interest In any and all cash, money market, savings or
checking accounts In the name of Wife as follows:
1) PNC Bank Savings Account No, 506-0130567; and
2) Navy Federal Credit Union Account No, 0135554.103,
11, CUBIC CORPORATION 401(K\ ACCOUNT: The entire balance of the
Cubic Corporation 401{K) Account No. 150-30-4016, Plan No. 007650, currently In the
name of Husband shall be transferred to Wife pursuant to a Qualified Domestic
Relations Order or other required documents so that there will be no tax consequences
to either party as a result of the transfer. Husband shall prepare the required
Stipulation for the Entry of a Qualified Domestic Relations Order and provide It to
counsel for Wife on or before April 15, 2.000. The balance In the 401{K) account as of
February 2, 2000 was $34,935,70,
, ";
.8.
14. MILITARY RETIREMENT:
a. Husband Is retired from the United States Marine Corps. He
is currently receiving retirement benefits. A copy of the retiree account
statement as of February 1, 2000 is attached hereto as Exhibit "A". The
following provisions apply to the military rellrement.
b. The parties agree that the portion of the retired pay
represented by the VA waiver, which on Exhibit "A" is the amount of $813
per month, Is a disability component of the rellrement and Is not marital
property and not subject to equitable distribution.
c. The parties agree that the marital portion of the remaining
pension, after deducting the VA waiver, Is 90.23% (representing
$3,669.95 based on Exhibit "A"), based on Husband beginning active duty
service on March 15,1961, the parties' marriage on February 29,1964
and Husband's retirement from active duty on July 1, 1991. (328 months
of service while married and a total of 363.5 months of active duty
service). The parties further agree that 9.77% (representing $397.35
based on Exhibit "A") of the remaining portion of the pension is the non-
marital property of Husband. Any increase in the retirement shall be
allocated pro rata based on the above percentages.
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b. Husband halS made the $1,357 payment of alimony
pendente lite/spousal support pursuant to the above referenced Order to
the Support Office for the month of March 2000. VVlth such payment
made in March 2000, the parties agree that Husband's alimony pendente
lite/spousal support obligation pursuant to the above Order has ended
and that no further payments are or shall be owing to Wife pursuant to the
Support Order dated January 12, 1998, as amended on February 5, 1998.
On or before April 20, 2000, VVlfe, through her counsel, shall file the
necessary documentlS with the Support Office to terminate the Support
Order effective March 31, 2000.
c, Husband agrees that beginning with the receipt of his
military retirement pay for April 2000 and for each month thereafter until
50% of the marital portion of the retired pay Is allocated and actually paid
to Wife pursuant to Paragraph 15 above and the contemplated Military
Rellrement Benefit Division Order, Husband shall pay to VVlfe promptly, by
the 5th day of each month, upon receipt of his monthly rellred pay in April
2000 and each month thereafter until the contemplated Order becomes
effective 50% of 90.23% of the gross rellred pay received by him after
subtracting the VA waiver, but before any withholding for taxes, All such
payments made by Husband to Wife shall be treated as alimony and
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considered as taxable Income to Wife and deductible by Husband
pursuant to the provisions or the Internal Revenue Service Code.
d, Except as set rorth in subparagraphs (a)-(c) above, no other
alimony shall be paid by Husband to Wife or by Wife to Husband.
16. REPRESENTATION AND WARRANTY OF FULL DISCLOSURE: Each
party hereby represents and warrants to the other that he or she has made a full and
fair disclosure of all or his or her Income and assets. Each party shall rurnlsh to the
other party their federal Income tax returns through 1999.
17. ATTORNEYS FEES AND EXPENSES: Each party shall be solely
responsible for payment or their respective attorneys' fees and expenses.
18. MEDICAL INSURANCE COVERAGE: After the entry or a divorce decree,
each party shall be solely responsible for his or her own medical insurance coverage.
19. WAIVER OF CLAIMS AGAINST ESTATES: Except as herein otherwise
provided, each party may dispose or 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,
dower, curtesy statutory allowance, widow's allowance, right to take in Intestacy, right
to take against the will of the other, and right to act as administrator or executor of the
other's estate, and each will at the request of the other execute, acknowledge and
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deliver any and all Instruments which may be necessary or advisable to carry Into effect
this mutual waiver and relinquishment of all such Interests, rights and claims.
20. ASSUMPTION OF MARITAL DEBTS:
a. Husband hereby agrees to be solely responsible for the payment of
the U,S, Department of Education loan for Nancy Davenport with a remaining
balance due of approximately $19,000. Husband agrees to Indemnify and hold
Wife harmless from any and all obligation with respect to said loan.
b, Husband agrees to be solely responsible for all outstanding credit
card obligations that existed as of the date of separation, and agrees to
Indemnify and hold Wife harmless from any and all such obligations. The credit
card accounts outstanding are as follows:
1) USAA MastercardNlsa Account No. 5416300832070503;
2) Visa Account No. 4428-9600-0303-8628;
3) Visa Gold Account No, 4445302248039245;
4) Visa Gold Account No. 4445320161208654; and
5) MBNA Account No. 4264292436000216.
21. QlY.QB.CE: Husband has Insllluted a divorce action to No, 97-4546 Civil
In the Court of Common Pleas of Cumberland County, Pennsylvania. Nothing herein
contained shall be deemed to prevent the parties from proceeding in the said suit for
absolute divorce against the other and in the said Court, and the parties agree to obtain
-14-
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a divorce by mutual consent pursuant to Section 3301(c) of the Divorce Code,
Affidavits of Consent to a 3301(c) divorce shall be signed on or prior to the closing date,
22. BREACH: If either party breaches any provision of this Agreement. the
other party shall have the right, at his or her election. to sue for damages for such
breach or seek such other remedies or relief as may be available to him or her, and the
party breaching this contract shall be responsible for payment of reasonable legal fees
and costs Incurred by the other In enforcing his or her rights under this AgrcolllEmt.
23. ADDITIONAL INSTRUMENTS: Each of the parties shall from lime to time
at the request of the other execute, acknowledge, and deliver to the other party any and
all further Instruments that may be reasonably required to give full force and effect to
the provisions of this Agreement. Such consent will not be unreasonably withheld.
24. VOLUNTARY EXECUTION: The provisions of this Agreement and their
legal effect are fully understood by the parties, and each party acknowledges that the
Agreement Is fair and equitable, that It is being entered Into voluntarily with full
disclosure of assets, and that it Is not the result of any duress or undue Influence.
25. ENTIRE AGREEMENT: This Agreement contains the entire
understanding of the parties and there are no representations, warranties, CO'. ('nants,
or undertakings other than those expressly set forth herein.
26, MODIFICATION AND WANER: A modification or waiver of any of the
provisions of this Agreement shall be effective only if made in writing and executed with
.15.
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the same formality as this Agreement. The failure of either party to Insist upon strict
performance of any of the provisions of this Agreement sholl not be construed as a
waiver of any subsequent default of the same or similar nature,
27, ACCEPTANCE BY PARTIES: Husband and Wife accept this Agreement
In lieu of and In full and final settlement and sallsfactlon of all claims and demands that
ho or she may now or herearter have against the other for support and maintenance, for
alimony, alimony pendente lite, counsel fees, costs and expenses or any other charge
of any nature whatsoever,
28, REVIEW BY COUNSEL: Husband and Wife acknowledge that the terms
and provisions of this Agreement have been reviewed by their respecllve counsel and
the Agreement Is being executed upon advice of and arter consultallon with counsel.
29, APPLICABLE LAW: This Agreement shall be construed under the laws of
the Commonwealth of Pennsylvania,
30, INCORPORATION OF AGREEMENT INTO DIVORCE DECREE: The
parties agree that the provisions of this Agreement shall be incorporated into but not
merged Into the divorce decree to be entered Into by the parties and shall be
enforceable by court order,
-16-
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THE COURT OF COMMON
PLEAS
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COUNTY
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STATE OF '*
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PAUL .G, .DAVENPORT,
Plaintiff
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klELEN p, DAY.ENPORT,
Defendant
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DECREE IN
DIVORCE
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AND NOW, ' . , ,. , , ,. .. ,. , . .. ,.,. , , . ,.. '. 1119 .~9PP.. it is ordered ond
decreed that., .p.~~~. ~'" ~~.v,~~J??,~~"."........"",.,.".,.. plaintiff,
and... /i.E\~\ln. .~.. P.a,,,E,!{lP.ql;"t...,.,.....,,.,......,........,'. defendant,
are divorced from the bonds of matrimony.
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The court retains jurisdiction of the following claims which have
been raised of record in this action for which 0 final order has not yet
been entered;
rT IS FURTHER ORDERED, ADJUDGED AND DECREED, that the terms,
p!,"~.,,:i~i.o.,!~. i'\,ncj .C;:~,n.cjH-~.q,!~. P.~ .t!1~. .l:-g~~,(]l!'~r.t. .1;>~.t:W:(]E,!{l. .~l')E,!. P!.\I;t~~.!!.
dated March 3l, 2000 and attached to the Praecipe to Transmit
RecDrd.. as .Exhibit. .'~A!'.,. .are. .horeb}' .incorpo.r.ated. .iJ:ltc ,but. .not. mell'ged
with, this Decree in Divorce.
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^ Nllll' I II Tll'llIk Yi)\1
'I'1l,lIlk Villi 111/ r I1q11lllit trill iUt i1ppl tt~i.lt ion ror insurance through Quotosmith,coJll.
Wlltll 111'" I.) II t.thll', YlHI n~(:oivu tho fastoat dnci mOBt courtoous
tlPI V It'" dVdt ,..blo,
MdllY 1111l ..lid hll,l1th lnlillrance companies today do requiro ~
hr'}'.", 1,II'tl'''I,,)-t.H:U .intorviow botwf'\en yoursolf ilnd an indepondent
1''''''"'''011'' "lI'hlll.d,tn. It tho upplicat.lon you've requested today
-ill"" t'llqlllrll I) plHltmLHt intorviow, qur paramedic technician will
"..II y'''' wllhln thll nellt fow ddYS to schedulq 20 minutes of your
1\11I11 ,)1 YlJllr hOnll! or your plt'lce of work to interview you and
"bl ill II i1I1Y "ddltlan"l applico1t.lon-related ltems that might be
.JlIUIl.lllJdtnq. Our ttH~hni.cian can meet you during the evening or
illl WI-lH~'Hldti to fit your Bchedulo.
'1'.) ""tll,1l1y Obl..lln t.he low prnmium rate you are applying for,
II'. dlmOR! c6rtain thdt the paramedic will want both blood and
111 lno HdltJphtf1 from you. 'rha end of this letter contains some
"..Ipllll Up" on how to obtaln tho best possible paramed ellam
'''HIlII:H. It normal1y takes 4 weeks from the dato of your
P,HiJnllldte tnttJrvinw for me to receive a decision from the
lJlldl!rwri.lor. If YOIJ need il decision aooner than that, please
",.11 Ill" f)l!r~OIl,llly and tell me that you would Uke priority
hollldl trllJ.
I \/1.11 '1I.V" you prolJross reports by phone or mail whenever
dll "1'1'11 '.:IIt.lon-relat,erj item I." outstanding and I will let
yo.) knuw .Hi Moon ;HI I receiv(J a flnal underwriting decision.
Ihlln11rnL)l!r, yuu 8hould not cancel nor even seek to cancel
..IIY "xl"t llll) Insurance that this application is des,igned to
rl.,d<lI:O lJnt il YOll have received your neW policy from our
,""npiHlY. 'I'hl:; is "ound advlce whenevor you are applying
tor .my rwW i.nsuri.1r1ce.
lrl l~tle meantime, please feel free to call me personally
..t 1-'JOO-!,56-9393, 9 to 5 Central Standard 'rIme should you
h,lV'! ,'ny quest ions. We provide fast, cheerful personal service
dlld w1l1 always treat you with respect. At Qu6tesm1th.com, our
motto 1.:3, "I::nd Insurance Confusion Forever!" I sincerely hope
t.hat. WI! huvo helped you do thls.
~jlnt;cn)Ly,
~lrke A. Christensen, JD, CLU
QlloteBmtth.com, tne.
B205 South Cass Avenue, Suite 102, Darien, IL 60561
Phon.. (BOO) 556-9393 ... Irall (630) 515-0270
GAt your own i'REE, personal Netscape WebMaIl account today at
~1,1\j!jlll", I i'W_'l.i
,:0:; 07 '01 071 371'V'1 f:CJS-P 430-8343
P.l
Medical Records from U.S. Anny Clinic
Patch Barracks
Stuttgart Germany
I. 'AltIched plellSC find the records for Paul G. Davenport, Colonel, U.S. Marine Corps (Retired)
for mila to the Stulli&rt Medical Clinic on 10 April, 30 April, 7 May, end 21 May in
cDl\lWICtion with Prostatitis and subsequent follow.up visits.
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CQI USMC (Ret)
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AUG 07 '01 07: :;8>4'1 E(JS-P ~3()-83~3
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Pereonal Data - Privacy Act of 1974
Dat6' 10 Apr 2001~094~
Provider, MCCRUDDEN,M1CHAEL P
Probl"m List.
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(PL 93-579) Automated Veroion of SY600
Clinicl PCH P~IMAR~ CARE
Divisionl PATCH STUTTGART
Allergies.
Objective:
Non6 listed, M/~
BP1'!ITt7..hand): 13t j "?Z_ Puhe, pq Relip, _~ T..mp, 17""
B~n~): ~ --'lIt, ~ _____
Current Outpatient Medications,
rf;1/J..J- .. .No active outpatient
pteHC dpt ions. . .
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l"lisht Status? Y ~ I
PRP/NUC/CHEM? Y V
Unit Notified? Y N/A
Reason for appointment: poas recurring prostititus
----.
63 year old male with ACUT appointment.
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20/150J04016 174 4111<48 Mll
H, 116 ii3 8818 OPT. IP. 489-6997
Rank, H06 "\
RR: O/(.o//{J2.i'jo
DAVENPORT,PAUL G
25 Oct 1938
Span: DAVENPORT,PAUL G
Unit :
,:0:; 07 '01 07. ~OHI'I EO'5-P .130-83~3
P.b
HEIDELBERG MEDDAC
Personal nAtA . Privacy Act ot 1974 (PL 93-579)
~te~~~' 21 May 2001~0705
PCH l'RIMAHY CARE Iii:RII8,'i'BBlfA. 21 May 2001 0930 ROUT BHAU
w~v, eMT, vfm
RSN, flu
INSURANC YES/NO,
BP, IJ~ -1' PULSE, 4, RESP, /1 TEMP' 1~." HT, r";'- WTl/Il. AGE: J
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ADDITIONAL COMMENTS:
DIVISION, PATCH STUTTGART
Automated Version of SF600
..CO~~=~U..~----~~W...~.s:ma==am=W.....~~.....*.~~.....~.......................
20/150-30~4016 DAVENPORT,PAULG Mll /ID,2,JYfI
25 Oct 1938 MALE W:430-5334 HI0160-3H I G9
Span: DAVENPORT,PAUl, G CIC,
CS, Rank: COL D1430-5334
SF600 Unit: SPONSOR RETIRED RR:
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Helen:
Enclosed are the papers that QuoteSmlth.com sent to myoid address, which In turn,
they sent to my present address. I would have thought you already had my new address
as ALL three daughters had that Information. In addition, I replied to YOUR e-mail and
GAVE you the correct address. So, I am perplexed to see that It was sent to the old
address.
Many things have changed In five months Helen, things that can affect such Issues as
Insurance.
. It was you, who held up the signing of the divorce, because you needed time to
gather all the quotes and to arrange for the insurance polley that you wanted. All
paperwork was to be completed by March 3181, BEFORE the divorce decree was
declared. The first I hear from you was the beginning of September, FIVE months
AFTER the divorce
. As my lawyer has pointed out to me, It clearly states in the divorce papers you are the
one who is taking life insurance out on me. There is no scope to these papers, Helen.
What I mean is it does not say how much you are asking for in life insurance, what
type of polley, etc. etc. He also advises me that since you are the owner of the policy,
you should be filling out all of this paperwork. I am not about to fill out a financial
statement, based on the fact that I do not know how much or what type policy you are
applying for.
A few things you SHOULD be aware of:
. Remember, I said in the beginning of this letter that many things can change in five
months time. Well they HAVE. First off, you should be aware that my PSA is
dangerously high. I just had ultrasound and biopsies done on my Prostrate.
Yesterday I was in the hospital for a Colonoscopy. Although, both tests seem to be
normal, nevertheless, they have to be watched. The pre-cancerous skin lesions are a
continuing problem. Which means I am NOT in the A+ category for inexpensive life
insurance. (Medical Records will show this testing took place).
. Since YOU received the WHOLE AMOUNT of our 401 k, the HOUSE, its CONTENTS,
and HALF OF MY MILITARY PAY, leaving me with 0 assets and bills such as
Nancy's education, and no money (as I had tried to tell you the beginning of
December), to payoff my creditors, my credit rating is severely damaged. Therefore,
when they do a credit check, they will obviously come back laughing hilariously at
you. Oh, and by the way, did I mention I have been out of work and have no
job...which I also told you clearly in January? I am existing on the kindness of my
Sister and Brothers' generosity. A fact. I CAN prove by my bank records should need
be. You see Helen, it was NOT in your best interest to leave me with absolutely
nothing. Because in the end, leaving me with nothing really left you in a difficult
position.
1
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E'l-.Ii; ()'I /.
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Doar Helenl
'---'-.
t forgave you a long tlme ago Helon. It was whon I decided to leave. It'.
too bad you did redli~o durlng our divorce that you played a part ln the
break up of our marriage. Ha~ you thought so, perhapa you would'vo askod tor
my forgiveneas then and taken only holf of the marital aaaeta, rather than
all .of them, becauae you felt you deaerved them and played no part in the
dlsaeverment of it.
Perhapa you have forgotten the letter, which [ aent back to you along wlth
the Quoteamith papera that you dent me; But flrat, lot me refreah your
memory, Helen. ~et I a go back BF.,OHF. the divorce waa fino 11 zed. F.ven though
you wanted to look on the Internet for a new polley, Helen, which
would be worth $500,000, I waa willlng and able to partlcipate in tha
insurance aearch, because as of that time, everything was atill in both of
our names, I was in good health and my credit rating had not yet been
destroyed. We were still legally marrled in the eyea of tho Court and I was
to co~ply with what you wanted 00 that you would be happy. So I watted for
you
to find the policy that, upon your insistence, you wanted to search out all
by yourself, with no help from mo. Helen, that was back in March of 2000. We
were granted the divorce on 18 April of 2000. You still hadn't done anything.
This was clearly your decision to let this lapse, Helen, and not mine. Then
YOu came to me six months later in september. I had severe prostrate
problems, I worked very sporadlcally, r couldn't pay my billa on time, my
credit rating suffered because not only could I not pay my bills on time, but
I had no asset. any longer, because you got everything in the settlement,
plua half my retirement pay and the 401K. I got all the back bille.
So, please do not make this sound that now, a year later, this is something
that I should have taken care of. Clearly, this is not the ca~e. I was
willing to do whatever you needed BF.,ORF. the divorce. Thi,s ia nct about my
unwillingness. As stated, I will be happy to show you my credit rating, ao
that you can see that I couldn't even get a loan for a thousand dollars. Not
to mention my health. In March, when we were working out the terms with your
lawyer present and mine, it was you who insisted that you did not want to pay
any monies on the policy I already had. It was you who insisted on getting a
different insurance policy, in the amount of $500,000. It was you who wanted
to shop around_and you insisted! It clearly states in the divorce papers. "at
the sole option of the wife." WHF.N you were still my wife Ho!lon and all the
financial matters were in place and my health was still good.
The divorce went through WITHOUT you doing anythlng about your policy
which was then no longer my r.esponsibiLity, but yours. You contacted me in
August. I sent you the letter which I had forwarded you the first time. I
still hold the same position, Helen. You have probably made much more money
than I, have a better credit rating and there is NO WAY I can get a $500,000
pollcy because I don't have the kind of jobs I uaed to have, have a poor
credit rating, and cannot pass the physical requirementa.
Now, almost a year later, you come to me and ask me agaln, ignorlng tne
previous letter that I sent you. The reason the insurance broker sent the
papers to me and n"t you to fill was because you waited toc) long...and you are
NOT MARRIF.D to MF. any Longer. Therefore, because of your Indolence, once
again, you are too late. 1his is not my fault, Helen.
My position has not changed from the letter I sent you. Neither have my
..
circum~tancae. Whon YGU hod thn chanco to do aomethlnq, you waited. That
cannot be held a~ my fault, At the time wu worn still m~rrled you were
supp080td to 'let this all don.. B~~f'QI\E: the divorce was ducrllad. But you didn't.
You probably an In a much I;>utt..r position tholn I am for someone who adm1tB
now that she needs forqlvunus8 for what want wrong ln tha marriage. You got
all that I had HlIlan, there 18 nothing left to get. And lf you really havo!
forglven m'l, you will let me live my Uf.. In peace. Any other move on your
part, would only ~how me you were not alnceru ln your request for forg'.eness
front me.
Paul
18 March 2001
PSI Below is the letter I sent you in September so as to refresh your memory
"Helent
~nclossd sre the papers that Quot'lSmith.com sent to myoid address, which ln
turn, they sent to my present address. I would havo! thought you already had
my new address as ALL three daughters had that Information. In addition, I
replied to YOUR e.mall and GAVE you the correct address. So, I am perplexed
to see that it was sent to the old address.
Many things have cha~ged In five months Helen, things that can affect such
issues as insurance.
- It was you, who held up the signlng of the divorce, because you needed
time to gather all the quotes and to arrolnge for the insurance policy that
you wanted. All paperwork was to be completo!d by March 31st, BE~ORE the
divorce decree was declared. The first I hear from you was the beginning of
September, fIV~ months AFT~R the dlvorce.
- As my lawyer has pointed out. to me, it clearly st.ates in the divorce
papers you are the one who is taking life insurance out on me. There is no
scope to these papers, Helen. What I mean is it does not say how much you
are asking for in life Insurance, what type of policy, etc. etc. He also
advises me that since you are the owner of the policy, you should be filling
out all of this paperwork. I am not about to fill out a financial statement,
based on the fact that I do not know how much or what type policy you are
applying for.
A few things you SHOULD be aware of:
- Remember, I said ln the beginning of this letter that many things can
change in five months time. Well they HAV~. First off, you should be aware
that my PSA is dangerously high. I just had ultrasound and biopsies done on
my Prostrate. Yesterday I was in the hospital for a Colonoscopy. Although,
both tests seem to be normal, nevertheless, they have to be watched. The
pre-cancerous skln lesions are a continuing problem. Which means I am NOT
in the A+ category for inexpensive life insllrance. (Medical Records will
show this testing took placF.l) .
- Since YOU received the WHOLE AMOUNT of our 401k, the HOUSE, its CONTENTS,
and HALP O~ MY MILITARY PAY, leaving me with 0 assets and bl11s such as
Nancy's education, and no money (as I had tried to tell you the beginning of
December), to payoff my creditors, my credit rating is severely damaged.
Therefore, when they do a credit check, they will obvlously come back
laughing hilariously at you. Oh, and by the way, did I mention r have been
cumberland County Pt.otbonot ilry' <l of [ice
Civil Ci1fJ(! Inquiry
1997-04546 DAVENPORT PAUl, G (VB) DAVENPl;)HT HEI,EN P
Reference Nc.. t DHAWER 1132
Caf)c Type.. ... t COMPLAINT - DIVORCE
Judgment. , . , . . .00
.Tudge AfjSlgnedt OLGR J WESLEY JR
DispoBed Dese. I GRANTED
- - - - - - - - - - - - Case Comments - - - - - - . - - - - --
PYSSIO
Pa~Je
1
Ft' 1 eel. . , . . . . . t
'f. me. 'I' .. . . . t
Execut on Date
Jrry Trial.. . .
D s oBed Date.
H ler Crt 1. I
H ~~er Crt 2. I
8/20/1997
3143
0/00/0000
4/18/2000
......*.........................................................................
General Index Attorney Info
DAVENPORT PAUl, G PLAINTIFF I,ANTZ DELANO M
11 W CHURCH STREET WEEKS RUBY D
FAIRPORT NY 14450
DAVENPORT HEl,EN P DEFENDANT
21 STONE LEDGE ROAD
NEWVILLE PA 17241
..**....'......................................*****..*..........................
· Date Entries ·
.......................*..........................................**...*........
8/20/1997
8/26/1997
5/06/1998
5/11/1998
5/20/1998
10/20/1998
10/23/1998
11/04/1998
11/05/1998
8/02/1999
10/08/1999
4/18/2000
4/18/2000
4/18/2000
- - - - - - - - - - - - - FIRST ENTRY
COMPLAINT - DIVORCE
ADDITIONAL COUNT - EQUITABLE DISTRIBUTION
-------------------------------------------------------------------
PROOF OF SERVICE
-------------------------------------------------------------------
MOTION FOR APPOINTMENT OF DIVORCE MASTER
___________________________________________M_______________________
ORDER OF COURT APPOINTING E ROBERT ELICKER ESQ AS MASTER
-------.-----------------------------------------------------------
PRAECIPE FOR ENTRY OF APPEARANCE FOR PLFF BY RUBY D WEEKS ESQ
-------------------------------------------------------------------
PETITION FOR SPECIAL RELIEF - RE DODGE CARAVAN
--------------------------------------------------,-----------------
ORDER OF COURT - DATED 10/23/98 - IN RE PLAIN~IFF'S PETITION FOR
SPECIAL RELIEF RE DODGE CARAVAN - HEARI~G ~lL4/98 1130 PM CR 1 -
BY J WESLEY OLER JR J - COPIES MAILED 10/23/98
-------------------------------------------------------------------
DEFENDANTS ANSWER TO PLAINTIFFS PETITION FOR SPECIAL RELIEF
-------------------------------------------------------------------
ORDER OF COURT - DATED 11/4/98 - IN RE PLAINTIFF'S PETITIQN FOR
SPECIAL RELIEF - BY J WESLEY OLER JR J - COPI8S MAILED ~1/5/98
_____________________________________________________________M_____
PLAINTIFF'S AFFIDAVIT UNDER SECTION 3301(D)
-------------------------------------------------------------------
AFFIDAVIT OF SERVICE BY MAIL
-----------------------------------------.--------------------------
ORDER - DATED APRIL 18TH, 2000 - BY THE COURT J ~lESLEY OLER J
---- - - ---- - -.. --- - - - --- - - - - --- - - - - - - - - --- -- --- - - - - --- - - - - - - - - --- - - --
QUALIFIED DOMESTIC RELATIONS ORDER - DATED APRIL 18, 2000
SY THE COU~T J WESLEY OLER JR J
NOTICE MAILED
------------------------..------------------------------------------
DIVORCE DECREE ENTERED BY J WESLEY OLER JR J
NOTICE MAILED
- - - - - - - - - - - - - - LAST ENTRY
********************************************************************************
· Escrow Information ·
· Fees & Debits BeG Bal Pvmts/Adi End Bal. ·
********************************~********~******w*****.*************************
DIVORCE
TAX ON CMPLT
SETTLEMENT
MASTER'S FEE
DIV PA SURCHG
ADD'L COUNTS
JCP FEE
,TCP FEE
35.00
.50
5.00
125.00
10.00
lO.OO
5.00
5.00
35.00
.50
5.00
125.00
10.00
10.00
5.00
5.00
.00
.00
.00
.00
.00
.00
.00
.00
A vom nEtA YS
Ih'n"~ Whlll )'ou cuu do 10 hell) gel )'our pollc)' dellnrcd III )'OUIl~ Iluickl)' ux po~~lhlc.
INSTRUCTIONS:
1) .;Hgn the application In ,,11 places required.
2) Complete all parts of your application In black Ink.
3) Complete and sign the Underwriting Requirements portion of your
Quotesmlth.com quote and mall It to us wllh appllcallon.
4) Mall application dlreclly to Quotesmlth.com regardless of when you had
your paramed exam. Underwriting cannot start until Quotesmlth.com
receives r..our aEEl.!Eallon_ c(jmJ!if!J.ed bY1ou.
!llIrke (,hrl~tenxen, ./1), ('Ur
Vice I're~hlenl, Operation,
QlIlIlexllllth.CIIIII. Inc.
tl205 SlIijth ('a" A\'C.. Snlte 102. Uarlell.lI. (,05hl
1'11111I" (HOO) 55(,-'1.\'13 Fax ((,.10) 515.0270
DeilY Burke.
To:
www.quotesmlth.com
I w"h III lip pi)' li,r Imllrance Ihrllllgh QIIIIIC~lIIlth.CIIIII and ha,e )'lInr clllllpan)' pre,ldenl, nllhert llIand, handle th"
IIllpllcalllln Ii,r lIIe a, III)' agellt/broker. Thllnk, fllr lIIaklng th" VI' eax)' alld XII fa,,', l'lea~e IlIlIk over lilY alll)lIcatlon
and lrlldemrlllnl! l{e'lulrelllenls. Ihell forward Ihl, ",Ihe underwriter inllnedlalel)' for prillrlty handllnR. !
IIl1d,'''IIII\lllhal alllll'lIrance cOlllnanie~ ,"'llIire ,e\'Crlllllll"hle Ielepholle hller,lew, "'Id the clllleclhlll of 1I11"ldc
lIIedlcal. drivln\!. credit IInd nnundallnfllrllllllllln hefore annal underwrltinl! dcc"llInl, lIIade. laRree 10 trllthfully
pro,ide ,"ch Infllrlllali<JIl whenever a.,ked. I al\1I und."tand thaI It " a crllllinalllffen~e tll kr\lmlnl!ly lIIake a fal~e
,lIlIelllenlllr dellberale 1I111"~llIn IInan)' insurance al'pllcallon.
o My intention is to pay on all 0 anllual 0 ()-1l1011lh O,/uartcrly 0 monthly basis,
o (alii cnclosing a ehcek made payable to thc insurancc company in the amount of $_____(e'/ualto the
paymcntmethod "elected). I uuder~land that if I elect to pay on a mouthly has is, I om now seuding a
check for !l'o months WOJ.th of premiums along with a blank, voided check. Based upon this payment. I
understand that you will Illail IllC a Cllllditional rcceipt. Il'romist! 1/0110 ('il//('('llII/Y il/s/I/'III/ct! 1'0tiC)' l/rllllhis
ill'l'ti(,lIllOl/ is cI('sigl/('cllo rt!l'liI(,(, /111/t1llwJ'c/irsllw'(,/I'('cI \\'ril/(,I/l'OI!/irmilliol/li'Olll yo"r COIIII'<lIIY l/rill /11.1'
afll'!rcallOII has h",," <l1'1'/'o\'('d,
o My dayllmc phone is ________..___________._____ _._____. evening __._.. _ ____.________.___._..________._'
o I have completed my application including evcry health qucstion in black ink and have signed the application
as the prospective insured in every place indicated. Evcn if ('vc already had my paramed examination. I
understand that underwriting cannot bcgin until you receivc my completcd application.
o I have completed and signed the Underwriting Relluirements which you pmvided to me with my price
comparison report and believe that I ,/ualify f(lr the plan I am applying to,
o (understand that the nonnal underwriting time is 4 . () weeks fmlllthe datc you receive my completed
application and that underwriting cannot begin until you rcceive my application.
Sincerely.
--~._--_...._----_._..._.--------,-------,- ----_._--
Signa/uY/..' Dille
('OPYRIGII'J' 1999. OI!()n:SMITlI.(,OM.IN('. Au.I{IGIITS Rt:St:RVt:()
(Over. please!
_A
.
TRANS 1 (12/23/99) #29
tiow to obtain tho !!9MD~h:ugsuJt!
fr.Q~QY.r.mI!!mg.~j~~~J.t
. If possible, try to schedule YOI)r exam early in the morning. Our examiners will be very accommodating
and will meet with you at your home or office, day or night, sometimes even on weekends.
. Be prepared to provide the examiner with the names, addresses and (elephone numbers of all the
doctors, clinics and hospitals you have seen within the last 7 years.
. Do not eat any food for at least 12 hours prior to your exam. NOTE: The U.S. cholesterol test Is a
fasting test. Recent food Intake can result In an artificially high rating. DO NOT EAT FOR AT
LEAST 12 HOURS PRIOR TO YOUR PARAMED APPOINTMENT.
. If you use tobacco products, do not use them Within 46 hours of your exam.
. Do not drink any alcohol or coffee for 46 hours prior to your exam.
. Plan your food intake carefully for several days prior to your exam: avoid salt, rich foods and those
foods with large amounts of sugar.
. Get a good night's sleep prior to the exam.
Here are some of the questions the paramed company will ask you:
Exactly wherl did you last use tobacco of any kind? _
Are you now or have you ever been disabled? _
Have you had any parent, brother or sister contract or die from Cf,lncer, heart disease, diabetes or
stroke before age 60? _
Do you have felony convictions within the last 10 years? _
Do you have any driving violations with the last 5 years? _
Are you a permanent resident of the United States? .._
Are you overweight? _
Do you participate in anv hazardous sports or activities such as racing, scuba diving, student pilot,
private pilot, mountain climbing, ballooning, etc.? _
Have you ever had illY history of blood pressure treatment, cancer, diabetes, stroke, blood
disorder, heart condition, elevated cholesterol, drug or alcohol abuse? _
Have you ever had a life insurance application rated up or declined? _ If YES, when and
why?
NOTE: If you are applying for one of the lowest cost policies on our printouts and you have a condition or
family history regarding your eligibility to receive the lowest preferred rates, please keep in mind that
borderline cases are always tricky. Based upon our experience, the lowest rates are typically given only to
t/Jose people who do not have any borderline conditions or histories. Typically, people with a borderline
condition or family history can expect the insurance companies to give us a counter-offer quote which can
be 20 percent higher or more - even though you might still be considered preferred. If there is going to be a
counter-offer quote given to you, we will let you know as soon as possible.
Again, thank you!
TRANS1 (12123199) *29
How to obtain the best cossible results
from vour caramedic visit.
· If poaa.ibltJ, try tv tldlt1dull' ).'...)111" t'xam l'dl L)-' 111 Ult.! ll1orninq. OUt:
examiners will bp Vt~l"Y ~'ccurnlllodatillq and wi!.l tllt!l~t with you at your home
or office, day 01" f11l]ht-., UOIllt..1t". i.meu l~V(?n un wtlekendu.
· Be pl'epa!:ed to Ill.w/tde the "Xilmlt1l'l' with the 1I,1mes, addresses and
telephohe numbl.!rs of ,111 the doctol.u, C1UllCS illld hOBpitillu you hilve seen
within the last 7 yeill.u.
· Do not eat any food fol. at least 12 houru prior to youl.' exam. NOTE, The
U,S. cholesterol test is a fasting test. Recent food intake can result
in an artiticially high rating. Regardless of what the paramedic
.xaminer may tell you, for beat results. DO NOT BAT POR AT LBAST 12 HOURS
PRIOR TO YOUR PARANBD APPOINTMBNT.
· If you use tobacco pl.'oducts, do not use them within 48 hou!:s of your
exam.
· Do not drink any alcohol or coffee for 48 hours prior to your exam.
· Plan your food intake carefully for several days prior to you!: exam,
avoid salt, rich foods and those foods with large amounts of sugar.
· Get a good night'u sleep prior to the exam.
Here are some of the questions the paramed company will ask your
Exactly when did you last use tobacco of an}' kind?
Are you now or have you ever been disabled? ____
Have you had any parent, brother or sister contract or die from
cancer, heart disease, diabetes or stroke before age 60?
Dn you have felony convictions within the last 10 years?
Do you have any driving violations with the last 5 years?
Are you a permanent resident of the United States?
Are you overweight?
Do you participate in ~ hazardous sports or activities such as
racing, scuba diving, student pilot, private pilot, mountain
climbing, ballooning, ~? ___
Have you ever had ~ history of blood pressure treatment, cancer,
diabetes, stroke, blood disorder, heart condition, elevated
cholesterol, drug 01: alcohol abuse? ____
Have you ever had a life insurance application rated up or declined?
If YES, when and why?
NOTE: If you are applying for one of the lowest cost policies on our printouts and
you have a condition or family history regarding your eligibility to receive the
lowest preferred rates, please keep in mind that borderline cases are always tricky.
Based upon our experience, the lowest rates are typically given only to those P10ple
who do not have any borderline conditions or histories. Typically, people with a
borderline condition or family history can expect the insurance companies to give us a
counter-offer quote which can be 20 percent higher or more - even though you might
still be considered preferred. rt the:'e iG going to be a counter'-offer quote glven to
you, we will let you know as soon aa possible.
Agatn, thank you:
~i'
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www.quotesmlth.com
11205 South C.ISS AWI1Ul', SUlh' 102, n.II'il'Il, 111111"" bll% 1
fl'l. 16:10) 515.01 70
F,IX lCl:lO) 515.0270
A Note to Thank You
Thank you fOl' applying for insurance through Quotesmith,com.
Our pdrnmedic tec~1ician will call you within the next few days to
schedule 15 minutes of your time at your home or place of work to interview
you and obtain any additional health history information that might be
outstanding, Our paramed can also meet with you at night or on weekends to
suit your needs,
To get the lowest rate you are applying for, it's almost certain that
the paramedic will want both blood and urine samples from you. Fellowing
this letter are Borne helpful hints to help you obtain the best possible
paramedic exam results. These are the same instructions that were given to
you on the Internet. Please do not eat any food for at least 12 hours Drior
to vour aDDointmlnt.
It normally takes four weeks from the date I receive your completed
application for me to receive a firm decision from the underwriter. During
that time we will aggressively manage and monitor the collection of outside
information which usually includes multiple telephone interviews with you
and the collection of outside medical, driVing and credit reports. We will
keep you informed by mail and phone.
I will let YOll know as soon as I receive an underwriting decision.
In the meantime, please feel free to call me at 1-800-556-9393, 7am to
lOpm Central time Monday to Friday or 8am to 5pm on Saturday should you have
any questions. At Quotesmith.com, our motto is, "End Insurance Confusion
Forever I " I sincerely hope that we will be able to help you do this.
Sincerely,
A
Burke A. Christensen
Vice President, Operations
P.S. Remember, you should not cancel nor even seek to cancel any existing
insurance that thie application is designed to replace until you have
first received your new policy and found it to be acceptable. This is
sound advice whenever you are applying for any new insurance.
S:\Mana913fnontIMaster OOClJIflcnls\Foldor lin\SUBTY (4/25100)
Life Inaurllnce
Buyer's Guide
Q~eSl1llth,com '"
.:
1.~:""'::~..!..L~_!1.!.~_!1
www.quotelmlth.com
8205 South Cass Avanue, Suite 102, Darlen, Illinois 60561 . (800) 556.9393' Fax (630) 515-0270
This guide can help you when you shop for life Insurance. II discusses how to:
. Find a Polley That Meets Your Needs and rits Your Budget
. Decide How Much Insurance You Need
. Make Informed Decisions When You Buy a Policy
This Guide Does Not Endorse Any Company or Policy
Importllnt Things to Consider
1. Review your own Insuranca needs and circumstances. Choose the kind of policy that has benefits that most
closely fit your needs. Ask an agent or company to help you.
2. Be sure that you can handle premium payments. Can you afford the Initial premium? If the premium
Increases later and you stili nsed Insurance, can you stili efford It?
3. Don't sign an Insurance application until you review It carefully to be sure all the answelS are complete and
accurata.
4. Don't buy life Insurance unless you Intend to stick wllh your plan. It may be very costly If you quit during the
early years of tho policy.
5. Don't drop one policy and buy another without a thorough study of tha new policy and the one you have now.
Replacing your Insurance may be costly.
6. Read your policy carefully. Ask your agent or company about anything that Is not clear to you.
7. Review your life Insurance program wllh your agent or company every few yea,s to keep up with changes In
your Income and your needs.
Buying Life Insurance
When you buy life Insurance, you want coverage that fits your needs.
First, decide how much you need n and for how long n end what you can afford to pay. Keep In mind the major
reason you buy life insurance is to cover the financial effects of unexpected or untimely death. Life insurance
can also be one of many ways you plan for the future.
Next, learn what kinds of policies will meet your needs and pick the one that best sulls you.
Then, choose the combination of policy premium and benefits that emphasizes protsctlon in case of early death,
or benofits In case of long life, or a combination of both.
It makes good sense to ask a life insurance agent or company to help you. An agent can help you review you,
Insurancs needs and give you information about the evailable policies. If one kind of policy doesn't seem to fit
your neads, ask about others.
This guide provides only basic Information. You can get more facts from a life insurance agent or company or
from your public library.
GUIDE (8131/99) 029
#
What About the Policy You Have Now?
It you ore thinkinG ulJout dropplll\j u 1110 1I1sumnco policy, hore ore 501110 things you should conElder:
.
It you decide to roplace you' policy, don'l cancel your old policy un III you hove received the new one.
You then have 0 minimum period to review you,l1ow policy und decldo if It is what you wanted.
.
It may b'l cosily 10 'eplace 0 policy Much 01 what you paid III theeorly years of the policy you have now,
paid tor the company's cost at selling and issuing the policy. You may pay this type of cost egaln it you
buy a naw policy.
.
Ask your tax advisor if dropping your policy could affoct your Incoming taxes.
.
If you are older and your haalth has changed, pramlums lor the new policy will often be higher. You will
not be able to buy a new policy It you are not Insurable.
.
You may have valueble rights and banellts In the policy you now have that are not In the new one.
.
It the policy you have now no longer meets your needs, you may not have to raplace it. You might be
able to change your policy or add to It to get the coverege 0' bensfits you now want.
.
Atleestln Ihe beginning, a policy may not pay benefits for some cause of death covered In the policy you
have now.
In 011 cases, It you ara thinking ot buying a new policy, check with the agant or company that Issued you the one
you have now. When you bought your old polley, you may have seen an Illustration of the benefits of your polley.
Before replacing your policy, ask your agent or company for an updated IlIustlOtlon. Check to see how the policy
hac performed and what YOll might expect In the future, based on the amounts the company 15 paying now.
How Much Do You Need?
Here ara soma quesllons to ask yoursalf:
.
How much of the family In coma do I provlda? If I were to die early, how would my survivors, especially
my children, get by? Does anyone else depend on me financially, such as a parent, grandparent,
brother or sister?
.
Do I have children for whom I'd like to set aside money to finish their education In the event of my dsath?
.
How will my family pay final expenses and repay debts after my death?
.
Do I have family members or organizations to whom I would like to leave money?
.
Will there be astate taxes to pay after my death?
.
How will infiatlon affect future needs?
As you figure out what you have to meet these needs, count the life Insurance you have now, Inclijdlng any
group Insurance where you work or veteran's Insurance. Don't forget Social Security and pension plan eurvlvor's
benefits. Add other assets you have; savings, Investments, reel estate and personal property. Which assets
would your family sell or cash to pay expenses attar your death?
Prepared by the National Association of Insurance Commissioners
The National Association of Insurance Commissioners Is an association of state Insu,ance regulatory officials.
This association halps the va,'ous Insurance Departments to coordinate Insurance laws for the beneflte of all
consumers.
GUIDE (8131/99) #29
What lithe Right Kind of Life Insurance?
All pOllClllS me I1etllw SO/11e Somo \Ilvn covmuge for your Ilfotlll1oUI1d others cover YOll for U speCific number of
yeurs S0/110 lJlIlld lip cosh vlllllUS ""'\ olllOrs do I10t SO/11e policies cO/11blne different kinds of Insurance, und
others let YOll r.lllll1l1u fro/11 onu klllll 01 II1SurnnCO to ol1othor SOlllll policies muy offer othe, benefits while you
ore stlllllV'"11 YOllr choicu shollld lmlJilsud on YOllr neuds nnd wl",t you cen offord.
There oru two bosle twos of Ilfo II1surnrlcn term Insuranco und cash value Insurance. Term insurance
gsnerolly 1105 lower prel11IU/11S In the eorly yuurs, but does not bUild up cAsh values that you con use In the future.
You l110y cOl11blnu cosh vollle life Insurnnce for the period of your greotest need for life Insurunce to replace
income.
Term Insurance covers you for a term of one or 1110ru yoors II pays a death benefit only If you die in that term.
Term insurance genelOlly offe,s the lorgest Insurance protection for your premium dollar. II genemlly does not
build up cosh value
You can renew lllostterl11 Insurance policies for one or more terms even If your heallh hos changed. Each lime
you renew the policy for u new term, premiums may be higher Ask what the premiums will be If you continue to
renew the policy. Also ask if you will lose the right to renew the policy at some age. For a higher premium, some
companies will give you the right to keep the policy In force for a guaranteed period at the same price each year.
At the end of that time you may need to pass a physical examination to continue coverage, and premiums may
Increase.
You may be able to trade many term Insurance poliCies for a cash value policy dUring a conversion period ., even
If you are not In good health. Premiums for the new policy wilt be hlghe,than you have been paying for the term
Insurance.
Cash Value Life Insurance Is a type of insumnce where the premiums charged are higher at the beginning
than they would be for the same amount of term Insurance. The part of the pl8mium that IS not used fa, the cost
of insurance is invested by the company and bUild up a cash value that may be used In a variety of ways. You
may borrow against a policy's cash value by taking a policy loan. If you don't pay back the loan and the interest
on it, the amount you owe will be subtracted from the benefits when you die, or from the cash value if you stop
paying premiums and take out the remaining cash value. You can also use your cash value to keep Insurance
protection for a limited time or to buy a reduced amount without having to pay more premiums. You can also use
the cash value to increase your income in retirement or to help pay for needs such as a child's tuition without
cancell,ng the policy. However, to build up this cash value, you must pay higher premiums in the earlier years of
the policy. Cash value life insurance may be one of sevelOltypes: whole life, universal life and variable life are
all types of cash value insurance.
Whole Life Insurance covers you for as long as your life If your p,emiums are paid. You generally pay the
same amount In premiums for as long as you live. When you first take out the policy, premiums can be several
times higher than you would pay initially for the same amount of term Insurance. But they are smaller than the
premium you would eventually pay If you were to keep renewing a term policy until your later years.
Some whole life poliCies let you pay premiums for a shorter period such as 20 years, or until age 65. Premiums
for these policies are higher Since the premium payments are made during a shorter period.
Universal Life Insurance is a kind of flexible policy that lets you vary your premium payments. You can also
adjust the face amount of your coverage. Increases may require proof that you qualify for the new death benefit.
The premiums YOll pay (less expense charges) go Into a policy account that earns Interest. Charges are
deducted from the eccount. If your yearly premium payment plus the interest your accolJnt earns is less than the
charges, your account value will become lowel. If it keeps dropping, eventualty your coverage will end. To
prevent that, you may need to start making premium payments, or increase your premium payments, or lower
your death benefits. Even if there is enough In your account to pay the premiums, continuing to pay premiums
yourself means that you build up more cash value.
~",.
,
GlIlDE (1\1.11/99) #29
Variable Life Insurance IS iI "",,1 01 II1SUr(1I1CO whero nl0 doulll OUIlOflls ond cush volues depelld on Ihe
Inveslmont porformilllco 01 OIHl or Ul0ro sop"rnlo "CCOIJl1ts, wllIch muy ho IIwoslod In mutual lunds or other
Investmellls ollowod ullder 1110 poliCY. Bo suro to gellho prospectus Irol11lhe compony when buying this kind of
policy and STUDY IT CARE FULL Y You will hovo hlghor deoth benellls and cush voluo If Ihe underlying
Irwestments do well. Your benellts aud cash value will be lower or may disappear If Iho IIwoslments you chose
didn't do as well us you oxpoclod You may poy "11 exlra plOmlum lor" guaranleod de,,1I1 benelll
Life Insurance illustrations
You moy be thinking of buying 0 policy where cash values, deolh benoflts, dividends or premiums may vary
based on evenls or slluollons Ihe company does nol guaranlee (s\Jcl1 05 Interest rotes). If 50, you mey get en
illustration Irom tr,e agent or company thlll helps explall1110w Ihe poliCY works. The IlIustralion Will show how Ihe
benefits Ihal are not guaranleed Will change os Inloresl rales end olhor faclors change. The Illustrotion will show
you whal the company guorantoes II will also show you what coulo happen In the luluro. Remember that
nobody knows whal Will happen In Ihe fulure. You should be ready to adjust your financial plans If Ihe cash value
doesn't Increase as qUickly as shown In Ihe IlIustrallon. You Will be asked to sign a statement that says you
understand Ihat some of Ihe numbers In Ihe IlIuslrallon are not guaranteed.
Finding a Good Value In Life Insurance
After you have decided wlllch kind of life Insurance 15 bast 10r you, compare similar policies from different
companies to find which one is likely to give you Ihe besl value for your money. A simple comparison of ths
premiums 15 nol enough. There are other things to consider. For example:
Do premiums or benefits vary from year 10 year?
How much cash value builds up under the policy?
What part of the premiums or benefils 15 not guaranteed?
What 15 Ihe effect of interesl on money paid and received at different times on the policy?
Once you have decided which type of poliCY to buy, you can use a cost comparison index to help you compare
similar policies. Life Insurance agenls or companies can give you information about several different kinds of
indexes that each work a little differently. One ty~e helps you compare the costs between two policies If you give
up the policy and take outtre case value. Another helps you compare your costs If you don't give up your policy
before 115 coverage ends. Some help you decide what kind 01 quesllons to ask the agent about the numbers
used in an illustration. Each Index is useful in some ways, but they all have shortcomings. Ask your agent which
will be most helpful to you. Regardless of which index you use, compare index numbers only for similar pollcies-
- those that offer basically the same benefils, with premiums payable for the same length of lime.
.
.
.
.
Remember Ihat no one company offers the lowest cost at all ages for all kinds and amounts of Insurance. You
should also consider other factors:
.
How quickly does the case value grow? Some policies have low cash values in the early yea,s that build
quickly later on. Other policies have a more level cash value build-up. A year-by-yaar display of values
and benefits can be very helpful. (The agent or company will give you a policy summary or an Illustration
that will show benefits and premiums for selected years.)
Are there special policy features that particularly SUit your needs?
How are non-guaranteed values calculated? For example, Interest rates are Important In determining
policy returns. In some companies, increases reflect the average interest earnings on all of the
company's policies regardless of when Issued. In others, the return for poliCies Issued in a recent year,
or a group of years, reflects the interest earnings on that group of,policies; in this case, amounts paid ere
likely to change more rapidly when interest rates change.
.
.
GUIDE (&31/99) #29
ISECTlON VII TEMPORARY INSURANCE AGREEMENT HEALTH QUESTIONS
TO Ill' l'OMI'I.FITI)()NI.Y II. MONLY IS SIIIlI\II ITI'II
If )lHl L}uulll), Ju )UU \\bh hI ha\1.' 11.'1Il1"'"UJ') ill'\UJUlh,:~ IUl Ihl.' Iile uf Ihl." PI'llj1lJ~l.'ll IIIMU....d(s) I~ti.m.! uclivl.'r)' III
Ih. 1'"lky h.llIg 111'1'11..1 1<" h)" Ihh IIl'l'lklllioll'! U Y., '..I No
It is wI,kr"olld Ihlll nllY 1<1111'01011) 111"""11.< \\ III h. ,uhj..1 h' Ih. .1I11d1111l1l' lie th. T.lI1l'umry 1II'lImll.. 1~...111l
alladl.d hI Ihls III'PlkllllulI IlIdlldillg Ih. 11111,111111111 ",nuunl uf S250.OIX). TlI ~uullly 1<,1' this T.lI1p<lrnTY In,umll...
Y"u II1l1st (u) ullm.r "NO" hI holh 1'111'1' lIf '1"<'111111 I) h.I"w; (h) un,w.r "NO" h' ~u.stllln 2) h.low Ii,r any d1lId(r.lI)
prul'",.d li,r 11I'"mll..; ulld (.) 1lI..llh. r.qlllt.II1.III', IlIdlldlng pU)II1.lllllfth. Iirsll'r.llIll1ll1. oflh. T<llIl'umry IIISlltllll".
1{..<Ipl.l)II<S1lol1 2) 1I11"t h. ",,,\\.r.d ulIl) if II dllld(r.lI) b/nr. I'rul'o,<d lilt 1II,"mll...
I) 1"0 Ih.... hl.'!'I1 of)'llllr kllll\\Il.Jg.... alld bdh.:'l: ha\C' )011:
a) Wilhlll Ih. laM .1 1lI01llh, h<<1I IIdlllin.d III' ,d\.dnkd lu h. ,,,III1II1.d 10 II hllsl'lllll ur uIIl<r lI1.dklll ,ildlll)"
olh.r Ihlllllilt chlldhlrlh'! U YI'S UNO
h) wlthlll Ih. III" 2 y'.ars. h<.1I diagllllscd \It Ir<III<d hy' a ph)"sklall Ii,r h.llr1 truuhk. slmk.. AIDS. or Cllllc<r. III'
hud all .1.clmcurdlugrall1li". ch.,1 palllllt 1Ilh<r phy,klll c",nplallu'! U YES UNO
2) Tu Ih. b<sl uf )"lIl1r kllll\\kdg. IIl1d b.II<I; dll.s III1Y child pmpus.d lilt illsumllc. hllv. allY CllIIB.lIllal or curr.1ll
ll1<dlcul probl<lI1(s) 1101 cuvored ill ~uesllolI I )b'? U YES UNO
SECTION VIII
PLAN DESCRIPTION
'a policy to be back.datad to aave ege? U Yea U No Requeated Policy Oala:
Note: Cerlaln plana cannot be backdated.
IWHOLE L1FEI
A) Plan Name:
B) Base Face Amount: $
Rider Name:
(e.g., ECO. STAR, ValuBlend, CTO)
Rider Fece Amount:
Rider Type: U Includes APPUA (level)
U Excludes APPUA (increasing)
APPUA Rider Premium: $ .__
SPPUA Rider Premium: $
C) Olher Term Rider Name & Amount: $
D) Other:
E) Dlseblllty Walvor of Promium? U YES
F) Accidental Death Benelit $
G) Guaranteed Insurebility - No. of Units:
H) Autometlc premium Loan? U YES
(II none checked, "Ves" will apply.)
I) Dividend Options:
U Paid-Up Additions U Cash
U Accumulate at Interest
U Reduce Premium'
U Purchase One Veal' Term Equallo Cash Velue
Balance of Dividends to be applied as follows:
U Paid-Up Additions
U Accumulate at Interest
U Reduce Premium'
U Cash
, Reduction of Premium NOT Available with EFT
UNO
UNO
I TERM Lilli
A) Plan Name:
B) Base Face Amount: $
C) Disability Waiver of Premium? U YES U NO
D) Accidental Deeth Benefit $
I UNIVERSAL LIFE I
A) Plen Neme:
B) Base Specified Amount:
Billed Premium: $
Add'l Lump Sum Payment: $
Rider Name: .
Rider Face Amount: $ _____.____
Other Insurej Term Rider (see section II)
Other: __
C) Automatic Paytner.t Benefit: $ ____ OR
Disability Waiver of Monthly Deduction: U YES U NO
D) Death Benefit Options:
U Level (Spec~ied Amount Includes Policy Fund)
U Increasing (Specified Amount In addition to
Policy Fund)
U Level. with escalating death benefit
Percent Annual Increase ( 2 - 8 % allowod):
% U Simple U Compound
E) Accidental Death Benefit $
F) Guaranteed Insurability - No. 01 Units: __
I.WI
Page 3 of 12
[SECTION IX
QUESTIONS APPLICABLE TO PROPOSED INSUREDS
A) In the past twelve months.
1) a) have you smoked clgarelles?
b) smokod plpos or cigars, used snull or chewed tobacco?
B) Has ony person proposod for Insuranco:
1) Operated an aircraft or boen 0 mom bel' of an alrcrew In the past 24 months or modo plans to do
so In the futuro? U Yes tl(No
If Yes, complote Aviation Quostlonnalre. Form 24.
2) Other than for vocation. ttavolod or mode plans to travel outside of the U.S.A. and Canada
within the next yeor?} j1iYes UNo
II Yes, where? (,/E,..!./-fA,"'J' How Long? /'" /-/.,..'lrrWhy? /,'.,"'oJ(-H
3) In the past 24 months, engaged in or made plans to engage In car or other racing, parachute
lumping, hang.glrdlng, sCIJba diving. or other hazal'dous activity? U Yes ~o
II Yes. complete Avocalion and Professional Sports Questionnaire, Form 56.
4) Had a drlver's Ircense restrlcled. revoked, or suspended wilhln the last 3 yeats? U Yes !):No
Drlve~s L1conse Number: State:
C) 1) Will the proposed Insuranco teplace or change any life Insurance or annuity
now In force?
If Yes, please submil all applrcable state replacement forms.
2) List all policies In force on tho lives of the proposed Insureds:
Primary
Insurad
UYes .9No
U Yes I!{No
Joint LIle Or
Olhar
Insured
UYes UNo
UYos UNo
U Yes ~o
Name of Company Amount
Plan
ADB
Year
Issued
Business
Insurance
Primary Other/
Insured Joint
Insured
iI\I
.1
/I
" ~o
II /lJo
UYes ~o
- ,
1. Transamerica Life 15 yr term 11,000,000) policy H 41846202
2. Mas~ Mut1ldl .';'1'10,000 Policy H c)7S1394
3. Troa ^D ~n $100,000 Fol i.l~Y U 01000ti-n026fj61
4. Dept. of Verterans.Attnirs $10,000.00 Pilcy H HfI 500-26020
5. Armed rorces Benefit Assoc. Policy H 42149'7 $38,000
3) a) Is any other application for Insurance pending at this time?
b) II Yes. lotalto be placed
4) Has anyone proposed for coverage ever been declined for life or disability Insurance. olleted
Insurance wilh restricted benefits or other than standard rates. or applied for and/or recelv~~
benefits because of III heailh or Injury? U Yea Il(NO
II Yes. give details:
D) II the Primary InRured is a child, please provide the amount of Insurance on the parentIs) or owner(s).
(Including any pending applications):
I-WI
Page 4 0112
THE CANADA LIFE ASSURANCE COMPANY
PARTIIA
NON-MEDICAL STATEMENT OF HEALTH
Print Full Namlls of nil
Live be Insured
IkrJI'.',.
Relnlionshlp to
Prima Insuted
.c
. ..... '-
BIRTHDATE
Mo On Yr
Ago
BUILD
FT IN WT
Wnlght Chango
In Past Year
Gain Loss
1.
I.) _'>
u
Reason for weight change?:
2. FAMILY HISTORY Pleasa Indicate any femlly history of diabetes, hoart disease. cancer, or any other heredllary
or significant disease:
0101 ana Ip
Ptlma
Ago II
llvln
Insured
Family HiSIOry or CllU50 01
Death
':>-(,v/L/T.,
eA,..)e k.,.t..
Relationship
Joint/ Othor Insured
AQo il Bmlty HISlOry or
Uvin DOOlh
DUlSO 0
go at
Death
3. The following Information must be provided for all Insureds named In Queslion 1 above.
INSURED
II ~,.; '1,,-
PERSONAL MEDICAL
ADVISOR
,v.}II.(vJ ~~v~r,L 7'
I. Ilto/Ul II ~ r"'-I/I
J f7"A~/'
-r:
ADDRESS
PHONE #
c.'-.I '- 'L(..Ij)
DATE & REASON LAST CONSULTED
ONGOING TREATMENT OR MEDICATION
l,. ...". <S(~,1 '-, <..J /'11....),)1'"74-!T-
~, '..1 8~'IJ
? /, ;Ji> ..., ~ .,if:.!:! ~
It" -;lIr., () I
4. Has anyone ptoposed for insurancll ever had or been treated lor:
a. Disease or disorder of the eyes. ears. nose. or throat? %Yes UNo
b. Asthma. persistent hoarseness, blood spilling. .1J!onchitis. emphysema. tuberculosis,
or other respiratory disordor? )4Yes UNo
c. Chest pain or discomfort. abnormal blood ptessure, breathlessness. heart murmur
or any problems with hearl, veins. or blood circulation? UYes ?4No
d. Ulcers, jaundice, gall bladder or liver disease, Intestinal bleeding. chronic diarrhea,
other disorder of the gastrointeslinal system? UYes _No
e. Sexually transmitted disease, (excluding AIDS/ARC), albumin. sugar, blood or pus In
the urine, or other kidney or urinary problem'? UYes ll(No
f. Amputation, deformity. arlhrilis. or any other problems with the back or neck, muscles,
bones, joints, or spine? UYes IIINo
g. Dizziness, falnling, recurrent headaches. convulsions. paralysis, stroke or other
disorder of the nervous system? UYes ~No
h. Nervous anxiety. depression, or any other psychiatric rlisorder? UYes IdNo
I. Diseases of skin. cancer. leukemia, tumor. anemia. hemophilia or any other disorder oi Yes
of the blood or lymph glands? UNo
j. Diabetes or disorder of thyroid or other endocrine glands? UYes Ol'No
k. Disorder of the breasts or roproductlve organs? UYes IJI'No
5.WI Pago 5 0112
5. Has anyone proposod lor Insuranco:
a. Ever been tested or trealed by a modlcal ptofeeelonal lor significant weight
lose, fover, night slNeats, porslslent dlarrhee, or swollon lymph nodes?
b. Boen dlagnosod 01 troalod by a medical professional lor Acqulrod Immune
Deficiency Syndromo (AIDS) 01' AIDS Relotod Complox (ARC)?
U Yes ~o
U Yea \l(No
6. Olher than the obove. has onyone proposed for Ineuronce wllhln Ihe past five yeors:
a. Had any montal or physical diseuse or dlsordet? U Yes )(No
b. Coneulted a physician or any othor proctltlonot? U Yes UNo
c. Been a patlont In a hospilol. clinic, or othor modicul facilily? U Yes UNo
d. Had an ele<:trocatdlogtOln. X.tay. blood or olhor dlagnosllc lest oxcludlng HIV? )(Yes UNo
e. Had a health Invosllgalion. hospitalization. or sUtgory which subsequently was
schedulod or complotod? U Yos i)(No
7. Does anyone proposod lor insurunce use now or havo ovor usod alcohol? ~ Yes UNo
II Yes, 'J I /
a. Amount per week: ....x..JLtLL2~._.. Type:1,,0 rJ('
b. Have any of the proposed Insuteds hod any problom, received treatment or
advice, or bolonged to an otganlzatlon because of alcohol use? U Yes ~No
6. During the past five years. have any 01 the proposed Insureds used heroin or other
narcotics, hallucinogenic or other habit forming drugs, Including cocaine and
mariJuana? (J Yes ~No
9. Has any child (age 16 or under) proposed for Insurance ever: )I' ~
a. Had any congenital abnormalities or hereditary disorders? / I.
b. Had any malignant diseases Including leukemia?
c. Received counseling or Irealmenl te~arding tho uso of alcohol or drugs?
SPACE FOR DETAILS OF "YES' ANSWERS. Underltne History, Symptoms or Disease. Identify
quesllon by number. Give dates, severity. duration and outcome. State names and addresses of all
altendln h slclans hos Itals clinics sanatoria and other modical facilities.
_ {dAr.nlf 1&.( t:) J~"I '; 1-!t.H ,s. , H ~
,,/..1. i ,Lf- t1- . "';,10... ''''ldl 11,L ~}/
'k',v,'", ~.. (" lrt /.)
',.
10.11 any child proposed for Insurance Is less than two years 01 age, were there any
problems during the ptegnancy or the first year of life? /-'/ A
//(/
"
~, L
. . "
~ ~> . i
c
A ,J
In ~t.' "- ... ~' , , ( .
C""'k'. -~.
.L
<L
r
( L. 1
" ," 7-
I . ( I - 1.""'C'
lc.JO I
",-
1 . (.~ ~ 1,.-"...
S-WI
Page 6 of 12
UYes UNo
UYes UNo
UYes UNo
UYes UNo
,0",
"l.
c.J.;l
Any pursQn who knowu1u1y, and 'lY11I1 1I11(Jl1l 10 IIlJUr'll, Ih..'lraud lJr dll(l.lIVLl /IllY IIl:iWllIll:t1 t;lllllpany, lllmi IIll1lpplll:allofl or II
6tnlQIllQl11 of dalm conln!nlllg nny In150, IllCOlllplulo or nll!)Il)i1dlf1~llflll)'f111111I)ll "lIIY tlll tillllJLlcl Il) Crlllll/ll\l or CIYII punalllL'f1
AUTHORIZATION TO OBTAIN INFORMATIO~, AGREEMENfAND5IGNAtuiifSECTION----.---..
'I/wo" and "my/our' 1'0101' to pOtti<ln6 who litO toqUlrod 10 tilUn Ill1ti npplic.ltlon. TIt<l60 pOISOllti nro Hw Pmtlnry '",urod. lito
O/hor Insured (II oppllcnblo) nnd Iho AppllcllIlt!s) Own,,,!,) Iii Hlo Appllcont(s) Ownol(ti) Is/lito othor thnn tho Prrmory
Insurod).
To uotermlno ollglbillty for Insuranco lot ooch ptoposod Insurod. I authorllo thu rolooso 01 Inlormllllon Cotlcotlllna (n) HUl
dlagnosrs. tteatment or prognosis of any past 01' protiont: f) physlcnl or montnl condrtlon; nnd 2) urug or alcohol comJlllon;
and (b) any non-medrcal Untn which rolntos to rnsurnbilily. Tho parlll;!s outhotlled to rolenso such Infotmotlon 01'0 (0) nny
physician or medicol prnctltloner; (b) ony hospllnl. cliniC. or medlclllly relolud focrllly; (c) ony rnsurnnco 01' rOlnsutnnco
compony; (d) the Medlcallnlormatlon Buteou or any con sumoI' reporlrllg ogoncy; onu (e) ony employer of those proposod
lor Insurance. Tho Inlormotlon mny bo released l<I: (n) Tho Conn do Lile Assuranco Compony (Cnnoda Lilo): (b) Hw
reinsurers of Canado Ufo; ond (c) the legal ropresontatlve 01 Canada Llle. Any data obtAined will not be relensod by
Canada L1le to any person or otgonlzation except: (n) to reinsuring companies; (b) to the Medical Information Bureau; (c)
to petsons porformlng buslnoss or legal services In connocllon wrtll my oppllcallon; (u) to ony physician nomed "' my
medical declarallons; (e) as required by law; or (I) os I furlher authorize. I agroe that a photocopy 01 this authotlzatlon wrll
be as vallU as the original. I know that I may request 0 copy 01 this 8uthorlzellotl. I agree thot Ihls aulhorizallon sholl be
valid lor 26 monlhs Irom the dato shown bolow. I know HInt I may revoko this nuthorilatlon at any time except to tho
extentlhat action Is taken In rolylng on II.
If a medical examination Is t'ilqulred. Ills port of this application. The medical portion 01 the application consists of Part II
and Part III. To the best of my knowledge and bellel: I) all statements In Ihls application are complete and true; and 2)
the Proposed Insured(s) Is/are In the same heallh condition as stateU in this application. Canada Life will not Incur nny
liability ptlor to the delivery of a policy except In terms of the Temporary Insuranco Agreemenl. Canada Life Will not incur
any liability under the policy applied for unless and unllllhe policy Is delivered while: 1) the first premium haa been paid In
full; and 2) the lacts concerning the Insurablllly of the Proposed Insured(s) ore the same as described In the application.
No agent or medical examiner can: 1) waive the answers to any questions In this apphcation; or 2) make or change any
insurance contracl. I (We) received a copy 01 Ihe Medical Information Bureau Notice; and the Notice required by Ihe
Fedllral Fall' Credit Reporting Act. .
If this application Involves an exchange under Section 1035 of the IRS Code, I understand that the amount of 1035 funds
transferred Into my policy may dlfler shghtiy from the estimated value Indicated on this application. The amount of Pald.Up
Additions purchased or additional lump sum premium will be determined by the exact amount of the transfer.
1'H
Daled at: . i,~ ",,' Slatu vi ___ this ~ day of
rlQ I'S' ~((....(.,,.~a&~ ({lH(H#.-<.-..~1 I (I-II.!. ~rl1, I.l..v ~'t t ~t'..,
)-1 It-y _ , Year: d.f!Y.J !
,+f. o'/tJ.t- (s.,...rr~~...r )
t:A~,...~",+
X
Owner. II other Ihan Inlured
Other Inlured (II Spouse, Spouse mUGllign)
Owner. II other lhan Insured
Olher Required Signature (II Child over 18, Child muM Ilgn)
1'0 the best of your knowledge~es this application Involve the REPLACEMENT 01 any existing Insurance as defined by
stale regulallons? U Yes ~No If Yes, give lull details on a separate memorandum of all existing policies to be
replaced. .
Agenl Slgneture (lIr.enaed Resident Auonlll ROQUlrlfl1 by law)
I-WI
Page 7 0112
TEMPOAAAYINSURANCE
THE CANADA LIFE ASSURANCE COMPANY acknowledges the receipt of $_ which Is to be applied in
payment of the IIrst premium lor Insurance on tho lives of tho Proposed Life Insured(s) In the Application having the same number
as this recerpt. The lull names of tho Proposed Life Insuted(s) ore I1S follows:
Dated thiS
.____ doy 01 ________.__.......___. YOUt_____.
__ , Agenl's Slgnl1ture.
This rocelpt is not VALID to ptovldo Insurance covemge unless Ihe requirements set out below are fulfilled. litho requirements
sel Oul below ate fulflllod. the Insurance coverage Is subject to the con1Ulons stated balow.
The reqUlremants necessary to render this receipt valid to provide Insurance coverage are as follows:
1) Payment ollhe monoy must bo made on or ptlor to tho dato of completion of tho Appllcalion. 2) The amount paid must be at
least equal to a monHlly ptonllum for tho policy applied for. 3) Any chock, draft, money order or olher Instrument tendered In
payment must be paid according to its tenor. 4) Quostions 1 )a), 1 )b) and 2) (If applicable) of the Temporary Insurance Agreement
must have been answorod "NO".
NO AGENT HAS AUTtIORITY TO MODIFY OR WAIVE THESE REQUIREMENTS, OR THE CONDITIONS OF COVERAGE SET
OUT BELOW.
THl:: CANADA LIFE ASSURANCE COMPANY agrees to Insure the Proposed Life Insured(s), based upon representations of health
In the Application, Including the representalions In the form of negative answers to questions 1 )a), 1 )b) and 2) (If applicable) of
the Tamporary Insuranco Agreement HeaUh Questions seclion, subject to the following conditions.
1. Insurance testricted to death resuUlng from accidental bodily injUry shall commen~e on the date of this receipt, but, unless
previously replaced by Insurance not so restricted. shall expire in 30 days.
2. Insurance not restricted to death resulting from accidental bodlty injury shall communce on the date of completion of Canada
L1fe's published inilialllnderwriting requirements for the insurance appltec for. consisting of the Appltcation Including all medical
examinations that may be required.
3. Insurance provided under this receipl shall be governed by the standard poliCY terms and exclusions. including exclusions
relating to suicide. which would have been applicable had the policy applied for beon in effect on Ihe date of death of the
Proposed Life Insured(s).
4. Subject to a maximum aggregate liability 01 $250,000 under thiS and all other temporary insurance receipts In force at the death
of the Ptoposed Life Insured(s). the maximum amount payable under this receipt shall be the lesser 01: (a) the amount applied
for; and (b) $250,000. In applying the maximum aggregate liability Itmit. amounts payable as between this and other temporary
Insurance receipts shall be prorated.
5. Insurance hereunder which has not previously expired or terminated shall terminate on the earl lost of:
(a) tender of a policy by Canada Life, whether such poliCY is accepted or rejected by the Applicant; (b) notice by Canada Life
tetllllnating the insurance (If notice is sent by mail. It Will be deemed to have been teceived by the Applicant on the second
day following mailing); (c) the 90th day following the date of this receipt.
6. II applying for Individual life coverage, we will pay upon the death of the Proposed Insured; If applying for survivorship coverage,
we will pay upon the death of the Proposed Insured second to die; If applying for joint first to die coverage. we will pay only
upon the death of the Proposed Insured first to die.
Upon termination of insurance hereunder. the Applicant shall be entitled to refund of the money acknowledged by this receipt,
except where the Applicant has accepted a policy. However, termination of Insurance shalt take place notwithstanding that such
refund has not yet been received by the Applicant.
I-WI
Page 9 or 12
THE FEDERAL FAIR CREDIT REPORTING ACT REQUIRES THAT YOU BE GIVEN A COPY OF THIS NOTICE
This 15 to Inlorm you Ihol 06 pClll 01 Thu CClllndCl Ulo AIiMJlIIIICO CornpClnY'6 procodulo lor procuSlilng youI' In6uranco oppllcollon on
Itwosllgollvo consulllor ropUIII1\C1Y 00 propllfud \\l!tJ'uoy InloTlnullun 16 oololnud 111Io1lUh por60nollnlorvlow6 wllh your nolghbors. Irlonds.
or 01110'5 with whum you 010 ucquulnluu. TlllH InqLJuy inGIIJt!IHi lillo' million nt; 10 your chnrnclor, gonornl roputnUon, pOlsonul ctloroclorlslh;s
and modo of living, You hUIJO 1110 f1tJllllu fIlnklJ 11 WlllliJll hlqtJIHil y..IIIIH1" wusunnhlo PUtIt)IJ 01 limo to wcolvo nddllionul, dotallod Inlormution
aboul tho nature ancJ 5capo 01 11116 illlJlJtilluullOIl
NOTICE REGARDING THE MEDICAL INFORMATION BUREAU
Inlormation rt3gardlng your IIHil/tnlllllly willlllJ IIUlIll1d iHi l;onhdlJllhal n1U Cllllada Lifo AStitUuncu ClJlllpnny or our rolnaurors may, 'lowovor,
mako 0 briol roport ltlOroOlllo ltlQ ModICulllll{JllJli1I10fll3UII1HU, n lloll,prnllllllUI1lLJUltilup orUlll1l/nhon uf 1110 11l6UUlflCO companios, whIch
operatos on information o)(chull!ju 011 bul1HlI ollhi 1I1umbol ti II YOlJ npply 10 unuUllJr OlJltHHI IIlUIIl!JIJr company for IIfo or hoollh insuranco
covorauo. or a claim lor bonoflts 15 tiulJrnlllud 10 tiLIl.;h n cOlllpany, 1110 lllJrulJlJ, upun lOqlJUlil, Will supply tJlJch company wllh tho information
In Its 11I0.
Upon rceolpl 01 a roquo5t from you, U10 f3uwalJ will rHfall!Jo dlGclO!.iwU of any InforrJHllion It may 111]\10 in your fila. II you quostion Iho
accuracy ollnformollol1 In Iho Buraau's Itlo. you moy conlucll/lo BurUllU and 600k a corrocl/ol1ll1 accordoncv with Iho prOCOdUt06 sot
fo~h In tho Fedoral FalrCrodl1 Ropolling Act. Tlto addros6 011110 BU'tJou'6Informallon oflico Is P061 OHlco Box 105. E6S0X Slol/on. Boslon.
Massocl1usulIs 02112, lolupl,onu numoor (617) .126.3660
We 01' our teln6Urot6 may 0160 relun50 Inl",,,,ollun In our I,Iu6 lu 01/1Ot 1,Iu In6uranco cOlllpanlos 10 \\hol1\ you may apply lot life or hoalth
,nsuranco. 01' 10 whom 0 clolm fot 001101,16 may bo submillod.
THE CANADA LIFE ASSURANCE COMPANY INFORMATION PRACTICES
This nolice is provided 10 glvo you 0 brlul doscrlplion 01 our ,nlotmallon praclices. Ii you would like a more delailed doscrlplion.
please write to us atlho oddress shown below.
Ona of our Impcrlant objecliv06 is 10 see thol our in6urance coverages aro priced In a way that Is fall' to all policyholders. To do
this, we noed personallnformallon about you and your family membots proposed forcovetBge under your policy. You are the primo
source of Ihat Info,mallon, but we may also obloln ,nformation from other sources 5u~h a6 phY6lclans, hospitals. the Medical
Informalion Bureau and consumer reporllng agencle6. You may request 10 be Interviewed In conneclion with the preparalion of a
consumer roport and you are entitled to oblaln a copy 01 the report on reque6t.
The Information about you which we obtain and keep In our files will not be disclosed to others without your authorization except
to tha extent necessery to conducl our businoss. For example. 60me may be disclosed for research study purposes, but no report
of such 61udles would include idenlilicalion of Ihe Individuals.
You have a right of access to Informalion we maintain In our files about you (modicallnformatlon Is normally disclosed only to a
physician 01 your choice) and to requesl correction of any Inlormalion you believe to be Incorrect. Should you wish further details
about your right of access or our Information pactices, write to: Underwriting Oepartment, The Canada Life Assurance Company,
6201 Powers Ferry Road, N.W., Suile 600, Alianta, Georgia 30339, 1 (800) 333-2542.
1.WI
Page 100112
InUll W-9
11~I'v tll'lI'mlli'II'I!lq
Request for Taxpayer
Identification Number and Certification
Give 'orm 10 lhe
rvqu..lvr. Do NOT
..nd 10 th. IRS.
Ill_"'tl1J1\,'IM dlhll lit ,I 'ljl)
InllHl~lllIIIW"I.1lI '",,\".,
N,II11U (II" JOI!l1 ,1Ullljl\! IIf )01' 1 1I,lthll'II lOut ,1.11111', ~l\ 'S1'.l:IIlC: IIulfudlQ/U ,)/1 P,IlP' .' I
__-E~.J,-"'L!.~t'J.()!;t<. . PIfVA",/t'Ofl,r.. __
I!U..IIlH.... 11,11111', II ,IIUplI'lll !tom ulll)YP [';"I! 5puclrlc: In'IJUl:III,"' ,m P'''I'' .')
~
b
-l ~:h"..'k~:'-~'~I~..~.i.~~~~~_~~.-=~_-_~I.~~I:~~,I~J~I'"111'_1)1'1.1.'>11"11)/1 I (-"'_II'II'I~I' "I
I Ad,lfI'~" (!lUlul)I'!. ,,>'"'1'1. ,1Il,1 Hpl .'f ',lilli' II<) I
lLdJ!'..LL__LV:]tf r'7of. r:..."".c:.
..1.111', nod I'P, 0<1"
c.:, M..E_ -A-t-~S2." D
__:r~.xp'aYIl!,I_<!o!'tin ._a.II~!"Numbor lTlN)
Enter your TIN in till! IIPPll)P'IIIIi~ 1)0)( ~OI
IndIVlduah. (hi') 1'\ your '\01:1;11 ~1?CUrlty nurnlll'r
(SSNJ Ih>wevl:r, II you ,liP il rt"lldl~nt illll'll Ol~ it
solu plopnclor. "('C nli~ Itl.,tructll)n~ Oil patJl~ '-
F Of olher ..mtille'i. It i~ your l'1l1flloycr
IdenWic.1llon nUlIlber (tiN) II Y1lU do nol tl;IVI! a
nlHlltJl~r. '\l!e How To Gol Q TIN on IWJI! 2
NOlO: If Ow .1(coufll I.') '" fIlOf/.' tfJ,Jn orlt' rJ;)IIl/',
5tW tfle) clwrt 00 page 2 (or glll(je'//fl('.'i Oil wlw.')I.'
number to (.>nfl,y,
Cortificallon
I)
"'"1IH'r:~~;,---rr~G":~'.!....:.:.:..:_:_.'..:.:.:.;..~..:..~:: .:..:..;.:.:..:__ ____
""'!I/I',>k"..lliltlllt mIll /lllll,. "1"PI~)I"lll
[ ---~~- -~~--I
~~:;..~nL;;:[ir~JL~J
OR
('mPlo,,,,.,n"'ttEu]
'1..1 I1rl ill/Ill nWlllwrl'>llwflJ Il)pll{jll.l~
For Pey... E..mpl From Blckup
Withholding (Se~ the In!ltructlon5
011 pilql~ 2,)
~
Undt?r penalties of perjury. I CI!ltlfy lIliH
1. Tile number .,hown IlIl till., forllll., my correcllilltpilyer Illentlllc,1tloll flU/llll.!! (l)r I ,11Tl willlmq for il r1lHll!JI'r (0 11C l'lsul!d In me). Ind
2. I nm not subject to b;lCkup wltl1tluldln~J becnuse: (8) I mn 1!Jl.Cl1lpt horn bilCkUp wlttltloltllng. or (b) I Il.lVl! not lJeen notified by 11m InWmil1
Revenue ServIce! (IRS) tt1ilt I illll subject to backup wltht1Qldlng .1S " result of il lo1l1ure tt) fl'port ,,11 u'tere~1 or diVidends, or (c) the IRS hils
notified me thot I am no 100lfJcr ~ljbJcct to bi1ckup wlthholdln!)
C.rtincaUon In!trucUons.-You musl cross out lIem 2 above rf you tll)Ve been notified by the IRS that you arc currently subject to backup
wrlhtloldlllg becJuo;l! you h,we f;]llcd to report allmlerC!lt .1nd diVidends on your t.:l)( leturn For re,ll estnte trnn~lIcUons, item 2 docs not apply,
For mortg.1gt! Inlcfo5t pi1It.J. llcqUl51110n or abandonmenl of secured propt.!rty. cancellation of debt. contnbutlons to nn indiVIdual retlroment
afTangement (I~A). and generally, payments other Ihan intere5tnnd diVIdends, you nm not required to sign lhe Cenlficatlon. but you must
provide your ct)(rcct TIN. (See tho instructions on pogo 2,)
Sign I
Here Slgna'ur. ..
Purpose of Form.-A person who Is
required to file an information return with
the IRS must get your correct taxpay(!r
Identification number (TIN) to report, for
example. income paid to you. renl {!st;"j(r!
Iransactions, mortgage intere~t you paid.
acquisition or abandonment of 'lecured
property, cancellation of (h!bl, or
contributions you made to an IPA
Use Form W.9 to give your correct 'TIN
10 the person requesting It (tho requcster)
and, when applicable. to'
1. Certify the TIN you Mil giving I~~
correct (or you t1fO wlllting for a number to
be Issued).
2. Certify you arc not subject to backup
withholding. or
3. Claim exemption from backup
withholding if you arc an exempt payee
Nolo: If iJ requester giV05 you ., (orm otller
than .1 W-9 to request your TIN, you must
use the requfJster's (orm If it IS sub,st.1ntlally
similar to thiS Form W.9
Whalls Backup Wllhholdlng1-Persons
making ccrt<1in payments to you must
withhold IInd ray to thf~ H~S J 1 % or 'iuch
payment~ lHl(kr certain condlllons rtllS I',
called ~backup withholding" Payments
th.U may be subject to b.1Ckup wlthho1dinO
Include Interost, dividends. broker Bnd
barter exchange transDctiol'S. rents.
royalties, noncmployec pay. .1nd certain
payments from fishing boal operiltors 1~l!al
estate transactions tHC not ':iUbjl!ct It)
backup will1tlokJlng
If you give the requcster your correct
fiN, make Ihe proper ccrtlllcations. and
report all your ta)(ablu interest and
dividends on your tax return, payments
you receive will not be slJbjnct to backup
withholding. Payments you receive will tlll
subjcr.t to backup withholdmg If
1. You do not furni'\h your TIN (0 ttli~
requester, or
2. The IRS tells the requester that you
furnished an Incorrect TIN. or
3. The IRS tells you that you are subject
to backup withholding becau'i(! you did not
report aU youI Interest and dlvldcnd'\ on
your tax return (for reportable intere~t and
dividends onryl. or
4. You do not certify to the requester
that you arc not subject to backup
withholding under 3 above (for rep()rlahh~
Intl!rl~'\t .md divldf?IHt i1c:c:ounl', opl'nl'd
iJlt~~r 1 !JIl3 only), or
e.11 No 10111:1
Dalo ...
5. You do not cerUfy youI' TIN when
required, See the Part 111 instructions on
pn~Jf} 2 for details
Certain payees and payments arc
excmpl from tlackup WIthholding, SeC'the
Palt II Instructions and lhe separate
Inslrucllons for the RequDslor of Form
WoO.
Penalties
Failure To Furnish TIN.-If you fail to
furnish your correct TIN 10 iJ requestor. you
ilre subject to a penalty of $50 for each
~)u(11 failure uflle~5 your failure 15 due to
reilsoflilblo r;ausc and not to willful neglect.
Civil Penllty lor Fils. tnlOfmlUon With
R.spectto Wllhholdlng.-1r you make 0
fnlse statement with no reasonable basis
thaI rcsult'i In no badup Withholding, you
am "'lJhJf~ct to a $500 penalty
Criminal P.nllty lor FI'sllylng
Informallon.- Willfully talsifying
cl~rtlflcfllion:,> or nffirmnlions may subject
you to crHniflilll)()rHIIUt!~ Including fines
.lnd/or Im~HI',nnn1I'nt
MI'iU50 of TIN'i,-lf !tIP II?qIH",II~r
cJl:,cIclW', or \J',l", IIN', III violalion 01
Fedl'rall.lw, 1110 reque.,It'r mlly hn subject
In riv!1 ilnd cllrtllnallH!I1i1llif?s
fOlln W.9 {I~IJV I}!)(ll
'111m W IJ 1I11'~ I;'.UliJ
Specific Instructions
Namo.-tI yt}llllr~ .111 Illlll\JIlhJill, yl)tI flllJ',1
UI."II~lIl1y 1!111t.'r 1Ill! III111W ')1111wn 1111 yllW
~I)uill 'I1'lllllly (md IIt'WI!VI'I, II YUIJ 1101\11'
ctlllll!J1lI1 YtJll,lll')t 11111111.1, '0' 11l'lliHlUI. t!w'
10 IIl1tl/iillllJ, WlthlJlJ1 IlIfo/mlrlH tllf.1 Sllrllll
SI!(lJflty AtlllllrU')lrutlllll of till! 11,11111'
chllllHII, "I1It', ynlJl IIf'l1 lIiltlH', 1111' 111.,\'
nnnm "h,JW/1lJtl YOIl' 'll)(lill "I'l'wlly I iUt!
lint! YUlJt 'll'W In"l 'lllllJtl
Ill1llJIlt:ClJW111'11IlJlJll1l/1,1II1l!'l.h'lll.r"t
lI/ldl/lL'll rllcll! 11m lIi11J11' of Ih.. pl'l',Oflll/
mllll) who')I' fll"'1bl~t YIlIlI'1l11'1 ull'illll ill
UllJ 101111
SO/I! /)WpIII-'(1lf Vou 11I11',1 1'1111" YIJUf
,"dlvldijII1111l11i! II!) <Jlll......n 011 YOlJr 'll}(lill
'Sl!cutlly cntd You Il1/1Y I!nt.', YIllIt
LJU!:III1r!"'l, !flldt.', 1)( "lhJIIl!J 1)l1',II1I~"'" II',"
nilfllO 011 t/w bUllnG" namo It'll!
OOlf.'r [fllltW.~, _.~ ['11m till! l.Jl1~il1l!')'l IUlnll!
05 'Jhown 011 fl!qUlft~d l'I,'(h!lilllilll
dOCUfl1t!llh 1111'1 IHUIll.! !.lllJuld malth Iht!
nanll~ ~hown on Itm ch;lfh'r (J/ Ollll!t le!}al
dQcumt!rlt crenling Itll! entily Vou may
entcr any business, Irndl~, 01' "doing
busiru.lss IlS" namc l)!l tilt! blJ.,tr1e!l~ nllnll~
line
Part 1- TaJlpayor Identification Number
(TIN)
You must enter your TIN In Ille ilpprOpriatt~
box If you nro a resident alien nnd you <Ill
nol have and aru not eltglbll~ 10 glH nn
SSN, your TIN Is your II~S individual
taxpayer idenlification number OlIN) [rHt.'r
it In the social secunly nlJll1brr hox, If you
do not have an ITlN, see How To Gol a
TIN bcrow
It you am a sole proprielor and you 11;1\1e
an EIN, you m.1Y enter cithm your SSN or
EIN. However, using your EIN 1l1.1Y rWiult in
unner.cssllry notices to I,he requester
Note: Sce the chart on tlli.') p,'lge (or (urtl1l.'r
cl.1rIf'CilflOn of f1.1me imcl TIN COmlm),Jf/()fl',
How To Get a TlN.-1f you do nol havo .1
TIN. ,1pply fOf one Imnwdiall:ly 10 apply
tor nn SSN, gel form 55.5 trom your IO';ll
Social Security Administration O(rICO, Cpl
Form W.7 10 apply for an ITIN or form
5544 to apply for an EIN, You can gl!t
Forms W.7 and 55.4 from till! IR5 by
calling '.800.TAX.FORM
11.800.829.3676)
If you do not have iI TIN, wflte "^ppltf!d
For" In Ihe ~pace for tile !IN, --.igl1 ,HId
date tho torm, nnd give II to the rcq\Je~tl:r
For intcrest Bnd dIvidend paymenls. and
certain paymcnts madc with rC'Jpccl to
readily trAdahll! Inslrumenls, you will
genl!ft1Uy hflve 60 c1ay'l 10 Unt n TIN jJnd
give it 10 the reqlHlstN OthN pnYflll'nl'>
ate subjQct 10 backup wlll1holdlflH
Note: Writing "Appfll'd f()(~ meiJfJ~ fllilr
you h.1Vc JlffJ.1dy applied for II TIN OR Ow
you Ifltl..lnC/ to ,lpply for Or1I.' .'loon
1'.,. II-For Poyoo. [.ompl Frolll
Oackup Wllhhol~IIIY
1I11I1Vlduill',lIl1dllL!II'1j "lIlt.' IIIOll'll'lol.,j all!
nut 11)'lIlI1pl r/tJllIllil'.~l/p WllhlhlltlUlIJ
Cll'Pl)tllllclll'l lUll l~lll~lI1pl Ill/Ill 11IIdIJp
WllhlltJ'thn!J!ill (l~llillrl PlIY"U.'tll'\, 'Ill I II w.
Ulll'tO'lllllUI dl....hh'/Ilh Ill' 1Il1)!!!
111/1)11I111111111 0/1 I'~prnpl P,IYI!I~'I, ')1'1' Ihlt
"I'plllllll' 111',lrIUlh1l1'1lnl 1I11! 1~I''1lHI',lt'' III
IllftllW!)
II YOll mil 1I1l/!mpl frllllllHld..llfl
WllIll1l1hluul. you '1110lll11 '11111 nHllpll'lo 1111'1
111/111 hl ilvold ptJ'l"llJh~ I'll Ll'lllllll'l !Jill,kul'
WlllllIl/hlllll) 11111'1 yL)llf 1.00II1d IIN III PUll
L Willi! 'l~I!/I1pl" III I'mlll. mill 'l1!J" lint!
Iluln IIII! lorm
II YtJlJ all/ i1/lIJI1II!,)ltJtml i)lll!tl flI illoll!llJn
1~f1l1ly !lot ~,lJhJl'rt 10 bad1llp WllhholtJllllI,
UIVI} IIH~ tl~ql/l!'IIt" ,I (l)I11pll'll!d Form W.O,
CI!lllfICllll! I)f IOfl,'I~Jn SI,jtu'l
Pa.. II1-CottlflcoUon
for., joil1ll1ccount, ol1ly IIw pl'r~lOI1 whO'll!
TIN i'l ~Ilown III Pari r 'lhol/ld ShJIl fW111!11
requiwd)
1. Inhunt. Dlvidond, and Bartor
EJlchango Accounts Ope nod Boforo 1984
and Brokor Accounts Consld'1rod Aclivo
During 1983, VillI flUI',l tjlVt! your u1I11'(\
TIN, but YOlJ do llulli;IVe Il) ,)1~ln llll!
Ct-'ftlflCilllOI1
2. Inlerosl, Divldond, Broker. and
Bartor Exchango Accounts Oponod Atter
1983 and Broker Accounts Considerod
Inactlvo Ourir9 1983. You rnLJ~il ')I!]n Itle
ccrllficatirll1 or backup Wtll11101111nq Will
apply It you ilre ~ubJI:ct to b;lCkup
withlloldin~l and you art~ Il1l..'rely prQvidlflg
your correct TIN 10 till! rl:qIJc'ller, you ImJ',t
cros~ out Itrml 2 in lilt.' cl~fllficiltlon before
"inning Ille fOlln
3. Roal Estato Transaclions. Vou must
~Ig/l tile certlllciHion Vou may era')') oul
Itr~/11 2 of thl! certlfl(;!tI(jf1
4. Other Payments. VOil /11u',l HI\l11 YOlJr
correcl TIN, IllJl YOIl do l101l1aVI! 10 'w)n
till! Ci~rtlflc;lIlon unit!.}') you 11IJv(~ IJI)I:rl
nollfled Itlal you tlaVt~ pr':IJIiJu')ly UIVI:r1 illl
II1COfrl!cl rlN "Ollwr pilyrnt~flh" Iflclu<ll'
pilynllmls f11il..1e III tile course of thu
requester's traue or bUSlnl~!)S tor rents.
tOY;Jllics, goods (olller Ih;m bills tor
!nPtCh.1ndl'lc), ml2dlCill ;jnd tll~illttl Ciln!
'lprvicQ"i (lf1dIJllltl~J pflynll'l1l') 10
corporntton,>j, paYfl1t~l1h 10 II nonl!rnploYI!I~
ror "ierVICI!') (Iflcludlng attorney lltld
accounting tl'C~), flntl p"yrnenl'. 10 cI~ftilln
ti~hlng boal crllW members
5. Mortsaga lnl....1 Paid by Vou.
Acquisition or Abandonmont of Socurod
Proporty. CaneollaUon of Dobl, or IRA
ContrlbuUons, You tnlJ'lt 9lVl! your unrecl
fiN. bul YOIJ do floll1ilVI! In 'iltjrl 1111'
clntlfico1liof1
Privacy Acl Nolice
~ll'din" 610~1 of IIlI' 11111'1t1;[11~l'v.~lllH~ Cnd!'
rl'lllll'."l YIlII In 1)1"''' YIlllr I (l/rl'(1 rlN Itl
!ll'r..I)n.., will) nUl',1 Ilh~ InfnrlllillltJfl rl'twll'.
wltllllm rWi Itl rl:pOlt hll.~rp',I, dIVith:lld,,>,
@
I',,,,.. 2
11/111 (I'll/Iii I lllhlJl IIlUJrlli1 plllll III you,
/llIJfI~JjIIJll 1/111/111'11 rou pllld, Um lIUIlli'lllhJll
lit ilhillldl)IIIIU!tlIO Ml(lIfml pwpwly.
(urlulluth)llI)I 11,,111. or cO/lltlbullt)ll') YtJu
IIHulu It) 1111 11M 'hu Ins UMlh 11m
flImllwtt. 1111 hllltlllll(UIIOI1IJUlPU'lI!'l mul It)
hl/lp VHllfy 11m lIlTlIlillr. 0 you, Illll II/hllll
I hu II~S tIIl1Y Ill'll) P")V tit!' thl'l 1/llelf/llHIIIJII
10 t1lH (}I!lllltl/llu/lt 01 Ju')llce rOl (Ivllul111
fllltWloIlllll\JlIlhJl1l1l1tJ III (1111''\, o.,lllll!'I, mill
Ihilllhltld III CoIUt1lI11U 10 UIf'Y ()UIIlWil
111).llIw"l
VOIJ IIltl'll 1I/IIVJd!! your' IN wl1pllll~t I)'
l10t you il'l' rl!ljIJiWilllJ tllu j) lilX Il'Ium
Pny..'r'l IIHJ'l1 'Wnl'llllly Wllhhohl J 1 'J(, 0'
IIlJo:nbln rllll~'I~'II. IIIVltll!/ul, 111111 (1:lImn 01111'1
PUYlIll'llh 10 II !lilYI'I! 'hhn dm!.., nf11 'J'vn II
fiN Ie) it PllYI~t CI~njHtl pl!/loIrrll/'l l1lilY 01..0
apply
What Name and Number To
Give the Requester
For Ihl, Iyp. of account: Give n.m. and 55N 01:
- -
1. huJI\I"hhll
1. I,^,) 1;1 ml)ll~
Inl:'''Hlil,ll~ ~I)"'I
11"')1'1111
l_"'.!'1,h,ul ;1' "11"'1 01
ill1l1IHJI IlJrlilnllll ';111
I.] MIIHJ1~ Ad)
4,.1 flll'IJ\1Jl11
II''''O(/thIoIM\l1I1!J''i
IIlJ~1 l<JrB"!!)1 11'0
/l1~O Illi~t"'lIl
LJ SU(/IIIl"'tru,>1
n,,:c<1lmtUl/tll,>1I01
/I k!gtll 0/ 114hd tru!.t
L1nd'!1 MBIlllnw
IS, Sakr plOpfllllOlMlp
For this type of account:
.. 5nlll plopuulllI,>hrp
1, A ...nlll' IruM, uMlllil. 0'
punMon l1uf>l
I, CfJ.pOllllil
t. A~"')Unllol1, (lull.
1,)II'J'l),,~, .:hl1"I.llllu
l'.hJ(.IIII}IIIlI.l)r()[hm
1,1. .l)~I'111pl
l)l'J,lfll{.,IIIHl
10, ",UI'H~f..tllp
11, A tJ,,)k,'1 l)I II~l'''h'II'd
noml.ll'C
n, Arcoulll With till!
Otlpruuncnlot
A<JIICullulllln tho nllmll
of. public 0111.1)' t'luch
t1'>lI,>lnlaOlklClll
(Jo"'''II1II1I1I1I. ~(11IJ01
111',111(1, III p",>o~lllhlll
II"..'I""~" JlIjrKulIIH.11
P'OU'1III1 pll)'munt..
tho UldiVlllull1
Ihi! 1t<:lu.,1 lJv,onp,..)f Ih'"
ll(cOtmllll,I'lQmblllll'tJ
IUllIJ'o, thll '~~l 'rlLlrvltJuBI
IIn IIii' /1((I}IHll'
IllI!Ill1J\()I'
'hll!J't'lIltOlIIlJ'>"'ll'
Ihl1.It:IUI!IIl\lll'C' '
1hltoWOllf I
Gin nlm. .nd EIN 0':
rhltlJwnr.r I
Leglllenlll)' .
'hll CO'po/llhon
rhilOl<JMl/nlron
Ihu pIl11111'I..hlp
Ttlt! !;tOItI!'l 01 nO'Il"lo!ll
The publiC IInlll)'
'1.1'>' tll~llInd (11(10 Iho nomo of I". JWf~ whOM!
nurnbro, )'OU tumlM If only one pltI'M)fl on II JOHII
ocwwu !In.. an 55N. thnl pfIlo,on'.. numbUl' mull be
lu.nl..ht'lj
'1:",10.. !1m ",II\1ll'~ numn IIntl rUlniMllhl/ minor \ 5~)N
I 'r'OU 11111,>1 "ihllw )")UI ItlllMtlu,11 f1Il1Tl1l, bul )'00 1l'I/I)' ,,1100
l'nlo.'1 )'our I)\Jr.nll'~'> III "lllllflU tlU'lH\Il\\ 11'1" 11'11I111 Vuu
Illll)' II..n 1'llIlm ~UUI S'lN u, fiN (II you hllY1t onuJ
'l",t l,r',l mill (IIrll, Ihll'loltllflll'lhu ll"I"llllU~1. 11,>11\111,
I~ ~lI'tl.,Mm IIu"l (Illl Ilul rUI1Il~h 1t!1l TIN of Ih., flltl'Wlnlll
.,'IIII....'.ll.llrVU ll,IIu'>hm WillI 'I'> (hit kl1J'11 ""I1l~ 11"11111"
11,,1111''>'(1'',11<'01 III Ih.. JIll "llnl IIth'J
Noto: If 110 IMml.' ''I , If( 11'11 WIII'IIIHIlI.' t1h1l1lJ1l1'
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3urvlvor l:Seneflt Plan
(58P) open enrollment
aen...el; Secllon 642 of Public Law
(PL) 105.261 provlde6 a period 01
open enrollment for parllcrpatlon rn
the Uniformed Services Survrvor
Benefit Plan (SBP)
Open .nrollment period: The open
enrollment period covers the period
beginning 1 March I SSS and andlng
29 February 2000.
Mambera eligible to enroll: You are
eligible to make an election to partici-
pate in the SBP or the Supplemental
Survivor Benefit Plan (SSBP) during
this petlod of open enrollment using
the following cnteria.
I) It you are not participating In the
SBP as of 28 February I SSS, you
have an eliglbla beneficiary. and are
entitled to retired payor would be en-
titled to retired pay but have not yet
eached age 60, you may:
a) Elect SBP coverage for an eligi-
ble benet1clary (spouse or former
spouse. spouse or former spouse
and child. child only, or eligible
Insurable Interest person; and
b) Elect SSBP coverage for spouse
or formeI' spouse If you have pro-
vided the SBP at the maximum
level.
(Note: Reserve retirees who
have an eligible spousa and are
making an inittal election for a re-
duced SSP base amollOt or child
only coverage. under elfher the
deferred or immediate optIon.
must have fhe spouse's concur-
rence on the DD Form 2656-3.
SSP Opan Enrol/ment Form)
2) If you are now partrcrpating rn
the SBP at some level. you may
a) Inctease your SSP base
amount to a larger amount not
to exceed your gross retired
pay.
b) Add YOUI' eligible spouse 01' for-
mer spouse to existing child
","f
(;'- ; I.lJ
","Iltlt NIW\ltI'U,
covet age
c) Elect SSBP for spouse or tor.
met spouse If you have pro-
Vided the SBP at the maximum
level
(Note: II you dls-enrol/ed from
/lIe SSP under PublIC Lew
105-85, you may not mako an
electIon under thiS open onrol/-
mallt ponod )
3) It you ere now partlclpatmg rn
the SSP you may not
a) Add child coverage to exrstrng
spouse or fotmet spouse cov-
erage
b) Drop current SBP coverage
c) Decrease current SBP cover-
age
d) Elect SSBP rf retired on or be-
fore 31 December 1956 be-
cause the annuity payable will
not be subject to a social secu-
rity offset
Making an elecllon: To make an
open enrollment election, a member
must complete and submit DO Form
2656-3 In accordance with the In-
structions printed on the form. Com-
pleted election forms received prior
to 1 March 1999 will become effec-
tive 1 March lS99. Elections re-
ceived after that date will become
effective the month following the
date the election Is received by
HRSIC if the postmark Is a date
within the open enrollment period.
Effect ot deeth within two yeara: If
the member makes an election dur-
ing the open enrollment period and
dies Within two years of the effective
date of the election, the electron is
void All premrums attributable to the
open enrollment electron will be re-
funded in a lump sum payment to
the person who would have been the
benefrcrary had the deceased mem-
ber lived the reqUIted two years
Pramlum tor Open Enrollm.nt
.Iacllons:
1) The Monthly premium ThiS pre.
mrum pays for the coverage and be-
;;; j '(11 1( I, 'ill
VOL UNt L ISSUE 2
gins wrth the effective date of the
electron
2) The one-time open enrollment
(Buy-In) ptemlum plus rnterast ThiS
Buy-In ptemlum Will be computed
based on the number of years that
have elapsed since your first opportu-
nrty to particrpate in the SSP. These
premiums are due at the lime the
member fries an open enrollment
election. and mey be repaid with the
following options
a Lump sum repayment of the Buy-
In ptemlum plus 6.5% Interest at
the time of election
b Partial lump sum payment plus
6.5% interest at the time of elec-
tron. with the remainder deducted
from retired pay In 24 equal
monthly Installments
c. The total Buy-In premium plus
6.5% Interest, paid by deductions
from retired pay in 24 equal
monthly Installments.
(Note: The member must pey in
a lump sum at the time of appllce-
tion any amount thaf cannot be
deducted by the and of 24
months. If the member experi-
ences B reduction in net retired
pey for eny reason, which affects
ability to repay the Buy-In pre-
mium within the 24 months. en
additional lump sum peyment
must be made.)
Suppl.mentlll Survivor Baneflt
Plan coverage (SSBP): It you are
now a participant In the SBP. or if you
enroll during the open enrollment pe-
riod effective 1 March 1999, you may
elso enroll in SSBP. It has been de-
Signed to allow yorJ to replace some
or all of the annuity reduction that will
taka effact when your spouselformer
spouse annuitant reaches age 62.
If you elect SSBP. your SSBP pre-
mium Is determined by the additIonal
coverage you elect The premium will
be maintained a, a separate cost and
rncreased by the ,a me cosl-ot-lIvlng
adjustment as applied to your retired
pay
The SSBP premium reduces taxable
wages the same as the SBP Beslc.
(l 'mtllflwd 0" pu" d)
PAGE 6
tC'mltmutd (film IkIX. $)
Opllon, under SSBP:
1) Members who retired on or after 1
January 1967 mey elect SSBP II
SBP coverage lor spouse or lor-
mer spouse is at the maximum
level
2) SSBP may be elected upon re-
marriage il member had prior
spouse SBP coverage.
3) SSBP coverage may be Increased
(II currently below 20%) upon re-
marriage or during an open enroll-
ment.
4) SSBP coverage may be elected In
5 percent Increments to replace 5,
10. 15 or 20 percent of tho annuity
lost age 62. The lactor associated
with your age at election Is used
agelnst the percent you eloct to
determine the premium cost.
When la the SSBP payable to the
ennultant:
1) When an annuitant receiving an
SBP annuity roaches Age 62.
2) SSBP Is not affected by the De-
pendency Indemnity Compensa-
tion (DIG) reduction. Only the SBP
annuity will be reduced by any DIC
being paid.
Other lacts concerning SSBP:
1) SSBP may only be elected II your
SBP base amount is at the maxi-
mum level. This means that if you
previously elected a reduced SBP
Base amount you must increase
your SBP Base amount to the
maximum love I during thl! open
enrollment period to be eligible to
participate in the SSBP.
2) An eleclion to provide an SSBP
annurty wrll remain effective as
long as sap coverage remains In
effect lor your spouse or former
spou se
3) Once effective. no election for
SSBP may be revoked However.
whenever your beneflcrary status
changes under the SBP. the SSBP
status will also change
IU TIRE( NfW5Lf TrEK VOlUMf }, I$5UI }
4) II you wera ehglble to relire on or 4t~~;';re~rums co;iected thet are \.
belore 1 October 1985, the ,attributable to the open enroll-
SSBP would probably not be ment election will be relunded In r.
the best choice '01' you. Annul- \. a lump sum payment to the per- I~
tants 01 most Reserve rellrees . slln who w8IJld have been the ",'
meeling this cnterla will have a benefrclary had the deceased ~
larger annUity computed under member hved the required two
Ihe social secunty offset tather years
than a computalion under the
two-trer system (55/35%)
Therelore. II your retirement
meets this criteria and you elect
SSBP, you must waive the nght
to have your SBP annuity com-
puted under the social security
offset system at a later time.
SSBP coverage for a fonner
.pou..:
1) Retirees with 'ormer spouse
SBP coverage whose date of
divorce Is prior to 29 November
1989 do not need SSBP cover-
age. The former spouse's annu-
Ity is exempt Irom the social se-
curity offset at age 62.
2) II a member voluntatlly enters
into an agteement with his/her
lormer spouse to elect SSBP,
the SSBP may be deemed in the
same manner as an SBP elec-
tion can ba deemed.
Addlllona'lnfonnallon concern.
Ing the SBP and SSBP open an.
rollmenteeaaon:
1) There will be no annuity payable
untrl your open enrollment alec-
tlon has been In effect lot two
years.
2) Your monthly premium will start
the month lollowing receipt 01
your election lorm.
3) A payment plan must be estab-
lished to lully pay the Buy-In pre-
mium within 24 months Itom the
date 01 receipt 01 the enrollment
lorm
4) II the member dies pnor to the
end of the two year period. the
open enrollment election be-
comes void Your two year pe-
nod begins the month your en.
rollment and costs ate effective
6) lithe beneliclary named on the
open enrollment eleclion dies
during Ihe two year penod the
monthly premium costs will be
stopped the month following the
death However. the Buy-In pre-
mium will conlinue and be col-
lected within the 24 months
agreed.
7) Open enrollment elections lor
SBP and SSBP do not require
spousal concurrence with the 101-
lowing exceplion: Reserve rellr.
ees who hava an eligible spouse
and are making an Initial elecllon
lor a reduced SBP base amount
or child only coverege under ei-
ther the de'erred or Immediate
option, mu~t heve the spouse's
concurrence on the DO Form
2656-3, SBP Open Enrollment
Election Form.
If you want to enroll: Relirees who
want to enroll In SBP or SSBP during
the open enrollment period should
complete DO Form 2656-3, SBP
Open Enrollment Election Form. (see
page 11 of this newsletter) as soon
as possible and forward promptly to:
Commanding Officer (RAS - SSP
OPEN ENROLLMENTI
USCG Human Reaourcas Service
& Infonnallon Center
444 SE Quincy Street
Topeka, KS 66683-3591
Your open enrollmentl!lection be-
comes effective the first day of the
month following receipt of the election
form at HRSIC(RAS). but not earlier
than 1 March 1999.
Examples 01 cost computation are
Included in this Newsletter on pages
8 & 9. Please write to us II you would
like to request an estimate of costs
lor enrollment into SBP. or rncreaslng
!('onll'''''''/Ollf'lIKt! 7)
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Please take note: Ruby Weeks sent this Order urCourt via RI!.\.trictl!/II)l!livl!rJ'lo Respondent's
address in Arizona. The Postnllln, knowing Respondcnt was living in Gcnnuny, rcleuscd it to his
wife, Victoria A. Dnvenllort. Otherwise. Respondent would hllve no knowledlle or this
Action,
If it pleascs thc CoUrl. nllmcd Respondcnt. Pllul G. Dllvcnport in CIVIL ACl'ION LAW In
DIVORCE 97.4546 hcrcin rcsponds to the IIl1egations contllincd thcrcin. Respondcnt CANNOT
afford to bc rcprescntcd by Counsel, und hcrein reprcsents himsclf. Respondent is also rcsiding
in Stuttgart, Gcmlany, has not becn the Unilcd Stutes since January 3,2001. and cannot afford to
appear in Pennsylvania in pcrson.
\, On March 31, 2000 negotiations took placc in the Law Offices of Ms Ruby Weeks. Also
present were Helcn P. Davcnport. Respondent's fomler spousc, and Mr. Dclano Lantz,
Respondent's illlomey. (Respondent participated via confcrence call on the telcphonc, as
he was residing in Pleasant Prairie, Wisconsin and could not afford to travclto
Pennsylvania, as he had been laid off from his job on January II'''.) Atlhe time of these
negotiations. Helcn Davcnport was the nmned beneficiary 01'$150.000 in life insurance
on a Massaehusctts Mutual policy. Helen Davenport. at this time. emphatically statcd
that the $150,000 policy was totally inadequate. She insisted on an insurance amount of
$500,000.00 TO BE OBT A\NED BY HER AT HER SOLE OPTION. It was mutually
agrced atthl: time that Respondent shull coopcratc in obtaining said policy. and would be
liublc I'll' no morc thun $167.05 pCI' month "rthc prcmium. SEE COURT ORDER. PllrU
9u. EXlIIBlT I.
2. Lifc insunlncc policy ulllounts lire predicuted on both the physiclll und finunciul "hculth"
of lhc insured purty. Atthc time of thcsc ncgotiulions, Murch 31, 2000, Rcspondcnt wus
slillmurried to Uclcn Duvcnporl, in good hculth, und slill sharcd inthc cstatc and
propcrty of the murriagc. Ue would huve bcen easily eligiblc for $500,000.00 in lire
insuruncc.
3. The Court decreed the divorce on April 18,2000. Uelen P. Davenport had nol yet found
out uboutlife insurance policics available (or had not shared any infonnation with
Respondent). Respondent's attomey, Mr. Dclano Lantz, advised Respondent that it was
not Respondenl's responsibility to find a suitablc insurancc policy duc to the e1ear and
unambiguous language containcd in EXHIBIT I.
4. Respondent was married to Victoria A. Davcnport on April 25, 2000.
5. Subsequent to the divorce datc of April 18,2000. NOTHING further was heard/rcceived
from Helen P. Davenport until e-mail. EXHIBIT 2. arrivcd on August 23, 2000 while the
Respondent was on a consulting job inlsmir. Turkcy. This was FIVE MONnIS after
the divorce negotiations. In the e-mail Uelcn Davenport statcd that she was "tircd" of
seeking a life insurance policy, and told Rcspondcnt shc was scnding thc papcrs in the
mail, asking him to verify his current address. (Respondcnt had movcd to Scottsdale, AZ
in May 2000).
6. The insurance papers arrived in Septcmber. They were enlircly blank as to policy owner,
amount and type of insurance desired, rate 1'01' prcmium, advance chcck for premium pre-
payment, or any othcr relevant information. On the ndvice of Counsel (Mr. Jack Keigher,
2
of Rochester, NY, a member of the PA Bar) the papers were returned to Holen 1'.
Davcnporllor appropriate corrective action.
7. It should be noted thm, subscquentto the divorce Decree, Respondent suffercd both
financial and hcalth setbacks. Suhsequentto hifllayoff in January 2000, Respondent was
unable to obtain cmployment save li.lr 2, two-week consulting periods in Gennany and
Turkey respcctively during all of the year 2000. This lorced Respondent to sell his only
real propcrty inherited asset, his share of jointly owned (brolher and sister) vacation
property in the Adirondack Mountains of NY in order to meet current cxpenses and to
avoid bankruptcy, due to not having received ANY of the tangible assets ofthc marriage
to Helen Davenporl other than his sporting fireamls ami ny-fishing equipment. Also,
Respondent had severe prostate problems, which required treatment and biopsies, and
also had to undergo a eolonoscopy. EXIIIBIT 3. The prostate problems continue, and a
PSA or above 22 was recorded in April 200 I.
8. Due to these tests alone, Respondent's eligibility for A + rated insurance is questionable,
as stated in a leller to Helen Davenport of September 26,2000. EXHIBIT 4,
9. In September 2000, Respondcnt accepted a position in Germany to begin in January
2001. This overseas employment MUST continue for an indefinitc period in order to
somehow pay down thc considerable debt incurrcd as part of thc divorce decrce.
10. After having returned the blank insurance fornls together with the leller (EXHIBIT 4) to
Helen Davenport, Respondent hcard NOTHINC; until March 14,2001. An e-mail,
EXHIBIT S, was received some SIX MONTHS later. Respondent immediately
responded bye-mail explaining his situation. EXIIIBIT 6.
J
II. III April 2001 Respollllelll received IIlcller viII his wife, Victllrill A. l>uvellportli'ol1l his
/lmner IIttomey, Dclullol.mtl/, stlltillg thllt he hlld received illSUl'UllCe limns Ihlln Ms
Weeks. .:XHIBIT 7. Olllldvice of Mr. 1.111111, these limns were lill'\vllnled to
Respolldent ill GennllllY. EXIIIIUT II.
12. RespOlldelltlilled out ullthe inSUl'UllCe limns promptly IIlld retumcd to Call1lda Lilc with
a cover letter. EXIIIBIT 9.
NOTE: HIE PAPERS RECEIVED WERE HIE IDENTICAL PAPERS WHICH HAD
BEEN RETURNED TO HELEN P. DAVENPORT IN SEPTEMBER 2000. THEY STILL
CONTAINED THE IN\ORRECT WISCONSIN ADDRESS. AND HAD NOT BEEN
F[LLED OUT IN ANY WAY BY THE PROSPECTIVE POLICY OWNER. NOR WERE
THERE FOR WARDING INSTRUCTIONS OR A CHECK FOR TflE PREM[UM
ADV ANCE,
[3. Canllda Ufe received the application on 16 May. and responded with a rejection letter
postmarked May 21, 2001 with their rCllsons. A copy of thc Ictter was provided to Helen
P. Davcnporl. EXIIIBIT 10.
14. On July 31, 2001 the subject petition contained in this order of Court was delivered to
Respondent's Arizona address, wherc the postman allowed Respondent's wife, Victoria
A, Davenport to sign for this Restricted Delivery document because he knew respondent
is in Germany.
15. REFUTATIONS.
a. Paragraph 4 of the Petition states that' Helen Davenport, .... .obtained quotations on an
insurance policy on the life of respondent through Canada LifefollOllillK elltry of decree," See
EXIIIBIT 2. Clearly the c-mail sent by Helen Davenport shows that this was the FIRST TIME
..
Khe mulle un el1ilrtlollo Komelhing ullllulthe insurunce, SIX MONTHS AFTER TIlE
[)IVORCE, N,)le: In Ruhy Weeks' kller to Dcluno !.untz in April 200 I she sluted tllUl her client
hud 10 wuit III suve up Illt. TWO MONTI IS prcmiums thut were necded to getlhc policy. Inlhe
divorce Decree of Allrll 2000. Ilden Davenport received:
· Owncrship und Titlc to the Newville home und ull fumishings contuined
therein (the laller currcntly insured for $103,000.00)
· The Dodge Aires (she already had full title 10 and owned the Dodge
Grand Caravan)
· The entire 40lK from CUBIC Corp. worth in the vicinity 01'$33,000.00
· That portion of Respondent's military retirement to which enlitled by
Federal Law (Currently about $1,900 per month)
· No obligation whatcver to sharc in paymcnt of over $40,000.00 debt
acquired duringlhe marriage, including college expenses for children.
b. Staled in Pnragrnph 5: Respondent "indicated" as if to say he only "spokc."
Respondent fillcd oul and rctumcd thc insurancc policy application for processing. He
cooperated fully. EXHIBIT 9
c. Paragraph 6: "Rcspondcnt has rcfused to cooperutc for insurancc..." Again, see
EXHIBIT 9 and Canada Lirc's response, EXHIBIT 10.
d. Paragraph 8: Respondcnt has not rcsponded to the corrcspondencc, which his counsel
forwardcd him. Again. ralsc. Scc EXHIBIT II.
c. Paragraph 9: Regarding SBP...Hclen P. Davcnport was clearly made aware of her
choices: The SSP program was again available to her in February 2000. Helen p,
5
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IN T" COURT or CONNON PLIAS or
CUMllIaLAllD COUJITY, PIIINSYLVAlfIA
CIVIL ACTION - LAW
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IN DIVORCI
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97-454&
CIVIL TIRM
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PAUL 0, DAVBNPORT,
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Plaintiff
v.,
"
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, 1'1
RlLIN p, DAVBNPORT,
"
Defendant
pnl'rION' TO BNFORCB COURT oan..
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RUBY D. nlU, ISOUI..
10 nST, .:r0ll STUIT
CAaLISLI, PA 17013-2'$5
717-243-12"
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PAUL O. DAVINPORT,
plaintiff
IN THI COURT or COMMON PLBAS or
CUMBBRLAND COUNTY, PBNNSYLVANIA
v..
CIVIL ACTION . LAW
IN DIVORCB
HILIN P. DAVINPORT,
Defendant
9?-.5.&
CIVIL TIRM
OlmElt OF couln
NOW, this ~ duy of :s- \J L r--' 2001, upon eonsiderutlon oflhc
within Pelilionlo Enforce COUl'l Order, u Rule is isslIed upon Rcspondenllo show euusc why Ihc
rclief rcquesled should nol bc gruntcd.
RULE rClurnuble Ulll hcuring sct for Ihe Ie? a
duyof ~......~
2001, in COUl'l Room No. I oflhc COUl'l Housc ul Curlislc, Pcnnsylvuniu, ut.';;> ~.gO O'c1oek_
p..111.
GeU!4!EL lor Ihe punles lIrc dircd~d 19 Dppeur for u eonfcrcJ1l'" \~ilh Ih.' IInder.illp",Un
chjlV"hnr:G ah
Duyol
2001 lit
o'clock
m,
By the Courl,
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com pliny 61ll1B bc rcquc6tcd to 6cnd II duplicutc noticc ofprcmiumlllldJor premium
delillllt to HU6bllnd. Inthc evcntllusbund Ihil6 to PIlY his portion of IIny prcmlum
pllymcllls thllt hc owcs to thc insurllncc compllny 01' cOlllpllnics pursuunt to this
Agrccmcnt, thcn Wife nmy curc uny such dcfllult by Ilusbllnd, Jnthc cvcnt Wili: Is
rcquircd to curc such dclhults by Ilusblllld, Wlli: shull bc cntitled 10 recoup [iii such sums
shc PIlYs to thc insul'Uncc compllny or cOlllpllnics thllt wcrc or IIrc Ihc obliglltion of
Husbllnd pursullntto this Agrccmcnt und, inllddition thcrcto, shllll bc cnlltlcd to collcct
IInlldditlonlll 15% of 1I11l1mounts pllld by hcr IInd shall bc cntitlcd to collcctllctullllcglll
fccs incurrcd in obtaining rcimburscmcntlromllusbllnd. lIusbund shllll hllvc no
obllglltionto puy wili:'s portion of thc prcmium, und if Wili: dclhults so thutthc policy or
policics lupsc, Husbund shall havc no furthcr obligutions undcr this Purugruph. Euch
party hcrcby IIgrccs to mukc urmngcmcnts for thc puymcnt of his or hcr sharc of thc
prcmium payment by wuy of an allotmcntlromthc military rctircmcnt puy that shull bc
apportioncd bctwccn Husband und Wifc pursuant to Paragraph 15, bclow.
.4, Pctition obtaincd quotations on an insurancc policy on thc Iifc ofrcspondcnt
through Canadn Lifc following cntry of thc dccrcc and has sought Rcspondent's
coopcration sincc Icarning of his ncw addrcss.
S, Rcspondcnt has apparcntly indicatcd to Canada Lifc thut hc is rcsiding abroad and
Canada Lifc cannot scll insul'Uncc in Gcrmuny.
6. Rcspondcnt has indicatcd to Pctitioncr thut hc rcfuscs to upply for or to coopcratc
in obtuining thc court ordcrcd insuruncc on his Iifc dcspitc rcspondcnt' cfforts to
havc him do so.
, .
7, Pctilloncl"s ~ounscl hus UllClllpl~d 10 I'csolvcthcllluller by, inlcr utiu, her lellcr to
Rcspondcnl'S ~()unscl.
8, Rcspondenl hus Iwt n:sponded lolhc ~orrespondence whi~h his counsel
rorwurded 10 hilll.
9, Thcmuller hus cerluin illllllediu~y us Petitioner (u) \Veil prior 10 thc divorec uction
hud givcnup righls to Illililury survivor's benclits und thc Iirc insurunee wus to
udJust equituble dislribution to rcl1e~1 his. (b) Respondent hus since remurried
und, pctitloner understund respondentmuy nol be in good hcullh.
WHEREFORE, Petilioncr pruys this Honoruble Court 10 cnler u Rulc upon Rcspondentto
show euuse why hc should not be required to( 1) Apply lor und undergo lhcnecessury insurunce
physlcul und puy his portion orlhe premiums us per Ihis court's decree or April 18, 2000. (2)
Rcquire rcspondenlto pOSl security lor fUlure insuruace premiums (3) lind respondenl in
conlcmpt und (4) uwurd Pelitioncr counsel fecs und costs us per purugrnph twenty-two (22), pllge
Iil1ecn (15) orthe Propcrty selllelllent ugrecmcnl belwecnthe purties incorporuted into lhe
divorce decree.
BY:~~-
Ruby D. ceks, Esquire
Allorney for DefenduntlPetitioner
ID 1123901
10 West High Street
Curlisle, PA 17013
(717) 243-1294
AGBE.EME.NI
THIS AGREEMENT mode thlll gl doy or March, 2000, by and between Paul
G. Davenport, of 8630 82nd Street, Apartmenll01, Pleasant Prairie, Wisconsin 53158
(hereinafter referred to 05 "Husband"), and Helen P. Davenport, of 21 Stone Ledge
Road, Newville, Pennsylvania 17241 (hereinafter referred to 05 "Wife").
WITNESSETH THAT:
WHEREAS, Husband and Wife were lowfully married on February 29,1964, at
Winston Salum, North Carolina;
WHEREAS, three children have been born or this marriage, all of whom are
adults;
WHEREAS, differences have arisen between Husband and Wife In consequence
. of which they have lived In separate residences since August 1, 1997;
WHEREAS, Husband and Wife desire to sell Ie and determine their property and
marital rights and obligations. Including rlghls to support. alimony pendente lite, alimony
and counsel fees and cosls;
NOW, THEREFORE, the parties, Intending to be legally bound hereby, do
covenant and agree as follows.
1. Sf.EABATJQ)Ij It shall be lawful for each party at all limes hereafter to
live separate and apart from the other party at such place as he or she may from time
to time choose or deem fit. The foregoing provisions shall not be taken as an
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admission on the part of either party of the lawfulness or unlawfulness of the causes
leading to their living apart.
2. INTERFERENC.E: Each party shall be free from Interference, authQrlty,
and contact by the other, as fully as If he or she were single and unmarried except as
may be necessary to carry out the provisions of this Agreement. Neither party shall
molest the other or attempt to endeavor to molest the other, nor compel the other to
cohabit with the other, or In any way harass or malign the other, nor In any way Interfere
with the peaceful existence, separate and apart from the other, and each of the parties
hereto completely understands and agrees that neither shall do or say anything to the
children of the parties at anytime which might In any way influence the children
adversely against the other party.
3. WIFE'S DEBTS: Except as otherwise set forth herein, Wife represents
and warrants to Husband that since the separation she has not contracted or Incurred
and in the future will not contract or incur any debt or liability for which Husband or his
estate might be responsible and shall indemnify and save harmless Husband from any
and all claims or demands made against him by reason of obligations incurred by her.
4. HUSBAND'S Om: Except as otherwise set forth herein, Husband
represents and warrants to Wife that since the separation he has not contracted or
incurred and In the future he will not contract or incur any debt or liability for which Wife
or her estate might be responsible and shall indemnify and save harmless Wife from
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any and all claims or demands made ugalnst her by reason of debts or obligations
Incurred by him.
5. MUIUAL RELE8.5f: Subject to the provisions of this Agreement, each
party has released and dlschmged and by this Agreement does for himself or herself
and his or her heirs, legal representatives, executors, administrators and assigns,
release and discharge the other of and from all causes of action, claims, rights, or
demands, whatsoever In law or equity, which either of the parties ever had or now has
against tho other, except for: (0) any or 011 cause or causes of action for divorce; (b)
any or all causes of acllon for breach of any provisions of this Agreement.
6. HOU5.EHQL~O.QOMND TANGIBLE PERSONAL PROPERTY:
a. Husband does hereby transfer, assign and set over to Wife all of
his right, title and Interest In and to all household goods and tangible personal
proper1y that Is In the possession of Wife as of the date of this Agreement, with
the exception of an antique wooden canoe that Is the property of Husband and Is
currently stored at 21 Stone Ledge Road. Wife agrees that the canoe may
remain at 21 Stone Ledge Road until Husband or his designee Is In a position to
take possession of It, or until Wife sells the home, whichever first occurs.
However, Wife may require Husband to remove the canoe at an earlier date
upon 60 days written notice to Husband.
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Husband and Wife. Wife has not yet deposited the check she received
from Husband for her share of the proceeds. If the check Is not accepted
by the bank, Husband agrees to write a new check to Wife for her share of
these proceeds.
8. REAL ESTATE:
a. 21 Stone Ledge Road. 'rhe parties currently own In Joint
names the property located at 21 Stone Ledge Road, Newville,
Pennsylvania. Husband agrees to and shall execute a deed transferring
to Wife all of his right, tille and interest In said property. Wife agrees to
and shall Indemnify and hold Husband harmless from any and all liability .
with respect to said property. Tille to said property shall be transferred to
Wife at the time of execution of this Agreement. The property Is
transferred to Wife subJect to the mortgage to First Nationwide that Is
secured by said property. Wife shall be solely responsible for payment of
the mortgage and shall indemnify and hold Husband harmless from any
and all liability regarding the mortgage. Wife shall not be obligated to
refinance the existing mortgage or to obtain Husband's release from the
mortgage. Wife, however, agrees to cooperate with Husband In the event
Husband, at his sole expense, seeks to obtain his release from the
mortgage. Wife shall not be required to accept any mortgage terms upon
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Husband, Wife shall be entitled to recoup all such sums she pays to the
Insuranca company or companies that were or are the obligation of
Husband pursuant to this Agreement and, In addition thereto, shall be
entitled to collect an additional 15% of all amounts paid by her and shall
be entitled to collect actual legal fees Incurred in obtaining reimbursement
from Husband. Husband shall have no obligation to pay Wife's portion of
the premium, and If Wife defaults so that the polley or policies lapse,
Husband shall have no further obligations under this Paragraph. Each
party hereby agrees to make arrangements for the payment of his or her
share of the premium payment by way of an allotment from the military
retirement pay that shall be apportioned between Husband and Wife
pursuant to Paragraph 15 below.
b. Any and all other life Insurance policies shall be and are
hereby assigned to the party currently owning said policies.
10. CASH. MONEY MARKET. SAVINGS AND CHECKING ACCOUNT~:
a. Wife does hereby transfer, assign and set over to Husband
any and all Interest In any and all cash, money market, checking, savings
accounts in the name of Husband as follows:
1) Navy Federal Credit Union Account No. 2060454705;
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12. IRA ACCOUNTS:
a. Husband does hereby transfer 10 Wife any and alllnteresl he may
have In Wife's Oppenheimer Funds IRA Account No. 70070037924554.
b. Wife hereby transfers to Husband any all Interest she may have In
Husband's Oppenheimer Funds IRA Account No. 7007003792426.
13. SEPARATE PROPERTY OF THE PARTIES:
a. All non-marital assets of the respective parties shall be
retained by the party who currently owns them, except that Husband
acknowledges that the entire balance of the Cubic Corporation 401 (K)
plan shall be transferred to Wife, Including the contribution made to the
plan after separation.
b. Wife hereby specifically transfers, assigns and sets over to
Husband any and all right, title and interest that she may have In the
property at Griffin Road, Indian Lake, New York, and any and all other
property received or to be received by Husband from his mother's estate.
c. Husband hereby specifically transfers, assigns and sets over
to Wife any and all right, title and Interest that he may have In all non-
marital property of Wife.
.9.
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d, The parties agree that one-half of the marital portion of the
pension after subtracting the VA waiver (one-half of the 90.23% set forth
in (c)) shall be allocated to Wife pursuant to a Military Retirement Benefit
Division Order in a form satisfactory to the Defense Finance and
Accounting Service. Based on Exhlblt.A", one-half of the marital portion
Is $1,834.83. Wife shall be solely responsible for all taxes on the portion
of the retired pay allocated to her, and Husband shall have no obligation
,
with respect to any tax obligations as to the portion of the military retired
pay allocated to Wife pursuant to the said Order. Husband shall
cooperate with Wife to submit the required forms and information to the
Defense Finance and Accounting Service on or before the closing date.
Any increases In the retirement shall be allocated pro rata based on the
above percentages.
15. ALIMONY PENDENTE LITE/SPOUSAL SUPPOB!:
a. Husband has been paying alimony pendente lite/spousal
support to Wife In the amount of $1,357 per month pursuant to a Support
Order dated January 12, 1998, as amended on February 5,1998, and
entered to Docket No. 931 S 1997 in the Domestic Relations Section of
the Court of Common Pleas of Cumberland County.
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b. Husband has made the $1,357 payment of alimony
pendente lite/spousal support pursuant to the above referenced Order to
the Support Office for the month of March 2000. With such payment
made In March 2000, the parties agree that Husband's alimony pendente
lite/spousal support obligation pursuant to the above Order has ended
and that no further payments are or shall be owing to Wife pursuant to the
Support Order dated January 12, 1998, as amended on February 5, 1998.
On or before April 20, 2000, Wife, through her counsel, shall file the
necessary documents with the Support Office to terminate the Support
Order effective March 31, 2000.
c. Husband agrees that beginning with the receipt of his
military retirement pay for April 2000 and for each month thereafter until
50% of the marital portion of the retired pay Is allocated and actually paid
to Wife pursuant to Paragraph 15 above and the contemplated Military
Retirement Benefit Division Order, Husband shall pay to Wife promptly, by
the 5th day of each month, upon receipt of his monthly retired pay in April
2000 and each month thereafter until the contemplated Order becomes
effective 50% of 90.23% of the gross retired pay received by him after
subtracting the VA waiver, but before any withholding for taxes. All such
payments made by Husband to Wife shall be treated as alimony and
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considered as taxable Income to W1fe and deductible by Husband
pursuant to the provisions of the Internal Revenue Service Code.
d. Except as set forth In subparagraphs (a)-(c) above, no other
alimony shall be paid by Husband to Wife or by W1fe to Husband.
16. REPRESENTATION AND WARRANTY OF FULL DISCLOSURE: Each
party hereby represents and warrants to the other Ihat he or she has made a full and
fair disclosure of all of his or her Income and assels. Each party shall furnish to the
other party their federal Income tax returns through 1999.
17. ATTORNEYS FEES AND EXPENSES: Each party shall be solely
responsible for payment of their respective attorneys' fees and expenses.
18. MEDICAL INSURANCE COVERAGE: After the entry of a divorce decree,
each party shall be solely responsible for his or her own medical Insurance coverage.
19. WAIVER OF CLAIMS AGAINST ESTATES: 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,
dower, curtesy, statutory allowance, widow's allowance, right to take In intestacy, right
to take against the will of the other, and right to acl as administrator or executor of the
other's estate, and each will at the request of the other execute, acknowledge and
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deliver any and alllnslrumenls which may be necessary or advisable to carry Into effect
this mutual waiver and relinquishment of all such Interests, rights and claims.
20. ASSUMPTION OF MARITAL DEBTS:
a. HW'iband hereby agrees to be solely responsible for the payment of
the U.S. Department of Education loan for Nancy Davenport with a remaining
balance due of approximately $19,000. Husband agrees to Indemnify and hold
Wife harmless from any and all obligation with respect to said loan.
b. Husband agrees to be solely responsible for all outstanding credit
card obligations that existed as of the date of separation, and agrees to
Indemnify and hold Wife harmless from any and all such obligations. The credit
card accounts outstanding are as follows:
1) USAA MastercardNisa Account No. 5416300832070503;
2) Visa Account No. 4428-9600-0303-8628;
3) Visa Gold Account No. 4445302248039245;
4) Visa Gold Account No. 4445320161208654; and
5) MBNA Account No. 4264292436000216.
21. DIVORCE: Husband has Instituted a divorce action to No. 97-4546 Civil
In the Court of Common Pleas of Cumberland County, Pennsylvania. Nothing herein
contained shall be deemed to prevent the parties from proceeding in the said suit for
absolute divorce against the other and in the said Court, and the parties agree to obtain
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a divorce by mutual consent pursuant to Section 3301(c) of the Divorce Code.
Affidavits of Consent to a 3301 (c) divorce shall be signed on or prior to the closing date.
22. BREACH: If either party breaches any provision of this Agreement, the
other party shall have the right, at his or her election, to sue for damages for such
breach or seek such other remedies or relief as may be available to him or her, and the
party breaching this contract shall be responsible for payment of reasonable legal fees
and costs Incurred by the other In enforcing his or her rights under this Agrc(//tll:lnt.
23. ADDITIONAL INSTRUMENTS: Each of the parties shall from time to time
at the request of the other execute, acknowledge, and deliver to the other party any and
all further Instruments that may be reasonably required to give full force and effect to
the provisions of this Agreement. Such consent will not be unreasonably withheld.
24. VOLUNTARY EXECUTION: The provisions of this Agreement and their
legal effect are fully understood by the parties, and each party acknowledges that the
Agreement Is fair and equitable, that It is being entered Into voluntarily with full
disclosure of assets, and that It Is not the result of any duress or undue Influence.
25. ENTIRE AGREEMENT: This Agreement contains the entire
understanding of the parties and there are no representations, warranties, cO'.f-nants,
or undertakings other than those expressly set forth herein.
26. MODIru;..A TION AND WAIVER: A modification or waiver of any of the
provisions of this Agreement shall be effective only if made in writing and executed with
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the same formality as this Agreement. The failure of either party to Insist upon strict
performance of any of the provisions of this Agreement shall not be construed as a
waiver of any subsequent default of the same or similar nature.
27. ACCEPTANCE BY PARTIES: Husband and Wife accept this Agreement
In lieu of and in full and final settlement and satisfaction of all claims and demands that
he or she may now or hereafter have against the other for support and maintenance, for
alimony, alimony pendente lite, counsel fee'S, costs and expenses or any other charge
of any nature whatsoever.
28. REVIEW BY COUNS.El.: Husband and 'Nife acknowledge that the terms
and provisions of this Agreement have been reviewed by their respective counsel and
the Agreement Is being executed upon advice of and after consultation with counsel.
29. APPLlCABLE!.8Y1: This Agreement shall be construed under the Jaws of
the Commonwealth of Pennsylvania.
30. INCORPORATION OF AGREEMENT INTO DIVORCE DECREE: The
parties agree that the provisions of this Agreement shall be Incorporated Into but not
merged Into the divorce decree to be entered Into by the parties and shall be
enforceable by court order.
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:1 IN THE COURT OF COMMON PLEAS :
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OF CUMBERLAND COUNTY
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Plaintiff
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Defendant
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AND NOW, . . , .,. . . .. . . . . . .. . ......... " "~.~99P., it Is ordered and
decreed that .. p.~~~. ~... . ~~.v.~~J??r:~.... . . . . ., , . . . . . ., . . . . . . . " plaintiff,
and. . . .H.~~'i!n. .J?, . p.a.'{'i'!lP.qr:t. . . . . . . . ... . ,. . . . . . . . . . . . . . . . . . '. defendant,
are divorced from the bonds of matrimony,
The court retains jurisdiction of the following claims which have
been raised of record in this action for which a final order has not yet
been entered;
IT IS FURTHER ORDERED, ADJUDGED AND DECREED, that the terms,
pr~.~i~i~l'!s. !l.n.4. ~~.n.cJH~.ql')~. ~.~. tp~. .l).gr~.~f!\~!'l.t, .l?~!:~~'i'!'l, .t,l)'i'. p.qr;t~~.!!,
dated March 31, 2000 and attached to the Praecipe to Transmit
Rec.ord. as . Exhi.bi t. .".A!' .,. .are. .hereby. incorpo.r.ated .i.nto .b\lt. .not. meJrgcd
with, this Decree in Divorce,
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PYS~ilO Cumbedand. county I!n.lL.hpnol al'y 'n
C 1 VII CoHI<' J nqu i r:y .
199"/-0-1~)'IG DAVENPORT PAUl, G (VlI) IJAVENPOHT IIEJ,I.:N P
Hefen'nc(~ No.. t DRAWER In"
ca'le Type.,.., t COMP[,AINT - DI VORCI.;
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.Iudge Anti 19ned; OLER .1 WESI,[';Y JH
Di BpotJed Dl'IlC, t GRANT8D
_ _ _ - - - - - - - - - Caf!e Comment B -. - - - - - - - - - - - -
Fil(?d. . . . . . . . I
TitHe.. ... I . . t
Bxecutl.on Date
Jtr~ 'l'rinl.",
B osed Date,
I 9 ler Crt 1,;
fl 9 ler Crt 2, t
13/20/ J 99'/
3 t 4 3
0/00/0000
-1/18/2000
.............................**...**........****...***.**.......................
Gel\l~ral Index Attorney Info
DAVENPORT PAUL G PLAINTIFF 1,ANTZ DELANO M
11 W CHURCH STREET WEEKS RUDY 0
FAIRPORT NY 14-150
DAVENPORT HELEN P DEFENDANT
21 STONE [,EDGE ROAD
NEWVILLE PA 172-11
.....***.***.............**...........................*.....*....*~...*......**.
* Date Entries *
**.****...................................................................**....
8/20/J.997
8/26/1997
5/06/1998
5/11/1998
5/20/1998
10/20/1998
10/23/1998
11/0-1/1998
11/05/1998
8/02/1999
10/08/1999
4/18/2000
4/18/2000
-1/18/2000
_ _ _ _ _ - - - - - - - - FIRST ENTRY - - - - - - - - - - - - - -
COMPLAINT - DIVORCE
ADDITIONAL COUNT - EQUITABLE DISTRIBUTION
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PROOF OF SERVICE
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MOTION FOR APPOINTMENT OF DIVORCE MASTER
- - - - - - - - - - - - - - - - - - - - . - - - - - - - - - - - - - .. - - - - - - - ... - - - - - - - . - - - - - - - - - - - - - - - -
ORDER OF COURT APPOINTING E ROBERT ELICKER ESQ AS MASTER
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PRAECIPE FOR ENTRY OF APPEARANCE FOR PLFF BY RUBY 0 WEEKS ESQ
---------------------------------------------------...---------------
PETITION FOR SPECIAL RELIEF - RE DODGE CARAVAN
- - - --... - - - - - - - - - --... - -- - - - - -.. - --- - - - - - - - - - - - -... - - - - - -..... ---- -- - - - -- - - --
ORDER OF COURT - DATED 10/23/98 - IN RE PLAIN~IFF'S PETITION FOR
SPECIAL RELIEF RE DODGE CARAVAN - HEARnjG 1,1/4/98 1:30 PM CR 1 -
BY J WESLEY OLER JR J - COPIES MAILED 10/23/98
- - - - - - - - - - - - - - - - .. - - - - - - - - - - .. - - - - - - - - - - .~ - - - - - - - - - - - ... - - .. ... - - - - - - - - - - - -
DEFENDANTS ANSWER TO PLAINTIFFS PETITION FOR SPECIAL RELIEF
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ORDER OF COURT - DATED 11/-1/98 - IN RE PLAINTIFF'S PETITION FOR
SPECIAL RELIEF - BY J WEsLEY OLER JR J - COPIES MAILED ~1/5/98
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PLAINTIFF'S AFFIDAVIT UNDER SECTION 3301(0)
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AFFIDAVIT OF SERVICE BY MAIL
-----------------------------------------------------...----..--------
ORDER - DATED APRIL 18TH, 2000 - BY THE COURT J WESLEY OLER J
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QUALIFIED DOMESTIC RELA'l'IONS ORDER - DATED APRIL 18/ 2000
BY. THE COURT J WESLEY OLER JR J
NOTICE MAILED
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DIVORCE DECREE ENTERED BY J WESLEY OLER JR J
NOTICE MAILED
_ _ _ _ _ _ _ - - - - - - - LAST ENTRY - - - - - - - - - - - - - -
**************************************************************.**...............
* Escrow Information *
* Fees & Debits Bea Bal Pvmts/Adi End Bal *
********************************~**...***~.*****....*..*..***...................
DIVORCE
TAX ON CMPLT
SETTLEMENT
MASTER'S FEE
DIV PA SURCHG
ADD'L COUNTS
JCP FEE
,IeI' FEE
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5.00
125.00
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5.00
5.00
35.00
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5,00
125,00
10.00
10.00
5.00
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PAUL Q, DAVENPORT,
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
CIVIL ACTION - LAW
IN OIVORCE
HELEN p, DAVENPORT,
Defendant
NO 97-4546 - Civil 'I'm'lJl
ENTRY (W Al't'.t:A"ANCF.
C~
TO THE PROTHONOTARY m- Y,'.lJJlIIW COlINTY, PENNSYLVANIAI
Kindly enter the appennlnce of Goldberg, KalllJlan & Shipman, P,C, and Paul J, Esposito,
Esquire, on behalf of Paul G, Davenport, Plaintiff, inlhe above-captioned Rction.
GOLDH~RG, KATZMAN & SHIPMAN, P.C.
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/tud. /1.111.1.'
i>.WL'.ftsi'Q~ITC), ESQUIR~--
320 Market Street
Post Office Box 1268
Harrisburg, I' A 17108-1268
Supreme Court ID #25454
Allorney for Plaintiff
By:
Da~e: November 30, 2001
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