HomeMy WebLinkAbout03-0227
SUZANNE F. BARTH,
PLAINTIFF
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO. 2003 -;/..2 7 CIVIL TERM
JOHN W. BARTH,
IN DIVORCE
DEFENDANT
NOTICE TO DEFEND AND CLAIM RIGHTS
YOU HAVE BEEN SUED IN COURT. If you wish to defend against
the claims set forth in the following pages, you must take prompt
action. You are warned that if you fail to do so, the case may
proceed without you and a decree of divorce or annulment may be
entered against you by the Court. A judgment may also be entered
against you for any other claim or relief requested in these papers
by the Plaintiff. You may lose money or property or other rights
important to you, including custody or visitation of your children.
When the ground for is indignities or irretrievable breakdown
of the marriage, you may request marriage counseling. A list of
marriage counselors is available in the Court Administrator's
Office, Fourth floor, Cumberland County Courthouse, Hanover and
High Streets, Carlisle, Pennsylvania.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY,
LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED,
YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO
NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
Lawyer Referral Service
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, PA 17013
(717) 249-3166
1-800-990-9108
SUZANNE F. BARTH,
PLAINTIFF
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO. 2003 - ;<..2 1 CIVIL TERM
JOHN W. BARTH,
IN DIVORCE
DEFENDANT
COMPLAINT UNDER SECTION 3301(c) OR
3301 (d) OF THE DIVORCE CODE IN DIVORCE
1. The Plaintiff is Suzanne F. Barth who resides at 601-0
Mallard Road, Camp Hill, Cumberland County, Pennsylvania 17011.
2. The Defendant is John W. Barth who resides at 2534 South
Market Street, Mechanicsburg, Cumberland County, Pennsylvania
17055.
3. The Plaintiff and Defendant have been bona fide residents
of the Commonwealth of Pennsylvania for at least six months
immediately prior to the filing of this Complaint.
4. The Plaintiff and Defendant were married on September 8,
1972 in Mechanicsburg, Cumberland County, Pennsylvania.
5. There have been no prior actions of divorce or annulment
between the parties in this or any other jurisdiction.
6. The marriage is irretrievably broken.
7. The Defendant is not a member of the Armed Services of
the United States or any of its Allies.
8. The Plaintiff has been advised of the availability of
counseling and that Plaintiff may have the right to request that
the Court require the parties to participate in counseling.
9. Plaintiff requests the court to enter a decree of divorce.
CLAIM I
C1a~ for Equitab1e Distribution
of Marita1 Property
10. Paragraphs 1-9 are incorporated herein by reference
hereto.
11. The Plaintiff and Defendant are owners of certain jointly
owned property or other property which constitutes marital
property.
WHEREFORE, Suzanne F. Barth requests this Court to enter an
Order equitably dividing or assigning the marital property between
the parties.
CLAIM II
C1a~ for A1~ony, A1~ony Pendente Lite,
Spousa1 Support and Attorney Fees
12. Paragraphs 1-11 are incorporated herein by reference
hereto.
13. Suzanne F. Barth is without sufficient income and/or
assets to support herself or pay attorney fees and is unable to
fully support herself through appropriate employment.
14. Suzanne
F.
Barth requires
reasonable support to
adequately maintain herself in accordance with the standard of
living established during the marriage.
WHEREFORE Suzanne F. Barth requests this Honorable court to
enter an award of reasonable temporary or permanent support,
alimony, APL and additional sums as they may become necessary from
time to time hereafter until final hearing and permanently
thereafter for attorney fees and other costs related to this
action.
~~ lb. ~
Thomas D. Gould
Attorney for Plaintiff
I.D. # 36508
2 East Main Street
Shiremanstown, PA 17011
(717) 731-1461
VERIFICATION
I verify that the statements made in this Complaint are true
and correct.
I understand that false statements herein are made
subject to the penalties of 18 Pa. C.S. 4904, relating to unsworn
falsification to authorities.
Date: 1- '3.,;l"03
~~.B~
Suzanne F. Barth
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SUZANNE F. BARTH,
PLAINTIFF
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
VS.
: NO. 2003-227 CIVIL TERM
DEFENDANT
: CIVIL ACTION - LAW
: IN DIVORCE
JOHN W. BARTH,
PRAECIPE FOR ENTRY OF APPEARANCE
Please enter my appearance on behalf of the Defendant, John W. Barth.
Respectfully submitted,
LAW FIRM OF SUSAN KAY CANDIELLO, P.C.
Dated: February 1L., 2003
Susan Kay Can
PA I.D. # 6499
5021 East Trin
Suite 100
Mechanicsburg PA 17050
(717) 796-1930
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SUZANNE F. BARTH
PLAINTIf'F : IN THE COURT OF COMMON fLEAS OF
: CUMBERLAND COUNTY. PEN\NSYL VANIA
V
JOHN W. BARTH
: CIVIL ACTION NO. 2003-0227
DEFENDANT :
ORDER OF COURT
And now. this _ day of
. upon consideration 0 the attached
petition for Alimony Pendente Lite and/or counsel fees. it is hereby directed that the arties and their
respective counsel appear before - on 1_ at
I
for a confere~ce. after which the conference officer may recommend that an order foj Alimony Pendente
Lite be entered.
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You are further ordered to bring to the conference:
(1)
(2)
(3)
(4)
(5)
a true copy of your most recent Federal Income Tax Return. includin W-2's as filed.
your pay stubs for the preceding six (6) months
the Income and Expense Statement attached to this order. completed as required by Rule
1910.11(c)
verification of child care expenses . _I
proof of medical coverage which you may have. or may have availa~le to you
If you fail to aI'Pear for the conference or bring the required documents, the ~ourt may issue a
warrant for you arrest. .
BY THE COURT.
Harold E. Sheely. President Judge
Date of Order:
Conference Officer
YOU HAVE TIlE RIGHT TO A LAWYER, WHO MAY ATIEND THE CONFEmE AND
REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CAi'JNOT AFFO . ONE. GO TO OR
TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU. Y GET LEGAL
HELP. i
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Court Administrator
Fourth Floor
Cumberland County Courthouse
Carlisle. Pennsylvania 17013
(717) 240-6200 .
AMERICANS WITH DISABILITIES ACT OF 1990
The Court of Common Pleas of Cumberland County is required by law to comply wi the Americans with
Disabilities Act of 1990. For infonnation about accessible facilities and reasonable accomm tions available to
disabled individuals having business before the court, please contact our office. All arrangem nts must be made at
least 72 hours prior to any hearing or business before the court. You must attend the schedul conference or
hearing.
SUZANNE F. BARTH,
PLAINTIFF
IN THE COURT OF
CUMBERLANo CO
OMNON PLEAS
, PENNSYLVANIA
v.
NO. 2003 - 0227
CIVIL TERM
JOHN W. BARTH,
DEFENDANT
IN DIVORCE
PETITION FOR ALIMONY PENDENTE LI
1. The Petitioner is Suzanne F. Barth who re~ides at 601-D
Mallard Road, Camp Hill, Cumberland County, pennSYl~ania 17011.
2. The Respondent is John W. Barth who resides!at 2534 South
Market Street, Mechanicsburg, Cumberland County, I Pennsylvania
17055.
3. The Petitioner was born on September 11, !1949 and her
social security number is 197-40-8017.
4. The Respondent was born on May 17, 1947
ajct his social
o~ January 15,
!
security number is 202-36-8958.
5. Petitioner filed a Complaint in Divorce
2003 in which she claimed a right to APL.
6. Respondent was served on or about February 7, 2003 and
has not filed a response to the Petitioner's complai t.
WHEREFORE, Petitioner requests that Respondent be order to pay
her APL as required by the laws of Pennsylvania.
i1H D.
Thomas D. Gould
Attorney for Petit oner
I.D. # 36508
2 East Main Street
Shiremanstown, PA 7011
(717) 731-1461
VERIFICATION
i
I verify that the statements made in this Peti~ion are true
I
and correct. I understand that false statements he~ein are made
subject to the penalties of 18 Pa. C.S. 4904, relat~ng to unsworn
I
falsification to authorities.
Date:~ - lo-o3
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Suzanne F. Barth I
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SUZANNE F. BARTH,
Plaintiff/Petitioner
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
VS.
CIVIL ACTION - DIVORCE
JOHN W. BARTH,
Defendant/Respondent
NO. 2003-227 CIVIL TERM
IN DIVORCE
Pacses# 942105436
ORDER OF COURT
AND NOW, this 2nd day of May, 2003, upon consideration of the attached Petition for Alimony
Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear
before R.J. Shadday on June 3.2003 at 10:30 A.At. for a conference, at 13 N. Hanover St., Carlisle, PA
17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be
entered.
YOU are further ordered to bring to the conference:
(1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed
(2) your pay stubs for the preceding six (6) months
(3) the Income and Expense Statement attached to this order, completed as required by Rule
1910.11<<;:)
(4) verification of child care expenses
(5) proof of medical coverage which you may have, or may have available to you
IF you fail to appear for the conference or bring the required documents, the Court may issue a
warrant for your arrest.
BY THE COURT,
George E. Hoffer, President Judge
Mail copies on
5-2-03 to:
Petitioner
< Respondent
Thomas Gould, Esquire
ll...Ll
..:1~.. 1. Shadday, Conference Officer/ ~
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YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE~~D
REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO
OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET
LEGAL HELP.
)1
Date of Order: May 2, 2003
CUMBERLAND COUNTY BAR ASSOCIATION
2 LIBERTY AVE.
CARLISLE, PENNSYLVANIA 17013
(717) 249-3166
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In the Court of Common Pleas of CUMBERLAND County, Pennsylvania
DOMESTIC RELATIONS SECTION
SUZANNE F. BARTH ) Docket Number 03-227 CIVIL
Plaintiff )
vs. ) PACSES Case Number 942105436
JOHN W. BARTH )
Defendant ) Other State ID Number
ORDER OF COURT
You,
JOHN W. BARTH
plaintiff/defendant of
2534 S MARKET ST, MECHANICSBURG, PA. 17055-5555-34
are ordered to appear at DOMESTIC RELATIONS HEARING RM
DOMESTIC RELATIONS OFC, 13 N HANOVER ST, CARLISLE, PA. 17013-3014-13
JULY 22, 2003
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You are further required to bring to the hearing:;~fT1
.en...,
I. a true copy of your most recent Federal Income Tax Return, including W_2s,CJ lll\J,
n
2. your pay smbs for the preceding six (6) months, _er<1
'Z-_
3. verification of child care expenses, and ~~
4, proof of medical coverage which you may have, or may have available to y u '"
5. information relating to professional licenses
6. other:
at 1 0 : 3 OAM for a hearing.
before a hearing officer of the Domestic Relations Section, on the
-
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Service Type M
Form CM-509
Worker ID 21302
BARTH
v, BARTH
PACSES Case Number: 942105436
If you fail to appear for the conference/hearing or to bring the required documents, the
court may issue a warrant for your arrest or enter an order in your absence. If paternity is an
issue, the court may enter an order establishing paternity.
The appropriate court officer may enter an order against either party based upon the
evidence presented without regard to which party initiated the support action.
BY THE COURT:
Date of Order:
(;-1-03
~f.J.
JUDGE
YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE HEARING AND
REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD
ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT
WHERE YOU MAY GET LEGAL HELP:
CUMBERLAND co BAR ASSOCIATION
32 S BEDFORD ST
CARLISLE PA 17013-3302-32
(717) 249-3166
AMERICANS WITH DISABILITIES ACT OF 1990
The Court of Common Pleas of CUMBERLAND County is required by law to
comply with the Americans with Disabilities Act of 1990. For information about accessible
facilities and reasonable accommodations available to disabled individuals having business
before the court, please contact our office at: (717) 240-6225. All arrangements must be
made at least 72 hours prior to any hearing or business before the court. You must attend the
scheduled hearing.
Service Type M
Page 2 of2
Form CM-509
Worker ID 21302
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In the Court of Common Pleas of CUMBERLAND County, Pennsylvania
DOMESTIC RELATIONS SECTION
SUZANNE F. BARTH ) Docket Number 03-227 CIVIL
Plaintiff )
vs. ) PACSES Case Number 942105436
JOHN W. BARTH )
Defendant ) Other State ID Number
ORDER OF COURT
You,
SUZANNE F. BARTH
plaintiff/defendant of
601 D MALLARD RD, CAMP HILL, PA. 17011-1287-76
are ordered to appear at DOMESTIC RELATIONS HEARING RM
DOMESTIC RELATIONS OFC, 13 N HANOVER ST, CARLISLE, PA. 17013-3014-13
before a hearing officer of the Domestic Relations Section, on the
JULY 22, 2003
at 10: 30AM for a hearing.
You are further required to bring to the hearing: 3:
OJ ""
mrn
1. a true copy of your most recent Federal Income Tax Return, including W-2s, a'
2, your pay stubs for the preceding six (6) months, ~ 0
3. verification of child care expenses, and R::::;:
4. proof of medical coverage which you may have, or may have available to yo g~~
5. information relating to professional licenses ~ 0
-<x
6, other: '"
Service Type M
Form CM-509
Worker ID 21302
BARTH
V. BARTH
PACSES Case Number: 942105436
If you fail to appear for the conference/hearing or to bring the required documents, the
court may issue a warrant for your arrest or enter an order in your absence. If paternity is an
issue, the court may enter an order establishing paternity.
The appropriate court officer may enter an order against either party based upon the
evidence presented without regard to which party initiated the support action.
BY THE COURT:
Date of Order: 6 - q -oJ
p. .1.
JUDGE
YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE HEARING AND
REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD
ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT
WHERE YOU MAY GET LEGAL HELP:
CUMBERLAND CO BAR ASSOCIATION
32 S BEDFORD ST
CARLISLE FA 17013-3302-32
(717) 249-3166
AMERICANS WITH DISABILITIES ACT OF 1990
The Court of Common Pleas of CUMBERLAND County is required by law to
comply with the Americans with Disabilities Act of 1990. For information about accessible
facilities and reasonable accommodations available to disabled individuals having business
before the court, please contact our office at: (717) 240-6225. All arrangements must be
made at least 72 hours prior to any hearing or business before the court. You must attend the
scheduled hearing.
Page 2 of2
Form CM-509
Worker ID 21302
Service Type M
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SUZANNE F. BARTH,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
V.
: DOMESTIC RELATIONS SECTION
JOHN W. BARTH,
Defendant
PACSES NO. 942105436
No. 03-227 CIVIL
INTERIM ORDER OF COURT
AND NOW, this 24th day of July, 2003, upon consideration of the Support
Master's Report and Recommendation, a copy of which is attached hereto as
Exhibit "An, it is ordered and decreed as follows:
The Plaintiff's petition for alimony pendente lite is denied.
The parties are hereby advised that they may file written exceptions to the
Support Master's Report and Recommendation within ten (10) days of this order,
Exceptions shall conform with the requirements of Rule 1910.12(f), Pa. R.C.P. If
written exceptions are filed by any party, the other party may file exceptions
within ten (10) days of the date of service of the original exceptions. If no
exceptions are filed within ten (10) days of this interim order, this order shall then
constitute a final order.
By the Court,
p. J.
Cc: Suzanne F. Barth
John W. Barth
Thomas D. Gould, Esquire
For the Plaintiff
Susan K. Candiello, Esquire
For the Defendant
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V.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
: DOMESTIC RELATIONS SECTION
SUZANNE F. BARTH,
Plaintiff
JOHN W. BARTH,
Defendant
PACSES NO. 942105436
No. 03-227 CIVIL
SUPPORT MASTER'S REPORT AND RECOMMENDATION
Following a hearing held before the undersigned Support Master on July 22,
2003, the following report and recommendation are made:
FINDINGS OF FACT
1. The Plaintiff is Suzanne F. Barth, who resides at 601 D Mallard Road,
Camp Hill, Pennsylvania.
2. The Defendant is John W. Barth, who resides at 2524 South Market
Street, Mechanicsburg, Pennsylvania.
3. The parties are husband and wife having married on September 8, 1972.
4. Difficulties arose between the parties in early 2001 resulting in their
separation.
5. The parties agreed between themselves that the husband would retain the
marital residence and assume the majority of the marital debt.
6. The husband applied to Members First Federal Credit Union to refinance
the existing mortgage on the marital residence to provide the funds to pay
the marital debt.
7. The credit union referred the husband to Murrell R. Walters III, Esquire to
provide legal representation on the refinancing.
8. The marital residence was jointly owned by the parties,
9. The credit union required an agreement signed by the wife relinquishing
her interest in the residence as well as a deed conveying her interest in
the property to the husband.
EXHIBIT "1\"
O(6)-1
10.Attorney Walters prepared a comprehensive marital settlement agreement
by which the parties agreed "to settle and determine their individual rights
concerning their marital property and all other marital rights and issues,"1
11.Attorney Walters prepared a draft of said agreement which the husband
gave to the wife to review,
12. On March 21, 2001 the parties went to Attorney Walters' office at which
time they executed the agreement.
13.Attorney Walters asked the wife whether she had any questions about the
agreement prior to the execution. She replied that she did not.
14. Attorney Walters advised the wife that she could take the agreement to
legal counsel of her own choosing before signing it. She chose not to do
so.
15. The husband settled on the mortgage refinancing the following week and
satisfied the marital debt with the exception of the loan on the wife's
automobile.
16, The agreement contained a provision whereby each party mutually
released the other "from any and all rights and obligations which either
has or at any time hereafter may have for past. present or future support
or maintenance, alimony pendente lite, alimony, equitable distribution,
counsel fees, costs, expenses, and any other right or obligation, economic
or otherwise, whether arising out of the marital relationship or otherwise,
including all rights and benefits under the Pennsylvania Divorce Code of
1980, its supplements and amendments, as well as any other law of this
or any other jurisdiction."2
17. The agreement contained a provision that each party waived "any right
that he or she might have to any pension or retirement plan of the other.,,3
18. The agreement contained a provision that each party had made a "full and
complete disclosure to the other of all assets of any nature whatsoever in
which such Party has an interest, of the source and amount of the income
of such Party of every type whatsoever and all other facts relating to the
subject of this Agreement.4
19. The wife moved from the marital residence in April, 2001.
, See Separation Agreement dated March 21, 2001, Plaintiffs Exhibit },
2 See paragraph 8 of Plaintiff's Exhibit 1.
, See paragraph 7 of Plaintiff's Exhibit 1,
4 See paragraph 11 of Plaintiffs Exhibit 1.
2
20. The wife filed a Complaint for divorce on January 15, 2003 in which she
included a claim for alimony pendente lite,
21. On April 1 0, 2003 the wife filed a Petition for alimony pendente lite.
22. The wife is employed as a clerk by Delta Dental Insurance Company
where she earns $11.14 per hourfor a 40 hour work week.
23, The wife is 53 years of age and is a high school graduate.
24. The wife was aware that the husband had a pension with the federal
government during the marriage and when she executed the separation
agreement.
25. The wife did not believe that she had a right to any interest in the
husband's pension when she executed said separation agreement on
March 21, 2001.
26. The husband has been employed by the federal government since the
early 1970's.
27. The husband was not aware of the exact monetary value of his federal
pension in March, 2001.
DISCUSSION
At issue in this case is the validity of the Separation Agreement executed
by the parties on March 21, 2001. The husband argues that the wife is precluded
from seeking alimony pendente lite because she waived her right to do so in the
agreement. The wife argues that the agreement is null and void because it failed
to contain a full and fair disclosure of the financial positions of the parties.
In Simeone v. Simeone, 581 A.2d. 162, 167 (Pa, 1990) the Pennsylvania
Supreme Court affirmed "the longstanding principle that a full and fair disclosure
of the financial positions of the parties is required" if the validity of a marital
agreement is to be upheld.s The disclosure need not be exact, but it must be "full
and fair." Simeone, supra, at 167. The adequacy of the disclosure is based on
the facts and circumstances of each case. Niqro v. Niqro, 538 A.2d. 910 (Pa.
Super. 1988). There is no requirement that the parties' respective disclosures be
reduced to writing. Sabad v. Fessenden 825 A.2d. 682 (Pa. Super. 2003),
Where an agreement provides that a full and fair disclosure has been made, a
presumption arises that the disclosure has, in fact, been made, and a party
seeking to rebut the presumption by asserting fraud or misrepresentation must
do so by clear and convincing evidence. Simeone, ~upra, at 167.
, Although Simeone involved an antenuptial agreement, the same principles of law apply to both post-
nuptial and antenuptial agreements, Adams v, Adams, 607 A,2d, 1116 (Pa, Super, 1992),
3
In this case the agreement provided that each party had made a "full and
complete disclosure" to the other of their assets. Therefore, the presumption
exists that full and fair disclosure was made,
The wife claims inadequate disclosure with respect to the husband's
pension. The husband has been an employee of the 'federal government since
the early years of the marriage. He has a pension under the Civil Service
Retirement System.6 During the marriage the husband frequently told his wife
what actions she should take with respect to his pension in the event of his
death. She was well aware of the existence of the pension, and she was aware
that by signing the agreement she was waiving any interest she had in the
pension. Neither the husband nor the wife knew the exact actuarial value of the
pension when the agreement was signed. .
The wife has not alleged nor proven by clear and convincing evidence
fraud or misrepresentation on the part of the husband with respect to the
Separation Agreement. Consequently the validity of the agreement will be
upheld.
Because the agreement contains a waiver by the wife of alimony pendente
lite, her petition for APL will be denied.
RECOMMENDATION
The Plaintiff's petition for alimony pendente lite is denied.
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Date
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Michael R. Hundle
Support Master
6 Under CSRS the husband does not contribute to social security nor will he receive social security benefits
upon retirement.
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SEPARATION AGREEMENT
THIS AGREEMENT, made this
:2--(
day of jv1ll,e C f.{
2001, by and between JOHN W. BARTH, of 2524 South Mar~et Street,
Mechanicsburg, Pennsylvania, hereinafter called "Husband", and
SUZANNE F. BARTH, of 2534 South Market Street, Mechanicsburg,
Pennsylvania, hereinafter called "wife".
(O'-~'
-:'.,:- :""
.<~c
r"- "'. ,,'*'
... I...
WIT N E SSE T H:
WHEREAS, Husband and Wife were lawfully married on September
8, l'n2, in Mechanicsburg, Pennsylvania; and
WHEREAS, differences have arisen between Husband and Wife in
consequence of which they intend to live separate and apart from
each other; and
WHEREAS, children of this marriage are over the age of 18
years and therefore adults; and
WHEREAS, Husband and Wife desire to settle and determine
theL: individual rights concerning their marital property and all
othe~ marital rights and issues.
NOW THEREFORE,
the Parties hereto,
intending to be
legally bound hereby, agree as follows:
1. SEPARATION - It shall be lawful for each Party at all
time,; hereafter to live separate and apart from the other at such
place as he or she may from time to time choose or deem fit. The
foreqoing provision shall not be taken as admission on the part of
ci.ther Party of the lawfulness or unlawfulness of the causes
PLAINTIFPS
EXHIBIT
1
:;
/
leading to them living apart.
2. TNTRRFERENCE Each Party E;hall be free from
interference, authority and control by the other, as fully as if
he or she was single or unmarried, except as may be necessary to
carry out the provisions of this Agreement. Neither Party shall
molest or attempt to endeavor to molest the other, nor compel the
other to cohabitate 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. Neithe:~ Party shall visit the
residence of the other without prior consent:.
3. PRRSONAL PROPRRTY The parties have divided their
personal property between them to their mutual satisfaction.
4. RRAT, PRORRTY - The parties are j oint owners of property
situated in Upper Allen Township, Cumberland County, Pennsylvania
known and numbered as 2524 South Market: Street, Bowmansdale,
Mechanicsburg. Wife shall contemporaneously with the signing of
this agreement execute a deed conveying all her right, title and
interest in said property to husband.
There is currently a mortgage with First Union Home
Equity Corporation taken out in 1989 with an original amount of
$58,500.00. Husband has applied for and is closing on a mortgage
"..ith Members 1" Federal Credit Union in the amount of $78,800.00
which proceeds will be utilized to pay these mortgages in full as
'Hell as all other encumbrances against the real estate.
2
5. DEBTS. The
individual
Jbligations
Parties have
on existing
divided
debts
their joint and
to their mutual
satisfaction.
6. ~NEY REPRESENTATION - This document is being prepared
by 11urrel R. \'Ialters, III, Esquire who does not represent either
party. This document is prepared for the purpose of confirming
the rights ane obligations of both parties to the real estate
situate at 252 \ South Market Street, Mechanicsburg, Cumberland
County, pennsyl' -ani a . The parties agree to equally divide the
cost of preparat: on of this agreement.
7. PENSION Each Party waives any right that he or she
might have to any pension or retirement plan of the other.
8. Ml ITUAT , .'Er,EASES - Except as otherwise provided for in
this Agreement:
a. Each . 'arty hereby releases and forever discharges the
other and the esta\ e of the' other for all purposes from any and
all rights and ob~igations which either has or at any time
here3fter may have for past, present or future support or
maintenance, alimo 'Y pendente lite, alimony, equi table
distribution, counsel fees, costs, expenses, and any other right
or cbligation, econom.c or otherwise, whe~her arising out of the
mari~al relationship or otherwise, including all rights and
benefits under the Jennsylvania Divorce Code of 1980, its
supplements and amendmelts, as well as unde:c any other law of this
3
or any other jurisdiction.
b. Each Party hereby releases and forever discharges the
other and his or her heirs, executors, ccdministrators, assigns,
property and estate from any and all rights, claims, demands or
obligations arising out of or by v:~rtue of the marital
relationship of the Parties or otherwise, whether now existing or
hereafter arising. The above release shall be effective
regardless of whether such claims arise out of any former or
future acts, contracts, engagements, or liabilities of the other
or by way of dower, curtesy, widow's or widower's rights, family
exer.1ption or similar allowance, or under the intestate laws, or
the right to take against the spouse's Will, or the right to treat
a lifetime conveyance by the other as tes.::amentary, or all other
ri9hts of a surviving spouse to participate in a deceased spouse's
est2.te, whether arising under the laws of Pennsylvania, any state,
Commonwealth or territory of the United States, or any other
country. The Parties each waive and release any and all right to
recel ve insurance proceeds at the death of the other, whether as
named beneficiary or otherwise, as well as any right to receive
any legacy, bequest or residuary portion of the estate of the
other under his or her Will (if executed prior to the execution
date hereof), or to act as personal representative of the estate
of the other.
c. Except for any cause of action for divorce which
4
ei t:::,er Party may have or claim to have, each Party gives to the
other, by the execution of this Agreement, an absolute and
unconditional release and discharge from all causes of action,
claims, rights or demands whatsoever, in law or in equity, which
either Party ever had or now has against the other.
9. INDF.MNIFICATTON - Each Party rep,~esents and warrants to
the other that he or she has not incurred any debt, obligation, or
other liability, other than those described in this Agreement, on
which the other Party is or may be liable. Each Party covenants
and agrees that if any claim, action or proceeding is hereafter
initiated seeking to hold the other Party liable for any other
debt:, obligation, liability, act, or omission of such Party, such
Party will, at his or her sole expense, defend the other against
any such claim or demand, whether or not well founded, and that he
or Ehe will indemnify and hold harmless the other Party in respect
of 211 damages resulting therefrom.
10. BRF.ACH - 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 any other relief
he Dr she is entitled to at law or equity. The Party breaching
this contract shall be responsible for thE' payment of legal fees
and costs incurred by the other in enforcing his or her rights
under this Agreement, or seeking such other remedy or relief as
"lay be available to him or her.
5
11.
FULl, DISCT.oSlIRE
Husband and wife each represent and
warrant to the other that he or she has made a full and complete
disclosure to the other of all assets of any nature whatsoever in
which such Party has an interest, of the s;ource and amount of the
income of such Party of every type whatsoever and all other facts
relating to the subject of this Agreement.
12 .
ADDITIONAL TNSTRUMENT
Each of the Parties shall on
demand execute and deliver to the other any deeds, bills of sale,
assignments,
consents to change of beneficiary on insurance
poli cies, tax returns, and other documents and do or ciO\use to be
done any other act or thing that may be necessary or desirable to
ef';:ectuate the provisions and purposes of this Agreement. If
either Party fails on demand to comply with this provision, that
Party shall pay to the other, all attorneys' fees, costs and other
13. MODJPICATTON AND WATVER - Modification or waiver of any
provision of this Agreement shall be effective only if made in
writing and executed with 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.
14.
DESCRTPTIVE HEADTNGS
The descriptive headings used
here in are for convenience only.
They shall have no affect
what30ever in determining the rights or obligations of the
Partj.es.
6
A~ettlement Statement
4
l ull ~rtmonl 0' Mousing
\Jnd- Uman D~lopnNlnt
~
mota "",prove! No. :2502-o2$fl
:' [~~ 8-=~';, L?J cc;~ [~-~-]:: __ __ r"~~~"-~
c. ~: ThIs rmn is furnished to give you e Ilt8leIfl'tnl of actuIIl ~ Q(IMs. Amounts pIIIid to $I'l(I by the setltemen! lIVpl'll aAII
&hqwn. ttgmlmlrked -(p.D.C.t weNpeidoutsirJedoMg: IheymwshOWll Mill rorfnlom1llflonal pVfI)O'lHiand no!:
inc:iudllldinthslotlllB.
O.H*rIt'M"""",,,fIf~r
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.JOHII..... BARTH
_PlflAMe.
ISa4 SOUTH MAUIIT STREET
!tJCHANIC8IIUIlO fA 1'7DD
G,~l~
~ SOUTH MAtlKET srflHT
_DlBeRI11T' C"
SOOO LOUIS. DIUYE
MICHANICAY~C!_
PA 11011
IIIICHAHICSIIURG
'" -
.tlulMllllrY_B~'~ K.hm~oI.~~"""'1Ct1on
,. OIOlS Amount ~ L'nIm........ . _ _"" Qrou; Amol,lf'lt ~ To s.n.r
'01.();l!.l~"'Ilriet' ._ ~401Conb;lltlfOCprioe__ ~
ttl2.~OI'CIll~.._ __ 4az.......... _
tN. ~1ltIMlM1O"",,"r~iMlOl _ 1..tl ~ _ __
11M. "AVOPP HC?!lEQ "IIVIClNCI ~ Mil""" 404
tOS. AOOD0097831J78___ . _ . 4O!l
Adj\atIMnbI'klrnv.nc.MkI:'!f_~1n--
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lot, Antpmgnb;__ ..!!;I
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111. II)
112. to
113, 10
114. 10
'15. to
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PA 170e
Il.~...l.nl
MURItIIL II. WALT" III UQ
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14 IIAST MAIN STRaT
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1 HA.VlCAREFUll '( R'!VI!W!D THE HUD-l 8E:m.!MENT ST"lEflEHl ~D TOnlE BEST at: MY KNQWlEOOE AN.O 8!f.1EF Lr:! IS ,.lRUE N<<) ACCIJR,\TE
ITATaENT OF All A!CIIPTS AND IJtSB\IA8ENI!NTS MAD&: ON"" ACOQUNTOR BY Mf IN THIS TRANSACTION 1 FUR1l4EH CEFtTIN THAT 1 H,.VE
MCII\1"!D 0\ COPY OF THI! HUl).1 SETT1.EMENf stATeMENT.
BOARC\-V'7R __. . SEllER
BORROWER 8E1.l&A
TO THS BEST Of MY ~OO&. 1)11 HUo.l iE-rn.eMeNr 8T.tiMENT wtfQf I HAVI PREPMED IS'" 'I'fllU.'Mt> A.CCURATI ~iJNT OF TI-E FuNOs
WHICH Wl!RI "lctIVED AND HAW- IlaN OR Will BE. DlStURSED 8Y THf UND!QIONED AI" PAfllT OF THE SE.TTll!MeNT OF THIS ~ACT1ON.
WARNING: IT 1$ A. CRIMI TO KNOWINGLY WoKE FIJ.I!I! 8T^lEMEH1'8 TO THE UNITID STATES ON 'tHIS OR,\NY SIMIlAR FORM. PINAL TIES UPON
CQNVlCTlON CAN INCl.UDi"" FINE;.NO IMPRISONMENT. FOR DETA.ILS _; TI1\I11 U.'. COD! eeCTlON 1001 . SECnON 1010 ,
PrwvioUI Ecntton It OblOlem HUO.1 (we)
A!9'-" HB 04305.2
..-.... -- -- ----.-
l'age 1 or j
Benefits Report
05/06/2003
6:55:20
AM
Input Data Summary
Employee
Date of Birth:
05/17/1947
Employment
Retirement Service Computation Date:
Current Retirement System:
Current Annual Salary:
10/01/1973
CSRS
$34,000
Retirement
Expected Separation Date:
Projected High-3 Average Salary:
Survivor Benefit Election:
Projected Sick Leave Balance:
0411112001
$34,000
Full
o
lSP
Current Balance:
Contribution Allocation
Rate Of Return
C Fund F Fund G Fund I Fund S Fund
$0 $0 $0 $0 $0
0% 0% 0% 0% 0%
11,5% 7.5% 6,5% 9% 13%
0%
Contribution Rate:
Economic: Assumptions
Infiation Rate:
0%
Computed Data Summary
Annuity Start Date:
AnnlJity SlarlAge:
0510112001
53 Years 11 Mon1hs
Early Retirement-lmmediate Annuity
Monthly Annually Description
Annuity Estimate
$1,452
$17.425
CSRS Base Annuity
http://www.seniors.gov/frb/frbweb,dlllbeneftt
5/6/2003
Mal:! 06 03 08:23a
John Bar-th
717-697-9584
".2
Page 2 01 J
($29)
($120)
($349)
($1,438)
CSRS Age Reduction
Survivor Benefit Premium (Full)
$1,303
$782
$15.636
Net CSRS Annuity
$9,384
Survivor Benefit (Full)
Retirement Benefits Projection (Inn.tlon Adjusted)
In addition to your retirement annuity, other annuity benefits were added and adjusted for Inflation to give a better
picture of your annual purchasing power during your retirement yealS. For ..xample, CSRS and Social Security
benefits are fully indexed for inflation while a FERS annuity and your TSP benefits are not. (See the "Explanation
of Retirement Benefits Projection" for more information about infiation and cost of living adjustments.)
I ,r (). c-,.;;,.
1)- (;,}tf.,., ,,(.
,:=;----;-.I--o..~ ()
Explanation of the Retirement Benefits Projection (~:i .;)... Co,' o-;;-~ 1-~
. --------
It Is important to see how inflation affects your retirement benefits over your retiremel1tyealS. For this reason.
estimated retirement benefits are presented for:
Age 53, 05/2001 Age 62, 06/2009 Age 72, 06/2019 Age 82, 08/2029
$15,636 $15,636 $15,636 $15,636
e $15.836 $15.636 $15.636
t /-- ~ S.$ 7A)> E 5 I .Pv,-,,-<~ (LA), O--'AC,j2
;-I-ptf:t.. ~~.,
CSRS Annuity
Net Annuity
9v...". '-I <).00 1<2.
<1 (j. ~ 1'\1...........-'" rli.rllTr1.
f!-li.LT; J..jl=e>,rJ!;' M.o
---------
1. YourlilStyear of retirement
2. The age at which you begin receiving your Social Security benefits Of eligible)
3, Ten-year intervais following the start of your Social Security benefils.
CSRS annuities and Social Security do not show a loss in purchasing power because eam of these benefits
receive an annual adjustment fully indexed to inflation. A FERS annuity shows 8 loss in pUrchasing power
because it is not fully protected against inflation. Regular FERS retirees receive no annual oost-of-lIving
adjustment until they reach age 62. law enforcement/firefighter FERS retirees receive inflation adjustments
. immediately. The FERS cost-of-Iivlng adjustment is:
http://www, seniors.gov/frb/frbweb.dlllbenefit
5/6/2003
Total number of exem tiOIlS claimed
7 Wages, salaries, tips, etc. Attach Form(s) W-2
Sa Taxable interest. Attach Schedule B if required.
b Tax.exempt interest. Do not include on line 8a
9 Ordinary dividends. Attach Schedule B if required
10 Taxable refunds, credits, or offsets of state and locallllcome taxes (see instructions)
11 Alimony received
12 Business Income or (loss). Attach Schedule C or C-EZ ,
13 Capital gain or (loss). Attach Schedule 0 if required. If not required, check here
14 Other gains or (losses). Attach Form 4797
15a Total IRA distributions. ~.. . 'I 15al I b Taxable amount (see instrs)
16a Total pensions & annUities '.~ b Taxable amount (see instrs)
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E ,
18 Farm income or (loss), Attach Schedule F
19 Unemployment compensation
20a Social security benefits I 20al
21 Other income, list type & amount (see il1strs)
22 Add the amounts in the far ri ht column furlines 7" throu- h 21 ,T~'i;'- i; --Our totalincome -..
23 IRA deduction (see instructions). 21~
24 Student loan interest deduction (see instructions) . _ . 24
25 Medical savings account deduction. Attach Form 8853 , 2!i
26 MOVing expenses. Attach Form 3903 2fi
Z7 One-half of self-employment tax. Attach Schedule SE Z}
28 Self.employed health insurance deduction (see instructions) 211
29 Self-employed SEP, SIMPLE, and qualif,ed plans. . 2~1
30 Penalty on early withdrawal of savings. 30
31 a Alimony paid b Recipient's SSN .. 31 II
32 Add lines 23 through 31a
33 Subtract line 32 from line 22. This is your adjusted gross income
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions.
FDIA0112 11107/00
Form 1 040
label
(See instructIOns.)
Use the
IRS label.
Otherwise,
please :;:)(Int
or type.
Presidential
Election
Campaign
(See instr~!clions.)
FiIi ng Status
Oleck only
one bo:~.
Exemptions
Income
Attach Forms
W-2 and W,2G
here. Also attach
Form(s) 1099.R if
tax was withhflld.
if you (Ill! !lot
get a W-2, see
Instructions
Enclose, but d'J
not attach, ;:[1"1\'
payment. Also'
piease use
Form 1040-V.
Adjusted
Gross
Income
BAA
Department of the Treasury - Internal Revenue Service
U,S. Indiviclu~"nc_o!!1~.IaxR!lturn
2000____19.9)_
, 2000, end,no
IRS use only - Do not write or staple in this space.
--------------.~~20---.---.. -of ,.~.~~ ~~.'-1"~4~--~~7~
Your Socl..t 5f.~urity Number
For the year Jan 1.Dec 31, 2000, or other tax year beqinn,no
Your First Name MI last N:lme
John
If a Joil,t Return, Spouse's first Nam..
Barth
202-36-8958
W
M'
Last Name
Spouse's Social Security Number
Suzanne F Ba,-th
Home Address (number and street). If You HaVe a P,O. Box. See Instrl,.lclions.
12524 S, Market Street
I City, Town or Post Office. If You Have a Foreign Address, See Instructions.
IMechaniCsburg
Apartment No.
197-40-8017
.. Importanti---l-
You must enter your social
security I'lumber(s) above.
State ZIP Code
PA 17055
You
.. 1X1 Yes [-I No
Spouse
Ix1 Yes I 1 No
ome)
Sf'.! ove & full name here ...
tructions.) If the qualifying person is a child bu1 not your
5
G_ X
b
I No. of boxes
_c::heckedon
... 61111nd,Sb.
- No. ot~our
(4) if ~~i~I~~ll on
qualifying child. Illlell I
for child tax WithYOll "__
credit (see . did lIotlive
instrnctlons) withYOll due to
dIvorce. or sep-
araUon(see
instructtons)
, ,
.L~I
(2) Dependent's
social security
number
(3) Dependent's
relationship
to you
__~___. Depen~ent9
on6c not
entered
abolle.
.L_I
.1-1
7
8_
Add llulnber.
entered on
. lines above ..
L~I
"0
9
10
11
12
13
14
15b
1Gb
17
18
19
20b
21
22
77,143,
10,807,
I b Taxaole amount (see Instrs)
77,143,
Form 1040 (2000)
corm 1040 (2COO)
Tax and
Credits
I--;~nd~r~----I
Deduction -.-
for Most __
People I
~XJl2beo I
I
I
I
I
1
Head of
IlcL'sehnld
$6,450
Manied filing
jointly or
Oualrfying
wldow(er):
$7,350
I Mamt:d fllil1g
separately:
$3,675
------.._----"--
Other
Taxes
Payments
If youT;a~;-i_
qualifYing
Child, attach 1-
SChf:>u~!:____~~~:
Refund
Have It lJlrectlv
deposited! See
IllstructlOllS and
fill in 6ib. 67c,
allei 67d.
Amount
You Owe
Sign
Here
John W & Suzanne F Barth
34 Amount from line 33 (adjusted gross income)
35a Check if: 0 You were 65/o1der, 0 Blind; 0 Spouse was 65/older,
Add the number of boxes ctll~cked auave Clnd enter the total hele
b If you are married filing separately and your spouse itemizes deductions,
or YOll were a dual-status allen, see instructions and check here. '.,.. . .... 35b
36 Enter your itemized deductions from Schedule A, line 28, or standard deduction
stwwn on the left. But see instructions to find your standard decuctlon if you checked
any box on line 35a or 35b or if someone can claim you as a dependent.
'3J Subtract line 36 from line 34
38 If line 34 is $96)00 or less, multiply $2,800 by the total number of exemptions claimed on line Gd. If line 34
is over $96,700, see the worksheet in the instructions for the amount to enter.
39 Taxable income. Subtract line 38 from line 37, If line 38 is more than line 37, enter -0-
40 Tax (see mslrs). Check if any lax is from a 0 Form(s) 8814 b 0 Form 497;:'
41 Alternative mirllmum tax. Attach Form 6251
42 Add lines 4(J and 41
43 Foreign tax credit. Attach Form 1116 if required.
44 Credit for child and dependent care expenses. Attach Form 2441
45 Credit for the elderly or the disabled. Attach Schedule R .
46 Education credits. Attach Form 8863.
47 Child tax credit (see instructions) .
48 Adoption credit. Attach Form 8839.
49 Other. Check If from . a 0 Form 3800 b 0 Form 8396
c 0 Form 8801 d 0 Form (speCify)
50 Add lines 43 through 49, These are your total credits
51 Subtract line 50 from line 42. If line 50 is more than line 42, enter .0- . ,
52 Self.employmenllax. AIIach Schooule SE .
53 Social secwity and Medic<ue tax on tip income not reportetl to employer. Attach Form 4137
54 Tax on IRAs, other retirement plans, and MSAs. Attach Form 5329 if required. .. .No.
55 Advance earned income credit payments from Form(s) W-2
56 Household employment taxes. Attach Schedule H
57 Add lines-51-56. Thrs is yourtotaltax .
58 Federal income tax wrthheld from Forms W.2 and 1099
59 2000 estimated lax paynrenb and arnuunl applied from 1999 return.
60 a Earned income credit (Ele) .
b Nontaxable earned income: amount ....
and type .... ___~_ _ _ _ _ _ _ _ _ _ ___ _~_ _ __
61 Excess social security and RRT A tax withheld (see instrs)
62 Addrtlonal child tax credit. Attach Form 8812
63 Amount paid with request for extension to file (see instructions)
64 Other payments. Check jf from. . . . . l!l D Form 2439
b 0 Form 4136
65 Add lines 58,59, 60a, and 61 through 64. These are your
total payments ..,.,..,...,..,...,.,..
66 1f line 65 rs more than Ime 57, subtract Ime 57 from line 65. This IS the amount you overpaid.
&7 a Amount of line 66 you want refunded to you
~ b Routrng number
... d Account number
... c Type:
202-36-8958
34
.0 ~Ir~.[
PaCJe 2
77,143,
43
44
45
46
47
46
0
36 7,350.
07 69.793,
38 5,600,
39 64,193,
40 12,269,
41
~ 42 12,269.
4'3
~
50
51 12,269,
52
53
54 1,081,
55
56
57 13,350,
~
58
59
60.
13 107,
61
62
63
64
o Clecking
~ 65
66
~ 67.
13,107,
o Savings
68 Amount of line 66 you want applied to your 2001 estimated tax. .,. . . ....1 68 J
69 If line 57 is more than line 65, subtract line 65 from line 57. ThiS is the amount you
owe. For details on how to pay, see instructions. . . . . . . . , . . , . . . . ,. .. ...... .
70 Estimated tax penalty. Also include on line 69 . , . . . . , . , . . , . .1 70 1 ,,'
Under penalties of perjury, I declare that r have examined this reh.lm and accompanying schedu.es and statements, aRd to the best of my knowledge and
belief. they are true, correct and complete. Declaration of preparer (other than taxpayer) IS bas.!d 011 all Information of which preparer has any knowledge
JUltl! ((dun!? Your Signature D,m YouT Occupatior, I Dayiime Phone Number FDIAOll2 IO/30/DO
See instrL:ctrons. ~ clerk
I:(eep a copy Spouse's Signature If a Joint Return, Both Mtlst Sign. Date Spouse's Occllp;ltion , :'Y Ihe 'RS d;""" ,,;, cel.,," w;lh Ih, ,
Tor YOUI- I-econjs, ~ clerk preparershownbelowr~
(see Instructions)? Yes No
Paid Preparer's .. ID,m I I Pce",,,', ss" " PT;N
Slgnaiure , Check if self'employed n
Preparer's Firm'sName Self-prepared - .-
(oryollrsif ~
Use Only self.employed), E'N
Address, and
ZIP Code Phone No.
Forrn 1040 (2000)
'.-",--, ",..-, -..,-, ~~'''~.
10Q55.37
. 'Social secl."ritY~-~g~::;--'
108.;;5.37
Medica,re wage::; and lips
10855,37
a Control Numbe'r-T-Oep\.--
.009993 YBM..' 00
c Employer's name, addrE"ss
PA DENTAL SERVIC
1 DELTA DRIVE
MECHANICS BURG p
b~ploye'~ED-lb-n',Jmbe
23 -1667011
Social securitY-'r'jl';- -."
'AdVanc;-EIC p-;y~;nt~-
l' NonqualiflecfpTans----
'-3 See in&trs. forb;; :;:J--~-
15--SbI emjoec;'~ed 'T?e-;;s
;:1 Employee's nil-m~'~addr-;;ss
SUZANNE F. BART
2524 S, MARKET S
MECHANICSBURG,P
1_6~~mPloye-~;_s_ ;";;leTOn
18Statein~'t-ax--'--'
303.92
lO Local wages, tips, etc.
10855,37
Employ.eR~
W-2 Wage
State
:apyC lor employee's records.
,. ,.........,.., "''-V''''''''''W'''''l'''U
1092,36
4 Social security tax withheld
673,03
6 Medicare lax withheld
157.40
-- Corp, I t.mployer use only
9 A 21
,and ZIP code
E CORP
A 17055
Batch #00921
.~. Employee's SSA number
197-40-8017
Allocated tips
-r,OD;p;;~dent care benefits
- 12 Benefits included in box 1
----r,-4" Other
I
I
jonPi~~egaIIeP' fDelerredcomp.
and ZIP code
H
T.
A 17055
- State wages, tips, etc.
o 17
10855.37
19 Localityn..me
WSTB
21 Local income tax
~ 108.56
eference 2000
and Tax
ment OMB No. 1545.0006
2UOI\J Inr~2 <:101<... i::;;.\Hlm~UiS SUiviiV,ARY
This blue Earnings Summary section is induded with your W-2 to help describe portions in more detail.
The reverse side includes general informa.lion that you may also find helpful.
. The following information reflects your final 2DOO pay stub plus any adjustments submitted by your employer.
Gross Pay 10855.37 Social Security 673 03 PA. State Income Tax 303.92
Tax Withheld Box 18ofW.2
Box4ofW.2 Local Income Tax 108.56
Fed. Income 1092.36 Medicare Tax 157.40 Box 21 of W-2
Tax Withheld Withheld SUI/SOl
Box 2 of W-2 Box 6 of W-2 Box 14 of W.2
2. Your GrO$$ Pay Was Adjusted as follows to produce your W-z Statement.
Wages, Tips, other
Compensation
Box 1 of W-2
Social Security
Wages
Box 3 of W-2
Medicare
Wages
Box 5 of W.2
PA. State Wages, WSTB
Tips, Etc, Local Wages,
Box 17 of W-2 Tips, Etc.
Box 20 of W-2
Gross Pay
Reported W-2 Wages
10,85537
10,855,37
10,855.37
10,855.37
10,855.37
10,855,37
10,855 37
10,855,37
10,8553'
10,855,3:
3. Employee W-4 Profile. To change your Employee W-4 Profile Information, file a new W-4 with your payroll dept.
SUZANNE F. BARTH
2524 S. MARKET ST.
MECHANICSBURG, PA 17055
Social Security Number:
Taxable Marital Statu:;:
Exemptions/Allowances:
FEDERAL: 0
STATE:
LOCAL: 0
197~40.8017
MARRIED
I!:l 2000 AUTOMATIC DATA PROCESSING. INC.
Join the 40 million Americans who will e-file their income tax returns this year! Visit www.irs.aov for details,
----'_.,----~^- .- _.~._. --------_._~._-----_._--
---.-----.--------------.-,--.-.,.-.----.------..
-------------ii:.j:.-----------:::;r-----.--,-------
, Wages, tips, other compo 2 Federal income tax withheld
10855.37 1092.36
3 Social security wages 4 Social security tax withheld
10855.37 673,03
5 Medicare wages and tips 6 Medicare tax withheld
10855,37 157,40
a Control Number I Dept. Corp. J Employer usn onlv
009993 YBM 009 A 21
c Employer's name, addresiS, and ZIP code
PA DENTAL SERVICE CORP
1 DELTA DRIVE
MECHANICSBURG PA 17055
b Empl2'er'lil FED ID number d Emplo~ee's SSA number
3 .16670t 1 97.40-8017
7 Sacl.' iSecurity tips 8 Allocatedtips
. Advance Ele payment 10 Dependent care benefj~
11 Nonqualified plillns 12 Benefits included in b(,x 1
,. 14 Other
15 Stdemp.! Oecellled I PensIon plan I legalrep'_.1 Deferredcomp,
c., Employee's name, address and ZIP code
SUZANNE F. BARTH
2524 S. MARKET ST,
" MECHANICSBURG,PA 17055
]
16 Statej Employer's state 10 no. 17 State wages, tips, etc.
PA 10855,37
i 18 State income tlllX ,. Locality nOllme
303.92 WSTB
! 20 Local wages, tifs, etc. 21 Local income tax
0855.37 108.56
PA.Slale Filing Copy
W-2 Wage and Tax 2000
Statement PuMB N _ 1545(008
, Copy2 to be flied with employee'sStatelncomeTu Reurn, 0 .,
2000 7 Social security tips 1 Wages, tips, ~,r3t~nSaliOn 2 Federal jnc~~~~ithheld
age and Tax Statement -
",~ress,andZIPCOde 8 Allocated tips 3 Social securitY9,~ef.61 4 Social secugb2~7 ,'fithl1eld
rive 9 Advance EIC payment 5 M,di"" w,g1N~~ t~j 6 Medicare taf 4W~gld
10 Dependent care benefits 11 Nonqualitied plans 12 Benefits included in Box 1
PA 170552015
13 See Instrs. lor Box 13 140thsr
ARmess, and ZIP code E 583.32
T ST f3i~~~o6'bidentification number
d Em~~4~~dflfuriIY number
IJRG PA 170550000 15"""'"" p"o""", .',;:.; I I,~:." """,,"
....'.."1 I I I I X". -
'~acrtate 1.0. number 117 Slat~~Y:SifS' ect. 18 S'')I~:i'.'f'6"' to< 1L13~J\t\1'1Yf'i""Y 120 LOC91, '7'2If.S 1ips, eel 121LOC<lIfi';.~lax
.
Till, ;"Iormnlur "bcrr.g IlJrlliSI'd I" Ill" 11l1~I"al r<cl""~~_' Se".'lce. I' 'i'JU d"~ re'i"""" '" iii" a w, rFHJ'n, a
OMB No ]:,4!;.OOOe neglil)ence p~n,llly or othe, 5nrlCIIon may be impos~r1 on you Ii Illis ircarne i, la,nblfl al:1 ,'ou fRiI 10 rr.po~ il
FocmW-2W
M'E~~I1(FrV1tT
100 Mt. Allen 0
PD. Box 2015
Mechanicsburg
soZJI:I'J1/jEr'ilc
2524 S MARKE
MECHANICSB
PA' St"'2pEr~s
Copy C for EMPLOYEE'S RECORDS (See Notice to Employee on back of Copy S.)
Dept. of the Treasury. IRS
Form W-2 Wa
ME'S'SI:I>:I'IVlt'r
100 MI. Allen 0
P.O. Box 2015
MechanicsbL'rg
Ige and Tax Statement 2000 7 Social seeurlly lips 1 Wages, tips, ~ifJ802!nsation 2Federalinc~:'S7"'ithheld
'A~ess, and ZIP code 8 Allocated tips ;;: Social securit~!f,61 4socialseculfo~,.~ithheld
rive 9 Advance EIC payment e, Medicare wag~m :~~ 6Medicarel~4'6~~d
-
PA 170552015 10 Dependent care benefits 11 Nonquaiitied plans 12 Benefits incllld3d in Box 1
'~ 583.32 140thel
~m-ess, and ZIP code
T ST .t.39~6bidenti!icationnumber
d EmPf9r.:..~e{!jl!f=urity number
IRG PA 170550000
15"''''''"'' "oo"""" r",,,~,, L"", I X:~::"
'"""I I p"'" I "'" I I
11drflale I.D. number 117 Slalf9~~.~1'S, eel. 18St~r2'.Dffiletax IL~t!i"I!'lI'ii'l'!'litY 120LOcgi,'l'~.-l51jpS' eel. 121l0Cll'9'JC.~lax
OMBNo 1545-00011
sOml\lM"l"M
2524 S MARKE
MECHANICSBl
pA' S"t~r'fJf!l'!i
Copy 2 to be flJed with Employee s State, CIty, or Local Income Tax Return
Dept. of the Treasury ~ IRS
lY:.TACr1 HEI'IE
1 Gross dlttrlbutlon
~ Corrected (if checked)
2a Taxable amount
THE TRAVELERS INSURANCE CO
1 TOWER SQCARE. 5MS 1216
HARTFORD. cr 1l6183.4051
$8,170,57
2b Taxable amount
not dele,rmined
;) Capllalg.!ln
llncludeain bOl<;2a)
5 Employe~ cbntrlbutlons
or InSUra1Ce premiums
SUZANNE BART
2524 SOUTH MA
MECHANICSBUR
H
RKET ST
G P A 17055-5555
7 Distribution l'IAA/SEPf
code Simple
1 0
9~~~fdFsrrig~~~a~1! of
PAYERS Federal ID #
~~0566~~~:=
~nl numb~;-~-~.as83252PA1
OMB NO. 1545.0119
RECIPIENT'S ID #
I
f-----
11 State/Payer's stale no.
197-40-8017
! 9b Total employee contributions
PA/06056H090
This information is being furnished 10 the Internai Revenue Service
FORM 1099-R
$8,170.57
2000
o
Distributions
From Pensions,
- Annuities,
Retirement or
Proln-Sharlng
6 Net unrealized appreciation Plans, IRAs,
In employer's securities Insurance
_ Contracts, etc.
L COPY2
-Ftle this cop'
10 State tax withheld I?dth your Slate
~Jty, or Local
Income tax return,
"hen required.
Total
distribution
o
4 Federal Income tu
wlthhald
$1,634.12
8 Other
%
12 Stale distribution
i
Department of the Treasury. Internal Revenue Service
~s ""m'i.address,ZIP code, and Fedllral identification number -- \ Grass dlstnbutiorl OMB No. 1545-0119
2aTaxablellmOl.lnt FORM 1099-R
LINCOLN NATIONAL LIFE INS CO $ 2,635.64 $ 2,635.64 2000
PO BOX 2340 2b Taxable amount LJ Total LJ
not determined distribution Distributions From
FORT WAYNE, IN 46801 1Densions, AnnuUie
:1 Capital gain (ineluded ,'+ ~~t~~:I'dmcom. lal( Retirement or
EIN, 35-0472300 Inbox2a) Protlt~Sharlng Plan
ANNUITIES 800-454-6265 $ 0.00 $ 527.13 IRAs, Insurance
5 Employee contributions or 6 Net unreallzeo appreciation in Contracts, etc.
Insurance premiums employer's securities
POLICY 97 9007321 Copy 2
$ 0.00 $ 0.00
RECIPIENT'S name.address,and ZIP code 7 Di$tribution code !~RA/SEP 9 Other File this copy with
SIMPLE $ your state, city,
SUZANNE BARTH 18 1 0.0 % or local income
2524 SOUTH MARKET ST. Recipient's identification number 9a Your percentage of tax return,
totatdlstrlbution when required.
MECHANICS BURG PA 17055 197-40-8017 %
10 State tllxwithheld 11 S~e/Payer'sstatenumber
$ 0.100
$,
$,
Form 1099.R
Dep",rtment of the Treasury - Internal Revenue Service
l.'JlJ_ -~-- - - - - u_ u__u_ u_ u -- u___u______u__u__ __ u_ __ ______ ---.._____u____u ___ u_ __uu__u __ u__ __ u__
PAYER'S name,.;ddiess,ZIP code, and Federal identification number 1l.:irOSsolstrlDutron " axa",eamount OMS No. 1545-0119
FORM 109B~R
LINCOLN NATIONAL LIFE INS CO $ 2,635.64 $ 2,635.64 2000
PO BOX 2340 2b Tallllbleamount LJ ,.otal LJ
not determined distribution Distributions From
FORT WAYNE, IN 46801 ens ions, Annuitle
EIN, 35- 0472300 3 Capital gllln (included I" ;it~~~dmc:ome tax Retirement or
Inbox2a) Profit-Sharing Plan
ANNUITIES 800-454-6265 $ 0.1I0 $ 527.13 IRAs, Insurance
5 Employee contributions or 6 ~~t unrealized appreciation in Contract!:, elc.
POLICY insufllnceprlilmiums employer'lfSecuritres
97 9007321 Copy C
$ 0.1I0 $ 0.00
RECIPIENT'S name,oldllress,and ZIP code 7 Distribution code I ~RAISI;:P 8 Other For Recipient's
SUZANNE BARTH 18 SIMPLE 0.01 % Record"
1 $
2524 SOUTH MARKET ST. Recipient's Identification number 9a Your percentage of This Information Is being
total distribution
MECHANICSBURG PA 17055 197-40-8017 furnished to the Internal
% Revenue S"Ylc..
10 State tax withheld 11 StatelPayer's state number
$ 0.00 Keep this copy for your
records.
s,
$,
Form 1099.R
Department of the Treasury - Internal Revenue SerJice
sueSTI TUTE 1098
FIRST UNIO
P 0
RALEIGH
(800
S name, address, and telephone number . Caution: The amount shown 'nay not OMS No. 1545-0901
be fully deduclible by you. Limils based Mortg
on the loan amount and the cm~t and
N MORTGAGE CORP value of the secured property may
BOX 900001 apply. Also, you may only deduct ~~99 Intel"
NC 27675-9001 Interest to the extent it was incurred by Statem
) 654-9322 you, actually paid by you, and rot
reimbursed by <lnother person.
Form 1098
rJenNication no I PAYER'S social security number 1 Mortgage Interest received from payer(s)/borrower(s)' COp
11 202-36-8'158 $ 4.217.77 For POl
The,nformation inbo::
'S name, street address (including apt. no.), city, state, and ZIP code 2 Points paid on purchase 01 prncipal rasidenca (See 2, and 3 is import,l
Bo)(20n bacl() information and is
ARTH $ furnished to the hi
F 8ARTH 0.00 ReV~'nue Selvice. If y
ARKET ST 3 Refund of overpaid Interest (See Box 3 on back.) I-equired to tile a ret
S8URG PA 17055-5555 negiigence penatlyol
$ 0,00 sanction may be impos
you ilthe IRS delell
..1.1..1.1..1.1.11.1..1.1..1.111.1.1.1111.11..1 4 that 1m underpaymenl
reliultsbecaw-;
oVt:rslaled a deduct:
this mortgage interest
ill) the$E points orbecau$
7'13li78 did not r-eportthis I'ell
interest on vour I
lJ CORRECTED (if dlecked)
AS OF 12<;1-99
REGIPIENTS/Lt':NDEP
age
est
ent
RECIPIEt.j I 'S hlrferal i
51i-08117
yB
yer
8$ 1,
nttax
being
ternal
0U are
urn, a
othel'
ad Oil
!lines
ottax
e YOll
on fur
or lor
PAYER'S,BOfmOWEF
.JOHN W 8
SUZANNE
2524 S M
MECHANIC
1...1/1...1/1..
Accoul1t l1urnbE,r (op-:ion
0009
Form 1 098
(Keep for your records,)
e j'UU
mdot
atwn.
Department of the Treasury - Internal Revenue Service
OIS3URSEMENT ACTIVITY 1999;
CURRENT TOTAL PAYMENT
CURRENT ESCROW PAYMENT
PRINCIPAL ACTIVITY 1999:
BEGINNING BALANCE
PAYMENTS APPLIED
REMAINING BALANCE
ESCROW ACTIVITY 1999:
BEGINNING ESCROW BALANCE
TOTAL DEPOSITS
TOTAL DISBURSEMENTS
CLOSING ESCROW BALANCE
YOUR CLOSING ESCROW BALANCE IS
630.22
0.00
44,342.58
2,153.11
42,189.47
0,00
0,00
0.00
0,00
BEING HELD
FOR PAYMENT OF BILLS AS THEY BECOME DUE.
1999 NET INTEREST PAYMENTS REPORTED TO IRS ****** 4,217.77
THE ESCROW REFUND TOTAL MAY INCLUDE FUNDS THAT COULD NOT BE APPLIED TO YOUR
ACCOUNT AND WERE DISBURSED BACK TO YOU, IN ADDITION, THIS TOTAL CAN
INCLUDE ESCROW OVERAGE REFUNDS.
amreu6!s
alBa -----.~~-
aJnnw6!s
.laMoJ,'o8~O:J -~----_.___---------..._____
8101dwoo pUE )OaJ.loo 'anJI SI WJOj S!ul LlO pap!^oJd UO!IEW.lOjU' aUIISu) ^I",ao I 'Ii1ni.lad jO sa'llsuad aul JapLln _ NOIJ.~:)I~IJ.83:)
{Ji-~ Nil.::' '0'/ J8ABdxE'1
'ON Al!1n~8S lepoS
.IaMo.Ll08
-- --~---
- 80
~~--~- ~--~'---
103M08100EI-0:J
ON ~1Il:1 '0'1 .l8J\edxEl
80
'ON lil!-Jnoes leqoS
-----
.----- ----
83MOlOI008
.'''100~ SIHJ. ~O J.NOIO" 3HJ. NO NMOHS SS3100CW 3HJ. OJ. "'100 '
(NIl.) laqul[lu 1I0Ire~)I~!rJap! j8AEdxtnmoA 4+!M sn ep!AoJd aseald 'UOll'8JodJOo e JOIiUBdw _ :I. ~)IH.l ll\iV\J ONV H8\f.L30 'MOI9q pereoJ)u! 8J8ljM
.mOA L[~!M sn 3j)lhO.ld a:-msld 'IBnp!AlpUl ue aJl3 noli 11 '881 eLll Aq ,Ill'; d $ DOE SJe noli I) MOlsq pare8!pU! aoeds 841 U! Jaqwnu ^lw:oes IBIOOS.
'.c" ~-:!, 111:)-:;:' )~' Ino;l 11C;'IIII~1 nr',\lPln '::',,~hc_, ,_";' .."" ,,'::..O~" BUlllnSe)_UBOUOlmllIlOjLlISIlI18PI^O_ldoJ8mln~ 'sno! l"rllIHY'I'r"' '>:>"""" '"''
- - __ _ _ _ _ _ _'_D-!t~c!1 ~~,=-a~~ ~a~_\!j~ !~u:.~at~e~t! _ _ _ _ _ _ _ __
r~orm 1040- V
Oej.JHrtln"'l_ c:r l~'e T"'<bury
Internal I-\"""enuo :3e(\ice
Payment Voucher
... Do not staple or attach this voucher to your payment.
2 Enter Your Social Security Number 3
-- - - - - - - - - - -.- - --.
OMB No 1545.0074
2000
202-36-8958
5 Enter Your Name(s)
John W & Suzanne F Barth
Enter Your Address
~
Enter the Amount 'l:"ou Are Payin~1 by Check or
Money Order
$ 243,
2524 S. Market Street
Enter Your City
Mechanicsbur
FDIA8601 10/24/00
State ZIP Code
PA 17055
COOi)(190387
THE: TRAVELERS INSURANCE CO
1 TOWER SQUARE, 5MS 1216
HA~:TFORD, CT 06183-4051
SUZANNE BARTH
2524 SOUTH MARKET
MECHANICSBURG PA
PAYER'S Federal ID #
I 06~~~~~~Oi(:=-~
~~~~~~==~~~8gB3252PA1
OMB NO, 1545.0119
.....r--1",'.....u, ,.-,..,'--
ST
17055-5555
RECIPIENT'S ID #
~-40-8017
9b Total employee contributions
COpy C . For Recipient's Records
[J Corrected (if checked) 0 i
2000 FORM 1099-R
Distributions From Pensions, Annuities,
Retirement o. r p'. ofjt.Sharlng Plans, I
IRAs, Insurance Contracts, etc.
This Information IS bell"lg furnished to the
Internal Revenue Sel'\fice.
1 Gross distribution 2a TaKable amounl
$8,170,57
$8,170,51
2b Ta)(able amount 0 Total 0 I
not determined distribution
J Capilal gain 4 Federal income tax~-
(Include8 In bOK 2a) withheld
$1,634,12 I
5 Ell1ployee contribl!tlons Net unrealized appreciation
or InsuranCe premiums In employer's se::urllies
7 Distribution IRA/SEP/ B Other I~I
code 1 SiDle L%)
910ia~~i~Mb~~~~ge of 10 Stale taK withh~,Jd
% L_
~1 :otale/Payer's state no 12 State dlstllbutlon I
PN060566090
ANY QUESTIONS, WRITE ANNUITY SERVICES,5MS !
OR CALL MONDAY THRU FRIDAY 8AM - 7PM, EST I
AT 1-800,842-9406
Department of lhe Treasury. In'.ernal R'venue S~fVice
,",CThr... "'CQC
....-
dTotal nurmer ofexernptionsclaimed ....,.. .._.............,.......'.. ..-.. ...... ......... =-..::. ..1 21
7 Wages, salaries. lips, etc. A\laChForm(s} W-2 ........................................ 7 66.336.
BaT"-inleresl A1lach Schedule B if required ................ _..,......... ........... 8a
b Tax...-npl ,"rerest. Do not Include on line Sa ..... - . , . . . . . LBbl
9 Ordinary dividends. AIIach Schedule B if required .......................... - .. .. .. , .. - 9
10 Taxable refunds. 0'_. .. olIsels of _ and local income _'" (see insIructionS) ..... 10
11 Alimony received ....,......,...,.,............,..,...,.............,.......,...... 11
12 Business income or (loss). Attach Schedule C or C.EZ .. . . .. . .. . .. . .. .. . .. .. .. . .. .. . ... 12
13 Capital gain .. (loss). Attach Schedule 0 if required. If rot required. check here .... · 0 13
14 Other gains or (losses). A\IaCh Form 4797 ...,..,.....,......,....... - .. .. . . .. . .. - .... 14
15a Total IRA distributions _ .: . . .1 15al I b Taxable amount (see instrs) .' 15b
16" Total pensIOI1S & anooiIJes .J16;1 b Taxable amount (see inslrs).. 16b
17 Rental real estate, r~, paob....hi"'", S co.""'dtiuolS. trusIs. etc. A\IaCh Schedule E.. 17
18 Farm income or (loss). Attach Schedule F ..,."..,...................,...,...,....... 18
19 UnernpIoymenl~tion ............. .._........................ .._.... ........ 19
211" SoI:iaI SOClOiIl' _ ..... I 2IIal I b T....1bIe amount (see instrs).. 2IIb
21 IltIJer income. USllMJe & amount (see i.....) 21
22 Add lhe amounIs in !he far right c:oIun1il b-I;MS 'i tiir;;';;;il ii .-ThiS is ;-.,;;. ioIiI it-=; -:. · 22
23 IRA deduction (see inslrUcIions).. . .. _ .. .. .. .. . .. .. .. .. . -.. 23
24 SludenIloan interest deduction (see instructions) ... _ . . . . . .. 24
25 Medical savings account deduction. AIIach Form 81153 . . . . . .. 25
216 Moving expenses_ AIIach Form 3903 .. .. , . .. .. .. - .. . ~.. .... 216
Z1 One-half of self-employmeol tax. AIIach Schedule SE ,..,... Z1
28 SeIf-e....,1oyed health insurance deduction (see instructions) 28
29 Self-employed SEP, SIMPlE. and qualified plans . _ . . . . . . . .. 29
3lI Penally on early withdrawal of savings .. .. . .. .. .. . .. .. . .... 3lI
31"Ali_paidbReo:ipient'sSSN..... ....31a
32 Addlines23l!11lugh31a ........,......,...............,.........................,...... 32
33 Sublraclline 32 from lme 22. This is your adjuslI!d glOSS income _.. .. _ .. .. .. .. . .. ..... 33
BAA For DI!".cIosure, Privacy Act,. and Paperwork Reduction Act Notice, see instructions..
Form 1 040
Label
(Seeinsb'u;:boRs...)
use the
IRS-.
Otherwise.
please prinl
or type.
F. iT. dial
-
C-... -9'1
(See insIJul;tions.)
Filing Status
Check only
one box.
Exemptions
If more than
six depender'ttr,.
see instructtorT5.
Income
AlIach Forms
W-2andW-2G
----
Fonn(s) 11199-<R if
lax WlIS withhold.
If you did rol
get a W-2, :sef~
instructions.
Enclose. but do
rot attach. ""y
paymenllllso.
plE>.ase use
Fonn l040-V.
Adjus1ed
Gross
Income
Fa<
Department of the TteaSl.I'y - Internal Revenue Service
U.S. Individual Income Tax Return
the year Jan l-Oec 31. 2000. or other tax .ear beginning
Your FIISt Nime .. laslName
202-36-8958
----
197-40-8017
. Important! .
You _ enter you' social
security number(s} above.
2000 1l99l
, 2000, ending
IRS use only - Do not wrile or slaplt! in 1tlis space.
, 20 I OMS No. 1545-007'
v....SarW 5eadw'.........
John
. a JoinlIWum. Spouse"s Fnt Name
W Ba rth
1M ""'......
Suzanne F Barth
Harne AGIIeSS (~and sIred). If You Have a P.o. 8aJ;, See 1nstnEtiORS.
2524 S, Harket Street
City, TDM'l or Post Office. If You ~ a Foreign AddreSS. see tnsbul;tions..
Hechanicsburl!
_,No.
s.- lIP """"
PA 17055
Spouse
Xlyes nNo
. _ Checking "Yes" will rot change yoUI' tax or reduce yoUI' refund,
00 . or r 5 itfili a - inl return. want $3 to go to 1hisfund? ... - -.. --
1
2
3
4
Single
Married filing joint rebJm (even if only one had income)
Married filing separate return. Enter spouse's SSN above & lull name here ....
Head of household (with qualifying person). (See instructions.) If lhe quaIilying per.;on is a child but not you'
dependent, enter this child"s name here .. . ·
Quality' widow(er with dependent child ear souse died. ). (See inslruclionS.)
~';'~:~~~_~t.e)can_c~~. ,,:,.a_depender1t.~.~.~....} :-:'::=.. .L21
.... _....... _..... _......... _.... _ _ _... _....................... _.. _. _..- ..01,..
(:OOeIlendenl's (3) Depenlenfs (4) · =...
SOcial security relationship - -.... I
number toyou -..._...:.i:.... .....
~ . lidllDllM
"you"'.
cIivan:lI:Clf's.p-1I
=--~~ .-L--'
-...
=r...1 I
5
6a
b
c o.,.....denIs::
(1) First name
last name
10,807.
77 .143.
77 , 143.
Form 1040 ('2000)
FDfA0112 11107100
Form 1_ (2000) John W 8< Suzanne F Barth 202-36-8958 Paae 2
Tax and 34 Amount from line 33 (adjusted gross income) .......".".,.......,....,....,.,',.".. 34 71,143,
Credits 350 CheCk it. 0 You were 65101der, 0 Blind; 0 Spouse was l;sIokler, 0 Blind.l[
Add \he I1lIft>er of boxes checked above and enter \he lotaI here . . . . . . . . . . . .. 350
S~ 1_ b If you are married filing separately ~ spouse ilemizes deductions, 35bO
or you were a dual-5lalus alien, see . ions and check here ............. ·
-.man 36 Enter your i.....' . __from Schedule A, line 28, or ....-,1_.......
tor_ - shown on \he Iell. But see instrUctionS to find your ~ -.ction if you checked
PeapIe any box on line 35a or 35b or if someone can claim you as a dependenl . . . . . . . . . . . . . . . .. 36 7,350.
Single: 'Sl SubIract line 36 from line 34 ....____....__........__............................--. 'Sl 69,793.
$4,400 38 " ti... 3( is $116.101 or less. _ply $2,IIIl ~ U.1DlaI number II """""",,IS claimed ...Ii... 6d. " Ii... 3(
Head of is_$1I6.JOO. ...the_inthei_onsforll1eamountlD_.....................,...... 38 5,600.
household: 39 TlIlGIbIe _ Subtract line 38 from line 37. II line 38 is more Ihan lire 37. enter -0. ...- 39 64,193.
$6.450 ... Tox (... inslJs~ Chock if "",tal is from . 0 Fonn(s) 8814 b 0 Fonn 497Z ... 12,269.
! ...-..-....--.--.---.--
Married filing :i 41 Alternative minimum tax. AttaCh Form 6251 .. , .. .. .. .. . .. .. .. . -_.--_.-- 41
jointly or 4Z Add lines 40 and 41 :::::::.~ 4Z 12,269.
Qualilying ...--................................... .. .....
_(er): 4'3 Foreign lax crediL AttaCh Form 1116 if required. . . . . . . . . . . . . 4'3
$7,350 44 Crdt for diId 011I dopnIenl care __ _ Fonn 2441 44
.........-
Married filing 45 Credit lor the elderly or the disabled. AlIach Schedule R . . , . ' 45
separately: 46 Educationcredils. _ Form 8863. ....................., 46
$3,675
L-----_.___ 111 01iId tax credit (see instructions).......................... 111
.. Adoption credit. AlIach Form 8839 .. . .. .. . .. .. .. . . .. . ' .. . .. ..
49 Other. Check ilfrom... 8Form 3110O b OFonn 8396
c 0 Fonn 8801 d Form (specily) 49
50 Add lines 43l1vuU4lh 49. These are your - credits .......- .....-.. -.....-.. .....-........... 50
51 Subtract line 50 from line 42. If line 50 is more than line 42. enter ..()- . . . ............... . 51 12,269.
52 SelI-dI.,AuyII....4taa.Attal:hSclledlRSE.... -.... -....... -....... -.........................-. 52
Other 53 Social securi4' and Medicare laloo1ip inoome noll\!llOllOd 10 empIoJEr. - lOOn 4137 ...-...........-- 53
Taxes 54 Tax on IHAs, other retirement plans, and MSAs. Atlach Fonn 5329 if required..., . ,No". 54 1,081.
55 Advance earned income credit payments from Fonn(s) W-2 .-.. ..,...... ............... 55
56 Household empIoymenl taxes. AttaCh Schedule H . . . . . . . . . . . . . . . . . . . . . . . ............. 56
'>1 Add lines 51.56. Tlis is ..urllllaltu....".".,..,.,...."..,." ....,..,... .... .......... . '>1 13,350.
Payments 58 FedefaI income tax wiIhheld from Fonns w.:z and lm9 . . . . . . 58 13 107.
II you have a L !iI!I 1lDI"",,-lal""""" 011I_......... ,.,.. 1900 reIum . . . . . . . . !iI!I
qualilying 6OaEamedincomecredit(ElC)........."...,.....,..,.,..., . 60.
child. attach r b~ earned income: amount .
~ EIC
and lype . ~
61 -----------------------
Excess social security and RRTA lax withheld (see instrs) ... 61
62 Additional child tax credit. Allach Form 8812 ............... 62
63 _paid_......,.tfor_lDfile(...inslruttiGns), ......... 63
64 Other payments. Check if from . . . .. . o Fonn :i!439
b o Form 4136 . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . ....... 64
115 Add lines 58. 59, 6Oa, _ 61 through 64. These are you-
tatillpayll......b ......... ..... ..-............... -.. ... ......... .......... ......... . 115 13,107.
Refund 88 U line 65 is more than Ii... 57, _Ii... 57 from line 65. Tlis is the amount)OlU -..aid . . . . , ........... 88
Have it directly fila A.rnolri: of line 66 you want Jet....ildl r to you ....-.-........-.-....-.....-.-.. 0__'_" . 67.
deposited! See ~ b Routing number .."'" ~ c Type: [] Checking o Savings
instructions and
fin in 67b. 6k. ~ d Account number .......
_67d. 68 Amounlolline66youWMloppliedIDJIIlII'llIII-tu....,... .168 I
-'
Amount 69 ~F~ ~e::~eo'::"~":. ~~=::OI1lline 57: l11i'is lhellllOlllll.you..... .
You Owe 69 243.
10 Estimaled tax penalty. Also include on line 69 ..............110 I
Sign
Here
Joint reb.Rn?
See instructions_
Keep a copy
for your r'ecords.
l.lnder penalties of perJury. I declare that I have exat!'med this relum and acoornpanytng ~uIes and ~ and to: the best of my knowledge and
belief. they are true, correct. and complete. 0edaRlti0n of prepamr (oChef Ihan f.alcpayer) f5 based on aU infonnation of which preparer has allY knOwledge.
Y"'f~ 1-'l'. I """ y....~ 1_""'1"'-' RlWl112 10130IOO
~r::::.(,~ 7,,/,/~~-:,":/C, / f),"") clerk (717) (,'/7-- 9/-';(,
\SJ 's signature. It a ~t . ....~S9J. Spouse'S'~ _the m disoIss I~
~ . ,-.~"v''''-_l, \ "---,,,'I-\J'. ,)ex clerk l;:r';;':\'f"'~
Date ~areI''S ssrt 0" P1'fl
Paid
PYeparer's
Use Only
~.
FlIIl1sNaIne
(ClI"JOIIISI
-_.
..........-
ZIP Code
..
Self-prepared
...
Phone ....
Form 1040 (2000)
Form
W2
Wage
and
Tax
Statement
2000
Department
ofthfl
Treasury-
Internal
Revenue
Service
I a C-mtrolnJrob"r J OM8No.1545-DOOa Tn"lnrorm'tlon I" b.",~ furnl'h.d'o In. Int.mll ".....nu. S,,...,<. IryoU or. roquhd to tll. o to> '''urn
rSDl::p~oO o ~'o"~o"" """."~. ,- 0'"'" ..",,,~~ mOl' ,. ''''.O''''~" ''"'' ~'~" 'n<"..., I, ""hl_ .~~ \_" "~", -'c-'" "
B7~~1575:t42numb..r I d EmPI2o'~t:cj'6:u819n58..r 1W"glil$,tips,othereo",p.n~-ati(m 2F-.d.....tin.,om.t.~wilhh.ld
46342.75 8958.88
ICEmpl<ly"r"nl,m..,add.ess,,,ndZlPeOd. 3S0cllllsecurltywages 4 Sod...! securj,yta~ wilhheld
DFAS OPLOC-CHAS (ZGT) 0.00 0.00
1545 TRUXTUN AVENUE SUITE C 5 M.dicat~ w"ges "nd U~IS 6M8dicarelllXWt,hh.ld
CODE p 4634Z.75 671.97
CHARLESTON SC 29405-1968 7Socialucuri'ytips 8Alloc"l.dtlps
0.00 0,00
.-.- 9Advanc.EICp"ymenl 100epe"d8nlc"r"b.n.fiIS
. E"mploy...'S nam.., address, "ndZip cod.. 0.00
JOliN W BARTII 12 S"nefitstncludedinb"x 1 14 See inslrs. for box 14 -
2524 S MARKET ST V 333.90
MECH'iNICSBURG PA 17055-5555 13S.... instrs, for box 13 X 10.00
"
DSlalu~~~ [JO.cea""d !ZJp"nsion DL"~'" DDe~~Bo
ern 10.... Plan com "n'.,1I1ion
16S'aw I sM3:r6 2"1605 n4'0 17St..teWlIgu,tips,.'c, 18 State income tax 19 Loc..fityn..me 20 Localw"gn,tips, "tc. 21 Loclll income ,..x
PA 46342.75 1297.63 HAMPDEN 46676.65 466,72
[...mm 0.00 0.00 HAMPDEN 0,00 0.00
Copy C
For
EMPLOYEE
RECORDS
(See Notice
on back)
Form
W2
Wage
and
Tax
Statement
2000
Department
of the
Treasury_
Internal
RQvenue
Service
I OMS N~.154-5:00UB - -
lao.:ont'''lrKnll,er
i C5_D.1:32800
,I, Erl'pl<'yer 'd~nlificationnumber I d emp'20'2:~316:u89n58er 1Wllges,lips,olheroomf,ensallon 2 Federallnoome lax withheld
: 31--1';75142 ,16342.75 8958,88
---- 0-..___-------
cEmployer 'name, eddr~ss, and ZIP code JSoeialucurityw"ges 4 Social security tax withh~rd
DFA5 OPLOC-CHAS (ZGT) 0.00 0,00
1545 TRUXTUN AVENUE SUITE C 5 M.dic..... w..gS$ and tip.; 6MDdic..rs.axwithh.ld
CODE P '~6342. 75 671.97
CHl'gLESTON SC 29405-1968 7 Social s.curity lips II AUocal.dtips --
fe~-E;;';-~~;';;-s name, address, and Zip eode 0.00 0.00
9 Adv.n~e EIC Pllym.nt 10 Oependentcllrabenefi!s
CSD'n~,o 0,00
JOHN W BARTH 12 B.n.filslneludedinbo" 1 14 S".'n$lr$. for box 14
2524 5 MARKET 5T V 333.90
MECHANICSBURG PA 17055-5555 13 s.... inltr... for box 13 X 10.00
" ---
DSlslutOry [JO.c.~sed [X]psnSion o Le"el DOeferrsd
---~ . --- employee Plen co, compansil(ion
16 State Employsr's ststs 1.0. no. 17 Stsl.wag.s,lips, elC, lllSllltS incoms tax 19 LOclllitynllms 20 Loclllwllges,tips,sle. 21 LOClll ineome tax ~,'-------
PA .. M3-6216540 46342.75 1297.63 HAMPDEN 46676.65 466,72
0.00 0,00 HAMPDEN 0.00 0.00
Copy 2
To Be
Filed With
Employee's
State, City, 0
Local Income
Tax Return
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DEPARTMENT OF DEFENSE
1. Pay Period End
06/28/03
CIVILIAN LEAVE AND EARNINGS STATEMENT
VISIT THE DF AS WEB SITE AT: WWW.DFAS.MIL
1. Pay Date
07/03/03
3. Name
BARTH JOHN W
4. Pay PlanJGradelStep So HourlylDlily Rate 6. Bule OT Rite 7. Batie Pay + Locality Adj - Adjusted Bule Pay
GS 11 08 19,97 30.83 62S4ll,OO
8. SoeSeeNo
1ll2,36-89S8
9. Locality e;.
9,62
10. FLSA Cdepry 11. seD Lene U. Mu Le.ve Carry Over 13. Leave Year Ead
E 10/01n3 2AO
01/10/04
16. Financial Institution - Allotment 1# 2
14. FiDudalIDStltutloo - Net Pay
MEMBERS 1ST FCU
17. To Marital Exemptions Add')
Slat..
FED S
PA S
15. Fiauclallnlltitutioa - Allotment #1
18. To: MarltalExemptloDl Add'. TalingAutbority
Statu
421080 S HAMPDEN TS PA
19. Cumulative Retirement 20. Military Deposit
CSRS: 27078.19
21. Current Year to Date 22.
GROSS PAY 2397,60 34097.48
TAXABLE WAGES 23SI,94 33467,32
NONTAXABLE WAGES 4S,66 630,16
TAX DEFERRED WAGES
DEDUCTIONS 894,7S 13028,37
AEIC
NET PAY IS028S 21069,11
CURRENT EARNINGS
TYPE HOURSlDAYS AMOUNT TYPE HOURSlDAYS AMOUNT TYPE
REGULAR PAY 110,00 2397,60
HOURSlDAYS AMOUNT
DEDUCTIONS
TYPE CODE CURRENT YEAR TO DATE TYPE CODE CURRENT YEAR TO DATE
CHARITY 0746 200 34.00 FEGU ZI 9,7S 136.S4
FEGUOPTNL ABC 92,3S 130S,60 FEHB 104 4S,66 630,16
MEDICARE 34,11 48S,28 ORGIUNION IS6A 13,00 179.00
RETIRE, CSRS I 167.83 2339,S4 TAX, FEDERAL 440.68 663203
TAX, LOCAL 421080 23,S2 339,18 T AX,LOC acc 421080 10,00
TAX, STATE PA M.8S 937,04
LEAVE
TYPE PRIOR YR ACCRUED ACCRUED USED USED DONATEDI CURRENT USE-LOSE!
YTD PAYPD YTD RETURNED BALANCE TERM DATE
BALANCE PAY PD
ANNUAL 23.30 8.00 96,00 14,00 S9,SO S9,80
SICK 20,00 4,00 48,00 S7,OO 11,00
COMPENSATORY 4,00 1.00 3,SO ,SO
DONATED 48,00 48.00
HOLIDAY 24,00
ADMIN 20,00
REMARKS
YOUR PAYROLL OmCE IOENTIFlCATION NUMBER IS 97380500.
MINIMUM HOLDING PERIOD FOR SERIES EEII BONDS ISSUED AS OF FEBRUARY 2003 IS NOW 12 MONTHS,
PRETAX FEHB EXCLUSION $ 45.66
TInS REPORT CONTAINS INFORMATION SUBJECT TO THE PRIVACY ACT OF 1974 AS
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7/21/2003
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DEPARTMENTOF DEFENSE 1. Pay Period End
05117/03
CIVILIAN LEAVE AND EARNINGS STATEMENT 2. Pay Date
VISIT THE DFAS WEB SITE AT: WWW,DFAS,MIL 05123/03
3. Name 4. Pay Plan/Grade/Step 5. HourlylDaily Rate 6. Basic OT R.llte 7. Basic Pay + Locality Adj - Adjusted Basic Pay
BARTH JOHN W GS II 08 29.97 30.83 62548.00
8. Soc Sa: No 9. Locality % 10. FLSA Category 11. SeD Leavl~ 12. Max Leave Carry Over 13. Leave Year End
202-36-8958 9.62 E 10/01/73 240
01/10/04
14. Financial Institution - Net Pay 115. Financial Institution - Allotment #1 16. Financial Institution - Allotment # 2
MEMBERS 1ST FeU
17. Tax Marital Exemptions Add'l 18. Tax Marital Exemptions Add'l Taxing Authority 19. Cumulative Retirtment 20. Military Deposit
Status Status CSRS
FED S 421080 S HAMPDEN TS PA 26574.80
PA S
21. Current Year to Date 22,
GROSS PAY 2397.60 26904.68
TAXABLE WAGES 2351.94 26411.50
NONTAXABLE WAGES 45.66 493.18
TAX DEFERRED WAGES
DEDUCTIONS 924,00 10344.60
AEIC
NET PAY 1473.60 16560.08
CURRENT EARNINGS
TYPE HOURS/DA YS AMOUNT TYPE HOURS/DA YS AMOUNT TYPE HQURS/DA YS AMOVNT
REGULAR PAY 80.00 2397.60
DEDUCTIONS
TYPE CODE CURRENT YEAR TO DATE TYPE CODE CURRENT YEAR TO DATE
CHARITY 0746 2.00 28.00 FEGLl ZI 9.75 107.29
FEGLl OPTNL ABC 92.35 1028.55 FEHB 104 45.66 493.18
MEDICARE 34.11 382.97 ORGiUNION 156A 13.00 140.00
RETIRE, CSRS I 167.83 1836.05 TAX, FEDERAL 469.47 5309.99
T AX,LOC ace 421080 10.00 TAX, LOCAL 421080 23.98 269.08
TAX, STATE PA 65.85 739.49
LEAVE
TYPE PRIOR VR ACCRUED ACCRUED USED USED DONA TED/ CURRENT USE-LOSEI
YTD PAY PO YTD RETURNED BALANCE TERM DATE
BALANCE PAY PD
ANNUAL 23.30 8,00 72.00 .50 27.50 67,80
SICK 20,00 4.00 36.00 32.00 24,00
COMPENSATORY 4.00 2.50 1.50
DONATED 48.00 48,00
INJURY (COP) 5.00 14.00 02/24
HOLIDA Y 16.00
ADMIN 20.00
REMARKS
YOUR PAYROLL OFFICE IDENTIFICATION NUMBER IS 97380500,
ENROLL IN TSP - OEAOLINE FOR OPEN SEASON IS JUNE 30,
BUY US SAVINGS BONOS,
MINIMUM HOLDING PERIOO FOR SERIES EE/I BONOS ISSUEO AS OF FEBRUARY 2003 IS NOW 12 MONTHS,
NET PAY BANK/ACCOUNT NUMBER/ACCOUNT TYPE CHANGED.
PRETAX FEHB EXCLUSION $ 45,66
THIS REPORT CONTAINS INFORMATION SUBJECT TO THE PRIV AC" ACT OF 1974 AS AMENDED
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5/21/2003
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$SVElIPtintl
DEPARTMENT_OF DEFENSE 1. Pay Period End
05/17/03
CIVILIAN LEAVE AND EARNINGS STATEMENT 2. Pay Date
VISIT THE DF AS WEB SITE AT: WWW,DFAS,MIL OS/23/03
3. Name 4. Pay Plan/Grade/Step S. HourlylDaily Rate 6. Basic OT Rate 7. Basic Pay + Locality Adj = Adjusted Basic Pay
BARTH JOHN W OS 11 08 29.97 30.83 62548.00
8. Soc See No 9. Locality % 10. FLSA Category 11. SeD Leavl~ 12. Max Leave Carry Over 13. Leave Year End
202-36.8958 9.62 E 10/01/73 240
01110104
14. Financial Institution - Net Pay 115. Financial Institution - Allotment #1 16. Financial Institution - Allotment 14 2
MEMBERS 1 $T FeU
17. Tax Marital Exemptions Add" 18. Tax Marital Exemptions Add') Taxing Authority 19. Cumulative Retirement 20. Military Deposit
Status Status CSRS:
FED S 421080 S HAMPDEN TS PA 26574.80
PA S
21. Current Year to Date 22,
GROSS PAY 2397.60 26904.68
TAXABLE WAGES 2351.94 26411.50
NONTAXABLE WAGES 45.66 493.18
TAX DEFERRED WAGES
DEDUCTIONS 924,00 10344,60
AEIC
NET PAY 1473.60 16560.08
CURRENT EARNINGS
TYPE HOURS/DA YS AMOUNT TYPE HOURS/DA YS AMOUNT TYPE HOURS/DA YS AMOUNT
REGULAR PA Y 80.00 2397.60
DEDUCTIONS
TYPE CODE CURRENT YEAR TO DATE TYPE CODE CURRENT YEAR TO DATE
CHARITY 0746 2.00 28.00 FEGLI Zl 9.75 107,29
FEGLI OPTNL ABC 92.35 1028,55 FEHB 104 45.66 493,]8
MEDICARE 34.1 ] 382.97 ORO/UN10N 156A 13,00 140.00
RETIRE, CSRS 1 167,83 1836.05 TAX, FEDERAL 469.47 5309.99
T AX,LOC OCC 42]080 10.00 TAX, LOCAL 421080 23.98 269,08
TAX, STATE PA 65.85 739.49
LEAVE
TYPE PRIOR YR ACCRUED ACCRUED USED USED DONA TEDI CURRENT USE.LOSEI
YTD PAY PD YTD RETURNED BALANCE TERM DATE
BALANCE PAY PD
ANNUAL 23.30 8.00 72.00 50 27,50 67.80
SICK 20.00 4,00 36.00 32.00 24,00
COMPENSATORY 4,00 2.50 1.50
DONATED 48.00 48.00
1NJURY (COP) 5,00 14.00 02/24
HOLIDA Y 16.00
ADM1N 20.00
REMARKS
YOUR PAYROLL OFFICE IDENTIFICATION NUMBER IS 97380500,
ENROLL IN TSP - OEAOLlNE FOR OPEN SEASON IS JUNE 30.
BUY US SAVINGS BONOS.
MINIMUM HOLOING PERIOO FOR SERIES EE/I BONOS ISSUED AS OF FEBRUARY 2003 IS NOW 12 MONTHS,
NET PAY BANK/ACCOUNT NUMBER/ACCOUNT TYPE CHANGED,
PRETAX FEHB EXCLUSION $ 45,66
THIS REPORT CONTAINS INFORMATION SUBJECT TO THE PRIVACY ACT OF 1974 AS AMENDED
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DEPARTMENT OF DEFENSE 1. Pay Period End
04119103
CIVILIAN LEAVE AND EARNINGS STATEMENT 2. Pay Date
VISIT THE DF AS WEB SITE AT: WWW.DFAS,Mll. 04125/03
J. Name 4. Pay PlanlGradelStep 5. HourlylDaily Rate 6. Basic: OT Rate 7. But.:: Pay + Locality Adj "" Adjusted Basic: Pay
BARTII JOHN W GS 11 08 29,97 30,54 62548.00
8. Soc: See No 9. Locality 0/0 10. FLSA Category 11. SCD Leavl~ 12. Max Leave Carry Over 13. Leave Year End
202,36.8958 8,64 E 10/01173 240
01/10/04
14. Fioaadallnstitution - Net Pay 115. Financial Institution - Allotment 1ft 16. Financial Institutioo - Allotment #:2
MEMBERS 1ST FCU
17.Tu Marital Exemptions Add'. 18. To MarltalEs.emptions Add') TniogJUthority 19. Cumulative Retirement 20. Military Deposit
Status Status CSRS,
FED S 421080 S HAMPDEN TS PA 26239,14
PA S
21. Current Ye... to Date n.
GROSS PAY 2397,60 22107,44
TAXABLE WAGES 2351.94 21705.58
NONTAXABLE WAGES 45.66 401.86
TAX DEFERRED WAGES
DEDUCTIONS 923,99 8495,96
AEIC
NET PAY 1473,61 13611,48
CURRENT EARNINGS
TYPE HOURSlDA YS AMOUNT TYPE HOURSlDA YS AMOUNT TYPE HOURSlDAYS AMOUNT
REGULAR PAY 80.00 2397,60
DEDUCTIONS
TYPE CODE CURRENT YEAR TO DATE TYPE CODE CURRENT YEAR TO DATE
CHARITY 0746 200 24,00 FEGLI ZI 9,75 87,79
FEGLI OPINL ABC 92,35 843,85 FEHB 104 45,66 401.86
MEDICARE 34.10 314.73 ORGIUNlON 156A 13,00 114,00
RETIRE, CSRS 1 167,83 1500.39 TAX, FEDERAl. 469,47 4370,51
TAX,1.OC OCC 421080 10.00 TAX, LOCAl. 421080 23.911 221.10
TAX, STATE PA 65,85 (f,)7,73
LEAVE
TYPE PRIOR YR ACCRUED ACCRUED USED USED DONATED/ CURRENT USE.LOSE!
YTD PAY PO TID RETURNED BALANCE TERM DATE
BALANCE PAY PO
ANNUAl. 23,30 8,00 56,00 1.00 25,00 54.30
SICK 20,00 4,00 28,00 32,00 16.00
COMPENSATORY 4,00 2,50 2,50 1.50
OONATED 48,00 48,00
INJURY (COP) 3.00 5.00 02124
HOLIDAY 16,00
ADMIN 20,00
REMARKS
YOUR PAYROLL OFACE IOENTIACATlON NUMBER IS 97380500,
ENROLL IN TSP - OEADLINE FOR OPEN SEASON IS JUNE 30.
BUY US SAVINGS BONOS.
USE THE WORK NUMBER FOR EMPLOYMENT VERIACATION: 1-800-367-2884 OR WWW.THEWORKNUMBER.COM.
MISSED TAX DAY? CALL THE IRS FOR ASSISTANCE AT
1-800-829-1040 OR ACCESS THEIR WEBSITE AT WWW.IRS.GOV.
MINIMUM HOLDING PERIOO FOR SERIES EEII BONDS ISSUEO AS OF FEBRUARY ;!003 IS NOW 12 MONTHS.
EFFECTIVE MAY 3RO OTHER GOVERNMENT OEBTS WILL BE COLLECTED VIA THE -rREASURY OFFSET PROGRAM
SAFEGUARO AGAINST SOCIAL SECURITY NUMBER II. IDENTITY THEFT, GO TO_WWW.CONSUMER,GOV/IDTHEFT.
PRETAX FEHB EXCLUSION $ 45.66
TInS REPORT CONTAINS INFORMATION SUBJECT TO THE PRIV ^,~Y ACT OF 1974 AS AMENDED
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5/5/2003
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DEPARTMENT OF DEFENSE 1. Pay Period End
04/05/03
CIVILIAN LEAVE AND EARNINGS STATEMENT 2. Pay Date
VISIT THE DFAS WEB SITE AT: WWW,DFAS,MIL 04/11103
3. Name 4. Pay PlanlGradelStep 5. HourlylDaily Rate 6. Basic OT Rate 7. Basic: Pay + Locality Adj = Adjusted Bailie Pay
BARTIl JOHN W GS J\ 08 19.97 30,54 62548,00
8. Soc Sec No 9. Locality -Ie 10, FLSA Category 11. seD Lean 11. Max Leave Carry Over 13. Leave Year End
202-36-8958 8,64 E 10/01/73 240
01110/04
14. Finuciallnstitutlon - Net Pay 115. Financial In!ltitution - Allotment #1 16. Financial Institution - Allotment II 2.
MEMBERS 1ST FCU
17. Tu:. Marital Exemptions Add') 18.Tu MatitalExemptions Add'l Tu.ingAuthority 19. Cumulative Retirement :10. Military Deposit
Status Status CSRS,
FED S 421080 S HAMPDEN TS PA 26071.31
PA S
11, Current Year to Date 11,
GROSS PAY 2397.60 19709,84
TAXABLE WAGES 2351.94 19353.64
NONTAXABLE WAGES 45,66 356,20
TAX DEFERRED WAGES
DEDUCTIONS 924.00 7571.97
AEIC
NET PAY 1473,60 12137.87
CURRENT EARNINGS
tyPE HOURSlDA YS AMOUNT tyPE HOURSlDA YS AMOUNT TYPE HOURSlDA YS AMOUNT
REGULAR PAY 80.00 2397,60
DEDUCTIONS
tyPE CODE CURRENT YEAR TO DATE tyPE CODE CURRENT YEAR TO DATE
CHARITy 0746 200 22,00 FEGLl ZI 9.75 78,04
FEGLl OPTNL ABC 92.35 751.50 FEHB 104 45,66 356,20
MEDICARE 34.11 28Q.63 ORGIUNlON 156A 13.00 101.00
RETIRE. CSRS I 167.83 133256 TAX. FEDERAL 469.47 3901.04
TAX. LOCAL 421080 23,98 t97,12 TAX,LOC OCC 421080 10,00
TAX. STATE PA 65.85 541.88
LEAVE
tyPE PRIOR YR ACCRUED ACCRUED USED USED DONATED/ CURRENT U8E.LOSFJ
y'fD PAY PO YTD RETURNED BALANCE TERM DATE
BALANCE PAY PO
ANNUAL 23,30 8.00 48,00 50 24,00 47.30
SICK 20,00 4,00 24,00 32.00 12.00
COMPENSATORY 250 4,00 4,00
OONATED 48,00 48,00
INJURY (COP) 2.00 2.00 02124
HOUDAY 16,00
ADMIN 20,00
REMARKS
YOUR PAYROLL OFFICE IOENTIFlCATION NUMBER IS 97380500,
ENROLL IN TSP - OEAOLINE FOR OPEN SEASON IS JUNE 30.
BUY US SAVINGS BONOS
MINIMUM HOLOING PERIOO FOR SERIES EEII BONDS ISSUED AS OF FEBRUARY 2003 IS NOW 12 MONTHS,
flUNG YOUR PERSONAL INCOME TAX BY APRIL 15TH IS ANOTHER WAY YOU CAN SUPPORT YOUR COUNTRY,
EFFECTIVE MAY 3RD OTHER GOVERNMENT OEBTS WILL BE COLLECTED VIA THE TREASURY OFFSET PROGRAM
PRETAX FEHB EXCLUSION $ 45.66
RETROACTIVE TIME ANO ATTENDANCE AOJUSTMENTS PROCESSEO.
TIllS REFORT CONTAINS INFORMATION SUBJECT TO TIlE PRIVACY ACT OF 1974 AS AMENDED
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5/5/2003
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DEPARTMENT OF DEFENSE 1. Pay Period End
03/22/03
CIVILIAN LEAVE AND EARNINGS STATEMENT 2. Pay Date
VISIT THE DF AS WEB SITE AT: WWW,DFAS,MIL 03/28/03
3. Name 4. Pay PlanlGradelStep 5. HourlyJDaily Rate 6. Basic OT Rate 7. Basic Pay + Locality Adj - Adjusted Basic Pay
BARTIlJOHNW GS 11 08 '}9,97 30,54 62548,00
8. Soc See No 9. Locality 0/. 10. FLSA C..egory 11. SCD Leavt!! U. Mas. Leave Carry Over 13. Leave Year End
2Jl2-36-8958 8,64 E 10/01173 240
01/10/04
14. Financial Institution - Net Pay 115. Financial Institution - Allotment #1 16. Financial Institution - Allotment # 2-
MEMBERS ISTFCU
17. To: Marital Exemptions Add') 18. Tn: MaritalE1emptioDS Add'l TaxingAuthority 19. Cumulative Retirement 20. Military Deposit
Status StatuI CSRS,
FED S 421080 S HAMPDEN TS PA 25903,48
PA S
21. Current Year to Date n.
GROSS PAY 2458.68 17312,24
TAXABLE WAGES 2413,02 17001.70
NONTAXABLE WAGES 45.66 310,54
TAX DEFERRED WAGES
DEDUCTIONS 943,68 6h47,97
AE1C
NET PAY 1515.00 10664,27
CURRENT EARNINGS
TYPE HOURSlDAYS AMOUNT TYPE HOURSlDA YS AMOUNT TYPE HOURSlDAYS AMOUNT
REGULAR PAY 80,00 2397,60 OVERTIME 200 61.08
DEDUCTIONS
TYPE CODE CURRENT YEAR TO DATE TYPE CODE CURRENT YEAR TO DATE
CHARITY 0746 200 2Jl,OO FEGU ZI 9,75 68,29
FEGU OPTNL ABC 92.35 659,15 FEHB 104 45.66 310.54
MEDICARE 34.98 246,52 ORGIUNlON I56A 13.00 88,00
RETIRE. CSRS 1 167,83 1164,73 TAX, FEDERAL 485,96 3431.57
TAX, LOCAL 421080 24,59 173,14 T AX,LOC OCC 421080 10,00
TAX, STATE PA 67,56 476.03
LEAVE
TYPE PRIOR YR ACCRUED ACCRUED USED USED DONATEDI CURRENT USE-LOSE!
YTD PAY PO YTD RETURNED BALANCE TERM DATE
BALANCE PAY PO
ANNUAL 23.30 8.00 40,00 6,00 23,50 39,80
SICK 2Jl,OO 4.00 2Jl,OO 27,00 32.00 8,00
COMPENSATORY 1.50 1.50 1.50
DONATED 48.00 48,00
HOUDAY 16.00
ADMIN 16,00
REMARKS
YOUR PAYROLL OFFICE IOENTIFICATlON NUMBER IS 97380500.
SHARE YOUR LIFE _ CHOOSE ORGAN ANO TISSUE DONATION - SHARE YOUR DECISION
IT IS YOUR DUTY TO COMPLY WITH FEOERAL TAX LAWS. CALL THE IRS FOR ASSISTANCE AT
1.800-829-1040 OR ACCESS THEIR WEBSITE AT WWW.IRS.GOV,
MINIMUM HOLOING PERIOD FOR SERIES EEII BONDS ISSUED AS OF FEBRUARY ;!003 IS NOW 12 MONTHS.
FILING YOUR PERSONAL INCOME TAX IS ANOTHER WAY YOU CAN SUPPORT YOUR COUNTRY, MAKE SURE
YOU FILE BY APRIL 15TH.
PRETAX FEHB EXCLUSION $ 45,66
TIllS REPORT CONTAINS INFORMATION SUBmcT TO THE PRIVACY ACT OF 1974 AS AMENDED
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5/5/2003
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DEPARTMENT OF DEFENSE 1. Pay Period End
03/08/03
CIVILIAN LEAVE AND EARNINGS STATEMENT 2. Pay Date
VISIT THE DFAS WEB SITE AT: WWW,DFAS,MIL 03/14/03
3. Name 4. Pay Plan/GradeJStep 5. HourlylDaily Rate 6. Basic OT Rate 7. Basic Pay + Locality Adj = Adjusted Basic Pay
BARTH JOHN W OS 11 08 29.97 30.54 62548.00
8. Soe Set: No 9. Locality % 10. FLSA C:degory 11. SeD Leav,~ 12. Max Leave Carry Over 13. Leave Year End
202.36.8958 8.64 E 10/01/73 240
01/10/04
14. Financial Institution - Net Pay 115. Financial Institution - Allotment #1 16. Financial Institution - Allotment # 2
MEMBERS 1ST FeU
17. Tax Marital Exemptions Add'l 18. Tax Marital Exemptions Add'l Taxing Authority 19. Cumulative Retirement 20. Military Deposit
Status Status CSRS:
FED S 421080 S HAMPDEN IS PA 25735.65
PA S
21. Current Year to Date 22,
GROSS PAY 2550.30 14853.56
TAXABLE WAGES 2504.64 14588.68
NONTAXABLE WAGES 45.66 264.88
TAX DEFERRED WAGES
DEDUCTIONS 973.24 5704.29
AEIC
NET PAY \577.06 9149.27
CURRENT EARNINGS
TYPE HOURSIDA YS AMOUNT TYPE HOURSIDA YS AMOUNT TYPE HOURSIDA YS AMOUNT
REGULAR PAY 80.00 2397.60 OVERTIME 5.00 152.70
DEDUCTIONS
TYPE CODE CURRENT YEAR TO DATE TYPE CODE CURRENT YEAR TO DATE
CHARITY 0746 2.00 18.00 FEGLl 21 9.75 58.54
FEGLl OPTNL ABC 92.35 566.80 FEHB 104 45.66 264.88
MEDICARE 36.32 211.54 ORGIUNION 156A 13.00 75,00
RETIRE, CSRS 1 ]67,83 996.90 TAX, FEDERAL 510.70 294561
TAX, LOCAL 421080 25,50 148.55 T AX,LOC OCC 421080 10.00
TAX, STATE PA 70.13 408.47
LEAVE
TYPE PRIOR YR ACCRUED ACCRUED USED USED DONATEDI CURRENT USE.LOSEI
BALANCE PAY PD YTD PAY PD YTD RETURNED BALANCE TERM DATE
ANNUAL 23.30 8.00 32.00 9.00 17.50 37.80
SICK 20.00 4.00 16.00 5.00 31.00
DONATED 48.00 48.00
HOLlDA Y 16.00
ADMIN ]6,00
REMARKS
YOUR PAYROLL OFFICE IDENTIFICATION NUMBER IS 97380500,
MINIMUM HOLOING PERIOO FOR SERIES EEII BONOS ISSUEO AS OF FEBRUARY 2003 IS NOW 12 MONTHS,
OIRECT OEPOSIT IS FASTER ANO SAFER THAN A CHECK, AND I~ COMBINATION WITH IRS E-FILE,
YOU COULD GET YOUR FEOERAL INCOME TAX REFUND IN HALF THE TIME,
PRETAX FEHB EXCLUSION $ 45.66
THIS REPORT CONTAINS 1NFORMA nON SUBJECT TO THE PRIV AC Y ACT OF 1974 AS AMENDED
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3/24/2003
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DEPARTMENT OF DEFENSE 1. Pay Period End
02/22/03
--'~'--
CIVILIAN LEAVE AND EARNINGS STATEMENT 2. Pay Date
VISIT THE DFAS WEB SITE AT: WWW,DFAS.MIL 02/28/03
3. Name 4. Pay Plan/GradeJStep 5. HourlylDaily Rate 6. Basic OT Rate 7. Basic Pay + Locality Adj = Adjusted Basic Pay
BARTH JOHN W GS II 08 29.97 30.54 62548.00
8. Soc See No 9. Locality % 10. FLSA Category 11. SeD Leave 12. Max Leave Carry Over 13. Leave Year End
202-36-8958 8.64 E 10/01173 240
01/10/04
14. Financial Institution - Net Pay 115. Financial Institution - Allotment #1 16. Financial Institution - Allotment # 2
MEMBERS 18T FeU
17. Tax Marital Exemptions Add'. 18. Tax Marital Exemptions Add'. Taxing Authority 19. Cumulative Retirement 20. Military Deposit
Status Status CSRS:
FED S 421080 S HAMPDEN IS PA 25567.82
PA S
2t, Current Year to Date 22.
GROSS PAY 2397.60 12303.26
TAXABLE WAGES 2351,94 12084.04
NONTAXABLE WAGES 45.66 2\9,22
TAX DEFERRED WAGES
DEDUCTIONS 923.99 4731.05
AEIC
NET PAY 1473,61 7572.21
CURRENT EARNINGS
TYPE HOURSfDA YS AMOUNT TYPE HOURS/DAYS AMOUNT TYPE HOURSfDA YS AMOUNT
REGULAR PAY 80.00 2397.60
DEDUCTIONS
TYPE CODE CURRENT YEAR TO DATE TYPE CODE CURRENT YEAR TO DATE
CHARITY 0746 2.00 16.00 FEGLI ZI 9.75 48.79
FEGLl OPTNL ABC 92.35 474.45 FEHB 104 45.66 219,22
MEDICARE 34.10 175,22 ORG/UNION 156A 13.00 62.00
RETIRE, CSRS 1 167.83 829.07 TAX, FEDERAL 469.47 2434.91
TAX, LOCAL 421080 23.98 123.05 T AX,LOC oce 421080 10,00
TAX, STATE PA 65.85 338.34
LEAVE
TYPE PRIOR YR ACCRUED ACCRUED USED USED DONATEDI CURRENT USE.LOSEI
BALANCE PAY PO YTD PAY PD YTD RETURNED BALANCE TERM DATE
ANNUAL 23,30 8.00 24.00 8.00 8.50 38.80
SICK 20.00 4,00 12,00 5.00 27.00
DONATED 48.00 48.00
HOLIDAY 8.00 16,00
ADMIN 16,00 16.00
REMARKS
YOUR PAYROLL OFFICE IDENTIFICATION NUMBER IS 97380500,
MINIMUM HOLDING PERIOO FOR SERIES EEII BONOS ISSUEO AS OF FEBRUARY 2003 IS NOW 12 MONTHS,
OIRECT OEPOSIT IS FASTER ANO SAFER THAN A CHECK, ANO IN COMBINATION WITH IRS E-FILE,
YOU COULO GET YOUR FEOERAL INCOME TAX REFUND IN HALF THE TIME,
PRETAX FEHB EXCLUSION $ 45,66
THIS REPORT eONT AINS INFORMATION SUBJECT TO THE PRIVACY ACT OF 1974 AS AMENDED
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2/26/2003
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DEPARTMEJ-/T OF DEFENSE t. Pay Period End
01/25/03
CIVILIAN LEAVE AND EARNINGS STATEMENT 2. Pay Date
VISIT THE DF AS WEB SITE AT: WWW.DFAS.MIL 01/31/03
3. Name 4. Pay Plan/Grade/Step 5. HourlylDaily Rate 6. Basic OT Rate 7. Basic Pay + Locality Adj '" Adjusted Basic Pay
BARTH JOHN W GS II 08 29.97 30.54 62548.00
8. Soc See No 9. Locality lYo 10. FLSA Cate~:ory 11. SeD Leavl~ 1-2. Max Leave Carry Ow'r 13. Leave Year End
202-36-8958 8.64 E 10/01/73 240
01/10/04
14. Financial Institution - Net Pay 115. Financial Institution - Allotment #1 16. Financial Institution - Allotment #I 2
MEMBERS 1ST FCU
17. Tax Marital Exemptions Add', 18. Tax Marital Exemptions Add'l Taxing Authority 19. Cumulative Retirement 20. Military Deposit
Status Status CSRS
FED S 421080 S HAMPDEN TS PA 25232.16
PA S
21. Current Year to Date 22.
GROSS PAY 2397.60 7108.06
TAXABLE WAGES 2351.94 6980.16
NONTAXABLE WAGES 45.66 127,90
TAX DEFERRED WAGES
DEDUCTIONS 923.99 2754.06
AEIC
NET PAY 1473.61 4354,00
CURRENT EARNINGS
TYPE HOURSIDA YS AMOUNT TYPE HOURS/DA YS AMOUNT TYPE HOURS/DA YS AMOUNT
REGULAR PAY 80.00 2397.60
DEDUCTIONS
TYPE CODE CURRENT YEAR TO DATE TYPE CODE CURRENT YEAR TO DATE
CHARITY 0746 2.00 12.00 FEGLl 21 9.75 29.29
FEGLl OPTNL ABC 92.35 289.75 FEHB 104 45.66 127.90
MEDICARE 34.10 101.21 ORG/UNION 156A 13.00 36.00
RETIRE, CSRS I 167.83 493.41 TAX, FEDERAL 469.47 1387.97
TAX, LOCAL 421080 23,98 71.09 T AX,LOC OCC 421080 10.00
TAX, STATE PA 65,85 195.44
LEAVE
TYPE PRIOR YR ACCRUED ACCRUED USED USED DONA TEDI CURRENT USE-LOSEI
BALANCE PAY PD YTD PAY))D YTD RETURNED BALANCE TERM DATE
ANNUAL 23.30 8,00 8,00 31.30
SICK 20.00 4.00 4,00 24.00
DONATED 48.00 48.00
HOLlDA Y 8,00 8.00
REMARKS
YOUR PAYROLL OFFICE IDENTIFICATION NUMBER IS 97380500.
SHARE YOUR LIFE - CHOOSE ORGAN ANO TISSUE OONATION - SHARE YOUR OECISION
USE THE WORK NUMBER FOR EI~FLOYI~ENT VERIFICATION: 1-800-367-2884 OR WWW.THEWORKNUMBER,COM,
MINIMUM HOLOING PERIOO FOR SERIES EEII BONOS ISSUEO AS Of' FEBRUARY 2003 IS NOW 12 MONTHS,
01RECT OEPOSIT IS FASTER ANO SAFER THAN A CHECK, ANO IN COMBINATION WITH IRS E-FILE,
YOU COULO GET YOUR FEDERAL INCOME TAX REFUNO IN HALF THE TIME.
BASIC PAY CHANG EO,
PRETAX FEHB EXCLUSION $ 45.66
FEHB OEOUCTION CHANGEO,
UNION/EMPLOYEE ORGANIZATION OEDUCTION CHANGED.
CFC ELECTION EFFECTIVE THIS PAY PERIOD,
THIS REPORT CONTAINS INFORMA TrON SUBJECT TO THE PRIVACY ACT OF 1974 AS AMENDED
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2/4/2003
In the Court of Common Pleas of
CUMBERLAND
County, Pennsylvania
Phone: (717) 240-6225
DOMESllC RELATIONS SECTION
13 N. HANOVER ST, P.O. BOX 320, CARLISU:, PA. 17013
Fax: (717) 240-6248
MAY 2, 2003
Plaintiff Name: SUZANNE F. BART'H
Defendant Name: JOlIN W. BARTH
Docket Number: 03-227 CIVIL
PACSES Case Number: 942105436
Other State ID Number:
Please note: All correspondence must include the PACSES Case Number.
Income and Expense Statement
THIS FORM MUST BE FILLED OUT
(If you are self-employed or if you are salaried by a business of which you are owner in whole or part, you must
also fill out the Supplemental Income Statement which appears on page two of this income and expense
statement. )
INCOME STATEMENT OF
X,HJJ
Cv. 6;t/ILiff'
Section I: Income and Insurance
INCOME:
Employer (},SII/~......PuTIV6 ~r/IC~S 'P I>P7. O~Cc. Mt'cf'foof-A)ICS~ v'La
Address /11/ F'Cf-lAIJ I' c t; ~ c/'1..-C ;?A I . r S~Ec' A""'}"(1I-k:~).
Type of Work
Payroll No. Gross Pay per Pay Period $ rQ: 3117, tOo Pay Period (wk1hl>i-wkly., etc,) t:3/ W/::'L y.
1:>1<."..0""(3-("0....... 'Z-L.
Itemized Payroll Deductions:
Federal Withholdio2 $ Ql/6-fd. Social Security $ 0 Local Wage Tax $.?~.'1
State Income Tax $ 4.~...<; Retirement $h". q~~ Savioe's Bonds $ D
Credit Union $ 0 Life Insurance FE'r-A.l; $ Of, 7 ( Health Insurance $ 't ,0
I!:fi> , $ ,"~ l1nt"n,......f. $
Other Deductions (specify) UM' .AI $ (!I.,dO' ('/.J.~"rY $ -2, c....
Net Pay per Pay Period $ < ~ O~ I i ~~
OTHER (Fill in Appropriate Column)
INCOME WEEK MONTH YEAR
Interest $ ''1"0 $ :J"n $ 1'2, CO
Dividends
Pension
Annuitv
Social Security
Rents
Royalties
Expense Account
Gifts
Unemo)ovrnent
Workmen's
Comnensation
Other
Other
TOTAL $ .~O $ ;)',00 $a,1.7C>
TOTAL INCOME $ 1:1., tJ 0"
Service Type M
PROPERTY
OWNED
Ownership II<
DESCRIPTION
VALUE H W J
Credit U niaD
Checking Accounts
Savings Accounts
Stocks/Bonds
Real Estate
Other
* H='Hnsband; W~Wife; J=Joint
Fonn IN-DOS
Worker ID 21205
Income and Expense Statement
PACSES Case Number 942105436
Coverage '"
INSURANCE H W C
COMPANY POLICY #
Hosvital I?I {p 177.!f<f2 ~
~
~
Medical ~ It.. t72.W2.- X".
~.'h_
ther
Health/Accident
Disability Income
Dental
Other
. H=Husband; W=Wife; C~Cbild
..
Section II: Supplemental Income Statement
a. This form is to be filled out by a person
D (1) who operates a business or practices a profession, or
o (2) who is a member of a partnership or joint venture, or
D (3) who is a shareholder in and is salaried by a closed corporation or similar entity.
b. Attach to this statement a copy of the following documents relating to the partnership, joint venture, business, profession,
corporation or similar entity:
(1) the most recent Federal Income Tax Return. and
(2) the most recent Profit and Loss Statement
C. Name of business:
Address and telephone number:
d. Nature of business (check one)
D (1) partnership
o (2) joint venture
o (3) profession
o (4) closed corporation
D (5) other
e. Name of accountant, controller or other person in charge of financial records:
f. Annual income from business:
(l) How often is income received?
(2) Gross income per pay period:
(3) Net income per pay period:
(4) Specified deductions, if any:
Service Type M
Page 2 013
Form IN-OOS
Worker ID 21205
Section ill: Expenses
PACSES Case Number 942105436
Income and Expense Statement
Instructions: Only show extraordinary expenses in this section unless you fllled out Section II on page two. The categories
in BOLD FONT are especially important for calculating child support, If you are requesting Spousal SupportlAPL or if
you assert your case cannot be determined according to the guideline grids or formula. this section must be fully completed.
(Fill in Appropriate Column) EXPENSES (
EXPENSES
WEEK MONTH YEAR (continued) WEE
Home Education
!?Mortgage,,-ent $ 1...0. eft $lJJ".~ $11 2/f,M Private School $ '"
Mati'i'fenance i, e.... <'^.oo 6oo.tJO Parochial School "
Utilities College ".,
Electric $ ~. , $ ':l 00.01'> $ ,llJ ...",., Religious 0
Gas ,... 0 1> Personal
Oil D 6 0 Clothing $';-'
Telephone 2.,. ..,"7 IJ-'S,() lJ 1.'100.00 Food 166.
Water " C> 15 Barberi 3.7
Sewer f) ,\ II H*",.'~'
Emnlovment Credit Payments
Credit Card C^,6
Public Transport. $ 0 $ 0 $ a Charge I--~
Lunch CA ..~ ..oO..OU 'hI, "
Memberships L..:"
Taxes Loans v '-"
Real estate $ ;?-v,,">I. $ "f'L,JL. $ t 1'0...,60
Credit Union $ "
Personal Property
Insurance
Homeowner's $ S;U' $ .".<n $ 1'7....00
Automobile / 9.<:'{) .,(l-.M> C I", ,^ Miscellaneous
Life '29.''/.... -;~~.J" ;' I:;"., ZO Household Hehp $
0
Accident Child care ()
Health 21..<<~ ql,~z.. 10 r~.f~ Papers/books t1
Other Ma01l7inp...
Automobile Entertainment 0
Payments $ 100 ~^ $ 'I )'1-0" $ 5:3. !r"~ Pay TV /1\0..".... ....1('0
Fuel ZGoll / DO, oJ> : ",,0. .011 Vacation <0
Repairs 1"2 :-;:'" 0,11) ';_", .dD Gifts
Medical Legal fees I..iI I
Doctor $/0. oj 0 $ 4/,' 0 $<-:"0,00- Charitable .,...
Dentist ~her . d ()
Orthodontist -~
J' Alimony r
Hospital . ,0 P.v~,';'.
Medicine 5. C,). '2.-6'01) ?-'fo,O' ' Other H.' 0 70 -",,,,.
(E~r $J~Y~
bfAr~. 41.l.7 }/,L,107' ..:J "~'."
. devit'H!
-,
Fill in Appropriate Column)
K
MONTH YEAR
$ $ (J
lJ
t:'J
0 (;)
o
00'
$
$
$
<r
. 00
/
I Total I WEEK MONTH YEAR l
Expenses: $/O?'{,nJ $ '-IJ'/~.'Z." s '19 10(., '/91
I verify that the. statement,s made in th~s ~come and Expense Statement are true and correct. I understand that false
state:e;;:e/:::r~SUbJect to the crnomal penalties of 18 Pa. C.S, ~ 4904, relating to ~n:a-n !alsZion to authorities.
Date I I ~
Page 3
Service Type M
Form IN-008
Worker ID 21205
StaDdud ,..!8-.
1leY.7111
U.s.OfIIct"'.........~ _
fl'Ms.". 81-33..... 4
NOTIFICATION OF PERSONNEL ACTION
5-A. Code
894
5-C. Code
QHP
5-E. Code
ZLM
5-8. NaIun at Actlon
Pay Adj
5-D.~A._
Reg 530.306 (A) (1)
5-P.~AlIlIlodtJ
E.O, 13282, Dated 31-DEC-2002
6-A. Code
ti-B. Nldurt or AdIon
6-C. Code
6-D. LepI Authority
6-& Code
6-P. LtpI Authority
7. FROM: PaIIdoD 11IIe.... NIIIIlber
IT SPECIALIST (lNFOSEC)
D1274 - 65453
15. TO: PGIltIon Tide and Number
IT SPECIALIST (INFOSEC)
D1274 - 65453
$60,660.00
so
so
ZOA. a.Ic ...,
S62,548.oo
2OB.LocaIIlfAdJ.
SO .
S6z,s48.oo
SO
13. Pay'" 16...,.... .7. Occ. Code .& GrMelLeYel
PA GS 1210 11
14. "'.... ~ and Locatlon or Pa.Jdon., 0rpnIutI0n
DISNWMPVTING SERVICES DIRECfORATE
DECC MECIIANlCSBURG
SECURITY DlVISI0N
INFORMATION ASSURANCE BRANCH
MECHANlCSBURG, PA ORA WMB-CDM22
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DISAlCOMPUTlNG SERVICES DIRECTORATE
DECC MECIIANlCSBURG
SECURITY DlVISlON
INFORMATION ASSURANCE BRANCH
MECIIANlCSBURG, PA ORA WMB-CDM22
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49. ApprcmaI Date
01-11-2003
Joyce M, Short
DlRECfOR, REGIONAL SERVICE CENTER
SUZANNE F. BARTH,
PLAINTIFF
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVlWIA
v.
NO. 2003 - 0227 CIVIL TERM
DEFENDANT
PACSES NO. 942105436
DOMESTIC RELATIONS SECTION
JOHN W. BARTH,
PLAINTIFF'S EXCEPTIONS TO SUPPORT ~STER'S
REPORT AND RECOMMENDATION
AND NOW comes the Plaintiff, Suzanne F. Barth, by and through
her attorney, Thomas D. Gould, and files these exceptions to the
Support Master's Report and Recommendation..
1. Finding of Fact #6 is not totally accurate. The husband
applied to refinance the existing mortgage on the marital residence
and to provide the funds to pay SOME of the marital debt, husband
did not secure funds to pay the marital debt on the vehicle driven
by wife.
2. Finding of Fact #10, although this finding is stated in
a "Whereas" clause it is contradicted by the parties testimony,
attorney Walter's testimony, Finding of Fact #9 and paragraph 6 of
the Separation Agreement. The stated purpose of the agreement was
to transfer wife's interest in the marital home to husband so that
he could refinance the mortgage.
3. The Master erred in failing to make the following
relevant Findings of Fact based on the evidence:
A. Attorney Walters stated that he was not either
parties' attorney.
B. Husband stated that attorney Walters was his
attorney.
C. Husband hired attorney Walters to prepare the
agreement for him.
D. Attorney Walters prepared the agreement and went over
each of the provisions with husband.
E. Attorney Walters did not review the agreement with
wife nor did he discuss any of the provisions with her.
F. The agreement, page paragraph 6, states that the
parties agree to equally divide the cost of preparation of the
agreement.
G. Wife never met attorney Walters before she went to
his office to sign the agreement he prepared at the request of
husband.
H. Wife did not pay any portion of attorney Walters'
document preparation fee.
I. Husband paid attorney Walters $250.00 for preparing
the agreement from his personal funds.
J. Paragraph 6 of the agreement provides ~This document
is prepared for the purpose of confirming the rights and
obligations of both parties to the real estate situate at 2524
South Market Street, Mechanicsburg, Cumberland County,
Pennsylvania."
K. The reason the agreement was not limited to its
stated purpose of establishing rights to the marital home, such as
pension and supportl alimony/APL, was at the suggestion of attorney
Walters to husband.
L. At no time was wife advised by husband or attorney
Walters that the agreement's purpose was other than the transfer of
ownership of the marital home for husband's refinancing.
M. Husband did not make a full and complete disclosure
to the wife of all assets of any nature whatsoever in which husband
had an interest, of the source and amount of such interest of every
type whatsoever and all other facts relating to the subject of the
Agreement.
N. Husband retained all the equity in the marital home,
estimated to be $10,000.00 to $15,000.00.
O. Wife received no consideration from husband for her
relinquishing her interest in the equity in the marital home.
P. The agreement does not accurately disclosure the
value of the marital home or the equity that husband was to retain.
Q. Paragraph 4 of the agreement is misleading it that it
states the gross amount of the original mortgage and the amount of
husband's intended mortgage without disclosing the amount of the
current mortgage or the fair market value of the marital home.
R. Husband advised wife that he had a pension and if he
died she would be entitled to make a claim.
s. Husband did not advise wife that she had any interest
in his pension prior to his death, specifically that it was marital
property subject to equitable distribution in a divorce.
T. Husband knew that his pension, at the time of
separation, was worth at lease $1,500.00 per month.
U. Husband did not disclose his monthly pension value
to wife.
v. Wife had no knowledge of the value of husband's
pension.
W. Husband agreed to pay wife's car payments in exchange
for her releasing her interest in the marital home.
X. Husband told wife not to tell attorney Walters about
the car payment because it would mess up his home refinancing.
Y. Husband made four of wife's car payments, following
the execution of the agreement.
z. Husband stopped making wife's car payments when he
saw wife's male friend driving her car.
AA. Husband's base pay gross annual income is $62,548.00
or $5,212.33 per month.
BB. Husband consistently works overtime averaging
$600.00 per month.
CC. Husband's gross monthly income is $5,812.33.
DO. During the marriage wife had cashed in her 401(k)s
from her past employers and used the funds to pay marital debt and
living expenses.
EE. At the time of separation wife had little or no
retirement or pension funds.
4. The Support Master made an error of law when he concluded
that there had been a full, fair and complete disclosure of wife's
interest in and the value of husband's pension.
S. The Support Master erred as a matter of law when he
concluded the wife's mere knowledge that husband had a pension,
even though pursuant to husband's statement~3, she believed that she
had no right to the pension unless husband died and she had no
knowledge of the value of the pension, is adequate disclosure of a
marital asset.
6. The Support Master erred when he failed to conclude that
husband and his attorney misrepresented to wife the purpose of the
agreement.
7. The Support Master erred when he failed to conclude that
the intention of the parties in entering into the agreement was to
establish the rights and interest in the marital home, not to set
forth ancillary property interests and rights.
8. The Support Master erred as a matter of law in failing to
determine that the provisions regarding the purpose of the
agreement were ambiguous and inconsistent and therefore the terms
should have been construed against the drafter, husband.
WHEREFORE Suzanne F. Barth requests this Honorable court to
vacate its Interim Order of Court and award her APL pursuant to the
support guidelines.
Respectfully submitted,
----;k"iU O. ~
Thomas D. Gould
Attorney for Plaintiff
I.D. # 36508
2 East Main Street
Shiremanstown, PA 17011
(717) 731-1461
SUZANNE F. BARTH,
PLAINTIFF
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO. 2003 - 0227 CIVIL TERM
DEFENDANT
PACSES NO. 942105436
DOMESTIC RELATIONS SECTION
JOHN W. BARTH,
CERTIFICATE OF SERVICE
AND NOW, this (
day of August 2003, I, Thomas D. Gould,
Esquire, Attorney for Plaintiff, Suzanne F'. Barth, hereby certify
that I have this day sent a copy of Plaintiff's Exceptions to
Support Master's Report and Recommendation by depositing a copy of
it in the United States mail, postage prepaid, addressed to:
SUSAN K. CANDIELLO, ESQUIRE
5021 E. TRINDLE ROAD
SUITE 100
MECHANICSBURG, PA 17050
DATED Jju,...rr 'I U1(J')
-1&........ /.). ~
Thomas D. Gould, Esquire
ID # 36508
2 East Main Street
Shiremanstown, PA 17011
(717) 731-1461
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SUZANNE F. BARTH,
PLAINTIFF
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
vs.
: NO. 2003-0227 CIVIL TERM
DEFENDANT
: PACSES NO. 942105436
: DOMESTIC RELATIONS SECTION
JOHN W. BARTH,
DEFENDANT'S RESPONSE TO PLAINTIFF'S EXCEPT.ONS
TO SUPPORT MASTER'S REPORT AND RECOMMEND~TION
AND NOW comes the Defendant, John W, Barth, by and through his counsel, Susan Kay
Candiello, Esquire, ofthe Law Firm of Susan Kay Candiello, P.C., and files this Response to the
Plaintiff s Exceptions to Support Master's Report and Recommendation,
1.
Admitted in part and Denied in part.
Admitted: Husband did not payoff
the loan on Wife's vehicle. Denied in part and by way of further explanation, at the time the
parties separated, Husband and Wife did not view this as marital debt, since Wife kept
possession of her vehicle, Upon Wife's request, Husband, after the signing of the Separation
Agreement (hereinafter referred to as the" Agreement"), verbally agreed to continue to pay the
loan and the insurance on Wife's vehicle. Upon seeing Wife's paramour driving Wife's vehicle,
Husband made a request to Wife that her paramour not drive Wife's vehicle, Wife ignbred
Husband's request, Husband again saw Wife's paramour driving the vehicle and stopped
making the payments on the vehicle loan and the vehicle insurance.
2, Admitted in part and Denied in part, Admitted: Paragraph #6 is in the
Agreement. It is denied that any contradictions exist. The Master's Fact #9 is true. The credit
union did require an agreement in which Wife relinquished all her right, title and inter~st in the
marital residence to Husband. Fact #10 is true, Attorney Walters did prepare a comp~ehensive
I
marital settlement agreement for the parties to sign. These two purposes are not exclu~ive of
II
each other. The language contained in the Separation Agreement is typical oflanguage
contained in a separation or divorce situation, where parties desire to resolve the property issues
between them.
3. Defendant responds to the Plaintiff's allegations as to the Master's individual
Findings of Fact as follows:
a. Denied: Attorney Walters entered this matter as a result oflnis
interactions with the credit union. Attorney Walters stated he
responded to both parties and attempted to address both parties' legal
needs and did not view himself as either party's attorney;
b. Denied: Husband did not state Attorney Walters was "his" attorney,
Husband identified Attorney Walters as the attorney recommended by
the credit union to assist both he and his Wife;
c. Denied: Husband went to the counsel the parties' joint credit union
recommended, Husband and Wife both wanted to achieve the same
goal of transferring the marital residence and marital debt to Husband.
Wife had a paramour and wanted to leave the marriage, This was the
rationale for all actions by Husband to identify how these things could
be accomplished, Husband only initiated what both Husband and
Wife wanted to occur. At all times Wife knew what Husband was
doing and his contact with Attorney Walters. Wife deliberately made
a decision not to take any action to obtain her own counsel ~ecause she
agreed with the utilization of Attorney Walters and she agref<i with
Attorney Walters's actions and documents;
II
d. Admitted in part and Denied in part: Husband was the individual who
provided information to Attorney Walters. Husband received the
initial draft of the Agreement from Attorney Walters and then shared a
copy of the draft of the Agreement with Wife. Attorney Walters
stated when Wife came to his office to sign the Agreement it was his
understanding Wife had previously received the copy of the
Agreement he sent with Husband to give to Wife. Attorney Walters
further stated he questioned Wife about the Agreement and she
appeared very comfortable with the Agreement, Attorney Walters
asked Wife if she had any questions or if she wanted the ability to take
this Agreement to another attorney. Wife said no to both questions.
Attorney Walters stated he did not review the Agreement by each
paragraph, but did generally review the Agreement with both parties;
e. Denied: Attorney Walters did testify he briefly reviewed the
Agreement with the parties;
f Admitted.
g. Admitted.
h, Admitted.
i. Denied. Husband paid Attorney Walters from marital funds,
J. Admitted. By way of further explanation, Paragraph 6 is ~ purpose
of the Agreement,
II
k. Denied. Husband stated throughout his testimony he expected the
Agreement to protect his source of income, since he had assumed the
responsibility for all the marital debt;
1. Admitted in part and Denied in part. Neither Attorney Walters nor
Husband could remember what was exactly stated. However, both
Attorney Walters and Husband could remember Wife was provided
with a draft of the Agreement prior to signing the Agreement.
Attorney Walters stated he asked Wife if she had any questions and,
further, Attorney Walters remembers he specifically asked Wife if she
had read and understood the agreement and if she wanted the ability to
obtain counsel to explain any questions she might have;
m. Denied. Husband testified Wife handled all the financial matters in
their home during their marriage, Husband further testified \Ie did not
know the exact value of his retirement, but he knew and repeatedly
stated to Wife she would get his retirement in the event of his demise.
Husband remembered when married they periodically received a
statement of his retirement, which Wife would have seen;
n, Denied. Husband testified he paid for four (4) months ofwl.fe's
vehicle loan and car insurance, in addition to giving several thousand
dollars to Wife for her new furniture and other items for Wife's new
home;
! !
o. Denied. Husband assumed full responsibility for the marital debt, one-
haif(1/2) of which was Wife's responsibility, Additionally Husband
paid to Wife the payments stated in Paragraph "n" above;
p, Admitted. By way of further explanation, frequently in a marital
settlement agreement where the parties have reached an amicable
agreement as to the division of marital property, specific val~s are not
identified in the Agreement;
q. Denied. Paragraph 4 is not misleading. Paragraph 4 states the old
mortgage and the new mortgage, clearly and correctly, Paragraph 4
was not intended to state any value of the marital residence; .
r. Admitted in Part and Denied in Part. Admitted: Husband did state to
Wife, at times throughout the marriage, he had a pension and upon his
death she would receive some benefits, Denied: That Wife's only
understanding of Husband's retirement was that she would be
provided for at Husband's death,
s, Denied, Wife knew it was possible to obtain a pension prior to death,
Wife withdrew and spent her pension with a former employer.
Further, Wife received information about Husband's retirement values
during the marriage;
1. Admitted,
u. Denied. Husband did not remember exactly what he stated to Wife.
!
I
Husband stated Wife had access to the same documents fro~ his
retirement, which came to the marital residence, Husband Jd access
!
II
to and from which he knew the amount he would receive through his
retirement;
v. Denied. Wife had access to the same documents from his retirement,
which came to the marital residence, Husband had access to and from
which he knew the amount he would receive through his retirement.
Wife did not deny this in her testimony at the hearing;
w. Denied. Wife agreed to relinquish her interest in the marital home in
exchange for Husband assuming the marital debt. Nothing was stated
prior to or at the time of, nor was anything included in the written
Agreement regarding the Wife's vehicle loan. If this was Wife's
understanding, why would she sign t.he Agreement without any
mention of the vehicle loan in the Agreement? By way of further
explanation, both Husband and Wife knew Wife's vehicle loan was
not intended to be included in the Agreement. After the p~ies signed
their Agreement, Wife asked Husband if he would continue to pay her
vehicle loan and insurance. Husband agreed, until he witnessed
Wife's paramour driving Wife's vehicle on several occasioIlls;
x. Denied. Husband did not make any such statement to Wife.
y. Admitted.
z. Admitted.
aa. Admitted in part and Denied in part. Husband's gross pay 'fas
significantly less at the time of the Agreement. Following t~e parties'
separation and the execution of this Agreement, Husband h~s been the
II
beneficiary of some significant changes in his employment position
resulting in increased income to Husband. This occurred after the
parties' separation as a result of Husband's skills and ability. Wife did
nothing to contribute to Husband's ability to increase his earnings
post-separation;
bb. Denied. Husband has frequently been away from work, as a result of
his poor health and surgeries. In fact, Husband is taking an early
retirement as a result of his poor health;
cc. Admitted.
dd. Admitted in part and Denied in part. Wife did cash in her 40lk during
the marriage. What marital bills and what individual actions Wife
utilized her 401k for was not offered into evidence at the hearing;
ee. Husband does not have sufficient knowledge to ascertain whether this
statement is true or untrue.
4. Denied. The Master did not make any errors when he determined there was a full and
fair disclosure of Wife's interests in the value of husband's pension. Both Husband and Wife
testified they had knowledge of Husband's retirement. Husband further testified he gl$lerally
knew of the value, but not specifically. Husband also testified Wife had the same or sImilar
knowledge through her actions as the financial officer of the parties' marriage.
5. Denied. The Master did not err as a matter oflaw in concluding Wife had adequate
disclosure of Husband's retirement. Wife is a reasonably intelligent person. Wife liq1f1idated her
,
own individual retirement. Wife handled all financial documents during the marriage~ including
II
Husband's retirement documents. Wife knew Husband had a retirement. The very word
"retirement" suggests income prior to death.
6. Denied. Husband and Attorney Walters did not misrepresent the Agreement to Wife.
Wife had the time and ability to read the Agreement. Wife had sufficient time and the ability to
make any inquiries about the Agreement she may have wanted to make. Certainly to s~gest
Wife believed the Agreement was only for the purpose of transferring Wife's interests in the
marital residence and to even scan through the Agreement suggests, if Wife's arguments and
statements are true, Wife would have refused to sign the Agreement and sought additiottallegal
counsel.
7. Denied. Husband repeatedly stated it was his intention to "protect his incolllle" to
enable him to afford the responsibility he had assumed at the time of the Agreement given his
income at that time.
8. Denied. The provisions of the Agreement are not ambiguous and inconsistent. The
provisions are very clearly stated.
WHEREFORE, Defendant, JOHN W. BARTH, respectfully requests this Honorable
Court uphold the Interim Order of the Support Master and deny the Plaintiff, SUSAN F.
BARTH, Alimony Pendente Lite.
Respectfully submitted,
LAW FIRM OF SUSAN KAY CANDmLLO, P.C.
Dated: August I S 2003
usan Kay Candie
Counsel for Defe
PA J.D. # 64998
5021 East Trindle Road, Suite 100
Mechanicsburg P A 17050
(717) 796-1930
II
VERIFICATION
The undersigned hereby verifies that the facts averred in the foregoing document are true
and correct to the best of his knowledge, information, and belief. This verification is made
subject to the penalties of 18 Pa. C.S.A. S4904 relating to unsworn falsification to authorities.
DATED: FYf..::;/o..3
,/
~rlvA~ !b.^~
~-WILLIAM BARTH
II
CERTIFICATE OF SERVICE
I, Susan Kay Candiello, Esquire, of the Law Firm of Susan Kay Candiello, P.C., hereby
certify that I served a true and correct copy of the foregoing Defendant's Response to Plaintiff's
Exceptions to Support Master's Report and Recommendation, by first-class United States mail,
to the following:
Thomas D. Gould, Esquire
2 East Main Street
Shiremanstown P A 17011
LAW FIRM OF SUSAN KAY CANDmLLO, P.C.
Dated: August ~ 2003
Susan Kay Cand', e
Counsel for De ndant
PA J.D. # 6499
5021 East Trindle
Suite 100
Mechanicsburg P A 17050
(717) 796-1930
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Suzanne F. Barth
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
V
John W. Barth
: NO. 03-227 CIVIL TERM
ORDER OF COURT
AND NOW, September 15,2003, the case is stricken from the August 27,2003
trial term and will be assigned to a judge for disposition.
By the Court,
~omas D. Gould, Esquire
For the Plaintiff
~san K. Candiello, Esquire
For the Defendant
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Court Administrator
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SUZANNE F. BARTH,
PLAINTIFF
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO. 2003 - 0227 CIVIL TERM
PACSES NO. 942105436
DOMESTIC RELATIONS SE<0IO~ib 0
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PLAINTIFF'S EXCEPTIONS TO SUPPORT MASTER'S'Z);;, :ri;
REPORT AND RECOMMENDATION ~;3:-~~
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AND NOW comes the Plaintiff, Suzanne F. Barth, by and~hnoug~
JOHN W. BARTH,
DEFENDANT
'-I
her attorney, Thomas D. Gould, and files these exceptions to the
Support Master's Report and Recommendation.
1. Finding of Fact #6 is not totally accurate. The husband
applied to refinance the existing mortgage on the marital residence
and to provide the funds to pay SOME of the marital debt, husband
did not secure funds to pay the marital debt on the vehicle driven
by wife.
2. Finding of Fact #10, although this finding is stated in
a .Whereas" clause it is contradicted by the parties testimony,
attorney Walter's testimony, Finding of Fact #9 and paragraph 6 of
the Separation Agreement. The stated purpose of the agreement was
to transfer wife's interest in the marital home to husband so that
he could refinance the mortgage.
3. The Master erred in failing to make the following
relevant Findings of Fact based on the evidence:
A. Attorney Walters stated that he was not ei ther
parties' attorney.
B. Husband stated that attorney Walters was his
attorney.
C. Husband hired attorney Walters to prepare the
agreement for him.
D. Attorney Walters prepared the agreement and went over
each of the provisions with husband.
E. Attorney Walters did not review the agreement with
wife nor did he discuss any of the provisions with her.
F. The agreement, page paragraph 6, states that the
parties agree to equally divide the cost of preparation of the
agreement.
G. Wife never met attorney Walters before she went to
his office to sign the agreement he prepared at the request of
husband.
H. Wife did not pay any portion of attorney Walters'
document preparation fee.
I. Husband paid attorney Walters $250.00 for preparing
the agreement from his personal funds.
J. Paragraph 6 of the agreement provides "This document
is prepared for the purpose of confirming the rights and
obligations of both parties to the real estate situate at 2524
South Market Street, Mechanicsburg, Cumberland County,
Pennsylvania."
K. The reason the agreement was not limited to its
stated purpose of establishing rights to the marital home, such as
pension and support! alimony!APL, was at the suggestion of attorney
Walters to husband.
L. At no time was wife advised by husband or attorney,
Walters that the agreement's purpose was other than the transfer of
,
ownership of the marital home for husband's refinancing.
M. Husband did not make a full and complete disclosure
to the wife of all assets of any nature whatsoever in which husband
had an interest, of the source and amount of such interest of every
type whatsoever and all other facts relating to the subject of the
Agreement.
N. Husband retained all the equity in the marital home,
estimated to be $10,000.00 to $15,000.00.
o. Wife received no consideration from husband for her
relinquishing her interest in the equity in the marital home.
P. The agreement does not accurately disclosure the
value of the marital home or the equity that husband was to retain.
Q. Paragraph 4 of the agreement is misleading it that it
states the gross amount of the original mortgage and the amount of
husband's intended mortgage without disclosing the amount of the
current mortgage or the fair market value of the marital home.
R. Husband advised wife that he had a pension and if he
died she would be entitled to make a claim.
S. Husband did not advise wife that she had any interest
in his pension prior to his death, specifically that it was marital
property subject to equitable distribution in a divorce.
T. Husband knew that his pension, at the time of
separation, was worth at leas1($1,500.00 per month.
U. Husband did not disclose his monthly pension value
to wife.
V. Wife had no knowledge of the value of husband's
pension.
W. Husband agreed to pay wife's car payments in exchange
for her releasing her interest in the marital home.
X. Husband told wife not to tell attorney Walters about
the car payment because it would mess up his home refinancing.
Y. Husband made four of wife's car payments, following
the execution of the agreement.
Z. Husband stopped making wife's car payments when he
saw wife's male friend driving her car.
AA. Husband's base pay gross annual income is $62,548.00
or $5,212.33 per month.
BB. Husband consistently works overtime averaging
$600.00 per month.
CC. Husband's gross monthly income is $5,812.33.
DD. During the marriage wife had cashed in her 40l(k)s
from her past employers and used the funds to pay marital debt and
living expenses.
EE. At the time of separation wife had little or no
retirement or pension funds.
4. The Support Master made an error of law when he concluded
that there had been a full, fair and complete disclosure of wife's
interest in and the value of husband's pension.
S. The Support Master erred as a matter of law when he
concluded the wife's mere knowledge that husband had a pension,
even though pursuant to husband's statements, she believed that she
had no right to the pension unless husband died and she had no
knowledge of the value of the pension, is adequate disclosure of a
marital asset.
6. The Support Master erred when he failed to conclude that
husband and his attorney misrepresented to wife the purpose of the
agreement.
7. The Support Master erred when he failed to conclude that
the intention of the parties in entering into the agreement was to
establish the rights and interest in the m2rital home, not to set
forth ancillary property interests and rights.
8. The Support Master erred as a matter of law in failing to
determine that the provisions regarding the purpose of the
agreement were ambiguous and inconsistent and therefore the terms
should have been construed against the drafter, husband.
WHEREFORE Suzanne F. Barth requests this Honorable court to
vacate its Interim Order of Court and award her APL pursuant to the
support guidelines.
Respectfully submitted,
~l2<? O. ~
Thomas D. Gould
Attorney for Plaintiff
1. D. # 36508
2 East Main Street
Shiremanstown, PA 17011
(717) 731-1461
SUZANNE F. BARTH,
PLAINTIFF
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO. 2003 - 0227 CIVIL TERM
DEFENDANT
PACSES NO. 942105436
DOMESTIC RELATIONS SECTION
JOHN W. BARTH,
CERTIFICATE OF SERVICE
AND NOW, this {
day of August 2003, I, Thomas D. Gould,
Esquire, Attorney for Plaintiff, Suzanne F. Barth, hereby certify
that I have this day sent a copy of Plaintiff's Exceptions to
Support Master's Report and Recommendation by depositing a copy of
it in the United States mail, postage prepaid, addressed to:
SUSAN K. CANDIELLO, ESQUIRE
5021 E. TRINDLE ROAD
SUITE 100
MECHANICSBURG, PA 17050
DATED {L.,...rT " 2-4(/3
~_D.~
Thomas D. Gould, Esquire
ID # 36508
2 East Main Street
Shiremanstown, PA 17011
(717) 731-1461
SUZANNE F. BARTH,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
vs.
CIVIL ACTION - LAW
03-227 CIVIL
PACSES NO. 942105436
JOHN W. BARTH,
Defendant
ORDER
.ill
AND NOW, this ...., day of August, 2004, the plaintiff having filed exceptions to
the Support Master's Report and Recommendation, it is hereby ordered as follows, pursuant to
Rule 1910.12, C.C.R.P.:
1. The stenographer for the Support Master shall transcribe and file the notes of
test.imony, and the plaintiff shall bear the cost of the original transcript.
2. The plaintiff shaH file a brief, in these chambers, in support of the exceptions not later
than fifteen (15) days from the date the transcript is filed.
3. The defendant shaH file a reply brief, in these chambers, not later than thirty (30) days
from the date the transcript is filed.
4. The issues raised in the exceptions wiH be decided on the briefs unless either party, at
the time of filing his or her brief, requests oral argument or the court directs that oral argument
be held. If oral argument is held, it will be scheduled before this judge.
BY THE COURT,
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SUZANNE F. BARTH,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
vs.
CIVIL ACTION - LAW
03-227 CIVIL
PACSES NO. 942105436
JOHN W. BARTH,
Defendant
IN RE: PLAINTIFF'S EXCEPTIONS TO THE SUPPORT MASTER'S
REPORT AND RECOMMENDATION
ORDER
AND NOW, this ,,,. day of September, 2004, following careful review of the
record and consideration of the briefs filed by the parties, the court being satisfied that the
Master was correct in his conclusion that the wife has waived h(:r right to alimony pendente lite
in an enforceable separation agreement, the exceptions of the plaintiff, Suzanne F. Barth, are
denied and the order of July 24, 2003, is herewith made a final order of court.
BY THE COURT,
v1homas D. Gould, Esquire
F or the Plaintiff
......crnda a. Clotfelter, Esquire
For the Defendant
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Support Master
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SUZANNE F. BARTH,
PLAINTIFF
IN THE COURT OF COMMON P
CUMBERLl\.ND COUNTY, PENNSY
v.
NO. 2003 - 0227
JOHN W. BARTH,
IN DIVORCE
DEFENDANT
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under Section 330llc) of the
Divorce Code was filed on January I, 2003.
2. The marriage of Plaintiff and Defendant is irretrie ably
broken and ninety (90) days have elapsed from the date of the
filing and service of the Complaint.
3. I consent to the entry of a Final Decree of Divorce after
service of notice of intention to request entry of the decree I
acknowledge that pursuant to Rule 1920.42(e) I have waived the
requirement that I receive notice of intention to request entr of
the decree.
I verify that the statements made in this Affidavit are rue
and ccrrect. I understand that false 'otat,ements herein are subject
to the penalties of 18 Pa. C.S. Section 4904 relating to uns ,orn
falsification to authorities.
DATED:
J/-/7-0lf
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BARTH
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SUZANNE F. BARTH,
PLAINTIFF
IN THE COURT OF COMMON P .AS
CUMBERLAND COUNTY, PENNSY ANIA
v.
NO. 2003 - 0227 CIVIL TE M
JOHN W. BARTH,
IN DIVORCE
DEFENDANT
AFFIDAVIT OF CONSENT
1. A Complaint In Divoice under Section 3301 (c) of I~he
Divorce Code was filed on January 1, 2003.
2. The marriage of Plaintiff and Defendant is irretrie ably
broken and ninety (90) days have elapsed from the date of the
filing and service of the Complaint.
3. I consent to the entry of a Final Decree of Divorce ater
service of notice of intention to request entry of the decree 1
acknowledge that pursuant to Rule 1920.42(e) I have waived the
requirement that I receive notice of intention to request entr of
the decree.
I verify that the statements made in this Affidavit are
ct
and correct. I understan::i that false statements herein are
to the penalties of 18 Pa. C.S. Section 4904 relating to unsw rn
falsification to authorities.
DATED:
1/ I ~G J~ -'1----------
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BARTH
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SUZANNE F. BARTH,
PLAINTIFF
IN THE COURT OF COMMON P EAS
CUMBERLAND COUNTY, PENNSY ~ANIA
v.
NO. 2003 - 0227 CIVIL TE
JOHN W. BARTH,
IN DIVORCE
DEFENDANT
WAIVER OF NOTICE OF INTENTION TO REOUEST
ENTRY OF A DIVORCE DECREE UNDER
SECTION 3301 (c) OF THE DIVORCE CODE
1. I consent to the entry of a final decree without notice.
2. I understand that I may lose rights concerning alim ny,
division of property, lawyer's fees or expenses if I do not c aim
them before a divorce is granted.
3. I understand that I will not be divorced until a div rce
decree is entered by the court and that a copy of the decree ill
be sent to me immediately after it is filed with the prothonot-ry.
I verify that the statements made in this Affidavit are rue
and correct. I understand that false statements herein are subj _ct
to the penalties of 18 Pa. C.S. Section 4904 relating to unsw rn
falsification to authorities.
DATED:
It- 1'1.0'-/
'\
BARTH
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SUZANNE F. BARTH,
PLAINTIFF
IN THE COURT OF COMMON P
CUMBERLAND COUNTY, PENNSYI
v.
NO. 2003 - 0227
JOHN W. BARTH,
IN DIVORCE
DEFENDANT
WAIVER OF NOTICE OF INTENTION TO REOUEST
ENTRY OF A DIVORCE DECREE UNDER
SECTION 3301(c) OF THE DJVORCE CODE
1. I consent to the entry of a final decree without no
2. I understand that I may lose rights concerning ali ny,
division of property, lawyer's fees or expenses if [ do not c aim
them before a divorce is granted.
3. I understand that I will not be divorced until a div rce
decree is entered by the court and that a copy of the decree ill
be sent to me immediately after it is filed with the prothonot ry.
I verify that the statements made in this Affidavit are rue
and correct. I understand that false statements herein are sub ect
to the penalties of 18 Pa. C.S. Section 4904 relating to uns orn
falsification to authorities.
DATED:
'! /;}.b /~()T) f
~7AJ.
.:fo N W. BARTH
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SUZANNE F. BARTH,
PLAINTIFF
IN THE COURT OF COMMON LEAS
CUMBERLAND COUNTY, PENNS LVANIA
v.
NO. 2003 - 0227 CIVIL
RM
JOHN W. BARTH,
IN DIVORCE
DEFENDANT
ACCEPTANCE OF SERVICE
I accept service of the Complaint in Divorce on behalf 0 John
W. Barth and certify that I am authorized to do so.
~-U ~ 3 ;lov <.
DA E I
usan Kay
1. D. # ~<I<
5021 East Road
Suite 100
Mechanicsburg, PA 17050
SUZANNE F. BARTH,
PLAINTIFF
IN THE COURT OF COMMON P
CUMBERIJi.ND COUNTY, PENNSY
v.
NO. 2003 - 0227
JOHN W. BARTH,
IN DIVORCE
PRAECIPE
To the Prothonotary:
Plaintiff, Suzanne F. Barth, hereby withdraws Claim # and
Claim # II of her complaint and wish that a divorce be gr nted
under Section 3301(c) of the Divorce Code.
There ar
no
outstanding issues to be resolved in this divorce.
t:W
Thomas D. Gould
ID # 36508
Attorney At Law
2 East Main Street
Shiremanstown, PA 17011
(717) 731-1461
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SUZANNE F. BARTH,
PLAINTIFF
IN THE COURT OF COMMON P
CUMBERLAND COUNTY, PENNSY
v.
NO. 2003 - 0227
JOHN W. BARTH,
IN DIVORCE
PRAECIPE TO TRANSMIT RECORD
To the Prothonotary:
Transmit the record, together with the following informa ion,
to the Court for the entry of a divorce decree:
1. Ground for divorce: irretrievable breakdown under Se tion
330l(c) of the Divorce Code.
Date of execution of the affidavit of consent
3,
2.
Date and manner of service of the complaint: On Mar
2003 by Acceptance of Service.
3.
by
Section 330l(c) of the Divorce Code: By Plaintiff, November 17,
2004; By Defendant, November 26, 2004.
4 .
Related claims pending:
N
5. Date Plaintiff's Waiver of Notice in S 330l(c) div rce
was filed with the Prothonotary on December 6, 2004.
Date Defendant's Waiver of Notice in s 330l(c) divo ce
was filed with the Prothonotary on December 6, 2004.
440.
Thomas D. Gould, Esquire
Attorney For Plaintiff
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IN THE COURT OF COMMON PLEA
OF CUMBERLAND COUNTY
SUZANNE F. BARTH,
PEN NA.
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STATE OF
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No.
2003-0227
Plaintiff
VERSUS
JOHN W. BARTH,
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Defendant
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DECREE IN
DIVORCE
AND NOW,
l)P -< c...~ 5(
ii{'11J:rfc.... .
p'l. IT IS ORDERE AND
SUZANNE F. BARTH
DECREED THAT
, PLAINTIFF,
JOHN W. BARTH
AND
. DEFENDAN .
ARE DIVORCED FROM THE BONDS OF MATRIMONY.
.
: THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHIC HAVE
.
. BEEN RAISED OF RECORD IN THIS ACTION FOR WHICH A FINAL ORDER HA NOT
YET BEEN ENTERED; NONE
~=----.....
PROTHONO RY
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