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OFFICE OF DIVORCE MASTER
CUMBERLAND COUNTY
COURT OF COMMON PLEAS
9 No~h Hanover Streel
Carlisle, PA 17013
(717) 240.6535
E. Robert Elicker, II
Divorce Mastel
Tr.cl .10 Colyer
Office Manager/Reporter
We.' Shore
697-0371 Ext. 6535
March 18, 1998
Paul R. Cullen, Jr.
1219 Kuhn Roazd
Boiling springs, PA 17007
Barbara Sumple-Sullivan
Attorney at Law
549 Bridge street
New Cumberland, PA 17070
RE: Margie H. Cullen vs. Paul R. Cullen, Jr.
No. 97 - 6093 Civil
In Divorce
Dear Ms. sumple-Sullivan and Mr. Cullen:
By order of Court of President Judge George E. Hoffer
dated March 16, 1998, the full-time Master has been appointed in
the above referenced divorce proceedings.
A divorce complaint was filed on November 5, 1997,
raising grounds for divorce of irretrievable breakdown of the
marriage. The complaint also raised the economic issues of
equitable distribution, alimony, alimony pendente lite, and
counsel fees and costs. Attached to the complaint was an
affidavit under section 3301(d) of the Domestic Relations Code
averring that the parties separated November 17, 1995, a period
in excess of two years. The Defendant filed a counter-affidavit
indicating that he did not wish to oppose the entry of a divorce
decree and that he wished to claim economic relief. As noted,
economic issues have been raised by wife in the complaint
consisting of equitable distribution, alimony, and counsel fees
and costs. Mr. Cullen has not raised any economic claims on his
own behalf.
Inasmuch as grounds for divorce are not an issue based on
the affidavit under Section 3301(d) and the filed
counter-affidavit, I am directing Ms. Sumple-Sullivan, as
attorney for Margie H. Cullen and Mr. Paul R. CUllen, Jr., who
represents himself, to each file a pre-trial statement in
accordance with P.R.C.P. 1920.33(b) on or before Monday, April
13, 1998. Upon receipt of the pre-trial statements, I will
MARGIE H. CULLEN,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
:
: CIVIL ACTION - LAW
:
: NO. 97 - 6093 CIVIL
VS.
PAUL R. CULLEN, JR.,
Defendant
IN DIVORCE
NOTICE OF PRE-HEARING CONFERENC~
TO: Barbara sumple-Sullivan
Thomas S. Diehl
, Counsel for plaintiff
, Counsel for Defendant
A pre-hearing conference has been scheduled at the
Office of the Divorce Master, 9 North Hanover street, carlisle,
Pennsylvania, on the 7th day of July, 1998, at 8:30 a.m., at
which time we will review the pre-trial statements previously
filed by counsel, define issues, identify witnesses, explore the
possibility of settlement and, if necessary. schedule a hearing.
Very truly yours,
Date of Notice: 4/14/98
E. Robert Elicker, II
Divorce Master
VS.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSVLVANIA
CIVIL ACTION - LAW
NO. 97 - 6093 CIVIL
MARGIE H. CULLEN,
Plaintiff
PAUL R. CULLEN, JR.,
Defendant
IN DIVORCE
RESCHEDULED PRE-HEARING CONFERENCE
TO: Barbara Sumple-Sullivan
Thomas S. Diehl
, Counsel for Plaintiff
, Counsel for Defendant
A pre-hearing conference has been scheduled at the
Office of the Divorce Master, 9 North Hanover street, Carlisle,
Pennsylvania, on the 17th day of August, 1998, at 9:30 a.m., at
which time we will review the pre-trial statements previously
filed by counsel, define issues, identify witnesses, explore the
possibility of settlement and, if necessary, schedule a hearing.
Very truly yours,
Date of Notice: 6/10/98
E. Robert Elicker, II
Divorce Master
LAW OPI'ICl-:s
BARBARA SUMPLE-SULLIVAN
~4" BRIDGE STREET
NEW CU~IIIERI.A.'JD. PENNSYLVANIA 17070-11101
}JUONH (717) n4-1-I4ft
FAX (717) "...70ny
Pursuant to your request. enclosed please find two (2) copies of the fully executed Marital
Settlement in the above-captioned matter.
/
August 19, 1999
E. Robert Elicker, II, Esquire
Divorce Master
9 North Hanover Street
Carlisle. PA 17013
Re: Cullen v, Cullen
No. 97-6093 Civil Term
Dear Divorce Master Elicker:
('
Barbara Sumple-Sullivan
BSS/lw
Enclosures
cc: Thomas S. Diehl, Esquire
Margie Cullen
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MARGIE H. CULLEN
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
Civil Action - Law
PAUL R. CULLEN, JR.
Defendant
NO. 97-6093
,
to. ,~ ~ASTER
AND NOW ,- , 19_. Esquire, is appointed master with respect to
the following claims: equitable distribution, alimony. alimony pendente lite, c:ounsel fees and costs.
By the Court:
p,
.,.
MARGIE H. CULLEN
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY. PENNSYLVANIA
v.
Civil Action. Law
PAUL R. CULLEN, JR.
Defendant
NO. 97-6093
MOTION FOR APPOINTMENT OF MASTER
PLAINTIFF. moves the court to appoint a master with respect to the fcllowing claims:
( ) Divorce
( ) Annulment
(X) Alimony
(X) Alimony Pendente Lite
(X) Distribution of Property
( ) Support
(X) Counsel Fees
(X) Costs and Expenses
and in support of the motion states:
(1) Discovery is not complete as to the c1aim(s) for which the appointment of a master is requested.
(2) Defendant has appeared pro se and has no attorney of record.
(3) The Statutory grounds for divorce are Irreconcilable differences. the two year separation period
has lapsed.
(4) The action is contested with respect to the following claims: equitable distribution, alimony.
alimony pendente lite. counsel fees and costs.
(5) The action does not involve complex issues of law or fact.
(6) The hearing is expected to take one day.
(7) Additional infonnation. if any, relevant to the motion:
Plaintiff requires documentation of values of various assets and" fonna 'on to value the marital portion
of Defendant's employment/retirement benefits. Said documentation d inf
control of Defe j~
Daled: .. ~ 51': F
arbara Sumple-Sullivan, Esquire
Attorney for Plaintiff
549 Bridge Street
New Cumberland, PA 17070-1931
(717) 774-1445
Supreme Court 1.0. No. 32317
MARGIE H. CULLEN
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
Civil Action - Law
..
PAUL R. CULLEN. JR.
Defendant
NO. 97-6093
.
CERTIFICATE OF SERVICE
I. Barbara Sumple-Sullivan. Esquire. do hereby cenify that on this date, I served a true and correct copy
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of the foregoing MOTION FOR APPOINTMENT OF MASTER. in the above-captioned mailer upon the
following individual{s) by first class mail. postage prepaid. addressed as follows:
DATED:
16/ff
Mr. Paul K. Cullen. Jr.
1219 Kuhn Road
Boiling Springs, PA 17007
/
/
/
/' --'
/a-dara Sumple-Sullivan. Esquire
Allomey for Plaintiff
549 Bridge Street
New Cumberland. PA 17070-1931
(717) 774-1445
Supreme Coun 1.0. No. 32317
MARGIE H. CULLEN.
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
IV:, lJII- tf (111 (f.. / 7;'( 1!'---
vs.
PAUL R. CULLEN. JR..
Defendant
IN DIVORCE
COUNTER.AFFIDA VIT UNDER SECTION 330 )(dl OF THE DIVORCE CODE
1. Check either (a) or (b):
I.--~) I do not oppose the entry of a divorce decree.
_ (b) I oppose the entry of a divorce decree because
(Check (j) Oi) or both):
_ (j) The parties to this action have not lived separate and apan for a period of at least two
years.
_ (ii) The marria!le is not irretrievably broken,
2. Check either (a) or (b):
_ (a) I do not wish to make any claims for economic relief. I understand that I may lose
rights concerning alimony. division of property, lawyer's fees or expenses if (do not claim them
before a divorce is granted.
~ I wish to claim economic relief which may include alimony. divisio~ of property.
lawyer's fees or expenses or other important rights.
( verify that the statements made in this counteraffidavit are true and correct. (understand
that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating
to unsworn falsification to authorities.
Dated: IIPt:/97
I .
NOTICE: If you do not with to oppose the entry of a divorce decree and you do not wish to
make any claim for economic relief. you need not file this counteraffidavit.
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MARGIE H. CULLEN.
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO: 9'1- ~o9J
Cl....... ( '--ri' /Z. ~
PAUL R. CULLEN, JR..
Defendant
CIVIL ACTION. LAW
IN DIVORCE
COMPLAINT IN DIVORCE
1. Plaintiff is MARGIE H. CULLEN. an adult individual residing at 422 Brook
Circle. Mechanicsburg. Cumberland County. Pennsylvania 17055.
2. Defendant is PAUL R. CULLEN, JR.. an adult individual residing at 1219 Kuhn
Road. Boiling Springs, Cumberland County, Pennsylvania 17007 and receiving mail at P.O. Box
472. Boiling Springs. Pennsylvania 17007.
3. Both Plaintiff and Defendant have been bona fide residents in the Commonwealth
of Pennsylvania for at least six (6) months prior to filing this complaint,
4. The Plaintiff and Defendant were married on April 22, 1978, in Pinellas County.
Florida.
5. There is one (I) minor child born of this marriage: Timothy J. Cullen. born
November 26, 1980.
1
MARGIE H. CULLEN,
Plainliff
v.
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO:
PAUL R. CULLEN, JR..
Defendant
CIVIL ACTION. LAW
IN DIVORCE
VERIFICATION
I, MARGIE H. CULLEN. hereby cenify that the facts set fonh in the foregoing
COMPLAINT IN DIVORCE are true and correct to the best of my knowledge. infonnation
and belier. I understand that any false stalements made herein are subject to
penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn falsification to auth?rities.
Dated: II- I ' ttl-
1)~~
MARG . CU N
v.
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO: 9'1- CoB CwJ. -rt--
MARGIE H. CULLEN,
Plaintiff
PAUL R. CULLEN. JR..
Defendant
CIVIL ACTION - LAW
IN DIVORCE
AFFJDA VIT REGARDING COUNSELING
I. I have been advised of the availability of marriage counseling and understand that I may
request that the Court require that my spouse and I participate in counseling.
2. I understand that the Court maintains a list of marriage counselors in the Domestic
Relations Office. which list is available to me upon request.
3. Being so advised, I do not require that the Court require that my spouse and I participate
in counseling prior to a divorce decree being handed down by the Court.
I understand that false statements herein are made subject to the penalties of 18 Pa. C.S.A
Section 4904 relating to unsworn falsification to authorities,
Dated: ", I' q1
17J'i,jL&.t
MARGIE CULLEN
-' . .
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LAW O"ICII
BARBARA SUMPLE-SULLIVAN
IAIl BRIDGI .TREIT
NEW CUMBERLAND. PENN5YLVANIA 17070.11131
PHON I t711111A.1AAII
'AX (7,')'14.1018
THII III A TRUI CORRECT COPY
0' THI O"IOIN~L
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MARGIE H. CULLEN,
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY. PENNSYLVANIA
CIVIL ACTION - LAW
vs.
PAUL R. CULLEN, JR.,
Defendant
IN DIVORCE
COUNTER.AFFIDA VIT UNDER SECTION 330J(d) OF THE DIVORCE CODE
1. Check either (a) or (b):
(a) I do not oppose the entry of a divorce decree.
_ (b) I oppose the entry of a divorce decree because
(Check (i) (ij) or both):
_ (j) The parties to this action have not lived separate and apart for a period of at least two
years.
_ (ii) The marriage is not irretrievably broken.
2. Check either (a) or (b):
_ (a) I do not wish to make any claims for economic relief. I understand that I may lose
rights concerning alimony. division of property. lawyer's fees or expenses if I do not claim them
before a divorce is granted.
_ (b) I wish to claim economic relief which may include alimony, division of property.
lawyer's fees or expenses or olher important rights.
I verify that the statements made in this counteraffidavit are true and correct. I understand
that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating
to unsworn falsification to authorities,
Dated:
PAUL R. CULLEN, JR., Defendant
NOTICE: If you do not with 10 oppose the entry of a divorce decree and you do not wish to
make any claim for economic relief. you need not file this counteraffidavit.
.
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I. State your name. age. date of binh. residence address. telephone number. social security
number and any other names by which you have been known. .':'1 0"7 Ji. .,.....::l.-
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2. What is your occupation?
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3. State your gross taxable income as shown by your Federal Income Tax returns for the years
1994 through 1996. Provide copies of your 1994. 1995 and 1996 Federal Income Tax Return.
(,1"..LOW'r" L.ld"'7~ /p{Jy. /ojlP.//,tftle J,R5 7:PA~~ Pf.cJ~
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4, Identify all ownership interest you have in real estate in the Commonwealth of Pennsylvania
or elsewhere. As to each property(ies) identified. please slate the address of said property. the
marker value of same and the value of any mortgages against the property.
a. Identify the holders of said mortgage and account numbers:
b. State the amount of the original mortgage. the amount
of the current mortgage balance. and the monthly
mortgage payments;
c. Slate the current market values of said property(ies).
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5. Are you employed? If so. for each employment which you hold. state:
a. Name and address of employer;
b. Date of commencement of employment;
c. Name. title and address of your immediate supervisor;
d. Your job title and description of duties;
e, Your hours and rate of pay on earnings. specifying gross average weekly salary.
wages. commission. overtime pay. bonuses. etc.; and
f. Expense and drawing accounts and allowances for transportation and other
accommodation and expenses,
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6, For each employment which you hold or held during your marriage. state whether you
participate. or have a right to participate. or have in the pa.~t participated in any of Ihe following
employment related benefits;
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a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
Defined benefit retirement plan;
Defined contribution retirement plan;
Any other type of employee pension plan;
Savings or thrift plan;
Cash or deferred plan (401 K)
Profit sharing plan;
Employee stock ownership (including tax credit or payroll lax credit employee
stock ownership plan);
Stock bonus plan;
Tax deferred. 403 (b) annuities;
Non-qualified. deferred compensation plans. including excess benefit plans.
whether or not refunded;
Executive stock option plan. including incentive stock option plans;
Welfare or insurance plans including group term life insurance and medical
insurance;
Voluntary employees' beneficiary association (VEBA): and
Any olher employment related benefit not disclosed in your Answers 10 these
Interrogatories.
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7. For each benefit identified in Interrogatory No.6 above in which you participate.
identify:
a. The nature and amount of any contributiuns that you have made in such plans as
of the date of separation and currently;
b. The nature and amount of any contributions to the plan made by your employer
as of the date of separation and currently;
c. The date you began to participate in the plan:
d. The date upon which your benefit in the plan are vested;
e. The amount of vested benefits in the plan as of the separation date and currently;
f. The amount of non-vested benefits in the plan as of the separation date and
currently;
g. The amount of contributions made to the plan prior to the time of marriage;
h. Date of hire:
i. The name(s) of the person(s) other than yourself who has information relative to
the details and amounts of your pension plan benefits; and
j. Please allach a recent statement of you pension plan(s). employee savings and
thrift plan to you Answers to these Interrogatories.
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jJ~.r tyJ~r& 6 -/0%, ,/07'/lU //& oJ ~rr~~/wt'Af5,
cJ-) J/pAJ' r X tV~"'; f AJ 19 i1 5'c~~ 7.:T.-IfC. .
dI) ,;W/f1 .Lj, p l' /M'J ;JoY' fbsrrr'~ w,f~7.;: ~!EJ~/p ",,up ".J()".)~l)ur~ ~
/ltY ,1rr>>!,t/p ?) .No,)'; it) ,-t/:I/J'r "") ~.&'/d ;ro rl7'tt: ,,#h"~ pA-tl ,A",I,D
6 ,'l1tL- rI/u.)4?4,,1,,4J3~ p-.)'r,o/",VL"
AJ./J"'/ ?"/ ;/(L!5o~.
8. As a result of your employment wilhin the past twenty (20) years. are you entitled to receive
any monies for any deferred compensation agreement? If so. for each agreement slate:
a. The dates such agreement was signed;
b. The parties signing such agreement; and
c. The amount you are to receive under such deferred compensation agreement.
rI~.
7
9. What benefits does your employer provide for you and your family? Please include:
a. Blue Cross/Blue Shield coverage:
b. Life insurance coverage:
c. Automobile expense accounts or credit cards; and ,
d, Any and all other benefits your employer provides for you and your family.
ti-. IJff,.J ~~",,) /#'4't 7H' ,5'.f'~p;Frs r~(!K -wP r,tf'o,., 1I1J-e:Jt>"3
?L-.II~~ . /?I)YA '1'.. p";- '7J/e e!f//l1~7 /'tA".) Jl?~ ';THr S4m/ ..4?l_.v.r-
~"/1 -r",,~ /1'I~/2L. EJt?~;I~ /'ufA./!:', (!v~/~",)T(.)I~ (J.ff..s,e: .I-/""4~ ~##?/6ttr~ i
'/"/"111" t!,,~-r5 ~ IISe>e>/yJ2 ",tip ~gU>/YR .r,.) /t/98. !
/;, ftPl/:rd:~ '1}/e Om,l'7"',J;CTY /C> g..)I &.&...r ~rFe .:r;v..5wf2".c.J~ !
vJ#.fc?Jl1 /J91 ~7/yLJ. ~o,e.
tJ,.. ~hve.
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8
10. State the date of your separation from the Plaintiff.
1l/t/9.>
II. Identify by name. age. date or birth. relationship custodian and address. every person
dependent upon you.
7f/l'hFIf y -:f: t!~J. ~,J) / /1 '.p~/JI", dv,f"R,f'",rL)' &-:r,J~4 ,.Jfr-r
#j"''/Mtff d,.,ue;J IPr ~.:u..c.GPJC &'~~~~A/es ,g",L'6.../J'J;. /JdI.t.
;;: ;:;, >' 5"~ffJ-r.
12. Identify any um:sual or extraordinary medical. mental. physical or other need which you
may have.
Specifically state:
a, any current health care provider;
b. the financial requirement of the need;
c, how the need is currently being satisfied.
d, the specific medical diagnosis; and
e. any treatment plan;
u) )/ML-r"/l;1'1~M
~ t4.R'/?,fpfLY Pd~5'~r';r..re..J fr/41t>. ft'/~r#r>u~ ~J-,.)fI f'~.4f..<Jec
()DUJ.O Ilt! /.s~~. ~/e flc!HVif~..s:r /.;lo/~.l>. H..;/#~7H .rt<J$vJf7A41~.f..
'~'/.i'y .$ /1'/6. ? #f~t-'1#'~....MN(!e /tD -1/lXJ.
q 1161t-~.-/~~:reA '
~ ~ - ,q,1.,A;:f .r:>.fSD~~"e I ~ #~d01t. P~Rp~~ I
ri) /Jl~pfC.'lJYfb~ A.,Jp -m~/y 8,,/7#6' 9~~sa:l>,J tJr /I rY.M-7JF...rr I
pJJ'/l$fJ-..r7")I t,.)/l's ,&1.:r~P;-;J 7'1'/& ,-?b-';r AslD (!,?,,) ,!?E A ~r...$ I
6NL:f'/.-J P6Pr-~Pf,c)(... D,J I/....>.:r ;r~r;,A1P '/0 /W"'~A7"fv~ ,o9"J.P~4-.1(' I
.
i
,
13, Do you own a motor vehicle or any interest in a motor vehicle either individually or jointly
with another person or entity? If so. state as to each such vehicle;
a. The make. model. year. color. and serial number of the motor vehicle;
b. Whose name appears on the registration or litle certificate;
c. The location and current custodian of the motor vehicle;
d. The purchase price of the rnotor vehicle:
e. Is there an encumbrance on any vehicle. if 50. state the name of the lien .holder
and current balance owing.
f, The market value of the motor vehicle;
g. The identity of all documents relating to purchase of the motor vehicle. evidence
of Ii lie or registration of ownership;
tv, Offl; (!rltv.tf7'Te", /979, 8u1(!K.I ~6J"E9'1r?-fr61s-
p, ./?1>t1- .e. ~ut.Lt'..J
C. /71 Y.5,f'Lr /! ~ K~.fI.v 120. .eE~,.J~
tI. /~) ./,;Looo
..i-. jJ...
l,--I"3pZJ.
'P. "fr-rJ.f,
10
\-1, Do you own or maintain any sailings or checking accounts. certificates of deposit. money
market accounts. mutual fund accounts. or IRA or Keogh accounts. either individually or jointly
with another individual or entity or in the name of any entity in which you have any ownership
interest or other involvement? If so. as to each such account or certificate state:
a, The identity of the institution in which you have the account;
b. The title and number or identifying reference of the account or certificate;
c. The identity of any joint owner of the account or certifica!e and the nature of
your joint ownership;
d, The nature of the account or certificate; and
e. The purchase price of the certificate;
f. The dates and amounts of your deposits or contributions for the last three (3)
years.
g, The dates and amounts of your withdrawals for the last three (3) years;
h. The current balance of the account or value of the ~ertificate.
c1-, t",J~-'-,t't:;J 6j?Q1I? I)~ ,dJvT~4'- ~"";D.s
1>. 11 ad. 11 /f5'I'!3t>J ~
d. /lJ~L';f~ H. r!/tlLE,.J 5TN 4DS
d /J'/M,eY M,('/c/
J... .-JIll. ttl>4- 6'itY ~4B.
/, '#tl#E. fi,,~" J.C:(..;t;V~..S':tt' Pf./f.-~~.
1... I~i ,4Fr.6)(;M/tI'E~)' !7/)O iP,f5 W'I'<#'#'~~
~. -?,.~:J.I.t:.g
11
15. Do you have any safe deposit box or other similar storage facility in your name (either
individually or jointly with another individual or entity. in the namll of any entity in which you
have any ownership or their involvement (either alone or jointly with another entity or
individual) or in which you have contained personal property with a value in excess of $IOO.OO?
If so. as to each such box or facility state:
a. The identity of the institution in which you rent or maintain such safe deposit box
or facility:
b. The number under which such safe deposit box or facility is rented;
c. The name under which such safe deposit box or facility is rented; and
d. The contents of such safe dej>osit box or facility.
tL. ;?;Ve 8/1NKJ ~~1Y1 jJ ~~~5) l>1et~,?-1.J:re.sCJ,f~J~fi'1 )7~
b. S;}.,).s
e.. /I'J"J. ,?,.,Jp 4J,t9~~4f' (!u u./..J. /IJ~;f'&JE #/75.4 K~Y '/'~ r//I!!'
$~)(
J, LtE'~L P~~~.5.1 ~.fJ.t.S,5~1I~.s.sp.,)J;J5 /1J.t h.l'e 7Jr/1407J..)Y
$ SeL#lI~ .
12
16. Since the date of your separation. please provide a complete listing of all marital property
retained by you in lhe marital residence on which you have taken as separate property from your
spouse. including an identification of said property. your estimated monetary value for the
property and its current location and custodian.
p -,,..J J ,II'; ,'J"Ohl
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tI ':(. it..1/11 -,~,.;,~r!
il~of
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7,;'aLc. /":''''1' .
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18. Have you sold. assigned. given or traded any tangible or inlangible personal property or
interest in personal property Wilh a value of $100.00 or more to anyone with the lastlhree (3)
years? If so. as to each transfer. please statc:
a. The description of the property:
b. The interest which you transferred;
c. The identity of the person to whom you transferred the propeny or interest
therein:
d. The dale of the transfer;
e. The consideration you rcceived for each transfer;
f. The reason for such transfer:
g. The fair market value of the intcrest at the time of your transfer.
A/b.
15
20. With regard to the accounts identified in answer to the prior interrogatory. identify the
amounts in each as of the date of separation and describe any transaction in the account since
the date of separation.
19{aJ ;Jo~~e;USr;fNr 19-r 5;(!11~~) I~
(p) Ilbff. 61 (d/;r/,R /J1)/$~ 6/? l.3f/7-'l-'l bAJ -:fif,ul
j/}Je III'/IJ& .e(pu~rJ ~M~
rg.) #6~-&J(:r6:rI9,.)r ;9y 6~i1~,.,J 10
17
21. List any and all savings. investments. and/or government bonds purchased by you or for
your benefit within the last five (5) years. and identify if any have been sashed. If yes. list
the date of liquidation as well as the proceeds received from each.
;Vhve-.
18
22. List any and all Certificates of Deposit and/or IRA accounts in your name. held for your
benefit. or which you have signature power over. Please list current balance for each.
lV(JtV~.
19
23. Are you the owner or beneficiary or any policics or lire insurance. For each such policy
slate:
a.
b.
The name of each owner or such policy:
The name of the bcneficiary of each such policy;
The face amount or each such policy:
The accrued cash value of cach such policy:
The date each policy was purchased;
Whether lhe policy was whole. lifc or term life: and
The nature and amount or any loan against any policy and the date any loan was
incurred.
,.
,
c.
d.
e.
r.
g.
t
f "?1lI ,AJP1"'7'h'e .sc:~'?;e7"~AJY tJ"c "fA)Y LJ"~e .f.v.s",.I?A~ ,Pc.L-J<?/tf5
Ib /J7 Y j(lfJtJ"""tf.r>6jf ,
f rll1,)E,. -r,;:'~ L-f'?~ .;r~vPAAJt!L.,a'/'fc!JES dltJ"-Y h~/1ift>~.r ,
;; /~:r,<?L. 0': .:;I/8~ "At> t1?,.)P $~~..7'.5 7?-# .l?F~.Enf!r~,L)" ~ rd"s,€, I
I
20
24, Do you own slOcks. bonds or mutual funds or fund shares of the like. if so. for each entity
to which you own such security. please state:
a.
b,
c.
d.
e.
f.
The name of the corporation or the issuer;
The number of shares and the base amoun! of such security;
The date(s) such securities were purchased:
The malUrity date(s) of such securities. if applicable;
The current market value of such securities: and
The dividends paid by each such securities for each year
for the last five (5) years.
Please identify the amount realized from the liquidation of IBM stock:
g.
tP ;t:'B/Yl (. J)$'f),;U~r',vO ~".AJJ)~~ T ~%~/J1 &'~:)
b. If ~I/A,{t'> @ 1/"d-' ;..1/~31
e) tJi/e.e' rlje ~T' /,;1. Y69/8 /15 ~~7' ~r p~
J) ...v/11
k) -IIQ;)-.
f) /J/P'4>J(. -IJ,~ --I(}LJ/YR~
t) 115:57 tP-J (;oft1
/HeK'e We~ o/'JLJ 9 SJ/4~.5 tPt.J4f,o 0..,) //;1/17 ~
19S .51/-9,t'e ~ .:1fSS. 7J/e $~{J* .1-//15 5~..cr ~Alo /J1"/U.
--rJj,..,,J Oo~8LU:> f.J .:2 Y64,/ls'.
21
25. Are any of the shares of stock owned by you listed in the above Interrogatory subject to any
cross purchase or redemption agreement? If so. state:
a. The date of such agreement;
b. The parties to such agreement:
c. The stated event which will bring about the sale or
transfer under such agreement: and
d. The sale price under such agreement.
~.
22
26, Do you own or have any interest in any other assets not already disclosed? If so. please
identify same, the estimated value. and its current location?
NO.
"
23
28. Identify all debts known to you to be ellisting as of dale of separation. For each debt.
a. Identify to whom the debt is due and owing:
b. Identify the account number;
c. Identify the individual{s) obligated on the card;
d. Identify each and every sum ellpended by you in payment of the dcblS:
~tL ,;u; tV ?"Jr!.. IItJ~ ~4JI.I~?, L~A.J,8tz:p,c,~ Ul~n/~
,t1 JOUK rt>.413f'17. ~J'. 'p",.)'rKNbWAr!e~"",;7"~. ff/.f.WS
..; --:JP..eN r '- ~4,J.
"
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"'",- Iv -;:
;" 'f, THRIFT SAVINGS PLAN
rr PARTICIPANT STATEMENT
Fo~ t.... '1I"~'8;!
, I/O 1/95 UlfOUqh O'::JO/'.-HJ
TSP-8-A
fOU~ TI"I"'I Soi,.ngs PI..', (L:ir'j .ccounl sl.lemon, ''; l~sw.d ,~.r.., S'll' month~ b, ltlv N,Illon..: FI!....nc. Cenle' lor th. F,1erill
R&llr.me~: Trult: In',e~lml'''! 8.14rd For l1tldit.o'lal in'orm,tion or to correct 'four .ddr,,, or .ny of th'" 'ollowing Items,
plt'JSI! conhel your .gency emploYing office
~.me PAUL ~ CULLEN
50':1.' Se::url\; I'~umb('r : fI', ',_...,...~}
Dill 01 Sinh 08/13/5]
Rellf.ment Co'"e'.~e r:E~5 (I( I
Sepifillon Statu:;.' Not ~O;Jilrlled
Tot.1 ServlC' ReQUited tor Vesting 3 Yurs trom 04/09/84 CT5P Service Comput,tlon Datel
B,neflclary O.$lgn.llon on File:' No
.You If' responsible for the corr'Cln,1S .nd cempl'lenlSs of your eeneflCIMY D'Slgn'tlon fForm TSP-3).
G FUND
Go....rnment Securities
Investment Fund
F FUND
Fix.d Income Index
In...utment Fund
C FUND
Common Stock Index
Investment Fund
TOTAL
ACCOUNT
BALANCE
Ratss of
Return ..
lNumbers tn
p~r.ntheSlS
ar. n.g't'\I~l
G Fund
F Fund
C Fund
B.glOnmg Balance
Tr,nucUons Tnts Plrlod
EIl'Olngs ThiS Period
Ending Blllnce
aegtnnmg B~llnce
Tranuctlons ThiS Period
elf"lngs This Pertod
Ending B.Jlanc.
Beglnntng Bllanc.
Tr~n:s~tlon:o ThiS Pertod
Elrnmgs ThIS Peflod
Ending Bal'nce
8.g1nmng B.llnce
Tr Mluctlons Thl~ PUfled
elfntngs ThIS P.rlod
Ending Balance
19U5
November Decomber
.51%
1.49%
4.38,..
.50%
1.39%
1,92%
Source of Contributions TOlat
Employee Agency Autom.tic 1196' Ag.ncy MIlchlng
4.487,16 6.934,74 4.417.90 15.839.80
962,72 216.14 805.50 1.984,36
153,89 217,07 149.42 520,38
5.603,77 7.367,95 5.372,82 18.344. ~4
119,91 39,91 119,91 279.72
210. B.1 42.14 168,70 4~ 1. lie
21.37 6.43 20.38 48. t8
352,12 88,48 308,99 749,59
4 .807 , 07 6.974,65 4 .537,81 16.119,53
1.173,56 258,28 974.20 2 . 406 ,04
175,26 223,50 189,80 568,58
5.955,89 7.456,43 5.681.81 19,094.'3
1996 lISt 12 Months
January February March April . IMlY '95-Ap, '96'
49'. .46'. .54~. ,54% 6.54~;.
,66% (1,75%' 1.68%1 1.56%' 8,52\.
3.41% ,91% ,97% 1.47% 30,1 ",
.....Clld' ret.1 01 ,etu,n elt., .dmlnl.H.tl\l. ..IIp.n..s. T"e mO"I"I.,. U1.. 01 r.lv,n ". lh. ,.... uud to comput. tn. .etu.1 "'nln". on your ICcou"t .ach
month. ., descnb.d on tn. b.Ck 01 t",. ".tern."t. TIl. 11'monl" lilt.. 01 r.tur" .Ilow t'" lnv..tm.nl p.rform.ne. 01 Only tll.t portion 0' your 'ceount Illlt
""U In.....'.d lor the enlfl, 12-mon,n p,"od. B.r:"uu 01 the I.mln" 'I'd Imount 01 you, eonUlbv1."nl. ,"I.rlunCl tunll.,.. ."d oth., H.n.'ctlonl, yove."not
u,. 'h. 12'monl" ratu 01 ,.tl.l'" ,"own .bov. 10 c.'cullt. YOVI ICII.l,I e.rnln", fa' In. M.y 1995 . ,,"pHI !tge p.rlod. Th.r. II flak al InVIum.", Iou .n
bOI/'! the F .nd tn. C 'undl_ Tn.r. II "0 usv"nce that "al1 r.t.. of ,.IUln will b. r.p..lId In 11'1. IU1u,..
FORM TSP'I-A IRevlud 0511151
Call the ThrlftLlne: 15041 255-8771 tor updat.d ICCeUrll Intorm.lIon (,vIII,ble 7 dlV! I we.k. 24 hours I day).
8536'500731N NV 24 2'77 973B06oo 05/96
T-01285 000210303
1."111".111",11",1",11,1",11,,,,11,1,1,,",111,1,,1,,1,1
TS~ Open S.ason ts May 1S - July 31.
To Change your contrtbutlons ask your perlon-
ne1 office tor tn. TS~ EJectton Form (TSP-1).
PAUL R CULLEN
1219 KUHN AD
BOILING SPRGS
PA 17007-9639
To change the way money already in your
aCCount ,. tnvesUd, call the Thrtt'::L.tne
at the number Bho~n above. Th. Thr1'tLtne
I. tn. most e"tel.nt way to make. Change,
or cancel an 1nt'~'und transfer request.
,
DET.A.IL OF ACCOUNT ACTIVITY Fa. I'" .., 11/0' ! " ., 04': jJ! .,; TSP-8-,l..
r..l'nc ~'AU , (ULltN ~() '''I Sr':lJ' 01, '.. - .. :.JiIol(' 0' ?-. ~'-, VE LJ . SJ
"('!".o:".
Source In~ostm('nt Fund
..(l,w't. P.h'OII p", P'IlCCS', All'-''':' AI:rlll. .
CO,I<- (Hlier: Il",,, [.I;lh E,'rlt>,rt' A,I"l"'''''' 11',1 .."1(1,,,'1' G J.:und F found C Fund Tolal
M,JrHH.E'm EALANc[ O:T 199~ 4 . 607 .07 6.974 ,05 of.~37 e, 1~.e39.S0 0,00 279,73 "6. ttti .5:1
D 9";':1BO:i~O 11/03/'::15 II/03/9~ 1'e.46 t9.G.:! 6!!.tl6 16c. 7~ 0.0(1 0.00 166.7.
0 ':,1729060'-' 11/17/9~ 11/17/9: it:.4G 19.62 6e,6€ '6(, .;4 0,00 C,OO 166.7.
E ~a. .;~ 37.03 ~e.O~ e 1.::S 0.(,10 1:!,24 -.. _ ~~.~_4}
MONTH.fN(J EA,lAN(:E NOV 1995 4.7~.,41 7.050,92 4.703,15 16.25~,51 0.00 291.97 ,"16.546, ~l!.
0 97380600 \2/01/95 12/01/95 78,46 19,62 6e,66 166,74 0,00 0,00 166.7.
0 97380600 12/ 15/95 12/15/95 78,46 19,62 68,66 166,74 0.00 0,00 166.74
0 97380000 12/29/95 12/29/95 78,46 19.62 68,66 166,74 0,00 0,00 166.7.
E 26,51 36,27 25.98 63.19 0.00 5,57 _ ,..!!.8,~
MONTH-END 8ALANCE OEC 1995 5.054,30 7.146,05 4,935,11 16.837.92 0,00 297.64 '. n. 13.!f~j.
0 97380600 0\/12/98 01/12/98 78.46 19.62 66.66 166.74 0,00 0,00 166.74
0 97360600 01/26/S6 01/26/96 100,40 20,06 60.32 140.66 0,00 60,24 200.80
f "9,47 :Jti.5t1 :/&.11 HJ.tJ8 U.OO ",lti \:t.a. '16
MONTH-END 8ALANCE .IAN 1996 e.~62,63 7.222.33 5.112.80 17.228.60 0,00 368.96 17.597.76
0 97380600 02/09/96 02109/96 100.40 20,08 60.32 140. e6 0,00 60.24 200,60
0 97360600 02/23/96 02/23/96 100.40 20.08 60.32 140.66 0,00 60,24 200,60
E 25,49 33.61 24,66 79,79 0.00 3.87 63.68
MONTH-END 8ALANCE FEB 1996 5,488,92 7.298,00 5.296.10 17.589.71 0,00 493.31 18.063.02
0 97380600 03/06/96 03/06/96 100,40 20,08 60,32 140.e6 0,00 60.24 200,80
0 97380600 03/22/96 03/22/96 100,40 20.06 80,32 140.56 0,00 60,24 200,80
E 31.00 39,46 29,77 94.69 0.00 5.33 100.2:i
~ONTH-ENO 6ALANCE MA~ 1996 5.720.72 7.375,61 5,488.51 17.965,72 0.00 619.1~ 16.584,8~
0 97380600 04/05/96 04/05/96 100.40 20.08 80.32 140.56 0.00 60.:!4 200,80
0 97360600 04/19/96 04/1~/96 100,40 20,08 80.32 140.56 0.00 60.24 200.80
E 34.37 40,66 32.66 97.70 0,00 9,99 107,69
MONTH- END 8ALANCE CPR 1996 5.955.69 7.456,43 5,691.81 18.344.54 0.00 749,e9 19.094,13
ActlYlty Codes
o . O,pOI.l
E . E.rnll'l'il'
L . Lo.n
P . Monthly 10.1'1 paymenl summary
T . InllflunCl tr.n,f.r
F . Forl,lI,d nanY'ltld mo",,,
R . RnlDrod .mlJuntl
A . AdJultm.n1
C . hfn,ng' cornClion
Y . elt"lng! cornel ion 1ftn,'"
V . R''''''"I 0' O'f"ln". cD,ne'lon
B . Deel.,.d ,blndanld
o . Co...,,-otd.,.d payment
W . Wlthdnw.1
M . Minimum di."lbutlon
N . R"undld IMC... deh",l
Monthly elrnlngs 'f' c.lcul.led by multtpl\Il"Y In, ,It. 01 ,eturn fOI ttle month shown by thl .urn of 'four plio' month-end b.t,ne. Ind anl.hatf 01
InfO 101,1 of dlPOIIU tlnd 10111'1 np.ym.nu during Ihl month tho.,..n. Elllnlng, '" endlt.d .~ In. .nd 01 lh. month shown. Adlustments, elrningl cornellOM,
forlel11.11es, lo.n', feltored .mounls, .nd wilndtflwlIh .Ileet 'four fleeount lot lh. cllleulllllon 01 ''1rnln;s '1 Ute end of tn. monlh shown, Int"lund Hansflt'
.110 .fllIet )'Ollt .ccaunt ., th. end of 1he month Ino....." Pay date 1"1 ItUt da'e rlPoltod by 'f01l1 p')'Ioll ollicll for dOpa,,". Process date" tht d~'t
o~.,,,,:.,t~ Iwd lo.n pa)lm"l1t~ w"r.. PIQC"'10" 10 )IlW "ttuun\ by thO T5P fUtur""OOpCf.
.(1;0', ~E;"&'A tl'l..",~,:. " c,
~-_.....- '~':-:'---;;='''_~:''':'-;-':-...::.-=:''.~
:,"t; THRIFT SAVINGS PLAN
rr PARTICIPANT 5T A TEMENT
I'll' ~l'l 'O,-j
1 , /0 l/q~'J lt1rO....~I., 04/30/:J;'
TSP-8-A
'l'Our frmfl S.i'Jlngs pj..~ (T'SPj iCCOi..<nt sl.llernenl t:> Issued e,r', ~i# rnontl'1,; b/ tne Nollton.1 Finance Conter tor the Fe,Jerd
"el'r"rnent Thrilt Inve::.tmenl Bo.ra For .utditlonal information or to carract your .ddrcn or any of the following Items.,
please contJct your .genev eOlph)'f'IlQ office
Nofmu PAUL R CULLEN
Aell'eme".~ Cover.gA F ERS IK I
Sep.Jf,llon StilUS: Not sepJirated
Soc,... Secuflt', I\jumber~..
,...~-~
0.,\8 0' Birth 09/13/53
Beneflcliry DUlgnillon on File:' No
TOlal Senllet Required for Vesting 3 Vurs 'rom 04/09/84 (rSp Service CompuUtJon 0,1.1
-It you choose to submit' Beneflcl.tv Oeslgnilllon (Form TSP-31. you If! responsIble 'or Its corr,cln,lS and completeness.
G FUND
Beginning Bil.nee
Tr.nucllons ThiS Period
Eifnmgs ThiS PerIod
Ending B.I.nce
Beginning B.lanee
Tr~Silctions ThIS Period
EJrnlngs This Period
Ending Ballnce
8eglnnlng BII.nee
Tranuctlons ThiS Period
EJfnlngs This Period
Ending Balance
Beginning B.lance
Tr.nuctlons ThiS Period
Source of Contrlbutlon8 Tot81
Emplo'fll8 Agenev A.tom.lle 11'111 Agenc'f M.tchlng
6.731,86 7.813,68 6.306,89 ~0,85~,13
928.34 185.72 742.62 1.856,68
240,34 263,13 222,90 726,37
7.900,54 8.262,53 7.272, I I 23.435,18
Government Securities
Invutment Fund
F FUND
Fixed Income Inde.
Investment Fund
C FUND
800,90 179,78 670,51 1.651.19
397,86 79,52 318.34 795,72
140,93 3 I. 05 117.13 289. I I
1,339,69 190,35 1,105,98 2,736.02
7.532,76 7,993,46 6.977,10 22,503,32
1,326.20 265,24 1.060,96 2,652,40
381.27 294,18 340,03 , ,015,48
9.240,23 8,552,88 8.378,09 26.171.20
1997 LISt 12 Month.
January February March April IM.y '96-Apr '971
,56% .51% .sn'. ,58% 6,gn.
,30% .24% 11.11%1 1.4910 7.09%
62210 ,791'. 14,13%1 6.00r. 25.02%
Common Stock Ind..
Investment Fund
TOTAL
ACCOUNT
BALANCE
Earnings ThiS PUrlod
Ending Balance
1996
November December
Rates of
Return ..
(Numbers .n
parenlheses
are negative)
G Fund
F Fund
C Fund
.53%
1.69~.
7.54~.
.53""
193%1
11,9n.1
--At:lull rll_' 01 r.tu,n .11" adm,n"".I,,,,. ..p.ns.s. Tno monthly r.t.s of '1luln .fl lhe 'lie. U'ld 10 computt Ih. .Chllll .I'n.ng. on your account e.eh
month. IS descllbed on Ihe blc. of In,I IIIlement. The U.monlh ,ete. 01 relurn ShOW Ihe m",eJlm.nl perlormlm::_ 01 onl.,. 1h.1 pOt lion of your .ccounl thll
....1\ ,nVtSled fer the .nt"t 12.month p'rlod. S.Cluse 01 Iht liming end .mounl of your conlllbullon'. int,rlund tr.nsf,n. end other tranl'CtlOnS, you cannOI
u.e Ine 12.monlh rile. 01 relY," Ihown atlove 10 cllcul". your .ctu.1 t.rnlngs 101 HI' M.y 199& . ....ptil 1991 periOd. Th.t, i' flS. 01 inv..tmenl Iou 11'1
bOln tht Find Ihe C FundS The.e IS no "suranc. Ih.1 pUI reles of relurn will be rep.".d In Ih. luture.
FORM T5P.a'A lRev,ud 05,'9':'1
The Thriftline: 15041 255-8777 can give you .ccount Inform.tlon. The Web site: http://~ww.tsp.gov hiS T51' lnformitlon ilnd milerl'!.
85165500731N NV 24 2177 9738060005/97
r'00005233 000842205
1",111",111",11."1",11,1",11.,,,11,1,1,,",111,1,,1,,1,1
TSP Open Season Is May 15 . yuly 31.
To change your contrlbuttons ask your person.
nel office for the TSP Election Form (TSP-1).
PAUL R CULLEN
1219 KUHN RO
P. O. 80,'( 472
e8IlYNG SPR:;~
PA 170,y'~9639
To change the way money already tn your
account 15 invested, call the ThrlftLlne
at ttle number shown above. The Thr 1 f t L , ne
15 the most eff;clent way to make. cnange,
or cancel an inter-fund transfer request.
DETAIL OF ACCOUNT ACTIVITY Fa, lIltf pOflod 11/01/Qb lnrougn 04130/97 TSP-8-,A
N.me: PAUL R ell! I p. 501;1,11 $OCUT1l'f 1'.'jfnblJr":" O.le 01 BIrth 09/t3/53
Source 1"".'1tmfltnt Fund
Acllvll.,. Pe,fl.lll Po, Proc.,. Agllnci' Agenc)'
Code Offl" Olllt' Dale Employ.. ""Ulomtll": In;1 "hlthtng o fund f fund C Fund Tot.1
MONTH-ENO BALANCE OCT 1996 7,532.76 7,993,46 6,977,10 20,852,13 0,00 1,651.19 22.503, 3,
0 97380600 11/01/96 11/0./96 100.40 20,08 80.32 140,56 0,00 60,24 200, B(
0 97380600 11/15/96 11/15/96 100,40 20,08 80,32 140,56 0,00 60,24 200,8
0 97380600 I 1/29/96 11/29/98 .00,40 20,08 80,32 140,58 0,00 60,24 200,6.
E 100,14 55.87 87,26 It I. 95 0.00 131,32 "3,2'
MONTH-END BALANCE NOV 199~ 7.934,10 8, .09,57 7.305,32 2 I . 385,78 0,00 1.963,23 23,348. 9~
0 97380600 12/13/96 12/13/96 100,40 20,08 80.32 140.56 0.00 60.24 200,BC
0 97380600 12/27/96 .2/27/96 100,40 20.08 80,32 140,56 0,00 60." 2oo,8(
E .7.79 37,49 lB.50 113.70 0,00 39,92' 73,1/
MONTH-END BALANCE DEC 1996 8.152,69 8.187.22 7.484.48 2..780,58 0,00 2.043,79 23.824,3-
o 97380600 01/10/97 01/10/97 100,40 20,08 80,32 140.56 0,00 60,24 2oo,8(
o 97380600 01/24/97 01/27/97 103.40 20.68 B2.72 144.78 0.00 82,04 '06. B(
E 104.13 58.50 90,44 122,10 0.00 130,97 253,07
MONTH-END BALANCE vAN 1997 8.400,62 8.286.48 7.737.94 22.188,00 0,00 2.297.04 24,4eS.O':
o 97380600 02/07/97 02/06/97 103..0 20.68 82,72 144.76 0,00 82.04 206,8C
o 97380600 02/21/97 02/20/97 103,40 20.68 82.72 144.76 0.00 62.04 206, BC
E 46,98 43, .7 42.63 1t4,17 0,00 18,6 I 132,7E
MONTH-END BALANCE FEB 1997 8.714,40 8,371.01 7.948.0. 22.89 I. 89 0,00 2.439,73 28,031.4:
o 97380600 03/07/97 03/08/97 103.40 20,68 82.72 144.76 0.00 62,04 206,B(
o 97380600 03/21/97 03/21/97 103,40 20.68 82.72 144.76 0,00 82,04 206,BC
E 7,21- 35,27 I. 8 I- 129,47 0,00 103,22- 26.2:
MONTH-END BALANCE MAR 1997 B.913,99 8,447.64 8.109,64 23.010,68 0.00 2.480.59 25.47t.2-
0 97380600 04/04/97 04/03/97 103,40 20,68 82.72 144.76 0,00 62,04 206, B(
0 97380600 04/18/97 04/17/97 103.40 20,68 82.72 144.76 0,00 62,04 206 , 8e
E It 9,44 63,88 103.01 134,98 0.00 151. 35 286, J:
MONTH-END 8.LANCE APR 1997 9.240.23 8.552.88 8,378.09 23.435,18 0.00 2.738.02 26,171,2':
o . CepOlit
E . Elrning.
L . LOin
P . Monthly loan payment summlry
T . lnl"'und tnnsl.,
F 'Forreited nanvelled moni..
R . RI,lored .mOURn
A I Adjustment
Acllvlty Codes
C . Earning' (:o".ctlon
y . e.,Ring_ correction tunst.,
V . A.....rul of '"nlnit correction
B . Declared .b.ndoned
o . COurt-ord.r.d p.ym.nt
W . Withdr.w.1
M . Minimum distribution
N . R,'und.d .xc.u d.lerral
Monthly a.rnlngs If' calcul.t.d by mulliplyina Ih, rata of return far the "lonU, shown by Ih. sum of your pilaf monTh-,nd b.I.nca .nd on,'n." 01
th. tOT.1 01 d.pa'IU .nd la.n rep.ym.nts during the month shown, ellnlng' .ra cr.dlted It In. .nd of Ih, monln .hown. AdJustm.nts. .lIning. cOIr.cl,ons,
for'.llur'., lo.ns. r..lor.d Ilmoun". .nd wilhdr,wll. Ill,cl your .ccounl for tn. c.lcuIOllO" 01 ,.rnlngs .1 tn. .nd 01 tnt' mOnth shown. Int.dund ItI"sl,,!
.1so .lfect YOllf fIl<,:counl II lh, tnd of Ino monlh .hown. Pay date u. I"" ddle fllporttld by YOUI payroll office fOf d'pOllls. Process date IS tn. de"
deposill .nd loa" pll/mlnts w.r. proc.sud to youl .ccount by In. TSP ncordk"pol.
FORM TSp.a'A IR....lno 05 9"
1'.'>.24 r'F'I:::l 1)17(,:: ,: .,.., ~:...,..,-,~...-, --:-~~~.~~.I".
~ .:. .J E , I~ I) 4 \. t l \) .
i;'.:, .::YI~'L~{E
. - .. + .
"~ .", . , ._ +.. '1 ,
r..TE ,;'E'),.IE:,IEO 1> 1,:,"'0:.
r.; 1 "J t "' :'.1 E. 1;;' 4 1 .; . '.' >:,
H,,;M /liUI~i:;ERI 1(14(1
-, '
,I"\."
.... r. i _; ~ -:" :'(:
, +..-
.
.. SFOUSE
r Ahr" A 'IER I rH: ,\.: 1 F I (: A' : (i ,-~ :...11", :"::1... -.:,.,- . -- ..it
T~:;?AYER IJE:~;IFICJtTIO~ NLII"::=EP~ "'~i~~
PAUL ~ JR m ~hR~lE " tG~L[H
1~19 KUrW Rll
BOILING SPRIN&S PA 17(107-0~39.t~t
A~Y ~l~US DELO~ SIGNIFIES A C~~DIT A~O~NT
ACCOUNT BALANCEI
:'CC.~:..IElJ liJ1 Ei"'\~C:.~l ~
~:C~"JFD rE:'J}.'-"'rVI
(1,(.(1
-.).0')
(I. I"
AS ,)r .) ,=. ..:. ' - ,,:;;
,4 ~ .'j. ,):,.. .~.:. ....~:;
A(':O'_'NT r:~Ll..n':,=
PLLIS ACCr'UALSI
0.00
... C::,::~~''''1':~~S~ ')3
...!" .i. \- . ,l.J ;: 7;" T J:,; .".... R ~ 1 ~ J F 1 L r '-~'~ J::.. rr
.+ 4DJUS7E~ GROSS INCOMEs
.. TAH.ELE II\COMEI
TAr; PER hETUR;~:
4'~! 186. (10
:3J, ,.=09(1. (l(i
4,~OI.OU PRI~~!PAL INDJ5~RY ACTI~ITY ~OJ~; ~SlS
... :E;;; r-'E: uR~.. OR AS AuJ USTED
'.;_ ~,:._':J:. ;.~r'..'~'N D~I=: DATE OR F:ETLIR~-: REC~! IJ~J ;:'l,:..TE {w~!:MEV~~ !.:; L.A.TEj:',
,',~.-':'';J-95 PF-.'(ICESSlt'toG DATE
TRi'NSACTION::;
(i':;' - ; ':_ - 9:::
t~')i~E.( AM:::...::~""
<IF APPLICABLE)
4 ,+~, <) 1 . '::1
4 , 4,)':' .. :: ~l -
. ).:-
: :,E
E>:;:'L~r~J.,Tr(:I~
RE~JRN FILEJ AND TA}~ AZ;E~;E'
~~EJIT ~ROM ~lT~~ELJ TA~:E~ a E}.~ESS ~::A
PA1~~N~ wITH REru~~
;)~~E
0::"'::: -~:;
",)4-:.:'>:5
,"
.. 4-.'
~~~ Oppart"'MI of the Trensury
~NJ' Intornal RovenUl, Service '
, '" I
1995
FOI'Ill,1040-V PaYIll \"IIl~~Jll'r
, ,,"',' ',' '''. ""'j", .' . I" ,I".. t .,,,.,' "1""".11,,,,, (JI,IO'''' 1~4') I()'" IOU f'APi:nWORK HfOUCtlON ACI NOlK:E. SEt rOAM lo.lUl'451H\tf;IIt)NS
......... --;-',....."1 '..~ 4 ... ...
-,----- ..... -
-
-
_' ':;~tT CULL 30 0 'ISle! 1010
b~
PAY~ ~ JR ~ MARGIE H CULLEN
~~fLIN~H~PRINGS PA 17007-'1103'1
~NTERNAL REVENUE SERVICE
o B llS3
HIL~~ELPH2A PA 1'11be!-IlS30
$ '.ol./P, -
Enter the amount 01 your payment.
Make sur. your social securllv number IS
written on your check or money order.
.. Use thIS voucher when making a paVm.nt With YOUf ,... relum.
~ Send your payment and payment youch8< 10 lhe addl... above,
.... 00 nalltapl. lhis vauche, or your payment 10 your return,
.. 00 nol use this voucher 10 pay quor1erly estlma'ed lu.es.
PAUL R. CULLEN ~ /.
MARGIE II. CUJ..J..EN
1319 KUlIN NO^U
BOWNG S1'IUNGS. I'^ 17007
, - I
-'.~-'
10(.
-..
, -
L'lr-'/f. 'll9-f~
6G-1Z7ll3l3
I
..'
A:1ytotMCKrW</fNr-Efdli"-, @'v~..Ju.(jd~$ / ?-YjI. h:J
lf~dr.f~,.Jj/-~"JP~62j?,,&>A'1')I ~"~A:'4IP_~-t:bb-s
PNC BANK
'Me IANI. M.A.
lOuntcaHnAL'A 040 11'1
~:';1y7;9~ ~~~_~". ,,,__ ,_~ \\.<:~<;Ja: ~!&__
1:03 ~ 3 ~~? 381: WI, ~II' 5 ~1,01, 5 ~ ml,u'
__-_10''''-
~:'..'" . .,tf. . .'.t, ...,(t'~~. ......:~#,...II.... ,:;~..""
5~~~~~~~~~.!rt.~
MARGIE 11, CULL~N ,'I'I!> twm iO<+<>
422 1A00K CIlCUl . J
MECHANICS.lIRG.'A 11035 7 .., ... '1
,.... '" r~,('I1)'I~~'fl&lC~,
~LB~..'- 3trlf/l:r
PM 'IOnfI ()UlU. Of
(Jl1t'. tflL"(~.1,\:1~ ILLI~.I1tul1f..J'ld....fLLILl dlld Ilr;"n
195
19%
&Q-al&1/31J
51201811J
I $ IZOZ.'~
U<JlLAU
Commerce
_Bank I H","",-'., N"
100 .....ATE AVI
CA"'''"ILL, Ill.. I ;ot I
MlM06/Z0;!. ~ $d~ '" ''!>C>-f'' '~~;rA(
I:OH30~8I,bl: 5~ 2088~~
_ __~~-/f.L.d..,J..___--~
;111' 0 ~q l!i
IffJ1l ~
-IT
-'7ilINl.~J.~~'W/'-.-Ztl~71~illt'ftAI
~ 1040
label
ISH
Iflllfuchonl
on P>Vt 11)
UI. Ih. IRS
Ilb.l.
Otherwll..
PII.S' pnnl
01 typo,
Prllld.nllll
EI.cllon Campllgn ~
ISee I e 1\,) ,
1
2
3
4
filing Slatus
IS.. peg. 11,1
Check only
on. bux.
Exempllons
(See page 12,1
If mOt' than sl.
dependents.
see page 13.
Incorne
Anlch
Cop)" B of your
Form. W-21
W'20. and
10i8.R her..
II you did not
get I W,2, .ee
page 14,
Enclo.e, but do
not attach, your
payment Ind
payment
voucher. S..
page 33,
Ad/ustments
to Income
A usled
Gross Income
o.Pa#1~1 0' the T,...ury-lnl_na' Rev.nu. Service
U.S. Individual Income TaK Return III
~@95
FOI lhe v-a, Ja" l-o.c 31.1995. or olh., I.. yea' btty'nn'otJ
YOUl lint nlAla and Im!,'l lalll flam.
, 995. ending
me; lh, (}"t--I'O 1\(11 ..,,'~ 00 .'<I~ '" 1"'\ "'.1'.
. 190MB No l',.I!j.(101..
Your loclal ..curlty numbe,
For Prl.acy Act and
Paperwork R.ductlon
Act Notice. ..e paoe 7.
V.. No Nol.: Ctwt<:.,Ttg "Yel-
WIll rIO' c:ntnge your
t._ 01 r,duCt your
'.fund
b SUI' .
a D.pend.ntt:
e11 Flfslnlm.
1ZI OePfndtnfS SOCIIl
IfCUllty number If bOrn
tn199 s ) 13
l3l 'Pln4tn!'1
rtllllon,hlP 10
a
, ,
,
.
.
.
,
,- ~ ....... - - ---2B
~.l.-~', . ~
PAUL R JR & HARGIE H CUt,LEN
1219 KUHN RD
BOILING SPRINGS PA 17007-9639
Otn"
BE
I
R ..,.. no,
S
.11.
spou.... .ocial..cunty numb.'
Single
Married filing Jolnl return lIven I' only on. hid Incom.)
Mimed liung "pir.I' r'lum. ent,r $pOuSt'S social security no. abov, Ind tu" nlm, her.. ...
Head 01 houlthOld (wilh quahfying person), (5., pag.12.) If the quaUfylng person Is I child bul not your d,pend.nt.
Inl,r thl, chlkj'. name her.. ...
5 Quam In widow Ir with de .ndent child lar I use died ... 19 . (See ,
81 [3' Youmlt. " your parent (ot IOmton. .Is.) can claim you 8S 8 dependent on his or hit' tSol
r.lurn. do nol check box 68. But be aur. to check thl box on hnt 33b on page 2
e 12,
} No. 01 bo...
~hlnl' 1M II
. '"~ I~
. Ho. 01 YOUI
'" Ho 01 monltls ."II~ft. o. Ie
WtdIll}'OUf .ho'
hOlfltll'll99S .
. II,,~ willi you --L-
.11I1'"'111'1' willi
'Hdu.II
'l'lDrllor
"Plrlllon 1.11
",'14)
D,plnd.nll Oil Ie
nol.lIl.r"lbow._
Add numb.,.
Inllr,don
Ilnll.bo.,.'"
,.; . ,
H
.
"
.
00 you want S3 to go 10 Ihia fund? ,
If. Int relurn, does our spoule .wlnt S3 to 0 to this fund? .
lulnlmt
d II your ch,ld d'dn'l IIv. W1lh you but is cwmld a.s your d.Ptndlnl undll. p".1985 Igrum.nl, check hll' ~ 0
. Total number at ,.em lions clalm.d
7
8t
b
9
10
11
12
13
14
150
18.
17
18
19
201
21
22
231
b
24
25
28
27
28
29
30
31
Wage" salaries. tips, elc. Attach Form(s) W,2
raubl. Intarest I"coml (s.. page 15), Attach Schedule 8 If over $400
Tu...xempt Inlerest (Sit PIQI 15). DON'T Include on line 8a Bb
Dividend income. Attach Sch.dul. 8 It over $400 , , . .
T~abl' refunds. credits. or offsetl 0' Ilat. and locallncam. taJlts ("I page 15)
AJlmony ,ec.ived
Business Incorn. or (105S). Attach Schedule C 0' C.EZ ,
Capilal gain or (Ios.), If requ"ad, anach Schedull 0 (.ee page 16)
Oth,r gains or (losses). Attach Form 4797 , .........,..
Tolal IRA di.tribulion., ~ LJ b TOlblalll1OUnl ('H page 161
TOlll p.nsions and annulll'S l.!!!J I-.J b Taxable amount (&It pig. 16)
Rental real estal., royallies. partnerShips. S corparalions. trultl, ItC. Attach SChedul. E
Farm Income or (loss), AttaCh Schedule F .
Unemployment compensation (se. page 17) . ,. ",'.
Social ..curlly benefit. 120. I I b TOlble lITlOunll..e Plge 181
Other Incom.. LIst type and amount-see paO.18 ....................................
Add the amounts in the lar ri hi column for Hnes 71hrou h 21. This Is ourtotlllncom. ...
Your IRA deauctlon (see page 19) . 23.
Spou.... tRA deduclion I.ee page 191 23b
Moving '.penses. Attach Form 3903 or 3903.F 204
On,-halr or stlf.employment 18.ll. . 25
Self-employed heallh Insurance deductIon (see page 21) 28
KOOOh & .ell,empioyed SE? plan., " SE?, check ~ 0 27
Penally on early wIlhdrawal 01 savmgs , 28
AlImony paid. RecIpient's SSN Ii" 29
Add lines 23a lhrau h 29. These ale our lotel .d uslmenll
~
9
10
11
12
13
14
15b
18b
17
18
19
20b
21
22
) -
~
SublliCI hne 30 110m fine 22 ThiS 1$ vour Idlullld grollln,om. tlles\ Ihan $26673 i"d a child h~td
wllh iOU (le'iS lhan $9230 II" Chiid dlun I h.e v.llh IUUI, ~tt . Ealnell inlurne Crt!!lr on ll~g~ t.7 ..
Ct1l1 No 12&uOW
31
2
.3
fi:"
,.,
,,"' ~
., " '7l."" -
ro,m 1040 i1'1Q',1
rOlm 10A0 11Q9S)
Tax
Compu-
tation
(5., Plge
n)
If you want
Ihl IRS to
fiour, your
IU.st18
plgl 35,
Credits
1511 p.gl
24,)
Other
Taxes
1511 p.gl
25,)
Payments
Attach
Forml W-2.
W,20, Ind
1099,R on
Ihe front.
58
59
&0
&1
Refund Qr &2
Amount &3
You Owe ll-4
85
Sign
Here
Keep a copy
of this return
lor your
records.
Paid
Preparer's
Use Only
32 Amounl horn IinB 31 (adjusted gloss InCOmlt) ,. . ..
338 Chock II: 0 You we,. 6~ Of oh,Jer. 0 Blind, 0 Spou.. WII 65 or older, 0 Blind
Add th, number oll>oxes. checked Aba..... Ind Bnlll th, tolll h'f' . ... 33a
b If your pa,enl (or someone 1l1u) can claim you a. I dopend.nl, check ht" ... 33b 0
o If you ,r, mlUled hlln", "..,o'llely and your .poUII it,mllll deduchonl Of
you are . dual-,lalul Dll"n. let plge 23 end ctNck her.. ... 330 0
IUlmllld dlductJonl from ScMdu11 A. IIn. 28, OR ]
34 Ent., Slandlrd d.ductlon Ihown below lOf your !lhng 11.lul. But If you ch.ck.d
th. ."y bo. on Iin. 3311 or b. go 10 ploe 23 10 nnd your Itandlrd deducllon.
l.rD" II you checked bo. 33c, your Itandard deduc1lon II I.ro.
~~ur: I Slng11-$3,900 I M.rrlld filing Jolnlly or OUllllylng wldow(orl-$&,550
. Head 01 houlOhold-S~,750 'Married filing ..pa,.tety-S3.27S
35 Subl,let line 34 from hn. 32 .
38 IIl1n. 32 II $86,025 Or I"., mulllply S2,~OO by the tolll number of l.IIempUon. cl.lmed on
hn. 61. IIl1n, 32 II over $86.025. .11 the WO,klhllt on pag. 23 for thl amount to Int.r 0
37 T...bl. Incomlo Subtract hne 36 ham hn, J~. If lin. 36 II mOfl than Un. 35. .nter -0- .
38 T.., Chock if from I [4T.. Tobll, bOT.. R'II Schodulll, C OCaptlal Olin T.. Wor!<.
,hili, 01 dO Form 86151..1 plgl 24), Amounl from Formll) 8814 ~ I I
39 Addltlon.II...., Chick .f from I 0 Form 4970 b 0 Form 4972
40 Add Ilnll 38 and 39,
41
42
43
44
Credit lor chIld and dependenl carl Illplnses, Altach Form 2441 41
Cfldit lor the elderly or the disabled. Attach Schedull R . 42
Forlign ,.. credi!. Anlch Form" 18. ., 43
Olher credilll'" plgl 25), Chick Illrom I 0 Form 3800
b 0 FOIm 8398 C 0 Form 8801 d 0 Form I.pocllyl- 44 0 -
Add IInll 41 through 44
Subtract IInl 45 from IIn. 40. If IIn. 45 II mar. thin hne 40. .nt.r -0- . ...
SIIf-employm,ntl... All.ch SChedule SE .
An.maU", minimum tax. Attach Fonn 6251 . . .
Recapture t...., Chock " from I 0 Form 4255 b 0 Form 8811 cO Form 8828
Social security and Medlca,e tl.ll on tip Income not reported to employer. Al1ech Form 4137
T.... on qualifild tellremlnt pllnl, Including IRAI. If requIred. anlch Form 5329 0
Advance e.rned Income credit payments from Form W-2
Household ,mployment ta.es. Attach SChedul, H 0
Add Unes 46 throu h 53. This il our total ...0 . ...
F.der.1Incom.III Wllhh.ld, lI.ny I. from Forml') 1099, chICk ~ 0 ' '1, "
1995 asllmllld IIll payments and emount applied Irom 1994 ,etum .
Earned Income credit. Attach Schedule EIG If you hlv, a Qualifying
child, Nontaxable limed tncome: amounl ... I I I
Ind tYPI ~ ................................................... 5T
Amount paid with Form 4868 (ext,nsion r,quest) . 58
Excell social security and RATA 1ax WIthheld (see page 32) 59
Olher paymlnll, Chick" from I 0 Form 2439 b 0 Fo.m 4138 &0 'J ..
Add lines 55 Ihrough 60. These are our total p, menta ..
If hnt 611s mOl' than IIn. s... lublraclllne Sot Ifom lint 61. ThiS is lha amounl you OVERPAID.
Amount of hne 62 you "ani REFUNDED TO YOU,
Amount 01 hns 62 you w,"1 APPLIED 10 YOUR 1196 ESlIMA1ID lAX ~ 64
If hne ~4 IS mor" Ihan line 61. subl,aclllne61 from line 54. ThiS is the AMOUNT YOU OWE.
For delalls on how to pay and use Form 1040-V. Payment Voucher, see page 33 0 ....
Estimated till penally (see page 331. Also include on hne 65 I 68 I
32
.\~?
~~f
~~
~~~
&.~~~"
~
I
~
34
35
:Ml
31
45
48
41
411
4D
50
51
52
83
64
f>(
P.oe 2
o-j ..
45
4&
41
411
49
50
51
52
53
54
55
58
57
..
"'~
88
'J
1 -
.,
1
Under PI~tt~, 01 pt'lury. I d~la'. lhall hh' '.Im+ned Ihl"flufn Ind ICCompanV'nQ .chedult1 ancI .111.men'.. and 101M bell 01 my knowltdQI ancI
belt.'.they '" !rue. cOlred. and cumf>!'" o.ell'lhon 01 pI'PIf" lothe' lhan la.paye'l II blled on IUln'OImaUon 01 whICh pi"P"'" hi' any knowtedge.
~ You~nllure 0,1. Your occupation
,. 6;,:.(~i:: d.:,. /:',' "
IL Spo~".. "!;Inilull. II . iflll.llIlvrn,
,. -/ . d/(
P"'Pd"'" ~
"!;InaIUI. ,
f,un', nol"IIIUt YOU" ~
,1 S"II...TlpIC,~I.'1d
.(1c1r,n
ZIP code
'U 5 Go.."""'" P.onh"V ()fle. 1"'. lU~'
t';) r..",...I,..." ,.,."'"rl ,....,'..
Schedule A-Itemized Deductions
SCHEDULES A&B
(Form 1040)
(Sch.dul. B I. on back)
... AlUich to Fonn 1040. iii" 8ft lnttructlon. for Schedul.. A .nd B (Form 1040.
AnKhInwll
s."".".. No, 07
Your loe..1 IKunty numb'"
--""-- .
0Ipef1rnen1 ollhl "...~
tnt..w n...r.u. s.w. 1101
Nlme(I) shown on form 1040
>J. L .., .J (, J
Medical CluUon: Do not include upon... reimbursed Of paid by others,
and 1 Medical and dental expensea (aee paga A,1) .
Dental 2 Entlr lmounl from FOlIO 1Q.10, 1101 32, 2
Expanses 3 Multiply Iin. 2 ebove by 7.5'IH075), , .. .. 3
4 Subtract lina 3 'rom line 1, II line 3 is more than line 1 enter -O-
Il State end local incoma taxea . II
8 Real utate taxes (see page A.2). , . . . . ,. 8
7 Personal property ta.es. . . , . , . , . .' 7
8 Other taxes, List type and amount ~ ..'............,....
Taxes You
PaId
(5"
p'Oe ....1.)
Interest
You Paid
(See
pao. ...,2,)
Nato:
Personal 12
Inteu.slls
not
deductIble. 13
14
Gifts to 15
Charity
If yoo mid. I 18
Oln and oot .
bone"t '0< If. 17
... pao. A,3, 18
Cllually and
Theil Lgsses 19
Job Expenses 20
Bnd Most
Other
Miscellaneous
Deducllons
21
(Sea 22
paoa "',S lor
elCpenses 10
deduct haro.)
23
24
25
28
Other 27
Miscellaneous
Deducllons
Total 28
Itemized
Deducllons
................................................................
9 Add lines 5 Ihrou h 8, . , , . , , . . , , ,
10 Homs mortglgllnlerlstlnd points reported to you on Form 1098
11 Hom. rnortgsgo interest nol reported to you on Form 1098,11 paid
10 the person ~om whom you bought Ihs home, S" page ...,3
and show Ihat person's name, Idenlifying no,. and eddress ~
................................................................
................................................................
................................................................
Points not reported to you on Form 1098, See page A.3
lor special rules. . . . . . , . . . . . ., 12
Investment Interest. II required, attach Form 4952. (See
page A.3.) . , . . . . . . , . . . . .. 13
Add lines 10 throu h 13, , . , , . , . . . .
Gifts by cash or check, II you made any gift of $250 or
more, see page A,3 . , , . , . , . . . . ,
Other than by cash or check, II any gift 01 $250 or more,
see page A,3, II over $500, you MUST attach Form 8283
Carryover lrom prior year. . .....
Add lines 15throu h17, , , , , , . . , ,
Casualt or theft loss(es), Attach Form 4684, (See pa
Unreimbursed employee e.penses-job travel, union
dues, job education, etc, II required, you MUST attach
Form 2106 or 2106-EZ, (See page A,S,) ~ ..............
................................................................
................................................................
Tax preparation fees , , . . , , . . . . . .
Other expenses-inveslment, sale deposll box, etc, List
type and amount ~.........................................
................................................................
() -
iZ -
'). .1(' .
i'
()
\ .
OMS No. 1~5.00'"
~@95
r
,
fl
I
!
I
I
'l. J '1. -
Add lines 20 through 22, , . , .
Enter lmount hom Form 1Q.10. line 32. 24
Multiply line 24 above by 2% (,02) , , . . . ,. 25
Sublract line 25 from line 23, II line 25 is more than line 23, enter ,0-
Other-from list on page A.5, List type and amount ~ ,......,.....................,
('
...............................................................................................
o
Is Form 1040, hne 32, over $114,700 (over $57,350 if married filing separalely)?
NO. Your deducli,on is not lim,led, ...dd tho amounlS in the far right column }
for lines 4 IhroU9h 27, Also, enle' on Form 1040, line 34, the larger of ,~
thiS amount or your standard deduction.
YES. Your deduction ma be limited. See a e A.S for the amounl to enter.
For Paperwo", Reduction Act Nollee, see Form 1040 InltrucUon..
Cat. No. t 1 J30X
Schedul. " (Form 1040)18115
SCHEDULE SE
(Form 1040)
Self-Employment Tax
OMB No. 15~!H)(I74
~@95
... S.. Instructions for Schedul. SE (Form 1040).
AlIKrvnenl
SoQuonco No 17
~o'tt-.f""....,
1nI-.! ~ Serw::. 1101 ... Atuch to Form 1040.
Name of pelton W'th 1.1f..mploym.nt Incomel.. Ihuwn on Form 1(40) Soc,.II8Curity numbel ot person
J i I With ..U-.mptoyment income ..
Who Must File Schedule SE
You must hlo Schedule SE ,f:
o You had not oarnongs from solf,omployment from othor thon church omploy.. incomo ~ino 4 of Short Schedulo SE or IIno 4c 01
Long Schedulo SE) 01 $400 or moro, OR
o You hod church omploy.. Incomo of S 108,28 or moro, lncomo from sorvicOl you performed as a m,nlstor or a mombor of a
roligioul ardor i. not church omployoo Incomo, Seo page SE.'.
Nato: Even il you have a loss or a small ,mounl 01 incoma lrom SOI',amploymenl, il may be 10 your ~no'" to me Schedule SE end
use either "opllonal method" in Part /I 01 Long Schedulo SE, See pago SE,3,
ExcopUon. II your only solf,omploymenl incomo was from earnings as a minlslor, member of a religious order, or Christlon Science
practitioner and you fiied Form 436' and received IRS approval not 10 ~ I..ed on lhose earnings. do not file Schedule SE, inllead,
write -Exempl-Form 4361" on Form 1040, Iino 47,
-~
May I Use Short Schedule SE or MUST I Use Long Schedule SE?
[)td you t'::IIYt --on 01 up' Ir'llV951
Yo.
No
Art )'OU . 1nInlS1.... member 01 . r~lOU. order, Of CMlllln
Sc.-.el pl'lCtltJONt' whO rettfYed IRS approval nollo be '....d V,.
on tanw'lgl "om If'lne IOUl'cn. tlvt you OWl H/t.emp&oymenl
ta. on 0''''' umrl9'1
W.. the lotal at 'fOAJf wIG" and 1!pI ~1 to toeiaI MCUrtty
01 r.l~ tttJtement 10 plue your net umtngI from
M1'--employn'lent mol' thAn "1.2001
v..
No
Are you UII"Q onI 01 the optiOnll melhOd1 10 ligUl' your ntt YII
l,arnmga I'" ~QI: SE.3}1
No
No Old you rtettYl' lips lubttd to soc:laI secunty or Mtdcare tax V..
thaI you did not report to yG\M' -"ploy...,
No
DId you 'lettY. church employ" IOC;Otne r.ported on Form Y..
W.2 01 $108.28 Of mOll?
No
YOU MAY USE SHORT SCHEDULE SE BELOW
YOU MUST USE LONG SCHEOULE SE ON THE BACK
Section A-5hort S~hedule SE. Caution: Read above 10 see jf you can use Short Schedule SE.
, Nel larm prof,l or (loss) from Schedule F, line 36, and farm partnorships, Schedule K-1 (Form
, 065), IlOe 15a , ' ' , ' ' , , , . , . . . , ' . , " 1
2 Nel prolll or (loss) from Schedule C, line 31; Scheduie C,EZ. Iino 3; and Schedule K-' (Form
1065), line 15a (olher than farming), M'OIsters and members of religious orders see page SE-1
for amounts 10 report on thiS line, See page SE,2 for other income to report, 2
8 Deduction for ono,hall of lell,employment tax, Mulliply line 5 by
50% 5 Enler the result here and on Form 1040 line 25 .
For Paperwork Reduclton Act Nolie., see Form 1040 instructlon3.
8
c,.', '" -
Cat No 1 \ J~8Z
Schedule SE (fonn 1040\1'"
for", 4.!182 (199~1 PIQ4' 2
Listed Property-Automobile ,Certain Other Vehicles, Cellular Telephonee, Certain Compute,., and
Property Used for Entertalnm nt, Recreallon, or Amusement
Note: For any vehicle (or which yo af. uSlf1g the standard mileage rare or deductmg lease e.-pense, complete only
23a. 23b. columns (a throu h c 0 Sactmn A, all 01 Section B, and SeclJOn C II appilceble,
S.clion A-De roelatlon and Olher Inform tlon Caution: S6e 5 of thl Instructions fOf limItations (Of automobiles
231 00 you hal'tl ev.dence 10 su ort Ihe bUSlI1ISl/in,esl eot use ~, Yes 0 No 23b II "Yes" " lhe evidence wllllen? !:krVes 0 No
W ~ m
tbl Bualrw..... 11ft BUll lOt deprK5ahon 111 lul (h) Elecled
Oal. ~ed 10 mW.u..'m. eot C t Of oU~' (butlOHtllnV'f1I,,*,,1 RKO~ M.ltlodI o.prec:l'hon aec11Qt1 119
Hf'wICI ~'c.nl.~ ~t1. UN only) r-nod ConvenllOt'l deducllOll COlt
See a 0 5 01 the instruclions,
7 Z"
'l,,",'
Add amounts in column (h), Enter the tolal here end on line 20, pa~e , ,
Add amounts ,n column i), Enter the total here and on line 7, a e' ,
Secllon B-lnlormlUon on U.. of Vehicle.
Complete thIS section lor ,ehlcles used by a sole proprIetor. partner. or other "more than 5% owner.. or related person,
ff you pro.God I'tl"cle, 10 'fO'Jf employees, fIrst illswar tilt quasllO{ls in 50<:11011 C 10 see " yOU meel ill "cw>tlO{l 10 completing lhis seellOlllor those ,elllcln
~ ~ W ~ ~ ffl
V'''clt 1 V~1C1t 2. V~ICII 3 VehICle .. Veh1de S Vetwc.IIl
I')
Type 01 Pfopt",. {hll
vlhlCln tnt,
24
Pro
I';;
uSlness use eo a e
S
~
&_'.
,~~~
I.
t.. . I'a.'
25 Pro e used 50% or less in a
28
27
28
r olal businesslinveslmenl miles driven during
the year (00 NOT include commuting miles)
T olal commuting miles dJlven dUJlng Ihe year
Total other personal (noncommuling)
miles driven. . . . .
Total miles driven during the year,
Add lines 28 through 30, , , ,
S/L -
S/L -
26
''''1'
27
29
30
3t
32
Wes the vehicle available tor personal
use during of/'duty hours?, , , .
Was the vehicle used primarily by a
more than 5% owner or related ptlrson?
Is another ,ehicle a,a,lable lor personal
use? ,
. ~
,
'7!'. ='>
,
Ve.
I
No
v..
No
Ve.
No
Ve.
No
VII
No
VII
No
33
34
."
/
"..I: rl u/.,-
"
Section C-Oue.t1on. for Employe" Who Provide V.hlcles for U.e by Their Employee.
Answer these questions to determine " you meet an exception 10 completing Section B 10' vehicles used by employees who Ire
not more than 5% owners or related persons.
V.. No
35 Do you maintain a written polley statement that prohibits all personal use of vehicle!, including commuting,
by your employees?, , , , , , , , , , , , , , , ., '."",
36 Do you maintain a wnllen pOlICY statement that prohibits personal use of vehicles. e~cept commuting. by )'our employees?
See page 6 ot the Instrucllons lor vehicles used by corporate cHtcars. directors. or 1 % or more owners
37 Do you treat all usa 01 vehicles by employees as pe,sonal use? , , , , . , , , , , ,
38 Do you provide more than five vehicles to your employees. obtain information from your employees about
the use of the vehIcles. and retain the Information received? . . . . . . . . . . . . . .
39 00 you meet the requirements concerning qualified automobde demonstratIOn use? See page 6 of the InstruChons . .
Not.: /I au' answer to 35, 36, 37, 38, 0,39 IS "Yes," au need not com lele Section B 10' the co,.red ,ehic/es,
JI.mortlzatlon
,:>;:X:: :\:"~0::::\.\i
lei
Amo<1IUble
amounl
"1
On.c'lptlUO 01 cosll
Ibl
0011. amorhzall()tl
~n.
Iq
Amo"llallO" '01
thll yeat
Idl
coo.
sechon
ear;
.:~'~> '~~'~~-,~~'{.:~:"'\',: ~'-~.~,\
40
41 Amor1lzalion of CO~S that b~an berore 1995 __
42 Total. Enter here and on "Other DeduclIons" or "Other hpen~es" lIne or your return
41
42
~oI" Tru.~
....WNII "-"- ~ IHJI ... St. H .r.t.lnltNCUonl, ... An.eh thll form to I"INm.
NamectllhOwn on 'Itum ~... 01 IC1Mly to whd1 thla form tW'"
t', i'l tit rr t- 'fl'
.ctlon To Ex~n.. Certain Tanglbl. Pro~rty (Section 179 (Not.: If you have any .UstlJd Property. .
com lete Part V before au com lete Part /,
Maximum dollar lim,talion, " an .nt.rp"s. zone bus,n.ss, .ee p.g. 1 01 the Instructloll. .
Total co'l ot lecl'on 179 p,operty placed in slrvlc. during the tax y.ar. SIt page 2 01 the
inltructionl, , , , . . . , , , . . ' . , , , , , , . .
Threshold r.Olt olseclion 179 property b.lore reduction ,n lim,latlon, , . . . , . .
Reduction In Iim,latic.n, Subtract IIn. 3 Irom line 2, " z.ro or I.... .nler .0- , . . . ,
Dollar lim,tation for lall year, Subtractlin. 4 f,om lin. " " z.ro or I..., Inler .0-, " mamed
filln a. arat.1 ,I" a. 2 of the Instruction. , , , , ' ,
II) OeSC""llOn of property
7 U'led property, Enter amount Irom IIn. 27, , , , , . , , .. 7
8 Tolal .Iected cost of ..ctlon 179 property, Add amounl. In column (c), IIn.. 6 Il\d 7 ·
9 Tentativ. deduCl,on, Enler the .maller of line 5 or IIn. 8. ",..,.. 8
10 Carryover of disallowed deduction from 1994, See page 2 of the in.tructlon.. . , 10
11 Taxable lncomal..",lalion, Enll( \he amaIler 01 taxabl. income (not leu than zero) or Une 5 (HI inallllCtionS) 11
12 Section 179 upens. deduction, Add lin.s 9 and 10, but do not .nter mOIl then line 11 12
13 C VII 01 disallowed deduction to 1996, Add IIn.. 9 and 10, l"sllne12 ~ 13
Hate: Do not use Part /I or PaIt 11/ below for listed pruperty (automobil.s, certain other vehicles, ce/lu/ar te/ephoflf/',
certain computers, or prope used for entertainment. recreation. or amu..m.nt), InstNd, use Part V for listed ro
MACRS DeprGclatlon For Ae.etl Pieced In Service ONLY During Your 1985 Tax Year (Do Not Include
U.ted Property.)
Section A-Generel A...t Accounl Election
14 If you ar. making Ih. election under section 168Q)(4) to group any ....t. placed In .ervlce dunng the tax year Inlo one or more
_II ...at accounls, check this be., See a e 2 ollhe instructions. , ~
Ib) Monlh and tc) BuiI IOf cMpfeciahon Idl RICO ___
tll ClUllf'le,ebon 0' property yeal' Plec~ in (bualnnlllnv..tmenl \1M ........:-'
Ml'\'ICt on Il"lltNCtionl .............
Section 8-Oener.1 D. recl.tlon S stem ODS
S/L
S/L
S/L
S/L
e 4 of Ihe Inslructions,)
S/L
12 rs. S/L
40 MM S/L
reelallon Do Not Include Listed Pro See a e 4 01 the InstNctlons,
17 GDS and ADS deducllons for assats placed ,n servlCa ,n I.. years beginning bafor. 1995 , 17
18 Property subJect 10 section 168(~(1) e18Ot,on, , , , 18
19 ACnS and olher de reciation, , , , , " ,',','," 18
Summa See a e 4 of the InslNctions.
20 Listed property. Enler amcunt from hne 26. , . , . , . , , , , . . . . , .' 20 I. .I,'
21 Total. Add daduc\lOn5 on lina 12, lin.s 15 and 16 ,n column (gl, and IIn..17 through 20, Enler here
and on the appropflale hnes of your return, Partnerships and S corporations-see Instructions.
22 For assels shown above and plJced In service dUring the currenl year. enter
the rtlon 01 the baSIS a1tnbutable 10 see lion 26JA casls 22
'<Wm 4562
Depreciation and Amortization
(Including Information on LIlted Property)
1
2
3
4
5
lb) Coo,
Ic)EIoc;'od"'"
8
158
b
rs,
3. ear ro art
5- ear ro
c 7 ,yaar property
d 10, aar ro ert
e 15'y.ar ro ert
I 20, ear pro pert
8 R.sld.ntial rantal
ro
h Nonresidential real
'0
MM
MM
MM
MM
Section C-Alternallve Deprecl.llon Sy.tem ADS) (S..
27,5
27,5
39
rs.
rs .
lea
b
For Paperwol1t Reduction Act Notice. sel pig. 1 of the up"." Inl'rucllonl.
c., No t 2906N
0MtI... 1&45-0m
i1@95
AII-....7
......,1---. ,.....,
1
17 500
2
3
4
200.000
8
,""" 45e2 1,1fl1
.
! 1 040 lts~''i~'d;~'d~;i',~'c-;';;';''';;~.R~~~~~ ,p ~@96 I
UI. the IRS
~I~-;wlse. ~ HO~~:~~g~~.~~7''':~ ):w r,,)\,.J P 0 be_. site pJ~' 11
pllall print : ~~ .0....... Of pOSI cH..:. 'lJ:' ana ZIP 'OJ, II ~o'" ,..,,10' , 10"'0" l~jrUs.
;;;~~:entlal .opfL.:rAlv ~?~~.Jt,5 ~A /7~p7
Election Campaign ..
See a e 111 ,
1
2
3
4
Label
15ft!
page 111
Filing Status
CheCI( only
one boll..
Exemptions
II more Ihan SOli.
de~en,jenlS.
,'.!! t'":e
Instructions
for line 6.:
Income
At1ach
Copy B of your
Forms W.2,
W-2G, and
1099-A her..
II ~-::>u ,:,;] ",~l
get 3 W.2.
see t"e
lr'\strucl'C',"S
IOf Ililt 7,
E'1:'os'.!. but 0::>
".:Jl anach, an,
pa,'"!'1fl"'1. A sc.
p,:.;;s'.! e:""::J5'.!
Form 1040.V
[see ''-,e
In~lr",J:t:o,..s
f:. !i'"'! f21
Adjusled
Gross
Income
II'lS ~'U:::~ .-(Ie ~:. *' '. O' "U. .. I~' Itl:.
Fo, Ir." ~e'"
n 1.Df': J'
23a Your IR~ Oeo'.J=t.,:I"l tsee InS!r.J:l'ons\
b Spouses I;:;'; C.;.:...:tt,)n i5~e 1r15truClt:l~S.i
24 MOVing eJ.peo'1S~S ':"Ua:h Fer,,", 3gJ3 cr :':903-F
~5 One.na'! of se'!'E-:;,J,'Tl~r;IIJ.. ,.c.l1a:h SChl?.1'J!e SE
I' I-~~" IS l..~:~,r 26 Sel!.f'''''j;'!=-J'~j t;~c..:~ In!./';J:"'i:e c"'ju:l,o~ lsee 1I1S~ J.
:~~ ...: ,..-:-" 27 I-.~o~~!. S',;!"~':'~ :,~j 5EP ~'a'~:o It SEP. c,",~-;;" .. LJ
;?,~':\"' +1 a c.., 'j 28 Pena'l, Cf) ('3" I \..:'~jfa,'..a' 0. sa:ln:}!. . . . . .
~:~\r1~~~,,~,~,'I'" 29 A.-.:r', ell j F.-;_ ~ ~-' 5 SS'~'" /;).:1. ~i2:./?1 ~
,-:.....::'::~; 1,' 30 Ad:! Lr,€S "~.:i lr ,:,..:;... (~ .
i ~ ~~ 31 Sut:'C!:II.- '. ~,,_, t. .-. . ",' :.' c' j~, \:.JU' adjuslcd gross income
Fer PflYilq' Act and Paperwork R'!d.Jello'"l toel f~otlee. !.e~ P;lJC 7.
')jo;;
.1996 eM'f,;!
. 11] 0'.-48""0 '!i45.00"~
You: .~~u~~umb.r.
.. ;. ~~-_.
.pou.... tOCi" ..cunty numb"
~1~1I!" :,H ,,,,.., t"'l,.,n.';!
,
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.
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,
'ro...' "fSI ~...,.. ."J ,r '.
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II 'jo,nl ,,1,,'" 1;';0..\1' ';": n"'T'tl ""0 f1!,l'
l's~ l"' .).....e
A;l 1':0
For help finding line
lnatruetion.. a.. pag..
2 and 3 In the bookl".
It. p.g. 11
VII
No
Noll: Cllrc.,n.
'Y.s~ ,,,1If10'
c"",~. yO\Jf fl. 01
r,CJ.,,, yOiJf "'.."d
00 you wanl 53 10 go 10 thiS fun.j"l .
If a 10lnl reh.;rrl. dJes your spou~e wanl 53 10 go 10 thtS fund? .
Stngle
Marrle;;l filing 10lnl return (even if only one had income)
Marr,td lll'~; 5e~ara!e r'1..rn. Eme, I~oule', &cellI St'::Wlfy no, abell' and lull nam. her.. ...
Head Cf I",ousehold IWilO qualifying person). (See Instructlons.lll lhe qualifYing person IS . ChIld but nol your
depenjenl. enler Ihl' child's name he'e. ...
Ouahf<"nlJ .....,dow/et) with dependenl child ( eat .pouse died'" 19 ). (See inSlructlons)
Yournlf. If )O-..lr parent lor someone e'se) can claim you as a dependent on hIS or her tax} No. of ~OIU
reIJ'~. do not chec~ bo. 6a. . . . , " . " . . . . . " .. ch.ek",,,
1IM16..ndID
Spou... , , . . , . , , . . . , . .. .... No, ",....
e a,plndlnts: 121 ~fPfnOfnT 5 SON! 131 e~fnatn" 1~1 '10 1)1 m~~lns clllldllll on lin.
5ftllrlty numb,r II :!orn ,,1"'llanSI'lID 10 Ir.tC ltI ~>>I Ic ."0:
111 FII" rIa"'f lUl n."e m for: 199! SH Inst ou 1'I~'l1r ~ '!%
. lived wilb Yl)ll
. did not Iiv. .lIh
you du'lo di"".
Ot "plr'lilln /~J
ISII 'ft'lruCllonSl ...!:::..-
D.p.nd.nts Oft Ie
nol tnl,"d .1I0Wl ~
Add numb.rs
.nl'AdO"
IinlS,h".
0,:>63
tJ
e
e.
/
b
D
d Tolal r:',Jmter cf e\.E-mptl:::lns clarr.'le:j
ILl
7
8.
b
9
10
11
12
13
14
15.
16.
17
18
19
20.
21
Wages. salar,es. I ;:os, elC. Alta:::n Formis) W.2
raubl. Inlerest. ;':~a:h S:hedule B if over s.aoa.
Tax'lxempt Irtl!~es:' 00 NOT Include on line aa
DIvidend lO:ome. Atta:h Schedule 6 if O\l!r SJOO
Taxable refunes, cre,j.ls. or offsets 01 sla:! and local Income ta..es (see InsuuctlOt'lsj
Atl~o~y 'e:el'"'~:
BUSIness Incom'! O' !k:asl. At:a:h S:::hedule C O' C.EZ
Capilal gain or (Ie!:s), II requ;,e:t ana.::h S:hed.Jle 0
O1her gan.,s or (Io!sesl. At1ach Form 4797
TolallRA dls!'.b~I,:"15 . I 15a I
Total pen5!~r.! a-oj a",ni,."lles 16a I
Renta~ real eS!alt. r:ia:lles, p'ir;e~Sh'pS. S cort:'orallons.
Farm Il'1come or Poss) Attach Schedule F
Ur,empi::}'me'll cc;r:;.ensa:ion .
S:lc'al !:'?:'.J~I~/ t'~~~f':5 I 20a I
7
8.
~i~
9
10
11
12
13
14
15b
16b
17
18
19
20b
16 1-
"
"
i'
<=:'1-
()
c:-
O
D
t:-
D !-
0
0 1-
,
v~
8b
o
l~
b Talable amour,l {see InSl.)
b Ta1il~ie im:::u~t 1st! IMs!.l
trusts, elc. Al1ach Schedule E
'I
b Talli!;t;lf a""=I.;":~ I~!~ 1".S:.}
~t~
Otl1er I~come. liS: type and amount-set! instructIon!
22
ThiS is yOJ' to1allncome ...
23. "1-
23b
2A
2S
26
27
28
29
21
22
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Ajd t~e i!"'Ct..:"'~ 'r t..~ fr r-J~I c:r.J"n1": fc.r ,:.,~s 7lrrC'u ~. 21
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"".0"" 1040 pQ1f.
P,:;!. 2
Tax 32 Amounllrom Ime 31 la,jl'JSletJ 9'(;!.') .ncomel 32 1,15:>01
Compu- 33. Chtrk II o You ....t't'! e5 0' 'lI':I~', o Bitnd. 0 Spoun was 65 0' older o B',~d ~ ','
talion Add !he number 01 bc~c~. ch.-I.,,:d .lDc..e and enle' Ihe lolal h@'; . 33~
, '
b II yOu ." married 11:1"9 Il!p.1r aIel.,. .nd your IPOUU Ilem'leS deduCllon, Ot ,~'~, '
you w,r. . dual.llalus alien. St~ InstruCllons and check her, . 33b 0 - <.~" .
(-"...--.- .-. .._" '" ) :&;f<
J.4 Enter Stlndard deduction Ihown below for your filing stalus. But see !he :;::-..>-',
:\.'-.~~' /,;l7<.i5""
tn. tnSUuchons II .,.Ou CheCked any bo. on hne 33. or b or someone 34 -
lar".r can claim ,au as a dependent ';(
01
your: . Sln91'-S~.OOO . ~larrl'd filing JOlnlly or Cualltylng wldow(,rJ-SS.700 ~~
. Head 01 hOuuhold-S5.900 . Mamed f'""9 Itparllely-S3.350 ;,\,"",,, ~.;J.!lt.
35 SublriCI hn, 34 trom hn. 32 35 -
If you want 38 II hn, 32 II $88..\75 or leu. mulllply $2.550 by the 101.1 numb.r of ...mphons claimed on .;! S"' j"~ -
Ihl I~S 10 hn. 6d. If hn, 32 IS o~er $88.4 i5. 51' the worksheet In th, "'Sl. 'or lh, amount 10 enler 3e
flgur. yout 31 T...ble Income. Subtract Iin. 36 from hn, 35, If IIn, 36 II mOt. Ihan Itne 35. enler .0. 37 "?()~"t -
la.. lee the .0
instructions 3e TI.. Set If1strucflons Ch!Ck If tOlal .ncludes an)' lall from Form(.) 8814 .;:~:~:
for 111'1' 37. b 0 Form 4972 .. 3e :5'"3:i7 -
39 Credit for ct\ild and dependant care e..penses A"ach Form 2....1 39 tJ - ~:~~~
Credits Credit for the elderly or th, disabled. Al1ach Schedule R. 40 (J - ~
40 ~'
, "
41 Fo,.ign IllC credit. Anileh Form 1116 41 0 ":fu
42 O1he1, ChICk .f from 8 0 Form 3800 b 0 Form 8J96 ~ .~
cO Form 8801 d 0 Form {specify) 42 " - ~
.~~'\.
" -
43 Add lines 39 through 42 43
44 Subtract IIn. 43 from hne 38. II hne 43 '5 mor, Ihl" hnt 38. .nler -0. . . 44 .s-3S 7 -
45 Sell.,mploymenl ta. AU~~" Schedule SE 45 V -
Other
48 Alltrnatl\lt minImUm ta.., Altaeh Form 6251 48 " -
Taxes
47 SOCial s~unty and Medtc:are tJ.:.: cn tiP .ncome not ,evorted 10 employer, Anaen Form 4137 47 G:J
48 Till on C1ualified rehremrtnl plans. .ncludl1"l9 IRAs. II reC!ulred. anach Form 5329 . 48 " -
49 Ad...ance earned Inccme credit pa,ments from Forml!) \\1.2 49 " -
50 HousehOld employme~1 ta..,s Allaeh Schedule H. 50 " -
51 Add hnes.U tnrOuQh 50, Tnls IS yJ.J' totallu. . 51 .:r3S '7 -
52 Federal If1come la... v.ntnnelj from Forms W.2 and 1099 52 t, y,,'Y - ~~:
Payments 53 1:}% U[lmaled loll Ci,rr'!r"-IS a~: a~oufll appl~ed fro,," 1995 relurn. 53 r!J
~,.;
54 E.rn.d Income credit. A'~a:~ S:"'e::.;!! EIC 11 you t'1ave I Qualifying ~"\ ~~~~,
c~l~d. NJntalatile e.r:"~:J ll"'.:::l-,!' a~z~r.: !li- I I I .,~,(,~ '$"~
~~~'.,,'. 'C\':-"
and type .. 1I4 .:J - ~,
A'~3:~. ................. ................................
F~'fT'5 W-2. 55 Amount ~a:d Wllh FCrrrl 4863 Ire::;J!sl for e.lenSlo~l 55 c) - >~~~,
\'/.2G. a",J 56 Excess social 5t:v'.:,' ii:l RF:TA ta:.: wlthne!:j (s!e .ns:.). 56 ,p '::'>;',
;C~3.R CoO :'.::,~~
t~; Ir:lr"1 57 ~~!O !:!\..,..e....15. CI'!:".I 10:-, a CJ F::'rr. 2.1;; b 0 For~ :1j6 57 0 "~ ., 6l'fy
."""
58 A:::Jd hnes 52 lhroua!'\ 5i. r"ese are your tolal ~8ym.ntl .. 58 -
Refund 59 If line 58 IS mo'e 1na" line 51. suoHacl line 511,om line 58. ThIS IS Ine amounl you OVERPAID 59 /6'7";)",
60a Amounl of line 59 you want REFUNDED TO YOU. .. 50. d~.~ -
~ -' ..! l~ Sl':,~:
o"e:'!lf t::l ~ ~heck'ng 0 ~".:.~~:
)Ol.ll tar-.k . b RouMg number c Type; Sa"lng5 ..~\~',
a::c.;n!, S..-f: Accour"numb.' ~CtI81"1;2J/ 1/ t7i/ls1 I I ITDJ ;~~'{
'n~t ard f " . d :!Z":
f" c. a~= :I 61 Ar-co.r::1 II~!:? \'~'j': !~: APPLIED TO YOUR 1997 ESTIMATED TAX !li- I 61 I 01 - :'./-{"
~>~
Amount 62 IIIir:e 5' IS mo'e tt1a"'l I,ne S5: Sutl.a;IIi'1e ~a from t'ne 51. Tnl5 IS the AMOUNT YOU OWE. :-X.;;.."'-
You Owe Fer de:a,ls 0" ho..... 10 ~a, a"'~ ...~! Form 1040.V. s-:t!: '~s!'uCII:::n~. . .. 62 " -
63 E510maled lal. penaily A'~~ In:IU'Je en line 62. . . . _ I 63 I 1 ;~~~~'~:~" ,; :~'S.,>.~~,. ~-~:-:~',:~~~..~~-.;;.
u...::t~ ~~'OII,t!. e! ~o:..':,. I Ct: :J.~ 1" a~ I r-,l.f' ~ '.l~.,I'\!':s ,..,~ "I Jr"l Ino l:ccmca~,1"9 set\,:sv:ts .~;;: S:atfmf':!S '1'010 1",. t>e~: C!"" ~now~d'it. ...:\
~~r tl I",)' a'~ ,.... tOr't:1 if";: ::"\'"; ~.~ t,~.J'J' :'-, ef ~.t:J.'.r jOl~l!'II"'a". la.pai"lls east:! Ol"l'! II"l1or""a:o~ 01 ....":'C" p't~al" toas any knowl.d;.
Sign
Here
Paid
Pre parer's
Use Only
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SCHEDULES A&B Schedule A-itemized Deductions OM8 ~o 15-&5-001.4
(Form 1040) (Schedule B lion blck) ~@96
o.u~.,........ofl"'" y,..,,,,,, (PI .l.ll,K1\ment 07
1"1...... A.....,..... s.--.o::. . Attach to Form 1040. ... h. Instruclion. lor Schedul.. A and I {Form ,o.tO). SeQlJenCI N~
N~)"'O"'-"on70.a~ ~.. I lal ,.c'$.~~"
;t? " to ,i ~ to t..It.A J . JC ~~ -
Medical Clutlon: Do not Includ. .xpenseJ fflmbursed or paid by Olh".1 ~'-~~\ .:1.i/1 ~~~,~:~
~*~
and 1 Med'cal and dental ..penses (sele pa~e ~~' ,'1'1 . 1 - '-''" ,
's"...
Dental ~':,->\" ,.",,',
2 Enler amounl from form 1040, hne 32, 2 ,1".- ,'c'"" 3'111 :'.lli~~\
Expen.es Multiply line 2 ebove by 7,5% (,075) . 3 -
3
4 Subtract line 3 from line 1. If line 3 is mor, than line 1. enter ~O~ 4 l' -
Taxes You 5 Slale and local income laxes . ~,h '!o;,r,fJ<,p- 5 .;:2".;J.S" *'s#
Paid 8 Real estale laxes (see page A'2) 8 .;13/7 - -i~T
IS.. 7 Personal property !a.as 7 v ~
p.g. A,1.} 8 Other taxes, UsI type and amounl ~............."...., \~l: ~
8 {) - -.'-:z.,J.,2
9 Add '1;~;;,j'5' ih;o~;jh'8':' ':..""" ,...'..,.. ,,,,,,,,........ 9 -
tnterest 10 Home mortgage Inlmsl and po,nlS reported 10 you on Form 1098 10 ;'3'h3 - *~
.~\..
You Paid 11 Home mongage IIllerest nol repMeo to you on Form 1091,11 paid ..':' ,;.~ t\~
IS.. 10 the person ~om whom you !lOughl t~e ~om', SH pa,' A'2 ~\. ~
~~~~"
p.,_ A'2,) ana Show Ihal per"'n', name, ident''Y,n9 no. end aOOress . ~\~~
................................................................ ~ I
................................................................ .{~~\ -~
Not.: 11 ()
...........................................-.................... I
F,rs:;r.al 12 Po,nlS nol reported 10 you on Form 1098, See page A,3
lme'est IS for special rules, 12 t? -~
no,
deductible. 13 Investment interest. If required, anach Form 4952. (See h~~'
~'
page A,3.) 13 () - '~t
~ '{ Z~D3
14 Add lines 10 through 13 14 -
Gifts to 15 G,lls by cash or Check, If you made any gill of 5250 or ;~<:~~, ~~
Charity t- - ~'"
more, see page A,3 15 ~
",",' ~~~'
II rcu made a 16 Other Ihan by cash or Check, If any 9,ft of 5250 or more, .;;':~.~. .*~
go.; 3~,d Iii,t a see page A,3. If o"er 5500, ~ou MUST a\lach Form 8283 16 () - "~"'~
te~'fi ~ l~' it. 17 Carryover from prior ,ear 17 .; - ,~~.
se-e c:a;;e A.3 ,~,~
18 Add I,nes 15 Ihrouoh 17 18 0 ,-
Casuallv and
The" losses 19 Casualty or theft losslesl, Attach Form 4684, ISee page A.4.) 19 0 -
,'" '1 :~~~~'
Jab Expenses 20 Unretmbursed employee e.penses-Job travel, union n'
L;t~: ~:~it
and Mosl O"os, jcb educalron, elc. If reqUired, you MUST attach ~i(
Other Form 2106 or 2106'EZ, (See pageA,4) ~...."......" ^,*-~'\' ~,
~>,;
Miscellaneous :~ ~:. ~~'&i'
........................-.- .............. ....-................ K~
Deduclions 20 L~ - ;,~;
...... ...... ....... ..... . . . . . . . . . . . . ... ~~
21 Tal( preparation tees 21 0 -
~
's:! 22 Ot'ier expenses-investment. safe de~ostt bc_-:. at:. List '<$.", ~-,~>'
,~~ ~,~,~
page A.4 lor type and a'"lounl .,.....,... ~~.
el:e'1ses to .............................. ."",-. K~\
22 0 -
deo_:: h.3e) ................................. .,... -. ......... ....., ....-.. ~~
23 Add hnes 20 through 22 , " 23 c) - '~~~~
24 Enler am~unl from forl"1 , O~0 I,ne 32, I 24 I I ~::}?;.~- ',~,
25 Multiply 10"" 24 abo',e by.'" I.C2) 25 () - tt~?1' I
' , .:~;~"
26 Su~)tract hne 25 from line 23 Illlr.~ 25 is more t1'l3"'l IIn,: 23. enter -0- 26 0 -
Other 27 Omer-Ircm lIS! on page A-4.. list tlP~ an:! amount . ~:;~I
Misc::lJaneous ,............. ..... .........
Deducliors ................... ... ..... ........ ............................. ,........ i?
27 -
Total 28 Is For:n 10~O, lire 32, o.~r $117,950 (o','f:( 555.975 If marned tiling se;:ara:e;y\? J
Itemized NO, Yc..r Ced'-lCllon IS net li'T 'Ed A:d 1l1e a""'c~";:s In t~e lar r.ght cc'...r""~ 1 /d. 7-/S
Deductions !,~.. lj"-,€,s .: : :/(1\...':;; 27 ,,;!-C'. E!"l:~O C""l Fcom '2';'0 1''''It: 3~ t!".1? larg,r c. -
, 28
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-
MARGIE H. CULLEN,
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO: 97,6093 Civil Tcrm
PAUL R. CULLEN, JR..
Defendant
CIVIL ACTION - LAW
IN DIVORCE
AEfIDA VIT OF SERVICE
I. Barbara Sumple-Sullivan, Esquire, do hcreby certify that I served a copy 'of the
Complaint In Divorce in the above-captioned matter by United States Mail, Restricted Delivery,
Certified No. P 308 769 833, Rcturn Receipt Requested, on the above-named Defendant, Paul
R. Cullen. Jr.. on November 15. 1997, at Defendant's last known address: P.O. Box 472.
Bolling Springs. P A 17007. The original receipt and return receipt card are attached hereto as
Exhibit .. A" .
Dated: November 19, 1997
arb3ra Sumple-Sullivan, Esquire
549 Bridge Street
Np.w Cumberland, PA 17070-1931
(717)-774-1445
Supreme Court ID #32317
EXHmIT "A"
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LAW OPPJ[JRH
BARBARA SUMPLH.SULLIVAN
1141111HIIlOH STHHRT
NBW GUMIlBHLAND.I'RNNHYLVANlA 17070-11101
IJHnNH (7171 "...14..ft
I' AX 11171 "".70ftU
April 10, 1998
E. Robert Elicker, II, Esquire
Divorce Master
9 Nonh Hanover Street
Carlisle, PA 17013
Re: Cullen v. Cullen
No. 97.6093 CIvil Term
Dear Divorce MaSler Elicker:
Pursuant to your Ictter datcd March 18, 1998, enclosed please find Plaintiff's
original Pre-Trial Statement in accordance with P.R.C.P. 1920.33(b).
I
Barbara Sumple-Sullivan
,
BSS/mts
cc: Thomas S. Diehl. Esquire (w/enclosure)
Margie Cullen (w/enclosure)
.
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II, PERTINENT PROCEDURAL HISTORY
11117/95
11/5/97
Parties separated,
Complaint in Divorce and Plaintiff's Affidavit Under Section
3301(d) were filed.
Defendant files a Counter-Affidavit under Section 3301 (d) wherein
he re~erves the right to claim economic relief.
Appointment of Master.
Plaintiff's counsel is notified that Defendant is now represented by
Thomas S. Diehl, Esquire.
11/26/97
3/6/98
3113/98
Ill. INVENTORY APPRAISAL
Allached as Elthibit "A".
IV. WITNESSES
a) Plaintiff
b) Defendant, as on cross
If the panics cannot agree on a value of the marital residence and Defendant's pension,
Plaintiff reserves the right to identify the respective experts to testify as to the value of
these marital assets.
None at ':his time but Plaintiff. reserves the right to identify witnesses after receipt of
Defendant's Pre-Trial Statement.
V, EXHIBITS
See allached Exhibit "B",
Plaintiff reserves the right to amend his Exhibit list after receipt of Defendant's Pre-Trial
Statement.
VI, INCOME INFORMATION
See attached Income and Eltpense Statement marked as Elthiblt "C",
VII, EXPENSE INFORMATION
See attached Income and Eltpense Statement marked as Exhibit "C",
2
VIII. PENSION VALUE
Additional information is required before this marital asset can be valued, Plaintiff has
requested said information from Defendant but has yet to receive said information.
IX, PERSONAL TV
If the parties are unable to distribute the marital personalty, Plaintiff reserves the right
to have this personalty appraised.
X, ISSUES
Additional information as identified herein is required from Defendant.
XI. PROPOSED ECONOMIC RESOLUTIOri
Upon receipt of the outstanding information from Defendant and upon completion of the
valuation of Defendant's pension and appraisal of the marital real estate, Plaintiff will
forward her proposed economic resolution.
DATE:
y/;o/9 J
.
/
/
/
/'
,,><- -
Barbara Sumple-Sullivan, Esquire
549 Bridge Street
New Cumberland, PA 17070-1931
(717) 774-1445
Supreme Court I.D. 32317
Attorney for Plaintiff
....
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EXHIBIT "A"
.' -"
MARGIE H. CULLEN.
PlaInt!"
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY. PENNSYLVANIA
v,
NO: 97.6093 Civil Term
PAUL R, CULLEN. JR,.
Defendant
CIVIL ACTION . LAW
IN DIVORCE
INVENTORY OF MARGIE H. C!.!IJ..tN
Plaintiff files the following inventory of all property owned or possessed by either pany at
the time this action was commenced and all property transferred within the preceding three (3)
years.
Plaintiff verifies that the statements made in this inventory are true and correct. Defendant
understands that false statements herein are made subject to the penalties of 18 Pa. C.S. Section
4904 relating to unsworn falsification to authorities.
Dated: t . 06 -'16
fJl,~J2u", I
MARGI H, CULLEN
ASSETS OF PARTIES
Plaintiff marks on the list below those items applicable to the case at bar and Itemizes
the assets on the following pages.
[xl 1. Real property
[x] 2. Motor vehicles
[x] 3. Stocks, bonds, securities and options
[ J 4. Certificates of deposit
[x] 5. Checking accounts, cash
[xl 6. Savings accounts, money market and savings certificates
[xl 7. Contents of safe deposit boxes
[ ] 8. Trusts
[xl 9. Life insurance policies [indicate face value, cash surrender value and current
beneficiaries]
[ ] 10. Annuities
[ J 11. Gifts
[ ] 12. Inheritances
[ ] 13. Patents, copyrights, inventions, royalties
[x] 14. Personal property outside the home
[ I 15. Business (list all owners, including percentage of ownership and officer/director
positions held by a party with company]
[ ] 16. Employment terrnil1.Rtion benefits . severance pay, worker's compensation
claim/award
[ ] 17. Profit sharing plans
[x] 18. Pension plans [indicate employee contribution and date plan vests]
[x] 19. Retirement plar.s, Individual Retirement Accounts
[ ] 20. Disability payments
[ ] 21. Litigation claims [matured and unmatured]
[ ] 22. Military/V.A. benefits
[ ] 23. Education benefits
[ ] 24. Debls due, including loans, mortgages held
[x] 25. Household furnishings and personalty [include as a total category and attach
itemized list if distribution of such assets is in dispute]
[ ] 26. Other
2
MARITAL PROPERTY
Plaintiff lists all marilal property in which eilher or both spouses have a legal or equitable
interest individually or wilh any other person as of th~ date of this action was commenced:
lIem
Number
Descrlpllon
or P~operty
Names or
All Owners
1.
1219 Kuhn Road
Boiling Springs, PA
Husband and Wife
Husband resides in
residence.
FMV
Mortgage
Nel Equity
$170,000.00
-85.895.17
$ 84,104.83
2.
Various Vehicles
The value of the parties' vehicles are
offset each other.
3a.
IBM Stock
Husband has cashed in some slock for
a vacation. Husband is in possession
of !he documentation !hat substantiates
!he value of Ihis assel.
3b.
Savings Bonds
Husband. II is believed thaI Husband
is in possession of the documental ion
concerning !his asset.
Sa.
PNC Checking
No. 5140452204
Joint.
5b.
PNC
No. 5080211715
Husband
6a.
Baxter Credil Union
Hu~band.
6b.
Uniled Mutual Funds
1151930-3
Husband.
6c.
DAFCU
Husband.
14,25
Personally
Marital personalty is localed al
both parties' residences. Distribulion
is still required.
3
MARITAL PROPERTY
Plaintiff lists all marital property in which either or both spouses have a legal or equitable
interest individually or with any other person as of the date of this action was commenced:
Item
Number
Description
of Property
Names of
All Owners
18.
NA VICP Defined Benefit Plan
Husband. Value to be determined.
19.
Thrift Savings Plan
DOS value = $16.119.53
Earnings on marital ponion to be
determined.
Husband.
9.
Life Insurance
Husband. It is believed to be term
insurance. Documentation is required.
4
NON.MARITAL PROPERTY
Plaintiff lists all property in which a spouse has a legal or equitable interest which Is
claimed to be excluded from marital property:
Item
Number
Description
or PrQperty
Names or
All Owners
14,25
Personalty
Wife. Various items are Wife's non.
marital property.
5
, . ~ ' _..._.--~ __~. :"It -....,....
,
PROPERTY TRANSFERRED
Item
Number
Description Date or
or ProperlY Transrer
COll5ld.
erallon
Person
to Whom
Transrerred
Husband may have transrerred some marital assets to fund a vacation and various other non-
marital .expenditures.
6
"
LIABILITIES
MARITAL
Item
.Number
Description
of ~perty
Names of
All Creditors
Names of
All Debton
Aside from the mortgage on Ihe marital residence, there are none,
'if
7
,
EXHIBIT "B"
CULLEN V. CULLEN
PLAINTIFF'S EXHIBIT LIST
Real Estate
.
.
Apprdisal for the Marital Residence must be completed.
Date of Distribution payoff of the Mortgage
Stock/Bonds
..
Plaintiff has requested an accounting of all bonds purchased during the
marriage from Defendanl.
..
Plaintiff has requested copies of statements from June 1, 1995 until the
present for the parties IBM stock from DefendsnI. Additionally, Plaintiff
has requested an accounting of the transactions and dividends from these
stocks from Defendant.
Accounts
.
Plaintiff will provide a date of separation statement for the parties' joint
checking account prior to the trial.
..
Plaintiff has requested various account statement from Defendant
concerning his accounts and mutual fund.
Employment Benefits
.. Plaintiff has requested that Defendant prov ide the information necessary
so as to value his defined benefit plan.
Thrift Savings Plan staternents dated 4/30/96 and 4/30/97.
..
Date of Separation statement for the Thrift Savings Plan must be obtained
by Defendant
.
A calculation of the interest earned on the marital portion of the Thrift
Savings Plan will be provided prior to trial.
Life Insurance
..
Documentation of Defendant's the terms of his life insurance policy is
requested.
Misc.
Joint Tax Returns for the parties for 1995
Individual Tax Return for Plainliff for 1996
Individual Tax Return for Defendant for 1996
1997 year end income information for Plaintiff and 3/10/98 paystub
Cullen v. Cullen
Exhibits
Page Z
Misc, cont.
..
Plaintiff request! Defendant provide his 1997 Tax Return prior to Irial
along with a copy of his current payslub.
.
A copy of Plaintiff's current paystub will be provided prior to trial.
. These exhibits must be obtained either prior to trial or through subpoena at trial.
.. These exhibits are in the custody and control of Husband. Wife requests that Husband
forward same.
Plaintiff reserves the right to add to this list upon review of Defendant's Pre-Trial Statement.
:,"tJ THRIFT SAVINGS PLAN
rr PARTICIPANT STATEMENT
For tnlt a.nod
1"01/9'3 'I'1rouqn 04130/97
TSP-8-A
Your Th(lfl S....,ngs P!,n ITS?} ..':COI./n! st..l,mlnt .s ISSu.d .'~er, SUI mont", bi ~"" N.ahon.1 FlnM1C, C.nt.r for tn, F.d.rjj
M.llr,menl ThrlH In~tlfm.nl BOMa, For .addition.1 In'orm"tlon cr to corr.et your .ddr.ss or ,ny 0' thl following it.ms.
pl..u contact 'lOur .gency emplOYing OffiCI.
N.m. PAUL Q C'.J'..l..E'i
50CI.l S...curtf'f Numbe'
O,ite at 8tfth: 08/13/53
R,llr.m,nt CO'I.rig.: Fe~s (IC)
SICM ,tlon St,hJS: Not S'PM .t.d
8,n"I<:IM''I Dnlgn.ltOn on FII.;- No
TOI.' S"'IIC' R'Qulred for VlStlng: 3 'f....., from 04/09/84 (TS? SIr'~ICI Compul.llon O.ts)
-" YOU chaos. 10 submit II Bene'lclary O'SllanA(lon (Form TSP-31. you Jr, r.soonSJbl. tor Its corr.ctn.ss and compl.eeness.
G FUND
Government Securitiu
Investment Fund
F FUND
Fixed Income Ind...
Investment Fund
C FUND
Common Stock Index
Investment Fund
TOTAL
ACCOUNT
BALANCE
Rates of
Return U
tNlJmbers In
p".nthases
..e ne;.all~e)
G Fund
F Fund
C Fund
aeglnnlng BII."cII
Tr.anuetlons nlls Period
eNmngs TtllS Pertod
Ending alLanell
aeglnnlng allinee
Trlns.aetlons This Period
eNn.ngs Thl3 Plttlod
Endcng all.anee
Beginning B.I."el
Tr.ansletlons This Petlod
EMnrn;s nlls Penod
Endmg Blllnee
Beglnntng alLanee
T"nUCllons This Perrod
EMnrng! ThiS Penod
Ending Balance
1996
November December
53%
1.69".
7.54'-'
.53",
t93'!",)
11.97~,1
Source of Contributions Total
Employ.. Agency Automatic 11"1 Ag,nc., Matching
6.731.86 7.813,68 6,308,59 20,852,'3
92!.34 185.12 742,82 1,856.6a
240.34 263,13 222,90 726,37
1,900,54 8,262,53 7.272. 11 23.435.18
aOO,90 119,78 670,51 1.651. 19
397.86 19,52 318.34 795.72
140.93 31.05 " 7. 13 289. t 1
1,339.69 290,35 I. lOS, 98 2,736,02
7,532,76 1.993,46 6.977,\0 22.503. J2
1,326.20 265.24 1.060,96 2,652. '0
391.27 294.1S 340.03 1.015. 4a
9,240,23 a,a52,aa a,378,09 26. 171 .:2C
1997 LoUt 12 Months
Jiinu.Jry Febru.ry M.rch April IM.y '96-Apr '911
.56lf. .51 ~. ,51% .58Y. 6.9n'o
.30% .201~ (111%1 \,49% 709%
6.22"- ,79% (4,13%1 6.00% 2S 02%
"-'CII...I fl'.' 01 r.lutn .It.r .dm,,,,,lta11.... ..0.""'. Tn. mg"lnl" t.l., of t.'lIt" .r. 1/,. ,.1.. u..d 10 compule In. aClual .a'nl"'ill on ,0uI .Ccou"l IICi"
monlh. a, ca,ct'b.d on In. Olell 01 Ill,. 'lel.m.nl. Tll. 12'mgnl" fal., of telUI" V'O. Ih. ,"....'Im.n, plrfotm"nCI 0' 0"11 'Ila' OOtIIO" 01 ,01.1' .ccounl Ill,:
....,. ,n....'..c:l 10' Ill. 1"11" 12''''0'''11 Olt'od. Blcau.. of IIlI I,mlng .nd .mount of 10ut conUlbul,on.. '"I..fund uan.'.". .nd Ollllt Ir.".ac"on.. you canna:
USI Ill_ 12'1'10"'" ta". 01 f.lurn .no.n aco.... to calcula" tOUI aClu.1 .atnl"'il' fo, "'I M'1 "95 . "~i1 1991 P"'Od Tn.t. ,. II,k of U,,,,,umln, tall ,n
bOlll tn. F .nd tlll C '\.Ind.. TI'l.t' '. no "Iuta"c. tnll PI" t.ll. 0' ,"utn wdl 01 t'lI.a'.1I ,n Inl 'I.Itut..
'ORM T5,...." 1"."'lud OS.,~.
rhe ThriftLine: 1504' 255-8777 e.n Ql'.e '~ou ~ccount Informltlon. Tn, Web lite; http://www.tsp.gov hn TSP In'orm~(lon Ind materl~;
8SJ65S0Q7J1N NV 24 2f17 97380600 05/97
r'OOC05233 000a42205
1...111...11111.11...111.11.1...11.11I11.,.1...1111101..111/.1
TSP Open Season IS May 15 ~ vul, 31.
To cnange your eontr'~utlons aSk your persor..
n.l off tee for tne TSP Election Form fTSP.I 1.
PAUL Ri CULLEN
1219 KUHN RiO
p. o. Bat 412
BOILING SPRGS
PA f7007~96]9
TO Change tne we, money already In your
account IS InveSted. call the ThriftLlne
~. ...... "'.-......r Shown above. Th. Thrl'tLlne
" ~,... "."",..~ Q"'IClent way to make. ehenge.
or cancel an lnterfund transfer re~uest.
DETAIL. OF ACCOUNT ACflVITY ;:or t'1e ~;Q' <): 1/01.' :6 , , ::)..;r GO:, JJ: jl TSP-8-A
"-.ame PA'.):'" ~ C~~LEN SOCl4' Se:;....rlt1' !'o:;moec Colle 01 Blrtn 08/\3/53
Source In"'8stment Fund
";.''''', ,,~'oll .., P'OC:'iU Ai.ncy Agenc.,
Co,u Oil.a Oil' O"e Implo~.. "''''lom'II' 11~.1 Ma. ~n,ni G Fund F Fund C Fund Tot.1
MONTH. END 8A~AI'.lCE OCT '996 7.532.76 7,993, 46 6.971, 10 20,852,13 0,00 I. 65t, '9 22,503, 32
0 97380600 11.101/96 11/01/96 100,40 20,08 80,32 140,56 0,00 60,24 200. 8Q
0 91380600 11/15/96 "/'5/96 100,40 20,08 80,32 140,56 0,00 60,24 200,80
0 91380600 11/29/96 11/29/96 100,40 20,08 80,]2 140, 56 0,00 60,24 200,80
E 100.14 55,87 87,26 11 1,95 0,00 1] 1.32 :243.21
MONTH~ENO BALANCE NOV 1996 7.934,10 0.109,57 7 . 305 , 32 2'.385,76 0.CY.l 1,963,23 23.348,99
0 97380600 12/ 13/96 12/ '3/96 100,40 20,08 80,32 140,56 0,00 80,24 200,80
0 97380600 12/27/96 12/21198 100.40 20,08 80,32 140,56 0,00 60,24 200,80
E 17,79 37. 49 18,50 11 3,70 0,00 39,92' 73.78
MONTH-END BAL.ANCE OEe 1998 8.152,69 8.187,22 7.484."6 21,780,58 0,00 2.043,79 23.824,37
0 973806000"'0/97 01/10/97 100.40 20,08 80,32 140,56 0,00 60,24 200,80
0 97380800 0'/24/91 01/27/97 103.40 20,68 82,72 144.78 0,00 8',04 '06 80
E 104.13 58,50 90,44 122,10 0,00 130,97 253,07
MONTH-END BAL.ANCE .J'N 1997 8,460,62 8,288,48 7.137,94 22.188,00 0,00 2.297,04 24.48$.04
0 97380600 02/07/91 02/08/97 103,40 20,68 82,72 144.71 0,00 62,04 206.80
0 91380600 02/21/97 02/20/97 103,40 20,68 82,72 144.76 0,00 62,04 206 ' 80
E 46,98 43.17 42,63 114.17 0,00 18,61 132,71
MONTH-END BAl.ANCE FEB 1997 8 , 7 14 . 40 8,371.01 7,946.01 22.591,89 0,00 2.439,73 25.031.42
0 91380600 03/07/97 03/08/97 103,40 20,88 82,72 144.76 0,00 62,04 206,80
0 97380600 03/21/97 03/21/97 103,40 20,88 82,72 144,78 0,00 62,04 206,80
E 7,21- 35,27 1. 814 129, 47 0,00 103,22- 26,25
~ONTH-END BALANCE ... 1991 8,913,99 8.441.64 8.109,64 23.010,68 0,00 2,460,59 2.5, .'1. 2.1
0 97380600 04/04/91 04/03/97 103,40 20,68 82,72 U4.16 0.00 82.04 206,80
0 97380600 04/18/91 04/17/97 103,40 20,60 82,72 '44,76 0,00 62,04 20\\ , 80
E , 19,.4 63,88 103,01 134.98 0,00 151. 35 286,33
MONTH-END BALANCE >P. 1997 9.240,23 8.552,88 8.378,09 23.435,18 0,00 2.736.02 26.111.20
.--
Activity Codes
o Duo..t
E E.rl'ung.
L LOin
P Monlhly 1011'\ p....m.nt 'UlTIlI'llly
T Inlldund trlnltl'
F FOlllll.d non....II.d mon...
R "",ored ,mounll
A AdJul1m.nl
C la,nlng. corl,C:llon
Y la'nlng' CO".Cllon tranlf.,
V 11I''''''1.1 01 ..rn'"1iI1 CO".ChOn.
B Dlclalld .blnclollld
o . Court-ord.nd p.ymlt'll
W . WI'hdr,.,...
M . MInimum d'llllbul'OIl
N . A.luno.d ..u:... oatl".r
Monthly ..rnings .r. c.Iculat.d by multlplYlnlil Iha rail of I"urn fer tn. month Ino.,.n 0, th. lum of your ",r,or month'I"d bllanca and o"I'r\lll of
Ina 10111 01 oapoll11 and lOin rapI'fm.nu dl,jrl"liI Ih. monUt Iho....n. Elln,n,,1 I" c..d,ted .1 11'1' ano of th, monlt'! .hown. Ad/Ul1mlnll, ,1'nlnIil1 CO"lct,onl
tOrlIIIU'" 101nl, ""0l.d I",oun,.. and "'"'lndt.......l1 alllcl '1'01.11 Iccount to. 'h. catcullllOI' 0' "'I'I,n'iJ' ., "'1 and 01 In, monln InOwII, 1n1"!-.mC! lr,n,I".
111e IIlICl YOu' leCOUIII al tn, .nd al ,,,, monln I"own. P'y d,ate 'I tnl 1211' reponed tI~ your PI,.,oll oll,c, fa' 01001'11 Process d'te 'I ,n, lUl,
a,pol'u and lOin PIY""'lnU WI" ll'OCII'ld 10 you' ICCOI.I"1 tiT tn. TSP '.co'd..,g~r.
'-'"
'-...I
FQAM TSp.e-A IRI"'''~ 0'5'9.
:,.,~ THRIFT SAVINGS PLAN
rr PARTICIPANT STATEMENT
i=or Ire oer,c'j
1 'i(}1:35 :N:;.......... JJ,1:)/'~.;
TSP-8-A
"our rl'lnf: Slvln\1S Pi." (TSPl ""ceounl S,.,tl"'OtH IS '!;,!,uUd ,'~.r'i SI:C monlt'ls Dv the 1\I..I,on.; ';In.lflCI Cent.r tor In, FI':Jlr..
RI!lr.m.n: Tnrdl Ir""..~Um.nl BOMj For .dd.tlo'lll inforn1.1tion or to carrier your .ddreu or .ny of Ihl folloWI"9 Items.
Pl..,. cont.act your .~."c.,. emploYing attlca
NMT'l1 PAUL Q C'JU..::N
SOCI.I SIC",'l'/" N",mot,.
o.t. 0' Birth: 08/13/53
;:;It,flm.nt COJ!Jf,g. FEw') (.c: I
S,gM'IIOn St.lu~ NOl 'ecarilld
TOI~1 Ser....lc. Reoul,e" tor V.stlng; 3 V"'I trom 04/09/84 fTSi' S.r....lc. Computlllon Colli)
8.nl'ICIMV 0'519f1.llon on Fill. No
.You "'1 r'SDonStel, for thl corrlctn.ss and COlTIQllllnlSS 0' ';'OLl( B,n.flclarv O"I;n'llon (Form TSP-31.
G FUND
Go....ernment S.curil'u
Invutment Fund
F
FUND
FiJl.d Income Ind....
In"utment Fund
C FUND
Common Stock '"duo
1"'oIutm.nt Fund
TOTAL
ACCOUNT
BALANCE
-
Rales of
Return U
(Number S In
p~ent"'eses
If. "lgI:I'I')
G Fund
F Fund
C Fund
eegln"lng B,I."cI
Tr.,uctlons Th.. F'.tlod
earnings Th" P.tloe
Ending 8,1""1
alglnnlMg 8'1~,.
Tr,"uctlo"S This F'.rIOd
EarnIngs This Petlod
Endl"; 9,lane.
a,gln"lng a,l""e
Tr~s.v;tlon:J Tnls F'e:"lod
E.unlngi ThiS PerIod
Ending B,l,n,e
aeglnnlng a.lanee
T,,",,etlo"s ThIS Period
E.rnlngs Th.s Period
Ending Balance
1~95
No"ember Oecember
.5 l~.
1.49".
4,38'"
.50'.
1.33':.
1.92%
Emplov"
Source of Contributions
Aglncy Autom.tic 11~1 Agency M.tching
Total
4. "87. 16
6.934,74
...'7.90
805,50
15,839,80
9a2.72
218. 14
t . 984 . 35
153.89
211.07
149.42
520,38
5,603. 77
7.367.95
5.372.82
18.3.14.54
119.9'
39.9 t
t 19. 91
279.13
210. a.~
42. 14
168,70
4~ 1.62
21.37
6.43
20,38
48. 1.
352,12
88.48
308,99
749,59
4.607.07
6.974.65
4.537,81
16. "9.53
1 . 113.56
258,28
974,20
2.406.04
115.26
223,50
169.BO
568.56
5.955,89
7,456.43
5.581. B t
19.094. , 3
~
Jolnu.ry
49~.
.66'"
3.41'"
1996
Febru.Jry
4e".
11.75'-)
,91%
,5."
l6a~.}
.97,.
M.rch
April
.54~
1,56")
I.H,.
Lut 12 Months
('Jby '9S-Apr '95i
S,S4l<
8,52'"
30.ll'l'.
..AcIU.1 r.I., 01 r"UH' .'UI .dm'n'.Ir.II.... ..pan,... TI'I. montnly '.1.. 01 ,aturn ..ra 'ha ,al.. u.ed 10 cOmDut. I'" ,ctu,1 ..,nnl~' On you, accounl .actl
monl". .. d..crlb.c on Il'Ia baclt 0/ '1'1,. .uum'''I. Tna 12-"'onll'l '.11ft 01 "Iur" ."0.... ",. ,n"'."m,nl p,rformanc' 0' only nUll portIOn 0' )l01.l1 .Iccounl Inll
...... In""Ud for tn. ."1". 12-"'orlll'l P,"od. S.cau.. of trIa ll"'''''~ an4 ,",ount 01 your con1tlbul.on., lnt."uno Ira,...I,rs, .nd GU'er tran'.ICIIOn" 'Iou C'''"OI
U., 11'1. 12''''0"1" 18'" 01 ,.tur" '"own .Ico"a 10 C.llcul.ll, your aClual ..rn'"gs lor I'" May "95 . .6.1)111 "'8 P'uoo TPI.,. i, ".. 01 in"l"m."f 10" .n
co I" In. , ."d I'" C ':1,1,,41. TIl.r. " no ...ut.ne. tn.t p.st '.1.. of return ....,It o. "P'."d '" tn. lulur..
'ORM TSP.I'A IR."I..d 051U'
e.l! the ThriltLine: 15041 255-8777 for upd.lld .C'ount lMform.llon ('.."II.ble 7 dol~s , WI,k. 24 hours.. dayl.
85365500731N NV 24 2177 97380600 05/96
T-01285 000210303
1"0111",111".11",111,1101."11,,"11.1.1,,,"111,1,,1"1,1
TSP Open Season '5 May 15 ~ July J1.
To ch.nge your Contributions aSk your person~
nil offtce for thl TSP Election Form (TSP~11.
PAUL Il CULLEN
,219 KUHN 110
80lLlNG SPRGS
PA 17007-9039
To Change thl way mon~y .lready In your
acCOunt Is tnvestld. call the Thr1ftLlne
It the number Shown above. The Thrl'tLt~
Ir.:he most .'flcl.nt way to make. enang..
I. tnt.r'und transfer reQuest,
~ TSP-8-,
DEi AIL OF ACCOUNT AC, ,.,JITY =::::r lr'e ;Jor,()..1 llG id5 If'lrou9n O~.'3on'}
"'''''. PAUL R CULLEN SOCl,)) Securllt' Number' D.~lt of Birth 06/1J/5J
Source Investment Fund
ACII"'''Y P.yrQII '" "oc;.u "'g..ncy AOlln,~
Coo. Olll,. Otl. O.'e Imrru,u ^.I1"m.IIC II~"I "'"CI'I'f1P G Fund F Fund C Fund r"'.l
MONT~.:NO B~LANCE OCT 1995 4.607,07 6,914,05 ',5J7.8 I 15.8J9, SO 0,00 H9,7J ,.-"lL-U9.-E
0 97 J80300 1 1/0J/95 11/0J195 7e,48 19,62 68,66 166.7.; 0,00 0,00 166. ":"
0 9"390600 11/11/g~ 11/17/95 76,46 19.62 86,86 166.74 0.00 C,OO 166, .
E J9.4:! J7,OJ :8.0: 8 " 2'J O,()Q t:!.24 ~~_---2~
MONTH-END 6ALANCE NOV 1995 4.7e2.4t 7,050,92 4 . 70J, 15 16.25A,51 0,00 291.117 ~~~~
0 97J606oo 12/01/95 12101/95 78,A6 '9.62 6e.86 166.74 0,00 0,00 tSe.7.
0 97J60600 12/15/95 12115/95 78,48 19,62 66.86 166. '4 0.00 0,00 186. 7~
0 97J806oo 12/29/95 12129/95 76,46 19,62 66.66 106.74 0,00 0,00 tSe.7.
E 26,51 36,27 25.98 8J,19 0,00 5,57 88.1C
MONTH-ENO 8ALANCE OEC 1995 5,054.JO 7,146.05 4.9J5,11 16.8J7,92 0.00 297,54 ~-r7, tJ5.4i
"-- --
0 9738060001/12/96 01/12/96 78,46 19,62 08,66 166,74 0,00 0,00 166,7'
0 97360600 01/26/96 01/28/96 100,4(\ 20.08 80,32 140,58 0,00 60.24 200.6,
. 29.47 :.Id.5tt :;uiJ.JI a;'.~8 0,00 11.10 Yol, ,~
MONTH-ENO 6ALANCE JAN 1996 5.262,63 7,222.33 5.112.80 17.226,80 0,00 368.96 17.597.7E
0 97360600 02109/96 02/09/96 100,40 20,08 60,32 140.56 0,00 60.24 200, 6C
o 97380600 02/23/96 02123/96 100.40 20,06 60.32 140.56 0,00 60.24 200,6C
E 25,49 33.51 24,66 79,79 0.00 3,87 8J.ee
MONTH-ENO 6ALANCE FEB 1996 5,468,92 7.296,00 5.296, 10 17.569,71 0.00 493.31 18,063,02
0 97380600 03/06/96 03/06/96 100,40 20,06 60,32 140,58 0.00 60.24 200,8e
0 97380600 03/22/96 0:/22/96 100,40 20,08 80.32 140. 56 0,00 60.24 2oo,8C
E 31,00 39,45 29.77 64,89 0,00 5,33 100.2.
MONTH-eND BALANCE MAR 1~95 5.720,72 7,375,61 5,466,51 17,965,72 0,00 619. t= 16.564,6J
0 97360600 04/05/96 04/05/96 100.40 20.06 80.32 140,58 0.00 60.24 200, 60
0 97380600 04/19/96 04/19/96 100.40 20.08 80,32 140.56 0,00 60.24 200,80
E 34.37 40,68 32.66 97.70 0.00 9.99 107.69
MONTH-ENO 8ALANCE 'PR 1996 5,955.89 7,456.43 5,681.8 I 18.344.54 0.00 749.59 19.094.13
o . OIPOlit
E . E.rnln\ll
L L.o.n
P . Monthly lOIn p.vmlnl summ.rv
Activity Cod..
...... _ . IlInll.,
F . Fort.U.d nonYllt.d moniu
R . A.llored .muunll
A . ....dJuJlm.nt
C . Elrnlngl carr.ction
Y . Earnlngl co".c1ion Ir.nlf"
V . A.....,..I 0' ..'nlngl corrlCllon
B . O.cl.,.d .b.ndonld
o . COUn"Ord.,ld p.vmlnl
W . W,thdrew.1
M . MinImum dis.,lbulion
N . 1l.lund.d '.CUI dlflrlll
Monthly earnings Ir' c"cul,"d b.,. mUlliplVing Ih. UI. of retutl'l 10' th. month Ihown b.,. 1'" lum of .,.our priOl monlh"end bll.nc. .nd an,-h.1I of
the lOTI' of dIPO'11I '!'lel 10';1 Up'.,.m.nu during th. month .hown, E""I"gl .PI credll.d, II lI'le .nd of Iht month .ho.....n, Adlu.lmtnrs, '.,nln;s cOl1l,tlonl,
10f',llur... lo.n., ,..tOrld .mountl, Ind Wlthdr.w.l. t".ct your .ccoun, 10' th. c.lcul'llon of ..,nl"g. II "I. .nd of t". mOn1tl Ihawn, Inlltlund Iflnl'.r.
111.0 ,fleet you' 'CCoun, '1 the tnd of the month shown. Pay date I, Uti d.U uporUd by you, ~'yroli olficI IN dlpo,its. Process d.te II the d'lI.
.IIPO\'t, and 'O<ln p.yments W'" proc.uad 10 your Iceounl Dy Iha TSp recQ'd~oapa',
"
;;OR~,I TSp.a.~ l.lll'....see 05J':1~'
~ 1 040 ~':s'.'''i~'~,~,';i~;i'',~'c~~'~;''T;~''R~'i'~~~.", 1)@95
Label
L
.
.
E
L
IS,e
In,lrucl!o''~
on p.1g. 1\ J
Use th. IRS
label.
Olh.r~ise.
please print
Of type.
P,uld.nllal
fl.cllon Campaign ~
(See page 11.1 ,
I
2
3
4
H
E
"
E
FIling Stalus
IS.. page 11.1
Check only
one bolt.
Exemptions
IS.. page 12,)
II more than sill
dependents.
see page 1 J
Incorne 7
lla
Attach b
Copy B or your 9
Form. W.2, 10
W.2Gt Bnd
1099,R her., II
If you did nol 12
get a W.2, see 13
page 14. 14
ISo
Enclose. but do 160
nol 811ach. your 17
payment and
payment 16
\loucher. Slit 19
p.g. 33 200
21
22
Adjustments 230
b
10 Income 24
25
26
27
26
29
3D
Adjusled 31
Gross Income
l"'J. .'111.,,'1
I"'. , .,. ' ", I '. ,.. , ..' ,'~ c' 11."", '" l'''~ 'I ~,r
. 19 ~u No '5.15-007.
_._-- --------
Your IlJciol "cIomly numb.,
,,,. Ill., ,\'.1' J,l!l 1-1.1,'<: :11 l~lJ'i. O' 01''''' I;H ,,"J' tJ"'l"W'''rl
,,;,,'!'I\IIIJrlllt,lrulll'l't'.ll linIn.,,,,
au
PAUL R JR & HARGIE
1219 KUHN RD
BOILING SPRINGS PA
H CULLEN
17007-9639
I
: rp~;-
.,1.
Single
1
Married flhng joint rei urn (even If only one had Income)
Mamed lilmg sepatat. relu'n. Enl,r spouse's SOCialsICuflly no. abOve Ind lull nam, here II-
Head 01 hOlJsohold (with qualifying pelson). (See page 12.1 Uthe qualirylng person 15 a chUd but not your dependent.
enter Ihis child's name here. .. ,I
5 Oualif in widower) with dependent Child ( ear s OUSt dIed"':. .g . (See pa
6a @ Your..lf. II your pBf8nl (or someone &lse) can claim you as . depend": on his or her tBlt
rei urn. do not check bo)! 6a. But be sure to check the bo.;i:pn line 3Jb on page 2
I/o'
b Sou... ./...
c O,plndenll: III OeQ,nd.nrSIOCIiI /.l3' '!llnd.nl's
(11 f I L.\ln.m, sttulltynurnbtr II born "rel.bonthl!) 10
IfS n,m, In 199 U I 13 011
d II your child didn't live with you bul is cl.11med as your ~epen~rnl under a pre-198S agreement. theCk here'" 0
, Tolal n",mber of exeMpllons claimed
Wages, salaries, Ups, elc. Atlach Form(s) W.2
Taubl. interest Income 15ee page 15). Attach Schedule B If over $400
T..-uempt Inlerest (see page 15). DON'T include on Ime 8a Lab
DIvidend income. Attach Schedul8 B if over S400
Ta~able refunds, credits, or oHsels 0lslal8 and local Income lall:e5 (see page 15)
Allmony received
BUSiness Incorne or (105S). Attach Schadula C or C.EZ .
Capital gain or (1055). It requjred, altach Schedule D (sae page 16)
Other gains or (Iossas), Allach Form 4797 . . . . , , . . . . ,
TolallRA dIstributions. ~ U b Taxabl. amountlsee pagl 16)
TOlll pensions and annUlhes l.J!!J l~ tl Taxable amount (see pig. 16)
Rental f8al estate, royalties, partnerships, S corporations, trust" lie. Attach Schedule E
Farm Income or (Ion), Attach Schedule F .
Unemployment compensallon (see page 17) " ..,.. '..
Socialaecurlty benefits I 208 I I I b Taxabl. amount (see page 18)
Other Income, list type and amounl-scl page 18....................................
Add the amounts in the far rI ht column lor lInes 7 throu h 21, This Is our total Income ..
YOUt IRA deduction (soe page 19) . 238 ...
Spouse', IRA deduction (see page 191 23b
MOVing expenses. Altach Form 3903 or 3903.F 24 I
One'hell 01 .oll,employmenll.. , 25, '7 'I
Sell. employed health Insurance deduction (see pa~e 21) 26 'J
Keogh & eell'omployed 5EP pions, II 5EP. ChOCk ~ 0 27 )
Penally on early wlthdra.....al 01 savings , 28 )
AJ,mony pa'd R.c,p,.nl', 5SN ~ 29) ..
Add lines 23a lhrou II 29 These ilte yOU' lotitl adjustments ..
Sublra:1 hne 30 110m liMe 2~ 1hlS IS ~uur adjllSllld ,reu jn~Dme II IC1~ If".}n S2E 6i3 and a ct~l~d h.~d
wI11\ you fles5 trla~ 59 2JO I' d chi;'] doiJnlll.f VI,ltl !,';Li ~et 'fdfn~d In::or1le (If'l.l on p~~ ';I ...
Do you want S3 10 go tc lhls fund1 .
II a joinl rei urn. doo!> your spouse wanl $3 10 go 10 thiS fund? .
, ,
Ca' r.~ . ~f.;.l'~'''''
spou.... IOCI.llOcurify number
For Privacy Act ond
Paperwork Reduction
Act Notice, eee page 7.
V,. No Nole: Checlung -Y,s-
WIll not C/1,Irlg' )'OU'
Iv 01 'educe )'OU'
1.lund
e 12
No, of ball I
eh.chdonl.
Inllllt
No, 01 your
ehlldrlft on Ie
whO:
. II". .111'1 ,ou -1-
. III'n',U" with
yov'ullo
IIlvorc.er
JlPlllllon 1111
P.gIU)
D.plndtrUI on Ie
nOllnllrldlboWl_
,
!
I,
,
r
I
,
I
I
I,
I
I
:J
If I II olmonlJt\
IrollllllYOU1
MlTlfl/'ll9tS
2
Add numbers [iJ
anllr.d on 2
Un.. .bon II> ~J
~ l "
t,
I
~
~') '.,
",.,
o
3D
,,' ,?
31
"orml0.liJp9'J'J)
Tax
Compu-
tation
(See pllge
23)
II you want
the IRS 10
figure your
ta.. see
page 35,
Credits
(See page
24,)
Other
Taxes
ISee page
25,)
Payments
Allach
Forms W.2,
W,2G, and
1099,R on
the front.
Refund Qr 62
Amount 63
You Owe 64
65
Sign
Here
Keep a COPY
of this r81um
10f your
records
Paid
Prcparer's
Use Only
"
32 Amounl Irom lIne 31 ladju510d gross Incomol ' ,
33. Chock II 0 You we,e 65 or older, 0 Bllnt.l, 0 Spouse was 65 Of older.
Add the number 01 bous. checked above and enter Ihe lolal here ,
b II your parent (Of someone else) can claim you as a dependent. check here
Page 2
".'; -
o Blind
~ 33a
~ 33b
c If you art married 'IlIng separately and your spouse il.milDS deduCllons or
you ar. a dual.slalus alion, lie page 23 and check her., .. 330 0
j It.mllld deductions Irom Schedule A, hn. 28, OR )
34 Enler Slandard deductlon shown below for your .lIlOg sial us But If you ch.cked
the In"(>'1 bOI on line 338 or b, go to page 23 to find your slandard deductlon,
larger "u checked bOI 33ct your atandard d&ducllon II zero,
01 .
you,. · l~ngle--SJ,900 . Married fdlng jOintly Dr QuahlYlng wldow(,r)-S6,550
. ~.ad of household-S5.750 . Martled filing Iltparalely-S3.275
SUblrac!ifi.34Iromlin.32. . , , , . . . . . . . . . . ., .
"
IIlina ~tlS $86,025 or less, multiply $2,500 by (he total number of exemptions claimed on
line ,-,,/1' .lne 32 Is over 586,025, leD the worksheet on page 23 'or the amount to Inter .
T']I,ble Incom.. Subtract Une 36 from line 35, If hne 36 Is more than line 35. enter .0- .
T/;{ Check If from I G{Tax Table. b 0 Tax Rale Schedules, c OCapllal Gain Tal Work.
ftrie.,. or dO Form 6615 (.a. page 241, Amount 'rom Form(.) BB14 ~ . I
39;' 'Additional taxes. Check II from a 0 Form 4970 b 0 Form 4972 . ,
40'"1 Add lin.s 38 and 39,
41 Credlt'or chUd and dependent cat, expenses, Attach Form 2441
42 Credit for the elderly or the disabled. Attach Schedule R ,
43 Foreign tax credU. Attach Form 1116
44 Olhar credit. (.a. page 25), Chack If Irom a 0 Form 3BOO
b 0 Form B396 cD Form BBOl dO Form (.paclly)_ 44
Add lines 41 through 44
SublrBclline 45 'rom line 40. If line 45 Is more than line 40, enler -0- ,
/2'1,,1
35
,.;
35
3B
'7~()tl
;.It
37
38
36
37
41
42
43
, -
o -
45 (I
48 , (
47 .
48
49 I
50 I -
51
52 1
53
54
45
46
41
48
49
50
51
52
53
54
~
Self'employmenltax, Altech Schedule SE .
Allernalive minimum tax, Attach Form 6251 , . , . ., .. ..
Rocaptura t""e., Check If 'rom 10 Form 4255 b 0 Form B611 cD Form BB2B
SoCial security and Medicare tax on tip Income not reported 10 employer. Anach Form 4137
Tax on qualilied relltement plans, IncludlOg IRA!. If required. attach Form 5329 .
Advance tarnltd Income credit payments hom Form W.2
Household employment taxes. Attach Schedule H.
Add lines 46 Ihrou h 53. This is our total tax,
flderallncOmllall withhlld. II any 15 110m Formlsl 1099, check" 0
1995 estrmal.ed tiP payments and amount applied from 1994 relurn .
Elm.d Incom. credit. Attach Schedule EIC II you have a qualifying
child. Nontaxable earned income; amount ..I I I
and type" ..... ...,., ... .......... ............. .... ......_ ..,
Amount paid with Form 4868 (extension request) ,
Excess social securily and RATA tax withheld (see page 321
Other coyman", Check IIlrom a 0 Form 2439 b 0 Form 4136
Add lines 55 throu h 60. These are our tot81 Bymentl
llllne 61 IS more than line 54, subtract tine 54lrom line 61. This Is the amount you OVERPAID.
Amount of line 62 you want REFUNDED TO YOU,
Amounl 01 1m, 62 you w,nl APPLIED TO YOUR 1996 ESTIMATED TAX ~ B4
II hne 54 is more than line 61, sublract hne 61 from line 54, This is the AMOUNT YOU OWE,
For details on how to pay and use Form 1040-V. Payment Voucher, see page 33 , ."
Estimated tax penall (see pa e 33), Also include on hne 65 66
55
6B
67
58
59
60
61
66
Urldtr pen.lt,es 01 ptffurv, I declate Inat I have ".mlned (hI' fltutn and accompanying 'cntdulu and Ilalem.nll. end Ie the bill .,1 my know1edge and
be!,e!. tney III IrUI, COfreel. and complel. Declaration 01 pt,p~rer 10Ih,'lhln (lAparll)I' bu.d on Illlnlermatlon 01 WhICh prePI'll hi' ant knowledg..
~ '(our~nalur' _ Oal. Your occupation
, ~;,._'~ /i,1;,. 1/ "
~ SPO~"'I Ilgnllure II . IfnI r.lum,
,. -I . dl/ '
Prepare", ~
S'Onalurl ,
Oale
f'llTlsnametu,,)OWS ~
I! 'e1r.emp1o)edl ,'\(1
.'.1,r,u
ZIP coae
Schedule A-itemized Deductions
UMUNo '~.I'.;vO.''''
. _ --._---._----- .. .._-~--
SCHEDULES A&B
(Form 1040)
(Sch.dul. B Is on back)
'll@95
Oepan....'" 01 ,"- "'U''''
..,,,...... F1......... 5.-...c. (10)
. Attach to Form lo.cO. . S.. Inatructlon. 'OJ Schedul.. A and B tForm 1040).
All.ehmenl
S~u.nu Nl} 07
Your ,ocl.1 ..curlty numb.,
Medical
and 1
Dental 2
Expensas 3
4
Taxes You S
Paid 6
15.. 7
paga A.'.) 6
Interest
You Paid
15..
page A'2,)
Not.:
Personlll
Interest is
nol
deduclible.
Gifts to
Charity
II ycu rnade I
girt and gol .
benefi! for It.
59 page A.3.
,
\ l ell'
>....:,.
Caution: Do not Include expenses rOlmbursed or paid by others. '~~;...:,,'.
Medical and denIal ..penses (see page A,') , 1
Enler amount horn form 1040, hne 32, 2 ~
Multiply hne 2 above by 7,5% (,075) , 3
Sublracl hne 3 Irom line 1, II hna 3 is more Ihan hne 1 enler .0,
Slala and local income liIJles , S
Real est ale laxes (see page A'2) 6
Personat prooerty laxes. , , 7
Olher laxes, Usllype and amounl ~ ,...................
.-
......................,.........................................
g Add hnas 5 Ihrou h 6 , , , , ,
10 Home morlgage inlerest and poinls reported 10 you on Form 1098
11 Home mortgage,nl..esl nol reported 10 you on Form 1098, II paid
10 the person Irom whom you bought Ihe home, .ee page A.3
and show that person's name. identifying no" and addre.. ~
.,~
................................................................
................................................................
11
, -
................................................................
12 Points not reported to you on Form 1098, See page A,3
for special rutes , 12
13 Inve.lment Inlerast, If required, attach Form 4952, (Sea
page A'3,) 13
14 Add lines 10 throu h 13 , 7 .
15 Gills by cash or check, If you made any gill 01 $250 or
more, sae page A'3 i'l. -
16 Othar than by cash or check, II any gill 0' $250 or more,
see page A'3. If ovor $500. you MUST attach Form 8283 2. t'('
17 Carryover from prior year
18 Add lines 15 throu h 17 , t. I '2..
Casually and
Thefllosses 19 Casually or theNlosslas), Attach Form 4684,
Job Expenses 20
and Most
Other
Miscellaneous
Oeductlons
21
(See 22
page A.S for
ell:penses to
deduct here.)
23
24
25
26
Other 27
Miscellaneous
Oeductlons
Total 28
itemized
Deducllons
Unreimbursed employee expenses-job travel, union
dues. job education, etc, II required, you MUST attach
Form 2106 or 2106,EZ, (See page A,5,) ~ ..............
................................................................
/J
................................................................
Tax preparation lees , . . , , , , ,
Olher expenses-investment, safe deposit box, elc, UsI
type and amount ~.......,....,..........,........,........
\ .
22
23
~
Multiply line 24 above by 2% (,02) , , , 25
Subtract line 25 Irom line 23, II line 25 is more than I,"e 23, enler -0-
Other-from I,st on page A.5, List type and amount ~ ................
................................................................
Add lines 20 through 22, ,
Enler amounl from Form 1040, Ime 32,
24
...... ................. ............................. ........... .....-..........................
o
Is Form 1040, hne 32, over $114,700 (over $57,350 il mallled flhng separalely)?
NO. Your deduclion is not hmite,d' Add Iha amounts in the lar fight column }
lor hnes 4 Ihrough 27, Aiso, enter on Form '040, line 34. the larger 01 ~
this amount or your standard deduction.
YES. Your deduction ma be limited. See pace A.S for the amounl to enler
For Paperwork Reduction Act Notice. see Form 1040 Instructions.
Ca: t~o 11330X
sCh.dul. A IForm 1040} 19115
SCHEDULE SE
(Form 1040)
Self-Employment Tax
---!: I~. ~~.~~.2_~.:J,,_~_'~ !'_~__
~@95
.,. S.. lnt.lrucllons lor Schedulo SE (Form 1040).
Allo1(;hrnfnl
Sequencl No 17
l/flI.,t,...". ~,Ilt'. Io,u""
Inl"'-"" A.,..,.~ .....0 POI . At18ch to Form 1040.
N,!flle at person ....I!h seU.employment income (a~ Shown on Form lOoSOl SOCIal ~ecurjly number 01 per$on
frLLrJ i t.'. ~j(. with IlIf.employmenl income"
Who Must File Schedule SE
You must hIe Schedule SE if:
. You had nel earn'ng. ham .ell'employment 'rom other than church employee ,ncome (line 4 of Short Schedule SE or line 4c of
Long Schedule SE) of $400 or mora, OR
. You had church ernplQyee income of $108.28 or more, Income trom services you performed as a minister or a member of a
religIous order I, not church employee income. See pa\J8 SE-1.
Not.: Even ,I you have a loss or a small amounr 01 income Irom sel',employmenl, ir may be to your benel,t to liIe Schedule SE and
use e,rher "opt'onal merhod" In Par/II 01 Long Schedule SE, See page SE,3,
ExcepUon. If your only self-employment Income was from earnings as a minister, member of a religious order, or Christian Science
pracl,l,oner and you filed Form 4361 and received IRS approval not to be taxed on those earnings. do not file Schedule SE, Instead,
wflle 'Exempt-Form 4361" on Form 1040, line 47,
~ li-~
May I Use Short Schedule SE or MUST I Use Long Schedule SE?
Otd you ..celye wag.. 01 lip. 11'I 19951
No
v..
Ale you I mll'll,Iiff', m.mber 01 . I...gtOUI Olae', 01' ChrI,t.."
Sc;lence prachl.on.t whO rK.iy~ IRS 'pp'oyal not lobe taua Ye.
on urnlOQs hom Ihne soure", but you owe MU.employmenl
t.. on Oll'\ttl' "'",,'\OI?
WAS thl 101.1 of your w.ges and IIPSlUbjKt 10 toClaI MCUfIt)'
Of rallr~d r.hremlnt ~. plu. your nil l,minO' Irom
1I11.tmpk)ymMll mol' Ihln 561,2001
VII
No
Ale you USing on. 011'" opllONll mtIthodl 10 "YUI' you' nel Ye.
.atl"Mt'lgl (1M page SE.3)"
No
No
No Old you recllY' IIPI lubtfCI to aoc!.1 .ec:unly Ot MedIC'" 'all Y..
thAI you did no' report to )'OUt emplOY'r?
o.d you lecelY' chutch employ" It'IComt rlported on Form Ye.
W.2 01 $108.28 01 rTlOfl?
No
YOU MAY USE SHORT SCHEDULE 5E BELOW
YOU MUST USE LaND SCHEDULE SE ON THE BACK
Seclion A-Short Schedule SE. Caution: Read above to see if you can use Short Schedule SI:.
Net larm profit or (loss) from Schedule F. line 36, and farm partnerships, Schedule K-1 (Form
1065), I,ne 15a , , , , , , ' ' , , , , , , , , , . , , " 1
2 Net profll or (loss) from Schedule C, I,ne 31; Schedule C,EZ. I,ne 3; and Schedule K'1 (Form
1065), I,ne 15a (other than farming), M,nisters and members of religious orders see page SE,l
lor amounls 10 report on th,s line, See page SE-2 lor other income to report, , , . ' " 2
3 Combine lines 1 and 2. . . . . . . . . . . . . . . . .
4 Net earnings Irom .ell,employment. Mull'ply fine 3 by 92,35% (,9235), II less than $400,
do not "'e th,s schedule; you do nol owe .ell,employment tax , ' ,~
5 Self, employment tax, lithe amounl on line 4 IS:
. 561,200 or less, mulliply line 4 by 15,3% (,153), Enler the result here and on
Form 1040, line 47.
. More Ihan $61,200, mult'ply line 4 by 2,9% (,029). Then, add $7,588,80 to the
result Enler the lotal here and on Form 1040, line 47,
3
4
<&'7'1
6 Deduction for one,hall of .elf,employment tax, Mult,ply line 5 by
50% .51 Enter the result here and on Form 1040 line 25 ,
For Paperwork Reduction Act Notice, selt Form 1040 instructions.
6 I
('.'f? 1-
Ca: f.(, 11353:
Soh.dul. SE (Form 104011995
Fl.lfnJ 456.! (1'J~SI P.IJ~ 2
Iil!IIl!J listed Property-Automobiles, Certain Other Vehicles, Cellular Telephones, Certain Computers, and
Property Used for Entertainment, Recreation, or Amusement
Note: For any vehicle lor which you are using the standard mt/si1ge fate or deductmg lease expense. complete only
23a, 23b, columns (a) Ihr(Jugh (c) of Secl'on A, all of Secllon 8, and Secllon C If eppllcabl.
Section A Depreciation and Other Information (Caution: ~e P..Q!Ll!. 5 of the instftJctiOns for limitations lor automobiles)
230 Do ou havo eVidence 10 su on Ihe buslnessllnveslment use cl"med? ' Ve. 0 No 23b It "Yes," 's Ihe eVIdence wfllten? [MV.. 0 No
lei ~I ~l
BU'lIl"w ld} SUi, lor depfKllIhon (1) (gl lhl Elcteled
Ul...Ulm.nl CosiO/other R~DV.ry Method! o.ptKI.tlDn
UI. b.SII (busmen/ln....'lm.nl penod Con....ntion deducllon .echon 11V
pllc.nt.g. us. only) cost
See a e 5 01 Ih. Instrucllon., :
1 I'. Z,) PI'>
!j .. 1,.,." .
~y
e 5 of the instructions. :
I"
T rpe of prOPllrty (11'1
....hlcles first)
10)
Oll.pIIC~1I1
"""C'
% '/' .
ualified business use
%
%
%
Add amcums in column (h), Enter the lotal here and on I,na 20, page 1,
Add amounls in coiumn i). Enter the total here and on hne 7, a e 1
Section B-Inlormatlon on U.. 01 V.hlcl..
Complete this section for vahle/os used by a sole proprietor, partner, or other "more than 5% owner, .. or rs/ated person.
If you proVIded vehicles 10 your employees, nrsl answer the quesllons in SeelJon C to see If you meet an exCeplJOllto complellng INs seellon for /hose vchides.
. ,....
25
Pro ert used 50% or les. in a
26
27
26 Tolal businesslinveslmenl miles driven during
Ihe year (DO NOT include commuting miles)
29 Total commutmg miles dnven during the year
30 Total other personal (noncommuting)
miles driven. .
31 Total miles driven during tho year,
Add tines 26 through 30,
1.1
V.hlc~ 1
Ibl
VehiCle 2
te)
VehICle 3
Id)
V,hiel.4
I.)
Vehicle 5
I~
VehICI. 6
.: t\
'1l'1 <;;
, (}
V.. No
Yes No
V.. No
Ve. No
v.. No
V.. No
32 Was the vehicle available for personal
use during oH'duty hours? ,
33 Was the vehicle used primarily by a
more than 5% owner orrelated person?
34 Is another veh;cle available lor personal
use? .
./
,/
lI..tr, uhf"
V
Section C-Quesllons for Employer. Who Provide V.hlcl.. for U.e by Their Employe..
Answer these quesllons to determine if you meet an exception to complellng Section B for vehicles usad by employees who are
not more than 5% owners or related persons.
35 00 you maintain a written policy statement thai prohibits all personal use of vehicles, including commuting.
by your employees? ,
36 Do you main lain a wnllen policy stalement tnal prohibits personal use 0' vehicles, except commuting. by your employees?
See page 6 at the instructions for vehicles used by corporale cHlcsrs. directors, or 1 % or more owners
37 Do you treat all use of vehicles by employees as personal use? ,
38 Do you provide more than five vehicles to your employees, obtain Information from your employees about
the use of the vehIcles, and relaln the Inform allan received?
39 Do you meet the reqUIrements concermng qualified automobile demonstration use? See page 6 of the Inslructions .
Not.: If our answer 10 35, 36, 37, 38, or 39 rs .Yes,. ou need no/ complete Secllon 8 for the covered vehIcles,
Amortization
Ves No
I.'
OescnptiOn 01 costs
(0)
Dale amorhzalJOn
bltQlns
lei
AmOt'\lliible
amount
101
C"".
lecllon
In
AmortlUllon fOt
lhisytlt
40 Amonlzallon 01 cosls that be
ear:
41 Amortlzalton of costs that beoart belore 1995
42 Total. Enter here and on "Other Deductions" or "Other Expenses" hne of your return
Fo~ 4562
Depreciation and Amortization
(Including Information on Listed Property)
OMti ,~O lM5.0172
~@95
1
2
.. Soe separate Inslructlo"s, ... Attach this form to Y"Jur r.turn.
Busmen or ,CIIVlt,. 10 whICh thIs lann ,...1..
lr (, I. lUlltlt ;:" ",[" C,', 'rlh
E ecllon To Expense Certain Tanglbte Property (Secllon 179 (Note: If you have eny "Usted Property,.
complele Part V before YOl' complete Part I,)
Maximum doHar limitation. If an enterprise zone business, see page 1 at the Instructions
Total Cosl of section 179 property placed In service during the lax year, See page 2 of the
instructions . . . . . . . . . . . . . . . .
Threshold cosl of section 179 property before reduction In Ilm,latlon, , , . . . . .
Reduction In limitation, Subtract line 3 from line 2, If zero or less, enter -0- , . , . .
Dollar limitation lor tax year, Subtract line 4 from line 1, If zero or less, enler -0" If married
filin S8 aratal ,sae a B 2 or the instructions . . . . . .
(.1 o.sCtipllon 01 property
110)
An,ehmanl
S4quencl No. 87
1d"'.frIn1I ........
[)t;1l.n1nltl\l 011..... ,,,..'"
!M..-r>1! R...__ SeMc.
1
17 500
3
4
5
2
3
4
200 000
5
Ibl Cool
Ie) EJecltd eost
6
7 Listed property, Enter amount from line 27, , . . . , , 7
8 Tolal elected cost of section 179 property, Add amounts in column (c), lines 6 and 7 8
9 Tentative deduction, Enter the smaller of line 5 or line 6 . . , . , . . . . . 9
10 Carryover of d,sallowed deduction Irom 1994, See page 2 of the instructions. . . 10
11 Taxablelncom.limilation, Enler the small.r of taxable income (nolless Ihan zero) or line 5 (see instruclions) 11
12 Section 179 expense deduction, Add lines 9 and 10, but do not enter more than line 11 , 12
13 Car over 01 disallowed deduction to 1996, Add lines 9 and 10,1.ss line 12... 13
Note: Do no/ use Part /I or Part 11/ below (or Its/ed property (au/omobiles, certain other vehicles, cellular le/ephones,
certam computers, or prope used (or entertainment, recrealion, or emus.men/), Instead. use Part V for list.d pro e
MACRS Depreciation For Assets Placed in Service ONLY During Your 1995 Tax Year (Do Not Include
Listed Property,)
Section A-General Asset Account Election
14 II you are making the election under section 168Q)(4) 10 group any assels placed In service during the tax year Inlo one 01 more
eneral asset accounts, check this box, See a e 2 of Ihe Instructions, , , . , , ~ 0
IbJ Month and (e) Bus 10f depfecillion (dl Aecov.,-y
II) CI..siflClhon 01 proper1y YUI placed In (buainlsslinveSlmenl use period (;1 Otpnclallon deduction
servIce onl -see Instructions
Section B-General DepreclaUon System (GOSI
15a
b
c
d
e
I
g 27.5 rs, 11M S/L
27,5 rs. 11M S/L
h 39 rs. 11M S/L
11M S/L
Section G-Alternatlve Depreciation System (ADS) (5.. a . 4 of the Instructions,
16a S/L
b 12 S/L
40 11M S/L
e a e 4 of the Instructions,
17 GDS and ADS deducllons for assets placed," servlc. in tax years beginning b.for. 1995, 17
18 Property subJecI to seclion 168mll) election, , , , 18
19 ACRS and other deprecialion, , , , , , , 19
Summa See a e 4 of the instructions,
20 Listed property, Enter amount from line 26, , , , , , , , , , , 20 ,. J,'
21 Total. Add deductions on hne 12, Iln"s 15 and 16 In column (gl, and I,nes 17 through 20, Enler here
and on the appropriate hnes of your return. Partnerships and 5 corporations-see instructions.
22 For assets shown abolie and placed In service durmg the current year, enter
the portIon of the basts attributable to sechan 263A costs 22
For Paperwork Reduction Act Notice, see page 1 of the separate Instructions.
Cat t~o 12906N
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~- _ CULL 3D 0 9512 610
PAUL R JR & MARGIE H CULLEN
1219 KUHN RD
BOILING SPRINGS PA 17007-9639
INTERNAL REVENUE SERVICE
PO BOX 8530
PHILADELPHIA PA 19162-8530
$ '<14~. -
Enter the amount ot your payment.
Make sure your Social secunly number IS
written on your check or money order,
~ Use thIS voucher when making a payment With your tax relurn,
~ Send your payment and payment voucher to the address above.
... Do nol slaple thiS voucher or your paymenllo your rei urn.
... 00 not use thiS voucher 10 pay quarterly estimated laxes.
PAULR. CUllEN ~.~
MARGffi \I, CUtJ.EN~-
1Z19 KUHN 1l0AD
DOlLING SI'IUNGS. I'A /1007
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'He lANK. N.A.
IOUTHCBHTlAL p" 040 171
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C""'''''HIL.I..''.,70I,
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Change of Address
0'-'8"10 B.l5.llcJ
lR... "'1.1, 19'1~'
Ill- Plu58 type or print.
::',:\.<'''4d cf 1~' 1"..",,.,
,..,..~.. A..,~..f 5......~- II> S.. Instructions on back. .. Do not Inach this form to your "turn.
~ Complete This Part To Change Your Home Mailing Address
Check ALL boxes this change atfecls
1 !d Individual Income tax returnslForms 1040, 1040A, 1040EZ, 1040NR, elc)
.... If Y':''':~ las: return was a JOInt return and you are now establishIng a resIdence separate ~
from the spouse with whom you filed that return, check here .. L:i
2 0 Employment lax returns lor Musehold employers (Forms 942, 940, 940-EZ, etc,)
... Enter your employer identification number here . "..
3 0 Glh, estale, or generation'skipp,ng lrans'er tax returns (Forms 706. 709, elc,)
. For Forms 706 and 706,NA. enler the decedenrs name and social security number below,
... Decedent's name
... Your n.m. (I,'st n."I,. WlII'41. .nCllnl nam'l
. Social ,.curlt number
<4b Your loclal IIcurUy numb.,
:::,4i-1' L ;f? t3 id..L-e..J -' 72 .
6. SpO\,l.... n.m. {f".: ,..,.m.. "'''1",. .I'\d 1&11 ".tTI.]
"-
Sb Spou..'. IOc.ill ..curtty numblr
..mAl c;-'::r.e ~
tlue--J
e Prior n.mllll, 5.. If"llruCllQI'I1
7. Old .dd'I" 11'10, Ill":, C,l"l or 10W:'I, I:':'. .nd ZIP COCIlj, I' a P.O. bO' OJ' lorl';" addrlSS, IN It1l!rl.lcl.o"..
ACl tiC
.11 ll'lllrucl.ons
A;: "'0
70 SPOUSI'I old .ddr..., II C ~I',nll'cm 1~r.1 7.lnc. 11'''1, Clry 0' low", 1:.11.
5-'.;l.:;l.. ,D--:C-~('.'/( Cfd'LLt' .A1""6#.;'A<Z',q-5$('..*,V~ ,;:}fl. /7~..:.-.:5-
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r
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Address or Business Location
Cr"l-=:.... ALL :::'OX!S tnlS cha~ge affects;
9 -, E:":":;:;:Jyment. excIse. and other b:.JSlness re~Ur,'1S (Forms 720, 9~1. 990.10.41.1065. 1120, e~c.)
10 [J Emolo'/ee plan rct;;rr,s (Forms 55'JO. 5500-CJR, a"d 5500-EZl Se! Inst~\Jctlons.
11 = :3L..:S r",-:i~ lo-:a:10:"',
12, Bus'"'1I nam, 1'21:1 Employer Identlficltlon numb.,
"
Old OIClC'"S ,~~ ....,:. C:J C' 1:"",- s:a:, ,..,: ,IQ c:o~.. 1'.1='0 t:o. o"e',;'" add'.n. It.. '''.'!'..:t,Ol'"'
Room c:., ....11. I"':C
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11040
Label
IS~!
ca;~ 11,
Filing Status
Chl!Cl( only
one bOll.
Exemplions
It more Iran 51:"
dece(1,je~:.5.
s,~ tOO!
,ns:.-wellons
f~r Itn~ E,:
Income
Attacn
Copy 8 ot your
Form, W.2.
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U,S. Individual Income Tax Return "
FJI::-.,'!J,'
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l'j'id t"Q.r'f
,Q:' .j- :. .-:: ";' ..' 'f~' t',,: t - '"" 1':1;'
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Us. the IRS
label. H HC""~CC:"u 1l"l,.J'T'Cir .1r"C' W.t~. If ,:'~ MoJ.'.1 P 0 eel, s.,., '.I,' 11
0'"."",., . j-: ('). g ox. ~ 7.;;L
aleast ptlnt ~ C,l\l .J......, Ot cest ~If,':;f_ StJlol ant::: ZIP cC.Jot II ''/0.... M,hf .. 'Otll'~ J.:jt"U
Op"YOdC II I 8"f?f,.Jv s?""~.Jtr5.PA /'7&J~7
resl en a
Elecllon Campaign ~
See OH 11 I ,
1
2
3
4
Single
Maltled lillng JOlnl retu," (e'J,n if only one had lMcomel
Marr:ed h~ln9 ~,wah' r"lurn. Enl!r s~ouses "'Cta! sKunfy no, ibo't' and rull 1'1,,",1 her.< .
Head 01 household (V/lln qualifying person). ISee instructions.) " the qualify,ng person 11 a cf1lll,j but nol yout
dependent. enter th.s chlld's name here. ..
OuaiJfy,n w1dow(erj wlln dec,nd~nI Child {year 'ClOuse dIed .. 19 I. (5<18 instruchons )
ea 0'Vourself. If your patent (01 someone elsel can claim you as a dependent on h.s or htr lax} No. " aOlls
return. do not check bOll 6a. . . . . . . . . . . . . . . . ,II,ek,d O.
1I..s Illnd III
b Spouse........, . .. No III ,our
C Oepend.nts: 121 Oe~tnoJtn! J IONI (3) Otcena.nr I 1111(0 c.r :r.:,'Ii'll ,DlI4na on IIn.
U:Jtlry num:w II ~Jrn r.I,lf1on"ilD 10 "'-t: " /:;;t Ie"
111 First t\Ji"'1' Un "1m, In Ce: tHE lIt ,n~t yO\l "e~t tI ,*; . Q
. IIvelt ..U, lOU
. 4i4 1101 li" .illl
'au dUI I. dhorel
IIUIlJtJllo. .
11"1.'II\l'tlons,~
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LJs: ~l-o!
.Ai;:l r.o
I.. Dol'1' II
00 you want S3 to go 10 thiS fund" .
If a jOlnl relurn. does your spouse want 53 10 go 10 Inll rund? .
5
d TClal n:Jm:'!r 01 ell.<!mCllons Clalr:1'C
7
8.
b
9
10
11
'2
'3
14
15a
16a
17
'8
19
20a
21
Wag!s. salaries. t ps. et::. AHa:n FormlS) W.2
Taxable in:arest. 04::1;:1"1 SChad!,,;t. B *, ov!r S,J''Jv ,
Tu.....mpt lrt:!~es:. 00 r:OT It'1clud! on line 83
8b
OI'il:1!nd 111:0m!. A:t:!C~ S:nedl.Ote 6 I! O'.!!" 5.1:0
T2,(301:, ferunas, cfed':s, or OH5~:S of s:a~~ a~d local InCCr.1ff 1allU Isee ms:rI..C~Icr:SI
A:-mony re:el"'!~
8..$lness .ncom! Of (1':1$5'. A~la:n S~ne':h.lre C O' C-EZ
Cap.tal ga'n or Iloss). It requited. at:a=h S:ne~wl-e 0
Ot~e~ ga,,"5 or {lols.sl. A:la:;h Form ':'79;-
TOll! IRA d'st..tl'''':I~('!s .~ I I b Tiaa::l! amcv:t {SH ;f's~l
T:lll ~er.~'cr.~ a:,j an"~u'!'~S ~ .i.--.J b Talac:! a~:ll,.."'\l t5!t :f!s~.\
P~''':;i: re:!1 est a:! r;'!a:Ms. ,,:artl".tr5~:.a. 5 c:tr;:tratIO"'lS I~~sls ,Ic Attacn Schee,.ole E
Fa~~ Incom! or (~O$sl. At:a::n Schedul3 F
U~.tm~lOimenl compen!l.1:;cn .
Social S!:urt:'1 beMfilS I 20a I
O:"'Itr H'\.:orn,!. LIS: t'/ce and amount-s!~ instruc:!on! ......... ......,.... ,.
b Ti,.iCi'! il~CI,,;"\~ 15~~ ,r,s:.l
22
.......................................................,......................,........
A:.::l t/":i! a'Tl:l>,.;!"'ls In 1"1'i! fr ,,~.,t C::lI~-r.M t:rl'nes 7 :nrcl.O:;~ 21 TrliS IS Y'J<J" tolal incomt ...
23.
b
24
25
25
27
26
29
~O
31
123a I
f23b I
12. 1
i 25 I
I 25 I
27 I
29 I
29 1
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o!
(.11
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"I
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Y::l'.J' IG:.. a~:I'.J::..:n fs-:-~ t(\str'.J:I'~"s'
!,.....:
5:01,15:'5 I;:;:' ~~~.;.:l,~n (5~-! ;ns:ru::I:".~
~.'~Ilng e,~~,!,rlSH Alia:" F::r:Tl 3:03 C' ,HJ3.F
O...~.11a'f c' H!t'!i:=::J'..'n:!r'!! Lb ~~:a:n S':~~'::L.;le SE
S~:!.er!1p!):l.;oj ne3'::1 Ins.;rJ."'\:e e~~t..:':'I,=n lse~ ;/lS~ I.
~ ~:t;:M !. S'~ij.!!~=.,J'i~d SEP ~fJ."'5 I; SE::. c"',e;;~ ... U
P.:~a:i 01' eJ~;) \\l(l".drJ'.'.3' c~ S.!.-If'!:;'5. ....
:".7';;f"itJ'~ P-:,:,::-~"'nS3'1'" ;;J:l. c;L~ ;;2.,;;1'/;1-
Ajj lor.;. ;!-3J ~rr:"..:;,'" 2::
S,;c:'a:f I"J 3'] !.")I" "'--: :,J T
";;',
./ adru:>ted CJr.::~~ ir'!c':'m-,
Fer Priva:;l Act and P.Jr;l~ro'fofll; R,>:hctl"~ A:;! NotlC'!, ~e~ n.l:.i'~ 7
.,..
01-
9
'0
11
'2
13
14
15b
16b
17
'8
19 1
20b
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22 1
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YOU( IOClil-I uc",ruv nu""".,,
.. ~ 4_.' ._.. :,:..'7
-~ .
SPOl,lS.', JOCI" S.c:unty numb"
Fo, help rindlng line
instructions, .ee pagu
.. Ind 3 in Ihe booklet.
Vu
No
Not.: Cl'1ee~,tti'
'Y,s' .."llflCI
,"."g. ,Ol.;r ~.f 01
rtdcJc:.ycvr,'.r,J
/
6
7
8a
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01
o I-
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61-
L.I~
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I
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,
5.:>,;:t~
"7'.j-..J-{1 1-
; ,..- 1040 ";/;
.:;....
Tax
Compu-
tation
If 'fOU wanl
In, I~S 10
hgure yOur
laJt. "eo! I'"
In:uruCllon"
lor line 3 7
Credits
Other
Taxes
Paymenl~
":'::1::-
-=;..-;- ~ ',', -:
'.','.2:: a..:
~ : ~~. = ;.-
:._~ I. ;I"~
Refund
;.. ~ .:- . So;-.
::..;;'.::
,,::.~. :: 1-.,
3:;: -: :-::
I ~ _, . 1-::'
.::::: ]-.:-:
Amount
You Owe
Si91
Here
c;-: a :;..
..-s.:.....
- ;.; ~
Paid
Pre parer's
Use Only
AmC\j~t ~r:Jm "r~]l ;J":jL..jl.:J Jr~',j Ij,;:;IT1~.
C~I:!~l\,~ 0 You ...~.~ 6:') ,;r J;,;'~" 0 Bi<r,j 0 Spouse ..;,11 '55 'JrJ:'1~'
A,jO It:" numc;:r 01 CG~~S :rt;~~J dC\1~e and enl~r Ire! tdL1) r~'.;
;OJ;! 2
i n IZ5-:>~1 ,
[0-'-
J2
33.
o 8 ,',j
.. JJ.J
)
301
,:-:;:.'
~h~
~,~~
35
1,;;1.
:J-
b If 'IOU ate rnJffI~,j 'd,n9 sep.1r Jle!!" and yout spous/! .feml'-:~S dejur.1H:\n, or
'/OU were a dl..JI-SIJt...IS ai<<!n. se"'! ,,,strucIIOos and CT1ec... r,~ri
.. 3Jb 0
..
38
31
~~.
38
"~~
~.
I
~~
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,,~~
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.;!.S-J."
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o
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:;
. ,0 7J'
v/77 -
/6 ;L !-
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,
'...:~=~' C-"-J~1~:::' ;1' .~. t :::,: :!'~ t~.'j ~.l.'" t':O~l"o!J 1~,S I"~~~ a~-: 3:::-:1",,'''g S:t'!:'J'iU Ir.: s~,r.Ir.''':s 1:"01.) ("f' ttl~:' r-f io.,~<:o.~"-:;t .1'::
:~. -t' '"'!, 3'ot t.~.. c-::..t:. ".: ::,.--: :::~ ~~:J,-J,. ~~ ci :::.-t:J.t. ::::-~'lra" t.~::I,t.lIS OJ1f:::::~.' ':".::r.....'::::.!'\ C' ''',~;ro or.:3"t' :"as a,t ..I'I:.~ '::i.
-.
301
lltemind deductions Irem Scnedul~ A, hne 28, OR
Ent!!t Standard deduction sno.....n D1!iow lor 'lour ',1lf19 slatus, But see the
the 'In~:ruclfons II you check.ed an,! ball on hn, 3Ja or b or som,on~
larger can claim )OU as a dep~ndenl,
01
your: . SingJIt-SJ,QOO . Matrl.~ tiling JOintly or Oua.hfojltlg wldow(erj-S6.7GO
. Hua 01 r.ousehold-S5.900 . Marned hhn~ separaleiy-SJ.350
Subtracl hne 3J Irem Itne 32
II hn. 32 IS Saa,475 or less. mulllpl', 52.550 by In, tolal num~er of .J:,mphons clollmed on
hnd 6d It line 32 IS Oll,r Saa,H5, see th. workSi'lt.t In the InSI, for th. amount to ,nl.r
TUAblelncom.. Suoftacl hn. 36 from fin. 35. II hn. 36 IS more than line 35. 'nler -0-
Tall. See Insrruchons. Chec;k " lotal Include!; any la~ Irom I 0 Form(s) eal4
b 0 Form 4972 , ' , , , , , , , , , , ,
35
38
31
38
39
40
41
42
43
44
45
46
47
46
49
50
51
52
53
54
55
55
57
56
59
60.
.. b
. d
61
82
8J
39
40
41
~~
42
CreeM lOf c;",!d a"d dependent care e"pens~s. Anac" Form 2.141
Credit for t"e elderlY or the disabled, Attach SCh.dule A.
Foretgn Ii" credl!. AlIieh Form 1116
OIMer. Check I' Irom a 0 Form 3aOO
cO Form aaOl d 0 Form (specl~/'
Add lin.s 39 through .s2
Subtract line 43 from line 38 If line -l3 IS more l/1an lIne 38, enler ~O~
o
"
b 0 Form 8396
"
Self. employment la.ll. AlI~~h Scr:edule se .
Allemall.... minimum t;JJI AI:ac;h Form 6251
SOCial so!Cutll'l Jl".d Ml!1,CJr. tJ.( en rip Income not f~;;orted to emeloyer, Anac" Form J137
TaJ: on qualifIed retlremel",t plans. tnc,uaing IRAs I' required, a{lach Form 5329 .
Adllance tam~d Inccme cre~M pa:imenls frem Form!sl \'1.2
HCiJsenol:j emplo~'rre~lla.lles Attac;n S.:nedul'!! H.
A.:::d lines .11 tnrou"" 50 ThiS 'S 'J,:/lJr tolal ta~ . ..
52
53
~'il
.~~\
&':\..
54
55
56
57
'.. "r
(I
OJ
~
~'
C-
..
F~derallncome- fa.. v;ltr.nej~ from Forms \N.2 and 1099
1 ~9Q UII!'l'1a!e-:2 11.\ ca',:j'l!r'lls,rj ar-.Cun: aoc!l~'j frc'":"l l1i5 r!~!,,;'" .
hrn.d income credit. A:~~' S.:::-t-:.!~ EIC If 'leu nol'l! a O'.J!i,t,,"g
:"1,';, ~j~r:la'J=::! U"~~: ir;.::r"".!-' 1~:-.('!1" I I I
anj ',/c" . .,_....,......,......... ......... .......,.,......
A..~cunt I:ld ~'.;l'" Fo;::'-; J!!S3 (fe:'J~S: far eJllt~r'ls:o-
elt:eS5 s:)cla! S-!:....:,. a"d RFOT:"la" w,rt;r,e::j \5~' Irs:.).
0:..11' (;3:r'!"l!",f). C:,-t-:., if ,.:"', a CJ F:;frr. 2J3a t:. 0 For"'"'\ ':1,j~
A~d hnes 52 lh!::u;;:.~ 5~ Tno!se a~e ';o..,;r tota; payment'
If line sa IS mort lna" IIn9 5 '. suClra:lllne 51 from !tn, sa TMIS 15 tT1e am.junl you OVERPAID
Amount 01 line 59 'fOU want REFUNOeO TO YOU. . ..
RouM9 "emO., 16'311 1:31/1.;tJ71~ c Tloe ~"ec.'ng D5.',,"gs
Account "emO,. ~"181"!~/11 J7i/l5! I
'.-,,;.,,' ',-, ;),;; '" A/PLlEO 10 YOUR t911 ESTlMATEO lAX" I 81 I ()
l~ I,/"\e 5115 ma'e lMa" j,n~ sa 5uC!~J:l hn~ 5alrom k'1~ 51. TI"1I$ (5 !he AMOUNT YOU OWE
F:r det3d~ on hO:. 1-: ;:a.. J~C t.;~! Form 1040.'1. !l~e Ir,S:.,;:t':~s . . ..
Es~'rr.at~c tat C~"JI!.' A'os" Ir:'....-::~ Cl"lj,l"1-! 62 f 63 I I
..
43
44
45
48
47
48
49
!iO
51
~Ij
~~~
.!~J
': \.
}~<:I
58
59
80.
~ d1;]'u~ C-Id- fr
~ s=::~u~s:~!:_.- ('J :"':'~.- ~'~"'-~1:S:..
1 CJ.~
I~/ '97
I 01'+
1~~~;~:~"-6-;,- 6Jtf';.v~.L
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-... S G~....rl"'r-..-~;l,~.-;:-:.. ~....;_~7!..""
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H:'~'
SCHEDULES A&B
(Form 1040)
o.c........,., lll~' f'U1J'1 IPI
Ln'..~.' o.....~. s..~.~,
(Schedule B i. on back)
Schedule A-itemized Deductions
to s.. InstructIons for Schedules A and B (Form 1040).
Medical
and
Dental
Expenses
Taxes You
Paid
(S!!
page A.1.)
Intarest
You Paid
iSe!
pa~a A.2)
Note:
Pt~s..:r.al
lnla'!,: ,s.
n::lf
de~l,;ct'lJle
Gitts to
Charity
I~ ~.'=U rr.a:::~ a
9": l"C ;-:: a
c-:-~;: f;' .:
He ::a;~ ~.3
Casually dnd
Theil Losses 19
Job E'penses 20
and Musl
Olher
Miscellaneous
Dedu:lions
:::.:!;~ ;',..:, r:r
e-"(:~"'1S:5 tJ
':';'; .:: I....cr~ I
24
25
2;
Ol'er 27
t,IIS: lllaneous
Oeducliol's
Total 28
Itemized
Deductlcms
9
10
11
Add hnes 5 Ihrall h 8 , ",',
Home mongage mlereSI ana pomls reported 10 you on FOlm 1093
Home mortgage Interest nor reported to you on Form 1098. If paId
10 Ihe person from whom you boughl Ih. homa, se. page A.2
and s/low thai person's name, idenMy'ng no., and addres. .
12
PalM IS nol reported 10 you on Form 1098 Se. page A,3
for special rules. . . , . . . . .
Investment interest If requirad. attach Form .1952. (Sea
page A'3,) "','
Add hne5 10 Ihrou 1', 13, ,
Gifts by cash or check, /: IOU made ar,y gift of 5250 or
more, see !Jage A.3 .
Otner than by C33M or cn<a:I-.. If any gift c' 5250 or mor~.
S3e page A-3. It o'.'~r S50'J. ~ou MUST atta.t;h Form 8283
Carf)'o\ier fr,J!T\ prior 'tea.r
Add lines 15 thrC\uoh 17
13
14
15
16
17
18
Casualty cr tnaft IOSSj~S\ A!ta:h Form ':63J..
OMS"'o l'Sol5.C;.1..
~@96
J.lt~"m.l'11
$tQ.....nc. N~
8
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3 17 ~'*,
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9
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.; 1- ~;::-.~
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Caution: 00 not incll.id, 'fPtnSIU re,mCUf'S6d or paid Oy ot""s :~~~~
1 Medical and denial .,p.n5es (see page A, ), , 1
2 E'lel amounllrom Form 10~0 line J2, 2 _ :~ i '~
3 Mu/liply lin. 2 above by 75% (,075) , 3
4 Subtract line 3 trom line 1. It tine 3 IS more than line 1. enter .0.
5 Sial. and locai income lax.5 , ~",' ;:;,:r,if)4, IS' 5
6 RoaJ e51ale taxes (5e. paga A'2) , , 6
7 Personal property lax.s , 7
6 Oth I S "Ily da I'" ~~":~
Sf axe . I-IS pe an moun ~.................... ,....,..
10
,"~,;
~\~
~~
~,":.
~~
~
~
,~~
11
12
13
.:~':$:~f
';'5' I
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17
Unr!lmburS'Jd emplOi'a~ exp;nses-Joo tra'..e1. U"'\lon
c;.J&S, l,=,b e:li.JCatIOt1, etc. If requIred. you MUST alia:h
Form 2106 or 2106,EZ, (555 page A,J) . ..............
ISe. pag5 A,4.)
,~:::':.i'
~~-,-i
......'1
~1~
,'~~
Add hn55 20 Ihrou,," 22 ,
Erl!~i amCU.lllrJm ~crn I'::':: !.r~}~. : 2~
~lultlpJy line 2":' above b12:~ (C2)
Subtra:t llna 25 'ro~n !ir:.:- 23 It !''''i 25 IS rn':Ir~ tna'" hn'3 23, entir .0.
Other-from lIst on p.];a ;.,.:. LISl t'..P~ and amou:.t ~ " ...._.....
21
22
Tax prtparahon fe~s
0tr'l@l"e;..pensas-lnvestm!nt. safe depOSIt b.~:<. et:
t/pe and a"Tlount ......
23
LIst
20
21
<t'~1
"~~'-l
~~'1
23 I
"'I
12'5"
13 For:-n lQJD, lire 32. o.~~ $11 7,95.J (v'.-:-~ 55:3,975 l~ fT1arn.:;d t,!:n-a s~=:!~a~~l..\"
NO. :,~~,"/~~~j.:"~:,'?;~i~:;~.~:,~ '~_':~:1 '\:'~.T"~ J~~":~:'?~ !~~ 3t~; ;~S'~~~~~.-~-~ 1"
li~ S .1""J~.-~;' /_.' ',::"~
l> 28
,\:;-
l' -
'S
i
I
I
1-
.l>3
I,;). 7?'si -
~
,
280
. ........ tw.....lIOI.oI'II_._....6b-.
40 1I8.n
JSoclII........,-.--
40 1I8.n
. WecIaf, .... and apa
40 118.55
J'".of'Il;IDmeW~
5 266.56
4 ~..".., III.....
Z 528.89
.~'lUlIIIIIWleilI
591.4]
~
:II
i:
N
$
. .,..,.... rwnt. ....... an:I liP CGde
DIVUII TlCHIlOl.OGIES COllPOMTIOlI
7905 MALCOLM Ao.\D. SIE 200
CLINTOlI lID 2073,
7 SocMI MCVlI'f' ...
.-...
. M.1t'Q IC laI'I'metll
m
i:
;!I
Q
m
m
"DIDIncIenICM"~
" Nlrq- .....Mi gl.IN
12...... ""'**' on 1011
NOlIE
dE~.IOC:IM""""'~
1
,,,,"..
8
'll
Iii
en
. .....,..'. rwne. ...... IIld ZIP CD:M
HAlOII CULLEN
422 IlOOK CIRCLE
HlCHAIIICSIIJIO PA 17055
m
or
S:
II
-
-
...
-
1997
J W.2 t.'f:,::: Tu
c:., lot EMPLOVEE'S
s..... City. .. L_
IncomI To Return
.......--
:a
~
o
Z
~
~-
U:ICIIl............
Ula__
o.o.r-c ~.... rr~--" "- w-.
--........:........4'-..."...'.... .__<:,..:.-........,..__.
PA. ',IA/f'.lPH
DIVERSE TECHNOLOGIES CORPORATION('" '''''ATEI 02-28-98 ,'..:.': 03-10-98
11100 IlOO 110'
", .",.,'
- -- -. "'"
T4H,1 fiCA TA 130.1 ...,2 liD TAX 2",1 '011,1 VAC ill
..U... Pi lAX 41.. 231,2 PI C fA '1,0 14.1 PUS LlL
51,,5 OCClI' I '0,0
001758
, .~.....
-,
PA: 5/001
YrO T oUAal WAGeS
"4..
-
.
'.L.J..
'-
""'"
-
-
1 287 .12
l 1040
Label
s..
Pd9' !'
U.. the IRS
IelMl,
OtherwIse.
pl.as. prlnl
or type
Prllldlnllal
Elecllon Campaign ...
S~. 0' . 11 I ,
I
a
3
4
Filing Status
Check only
one eo..
Exemptions
If more than SOl
dependents.
see the
Instruchons
lor l1n8 6c.
Income
AlQch
Copy B of your
Forma W.2.
w-ao. and
108V.R her..
I' you dId nol
gel a W-2,
see tM
Instructions
lor hne 7.
Enclose. but do
not attach. any
payment. Also,
please enclou
Form l040-V
(SH lI'1e
instructIOns
fOt li".621.
L
.
.
I
L
"
.
.
I
O.tl.""'ofnl ,II"'" 1''','''1,1''-'''''''''''',111-1..".,1". ',...,...,,,
",',"'96
.~ ,!' j .
LI >,~/
j.l', lot ',--,
'.' ..,,~
'J:;.
.;-~ ~
''l OM8 ,"0 ''j4~-,:j{}7'"
'tOUl lOCI" leclKlty numlMf' r>--'
I ~2. "''' 2.r.),/z-
Spou,,'IIOCI. .ecunty nwnber
7
80
~'<<
V
10
II
la
13
14
ISb
leb
17
Ie
IV
:lOb
U.S. Individual Income Tax Return
0:0' !~. /.", ;,If' '.-1..: )1
T-}~ ;r"'''''''.ul.'' t..v'''''''I
~ -;96 'tf'\(lIr\q
For help flndlnllllne
In.tructton., ... 5>>89-
2 .nd 3 in the booklet.
v.. No
Note: C/'lec/ut't9
'Y..~ Mil not
e!l4l1ge toof ~... or
rlduC. (OV r.n:.na
S,ngle
Mamed ftllng IOlnt relum (ell8O If only one had Income)
M1HiKl 'Io"g !ltparale "'urn. Entet spouse's SOCIal secunty no. aoove at'd lull name hef' ..
/ Httad of household (WIth qualifyIng pet'son). (See InstructionS.) If the qualifyIng person 15 a cl'1l1d but nol your
dependent. enter thl' duld', name here. ..
QualitYJn wldow(erl with dependent child ( ear spouse dIed .. 19 ). (See lflstrucllOns.,
Yourself. It your parent (or someone else) can cla.m you as a dependenr on hIS or her lax} No. 01 'u..
rerum, do not check !:lOll 6a. . . . . . . . . . . . . . . . =:: :a.. .. ...1.-
~OUM ,...,....... ... ' ~.~~
o Dependent.: m eoeMenl S SOCial 13) Oeo.nll.nn '41 ~o JI mOllI"' dUld",lI II III'
SfCU(lfy numller II :lom '11111OllsnlQ 10 ..\'tiS oil ~Qur k ....:
11) F'r11llam, LUI.1am. ,n Ote 1996 ~et 'M! OU '~rl' n'99&
__. l. . Ii'" WI" ,.. -L-
IIr110trw t :5., It.. dldllOlI"".I'l
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"-01 "0
1-4
Hlu"'::'lfi "'11 'olfl"lI.lnc1 ".Iloll
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..; '/...2. J.,,.,~ /.
r:,tv. '")1'1" )r ':;OSI .Jrt,,;. 11.11..,JIld liP cod. II 'fOU 1',)",. J ror"'Jn .aodr.u. $" cage \ I
110,;6,1-/&1.1
Da you wanl SJ to go I lhl' fund? .
It .I jOll1t return. does your spouse want 53 10 0 10 thiS fund? .
S
e.
b
d Total number of exemptions Cll11fT1ed
7
e.
b
V
10
"
12
13
14
180
Ie.
17
18
IV
-
al
Wages. salanes, tips. etc. Anach Form(s) W.2
r.)fabl. Lnterest. Anach Schedule B If over S400 .
Tu....mpt Iflterest. 00 NOT include on tine 8a 8b
DiVidend Income. Anach Schedule B If uver 5400
Taxable refunds. credllS. Or offsets of state and local Income taxes {see ,nstructlonS)
Alimony rec8l...ed
Buslnes9 Income or (lOSS). Attach Schedule C or C.EZ
Capital ga.n or (loss), If required. attach SChedule 0 .
Other gaIns at (Iosse'). Attach Form 4797
Total IRA dlstnbutlons . l.!!!J .i.-J b Taxable amount (SIt Inst.)
Tolal pen..on. and ",nu.II.' lJ!!.1 ~~ b T.,.abl. amounl ('" .n"l
Rental real nlate, roVallles, par1nershipS, S corporations, tNStS. ele, Attach Schedule E
Farm Income or (Iassl. Atlach Schedule F
Unemploymenl compensation ,
SoCIal secunly benellts I 20e I -+ b Tax.abIe amount {see InSl.l
Other Income. Listlype and amount-see InstructIons ................................
[L
1-/ " ~ I rJf1
501
:l2 Add lhe amoun1s In lI'1e far rl "I column lor hnes 7 throu 21 thiS IS our tot.. income ..
:z3oI Your IRA deduction (see InstructIonS) a3a
Adjusted b Spouse's IRA deducllon {see ,"stl'llcllonsl :z:Jb
Gross a4 MO\llng expenses. Attach Form 3903 at 3903.F a4
Income as One. half of selt.employment lax. Attach SchedUle SE as
'. ' I' line 31 IS under ae Se!t.ttmployed health Insurance deducllon (see Insl.). ae
'28.~95 (undef a7 Ke09" & self'dmploylKl SEP plans. If SEP. check" 0 27
$9.500,1 a child aa Penally on early wIlhdrawal 01 savIngs a8 V
did nOI h... e ',f,rltl'1 :zg AilmQ/"lY pan1. FlecICil!f'1!'S SSN .. Z1I
yOU). see Ihe
,"struchons for 30 Add lines 23.1 through 29 . 0 () '1
line 5~ 31 Sublract 11/16 30 from line 22 Thls;s our adjusted rOil income .
'or Princy Act and Plperwork Reduction Act Nolle., ..e page 7. Coil "40 11600W Fonn 1040 II_I
.........................................................................................
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EXHIBIT "C"
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MARGIE H. CULLEN
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
Civil Action - Law
PAUL R. CULLEN. JR.
Defendant
NO. 97-6093
INCOME AND EXPENSE STATEMENT OF:
MARGIE H. CULLEN
VERIFICATION
I, Margie H. Cullen, hereby certify that the facts set forth in the fort!going Income and
Expense Statement is true and correct to the best of my knowledge. information and belief. I
understand that any false statements made herein are subject to penalties of 18 Pa. C.S.A. ~
4904 relating to unsworn falsification to authorities.
DATED: .~ ~ o~.tJ 8
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Medical
Doctor
Dentist
Optometrist
40,OO(Co-pay)
48.00
Hospital
Medicine
Special Needs (physical
therapy, orthopedic devices, etc.)
(Son requires oral surgery)
25,00
67,00
Personal
Clothing(Dry Cleaning)
Food
Barber/hairdresser
Clothing(to wear)
Credit Payments
40.00
500.00
40.00
134.00
Credit payments:
Credit Card
120,00
EXPENSES
Monthly
Miscellaneous
Household help
Papers/books
Magazines
Entertainment
Pay TV
Vacation
Gifts
30,00
180,00
27.00
50.00
Legal fees:
Charitable Contributions
on going(approximately $80 per month)
OTHER:
TOTAL EXPENSES:
$3155.00
4
....."
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INSURANCE
Company
Policy
~
Covera&e.
H W C
Hospital
HealthAmerlca
I.D, 163-44-9926-02
Fed. Gov.2
HealthAmerlca
10000100001
H,W,C
Medical
H,W,C
Healthl Accident
Disability Income
Dental
Other
H = Husband; W = Wife; C = Child
5
-.,
MARGIE H. CULLEN
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v,
Civil Action - Law
PAUL R. CULLEN, JR.
Defendant
NO. 97.6093
CERTIFICATE OF SERVICE
I, Barbara Sumple-Sullivan, Esquire, do hereby certify that on this date, I served a true and correct copy
of the foregoing PRETRIAL STATEMENT, in the above-captioned matter upon the following individual(s)
by first class mail. postage prepaid, addressed as follows:
Thomas S. Diehl. Esquire
Griffie & Associates
200 North Hanover Street
Carlisle, PA 17013
DATED: ~o~jr~
arbara umple-Sullivan,
Attorney for Plaintiff
549 Bridge Street
New Cumberland, PA 17070-1931
(717) 714-1445
Supreme Court I.D. No. 32317
o '\ltl?&1t.
MARGE H, CULLEN,
Plaintiff
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
vs,
PAUL R. CULLEN,1R.,
Defendant
97-6093 CIVIL TERM
: IN DIVORCE
PRE-TRIAL STATEMENT OF DEFENDANT,
PA UI. R. CUUEN, JR.
AND NOW, comes Defendant, Paul R, Cullen, Jr" by and through his counsel of
record, Thomas S, Diehl, Esquire, and the law firm of Griffie & Associates, and files the
following Pre-Trial Statement:
I. MARITAL ASSETS
See attached Initial Inventory and Appraisement
II, EXPERT WITNESSES
As the value of the home is at issue and a recent appraisal is not yet available, it is
anticipated that an expert may be necessary to testilY relative to the value of the home
purchased during the parties' marriage, The use of this expert is dependent upon the
position taken by the Plaintiff through counsel at the pre-trial conference.
III, WITNESSES
The only witnesses that are anticipated to be called in the above-captioned matter
other than the expert referenced above will be the Defendant. Defendant reserves the
right to name additional witnesses following the pre-trial conference,
IV. EXHIBITS
Defendant anticipates the following exhibits at trial:
A. Updated Inventory and Appraisement
B. Income and expense statement of Defendant
C, Documentation reflecting the value of the Defendant's pension at time of
separation
D, Documentation reflecting the appraised value of the parties' personal property
(this document may not be necessary depending upon the agreements reached at the pre-
trial conference)
Defendant reserves the right to identifY additional exhibits for presentation at the
time of the trial following the pre-trial conference and further proceedings in this maller,
V. INCOME
The Defendant has been employed by Nausealogeen as an electronics engineer
since 1989. He works a forty (40) hour week at TWENTY-SIX and 57/00 ($26.57)
DOLLARS an hour, i.e" FIFTY-FIVE THOUSAND FOUR HUNDRED FORTY-FOUR
and XX/I 00 ($55,444,00) DOLLARS per year, Bonuses are unpredictable, but when they
do arise, they are of approximately THREE HUNDRED and XX1100 ($300.00)
DOLLARS per year,
VI. PENSION
The Defendant currently has pension through his employer. The current value of
which is not yet available to him, He will provide that information to the Master and the
opposing party as soon as it is acquired,
VlI, MARITAL DEBT
At the time of the parties' separation in November 1995, they shared two
significant marital debts, Those were the mortgage on the home held by Harris Savings
Bank and a home equity loan through PNC Bank, Immediately following the parties'
November 1995 separation, the Defendant paid off the PNC home equity loan using the
proceeds from a joint account also held at PNC to do so, The amount of the home equity
loan at that time was THREE THOUSAND FOUR HUNDRED SEVENTEEN and
48/100 ($3,417.48) DOLLARS,
Therefore, the principal outstanding marital debt is the mortgage on the marital
home,
VIII, PROPOSED RESOLUTION
Until his pension is accurately value and his wife's income is known, the Defendant
will not be able to offer a realistic proposed resolution,
IX, COSTS AND EXPENSES
As both parties are gainfully employed, the Defendant avers that each has the
ability to compensate their counsel and pay all costs associated with these proceedings,
including the costs of expert witnesses,
Respectfully submitted,
t~)(
Thomas S, Diehl, Esquire
Attorney for Defendant
200 North Hanover Street
Carlisle, P A 17013
(717) 243-5551
(800) 347-5552
INITIAL INVENTORY AND APPRAISEMENT
MARITAL DATE OF NON-MARITAL
ASSET VALUE VALUATION PORTION ENCUMBRANCE
I)RcaI Estate 14',000,00 four years ago None $ 8',89',00
1219 Kuhn Rd. (NovemMr (997)
Boiling Springs, PA
2) Personal Propcny
(Wifc) unknown N/'" None None
3) Pcrsonal propcny
(Husband) $2,140,00 Present None None
4)1979 Chevenc $ 300,00 Prescnt None None
')1987 Buick $1,000,00 Prescnt None None
6)Wife's retiremcnt
account unknown N/A None None
7)Husband's retiremcnt
acc:ount
8)Bank accounts
Baxtcr Credit Union nominal Prescnt All None
PNC account -0- Prescnt None None
PNC account $1,0'0,00 November t997 All None
9)Undistributed funds
from prior retiremcnt
accounts
IO)Reotal value of
the home unknown N/A None None
It )Tax funds (escrowed) -0. N/A None None
12) Money markct
accounllUniled Group $322,00 Novcmber 1997 None None
(approximate)
1J )Stock
ffiM $1,932,00 Present $1,083,00 None
(approximatc) (approximate)
(4)Bonds $ 300,00 Prescnt Unknown None
(approximatc)
MARITAl. DEBTS
MARITAL
DEBT
AMOUNT AT
DATE OF DATE INITIALLY INITIAL PURPOSE PAYMENT
SEPARATION tNCURRED AMOUNT OF DEBT MADl
Mortgage on
Real E&llIle
(Harris Savings)
$88,000,00
(approximate)
June 1987
$96,000,00 Purchase of By
home Defendant
MARGE H, CULLEN,
Plaintiff
: IN THE COURT OF COMMON PLEAS
: OF CUMBERLAND COUNTY,
: PENNSYLVANIA
VI,
PAUL R, CULLEN, JR.,
Defendant
: 97-6093 CIVIL TERM
: IN DIVORCE
PRAECIPE
Please enter my appearance on behalf of Paul R, Cullen, Jr. for the above-
captioned maller,
Respectfully submitted,
Date: g-l J-qf;
omas S, Diehl, Esquire
200 North Hanover Street
Carlisle, PA 17013
(717) 243-5551
(800) 347-5552
14 North Main Street, Suite 550
Chambersburg, PA 17201
(717) 267-1350
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MARITAL SETfLEMENT AGREEMENT
THIS AGREE.'tJENT, made this.L:.!:.!!... day of ~/llly 1998. by and between
PAUL R. CULLEN. JR.. hereinafter referred to as "HUSBA.l\ID". and MARGIE H. COLLEN.
hereinafter referred to as "WIFE".
WITNESSETH. That:
WHEREAS. the parties hereto are husband and wife. having been lawfully joined in marriage
on April 22. 1978. in Pinellas County. Florida.
WHEREAS. one (1) child was born of this marriage; being Timothy 1. Cullen born November
26. 1980. which child resides with WIFE.
WHEREAS. it is the intention of me parties to setlle fully and finally their respective financial
and property rights and obligations as between each other arising out of the marriage relationship or
otherwise. including without limitation (I) the settling of all matters between them relating to the
ownership of real and personal property; (2) the settling of all matters between them relating to the
past. present and future support and/or maintenance of HUSBA.l\ID and WIFE. and (3) the settling
of all matters between them relating to any and all rights. titles and interests. claims and possible
claims in or against the estate of the other.
NOW THEREFORE, with the foregoing recitals being hereinafter incorporated by reference
and deemed an essential part hereof in consideration of the foregoing recitals, the mutual promises,
covenants and undertakings herein set forth, and for good and valuable consideration, receipt of
which is hereby acknowledged by each of the parties hereto, HUSBAND and WIFE, each intending
to be legally bound hereby, covenant and agree as follows:
1. A DVlCE OF COUNSEL
HUSBAND and WIFE declare that they have each had a full and fair opportunity to obtain
independent legal advice of counsel of their selection. WIFE has been independently represented by
Barbara Sumple-Sullivan, Esquire. HUSBA.l\ID is cognizant of his right to legal representation and
declares mat he has been independently represented by Thomas S. Diehl, Esquire. Each party further
declares that they are executing this agreement freely and voluntarily, having obtained such
knowledge and disclosure of they legal rights and obligations and that they acknowledge that this
agreement is fair and equitable and is not the result of any fraud, coercion, duress, undue influence
or collusion.
2. PERSONAL RIGHTS
HUSBAND and WIFE may and shall, at all times hereafter, live separate and apart. Each
shall be free from all control, restraint, interference or authority, direct or indirect, by the other in all
respects as ifshe or he were unmarried, except as may be necessary to carry out the provisions of this
Agreement. Each may reside at such place or places as she or he may select. Each may, for his or
her separate use or benefit, conduct, carry on and engage in any business, occupation, profession or
employment which to him or her may seem advisable. This provision shall not be taken, hnwever,
to be an admission on the part of either HUSBA.l\ID and WIFE of the lawfulness of the causes which
led to, or resulted in, the continuation of their living apart. HUSBAND and WlFE shall not molest,
harass, or malign the oth(;I' Dr the respective families of each other, nor .:ompellhe other to cohabit
or dwell in any manner with him or her, nor in any way interfere with the peaceful existence, separate
from each other.
3. m:BTS
Each party represents that they have not contracted any debt or liability for the other for
which the estate of the other party may be responsible or liable except as othetwise provided herein,
and that except only for the rights arising out of this Agreernent, neither party will hereafter incur any
liability whatsoever for which the other party or the estate of the other party will be liable. Each party
agrees to indemnilY and hold hannless ti-om and against all future obligations of every kind incurred
by \hem, including those tor necessities. To the best of the parties' knowledge, the parties affirm no
joint debts exist aside from the mortgage associated with the marital residence as discussed below.
oJ. WAIVER OF APPRAISAL AND INVENTORY
The parties acknowledge and agree that they have each had an opportunity to value or have
apprabed any and all marital properry, and they do hereby waive a formal appraisal and inventory of
same, and no statement or representation by either party as to value shall be deemed a misstatement
or misrepresentation to the other or be deemed traudulent.
5. MARITAL AND N'ON-MARITAL ASSET~
HUSBAND and WIFE do hereby acknowledge that they have heretofore divided the non-
marital assets and marital assets including but without limitation, business interests, jewelry, clothes,
-)
.. .'.
FIVE Dollars (S85,025.00) as of June 7, 1998. WIFE agrees to convey the real estate to
HUSBAND. HUSBAND agrees to refinance the unpaid balance on the mortgage, together with
interest thereon, and hereby agrees to hold WIFE harmless from any and all liability as a result of non-
payment of!he mortgage or any other debt associated with this real estate by him. WIFE agrees to
execute whatever documents necessary to effectuate this transfer at the time of settlement for the
refinancing of said real estate. Settlement tor HUSBAJ'ID's refinancing must occur by June 20, 1998
but no later than June )0, 1998, If tor whatever reason said refinancing has not occurred by August
1, 1998, the real estate shall immediately be listed for sale.
7. CASH Pc\. YME:'tT TO WIFE
HUSBAND agrees to pay WIFE fifty (50%) per cent of the equity in the real estate. The fair
market value has been determined by an appraisal as performed by David Eskin and is ONE
HUNDRED FIFTY EIGHT THOUSAND FIVE HUNDRED Dollars (5158,500.00). The current
mortgage balance, provided same is current, shall be subtracted from said fair market value to
determine the net equity in the real estate. Said mortgage balance is currently EIGHTY -FIVE
THOUSA.'1D TIVENTY FIVE Dollars (585,025.00), HUSBA.\ID acknowledges that he has been
approved for refinancing sufficient to remove WIFE from the current first mortgage, to pay her fifty
(50%) per cent of the net equity which is estimated to be approximately THIRTY SIX THOUSAND
SEVEN HUNDRED THIRTY-SEVEN DOLLARS and FIFTY CEl'4'TS (S36,73750) This sum
shall be paid upon refinance of the house upon WIFE's signing the Quitclaim deed to HUSBAND
HUSBAJ\ID agrees to pay WIFE hcr fifty (50%) intcrest in his Thrift Savings Plan as set forth
in Paragraph 9a, WIFE's portion of the Thrift Savings Plan is estimated to be EIGHT TIIOUSAJ'IO
5
~IFTY NINE Dollars and SEVENTY SE'v'EN Cents ($8,05977) plus interest and earnings since
November 17,1995, The total sum due to WIFE is TEN THOUSAi'ID NINE HUNDRED f[FTY
NINE Dollars (SlO,959.00), The exact calculation tor this tigure is attached as Exhibit "B" and
incorporated by reference herein. HUSBAND agrees to pay this amount at the time of the
refinancing of the mortgage upon WIFE's signing the Quitclaim deed to HUSBAND Any deficiency
in monies from the sums received from the refinance shall be paid by the liquidation of HUSBAND's
stocks, personal assets and gift monies and paid to WIFE at the closing of the refinance.
Therefore, the total to WIFE upon closing ofHUSBA."ID's refinance or sale of property is
FORTY SEVEN THOUSA.l'ID SIX HUNDRED NINETY-SIX DOLLARS and FIFTY CENTS
($47,69650).
8. MOTOR VEHICLES
WIFE shall have sole title and ownership of the parties' 1987 Buick Century. HUSBAND
shall have sole title and ownership of the parties' 1979 Chevette and 1975 Celica. Neither of these
vehicles are encumbered,
9. PENSION
The parties acknowledge that HUSBAND is employed by NA VSEALOGCEN. As a result
of this employment, he is entitled to a defined benefit plan and a Thrift Savings Plan. It is the
agreement of the parties that WIFE shall be entitled to fifty (50%) these benefits With respect to
each benefit, the parties agree as follows:
~
a. Thrift Sllvini~ Plan. WIFE shall be entitled to tifty (50...) per cent of HUSBAJ\ID's
Thrift Savings Plan as or the parties' date of separation plus interest and earning on this amount since
November 17, 1995, It is agreed that the value as of the date of separation is SIXTEEN
THOUSAJ'IDONE HUNDRED NINETEEN DoUars and FIFTY TIIREE Cents ($ 16,1(953). The
calculation of interest and earnings is contained on Exhibit "B". The total amount WIFE is to receive
is TEN THOUSAJ'l'D N'.NE HUNDRED FIFTY NDiE Dollars (S 10,959.00). HUSBA!\ID agrees
to pay WIFE her 50% of this asset at the time of refinancing cf the mortgage associated with the
marital estate or sale of the marital residence, whichever first occurs.
b. Defined Benefit Plan. The parties acknowledge that the marital estate included
HUSB.-\1'l'D's pension interest under the pension plan through HUSBAJ'ID's employer identified
above. WIFE shall be entitled to tlfty (50%) of HUSBAJ\ID's benefit. An actuary shall value the
marital portion of said pension. HUSBAJ\ID shall forward the documents necessary for this valuation
within ten (10) days of the execution of this Agreement. Husband shall, if necessary, execute an
authorization which ....ill allow the actuary to obtain any information he Ishe deems necessary for the
completion of the valuation. The parties shall equally divide the costs associated with valuation of
HUSBAJ'ID's pension and, if necessary, the Qualified Domestic Relations Order (QDRO) for division
of said asset.
Upon determination of\\1FE's fifty per cent (50%), WIFE's portion shall be transferred
to her through quarterly payments on the 15'. day of a three (3) month period over forty-eight (48)
months for a total of twelve (12) payments. These payments will commence within thirty (30) days
of obtaining actual value tram the actuary, and will be addilionallO any other monies specified in this
./
-'
Agreement. lfpayments due are notl'emitted by HUSBAJ'ID to WIFE on the 30'" day of the month
due, WIFE retains the right to obtain a QDRO for the fulfillment of the balance of HUSB A..\ID , s
obligation to WIFE pursuant to this paragraph. The parties agree that the Court shall retain
jurisdiction over distribution ofHUSBA..\ID's pension and that this Agreement shall be incorporated
but not merged into the parties' divorce decree.
In the event HUSBAJ\ID becomes deceased prior to fulfilling payment to WIFE as provided
in this paragraph, HUSBAJ\ID's estate shall be liquidated and the balance of monies due WIFE shall
be satistied in full from its proceeds. This shall include, but not be limited to, any attorney fees or
actuary fees incurred by WIFE to collect said sums outstanding. HUSBA..'-l1) further agrees to name
WIFE as irrevocable beneficiary on a life insurance policy to the extent that he is still obligated to
WIFE herein. HUSBAJ\ID shall provide WIFE prooi of said insurance on an annual basis.
Given the cash payment to WIFE, WIFE waives her right to claim any current survivor benefit
incident to HUSBAND's pension.
10. BANK ACCOUNTS AND INVESTMENTS
Each party shall have sole possession of the bank accounts and investments in their own
names.
11. INSURANCE
Each party shall retain ownership of any life insurance policy in his or her name.
3
12. MUTUAL WAIVER AND RELEASE OF RIGHTS AND CLAn-IS
CONFERRED BY THE PENNSYLVANIA DIVORCE ACT OF 1980. AS
AMENDED
HUSBAJ\ID and WIFE acknowledge and agree that the pro,isions of this Agreement are fair,
adequate and satisfactory to them. Both parties agree to accept the provisions set forth in this
Agreement in lieu of and in full and final settlement and satisfaction of all claims and demands that
either m'1y now or hereafter have against the other for equitable distribution, alirnony, alimony
pendente lite, counsel tees, costs and expenses or other provisions for their SUppOI1 and maintenance
before, during and after the commencement of any proceeding for divorce or aMulment between the
parties.
13. AFTER ACOlJTRED PERSONAL PROPERTYfFUTlTRE EARNINGS
Each of the parties shall hereafter own and enjoy independently of any clairn or right of the
other, all items of personal properry. tangible or intangible, including all pensions hereafter acquired
by HUSBAJ'ID or WIFE, with full power in him or her to dispose of the same as fully and effectively,
in all respects and for all purposes, as though he or she were unmarried.
14. ALIMONY. SUPPORT A'iD MAINTENANCE
Both pal1ies acknowledge and agree that the provisions of this Agreement providing for
equitable distribution of man tal property are fair, adequate and satisfactory to them and are accepted
by them in lieu of and in full and final satisfaction of any daims or demands that either may now or
hereafter have against the other tor support, maintenance or alimony. HUSBAI'W and WIFE further,
--
voluntarily and inteUigently, waive and relinquish any right tQ seek from the other any payment for
spousal support, alimony and maintenance.
..
15. SUBSE~UENT DIVORCE
A decree in divorce, entered by a court of competent jurisdiction to either party, shaH not
suspend, supersede or affect the terms of this Agreement. Both parties agree to enter a Consent
Decree consistent with the provisions of this Agreement in the Court of Common Pleas of
Cumberland County, Pennsylvania, or any other Court of competent jurisdiction, as a part of a
resolution of any divorce action tiled. This Agreement, and the terms and conditions contained
herein, as well as the enlorcement of said terms md conditions, shall not be contingent upon the
granting of a Divorce Decree to either parry by the Court of Common Pleas of Cumberland County,
Pennsylvania, or any other Court of competent jurisdiction. Furthermore, both parties hereto agree
to timely execute the appropriate affidavits and consents to secure a No-Fault Divorce as may be
required by the Divorce Code of 1980, as amended. Both parties hereto agree that this Agreement
mal be incorporated into a separate Court Order but shall not merge in such urder in the Court of
Common Pleas of Cumberland County, Pennsylvania.
16. OTHER DOCUMENTATION
HUSBAND and WIFE covenant and agree that upon request of the other party, they wiH
forthwith execute and deliver to the other party, any and all written instruments, assignments,
releases, satisfactions, deeds, notes or such other writings as may be necessary or desirable for the
proper effectuation of this Agreement.
17. MUTUAL WAIVER AND RELEASE: OF RIGHTS AND CLAIMS rN EST,HE
Except lor outstanding sums due to WiFE pursuant to this Agreement, specifically but not
limited to Paragraph 9b, each party hereby releases, waives and relinquishes any and all rights which
he or she may now have, or may hereafter have, against the other parry under the present or future
laws of any jurisdiction (a) to share in the estate of the other party upon the other party's death and
(b) to act as executor/rix or administrator/rix of the other party's estate.
18. ~mTU.U RELEASE
Except for outstanding sums due to WIFE pursuant to this Agreement, HUSBAJ'ID and
WIFE each do hereby mutually remise, release, quitclaim and forever discharge the other and the
estate of such other, for all time to come, and for all purposes whatsoever, of and from any and all
rights, title and interests, or claims in or against [he property (including income and gain from
property hereafter accruing) of the other or against the estate of such other, of whatever nature and
wheresoever situate, which she or he now has or at any time hereafter may have against such other,
the estate of such other or any ~art thereof, whether arising out of any former acts, contracts,
engagements or liabilities of such other or by way of equitable distribution, dower or courtesy. or
claims in the nature of dower or courtesy of ....idow's or vvidower's rights, family exemption or similar
allowance, nr 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 testamentary, or all other rights of a surviving spouse to
participate in a deceased spouse's estate, whether arising under the laws of (a) Pennsylvania, (b) any
Slate, commonwealth or territory of the United Statcs, or (e) any other country, or and rights which
HUSBAND or WIFE may have or at any time hcreafter have for the past, present or future support
or maintenance, alimony, alimony pendente lite, counsel tees, costs or expenses, whether arising as
a result of the marital relation or othef\1l'ise, except, and only except, all rights and Agreements and
obligations of whatsoever nature arising or which may arise under this Agreement or for the breach
of any thereof
Each of the parties hereto further covenants and agrees for himself and herself and his or her
heirs, executors, administrators and assigns, that he or she will never, at any time hereafter, sue the
other party or is or her heirs, executors, administrators and assigns, for the purpose of enforcing any
of the rights relinquished under this paragraph. Each ofche panies funher covenants and agrees that
he or she will permit any will of the ocher to be probated and allow administration upon his or her
personal, real or mixed estate and allow effects co be taken out by the person or persons who would
have been entitled to do so had HUSBA,'iD or WIFE died during the lifetime of the ocher Each of
the parties hereby releases, relinquishes and waives any and all right to act as executor or executrix
or administrator or administratrix of the other's estate,
It is the intention of HUSBAND and WIFE to give Co each other by the execution of this
Marital Settlement Agreement a full, complece and general relec;se with respect to' any and all
property of any kind or nature, real, personal or mixed, which the other now owns or may hereatler
acquire, except and only except all rights and Agreements and obligations of whatsoever nature
arising or which may arise under this Agreement or tor the breach of allY thereof.
19. SlTCCESSOR'S RIGHTS AND l.lABILlTfES
This Agreement shall, e:<cept as otherwise provided herein, be binding upon and inure to the
benefit of the parties hereto, thcir respective heirs. executors, administrators, successors or assigns.
12
. - .---....--
20. SEVERABILITY
If any provision in this Agreement is held by a court of competent jurisdiction to be invalid,
void, or unenforceable, the remaining provisions shall nevertheless cC'ntinue in full torce and effect
without being impaired or invalidated in any way
21. UtTIRE AGREEMD'T
HUSBAJ"'U and WIFE do hereby covenant and warrant that this Agreement contains all of
the representations, promises and Agreements made by either of them to the other for the purposes
set forth in the preamble herein above; that there are no claims, promises or representations not herein
contained, either oral or written, which shall or may be charged or enforced or enforceable unless
reduced to writing and signed by both of the parties hereto
22. BINDING EFFECT OF AGREEMENT/WAIVER
This Agreement shall remain in full force and effect unless and until terminated under and
pursuant to the terms of '.his Agreement. The lailure of either party to insist upon strict performance
of the provisions of this Agreement shall not be consuued as a waiver of any subsequent default of
the same or similar nature, Poor shall such failure be construed as a waiver of any other term,
condition, clause or provision of this Agreement.
23. UBEACH
If either party breaches any provision of this Agreement, the other party shall have the right,
at his or her eb:lion, to sue lor damages for such breach or seek such other remedies or relief as may
COMMONWEAL TH OF PENNSYL V A.l'lIA
COUNTY OF Cm-mERLA.l'lO
...----.--.. . ,.-------...
)
) SS.
)
Before me, the undersigned officer, a Notary Public in and for said Commonwealth and
County, personally appeared MARGIE H. CULLEN, who being duly affirmed according to law,
deposes and says that the facts and matter set forth in the within and foregoin!! Marital Settlement
Agreement are true a correct to the best of his knowledge, information and belief
-' . U!
MARGIE . CULLEN
Affirmed and subscribed to before me this
.2:7~
l{ Pl"3LlC
:0.,: .(1lTUnission eXPires~ /~ /91f1
COMMONWE(!!.:::ENNSYL VA1'<lA
COUNTY OF ,.(/J. ..,~
t,~ dayofh 1998.
(SEAL)
Notarial Seal
Kay S. Wachlman, Notary Public
) Upper Allel1lWp., Cumberland County
) S My Commission Expires March 16, 1999
)
Before me, the undersigned officer, a Notary Public in and for said Commonwealth and
County, peisonally appeared PAUL R. Cl:1.LEN, Jr., who being duly affirmed according to law,
deposes and says that the facts and matter set forth in the within and foregoing Marital Settlement
.-\greement are true and correct to the best of his knowledge, information and belief.
&:~~ C~~
PAUL R. CULLEN, Jr. ,f'
'1f'~ I~ /991
~A day of h 1998.
. Notarial Seal
Kay s. Wachlman, tlolary Public
U per Allen Twp" cumberland County
MYP Commission Expires March 16, 1999
1 S
Ii
EXHIBIT
"A"
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Property rtlllotiwog ~11219 Kulln ROJa, !Iotllog Sprin~, Pel1D~lv:miJ, in tbe paSJu,jall ot'P~ul R.
Cuile.a. .Jr.:
(' denote.:! ,wos that ore eilll~r pre"llJrit:U pmonaJ property a1 mille, or peMona! propU'l'! JA:qulred
durin~ tbe lIlarrja~ that were :I'n~r moae or me or I"\!cehed ~ ~t.1 to mo from (riends Uld (amdy.
ThOle 1/'ll1ll0 lIomJ r '~.uld Ilke returned :0 m..)
n.J
cl;n~ra~gr.;;C:!i;;G3>
r---ITr9 "'....ITOJ.t ClIO'''':::
,. Taro lcaiolo...or
.1, Lol?lt1 mC"i\'er
'" YJr:1lDd ~:n :quipcenc 1,:., shovel.
r.l..~I:$. :cc.
.;. . E-tn..r-=.,,,"';':t"" _~:!:~
-: d';t1' tCQ! ~lne:
3. ::0) mo!.1l111c:.!'."Ul8 ').IlCJ
.~ (;!.) ;:13$:: s.eei',1.Dg U!Uts
la. CJle~ :.m::.pUlg l3!:r~r:t
i 1, CoJle::um. nove
11. CJtexr.an ~oJe: iet
1;. "l.omc 313Q 3'"J.1
,J, ?!cc ofuung set (taol: WI':.VQ ;~2.l:J)
l,S, W=:!d :'"'It... :n.:n..r:1r::
1d. i"dO' :r.tid::i l......~ :1Jg
,i, l'x! l' Crie:tJ! :1:g
13. 4.'xd' Cti~w ~
~3. 2~IO:tci' Oncnt:lJ :"Jg :.l:l!1C:
20. 6'x9' bound:!J'e:l:1:~ (:1:at:::OJ "amil" raoe::
ca.r;:.tj-i(- .' . < _.
21. 9010;'(7' pUle leade::1 5~5 tight:!! ..:hi:la c~os::
OlL'!.:b. acd ba:ieJ
l:!. 90" pin: :rest!e ttille ""~~ (cur ::l.1t::ung
Windsor :l1air.
2:;. A.:1tique ;.:llc~3.~cck:r. oak
2~. ....nticu: :oJ.:l1o:e :able"
2.:. Ca.m~ibaci" ';"hiceig:::::: :1crJl ~nm sari
::5, A.Ll.tiqu: ;:e:::, ~of!t: :.:!~!:..
27, j' ~ocr :!cc~
23. (2J ,-,mss \:abh: ~"'Ilp~ ~O"
29. ~!) b!:w !~id ::ar,ied taol: ::1.-:1;=11 27"
30. (2) (e:::t ~le lamps, ! :rau. : ~:r;unjc.
11"
H. I 1e::u.'1..
J2. (2) 3ecs 'Ji .:1ar;\'a.r::
;;. idccll=:1 UIC.S:l~, !cc;~~n :C1.b~
3.;1. 1 5:: mncdi:zed ccck',I,'l:'~
J ~. t Jet bar.~d ~n:u:1:!~::c~'Va.:::
;Q. ~filic:U:1..'ecc.s :ou.r...ng."ba..tnng..ic::oy..:n'l p<UlS
j';, (1) sees ~J.Ss-.''-~~
:.,'l7' C:cdc;~,~.
]9: ~lc.cmr: CUl \Jcc::~ WI ;c-..if=3h.1r:en~d'"'
.to. EIec::ic r~ Td. :JUke:- .
H. Wllid;:ecl ",ll.il:~
.12. ?'-'hul~ccl Zj'er (~le:::r.c)
ij, "\---:::':~i=cd l;~ ~y si..:.~ ::.""':'''J~;.H:r
., -...., ,
;,.. :ct'J(:;:,:je
4". lq\l:lre ~= end 1llble
~. ~ClQgon pe= ::ld t:1ble
47. 4' :natc~?= cae:: :Jbl:
43. Mtique Windmr :t:cnng ;hair
43. S= oa.~ =01.1.1" cclor :e!lMSlcn
~O. 1.l' black 3lld "'lute ...l..llS1oa
n. SterO<l sy51e:n 711 (:) j2'~3' ;:e:llh.lut
spe:1krn
n. t:prig!lt;:Uno , , ,_ -:/<,
33, 27" mew 2...:a-awc:: 5.!.i.::g ;~bi.nct LC.Ht.:rl.lt.;:s p W t I~~ .I
54, R.-st",mc =It:tr~$S lad :0.'( spr..:g wI :tunc,
Que:a size
U Ma= IVtt.!l brckl!:l box sprtog me! cc
thme, Twin .!i~
j6. Nlght.:;:and (I ,._-i'......./J ~r. I J.t1.~-bJ
l7. (1) ~oubl~ dressers '.,.U'7ro......-.!'. rtr~, J" I~)
l3, (3) !e'.:5 Ollllo.u !)J
59 3~:1 c::rr,iort:r Wlt:l .:n3.t~~ sh~s JJ1d
drapes, Que:n m.
60. (4) sots ofbatll :i::o~
61. .J' utiiic:;l!, ClI:isc!a.s::e.
62': 0':<.20" butcher olcck lcitcl1.a utility C2ble
(lUade by llle)' '
63.-(1) .:........J..;_... "-'~r...:
6J C"" ... .....-=t~_.
',_ . ca..tr.....-gr_~...WB-..-----..--~?A6l'...... .
6.1. (6) portrait photo:pJlhs cfTI 1I1d1or m~'
funily.
66. E3ngmg antiquo Or:l.$.l ".1Ch iamp (lIl:lc: by
:ne)~
6i 2':<.2.5'......u hwtng-'l!'
63. Che:r,laurbl: cl.alll mncH'-
69, Sc: Cll1'.i...iCr~d 'candle JC9nc.:s
70, Fin. =dJ: IC:::UC:.
71. Set cf ::!le"Y =dJo ICllnees
72. -Sl_~, ",,-,COO;,;g ',""*'"
. " ..&
~c.:.u,....:..J."'''''''''''''1
ij. Wood lcitch.n c!cck .
7~, Toa...r
i5. (let (2) wtinsuiJed cak ;aclIIoc.s
i6. lac. wioccw t::acnelll in fanul)' roem.
ii. (1) Jabot wlC3.lcad: windcw =tm.nlS in
li'iin~ rcom.
is, Finpbct: teol3 :md ~quipm~r.t.
77, De::crati\'e lc.:ns on :inplnc= mamk 2 dee.
=dJe lighl:l, weeden jil!. 5Imll pic:ur.,
lug. gr.Jp....ine wr:at!!. '
30, (J) :;mt'.vin. ."..",lu in ,'c':;',n"
-3 t r ~.. .~ 2~" land.icj!=~ ?rim
.~:. p~~ or~dto:'(
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:V'I. 3. ~3Se
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L'"':" i 'oaf ' .~~.~I;"'Jm'H\.. ............4,.~
304, :fumel1lu.s boc:lu. :C<-,J, md ;-e(e:=
:lWClW, I.Ilclud1ng =C:ll:ic~edla let
3~, U' x" boek;:L5c~' cea:com clem
~6. AllUI' J POrt!lli.io ;<lCW1UIlg ~UlIleroll.l
~e:u J( arnvork'
37, 3c,,:f U1lUppUCS, :,:., ;1;UJlts. cw:::ll
pccc:.ls. ;a3t~t -:rnyoQS. ~te. .
83. Oee:::! 1Wt:lr'
89. (2) 3arole ~ol!.l witll ac=oncs"
90. Col il:lS.l pUllC~l:oWIIO,*,
n Table.,,!, clr.ll1lic 01... C:,.."II:'.:I# em
n Sol of J/ilSS ,..: :!lug,
91. :Jo::::c ~UlDld.l.:ler
~4. E..1::-::IC~e
15 ~op 'lac
;6. ~;JJ'C!-'...:J. 12 unp '/C1C"..ll.U:l ~~e:'
n Sltli1!I c:1.ilp!e iiG~ t:1bl~
38. Fr:u::::i ''',V.:icome'' Pl":.n'
99, :=011 =NeJ art In !aundrf noom"
lOO.fr.u::.e~ :=d!~QU1t 111 in !d[chea-
:01. 'Vi' .1' . ~.s"r. ~1"":1!.. ."-.1~ "J:' 9\p..
l'J2..-\D.tiquc ::u!.kg!as.s mac~ Jet j'om :ny
j!'Jndfat.be:-
l'JJ. tNic.k:: ::1Sk~~ ;:Jlk:;~:oQ"
'ot. :)11':' C3'~4.. 01~ .u."n~i,) I~~~ .!f
I~ ~~~~ ~J-
lit;
jiL(1
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~1_f'j. 3.1S~E ~~;.j7'::~
'''.7531 :;..:62
"!Q..';i)~
7
\:
j'
C.tlcuJatiCI1 of lllrtle:nent dlmlbuocn fJ~ sunplo i=cst fer Thrift Savtngs .?I:m:
:-IovCl1lber 199' to ....pr.l19%:
"O"l'>JlId
"C" Fund
6.54.l ,7" 4.:513
30.11 " .3 a i.Q1l
13.611%" 53,0'9.77" 51097.0212 -
5'43.51
Fisur= :ue ca:scd en emplcye~ eonll':buticn broken intc two (2) funds at tho r:no of
, ':"0% to "Q"' Fu::ad
. JO% [0 "C" Fund
MAy 1996 ~o ,...pnl1991
"G" Fund
"e' Fund
6.97".7 a 4.379
25,02,,3 " 7 506
12.335%" 53,0:5977 - 599UO
May 1997 to AprJ 1993
"cr' Fund
"e" Fund
0.-16 x.1 " 4.520
~0.8j".3 " 12.260
16,730% X 53,059.71- 513:52.41
52399.14
52899.14; S80:i9.7i" Ji97 JH1%/2.! yrs, " 14,J88%
;0% of Thrttr SaVIngs ?!.m <:It:e tc Mie: 53,0:59 77
.'( t.1.39%
510,959.00