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Home My WebLink About98-00387 .' . . ":"r'..:..'. ,,/,:~' ..:~,';.,,:"'=-";;.'~\...;'.' ;'.:~~.1.}~.'.:.):i.,1r/~,.r,':'/.;..>.~t"-;~~..~,,:,t,..;:.'~)'lt:~:~~..:~1~...>,'..3;!!::".:': .'!{ "; '.' . ." . .' ".~...,\. >:, 'j' j',t.,>,.:' l~~~~ ~ .,..,,,r>o;t,.I,'~'tf\~'\"'I),,,.~:;l\\ .....fJ,.'r..t::.'l.\.;' I" ~;{.,' 'I....:....,~.. ~ n :":';>{".lY' I 'J"'l,;'"rt~t!...j" ". I . .,". "," ,'. ' ' " I. ' . ,'~. 01' '~l '~"r. ';I<"';~ ~," " ... J'... ( .. ,'v' ,-' " ...d' . 1 1 I. '~.., l.i~~;~".>,~ ~1'j:~,'!('..t'>h,.~t\r.iMt'~~$,~~;;,.,-~~')':' ,\, j '::i~'/.fif~'l.~ ~:f""~_' ';;;'''.'1!': . ......__....,.~.. 'I '-.~,.~"...,.l~~l!11.-_,~ , . , _ , ~~....__ ~. . '--~',,~~ , . .. , ~. ' . ,ro*'~**~~**'~*~~~~'~'*~'**)*:'*:'*'~'~*M~~'~ ~ -.. ,..............-----.....-...._--..__.--..__.--........--...-.,._-~-...--~....-....,,--...'---.-.-.,....'. ,,,- ..--. .,'"--..~....--'.....~ ~+ .'~ V , ~ ~ $ IN THE COURT OF COMMON PLEAS ~ .'~ ~ OF CUMBERLAND COUNTY 1'!S' ..~~~, PENNA. 'r~'<<.iJ'-" . .....~~l. ,...~;.J'J-,...r * .'~ ~ STATE OF ~ $ i1 , N (),.98~,3,8.7.,......... It) 98 $ ~ JERRY W. SIMPSON $ Vl'I'..HIS ~ ',' $ BEVERLY A, SIMPSON *- ',' ." .', ~ ~ ',- ~" ~ ~ ~.' , ~ t'; .', ~ ~ :.' ~.~ ~ ;t! ~.~ $ AND NOW, . , DECREE IN D I V 0 R Cll it~; (S f)A, "..,~.~,. 19,.,~" it is ordered and decreed that ",.". E.RRY, .w... . SIMP.SON. , , , . . . , , , , , , . , , , , , . , , " plaintiff, and, , . , , . , . , . , , , , , , .~~y~,~~~, ~:, ,~~~l,~~?~, , , , . , , . , . , . , , . , , , " defendant. are divorced from the bonds of matrimony. *- ~.~ ~ The court retains jurisdiction of the following claims which have been raised of record in this action for which a final order has not yet been entered; ~ ~.' ~ ~ ~.' ~ ~ ~. , ~ .'~ ".""""""."", ,t-I 9 I'I.E. .".""".....".."",."",."",.,."""", p ,', ~ ~ .' ~ y * ~ .~ ~ * ~ _________~ ___..__ ....____~, _...~~___---'-_.....___, __~_ . - ,_ -- .. '..~ . - _, ,_,____~.~_,._____.....-~~..._. -0 _____~ _. _..._,_~_. ~ ~~~**~****~~***~*~.*********ro**. ~ ... .'~ ~ $ * * * ~ ',' ~ ',' ~ ',' * $ .'. ~ * * * f,' $ ~ ... . * ~ '.' ~ ',' .. ~ ~ ~ ~ ~.' * ~ ~.~ ~ ~ '.' ~ ... * ~ $ * J, '1 I I f ~~ I ' , I $ ~ ( I I i. I s \ '"' 5. EOUITABLE DIVISION By this Agreement, the parties have intended to eficct un equitable division of their marital property, This division is not intended by the parties to constitute in any way a sale or exchange of assets. 6, SUBSEOUENT DIVORCE A. AGREEMENT NOT PREDICATED ON DIVORCE - It is specifically understood and agreed by and between the parties hereto and each of the said parties does hereby warrant and represent to the other that the execution and delivery of this Agreement is not predicated upon nor made subject to any agreement for institution, prosecution, defense, or for the non-prosecution or non-defense of any action for divorce; provided, however, that nothing contained in this Agreement shall prevent or preclude either of the parties hereto from commencing, instituting or prosecuting any action or actions for divorce, either absolute or otherwise, upon just, legal and proper grounds; nor to prevent either party from defending any such action which has been, mayor shall be instituted by the other party, or from making any just or proper defense thereto, It is warranted, covenanted and represented by Husband and Wife, each to the other, that this Agreement is lawful and enforceable and this warranty, covenant and representation is made for the specific purpose of inducing Husband and Wife to execute the Agreement. Husband and Wife each knowingly and understandingly hereby \~ , It , , I \ r I waives any and all possible claims that this Agreement is, for any reason, illegal or for any reason whatsoever, unenforceable in whole or in part. Husband and Wife each do hereby warrant, covenant and agree that, in any possible event, he and she are and shall forever be estopped from asserting any illegality or unenforceability as to all or any part of this Agreement. !\ \;.;". B. ENTRY AS PART OF DECREE - It is the intention of the parties that the Agreement shall survive any action for divorce which may be instituted or prosecuted by either party and no order, judgment or decree of divorce, temporary, final or permanent, shall affect or modifY the financial tenns of this Agreement. This Agreement shall be incorporated in but shall not merge into any such judgment or decree of final divorce, but shall be incorporated for the purposes of enforcement only. C, MUTUAL CONSENT DIVORCE - The parties agree and acknowledge that their marriage is irretrievably broken, that they do not desire marital counseling, and that they both consent to the entry ofa decree in divorce pursuant to 23 Pa.C.S.A. Section 3301(c), Accordingly, both parties agree to forthwith execute such consents, affidavits, or other documents and to direct their respective attorneys to forthwith file such consents, affidavits, or other documents as may be necessary to promptly proceed to obtain a divorce pursuant to said 23 Pa.C.S.A. Section 330 I (c). Upon request, to the extent pennitted by law and the applicable Rules of Civil Procedure, the named defendant in such divorce action shall execute any waivers of notice or other waivers necessary to expedite such divorce, 7, DIVISION OF PERSONAL PROPERTY With the exception of the following items of personal property described on Exhibit "A' which shall be delivered to Husband on or before August 2, ] 998, by Wife. Wife agrees that all of the personal property in the possession of Husband shall be the sole and separate property of Husband; and Husband agrees that all of the personal property in the possession of Wife shall be the sole and separate property of Wife, The parties do hereby specifically waive, release, renounce and forever abandon whatever claims, if any, he or she may have with respect to the above items which shall become the sole and separate property of the other. 8. DIVISION OF MOTOR VEHICLES With respect to the motor vehicles owned by one or both of the parties, they agree as follows: The 1998 Ford Taurus currently in the possession of Husband shall become the sole and Ii If Husband agrees to waive any interest in the 1996 Cadillac and its lease and agrees to assign separate property of Husband, A lien presently exists on this automobile which names Husband as sole debtor. The 1996 Cadillac currently in the possession of Wife shall become the sole and separate property of Wife, This vehicle is presently being leased through GMAC, The titles to the said motor vehicles shall be executed by the parties, if appropriate, for effectuating transfer as herein provided, on the date of execution of this Agreement or at any time thereafter at the request of either party. ,; any interest or rights he may have in said vehicle to Wife, Each party shall be responsible for and shall exonerate and indemnifY the other party with respect to all debt amounts due and owning on the automobile in his/her sole possession, 9, DISPOSITION OF PROPERTY , ~.. , !' From and after the date of the signing of this Agreement, both parties shall have complete freedom of disposition as to his/her separate property and any property which is in their possession or control pursuant to this Agreement and may mortgage, sell, grant, conveyor otherwise encumber or dispose of such property, whether real or personal, whether such property was acquired before, during or after marriage, and neither Husband nor Wife need join in, consent to, or acknowledge any deed, mortgage, or other instrument of the other pertaining to such disposition of property, 10. DIVISION OF REAL PROPERTY The parties own various parcels of real property which shall be distributed as follows: A. Husband and Wife hereby agree and acknowledge that they own certain real property located at 1448 High Street, Camp Hill, Pennsylvania 17011, as tenants by the entireties, Husband hereby agrees to convey all his right, title and interest in said property to Wife. Husband agrees to execute a deed or oth.'r instrument of conveyancing necessary to effectuate this transfer at the time of the execution of this document. T~e parties acknowledge that there is a primary and a second mortgage against this property held by Mellon Bank in the approximate total amount of$ I 60,000,00. Wife agrees to assume total liability for these mortgage obligations. Wife shall hold Husband harmless and indemnitY him from liability for these mortgage obligations and other obligations arising from this property, including, but not limited to, any and all real estate tax payments which may be imposed upon the property during the course of Wife's ownership of said property, or upon the sale or said property. B, Husband and Wife hereby agree and acknowledge that they own an equitable in!erest in certain real property located at Unit No, B-11 B-11 G Laurel Hills North, Condominium I, Enola, East Pennsboro Township, Pennsylvania, Wife hereby agrees to convey all her right, title and interest in said property to Husband, Wife agrees to execute a deed or other instrument of conveyancing necessary to effectuate this transfer at the time of the execution of this document. The parties acknowledge that there is an installment sales agreement by Deluxe Homes of P A in thc approximatc amount of$90,OOO.00, Husband agrccs to assumc total liability for this installmcnt salcs agrccmcnt. Husband shall hold Wifc hamllcss and indcmnify hcr from liability for this mortgagc obligation and othcr obligations arising from this propcrty, including, but not Iimitcd to, any and all rcal cstatc tax paymcnts which may bc imposed upon the property during the course of Husband's ownership of said property, or upon the sale or said property. C, Husband and Wife hereby agrec and acknowledge that they own two lots at Raystown Lake identified as a commercial lot and a residential lot. The patties agree that Husband shall receive the residential lot and Wife shall receive the commercial lot. The parties agree to cxecute decds or other instruments of conveyancing necessary to effectuate the transfer of these properties at the time of the execution of this document. The parties agrce that these lots are not subject to any mortgage or loan obligation, however, each party agrees to assume total liability for any and all real estate tax payments which may be imposed upon the property during the course of each party's ownership of said property, or upon the sale of either property by its owner. 11. PAYMENT OF SPECIFIED OBLIGATIONS The parties agree that the following constitute joint marital obligations which shall be paid by the following person: A. WIFE - Mellon Mortgage No, home equity loan Mellon Second Mortgage No, Any debts incurred in her name since the date of separation, B. HUSBAND - Deluxe Homes of PA Installment Sales Agreement on North Hills Condo Any debts incurred in his name since the datc of separation, Husband and Wife are accepting the sole responsibility to pay certain enumerated joint debts in this Agreement. Husband and Wife agree that all debts shull be paid in a timely manner, In the event that any debt shall remain unpaid more than 60 days Irom its due date the purty responsible under the Agreement for paying this debt shall: I.) NotifY the other party of the situation in writing. 2.) Take immediate action to place the property which serves as security for the debt for sale, 3, Pay any legal costs the other party shall incur in enforcing the terms of this provision, 12, LEGAL FEES Each party shall pay his or her own attorneys fees, 13. ALIMONY Both parties acknowledge and agree that the provisions of this Agreement providing for equitable distribution of marital property are fair, adequate and satisfactory to them and are accepted by them in lieu of and in full and final settlement and satisfaction of any claims or demands that either may now or hereafter have against the other for support, maintenance, alimony pendente lite or alimony, Husband and Wife further, voluntarily and intelligently, waive and relinquish any right to seek from the other any payment for support, maintenance, alimony pendente lite or alimony, 14. PENSION PROGRAM Each party hereto shall maintain sole ownership over his or her individual pension plan, profit I' , , Ii I ( '. '..., sharing or similar rctircmcnt plan acquircd individually or as thc rcsult of contributions by his or hcr employer. Husband hereby 8grees that he shall maintain Wife as the sole beneliciary of his retirement plan through his employment by Deluxe Homcs of P A until such time as he retires. At the time of retirement, Husband shall have full power and authority to direct the beneficiary declaration of this fund without consent or joinder of Wife, Husband hereby releases any interest that he has in the retirement benefits of Wife accumulated as the result of her employment by ReMax Realty and any other additional benefits she may have accrued. This waiver is a full and complete discharge of each parties' marital claim to these retirement benefits, 15, MISCELLANEOUS Husband agrees to maintain insurance on his life. These policies are offered through his employer in the amount 01'$50,000,00 in death benefits and through a private policy on his life with $250,000,00 in death benefits, Husband agrees to name the parties' children as the sole beneficiaries of these policies. These policies shall be maintained by Husband until he retires from Deluxe Homes ofPA or achieves age 65 whichever first occurs, Husband agrees to provide Wife with written proof of the designation of the parties' children as beneficiaries under his two life insurance policies on an annual basis, Husband agrees to maintain Wife on his employment provided health insurance plan, at his sole expense, for a period of thirty-six (36) months under the COBRA program, or until such time as Wife acquires her own health insurance coverage. Coverage of health insurance for Wife is predicated upon her eligibility under the COBRA program, All assets including, but not limited to, savings accounts, checking accounts, certificates of deposit and life insurance policies shall be the sole and separate property of the title holder of said asset. The parties believe and agree, llnd have been so lldvised by their respective allorneys, that the division of property heretofore made by this Agreement is a non-taxable division of property between co-owners rather than a taxable sale or exchange of such property. Each party promises not to take any position with respect to the adjusted basis of the property assigned to him or her or with respect to any other issue which is inconsistent with the position set fbrth in the preceding sentence on his or her federal or state income tax returns. The parties have heretofore filed joint federal and state tax returns, Both parties agree that in the event lII1Y deficiency in federal, state or local income tax is proposed, or any assessment of any such tax is made against either of them, each will indemnifY and hold harmless the other from and against any loss or liability for any such tax deficiency or assessment and any interest, penalty and expense incurred in connection therewith, Such tax, interest, penalty or expense shall be paid solely lII1d entirely by the individual who is finally determined to be the cause of the misrepresentations or failures to disclose the nature lII1d extent of his or her separate income on the aforesaid joint returns. 16, GENERAL PROVISIONS A. WARRANTY AS TO EXISTING OBLIGATIONS - Each party represents that they have not heretofore incurred or contracted for any debt or liability or obligation for which the estate of the other party may be responsible or liable except as may be provided for in this Agreement. Each .. party agrees to indemnifY or hold the other party harmless from and against any and all such debts, , , , I , ' liabilities, or obligations of every kind which may have heretofore been incurred by them, including ! \ I those for necessities, except for the obligations arising out of this Agreement. B, WARRANTY AS TO FUTURE OBLlGA TrONS - Wife lII1d Husblll1d each covenlll1t, r, ... warrant, represent, and ugree that eaeh will now und ulull times hereuner suve hurmless und keep the (lther indemnified fromull debts. churges, und liabilities incurred by the other aner the execution date orthis Agreement, except us muy be otherwise specilicully provided for by the terms of this Agreement and thut neither of them shall hereuner incur uny liability whutsoever for which the estate of the other may be Iiuble. C, SEVERABILITY - Ifany ternl, condition, c1uuse, or provision of this Agreement shall be determined or declared to be void or invulid in law or otherwise. then only that term, condition, clause, or provision shall be strieken from this Agreement and in all other respects this Agreement shall be valid und continue in full force, effect, and operation, Likewise, the failure of any party to meet his or her obligations under anyone or more of the paragraphs herein, with the exception of the satisfaction of the conditions precedent, shall in no way void or alter the remaining obligations of the parties. D, OTHER DOCUMENTATION - Wife and Husband covenant and agree that they will forthwith execute any and all written instruments, assignments, releases, satisfactions. deeds, notes or such other writings as may be necesSlll)' or desirable for the proper effectuation of this Agreement, and as their respective counsel shall mutually agree should be so executed in order to carry out fully and effectively the terms of this Agreement. E, ENTIRE AGREEMENT - This Agreement contains the entire understanding of the parties, and there are no representations, warranties, covenants, or undertakings other than those expressly set forth herein, F, WAIVER OR MODIFICATION TO BE IN WRITING - No modification or waiver of any of the terms hereof shall be valid unless in writing and signed by both parties and no waiver of any breach hereof or default hereunder shall be deemed a waiver of any subsequent default of the same or similar nature, G. MUTUAL COOPERATION - Each party shall, at any time and from time to time hereafter, tuke any and all steps and execute, acknowledge, and deliver to the other party any and all further instruments and/or documents that the other party may reasonably require for the purpose of giving full force and elfect to the provisions of this Agreement. H. LAW GOVERNING - This Agreement shall be construed and governed in accordance with the laws of the Commonwealth of Pennsylvania, 1. BINDING EFFECT - Except as otherwise stated herein, this Agreement shall be binding and shall inure to the benefit of the parties hereto and their respective heirs, executors, administrators, successors, and assigns, J. NO WAIVER OF DEFAULT - This Agreement shall remain in full force and effect unless and until tenninated under and pursuant to the terms of this Agreement. The failure of either party to insist upon strict perfonnance of any of the provisions of this Agreement shall in no way affect the right of such party hereafter to enforce the same, nor shall the waiver of any breach of any provision hereof be construed as a waiver of any subsequent default of the same or similar nature, nor shall it be construed as a waiver of strict performance of any other obligations herein. K. HEADINGS NOT PART OF AGREEMENT - Any heading preceding the text of the several paragraphs and subparagraphs hereof are inserted solely for convenience or reference and shall not constitute a part of this Agreement nor shall they affect its meaning, construction, or effect. L. ADDRESS OF PARTIES - Each party shall at all times keep the other infonned of his or her place of residence, and shall promptly notifY the other ofany change, giving the address of the new place of residence until all obligations under this agreement have been satisfied. M, WAIVER OF CLAIMS AGAINST ESTATES - Except as herein otherwise provided, each party may dispose of his or her propclty in any way, and cach party hereby waivcs and relinquishes any and all rights he or she may have or hcreafter acquire, under the present or future laws of Pennsylvania or another jurisdiction, to share in the property or the estate of the othcr as a result of the marital relationship, including, without limitation, dower, curtesy, their statutory equivnIents, widow's allowance, homestead rights, right to take in intestacy, right to take against the will of other, and right to act as administrator or executor of the other's estate, and each party will, at the request of the other, execute, acknowledge, and deliver any and all instruments which may be necessary or advisable to carry into effect this mutual waiver and relinquishment of all such interests, rights and claims, N, ATTORNEY'S FEES FOR ENFORCEMENT - In the event that either party breaches any provision of this Agreement, and the other party retains counsel to assist in enforcing the tenns thereof, the parties hereby agree that the breaching party will pay all reasonable attorneys' fees, court costs, and expenses incurred by the other party in enforcing the Agreement. IN WITNESS WHEREOF, and intending to be bound hereby, the parties have signed and sealed this Agreement on the .,.. I \ ' <1 -,- , 1998 at Harrisburg, daYOf~llsi- Pennsylvania. In the presence of: , I t ~., j , , I /'J ~-1. /~":\~,, -Jj,----,"' (SEAL) Be,v Iy 1\, Simpson '~6 ii a1'U .eC L. EAL) " 'I i: ~ ~ ,:... '. I. 2, 3. "4, 1/5, 6, ( !>rol'u-,) '/7. v'8, 9. v10. VII. JERRY W, SIMPSON PERSONAL ITEMS All trucks and cars (Winross, Hess, Ertyl) Train, train platforms and buildings All PRR lanterns and box of schedules Grandfather clock Wooden ice box Cedar chest Gate leg table One of the large Chinese bowls Tools in basement Radio and stand in basement Books and papers in washstand in basement, specifically excluding any and all photographs and/or photo albums in the washstand, EXHIBIT "A" ~ JERRY W, SIMPSON, Plaintill' : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYL VANIA NO. 98-387 CIVIL v, BEVERL Y A. SIMPSON, Defendant CIVIL ACTION - LAW IN DIVORCE To the Prothonotary: PRAECIPE TO TRANSMIT RECORD Transmit the record together with the following information, to the court for entry of a divorce decree: I. Ground for divorce: irretrievable breakdown under ~ (3301(c) (3301(d)(I)) of the Divorce Code, 2, Date and manner of service of the complaint: U, S. Mail, Certified, Restricted Delivery, Return Receipt Requested to Beverly A. Simpson, 1148 High Street, Camp Hill, P A 170 II 3. (Complete either paragraph (a) or (b),) (a) Date of execution of the affidavit of consent required by ~ 3301(c) of the Divorce Code: by plaintiff August 3, 1998; by defendant August 3, 1998. respondent: (b)(I) Date of execution of the affidavit required by ~ 3301(d) of the Divorce Code: ; (2) Date of filing and service of the plaintiff's affidavit upon the 4, Related claims pending:None 5, (Complete either (a) or (b).) (a) Date and manner of service of the notice of intention to file praecipe to transmit record; a copy of which is attached: (b) Date plaintiff's Waiver of Notice in ~ 3301(c) Divorce was filed with the Prothonotary: August 3, 1998 n ...0 n C ':';'u " I .n 7" " , ,. ,-' . ., -"1 .. i";;' , , i'+"l ";11'1 ; '_1 .lC") , i:-,~ ; , '::., " " '-j :1:1 . , . .. (') .. ;'-"; _';'il I ;.;! r:" " (11 ~.':! , ", JERRY W, SIMPSON, Plnintilr : IN TilE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW v. BEVERL Y A. SIMPSON, Delcndnnt NO. 'I ~, 35 / : IN DIVORCE (J (-L'~C NOTICE TO DEFEND AND CLAIM IUGIITS YOU HAVE BEEN SUED IN COURT. If you wish to defend ngainst the clnims set forth in the following pages, you must tnke prompt action. You arc wnrned that if you fnil to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the Court. A judgment may nlso be entered against you lor any other claim or relief requested in these papers by the Plaintill: You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling, A list of marriage counselors is available in the office of the Prothonotary, Cumberland County Courthouse, One Courthouse Square, Carlisle, Pennsylvania 17013. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES, OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP, CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE PlI 17013 (717) 2493166 NOT/CIA Le han dcmandado a usted cn la corte, Si usted quierc defcndcrsc de eslas demandas expucstas cn las paginlls siguicntcs, lIstcd ticnc vicntc (20) dias dc plazo al partir dc la fccha de la demanda y la nOlificacion. Ustcd dcbc prcsentar lIna llparicncia escrita 0 en pcrsona 0 por abogado Y archivar en la corle en forma escrita sus defcnsas 0 sus objecioncs alas dcmandas cn contra de su persona, Sea avisado que si usted no sc dcfiende, la cortc tomara medidas y pucde emrar una orden contra usted sin previo aviso 0 notificacion y por cualquicr qucja 0 alivio que es pedido en fa peticion do demanda, Usted puede pcrder dincro 0 sus propiedades 0 otros dercchos importanates para usted, LLEVE EST A DEMANDA A UN ABODAGO fNMEDlA T AMENTE, SI NO TIENE ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA 0 LLAME POR TELFONO A LA OFICINA CUY A D1RECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. COURT ADMINISTRATOR 4TH FLOOR, CUMBERLAND COUNTY COURTHOUSE ONE COURTHOUSE SQUARE CARLISLE, PA 17013 (717) 240-6200 I , I I, I I. 5, Neither Pluinlifrnor Defendant is in the military or navlll service of the United States or itsllllies within the provisions of the Soldiers' and Sailors' Civil Relief Act of the Congress of 1940 and its Amendments. 6. The cause(s) of nction and section(s) of Divorce Code under which Plaintiff is proceeding are: A. Section 3301(c), The marriage of the parties is irretrievably broken. After ninety (90) days have elapsed from the date of the filing of this Complaint, Plaintiff intends to file an Affidavit consenting to a divorce, Plaintiff believes that Defendant may also file such an Affidavit. B, Section 3301(d), The marriage of the parties is irretrievably broken, The Plaintiff and Defendant separated in April of 1996, 7, There was a prior divorce action filed by the Plaintiff in the Court of Common Pleas of Cumberland County that was discontinued by the Plaintiff. 8. PJuintiffhas been advised of the availability of counseling and that Plaintiff may have the right to request the parties to participate in counseling, 9, The parties may enter into a written agreement with regard to support, custody, visitation of children, alimony and property division. In the event that such an agreement is executed by the parties, the agreement may be incorporated by the Court into the final Decree of Divorce, WHEREFORE, Plaintiff requests your Honorable Court to enter a Decree in Divorce, divorcing Plaintiff and Defendant. {) "- ...:J' (.: rj; lr. I:':''';; ;~ I.!JC: 6\ :'J..,- C::J:;/ ~,~: ; ',c, ~- :">~4' 1..'- .-. ~::t: (:'\ ::s ~'l) t:.>.' :")- or l.., ,') ;',;'0) ,-' r ~ (::,l." I ,-:.' :).Z ri::;.:-' '--" (.;JLO 1= ~::J ~:~ n.. o.:t II. en :-..J 0 0" 0 t. , \: JERRY W. SIMPSON. Plaintiff : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY. PENNSYLVANIA CIVIL ACTION - LA W v, NO. 98-387 Civil ,1 " , BEVERLY A. SIMPSON. Defendant IN DIVORCE r , WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301 (C) OF THE DIVORCE CODE " J. I consent to the entry of a final decree of divorce without notice. 2, 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. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be went to me immediately after it is filed with '7~ the Prothonotary. I verify that the statements made in this affidavit are true and correct. I I \ , I understand that false statements herein are made subject to the penalties of 18 Pa. C.S,A I , , ~4904 relating to unsworn falsification to authorities, Date: 'Ci \,,3 tqe, By: ~ I' , i l , , ( " " '. . I I ~ '- ~~ t~ llJ.',. S~2t:) U~_._ (~) f::~ , , r.'u S~j~., II- , i--= II. o ."' 6 .. \1 . , " t',' . '~ II I ~: U I , , . ). r- I' 1- I' u-; 6; '- ,~ 3;;; C)::t: '''):::J .......- ~-~~;~ '"4- i.uUJ ,::](l.. ...:;: "j 6 .- ":-C .;."') I (,!) :=J 0..:( co c."' i'.> J,' \l'~J ~:,:.' Xi; ,".' .;;;" ,. I~~' ~", ~' :~.';''-~ f', ~l :. ..' :,.:,~ JERRY W. SIMPSON. Pluinliff : IN TIlE COURT OF COMMON PLEAS : CUMBERLAND COUNTY. PENNSYLVANIA : CIVIL ACTION -LAW v. : NO. 98-387 Civil BEVERLY A. SIMPSON. Defendunt : IN DIVORCE By: ,-? WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301 (C) OF THE DIVORCE CODE I. I consent to the entry of a final decree of divorce without notice. 2, I understand that I may lose rights concerning alimony. division o I' property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be~t to me immediately after it is filed with the Prothonotary. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein arc made subject to the penalties of 18 Pa. C.S,A ~4904 relating to unsworn falsification to authorities, Date: ~- .3- 98 l " :-.A' / Beverl A. Simpson i I I I i I I '.. .h '- r\:: .- f;..: ..-:i, Lr: I,. 6; _.~' '" lIJC? , t~:~ r~ i ;.~~ .~'l ,":") ~:J s>[:T '- ec> _ ~ 1 ;:0 Op. 1 .,'~, t~_' .". I.: % _,.I .' UO '" UJ u: :::; ~:~~ 0_ r= to:( ::) 1 L c:J 0 cr' U r""'-1. ..... I~" .........,.. .....- ~ 'i (, E DER:." ,.' . I :... Compl.t. It.m. 1 and/or 2 for .ddlUonIl MrYle... I' "., Compl.te II.m. 3. .nd .... & b. . Print your nlml .nd Idd,... on the r.ver.. of thl. fOlm ,o'thlt WI can (: r.tumthl. elrdto you., . '. " .' ' I .'.' Att.eh thl. form to the front 01 thl mallpllc,. or on thl blek II .p.e. . dOli not pennlt. I. ".. Writ. "RltUm R.celpt Rlqull.tld" on the mlllpllcl below the.rtld. numbar I .,. . Th. Rltum R.CllptFII will provide you the Ilgn.tura of thl peraon dllly.r. I .: to' and the dlta of dlllv. .' :W,;rtlcIAddr....d to.' Q. : T/1ff ' xf.,O...LLL I'~ 'ftc /101/ :\6.' I 6. Slgn.tur lAd r.....l I f, f' I I .l r I ",., I also wish, to receive the' following services' (for en extra f..): ' . 1. 0 ~rBssss~~ Addre~~:' 2. l'l'R..trlct.d D.llv.ry .' Consult ostmast~r for fee. ' 4a.Artlcle Nurybor. ',,.?; . . rf.J..l/J 7'1 ~ '7~ ~' .rvlc. Typ. ' " ' o egl.t.r.d Olnsur.d '. ., ' C.rtlfled O.tOD o Expr.ss M.II 1!1' R.turn Rec.lpt for ercha J . 7. oet./ ~~v '18" 8. Addresses's Address (Onlv If rsquested .ndf..I.p.ldl" .' ", " ,I ,,' ., I \ .I I { I ! .f 'I ,;/ .' ,. rl:,' .'. ;'j '.U.8. OPO: '"';-21'_ "DOMESTICRET:URN R~~EI~:; ..:1 ,:o! , , , , ,i I " " . ' . ,'I "--. -" Q dJ "... , ~:.:J " , ~ '-' , ' -1'1 ('" '- ,. , , 1'''4 , '. C,,) n i , u , .,-! r; 1',: " () .'~I 0"" ,.~:: , on , rj .. ;-S. .. "I'I I ~,) ---I " r:-' ,- ~..l ~: I -~ ,~ -, l J r I '* OFFICE OF DIVORCE MASTER CUM8ERLAND COUNTY COURT OF COMMON PLEAS 9 North Hanover Slreel Carlisle, PA 17013 (717) 240.6535 I, Robert IIIeker, " Divorce Masler Trael .10 Colver Office Manager/Reporter West Shore 697.0371 Ex!. 6535 April 20, 1998 Kathleen Carey Daley Attorney at Law 1029 Scenery Drive Harrisburg, PA 17109 Keith o. Brenneman, Esquire SNELBAKER, BRENNEMAN & SPARE 44 West Main Street P,O, Box 318 Mechanicsburg, PA 17055 RE: Jerry W, Simpson vs. Beverly A, Simpson No, 98 - 387 Civil In Divorce Dear Ms, Daley and Mr, Brenneman: By order of Court of President Judge George E, Hoffer dated April 13, 1998, the fUll-time Master has been appointed in the above referenced divorce proceedings, A divorce complaint was filed on January 21, 1998, raising grounds for divorce of irretrievable breakdown of the marriage and the economic claim of equitable distribution, No other economic claims have been raised in the action, I am going to proceed on the assumption that grounds for divorce are not an issue, Based on that assumption, I am directing each counsel to file a pre-trial statement in accordance with P.R,C,P. 1920,33(b) on or before Friday, May 15, 1998, Upon receipt of the pre-trial statements, I will immediately schedule a pre-hearing conference with counsel to discuss the issues and, if necessary, schedule a hearing, Very truly yourS, E. Robert Elicker, II Divorce Master I \ 1 i j , : " , , J vs. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 98 - 387 CIVIL JERRY W. SIMPSON, Plaintiff BEVERLY A. SIMPSON, Defendant IN DIVORCE RE: Pre-Hearing Conference Memorandum DATE: Friday, July ~7, ~998 Present for the Plaintiff, Jerry w. Simpson, is attorney Kathleen carey Daley, and present for the Defendant, Beverly A. Simpson, is attorney Samuel L. Andes. A divorce complaint was filed on January 21, 1998, ra~s~ng grounds for divorce of irretrievable breakdown of the marriage. The parties separated in April ~996; consequently, the parties can obtain a divorce either by the filing of affidavits of consent or based on the fact that the parties have been separated for a period in excess of two years. The divorce complaint also raised the economic claim of equitable distribution. There have been no claims for alimony or counsel fees and expenses. The parties were married on April 2~, 1962, and are the natural parents of three children, all whom are emancipated. The Master has been advised that counsel have been working diligently to settle this case and that, in fact, it appears as if there are only a few minor issues to be resolved before an agreement can be signed. Counsel are hopeful that those issues can be resolved and the case will be able to be settled. However, in the event that no resolution is completed with respect to the outstanding issues, the Master is going to schedule a hearing date. A hearing is scheduled for Monday, August 3, ~998, at 9:00 a.m. Notices will be sent to counsel and the parties. E. Robert Elicker, II Divorce Master " JERRY W. SIMPSON, Plaintiff ~lle '4~l'L IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION. LAW NO. 98.387 CIVI L TERM IN DIVORCE vs. ) ) ) ) ) ) ) ) ) BEVERLY A. SIMPSON, Defendant DEFENDANT'S PRE-TRIAL STATEMENT Defendant, by her attorney, Samuel L. Andes, files this Pre.Trial Statement in accordance with Pa. R.C.P. 1920.33(b): 1. ASSETS. Attached hereto and marked as Schedule A is a list of the marital assets as known by the parties. It should be noted that Wife has entirely liquidated the funds in her individual retirement accounts and applied the proceeds of that liquidation to pay the mortgage and home equity loan owed on the residence and to otherwise maintain marital assets and pay marital obligations. It should also be noted that the mortgage owed to the parties by their daughter, Sue Getz, was paid off in March of 1998 and that the parties divided the proceeds of that transaction. Wife does not believe that the Court need be involved further in the distribution of that asset. Attached hereto and marked as Schedule B is a list of the non.marital assets as known to Wife. 2. EXPERT WITNESSES. At this point Defendant does not intend to call any expert witnesses. If the parties are not able to agree upon the value of assets, she retains the right to call appraisers, accountants, and other experts as may be necessary to present evidence as to the value of those assets and she further reserves the right to call expert witnesses in response to evidence submitted by Plaintiff in his case. 3. FACT WITNESSES. At this point, Defendant does not intend to call any fact witnesses other than herself and the Plaintiff, as on cross examination if he does not testify as part of his own case. She reserves the right to call any witnesses necessary to respond to evidence submitted by Plaintiff in his case. 4. EXHIBITS. The exhibits that Defendant would intend to introduce at the hearing would be: A. Copies of tax returns and other documents to verify the current and past incomes of the parties; and B. Copies of statements from her IRAs and deposit slips, canceled checks, and similar bank records to show how those accounts were liquidated and what disposition was made of the proceeds of them; and C. Documents relating to the mortgage given to the parties by their daughter and the documents demonstrating the payoff of the mortgage and the division of the proceeds between the parties; and D. Documents, primarily consisting of account statements, showing the balance in various accounts held by either of the parties, both at the time of separation and from that time until the date of the hearing, for the purpose of valuing those assets; and E. A copy of the documents relating to the lease of her vehicle; and F. Copies of appraisals of any of the assets for which the parties cannot agree upon a value; and G. Such other documents as are necessary or appropriate to respond to the Plaintiff's case. 5. INCOME STATEMENT. Defendant is self .employed as a real estate sales agent and her income fluctuates from year to year. She has not completed the preparation of her 1997 income tax return and has no accurate information about her current income at this time. She will provide a copy of her 1997 income tax return at or prior to the hearing and will supplement that with a formal Income Statement. 6. EXPENSE STATEMENT. Defendant will file an Income and Expense Statement at or prior to the hearing which will list her living expenses. In addition, she will present evidence about the expenses she has incurred since the date of separation to maintain various marital assets. 7. RETIREMENT VALUATION, The only retirement accounts held by the parties can be valued by a review of balance in retirement accounts at various dates. Defendant believes that the parties will be able to agree upon a value for each of these assets. If they cannot, she reserves the right to call an actuary or accountant, if necessary, to calculate the value at the time of the hearing of the marital portion of either parties retirement accounts. 8. COUNSEL FEES. At the present time, there is no claim for counsel fees pending. Defendant reserves the right to make a claim for counsel fees if appropriate and, if she does, she will present evidence of the fees she has incurred throughout this case ~ I I I I I I I 1 with the attorneys who have represented her. That evidence will consist of their statements and a description of the hourly rate which she agreed to pay to those attorneys. 9. PERSONAL PROPERTY. Defendant believes the parties have agreed upon a division of the tangible property and that the Court will not have to take testimony on that issue. If there is a dispute about personal property, Defendant reserves the right to call an appraiser as to the identity and value of the items and dispute. 10. MARITAL DEBTS. The only marital debts known to Defendant are those listed in Schedule A which is attached hereto. 11. PROPOSED RESOLUTION OF ECONOMfC fSSUES. Defendant proposes that she be awarded the residence in Camp Hill, subject to the mortgage and home equity loan which she will be responsible to pay. The commercial lot at Raystown Lake, the funds she withdrew from her IRA, and the funds in the parties' bank accounts (both those in Wife's name alone, and the jOint accounts) at the'time of separation. She proposes that Husband be awarded the Laurel Hills North Condo and his retirement plan. She further proposes that the parties each retain the monies they received from the mortgage owed by their daughter, the personal property in their possession, and other marital assets in their possession and that each party waive any further claim to alimony or counsel fees. Respectfully Submitted, ,~ Samue L. l'If1ae Attorney for Defendant Supreme Court ID 17225 525 North 12th Street Lemoyne, PA 17043 (717) 761.5361 Schedule A Marital Assets illEr ~ DATE or MARITAL ~ AMOUNT or VALUATION PORTION I.J..E.H Residence at 1448 High $225,000.00 April 1998 100% Mortgage to Mellon $80,000.00 Street, Camp Hill, Bank (Approx.) Pennsylvania Same April 1998 100% Home equity loan to $80,000.00 Mellon Bank (Approx.) Rental Condo at Laurel $110,000.00 April 1998 100% Installment Sales $90,000.00 Hills North Agreement with Deluxe Development Corp. Two lots at Raystown $45,000.00 April 1998 100% No liens known. Lake, Pennsylvania Husband's money $111,547.52 30 April 1998 100% No liens known purchase pension plan with Deluxe Homes 01 Pennsylvania, Inc. Wile's IRA's with MFS $27,000.00 April 1998 100% No liens known. Funds and Janus Funds (Approx.) Mortgage owed to $98,000.00 March 1998 100% No liens known. parties by their (Approx.) daughter, Sue Getz. Wile's 1996 Cadillac None (this April 1998 N/A Wile owns no equity Lease vehicle Is in this property as it leased only) is merely leased. Joint checking account Unknown April 1996 100% No liens known. at Mellon Bank Joint checking account Unknown April 1996 100% No liens known. at Core States Bank Wile's checking account Unknown April 1996 100% No liens known. at Mellon Bank Wile's checking account Unknown April 1996 100% No liens known. at Core States Bank " Schedule B Non-Marital Prop.JU:ty Am! WM I2i1ul Valuation April 1998 Reason for Exclusion I.lMi Wire's interest in the Ice Cream Shoppe Unknown but believed to be negligible This asset Is non. marital No liens known, because it was purchased by wire after the dale of separation entirely with her post separation earnings. " , I ". - '.--. . - ',__OK' - -- '.' ' , '."..,.', . . \' ,1 " ,} '., :,;,,'",' !. l '.~" '.' ~ ' 'r " .' . , . . , . . ., ,. ,I,'" .., ' , ',1 ,.> ".} , 'f' .. \ f .' .' .) , . . I' , . . .. . ',' '.' .' ~ .i~I""!';,"I', \..i.:~(:.I:l ',', ~/'j ,.',':"}, ." '.' I '.. ,:"',' t' .; .'...., ' . " .. .. " JERRY W. SIMPSON, Plaintiff " ,I " v. : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : CIVIL ACTION. LAW BEVERL Y A. SIMPSON, Defendant NO. 98.387 CIVIL IN DIVORCE INCOME AND EXPENSE STATEMENT UNDER RULE 1920.31 I hereby file the Statement of Income and Expenses required under Rule 1920.31 and verify that the infonnation therein contained is true and correct to the best of my knowledge, infonnation and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S.A. ~4904. relating to unsworn falsification to authorities. , ,i ;\ :1 : i . .( ., Date: tfjlO!1k By: il r ~ \, '/ , . II \ I . .. INCOME AND EXPENSE STATEMENT OF JERRY W. SIMPSON INCOME Employer: Deluxe Homes ofPA Address: P.O. Box 323, Berwick, PA 18603 Type of Work: Land development and home building Payroll Number: SIMPSJI Pay Period (Weekly, Bi-weekly, etc.): Monthly Gross Pay Per Pay Period: $5,000.00 Itemized Payroll Deductions: Federal Withholding $812.92 Social Security $310.00 Local Wage Tax $50.00 State Income Tax $140.00 Retirement $ Savings Bonds $ Credit Union $ Life Insurance $ Health Insurance $ Other (specifY) '. Net Pay Per Pay Period OTHER INCOME: MONTHLY Interest $ (C.D. & Mun. Bonds) Dividends $ Pension $ Annuity $ Social Security $ Rents $ (net loss) Royalties $ Expense Account $ Unemployment Camp. $ Workmen's Camp. $ Gifts $ Total $ TOTAL INCOME: $3,614.58 monthly S3,614.581month -, EXPENSES MONTHLY HOME: Mortgage/Rent $720.50 Maintenance & Lawn $ Utilities: Electric $ 60.00 Gas $ 50.00 Oil $ $ Sewer Telephone $ 30.00 Water $ 30.00 EMPLOYMENT: Public Transportation $ Lunch $200.00 TAXES: Real Estate includes: Laurel Hills Condo and 2 lots in Huntingdon $185.00 Personal Property $ INSURANCE: HomeownerslRenters $ 20.00 Automobile(s) $ 30.00 Life $ 82.00 . Accident $ Health $ Other $ AUTOMOBILES: Payments $580.00 Fuel (all vehicles) $ Repairs $100.00 MEDICAL: Doctor $600.00 Dentist $200.00 Orthodontist $ Hospital $ Medicine $300.00 Special needs $ (glasses, braces, orthopedic devices, etc.) EDUCATION: Private School $ Parochial School $ College $ Religious $ PERSONAL: Clothing $500.00 Food $600.00 . . BarberlHairdresser $10.00 Credit Payments $300.00 Credit Card $ $ $ Charge Accounts Memberships LOANS: Credit Union $ MISCELLANEOUS: Child CarelBabysitting $ PapersIBookslMagazines $ Entertainment $ Pay T.V. $ 32.00 Vacation $ Gifts $ Legal Fees $250.00 J , Charitable Contributions $ 20.00 Laurel Hills Condo Info $750.00 $700.00 $ 62.00 $I500.00/year Rent: Payment: Condo fee: Taxes: TOTAL EXPENSES $3,531.50/month , r \ .~ ." ". ~..l n Ie C ,.... ~ 'i , ~) ,... ,... lj .;) (-~ H "'"," ~ ~ n) 0 " C:t " ,;) (.) ,;) Q '-t . . ,... ~ <:> 0:) Q " , . < ~ fi-' ~ '-l r:t r. ,... r1 H -.J ;;:t ,') ;~ (~ ;;:t :;'''' . -< ".1 l'" ;0) , . (oJ ii j.J ,... r.J r.,) l1 jJ H . r., .J =; .". ;.) , !/) _-1 ~ .. r.~ ~ '.J .~ ~ \j il ,., ;; , <:> , Li'J 1;"1 r.J . 0 '. ., j.) ;~ . . 0 .;) 0 ;:j -<, , '." 0 'n -10 ,;) I";tO ,;) - , U . ""J ::> ,.' IS l' <-I - ;=i !-"'rJ ,..... ,- ,... .:.. (:a- ., '.... Ui () ., ,- ~ . , . ,=--t,) (, fJ ~~ c:) <:) il <) " ,) .. C::. ; . . . ('" ,..... () (, '::0 01 . 'J " &) 0 ,.' .J ! rJ .. 1'J .. -, ,) C> '-' <;) r= ,.:- H p . . ~ .. .... (-) <) ,) ~ .;; ; <) ,) ~;) ri " .J .~ c, r.J ., .: !~ ~ P -J C"'r~ ~ " ;....1') f..j ,- t!;) .:..'.) .' .) t) " ~ !1 j' -"\ , . . . . , " L.l t) <) ., ,) ,) . ) f""-.) J::Q ,) ,.) ,) <) ',' C;) f,; t:, ...,. , , ; . Conlrol numoer 333 OMS No. 1545.(l()()8 b Employer's Identtflcatlon number 23-1648999 c Employer's name, address, and ZIP code DELUXE HOMES OF PA, INC. 499 WEST THIRD S'mEE:l' PO BOX 323 BERWICK PA 18603 d Employee's social secUlity number 161-32-8656 . Employee's name, address. and ZIP code JEIlRY SIMPSON 1448 HIGH ST. CAMP HILL PA 17011 16 StiIII Employer's stale J.D. No. .~l!..I... .~~:-;3~.~~,:,!l...... . . Copy B To Be Rled with employee's FEDERAL tax return 1 w.ges.lips, D1I1efcompensallOn 2 Federal income tax Wl1MeId 6 3 SodeI secunly weg.. 61200.00 5 Medicare wages and tips 4 SocIal secunty tax withheld 3794.40 B Medicare tax withheld 65500.00 7 SocIeI.llCtJnly Up' S Alloeeled lips , 9 Advance EIC payment 10 Oependenl care benelils 11 Nonqualified plans 12 Benefils included In box 1 13 See Instrs. tor box 13 14 Other 5 StJMOry ~ PIftSlOI'l UoaI HShId. Im!)loytt plan rip. Mlp. X 19Locablynam. 20 l=lwagos,llpl.III:. ~ ............ 17Sla1e_l!lSoelO. ISSIa,.ItICCIll.tax . ..li!i~9P...QQ. .. .V~~~...qq. . . .F;IT. ... ... 9.5.!!QQ, 9Q ... 9.!!!i, 99.. E W 2 Wage and Tax 1995 ~ · Statement 21l=limnotax Depanment of lhe Treasury -Inlemal Revenue Service This information is being fumished fo thelntemal Revenue Service. ~.... ' ~~ --- . ' -- , '"' p., " f '. Form 1'040 Label (s.. IIlIl/Uc1lonl on plglll.) UII th. IRS IabIL OthOlWlI., pl8_prlnl or type. PruldlnUIl E1lcUon ~m 588 1.11. Filing Status (S88 pIg. 11.) Chect< only on. boll. Exempllons (588 pig. 12.) If moll than IIx dependents. ... pIg. 13. Income Attach Copy B of your Form. W-2, W-2G, and 1099-R hlrl. II you did not g.t I W-2, ... I p"g. 14. . Encloso, but do not anach. your p.ymontand p.ym.nl youchot. See p"g. 33. AdJustments to Income AdJusted I OAA ... '- --' O.p."",."1 of Uti r,.uu,.,..I"It'"I' n.'III"UI ~.rvIU U.S. IndIvIdual Income Tax Return "" the .., J.I". t.. O.e. J t flU. 0' ath., tu ....., b. I""'" 1915.."111" . . IRS U.. 0,,1 .. Do ".t -.ftl.., ".plelll thll Ip.C.. '. " OU8 HI. '141?0001. Vour lIOC'"IIICUrlty number 161-32-9656 Spoul.'llOCllllICurlty numb... 161-34-9827 For Pr1Vlcy Act and PlpllWork RlducUon Act NoUcl "' I .7. V.. No Not.: Ch.......oy... ..II ".. chang. yow tu 0' ,...u~ yow ,,'u"d. 1995 '''' L A B E L H E R .' E ~ 1 2 3 4 5 61 u,,",m. Yo", fl'll "''''1 IIId I",UII JERRY W .SIMPS9N' ,','" .. .""'.' \........ ... " . .nl'I'. BF 161-32-8656 . 161-34-9827 528 5E "- -.:.' "1:'--"~"-"" --...,....:..-..:..--... .._- . .... "J1lRRY'W ,& 'BEVERLY A' ....SIMPSON ',1448 HIGH.5T::' ,.." :CAMP, 'HILr.:PA :~701l=3945,~'-"':" ...... . ,- ..... .. I R S Apt. no. _' '~.l,~ ,:.! ."~~~__..:. __ .. Do you want $3 10 go 10 this lund? ............... ....... ..... ... ...... ............ II. oint r.lUrn. do.. our oeou,. w.nl $3 10 0 10 Ihl. lund? Slngl. Man1.d mlng Joint r.lUrn (.v.n If only on. hod Incom.) Man1.d lIUng sapar.t. r.lUrn. Ent.r .pou.a'. .oclal .ocurlty no. above and lull nll/ll8 har.. . HI.II of hauuhold (wilh qUAlllyi"Q p"'lanl-(S" pg. 12.) II Ih. qUIMIYl"G p".a" II. child but nOI you, cllp."d.".. Inti' thl, child' nlm. h.'I. ~ OuallMnn wfdow,er wilh dee.ndenl child' .or .eou.. dl.d. 19 . 5.. ao.l2.) Voursel'.1I your par.nt (or somoon. .1..) can claim you as I d.p.nd.nl on his or h.r I.. return. do not check box 8a. But be sura to check the box en fine 33b on page 2 .......... b Souse c Dlpendents: 1 First".m. ust".m. (2) a.plndl"t'.t 10dll llcurltv "umb." It barn I" H11I5. "'11.11 .13. (3) O.p.nd."t'.... ,-"IUc",hlp to 'u (4) ~~'n1t, IIv.dl")'CIur d If your child didn't II.... with you buill c1&l"'.d'" YOIl' d.pI"d'ftl uRellt.p,.-tIllS ..gu.",,".. ch.ck h.,. ............ e TotaJ number of Bxemadons claimed. . . . . . . . 7 W.g.., .alarI.., Up', .tc. Anach Form(.) W-2 ................................................. 81 Taxablalnlerostlncomo ('.0 pogo 15). Anach Schadula B II ov.r $400 ... ...................... b Tax-exemptlnt.rost (... pogo 15). DON'T" Includa on IIna 8a. . ... 8b 9 DMd.nd Incom.. Anach Schadul. B II ev.r$4Oo ....... ................. ........... ........... 10 T..abl. relunds, credill, or 011..11 01 .talo and local Incom. I.... (... pogo 15) ... . . ... . ... ... .. 11 AIlmony racalv.d............................................................................ 12 Buslnosslncom. or Ooss). Anach Sch.dul. C or C-EZ......................................... 1:1 Capilal gain orOoss).llr.qulr.d, anach Sch.dula 0 (... pag. 16) ........... ...... ............ 14 Oth.r gains or Oe....). An~ach Form 479~............ ...1............................ ......... 15a TOlal IRA dl.lllbullon. 15a,' b Taxabl. amount ('88 pag.16) 16a Totalp.n,lonlllldannultl.. 16a b Taxable amount (see page 18) 17 RentaJ real estate. royalties, partnerships. S corporations. tnJsts, etc. Anach Schedule E . . ........ . 18 Fannlncom. or 00"). Anach Sch.dul. F ..................................................... 19 Un.mploym.ntcome.n.alll~~(sl.a pogo 17) ....... .... .,................... ........... ....... 201 Social ..e. b.nenll.... I12!..J b Taxabl. amount('88 pag.18) . 21 Oth.r'ncom.. Ustlypa & amount-... pag.18........... ....................... .............. 22 Add Ih. amount. In tho far rl hI column 'or line. 71hrouoh 21. Thl. I. vour tot.llncome . 23a Your IRA d.ducllen ('.0 pag.19) .............................. 23a b Spou....IRA d.duc1!on (... paga 19).......................... 23b 24 Moving ..p.n.... Anach Form 3903 or 3903-F . . . . . . . . .. . . . .. . . . 24 25 On.-hall 01 .elf-employmanllax ............................... 25 26 S.Il-.mploy.d h.alth In.uranca d.ducllon (... pago 21)......... 26 Xl Keogh & ..Il-.mployed SEP plan.. II SEP; ch.ck . 0 ........ 27 28 P.nalty on .arly wfthdrawal ol.avlng. .......................... 28 29 Alimony paid. RocIpl.nt. SSN ~ 29 30 Add lines 2~a throuah 29. Theso ara your total ad ustmenls .. 31 Subuactln. 30 'rem In. 22. ThI.I. your .dlu.tod 9ro..Ine.II I... Ihan $26.673 and 0 child IIvad with you (less than $9.2:10 If a child didn't IIvB with you), sea -Earned Income Credit" on .27 .. 31 3 I I I I ,I j' f' f;; I I, ': 1 ~ 0.0 axes checkld on 51 and 6b ~ No. of your children on 6c who: . livid wtth you . didn't IIv. wtth you due 10 divorce or aeparaUon (SH pallll4) Dependents o~ 6c not on1ontd abave Add numb entered on In. abov.. 2 65 500 2 752 t 570 77 940 65 ~08 -~5 995 ~95 875 4 480 ~9~ 395 F"..1040 t".., ~".,i"'l JERRY W & BEVERLY A SIMPSON, 32 Amounl from IIno 31 (adju.lod gro..lncomol................................................ . '32 33a Chock If: 0 You woro ll.5 or oldor, 0 Blind; 0 Spou.. w.. ll.5 or oldor, 0 Blind. I:~' :..... ~ Add Iho numbor 0' box.. chockod abovo and onlor Ihelolal h.r. ~ ~ ' b II your par.nl (or .omeon. 01..) c.n claim you.. e d.pondon~ ch.;d; 'h~;'; :: : : : : :: : . 3:lb r ;.;:: . o II you are man1.d nllng ..paratoly and your .pou.. It.mIz.. doduc1loos or ~'" , you are a dual-.tatu. all.n, ... p.g. ZI and check h.r. .. .. .. .. , .. .. . .. .. .. .. .. .. . :J:Jc 0 ~t; 34 Entof [ltemlzeddedUcUonSftamSChtdUltA,lInt:Z.,OR } ~ thu Standard deduction .hawn below 'or vaur flUng atatu. Butlf you chlcked 34 'a 9 Art)' bu an Ou 331 ar 11,110 10 plge 2:110 find yaur .tlndlld deduction. r er .f )'ou chlck.d boa 33.:. your .tandatd deduction I.,.ra. at · SJngle-h,lIDD . Married IllnaJalnll)' arOualUyfnG wjdaW("~SI.550 YOUr. · HNd at hou"'hald-U,150 . M&n1ed mlng "Parattlv-I:I,27S Subtract IIno 34 from nne 32 3S .................................................................. IIlIn. 321. $aB,~ or I..., mulllply $2,~00 by Iho 10lal numb.r at exomplloos claimed on IIn. B.. IIlIno 321. ovor $aB,025, '0. Ih. work.hoot on pago 23 for th. amount 10 .nlor. . . . .. . . . . . Taxable fncome. S"bL IIno 3B Irom IIn. 3~, If In. 3B I. mar. than In. 3~, .nlor -0- Tax. Check II tram a 0 Tax rabl., b 0 TAlC Rat. Sch.dul... C ~ C.PILa; ~~.~ ~~ ~;,~~' . . .1'1..1,0' d 0 Farm II'S(I..pag.2').Amaunl'ram Farm('IU1. .. . 38 Addlllonal t..... Check If Irom a 0 Fonn 4B70 b 0 Fonn 4972.. .. .. .. .. .. .. . .. .. . .. 39 Add IIn.. 3a and 39 . 40 ~::: ::; ~~I:I:~y~;I~:d=I~~~~:.o;~:;~~~:.~~I: ~o.~ .~~:.. . :~ II For.lgn tax credit. AlU1ch Fonn 1116 . . . . . . . . . . . . '0 .. .. . .. .. .. " 43 .;W.'II.<..~.... Oth.r credits (... pago 25). Check If from a F"m 3ID. . . b 0 Far," 13811 C 0 Farm "0' d 0 Far," IIp.cily) 44 '- ~i Add IIn.. 41 through 44 ,. ........ ............ ......... ........ ......... .,...... ......... .... 4S Subtract IIn. 45 from IIn. 40. If IIn. 45 10 moro Ihan IIn. 40. .nlor -0- . 46 S.If-.mploymenlt... Anach Sch.dul. SE .,...... ........ ........ ... ..... ......... ..... ... ... 47 AU.rnallva minimum tax. Anach Fonn 62~1 4a Recapt1Jr. t..... Check If tram aD' F~'';';'4255'''i,'' 'D"F.;;';;8ii;1"'~"'D "R;';;;8828 49 Soclal .ecurity and M.dlcaro I.. on lip Incomo not roponod 10 omployer. Anach Fonn 4137 .. ... . 50 Tex on quallnod r.Ur.m.nt plan., Including IRAe. If r.qulr.d. alU1ch Fonn 5329 . . . ...,. . ... .. . ..., 51 Advanc. .am.d Incom. crodlt paymonts tram Fonn W-2 ........ ........ .,.... ...,..... ......, 52 Hou..hold .mploym.ntt...., Anach Sch.dul. H ..."............................... .."..... 53 Add IIn""46-53. ThI.I.vourtolaf lax ." ",,"" " ..""." ~ 54 F.d.....llncam.tuwHhh.,d.lranyl.'ramFarm(.110aa.ch.ck ... .. U 5S 11 353 ~~~ 1995 .stlmat.d I.. paymonlo & amountappllod from 1994 ret1Jm sa b!{'$ Eamed fncome credll. Anach Sch. E1C If you have a qualifying Jlf!!'.il (};.~f&[M""<"~" .1 I *N$ wm child. Nonl..ablo oarn.d Inc,: ami. ~ tifF ,\1;;; &typ. ~..,..,.............."..........................N9 1r1 il$j Amount paid with Form 4868 (extension requesl) ................ 58 ~1~ Excess soda! security and RRTA tax withheld (see pogo 32) ...... 59 ~f:ill*i~ Other paymanl.. Chock If trom a 0 Fonn 2439 ~\ilW O :,~<(-,.<~ b Fonn4135........."................................. 60 t%U Add IIne9 55 throuqh 60. These Bre your total payments . . . . . . . . . . . . . .. 81 If IIn. 51 I. mar. than IIno 54, .ubtract line 54 from IIn. 51. This I.,he amount you OVERPAID ,. 52 Amount o'''ne B2you want REFUNDED TO VOU.:...... ....... ...,.... .,................. ~ 63 Amount 01 IIn. 62 you want APPUED TO YOUR 1996 EST. TAX ~ I 64 J Wlr1\ II Un.UI. ma!...thanlin.8t. sublta~UnlJt tram IIn.U. Thl.l. th.AMOUNT 65 40 570 Fard.taJlt:an('awtap.y.!nCNdlngUllngForm 1040..V.P.Ym.ntVauchlt.....p.g.3;1 ..................... __" {."<'<" . _'_. _._ _ B6 Esllm.l.d lb o.nellV "00 paco 331. AI.o Includ. on IIn. 65 . .. .. I 66 I ~ , 556 W*ffi"'ijWllil@.'iiW~ Undltp.n.lti.. at~~u ,I d.clu. th.tl h.",. .umln.d this r.turn and accamp&nYl"II,ch.dul.. and at&t.mlnts. and fa the b..1 af my knawl.dg.and Sign b.u.r. theyar. tru" car ct,lnd camplal', Clcw.tIan of pt.patlrlath" than lup'Y"II. bu.d an alllnlarm.t1an 01 which pUp"" hUInY knawladg.. Here ~ YauralgnatutI "\ J\ /_ o.t. Vauraccup.tlan ....."'py~r .-../ CONSTR MGR .IIhl....... ..,"I. toryaur. .....,~ r I~ Iltum.BOTHmultslgn. ~/I..~':-;:-- /, ~ SpauII"Qccup.tlan "'''d.. . ~ - dj J /~ I'.. R E SALESWOMAN Paid :::.~u::s ~ ~D P -"'~ Q. Q CYA o'';/;~9{; ;'~;::~~''''d n I Pr~~.~s~~~:~~~~ Preparer'sFl<m's",m.("y."s It. CHUBE AND ASSOCIATES "N 25-~645828 Use Only ".."-.m,l.y.dl.nd , P.O. BOX 6597 .dd,... HARRISBURG PA ZlP"d. ~ 7~~2-0597 Tax Compu- tation (5.. page 23.) II you want the IRS to nguro your Ib,see pag. 35. Credits (S.. page 24.) Other Taxes (5.. p.g. 25.) Payments Anach Forms W-2. W-2G. and 1099-R on' tho front Refund or Amount You Owe OAA 161-32-8656 .....2 ~91 395 ~6 035 3S 36 175,360 37 3a 36 37 4 200 ~7L~60 39 40 41 42 43 44 43 209 43.209 45 46 47 4a 49 50 51 52 53 54 65 56 1r1 43 209 7 ~58 50 367 sa 59 60 61 62 83 64 65 11 353 " . Form 2'210 Ullderpayment ot Esllmaled Tax by Individuals, Estates, and Trusts ~ SII "",""'1" InllrucUon.. ~ Attoch 10 Form 1040 104M 1040-~ 1040NR 1040NR- . . OMS No. "u.ouo O"ttt""nl.f thl r'luury 1"'lmll ,...,tnVI Ibf"llce H''''ICII'hown an Wlltu," AttachlR"" or t041. SIQu,nce No. IdenUlylng number 1995 06A JERRY W & BEVERLY A SIMPSON 161-32-8656 Nole: In moll CU.., you do nol no.d 10 m. Form 2210. Th.,RS will "gur. any ponally you ow. end ..nd you I bill. AI. Form 2210 only I' on. or more box.. In Part I apPly 10 you. II you do nOI no.d 10 m. Form 2210, you onlll114Y u.. 11 10 "gur. your ponolly. Entor Iho amounl Irom IIn. 20 or "n. 38 on Ih. ..nallV IIn. 01 your r.lUm. bul do nol onach Form 2210. LlP.l1!:(ifllJ Reesons For F1l1ng- 111.. b, Dr c bolow appll..lo you, you I114Y b.obl.lD low... or .1Im1net. your p.nohy, But you MUST chocl< th. box.. thaI apply end ",. Form 2210 wllh your lax r.lUm.1l1d b.low eppll..lo you. chock thot box end "I. Form 2210 with vour tax r.lUm. 1 Chocl< whlch.ver box.. apply 0' non. apply, ...th. Noll abovo): a 0 Vou requosta walvlr. In conaln cucumslanco., tha IRS will walvo all or part ot Ih. ponally. Soe Waiver 01 Penalty on pago 1 olth. Inswcnon.. b 0 Vou u..th. annualized Income In.Iallment method. II your Incom. vart.d during Iho y.ar, this molhod I114Y reduc.lh. amounl 0' on. or moro requlr.d In.tallmonls. S.. pogo 4 ot tho In.trUctions. C 0 Vou hed F.d.ral Incomo lax wllhhold 110m weg.. and you U.alll as paid 'Dr osUl114lod tax pUlp D... wh.n II was aclually wlthh.,d 'n.I..d olin .qual amounts on Ih. paymonl duo dOl.'. Soo tholn.trUcUon. 'Dr IIn. 22- d 0 Vour requlr.d annual paym.nt 0In.,3 b.,ow) I. bas.d on your 1994 lax and you m.d Dr 010 IIlIng a)olnt relUm lor ollher 1994 or 1998 but nollor bolh v.arn. 2 Enleryour 1998 lax a/l.rcredlts (soo In.trUc1fon.)........................ ....................................... 2 3 Oth.rlax", (s..ln.truc1fon.) .... .... ......... ........ ................... ..................... ...... .... ...... 3 4 Add IIn.. 2 and 3.. .................. ................................................. ...................... 4 5 Earn.dlncomo credll................................................... ........ 5 h...'r.~.~*.;... 6 er.dlllorFod.ral lax paid on ru.l. .............................................. 6 " 7 Add IIn.. 5 and 8.. ............... ............ ...... ........................................ ........ ......... 7 8 CUrrenty.artax. Subuactlln. 7/lomllno 4...... ...... .................................. ........ ..... .... ..... 8 9 Mullfplylln.8by90%(.90) ..................................................... 9 45 330.\NF' 10 WIthholding taxos. Do notlndud. any ..timat.d lax paym.nts on thl.llno ('00 InstnJc1fon.) ....................... 10 11 SubUacl "no 10 /lom IIn. 8. II I... than ~OO, 1l0p her.; do not compl.t. or m. thl. form. Vou do nOlow.lh. p.nally ....... ........... ..................................... ................................ 11 12 Enl.r tho lax .hown on your 1994 lax relUrn (110",01 thaI amount IIlh. od/ust.d gro..lncomo shown on thaI relUm I. more than $150,000. or II mlllTf.d filing s.parol.'y for 1995, mora than $78,000). c.aUUon: Sea Instruction. ........................................................................... 13 RequIred annual paymenL Enlerth. .mallero' IIn. 9 orlln.,2......... ... ... ......... .... ............. ........ Nole: IIl1n. 161s .quallo or more than IIn. 13, Slop h.r.: you do not ow. Ih. ponally. Do not m. Form 2210 unl."" you chock.d box 1d abova. ~ea.tt:l.ln Short Method (Caution: R.ad tho Instrucllon'IO ... II you can usalh. shon molhod.1I you chock.d box lb or c In Part ,. .kl Ihl. art and 0 10 Part IV. 14 Enlor th. amount,lIany, Irom IIn.10 aIlove ...................................... 15 Ent.r Ih.tOlal amoun~ II any, of ..Umat.d lax paym.nt. you mad. ................ 16 Add IIno'14 and 18 .......................................................................................... 17 Tolal underpayment lor year. Subtractlln. 16 from IIn. 13. II z.ro Dr 10... Slop h.r.: you do not ow.,h. p.nally. Do not m. Form 2210 unl."" you ch.ck.d box 1d abov. .................................... 18 MUlllply nn. 17 by .06066......... ................ ............................................................ 19 I 11th. amount on IIn. 17 was paid on or aller 4/15/98, .nl.r -0-. · IIlh. amount on IIn. 17 was paid belore 4/15/96. maJcotho following compulallon 10 nnd Ih. amount to enter on line 19. 43 209 7 ~58 50 367 i'lejt.rum Required Annual Payment . 12 13 50 367 ~~ 353 39 0~4 .~I 37 001 37 OO~ 14 1S 11 353 &i;i:t! i~- 16 11 353 , 1>,1 17 18 25 648 ~ 556 AmQunt Oft Numb., af d"YI paid IInl17 X b,'ar''''15/1111 X 20 PENALTY. Subtracllln. 19 from IIn. 16. Enter tho rosull h.r. and on Form 1040.lIn. 66; Form 1040A, IIn. 34: Form 1040-T, IIn. 42; Form 1040NR,lIn. 66; Form 1040NR-EZ.lin. 28; or Form 1041.lIn.28 For Paperwork Reductlon Act NOUCB, see page 1 at separate InstRlctlons. II ,00025 19 o ~ 20 ~ 556 Form 2210 118115) OAA ~.... 1111 Pa I , . SCHEDULES A&B (Form 1040) a.,ut,unt of th. Tr.uury Infima' A....tftu. Sat'tlr:. nt Taxes You Paid (See peg. A-I.) Interest You Paid (See peg. A-2.) Not.: Personal 12 Int.rost Is not deduc1lble. 13 14 GIfts to 15 Charity If you mad. a 16 gltt and got a benelll tor II. 17 .... pege A-3. 18 Casualty and Theft Losses 19 Job Expenses20 and Most Other MIscellaneous Deductions (Se. peg. A-5 for expenses to deduct hera.) 23 24 25 26 Other 27 Miscellaneous Deductions Total Itemized Deductions Schedule A-itemized Deductions ~Allach 10 Form 1040. (Sch.dul. B Ia on back) ~See Instructfons for Schedufes A and B i!.~?0~' 1 ;tP~J 3 5 6 7 :f~~q 8 Ham. mot1g.lg.lntlr..tnotrlpartld to you an Form 1011I.1' paid to thl pltlon from whom you bought th. homl. .11 pagl A-3 and .how that plrson'. naml.ldlntlrylnQ no.. and .lddra.. ..... . . . .... . ... . . . . ... . .. .............................................................. .............................................................. .............................................................. Points not roported to you on Form 109B. Se. peg. A-3 for .peclal rule............ .............. ...................... 12 Inv..tm.ntlntere'L If required. enach Form 4952. (See pageA-3.) .... .......... ............ .............. ..... ..,... 13 Add lines 10 Ihrou h 13 ...... ........... GIlls by cash or chacko If you made any gltt of $250 or lfJHi more, see pegeA-3 ............... ..... ....................... 15 Other than by cash or check. If any gitt of $250 or more, JIlS1iil .ee pege A-3.1f over $500, you MUST enach Form S2ll3......... 16 Canyoverfrom prioryeer ............... ............ ........... 17 Add line. 15 Ihrouoh 17 ......... . . . . . . . . . . . . . . . . . . . .. .............. . Casuelty or thett loss(e.l. Anach Form 4694. See eoe A-4.1 . Unrelmbursed employee expenses-job Iravel. union dues, job education. etc. U required, you MUST auach Form210Bor2106-EZ(Se.pegeA-5.).. ...................... ~:;:;~W.i %.€~..~~ <<<>;:.,'::i If 20 21 . ............................................................. 22 Add line. 20 through 22 ................ ...................... 23 Entlr amount 'rom Form 10'0. Unl 32... 24 M'& Multiply line 24 above by 2"10 (.02) .............................. 25 Subrract line 2S from nne 2:l. If line 25 Is mora than line 23. enter-Q-.............. ........ ... ... Other-from list on pege A-5. U'ltype end amount" ............. ... ............... ....... .... 28 I. Form 1040, line 32, over $114,700 (over $57,350 If mesried filing .eparalely)? NO. Your deduc1lon I. not IImUed. Add the amounts In the far right col~mn for lines 4 through 27. Also, enter on Form 1040, line ~4. the larger of this amount or your standard deduction. YES. Your deduction may be limited. See DaCle A-5 ror the amount to enler. For Paperwork Reduction Act Notice, .e. Form 1040 In.!ructlon.. * LIMITED .............................................................. .............................................................. 21 Tax preparation fee. .......................................... 22 Other expenses-Investment. safe deposit box, elc. Ust typ. and amount" ........................................... %TW i~;,kJ <<~*~,.,; N.",aeallhown on Form 10.0 JERRY W & BEVERLY A SIMPSON Medical Caution: Co not Include expen.e. relmbur.ed or pald by olhe",. and 1 Medical and dental expenses (see pege A-I) .... ................ Dental 2 Enteramounthom Form 10'O,Onl32 2 Expenses 3 Multlp/y IIno 2 above by 7.S% (,07S) ............................ 4 Subtract line 3 from line 1. If line 3 Is more than line 1. enter -O- S Stale and local Income taxes................. ......... ......... 6 Real estetetaxe. (.ee pege A-2) ..... ............... ..... ...... 7 Personal property taxes................................... ..... 8 Other tax... Ustlype and amounl ............................ . . ......I?Ji:;E!.~~~~J;...~~F;~............ ................ 9 Add lines S Ihrou h a . ....... ... . ..... .. 10 Home mortgage/nlere.t & points reported 10 you on Form IOSB 11 ............................................................................................ i OAA }........ BY AGI OMU Nit. '....00,. 1995 Attach""...t 07 o 9 052 9 01.4 18 270 o * 28 ~6 035 fr"'1~__~..ik'M.m t/l~.,.: Schedule A (Form 1040)1995 ",.tIIIt(..."."""." ,,,,,.1040. O. "01"""""". &lid IOCI.I..cullly ",.,,,It.,., ."._" 0" .,,,., lid.. JERR~ W & BEVERL~ A SIMPSON Schedule B-Interest and DivIdend Income ;................................................................................................ Add the amounts on nne 5.............................................. ...................... 6 Capital galn dlstrlbuUons. Enter he'e and on Schedule 0" .......... 7 Nontaxeble dlstrlbuUons. (Seethelnstr. fa, Form 104O,I/no 9.) ...... 8 Add I/nes 7 and 8....................................... ...................................... Subtractl/ne 8 from I/no 8. Enter the ,..u~ he,e and on Form 1040, I/ne 9................ ...... ~ "If you do not need Schedule 0 to 'eport any olher galns or 10...., see the Instructions for Fann 1040. line 13, on oa e 18. If you had over $400 of Interest or dMdends or had a foreign account or were a grantor of, or a transferor to. a forelan bUst. YOU must complete this part. 11 a AI any Ume during 1995, did you hove an Imer..tln or a slgnoture 0' othe, BUthoriry over a financial account In a foreign country. such as a bank account. 3&CUritfas account. or other RnandaJ lICCOunt? Soe pago 8-2 fa, ""copUons and nl/ng ,equl,omonts 10' Form TO F 90-22.1 rr-vos... enler the name of tho foreign counuy .......................... ............ ::: :::::::::::::: ::::: ::: :::: Wero you lha granlor of, or transferor to, a lorolgn trust that existen during 1995, whelher or not ou have anv beneRdallnterest In 1t11f "Ves." vou may have to file Fonn 3520. 3520-A. or 926 For Paperwork Reductfon Act NOtlCD. seD Fonn 1040 Instructions. 1111 . flo II SCh.dUI...A&8 .' Part I Intarast Income ISH "11.,11 Md8-I., Hale: II you NCatved a Form ID'~HT.Fo'm to."'OIO,or ..uUtut. ltat..",t',a", abnlk"lI.fl,,,,. lit .". fit..... ....... U.. papt and ...t... t".t.cltaJlnt_Nt ."own." I"at 'or... Part II DivIdend Incomo (a.. pag..tS anelB-I.) Hole:or you rtcefv.d a Farm tDIiII-OrY Dr ..UUtul. mla",.,.,t'ram a btoklWlG. n,,,, 1ft I". flrm'.nam... IPl. pay.r and ..1"'1".101&1 di....dMda ."awn on Ihal 'o,m. Part III Foreign Accounts and Trusts IS.. p.goa..Zo) ". oun Hit. taU.OO" P. .2 Vaur locllll.CUrtly numb.. 161-32-8656 Attaa""'ent S..."...c. No. 08 Hato: II u hid ave' $400 In t..ablelnlores1lnco"", au must Ilso com 1010 Port III. 1 Uot nl/118 01 payo,. If any Inlerealls ~om soller-financod mortgage and the buyer USGd the praporty os I parson" rasldonce, see page 8-1 and list thlo Interest ftrlt Also, show that buyer's social soalrfty number Ind Idd,... ~ DONALD E AND SUE ANN GETZ 161-60:.:9761............. . 's"N' ':i'oTif'STRE'ET" "ciMii' HILL'" 'PA'" ............................ ....... ., ..... ..... .... .............. .f.................... t.....................,...................... CORESTATES BANK ................................................................................................ Amount 2 663 89 ................................................................................................ I: ................................................................................................ 1 ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ 2 3 ................................................................................................ Add the amounts on line l' 2 ..................................................................... Excludlblelnto,BS1 on seri.. EE U.S. savings bondsl..ued alter 1989 Irom Form 8S1S, line 14. You MUSTonach Form 8815 10 Form 1040.. .......... ................. ..... ....... 3 4 Subtract line 3 from line 2. Ente, Iho result he,e and on Form 1040. line 8a . ~ 4 Nat.: It au had over $400 In rass dividends and/or other dlstr1budons on stock. u must also com lele Part III. S Uot nome 01 peyer. Include gra.. dividends and/o' other dlstrlbuUons on Slack here. Any capital galn dlstr1buUons and nontaxable dlstrlbuUons will be deducted on On.. 7 and 8 ~ MFS TOTAi..RETURN..FUNO..... ..................................... ............. ................................................................................................ 2 752 2 752 Amount 570 ................................................................................................ ................................................................................................ ................................................................................................ i , I ................................................................................................ ................................................................................................ 5 ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ 6 7 8 9 10 570 I" 9 10 570 I', Ves No b 12 ~~i"t1-t~ ~.ffi\S);ff: t:t$t~l1 tJt_ f.;yU'll:: ;,- . ^:>" "~ X r$d~n~ ~~~:. W'>:l::~~~:<<, tt':{~.:~\ W1t~~ :AwkJf X Schedule e (Form 1040) 1995 Profit 01' Loss From Business (Soil Proprillorahlp) . Pat1nI"'hlpa,lolnl vlntur... lto., mUll nil Form 1065. 0..111......10' thl T......ury Attaahm...' In',mll ......."". I.MU 'II .. Attach to Form 1040 or Fann 1041. II- See '"BtruettO"1 tor Schedule C Fo"" 1040 . S.ql""Ct He. 09 .......,'..'ri.tor SocIal IICUrily number (SSN) BEVER!.'! A SIMPSON' 161-34-9827 A PrincipII bulln_ or pro'osaJon, Including product or servlco (see pogo C-l) D Enllrprinclpll bulln... codl REAL ESTATE SALES - REAL ESTATE .... . IC-8 . 55~2 C Dull... n~. II no sepllllll bulln_ n~, I..vo blink. 0 Employer 10 number (EINI,1f onv BEVERLY A. SIMPSON' REMAX RTY 25-~605973 I! Dull... oddr_ Qncludlng IUlll or room no.) ................................................................................................ IOwn or 011 omc. lIat. .nd ZIP cod. CAMP HILL PAl 7011 Accounting melhod: (1) CAah (2) AcctuoJ (3) Olher (.pac/fy) . ................................................... M.lhod(.) used 10 Lower 01 caS! Olher (attach 00.. nol apply Of VolUI clollng Inv.n1ory: (1) 0 eo., (2) 0 or mark.1 (3) 0 .xplanation) (4) ~ choc/c.d, skip IIn. H) H Wu lhlll. eny chang. In d.l.rmlnlng quanUU.., COIlS, or valuaUon. b.lW..n op.nlng and clo.lng Inv.nlory? II "Y..,. attach IlCJllonatlon .. ............ ............... ... ... . . ... . . . . .. . .. . . ... .. . . . . . . . .... .. . . .... . . .. .. . . .. . . . ... . .. . . .... .. . .. . ...... .. . . . Old you "mIlerfally plll'1lclpal..'n lh. operaUon ollhls bus/n.... dunng 1005111.No,. see page C-210r IIm11 on 10.... ................... X J II u lIarted or ac lrod thl. bu.ln... dunn 1005. chack h.re !Mp.lii'flm~ Income 1 Gross receipts or sal... C;auUon: IIlhls Incoma was repon.d 10 you on Form W-2 and Ihe "Slatulory ""'I'loy... box on lhal formwu chack.d, see page C-2 .nd check h.re......... ......................... . 0 2 R.turns ond allowances .................................................................................'-.... 3 SublractUne 2 tram line 1... ......... ......................................................................... a Co., of goods sold (tram line 40 on page 2)..... ..................... .... .... ... ...... .......... ............... Ii Groaaprant. SublractUn. 4 tram line 3... ..................................................................... 8 Olher Income, Including Federal & lIale gasoline or tuell" cradll or r.t. I... .... C-2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Gra.. Incom.. Add IIn.. 5 and 8 . iltPtittliltlS Ex enses. Enler e .n... for bu.ln... u.e 01 our home ani on line 30. a Adv.nlsJng..................... 8 2 384 10 P.nslon and profil-.haring plan........ 10 8 Bad d.bts tram salas or 2D R.nt or I.... (... page C-4): 'Wtl servIcos (... page 0::-3) .. ... .... 9 a V.hlel.., machln.ry, & .qulpment.. . . .. 10 Car and truck expen... b Olher bus/ness prop.ny . .... . ... . ... .. (seepagaC-3) ................: 10 3 725 21 R.palrsand moJnl.nance ............. Commissions and f... .......... 11 22 Suppll.. (nollnelud.d In Part III) .... ... D.pl.Uon....................... 12 23 T.... and licenses ................... o.proc/ation and .acUon 170 24 Trav.l. meal.. and .nlenalnment exp.nse d.ductlon (nollnclud.d a Traval.................. .. .... .... .. In Part III) (s.. page C-3) ....... 13 b Meals and en- 14 employ" b.nullt programs I.nalnmant (olh.rlhan on line 19) ........... 14 c Enlar50% at In. 24b .ub/oct Insurance (other lhan health) .... . 15 ~ 339 10 llmilalions Inlerest :14%-jf:i (... page C-4) ~3 541 a Mongage (paid 10 banks, .IC.) ... 16a d Subllact IIna 24c from IIno 24b . . .. . .. . . b Olh.r .......................... 16b 2S UtlllII................................. 17 Legal and prolesslonal 25 Wagas (I..s .mploymenl cr.dllS) ...... sorvlcas........................ 17 725 27 Olher exp.ns.. (Irom line 48 on Olfice ex .nse 18 875 aoe 21 ................. ............. Total expenses before expenses for business use of home. Add IIn9s 8 through 271" columns ................. ... Tentalfve profit 00"). Sublractllna 2B tram IIna 7 . .... .......................................................... Exp.ns.s forbus/ness u.e 01 your homa. Attach Form 0829..................................................... Nal pront or (loss). SJblractlln. 30 from line 29. IIf a profi~ .nl.r on Form 1040, IIna 12, and ALSO on Sch.dul. 51!, IIn. 2 (.tatulory employ.... ..a paga C-5). Estalls and tru.lS, enl.r on Form 1041, line 3. .If a loss, you MUST go on 10 line 32. 32 If you have a loss, ch.ck lhe box lhat descnbas your Investmenlln Ihl. activity (... page C-5). IIf you chock.d 32a, .nt.r lh.lo.. on Form 1040, IIn. 12, and ALSO on Sch.dulo 51!, IIn. 2 (statutory employees, sea paga C-5). Estates and trusts, enter on Form 1041, line 3. "II you chack.d 32b. you MUST attach Form 5108. For Paperwork Reduction Act NaUee, see Form 1040 Instrucllons. OAA 1"1 PI tI 'SCHEOULE C (Form 1040) F G 11 12 13 27 081 15 18 18 28 29 30 31 OMU Ho. t...s.oau 1995 v.. No . 1 2 3 4 5 8 7 ~08 8~9 ~08 8~9 ~08 8~9 ~08 819 20. 20b 21 22 23 iUHlW 24. 8 ~99 ~42 ~ 33~ 24d 25 25 ~3 2 ~3 540 704 000 27 28 29 30 ~6 575 64,539 44 280 } 31 } 32a B Alllnv"lm.ntl.aln.lc. 32b Sam.lnvutml/U i. nat atn.lI. Sch.dul. C (Form 1040) 1905 44 280 t'ala BEVERLY A SIMPSON . Schodul C Form 1040 1095 REAL ESTATE SALES - REAL ESTATE Ileiffilfij Cost of Goods Sold (sOG pogo C-5) ~6;-34-9827 P. 02 33 InvonlolY at beginning 01 yoor. If dllforont from lost you. closing InvOnlolY, aeoch o.planation ..................... ~~ :J4 purchosos I..... coot 01 IIams wllhdrown 'orporsonai use ........................................................ ~4 35 Cost orrabor. Do not Includ. oaill/Y paid to yoursalf................................................. ............ 35 38 Maloriols and suppllos........ ...... ....................................................................... ... ~8 ~7 Olhorcoots.................................................................................................. ~7 38 Add nnos ~~ through 37. ..................................................................................... 38 39 Inv.nlolY at.nd oly.or ... ........ ........................................................................... ~9 40 Cost at ~"1I\m ~.%.'>.~~ aads saId. Subtract IIno:l9 from IIno :18. Enrer tho result hero and on 0 a 1. IIna 4 Informatlon on Your Vehicle. Compl.l.lhls pan ONLV If you or. claiming cor or truck ..pons.. on nn. 10 and are not required 10 m. Form 4.562 for Ihls busln.... SOG th.'nstructions for IIn. 13 on peg. C-3 to nnd out if you must me. 40 41 When dId you placa your vehlcl.ln service for business purpos..? (month, day, yeor) ~ .................... 42 01 th.tolai number of mil.. you drove your v.hlcl. during 1995, .nl.r Ihe number 01 mil.. you uS.d your vehlcl. 'or: . a Bus/n..... ................................ b COnvnuting....... ............... .......... a Olher .................................... 43 Do you (or your spous.) have another v.hlcl. availabl. 'or p.rsonai us.? ............................................... 0 Ves 0 No 0 Ves 0 No 8 Ves ~ v.s J86 ~2 275 ~ 55J ~ 700 66~ 44 Wosyourvahlcl. availabl. for us. during off-duty hours? .............................................................. 45a Do you hav. .vld.na.lo suppor1your deduction?.... ............ .... .............. .......... ........ ........ ..... ... b If "Y....I. th. .vld.nca wrttlen? ~ml1 Other Expenses. Ust b.,ow business e.pens.. nOllnclud.d on IIn.. 8-28 or IIn. ~O. PARKING & TOLLS . MANAGEMEN.T" &"O'F'FICE' .FEE.......... .............................. ........ ............ .......... ..... . MULTI' 'i,'IST'" .... ..................... ... ...... ................................................. .... ... ...... . MISCEI.'i.ANEOUS....... ....... ............................................................................... . DUEs.............................................................................................................. . ...................................................................................................................... . ...................................................................................................................... . ...................................................................................................................... . ...................................................................................................................... . ...................................................................................................................... . ...................................................................................................................... . ...................................................................................................................... . ...................................................................................................................... . ...................................................................................................................... . ...................................................................................................................... . ...................................................................................................................... . ...................................................................................................................... . ...................................................................................................................... . ...................................................................................................................... . ...................................................................................................................... 46 OM Total other ex enses. Enter here and on aoe 1./ine 27 ... 46 16 575 &uliMa addr&Sll Qncludlng sull. or roam no.) ~........................... .l,.:'l! :'l!!3.. .1:I.+.q~. .~';l:~W:.J;::.r...................................... C "'wnar alllalnco lIIal. and ZIP cad. CAMP HILL PA 170~~ AccaunUng ","lhad: (1) Cash (2) Accrual (3) Olhor (specify) ~ ................................................... Molhad(s) usad to Lawor 01 cast Olh.r (attach Do.. natll/lply (If value clallng Inv.ntary: (1) 0 Cast (2) 0 or markat (3) 0 ..planaUan) (4) ~ chockad. skip IIn. H) H Wu thC!re any changs In determining quantities, costs, or valuations between opening and closing Invenlory1lf -Vast" attach ..planaUan ............... . ... ....... ..... .... . . .. . . . . . . . ... . . .. . . . . . . ... . .. . . . . . . . ... . ... .... . . .. . . . . . . .. ... ... . .. '" . ......... Old you "mat.rially par1lclp.I."In th. aporaUan of Ihls busln... during 19951 If 'Na," .... page C-2lar limit an lass.. ................... X J If u startod or ac ulrod this business durin. 1995. chock horo . . . . . . . . . . ,*Piiitll1W Income 1 Grass r1lColpts or sal... CauUan: If this Incame w.. ropartod to you an Form W-2 and Ih. "SlaMory employ... bo.on Ihat formw.. chock.d,.... pago C-2 and chock hara.... ................ .............. ~ 0 2 Rolums and allawanC83 ....... ..... .......................................................................... 3 Subtractllna2 from IIn.l....... .... ...... ....... ......... .... ......... .......................... ....... ..~... 4 Cast at goods sold (from IIno 40 an pag.2) .... ............ ..... ......... ......... ...... ........... ...... ...... 5 Gross prom. SUbtract IIna 4 from IIn. 3........................................................................ 8 Other ("came, Including FedersJ & state gasoline or fuel tax credit or ref, (... pa;e C-21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Gro.. Income. Add IIn.. 5 and 6 ~ fiPtl.iti:1W Ex snses. Enter ex enses for business usa of our home ani on line 30. 8 Advartfslng..................... 8 19 Panslon and prollH.haring plan........ 19 9 Bad dobts from sal.. or 20 Ront or laaso (see pago C-4): B8lVicas (aee paga C-3) ..... .... 9 a Vahlcl.., machlnary, & oqulpment... ... 10 Car and truck axpansa. b Othar business propany............... (seap.gaC-3) ................. 10 540 21 Rapalrsandmalntanance ............. Cammlsslons and fa.. .......... 11 22 Suppll.. (notlncludad In Part III)....... oaploUon....................... 12 23 Tax.. and llcen... ................... oapreclaUon and sactfon 1711 24 Trav.l, meals, and .nt.rtalnment axp.nsa d.ducl!an (nallnclud.d a Trav.I........... .... .... .. .. .. ..... In Part III) (s.. page C-a) ....... 13 b M.aIs and .n- 14 Employee b.nellt programs tartalnment 14 cEnter 50% of (other Ihan on IIn. 19) . . .... ... .. In. 24b sub/act 15 Insurance (olh.r Ihan h.alth). . .. . 15 to 1Im1laUons 16 Inl.r..t !lllil@ (sea page C-4) a Martgag. (paid to banks, .tc.) ... 16a d SUbtractlln. 24c from IIn. 24b . . . . .. . . . b Olh.r ......... ................. 16b 25 UUIIU.s.......................... ..... 17 Legal and proless/onal 26 Wag.. (I.ss .mployment cr.dlts) ...... services .... ...... .... .. .... .... 17 27 Olh.r exp.ns.s (from IIna 46 on ames ex Bnse ..... ... 18 Bas 2) . . . . . . ... .................... Total expenses b.'ora ..p.ns.. for business us. 01 home. Add IIn.s 6 through 27 In columns ................. ~ T.nlallva prollt Qass). Subtractllna 28 trom IIn. 7.. ........ .... ...... ........ ........................ ........... Exp.nses larbusln.ss us. 01 your ham.. AtlJlch Form 8829. ............... ........ ............................. Net pro1l1 or (lass). Subtract IIn. 30 from IIn. 29. olf. profit, .nt.r on Form 1040, line 12, and ALSO on Schedule SE, line 2 (statulary .mploy.... s.. page C-S). Eslat.s and trusts, .nteron Farm 1041,lIn. 3. olf a loss, you MUST go an 10 IIn. 32. 32 If you have a loss, chock Iha box Ihat d.scrib.. your Inv.stm.ntln this activity (s.. page C-S). olf you chockad 32., .nter Ih.loss on Form 1040, line 12, and ALSO on Schedule SE, line 2 (slatulary .mployoas, see p.g. C-S). Estal.. and trusts. .nt.r on Farm 1041, IIn. 3. olf vau chock.d 32b. vou MUST attach Form 6198. For Paperwork ReducUon Act NoUce, see Form 1040 Instructions. OM SCffEDULE C (Farm 10'0) Profit or Loss. From BusIness (501. Proprietorship) ... PartnershIp., Joint ventur.., lie., mUll flla Form tOSS. ... Atbch to Farm 1040 or Farm 1041. ... S.. Instructions tar Schedule C DeJllt1Mtfttof ,,,. Tt...ury 1""",.1 A...eftu. S.Mlle. "' Ha",..f ,tOP"IIO, .. JERRY W SIMPSON' A Principal buslnllSll or prafosalon, Including product or servlco (s... png. C-l) REAL ESTATE MANAGEMENT C Busln_ name. It no saparal. bus/nllSll nama, laava blank. I! F G 11 12 13 18 28 29 30 31 aMn H,. '....-0014 1995 Farm 1040 . ;:::n~:nJ.. 09 Sactal aacurity numb.r (SSN) 161-32-8656 B Entar principal bualn... cad. soa . . c-o ~ 5512 o Employ.r 10 numb.r (EIN),/f any V.s No ~ 1 2 3 4 5 6 7 34 200 34 20q, 34 200 34 200 20a 20b 21 22 23 R:tf~ 24a 24d 25 26 TT 28 29 3D 540 33 660 } 31 } ~: 33 660 B All Invutm,nt Is al risk. SO""Inv,stm,nl I. nat altisll. Schedule C (Farm 1040) 1995 17 NeIlan -term c. 11., "n or 1'0" . Combine column. In .nd (a 01 line 16 .. it!PilitillJ1! Summa of Parts I and 1/ 18 Combine line. 9 and 17.11"0... go 10 line 19.11. galn. enlar the galn an Form 1040, IIno 13. Nal.: II both line. 17 and 19 aro galn., .eo Iho Capital G.ln Till( Work.he.l on paga 24.......................... 19 II11na19 I. ala.., enler here and as. (10") on Form 1040.lIno 13, Ihe .m'lIar a/lhe.ela..a., a TIla loss on line 19; or b ($3,000) or," married IIlIng .oparately, ($1,500)................................................................. Nal.: See Ihe Capital La.s C.rryav.r Worksheet an p.ge 0-3 "Iho las. an line 19 o.ceed. the loss en line 19 or It Farm 1040.11"9 35./s a loss. OM For Paperwork Reduction Act Notlco, see Form 1040 Inslructlons. O'PII1M,nt'ol th. r"..Uf" 'n,.Nt" A'venn S.rvlc. Capital GaIns .and Losses .. All.1ch to Farm 1040. .. s.. Inl""cUanl lor Sch.dul. 0 (Farm t0411).' .. U.. line. 20 .nd 22 lor mare. IC. 10 1I.llnln.lcllan. lor IIn.. t Ind 9. ;:':::.";:.~.. Vaur lac'l' l""Urfly nUmber 161-32-8656 12 OMO Ho. ,,.1.007. filii 1995 ......1(.I.ho.,. on 'or", 1040 JERRY W & BEVERLY A SIMPSON Pa, ~U Shorf-Term Ca I/al Gains and Losses-Assets Held One Year or Less (I) D"crf"UII" at "top.t1y(E'Almpl.: IOO.tr.XYZCa.) (b) 01" acqulr.d (Mo.. day. )'r.) ee) Oll..old IMo.,day,rr.' Cd) S.,.. "tic. (.n p'a. 0-3' c.) Co.tor olh_bul, ,,,,plg.0...31 (Q LOSS lI(,'I'IItDI"""'(dJ" IVtlttlcl(dll"IIt'.) Cg)GAIN IICdJI'Mor.tltan(... IUblract('J',OIll(dJ 1 2 Entor your .hart-Ierm total., II any, (..f*lf/ftB<W"Wi_~lW" ~,t5' 2 U.i~t1",l': sr:.... j :. __ ~w.: tromUna21 ........................ ;-"<..~>',x:~~$', ,. _. . .<'<., .... / 8"""'.%W/.!""'!lf&1'>'Mflii '""<#M":"I' "1"""11". ':'J!W "'''''i;@_..... Tala .hart-t.rm "",.. prfc. 41?\H\0MWI@h&~ ilft'Wa; " <'?" . I'M ~"\w..' ,. . .maunts. Add column Cd) a' IIno'l & 2 3 +N"i';\~:'m'Z'b,hY""MW ;,~iin '.. ".. .. ,'..' MW mmWit". . ". . . Shart-Iorm galn tram Farm. 2119 and 6252. and short-Ierm galn or 10.. 'rom Farms 4664. 0761, and 6924......................."................................ 4 Nel.hort-Ierm galn or 10.. 'ram p""narshlp.. S carp oration., e.latos. and lnJ.lS Ircm SChedUle,.) K-l...".............."....."................."........... 5 Shart-Iorm capllal la.s carryover. Enter tho arnaun~ II any, ~am IIno 9 01 your 1994 Capital Lass CarryoverWark.hoet. ...".............................."......... 6 3 4 5 6 7 Add IInes1thraugh 61n columns (Q and (9).. ................. .."...... ..".... ...... 7 8 N.I shart-l.rm ca Ita' 'n or las.). Camblna column. In and I 01 line 7 WP'affilMl Lon -Term Ca lIal GaIns and Losses-Assets Held More Than One Year 9 .. 8 10 Enter ~'Our lang-Ierm 101als, II any. Ircmllne23 ........".............. 10 Talallang-l.rm saf.. prfc. .maunts. Ad~ column Cd) a' 'n. 9 & 10 11 Galn Ircm Farm 4797; lang-Ierm galn from Farms 2119,2439. and 6252; and long-Iorm galn or lo"'ram Farms 4694,6791, and 6624 ............. ............ Net long..tenn gain or Joss from pannershlps. S corporations, eSI,:Ues, and lnJ9l9 Ircm SchoduloC') K-l....... ................................................... 13 11 .,.....''i''<il;.. '.'1''''*'''''.'' """2""''\ :i~;':<<'W~rJi; ~N~~~..: . <<~.~~i:: ""'Th""J~,1(%}_"",.,,:W" ':.-::M'~~~ --W'~M;.<n:.,if.k:::~::::' ~::~\>1~~:W.1.ffiMr0~mt$W; {{W:::4ri};xrMt@1lli,~'<Vt~Wti ~:;\W1&';:.~';:>>'#k'1*t~~"~"" -~<.': : :{lr4Pl&.:*!W:~i~&.;WiU~.'..~~~ fr..:~f.~h?<..i~NgW~...Al;II~>>.~ *#~.-:uW:t~M{$,fre. . .,. ;.'.:' ,'.:-~:,..,.",;."'."',..."'"'''::N.._~.,W.~'''~;;.:,,.,'":';_ .:;:;~r>><;;;::y.::::Wii':,~~Nj;~~,~~*~'}:::;::-;,":..~;:-~,."'..:.tlf.tt.V'=l::)>':x,.d~~;{;':':i (.,~'<< , 12 13 12 65 108 14 Capital galn dl91l1butian. 15 LDng-Ierm capital 10.. c;,;y~~~~: e,;1~~'th~ ;';';~~~t: ii ~~y: 'f;~':'; i,~~ ;:; ~i"""""""" your 1994 C.pltal La.. CarryaverWark.heet......... ................................. 14 mli.~\l~I"'l 15 i"'.""'I.."~..I.>.'.'.''""'i!"''I''''' .>~:;.~~~: ,- . ..~-.,~. wli'~0x'o;,~.;l};( tYi:. ..<, ,_x... x~~' }~w#;\%> ;.<-~1f~}..t\-A-.W~~.,"'m;>.-:~. 16 Add I/nes 9 through 1~ In column. (Q .nd (g). ......................................... 16 65 108 17 65 108 18 65 108 19 :Y::f1:ff;1~iltt:tz')~!t!:ml~~;~v Schedule 0 (Farm 1040) 1995 Depart"""1 Dr .h. r'..IU,l' ''''''''I'AlYt''UI Stmct Hallle(I,.hDWlla"'lt"m Supplemental Income and Loss O..DH.........,. (From r.ntal r..l ..tal.. rOYIIU... plrtn.rlhlp.. 1995 S corporaUon., ..talo.. tru.la, REMICa, .'c.) S I Attachlllllftl '" ~ An.ch to Fonn 1040 or Fonn 1041. ~ e. natnJc1lon. lor Sch.dul. E Fonn 1040 . a ..... H.. 13 Vour aocllllllCUrI1y nUmb., 'SCHEDULE E (F.nn 1040) JERRY W & BEVERLY A SIMPSO~ ~6~-32-8656 1fI.l!8I:tlIll::l Income or Loss Flom Rental Real Estate and Royallles Nol.: Repcrt Income & up.n_ from your buol... 01 ,.ndng o...onol orooe"" on Schedule C or C-EZ r.ee oe.e E-lI. Reoort IIum mnlallncome or 10.. from Fonn 4l1:l5 on o.oa 2 nna 08. 1 Show the kind Ind locarton 01 each rental rell e.late orooertv: 2 For each rental re" 8I1Il8 V.. No 506 TERRACE DRIVE properly listed on line 1, did ............................................................................................. A 'NEW"C'UMBERLA'iio':"PA .......................................................... you or your Iamlly u.. n for p8l1Onol purpo... for A X . ~. .~9.J;l.~~.. ~ R?::~. .f?::r~F;F;?:: .. . ... . ... .. ... . .. . . . .. . . . . . . . . . . ... . . . . . . . . .. .. . . . . ... . more lhan the gre.t81 0' B ............................................................................................. 14 days or 10% 0' the total CAMP HILL. PA daya ,.nl.d at fait ,ental B X 3E SOUTHMONT DRIVE value during the tax yelt? ............................................................................................. C ............................................................................................. (See page E-l.) ENOLA PA C X Income: Pronertle!l Total. A B C 'Add CON'''''. A. e, atId C.I 3 Rents rocalved 3 4 200 8 700 3 ~2 900 ................ 4 Roveltl.. recelv.d 4 4 Expenses: I 5 Advenfs1ng ................... 5 gi~~.~ "'lY'" 5 Auto and lI'.v.' ('aG page E-2) 6 BIt, 7 Claan/ng and malnt.nance 7 '. .... I 8 Commlsslon. 8 ................. ..~" S Insurance .................... S 276 hili 10 Lagal & othar profasslonal ,... 10 , 11 Managomem I................ 11 "." 12 Mortgag.lnt8llll1 pald 10 bank., ole. (.... pago E-2) ........... 12 ~ 750. 7 601 12 9 35~ 13 Othar Inl.'.., 10 I~'t ................. ,. ;i\ 14 R.pllll1l ...................... 14 3 ~97 47318.11 Wi. ' 15 SuppU.. ..................... 15 362~J 16 Tax.. 16 102 ~ 996 ~ ........................ 'i'i1* 17 Ulllld.. ....................... 17 31 ~;~~ 16 Oth8l(1ls1) ~ ................. i~" t."'$1j SEE SCHEDULE 16 6 7 2 rf{f1~ ............-................ ~11i 18 Add Un.. 5 through 16 ........ 19 5.356 ~ 996 ~o ~08 19 17 460 20 O.praclaUon ..p.ns. 0' d.plaUon ('aG pag. E-2) ...... 20 2 012 3 778 3 843 20 9.633 21 TOlale.p.n.... Add Un.. 19 ;Wt.1 and 20 ....................... 21 7,368 5 774 ~3 951 ~I~~ VacaUon home adJu.tment Rf>,j~ .l~~ 22 Income or QO") 'rom mntal mal ~1i ..late or royalty proper1f... ii' Subll'act Une 21 from Une 0 (mnts) ., Une 4 (royaltl..). It the ,..un Is a Qo..), .... page E-2 to nnd out ''''f:M: Ilyou mu51 m. Fann 6196 ..... 22 -7 368 -~ 574 -5 251 IX* M<"A~ 23 Oed"cUble renlal mal oslal. 10... ~W~1i C.uUon: Your rental ,.allll1ale .:::%{~ loss on Une 22 may be llmil.d. I Sae pag. E-O to nnd out II you '>'.'.. mu51 me Fonn 8562. R.al DStala WI~ professlonals 1T'll51 camplala Une 8 406 6 7.581 420" page 2................. 23 dir 24 Income.. Add positive amounts shown on line 22. 00 not Include any losses ..."....................... ... ....... 24 0 25 Lo..... Add ,oyalty 10.... from IIn. 22 and ,.ntal ,eale'lOl. lo..a. I,om line 23. Enl.' Ihe 101allo.... h.re 25 ~5 995 25 Tolal ,.ntal mal ..lalO and ,oyalty Incoma 0' (loss). Combln. line. 24 .nd 25. Enl.' Ih. ,..ull here. . . . . . . . . . It PIIts II, III, IV, and IIn. ~~h~n pag. 2 do nOlapply to you, also ent., Ihi. """,unt on Form 1040, -~5.995 IIn.,'7 . In''';;'';~ ,I_ ~m~'~'';; In rl~;-" . ................ ...... ....... 28 DM For t"'aperwork RadUCUon Act Nollce, saa form 1040 lnslrucllons. chedule c (Fo'm 1040)1995 i ( , r'". Sc';odu,.SE Form 1040 1005 H.",. .t,_..,. ..,ft HIf..mp'ovm.nll~ca""I'" IPta_" an Fa'''' 10'01 JERRY W SIMPSON SlIcUon B-Long Schedule SE biidiltJ SlIlr-Employmont Tax Noll: II your only Incomo oubJIClIO oen-omploymont lax Is church Imp/oYlllncom.. skip IIn... 1 through 4b. Enler -0- on Une 4a and go Ia Unl 00. Incomo tram IGIVlcos you parlormod as I mlnlsler or I mombor 0' I rallglous ardor II not church employee Incomo. See plga SE-l. A /f you ora I mlnlslll', member 01 I rollglous ardor, or ChrlsUan Sclonca prlCtlUonor Ind you mod Form ~Bl, but you hid S400 or rmre 01 othor not lornlngstram .."-omploymen~ chock harl Ind conUnuI with PIll1/ ................................... . Attlch"'.nIStQu...uHa. 17 tloaa'..curttynu"'btr.1 .....,on' ....UPl ..If".m 10 ment ,"cu.. .... 1 Not lorm prontor Qosa) tram Schadula F,lInl ~B, and lorm plll1narshlps, Schadu'a K-l (Form 1065), Unll00. Noll: Skip this IIna" I'OU usa tho formopUonal method. Soo pogo SE-~........................... Not prom or Qosaltram Schadula C, IIna ~1; Schadula C-EZ, IIna~: and Schadule K-l (Form 1065), Un. 10. (other than IormIng). Ministers and mombors 01 rallglous orders .... pogo SE-l lor omounllla report on this Uno. Soo paga SE-2 for other Income 10 repolt Notl: Skip Ihls line nyou UM tho nonlarm opUonalmothod. Soo page SE-~ ... ..................................................... Combln. Unos 1 and:l. ....................................................................................... "Unl ~ Is rmle than zero, multiply line ~ by 92.~0% (.9235). OlhelWlse, enlor amount tram line ~ ................... /f you elected one or both 01 the opUonal methods, enter the 10lal 01 lines 10 and 17 here.......................... Comblnl Un... .1 and 4b. III... than S4OO, do not nle this schadule: you do not owe ..'f-employmont , tax. ExcopUon. III... than $400 and you had church omployoo Incomo, enlar -0- and conUnue . Entar your church omployo.'ncoml Irom Form W-2. ~uUon: See I I . . . .... . . . ... . page SE-llor dannlUon 0' church employee Income.. . . .... . . ... . . . .. . . . ... . . .... ~ MulllplyUneoa by 92.:15% (.9230)./f1... than $100, enlor-o- .... ......................... ........ ....... ....... Not umlngs rrom sell-Imploymonl. Add Unas 4a and 5b ..................................................... Maxlmum amoum 01 combined wagas and .."....mployment oarnlngs SUbJect 10 soclal sacurf1y tax or the B.2%portlon 01 the 7.65% railroad re!!rament (IIerl) tax for 1995........... ...................... Total soclal sacurf1y wages and Ups (Iolal 01 boxes ~ and 7 on Form(s) W-2) and railroad relfrement (Uer 1) compens.Uon....... . ..... . . ........ . .... . ... 8a Unreported Ups subJect to soclal sacurlty laX (tram Form 41~7, line 9) .............. 8b Add Unos 8a and Bb.......................................................................................... Subtracl Une Be tram line 7. II zero or I..., enter -0- here and on line 10 and go to line 11 ..................... . Multiply the smalllrolllne 80rUne 9 by 12.4% (.124).............. ............................................. Multiply Une 8 by 2.9% (.029) .......................... . . . . .... . . . . . .... . . .. . . .. . ... ... ..... . .. . . . .... . . . ...... 2 3 4a b c Sa b 6 7 8a b c 9 10 11 6~ 12 Soll-omp/oymonttax.Add Unaslo and 11. Entorhere and on Form 1040,IIno 47... ........................ ..... ~ 13 OoducUon lor ana-hall 01 sell-omployment tax. MulUply line 12 by 00% .0. Enter the resun here and on Fonn 1040. IIno 25 . . . . . . . . , , , , , , ~eimlmi Opllonal Methods To Figure Net Earnings (See page SE-3.) 13 Poco 2 161-32-8656 1 2 3 4a 4b 33 660 33 660 31 085 4c II.'"'' .... ' >'Y-", ,. 5b 6 31 085 o 3~ 085 7 ~ 200 "'~, $81.200 .' 8e 6~ 200 9 0 10 0 11 90~ 12 Fonn OpUonaJ Mothod. Vou may usa this melhod only If: .Vaurgrass farm Income 1 was not mora than $2.400, or .Yourgross farm Income twas mora than $2.400 and your net farm profits 2 were less than $1,133. 14 MaxlmJm Income for opUonal methods 14 15 Enler the smalloro~ two-thirds (2J~) 01 ;jr~;';" ;';';;"I~;';;';'~ i (~~'t"~~' ;,;~~ ';~r~)' ~~'$1,600:Ai,;.;:""""""""'" Includelhls amount on nne 4b above. '" ....... . . .. . ... . . . ....... 15 Non1ann OpUonal Mothod. Vou may use lhIs melhod only If: · Your net nonfarm profits 3WBrO less than $117:13 and also less than 72.189% of your gross nonlwm Incame, 4 and oVou had nBt earnings Irom sell-employment of at le"l $400 In 2 of Ihe prior ~ years. ~uUon: Vou may use this melhod no more than Uve Umos. 16 Sublract line lS tram line 14 16 17 Enterthe smallor 01: two Ihlrd; (2i;; ~I'g;~~ '~~~;';';;"j~"'~';;'; ~'(~~,',~~'ih~~';~r~i ~~'Ih~ ;';';;'~'~I"""'''''''''''' on line lB. Also, Include this amounl on line 4b Bbove........................................................... 17 1 Flam Sch.dula F. Un. 11, Md 5eh,dul, K-1 (FaInt 10115I,lIn. Ub. :I From Ben.dul. C.lin. 31: Seh,dul, C.EZ,line 3:&Ild 5eh.dul. It-I (Fa,," 10U).lIn. 1$a. 2 Fto," !ch.dul.F, 1".38, ."d Sch.dull K-llFot'" 1085).11"1 l!l.. "~to", Schldul. C,lln.1' Sch,dull C.EZ 1I".':.I"d Schldull K-t 'Fat'" 10ll!ll II". 1 !Ie:. OM $1.600 Ittl "II 21 .SCHEDULE SE (Form 1040) Seft-Employment Tax oun No. '''1..0074 . S.. InllrucUonl lor Sch.dul. SE (Form 1040). 1995 Attaotlluft' SICUllftCI No. 17 D'~""r!"fttof It'l r'I..I"'Y l"fl""1 RIVI"'" IIMCI II H4rII..f ,,,..,, ""'." ..If-empfoym.nt I"CGIIlI(U Iho""" Or! Fa"" 10401 BEVERLY A SIMPSON . An.ch to Form 1040. locul..cunly"ulIlb.,o' peru" "'''llelf-em 10 ment '"Cd,"1 ... 161-34-9827 Who Must FIle Schedule SE You must m. SelI.dul. SE /I: .You hid net ..mlnlll from I.II-employment from oth.r th.n church omplayoelncome (nno 4 of Short Schodulo SE or IIno 4c of Lang SelIodule SE) 01 $400 or maro, OR .Yau hid church omployealncome 01 SI08.28 or mare. Incomo from sOIVlc.. you porfarmod .. I minister or I member 01 I religious ardor II nol church omplayoe Incomo. See pogo SE-1. Nol.: Even II you hlv. .10.. or I small amount allncamo from self-omplaymenl, It may bo 10 your bononlla nlo Schodule SE and usa olthor 'aptlonal "",\hod" In Part II of Lang Schodule SE. Seo page SE-3. ExcepUan.11 your only sell-emplaymenllncomo w.. from oarnlng. .. I mlnl.ter, momber at I rellglou. order, or Christian ScIence practitianor and you med Farm 4:161 and received IRS approval nalta be laxed an those earning.. do nal me Schedule SE. Inslosd. wrtlo "Exempl-Form 4:161' an Farm 1040, line 47. May I Use Short Schedule SE or MUST I Use Long Schedule SE7 I ~ 1 No Old you receive waqe9 or ttDS In 19957 Lves Are you a minster, member of a religious order, or Christian ScIence praclltianor who received IRS approval nolto be taxed on earnings from th..e sou...... but you owe sell-emplaymenl tax on other eemln 7 W.. the talal of your wag.. and tip. subjoct 10 social security or railroad retirDmDnltax plu. your nelearnlng. from sell-omployment more than SS1 2001 v.. Ve. No No No Old you reco;vo tip. subloct to social socurity or Ves Medicare tme that you did not roport to your em 10 er? Old you roceJyo church omployoe Income '" aned on Form W-2 01 S106.26 or maro? No I YOU MAV USE SHORT SCHEOULE SE BELOW [VciUMUST USE LONG SCHEOULE SE ON '!liE BACK Sectlon A-Sho!:f Schlldule SE. Cautlon: Ro.d .bavota ..o'f you can uso Short Sch.dulo SE. 1 N.I farm prolll or 00") from Schodulo F, IIno ~6, and farm partn.rshlp., Schodulo K-1 (Form 1065), line 15. ............................................................................................... 1 2 N., profit or 00") from Sch.dulo C. IIno ~1; Sch.dulo C-EZ.llno 3; and Schodulo K-l (Farm 1065), IInolS. (athor than farmlng). Mlnlsl.rs and memb.rs of rollglau. ardor. ..0 p.go SE-l far amounls to ropart an this IIno. 508 p.go SE-2 rarathorlncamo to r.part ............. ......................... 2 44 280 3 Cambln.lln.. 1 and 2 ............ ........................................................................... 4 Not earnIngs !rom .01l-emplaym.nL Mulllply line 3 by 92.35% (.92:15). " 'o..th.n $400. do notfllothlssohodul.; you do nalowo s.ll-omploymenllax................................................ .. Soll-.mplaymenl tax. "tho amount an IIno 4 Is: .S61,200 or I.... IT11Jltiply nno 4 by 15.3% (.153). Enl.r tho resull h.ro .nd an Fann 1040, IIno 47. "Marothan S61.200, multiply IIno 4 by 2.9% (.029). Th.n, .dd $7.566.60 to tho rosulL Ent.r tho talal h.ro and an Fonn 1040, IIno 47. 3 44 280 4 40 893 5 }............................ 6 CoducUan lor one-h.1l 01 .oll-employment tax. Mulllply IIno 5 by 50% .5l, Enter the result here and on Form 1040. line 2S For Paperwork ReducUon Act NoUee, :see Form 1040 InstrucUons. 6 3 IIU' '11 II /'oim 4797 Sales of Business Property (Alia Involunt.1ry Convlrllonl Ind Rlcaplur. Amounto Und.r S.cUon. 17g and 280F(b)(2)) .. A"lch to our taw r.tum. .. S.. I IratI Inatructfonl. 0"'. HII. 114M'... 1995 27 D"II1""ftIO' 'hi 111u\l'1 li'lt,,",1 ".v'"\I' ,rwtu II. HulI(.I.hoWftIl'"hlM AttlehM..' "CfUftct Ho. Id.nUly/ng numb.r JERRY W & BEVERLY A SIMPSON 161-32-8656 1 Enlor horo Ih. grail! pracoaclo fram Iha Iala or exchange 01 ra~ ..tala r.perlad 10 yeu lor 199~ on Fonn(.) 10g9-S orOlublltltulall1alamanllhat euwlllb.lncludln ennn.2.1'.er22 1 74 900 i1fattUi! Sales or exChanges ot Property Used In a Trade or Business and Involuntary Conversions From Other Than Casual or Theft-Pro e Held More Than 1 Year (b) aalucqulr.d (l\'Io..d..,..~.1 I D'lcrlotlan of tOOf (d) orauN'" price ( Ca.tarath.,. bUl'.plll. Imorov.m. '.and (g) LeS. l(f)mlnUllh,.um .. to,,,,. (." (h) OAlH <<dlp,,",.(.) IIllnu.(tD e) D'ar'datlan aUaw.d arallow.bl, ,Inc. (c) D.tuald (mo..d..,..)1'., 2 Gain, tl any, from Form 4664, Una ~9.... .......... ......... ........ ............ .... ... 3 S8C1len 1231 gain from InSlallmant slIIa. frem Form 6~2. IIn. 26 er 37 .................. 4 S8C1len 1231 gllln er Oe53) from Ilka-klnd .,chang.s frem Form 6624 . . . . . . .. . . '" . .. . . . 5 Gain, If any, tram line 34, from other than casualty or theft .............................. B -f~};:r#E4~b'~'ftiiHt1ff~ Add Un.. 2 through 81n columns (g) and (h) ..... ...... .... ....... ....... .... ...... ... 7 Combln. columns (g) and (h) el nna 7. Enl.r gllln er Oe53) h.r., .nd on Iha appreprlal.lln. .. lollows: ..... .... .... Parlna"'hlpl- Entar Ih. gain er Oess) en Ferm 1065. Sch.dul. K, IIna 6. Skip nn.. 9, 10, 12. and 13 b.,ow. S corpo~Uon.- Raperllh. gain or Ooss) fellewlng Iha In.trucUen. lor Form 11205, Sch.dula K, nn.. Sand 6. Skip nn.. 9, 10, 12. .nd 13 b.lew, unl.ss nna 8 Is a gllln and Iha S cerperaUen Is sub/act Ie Iha caplllll glllns tall. All olh.",-II nna 81. zero er ale.., .nlar Iha amount on IIna 12 b.,ow and .klp IIn.. 9 and 10. IllIn. 81. a gllln and yeu did nol hava any prier yost .8C1lon 1231 Ie...., er Ihay wara recaplUred In an .arllar y.st, .nl.r Iha gllln as aleng-I.rm caplllll gllln on Sch.dul. 0 and skip IInas 9, 10, and 13 balow. NonracaplUred n.ts8C1len 1231 10.... from prier y.ars (S09 In.tructlons)......................................... Subtract Un. 9 from IIna 6. If %DrO or I.... .nlar -0-. Also anl.r on Iha appreprlal.llna as fellows (.aaln'IT.): S corpo~Uen.- Enl.rlhls amount en Sch.dule 0 (Form 1120S),lIna 13, and skip nn..12 and 13 balow. All others-If Una 10 Is zero, enter the amount frem line 8 on line 13 below. If line 10 Is mora than zero, enter tho amount rrom Une 9 on line 13 b.low. and ant.r the amount from IIn. 10 as a leno-I.rm caoillll oaln en Sch.dula O. iI;lR'tiffillfi Ordlnarv Gains and Losses 11 Ordln alns Bnd losses not Included on lines 12 throu h 18 "elude fa e held 1 ear Dr less: 3 4 5 8 7 8 ". "'. """B" ill''''''.. """". ~.~ $o".,:~:14A';' - . .~.,;;(~..u.1J{~ .W; .i)j;J;''1\fl}!!i'>>,,-w:!o>kPt 'W tt=. ,'8.';!L>H..fm~'b::~~~t,..>>.~<,~. 9 10 19 20 Loss, If any, from IIna 6. ...... ...... ... ............ .... .... .......................... Gain, If any, from IIn. 8, or amounl from IIna 9 if appllcabla .... ................ ......... Gain, If any, from IIna 33 N.t gllln orOe53) from Fd';;".j6a4:ir;;~; ~'1' ;';;d~a'~:::::::::::::: :::::::: ::: ::: :::::::: Ordinary gain frem In'lallm.nt slll.. frem Ferm 6252. IIna 25 or ~6 ...................... Ordinary gain er Oes.) from lik.-klnd oxchanga. frem Form 6824 ....................... Recapture of seeden 179 expense deduction for partners and S corporation share- 1lli#f$t~~;;~1~$ .i~~ftt*mID}W_MKi holders from property dispositions by pannershlps and S corporollons (SOB I"stt.) ........ 18 W.4t~WJ{*1W:~ Add IIn.s 11lhreugh 181n column. (g) and (h) ........................................ 19 Combine columns (g) and (h) 01 line 19. Enl.r gllln or (loss) h.r., and on Ih. approprlatalin. as fellew.: . . " . .. . . .. . 20 . For 1II1oxcapllndlvldulll ralUm.: Ent.r Ih. gllln or (10") Irem IIna 20 on Iha r.lurn being filed. b For Indlvldulll r.lUms: (1) If tho less on IIna 12Includ.. a loss frem Form 4684, nna ~5. celumn (b)(lij, .nt.r Ihat pan ollha less hara and on line 22 ef Sch.dula A (Form 1040).ld.ntily as frem "Ferm 4797, line 20b(I)." S.alnsll1Jctlen................. 2 R,d.l"minl the qaln or(loula" lin, 20. uetudr",~ th,lau. it anv. an Ii", ZObUI. Enl'r h.,. .lnd on Fa,", ID40.fln. 14 12 13 14 15 16 17 16 12 t1mk1lW~iff&W~ttlM~~m 13 ~.-A.\%\t~*';>:Mf~~~.~'m.'.t~# Mi(4\ftlEt#"WiW%"IwJ 14 ...~~~?::-',;,,~~~~m.,.*";:;.;,J~.:::W< 15 16 17 ?:&<N&tfglfJit%\-w;W~~ For Paperwork ReducUon Act NoUe", see page 1 01 separate InstrucUons. OM F.,m 4797 1''''1 \ .'101 "W14 PAGE ~ OF 1 JERRY W & BEVERLY A SIMPSON 161-32-8656.,,, 2 Garn From Disposition ot Property Under Sections 1245, 1250, 1252, 1254, and 1255 'a,,,,'71'flitSI fillltlll~ 21 Co) O..afpdan of .ocUan 1249, 1290, 1292. 1294, or 12SS praplllly: (b) 0.,. ocqulr.d Co) Olllloold 'rm, d.u -,' (rm, d... ....\ A RESIDENTAL RENTAL VARIOUS 71 ~9/95 B c 0 : Rel.t.nn.. 2tA thrauqh 210 to the.. column. ~ Proo..... A Pro;;;;,,;,; II Pro"..... C Proo.rtv 0 22 Gross .a/os pric. CNot.: S..lIn. 1 bafare campl.Ung.) ...... 22 74 900 23 Casl or ather basi. plu. ""p.n.. of laI. ..............,..... 23 35 240 24 O.procladan Car d.pl.Uan) a1law.d or a1lawabl. ............. 24 25 225 25 Adju.,.d basis. Sublractlln. 24 from IIn. 23.........,....... 25 ~O O~S 26 Talal "a1n. Subtr.ct IIn. 29 tram IIn. 22 26 64 885 Xl 11..ctlon 1245 prop.rty: a Oaprocl.dan allaw.d or allawabla from line 24 . . . . . . . . . . . . . . . 27. b Enlar tha .m.ner of line 2B or 27a 27b 2B If slcUon 1250 property: I' .uaJghl Unt d.plldatJan wu Ulld. ..,t,,-o.- an In' 21;. .xc.pl lot , corporation aubl.cl to ..cUa" 211'. a AddlUanal daproclaUan alter 1979 (.e.ln'lnlcUan.) .......... 2Ba b Applicable percentage mulUpllad by tho .m'lIar of IIna 2B arlln. 28a C'eo Ins1l'Uctlan.) ............. .................. 2Bb . a SU~lr8ct IIn. 2Ba from line 2B. n rosldenUal rental prapeny or Un. 28 I. not mare than IIn. 2Ba. .klp IIna. 2Bd and 2B. ... 2Bc d AddlUana/ daproclaUan altar 1969 and bafare 197B .......... 2Bd . Entar th. .maller 01 line 2llc or 2lld ........................ 2Be I SocIIan 291 amount CcarparaUan. only)..................... 2Bt ft Add Unos 2Bb. 2Be, end 2BI . ................... 2Ba ..... 29 It sectfon 1252 property: Skip thl. .ectlon I' you did not dl.po.. at fumland orll this 'a,m Is being camplet.d fat' partner. hip. a Sail, water. and land deartng expenses..................... 29. b Une 2ge mulUplled by appUcable percentage (.eeln.tr.) ... .. . 29b a Enter tho smaller at nne 26 or 29b 29c 30 " .ectlan 1254 property: a Intangible drilling and devalopment co.t., e.pendllure. lor development at mine. and ather nerural depa.lt.. and mining explor".!'on ca.ts (.ee InstrUction.), . ... .. . .. . . . . ... . . 30. b Entar the .maner 01 line 2B or 30a 30b 31 "..cUan 1255 property: a Applicable percentage of payments axcluded from Inca me under .ecUon 12B (.ee In.lnlcUon.) ........................ 31a b Enter the smaller of line 28 or 318 (sse Instnlcdonsl 31b Summary of Part III Gains. Complete prapeny column. A lhraugh O. through line 31 b befora going to line 32. 32 Total gains tor all prapenle.. Add propeny column. A - O. line 26......... ....... ......... ............ ........... 32 64 885 33 Add propeny calumn. A through 0, line. 27b, 2Bg. 290, 30b. and 31 b. Enlar here and an line 14 33 34 Subtract line 33 from IIne:i2." E,;t~~'t;'~ ;'~rU~'~ i;~';; ~~'ai~ ~'r'th~ri ~~ 'F~';;"';G84: il~~ ~3':e;,i~; ih~'p~ni~~"""'" from other then cDSualtv or thelt on Farm 4797. line B 34 64 885 1JiP.:;jitll~1! Recapture Amounts Under Sections 179 and 2BOF(bJ(2) When Business Use Drops to SO% or Less See Instructions. Ca) SecUan 179 (b) Sactlon 2BOF 2 3S SocIIon 179 expen.e deducUan or depreclallon allowebleln prior yeer., , . . . , . , . . , . , . . . . . 35 3B Recomputed depraclaUan. Saeln'lnlcllon. ... ...............,.....,........,......,.. 36 37 Recacluro amount. Subtract line :36 Irom IIn9 35. See InsrrucUons for where to reeorf 37 OM Form 4562 Depreciation and Amortization (IncludIng Informal/on on Usled Property) o...n No, 91.1.0"2 D.panltlltftt., In. 't.u",y '"t,""...",."". SIMe. 11I1 HulI(.) ....""'." ,.tunI ... s.. ..pnate 'nltnJcUona. ~ Albch lhl. farm to vour r.lum. 1995 Atuc"",,,,, bClU.IIU Ho. 67 Id.ndly/ng numb or JERRY W & BEVERLY A SIMPSON 161-32-8656 luat"....rutlYttyto whloh thl. 'a'", r.llt.. RESIDENTAL RENTAL itlPart: ll1l 0 a I 0 9 I'" u'". 1 Mlldmum doliII' IImItaUon.11 an .morpr1M zone bual........ page 1 01 the InltlUctlonl ................,.......... :2 Toll! cost of sac1lon 179 proplll1y pllCDd In IIIIVlca durlng Ihe till vear. Soo page 2 01 the InstrlJcUons .............. 3 Thruhold costal sac1lon 179 proplll1y belore reduction In IImilaUon....... ... ..... .......,..,.....,.............. 4 Rlductlon In IlmIlaUon. SUbtract line 3 from IIn. 2. II zaro or I..., dnlor -0- ....................................... 5 001111' IlmltaUon lor Ill( vear. SUbtrsct line 4 ~om IInd 1. II %lira or Id", dnlor -0-. II marr1dd nlln lID araldl see I. 2 of the Instructions . . m .. " 1 517 !lOll 2 3 S200 000 4 5 . D..en tllIna' tap. b Colt c ~I.cl.dcarl 6 7 Usldd propony. Enler IIMunt ~om line 27 .......................... .................. 7 8 Toll! dlllct8dcost 01 IIDCUon 179 property. Add amounts In column (c), IIn.. B and 7..........,.,. ................. 8 9 Tentallve deduction. Entdrthe smalldrol IInd5 or line B .... ............ ....................,.... .... ... ..... .... 9 10 CDllVovarol dlsallowed deduction ~om 1994. Soe psge 201 the InstrlJcllons...................................... 10 11 T,,"ble Income lIm1taUon. Enldr Ihe smaller 0' I..able Income (not less than zero) or line 5 (soe InstrlJctlons) .. 11 12 S8C1fon 179 expense deduction. Add lines 9 snd 10, but do not anler more than line 11 ..... 12 13 Cover 0' disallowed deducllon 10 199B. Add lines 9 and 10. less line 12 ~ 13!)t&im\t'\J@**,~ Not.: Do not U98 PSIt II or PlII'llll bdJOW 'or listed property (aulomoblles, certain olher vehlcl.., cellular Ialephones, certain compute~. or propertY used for entertainment. recreation. Dr amusement). Instead. Use Part V for listed propertY. iliFtiitlllJl MACRS DeprecIation For ASgels Placed In ServIce ONLY Durlnq Your 1995 Tax Year (00 Noll.'lud.U...d ""'......1 Section A - General Assel Accounl Election 14 If vou are making the elecUon under section lBB(ij(4) 10 group anV .....ts placed In SllVlce durlng the tax vear Into one or more eneraJ asset accounts. check this box. See a e 2 of rho Instructfons ... (b) Month and (C) Bul. 'or d.pr.ciatlon (a) Ctautflcadon Dr prop.rty '1'-:.~::d In Ibu.ln...nnv"lm.ntu.. (g) O,pr.cI&don d.ductlon 27.S 27.5 rs. ~9 rs. MM S/L MM S/L MM S/L MM S/L Soe B 9 4 0' tho Instructions. ro e Section C - Alternative De rec/atlon S slem ADS Class life ,W~Aoo~ntt.*Rf$W ',<oi1::o:.:<~m-~*~)~i~~:;.'';~~ 12.. ear }gg~*~~9.~h~4i:tMR~ 12 1'9. e 4O-year 40 vro. MM WRaitilf[~ Olher De rec/allon Do Nollnclude Usled Pro ert. See a e 4 0' Ihe Instrucllon.. 17 GDS and ADS daductlons lor ...ets placed In selVice In tax VelllS beginning be'ore 1995 18 Property subject!o section lB8(ij(1) elecllon .. ..............,.......,............... .:::::::::::::::: ::: :::: ::: 19 ACRS and olher deoreclellon . l'!JFai1UV!l Summa See e. 4 0' the In.tructlons. 20 Usted propony. Enler amount Irom line 2B .................,............,......................,............... 21 Total. Add deductions on IIno 12, IIn.. 15 end lB In column (g), and lines 171hrough 20. Enler hero and on tho appropriate IInos of your ralUrn. Pannershlps and S corporallons-see fnslrUctlons For assels shown abave and placod In sorvlco during tho current year. entor the port1on or the basis attribUltlblo to seedo" 26:JA cos!s For Pi:lperwork RaducUon Act NoUcut see page 1 ot the separole Instructions. OM S/L S/L S/L 17 18 19 2 012 20 21 2 012 22 t~~t~1Jlf*lj~~t~!~t~~:J;..f Form 4562 1""1 THERE ARE NO AMOUNTS FOR PAGE 2 .' Depreclallan and Amart/zallan (Including Informallon on Uslod Property) CMI He. tI4H":I 'Farm 4562 D'''II1I'/1I"' I)' 'h. r'luury 1"'IH'rII' .....!Wt SIMCI 111 HI"'-C,),".wna",.rum ... S.. .eparal. 'natructJona. .. Altach thl. rorm to your r.tum. 1995 :::::""::11.. 67 Id.nl/lylng numbar JERRY W & BEVERLY A SIMPSON 16~-32-8656 .~""'IJ' acrtMly 'A .hlah till. 'orm ",-,.. RESIDENTAL RENTAL l'IlPartHWll Election To EXDense CertaIn Tanelble ProD. II 9 10'". , 1 Maximum dollar IItr/tltlan. II an enlerprise zone bullln...., .... plgo 1 a' IhelnslrUctlans ........................... :z Tallll calt al_n 17U proplll1Y placed In IGIVlce durlng Ihelax year. 508 pogo 2 allhe InslrUcUans .............. 3 Tl1reahald call 01 lGCllan 179 properly belare reducUan In 1Im1laUan. ............................................. 4 R.ducUan In IIm/tatlan. Sublractllne 3lramllne 2. II %Ora or I.... enlar -0- .... ...................... .... ... ..... 5 Dollar IImIiadan far tax year. Subtract line 4 from line 1. II zero or I...., entar :0-. " mlll11ad nnn se Bl'8le see 8 8 2 or ths Instructfons . . M .J 1 17!lOO :z 3 S200 000 4 5 I a..en tlc,ItO' taa. b CQ,t C EI'et,deo.t 6 7 Usted prapony. Enl8r omaunl from line 27 .... ......... ............. ... ............... 7 8 Tallll elected cast a' B8C1fan 179 prop arty. Add omaunLs In column (c), llnaa 0 .nd 7............................... 8 9 Tentallve deducUan. Enlerthe smaller 01 line , or line 0 ... ...................................................... 9 10 Canyavera' disallowed deducUan from 1994. 508 pege 20' IhelnslrUcUans .... .......... ..... ....... .... ..... ... 10 11 Taxablelncame IImItadan. Enler the smaller at taxable Income (nolle.. 'hen zero) or line' ('08ln'lrUcUans) .. 11 12 SecUon 179 expense deducUon. Add lines 9 and 10, but do not enler marelhan line 11..... 12 13 C over 01 dl.a1lowed deducUon 101990. Add line. 9 end 10. Ie.. line 12 .. 13 (!l\iWli'i1U~~ Note: 00 not use pan II or pan III below lor listed property (eulomablle., cenoln other vehicles. cellular to/ephon... carteln compU!""'. or propertv u.ed for enterto/nmen!. r&cre.llon. or amu.ement). In.teed. u.e pan V 'or IIsled property. PBrtlIUl MACRS De reclallon For Assets Placod In Servlco ONLY DurIn Your 1995 Tax Year D...""....L/"...... .1 Section A - General Asset Account Election 14 II you are making the elecUon under B8C1fon 188(1)(4) to group any ...eLs pieced In service durlng the tax year Into one or mare aeneraJ asset accounts, check this box, See 8 e 2 at the InstnJC1tons ~ (b) Mo"th and (e) Bul. 'or d.prtdatto" (.) Cta..lflcatlo" al prap.rty )'e':e~::lIln Ibu.I"..'II""'e.tme"tu.. (;) Oepr.aatla" deductJo" 3- ear ro e S- ear ra e 27.' 1'5. 27.5 1'5. 39 vro. MM SIL MM SIL MM SIL MM SIL a 04 at tho InstnJctfons, ro e 160 Closs lire .',*fMl.0Kti~ >Mf.fytw..~%1~;*'*\>t.4 b 12.. eat m>:;'%$~~.;i>.,~~w:~f::*~ 12 rs, c_~ ~~ ~ l1l1FadWf.1l Other De reclallon Do Not Include Usted Pro ert. See . e 4 althe In.tructlon.. 17 GDS and ADS deducUon.lor ..seLs placed In service In lax ye... beginning berore 1995.......................... 18 Property subject to B8C1fDn 160(Q(1) elecUon ................................................................... 19 ACRS and ather deDreclallon . i!l!Fait!IV.~ Summa See e e 4 of the Inslrucrions. 20 Usted property. Enler omaun! rrom line 26 ..................................................................... 21 Total. Add deducUon. Dn line 12, line. l' and lOin column (g), snd line. 171hrough 20. Enler here and on the spproprlatellne. of your relUrn. Pannershlps and 5 corporaUon.-seelnslrUcUons 22 For assets shown above and placed In seNlce during Ihe current year, entor the Donfan of the basis atu1butable to secllan 263A cosls For Paperwork RedueUan Act NaUce, see page 1 at the sep.lllOllo InstrucUons. DM Section C - Alternative De reclatlon S slem ADS 508 SL SIL SIL 17 18 19 44 3 734 20 21 3 778 ~t*..:g~ l~~~_wur.er~ F"M 4562 1""1 PAGE 2 22 THERE ARE NO AMOUNTS FOR "11' I', '0 Form 4562 DeprecIatIon and Amortlzatfon (IncludIng Intormotlon on Ustod Proporty) 1995 Attaah",.,." 7 S.QUlnCI Ho. 6 Id.nUlylng numb... OMII Ho. '1.1-0111 DtOltt1nlflta' Ih. r,.uury In'.,.." ArllflU. a.MU '"' Hull(".hawn an ,.tum . ., ~ 51. IIpa...l. InawcUon.. ~ Alloch Ihl. lorm to your relurn. JERRY W & BEVERLY A SIMPSO~ Bu""... 0' acdvUy to whlah thl. '0'"' nlll.. RESIDENTAL RENTAL " ~Paitlft\lil Erection To Exoe e I . " . " . . 1 Mlllln'alm doUorIlrrlllUon." II1l11t1rpr1ll %Dill bUsln-. _ page 1 0' lhelnal1UC1lolU1 . .... .... ..... ........ ..... 1 2 TolaI COil 01 IIC1fon 1711 proplll1y pllCld In IDIVIce dwfnglhe tax year. See page 2 0' lhelnsl1UcUon. .............. 2 3 llvasl10ld COlloIlIICIfon 1711 propeny ""'orerlducUon In Umll.tlon.... ... ...... ........ ................. ........ 3 4 RlduC1lon In "mllItIon. SIlblrlct UIlI 3 from line 2. ":.ro or IIISS, enl.r -0- ....................................... 4 5 Dollar IilrllAllon lor tax y.ar. SIlblr.ct line 4 ~om line 1. "ZIlt'O or ,...., enlor -0-. " man1.d IIlln .1 ....t. - I . 2 o"he InstruC1lon. 5 161-32-8656 blfll"PI. I.) 117 eoo 1200.000 . D..crl tlon at '0 Co.t e Er.etedcolt 6 7 UsI.dpropor1y. Enteramounltromlln.27 ............................................ 7 8 TOlal.'llctDd coat 0; SDCt!on 1711 prop.ny. Add amounts In column (c), IIn.. 8 .nd 7.. ..... .................. ...... 8 9 T.ntallv. d.duC1lon. Enlorlh. oma/ler 01 IIn. 0 or """ 8 ...:............ ............... ................. ......... 9 10 Cmyoverol dIsaJIow.d d.ducUon Irom 1994. 508 p.g. 20flhelnsl1UC1l01Ul............................... ....... 10 11 T...bl.'ncome IIm1tatlan. Enler Ih. oma/lor at t...bl.'ncome (not I... Ih.n ..ra) or IIn. 8 ('08ln'l1UC1lan.) 11 12 Soc1fon 179 "p."" d.ducUon. Add IIn.. 9 and 10, butda nal.nt.r mar.lhan IIn.11..... 12 13 C av.ra' dl..llawed deduC1lan 10 1998. Add IIn.. 9 .nd 10.1... IIn.12 ~ 13 *!i~;U"l;jiWm'1i"l~ Nal.: Do nal Ua. Part II or Part III below far Ilotod prop.ny (QlJfamabll.., COltaln alher v.hlcl.., cellular t.'.phan.., certafn co utent. or ro used far entertalnment. recreaUon. or amusement. Instead. usa PIlIt V far nSled roD Paibllill MACRS De roeratlon For Assets Placed In Service ONLY Durin Your 1995 Tax Year a.H.Il"..'.u...,..... .1 SectIon A - General Asset Account Election 14 II you 111I maklnglhe o/oc1fon under lI8C1fon 168(1)(4) fa group any .....ts placed In S8lY1ca durlnglh. tax y.ar Inla one or mare .noral ....1 accounts chock lhl. box. S08 a. 2 01 Ih. InstruC1lana ~ (b) Monthud ee) OI.aiJI'ordep"dation e-) OaaIncatlon 0' p,op,rty )'~.~:d 'n Ibu8tn..."nn.tmen' u.. (g) O.p,.d.ttlon deduction roelatlon S stem MM S/L MM S/L MM S/L MM S/L a B 4 of tho InstrtJcUans. 3..arroe S arrae 27.5 ",. 27.5 :39 rs. ra . h Nonras/dentlaJ real Section C - Alternative Da SL S/L S/L Se. 168 Class life ~%J~W';~.-'f~:}:.I:~;:<:" .wm. .llillM~t#.t'.jill b 12- ar _~WTh-9~~Y-hS2l 12 m. C 40- .ar 40 v",. MM ~Partll1rnl Other De recratlon Do Not Include Ustad Pro art. S08 a .4 of thelnalrUctlan.. 17 aDS and ADS d.ducUans far ....ts plac.d In ..rvic.'n lax y.... beginning b.'ar. 1995.......................... 18 Prapor1yaubjOClta sllCllan 189(Q(1) .locUan ................................................................... 19 ACRS and ather de _.Uan .... ....... i!llPlIrtllW Summe s.. a .4 at th.'n.lrUctlan.. 20 UsI.d prop.ny. Ent.r amount from IIn. 28 .. ....... ... .... ........... .......................................... 21 Talal. Add d.ductlalUl an line 12, IIn..l0 and 181n column (g), and IIn.. 171hraugh 20. Enl.r h.r. and an Ihe appraprl.I.lln.. at your rehJm. Partn.rshlps and S carpar.UalUl-.eeln'l1IJcUan. 22 For assets shown above and placed In servlco during the curront year. onlor the ontO" of the basis artrfbufable to section 263A cosls For Paperwork ReducUon Act NoUell!, sea page 1 01 the separate InstrucUons. OM 17 18 19 3 843 20 21 3 843 ::.~:r",-;;,~'i(t..vi'i~~':;;~<~fj/';'~(<~>;'~'j' f~;~11Wmlt}@Thrj~uMli~t!:~\ 22 Farm 4562 (IU51 THERE ARE NO AMOUNTS FOR PAGE 2 Itli Po 31 Fonn 6252. Installment Sale Income .s.. ..par3l. InslnlctlonL .Albeh 10 your lax r.tum. .Us. a upar3l. form for uch ..,. or other dlsposlUon of ro e on the Installment method. OMD No. taU-ou, 1995 D''III1'"'''' of I". Trluury IlIt'f'fl.'A.w.'It".llI.f'VICI ~:~:"~:"~a. 79 NaMt(.) .ho"" 011 "tvm Identifying nUfnber JERRY W & BEVERLY A SIMPSON ~61-32-8656 1 Doscrtpdon 0' propony ~ ......~..<<..~.Q~ff. .~'KRJ;:.J;:~.......................,.................. ....... ..................... ............. 2a DII..cqulred (month, doy, YIII) ~ I 1. 0 / ~ 3 /831 ,b. Dola 1IOId (monlh, day, yell). I 8 /01/951 3 Wu tho proparty sold to arelalod party aft... Moy 14, 1980? See inlbUellonl .............................. .............. ~ V. 0 No 4 litho lU1IW...IO qu8l1l0n 3 10 "'(..,. wu the proporty alTlll1<o'oble seanity?1I "'(lJIl,. complole Port Ill. II "No." conllllotl Port III 'or the \'liar a' ..II ond 'or 2 yoars onar tho yaar 0' Silo . . . . . . . . . . . . . . . . . IJ V.. ~ Pai1Hf,Q Gross Prom and Contract Price. Com lalathll IlI1 'orthe oar a' solo an . 5 Soiling price Ineludlng mortglg.. and olher dabts. Do notlneludo Inloreot wholhor stalad or unstolad . . . . . ... ..... . . 6 Mortglg.. ond oth... dobts tho buyor OS:Jumod or took Iho prop arty sUbJoct to, bUI not now mortgog.. tho buyor gal from a bonk or olhor saurco .............. 6 7 SublTactllna 8 from IIna 8.. ...... ...... ............. .............,..... ......... 7 8 CosI or othar basis 0' property said....... .... .... ............,...... .... ........ 8 9 Depraclldon eDawed or oJlowlble ......... .... .................................. 9 10 Adjusted basis. Sublrect Uno g from IIno S........................................ 10 11 Commissions ond oth...expens.. a' solo.. ...................................... 11 12 Incomo rocsplllre from Fonn 4797, PIlI1I11. SeelnOtnJcdans........................ 12 13 Add IIn"10, 11, and 12.......... ............................................................................ 14 Subtract IIna 13 from line 5. lI:zoro or loss, slop h.ro. Do nol complalo tho rost a' this fonn .................. _.... 15 litho prop arty doscribad on Uno 1 abava w.. your main homo. anlar tho 10101 of IIn.. 14 and 22 Irom Fonn2119. Otherwlsa, anlar-o- .... ....................................... ..... ................. ..... 15 16 Gro.. profit. Sublract IIna18 fromllna14 ............................................ ......................... 16 17 Sublractllna13 from IIna 8.lIzotO or I..., anlar-o- ............... ............................................. 17 18 Con~cl rfeo. Add IIna 7 and IIna17 18 !2E#!:WI11l Installment Sale Income. Complala Ihls pen far tho yaar 01 sala and ony yoar you rocolvo a poymonl or have certain debts u must treat as a a ment on Installment obll adons. 19 Grass prout poresnlogo. Dlvldo line 18 by IIno 18. For yolllS ono"ha year 0' sale, see Ins!rUedano .. . . . . .. .. . .. . .. . . . 19 20 For y.... of ..II only- Ent... amounl from line 17 obove; olherwlse, enlor -0- .. .. ......... ............ .. ......... 20 21 poymonts received during year. SeelnOtnJcdans. Do nOllneludolnlarosl whether slaled or unslalad ................ 21 22 Add lines 20 and 21............. .................................. ..... .................... ........ .......... 22 23 paymonts recalved In prior yaars. Sae Ins!rUcdans. Do nallnclude . Inleroolwhetherslated arunololed ............................. ................. 23 ",.jl'~ 24 Inslallm.nlsal.lncomo. Muldply line 22 by line 19 ... ............ ..... ............ ... ..... ............. ....... 24 25 pen of line 24 Ihalls ordinary Incomo undar rocaplllre "'100. SeelnsbUctlons 25 26 Subtract line 25 from line 24. Enler haro and on Schedule D or Farm 4797. S';"I~;~;,fl~~';"""""""""""" 26 WPiirtmU Related Party Installment Sale Income. 00 not camplele n you received Ihe IInol pavmenllhls lox vear. 27 Name, addr..., and laxpayerldantitylng number of relaled party....... P.9.~~R. .~.I?..~~n;;. .~.. ~;E;':l:;::.......... ;J,?:;1,:-.9.Q.,:,.!:!Z?:;1, 5 N 30TH STREET CAMP HILL PA ~70~~ 28 Did'U;~ ;';i;l~d p'.;,;y: d~'ri~g'th~ :~'y;~,';~;;li ~~'di;p~~~'~i ih; 'p;~p~;.y'i-~;';;~~d'';I~~~~liJ~'~i7':::::::::::::::::::::::::::' n 'y~"'" .~.. N~' 29 If the answer to quesUon 28 Is "Yes." complete lines 30 through 37 below unless one of the fallowIng condlUons Is m.t. Check only the box thaI applies. a 0 The aecond disposition was mare than 2 years aner the IIral disposition (alher than dispositions of markelable securlUoo). II this box Is checl<ed, enler Ihe dale 01 dlspasldan (month. day. yeer) . . . . ..... . . .. .. . .. . ... . . ~ b ~ The IIBI dlaposidon woo a sole or .xchanga 01 slock 10 Ihe Issuing corporation. e The second disposition was an Involuntary conversion where tho throat of conversion occurred alter the first disposition. d The second dlsposldan occurred afiar the death of the orlglnol sellar or buyer. . e It can be ostabllshed 10 the aadafaction 01 the Inlernal Revenue SeNlco Ihal tox avoidance was not a prlnelpal purpose for elthsr of the dlspasldonSo II this box Is checked, aoach an explanaUon. SaelnSbUcdans. 30 Selling price 01 property sold by relaled party.. ................................................................. 31 Enler contract price from line 18 lor yeer of IIrsl sole............................................................. 32 Enlerthe smalt.rof line 30 or line 31 . ......................................................................... 33 TOlal payments recalvad by Ihe end of your 1995 lox year. SeelnslrUcdons ............................. .......... 34 Sublreclllne 33 from line 32.II%ero or I..., enler -0-........................................................... 35 Muldply line 34 by Ihe gross prolll percentage on line 19 for yesr 01 llrol sole...................................... 36 pen of line 35 Iha, Is ordinary Incoma undar recapMa ",Ies. SaelnslrUcdons ..................................... 37 Sublract line 38 from IIno 35. Enler here and on Schedulo 0 or Form 4797. Sea Inslruclfons For Paperwork ReducUon Act Notice, see separate Instructions. OM 100 000 ~oo 6~ 44 ~7 ~7 938 82 062 82 o 062 o 000 ~oo 82.0620 o 272 272 223 223 30 31 32 33 34 35 36 37 Farm 6252 (1'15) , '\ . , " ~ -, _ ....._:.::_'.:... -. . Canlrol numbor OMD No, 1S"!H)(}08 Copy C For EMPLOYEE'S RECORDS (HI NoUce on blck.) Waoes. IIp'. othM compensatlOo 2 Fodoral Income IIX wtthh,td ';0000.00 10083,72 3 Social securIty wagel 4 Social lecunty tu wtthhekt 60000.00 3720.00 0 Medicare waQes nnd Ups 0 MOOlearo IIUt withheld 60000,00 870.00 7 Socialllocurlty lips 0 Allocated tIps b EmplovOl's Ido"IlhcnlJon numb"r 2 J-lt;'18\'9~ c Employor'lI namo, nddross. nnd ZIP codo [,r.:'U:\E !-lOME::; OF ?A" nle, 4~) WEST THIRD STREET aCRWrCX ?A 19603 d Employee's !'K)CUlI securlly numbor .!.61-12-365E . Employee's name, addross, and ZIP codo 9 Advanco Ele payment 10 Dependent care benefila 11 Nonquahfiod prans 12 Bonefilllncluded In box 1 JEliiH SZMPSON 13 See Inslrs. 10r boll 13 14 Other l.'~ IL~ H!~;l-: ST. ,:A;'12 H::":" ?A 170::'1 '. 16SIJlutory Detelsed PenSIon LtQJJ employu ~~ flp. Hshld. .mp. Dtl'rnd eonlPtnsation 18 51~le Employer's slale I,D. No, ".~ ~..l,.. .:.:.~.~. 7:?, ~ ~ ~......., 17 S~!tWlOes, llps,rle. 60000,0 18 S~leincomefar 1D LocaJityname 20 lOUlwaors,IIPI..le. 21lowlneomtllll 1680,0 EIT 60000.0 600.0 ................... .................. ............... .................... .................. ! W.2 Wage and Tax Statement en Oepanmenl 01 the Treasury-lntemal Revenue 5<<vlce This InlonnalJon Is beln9'umlshed 10 the Inlemal Revenue Service. "you 81'8 required to file B lax relurn, a negligence penalty or other sanction may be Imposed on you Illhls Income Is taxable and you fall to reponl!. 1996 --- --,~ -- -'.- --- ,.-,...-. --- .- ~ -._- -----,.....----- ..- ...- ".......'.:... ',. 8922 Po , ~OP~ OMQ No. 1S45-007~ Form 1040-V Payment Voucher Olp.ar1menl olIPl. TnuutV Intltn.IR.vlnu.SetvlI:. 1991 Enter the amount ot the payment you are making ~ $ 2 170 4 If a joint rOlurn, entor your spouse's social security numbor 1996 .. Do not ala Ie or attach this voucher to 2 Entor Iho firsllour lonors 01 your lasl name 3 Enlor your social S<lCurlty numbor 16~-32 8656 Enter your namo(s) JERRY W SIMPSON Enler your address 4161 SPRING VALLEY ROAD Enler your city, stale. and ZIP code HARRISBURG PA 17~09 A3~ OAA .. '\!In ..f'g e Form 1040 Label L (See A pege 11.) B E L u.. tho IRS l.b.I, H Olherwl.e, E please print R or Iype, E Pr..ld.nt/ol EI.ct/en Com olgn See Boll. 1 Filing Status 2 3 Check only 4 one box. 5 Sa Exemptions II more Ihan six dependenls, see Ihe Instructions for line 6c. Income Attach Copy B 01 your Forms W-2. W-2G, and 1099-R h.r.. If you did nol gel a W-2, seethe Instructions for line 7. Enclose, bUI do nol aRach, any payment. Also, please enclose Farm 1040-V (see Ihe inSlructions for line 62). Olp.,lmlnl of till r'luuIY.'nl"n.1 nlWlnUI 911'1":1 U.S. Individual Income Tax Return 1996 IRSU..Onl -DonolwrUlo,.lIDt.lnlhl.. In. . 1l~"1I. Indln Fur IIlI.,I.,ol.n. I-D.c. 11. '""11. n'Olh"I.. lA, b. 'nnln '(ou"l,.tnam',ndlnlhll Lutn,m. SIMPSON JERRY W II, jOlnl "Iu'n, .pau.... 11'11 "'me .nd In'h.1 Lutn,m. .tam. 'dd"ulnumblr ,nd .1,..1).11 you hlw., P.o. &JO., II. p.gl t I, 4~61 SPRING VALLEY ROAD Apl.nu, A31 Clly, town 0' POlt DltICI, Ilfll., Ind ZIP cod.. It you hlw" falll;" Idl1"",.n PI;' It. HARRISBURG PA 17~09 Irrr.. Do you want $3 10 go 10 this fund? .. .. , .. .. , II a oint rOlurn. daDS our souse wanl $3 10 0 to Ihls fund? Single Merrled filing joint relurn (even If only one had Income) Married filing separafo TOfurn. Enler spouse's Docfnl socurlty no. abovo and full namo here, ~ BEVERLY A SIMPSON HI,d or haullhald (With qu,ll'yln; p'lr.anl. (S..ln"r.) If Ihl qu,lilylng plllan I.. child bul nal your d.p.ndlnt, In III Ihll child. naml h".. . Qunll in widow Dr with de endent child Bar S OUSO died. 19 Soe Instructions. Yourself, If your paront (or someone elso) can claim you as a dependent on his or her lax relurn, do not check box 60 b '. ,,, OMO No. U4S-00U Vaur .oc'o' ..curtly numb.r 161-32-8656 Spousals IOCIII lecUrfty numb.r 161-34-9827 For h.lp nndlng Ifn. Instructlona. see pages 2 and 3 In tho boakl.L Yea No ate: Ch.cklng "V... will nat X ch,nglyauttuat ndun aur,dund. o. 0 axes checked on fn. 60 & 6b No. of your children on (4) No, o. Ifn. 6c who: ~::J~~ -lived with you, ham. you In t9911 -did not live with you duo to divorce or sepafilUon (...'n.tr.) DOf!.nclonts on Gc not entered above Add numb. entered on Souse Dependents: ......................................................... c (2) Clp.ndlnt'. 'oci,1 UCU'llynumblr.1f ba'n In C.e.lgge ...lnltr. '" d Total number or exem tions claimed. . . . . . . . . . . . 7 Weges, salaries, tips, elc. Anach Form(s) W-2 . . . . . . . . . . .. . . . , .. . . . . . .. . . . .. . . . .. . . .. . . . .. , . .. . 7 8a Taxable Interesl. Anach Schedule B if over $400 . . . . , . .. .. . , . .. , . . . , . . 0 . , . . . .. . . . .. . . .. . 801 b Tax-exempt Interesl. DO NOT Include on line 8a ....., . . . . , . . . . 0 8b 9 Dividend Income. Anach Schedule B If over $400 ......................,....................... to Taxable refunds, credils, or offsels of slale and locallncomo taxes (see Instructions) ..0........... 11 Alimony received. ....... 0 o. 0...0.'..,......0.0... .. 0.0.0.'...,....,......... 12 Business income or(loss). Anach Schedule C or c-ez . . . .. . . . , . . . . . , . . . , . . .. . . . , . . . .. . .. .. . . .. 13 Capital gain or(loss), If required, enach Schedule 0 ................,........,................. 14 Other gelns or (losses), Anach F~orm 4797 . . .. . . . .. . .. . .. . . .. ../' .. .. .. . . . . . . . , . . . . . .. .. .. .. . .. . ISa TalallRA dlstrlbutlons ,..,.,. ISa. , b Taxable amount (see Inslr,) 16a TotaJ pensions and annuities 16a b Taxable amount (seD Inslr.) 17 Rental renl estale, royalllos, partnerships, S corporations, truSlS, elc. Anach Schedule Eo.......... 18 Farm Income or (loss). Anach Schedule F 19 Unemploymenl compensation ..,'. 20a Social socurity benofils ..~ ..0 'lob" 'T~~bi~ ~~'~t i~~~ 'I~si;.j' 21 Other Incomo. USI type & amounl-see Inslr. . . . . . , . . . . . 0 . . . . . . . 0 . 0 . . , . . , . . . , . . . , . . , . . . . , . . . . . . . 22 Add Ihe amounts In the lar rl hi column lor lines 7 throu h 21. This Is our total Income ... . 23a Your IRA deduction (see Instructions) . . . . . .. , . . . .. . . .. .. . .. . . . . . 23a Adjusted b Spouse's IRA deduction (see instructions) , . . , . . . . . . . . . . . . . . . . . . . 23b Gross 24 Moving expenses. Anach Form 3903 or 3903-F . . . . . . . . . . . . . , . . , . 24 Income 25 One-half 01 self-employmenl tax, Anach Schedule SE .....,..... 25 If line 31 Is under 26 Self-employed heallh Insurance deduction (see Instr,) 26 $28,495 (under 27 Keogh & self-employed SEP plans, If SEP, check ~ D::::.:::: 27 $9,500 /I a child 28 Penally on early wilhdrawal of savings 28 did not live wilh 29 Alimony paid. Recipient's SSN ~ 29 you), see the Inslrucl/ons for 30 Add lines 2Ja through 29 line 54. 31 Subtraclline 30 lrom lina 22. This is our ad ualed ross Income For Privacy Act and Paperwork Reducllon Act Nollce, see pOlge 7. 0.. 1 FIt'ln.m. L.Uln.ml (3) C.p.nd.nt', nllllonshipta . . . . . . . 0 . . . . . . . . . . , . . , . . . . , . . . 60 000 13 9 10 11 12 13 14 15b 16b 17 18 18 20b 21 22 60 0~3 ~ 30 31 60 0~3 Foom 1040 I"'" -! aD:: Po 1 Form ,0.0',91111 Tax Compu- tation II you want Ihe IRS 10 ligUle your lax, see the Instructions for line 37. Credits Other Taxes Payments Anach Forms W-2. W-2G, end 1099-R on the Iront, Refund Have It sent dlrecUy 10 your bank account! See Inslr, and 11I1 In BOb, c, and d, Amount You Owe Sign Here KIIP..eapy althl.tlt"'rn lor yo"" r.catlll, J!;:RRY W SIMPSON 32 Amounl 'rom IIno 31 (adju'lod gr... Incomo) ....... .. ...... ...... 3:J.J Chock II: 0 Vou woro 65 or older, 0 Blind; 0 Spouse wa9 65 or oldor, '[j 'Bli~d:'" Add 1110 number ot bOl109 chockod above and ontor the totnt haro . . . . . . , , . , , . . . . . .. ... 33a b II you aro marrlod II11ng soparaloly and your .pou.o 1I0m/zo. doducUon. or you wore a dual-slatus aUon, soe InstructJons and chock horo ................... 34 Entor [itemized dlductJons ham Scllldull A,linl 211, OR tho Standard dlducUon .ha.....n bllaw lor your Iillno Italul. But "Ilhl I lnlltuehanlll you ch.ck.d any ba. an IIn. 3:1.. at b or .amlan. .rger c.ln el..lm you... A dlp.nd.nl, 01 . 5ingl.-S.,000 . M.m.d riling IOlnlly or aUAlllylng wldalNilfl-SII,100 your: . H.adat hau..hald~U.1I00 . Ma"..d tiling upar"l.ty-U,3!10 Sublroct IIno 34 from line 32 ......................... . .. .. .. .. .. . . .. .. II IIno 32 I. $88,475 0' les., multiply $2,550 by Iho 10101 number 01 oxompUon. clalmod on IIno ed. II line 32 Is ovor $88,475, SOO Iho workshoet In the Insfr. lor tho amount to ontor . . . . . . . . . . . Taxable Income. Subl. IIno 381rom Uno 38.11 In. 381. more Ihan In. 35, ontor -0- .........",.,.. Tax. Soo In.tructlon., Chock II lotalIncludoa any tax Irom a 0 Form(.) 8814 b Form 4972 Cr.dlllor child end dopendonl cara .xpon..., An.ch Form 2441 Credlllor the oldorly or tho dl.abled, Anach Schodulo R . . . . . . . . , , Foreign tnx crodlt. Attach Form 1116 Other,Chacklllrom a B For~3'BciO"'''i,''D'F~r;;''8396 c 0 Form 0801 d Form (speclty) 42 Add lines 39 through 42 ............................................................,..~..... Subtract line 43 Irom Uno 38. IIlIno 43 Is moro lhan line 38, enter -0- . Solf-.mploymont lax, Anach Schedute SE ......,.....,.........,........"..,.,'...,."".." Alternative minimum tax. Anach Form 6251 ,. . . . , . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . , , . . . , . . Soclal.ecurity and Medlcara tox on tip Income nol roportad to omployer, Anach Form 4137 ., , " , Tax on qualifJed rotlrement plans, IncludIng IRAs. If required, aUach Fonn 5329 . . . . , . . . . . . . . . . . . . . Advance earned Income credit payments Irom Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hou.ehold employment tax.., An.ch Schedule H .,......"............,...........".,."",. Add IInos 44 - 50. This I. our total tax ~ F.deral income tax wllhheld Irom Form(.) W-2 and 1099 . , . , . . . . ~ 0 084 1996 estJmatod tax payments & amount applied Irom 1995 return Eamed Income credlL Anach SCh, EIC II you havo a qualltylng child. Nonlaxable earned Inc.: amI. ~ I &Iy~~.............................,@ Amount pald with Form 4868 (r.quest la, utlnslon) ................ Excess social ..curlty and RRTA tax withheld (see Inslr,) Olher peymenla, Chock II from a 0 Form 2439 .. . . . . . . . b 0 Form 4136 .. .. . . . .. . . .. .. .. .... .. .. .. .. .. .. .. .. . .. .. . . 57 58 Add lines S2 throu h 57. These are our total a ments ... 59 If line 58 Is more than line 51, subtract line 51 from line 58. This Is the amount you OVERPAID. . . . . 60a Amounl 01 line 59 you want REFUNDED TO YOU. . .. . . . . . .. . . .. . .. .. .. . ~ Ill> b Routing number I I c Type: 0 Checking tf' S~V'I~~~' . . . . .. ~ 33b } 35 36 37 38 39 40 41 42 39 40 41 , , '161-32-8656 32 60 43 44 45 48 47 48 49 50 51 ~ Una., pln.1111I of pltJury.1 dlelatl thai I have ....mln.d this t.lurn and ..ccompAnying Jell.dur.. And ItAI.ments, and to the tlasl a' my kna.....l.dll. and blll'I.lh.y .rlltul, ear"et, and compl.te. O"I.'allon at pupa"r (alhlr than tupayerlis based an all intormalian 01 which preparer has ..ny knowl.dgl. ~ Yaurllonalut. ~ Prep.'er'. 43 44 45 48 47 48 49 50 51 52 53 54 55 56 57 . d 61 62 Account number I I Amount 01 line 59 ou want APPLIED TO YOUR 1997 EST. TAX ~ 61 If line 51 I. mora than line 58, subtract line 581rom line 51, Thl.l. tho AMOUNT YOU OWE. For details on how to pay and use Form 1 040-V, see Instructions .......................... Estimated tax onal . Also Include on Une 62 63 63 o.t. PI .2 013 4 863 55 150 2 550 52 600 ~2 254 ~2 254 ~2 254 ~o 084 Spauu's slon.lure. 1I.a lOin' r.l",rn, BOTH must IIIlII. Spauu'saeeup..tian Your aeeupltian CONSTRUCTION MANAGER Oall ~ Dale Check.t 1Ill'.lmpla ed Ptlpa,.r's.aclal..eurltyna, 191-40-820~ 8N 25-1645828 Paid II nllur. P reparer' S F.rm'l nama (or yours Use Only iluU-emplay.dlalld OAA Iddr.., ~ CHUBB AND ASSOCIATES P.O. BOX 6597 HARRISBURG PA lIP,.d. ~ 7~12-0597 un !;" Schedule A-Itemized Deductions SCHEDULES A8cB (Form 1040) D,p.,lm,n' of Un rn..ulY Inl"nIIRI"'"u. SllVIC' Taxes You Paid (See pogo A-1.) Interest You Paid (500 pogo A-2.) Nato: PorsonaJ intereslls nol doductlble. Gifts to Charity If you mado a gih and got a benelll for It, ... pogo A-3, Casualty and Theft Losses 19 Job Expenses20 and Most Other Miscellaneous Deductions (See page A-4 lor expenses 10 deduct hero.) 23 24 25 26 Other 27 Miscellaneous Deductions Tolal Itemized Deductions (Schodulo B I. on back) .Attach 10 Fonn 1040. .Saelnlllructlons tor Schedules A and 0 OMU No. t545"0074 1996 Attach"'.nl 07 p.llon'. nlm'.ldlnlltYln; no., and .dd".. ..,.... 1 3 0 5 6 7 8 4 799 11 12 13 16 17 18 95 H.mela. ahown on Fo,," '040 JERRY W SIMPSON MedIcal c.uUon: Do nOllnclude expens.. reimbursed or paid by olhors. and 1 Medlclll Bnd dental oxponsos (soo pogo A-I) . . . . . . . . . . . . . . Dental 2 Ent.r .mounl from Fa,,,, 1040.lln. 32 2 Expenses 3 Mulllply line 2 abovo by 7,5% (.075) .......... . . . . . . . . . . 4 SubtraClllne :J from line 1. If Ilno 3 Is moro than lino 1. onter ..O- S SlalO Bnd local Incomo laxos .. .. .. .. .. .. .. .. . . .. . .. .. .. .. . 6 Real 0.1.10 laxe. (.oe pego A-2) 7 Por.onal propeny laxe. . . .. . .. . . . . . . . . .. 8 Olhortaxo., U.llypo and amounl ....... .. .. . .. . .. .. . OTHER TAXES .............................................................. 9 Add IIno. 51h,ou h 8 10 liomo mortgege Inlo'o91 & polnls ,oportod 10 you on Form 109B 11 Ham. mort;.;. inler..t no' r.por,.d to you on For", 109a.lt p.id to the p.r.on "0m whom you bought Ih. ham..... page A.2 and show Ihat 12 Points not reported to you on Form 109B. See page A-:J lor special rulo. . . .. . . . .. . .. . . . . .. . . .. , .. . .. . .. . . .. , .. . .. , . .. . . 13 Investmentlnteresl. If required, anach Form 4952. (500 pago A-3,) ..........................,..,......,..,........... 14 Add line. 10 Ihrou h 13 15 Gin. by cash or check. II you made any gin 01 $250 or more, see page A-3. ........................ ....... ... ........ 16 Olher Ihen by cssh or chock, II any gin 0' $250 or moro, see page A"3. II over $500, you MUST anach Form 8283 . . . . . . . . . 17 Canyove, from p,lor yoar ..............,............,.......... 18 Add line. 151hrou h 17 Casual or the" loss es). Anach Form 4684. See a e A"4. Unreimbursed employee expenses-job travel, union due., job education, ole. II requlrod, you MUST aUach Form 2106 or 2106-EZ. (See pogo A-4.) .. ........... 21 Tax preparation lees .. ............................ 22 Other expenses..investmonl. sale deposit box. etc. Ust type and amount. . .. . .. . .. . . .. . . . . . .. ... . . . . Add line. 20 Ihrough 22 ..... . . . . Enter amount 'tom Fo,m 104D. 11n, 32. . . 24 Multiply line 24 above by 2% (.02) ....... .."..,... ... .......... Subtraclllne 25 from line 23. IIl1no 25 Is more than line 23. entor ,,0.. Olher-Irom "'1 on pago A-4, U.llype and amounl .. .. . .. , . . . . . 22 23 25 28 I. Form 1040. line 32, over $117,950 (ovor $5B.975II married filing .eporately)? NO. Your deduclion is not limited. Add Iho amounts in the lar rlghl column for lines 4 Ihrough 27. Also, enter on Form 1040. Iino 34, tho largor 01 this amount or your standard deduclion. YES. Your deduction may bo limited. Seo Q 0 A"5lor the amount to onlm. For Paparwork RoducUon Act NoUco, soe Form 1040 Instrucllon., * LIMITED DAA * }........ BY AGI Schodulo A (Form 104ll) 1996 JERRY W SIMPSON SSN: ~61-32-'B656 8922 PAGE ~ SCHEDULE A, LINE 5 - STATE AND LOCAL INCOME TAXES DESCRIPTIon LOCAL BALANCE DUE STATE BALANCE DUE STATE WITHHOLDING ON W-2S CITY WITHHOLDING ON W-2S AMOUNT $ 350 ~, 909 .' ~,680 600 4,539 $ ~ ') I , I ! ~ I ( I ! , !'-, 1111 PlI 11 Farm 1 040 Salaries & Wages Report . :'>.,F'FYh~;~y;:~?;;:'~ '1996"-;'''''''' . . , :'- : ,~ ',' ':';: ~'_":-:'::::."-",:,:..-:,.rt:,~.j>-::- Nama TBllpayor Idanbllcallon Numbsr JERRY W SIMPSON 16~-32-8656 TIS Employer A DELUXE HOMES OF PA. INC. B C o E F G H I J Federal Wages 60,000 Federal Withholding ~O,084 Soe See Wages 60,000 Taxpayer Spouse Totals 10,084 60,000 60,000 Sac See Medicare Medicare Allocated Advanced Dependent Other Bonents Withholding Wages Withholding Tips EIC Care Ben Box 14 A 3,720 60,000 870 B C D E F G H I J Taxpayer Spouse 3 ,720 60,000 870 Totals State State Local Local Wages Withholding Wages Withholding A 60,000 1.680 60,000 600 B C D E F G H I J Taxpayer Spouse 60,000 ~,680 60,000 600 Totals au" ~Po t4 : 1401 Cornmonwoollh 01 Ponn!IVlvonla 1996 PA Doportmonl 01 Rovonua 0 PA-40 (09-90) Rovlow Illllho proprlntad Information on your labol and placo It In tho noma and addro!JS oroa. Mal!.. any n.cu..ty cou.cllonl 10 your lab.llnd chick Ih. SSN I NAME I ADDRESS Chano. bO. b.low. If au do not have a re rlnted label enter alllnfarmaUon" Icase rlnt YOUR SOCIAL SECURITY NUMBER SPOUSE'S SOCIAL SECURITY NUMBER, "" if "'oo" up, 161-32-8656 ~61-34-9827 PENNSYLVANIA INCOME TAX RETURN '''YOU MUST FILE BY MIDNIGHT, TUESDAY APRIL 10, 1907'" LaSI Namo Flr'l nama and Inillal- includ. .poulI'lnu", II IllinOlolnll.,. SIMPSON JERRY W Homo Addres. 4~6~ SPRING VALLEY City or PO.I olflco HARRISBURG -0 SSN I NAME I ADDRESS CHANGE It ANYol Ih. .lboII" intormatlon I. dlff".nl tram Yllur 11195 PA tu nlurn, th.tk Ihl. Bo.. II your .ddr... ch.nG.d, II.ll ptOvid. th. nlm. and ZIP Cod. a' Ihl ~ty, lownlhlp, borough or municipalily whIff you ~.".d on t2/31/90. Nam. Zip Cad. ROAD Slalo PA APT NO. A31 Zip Coda 17109 OFFICIAL USE ONLY -0 FISCAL YEAR FILER Ftom " TYPE FILER {Ch.ck Onl~1 5 0 MUY Singl. MFS II th.tlllng bOlC F b.cauIIlh. "..p..,,, Is dec.aud. .nl.r the Oal. or O..th RESIDENCY STATUS (Chlcll Only Onel R[]INRD pO R..lellnt Nanruldlnt Part-you r"ld.nt Enl.r Ih.lIml you wlr.a PAtllld.nt: rtam to JO MFJ FO Final NAME OF SCHOOL DISTRICT CENTRAL DAUPHIN .CHOOL OIOTAICTCOOO I 221401 OPTION FORA 111117 BOOKLET Ch.ck II au willnol "..d a 111g7 PA Tn Boakl.1 REAQ ALL IHSTA. BEFORE COMPLETINQ YOUR PA-40 Pt:EA9E'Dokm:tJ'S'Ei:cimsiRouNliTt)"l,vHQti'ri&lXRs~ 60 000 1a AluchyourW-210rm.toth. 1 b nVlt.. .id. or our ,.turn, la lb lc 2 3 4 5 sa 6 7 6 9 Grass Camp, from W"2forms and olher wage stmt. ............... .......... ....... 1a Unrolmbursed Employee Buolna.. Exponoo.lrom PA Schedule UE , " . " , , , , , , , , , , " 1 b N.tPA TaxabloCompen.aUon, SubVacllinelblromlino la..,.. '.. ,,,.....,,,, ,.. ",..,..".. ". "'" '" ,~, PA Taxabl.lnlore.t (Complot. and anach PA Schodule A li over $1,000) ,.",,,,,..,,,,,,,,,,,,,,,"..,,,,.., PA Taxablo Divldond, (Complole and anach PA 5chodule B li ovor $1,000) ..""",,,,,,,,,, .., ..,,,,,,,..,,, Notlncomo or [loss} Irom the OporaUon 01 a Busin..., Prole,olon or Farm ""'"'''''''''''''''''''''''''''' NOI Gain or [Loss) Irom Ihe Sol., Exchango or DI.poslUon 01 Property " " , " . , , , , , , , , , , , , , , ' Amounl of Gain Exclud.d ham PA Schodule PA-19, ,.., .., ,.. ..... ... ,.. ...... Sa Not Incomo or [lo..] Irom Rents, RoyaJUe., PalonlS and Copyrlghl. , " , " , " , .. , , .. , .. " , " , .. , " , .. , .. , .. , " Eslalo ond Truotlncomo, '" .., ..' .. .. .., .., .. , '.... ....,.... ..' ", .......... Gambling and ton.ry WInning. .....,..,....,....,....,...."....,....,....,......,.."..,..,....,..,.... TOTAL PA TAXABLE INCOME Add In, 1C, 2, 3, 4, 5, B, 7 and 8. Do not .ublraeta (Iou) r.,portld lc 60 000 lc 2 ~3 2 3 3 4 4 5 5 5a 00 noladd or d.duct Iln. 5a 6 0 7 7 6 0 9 60 013 9 an an. or mort Iln.. ham Ihlllrolll.lncamlor a.ln on .nyoth.,lncaml IIn.. Nor~n Icau... affllt Itch oth.r'. incoml Ind Ilo....l.v.n If on thl 11m. Un.. YourSlllnltufl X a.te Daytime Tllephone No, 10 PA TAX UABIUTY MulU I lin.9 b 2,61'. 0,026 11 Totol PA Tax Wllhh.ld IromW-210rms, .tc, "..,..,,,..,.., "..."" ,..'..' ",.. ,....".., ::: ~;::I~~:a~::5p::,:,::olUrn I :~~ :::':~~:'~~:~~h::~~:I~:~;~..~~~:;" 12. Tolal EsUmaled Paymonts and Crodll. Add lines 12a, 12b, 12c and 12d ,....,..,..,..,........, ....,........ 120 13a Hou,.hold M.mbers 'rom PA Sch.dulo SP, Pan II, lino 4 """"""""""""'" 13a 13a You mu.t ",. by 13b Your E1lglbliity Incomo from PA Sch.dulo SP, Part lII,lino 2, """ "", """"""" 13b 13b AprtI15,1997. 13c Your Tolal Incomo Irom PA Schedulo SP Part III, lino 1 , , , , , ' , , , ' , , , , , , , , , , , , , , , " 13c 13c Fila .art If ou can. 13d Tax Forglv.n.ss Credit Irom PA Schedule SP, Part III, line 7 .., .. , .. , .. .. , .. .. .. , .. .. .. , .. .. .. .. .. . .. .. .., .., 13d 13d 14 TOlal Crodll for Taxe. Pold 10 Olher Slato. or CounVios Irom PA Schedulo(.) G """""""."""""""" 14 14 15 Employmontlnc.nUvo paymenl. Crodltlrom PA Sch.dul. W .. .., ..........,..........""..,..........,.... 15 15 16 TOTAL PAYMENTS AND CREDITS Addline.l1,120, 13d, 14 and 15 16 ~ 680 16 17 PA TAX DUE Uno 10 i. mora lhan IIno 16 ....,..,......, .. '" ........ ,.. """,.." 17 17 S..ln.INoUon.lor MaI<e chock ovablo 10 PA DEPT, OF REVENUE USE YOUR PA-V, HOW TO PAY 18 OVERPAVMENT Uno 10 I. more Ihan line 10 ..........,........ ,............,.... 16 10 Ch.ck all our calc. IMPORTANT: The lOlal olllno. 19a through 19d mu.t equallin. 18, .'P1Ollii,,'donotcall'iibOuf''Ou,:iiJIoi1d'lJ'iibtii'weel<ifillilidiilii'i,jM 19a Amounl of IIn.18 you wanl 09 a R.lund Chock mail.d to you, ,.. ..........,..,..,....,.......,.. .........., 19a 19a 19b Amounl 01 line 18 you want Crodilod 10 your 1997 E.tlmal.d Tax Account...,.."..,..,..,..,..,.. ..".. ..,.. 19b 19b 1ge Amount of line 18 you want to Donale to tho Wild Resource Conservation Fund............... ,....... ........ 19c 1ge 19d Amount of line 18 au want to Donato to tho US 01 m Ie Commlnee. PA Division 19d t9d SIGN YOUR RETURN. Under .nl.llltS 01 PI' UI ,1(Wllt tlllnGIQinUy) dllclulllhalllwlt) hall" luamlnllel1hl. 'lIlurn, Including all o1c.:ampanY'"Q scheelullll "nel slal.m,nU,.nd Spouu'. Slgnatute (ir tiling Jointly) X o.te Pr.pa"r at Campan Naml, oth.r thAn IUllly"l.l. band on.lI into. of which thl pttpar.,r h.. any IInowlld I. 0.1. CHUBB AND ASSOCIATES 10 11 ~ 680 10 ~ 680 11 s.. th.lnstructians, 120 Your OccupatIon CONSTRUCTION MANAGER Spouu'.Occupalion "DOUBLE CHECKALL MATH" ATTACH ALL 9CH. AND FOAMS. NI='IlTVI='4A ...nll willll'~n Ill! .hl..ln m~II:II' riIlA.I,"""' ,UM ".,In' \/nH nllllr""'M.."ltn '1'111 "AnAN n"NOR AWARJ:'Nl='qc; TRllqTFIlNn Pttpar.r'. T.I.phone Number 7~7-54~-1860 'f,\\P,'. 't'EF. 19')(j CENTRAL DAUPHIN AREA INCOME TAX OFFICI~ 75 South Houcks Road, Suite 118 Harrisburg, PA 17109-2896 EAJ{NED INCOI\IE AND NET PROFITS TAX FORM 531 (717) 545.2791 ~ 1; Nalllt.- NUIIIl' Sudlll S~"'orill' /I , , Sudlll S"I'lII'ill /I 1. Earnings from W-2s (Must attach all W-2s) 1. 1.0 1. 2. Net Loss from Self-employment (Auaeh Schedules C, F, K.I) 2, 2, ADJUSTED EARNINGS 3. Employee Business Expenses (Form 2106 & PA UE-I/UE-2) 3. 3, NET EARNINGS (If less than - 0 - , Enter - 0 - ). 4. Net Profits from Business (Must AUaeh Schedules C, F, K.t) 4. 4. 5, Other Taxable Income (From 1099s, etc,) 5. 5, TOTAL TAXABLE INCOME Ic-() ./) 6. Tax Liability - I % of Taxable Income 6. /, 6. 7. Tax withheld by employer (From W-2 forms) 7, ,,~ 7. 8a, Quarterly Payments and/or credits from prior year 8a, 8a. 8b, Credits for taxes paid to Phila and/or states other than P A 8b, 8b 9. TOTAL WITH HOLDINGS and PAYMENTS 9, I - 9. 10. Tax Balance Due (Subtract Line 9 from Line 6) 10. i"') 10. 11. Interest & Penalty (see instructions) II. 11. TOTAL BALANCE DUE (Payuble 10 CDAITO) 0 12. Overpayment (Subtract Line 6 from Line 9) 12. 12. Refund Credit to Next Yeur I dL'L"I:II~. IIndc, pcnaltics of Ia\~. Ihat I have examined this Iclllrn and accompanying srhcuules and. h) lhl' hl'st tllmy kllo\\.lcdge and belief. i14,S tllle. COITcct. mill complete. ' Your Signature Daytime Phone /I Daytime Phone /I Date Occupation Spouse's Signature Date Occupation .-~ L f' Paid Preparer's Name .~1, II. ~~ WO " (Please Print) (.1?A Firm (1,/dril.".4 ", ~,..;-.;c '/ 0 Phonc#5" -/"'/"c Did you move during the year'! Yes _ (Plcase complete residence schedule on next pagel No If you had NO EARNED INCOME. please check the reason why so that IVe may update our records: Homemaker Disabled Retired Unemployed Student D~ccascd Other , b Employer's identIficatIon number 23-1648999 c Employer's name. address. and ZIP code DELUXE HOMES OF PA., INC. 499 WEST THIRD STREET BERWICK PA 18603 Form , 1040 Lab., (S.. In.tnlctlona on peg. fa,) Filing StatuI Check only ani box. exemptions a Control number a.plum.nl of th. T'...lIry-ln,.tn.1 ".....nu. h.....,~ U.S. Indfv/dual Income Tax Return i" I 1997 l'IIlIl IRS Use OnIV"Oo not writ. or lI.pl.l" IhIlIP'OI. . IIlQ7, .ndlnG ,1Q OMB No. ISAS-007A Your IOcI.1 'ICIIrlty number 16~-32-8656 Spou..'. IOdal .~urlty numb.r 16~-34-9827 For h.lp In Itndlng IIn. Inelructlon., ... peg.. 2 Ind 31n Ih. booklet, Va. No .: Ch.CklnG -v... will not X chang. your lu or IIdUCI ollr"'lInd. i'l f, f: r, " I, [I L A B E L H E R E for th. .., Ja". I-O.e. ,U. 111111, orolher lax Your tlrs' ",m. Ind 1n/1I.1 JERRY W i' " "'b. Innl Lltlnlm. SIMPSON It Ilolnt '1Iurn. 'POUII'. nnl n.m. .nd InlUlt Llltn.ml Ham. .datu. (numb., .nd tllI.ll. It you h...... P.O. box, It. p.g. 10. 137A N 2~ST STREET "'pl.no. CIIV, lawn or po'l o'lIct,.UI., .nd ZIP ODd.. If you h...... tOlllgn ladt.u.... p.g. 10. CAMP HILL PA ~70~~ 00 you w.nt $3 to go to thla fUnd? "".,"""",,",, """"'"""""'" "",'""',"""'"' I' a c1nl..tum, dotS u'a usa want $310 0 10 this fund? . . . . . . . . . Slngl. Mamed ftllng Joint ..turn (avan ~ only ana had Income) Mamed ftllng ssparole ..turn, Enter spouse's saclel securtty no, above and full name ha.... ~ BEVERLY A SIMPSON H..d 0' hou.lhord (wllh qUIlItVlnoper.onJ.IS" P'II' 10.11' th. qUIIUlylnlJ per'onl. II cnUd bul nol vourdlp.nd.nl. Inllt In III cnllo'. n,,'I'II n.rl. . Quail n wldow(e,) whh de endanl child ( ear s use died ~ 19 See a e 10,) Youra.~. " your pe..nt (0' someone else) can claim you as a dapendenl on his or har laX retum, do not check box6a""..",""","..","""..,,"..,, ,..,,"",'..,..,"",,",,""", 4 5 Sa No. or Do,... chacked on Sa and 6b 1 No. of your - chlld,a" on Sc (4) No, 0' who: ~.:.~~~ . lived with ",.you _ I . dId not IIv. - wHh you dua to dIvorce or leparlllon (a.. page 11)_ ,.. Dep.endanta on 6c not .. .nterad .. abov. _ Add numb.'D .nterad on trn8!1 lIlhOVA 60,000 36 b c S au.. Dopandants: (2) aeplnd.nl'S (3) D.p.nd.tnt', ~ I .a_....._~....a._..... ............_..1_... OMS No. 1545.0008 Copy B To Be Filed With Employee's FEDERAL Tax Return 1 Wages. liPS. Olne, compensation 2 Fecerat Income tax WI!rlheIO 3 Socral securllV wages 5 7 Social secunty liPS 9 Aavance EIC pa~menl 11 Nonquahfied plans 13 See Inslrs. tor box 13 ~ 4 Social secuntv tax Withheld 6 Medlco1re lax Withheld 8 Allocated lips d Employee's social secUrity number 161-32-8656 e Employee's name. address, and ZIP code 10 CepeMent care boneflls 12 8enellts Included In box 1 JERRY SIMPSON 14 Olner 137A N. 21ST STREET CAMP HILL PA 17011 15 SIJllllarl OmJSe!3 Pe~slor\ lt~ll fmCloyu elln rell Hsnj.j ,m, Celerrea ccmcenutoon 16 Slllt Employer's slate 1.0. No. 17 SUit \u~n. tlOI. flC. 18 Slale Income IJ,1, 19 LOC3f!ly n3me 20 lCCJI'/dQU,I,ps. ele 21 lctillflcom, I... ,.R~..l...J,~,:-.;3.?~~::I!........ ... ,9,9.9,9.Q "Q. ,....~.Q.a,Q".o. ......E:J:T... ,....6.0,O,O,O...Q .....,600...0. 850 60,886 ,..: . .1 ) ! Ot!Partmenl of Iho Treasury-Inlernal Revenue ServIce ! W-2 Wage and Tal( Statement This information is being fumished 10 the Internal Revenue Service. 1997 ..- .-. ..... ...... JU . Alimony palU D H8Crplenrs ::i~N ,. .)U.. ~;:jf;;{;: you), see EIC Insl on page 21. 31 Add line. 231hroU9h 3Oa"","".."..,""...."",""","""""........"" "..,""..,"..".."..........".. 31 32 Sublrecll/ne 31 from line 22. This Is ur ad u$led ,OSS Incoma ~ 32 For Prlvscy Act and Paparwo,k Raductlon Act Notice, .e. pago 38. OM 60 60 826 Form 1040 II"n f~ l "', d Total number of exem tions claImed ...".,................. . . . . . , . , . . . . . . . . . . . 7 Wages, saleries, tips, ete, Attach Form(s) W-2"",,"'" """"','," "',""""""",' ",. 7 Sa Taxabl.'nteresL Attach Schedule 8 ~requlred..,..........,...... .... ..,........,...... '.., Sa b Tax-ex.mpt InteresL 00 NOT Include on line 8a""""",."" 8b 9 Dividends. AtIoch Schedule 8 ~ required ..,............,........,........,.................., 9 10 Taxable refllnds, cred/ls, oro"'ets olstate end local Income taxes (see page 12) ..,............, 10 11 Alimony received ................,....,..................,...., .... '.... , ....,....,......... 11 12 euslne..lncome or 00"), Attach Schedule C orc-ez ".."'..,,,..,...........,.., ..,..,.." 12 13 Capital gain or (loss),AtIoch Schedule 0 ,......................"....,...., ,..,.............. 13 14 Other gains or (10""). AtIoch F~orm 4797 ........ '.......... '/..,....,............,.......... 14 150 TotallRA distributions........ 150. . b Taxable amount(see page 13) lSb lSa Total pensions and onnu/IJ.. lSa b Taxable amount (see page 13) 16b 17 Rental real estats, rcyatues, partnerships, S corporations, trusts, etc. Attach Schedule E .......... 17 18 Farm Income or (loss), Attach Schedule F..,......,..........,..,..........,..............,.., 18 ~~ ~~:,:~~~;tb"."n::nsation, fuJ' , , ", , ." , . , '" , " , , , , 'I' b 'T;';';"bl~' ~;';~~~i '(~~... p~'g~ '14) ;:b 21 Other Income, Ust type & amount-see pg.15 ...I?;1;:;r,.~~ ..l:f9~,E;~, ,C?,f, ..~!L......".., 21 22 Add the amounts In the tar ri ht column for """57 throu h 21, This 15 urlotallncomo ~ 22 23 IRA deduction (see page 18) .. ....,.... '" .......,............ 23 Adjusted 24 Medical savings account deduction. Attach Form 8853 , , , " , , , , , , 24 Gross 2S Moving expen,... Attach Form 3903 or 3903-F "","""""" 2S Income 26 One-he~ of self-employment tax. Attach Schedule SE , , , , '" , , , , 28 II line 32 Is under 27 Self-employed heallh Insurance deduction (se. page 17) """" 27 $29,290 (under 28 Ke09h and self-employed SEP and SIMPLE plans "","""'" 28 $9,nO ~ a child 29 Penalty on eariy withdrawal of savings.. .. ,.. , .... , .... , , .. , , , .. 29 did not live with 3D . Alimony paid b Roclplenrs SSN ~ 30a ~u~~~e2~~c Inst'31 Add lines 23 through 3Oa"""""""" "" """""""""".."""", ",',"'" ""'" 32 Subtract line 31 flcm line 22, This 15 our ad usled ross Income ~ For Privacy Act and Pap.rwork Reduction Act Notice, se. page 38. OM ."022 Po. 11 Form Leb.1 (So. InstnJcUons on pogo to,) flUng Status Chock only one box. exemptions II more than six dependents, s.. pogo 10, Income Attach Copy B of your Form. W-2, W-2G, .nd 10911-R h.r., II you did not got a W-2, s.. page 12, Enclo.., but do not attach eny poym.nL Also, please use Form 104D-V. 1040 D.p.Mm.n' or th. Tt...ury~lnl.'nal R.v,,,u, S.rvlee U.S. IndivIdual Income Tax Return Forlh. ..rJ.n,I~O.e.31.tDD',orolh.rll.ll .rb.lnnln Your IIUI n.m'lIld Initial LUI n.m. JERRY W SIMPSON ",0' IAS Un OnIY~Oo NIl wrll. or lIaDI.ln Ihll'D'ca, . t007. .ndlno .1' QMB No. 1UI~OO'. Vaur .ocl., 'KUrtty numbo, ~61-32-B656 SpoUII'1 lod.'IKurtty number 161-34-9827 For help In nndlng IIn. Inltrudlon't I.. ~I. 2 .nd 3 In tho booklet, V.. No .: Ch.cklno -V..'wlllnol X ChlnfJ' your lax or reduca our ,.rund. 1997 L A B E L H E R E If .Iolnl tllurn, .pou.... IIUI n.m. .nd InllltJ Lattnltn. Hom. .ddreulnumbtr .nd "'''11.11 you h.v,. P.o. ball,... P'O' 10. ~37A N 21ST STREET "pr.nO. Clly. town or po., oUlet, .1.1., .nd ZIP cod.. II you h.v,. lorelon .dd'.... s.. P.O' 10. CAMP HILL PA 1701~ 00 you wlnt $3 to go to this fIlnd? '."""""""" """:""""",,, "" """" II. oint ratum, does ur 5 us. want $3 to 0 to this fIlnd? . Slngl. MalT1ed ftllng Joint return (.ven "only on. had Income) MalT1ed ftllng separat. return, Ent.r spous.'s soclalsecurtty no, above .nd filII n.m. h.re, ~ BEVERLY A SIMPSON Hud 0' hOu..hold (with quaJUy1no plt.onl.IS.. p.o' 10,1 It tn. qu.Ulytno p.raon', Icnlld bUI nol your dlp.ndlnt, Inllr Ihl. cnllo'. n.m. htr.. . Quail n wldow!.r) with deoend.nt child fear s us. died ~ 19 Se. a e 10,) Yaur..ll. If your porent (or someone .'se) can claim you as a depend.nt on his or her tax return, do not check box6a .......... .............................. ..... ..... ........ b o. 0 ox.. ch.cked on Sa and &b 1 No. of your - (4) chlldr.n on Ilc No. or who: ~.n~?~ 'lived with vour home you _ In 10D7 'did not Jlv. with you duo to dlvolce or ..paratlon (... page 11)_ De~.nd.nt. on Gc not entered abov. Add numb.r entlred on S ouae Depend.ntt: o (2) D.p.nd.nl's socl.' s.cutltynumb., (3) D.p'n~.nl's t.lallonshlp 10 ou 1 Flut n.m. Lutn.ml 60 000 36 B50 60 B86 60 60 826 Form 1 040 Il"n Account number I I Amount ot IIno 61 u wont APPLIED TO YOUR 1998 EST, TAX . 83 II IIno 53 I. more thon IIno 60, .ubtroct IIno 60 from IIno 53, Thl. Is tho AMOUNT YOU OWE Fordolall. on how to poy, soo pogo 27 ..............'..,........................,........, . 3 237 155 EstJmated tax ena . Also Include on line 84 65 1 0 9?%t~W~&~~Wf;r4?::'Ht.~Wb'lJMH~.m Und.r p.nllll.. ot p.rlury,I d.d"'.lhlll hAY' 'x&mln.d Ihls ,.Iurn and Iccomplnylng scn.dul.1 and slIl.m.nIS, and 10 Ih. bill ot myknowl.dg. and b.II",ln.y &,.Iru., corr.ct, Ind compl'l', D.d.rlllon or pr.p.rlr (olh.r Inan luplY'flls blS.d on IlIlnlormlllon 01 whIch pr'pl,.r has any knoWI.dg.. 1122 Pg,12 .FOf'm1040U-0011 Tax Compu- Illlon It you want tha IRS to tlgure your tax, .aa pogo 16. CredIts other Taxes Payments Attach Form. W-2, W-2G, and l099-R on tho fronL Refund Hav.1I 3=edl 5.. pogo 27 and ftllln 62b, 82c, and 62d. Amount You Owe Sign Here K..p.copy Orlhl',.lurn lor your r.eords, JERRY W SIMPSON 33 Amount from IIn. 32 (adlusted gross Incom.) ""',' 't)..........'.............. 't)........' _ Ch.ck It: 0 You wore 65 or older, 0 ElIlnd; Spou.. wa. 65 er old or. Blind, Add tho number el be.os chocked abev. and onter \ho tolal hero, , , , , , , , , , , , , , , , , . _ b It you ore married ftllng seporat.ly and your .pou..II.mlz.. deducUen. er you w.re a dual-statui all.n, ... pago 18 .nd chock h.re .. , , , .. , , , , .. .. , , .. , , , .. . 35 Enter [nemtzlld deduction. Irom SCh.dul. A,lIn. 21, OR the standard deduction ahown t1.low torvour rlllno l'alul. But II' larger P'O' I' It you cn.c..et .no; bOlt on 1111. 34' or 3.4b or .om.on. ...an c1llm you II I et.o.net.nl. of . 5InOI.-I.4,150 . ,-,."r.d rUIng lolnlly or QU.lltylng wldow"I"I-III,OOO yoUr: . Huet at hClUllholet-U,050 . '-'''M.d IIIlno IIP,"I.ly..13,.450 Subtract IIn. 35 from IIn. 33 """"',,',"""""""",',',',,""""",',',,"',",',," It IIn. 33 I. $00,000 er loss, mulllply $2,650 by th. tolal numbor el ...mpUens cl.lmed en IIn. 6d, IIl1na 33 I. ev.r $00,000, ... tho werk.h..t on pogo 19 fer ih. .meunt to .nt.r , , , , , , , , , , Taxabl. Incom.. SubL IIn. 37 from IIn. 38, It In, 371. mere than In, 38, ont.r -0- Tax. S.. pogo 19, Chock hny tax from I 0 Fonn(.) 8614 """,,,,,,,.., b Ferm 4972 . Cr.dlt fer child .nd d.p.nd.nt care ..p.n..., Attach Ferm 2441 40 Credit fer \h. .Id.rly er tho dlsobled, Attach Schedulo R """", 41 AdepUen credit. Attach Fenn 6639 ""....".... '" ,,,,,,..,,,, 42 Ferelgn tax credit. Attach Ferm t 116 43 Other, Chock It from I B Ferm'3800"'" b' U' j:~;;'; 8J9s c 0 Ferm 8601 d Ferm (.peclfy) 44 45 Add IIn.. 40 through 44.."" .."......,,,,,,,.. ,,,,,............,,:..,,, ,,,,..,,,,,,,, '..'.. 45 Subtroc1l1n. 45 from IIn. 39, It IIno 451. mere than IIn. 39, .nter -0- . 47 S.II-.mpleym.nttax. Attach Schedul. SE ""','" """"",.""""""""""""""", 45 Alt.m.Uv, minimum tax. Attach Ferm 6251 "...." ""......,,,,,....,,,,,,,....,,,,,,,,,,,,, 49 Seelol .ocurtty ond Medicare tax en Up Incem. net reported 10 .mpleyer. Attach Fenn 4137""" 50 Tox en qU.ll1led reUrem.nt plan. Oncludlng IRAs) & MSA.. Attach Fenn 5329 It required, , , , , " , , , 51 Adv.nc. .amed Incem. credll poym.nts from Fenn(s) W-2"",..""""""""".."""", 52 Heus.held .mpleym.nttaxas, Attach Schedul. H """""""""',"","""",',"""'" 53 Add IIn.. 46 - 52. This I. ur total lax . 54 Fed.rallncom. tax wlthh.ld from Ferm. W-2 .nd 1099""""" 55 1997 ..Um.ted tax poym.nts & ameunt applied from 1996 return 561 Earn.d Ineam. oradn. Attach Sch, ElC It you have . qu.llly1ng child b Nontaxabl. ..med Inc,: amt .1 I and typo . "...... '" .................... ,,,.. ..,,, ...." ,~.9 560 57 Amount paId with Form 4868lrequ.sl ror,xltnalonl ................ 57 58 Exc.ss social socurtty and RRTA tax wlthh.ld (s.. page 27) 58 59 Olhlrp.ymtnu.ch.clclffrom . 0 Form2430 b 0 F~r~~;~a 59 60 Add In. 5.4,5!5.5aa.S7.55,&SO. Th..ur.yourtutal a menta ... &1 IIl1n. 60 I. mere than IIn. 53, .ubtract IIn. 53 from IIn. 60. Thl. I. \h. .meunt you OVERPAID, , , , 821 Ameunt etlln. 61 you want REFUNDED TO YOU, ",,,............,, ,,,,..,,,,.. ,,,,,,... . . b ReuUng number I I . c Typo: 0 Chocking 0 SaVings 34b } 3S 37 38 39 40 41 42 43 44 . d 83 84 Pa .2 826 3 015 57 811 37 2 650 38 55 161 .t~:.:. 39 12 932 45 4& 47 46 49 50 51 52 53 ~2 932 120 13 052 9 924 vouroccup.tlon CONSTRUCTION MANAGER 0.1. SPOUSl'S oc:c:up.llon Paid II nllutl Preparerts Flrm's nlm_lor yours Use Only It "U-.mploY'C1llnd lddtlu ~ Qp.,\, CHUBB AND ASSOCIATES P.O. BOX 6597 HARRISBURG Dill .;1. '(/9':- Ch.ckll Sllt-.mployed OM PA PrepI,.", aodaJ .tcurllV no. ~9~-40-8201 ~N 25-~645828 ZlPcod. 17~~2-0597 .Form 2210 . , Underpayment of Estimated Tax by Individuals, Estates, and Trusts ~ Se. "p.,lI. InllrUcllon.. ~ Allach to Form 1040 1040A 1040NR 104ONII-EZ. or 1041, 1997 AUlCf'lmtnl 06 SIQUlnc>> No. OMS No. 154'.OUO DIOlnlM"' or 'h. r,...ury Inlttnl' A~nue Strvlce NIIM(.II"ownCln IlJl '1Iur" Id.ntlfylng numb.r JERRY W SIMPSON ~61-32-8656 Nolo: In most cos.s, you do not n.ed to nl. Form 2210, Th.,RS Will ngura any p.n.1ty you ow. .nd s.nd you a bill, Ala Form 2210 only W ona or mora box.. In Part I apply to you, I' you do no1 n.ed to nl. Form 2210, you sUII may us. II to ngur. your p.nalty, Enl.r the amount trom IIna 20 or IIna 32 on Ih. .n. IIn. at ur ratum, but do not allsch Form 2210, 8:.1!..tl.8 ReBlons For Flllng- If la, b, or c b.low appll.. to you, you may b. abl. to low.ror .IImlnat. your p.nally. But you MUST chack the box.. thaI apply and nl. Form 2210 wllh your lax ~etum, If ld b.low .pplles to u chack that bound nl. Form 2210 WIth urtax ratum, 1 Chack whlch.v.r boxes apply (W non. apply, see the NoI. above): s 0 Vou requ..t a walv.r. In c.rlAln cln:umstanc.s, the IRS Will walva all or part 0' the penalty. See Waiver of P.nalty on page 1 of Ih.'nslnJctions, b 0 Vou us. the annualized Incom. Inllallmant method. It your Incom. verled durlng th. yoar, Ihls method mey reduce the amount of ona or mora required Installm.nts, Se. page 4 0' the Instructions, c 0 Vou had Federallncemal4x WIthheld trom wag.. and, rer estimeted lax purposes, you lroal the WIthheld tax as paid en the dale. ft Was actually wtthheld, Inslead 0' In equal amounts on the payment dUB dates. See the Insb\Jctfons far IIna 22 on paga 3. d 0 Vour requl'ed annual paym.nl (IIn. 13 belew) Is based en your 1996 lax and you nled er are nllng a/oint return rer ellher 1996 or 1997 but net rer both y.ars, . ftJ:!iffilW.1 RequIred Annual Payment " 'j J , 2 Ent.r your 1997 lax ener credits (se. page 2 of the Instrucllons). Caution: Also s.. page 2 rer a spacial 1\11. Wclalmlng the res..n:h Credll",."".,."".,.,."".".,..".""""."",..."". ",.",..,., Other lax.. (sae page 2 etlh.lnstructiens) ,.,..,.,.,.,.,...".,',..,..,.".",.."".,.",.,...",...",....., Add IIn"2 and 3"",..",.,...".,..,.....,.,..,..,.,.,.".,..",."."..".",...,..,."...",...,."..." Earned Incoma credll ..,.."..,',.......,..,.......,.,.,....,.",....",.",." 5 Cradllfor Federal lax paid en fu.,s"." ",.".".,.""".,.,..".",."."."" 6 Add IIn.. 5 and 6"", ,.""".,. ,., '" "",..,.,"".",.".".",."."." ,.".""."""..,..,. "", '" " 7 CUlT1lnl year tax. Subtractlln. 7trom IIn. 4,.".""",.",."".",.",."",..".."".." ",.,.., "'," '" ,. 6 MulUply IIn. 6 by 90% (,90) 9 1 ~ 74 7\{W;; ..................................................... .-:;;::.$;':-."" 'Mthholdlng taxes. Do not Include any estlmated tax payments on thIs line (see page 2 ot the WMk Instructiens)..",.""""""".,.,. "",.".". ,.,',.,""',..,"',."."."""".,.,..."..",.."..". ,. 10 11 Subtract IIn. 10 trom IIn. S, If less th.n $500, Slop h.re; do not compl.te or nl. this rerm, Veu do not ewe Ih. pen.,ty.""".""",.". "",.".,"""""",."..,.".."..".",."",..".."...",.,., 11 12 Enter the tax shown on your 1996 tax retum (110% e' th.l.meunt W the adjusted gross Incom. shown en that return Is mere than $150,000, or W mented nllng separately for 1997, mera then $75,0(0), CaUllon: S.e page 2 ofth.lnsb1Jc1!ons ....,.,...,..,.."."..,..,..".."...,...".,..,.,.....",... 13 RequIred annual paym.nt. ent.rlh. amall., eflln. 9 orlln.12 ..,..".,..".,',.".."...",..,.,."...."..., NoI.: If IIn. 10 Is equal to or mera than IIn. 13, stop h.re: you de not owe the p.nalty, Do net nl. Ferm 2210 unless u chac~ed bex ld abeve. ~P..~l.\'tl.(U Short Method (Caution: Se. page 2 e' thalnstrucUens to nnd out W you con us. the shert m.thod,l' u chec~ed bex lb er c In POll I, sid Ihls rt.nd e 10 Part IV, Enter the amount, It any, tram line 10 above ..................................... Enter the lotaJ emeunt, If .ny, 0' ..Umated tax payments you m.de " , , . , , . . , . , , . . . Add IIn.. 14 and 15 ......................................................................................... Total und.rpaym.nt fo, year. Subtract IIn. 16trom IIn. 13, It zero er less, step h.'.: you do net ewa the panalty. Do net nl. Form 2210 unless you chac~ed box ld .beve .............................,...... MulUply IIn. 17 bY,05966 .""'.,, '" ,,'.. ", ", ""',.,',.,.."."..""."..",."."., ,.,.".,... "',"',' . If tha ameunt on IIn. 17 wes paid on or an.r 4/15/96, .nt.r-o-, . "the amount en IIn. 17 w.s paid b.for. 4/15/96, m.k. tha following cemputatlen to nnd the amount to enter on line 19. 3 4 5 6 7 8 8 10 2 3 4 ~2 932 ~20 13 052 r, fj [1 111 ~3 052 9 924 3 ~28 12 13 12 254 1~ 747 .. '! .I 9 924 , I , ~ , ~..; I[ 14 15 16 17 9 18 18 ~ 823 109 " . " .' I Amount on NUmblror days paid IIn.17 X b"O'.4/1SI9B X 20 PENALTY. SUbtract line 19trom IIn. 16, Enler the re.ult here and on Form 1040, line 65; Ferm 1000A, IIn. 34; Ferm 1040NR, IIn. 65; Ferm 1000NR-EZ. IIno 26; er Ferm 1041, IIn. 27 For Paperwork ReductIon Act Notice, se. page 1 ot separate Instructions. DM .0002S 19 o ~ 20 109 Fo,m 221 0 I"on I [, ~ : .'. ..122 P2'<I Taxe. You Paid (5.. peg. A-2,) 9 Interest 10 You Paid 11 (S.. peg. A-2,) Not.: Pel'lOnal 12 Intoreat I. not deductibl., 13 14 Gift. to 15 Charily II you mad.. 15 glll.nd got. b.n.1Il !Dr U, 17 ... peg. A-3, 1S Casually and Theft Losses 19 Job ExpenseS20 and Most other Miscellaneous Deductions (5.. peg. A-5 !Dr expenses to deduct h....,) 23 24 25 28 other 27 Miscellaneous Deductions Total itemized Deductions Schedule A-Itemized Deductions ~ A"ech to Form 1040, (Schedul. B I. on bock) ~ Se. Inotruellon. for Schedul.. A .nd B SCHEDl1LES A&B (form 1040) O.pll1m.nl of 'h. rr...ury Inlltn.1 R~"ue a.Me. f'QGI H.m'I'I.hownon Form '0<10 JERRY W SIMPSON Medical c"utlon: Do not Includ. ..p.n... ..Imbursed or peld by olhors, and 1 Medlcol.nd donlal oxp.n... (... pogo A-1) .",.,.,..,..."... Cental 2 Enl.r .mount 'rom Form 1010.lIn. 33 2 Expen.es 3 Multiply IIn. 2 .bov. by 7,5% (,075) .. .. .. .. , .. .. .. . .. ,.. .. .. . .. 4 Subtract IIn. 3 fnlm IIn. 1. II IIn. 3 I. mo.. th.n IIn. t, .nl.r-o- 5 Sial. .nd localincom.tax.. ................,..........,...... . 5 R..I..IaI. lex.. (... peg. A-2)...............,..........,.... 7 P.rson.1 prop.rty tax.. ..,.... ..........,...................., 8 OIhortaxo., U.t typo .nd .mount ~ ,..............,......,.... , ',:' 1 3 5 8 7 8 Add IIn.. 5 Ihrou h 8 Hom. mortg.g.lnl....t & points r.ported to you on Form 1098 Ham. mort;.;.lnt.r"l not r.pa"'d 10 you on Form 1001.1' P.ld 10 Ih. p."on tram whom you boughllhct ham.. u. P'O. A-3 .nd 'hOW thlt p."on.'n.m..ld.nIUylnono....nd.ddr... . ........ ................. .............................................................. 11 Points not ..ported to you on Form 1098, 5.. pogo A-3 for .pecl.1 rill.. """"".""."",.,." ,.""..".,.",.." Inv..lm.nl Inl....l Attach Form 4952 II required, (So. pogo A-3,) ."........,..,....,...........,..""."...,.".., Add IIn.. 10 Ihrough 13 Gilts by cuh or checlc. II you mad. .ny gill 01 $250 or more, see page A-3 .......................................... Oth.r th.n by cuh or checlc. If .ny gill of $250 or mo.., ... pogo A-3. You MUST .ttach Form 8283 II ov.r $500 , , , . , . . , , C&nyov.rfnlm prloryear....,..,.... ........",..".,'.....", Add IIn.. 15 throu h 17 12 13 15 ,".;.:,;,.',. Ji:'d~ 15 17 ea.u. or Ih.n los. ..), Attach Form 4884. 5.. . . A-4. Un..lmbursod .mploy.. exp.n...-Job trav.l, union du.., lob educotion, .tc, You MUST .ttach Form 2106 or 2108-EZII requlrod. (5.. pog.A-4,) ~ "".""""."".." .............................................................. 21 Tax preperation I... ,.,.".,.""""""""",."." ""., ,. 22 other expenses-Jnvestment, safe depostt box. etc. Ust type .nd .mounl ~ .... ,...... ........................ ,......, .............................................................. lit 4 2 280 :h@~~ 462 'MP~ :..~""~~.>, 255 KRi' I~ 9 Add IIn.. 20 through 22"".""", ".,."""",..,..,.""" Ent.r .mounl from Form 1010. line 33 .. 24 Multiply line 24 ebovo by2% (,02) ."".""""""".".".", 25 Subtract line 25 fnlm line 23, II IIn. 251. mo.. th.n IIn. 23, ent.r-o- OIher-rrom list on p.g. A-5. U.t typo .nd .mount ~ .,..,.",.".,.,.',.""""."",.,.,.", ............................................................................................ 28 I. Form 1040, line 33, over $121,200 (over $80,600 If man1ed nllng .eparalely)? NO. Your deduction I. nol IImUed. Add tha amounts In the (or rtghl column !Dr IInas 4 through 27, Also, .nler on Form 1040, IIn. 35, Ihe 'arg.r of thl. .mount or your .tandard deduction, YES. Your deduction ma be IImtted. See a B A-5 fer the amount to enter. For P.p./Work ReductIon Act NotIce,... FO'm 1040 Inotruellon.. * LIMITED OM }......,~ BY AGI ;;,'.;.,~.-.;.'. @?iM , l~ 14 it]fHl 25}wk I 18 19 I ~'~i .4"" 'f1,~i"~ '1''\1 f&ffjj tt\:~# ~I 25 II 27 * 28 OMU No. "15.0014 1997 AtI,c''ttMnl 07 o 2 997 25 o (~#;{!MjH.Ot+tit~f~:~~Kflj~t~~%UH.:. :n;{,~~:::::?-~.*~~,~3./HW..$~., ,A~,-~...~:.._.: ..................,--.."'.,'.,.,:'.,.,.,....,;::;:,::%:........ ~~>:;I'" y.'....... 3 0~5 Sch.dul. A (Form 1040) 1997 .IOU PillS SCHEDULE'SE' (Form 1040) Self-Employment Tax · 8M Inotrudlon. lor Schadul. SE (Form 1040). 0'""" No. f541:1.oo,. Oolltrnent at Ih. T,...ury Inf.,nal AlYtnue S.,..,l~ regl HI"" 0' p.tlon\llwlth .,"-employmlnt Inc:oma (.. thown on "ot," 1040) JERRY W SIMPSON . AnKh to Form 1040. 1997 Alllehm.nl 17 S.Qu.nc>> No. I , 161-32-8656 Who Must File Schedule SE You must ",. Schadul. SE It. o You h.d nal earnings Ircm sall-employmenllrcm other th.n church employee Income (line 4 0' Sho~ SchOOul. SE or IIn. <Ie 0' Long Schedule SE) 01 S400 or mora, OR o You had church employee Income 01 $108,28 or mora, Incomelrcm services you p.rlormOO II a mlnlsler or e member ala rallgloul order I. not church employaalncoma. Sa. psge SE-I, Not.: Even II you h.d .1011 or. small amount oIlncom. tram ..II-employmenl, II mey bo to your benom to "Ie SchOOule SE ond un olther 'opUonal method' In Pa~ II 01 Long Schadule SE. Soo paoe SE...:!, ExceptIon, II your only sell-employmenllncome WII tram ..mlngs es e mlnlstor, member 0'. religious order, or ChrlsU.n Sclonce practitioner .nd you "'ed Form ~~81 end recelvad IRS epprovel nollo be laJeed on thoso .amlngs, do not ",. Schadul. SE.lnstoad, wrlte 'Exampl-Form 4:l6t' on Form 1040, line 47. May I Use Short Schedule SE or MUST I Use Long Schedule SE? jNo DID YOU RECEIVE WAGES OR TIPS IN 19977 Lvea Are you . mlnl.'Ster, member af a religIous order, or ChrlsUon Selence pracUUoner who received IRS epproval not to be taxed on earnings tram these sources, but you ewe self-employment tax on other eaml" s1 Vea Wuthe total 01 your wages and Ups subject to social securtty or rallroed roUrement tax plus your net ..mlngs tram sell-employment more than $65 400? v.. No No No Old you receive Ups subject to social securtty or V.. Medicare tax thai you did not repo~ to your em 10 8r? Old you receive church employee Income re ~ed on Form W-2 01 $108,29 or more? No I YOU MAV USE SHORT SCHEDULE SE BELOW v.. I YOU MUST USE LONG SCHEDULE SE ON THE BACK SectIon A-Short Schedule SE. Caution: R..d abova to see II you can use Sho~ Schedule SE. 1 Net Iarm proftt or (loss) Ircm Schedule F, line 36, end larm pa~ns..hlps, Schedule K-l (Form 1065), line t50 ""","""""','" ,.",..",.", """',""" ,."",.,.,.",."."..,.,.'."",.",.."" 2 Net prom or (loss) Ircm Schedule C, IIna 31; Schedule C-EZ, IIna 3; end Schadulo K-t (Form 1065), IIna 150 (other then larmlng). Mlnlsta.. and mambo.. 0' rollglous orde.., sa. page SE-l Ioremounts to repo~ on this IIn., See psgo SE-2 fcr other Income to repo~,..."."..,...,.",......,.."."..., 3 4 Comblnelln.. 1 and 2,..",........,. ....,..,......,.,.."",..,.""".,.,."..".....,...,.,."."..,.,." Net ..rnlng.trom .."...mploym.nt. Multiply IIno 3 by 92,35% (,9235). I' less than $400, do not "Ie this schadule; you do nol owe sell-employmont tax ,..".."".".,.,."'..".,.",..'.".".,,.,.. . Self...mploym.nt lax, If the emount on IIna 4 Is: 0$85,400 or loss, mulllply line 4 by t5,3% (,153), Entor Iho rosult here .nd on Form 1040, IIn. 47. o More then $65,400, mulUply line 4 by 2,9% (,029), Than, edd $8,109,60 10 tho result Enler Ihe total here and on Form 1040, line 47. }............................ . " , 1 ! I 2 850 I 850 , 3 ~ 4 785 ~20 5 6 . 6 Daducllon lor on....h." oleelf...mploymont tax. Multiply line 5 by 50% ,5). Enlertho rosull hare end on Form 1040,IIno 26 For Papsrwork Reduction Ad Notice, seo Form 1040 Instrudlone. 60 Schodulo SE (For~ 1040) 1997 OM ~ 'F~ "10~O SalarIes & Wages Report . .. . Name Taxpay...'donllftcaUan Numb... JERRY W SIMPSON ~61-32-8656 Federal Federal Soc Sec TIS Employer Wages WithholdIng Wag.. A DELUXE HOMES OF PA. INC. 60.000 9.924 60.000 B e 0 E F G H I I J Taxpayer I Spouse 60,000 9.924 Totals 60.000 , Soc Sec MedIcare MedIcare Allocated Advanced Dependent other Beneflts WithholdIng Wages WithholdIng TIps E/e Care Ben Box 14 A 3.720 60.000 870 B e D E J F -- G I , H , I J r J' I," Taxpayer I I SpoU8e , 60,000 -- I Total8 3,720 870 I I ( ! State Local Local , State , Wages WithholdIng Wages WithholdIng I , A 60,000 ~.680 60,000 600 ~ B I 'I- e 0 E i, F . G '. H " I J Taxpayer Spou8e - Tota/8 60,000 1.680 60,000 600 4, A list of all exhibits which thc PlaintilTintcnds to oller into cvidcnce: A. Thc Invcntory of Plaintiff, Husband, B, Thc Incomc and Expcnsc Statcmcnt of Plaintiff, Husband, C, Any additional exhibits will be forwardcd to Dcfendant prior to trial. 5, The gross income of the PlaintilTfrom all sources including payroll deductions, recent state and federal incomc tax rcturns and pay stubs: Incomc and Expense Statement includes this information, 6, A listing of thc expenses of the PlaintilT: Income and Expensc Statemcnt includes this information, 7, The valuation of pension or retiremcnt benefits and a calculation of the marital portion thercof and the facts and documentation upon which the party relies to support the valuation: See Inventory as to PlaintilT's pension data, Thc infonnation regarding the Defendant's pension data has not been supplied to the Plaintiff. S, Claim for counsel fees: The PlaintilT claims $2,000,00 in counsel fees, 9, Tangiblc personal property values: See Inventory, 10, Listing of marital debts: See Inventory. 7, Additional infomlRtion, if any, relevant to the motion: None, Date: ...;FI Nt I f ~- /' Litl4.iilv- LttUL- All mey for Plaintiff ~' {' I' / f'; 'J:- AND NOW, t"'-C /3 ,1998,', htu.t {lci.cl.fT. E"";,, ;, .pp';' ,d ~ "'P'. to tho "II,.,;,. ".;~, BY THE COURT: J. . \ ~ I! , ! , , , . , I, ". f': ~:I.IJ;:;':,':r: C';: :' .I',-..r....::;'( sa rr-7: I:) i.J I. ..,." 1'1 ..; "":,,.,. l.,.ll. t" ",\.1 I.." -' , ._1'.[. ' I I f. i t. /0' i' !, i -.... >- b; ,..-: ,.. ~--:: ~.: I?: :,-.~ ~(. UJ(.~ " , .' '-' : F"; :-:~~ 1::'- '-' .... 9'~ .. , ' (f") : , r.J'. ' , " I.J.! .~- .. ....1. . c: , ((I U' ..~., L;._ ~:,~~1- (', -.:: I L C~ :5 I CJ U' \_> ... " .~ .' I , I , \ JERRY W, SIMPSON Plaintiff : IN THE COURT OF COMMON PLEAS :CUMIlERLAND COUNTY, PENNSYVLANIA : CIVIL ACTION - LAW v, BEVERLY A. SIMPSON Defendant : NO.98-387 CIVIL : IN DIVORCE NOTICE OF SERVICE OF PLAINTIFF'S FIRST SET OF INTERROGATORIES TO DEFENDANT TO: THE PROTHONOTARY OF CUMBERLAND COUNTY SIR: , / Please be advised that on the I (;i1) day of fVl-'<-.t.-C. . 1998, an original and two copies of the Interrogatories of Plnintitf, Jerry W, Simpson, were served upon counsel for Defendant, Beverly A. Simpson: Samuel L, Andes 525 N, 12th Street Lemoyne, PA 17043 by United States first class mail, from Harrisburg, Pennsylvania to the above address, DALEY LAW OFFICES Date: rI-!/() / Y q .&t!c{c<., ~/ K hleen Carey Daley, E~qulre Attorney No, 30078 1029 Scenery Drive Harrisburg, PA 17109 (717) 657-4795 By: Attorney for Plaintiff . '~-. ..... .'1' :'~ ~ , ' V:l, : . . r ,. .,;.- co;,.. ... \.. ";:", --J -, o ~;.; . I , '" (') :;.~ ',-j 7~. ::;J .r, -" ~" '!Ii";'; ..".,"7' tS {......"1 10 I' ~~ '~IC) "'("J ,.J-," . .c,; :~'} -.,.. "-~C' ~.;l ;.;;,I"n '~;1 r~ j> ~rJ .< , .j , :1 ,", ;-. ~ . ;~; .' .' .~\ ;~ JERRY W. SIMPSON, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW v. BEVERLY A. SIMPSON, Defendant NO. 98-387 CIVIL IN DIVORCE PRAECIPE TO THE PROTHONOTARY: Please enter the appearance of Keith O. Brenneman, Esquire and snelbaker, Brenneman & Spare, P. C. as attorneys for Defendant Beverly A. Simpson. Date: January 30, ~998 SNELBAKER, BRENNEMAN & SPARE, P. C. By: ~~- Ke~th O. Brenneman, Esquire 44 West Main Street Mechanicsburg, PA 17055 (717) 697-8528 Attorneys for Defendant Beverly A. simpson LAW OFFlctB SNELDAKER. BRENNEMAN 8: SPARE ., J ~ .' n \.") ,:"J F.~ .:J' I I -., J .. , "....1 (, ! , : :n . ,-- '. 1 " :." (,', C) 1'-' .": I .. . . ".,0 r .. , . ".-, ,.-n . - , ~~}~'1 .. " r:- ~j I 11 ~~ . ~;: I .' ':::I In :.11 -, -0;. ; ~ .. . ..,.,.;."",.",j_JI"""p,":!:i'::::;:;_:'_':\~:;.:";.,....; . ",:" .:,. .' ,'. .' . ' , '" ,. ", v. ':..:.. "j- 'J,. "0 A: ,If",.," -';1 1',",,;(.,," " " ' '" " , . '~~;,(:!":{""!},,;:~!:,;,,:;(:;,::):,;::,;,,,,,,:,::,,::";"""':-"---.,."" . . ',' - '" - ~,,' 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, (X) I. Real Property (X) 2, Motor Vehicles () 3. Stocks, bonds, securities and options () 4. Certificates of Deposit ( ) 5, Checking accounts, cash ( ) 6, Savings accounts, money market and savings certificates () 7, Contents of safe deposit boxes) () 8, Trusts (X) 9, Life insurance policies (indicate face value, cash surrender value and current beneficiaries) ( ) 10. Annuities ( ) 11. Gifts () 12, Inheritances ( ) 13, Patents, copyrights, inventions, royalties () 14, Personal property outside the home (X) 15. Businesses (list all owners, including percentage of ownership, and officer/director positions held by a party with company) ( ) 16, Employment tennination 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 plans, Individual Retirement Accounts () 20. Disability payments ( ) 21. Litigation claims (matured and unmatured) () 22, MilitarylV,A. benefits () 23, Education benefits () 24. Debts 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 ";~ a .. .Il R .1:: C ...OS ... a <- a 8 ~ :l ~ OJ, .... - lol '" II. 0 8 8 II: 8 II. .. ~ ~ ~ e e ~ ..l " ~ ~ ~ ~ ~ ~ " 0 ~ on s:" " 0 ]i " 0 "~ .a~ ~~ M '" Ci M ~ > > II: '" '" > >::J < :IE ..: ..: ..: >. >.. '<;' ~ ] ] b ~ :- '" " " ... J: ~ a:l ~ '" ,5 .. .. "0 ] "0 .5 en fl! a a en ..: ~- :i~ :i ~ :i ~ :i .l:> Z;C 5'''' 5'''' 5',~ r lJ ,5 ,5 ~ ....en ....en ....en &! t' .. '€L~ '" !l !l e :i;g 8 J J II. 00- 1L ... "'"< :i; :r: ~ .. c a :!;'" .'" , , .e , oJ 3 ] lj lj ~ ~ C. "';; :r: u u e", " ..l ..l 'C o a ,$ ..l ~ :a ~ Ci ... ::u .'!l ,$ oJ; fl ::- "5 '''' = .....r .a .g 6 ... !i 'ji !l 0 c "5 ~ 11 ~ ~.7l .. 8 ~ ~ f-o '" !l cl .:::z ...: M ,.; .; III ..; .. il .51 .. 1; :a ~ "'IS! ~.s ~ ~ S ~ l ! 8 8 II ~ I" I: ~ I" ~ I" I" " '" ~ ~ '" '" '" ; 0 " 0 0 0 0 0 0 0 ~ ~~ ~ ~ ~ ~ ~ M 0 .. ~ ;:J .., a .., c ~ a c ~ ~ ~ Ii! c Ii! c ~ "- "- Ii! "- Ii! "- "- ... f "- ,$ .5 ~ "-.$ ~ "- ,$ .$ .. II ,$ '" '" g ,$ '" ,$ '" '" r!~ '" <: <: 0 ~ ~<: en '" <: <: ~= ::i ~ ~::E ~,;,;. ::i ::i :., :., z< 6' Il b - ~ 6'~ 6' 6' l ~ ;:; ~l ~ .... a:l ;:J ....a:l .... .... a:l to " .!l II ~ !l ~ Co 8 ~ e '" :z: ~ ll. g < u & :z: ~ ... il 1! , , .. ~ g , g , c 2 ,5 ~ g g .Si ~ ~ - ~Q'; "-"" "il .., ~ ] of' ':J ]~ <>: " & < < u 5'5 <>: "il co < co " r! '! ~ 19 1"'5 ~ ~ ,5 :!t ~ :!t !l III .. '" ... "" ,? ,~ r: '5 '" ~ !l II ~~ o 0 !:E .c ~ .c 'i. > ~F5S c .. Q, u '" u '" '/ , , 9 cl ! : .,,; ...: N ,.; .. an .:::z ,..: 00 '" - - - - - - , , , " Ho\Nllnl. l..o\HII~H .1, liMIT 1I1ll,UN n .s^~I1JI~J. L.ANJWH A'I.'I'UUNH.... A'I' I.A\\' n:.tn NUln'1l '1'\\'lU,l"rll HTUIOtT I',n, fluX Ifill I.I~"I()YNI~, JlI~NN!n'I.vANI^ .JU,la CCQ)~1f T'U.IU'lIuHK OIU '"I.n:1l11 1'0\)( t7l1l 1l1l....:ln 27 April 1998 Keith O. Brenneman. Esquire 44 West Main Street Mechanicsburg, PA 17055 RE: SIMPSON Dear Keith: Enclosed is a Praecipe to withdraw your appearance and enter mine in the Simpson case. Please sign it and mail it directly to the Prothonotary or file it the next time you are in Carlisle. Thank you for your cooperation. Sincerely, Samuel L. Andes amr cc: Kathleen C. Daley, Esquire (w/enclosure) E. Robert Elicker, II, Divorce Master (w/enclosure) .~. CC~fP1f JERRY W. SIMPSON, Plaintiff ) ) ) ) ) ) ) ) IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION. LAW NO. 98.387 CIVIL TERM IN DIVORCE vs. BEVERLY A, SIMPSON, Defendant PRAECIPE To the Prothonotary: Please withdraw the appearance of Snelbaker, Brenneman & Spare as attorneys for the Defendant in the above matter and please enter the appearance of Samuel L. Andes as attorney for Defendant in this matter. Snelbaker, Brenneman & Spare By: Date Keith O. Brenneman Date Samuel L. Andes JERRY W. SIMPSON, Plai ntiff ) ) ) ) ) ) ) ) IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION. LAW NO. 98.387 CIVIL TERM IN DIVORCE vs. BEVERLY A. SIMPSON, Defendant PRAECIPE To the Prothonotary: Please withdraw the appearance of Snelbaker, Brenneman & Spare as attorneys for the Defendant in the above matter and please enter the appearance of Samuel L. Andes as attorney for Defendant in this matter. 1\,.. I\. 2.*. 'lit" f Date Snelbaker, Brenneman & Spare B~~ Keith O. Brenneman ~ . ~..p.;.l t '<r8 Date ~- ~._~~ amuel L. Andes I \ ~~ , I ! " I, I' I I ' f ,- I . 'O. ."'..... ..... (") ..0 (") r:: r;o -" "'l"': ~~. ;"':;\1 =::1 (" - . '~J ?d~':t ~...., li:!J ,.... f!.:S;. ;>.) .....":1 1,:1 :;g ., " ,0) ,::f..o' 'T) ~~=a ~;~Cj ..,.' {:~~ ~(") 1:';"1 ,~'"'rn ,-, ;:";~ ;>.) -=' ti $ -~ - -<: t I i I I ....~--... "'.....-;;l I, : MARRIAGE SETTLEMENT AGREEMENT THIS AGREEMENT is made and entered into between Jerry W. Simpson and Beverly A. Simpson, herein after referred to as Husband and Wife, The parties were married on April 21, 1962 and there are three children born of their marriage, all are sui juris, As a consequence of disputes and unhappy differences, the parties have separated, The parties desire to confirm their separation and make arrangements in connection therewith, including the settlement of their property rights, support, and all other rights and obligations arising out of the " marriage relationship, It is therefore agreed: I. CONSIDERATION . \ , , The consideration for this Agreement is the mutual promises and agreements herein contained, 2. SEPARATION AND NONINTERFERENCE A. It will be lawful for each party at aJ1 times hereafter to live separate and apart from the other party at such place or places as he or she may from time to time choose or deem fit. B, Each party shall be free fr~m interference, authority and control, direct or indirect, by the other, as fully as ifhe or she were single and unmarried, Neither shall bother the other or compel or endeavor to compel the other to cohabit or dwell with him or her, , 3, MUTUAL RELEASE Subject to the provisions of this Agreement, each pany has released and discharged, and by this Agreement does for himself or herself, and his or her heirs, legal representatives, executors, administrators, and assigns, release and discharge the other of and from all causes of action, claims, rights, or demands whatsoever, in law or equity, which either of the panics ever had or now has against the other, except any or all cause or causes of action for divorce, 4, FULL DISCLOSURE " TIle provisions of this Agreement and their legal effect are fully understood by each party to this Agreement, and each pony acknowledges that the Agreement is fair and equitable, that it is being entered into voluntarily, and that it is not the result of any duress or undue influence, Husband and Wife each represent and warrant to the other that he or she has made a full and complete disclosure to the other of nil assets of any nature whatsoever in which such party has an interest, of the sources and amount of the income of such pany of every type whatsoever, and of all other facts relating to the subject matter of this Agreement. Husband acknowledges that he was represented by Kathleen Carey Daley, Esquire, in reaching this Agreement, and Wife acknowledges that she was represented by Samuel L, Andes, Esquire, in reaching this Agreement. Both panies represent that the tenns of this Agreement have been fully explained}o them by their respective counsel. 5, EOUIT ABLE DIVISION By this Agreement, the parties have intended to effect an equitable division of their marital property. This division is not intended by the parties to constitute in any way a sale or exchange of assets. 6, SUBSEOUENT DIVORCE A, AGREEMENT NOT PREDICATED ON DIVORCE _ It is specifically understood and agreed by and between the parties hereto and each of the said parties does hereby warrant and represent to the other that the execution and delivery of this Agreement is not predicated upon nor made subject to any agreement for institution, prosecution, defense, or for the non-prosecution or non-defense of any action for divorce; provided, however, that nothing contained in this Agreement shall prevent or preclude either of the parties hereto from commencing, instituting or prosecuting any action or actions for divorce, either absolute or otherwise, upon just, legal and proper grounds; nor to prevent either party from defending any such action which has been, mayor shall be instituted by the other party, or from making any just or proper defense thereto, It is warranted, covenanted and represented by Husband and Wife, each to the other, that this Agreement is lawful and enforceable and this warranty, covenant and representation is made for the specific purpose of inducing Husband and Wife to execute the Agreement. Hu~i!nd and Wife each knowingly and understandingly hereby , .. waives any and all possible claims that this Agreement is, for any reason, illegal or for any reason whatsoever, unenforceable in whole or in part, Husband and Wife each do hereby warrant, covenant and agree that, in any possible event, he and she are and shall forever be estopped from asserting any illegality or unenforceability as to all or any part of this Agreement. B. ENTRY AS PART OF DECREE -It is the intention of the parties that the Agreement shall survive any action for divorce which may be instituted or prosecuted by either party and no order, judgment or decree of divorce, temporary, final or pennanent, shall affect or modify the financial tenns of this Agreement, This Agreement shall be incorporated in but shall not merge into any such judgment or decree of final divorce, but shall be incorporated for the purposes of enforcement only, C, MUTUAL CONSENT DIVORCE - The parties agree and acknowledge that their maniage is irretrievably broken, that they do not desire marital counseling, and that.they both consent to the entry ofa decree in divorce pursuant to 23 Pa,C,S,A. Section 3301(c), Accordingly, both parties agree to forthwith execute such consents, affidavits, or other documents and to direct their respective attorneys to forthwith file such consents, affidavits, or other documents as may be necessary to promptly proceed to obtain a divorce pursuant to said 23 Pa,C,S,A. Section 3301(c). Upon request, to the extent pennitted by law and the applicable Rules of Civil Procedure, the named defendant in such divorce action shall execute any waivers of notice or other waivers necessary to expedite such divorce. . 1 I ( , 7, DIVISION OF PERSONAL PROPERTY I , ~ With the exception of the followin~:items of personal property described on Exhibit "A' which shall be delivered to Husband on or before August 2, 1998, by Wife, Wife agrees that all of the personal property in the possession of Husband shall be the sole and separate property of Husband; and Husband agrees that all of the personal property in the possession of Wife shall be the sole and \, " separate property of Wife, The parties do hereby specifically waive, release, renounce and forever abandon whatever claims, if any, he or she may have with respect to the above items \vhich shall become the sole and separate propeny of the other, " 8, DIVISION OF MOTOR VEHICLES !t With respect to the motor vehicles owned by one or both of the panies, they agree as follows: The 1998 Ford Taurus currently in the possession of Husband shall become the sole and separate propeny of Husband, A lien presently exists on this automobile which names Husband as sole debtor, The 1996 Cadillac currently in the possession of Wife shall become the,sole and separate propeny of Wife, This vehicle is presently being leased through GMAC, The titles to the said motor vehicles shall be executed by the panies, if appropriate, for r r, I I , , effectuating transfer as herein provided, on the date of execution of this Agreement or at any time thereafter at the request of either pany, Husband agrees to waive any interest in the 1996 Cadillac and its lease and agrees to assign any interest or rights he may have in said vehicle to Wife, Each pany shall be responsible for and shall exonerate and indemnifY the other pany with respect to all debt amounts due and owning on the automobile in his/her sole possession. 9, DISPOSITION OF PROPERTY From and after the date of the signing of this Agreement, both panies shall have complete ~~ I" freedom of disposition as to his/her separate propeny and any propeny which is in their possession or control pursuant to this Agreement and may mongage, sell, grant, conveyor otherwise encumber or dispose of such propeny, whether real or personal, whether such propeny was acquired before, '. during or after marriagc, and ncithcr Husband nor Wifc nccd join in, consel1lto, or aCknoivledge ilnY deed, mortgage, or othcr instnllnCl1l ofthc olhcr pcrtainingto sllch disposition of property. 10, DIVISION OF REAL PROPERTY The parties own various parcels of real property which shall be distributed as follows: A. Husband and Wife hereby agree and acknowledge that they own certain real property located at 1448 High Street, Camp Hill, Pennsylvania 170 II, as tenants by the entireties, Husband hereby agrees to convey all his right, title and interest in said property to Wife, Husband agrees to execute a deed or other instrument of conveyancing necessary to effectuate this transfer at the time of the execution of this document. TJ.1e panies acknowledge that there is a primary and a second mortgage against this property held by Mellon Bank in the approximate total amount of$160,OOO,OO, Wife agrees to assume total liability for these mortgage obligations. Wife shall hold Husband harmless and indemnity him from liability for these mortgage obligations and other obligations arising from this property, including, but not limited to, any and all real estate tax payments which may be imposed upon the property during the course of Wife's ownership of said property, or upon the sale or said property, B, Husband and Wife hereby agree and acknowledge that they own an equitable interest in certain real property located at Unit No, B- J I B-t I G Laurel Hills North, Condominium r, Enola, East Pennsboro Township, Pennsylvania,.. ' Wife hereby agrees to convey all her right, title and interest in said property to Husband. Wife agrees to execute a deed or other instrument of conveyancing necessary to effectuate this transfer at the time of the execution of this document. The panies acknowledge that there is an installment sales agreement by Deluxe Homes of P A in the approximate lUnount of$90,OOO,OO, Husband agrees to assume total liability for this i'nstnllmcnt snIes agreement. Husband shnll hold Wife harmless and indemnify her from liability for this mortgage obligation and other obligations arising from this property, including, but not limited to, any and nil real estate tax payments which may be imposed upon the property during the course of Husband's ownership of said property, or upon the sale or said property. C, Husband and Wife hereby agree and acknowledge that they own two lots at Raystown Lake identified as a commercinllot and a residential lot. The patties agree that Husband shall receive the residentinllot and Wife shall receive the commercial lot, The parties agree to execute deeds or other instruments of conveyancing necessary to effectuate the transfer of these properties at the time of the execution of this document, The parties agree that these lots are not subject to any mortgage or loan obligation, however, each party agrees to assume total liability for any and nil renl estate tax payments which may be imposed upon the property during the course of each party's ownership of said property, or upon the snle of either property by its owner, 11. PAYMENT OF SPECIFIED OBLIGATIONS The parties agree that the following constitute joint marital obligations which shnll be paid by the following person: A. WIFE - Mellon Mortgage No, home equity loan Mellon Second Mortgage No, , , , .. Any debts incurred in her name since the date of separation, B, HUSBAND - Deluxe Homes ofPA Installment Sales Agreement on North Hills Condo Any debts incurred in his name since the date of separation. Husband and Wifc lire accepting Ihc sole responsibility to pay certain cnumerated joint debts in this Agreemcnt. Husbllnd and Wifc agree thai all dcbts shall be paid in a timely manner, In the evcnt that any debt shall remain unpaid more than 60 days from its due date Ihe party responsible under the Agreement for paying this debt shall: I,) Noti/)' the other party of the situation in writing, 2,) Takc immcdiale action to place the property which serves as security for the dcbt for sale, 3, Pay any legal costs the olher party shall incur in enforcing the terms of this provision, '. 12, LEGAL FEES Each party shall pay his or her own attorneys fees, 13, ALIMONY BOlh parties acknowledge and agree that the provisions of this Agreement providing for equitable distribution of marital property are fair, adequate and satisfactory to them and are accepted by them in lieu of and in full and final settlement and satisfaction of any claims or demands that either may now or hereafter have against the other for support, maintenance, alimony pendente lite or alimony, Husband and Wife further, vo,!u!1tari1y and intelligently, waive and relinquish any right to . " seek from the other any payment for support, maintenance, alimony pendente lite or alimony. 14, PENSION PROGRAM Each party hereto shall maintain sole ownership over his or her individual pension plan, profit sharing or similar retireme/ll planncquired individunlly or liS the result of contributions by his or her employer, Husband hereby agrees lhnt he shall mnintnin Wife as the sole beneficial)' of his retirement plan through his employment by Deluxe Homes of P A until such time as he retires, At the time of retirement, Husband shnll have full power and authority to direct the beneficiary declaration of this fund without consent or joinder of Wife, Husband hereby releases any interest that he has in the retirement benefits of Wife accumulated as the result of her employment by ReMax Realty and any I' I other additional benefits she may have accrued, This waiver is a full and complete discharge of each parties' marital claim to these retirement benefits, " 15, MISCELLANEOUS Husband agrees to maintain insurance on his life, These policies are offered through his employer in the amount of$50,OOO,OO in death benefits and through a private policy on his life with $250,000.00 in death benefits, Husband agrees to name the parties' children as the sole beneficiaries of these policies, These policies shall be maintained by Husband until he retires from Deluxe Homes ofP A or achieves age 65 whichever first Occurs, Husband agrees to provide Wife with written proof of the designation of the parties' children as beneficiaries under his two life insurance policies on an annual basis, Husband agrees to maintain Wife on his employment provided health insurance plan, at his sole expense, for a period of thirty-six ~3~) months under the COBRA program, or until such time ' .. as Wife acquires her own health insurance coverage, Coverage of health insurance for Wife is predicated upon her eligibility under the COBRA program, ~ ; " All assets including, but not limited to, savings accounts, checking accounts, certificates of \, .' I deposit and life insurance policies shall be the sole and separate property of the title holder of said .' warrant, represent, and agree that ClIch will now and at all times hereafter save hannless and keep the /"i I' , other indemnified from nJl debts, chnrges, and liabilities incurred by the other after the execution date of this Agreement, except as may be otherwise specifically provided for by the tenns of this Agreement and that neither of them shnJl hereafter incur any liability whatsoever for which the estate of the other may be liable. C, SEVERABILITY - Ifany tenn, condition, clause, or provision of this Agreement shall be detennined or declnred to be void or invnJid in law or otherwise, then only that tenn, condition, clause, or provision shnJl be stricken from this Agreement and in all other respects this Agreement shall be valid and continue in full force, effect, and operation, Likewise, the failure of any party to meet his or her obligations under anyone or more of the paragraphs herein, with the exception of the satisfaction of the conditions precedent, shnJl in no way void or alter the remaining obligations of the parties, D, OTIiER DOCUMENTATION - Wife and Husband covenant and agree that they will fonhwith execute 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, and as their respective counsel shall mutually agree should be so executed in order to carry out fully and effectively the tenns of this Agreement. E, ENTIRE AGREEMENT - This Agreement contains the entire understanding of the parties, and there are no representations:. warranties, covenants, or undenakings other than those expressly set fonh herein. F. WAIVER OR MODIFICATION TO BE IN WRITING - No modification or waiver of any of the tenns hereof shall be valid unless in writing and signed by both parties and no waiver of any breach hereof or default hereunder shall be deemed a waiver of any subsequent default of the . . same or similar nature. G, MUTUAL COOPERATION - Each party shall, at any time and from time to time herenfier, tnke IUlY and all steps and execute, acknowledge, and deliver to the other party any and all further instruments and/or documents that the other party may reasonably require for the purpose of giving full force and effect to the provisions of this Agreement. H, LAW GOVERNING - This Agreement shall be construed and governed in accordance with the laws of the Commonwealth of Pennsylvania, I. BINDING EFFECT - Except as otherwise stated herein, this Agreement shall be binding and shall inure to the benefit of the parties hereto and their respective. heirs, executors, administrators, successors, and assigns, ], NO WAIVER OF DEFAULT - This Agreement shall remain in full force and effect unless and until tenninated under and pursuant to the tenns of this Agreement. The failure of either party to insist upon strict perfonnance of any of the provisions of this Agreement shall in no way affect the right of such puny hereafter to enforce the same, nor shall the waiver of any breach of any provision hereofbe construed as a waiver of any subsequent default of the same or similar nature, nor shall it be construed as a waiver of strict perfonnance of any other obligations herein, K. HEADINGS NOT PART OF AGREEMENT - Any heading preceding the text of the several paragraphs and subparagraphs hereof are inserted solely for convenience or reference and shall not constitute a part of this Agreem~n~. nor shall they affect its meaning, construction, or effect. 1. ADDRESS OF PARTIES - Each party shall at all times keep the other infonned of his or her place of residence, and shall promptly notifY the other of any change, giving the address of the new place of residence until all obligations under this agreement have been satisfied. M, WAIVER OF CLAIMS AGAINST ESTATES - Except as herein otherwise provided, each party may dispose of his or her property in any WilY, and each party hereby \vaives and relinquishes any and all rights he or she may have or hereafter acquire, under the present or future laws of Pennsylvania or another jurisdiction, to share in the property or the estate of the other as a result of the marital relationship, including, without limitation, dower, curtesy, their statutory equivalents, widow's allowance, homestead rights, right to take in intestacy, right to take against the will of other, and right to act as administrator or executor of the other's estate, and each party will, at the request of the other, execute, acknowledge, and deliver any and all instruments which may be necessary or advisable to carry into effect this mutual waiver and relinquishment of all such interests, rights and claims. , N, ATTORNEY'S FEES FOR ENFORCEMENT _ In the event that either party breaches any provision of this Agreement, and the other party retains counsel to assist in enforcing the tenns thereof, the parties hereby agree that the breaching party will pay all reasonable attorneys' fees, court costs, and expenses incurred by the other party in enforcing the Agreement, IN WITNESS WHEREOF, and intending to be bound hereby, the parties have signed and sealed this Agreement on the j" J day of /-h-CO~ . 1998 at Harrisburg, Pennsylvania, In the presence of: ~i101l Q?,":. .: -? / ~.'-7~I~,.L!':l Beverly A, Simpson (SEAL) (SEAL) I i" co J) , :'-) , ;-,. , ,-.. 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