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Home My WebLink About98-01841 () ''"'t' ",' 'd,' , .:~ t:m! c.:~) I 1 Cl ~ \\ ... o J v1 ~ <: I;j, ~ "" ,. " ~ "\ \ \ \ f i I / ",' , I , f , I t \. \~ ...... ~ .-:\ .... CJ - 'J-. c... - I D- c-- , ~I ! SHEILA JORDAN, Plaintiff Vs. JAMES W, ,JORDAN , ,JR, , Defendant IN 'rHE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYINANIA NO, 98 - 1841 CIVIL IN DIVORCE MASTER'S REPOF.T Proceedings held before E, Robert Elicker, II, Master 9 North Hanover Street, Carlisle, Pennsylvania proceedings held on Feb:r:'uary 20, 2003, commencing at 1:30 p.rn, APPEARANCES: Sheila Jordan Pro Se (Did not appear) n (" ~'~,,:r~:; l:i'~':,f ~;~: :;: ~'3,~,-, !,,~,("c )","' , ~t~ . ;;;.1 < ," Theresa Barrett Male Attorney for Defendant (-':f' r:; :\'1 , . II ,", ';j'.( . , '0."1'(1 ~:..~ ~i' ;;~ r.\'-; "'0':" 1ft :--fl 10 ..... 20, 2003, THE MASTER: Today is Thursday, February This is the date set for a Master's hearing in the above captioned divorce proceedings, Present in the hearing room are the Defendant, James W, Jordan, Jr" and his counsel Theresa Barrett Male. The Plaintiff, Sheila Jordan, is not present nor is an attorney present on her behalf, The Master's office has had no communication from the Plaintiff, or an attorney, that she intended to be present today to participate in these proceedings. Notice of this hearing was sent to the Plaintiff at her address at 205 East Madison Street, Apartment 101, Mt, Pleasant, IA 52641. Notice was sent by regular mail and the post office has not returned the notice indicating that it was undeliverable or unclaimed, 'rhis action was commenced by the filing of a complaint in divorce on April 3, 1998, raising grounds for divorce of irretrievable breakdown of the marriage. No economic claims were raised in the complaint. The Plaintiff subsequently on April 27, 1998, filed a petition raising the claims of alimony and alimony pendente lite. No claims have been raised by ei ther party for eq,li table distribution or counsel fees and costs. An affidavit under Section 3301(d) averring that the parties separated on June 18, 1998, a period in excess of two years, was filed on Decenilier 4, 2001. The 1 affidavit was filed by the Defendant; the plaintiff filed a counter-affidavit under Section 3301(d) on January 8, 2002, indicating that she did not Oppose the entry of a divorce decree but that she wished to claim economic relief. As previously noted, the Plaintiff did raise a claim for alirnony. The purpose of today's hearing is to allow the Plaintiff to go forward with her claim for alimony which was the only economic issue raised in the proceedings. Inasmuch as there is no issue with respect to grounds for divorce and a 3301 (d) affidavit has been flIed and the parties have lived separate and apart for a periOd in excess of two years, the Master recommends that the divorce proceed under Section 3301(d). With respect to the claim of alimony raised by the Plaintiff, the hearing today was scheduled for 1: 30 p.m. It is now 1:53 p.m. alld the plaintiff has not appeared to assert her claim. Also as previously noted, notice of today's hearing was sent to the address provided to the Master by the Plaintiff in prior correspondence. Consequently, the Master concludes that the nonappearance of the Plaintiff to assert her claim today acts as a withdrawal of this claim before the Court, and we are not going to, therefore, continue to hold open the proceedings for the purpose of the Plaintiff asserting 2 this claim or any other claims. The Defendant is entitled to a divorce under Section 3301 (d), the proper documents have been filed allowing him to proceed on that basis, and there being no economic claims raised and pursued by either of the parties, the Master recommends that the Defendant be granted a divorce under Section 3301(d). The Defendant can file a praecipe transmitting the record to the Court following the passing of the ten-day period during which either party can file execptions to the report of the Master or remarks on the record by Defendant's counsel. The Court can then proceed to enter a decree divorcing the parties from the bonds of matrimony and finalizing all economic issues based on the failure of the Plaintiff to appear and assert her claim for alirnony. Ms. Male, do you wish to make any remarks on the record? MS. MALE: Just a few, Mr. Elicker, In addition to what you have already discussed in the nature of the filings, I just want the record to reflect that the Plaintiff filed a subsequent petition for alimony and alimony pendente lite on August 17, 1998, and that was after the Dornestic Relations Office denied her alimony pendente lite claim from the April filing. She participated throughout both of those proceedings along 3 wi th her then counsel, .James J. Kayer, At some point during 2000 into 2001 Mr, Kayer apparently stopped representing her and for much of the time in 2001 into 2002, whenever' we served anything on the Plaintiff, we also served Mr. Kayer at two addresses; his prior law offIce address which had been 4 East Liberty Avenue, Carlisle, Pennsylvania, and also his home address whiGh was 1913 Deer Path Road in Harrisburg. The 3301(d) affidavit and also tho notice of intent to request entry of divorce decree both were served by me; not only on Ms. Jordan but on Mr. Kayer at both of those addresses. Those proof of service have been filed and are part of the courthouse record, THE MASTER: Did the Plaintiff participate only in the alimony pendente lite proceedings? MS. MALE: Yes, she did. Mr. Jordan, the Defendant in these proceedings, had also filed a custody complaint and she did participate in the custody proceeding and in the child support proceeding related to the youngest child. But beyond the child support and custody matters, the only other matters that she participated i.n with respect to the divorce were those two APL proceedings, 'I'HE MASTER: And did she pp-rsonally appear at those times? MS. MALE: Yes, she did. THE MASTER: And at that time did she use 4 the same address that she is currently using today, the Madison Street address in Mt. Pleasant, IA? MS, MALE: Not during 1998. The parties were living separate and 8.part in the same household back in April into August of 1998. She moved to Iowa in I believe it would have been perhaps September or October of that year -- MR. JORDAN: It was earlier, right after the school session. I believe it was J'uly. THE MASTER: And did she move to the current address or d~d she have another address in Iowa? MR, JORDAN: She had an address MS. MALE: With her sister? MR. JORDAN: Yes. She has moved a couple of tirnes, but she has been at this address for a couple of years. THE MASTER: For a couple of years? MR. JORDAN: Yes. THE MASTER: For the last couple of years, this is the address that you have been using to communicate with her? MR. JORDAN: Yes. THE MASTER: Have either you, Ms, Male or your client heard frorn the Plaintiff regarding today' s proceedings '/ 5 MS. MALE: No, The last communication I had regarding the divorce was back in 2001 when we had a petition for bifurcation pending and since then I have received nothing directly from Ms. Jordan at all. THE MASTER: Followi.ng the remarks of the Mast.er and counsel for the Defendant, the Master recommends that. the parties be divorced and that a divorce be granted under Section 3301(d) of the Domestic Relati.ons Code. The Master is satisfied that the parties have been separated for a period in excess of two years and that the proper notices have been provided to the Plaintiff with respect. to the grounds for divorce and with respect to the hearing for her claim for alimony which she has filed so that she has had an opportunity to appear in these proceedings to represent her interest if she would have chosen to do so, A copy of these remarks and recommendation of the Master will be provided to counsel for the Defendant and Mr. Jordan and also sha] 1. be sent to Sheila J'ordan in Iowa at her Madison Street address. Upon receipt of the report, and if no exceptions are filed theret.o within the prescribed ten-day period, the Defendant's counsel can file 6 THERESA BAIU,ETT MALE COUN~n:1,01I AT I.AW "-- SI) NOllrtl SECOND STIlf.':T HAIlIl/511DIlG, Pf:NN5YI.VANIA /7101 THf.IIl:sA HAHIlE:". MA~f. SUSAN C, ApPLERY, rAMl,lOAI, JONATHAN }, MALE, L'OAL MI"rA!<T December 26, 2001 (717) 233,3220 FAX (717) 233,6862 Sheila Jordan 205 Madison Street Apartment 101 Mount Pleasant, IA 52641 Re: Jordan v, Jordan (1198-1841) Dear Ms. Jordan: Enclosed is the notice of intention to request entry of ~ 3301 (d) divorce decree, If you have any questions regarding this cOl'l'espondence, please consult your attorney, Sincerely, /I"",L/.L7C~ Theresa Banett Male TBM/sea Enclosure cc: James J, Kayer, Esquire, 4 East Liberty Avenue, Carlisle, PA 17013 (w/ene) James J. Kayer, Esquire, 1913 Deer Path Road, Harrisburg, PA 17110 (w/enc) James W, Jordan, Jr, (w/enc) via certified and regular mail to addressee Vlml1<'ICA'I'IO'" OF PLEAnlNGS --.~.~.......__~___.....L'__.__._._ .._._~_~__~__.___._~_ The foregoing doclIInenl is hased npon )nfollllatioll which has been pllhered by illY couus(lllllld myself In the preparation of this actioll, The langulIge of the doelllllcllt IIlIlY, ill/HII1, be the langnag(~ of lilY conllsel und nol my own. I hllve !'Cud the stateITwnls lIlade In this documellt ulld to the extent thai it is based upon informatioll which I have givell to lilY connsel, it is tnw ,lIId eOlTecl to the best of my kllowlecl/:e, IlIformation alld belier. To the extent that the cotltellts of the slalelllellls arc that of eOllnsel, I have rdled upon counsel in muklng this Verification, lunclerslallcl that false statements herein me maclc subject to the penalties of 18 I'a, c.s. Section 4904, relating to unswol'l1 falsifieatioll to authorities, . Date: .~. ~(, ~, 1998 '~~J ~. I' IINDI": "=_'l1'4'ora",,__, 'laIIowllhto'~lhe . _ 3, 41, ond 4b, foIIowfng ..Meel (for III 'J .,::r! . ':"""'ond.dd.....'..._O'lI1IIlorm ""'1 wo'" rolumll1i' ext..tH): J' ...r:'fonnlO.........oI......,..,...,.,ororllhtboGkN__"" " Cl Add,_'IAdd'1III . .e::::;,."." ~ /tIquttIItd' on the moIIplI<e _lI1o .rtlclo numIIor, 2, III AMbtClId ~ 'Tho ""''''" AoooIpl,wII......lo whOm tho IItIclo - -.... ond tho dot. J & - ' ConIuIt poolmUler for IN,\ I Mr. ~ame:' .r:rdan, Jr. ..., p '4~355 914 '.' J 1219 Biddle Drive 4b, I ype , Carlisle. PA 17013 [J Rllllatorlld III Celfttd [J Exp.... Mall [J I_red 'I [J Altum ~ 101 MIId1Indl.. [J COD 10 7, ltoO VI ole .. I J a, 102695.97.9.0179 .. EXHIBIT "A" , 20, 2003. 'I'IH~ MAS~['ER: ~['oday is Thursday, P'ebruary This is the date set for a Master's hearing in the above Captioned divorce prqr-eedings. Present in the hearing room are the Defendant, James W. Jordan, Jr., and his counsel Theresa Barrett Male, The Plaintiff, Sheila Jordan, is not present nor is an attorney present on her behalf, 1'he Master's office has had no conununication from the Plaintiff, or an attorney, that she intended to be present today to participate in these proceedings. Notice of this hearing was sent to the Plaintiff at her address at 205 East Madison Street, Apartment 101, Mt. Pleasant, IA 52641. Notice was sent by regular mail and the post office has not returned the notice indicating that it was undeliverable or unclaimed. This action was commenced by the filing of a complaint in divorce on April 3, 1998, raising grounds for divorce of irretrievable breakdown of the marriage. No economic claims were raised in the complaint, The Plalntiff SUbsequently on April 27, 1998, filed a petition raising the claims of alimony and alirnony pendente lite. No Claims have been raised by either party for equitable distribution or counsel fees and costs. An affidavit under Section 3301(d) averring that the parties separated on June 18, 1998, a period in excess of two years, was filed on December 4, 2001. The 1 I affidavit was filed by the Defendant; the plaintiff filed a counter-affidavit under Section 3301(d) on January 8, 2002, indicating that she did not oppose the entry of a divorce decree but that she wished to claim economic relief. As previously noted, the plaintiff did raise a claim for alimony. The purpose of today' s hearing is to allow the Plaintiff to go forward with her claim for alimony which was the only economic issue raised in the proceedings. Inasmuch as there is no issue with respect to grQunds for divorce and a 3301(d) affidavit has been filed and the parti.es have lived separate and apart for a period in excess of two years, the Master recommends that the divorce proceed under Section 3301(d). With respect to the claim of alimony raised by the Plaintif f, the hearing today was scheduled for 1: 30 p.m. It is now 1:53 p.m, and the Plaintiff has not appeared to assert her claim. Also as previously noted, notice of today's hearing was sent to the address provided to the Master by the Plaintiff in prior correspondence. Consequently, the Master concludes that the nonappearance of the Plaintiff to assert her clairn today acts as a withdrawal of this claim before the Court, and we are not going to, therefore, continue to hold open the proceedings for the purpose of the Plaintiff assert.i.ng 2 , this claim or any other claims, The Defendant is entitled to a divorce under Section 3301(d), the proper documents have been filed allowing him to proceed on that basis, and there being no ~lconoInic claims raised and pursued by ei ther of the parties, the Master recommends that the Defendant be granted a divorce under Section 3301(d). ~'he Defendant can file a praecipe transmitting the record to the Court following the passing of the ten-day period during which either party can file ,execptions to the report of the Master or remarks on the record by Defendant's counsel. The Court can then proceed to enter a decree divorcing the parties from the bonds of matrimony and finalizing all economic issues based on the failure of the Plaintiff to appear and assert her claim for alimony, Ms. Male, do you wish to make any remarks on the record? MS. MALE: Just a few, Mr, Elicker. In addition to what you have already discussed in the nature of the filings, I just want the record to reflect that the Plaintiff filed a subsequent petition for alimony and alimony pendente lite on August 17, 1998, and that was after the Domestic Relations Office denied her alimony pendente lite claim from the April filing. She participated throughout both of those proceedings along 3 with her then counsel, James J. Kayer. At some point during 2000 into 2001 Mr, Kayer apparently stopped representing her and for much of the time in 2001 into 2002, whenever we served anything on the Plaintiff, we also served Mr. Kayer at two addresses; his prior law office address which had been 4 East Liberty Avenue, Carlisle, Pennsylvania, and also his hams address which was 1913 Deer Path Road in Harrisburg. 1~e 3301(d) affidavit and also the notice of intent to request entry of divorce decree both were served by me; not only on Ms. Jordan but on Mr, Kayer at both of those addresses, 1'hose proof of sorvice have been filed and are part of the courthouse record. THE MAS1'ER: Did the Plaintiff participate only in the alimony pendente lite proceedings? MS. MALE: Yes, she did, Mr. Jordan, the Defendant in these proceedings, had also filed a custody complaint and she did participate in the custody proceeding and in the child support proceeding related t.o the youngest child. But beyond the child support and cus tody mat. ters, the only ot.her matters that she participated in with respect to the divorce were those two API, proceedings. THE MASTER: And did she personally appear at those t.imes? MS, MALE: Yes, she did. THE MASTER: And at that time did she use 4 the same address that she is currently using today, the Madison Street address in Mt, Pleasant, IA? MS, MALE: Not during 1998, 'rhe parties were living separate and apart in the same household back in April into August of 1998. She moved to Iowa in I believe it would have been perhaps Sept.ember or October of that year -- MR. JORDAN: It was earlier, right after the school session. I believe it was July. 1'HE MASTER: And did she move to the current address or did she have another address in Iowa? MR, JORDAN: She had an address MS, MALE: With her sist.er? MR. JORDAN: Yes, She has moved a couple of times, but she has been at this address for a couple of years. THE MASTER: For a couple of years? MR, JORDAN: Yes, THE MASTER: For the last. couple of years, this is the address that you have been using to communicate with her? MR. ,JORDAN: Yes, 'rHE MASTER: Have ei ther you, Ms. Male or your client heard from the Plaintiff regarding today's proceedings? 5 MS, MALE: No, The last communication I had regarding the divorce was back in 2001 when we had a petition for bifurcation pending and since then I have received nothing dir8ctly from Ms. Jordan at all. ,!'HE MAS'l'ER: Following the remarks of the Master and counsel for the Defendant, the Master recommends that the parties be divorced and that a divorce be granted under Section 3301(d) of the Domestic Relations Code, The Master is satisfied that the parties have been separated for a period in excess of two years and that the proper notices have been provided to the Plaintiff with respect to the grounds for divorce and with respect to the hearing for her claim for alimony which she has filed so that she has had an opportunity to appear in these proceedings to represent her interest if she would have chosen to do so, A copy of these remarks and recor~endation of the Master will be provided to counsel for the Defendant and Mr, Jordan and also shall be sent to Sheila Jordan in Iowa at her Madison Street address. Upon receipt of the report, and if no exceptions are filed thereto within the prescribed ten-day period, the Defendant's counsel can file 6 a praecipe transmitting the record to the Court requesting a final decree in divorce, Respectfully subm~tted, (lJ.~~4i{}Ur1iC E, Robert Elicker, II Divorce Master 7 SHEILA JORDAN, PIa inti f f VS, JAMES W, JORDAN, JR, , Defendant IN THE COURT OF COMMON PLEAS OF CUMBER1,AND COUNTY, PENNSYLVANIA NO, 98 - 1841 CIVIL IN DIVORCE NOTICE OF FILING MASTER~Ef~ The report of the Master has been filed this date and copies have been sent with this notice to counsel of record and the parties. In accordance with P,R.C,P. 1920.55 within ten (10) days after the mailing of this notice and report exceptionS l\\ay be filed to the report by any par ty . I f no exceptions are filed within the ten (10) day period, the Court shall receive the report, and if approved, shall enter a f~nal -,! i) decree in accordance with the recommendations contal-ned i;n the report. (;./1 j ". [J'h-~ c'..V (1ffi.W\..W " , " Date: 2/24/03 E. Robert Elicker, II Divorce Master NO'I'E: If exceptions are filed, file the original with thEl Prothonotary and a copy with the Master's office. At that time, the party filing the exceptions should notify the court reporter in the Master's office so arrangements can be made for a transcript. Upon completion of the transcript and receipt of payment, the entire file will be returned to the Prothonotary's office for transmittal to the Court at time of argument on the exceptions. ... r SHEILA JORDAN Pluintll'l' l IN 1'IIE COUWl' OF COMMON pr,r,AS OF' CUMBERLAND COUNTY, PENNSYLVANIA VB. CIVIL ACTION - LAW , : 9H. 1841 NO, c::rVJ L 1 ~J JAMES W. JORDAN, JR, IN /llVO/lO: , bol'ondullt S'll^'I'IJ~-,; ~jHEE'I' lJIITE: N~.~ II~~ I' (r L''L ~Lt-'t6"1;. '7.'/'L'l'(<> "1 ~ ' l\~'I:L\lJ't IE!; : , ' _fhrtEJl11101_thbj~,__,_____,____,_~_______, ~ -\-M~ .4-nk.4.( ~ 1.."'1" ':J , M ~ Li?!,-uJ~--;(7ii: I.Nv.I ~(. ~ " ,N'N..tv. \Il/l.Au.~~ 't. 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PE",,~v ;-;:-.., ; ~ AN~ v, NO, 98-1841 Dille; II Ivovel1lbcr /4 , 20()1 Theresa Barrell Mille SUprellle COUrt 1/ 46439 5l.1 North SecoII" Slreel Hllrrlsbllrg, PA 17101 (717) 233.3220 COIIII.'e/lilr DelcII"III" - COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA SHEILA JORDAN Plaintiff v, lAMES W, JORDAN, JR, Defendant NO, 98-1841 CIVIL ACTION - DIVORCE PROOF OF SERVICE I "'"by ""lify Ih" I .m fhl. d.y """" fho O'd" of CO". d."" NO"m"', 8, 2001 "''"' Ih, '<too", '''d " ,''' '""''''' I," /""d "'/ow whkh "~/,,, ""."" '''' "'0/","",. 0/ Pa, R.C,p, 440: SerVice by first-class mail addressed as follows: Sf.iI. 'ON..., 20' M'di", ""'I, AP'.m'", 10/, Mo"", PI"""" IA 5264/ Plaintiff James J, Kayer, Esquire, 4 East Liberty Avenue, Carlisle, PA 17013 '"'''' J, "Y<t, &q",", 19/3 0", Pofh ''''d, H'ff/'''''rg, PA 171/0 Attorney for Plaintiff Date: November 14, 2001 J2'u,-~~?Z /)(~ Theresa Barrett Male, Esquire Counsel for Defendant ,.' wi. '. '.""""',.'n.f1. ' "" .'-~ .4 ~~I'r , ~~'{ ~y~~ ~'t'{ .. co,,) ~'O ~..\,I" '^'\}\~~~<) c;'0~<p~ e\\ ~".. e\ <0. \'I\}\\ ,\\" .,,\\e 0\'. \e" coo' ,,,<1>~ \<;J\ a l'-~ , ,\\\e \<1>e ."ec \1 <>\-'" '. .,,~'1\e ,\~ 'I" \ ~ ' ,,\~ ~~\\~\'/,\').').<;J \e<1>~\}\' ~~O \\\}\\~ ').~\..,,\ ~e ~ CO (\\ ;;<1>"'\ 't 0 C~,,)v;. 'Ol'-~ l'- 'O~\\\\ ~~~\\- y"~\~ ~IJ.\ ~~.\. W..' l'-~' 0v;.'O ~, ~\ ~~'" <'\e....e~6.~ ,I" v 'oj. ~~., CO,,) 't~~ <p'{ ,. / ,- -. (: r,'; -,) ,. t. " tl.... r'-', ')'1': tU" :3;1~ t); ! '-'-'0 (") :";:j' r. :l,"'[.[.; :, ',I''') i , (,~ ) ~ 'w ""--l' I., 1-- _:_.lt~,1 u liln.. Cl "':; ,,'... , " ::) , (:!l 0 . I , , i I p I" \i I ! ' (. d( h t' "1 . \ I ! I } I /':~'~ t ,,V, c":C', I,'"' - > 0 f.....' .d'_. 0 (',' ,'" a.. ~~ C) l.!' l.~ ,,;. .1:~ !!.: 1\ J '(,"n'. /g , r ~~ 'lR ~~ i I' i --- :; <..,(.;) ,J... ~ \ ~ , ,\ ,T,"'llt' , . " :- ~ )."" , ' .. ., ~ '1, .;~ I j_~;; ~lr -~ \'!'~,\, 'f~ i,l/< f~' ij"'~ 'I /il t~i ~~ 'I II "~ f ;~ it <oj . ,'. ~ , {1't.~1'..."-~_' 0;'" "'" ~if'" ,""'1'. -'\ft..'1 ".'.l, , ~." '(i~!, .~ \.'1 ' '.. ".. 4' - I ~ '. ~.ft'i"- . 1.1 :~;;J ,,-,.... ' 1'"':','''4.''' ,:" i ",~ ".. .' 0"" " ' IT' IJ."" .,' ,,~, , i '.: ;~" I" :;.. "I \" "I " " If, - ,-' ~ .-,' . .,-. r,' \' lIt, i'l, ~-'-- ,'" j.Jl~ "'~ ~ 1(, y, ',"" i ~ 1. ; If: l<J' ' W- j -, .;-~ I,,, ,. .. I -... '. ' J.A' t J7;r.'~.. ~.>> .~ " ;.;: ,'- l! " 1,( v, " :tC. '" '., " ,. ... SHEILA JORDAN, . Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYI, VANIA va. : NO. 98-1841 CIVIL TERM CIVIL ACTION - LAW JAMES W. JORDAN, JR., Defendant IN CUS'I'ODY aUJBR OF <XXIR'l' AND tOi, this 19th day of An6L/.d , 1998, upon consid$ration of the attached Custody ~raHon Report, it is ordered and directed as follows: 1. The Mother, Sheila Jordan, and the Father, James W. .lordan, Jr., shall have shared legal custody of Katie Jordan, born October 7, 1985. All decisions affecting the child's growth and development, including, but not limited to, medical and dental tl'eatment: psychotherapy, psychoanalysis or like treatment: decisions relating to actual or potential litigation involving the Child, directly or as beneficiary, other than custody litigation: education, both secular. and religious; choice of camp, if any: and ath1e'dc pursuits and extracurricular activities shall be considered major decisions and shall be made by the parents jointly, after discussion and consultation with each othel' and with a view towards obtaining and following a harmonious policy in the Child's best interests. 2. The Mother shall have primary physical custody of the Child. 3. In 1999 and in years thereafter, the Father shall have partial physical custody of the Child during every SUlllTlElr, beginning one week after termination of the school year and ending at the end of the first wee,k of August. In 1998, the Father shall be entitled to have custody of the Child for seven ('7) consecutive days (excluding travel time) during August 1998 before school begins or during the one week school break in September 1998. The Mother shall not object to the seven en days designated by F'ather under this provision. For the period of custody scheduled under this paragraph only, the Father shall be responsible for payment of all travel arrangements. 4. The parties shall have custody of tha Child over holidays as follows: A. Christmas: In every year, the Father shall have custody of the Child over the Christmas holiday from December 26 through January 3. The Mother shall have custody of the Child for the remainder of the Christmas holiday in every year. B. Thanksgiving: In even nurrbered years, the Father shall have custody of the ChIld over the Thanksgiving holiday from the ~ .... sunday imn~iata1y preceding Thanksgiving day until the sunday ilT1nediately following 1,'hanksgiving day. The Mother shall have oustody of the Child over: the Thanksgiving holiday in odd nurrbered years. C. Easter/Sprill9 Break: In every year I the Father shall have oustody of the Child over the Easter holiday/spring break from the day after soh001 ends until the day before school resumes after the break. The parties agree that the Father's period of custody over the Easter hoHday/spring break shall extend for a period of seven (7) days. 5. The Father shall have additional periods of custody with the Child at any time the Father travels to Iowa as arranged by mutual agreement of the parties. unless othet'Wise agreed by the parties, the Father's periods of custody under this provision shall not be scheduled to interfere with the Mother's holiday periods of custody. 6. Except as otherwise provided in this order, each party shall be responsible to pay a percentage of the costs of the Child's airfare/transportation for purposes of custody exchanges in proportion to each party's income. Any child/spousal support received by either party shall be included in that party'e income for purposes of this paragraph. The Father shall be responsible to make all travel arrangements for exchanges of custody. 7. The Mother shall be responsible to make all necessary arrangements with the Child's school for the Child's release from classes during the Father's periods of custody. 8. Both parties shall have the right to contact the Child at any time by telephone when the Child is in the other party's custody. The Child shall have the same right to contact either parent. 9. This Order is entered pursuant to an agreement of the parties at a Custody Conciliation ConferencJ. The parties may modify the provisions of this Order by mutual consent. In the absence of mutual consent, t.he terms of this Order shall control. BY THE J., cc: James J. Kayer, Esquire - Counsel for Mother Theresa Barrett Male, Esquire - Counsel for Father C~"',..,V\,~ rrjlf/qr, -,S, f. or: \ HL'?) 0, I" i'i/'nY I I , ! " I , i I I qn r~t\C ? I) " il'l.'-; j I' -, ~I ~"'\~'" ",.,,,,, 0"'" 0"""" eo" , \rtW "", o! ,h< ,"".' '. '. '''''~.,'. \ """" "",~, ~. " o.s. ...11. ,.,...' ..""Iu. , de\\\'!\ eO\l\\!\e\. \1)' \l\t!\\ e\\\,' _A 0\\ oefe\\d\\\\\IReS\lO\\ . 'II\\lI sefl/eu . COn" \\\\\O~ \\ \tlle \\\\d CO\1eC. ' r 1 1\lereSll "arrett ~a\e. !.lI\\u\re \ \S f\ne Street "arr\llllUr" \'~ \'\\)\ !. } (7 ____, . \99% O\\\e:~' 'I 1. .," ':.' , , , " , , , I ,c " , .. I . .' . . ' , ,: . " ~ , ' ' " ,I, I, ;' ,I' '. ". IF YOU 1)0 NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LA WYER'S FEES OR EXpENS[~'l 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 MFOHD ONE, no TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOIl CAN GET LEGAL HELP. Court Administrator Cumberland County Courthouse - 4th Floor I Courthouse Square Carlisle, pA 17013-3387 (717) 240-6200 AMERICANS WITH J>ISABlLlTIES ACT OF 1m The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilities Act of 1990. For infofl\1alion about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You mllst attend the scheduled conference or hearing, BY THE COURT: J. 2 . . ;1_ ' \~\9 y,\Uu\e \\'l te~\Ue~ a\ '/oI'tI0 c\,\tte\\ S'" " ",.~,,". , .,. ,.".., ". ,-,'\l\ \~ )a\'(\c, 0\ \\\e c,,\ ~'tIe \a\'tIet ., 11.'" '1' ",,,,, ~ , caf,'''' I . "" .. "" "', D' <" · ""'.""'., " "",,,,,,,". , ,."""" .. \ . , . .,.",' ",.", ~,...'" """,. . ""' "",' "I.,,, . . ,I" 10110""" ,- "" ,,'V>""" . b. . '" ." I.,,,,, .. . ." 0>'''''''' <"" .. ,I" """,,,,' . .", "",," -r<< .."." . " '/ai""''''' . I'" ""V> · ,,,,,," . "",,,, , . V"'''''' ,,,, ,,\>,,#'. . . ,,,, "" \01".'" tC~\oc~ ~ ua\\\ C\\ttC\\\\~ . .~\\e oe\e\\ , , \\\~ c\\\\O'. \ \\\e \0\\0'/01 ~~ C\\\\\06~ 0 W\\\\'Ia\\6 \\ee ' AlldrfSS Ml \~ """ " ", ",110. . V",.... ~ \ 0 ~"" '0'''' " \. ,'0 ".", j . .\'" ,,,, ,,\\0'''' .", ..,#'" Ii" ." "",", ~\\e c ~t~ \\\e C \ a~\ \\"e ~') ~ ' , V\,\t\\\~ \'tIe ~ , l\Ote\\\\C\\'. \o\\o'/ol\\\~ lIi ~. \l,'/oIa \)a\e\\ Q11041\:)1 . 061\%1\:)% ",Ol\tC~S 0.' "u\e Vt\"e \~\\:) ,,\I.' cat\\~\e, "", ~ %''1.\\U '" "e\\\,\e "c:,'\~' '. \,1\.. .,. . , ""t\\\~s, cota\ ;:>y ~a\'\\C .~I )otoa\\,)t, )a\'\\cs'l" . S'tle\\a )ot6a\\ ~ )otoa\\,)t. )a\,\\es . {\ \\ r;'tIe\\a )01oa\\ .,,,' \ s S'tlc\\a )01 '3: . ;:> ,-" c'tl\\u . \'tIet 0\ \\'C ~'tIe\'\\o 1, 0\ \'(\0\'tIe1, o 'tIe1 \a\'(\\\~' ",\s\et a\\ ~ ~ 1I) , \", ~; C,6 i3:-r; r '(~.~ :~' ) ;~'! . ~ ~~~ c rr: c::" ft) I.,., N {~l ~:;~ re", 0:: dll-Cr :.l. C,. ~( ~ u.. I'd .., '. ~ ~. CO :::,) (1\ (.) M/clol if) p(to~),"n(,/?, !(), I.. ('I - 9. On August 17, 1998, Wife filed an "et:ol1omic" petltiol1 for alimony and IIlimony pendente lite, 10. By order dated September II, 1998 the comt again denied Wife's apl claim. II. Wife left Pennsylvania on June 18, 1998 und has been domiciled in Iowa since that time, 12. The advantages of bifurcation arc substantially greater than the potential disadvantages because: a. the parties have lived separate and apart since June 18, 1998. b. the parties have not filed joint income tax returns since 1997. c. all pl'Operty acquired during the marriage has been divided. d. resolution of the divorce claim will allow the parties to restructure their personal lives aftcr a separation of wcll over two years. e, the only economic claim of record is Wife's claim for alimony. f. bifurcation will assure that each party's personal life is not held hostage because of economic claims, g. bifurcation will not prejudice, diminish or impair Wife's economic circumstances or her alimony claim. 13. The policy of this Commonwealth and the legislative intent of the Divorce Code warrant granting of a bifurcated divorce decree. See 23 Pa. C.S.A. * 3102(a). 2 . ~ economic claims. On April 27, 1998, Wlfc filcd a petition for IIlimony IInd alimony pCl1d\lOte lite ("apl"). By order dllted ./UI1C II, 1998, the court dcnied Wifc's apl claim without prejudice. OnJuly 6, 1998, Husband filed a countcrclalm for divorce and custody of KlItic. Following II custody confercnce in which Wife participated by telephone, tht: court entered a custody order on August 18, 1998, Wifc filed another "economl;:" petition for alimony and apl on August 17, 1998. On September II, 1998 the court entered an order denying any monetary apt but directing Husband to maintain Wife's medical coverage whilc it was availablc through his cmploycr, On Scptcmbcr 27,2001, Husband filcd a petition sccking bifurcation of thc divorce action. The court has set November 28 for hearing on the pc:tition, in support of which Husband submits this memoran- durn of law. Applicable Law As early as 1983, Pel1l1sylvania' s appellatc courts recognized the benefit of bifureation in divorce actions: Bifurcation separates the termination of the marriage from the distribution of property so that thc marriage and each party's personal life are not held hostage to economic demands. A the same time, the dependent spouse is not economical- ly disadvantaged by the fact of the divorce being Issued because support and/or alimony pendente lite are rcquired to continue at their pre-divorce levels pending resolution of the economic matters. Walk v. Walk, 318 Pa. Super. 3] I, _, 464 A,2d 1359, 1361 (1983) (remanding because lower court grallled bifurcation under local rule and not on examination of facts of case). In fact, ... [The goals of the divorce code] can be accomplished only by the prompt dissolution of a marriage that is demonstrably over (as defined by the code), and allowing the parties 2 In the Court of Common 1)leas of CIIMU.:RI,ANI> Connly, Pennsylv"nlll DOMIlSl'IC Rlll,Al'lONS SIlCl'ION SHEILA JORDAN ) DlIck~1 NUll1h~r 98-1941 CV Plahuift' ) va. l PACSBS Caa~ NlImh~r 265100107 JAMES W. JORDAN JR ) Odclldum ) Olh~r Slale ID NUll1h~r D-27543 Qrfu AND NOW 10 wit, this SEPTEMBER 11, 1999 it Is hereby Ordered that; UPON CONSIDERATION OF THE RECo~~ENDATION OF THE ALIMONY PENDENTE LITE CONFERENCE OFFICER, NO MONETARY AMOUNT OF ALIMONY PENDENTE LITE IS ORDERED AT THIS TIME, HUSBAND IS TO MAINTAIN MEDICAL INSURANCE ON WIFE. THE MONETARY AMOUNT 01' ALIMONY PENDENTE LITE CAN BE REVIEWED, UPON REQUEST OF WIFE, AT THE BEGINNING OF YEAR 1999. DRD I R. J, Shadday ~ eel defendant and plaintiff eStliv /! e 1.J Kaye r, Esq. il\\,i).el eel ~hmsa Barrett-'~ale, Esq. NoL'LI (1\11Iq~ EdWard E, GUIdu, JUDGE Purm OB-OOI Wllrk~r lD 21005 'E;:: "'" ~ '~ Q .. ~ <:) ~~ co (;:)~ ffu x. ()~1: ' ....rl' ~:c CJ~ ~c; r-. '':'65 ri' - Cl :')Z u.;lL! 0_ (I-Z <,J1lU (l.: Lt.) l.lJ'l. (.I) b ro a C1\ 5. Plaintiff filed the instant action on April 3, 1998. 6. Defendant filed a counterclaim for divorce on July 6, 1998. 7. Defcndant has incurred substantial counsel fees in attempting to bring this divorcc action to a cOI1c1usion, including those incul'f'ed as a direct and proximate result of Mr. Kayer's conduct as set forth above. Wherefore, Defendant again requests the Court to make thc rule absolute and enter an order bifurcating the divorcc proceeding and dissolving the parties' mal'l'iage. /), 4i-(/II'tJ:lAAJ/(/)tt-lc... Theresu Barrett Male, Esquire Supreme Court # 46439 513 North Second Street Harrisburg, PA 17101 (717) 233-3220 Counsel for Defendant Date: November 6, 2001 3 "0-" .:1' ..~.. ("( cr: r. "- <.--t I .. 'j ,"-' tJ i .'-, ,) , , .. I , I r.. I .. _J C) (,,' , I. \';'\"'I',r)), ",lIt.,!! 02 OCT :J PI'I (:: I 7 OU~ "'l' '''''')' I'fY ,IoU ~ Lf\i'i:_J \,Ul/\ /'l..'" I" '\I"J \ . " '1\""'" ;1-'1' /, ~ ~- I.~ ." (\ ., >- '\.~J r.; rs; c 4~_ re' " ., ;:5 c', -~ ?) IU:~~ () -:~ , i'j ~-~5 1+ It;O;: (', , '" i , 0', (J <'1 ..;-. , ,1- }\C;;] I, I- Ll '!_) 0.. C . I '. I~',J ~5 ( 'i ,c.-, () In the COlin of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION SHEILA JORDAN ) Docket Numher 98-1841 C\I Plalllllff ) VB. ) PACSES Case Numher 265100107 JAMES W. JORDAN JR ) Defendanl ) Olher Slale ID Numher 0-27543 Order AND NOW to wit. this JUNE 11, 1998 it is hereby Ordered thaI: UPON RECOMMENDA1'ION OF DOMESTIC RELATIONS ALIMONY PENDENTE LITE CONFERENCIl OFFICER, PURSUANT TO THE PAR1'IES RESIDING IN THE SAME RESIDENCE WITH THEIR TWO MINOR CHILDREN AND THEIR CURREwr FINANCIAL SITUATION OF HUSBAND PAYING ON THE HOUSEHOLD EXPENSES AND OTHER MARITAL DEBT FROM THEIR RESIDENCE IN FLORIDA, THE REQUEST FOR ALIMONY PENDENTE LITE IS DENIED, WITHOUT PREJUDICE. THIS ORDER SHALL BECOME FINAL TEN (10) DAYS AFTER THE MAILING OF THE NOTICE OF THE ENTRY OF THE ORDER TO THE PARTIES UNLESS EITHER PARTY FILES A WRITTEN DEMAND WITH THE PRO'mONOTARY'S OFFICE FOR A HEARING DE NOVO BEFORE THE COURT. ee~ ee~ eel petH:l.uller and reSPUllde:Jt. . James J, Kayer, Esq,. \l\(,l&~d ~16t(.1. Theresa Barrett-Male. Esq. lJ,\ )r< .. __ 11 I"~ BY THE COURT: ~ Edward E. Gu tdc), JUDGE Service Type M Ponn OE-OOl Worker ID 21005 "'- 01 ',. tij. (r) !0 r.: ,. :--, ." ,''', (J'I i:);~;~ LLJ.~ .:- (2("; .,- - <) ~;'!; fJ'i ;~ '.:: i:,. ,.- .~ -.J e,)....' r-. .~')f) G"';. li;'_:; J;. -,.. ~:c ~.: u.:.1 "'... _1.1 LtJ _I. :,-::) .,:\ (I. I.... -.) ".,"' ,"'., lJ.. ~ ::> 0 () SHEILA JORDAN, PlaintIff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS, CIVIL ACTION - LAW JAMES W, JORDAN,. JR" Defendant NO. 98 - 1841 CIVIL IN DIVORCE CONFERENCE WITH COUNSEL AND THE PARTIES TO: -______u______..__ Sheila Jordan , Counsel for Plaintiff , Plaintiff Theresa Barrett Male James W. Jordan, Jr. , Counsel for Defendant , Defendant A conference has been scheduled at the Office of the Divorce Master, 9 North Hanover Street, Carlisle, Pennsylvania, on the 23rd day of January 2003, at 2:00 p.m., with counsel and the parties to discuss the outstanding economic issues to determine if there is a basis of settlement of claims. If issues remain after the conference, a hearing will be scheduled at another date. Very truly yours, Date of Notice: November 18, 2002 E. Robert EUcker, n Divorce Master * THE PARTIES ARE DIRECTED TO BRING CURRENT INCOME AND EXPENSE STATEMENTS TO THE CONFERENCE. ,~. , . ~ ~ In the Court or Common PI..... or IIO~tl51'IC RKI,A'rIONH SECTION County, Pennsylvania ,,' """ " ." '.. -,;" "', ,., " . Plaintiff Name: Defendant Name: Docket Number: PACSES Case Number: Dlher Stale ID Number: PI'Id.IO'" Ml......po....IlC. 1a1llllacludt lilt PAC$ES Cu. N...bc.. IncoII\8 and Expense Stateme,,~ THIS FORM MUST BE FILl-ED OUT (It you.... ..,f'ehlploylld or It YOU are .alarled by a business or which you are owner In wbole or pll1, you IllUIl aI.o nil OUt lho SUpplemenclllncome Slltement which appears on paae two of lhlslncome and expense lI.lemenl.) INCOMIlSTATIlMIlNTOI' ;r /'Jt4r.f~ . tv - TO!Z.!2AIIJ J'1t.. Sectlolll: Income and IlllIutanco INCOMEI /lmpI<lYfI AtUr," .. Type ot "'olk ,;. 'aYIOII No, ____._ Ora.. "Y po, 'ay Ptrlod $ ;J RA' ~ , t..? oS 'III/a. if I~ sr. '6,,1(. - Pay 'oriod(wkly.. bi.IlIkly.. '!C.) tit...... '"VfOII P'cklcllollll iii ..To,! I Ollle, Dt4l1CdcIIIl (.,..11)0) SooI.1 S.curt R.IIt.....t ~ w.1I000 s s s l.A>c,IWo otax so.1n I Bendt .aklllnsunDc. s , . N., P,y po. Pay ',rlod S 171! . 005- ~ Onma OWllIl'fhlp . INCOME PROPERTY ....... OWNItD DESCRlPl'lON V ALV& B W j DIvide.... I'Illllo Ch..kln. ""OUAIt 1 Sov.... "UOUlllt C,ocIh Union SlO<lk.lIlon<1c - - RCIIIl.<a,. -- Olhlr - - TOTAL $/IJ J I 1 ... . , TOTAL - .... "- 'I'OT,\.I, INCOME $ Gl " 0 '""Husband: W-Wlt~: J-Joint Form IN.ooft Sorvl~e Ty~. M WMk~r lD '''.. , Income IIld Expense Stalemenl INSURANCE PACSES Case Number Coyel'll' . COMPANY POLICY I tI W C >< K. -- X ~ k c - &wlII Blu. Cro,u Olll.r Mt4lGal 811lt ShI.1d Olllll HedlblAcolcMnl DllIbllhy Inco.... D.."I Odlor ~ f G / (t.41... . H..Hulbolnd; w"wir.; C"ChUd &nIOh U: SUDolemenlal Income Stalement .. 11Ib form b 10 "" filled ou, by , pon.. ~ (I) wbo opo"", , b",Int.. or pracdc.. . proroui... .r [J (2) ~ b. ...mbe, 01. p_mhlp 0, join. "._, or o (3) who II , ,bo,.ho/der In .nd II IIlarlOd by . clo..d cotpOradon or Iimlllr ..til)'. b, AlIaclllO Ibll .....lIMnl. copy ordlo 101l"wln, dooll/llllnu "'ldn,1O rh. pannonblp. JOinl YOOlllro. bullntn. prol...loo, cotpOradon 0' Iimllll.ndl)': (1) ... lIlOll lOUD! Fodtrollllcomo Tu R.lUm. 'Dd (2) Ill, 1llO11_ Proftl Ind 1.0" S"IO"",nl o. N'III..lbutlno", A"", WIl:'1 ? IJ , "I + R n.. Mdr... IIld lIItpho"llIlIIIbor: I d. Nlauo Of bwinou (ebeck toe) -- '0 D 8 D D (5) olbor N.... 0' ~-. oo_lIor Ol~ ponoo ill ch'". or llnancial roeolllJ: l\ II\-'.'C. : l.At. .) h cu.. ~ ct , Aoaual il1co... from busloou: ,I A~ ~- n-l~ Ho.. olltn II iI1como roco!_Od? (1) Pll1lMl'lbJp (2) Jalna yOllAlro (3) prott"lo. (4) clo* oo/pOl.do. (I) -I-AI .' ~-e.~~~ h1. ~'""'7 v... ct~ Ln.~ t. - (2) Oro.. illcolM per p,y period: - (3) NOIIMom. p<<r pay period: - (4, SpocifiOd dld.cUon.. Ir .nYI - <'....,l..... .......... ., l'aA' 2 nO Form IN-<<l8 w"'"........rn . ". IneoN and Il.pwe Statement SIdJon WI ~ PACSBS Caso NUlIIber "lM~lII: OIllY,lboW ucnollllnlrY upen... In 1hllloclJon ~I you ftUod OUI Soodoo 0 00 paao IWOo TIIo "le,oriN II .OLD PONT a,. olpecillly inlpaNm (or cakulllln, chUd IUpport. Uyou aro requOIdtIa SpaWI' Suppclrt/APL or If you ....n your OUl CIUlIlOI he deft""I""d ~oordlna co lbo auJd.lillo ,rids or fonoull.1bJ1 secdon GlWlI be ftJIIy C4l11ploled, f~ I I EllIIaues. S S $ 1 verify ib.i d\O IlIremOOllwdo 10 IhIs locomo .od BxpOI1J1 SralOlllenllre lnlo and correct. llllldersllDCllbal fAko IUollmonU horoiA uo sUbJect to tl\O crlmlnol penaJllet of IS Po. C.S.. . relsclni to W1SWOI1l fobl&olioll IUlbaritlel. ------- (FIll ill /oflIlropnl. CollUM) 1XI'~1IlS . (p' mlN'1I .-- WEIlX MON'l1l VIAll. (collllAutd) WEE -- Ho..... - I PI/, S 111 ljl' MoI\II~ .. 1'11''" lebol $ r~ - "~ .....dIlaI SclIooI -- - Colli., 1Iootri. S S - S - ReIloto'lI Ou - _. *...;-- - - Clod'],," S T' 1\1 II'12.S' ill) 0 'ood ('"IS WI" - - lIII,OO" tow.. - - croctlI P.l'JIlIIlll . -- CredlICud Milo . $ S lZir S CIw1r. ~ ',,"-r ~// () A~...o MIIIlbe;';"'M T..... LUiU .... MUll S S -- . ==- CftdnUllIon . r.1IOlIII- - - ~/ j oJ J...... - I\O~'I . S - Slit 1 Aftt.l~1Io u^ j6l.-i, UI Lt. .. - HolllOllold Re" . AooUoGI ~ - CUd cart IlMIda - 0 0lMl' - - 5aIMalMleel 11I- . Is S PlY TV I'IMI :to ki\ Q/A VlCIlloo - - "\~ 0ltlI 1lecI" . S $ ~ IIlIdIl rl ") ~,- 0nIl0d01lial ' C"" () .- tltnlISaI - - ~ foIMIcIat "'" 7.f~O n.....~ ~ r J .... /i.7)" ).a-r. s II...., __, qt.t (rt..y Total Wllllt MON'l1I YEAR - , ,)~'f n ^ ,...t"rl~ W ill APPCOpda_ Colllm.'1) " MONTH YB.Ut s S - ....... - () (> , S 0 "0 - . $ .. S $ JIl- e. ."",.J. s ~ ftTT4Ch, 1- ~;) -0 3 O.le ~... lof 3 $orvlco Type M Form IN.ooS Workerm ,'.' , . '" DATE DATE DATE 9/10/98 3/25/02 1/15/03 AMERICAN EXPRESS 3,875 3,675 3,875 AMERIOAN EXPRESS 2,024 2,0'.4 2,024 AMERICAN EXPRESS 4,325 4,325 4,325 DR, BERRY 776 775 0 JAMES JORDAN SR. 4,000 5,000 1,200 ATLAS PERLMAN BORKSON 3,854 3,854 3,854 THeRESA BARRETT MALE 0 3,153 2.430 IRA MARCUS5, (01/99 $5,000] 0 775 0 IRS '1,937 5,905 O' STUDENT LOAN 0 4,000 14,000 .. SEARS 3,288 0 0 VISA (MELISSA) 988 0 0 VISA 602 0 0 ASSOCIATES 5,439 0 0 CITY CREDIT UNION 11,522 0 0 PP&L 689 0 0 DISCOVER [MELISSA) 775 0 0 CAPITAL ONE 829 829 0"'" RETINA CONSULTANT 291 0 0 DENTAL 730 0 0 PAMll Y MEDICAL [MICHAEL] 108 0 0 TOTAL 46,061 34,515 31,708 ADDITIONAL EXPENses COMCAST MONTHLY 0 66 65 stORAGE 106 106 106 DENTAL 0 400 11.285 .... ORTHODONTIST 0 250 500 PERIODONTIST 0 600 1,200 TOTAL 1421 13156 'IRS Bill TOTALED $7,642 "14,000 NOT ADDEO TO SUM OF YEARLY TOTAL, "'CAPITAL BILL IN DISPUTE, CREDIT GIVEN TO MINOR. ....OENTAL WORK IS EXTENSIVE. NOTE!: INSURANCE MAY COVER 50 % OF DENTAL WORK. .' tJ JI' DEe 3 '2001 \. 205 E. Madison Mt. Pleasant, Iowa Deoember17, 2001 judge Edward e. Guido Court of Common Pleas Cumberland County Pennsylvania Dear Judge Guido, This letler is to Inform you that James Kayer is no longer representing me In the divorce action ourrently before your court. (Case 98-1841 Civil Term) I retained Mr. Kayer In January of 1998 and filed for divorce in March of that same year. When I moved to Iowa, Mr, Kayer stOPped working on the divorce; and I understand he has since stopped practicing priVate law entirely, though he never Informed me of this fact. I have obtained a copy of the Income and expense form you requested and am sending it to my husband in order that the matters of alimony, child support etc, can be resolved more easily. Please let me know if I've filled out any items Incorrectly or If there Is any additional inform!:ltion you need. Thank you for your time and consideration. Sincerely, cc: R. J. Shedday Theresa Barrett Male, Attorney for Defendant James W. Jordan :Pa, Code Rule 1910,27. Form of Complaint. Order. Income and Expense<::SR>Statement... Rule 1910.17. Form of Complaint. Order. Income and Expense Statement. Health Insurallce Coverale Information F"rm. Form of Support Order. .Form Petition for Modification. (a) The complaint in an action for support shall be substantially in the following form: (Caption) COMPLAINT FOR SUPPORT _._~~~:~~.~ at SAe:J~ ;10(Jo." . a..oS IE. ~1.sC)l\ ~~~~, (City) (Zip Code) Mt. fIU'OM, ::to. 5:tl,YI :~:~~ Plaintiff's Social Security Number is /-Ie.n';j CoV(\~ ,and dale of birth is SSM 18(, 'str 304:1 ol. ~",.,~ B r> .3 ...3/ . 4/ '1 2. Defendant resides at ~Me.s W. J'orJ()1\ .,yM...,.'''W.,."",,,",,,,,,''''''.''A''''''.',,, , (Street) (City) (Zip Code) County. Defendant's Social Security Numberis 31 ~. 5'1 S'\, S.3 . and date of birth is 5-'-1./9 3. (a) Plaintiff and Defendant were married on , (Date) at aU5\lSf I-'J I ~1'1 Oc.-I1lIitl "'ie-h', 9'l" (City and State) ..,'....,......."...,,,,,.,,, (b) Plaintiff and Defendant were separated on ~M. 111/1912 (Date) (c) Plaintiff and Defendant were divorced on ,'."".'" - Pa. Code Rule 1910,27, Form ofComplnint. Order. Income and Expense Statcment,. Page 2 of 16 , ll'l (Date) (City and State) 4. Plaintiff and Defendant are the parents of the following children: ",~IJ." (a) Born of the Maniage: ").uS ~Il$./ltl 1-. Name Birth Date Age Residence )'\t. ~~ loNI'" J.(, U. of IoIlJ(Jo - (Ju'i" {,./..Og' J.f."'} M /f\1'....t1t. ,1..'1"1 "I.oi;"/IS,,I. ~~~t '';I#/~'--:;''--'"-'"-"""-,--,~--""~""""""""~"-,,,,,,,,,,,,~...,~...~-~~,~...._....__.....- ~~~:~~:t1::s"}l--.._~(i&-6...~~....."hr.~4S4.~.~~~ ti~;:tJ~~:;: (b) Born out of Wedlock: Name Birth Date Age Residence '............"""""""............. .---....- .............._-"""--....,........................... ,.............-- "'''.""...,.........''....".....""w....,...,._.,'...w.,...........,,.....w.................."',....."........"'....""".....'w............"._........"..........."....".....".........."',....."'......,...........,,.."..._'....."""."".............,.. ~"""''''''''''''' 5, Plaintiff seeks support for the following persons: KaJie, j'.,J,,,,.. - qfF /(, . SopHJHre. i" /-li," ~, 6. (a) Plaintiff is (not) receiving public assistance in the amount of $ per for the support of AJ 01\<<- (Name(s)) (b) Plaintiff is receiving additional income in the amount of $ from No,,1l. e!<<t'~ c:J,:1II s ...""t - ::Jill\. ...'.M...._... I.J Hf. ", /r>Dt\-H. J;"c.e, ... 01 000 ........ 7. A previous support order was entered against the defendant on 1/-4rJ. ,f Sept Jf9t ~~~~~~~t Caud of CO""...." PIe. S Cu...j,ul#...I Co.."." t'tM. in the amount of (Court, term and docket number) OrtAu ; ,,,~ oS , i ~- PAC.~t.S Cc.",: 3S~/003~1 ~~~~~~ support of J(o.J. ie j., t4" O-l-#er Slrdt J..D 0 .. ;n '05 . There are (no) arrearages in the (Name) - . I .;,.S ~afk St.A/port re.tA..ct" '.., ~OO" in JV\. .lOOO - (11;" .~(#~. ~~'~~.1' c./'()f'1U) ~~1or,; wet,t~ ..I~~.l Pa, Code Rule 1910.27. Form of Com pi III nt, Order, Income and Expense SIMt'ment,. Page 7 of 16 -f" (', -r-/IIi\, i..s. J- Co. ,.,~ "....~J. ",,,,, -.---.--. ---'rr-..v----..,.....J>o\ .; .....l/\IUr' .'''''.......'''..''''''''.''''''.'''-....''''...__...''^'_..,_..''''......"...'''...,>V .~' Health Other Automobile $ $ IOOIJ. ":i (i:'....,.. --__ __.:..it ~_._CL,) "..........,,,........,..,,,,, .."..5.Q".I!.~,~.., ,,,,,...,,....,,,,,,...,.,.,.. .... ".....,......,.....,..."...." ,..".41,Il.."...".....,. ...""..."".,.,.......,.... Payments Fuel Repal rs Medical Doctor Dentist Orthodontist Hospital Mediclnc Special needs (glasses, braces, orthopedic devices) Education $ $ $ ....,-....,..........."......." ..".,-..."'.....'''...,..,- .",..."...".."",....... ,.,.....""'"..................' "..."........."'............... ...".........."'"...............". M',................,.....'-'."''''''''''......''''''''-''.......'''''...,...w ...v.,.......,._.....""'"',"'''''' ......_..........."""........ ...\W......,......,...---.- ..."""''''''''''..._..,..... ....""....................................w """""'.,,,,"""',..,..... ....."""......."'.........,,, .......................-..."'.........., "....."..................,"'",..... ............."".....................".... Private school Parochial school College Religious Personal Clothing Food Barber/hairdresser Credit payments Credit Card Charge account Memberships Loans Credit Union $ $ $ ,,,,,"',,......"''''''''''''w ."'VI.................."""",........ ..,,,............,,,,,,,"""'",,, --- ..............,.....-..."""""",.............,..,.........""'................,."'.."............................... ~ !...IO:;or $ ~ w,"'"...,",....,.,...._.".........,"'''~~~._,.._._"."''''''..\'''_.,,'I."""".... .' '."..",."'v...................." ,......Q.,Q,...."',......".. "',...."."...,"'_"..,..."', - "...."'....'..'..1'_.'_.."'.,..............""'...".,...."'.,...._'W'''''','.''.''''','''''''''' .... ,.........".....,,,,,.....,.,.,"'............,,,'.....,......,'..,,,....''''''''''''''''.".,-".'' ....-. ....._--.......... i ~ (,u}U .>> I.. Mil ,. rf'P .;.lVl ,I'J' ~tlrt' r-j ~~; t ~~~f~.,.;J Dr- I I .~ .w~", "Si'" U"" \II "..",,, \..g,( elf (1 \4& s\...~c. I .Q6,...i~ f '"1 50 \ . t'llf"" .-..-.--.. . -::.._~-. -'-,-J,..e I~ ~O".....~ CO Ileat..loQl\S "(, Mr .. u ,'" , Oo"i~ I~S 1M""" J $ $ $ ,.,..."."'.....,.........",, ."'''1..........'''....... ....u,........,............., - --- "".............................,........."'" --...................--, --............................ ......".h.t..<<..'.,..''''.,. ............,..,....,...".,...., "....".........."..,"',..... ....".......,...."',.."....... .......""......~,,......... --- Miscellaneous Household help Chll d care $ - $ $ .....W;....._...,"""".._."'_ ....._'lOo.".......-,..._.. _ . ." ....-. --.......,......,...-,..,.."'''''''''...-...-...... ..............-- . Pa. Code Rule 1910.27. Form of Complain I. Order.ll1come and Expcnse<I3R>Statcmen.. Page 13 of 16 , . coverageo\Vithin 30 davs after the entry of this order, the (PLAINTIFF/DEFENDANT) shall submit to the person having custody of lhll child(ren) written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum, of: I) the name of the health carc coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on Usagll, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet OJ' coverage contract; 7) a description of all dedllctibles and co- payments; and 8) five copies of any claim forms, IMPORTANT LEGAL NOTICE PARTIES MUST WITHIN SEVEN DAYS INFORM 1HE DOMESTIC RELA nONS SECTION AND THE OTHER PARTIES, IN WRITING, OF ANY MATERIAl. CHANGE IN CIRCUMSTANCES RELEVANT TO THE LEVEL OF SUPPORT OR THE ADMINISTRATION OF TIlE SUPPORT ORDER, INCLUDING, BUT NOT LIMITED TO, LOSS OR CHANGE OF INCOME OR EMPLOYMENT AND CHANGE OF PERSONAL ADDRESS OR CHANGE OF ADDRESS OF ANY CHILD RECErvING SuPPORT. A PARTY WHO WILLFULLY PAILS TO REPORT A MATERIAL CHANGE IN CIRCUMSTANCE MAY BE ADJUDGED IN CONTEMPT OF COURT, AND MAYBE FINED OR IMPRISONED, PENNSYLVANIA LAW PROVIDES THAT ALL SUPPORT ORDERS SHALL BE REVIEWED AT LEAST ONCE EVERY THREE (3) YEARS IF SUCH A REVIEW IS REQUESTED BY ONE OF THE PARTIES, IF YOU WISH TO REQUEST A REVIEW AND ADJUSTMENT OF YOUR ORDER, YOU MUST DO THE FOLLOWING: AN UNREPRESENTED PERSON WHO WANTS TO MODIFY (ADJUST) A SUPPORT ORDER SHOULD (insert instructions for local domestic relations section). Al.L CHARGING ORDERS FOR SPOUSAL SUPPORT AND ALIMONY PENDENTE LITE, INCLUDING UNALLOCA TED ORDERS FOR cHlLD AND SPOUSAL SuPPORT OR CHILD SUPPORT AND ALIMONY PENDENTE LITE, SHALL TERMINATE UPON THE DEATH OF THE PAYEE. AMANDA TOK Y INCOME A TT ACHMENT WILL ISSUE UNLESS THE DEFENDANT IS NOT IN ARREARS IN PAYMENT IN AN AMOUNT EQUAL TO OR GREATER THAN ONE MONTH'S SUPPORT OBLIGATION AND (I) THE COURT FINDS THAT THERE IS GOOD CAUSE NOT TO REQUIRE IMMEDIATE INCOME WlTffiIOLDING; OR (2) A WRITTEN AGREEMENT IS REACHED BETWEEN THE PARTIES WHlcH PROVIDES FOR AN ALTERNATE ARRANGEMENT. DELINQUENT ARREARAGE BALANCES MAYBE REPORTED TO CREDIT AGENCIES. ON AND AFTER THE DATE IT IS DUE, EACH UNPAID SUPPORT PA YMENT SHALL CONSTITUTE A JUDGMENT AGAINST YOU, IT IS FURTHER ORDERED that, upon payor's failure to comply with this order, payor may be arrested and brought before the Court foJ' a Contempt hearing; payor's wages, salary, commissions, and/or income may be attached in accordance with law; this Order will be increased without further hearing to $ a month until all arrearages are paid in full. Payor is responsible for court costs and fees, Ther.sil 1I11rr.1I Mille Suprellle Courlll 46439 513 North See",ul Slreel HlIrrlshurg, PA 17101 (717) 233-3220 Couns,,1 "'r Defendant COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA SHEILA JORDAN Plaintiff v, NO, 98-1841 JAMES W, JORDAN, JR. Defendant CIVIL ACTION - DIVORCE PROOF OF SERVICE I hereby certify that I served the Notice of Intention to Request Entry of Divorce Decree . on December 26, 2001 upon the persons and in the manner indicated below which service satisfies the requirements of Pa. R.C.P. 440: Service by certified and first-class mail addressed as follows: Sheila Jordan, 205 Madisl'n Street, Apartment 101, Mount Pleasant, fA 52641 Plaintiff Service by first-class mail addressed as follows: James J. Kayer, Esquirc, 4 East Liberty Avenuc, Carlisle, PA 17013 James 1. Kayer, Esquire, 1913 Deer Path Road, Harrisburg, PA 17110 Date: January 3, 2002 $ut~/:J(lztr)Jtt~ Theresa Barrett Male, Esquire Counsel for Defendant MAK-,b-,UU2 MON 02:4U PM , ' FAX NO, p, 02 " , . In ... CGll... of Ctmmon PI... or COUi1t)1. '-1ItJM"" ~c lleuno,"" .-cI10N " , "'~..'." , t., ' .... "1.-1, I'"", PI.llltlft Namo: D.fendanc Name: DockOl Number: PACSBS Cue Number: I 0dIer Slat. m Number: .....-. AIl..,r~ .~u _........... .""CIU c.. ......... I_a lall ~ Slat-~ THII POnt MUST liB "/LUll) OUT (It JtII .. NIf.4lIljIIoyt4 or If JOlI It, NIarted b, . bw_ of HioIh ,OU 1ft OllDlr 1ft *1. or,lI1. YOIIIIlM aIIo AU OI' lbo SuppItMlftIll IIICOIIIt Swemcm wlllclllpplUf 011 ,.. IWO or ell,. 100l1llO IIICI tlIpWt . ;=~~TlMBNTOP ? Imu; ~ IV. J Oh ~CLh J fl ...... I: r~ .... .... ........... IJtlC&CIa ..... ""'" "". , Tnt...... 1" sv' .~ "",.tle._~ a...,.,,,,,,,~. , a--nl(l., 11. IS V - '. C' ..... (wtiJ" ......,....~ ~I"'F~, ,,~ .... N_ .. pit'" ...... OJ $". J.( ftOfII.1'Y hw~. OWNID DUCaImON . w- I - - ..- ~-- --. ...... ~ - - - c..... UN '- ........ ""- - - - ..., .... - - OIlIer - - - - TOT.u. I~ ~) , 7~'^-I · H.H.......; 11/.9011.: I..Jnfnl ~ tN.ooI \\I.'.....ID - - - - -- - - ..... - fOTALIHCOMI. c> ~1c.TrJlI ... MAR-25-2002 MON O~:40 PM FAX NO. p, 03 I\)~'. ()]Jo..~J f'v-y- ~1u1,::r;~ (L~ JrI,/, /"..{J 3 ), j 71 7 ~ ~ J t c~;,( d -Pi" "", C l'cJ M J4"1 ~~ . blcollll .. ...... SI.-.. MClIS CaIe NIIlIIIlIf Iecd.. WI ~r--"- IMtnIIIiNI: OIly llItw .~lIIIY ..,..... II 11I11 .... ... ,. liIIe4 011I.... a ..... lllV, TIlt MIllO"" II IOU) POH'l' 1It...._ ..'_ 1M CIIclIlallIlt .WIiI...,.,n. .t)Oll UlIWlI\II'" ..... SwlMIIAPL or It )'Ill utili,. _ - N _lUIIIIlltf4ll'll!Dt "die ....... .... or -...... ... -- ... 11;..., ..rqllll., - ~................CMotl IWY'iIHIIlI WIIIt MONnI Y&U - I' . v^f/. .m;q t - ,""..... - r=- -, It It ...,... ~ - - ... - I"~.'" ~; f1'(1 1:1 .. -. F . .~1Ji: - :tJ.r' I...... 1l4It_ . _. I- -- --- - 1':::\ . . . 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'." ;\.~_\:.,\.~,~d~~;:~:,~'lt::'..,,_..:. '.-' "'. ":'i'I""~ '. .,', .'.- ': ";."I;:.'J;",~'" .:""",:.' -": '.-'. ':jj.!,j, ,:,.; ", ;"', ';, }.....,-. :::0"11 to/, l7,,, .r 0/'11. "/,L ...... a "", 011 ....~~. (l,Olj ........... Ill/Ii' hI\! I"" "'t. (/) -4 t I'''c. "1't1}" "/01 C, _ ~ O/~ '/Jft. '/ v "O(f C1d. ,.)() ""p. 01 '/JOll f) 1'0111 Iho Dol.: 01111. "'Ill" hIlt Oil 'I1101J. '1/10 '1'" "'91111 P, . C"0It. " k,,1. e /9/ 0< . ~ /-' 01: " J/,c ol11pl. . /11111 .Dt~ et; " "co 'IQ, "Il 'l/dl!J -tPe O/'~ Col<e'; P/~POb_ I ~~ '''fili'''<i, A tJ"SIIlI:~1} 1iI1r1 ~<tIl1fili' o Po. 'I11e/1 Ihlll 11I'o /'t>v. J>/~ "'II" t IIl'e lite ~011l "e.v. 'lttl/fr fio" irQ "lilt. el111 'Is lit O/' 1/11,,/111"11 0110/'111/1 ......... P/I Co t" ChI/. 01'11. ......... 'Q/~'''c 111/i11. rill: el'h "" "-~' I " 'J" Oy " <0.. "v, ",...~., .. '"' .." "''''Q - "~ "",' " "'-- ., '", v~ " ' 1'8 '<I -0 ...... Il . '" r.. "- '" 'd ~ "PI. ""6"'" "...... ...:::;:..., '-~ to 'f';;'" 1, '" "c.. a' ... .. -.:::;.. .. ","'... ..... .... J" "1)j .,~.. "'" ,-'" ,.".... ... " .. "". '.. . r~ ..... ""- iii" ". ., '" ""'" d '. (e ... 4 to _. -'7c '-,".. ,... ~ '<>t '" ... '.. to 6 .... '" r.. · ',- -", ". '.. '" 0.. Oy , fh, :.... ".. ~'" ,,"-, f" "" · "- '~, '." 0< .. %, '- ,,, ""'.... '" ". "'" .-" ~ " --.. ., "Op " " ."., ',"" '- '... "" ," ,,-" eo" '{rib fh,. .ro.... ""-. '" 'C1,,~"" 1\'... !f>..., 'l>.. % 0, ""- fo ~ ,'" " ." ." " ..".... or,. ..~, "- ~ ''''. '...... ""'- :..,.... 'PI.,"" ~ '- .. 'Of ~,," '> ",'" f... ",' .. c '- or "."" '..... . ,~ ~' or 8IJIJ. .." ~, ... ~ ..' "', ~ ~ ... "'" ..... ~ Otl. ""'0 '11 tli" '<:7JJ> <t":"s. "'16/11 0111 '" A "'ke Jo/, /(f . . '. Pa. Code Rule 1910.27. (0'0. JfComplalnt. Order. Income and ExplJ Statemen... Page 13 of 16 coverage. Within 30 days after the entry of this order, the (PLAINTn1F/DEFENDANT) shallaubmlt to the person having custody of the chlld(ren) written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum, of: 1) the name of the health care coverage provider(s); 2) any applicable identifioation numbers; 3) any cards evidencing coverage; 4) the address to which olalms should be made; S) a desoription of any restrictions on u&age, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and ('.0- payments; and 8) five copies of any claim fomls. llMPORTANTLEGALNOTICE PARTIES MUST WITHIN SEVEN DAYS INFORM TIiE DOMESTIC RELATIONS SECTION AND THE OTHER PARTIES, IN WRITING, OF ANY MATERIAL CHANGE IN CIRCUMST ANCESRELEV ANT TO TIlE LEVEL OF SUPPORT OR THE ADMINISTRATION OF THE SUPPORT ORDER, INCLUDING, BUT NOT LIMI1ED TO, LOSS OR CHANGE OF INCOME OR EMPLOYMENT AND CHANGE OF PERSONAL ADDRESS OR CHANGE OF ADDRESS OF ANY CHILD RECEIVING SUPPORT, A PARTY WHO WUJLFULLY FAILS TO REPORT A MA'IERIAL CHANGE IN CIRCUMSTANCE MAY BE ADJUDGED IN CONTEMPT OF COURT, AND MAYBE FINED OR IMPRISONED, PENNSYLVANIA LAW PROVIDES TIM T ALL SUPPORT ORDERS SHALL BE REVIEWED AT LEAST ONCE EVERY THREE (3) YEARS IF SUCH A REYmW IS REQUESTED BY ONE OF THE PARTffiS, IF YOU WISH TO REQUEST A REVIEW AND ADJUSTMENT OF YOUR ORDER, YOU MUST DO THE FOLLOWING: AN UNREPRESENmD PERSON WHO WANTS TO MODIFY (ADJUST) A SUPPORT ORDER SHOULD (insert Instructions for local domestic relations section), ALL CHARGING ORDERS FOR SPOUSAL SUPPORT AND ALIMONY PENDENTE LITE, INCLUDING UNALLOCA mD ORDERS FOR CHILD AND SPOUSAL SUPPORT OR CHILD SUPPORT AND ALIMONY PENDENTE Llm, SHALL mRMINATE UPON llffiDEATH OF niB PAYEE, A MANDA TOR Y INCOME ATTACHMENT WILL ISSUE UNl-ESS THE DEFENDANT IS NOT IN ARREARS IN PAYMENT IN AN AMOUNT EQUAL TO OR GREAmR TIIAN ONE MON'IH'S SUPPORT OBLIGATION AND (I) TIIE COURT FINDS TIiA T llfERE IS GOOD CAUSE NOT TO REQUIRE IMMEDIATE INCOME WITHHOLDING; OR (2) A WRITTEN AGREEMENT IS REACHED BE1WEEN TIiE PARTIES WIDCH PROVIDES FOR AN ALTERNAm ARRANGEMENT. DELINQUENT ARREARAGE BALANCES MAYBE REPORTED TO CREDIT AGENCIES, ON AND AFTER TIm DATE IT IS DUE, EACH UNPAID SUPPORT PAYMENT SHALL CONSTlTUm A JUDGMENT AGAINST you. IT IS FURTImR ORDERED that, upon payor's failure to comply with this order, payor may be arrested and brought before the Court for a Contempt hearing; payor's wages, salary, commissions, and/or Income may be attached In accordance with law; this Order will be increased without further hearing to $ ,-,.,........ a month until allarrearages are paid in full. Payor is responsible for COllrt costs and fees, , Pa, Code Rule 1910,27, Fl ofComplaillt. Order. Income and Ex". .;e Statemen", Page 15 of 16 . . unsworn falsification to authorities. ,n --- Date Petitioner (g) The order to be attached at the front of the petition for modification set forth In subdivision (f) shall be in substantially the following form: (Caption) ORDER OF COURT You, - , Respondent, have been sued In Court to modify an existing support order, You are ordered to appear in person at on -.......'" at -- ,M" for a conference! hearing and to remain until dismissed by the Court, IfyOll fail to appear as provided in this Order, an Order for Modification may be entered against you, . Y QU are further ordered to bring to the conference (1) a true copy of your most recent Federal Income Tax Return, Including W-2s,as flied, (2) your pay stubs fol' the preceding six months, (3) the Income and Expense Statement attached to this order, completed as required by Rule 1910.11(c), (4) verification of child care expenses, and (5) proof of medical coverage which you may have, or may have available to you. THE HEARING OFFICER MAY MODIFY OR mRMINA m THE EXISTING ORDER IN ANY APPROPRIATE MANNER BASED UPON TIlE EVIDENCE PRESENTED, Date of Order: ......."......" J, YOU 1M VB THE RIGHT TO A LA WYF..R, WHO MAY ,. .."", '101 ............ " FOIm 1 Lalatl 4100"'-"') UMlhe ......... 0ll1~, pi.... Pllnt or \YIM. .......1Ie4IlIIl -~ flUng StItuI Checll only one box, btlllflllolUl II moo" lhlll .Ix C!tPtndents, _ ioSIrlldJClIlOl. InccmJe =B ....Al..1ItIch '0I'llI(e)101NtIl lu w.. wlt1hIkl. 1f~d1dno\ alit . W.2, "I rnm..:tJoos. EncIO.., buI do not 1IItecl1, ""y peyment. AlsO, PI_ use F_'04O-V. A41lSted Qro.. Income ., 1l~,~<,,:~'''''\I lll~ 111/1 ItV, i I VC./!! 2001 ,1OO1:lftdinQ JORDI\N. 111. LM'_ I~ lRlI.....~- 00""...110... 1ft... 20 lM 116, lMl<lOl. -............. 72-54- S --'.-.....-- 486-58-3062 ~'-, No, 1ft!port8ftt1 . You m.... enter your ....1.1 ..curlly number(s) above, _ AlIi.... (_.... oholj. If ViN How. P.O, B.., 'M ,__. 9 DOGWOOD @Vll.bING ._ atII, T.... Of Poo1 011Ioo, "Vou _. F...... _"', eo. ""_ IDDLET If 14 .n ZII' Codo PA 17 51 .. Holt; CllecKng ''(u' will not change yOur tax cr re(kjee )'OUl' rtf\Jr1d. Do 011 or _ Ilfli . o,"t reun want $3 to Qll to itlls fIM1<1? .. . .. .... ... 1 Single 2 MlrrIed ftllng Joint rmn (awn It only one had Income) S M",'led ftlillg separlfe r.un, Enw spous.'. SSN above & full name her. ... ... SHELI~ J JORDAN ~ " Helld of hOLllllholcl (with qulllitjlng ptlllOn), (So. inn-uctlol'lll.) It 111. quall~g pll'8on Ia . chllc\ but not your dtpenden~ enter ttlie child's".". her. ... I au'lI I wiClO er wi1l'l endent chllc\ ear OUH died . . I. InstrUCtiONl, '1 ~:::"..~.r~~'~I~~, ~I.S,~), ~~,~I~~ ~~ ~'.e,~~~~~~,~t.~~.~I~, ~,...} ~... 1 b ,......,....,....,....."'(i)""......f~. "(i)~'~~;:~"....~ N =-= c DtpIIodoonlII: soc~ty "I.gonshlp ~ '_ number to you ..~ _", ,.", m FIr.t naml last nlme - . tU... t:"ft:.. r:..-=r ' , lI~n'~. ::.::.r'_ . 'ihollll runber of e~emp"ons clllmed ..."..",,,...,,,,...,.,,,.,,.......,,,,,,,,,,,,,,,.. 7 Weges, ..Ialles, Ups, etc. AIIIoch Form(.) W.2 Of. C.,,47.69 . , . . . , , , , , . , . , , . , , , , . , , , . , , . 7 e.TllIlIbCelnt"llt. ,,\tech SClleO.lie 9 ffrequlred..,...............,,,,,.......,,,,...... . b T~ InterlSt, Do nollncluae on line 8ll ,.."...,.,..l.!JL F'~<I': . 0r<:llnIry 1II'<1dends. 1'._ Scht<UI 9 Illt<llJlr6cl ........ .. .. " " , .. " .. .. , .. .. .. .. .. , . 10 TllXab'l rlflrods, ortdlls, or off..ts or atall .ncl local Income taxe, (pe Int1YuOUons) ..,., 10 11 Allmonyrec.lved "..,." ,,,........,,..,,,, ......"."".., ..... ."..." ,,,.. ,,,.. " 12 ~lnccmeor (1011I). AttachScIloduleC or C.EZ ""....."....".",.". ",..., I IS CIpl'-'lIIln or (Iol$), AItacb Schldull D n ",!uirId, "not roquirld, chick'*' , , , . , . , , , . . ... 0 3 ,. Olhtr gains or (Iosse.). A\tach Form 4797 . , " . , .. .. .. .. .. . , , , .. .. , .. . " . . " .. .. .. .... , ,.. TotIIllAA dka1rlllu~OIIll "", l.JI!l. _ ..J b Taxable amoLl\\ (H.lntlre) .. , It 1.. Tota( penelons & 1IV1Ulttes . O!!I ----:=J It Tlll(able amOLnl (ael Inslrt) " 11 17 Rllntal ...1 Illata, royelUes, plVTlerllhlps. S corporltions, 0'US1I, etc, A1Iach Schedule E " 17 ,. Farm InCOIM or (loa). Attach SchldUle F "",,,.....,,,, .. " .. . " , , .. " . .. . . " . " .., ,. =.=~=~~mp.~~ItIo~,...".,..",..... 'j b ';'~~I~'~;';~i(~~'~j;.)':: 'It ~*~ ~ ZZ Add the emou,iiil 'iI. iir-'llCO~l;';ii,;e;f tii-- 2;.Thla-rs- - - iG4ilinCoifn. -... ZZ 2S IRA deOJctlon (see Il'll>lrUctfons)"..".".""." ,......." 21 I': '. 24 SUlent 101l'llntoleet cleductfon (He ins\nJCUOI1I) "" .. .. ... 24 ,: 21 Archer Mal'. dedUCtion. Attech Form lI853 . , . , . , , . . . , , , . , . " 21~~j\ at .. '11 'It F ... ,','" ",0 ngelCptl18U.... 8ch ormS903."""....."...".", .. ,Ilh 27 One.hall ol..lt.employmlnl tax. Attaoll Schedule SE ,.. . , ., 27 . 1m, 28 S.lt.emploYld II.81th inuance deducHon (oee ins1rYr.tIons) , ,. 'llfl 21 Selt.emptoY'd SfP. S I"''I.E, 11I11.1 quallfted plans, . , . , , , . , . . ! so PenellY on eWlY wl9'ldraW1l1 01 ,.vil19' ' ... .."...."...", so SII Alimon,peklltfllcipilnt~ SSN "., .. _____ " 1\. . 32' Add lints 23 \tlrQugh 31a ,....'.,.., I.,., .. , ., ,. , , .. ""'" " ,.. , ,.",.,.', ,." ,., t., ." , IS S~ractllnl32l1om line 22. Tllla Is out' ad ~..."."..""."". Pt1vKy Act.llI'Id l'1l*WCMk AeducIlen d Nollce, _~. .1 3 '. J^"ES W JORDAN. JR -- 1Z-S4- 6S3 P M Amo\l'llfromllne~(~grOlllIMOm') ....""......"."...."........,,,..,,. 54. ~ 61. .a Ch,Cl< II: 0 YOII wel,!Wolder, OSIInd: 0 SpoIIN - 65lolde" 0 Blind, i:i]~j,~ L Add 1M I1\W1\btr of bOX" C/1ec:lled IbOveene ,nter lIlelo\lll here, , , .,., ,.". .. lIia '.:;./- bll ycu we mttTl,rl fillnO ..~ately W\Cl yrr.IlpllUtIllem~ llerluctlons. 0 ,'tl~~ Of ycu wer, a pl.alallA allen, M' los1rUoUO(lS and C/1eeK here. . ,. ", ..,., ." II" ~"'::i,i, .. ........11II r'(mSehed~ItA)lIjC1lr............(..ItttIllllQi.) ,......."..",..,,, 31 rn Sub1llll:lllnt 36 !rom line 34 ""..........,,,....,,,,,,.,,....,..............,,..,,. 17 , :'" . II line 34 It 599,72S or leu, [l)UllJply 52,900 by Ihe lolal number 01 exemptions clalmld ' .';; I. on lint 6d. II lint 34 Is 0"'" $99,725, ... the Wor\<SIletl in the Ins1ruetlons . . , . , . . . , , . . , ., ~ .. T.... ___ SubtrlCl lint lIltUm II.. 31. "11M III1I11Of' u.n lint 37, enllr.o. ,.. . .. .. . . , .. , . . .. . .. " , .. .. . . .. , , .. .. . . .. .. , " .. . . . " !It .. TU(...lI\Itrl~ OlIok II 8I\Y tall is 110m a OfOf1l1(I) 1114 It DfCl!m 4912 ,......".........,,'" .. 4\ Il\ttmlIlM IIIlnlmIMII'" (see lns1JUctlons). Anach Fenn 6251 ............."..,,,....., 41 42 Add line. 40 and 41 , .. , , " ....."" , . . , . ... , . , ... . .... , . . .. , , .. .", . . .. .....", . . .. 42 G FCf.lgn \IlX credit. Attach Form 1 I 1611 required, , . . , , . , ' . . ., G \).~~:! 44 Qtdillor ctIlld ..d dI\lIIldlnl"".- ~h form 244\ ..."..... ~ ~~:tf,. .. Crerlll 101 lh' elderly or 1M dlmled, Al\adI "'eII.dulo A , . , ,. 4Ii "(.',:!,: ___ -A-F - - ~I~ _ ............01'1 <<."'... ,,~I orm..,...,.'.....,.,..........., - t: 1''( IrI Rate lerlUC\lon credl\. 5., 1l1. wCII<Ah'" ,......",..,.,... IrI ~;:Jm il8 Cllild tlIl< <<.drt (se. Instructions) .. .. , . . " , " , .. . . .. , . . . ... 48 !f:';!(': .. Adopijon crtdll Attach FClTll 8839 . . . , . , , . . . , , . . . . . , .. . . , " .'}~)\ 50 O'.hIlendll1l",," . 8Form3lOO It Oforllll3'lll )~\:ij :"Y c 0 form aIll d fOlm (lI*\lly) _--- 50 \1'.'; 51 ,\ddlillM41~50,ThUOII'jQUrl.taludlh "..,.....,,,..,........,,.,......,,,...,... 51 12 Subnct lint 51lrom line 42, I1ll1'1e 51 Is mor,lhen line 42. .nllll .0. '-'-' ' ."...,." .. .," 11- II S,".tIIIPiClll'll1ltu.AllaC~SdlId.ItSE......................"............"........"..... IS 14 Sodal..urltyI!ldMld~lrttax."tipl_1lO1 ,tplH1tlllOtIIlp1ojtl, AIlIC~feIm4tl1 ".".".,......, M " Tuon qll8l"1td pill", includlllO 1RAJ,.1Id oll\el tal.-Iwoltd ICCC4lftlt, A\lJCb ferm 531.911 requirlll..... , , , ". iii 16 ActvanCuomod ~ome <<edll p.ymonllllrom Form(') W.2 ." .. .. .. " , .. .. .., ..,,,.,, .. ", Household emplOyment laX", A\\aC/1 Scheci.lle H .." " , . .. . .. " " .. . .. .. .. . .. . " , ." rn III MilIInoa S2-57, T~1a II youl totll bl " .. .. . . , . .. .. " " . .. .. " " .. .. .. .. . " . .. .. ..'" , .. . ' ... lit Fader", _.laX wtthhelCllrom Fcnns W.2 end 1099 , , . ' ., .. 1 4 10 2001 estimalllll8l( ~ta ani! 8I1IOll\lllllPlicd frem 2IOl ,*,m , . . ' , , " to _ 1l.!."...._.CI'IdIt(ElC).......''''............''....'' .1. I 12 tA :=:~I::':"'~~ RATA ;'x'wt~held (st. \rl5trO) ",lcU'i U Addillonel child \a)( <(.drt. A\1aCl1 Fonn 8812 ,.,..,."..,'" C3 " MlooIftl paid ...11I ,,,,,*lloI_101I bllilt (lit Iftttrllctl'll\$) ." . , , . . " .. . Olhet paym.nls. Ch.Cl< Illrom . . , . " 0 FClTl\ 2439 It 0 Fenn 4136 ....,,,,..........,.,,,,.......,,,....,' is Ie Add lines 59, eo. 61., end 62lnrolJllh 65, Th..' ore YOUI' lllW~ ".."..."......."",.,........,..."..."..."............,',..... Ie ff1 "1I1101611_\tIIII \lnaSl!, tlIblraclllllO!i8ltUm Illlfl6, Thlllllhtamooot"""'''.'''''''' ....,..' " ..AmomloIlN67 you WlI'I\NlundtdtoYOU ",........". ".. ,,,. ......."".....".. .. .. ItROUIInIIlUllber ..,.... .. c Typo: 0 Cn.c\<i1ll 0 Savtngs '.<,. " .. d lb. I~~' ~fI. Act.rM\ num er ,., . , , , I, '{IR' .. An1Qojftlollin.67 I. It ....... ."'.,....lit ?;~ri 70 MMI,.. _ suwact 11110 66 f10m IInllt for del8JIs on IlcNt \0 pay. lit iftstnlclloN ......" .. .. . ,," 70 7T Eatlmaltd \IlX penallY. A~ jnclude on line 70 .".", , , , ,. . 11 ~'i' ,', Do "" WIt blllllCOllll\O\tllr \)IllIOII1O dltCllll III1s ,,11Im willt ilia illS (lit inllNClIonl)l , . , . . , , , , Y... Complete the fallowinG. _'. .. """"" p_IlIooIlIcalI'" _ No." . -~= .. = ~l\:U-.t:Y..:,~::~~~':c~=..~~,":,(:::,:::;l;"-=::~ ':l"J:t.~~~"'~~~~. v.. eio1lND 01. ~... 0..... ~ ",-- . XECUn pIIlECTO" 7 94. 4 0 ._...~_.IIIJol.._,..........Itn' Do. ,........~..... v,', ~ ~ Dolt ,..,...... tIM Of .."...... , ... .--" F~ 1040 a.oo 1) Tu lAd CMCltl ~ Ief- . peopl. wh9 chedl6Cl flTY bOX on line S5a0l' 35b ot.....o cen o. c:ta\med II a ~8ndlln~ - ~iItrvctlons, . All o\h.r.: SInGle: $4,!I!IO Heed of hOllHhold, $6,650 Married ~lIng =r~ wlrlolli(.I'l. $7,liOO MarrIed ~1!1\9 .~.tely. Oth.r TIl\lU FWllm 11110101 Rehlnd DIrect de\>Oalt1 s..IntMona and all In 681>, 680, and 68<1. - Amount You Ow. ThIfd PIlty DeIlgnM SIgn ...,. Joinl r.\lm? S..lnItructIClr1lI, K.ep . copy lor yM rOCCl'da, 'lid '''P!I''!r'. OM Only ,,,,,,,,,., ,~.~ -..- ~~. CNoiM. - Slllf::.~reD.rer;t IJH No, ,. .. .- 1~. 243-: 122 4 . 11,547....., - t"'._"".Mlit"'Wl" Sdtedul. C <F_1NG1 ~~ (99) _."...- m1ES W J!!~.DAM. JR_ _. A ~--.._,lncWIlt'_.._('MtInl_) SALES : A"WAY __, 11.....,.....__, L_'~'" Profit or Loss from Business <hi- ProtHfelonhlP) ~ I'M'lIIIfthIH.loInI VIt1lI.nI. eec. mutt m.,_ 1011'-or FOl'1lI ,.... .AIIKII..'_1001ll1i1r'_1G41... "'/MtnlClIoMk1rIclwlMeC(l'_l040~ og _ ...., ....../l1lO 72-S4. 653 . ___'-A - ~ 45090 ~I)__(QI).NA" .,. No, IIMI<lOU 2001 c _.,--- E ~~~~..'::'"~~d J_Q.oJ;~Q.Q1U!.lLIJ,P'~~_ _ __ _ _ _ _ _ _ d' _.. _ _ _ _ _ _ _ _ _. _ _ _ _ _ _ _ _ _ _ _. , ,. 111DDLEOWN. PA 1 TODe ' Accounting m.lIlod: (1) gJ CIlIh <%) Accrual (8) OIner (sp8Ql1y) ~ _ _ _ - - _ _ .. _ _ _ -_ _ ,. _ rer _ _ _ _ G Did you 'mllerllllly pll1tclPllt.'In lhe OjMrtUon ot lhls bualrlOA lNrIng 20011 It 'No,' "eln~OIl$ tor limit on 10.... ", ~ VII No ~'let1tQora<<tJlt'tdlh\abUlln_dUllng200\, chlcl<h.re .., .............. ....... ..........,....... ,.........",....... ~ IIK*nt ____ 1 Qrou receiplll lit HI... CIullO!\. It 11111 InCome 1Va, reported la you on Form W-2 Wld tn. 0 'S1a~ einplO'f',' box on lIIet form WIllI checl<ed, ... \he Intllr\lCUons an<l chec:l( here .,.......,..., 125 . 2 Retumslllde~ ....... '''''''' ................ ,.... ..""....,.,.' .........,...........".". 2 S SLblr.ct line 2 tram line 1 ...,.....,.............,....,.."'....."........"......,,................. S 125, .. Coe\olgoodlll.,d (from line 42 on page 2) .....,.......,..,......,......."..."....,.....,........". 4 I ChM proftt. SLblnle\ line.. trom line 3 . . .. " , . .., ...... .. . , . , " , '''''' . ,. .. , ....... , . , "'" .. .. , . . , '" I , Other lnaoml. incI\IClIng federal Wld ellllll glSOllne or fuel ~ credit or rl1uod , . .. .. .. .. .. . .. .. .. .. .. .. .. . .. , 12 . 7 llr-.tnc_AcldI1nU5ll11de, ,....... ................,.... ...........,., ......... .........,........ 7 ".... Enter. ""'.. fer bullllMa use at home on line !lO. I Adwrtlall1ll....,...........". I ,. P,nslon end pront.lharing pi"... ....,... ,. I BIl4l dtblll trom 8IIo.s lit 20 Rlnt or I.u, (sel Inst'uctions); ;J,.~.. SIlVICllS (..elllllructioM) "'" . I VeIllcl.., mllChlntly, end eC\Ul\>men\ " ., . 10 IMlIId Inldc"","*(~ 111M) "" 10 1 80. bOlner business property ...",,,"...... " CommlUlons and 1Hs .,."". 1 21 Repairs and mllntonarlc:e . . , , , , . , , . . . , . , 11 Deplltlon..."",....""..,,, 12 22 SLIpflIl.. (no\ il'lCluded In P'" III) "...... 2Z 18 Dr.eaellon and S!lClion U Texes IIld licenses ....""",."""" ZI ~ e~~~),." ,." 11 7A, ~~::' ~~~~~'.~. ~~~~~~~t',.., ., , . ~~; 14 ~Ioyoe beno~t P!9lllM's b Meals and I (ottier lhlll on IIn. 1~) .. " " '" 14 entertainment ".."... 11 InIUI'ance (Oil., "'." h'II1h) 11 c Enlll. llOI'l(Mduotible u, , . , ,. emoumlnclud.d on 1. Inter..t',:~'I'::, line 24b (see 11'\Ilr1) "" '~(Plldil_~) "'''''' ", dSubtllct IIno 240trom line 241> ".".".. 7Acl bOthlr ..""""""......"" ,. zs Utilities ,......"....."""."..,.....21 17 Legal & pro1"'IOI'IllI StrVjc:e.s " 17 21 Wages (Ies. employment credits) , . . . . , " Z6 1. CIIIce e """"..'''''' 11 1:1 Othlr frOlllI"" 18011 "....." Z1 za ToIeI....- belore e.pen$I& for bueintas use of homl. Add IInos 8 tnrough 27 In OOIUlMll "....",." za 12 . -- O. 1 52 Zt Tentative prottt (IOIS), SLbtrect IIn' 281tom lint 7 . .. . .. , , . .. . . . . .. " " " .. . .. . . .. " . , .. .. .. .. " .. " . ' . '. Zt III ~ll!r~Ueto1yolJ'hOnIl, AlIIchFonwlll2t ..,.." """'''''''''' "......""",..,,,,, III S1 Net 1l"Iftl.... (I011~ SutmIct line 30 from line 29. · III proftl, .nter on F_1040,lInel2,lII1ll_ on llchedIll. SE, n".2 (statutory } ImploYI.., Sll InII1\10110nl). l!SIlI.s and truslS, Inlllr on Forni 10<11, line ,;\, , , , . . . . . . . . . . . , , ' , , . e If 'lOll, you II\\lII go 10 II'll 32, 12 If you hi"" e 10.., ch.ck the box 111.1 describes your Investment In tnls Ictivlty (e.. itiitruc:liona). · If you c:hocl<ecl 321, enter 1110 Iou on '_11140, llnot 12, lII1ll.... on Sc:IIlclllie SE,IInt 2 (statUtory employe.., ... Inltructlons). Eltatu end trusts, .nter on "arm 1041, line ~. } Alllnvntrnent Is Ih gj" rt.k. .,'. Some Jrwetlm.nt Rll Dlanotlllrlllk, $ohedule C tl'orm lIMO) 2001 · If you d1ed1od'32II, YOU ",lilt llIIc:h """" .111. 8M Far ".rlll!ll RtCIuctIo4\ Act~. _ 1'_1040 1mI1lucIIGne. ~"'" Ifl. ~ (Fonn 10040) 2001 J AtlfS W ,JORDAN. JR ~.!.!lQoo.~ilCMt ~MIi~ _ II Method(t) ","d \0 ...k>> ekllling Irwtntory I LI eoll ~ cost or mlll<l\ C DOOler (atttCll expllnation) 14 ~!?~':tt.~ ::r~~~tl~~~.~~~I~~., ,~~~: ,0:. VI~~~.~~~. ~p~I~~, ~~ ~1,~~,I~.v~t~:.. . , . .' .. ." 0 v.. . In_tory II b~ of year. If dlllerenlllom 1011 yolll" cIoalng Il\wnlO4'Y, .naon~lan.fion . '. """"""" ""'" .", ,. '..,., ,."", ,. .."."." ,.,.1'".,.., ,. ..."., I "," . 312-'4-5&53 Plge Z ONo . PIt~ Ie.. COlt 01 I\IImI w1tndrawn for pttrsonll ....e .. . , , .. . . .. . .. . " " , " , " . . " . . , .. " .. .. , , .. " ." llIl v coat ofl~or, 00 not InctuclllI'\Y amO\lllla paid to yourself, , .. .. . , .. " . " , " , , .. . . " , .. . . .. .. , " .. . , . "" J1 . Maltfilillll'ld .""plll' ,."",.."......".,."""...."..."..,,,,,.,.,,,,........,..,,,,,,.......,, 38 . Ot'\wcosts .,.,......, .""...., ,. "." " ,. ".."", .,. ..." .,...... ,.."."" ,.., ,.t,' I '" .f'" "" >> 4rO Add linet SS through 39 """ ,."." ", ,'""."" .,..."",.., _""...""".".. " ......." ,.'.. ..., 40 41 Inl'tflloly Il8nd 01 year .. " . . .. , . .. .. .. .. , . .. " , .. , " .. . " , " . " " . " . .. , .. . " " " . . , " .. .. . .. , , . , ... 41 ~oold. S~1raelllne 411rom Ilno 40. Entar the r..u~ hertllld on Plat 1. line 4, . . , . . . , , . , . , , " 4Z ~ .ntormlllOll on Your Vehlde. Complota Olls part only If ~ .,.1 claiming car or fruck e""emos on line 10 and .... not re<lol4rod to IIle FO(m 4l!62 for lhls bu$lMI6. S.. lhe lr61NQtiono IOl"ine 13 to find out if you mUll file, 41 Yfflen dla you pl_ YIM vehlell In service fO( busineM purposu? (month. diy, )~ar) .. .PlLQ.lg0Jlg _ _.. 44 Of lhft fIltal number 01 milK you drOVft your vahlel. .....ing 2001. enl6l' lI1e nurnller of millS you USlld y..... vehlcl. lor: . Burliness __ _ _ _ __~...Q.O.9 bCommullng _ _ _ _ _ _ _ ~L.5JQ .01l1er __ __ _ _ _ ~..4~Q . Do)'OU (orytJl.f spouse)ha"" another ".hiele awl/able for perSOl1llI use?"",.."",...,...",.....,.,..,...,." ,.., I&lv., DNa '" Was yOU' Yehlele al/llllllllll for perlOllll use during olf.<*.IIy h0l.n7 ...........".......,,,......,,,.,,...,,,,......., IRl V.. 0 No nlOoyoy havelNld.nce tOll4lPort)'OU'deduetion7 ",...,.."...,.....""......"..... """'"'''''''''''''' "... @V.. ONo b If'V"',' 11th. Ivldence ",itten? ,...",..."",.....,..".,,,..,,..,...,,..,.,,..,..,,,,,.,.,.,,.,,...,..,,,,.... ~ ~:}1I bthtr ~pe",". Lilt below business hPllIIeS net Incio.lded 0111"- 8 - 26 or lint 30:..- MEMBERSHIP ----------.---------------~-----------_.._------------~--- _..!L 7 !.Q~1Mi~_ - -- -_ _ ___ _ __ _ ___ _ _ _ __ _. __ _ __ _ ___ _ __ ___ _ .u_ ,._____ ___ ._---~-----------------------~--------------~------------- ------------------._----~-----------.---_._-------------. ---------------------_______________M~___________________ ---'-~---_..._------------------------~------------~----"-~- ------~------------~-----.------------------------------- --------------------"---------.--.------------------------ .:. _.. TOll! 6thIr EnIerh.relll1<lon oll1ne27..""""""""....""",,,,,.....,,,,..,,,,.48 4 . ScI1eliJle C (Form 1040) l!OOl .....J PLEASE D:IoODUSDlI3 L... DO NOT USE YOUR 2001 PAo4O LABEL P.l 0'2 312-54-51053 .10 4alo-IHI-3DIaI! E)( 0 RS R JORDAN JR JArlES iii A 0 FS rI FY 0 X)( ~ DOGWOOD BUILDING SC 2i!IaDD rlIULETOWN PA 11057 PN loA bI!15?DD 1B ,DO lie 102157.00 i! l24.Do 3 .00 If -3.3'15.00 5 .00 b .00 7 ,00 1\ .00 'I 1026111 , DO loD .00 U bl!a&:L . DO 1i! 171:0:10 .00 --------------------~~--------------------~----~-----------.---------. Ple...e 1ald PIlI8 Ilang thl& line LOCIlIn'_uon, Enlbr where you IIwd IS of 12131101. ScMal Dl.tricc HIDDLETOWN AREA School COlil~ 22600 C~~: DAUPHIN COUNTY Munlcipallty, MIDDLETOWN BORO Elc\entIon, (check this boX) AtMncIed Re:, 'm, (chlckltlls box) FItIc:Il Ya... "'let, (check mls boX) Rll8Idoncy Stltua. (Chedc \I.. e<omd bo~ R X .......vlvll1le Reeldent NIl No.. Idlnl P Port.Y.... Rnlclenl From: To: Type 1'1..... (Clteck OIIly one box) S J II , x Single MInted, FMlno .IoInlIy Memed, FWIno Seplftlely Flnel Relum.Ind/caIe_: . D o.,e of death Dtc:e..tcl 1aOrossccmpensa\lon.Seolns1rUC1\ons "'''''' '"'''''' "". "... ,,,...... """.." '" "..... 'a 1 b UnralrrburHd .mployeeoullnelulCpensel, See Instructlo'" " " , " . " .. . . , " .. . " . , ' , , . . .. " " 1 b 1cNet comptnH1Ian, Slbttclllne It! Il'om line l' ..... """..,.." ".."..,,, "'"'' ....,...... ,. 2 Inter..t income, Comple'" &nd lIbnil. PA Sthedule A, It over $2,5QO, . , , , , , ' , , . , , , , . . . , . , , , , ' , , , 2 S Dlvldend Income. CompNl18 _ Ili>mIl PA Schedule e, ~ over $2,500 . , , , , , , . . . , . . . " , . . . . . . , . , . I .. NttlncomlO.l6IafnlmIlltOl*'lliOnohlKisilltU,pIOfmiofl,OIfl/lll,..,..... .""....,.."",.."" ,,,,,.. .. 5 Nellf1lln or Iosa fl'om lIIe sale, exthenge, or <lispOlition of property .. .. , " " " .. .. " , , .. .. . " .. " I I Net Income or loas fl'om rents, royalUtI, patents. or capl'nghls, .. . .. . , , . . , " . .. .. " , " " .. " " .. . 7 Ellal..,' ""lit Inceme, Complete end enclose PA Sthtdule J , , " .. .. .. " . . " . .. " " .. , .. .. " '" 7 . Gembllngtndlalterywlnnlngs.".. .......,..,......""",.. ..."".. ,.. .."".... .""..... . 62,757.00 .00 62,757.00 124 . 00 .00 -1,395 .00 .00 .00 .00 .00 . ~,.r~ taIbl, '- Ma only III' pOlltlve Incomt amourIlI from 1",..10, 2, 3,4, , , ,end ,Donotlldd tllYioI.seIreported onllnM4, 5, 01" 6....."."....."" ,.. ...."".. . 10 Cclntrib~t6_lItclIcels.vtI1lltAc:ooWll. SttlnlnwtiOrJI ,..,.."",..... "..,...".." , '0 11 AduIltd~lllXIbIe~,Slblrictllne lDlrom IIrw9 .."".',..."..',...."". " " 12 P4InMYN1lllt1elC 1laIII~.lIuIlIpI)' nne 11 bV 20ft (0._ Alto tnItr (In lint ,I, ... 2 . , " .. , , , ... 12 '_'1 1241AlI 62,881.00 .00 62,881.00 1, tEll. 00 I EC Fe rn rTTTTTl rn lil n., nn,.'. r.n'1. ~ J v ')~ ')1 ). ~ -a~ :'lo'~ ~ t'a )1'" .~~ 'to; "..~ .~ n t~ ,,, ~Q~ . ~:~ ~>>, ,~ ,,~ .~ 1'\ ~~ "","'.',..' ,~ .. " . ~:\\ ,.' ,.' .... ", ,~~ ", .... .....".......:...:...:. '~ t>> . ~~ " .' . .' .' '" t~ . ,~9rJt:\ "., ",'.','"" .."",'.".",,~.......,'.' "',~"". ..... ~" \~~"" ...."",..,. "~oj\""",.,. ''''ll ~~ ~.p~..#' ,.' " I'~ .,' .... 'lII ~"" ~~\~ ~ ..,\,,'1- ,.... ..::~.,w.~ "~(\'" .,.." ","', 't- --<.~ ~~ ",... rd"<II' .... ....' ~'"",\'6 ~~ "" .,.., ,.,' 'f). .-=.. 'IIfi'''~' ..~ ..., ,." 1f-"\1":;; ..~'_..,I>' ..' ".' .", 'I> ~~ ~~~"'~(\~".,..~tf,...,,:\,, ~..6"t'~..,....,." ",~..,$, ". ~~~\.-""'l~ ~~1" .,~.\,~,~, ,,' ,.' ,.4f'i':".. 'lII ,,~III! ~&fP',.p~..'f,(\f1' ,<.~... ~tA\.\.f1:(> ~ "","',,"".,...-:-.:.s..O ..""':,, ". ~ ~'l....a\l* .~. 'f"" ~~, ....~".. ..,., ,.... "'~ .... ,.,' .... 1:1 ,,, ,\0 ;\..~.,.,- ~.~ .~<1' ~.....",. "", ",f?" <:of? "~'?~ #-,\ .....:;"..\ ,,' .... 'I.' ~ tJ. ~"'~<1' .,r.'t'f." \~ ':~."'''i ~ ~ "\'_''''\"'~.\" "<"" .... ..' " ,\, ~\. ~~.,p. Co<<"~~ "'~~"ip."'~p."'~:'."'~..i~'\~...I.\I~\\I-'\ ",.,., .,." .' ~ .",.. ~ .......A'\. ~~'I..f?" \\. t. dJ$".... \o.""'~_~ .,. ,,' ..' " . \, ~ ~'~.~~'/.. C'\\~Q \~~ot ""1""~~\o.""~""'''~''?f>'''''''",, .'."..", ~ '" ;~~;~,*~..:"J;;'~~~~"'.."~'~~~'\~""oJL~ -'\'0 ".~ ~~, ,.....'':-...\1.':1'''. \P"' c."~'~ di ,.' ~ ~..._ .IL .... '\o"'\ot~\ot'.-I""'.I)"" ",\",~\ ~1"t'~~ tP ,,' ~4 (IIof' r 't- ~c;tt,&' \}\'4'4it':-_ '\~...66 ~ 'tl." ~. e<' 'J!'. 6"0 'l '~':c<II -.-6,<' , ' ' . " .,. ~ ,\O~#" ~~~'''- '""~~ol\\\l"'_~~~ u~.~~"9..v:__O~. ~.,." "", 'I> .. ~......;o-- .'<<'.... ""'" fIJIr ~.~" 'V' ""... "_',' .... ~~.. ':. /....-::. .;::~~::.:;..;..~~~? . .,. 1,~~\\~ \\~ _......~~ ;~I\O (ill"'''' o<ro.~" '~... 'tI l,P _.~ ,,110\~1*~ 'f>~ .....\'" ~\.\~ ~:'c:JI."~_ .,. '~""...I' ~\I(\' 1* >o)...~ 'If>6~. <ro" _Jo- 'It 'Cf1'~~"':~0 o\~ 1*'f" """\.'ll,.~",I~......" ..""~. ~ -: tlI'~~ o\\'f'I' 'I!l~~ ~'" 4'l;\/I ~. · ~..&\dl' .p'" '^\~"'~~O~~\\ll '" ~~~~ O~.-.\~~'l_.......... oJL ~ ~_~- o,\~ 1*'- "yo ~.o::"~O\~l'" ~~~t.'> ~. \\\\\\ ~~ ....'t>~.~ . ~\)\) . \)\\~ ..;;1 . \\\) . . . \\\) ~~ ')~ "b~ ~\) ~~ t" to., ~t ~~ ~...~~ ~".. ~1-e.'" ()\\ .. ' \\\\ , . \\~\\ .~~ .\\ ~ .~~ .\\ ~\\ ~'\) El\ . '\)'\) \ " 1.~ . ()() \.~ , '\)'\) , ~f:l . '\)f:l '.'\)f:l ()() '\)f:l f:lf:l . r;;;,() . '\)f:l , '\)'\) . '\)'\) . ()() . '\)f:l '.:1.'" . '\)f:l \ ,v\~1 . ,()f:l .r;;;,~f:l . '\)() . .'\)() f:lf:l . f:l() . ()() . \ ...J OJ.OJ.'lS0loS Wlge Stltem.nt Summarv _ ~w.6(llto01)_-iQO' _ II "-' ,11II..... P....,_ ro. .....,,, ~AHES W JORDAN JII ___. 72-54- 653 L.A_dlD,*, Do not iWnll ~ Form(s) W.2 tfusjng this am,dule, En'" the reql,!it~Inf,,"",tion tllll1slld1 Porm W.2, and kt~ Y1!\!I' orlaNl forms, ""poIIIftl. Ywr PtMlyt....i.lh<llllder., CCllTlI*1HUOI'I may be different, QuIlon. Do nol UH this sc:heOJI.: (1) It yOlJI' Farmls) W.2) SIIowslNil yOU ellrNd Income II'l ano1ller slltf - you must lubmlt your ac\\jal Form(s) W.2, or (2J It you believe an emO\MlI on your Form(s W.2Is II1QOO'ICt - you n1UlllUlmit the IlCIulII Form(sl W.2 wtlh . written expllnllllon trom your employer. If yOU havt cOf'IlptIlaUon Irom forml other than Forml W.2. complete PASctlldl~J!~w, NumlIIrot'onn(t)~ 3 If you noed mare ope... you mlY copy II1ls sr.nIClUle or prlpar. yo~ 010n sell'Ck/ltln Ihlllormet, IN It : Il1dlca Voillllllr thl Form(s) W.2 ar, t thl rl/NrY tlxPtytr lilted lir. on!h' P.40 ar OUII (b) (0) (d) F td..., wag.. Irom bOJC 1 P,rvllY'lIMla comJloOl\S8tion PenNll/tllenla lllx from box 16 wI1hheld'from box 17 5 38 1583 14 0 41 476 0 Ol'I'ICI.... UII! ON. V T T T 56 45 4769 t: .,,,,,"...,,.........,,,. dotoItlmenl_l. the riallt to.,.,.. YIN1 iiclI!II W- eM 1 P~_IIIC(OIo'lI) __ MI$Cel~neousC~__ _.._,.........p...........r.._, l-'slClo<tljl-, lMtnIctlonL Enter lhe netesHly InlormotJon Irom yolt'lorma below, lmpot!on\. '(016 Plmsy\VInla lIIxeble compenaallon ,nay be dllf.rent from your fedoral \VlIgts, Enbt! only )'011 Plnnsylv""'a amOt.lms. CauIJoil. II a Pemlylvanle amount on e form Is Incorrlct. you must Nlmlt Ih. IlCt&ltII 101m willi an expl_tlon, . ~001 IIInttcl HN.... .I!!~v: Indlcale whoth.r thl Incom. I. lor Ihe I Ir IlstIJd tlrst on tho PA..qQ m or ....OUll. I!l\ (e) (b) (0) (d) ($) TIS Pl\)'or EIN Payer Nam. Cade PlrY\'iY~:r'la IlUClble Ponr=alllx F.doralllxlble o'rSSN com nsallon . Ihheld Income - . - - - -- - - - - . l!!!'.ToIaIcolumMl"'lII\dllO,.,.,,... ,,,....,,,..,,,,.,, 1 r CodN: A Executor '"' B Jl6y duly E HonorarlLrn f' Co'iMlllt not to compete H Olh.r nanlmploye8 componsation, Ooecribe: C Dlrtclor 'el 0 Exper\ wtllltU lei Q On.ges or "\1ltmenl lor 1011 wages, other lhan ptrIOIlIIlnjwy .. " I -. -. .... ..-... n'l,('I\"1.rmu -I Schedule C (fOlol11040) Profit or Los. from Business (Sol. Prtpnllorwhlp) 2001 ~ AW~=-;J..l'~~,~cs:'T~o:.l~~~.~~ 1040). 09 -- ............. N_r (111I) 372-S4-S6 3 . IIMOMI..........N ~ 4 4390 ........ID _lUl), W A... ClN8Ilo,I_'4 r.:=~.=1Y (99 Nil....ol~""_ _ JAMES \UQ!!.Q.ML.. JR ~ p.......,-...r.._tltn, Indllflntp""j,oc\",_C... __I SALES - AI1WAY C ......... ....... 1/ No ...."..1o?i.... _, LA"" ....... E ~:"f:,,~<O"li~~l..'l:~~~U-~iQ~~sf- - - - -- - - - - - -- -- - - - - - - --- - --- -- - _. F Accoooting m.l71oct(h ~ C.s.. (2) U Ac~(i)'rr Other ($pOclM .. _ _ _ _ _ __ _ _ _ __ _ _ _ _ _ _ _ Q Old you 'm.tetl.lly pllrtlclplte' In the oper.tion 01 this bu. In." cturlng 200 I? II 'No,' .ee Il1$l1uttions to< limit on loss" ... I8T Yes TI NO II u .tartld or IC ulreQ this buslnMS duf\ 2001 oheok hell ......"..,...".....,.....~..".....,..,......,',.........-il- I. ~ ~ome 1 Grou "e.lptt or ....,.S, CllUtlon. If this Income W\l.' reported to you on Form w'~ ,,"d the 0 'Sta\utofy omploy..' box on mat 10m' ~ check.d, s.. th. InllructloM and cheCk here ,..,........ 2 Retl.ms enihllnwancts .. .. ., ".....,."........ .,..... . ,." ,..... .. ..,........,. .,.."............. a Subtract line 2 from line 1 .......,............".".,...,..............,... "",,,,,,,,""" ...,.. 4 Cost of goods sold (from line 42 on page 2) ...,,,,,,...,.,.................................,........,,, 1 2 3 " 125. 125," - 5 Gl'oH 11'011I. Subl1l1Qt IIn. 4 from line 3 . ' , , , .. . .. , . , .. " .. .. " , . .. .. .. . " ' I Other Income, InclUding tedoral and state gasolln. or lull lax cr.~il or r.'LIld .. 5 6 125. ..Add IlnosSand6...... ."........"................. ,..,.. ..",........., "... ,,,...... 7 n.... Enter 0 eoses 'or buslnoss use or- 0lI' homl on line 30, A(jyortJalng " . . .. .. . . " .. . . ,.. I 19 P.nslon and Ploftt.sharlng plans .,...... 1. Bsd debts flom sales or 2ll Rent or I.ase (see instructions): ,I ~ ..rvlces (ltO instructions) ,,',' . a Vehlclos, mochlnory, and .quipment .. .,. 2lla 10 Ca'lIld Ir\lck IlllII1l1S (toe /01111) . ... 10 1 O. bOther bus",o" property ., .. .. . " .. .. .., ZOb 11 Commlsslonsand tees ."..". 1 21 Rep&lrsand rnaintonanco .. . .. . .. .. .. ... 21 1a Depl.1ion......"........"... 12 ZZ Supphos (not IncllJded In Pan III) .. .. .." 22 18 OI",ICiaUon lII1<l Section as Taxo. and IIc,,,,es .,........,......... 23 179 expense doduc1iOll ! .. (nollncludod In Pan III) ZA Trlvol, meals, and entertainment: !.~~ .' (s't InstructJons) .......".,.. l' . Trov&1 . . " .. ... . . . " . " . . . . . . . . . , . ... 241 14 Employ... ben.flt prorams b Meals and (ottier thlll on line 19 """'" 14 .nt.rtalnmenf .... " .. , 15 Insuranc. (0171" ttien health) . ,. 15 c Enter nondeductible amount lnoluded on ,. Imerest: It!!:~i Ilno 241> (..einslrS) .... s MorlQlgl (plld to banks. .le) ., . . . . ,. li. d S~btract line 240 from line 241> ,.. ZAd b Oth.r .. " " . " .. . " , " " ".. lIb 25 Ublitlt. .....".......,.."...".."... 2S 17 Ltgal & prollsslona' services ,. 17 25 WSQes (lOSS employment credits) . . . . . , " 2' l' 0 e 0 on..""""..""" 1. r1 Olho, ltl mm Iiol 4800 2" ...." r1 21 To~lllllptlll" be'ore 'xp.nses for busln... uso ot home, Add 111'1.' 8 through 27 In columl\S .......,...... 21 25. 40- 1 S2~ at T.ntatlve proM (loss). Subtract line 28 from line 7. , . . . .. . , . .. . , .. .. . . , . .. , !ll Expenses for business uso ot your home, Anach F_lI829 .,....,...'.... S1 Ntt pro4lt or OMS). Sulltract 111'1' 30 ~'om line ;19, I 11 a proflt, sntor on Form 10.40,111\112. and Ilso on $chtckl'" IE, 11M 2 (slawtory } amploye.s. .eelnatructioll$), Eatates and trusts. enter on Form 1041, 111'1.3, ,....,...",... ..... S1 . If a 10$1, ~ mus.t go to line 32. !2 It you havs a loss, oh.ck the box 1I1at dascflb.. your Invutment In thiS activity (sa. Instructions). I If yOU chocked 321. enter tho Iou on Form 1040, IIn.'2, and also on Schtdula 5E111"" 2 (staMory .mploy.... St. Instrucllons), Estat.. Md trusts. anler on Farm 1041. line ~. .. ................... 29 30. -I 95, -1,395. · If you chac:koa 32b, you mutt attach Form .11&. 8M FOI' 'a'"111f01'k RtcIuctlon A.ct Nolle.. _ F_l040 InslnlcUons. } IVl Alllnvastment Is Sh CJ at risk. o Som.'nveatment B2b is nol at risk, Schedula C (l'orm iCl4O) 2001 _""\~" InllllWl' [ 2001 Earned Income Tax Return 1 Middletown Am Tax ColI.~tloll Dureau (MATeD) S5 Wesl W~'er SINel . Middleh,wn, PA \7057 . (7\7) 948.3321 . Part f" C;;o~pieteOn1y 'lfyoUl1)~"~~ d~r,rng~'t"'e.w:y,~~~/;:;":,:);.<~::,,:~':i{':', 1'IMlipIlRIOP ".~ ; --. MAnjNtl,ADrJRESS CITY 1 BOROUGH ' WNSHn' Ii I 101 TO 1 1 -- --- liTO 1 1 C:;lrrclll Addl~;" (If dU-{';relll) , Pljrt 3 . 1iJx Computation .: RoundingNOt rel~ttted'" . ..1 .... :,r*~Yl:~\~.,:,.'.;~';:n~Y''''i~R I To'rAL W.2 e...RN1NOS 1~~.~~.IlIO",\ if.n,lo" W.l (Mnl (ro",...h ''''11(0)'01'). 1 'r'7 Q9fl.. II " 2. LBSS AI"lOWAULI1 CMI'1 ,OYE~ BUS1Nl\SS ~>(~UNSIlS (6",-,.", P"",,,,\ Po,", 2106 ",,"'., S",o Ul! Form) 2 I ----" . ~, .~7 9~ 1/.<,- + ~~~ w 3 fiARN~~OS ILin. I oliou~}io.l) _" ....- " ""'4 .....>.L I -- --" 4, OTHBR r~~.n BARNRIlINCOME IlllUll'l IIwl,,"" 11l,,".<I UII~ ~ividuo"". _4-- 5. 'COlJ\!. T^,'A91.ll ~Ai\NllD INCOMH (Ad" Ii,,,, ) ,od 4) ~ "'., (fit <g. ,;...- ! 6. NF.TI~~ f'KOM 8ljSINP_~!,~RM OiiP~fl.SS'ON (F.,~~~", 1111 SII'" or "':~""I\I ,ehud"k',~L- 6 17 - /:':1 '1, \" i 0 0 ----1-- 1, SURTOTAI.tLI"" 5 minu.Ii".~, (If ,,,. rl,,,,, ""ro. en'", "",,) 7 . ",(' SQ':? i-.r : ~. Nti.C PROFI'j-"PKOM aUS'NE.~S, r:A~M OR PROFFSSION f.B"",,,;~-;iS;;;;:;;;;;"r.J "hed"I;'C':F,i(,I.) 8' : 9. "^XJ.aLll/JARNiDjNC()MB^NDNF:;'i'I(()I'ITS'~;"lIn.~;) .", 9 ~<:-.<..'19"l. i.l~~ -. ! --.- ._--_....~......--,..- ~, ~: I.I,\~.~~I'\'Y: l'itH,tliI" .~!!:i~'lrl~ Ii", 9 !~r :~I) _.. II; roTAL LOCAl-INCOME TAX WI'I'HfmLll IF"'''' 1','01 4 0' hUIl(lIlI) --' . . -.." 13, TllT^L"~~"I'IMATllD r^YMf.N'I'~~~I\ P,\YM~.NT~_, iJ, TOTAI.,P^Y~llNl~ AND I.,OCAI.'I',:X WlllUiRI.O IAdd "'M' II and ~2i ,... TAX QALANCH DlIf', tlr lell:! (Mil $1,00, cnler l.orll) (Iin!'": 10 minu~ line I~\ -.". .....---.,... ......... ", 15, pEN^I.~'V A.~l) INT'BREST I)U~.:"fr~l\ APRil, 15.: 2W:lIS.e i"."r"I\.U"~' ." br,e' uC y".~~ Cop." Iii. TOTAL llAI.AN(;~ UlIB. M,k. .heck, P'1"hl, I" M.A,T.C.O. (Ad~ Ii,,,,., I~ '01" 15) .. .. ". _n_ r'-?..~"~rAYMEN1'lrrl;~~~~.,:.or") U-ia, 1,1 "'il~O;~!!.~.'~.. ." 18. OVf.RPAYMBN'I'TtI RE RllVl'NI.,m) IHn NI"nd,""~,,, $1.(1(1) .,-...- ".",.,. ....--.,. 19. OVERI....VMP.N'I'1.0 HE CREDITP,O -re) NEXT YFAR'S 'I'.~X (N,' ",,,die on~" $1.00) ~ Part 2: Taxpayer lntorm,\ti'oit ,d , In7u~-;)n;;IJ~'~1l ~ilJd bt' XD!!tu::(~ -- -. --, - JAMllS W JOmAN - JQ 19K (J,914 ? /)06-/,1/&06 /j(.lti',o,.'.#(j- lJAUI8Bvao PA fiillb,11lS4 1...III,,,f,"llll...,lluol,III.I,,,,IIIII,,I,,II,,I,,lolllll L t?1 "',/)iJj.~T1:>I,.<//V I ,,0"1 I?o s7 ~ FbOIld llI4I.w~, ll1'~ ~. ~Oll ~~ larm, boW'''',';''' ..1i:"I.~.nllllu,iII. ~.\1l1<lln .<p<oril. t<ibie';..,.j A, 0 l'mnnntlllly Retired. I;) Ol!ahlcd, or q Active Dml' .~ of ..J _, _ B. Q Permanently Refired, 0 Disabled. (lr 0 ACtive DUly as of j .I _ c r~il\C{~): A(lttFllll:l: 2001 ---, ..... -.' .' , '/:",,:' ..'..1;.(....,.'", '. ~/.-..~,~.,~;,. " "". 0020 City. (joro\le" ('IF 'lb\All\~hjfl nt' Current A~dta'lI: m, 'lJ/J).,$"70W/II [Your Soc, See, No. A 372;54-5653 L SpoU~.'1 Soe. Soc. No, B I J 10 '. ........._..".,~\...,,,'."''''..'.'''....d .'''' ';"'Q,"""l'f';.~_.,':':.'../,\.!.;',..",:.:.".':'."I" , o;?l;. ';"" II.(,( ,_.!..!. 12 ....---.-..--. I; 1.\ 15 16 17 I~ I~ Part 4.. E~{iloyefInror'!latl(1n ~; nale ><mplI'yo" BM \,OYFlR'S NAME' -..rti.,iiii: '1'6"" 01'0" E:ll11od IlIcome I.\lenl Tnx Withhold Oro.. U.r.od Incorne :I, ";;c7"IV~ I;.~'P, ;it.',lt .. _ SllJS35;.i~hZI '"~..,, r~ I h. bA^ ,. ,~-'I,(10--"-,," __~n~.)7.). ...,_~ : i-"".'- .-.... i ..~..-i..-- ' To"" C.rry to P~.!Llno' I & \I _'"'' .-r.'J.i~i:'?,<;" It, <" '.11 ..",,i:,,,,,,.jl'V,( (':1""" ,.. 1.1" , ('IlI"'Y ,,, !,ilil' , : II w~ IkdllN tU'Il~\( 1It.!II~hl~~ 1I'1l"ILl~'1I by Ill". HI:,I Ihl( NIUI" illlU ~II ~\\'llI"j\;lnylll~ ,,'INd\lI~~ 1111,1 ~t."."WIlI~ h~"'~' lo.:l.'4l nlll\\ln.:1l lIy ru.: milt t(. 1111I tI<lillll In)' kMlwlild,o 1111(1 t.llcf ai'.jNO.lIOtiCCf, ,.,.,. ~~. 1~1' 1l".llllf~ ')~ lr~~~AL~L1 - (k;"'''{I~ '1/t'..C~. A,$~v7;~ O.."/,JJ:or:.;>t);{) 'lu'lIl1l1',lK""1l1l'll ....".--.,.'.'-----.. ... (;11,' --" 'hl'll"""'" lCe'lp~11III ,.. 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