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Home My WebLink About98-03898 q, ~ d ~\ ~ ~ ~ ( j r - . . ,b ..." c:::J . ~. ~ 'j," " ,i- ,r)1 " " ;'--' I, ".' t,t,. ,h~ " ..,~ 'L II, \ " ~~ " \ , " ,I .....,) .... c0 " " H ~ ~ 00 r') , 0- 0- " ,r;; p >i I' " " I,'; " ;; , " ,I d ,. it' 'I. I' ;,1' ", " " ~ s " ~ ~ ~ ~ l!1 ~ ' ~,,,.,,,._,, l..:. .>>:., .:.;. ~ Ii ~ ffl ~ ~ ,', ~ $ l!1 '~ ~'1 'ffl $ ~ ~ ,I; l!1 $ " ~ ~ ~ ~ ~ .1 ~ " ~ Il ~ " ~ " S ,,~ " 'l!J ':1 ~ 01'0 dlvorcod from Ihe bonds of mOlrltnony, l~\lr.thor.f tho^grool11ollb Ol(oout;ocl by ~ I the pm' ties on Milroh 1612000, .ia, incol"[Xlrnbxl her.6in :01' l7<ll"[XlSOS of 'onforcoment "1 only but: otherwIse ahi\ll'\nt be l110rged in~o I>Edc1 I)~oree. 'l'he Ixl1;tioll are ** ~ Tho COllrt rutQlns"lurlsdldlon of tl10 lollawlngcloll11o wl.1lch hovo ~ been rolsod of rec~rd In Ihls pella,/\ lor whleh 0 flnol arqor hos not yet ;:: boen entered; : l,~ ST,4\TI:. OF PENNA. "lnaJlI\!~p ,flOHIl^!. 1/ N II, ,,~l.\::Jfl~,(\.. aup!.."" 11)!lO Ii ii II II 1'1/\1111:1 rr V""IIIIII ",,\1f\QmmkfN1J n01W^, IJofonrlant: DECREE IN " D I V 0 R C E, "" MVc,I.., 2.00D AND NOW, """,', ,VI, "~"'''\''''' I' "'" .""", It Is ordered ~1I1d dOCI'oed thol ,,", ,lj~911P,l;[J, J3,~l;(J(I""""" ""'" """""" plqlntlff, and" t,."" t" t, I ,':. ,l~~'9~P,~~+1,lP, ,'~9r~1,l' ,';"" "" t"""", I clefendol'1t, ,', I , , ,~9 ,._,a,.~~+t",8. ,.t;9In!l,:I;I~ , ,', , ; : , , , , t.' ,", , "'l" , , , .. , , , , , . , , , . . . t . , , , , , t , , , , "., , , I ' . ",:,) .,.,."""",.,., '.."",.", ,..,., ,."",..."""" t..t."",.".,...,." ** ordered to comply \.~.tth t:he t:e110s of anld ^greelllent. IIv Th" CI')'JI./) () \ o w~ O(i"^. ~-t ^"".II j:J, ~.~~ "'."""''''''.,., ;;; ffl ~ ~ ~ ~ ~ I,' ~ " ~ ~ ~ ffi ~ ~ , S 'ji ~ $ l!J 'f'i ~ ~ " '+' *- I,' ~ , i'l ~ .', l~ ,', ./, ~ ,', ~ ~ " ,', if. ,', , ",:._" . " ~, '*-'~'~'~'~'~"~'~'~'~'~'m'~"*';~"*'~~'ID'~' " , , I 4, W.u'o ullI1.!.l rO\:id.1\ hqr 1~()()nlt1c1 Yiwi1\:ion nl\rl POl:Uol\n.1 louVll ilCClIllIlIlill:qcl illl of' UllPiHiltIon \~j I:h II Vil11lo In 'tho uHlount 01' ,$6, !lBU,OO, 5, IIlwbnnc! lihnll rotid,n \'.hp mnrJtnl porUon 01' iI 1\111I11 PII!I\ worker III C()!IIP011B1I \:101,1 awn rcl ill rellrly I:OCO.i vm1 In tl10 i\l\\olln t 0/: $~6,~20,OO, Ihlllbnnd nhnll rotilIn tho non-HlilrItn,l portIon of th'll: ilWilrel i1lnHldy reCloIyod (,1fI Wllll, \~hioh I:o\:i\llecl wItl) .. the lIIi1I:Jt:id POJ.:\:j.on, ill] allloUnl: of \1~0, 000,00 i\f(:(11:' 11t:\:ornoy 1'006, . 6, Wifo I1gro06 to terminnt:e the llxJstJng ohild sllPport: oreler docl;et:ed al: No, :lB90 CIY,ll 'l'orl11 1990 ofl:ootiVC-l Maroh 16, ~OOO, Further, W11'o agreos 1:0 forgIve all eXistIng f.lrrel1r/;1ges owecl 01) that: orcl(lr, and IUlY olleol;(3 she reoe1 Y(3(j aft:er March 16, .;1000, purtl\.li1nt to the oXillt:ing \~ilge at\:i\ch1l\ent, \dll be ondol:CiBd ilnc1 rel:lu:necj to Mr, Ilorda as Soon 118 thoy arB roqoiyod..uI1Ul'l'he \~alfle atti1Chll\ent is UnIshed, ' In the eyent w,He or flny other ilClult 1ndiyicl'ual on 'bohilIf: 01: lUchard BOJ:c:la, .11'" shollJ.c:l ref.U,e a cOHlpJ,aint for ohl,ld support, wHe agrees to indemnHy h\ISbancl for, any support order which Hlay bo orclered agil1nst h1lfl 1:or the 811pport of R1chard Borda, Jr" in an amount equal to whatever ordor would be enterec\, '1'he indelTlnH.ioation Js also Jnclud.ing reasonable oOUl1sel feos, , ~ 7,. Wit:G agrees to pay 118 al.Imony for a pe.docl of ,l;hree years, dJrectly to the appropriate offico with1n the Commonwealth of Pennsylval1,\a, the COBRA ptomJwlI to provide tl)e Silme medical coyel:age as currGnt:ly enjoyed or in th~l eVent: w.tfe' s O'overago" Js modJfIed in any way, i1 ooyerage . identiol11 to wJ fe's covol:age.' '1'ho C0I31U\ premJUII\ constlt:utoli illimony which shall bq deductible 1:0 WHe and includilble in husband's l,ncol1\e, '1'I1Ja perJod of alimony shall'be nontlloc:lHiablo subject to l:el'mJnat:1.on upon eHher partles' death or Upon husband's remarriage or oohabitationWith a member of the oppoa1te sex. " " B, W1t:h regar.'d to w,Ife's pens:Lon wHh the COllllllollwealt:h of PennsylVah.ia, husbal1d's coul1sel shall prepare an approved Qualified DOl1\Ost:1.c l\ola\:iol1ll Ol:dorpl:oyid1ng that husband shall be ol1t1tled to 351 of W11'ol~ pens10n bqnef1t basod on il coyel:ture fnioUon 0/' 92, ~9V>, Husband shall ,be etltitlecl to tho same benofit~ as the alternate payee. to wh1bh wif~ is entItlod a~ the pilrtioipant in the plan, I' In tho oVent: that hllBband IlllOUld dlopl:Iol: to nlco.1.pt 'bf tho Init:1.al b(mefHs \\llClnt'tho ilppr()v~ld Qualif'.1.od f)ol\lestic , , ~ ,,' l\il.\(I\:.IolllI (lIdoI', 110 111/1'(11111 1.0 donl\J!llll'o Ilol:h nhlldl'ol1, 1':I',lulI 111111 1\lI~hil d dr" i111 Il'I'\IvoClnl>lo bOlllll'lnlilllllll Oil hln por\:lol1 0(' I:hll 1'0111,1011, 111 1:110 llVlln\' Wi ('11 IIlillllld plodoUUI\IIO. hllllhllll(1 Imt:ololl\lllllillHllll \'/.11'0 rllclllvlIlIl:hlllIII1H,lill 1l1l11uI'II:II1 Wlf:o IIUtLHHi 1:0 dmd\fllill:o hllllllillld illl 1IlIIvlvllr Illlllof',II;,lnry 1:0 I:ho Ul\l:llI\l: of'l\l/J 1II111,'Ji:11I 111(:01'0111;111 I:llo pOl1l1lon,. It: 1./3 l:ho ,jl)I:IJIII: oj' I:ho pilr\,loll I:hlll: I;ho ooyoll:uro J'fllcJ(:lol1 of. D?, 49Y, III bllflUd 011 YOIU:II of: IHli:q.li1.l <II\I'ln9 IIliln:1119o oYor YOQ!'ll 01' bOllufJl: 11cc:r,llid iI/I of' !'Jocul\Ibol p/ .\ fJl.Jli/ clill:o of' llopa!'ilU.olI, IP\II:(:hor, It: III tho II1l:onl: at: I:ho pllt:l:loll 1:1\111: "hl.\I,IIJand W,I)l rOOllJvo tho IJ0I111('I.\: 01' (:ho JI1(:11I:llUI: (lCCJI:'IIOd 011 I:hal: l\IilrJtal pOll:ion t:rol\l dlll:o oJ'UOPllrill:Joll untJl loco1pl: ol! bonol!il:o oXol\ld1nu (Illy oOlll:rJbut;i,on IJY wU'o ann!' di\l:O at: sepillilt:l.on, 01 130th pnrl:Iotl agJ:'lm thaI: I:huy Bhall be rOllponli1blu t:or I:hoJr (JIm iI(:tol:noy J:lH-1Il. i,md WnIYtJ III1Y and 1111 cla.i.11I lI(]ainllt the othol I'or cOI,1l1flnl fOBS I " 10, . Ol:her thiln what 18 IJ1"odl!,jocl ITi I:ho provillionll 8t:ilt:eet/ bot:h pill:tJ08 <\180 Widvo ilny ill\d illl 011\111\ for aHmony . pend0nt:u. IJ.to, Bpousal 8\11"port:" or nHl1\ony, 11, mX00pt: as, h0reJn ot:henl.i,fjo 1"rov.i.deet/ eaoh part:y'may diBpOSO 01! his 01: hur lnoport:y III illW way <\net 011011 pnrt:y heroby \~ilI.V0s ill1d reUIH1ull.,holJ ilny and aLl rj,(]ht:s he or she may now have 01: herua fto I: acqu.i.l:e. unclQr I:ho pros en t or fut\ire laWB of ilny jllriset1ctJon 1;0 shilre In t:he pI:opor(:y 01,' the qsl;ilto of 1:110 ot:hor i1l3 a result: of t:he marItal relationBhlp.i.noludJn(] withoul: lim1tiltion, stiltutory illltJWance~ wl.doW's allowilnpe, rl.ght: of intestaoy, right 1:0 t:ake ilgainsl:tho wIll of the ot:hur, and right 1:0 DCI: as adminJst:rator or eXecul:or In the other's estate, maoh will ilt the request bf the ol:hel~ execute/ aoknowledge, and. deliver any and all Jnstrul\lonl:s Which may be necoesary or ndvisable to cilrry Into et:feot this l\Iutual wi\iyor and reLinquIshment of all such Inturost, rights, find olaims I Me, SlilRRA~'ElI,LI I Mr, Borda, I Wan t ' to as k you " }fyou have heard the full agreement Bnd whether YoU agree with thip volunl:arl.ly? MR; BORbA' Yes, I do. " " 'Me. slCRRNrl1LLI I /\ro you under t:ho ~.nnuence I' ~ ,j'l: ~ " ':. ,.J '-(' , , '1';1 \' I , '-' (i'; ~) \f') , , rotS' 'r'") I., I"'~ , i' "''<<1 (, " '() ", , " ,.\ I , I ..,. ,~ II ( , , I I ' J - ~ n~ --. ,I' " I I " " " , 1","II'IAII1 ' t ~Hll'!fOlI"'~Il"".':::I"~1~t~~~~' Itllll, IO~ t'lliol tWo V wun I1VJt 11Y ", I,. "'l"" ''K, ,'(" I'n .l" '\;) "'- - - ........ \,\) ->< \.\.... \.......-:, Ow "- \'''''''":l r~ \ ''('"') ',-,,) ",'1 " ,I ~ .~ ~ .~ -..JJ ~~ " U III ~ ~ 8 ~ fJ:\!" H j! I~ ~ ~.~ ~i~i;;: l ~~~E' J " .' I " " !!:\.,. p~AilltHf ~nO~13 f,lllf!'!o!en\: prppl3rty, !nplwHng 1)l1t not ~imitf.l~ to, Any pvdperty ~lf.ltr!~lte~ pl1rf.lI1Ant tp the plvoroe Po~f.l " oC 190P, Af.l Amf.ln~ert, to provi~e Cor hif.l rI3Af.lonA~le nee~f.l, . WII~1RlUFQRm, Nnlnt.l.fC PI;IWf.l tlHlt VOI\r, lIonornhle OolH"t grAnt An Drrtl3r'l1pOn PeCenrtAntl (AI pompellihg the pefen~Ant t9 PAY alimony to plAintiCCI Ref.lreotCu~ly f.luhmitte~, II' c/J " J . IJ," ~'/ ,,'-.\V ~ +J! j! Y . r.or!e /3er"'f1talU I IOf.lCJl\ir.e /3mRRATm~~I, /30IlIFFMAN, " l3ROWN tc OAWODN, ),>,0, !!OOO ~inglef.ltown ROAQ /3\1itf.l 201 "a~rif.lhl\"g, VA 17110 (7171 540,.9170 ATTORNF.Y FOR P~AINTIFF .' :1 " 'f! ;1 ,j ii I " ,,' " 1l\\-WI~....t1'"I"i"'tll'l ,"HI" I'ONl'I'vo' '~"II'WijO({YNW'INl.'M"1f <<J NOlVtAlQ. 'lYOnIIVII ". " \!. """ 'I 'I ~ ~ j Id !~~ M " ... Ji Ig~ '" , , !i1~ ill .... , " ... ... , ~J~ d In In , , l:'hl M M' l' ,.....' ~~ J " " , \, , ,I \, " HIOIMHl> HOIUM PlnlnHf'f' IN TIIN OO\JH'I' ()II' OO!\'UVION PI~IMH (J\JMHI~nIII\NP COUN'I'Y,PNNNSYrNI\NIi\ v, No, fl!HI~IIH ~ ,Civil '1'111'111 . '1'1 III V()IHJI~ ,rI\(JQ\JI~I,INIO IWHD!\. PIlf'lIl1flnn(, ^1~11'ln^V"I' 01" OONflNN'I' \, 1\ (J01HpllIlnl, In 1l1\'1I1'00 lIlHlol' l,ho /l1\'lIl'1l11 olldll WIIH f'ilod lIll .JIlI\' la, lPflH . ' ", . lInl,ho HI'lI\II11IH I,hlll; qw 111nlll'l0/-[olll' Iho PllI'tl\IH IH h'I'OII'lo\'lIhly hl'lllwn, \J, 'I'ho 1HIII'I'lnHIl Ill' \llninlif'f' nnd 1)0fhnlllll1l: IH h'I'{lI'I'lo\'llhl~' hl'olwl1 Ilnd nlnol,\' dll~'H hn\'1l OlllPHOd Il'lllH t,hll dnlo of' filinH I,ho OIll1\plninl:, ' , ii, I,OllnHonlllllhll onl;I',\' lIf' II finnl dlllll'OO 01' dlvOI'\lll, " it, I \IIHllll'HI'lIl1d I,hnl: 111111~' IIIHOl'll{hl,H lI11IHllll'nhlH 1l11l\111I1Y, .dlvlHlol111f' IIl'olllll'I,)', InW,I'!l1"H fllllH Ill' OXllllnHllH if'l do nol, 1I1111111I:hol\1 holbl'o II dlvl,IYCllIlH I{IllInl.od, Il1l1dr\it,llln, I Hplllli/'illllll.I' nllllnllwlndHlI Ihnl: n I'll II ul1d /'innl HlIl:l:lonHlnl, of' nil PI'Olllll'I;~' nnr\ 1I1;hlll'l'Il{hl,H ol't.lw PIII'I.lllH hllH hllol1onl:ol'!HI hOl,woon l:ho PlnhHII'/'lInd !)ofhl1dnnl: h,I' n MllI'll,nl Sol,t,lo1Honl; A[.fI'OOl1lllnl" 1 vol'\f~' t,hnl. 1,110 HI:nl,oll\Ollf:H 111/1110 In I.ho Af'fit1nvlf, 111'111:1'1\0 nnd 001'1'11111" I \1111lol'Hl,lInd (,hnt: l'nIHoHl;nl:oll1onl,H hOI'ollllll'O n\lldo H\1h.lolll: l:o.I,llO(lllllnll,lllH nf 18 Pn,O,8, ~ 4f](},tl'1l1Ill:ln[.f In \1nHWlH'n IhlHlfi;J1 liollln l\\1t,hOl'II:ioH, . .. /1. /.."1 Dnfoi ,B-N-()(), 'uV:J,{j",Uu,ILLj;){)'t1r^-;:, "A(J(~' ml~INIO BORDA I... " I j, .['-";1" " .. 4 , W:\ r Il Ilhfl.11 rll I:i\.! \1 hll r illHl rlllld V.'1{ln \' 1011 illl<l pur IIlllllli llli\VO I1Cc:lIlIlIl.lq\,od fin of IW\"'lriltlol1'w,!tll II VI1,\.\11l 111 tl\ll AIIIO\lllt 01' IICi,II(1!l,O(l, Ii, 11\1111><111<1 Hhl1ll rotlllll tho lI\<'Irll:l1l porl:.I.olI or iI l\llllp HIIIlI worf;or' Il (JOII\\ 1I1 11 II il 1:1011 ilWilrd II! rDlldy i:lJCn\ VlH\ 111 t\10/\I\\0I\l1t o/' (I;H" !)?,O,O(), II\HIIJi\ndul1l1ll 1:(.1\:,dn \:ho I'\OIl-milrH,ill pOl:t,lol1 oj: 1;l1nt IIWilrd i\,\rllilclY rllcnlvoc! i\fi WLJll,\~h:l.(lh l:o\:nllod \~I\:h thn IIIIH'ltn.1 porl:.!on, i1n 1111\01\\11: o/' tHO, (lOO, 00 n t:\:o 1: i\\:tornoy /'tHlll, 6, W!l:o II(J)'(1()H 1.:0 \:clrll\ll1i\\:o l:ho oxllJUnrJ ohLlc\IlUPpLJrt onlLJr <Ioci:n\:odil\: No, :1Il!)(J clvll 'I'orll\ .1!)!)O u/:f'ou\:lvn Mnrch. 16, ;WOO, 1!'ll r'\:ll1Jr i wl/'o ilrJrmHI 1:0 f'onJl VO illl 8X:l. nU.I)rJ nl:roilnl<jpli owod on \:llil1: ordlJr, nn(l,nI1Y OllOOkiJ uho rOrJolvofi id',\:orM1\roh 16, 2000, purlllHlnl: \:0 \:hlJ' clxlll\:ln~J \~ilrJ(J . It tl:llohmont:, W:l.ll 1m elHlortJod nnd rO\:\lrnod\:o Mr, Bonin ilU soon au \:hoy lire roooi.voc! u1lt:ll t:ho wngo i.1I:\:/whmoll\: i.fJ fInIuhed, . . In t:ho ovont: w,j tCl or any ol:hor adult: i.ndlv1duul on bohll.1.j'of H1chnrr.l Ilprdn, .Jr" shollld rcd'llo n oomplilln\: for chj,lel I3UppOI: I: 1 w1fn nrJrooll \:0 Indo1l\n.l f!y hllHbllnd for: 11IW lJupror\: oreler whIch may bo ordorod IIrJQIns\: h111\ for \:ho,suppot\:of' rU,ohnrd 130);(111, <1r" 1n nn amount: equal 1:0 whlltevor oreler. WO\11d bo enl:oreel, 'J'hlJ Indel111lLf1caUoll 18 Illso 1nolud1ng r.BllfJOnablo oounsol f'001l, 7, W1fo IlgrnlHl .\:0 pay Illl al1mony for a pod,od of' \:hroe yellr[:ll di.r:ect:ly I:c I:hn Ilppropdal:o onlcn wHh1n thfi) COI1\1l\onwolll\:h of' 1'0nnnylvnp1n,.. t:ho COBR1\ pl:nm1\1m \:0 prov1de \:ho [Hlme \1\oc!lcal ooverngo as currently on:loyecl or., 1n the evon I: W1 fa' fl OOVOI:age 11l II\oclH1ed 1n uny Way I <\' coVerage 1dont1cal \:0,w1fo'll covoralJ8, '1'l1e COBR1\ prl:l1l\1um oonstll:u\:os alimony wh10h f.lhllll bo doduol:1bln \:0 wU:o and .lncludi.\ble i.n hUBbQnd's Inoomo, Thill pnrlod of' Ill1mony shall bo nonmodH1ablo l3ubjoot: 1:0 1:03:1111n111:101\ upon elt:hor.' parUel'l' dei1~h or upon hUabnnd1u rambrr.lllga 'or cohob1\:al:10n w1th Q mO\1\bo3: 01' t:ho oppos11:0 uex, 0, W.l.l:h rogll r:d 1:0 WHO'll pons.1on w.i.th \:he COlllmonweal th of' POl1lHlylvIln11l, h\1ublllld'l3 coulllwl shall propa3:o an approvoc! QIlc1UfloclPomollt:Jc 1\01111:101113 Ordor p,:ovi.cHng \:hllt husband uhn11 bo onUtlod 1:0 35'1,"01: WHO'E! pen81(1) bonof:lt based on n covor\:lll:o frno(:lon of 92,49'1" Husband E1hall be onU,\;lad to \:ho UIl1l\0 bune 1'.1. tB Il/J \:ho III l".orna te' payoe to wl1.l.oh wife Is ImUtlod IIIl I:ho pnl:t:ld.pllnl: In l:he plan, i ,I In tho nvon\: l:hlll. husb/lnd should d:l.e pdor. to rece.tpt: of, the InlUol bel1nLi\:1l \Indo}: the Ilpproved QuallUed l)om88UC" " IWlllt:iO\\Il On!or/ ho i!<j1:0U/J 1:0 donl\J1lilto bot:h chllrlro!1, H:I'Ln/1 /lnd IUchllrd dr" IlIIlrrovouilblo bonol'leJ\lIrloli 011 Ill.n po1'l:le,ln 'nl' t:hu pOlwl.on I Tn' tho ovunl: wi ('0 Ilholllcl prlldnoo/wu h\llllland bol'oro h\lnllll\l<!,or w,!f:o rouulvpu l:holl^tnll:.inl bonoUl:Il/ w.u'n 11grllol.i to dnll.j (11111 1:0 h\lUbll\lcl '/HI IlIlt'vi Val' bonol'lciilry 1:0 tho oxl:ont: 01' hill IIInrit:al illtnrllut: in 1:IHl ponulon, ] t: In I:ho I nl:onl: oj' l:hu pilrl:lulJ l:hlll: I:ho onVqr't:\lro f'riwt:ion 01' [)tl,~!J\\ ill bnlincl 0\1 yont/J of: i\cot:lliil chl!'lnu Inlln:llIgo ovor YOllttl oj' 1)01l01'1l: /wcnl/ll {HI 01' DllOOlllbtll,' !l, ]!l[)Ei/ dllt:o [11' /30PII I'll I: Lon I i'llrl:hn I' / I l: ill l:ho In 1:011 (: 0 I' U\lJ pn r\:LoB 1:1111 I: h\lllbilllrj \~ 1..11 I"lJCCl I vo \:110 Iwno I' Jl: 0 f:' l: ho I. n I:l'l rOil l: <\l'Jr) rtleld 01\ \:hill: nlilr.tl:ill POI:I:,jon frolll dnl:u of:' IHlpllrlltl.on lilll:ll rocu,!pl: of j)u\wf:'il:l3 oxo.l\rdillc;J /lilY cO\ll:tib\ll:lon by Wlf:'o III'I:O!' dlll:o 01' 1ll1pil1'n l:lon, 9, )]ol:h [111 rl:l.o/l ilCjl:nO l:hii l: (;)wy nh/Ill bo l:onpolllJ.iblo for I:hoi I.' own 1\ I: l:or\loy I'OO!i find Wirl.V(l. IIIlY find ilIl 01id,111 ngaJnsl: \;h~J ol:hor for (')()\lIlHo1 ,1:00B, 10, .Ol:hor l:hnll whal: 111 lipo[JI(,Jml .In l:Iro fJrov.lo.lolH3 /Jl:/lt:ad/ bo\:h par(;ioli illllO WILlVll illlY ilnc\ illl 011l.l11\ rill' allll\ony pondolll:o U,I:o/ flpOUI.lhl 11UPPlWl:, or nLil1\ollY, 11, WHoopl: fiB 110 1.'0 ill ol:hol:Wiso pro~ldod, oiloh pflrl:y lIIa~ diBpO/JO 01' h.lll or hor'properl:y 1n /11lY Wily,illld oiloh Pll!:l:y hOHlby w<liVoli illld rolil)()\lillhO!i 1111'( ,illldL fill rlghl:s ho or she may now have orhoJ:Oi.l nor 'l1cquJro Ilnder. l:ho presonl: or fu\:uro Ia\~ll of nny :lurJscUcl:ion l:o Ilharo .In\:ho proporl;y or \:ho estato 01' l:he ot:hor ill, a l:l'lCiul\: 01' tho II\fld(;al 1:01flt.i.on8h.i.p .i.llo)\ld.i.ncJ W,U:.I~out .llmt,tatlolll, UI:il(;Ul:Ol:y , , nllowallcD/ w.i.do\~ H flllowanco, 1J9hL of.\nLcwLacy, d,ghL 1.0 \:ake nCjfllnllt I:hn will 01' tho ol:hor, n~d rlCjht l:o nct as achnln.i./itl:atol: or OXOC\I\:Ol^ ill tho ol:l1(-)r' II ostnl:o, leach will at the roquo'!;l: of l:he ol:her execute, acknowlodCjo, and delivor ilny and nll In/J!:nullenl:lj wh.i.ch 11\i1Y bo lIoce/lllflry or advIsilble \:0 entry Jlll:o o(,l'ecl: th.i./! mutllid willvorand rel.J.nquJolunonl: of fill Buch In\:o1:o/1\:, rlghl:B, nnd clnill\s, Mfl, SIilRRA'l'ElLf.,II Mr, Borda/ I wan\: l:o ask you H you havel hoard l:ho I'ull ngroemonl: find whol:hor you agroo with this volunl:ilrI1y? . MR, 130RDA I Yori / I do. MS, SElRRA'rJllLLII Are you undor tho J.nflU811Ce r('~ ,,' \; ILI--. t.:IC p: " \ I t.'!( . J\" I, \ I I', t..I' ~ ... ("',: ,. J". .-,'1..,' t',: ) ~ :.1 (.J;;i: (':".':'." ,/1.... "(II 1'1.1:',.:. :,:\\U " U lfJ " .~, ...... "J" ;', .~ ,t ('J 171,; t: ~, ,.. n C;,) " " " ,1 ,,' " I' , " I' lJ '" ~ ~ 3 ~ ~ i Q l"'1 I' oo l"'1 .. II"r '" .n I I ~ 'l~ ill Q Q .. .. ~r I In !!l .- h I, ... ... , ~ ~ h' I' I I' \, Vi'll 'I HI 'l'IIJU GOUIN' OI" COMMON P!.,I'lMl Ol~ I cUMpmR~ANP COUNTY, PI'lNN~V~VAN~^ I , NO, 90 - ~a90 c~vr~ , I , :t'N P~:VORCI~ HrellAHP 110RP^1 P:l.111nt;ff. J^OQUI'l~JNm BOHPA, , Pqf.anrlnnt " H1UI Prollo<1I:'.\.ng conferanoo Momornncl~lm PATJU,' Mon~I1Y, AU~UBt 30, ~990 " presunt for the Pln.\.nt.\.ff, RlohArrt aor~l1f ts l\tto~'ney I.or,' i, 1<, l3arrl\ta:l. U I nnd praJilontf.ol~ tl1!3 paf.on~nnt, Jnoqualina Bor~l\, is l\ttorney RichArd ~, Prie~mAn, A ~ivoroe oomplAint wns fila~ on July 1~, 19~0, rniflinc,l gt'ounclp for cHvoroe of h't'qtr .leVAPle \J):eAkdown of t.ha m/.wr!Ag~l, CoL1nl3el hl1ve ind.\.oAt.ecl thAt the pnrt.lep wU:I. l3.\.gn And f.lle Aff.\.~nvits of oonsent And WAiverfl of notioe of .lntontion to request entry of. divoroe decree prior to the heAring so thAt the ~ivoroe OAn PO"oonolL1~ed undor S'otion 3301(0) of thq pomost.lo RelAtions Coda, The oompln.lnt also raifled tha eoonomio oll1ims of equitl1pla dil3tripution, Al.lmony, 111imohY pan~onte lite, an~ 00"nl3a1 faaS and expenfles, Withrespaot to the olnim for aqUitnple distrlpution, Mr, priadman has indicnted that he intends to t'<lise an argllmant l:egardingthe factor of. dil3sipation of madtal nssets Py huspand and oonttibution by wifa totha marital IJptate, Also, oounsal have indioated that they wUl need,to, h<lva testimony on the faotor of mnrital mifloonduat QP that ,faotor mQY affa6t husband's Qlimony clnim, Consequently,' wa nre, going to sohedule 11 heQring for ona d"~ to begin with the. . teetimony of the oonduot issue nnd the dissipation/oontripution issue to the mar!tnl esta'\:,el and tl)en' cont:inue with any , testimony that the pa~ties feel ie relevnnt regnrdinq the other fnotora ralating to equitable d.latrlbution and alimony _nd the identifioation and valuation bf Qssats, With respect to the dissipntion argument and"the maritnl misaondUot,isaue~ oounsel are direoted.to provide eaoh other n list of witnosses at lenet two months prior to the hearing to besohedUlod, 'with rel3peot to the arc,lument that huspnnd is going to nddress dealing with his addiotive p,rsonlllit.YI Ma, l3arratalU has lncUontecl that she ,maY offel.' tostimony 01' thnt issue,' If. ahe does intend to offer suoh " testimony 1 sha shOUld hnve II report. prepared and available to Mr, rriectman by NOVember 301 1990, ~~'at date will give M~. ';, ,', " I' I~daqlnnn IIn IIcleq\lflto ppportllni\:y to l:oviow t,llP l:eport and reflpond, 110 lMY nt thl1\: pqlnt n~!i1o cleoi.c1o to provic:lo tOl'ltin10lW tlwo\1t:lh l'\not:110t' wi\:na~s 01: hifl own ohool3i.ng onc1 ho I3ho\11cl pr.avi.cla tl1nt pv!f.lonoa to Mf3. SOrl7Qj;e~U nt. lOllst: II month prim: to tho l1aar.ing., ' IlIlf.ll)nncl 113 ~ 5 ya,ws of I1ge ancl rafl!,r1al'll,lt 317 SO\.1th Mnrket ptt'aat, Saoond l'loor., 11aQh<ll11,ofl}J111:g, l'el1lWylvl'Inin, whare ho l~Vel3 alonp, lie ifl a high OQhool gl'ndl1l1te And is q\ll'rent~y r.aoe.lv.lrig war.Kat"f.l oompenl3ntion in tl1a amount of '90~,l4 net mpnth~y, The worker'l'I oompensntion nwnr.q nt'ol3a out of I1n injury to Mr., porcln to l1is fll1oulcler. nncl oervionl sp.ln13, 1113 113 ourrl3ntlY nlso 1)13,lng tranted for hepAtiUs 0, lI\.1sl)nncl hnfl modion1 }Janee! tl3 tlwough hi!3 w!f:a' s omploymen\~ hut ~,IPon the divoroa he will lOl3a tl10sa penefitl3 hUt Will lJe ant it led to 0013R1\ lienef!.ts. IIUsl)nnd nlflO raoeives ml3dionl henefitfl r.el.At!nc,l to hia work .lnjury f.r.om the worker'l'I oompenl'lation I1WArq, ' lIus~Anq il3 ourr.ently directed to PAY for ohild suppgr,t the f3\.1m of. 8130,00 per. month, Mr. ,riedman indioAted thnt he intl3,.nc:ls to Pli1uition the ooUt't to raview the support I)naed on the ollrrent gUidalines, . Wif.e .la 45 years of. aga nnd rel3.ldos at 33 1'1.aa13anton Priva, East Perlin, PennsylVnnin l73l6 whera she liVel3 with Riohard Bordn, jr.., tha minor ohilq of the marringe, bbrn on AugUl3t 19, 19Ba, Ther.e is an emanoipAted daU,ghter. ~ho is aD yeare of aga and who is ourrently in the Arm~ ROf3ervs, Nife 113 11 hi~Jh 130hool gracluata and .is employed in the peparj;ment of mnvironmantnl protaotion with the oommonwenl.th of PennsY1Vanial' IIjr lJiweakly not inoome is 81,oBa,67. She ioin , gooq health, ahe is not under Any olJlignt.lon to pny hUspancl apouaal. flupport Ol' a Umony P, endente Ute, \Hf.a" has mecHol11 insuran~e ooverage through her employment, . The partiea were married on ootobar. la, lD74,and separnted peoemper 9, l006, Nif.e is realding in tha mar.\.tal home at 33 , pleManton Dd.va, East llel'l.in, l'ennl3ylvnnia, whioh she woUlcl UI~e to rata iI\', she is living ther.e wHh thj minor ohild, Ms, S,errote 11 i hod tha housa appl~n ieed by Mark \q I Haokman on ootober 10" 1990, who cilad a report otating the market valUe ~t $lOD,OOO,oo, 1\s of. th~qate of.sepnration, the balanoe on the mortgnga with Nntionnl oity Mortgage was 865,a9a.oo, Mr, pviodmnn lncl:l,oated that he woUld Uka to raoerva the oppol.'tunity to hnve the prbper.ty appr.aisecl by hie own appraisel' n,l,ld will ndvioe Mo" Serr.otelli of. the Ynlue that his oppr.aiser. qeterminee LIS floon nl'\ the llP!)):'O ien 1 i", oomplete, 'l'!\e mOl'tgage pl\yment " whio!\ w:lce hne baan mllkillr;J illl $630, a!i par month whioh "lnqludes tnxol3 IIncl llW\\I:flnoq, Mf;1, (:lol:I:l1tslH incl1nnt:pcl thnt: nho w,",tl" t:q t'otldn hor. right tp l:q.lnp " roni:nl Valllo ~'lnlm, Wifo hnp q ponoion w.\.~h tho commonwO/1lth of fenn13Y1Vqnin wh.lol1 oo"nsel ha~ Vnllle~ 11[;1 of the ~nto of f.lepnrntion At,$l46,346'OOl oollnsel hAVP in~iol1te~ thnt it if.l mOlOt !ikel~ thqt tho ren~ on win llAve t:o 1)13 ~.lstr.tI)\.1tec\ ul'I,tnc.r q QPRo I3lnoe there ~oas not nppeAr to pe offsett.lng nssotf.l in order to nllow fI ~il3tripution of the penflian to wife .In k ,n~ nor doel3 wif.o hnvs f.luff..loient ~nf.lh to puy out hUl3pnn~'f.l .lnterest, All3o, QOunflel hnva indio<ltedthnt there ifl n penefi~'dlle Wifa whioh Was enrne~ c\uring tho mnrriag~ for' vAontlon lenve wh,joh hns 1\ vnlllo, A0001:ding to MI3, SIH'I7f1tel!! there il'l 1'\ VAlqe alflo for l3.lo~ lanVQ, Ml'. I~r.iodman .lncl!onted thnt the):'eis no aal'lh}Jenef!t to the I-'I.l.ol~ leaV13AOOlln\\\1Ation <lll~ hna ~lIt n Value on tho vAontion leAva At $6,660,06. Mfl, Serrntoll.\. is gping to attempt to verify thAt the f.liok lenve hAs no oal3h VClllle, " HUsband, qi n result of hip injury, r.eoeived A worko):"13 oompensntion awnrd Clnd DoUnflel hAve stipUlntacl thnt the mf\dtal nmOllllt of the aW~\l:d after. pnymant of atto,l'nOY faes Wnfl $26,920,00, Thoie il3 soma .\.ssue with ral3peot,to tho vnlue of per.sonnlty..ln a flhocl ownocl \Jy tha pal~tios, wife saying'the property in tile shad had a Vl11ua of $60,00 i'1nc\ hUPPAnd $l,OOQ,OO. Mfl. Serr.atelli hafl a l.lst whioh ahe ie going to preflent to Mr~ Friedmnn and they ann see if thay Oi'1n determina ultimf\tely whnt Vnhle we flhoUlc\ use for. the property iI' the flhed, With ~ospeot to the other hOUsehold tangible personnl property in pOsflession wifa, wife says that the pr.operty thnt'is maritnl in har pOflflel3sion has n Value of $4,476,00/' hUspand has PlAoo~ a Value on the personnlty in wifa's po~session of $6,276,00, The numbers Ufle~ w{th reflpeot to ,the parsonalty of '$4,476,00 and $6,276,00 c\d not inoluc\e tho value of the items in thl'l shed, Husbancl's lifes\:y:\.e and oonduot hAs paUsed Wife t6 rAisel1n Argument ragardinghis disfl!pation of Rssats nnd ~h l'1oted I' We ,will have testimony on that fAPtOr., }\Qoor.tling to wife'l3 oounsel, hUsband Was n drugapuaoli and made little' " aontrib4tion to the ~nl'ital estnta, usin~ his assetf;1 thnt he earned for tha benafit of supplying and suppor.ting 'his addictive hnbits, I., 11 hond.nl) is sohedUled for 'l'hurscln,Y, Maroh 16, ~OOOI nt ,PIOO l~Art ,Pi'll ' pql " II "", Np~,lp",1'1 win \?P ,t', ~ori K, serrntal1i Attprney fop Plnintiff Bioh/.wcl f.I, Attol:ney " rr1.aclmfln fOl: pafencll1nt I' ,,> ", . " I' I' " I' " !' H " jj Ii ...,. I3pnt \:0 pOlmflPl nnrl thp 1~1 gol~P1't'lQl.lol~pr, r.r. p ,vorop Mnfl\;pt' .,J' I' '" , ., " I; I' " " 'ii'" I, " " 'I " " H Ii ij " " I' ii' "I' " '" IlWII^IlP 1l011l1A, P.litJn \: 11' t: HI 'I'III~ COUll'I' PI~ COMMON I'HI~A!:l 01" c1JMlll~lll,l\NP OOUN'I'V, l'IUNNUVINANll\ NO , \1 U - :l!l \111 01VII, ^C'I'ION - 1,^\1 VI!, iJACO\lltil.:lNI~ IlDll\l^, \lot:onrlnn I: IN IHvoHol~ Q.limm.J'tl'lIU'IO'I' lQ.\L!l N1"1'I!i..Clllli..lll.!.t NO '1'01 IHolHlrtl Ilordl\ I,orl 1(, BelTI1\:n,l,Jj, I 1'1n,1.nt:l,I'1' I COLlnllol for Plaintiff , Pofondl'lnt' ,Counael for Defendnnt ,la(lQUellno Ilonln H.i.0 ha.]:(l l:l, 1.'doc1l11f1n You are dirooted to appear for a hoaring to tnko tostimony on tho outstanding isauoa in the above oaptionad divoroe prooaodings fit the Offioe of tha Divoroe Master, 9 North Hanover street, Cnrlillle, ronnllylvanin on the 16th dny of Mnrah , 2(lOO, nt \1100 n.m" ,nt whioh plnae and t~na you will be g.i.ven tha opportunity to present w.i.tnasseB und exhibitB .i.n Bupport of your aasa, t ""it- g, Wllol'f'1r I I'roBirlen \: ,ludge Dote of Order and Notiael __aLJO/99 By I 11lvoroa'Mastar " ll~ YoU DO NO'I' "^ VE A 'I'El,~lI'IIONm '1'1m OPl~ICE GIU'l' !'EGI\I, 1Il~1,1', " !'^\1VICIl Oil C^NNO'I' ^\ll~OIlD oNm, GO '1'0 OH SET POII'I'II BE!,OW TO PIND bUT WllmnE YOU C^N CUMl1lml,^Nll COLJN'I'Y 1l^1l I\l:lBOCJ^'I'JON 2 1.1Il1W'('Y ^ VI~NlJ E Cil'H11lflJ,E, 1'1\ 1,/013 'l'Jo:I,I':l'lIllNI" ('/1'/) 24\1-3166 , ." ;1 i, 1Q!'ll'~O'(HlllN'~I', p\lbHo 'l't'apOpOl:l: $ li I/Ii,OO $ 'lit/O,OO , , ['\Inch $ YIi,OO $- oj J:IOO,OO '- 'I',/\.lqilI3' Rl'lA:\..EJstAte $ $ $ UOIJ,OO , " , PersonAl propel:l!y $, -..,.- $ $ llJll,OO --. ~":'"""" Incol11l'l $ - $ $ ," :r.NIl~Qlll' Homeowners $ $ $ YOO,OO !\Lltomobile $, $- $ 1'P.t/2,OO r..iF,e $ $, 172,/QuO/.toI'IY $ flIIR,OO l\cciqen t $ $ $ HeAlth $ $- - $ - ., Other. $ $ $ 5277,00 ~U'I'OHOBJ:I.1il1 l?AYments $ $J,JY,JR & 3HIll $--1j05,OB FUel $ 25,Oll $. $ 1.~00,OO Repairs , $ - $ 50,00 $_flO(J,OO MlllD:tCAt.1 Poctor $ $ $- Dentist '$ $ $- Hospital $ $ $ I. I Nedicine $ $ $ - ,., Special Needs $ $ $ fJUB'I'O'I'At.S $ $ $, 14,5//3,07 I'ngo 3 JilPl1Cl\'l'XON I ' llr.J.Y<I\;S Schl101 ll<lrochial school College ., ReHl7iol\s J.>EmI30NM, C~ot;hil1g FOOQ aar.ber./Hair.dresser Ct't;jpit:. Payment; " s " $ , . 'I --- ----:-- .' S S " , , " $ $ ,> - $ $--- $ ~ ---, $.- $ --1.Q!l, (J (J $ 12(JO,OO 1 -' !1Il,O(J $ $ '/W(J,OO " -- $ $ 20,O(J $, iit/(J,OO . $ $ $ PaY'I'V , VAolll:J.on llJ.Ccn J"e\Jl\l !;'el3fl chAriC/.lbl~ contrib Chilq ~upporc l\+ imony- PAymen t: 13 ot:hElt' (speal fy) I'I"'n~h /3UBTO'l'I\1l/3 $ (i. :I/,(JO ~ !l711,(J(J II f.i $ lI()(J(J,OO " "".., $ $ -- '$ " $ D(JO,OO $ lI(JOO,OO ~~ $ $~ $ $ $ $ $ $ $ " $ $.- lli,O(J $ lRO,OO $ $ , $ , , $ , $ $ 4Ii/ill,OO ~ ............ -"1--.............-.. ~ -..,-.................. '!"'--...-..... .....---'-.................. ~......... -_.....;..,.,... 'l'OT~ ~~ mxpm~/3mal $ II-j). . 0.!38, 0 'I I ___~______~_____"1____~______-_________"__"'_-"'_"'___;"-_'"... I P\\Ol'.mR'l,'Y . OI'lN'JilP I Checking Accounta S!wings 1\ocounts Credi t:. union S tockf.l/l3omlf.l Real ES,t:.at:.e PESCRIPTION VlIwum, !! l:l ~ -- -- -- _.r-- --- TO'l'M ... ',' t. t.. ......... .'... $_ See ~nventory and 1\pprais8m8n~ ...- " ~ - , ' ~--_.......-..._---_..._------------_..._-----------...--_.._------...- ,. :-----_..._...-----~--------_......_...-~---_...----_..._..-~~-----;........- (H) " Husband (W) " ~/iCe (cr) " Joint:. , Pogo 5 ,,' " " .,., ;, ' " I, ..~ 0 ~ ~ I ~ ~ !~ ,." 8 m I~ III J~"l"'1 d ~'~ I i ' " .. ! ~I!""' ~ I t !; II p;'I"" ~ Q Q , ~ f.~~ T I'" 00 Ul ,.. I'" ' ~ L r ~ ' ..g) ~' ' ~ ....... ~ - ~ b h ,. - ~ ~ '" I ~ .~ " I, P " ,1 ,,' " I' I H""'h'!i.bt.j . i ~ftIl<); 03 AW.t. ~lM .1U..~~.IIt,~ . I , . " ., " .,' , ' , , 'HC! IAIlI> IlllHPA, 1'111111111'1' 'I I IN TIIIi COIJln OF ('()MMoN PLIWi OF I qJMIlIlHI,ANP(.'OUNTY, PliNNHYI"VANIA VS , " "I NO, lJtklHlJH C/VlI" Tnl~M I CIVIL ACTIoN, '"AI\' ,,^CQU/lI,INIl fjORPA, I , Pol\.ll1\llIl1l , " , I IN PIVOIWIl ~mM(lHI\NI>lJI\II.', HIJl'l'Oln Oft' I'I,AIN'I'Ift'ft"1l CI""M F(}I~ 1llST/.UlllJ.1W1SJllU\1lliKICI~S' COl\'I/.!JlliS4TlUN A W Aim II' .I' AND NOW COMIlH .Illllllllln; ({Iohllnlllordll, h>, IIlld throllgh hlH 1I111l1'l1/0H, f,od 1<', Surrlllolll, IJH'llllro 1l111llho 11111' 111'1ll o/'SICIUtA'I'ICf,I,I. SCIIIFFMAN,IIIUlWN.1/: CM,IIU()N, II,e" 1111l111l0H, OIls MOIllOrlllldlll11/11 Hll/lport of' PllllllllfPH Chlllll (\11' PIHII'lblllloll. ' ofWorliurH' G\lI11pOIlSnllol1 AII'llI'd nlld IIVors lis fill/oil'S: I, S'I'ATlCMI~N'I' OF QIJICS'I'IONS I'IUCSICNTICI> "', hlm'l I, ShOllld PllIllltif't's workol'H' o0I11/l0l1Sllllol1l1Wnrd flo o\1ulhlhl>, dlslrlhulod sololr 10 " ,., SUf,(/,\UNlutl AIINWU", "us. q " II " " if , .': \)Plbllll!\llll~ PIII'l'Ulllly Wlll'Klllg I\IIHIIIW Ihl' Ihu PUPIII'IIIWIII or l\1I\'lnlllll1\ll1ll1ll'rotolllloll wllh Ilw CO\11\11I1I1WUllllh 01' 1'01l11~yl\'lIl1ll1, Ilul' \11.wuulily Iwllllo\1lnU Is $I,OH2,m, Pol\Jllllllllt I~ I'IlHI\lIl1g III 11\0 111111'11111 hOIl1\l, whloh shu WI1lilIIIlK\l 10 I'UIIlII1, wllh Ihu plIl'llus' 111111111' uhllll, lJorPIHhmllllso hll~ II pPlIslolI wllh Ihu C0I1111101\\\'ulIl\h nl' l'ullnHyl\'1I11111 whloh hllH 11111111'11111 \'lIhlU .. nl'$\Mi,34fl,OO, Alllllllnlllllly, \)ulbl1lll1l1t wllll'\lUolw ulIsh \'1I11l1l1\11' \'1101111011 IllIl'l1ull IIpl1l1l\Ol' " .. \'lllll'ul1\OlIl, C19111'1y, \)olbl1lllml Is 1I0t lillllllullllly lIuplll1l1ul1t nn 1'11I111111'\', 1'llIll1tlft~ ol1lhu ollllll' hlll1ll, Hllftbl'lll\'ol\1 1Il1l1l1l1lull\'u pOI'Hlll1l1llty 111111 hilS nol \1uUI1 IIhlll II) 1111\1I1tlllnHIIllllly 0li1ploYl1\oI11 sll10u hlH work I'ulllloll 1 11,1 \11'y , 1111111(1111011 to Hufturlng Ihll11l1w Il1.1ul'y tn his HI1OUllllll' 111111 OUl'vloll1 Hpll1o, PIIIIIlIII'\'lIlso sul'lill'H I'I'llI\1 \1oplltltls C 1111\\ 01ll'pIIIIII\11101 HyIlIlI'OIlW, Tho hU11P H\II111101111lI1Wllt lllll'llool\'od 11'11111 WOl'kOI'H' 1l11l11pOnHlllloll \11111 hoollllll'gllly IlsllII ,In PIlY hlH IIttO\'lwy's luos I'olllllw to tho PlIl'llos' dl\'nroo 1IIHIIo.llooo\11l\1mllllo o\'ol'ydllY IIvll1g OXpollsOH, 1'11I11ltll'\' Is II high Hohool gl'lIl1ullto with 110 HOOlllllIlIl'Y oduollllol1l1l111 1\1lllh11111 vnollllolllll~klll~, BlIsoII Oil \lIIIII1I1I'1"H hollllh 111111 Ol11pll1y"hllltY,lIl1d III oOllsldol'llllol1 ol'lho, Oh'Ollll1S,IIIIlOOS ol'lh!s OIlSO, tho OO\11't shollld IIlvl\I'1I tho olllll'o w\lI'kol'H' OOI\lPOIlSllllonsolllol11Ol1\ tn 1'11I11l1lft~ roglll'llloss ol'tho pOI'OOl1ll1go I'lIluos uRod 1\11' the equlIlI\llo dlsll'lhutlol1 o1'1I1~ \'(11\1\11111101' or tho 111111',11111 \1l'opol'ly, I . I ()Il Augusl 13, lljl)IJ, Ju(lge Olel' hellnl PllIlllllir'HI'etltloll Ill\' ^lIll1nll~ Pelllle\llo Lito,.1I WIIS dOl\IoII dUlJlo Iho lhet Pllllnllffhllll Iho WOl'kol"s Ollll,lPOIIHllliol1 hU\J\( n\\'lI1'11 ol1\\'hloh to Ilvo,' " <I " . {;o' ..t' " !llf , , 1'1 I' (1/: I,ll ,/1/' (i:'1 'I' II'J I' I.J: ", ,,:,1) I: , , " .. , " ';1 (\' (', (, " \ t, .;'. ,,' I, ' "/I'I} ','(I: ,1 ,.1 \../ rf, 1,)-", " ,/ 1"'''II'tAttttll.'1tttll.iltt'''b l'tl~IWO' 'ONl'tyNOlI~'mlljl"j.ltll'f';oN(ll"Alo,V'1YOHIl"I"tt' \, " " " I' " , ," ~ ~ ~ ~ ... id ~~ Q l~ .. ... .. "~ll '" In I , Q Q (tl ~ ~ .. .. ,~ I ~ ~ J In In ~~ .... h ... ... h!.: II) 1 '" " " .. I .. ,. III TilE CO\1l\'f or CO~q.ION l'LE,\S OF CU~!UERL.\NP CPUN'I'Y I PENNs'(l.YMII" IlTCIIl\111l ,IlOHll/\ , Pl4in~iff _I -' , I I -' , _I I NO, '.l1l-311Ull Cl.vU 19___ VII, \W..'QPI!lf,rNI~1l0111~'\ , ~ , " R1Clhlltc1 1I0nln A I11lallU1l1I wi~h IIllllplll:\<< ~o ~ha , , (X) D;j.VOl1oa ( ) .\1mI11plan c ( X) !\litqOI\Y, () r.lin1oIW !'1ll\<1lln~a ~IOTION FOil ,\l'1'0 nl'l'MENT or ~fAS'rEl\ (l'l,lin<<iff) (~\Q;~~)', folJ.pwil\g alAi,l11El' 1110VIla ~hu eO\lIlC ~o (\ppoil1~ Lita (l\ ) ( ) (l\ ) (l\ ) Dia~lI~bl1tion of !,ropall~Y Snppo lit C0I1\l11 al Faaa COllts Al\<1 EXplll\aaa , " l\n<l il\ a\\ppollt of <<he 1110tiOl\ Iltl\l:al1l (l) Piaoovery h oOtqplal;a 1\:1 tq ,tha 01111I11a(9) EOt' '1hioh tha llppoil\tllUll\t oE II mlla<<ll/.' ia ,0<1\\ell<<ad, ,(2) The <1e.fe1ldal\t (lll:ts) (hus 110~) l\ppal\lIo<l in ' (by hill I\tUornAY, ' niohm:d, s. fo'decll1l'1l1. ,,(3) 'The Iltllt\\lIpllY !lllol1nd(ll) fOil <1ivolloe (ill) , . the I\o~ion (pallllonAlly) " ,F.,1<1l1ire), (AIIO) ~01lowin8 olAimo! (4) Deleta ~he inAppliaab11l pallllgllaph(1l (a) 11flO<Xl~Il;~>>l~>>mn:l<lIl1tl!ltch; (b) r.n l\!lrot:ll11ont hao baan roaohec.t with 1I0apaqt to tha N/I\ (0) l'he sotion i9 aontestll<1 with raapaot to tha Eollo\1in!l DIVOt"co. J),i.al:l'.i.burl::I.on of PmlxlI:l:I', I\U,l1fll1Y, ~'ol1llllo1 F'eoa" Coal:a r. ElXPOlllloa (5) 1.'ha 'lo~ioll \illVo1V<1s) (<1oas noC invo1va) oOl11plll;l i,llSlll1Sof :\..W " ' (a) Thu huuring ill a.~l'l1ote<1 co tl\'(e 1 (ll\lSU~) (<1<1:111) I ' (7) ,\d<1:1:ti,onl\l info'nnacion, 'i.f any, ra1l1vitnC to tha U1otion I ~I oll\imlll 0).' fl\u!j, Dacsl It,/;,~/y.. ? " 1m:.!. 1<. lJon:lll:oll.i.,Attollnev , \ -) } /I. . ,. ,I, , I .~G. _~ f r(l'hi!1.qit~) (~~~llMll~l\~ , bROIl APOIN'rINa:.fA TER MID NOI{ Op/'(,(j,... 1'( ,19.2.2., f' ,.2,./ ',I'V{ '::f(.~.I?l"1 b appointo<1 m~Jtllr wi tll ros\leo c to ,711n "fo.lloWin!l a1aims, CC/t!._., "-IIQlUra', - J " " .. , " I, " " 01, i,i " " , " i' ,. ., " I' I' " " Ii " II. II " 1.1) ,,'I. Q q H fr.; 'I.ll 7m "eJ "tllr'i "IJ OJ " ~t riff.! k, ,,.J " " ':;:t," :>1 II " /J'/ ,',:, ( I~ (',,),I} I" 1"'( i!;l['j , ,,~ ..~ ~,.., I' t-;--r-l "" ,~,-,~ ;.1) ."i. 'I, ,I.' .;_,("'1 :r;r ty" 'J~' '- " ,,' k~ ,1,1' 1::;'1 ~r !J.] 'i ,. I' I;:' >It "<. .." " \, ik , , " ,. I' H , " I' 'I, " j' " ;',',1, I' .n I' Ji " J' " ," !I, Ii ,,'I " " , ~ ,: ill Ii J. i " " " I : ~ ,. " I,l I' " , ,. " " " ;/' " " (':I" Q ~o , I' ~,;j l(J 'fl. 'I iI ~lW "'tot "1 'u "!:I"') I' I. "{J " ;':1 f~_' , .(;~" 'u -/ Ii , (d'L, C~(J'J t~ru; I,;, ';,:; "," -rJ ;'."" :::1: ,HJ" t: ~;. <./1 J 'II.') CtJt") I t.~ :',1'(1 .I"'C': t. :t:) (',' I.'.. ~ -, ,r.' " " I. !' "II, /, I' ~~ I' i,; 1/1 I I I " 'I ( I , , I ;, "I' " Ii', , ill I , III.. I I' I , 1" ( ) ('., ,) I, I i: I, I, " " " " " I' .' ... ,. UII. IOI/WIKU . .' tMttIlOI,l,01ti10,,,'UjbONOl,;AlaV IWOnIIV.I'HY , f .tlNl'1~IfOljV"~.INI.'lVil 1" ~' '~ ~ c 8 "~ Q'" III ~ I'" ! " ~!: i~~I~~,~ : Is' ~I~"" t=1 1"'4'"" , ~ ~ !:. t:. " je " .. , t. 'f" ,,,' " " ,. " QQ1ltl'LU \ ~ 11, PftVft9Vnphs one thv049h ten I1VI3 herepy inoorpQr~ta~ \Jy " 1~, p:\'ftintiVf st~te~ that Plaintiff nn4 Pefen4ant Possese Vftt'loUe Heme Of poth j:eC\l nnd perfilOnnl 111<1dtftl pl:oPerty whioh is sLlpjeol: to equ.ttnpla d.tetrtbutian \Jy the aourt, 13, Plnintiff req4e13te thnt thil3 ao~~t grnnt equitn\Jle 4btr!pution, ' Wlm~E1pqRE, plflint,iff prElYs thnt Vour Ilonovable pourtl (A) Eq4itC\\J1y d.lfltripute a:\.l prope~~y, perflOnnl and real owna4 ))y the pl'lrtiesl ," I' (p) Grant sl\oh further reHat: ns the oourt mElY deell\ eq4itaple and just, aOUNT III 14, Paragr.?lphs one ,throl\gh t,en are" hare by inoovporated by' referenae herein, 15, 'I'lli'll: by reason of the fhstitution of I:he aation to the " above tf.l~'l1\ aM numper, Plaintiff. w.l,ll be and hf\s pl;\en put to oDns.tdara\Jle expenfle in the pl:eparation of his oase, .I,n the amployment of oounsel and the payment of aost@, 16, 'l'hat the Plaintiff I s inoome is diflproportionately 10War tlHlli Pefsndant I S inoome, and plaintiff iF.! witho4!: adequata funds to pay the"oosts and expenees of this litigation~ and,is, (I:.' 0:'" ,"'.: I , , " I' " j'I' '/ I I J'" 1/,' I I:"~ I ( jl I I. "1 I' ' ,:'j I I' .... ,.-.:. /10 VJ "i.q " " 1',- II ";,I I I , 01 h'i, 1', I ..1 .1 il ~ U i<'} ,:; " , 'I 1.';1 ~ ~ J I Q ... Id !" I' O! ~ "m ... ... .. In , I IjH) .. Q ... ... In 10 .. I' ~ II ... ... I' h ~ ~ ifi \~ ~. " oj' " " "" " , " - ',." IIMfll""0I1111'''"I/''fI'llIl1 IONrl101 '~Hi i-tYNcidtkll~I~.IIVI."lV#O NOltv.Io't'lYO' u'tJ"1W " \, '" Ih" rill "'I III' Cn",,,,"n !'IIlIIS III' IllJlt""~III,M'ln C"""'r, I'llllllsYlvnnlll ' IlllltIlCS'IW IIIQ,I\'I'IIINH HI~I]'I"IIN IIWIIIIIIl> ~, 1l01l!>1I BIl ) IlIl~k~1 NIIIII\l~r DO 3000 CIvn, 1'111111I11'1' ) 6051 000 oo/(l~~\'1'i'~ V~, ) 1'AC~H/lH CII~~ NIIIII\lur ,11lr.Qtllll,Il'lfl II, 1I01lP/I ) llul~1I\1i11l1 ) DUlur HIIIIV III NIIIII\lur lll'twl' ^NPNOW \0 Wll,lhls WIY ~O, 1000 Ills horohyDl'llor\l(1 " , thllll UI'Ol'l CONBIP~IlI\TIOtl ai' 'I'HIl IlIlCO/olMIll'lP/lTION of" '.rum /lLIMONY I'Ill'lPIlN~'m LI'I'1l CONI'IlIlIlNCIl OI'I'IcmR, l'URIlUIIWI' '1'0 RUI'1l 1010,15-4 (a), 'l'1I1l IlllQUIlB1' 1'01lIlLIMOl'lY I'IlNPIlNTJ;: LITIl III PIlNIIlP, " 'I " Ii, " I, , nv 'I'IIE cOUrt'l'l IlllO I I\J :1hudcluy lIC I plu I,Ilt IH-"""", (10fOlldullt .,'), 1\, 1"dOclnt'\ll" BIIII' ~(Y~1"1~~'t\ I" Ron-uto11I, 1\lIq')'\~I~M'I i ...-" ,'tJDGl~ Survlcu Typu M Flinn OIl-OOI Wutkurl/) 2100B ".. ~, I': [,' ,';"j , >ill ",li (t~1 i , I " " l.l! , , , I.' 11' " c.. " , .', Ii'! ' (t'} " lill' " , " . II' (I'j " 1\1:1 1.1'. , II, ~ If \ }, I 'I ~ ll" '" ,) ;, rn ... ,I' i' " " , " : .. ' ~ .. ~ . ~ ~ " " ~ .,M ! ,', , ~~ i "'i Ilt ~i j ,~~ , , i~ ~~ iJ ~~ ! IIG~~ ] ~ ' , ill"'''' ~'m ~ ') . JHi ill ~ H ,-. ,...'" " r.;, !' co ~ ......, " Cl'I t.. b fij co f~ , ~ ~ w ' - ~ , J ,~ Cl'I I l~ ',9- .. , , " ", I,j '-,t J,t I' ,.1' \,'t " " , "I' O'J.1llJilll :n~oPI'llllI WIilI1lI< MON'I'Il. YID^H ---- Int:'I~I:(~f.l\: i.i ," $ '. '.' Pi V ,i.qsnc1B t~ ." ." ,? '1' , I'anflion $ l~ 9 fjooiAl l3aoud t:.~, 9 s t~ '. Hsn\:fl I.; " II 111 ~ " HOYAll::(.Sfl $ $ $ l~xpenf3e Ao 0 0\111 I: 9 " $ .-.. ,,' i~- a~f.tQ $ 1" $ ,1 Ur\OlllP 1 oYl\1en t COI\1P, , $- ,,$ iil WDI;lqnep I s Comp, $ $ s , 'l'O'J.1~Il WIl'l' ~lt.Il ;n~qOf.fm t. I II' 11'11 I t II I t I I , 1';' $ 1.0,fl1.G,OO , ' " " !IIPgQN,l1:!:ON, Pr.j. VAts Sall0Cll s s $ " " -- p<1l'oc!11l\1 school $ 'J. $ ,,' . CoHflga $, $ S "t'"- Hal ig iO~Hr $ l~ S , " J.'1!l1R~QW^,H' Clot',h~na $ I' $ 31i , 00 $ 420., on ',' li'op('\ '$ 40.,0.0. $ $,.., ;lOBD , DO. , Bar~el'/II<11rQrBBsBr $ f~ 10.,00 $ 1.20.,00 Credll:. PaYl1\en t: $ 9 $ r~ohWS I $'," ,. *-- $ t-!:J:SCIllLLM-ImOUSI Child Care s , $ 20,00. $ $ ," $ I, '1'- $ $ 1.040.,0.0. $ /, 3660,00 I' , Papers/Books/Maga~ mnl:.ertalnlnenl: " " I SUBTO'l'AL$ $ Pnge'l PnX' 'l'V $ $ $ VIWf\\:1.0n ~ $ $ " . G!l:t:!3 $ ----, $ ~ ,'1~ I.eoC\l !;'ees $ I! 4%,00 $ 5000,00 - Chm: i t:abl e Cont:r.i.b $ ,,~ $ _ 1 Ch:l:lc1 f.IHPpor.\: ~ $ 226,5'1 $ 2nO,04 I , I\limony Pl'\X'menl:s $,- $ $ Ol:he~' (l3pea if:y) $ $ $ -, , $ , $ $ " f:JUA'.fO'l'Al!f:J $ $ $ '7'110 I 04 -----~--------------------,.~--------------------------~ 'l'O'l'~~ ANNUA~ R~~R~f:Jm~, $ 19,%6,50. I .. , __h___________________~--------------------__~-.~-----__ ~ROPlllR'l'y OWNlllO, nmSCRr. P'l'IOltl YAI.,um H - W J ... - Chealdng AC;JOounl:.s See Ihvent:ory and Appraisemenl:. f.Iavings Acaounl:.s -- 'I --- Ci'ecti l:. Union Sl:.ooltJ3/Bonds . ,,- ...- - ---.-- Real Dlsl:.al:.e - , -'~,- ---~-------n-------------------------..-----------_-~-___ I' iJ,'O'1'Alt .,., ,'.....,...... '.'" 'III $ , ------------------------------------------~------------- (H) '" llllJ3banc1 (W) ,., WHe (J) = Joint: " 1'1I110 5 " " . " R~ cHARP 1101W/I, P+nint:iff " , r.N 'l'lIlD OOUIW Ol~ OPMMoN l~~1D1\1'l ' I ,OIJMI11DIU"lII'IP POl1N'l'V, PfJlNI'lI3VLNI\N:f/l , , I I I I v, NO, OO-~BOB o~vn~ l\c'NON OPMPI"MN'l' m - ~I\N P~VOHGlil ffAOQl1lD!:lnH!1 UPHP/\, pefeMl'Int AN~llliIlillLQQ.MELhIN'1' IN D:t~ flf1QW.I.QN 3301-'''1 ANILlal OF....j1IIi'l DIvanmL.mmll COUN'll 1 , ~,' Mmitt:eq jl , Mmitt:aq 3 , Mmi tt.aq " 4, Mmitteq .. 5, Mmitteq , 6, lIdm,itted 7, Mmitted 0, Ac\mitl:.ed 9, Mmittec.l 10, ,l\dmit,ted thl1t tha partiel3 are tha parents of one son, Richard Uorda, ,Tr. Danied that hia elate of birth is )\ugUst 101 .1003, .l1nel moreQver I1Verr13d that his date of birth AugUst,19, 1902, WlmREFQlUl, Dsfendl1l1t prnY13 your Ilonorabla Oourt toenuel' 11 Deoree 1" Divoroe from the bonds of Matrimony, " OOUNT II. 11 , Mmittaq 12, Ac\mitted l3, Mmitteel ,il ,. " '\ " W"I'lRPVORI, pefpndnnt prAY~ thAt V04r l~norAble oourt! , " (A) Iquitn}Jly rHflt:d}Jute AU property," parnon<\l Anc\ reAl, ownec\ py the pArtiea, ' (p) d~Ant suph f"r.thpr rel.lef AA tho oourt mny c\aem ,equitnple Anc\juPt, Dount II:t +4, MmittPc\ 15, peniec\ thAt Nt\.tnt!ff WUl 1)13 nnd IHIP I)een put to OOnl'lic'\fwnp;\.e e~penl3a in prepnrAtion of thil3 onl>e, And f\lrthElr Ayerrec'\ that POsts of tha parties w.lll pa opmparAPle in employing oounsel And praparing for their onl3a, lG, Pefenc'\Ant il3 without l3uffioient lnforml\tion to form An op.lnion Aa to the tt'uth or falsity of the AHegAtion regarding l'laintiff' f.! inoom@ \Jeing lOWer thnn PE1fenc\l\nt' s inoome , and proof therl,i!of ifl tharefo):'e c'\emAnc'\ec'\, Mot'eover i .), t .ls Averred th<\t PIAintiff'fl aarnlng oapAoity ifl eqUAl to or g~eAter thnn OefendAnt's eArn.lng oAPno.lty, Anc\ that through PIAintiff'13 own free WiU, he hAS c'\iminil3hed eAt'ning OApl1oity due to hifl pAr3t And preflent APuse of Aloohol and c'\rugs, L.tkewil3e, it is deniecl thAt plAintiff cloes not hAve sllf.f ioient funds to mfdntn!n himl3elf during the pendenoy of the, litigntion, and further avarred thAt if in fAot! thi", A1lagl1t!on is oorl~eot, his enrning oapaoity oet'tainly is auffloient to sustain h.lmself, I ' 17, PefendAnt is without sUff ioient inf.ormal:ion to respond to the Allegntions oontAined in pArngrAph 17 of tha oomplaint, Anc\ proof thereof is therefora demnndecl at tril\l. 10, It ia ac'\mit.ted thl11: Pefendant is employec\ by the oommonWealt:h of l'el1nsylvnnia wi.th an inoome of approximatelY $41,000100 per year. ' , WIIERI!IFORI!I, Pefenc\ant prays your lIonorabla Oourt de.n~ An Order L1pon the Oefendant no pay Plnintifr l\1imony p.QJldente ~ I1nd ooUnsel fees and oopts of H tigut!on, " OoUnt IV 19, Admitted 20. Denied as mora fully sat forth in pAtAgrAphs 1G Ancl 17 of the AnsWer. R;foHI'IRP PPHPI\( .. 'NA,tn\:Hf v, 4I\oqum~~N~ pORPI'I, PaCen~An\: I. ~N '~'lIlU POUR'l' ol~ cOMMoN pt..mMI oUMI1)j)Hr..I\ND pOUN'ry I PIDNN/3Yt..VI\N;f1\ NO, 90-3090 O~VI~ ~~RM OIV~t.. AO~;fON ~ LAW IN Pr.voROIll ~SE)TS OF PbRTIE~ Pafen~l1nt, JQoqualina por~a, mnrks on the lil3t pelow \:hosl3 .ttem~npplianbla to the on sa At bill' An~ itemiza~ 'the Asaetl3 on tha following pqges, r.f An itam h~s \Jeen APPraise~, n oopy of tile appraisal report is nttAohe~t xx XX xx lxxl i , (XX) I 10, 11. 12, 13, ) ) 14. 16. 16, 17, 1, 2 . 3, <I , 5, 6, RQnl property Moto~' Vahioles I3tookfl( bonder seoL1ritisl3 and options Oertifiol1tes of deposit Ohsoking aoOountfl, on,sh snvings aooounts, money market And savings oertifiantsl3 Oontents of eafe daposit boxefl TrL1flts Life" insu~'l1noe p01iOiBI3 (indionts faol;\ V<llUB, oAeh surrell~er VI11Ue an~ o4rrent penefio.tnri~s), Annl\ i tiQI3 Gifts r.hher i l:.anoe " Patentl3/ oopyright~, inventions, royalties 'I PersonAl property outside the home Businesses (list all ownet'a, inolucHn.;t peroentage of ownership, an~ offioerl direotor positions held by a party with tllQ oompany) . EmploYl1'sht termin'Ation' banefits.... " sev.ranoe pay, workman's oompensation olt1im/ nWat"d Profi~ Sharing plnh~ 7 , B. 9. " ,. '" .1', , j; J, 01 UI '" w N I-l p~ , , , , , , - ~' B' ~ si r~ ltJ ro ~ltJ r'l '0 t:l ~, '~ ,J W !gill U'd' ,~ !\l ~ '1tI ~~' 0 0 ,-I " '~ 0 ~ ~ ~~ -lJIf1Il '1=1 F- :r 1=1 ,01 r ~ ru ::.',. ..... ~ 'tJ ItJ 0 '1 11 121 ~/I it jj. 0 0 0 , g f~w~1 ~S 2- l(j 'tJ 1=1 0 I~ ~ '0 ITJ 00 II> i1"~ OI~O .Q!\l , 1 0 ~' "h ~' I' ~~ -- -lJI .(II 11' .(II ." -VI .(II m~8 I'" ,'" 0 ~ ~ 01 01 01 1D , .. , , , '" ~ 0 Ul ::I W N 0 01 ,I> 1I1 ,I 0 I ~ ~ 00 W 01 0 UI 0 , , , , , , 0 00 1I1 0 0 0, 0 ~ 0 . 0 111 0 0 0 0 I1j .(II .(II 11 .(II .(II 11 i~ 01 , 21 "" 0 111 01 01 III 01 , , " 00 , w N 0 , Ul ,I> 1I1 '-l 0 00 UI 01 0 UI 0 (j)~ , 0 , , , , - - i f;1 .' g; ~ ~ ~ ;~ ~ ~ ~ ~ ~ .. .. ~' ,~ i ~ .~ ~ I~ ~ ~ ~ ~ ~ -- ,g; ~ i r ~ ~ ' ~~ re .~ '~ ~ t: ., ~ ~IJg ~ ~~l ~~, w~~ ~~I at; SAUl m~J l~ III ~ 'l~ ~, ~ gg ~ n~ ~ ~' ~,~ rt~ ~ ~, t rt . , ~ 1 ~ Ii m 'I 01 '-l p~ " I -- - --- -- .. ~eM[! 1'ltl~gtlmif ~tl O>f\.lOI;lf\.lj' d o ~ t04, . I '" .,., ., II' , I , ~ ~ ~ ~, ~ g ~ , g ~,gl~ , o r.' 61Fl 14014g01~tt II> 0,,, 0 , ~ o l:lVi '4 B m II ~ l(j ", litO 0 Iii ""0 0 ITj ~, ~ ~ o I I-n ~ I - - .. I~ --:: - - .(Jj ,.(Jj m~~ H 0 w 0 1\1 , , ~~o 0 01 0 W -~~ <:> ," , I 0 .. 0 0 IZ;~, 0 0 - ,. ~~I tl ~~. f\.l , ~.~ 01 W I g-I ," I 11m -- I ~ ~~ ~ , ~ " ~ I~ ~ - - . ~ ~~ ~ ~ .. l:l , " i', ," , I, - ~ 14 p~ I - -- to IJJ ~ to f? ~tl en 0 ..,/, ~ ~' at! 8fr &' Itl~ ~ ~ ~~ ~ 'it ~ I , ~ ~,~ IZl 0 "j - -- ~ , , -- " I! ~ - 11 11 I~I~~ , , O't Ul 0> 0> lO O't "j ~o . , , 0> J. " ~ ...1 lt1 o ....I~ " IZl ,,' " ~~ 11 11 i;~ , , O't 01 " 0> 0> lO O't , , 0> ~ oo~ o..l lt1 IZlI1J -- ~~ u " ~~ ~rri ~~ I- I1J ~~ " '~ ~ ~[ w~ ~' ~'_I ~;t ~.~, , l~ ~ ft~ " ~' ~ , '~~ '~ Ii :; m ~N "{ ~ '" ,I " I" ~ ~rt'li ~lld t~ j '~ ' ~;g. F /1" ~f ' I:JI j:t~4. ::j ~ ~ HI "1 Et,~ ~ ~ R'~, ~ ~ ~ J~~ , r~, ! ~ F "I '~g o~, (;i( ~~<lEt 0'1.. ~'1I1 P 011'1 ~fV , <j [~ 1 ~[~~ m g~~m f?~~[ hf: i ~ ~'G o ~(1l1\l ~.~~~ Ii " l" 1-1 p~ , , - !111 <j ~. m ~ ~m " ' I I~~ If3 ~' "I tr f~ .~,~ * ~o1l1a 111 1.' m , ~ W '~ 111 (1lt-i; 0 0, tr 9 ~ ~ l2; ~ 0 hJ Q, II , , ~~ ~o ~ hJ ~ , ~~ f;lo 1-:1 hJ I 0 , ~ - ~I~~ ~I ~. In , - - (J) m~~ 0\ UI , ~~~ Cl l" I~ I , , lO 00 ' lO l2; hJ - 0\ II w , ",. , ~ , 0 0\ ~,~ :1 ~,~ 101 ~ ., ~. ~ tll fJ , fit ~~ ~~" , ~,~ "~ :8 ~ Iii 11, ~ rn ~, ~ . 0 Ii I tr ~ ~ ~ r . ~ " ,.... ~ I 'flOIll' , 040A hllpel (000 pm 14,1 ,,,. Iho InB lohol, OII1OIWI,o, ploP'o pll"l 0' IVpo, Oheck the POll for your filing Eltl'ltUEl (B.o P'O. 1~,) OhoOk onlv ono ball, ! FigUre' , your ell~mntlonEl IBoo pOQO IS,) II maIO IMn ,ovon dqpondon\8t '00 pOQO a1. Figure Y9ur totElI Inoome Allooh oOPv B of' Vall' pornl, w,a on<1 '090.n hOI" II YOII o'on'l OBI 0 w.a, "0 pnoo aa, Attach C/lllOk or mOlloy oldoron lop 01 allV l10rmb W.2 or looo~n, FlgUl'e your aclJUBted gruBIl Income ~ D(lllllltll1\1nl 01 Illy rftllll1\I,ly-lnlufI'''' H\l~yn\l\l U. ':ICQ U a, d Iduallnoo e aX Ruhll'n 10J a02 Il\n lito Olllv-Do 110t Wlllu or aluplo In tllla "H'CO. 0~1U ~o, ,o4S,OOon \'0\1' ';'0101 ..oWIIy ~I"ll,hor __._,____..___ JQL~UU,~.1.11, Sl'."'o', ,..101 ".Iully ,,,,mh', _ 208 ! 1" IlflO,( for Prlvoov Aol 8n~ Pnpp!"Work , RB~~Ullol1 Aol Nollotl, atltlllnllll 4. Nnlpl P/lp(1k/(11l "Ypij" will nof oll(wOP YOII' fox or radLloa our ralund, all liD YOllrsulf, If Yollr porool (0' 80;'0000 ~I'o) 00, 0 clolrn VOII 08 0 dopnndonl on hi, 0' hci! 10' ,olml\, do no' ohook IIOX Go, alii ho 8uro \0 chocl! \1\0 hox on IIno lGIl on P090 2, I> liD SpollsO o PopOI\I/OnIBI , , ~~ame (111'1, lnlllal, 'nd IU' namel Er 0 fjord, Rlo/wIY/ J, ROIYlCl, Jr. (1/ CI,o., I undor . 0 , (alII ouo , .r 01001, dopandonl" 1001(11 800wily numb or 10l 60 i 7.12.1 1 OS 6~ :R~OB 1 I I (4) P,,,,no,",', (01 No, '1 m..'~' rl1tallon8hlp lu IIV\lilln your you hom, In 1002_' f)ounl1tar 111 Son'liL__ ti If your ol1l1d dldn'l live wltl1 you pul IB olalmed as your depunden, I ~nder a pre-1005 I1grssmslll, ollila (l1erB , , , , , ' , I>- 0 II Tolal number at eXBrnp\lolls clalmad, " . 7 Wagea, salarlss, tips, slo, TI1IB Bl10uld be B!1own In pox 10 of your W'2 _-1brm(!!LA\\aol1 form(B) W-2, 011 Tllxa~le InlBreal Incolne (BBa pllge 24). If aver $400. also oomplele and a IBoh Sol1Bdule 1 Pllr . b a ,oxa I Il1tsrBBI, DO 0' Inolude on line 0 . Ob II Dlvlde~dB, If OVBr 400, alao oomplete and at aol1 Sol)edule 1 , Pari II, 1011 TolallRA 10b TllxllPle amount d!atrlputlons, 1011 ' aea a e 25 I 1111 TaiBI, penslonB 11 b Taxable amount llnd annullleBI 510, ,11 (aee page 25 , 12 Unemployment oom el1Bllt on see a a 20 , '1 Gll aooial Beourlty bBnefltB, 131\ 14 Add linea 7 Ihtollgh 1:lb (far right column), TlllB Is your lotallnooma. 16n Your IRA dsduotlon from aEJ?lIoabls workBheet. 15a ..,- b Spouaa'B IRA deduollon from applloable work-" allBet. NolellMes lor /RAIl bBgln on page 1l1. ' 15b o Add IInBB 150 and 15b, TI1Bae nrB youl' 1018111 JUBlmenls, 10 Subtract line 100 from line 14, Tl1la 10 your adJusled groBB Inooms, If leBB than $22Mo, SOB "Earned IMome orodlt" on page':lo, 0,", No, "oe7A 1Gb .....~.;""': -.... N',ofho..o , g~oo~Mil~n .iL ~1?II~r~r-O~'I\ Sa W'.I ' . liYo~ Wllh _~ ,volI . ~I~II'\ IIv,' ~llh VOII <<110 D dIVO(O' Dr 0'"'' 10\\ p ,0' pouo ~1l ' _ Na, 01 ~\hor ~'polllo\\l~ oil eo M~ ollmh." I"toro<< 0" IInOl .hoyo , 4 yo\if Ih,lll~llj. fnd Inlll~' '\.0,,1111\1'" I, J 0 Cl Cjl!!!.1.!lliu1L llo rrl C1 A If . 1~1/l' I~I\jln, tllo\ln', 1\lt' !lotnl' ~11\111\'li~1 I.MI MI1\9 ~ ,,-B.I.~.!LCUYI Jt BOIY:/C1 .._- -r"""--- !lOlli, ~lllll'n lI1\lll\ll'( "Id .\1,,1), 1,1 ~Y" 110~' 4 P,O. bo~. .,U, 11,\~' \G, ^lll. no. V _..!HLfJOC1oClntol1 Pr(vo '-_ g CiIV, luwo Oll'lI'\ \lllia,. ,I,t,. ,n<J ~1I1 'odl'.1I you hl1~9 I1loIV'YII ~~l,lr~u"" p.1fJ' 15. , ll'O,OOll /11\/7.1111 PI'PIII~hm,lIpllS.lo,Qllpn Qpmp" pion F~n~1 (SBtllinml 1 P,) , , ..Yell,::H!.L Po yoq wont $110 00 10 \Ilia fuml? I' . . , , , , " .\' If .!!Jolnt relurn. does our s oUBe want $1 0 010 11110 fund? ,'t! 1 0 81~\l11l ' " ,',.' 11 ~ Morrhlrj IIllno lolnl relurn (even if only one I1l\d Inoolna) tl P Morrlecj IIl1ng Bepnratll relurn. ~nler epouoe's aoolAlspourllY 11LII1111er opova and rull nl1me hera, ,.. , " . 1\ P Heag of. !1Pl1eel1plcJ (with qUllllfylno parson), (Ses page 1 (J,)1f \l1e quallfylno peroon Ie 11 ohllg bul. npt your Qspendent, Bnler Ihle ol1l1c:l's 111\1118 hllre, I>- , " , ' B P Qqallfylng wldow(Elr) wltl, qalJendenl ol1l1d (yellr ftpoUBe dlBel ... 10 -. ), (Sea fJI10e 17.) 7 ~ IW,'(3,13 DDO,7 lln o ~o'"' - 519, 2 ~ ~ ~ ,.,. 20,47 ;1/1' 4 60' "0" \ 'I>- e ?'1 ,1". '" 100B ~otlt1 104M f1bU. 1 ., . '. , , 1002 Form 1OIIOA 11\1I1I? ... f I 411"(') "101'1" 01\ ,'11\14 !' "'" 'Yo111 IO~llr"4\"IIV l\I"n~'r ' J'''oll\lllllnfl It, /Jom" !Ilo/ I r!!' 1,~,1,11 Ffplclrll lLJwlpr tho lJJlllllilUJlllli1.l1n1l10, .___._" ',7 ',. , 1I()ltL~li.= yqur 1111l Clwck f P YPII Wllrll 06 pr pldur P PllllQ) !lnlur ",1Il1hor \liD Qtllmhmf ~_~QIIQO WIIO 66 or olQor Q 13l1nd PO~IIQ ol~!!.L 1011 ' f:ffHfIclQtlon, ~ If your Pllronl (oraOmool1o oluo) 01111 ollllm YOll lIa 1I noponrfol1l, exemption 0110011 hare, """""""'" ....'1011 bl llmplclht, 0 If you lire marrlpd fIIlno appnralaly linn youI' apouae 11I00 Form I'Inf:f , 10'10 and lIoml~o!!.c1eclucllono'~-E!Joa 36 ancJ ohooll horo .... 10ll.-bI t~Xll~le 111 /:nlol' Iha Slll/Hlllrn qpllullt!on ~hown palow fpr YOllr 'IIIno 1I111111a, 1M InQOmll If vou "','llpkpcJlInv hox onllnll1111l PI' ~J OP Ip PlIoa 36 Ip fll1cJ ypur' atllnliArc:J qaliuotlpn, If VPII ohppkllq /lpXllll1l enlor -a" · SI11010-$3,600 " Hellel of,l1ouoaholli'-$/i,1!60 " Marrleel f11lno jPlnllY or qualifying Wlliow(ar)-$6,000 " MIlI'r1acJ filing Baparaloly-$3,OOO 10 Sljlllmot IIna '10 from IIl1a lLJH line 10 IB more Ihan line 1L..!llilar -0-,) 20 Mlllllply $P.,GOO py 11113 total..l.lill!ill.QLQ!..~lIona olnhn\!9JlliJJue 60, 21 SulJlmol IInl1 21 from line 20, (If IIna 21 la more limn IIl1a P.O, onler ,0,,) This IB your ta~l1ple Inool11l1, " 2 113' 'Find 1I1e tax on tl1a amounl 011 line I!~, Ohaoll If from I ,,' " ~ TII~ Table Ip~ges 40-61l) 01' b! Form OllliUaea page (7), 23 114110rpdll for 01111e1 linn nepllnqllnt oare exp, anaoa, , ~.. .Qompleta IInli 011110/1 Sohodulo 2, 240 -0. P Orolill for Ihe oluorly or llie cJIBa/Jlecl, .... OorllPloto uncJ allaeh Sohadulo G, , -0. _LArld IInoa 240 and 24p, TI~re our to 01 o.oq,ls: 0 ll8 Sublract IIno 240 from IIna 23, (If line 240 B mora Ihon IIno 23, onlor -0-, 26 116 Advonlle'earnad Inooma orodll PIIYmoll1a from Form W~_ 26 117 'Add IInos 1!6 and 26, Thla la your 10101 tax, ~ 2 , 1l0aToloI Feqemllnoome ta~ withhold, If IIny tux la from Form(o) 1090, ohaoll hore, I> I:L_ 26a /J 1002 notl/nalod ta~ puymonla I1nd amounl IIPplleg from 1001 roturn, o llamed Inoomo oroelll, Oomplete and pllaoh Sohodulo 1:10, ' 200 d' Adcf IInoB 20a 20 a cI 200, hoae re 01 r lola a ts Figure ll9 If line 20d la moro than IIn9 27, aupIraot IIno 27 from IIna,2an, Thin la the amount YOII overpaid. . 20 r~f~~d o~ 30 All10unt of line 29 you Want refunded 10 yow' _ G amount tl1 Amount ofl/ne 20 you wllnt applhlli 10 YOllr ' r ' 1993 ealllnated I~~ " (j1~_ yoU owe 311 If IIno 27 la moro than IIna 20d, BuPtruot IIna 20d from I/no 27, This IB Ihe' AIIQ~h ~Ilook or amount vou OWo, Altaoh ~heo'l or monoy ordBr for full amount raYllble to [\10110(FordO[ 0/1 Iho "Internal Rovonua Servloe", Wrlto y,our namo, addreBa, Booln SBourlty W~2~ 010~~~,~1 numbar, dayt/mo phono numpor, and' 1902/10rm 1040A" on It, G2 n n 1, 33 Eat/motod Il1x onnlt BBa a 0 41 . GO' Sl Undor P.p.III.. of po'lul'/, I d.cloll1lh.11 hl1Y' 4'"I1,ln.<I Ihl. ,olum .nd qcuampanylno tohld'\'08 .nd ,'ol.m1nll, I1nd 10 iho bo,l 01 mv knowlodOQ gn Your 4nd bOIlOI, Ih.y./O II"', 00"001, ond OI/11plo,", IJoo'or.llan 01 p,op".r (111hOl "Wllh. IlIJ<poVO' I' b..." 0"., ',,'nlmollon of WhICh 110 p'4pll., hll' retur' ."y knoWI.<I.." , , ' " ~ va,l tr ,lonUIUUl bato VautoucUpBlIon ' 'JI" '{, ' ',_ 3+03 Clerioal 110011 n OOlly of --'--''- Il1la return tor ~ SuouSo'!lIII(lnntwu, If jOin I lolU/nj Doni mUDl IIlgn, Dale 8P9UID'IOCOuPl\IIOn oUtlooo,do, JI" . 3-J-03 unomployed Pal P,o"".,', .. 001. preparer's ~o JI" Ulle only Fllm'4 nomo (0' yo"" ~ ...,' .. " Soll'amp/oyad) and . ' RddroBll .",. ,II! 110 ~1 Illl FIQlclre YOUr tElX, lJredltll, I1ncl ",.' pl1ymenta If yOU Wonlllil Ins 10 Ilo~ro yOllf lo~, 801 Iho 1I\0lruoll01\1 for 11110 22 01\ paUl Po, ,1,"Q '--- I' 20b "'0;.. "'0... ~ ~- -..,..... 'U.8. nOV.itvntnl "'!nUllO ot~U! 1m _ ala-I'" 199~ Fotln 104M pagil ~ I' 2,l"l- ~o", 2 il:'iL P"P.""1 10Qllllooo,IIV 00, I I I --' fit" , , " ", , I " , '~ ", '., 'I> 1 '",~I~n!!t ~.r\lt. 1~1'tH"n\1 .'I{' nilt COM"IOtiWPA~T1i of PPNNQYWAtilA PUR liARRIQPUlla FA 17120 I IfN~II~'~"a~dll'II" "",, 'I 1""'11~V'i/: Q'~ '-'-"'4 , , ""1..1'.0' ~ U '~flll lt9\1'IIr 1I~, m,I'~"1 IU~II'I"'!t~ ~~!"llt! 2Q,'a 1'Iaaoo 'I l-=:J (liT CJ' , II uflilrn""lfln I" 11110'"0 P f tt/'ll t' i~., 11, In lyll~~'!f MOa,D\] oj tN'tYl" ~'tlt flV"'PI' aQ.a 17UOQ , "1","" tIC r'\,1\1'"1 I; hfit"ht~Ult"I," \lO~~'I, po '~Jm^,'1l6h~'AI' I~"'" I'~ '" '''' ' DD P~~AQAtiToN oRIVE PAaT PUII~IN PA 17(J1o W'"I, \1", """I"WllIl,t QQ7QB,IQ , ItIt inUit" I" H 5U1t w,'u, "'I. 'II QD1,DP QO~47,QO rOlm I, ,W'l."IIII IOf 11, 1''''"1'' IPaa 017DOO P17Q07 I I. ,M'''ir, ,it l'I'U" t"~ liP' 'j. M'II."', 'If ,l"I'Hhll"~ 00847,110 4DD,OO 11 ht 1"1111.1" PU' 17 H t);""'WI "'t ~'~".11 'n .,~,fll' 1~,I\'_,n~ aU 10 lQlj,m, ,151,1, PA --- P \H,I Ifllt"" u_ Da,aD ~, ~Utj 1'1""1. lit!, '". ~O Ij,m, ,I [,,,Iolr I~- PPO?,ap IIUMINa TWP, 6,\7 ,"'/Ji). \', P~Q a 1~1 0000 1 op~op I (Ill ,P4Q - oppy 0 ~ For ,mplnyo,,'. ~'~f1f(h ~. h_.., ~ '"'''' ". ~ ,. .... "';'- ._.~...,,-.....~... 'l_~_"""~"""'''''''''''''''''~'~-''''I_~_n.\ _ ,""i~~~t< , I I, '" , 'I, :,1' ';' ',' '.. , I, ,," Iii .'\ ,,, :' ;. ,O' " i'" I, I, I', .. I' .. " f' ........._~.,.. , I I ~ ~I Child dldn'llIyo wllh you buill ~I~I You I aOPOMtnl uMIt I PIodR8i II'umonl, ChOC~ htlO ~ P I Tolol numbor 61 oxompllona o""mo~ , , , , , 7' Waooo, 00101100, IIpa, 010, Allnoh POlm(al W.~ , , ,,' , . . " " 011 Toxnhlo Inlorosllnoomo (000 pOOo 10), Allnoh Soho(lIllo S II oyor $,100 " 'I . h ToxiOxOrnpt Inlolosl (soo pooo 171, PON'T Inolu~o on IIpo 00 I Oh I , 9 Plyl~on~ Inoomo, Allooh Sohod\llo D If Oyo! $1100 . , , , , 'I '., 10 Toxnhlo rohm<lO, o,odllo, or 0110010 01 Slolo ond looollncomo loxoo (000 POOo 17), , 11 Alimony rooolvoct t t I I " I I I , . , , I' I I , , , 19 Dualnoss Inoomo or Ilossl, Alloch Schodulo 0 or O,~Z , , I. ,'.., ... 10 Oopllol ooln:or Ilossl, Allooh Sohodlllo 0 , , I , I ",. , . , ,,' . , 1~ Oopllol Ooln dlsHlbllllons nol rollO,lo(1 on IIno 13 (BOO pooo 17) , , I , , , , 18 Olhor golns or IloRBOSl, A loch Form 4797, :fj' . , , , I , , I , I 100 TolollRA dlsHlbilllons, JQlL --.:.~ h Tnxoblo omounllsoo pogn 181 1711 Tnlal poo"Ooland anoUlli1l 0 ", _ h Toxoblo omoullllsoo pogo 181 10 ROlllol, 1001 oSlolo, royolllos, P01III018hlpn, S cQ,porollons, Inllls, 010, Alloch Sehudulo n 19 Fnrm Incomo or Ilossl, Alloch Schodulu F , """" I , , , ~O Unomllloymonl oomponslllon Ii.. peoo 10) , I . ,I, ' . , , I , , I , 910 Suolol SOollllly bon.llls 91. ' 1-1 b Tn,nbl. omounll". pogs 101 22 Olhor Inoomo. List typo and I1mounl-ooo pnOD 20 "'.1"""""","''''''''''''''1111 90 Ad<l Iho nlnounlO In Ih.'M II hi column 101 IIn.s 7 Ih,oU h Ba, This I. Ollr 0101 noonlll ~ 940 Your IRA douuollon IS.o pogo 90) " , , , , , I 241 __, b Spous.'s IRA Uoducllon (BOO pOO. aOl, , , , , , 94h '98 ,Ono'holf of aoll..mploym.nllox lao. pOOO ~ I) , " 2U 90 Soll,oll1ployo<l hoollh Inslllonco d.<lIIollon 10.0 pOOo 2BI 20 27 l<ooOh rolllomonl pion and soll..mploy.<I SEP <I.Ullollon 27 90 Ilonolly on oarly IVllhd,owol 01 sovlnus, ", , " 96 99 Ailmony PO'd, RlIOlplOnI'a SON ~ _ ! ! ---:. 20 00 " Add llnoa 240 Ihroll h 9, Tlmao alO alII lolnl ouluo monll " , , ~ UsIa ,01 ';,"bIlSOlllno 3U 110m IIno 23, Th" ,a yOIll 8dlU"O<l oro,IInoom81 I Ihla amoun/I,'oU/han n....... In I 2J,~IO a"'l a child IIVOd IVIIII you, ,.a, pago E C" 10 Ind oul Il.yeu call claim Ilia 'Eamod ,\!J.\!~l!...LOO.no "_ ,.como C,.dl/' Oil IInol6 (, , , , ' , , " , , , , , , , , , ~ C.II, No, 1 aooov w. v' ... ~"'PQ' 18" ' nll/\Jollonl no P'9' IU ~,W, 'h, IRq ~II. IIl'IWI", plom pllnl br IYPII Pr.,I~,nll'l ~ltillon g,m 'Ign eoo 0 2, FIllnu atnlUs ISao poOo I~,I Ohlok only Oil. pox, axompllons lea a Pogl Ig,) If mo,a Ihfto Ilx ~apanl1aoll) lal pogo 14, lnoama Mnoh , Oopy 11 ., you, POl1m W'e, W.RQhonu 1090. hl'o, II YOd did 001 001 n W,a. aoo pago 10, If you,.ro olloohlng 0 'ohank or moooy .. O'dol\ Pili II 00 top 01 any Penna w.e, W.2Q, or 1099.R, " Adluslmonts to Inoomo (Soo pooo eo,1 P'f1~",,\,nl of th, TII'","'y-lfll"fllll n'VlIII!, U"VIU, ~(h\93 U 8 I 00 Q l( !!Yrn (II) lIiW ':POllhl '.., Jsn, H).o, 31, 1003, or Olh" 18. yosr blglnnlnO '.. YOIIIIIIII n,m, ,nd Inllll1 " l,,' nlml ~ ' """KKK CAR-RT-anRT""RRPI NX I ~ n -(, g-113 3\ fll1 11-(, (t- HI \l7ailU A I ,-.---- .~AqQUIH.INI: A /I fW:IIARP ~ nnRPA " ~ 33 pl.~Af1ANTnN PII 033 : AIII,no, J~ n~ll~lH fA 1"31~', Oily, lown 0' posl ollico, Blal" ,lid ~In .011,,11 you havo IIOIal9n '~~Im, saa naVol?, 1 ~ n ~ L_ '"0 "" o"r-o. '" .", "II nI "lh' " I 100~, .IIIIlnO , IV () I ,~~ YOII, ,o~'" "'lIll1y nVm~~, , I I 6pOlln'I 1001'1 "',uIIY nUrn~,,' --LI ror Prlyqov A~I A nil, - rAr~rwork Aocluollpl1 Ao /'ioUool 000 PIIUo 4. YOo No NOIII CIIOCIInV 'VII t ' _. -- 1'11/1 no, elllngo rout , 1. -_ 'MOIf9C1UCffYOI,Jf' 101.tno, ' po YOII WOIII $3 10 00 10 Ihlo fund?, , , , , . . , " , . I II 0 0111 '.Iulll dooo nUl 0 )Ouso wonl ~ 10 0 10 Ihla lun<l? .. SIIIOlo ~' Mor/!o(llillllU lolnl '.I\IIn(oyon Ii 'ollly 0110 hou Incolnol M~ulo<llillnu ,.parola lollltn, ~nt" Inou,o'"cclal'8CuIlIY no, ~Poy. lmllull n~rnq hclo, " HOo<l 01 hOlloqholcilWllh qll~llIylnU PQ'OQol<l~oo pogo 1~,11f 1110 qllollfylno poraoo I. ~ ohlld bul not your dopondonl, - onlor 11110 01111<1'0 lI~mo hOlo, ~ __, 8 Quoll '"U..lY!!!!!W(orl Wllh dopulld.nl ohll~spolla. dlod ~ 10 I, (000 n 0 13, 00 QJ YO\lr~.II, II your p~'onl(or 10111000' .Iso) 000 olohn YOIl48 . doponuonl on hlo or 110110' "" Ill'''' lululll, (10 1101 oh.ck boo 00, Dill bo ,uro 10 foh8Ck 1110 box on lino OOb 00 pooo a, lh'l If 9n " 2 ('";10_ ,nIl _ II 1olli.J!I!~lu 110 olyo~' o POPOlldo"''! 0 9 -.nlftl lhllllln 9n ., 111 I/lml 111111, Inlllll, In4 1111 n,m" ~"'~I:n \9 I wh" 2 IIr(oo tr/, IJr)l'(/o :/2:/ 12' lI"hllhl9~ .:..-.-.. R (o/lOI'!L." /lrl/'Cln :wa .121 'ons;II~T,1 wllh . II"" 9r ml'l~'nl"l ,.....PIII ~ PsPlnd.ol, on 'I nOllnllllfUoYI_ Mdnumblll Inllll 90 , n , , - I; ~ --~ ~- ----". 307'087 -0- tllPHt;P\.J~Jl~ A,!.P \pllnn lll'10) Pf!I"\I1'""I,f~""~"IV 10j ~ltv"l\'n..'t1C NOII\II('I ~\0W11 01\ follll I\I\n ..2!ll!!1IHlllnu A. clc Illul1n/'el J, /Ju/y " 'Mlltllp!lI' 1l~111I1l11l po 1101 1IlCIIJ(lfI Q,;poIlSOS 101mPIIIS\K! or polel flY O/lIolS, ~ !lml ,1 Modlolll fll1q clonlnl OXPOI1UPII (uup pnQP A'l) I , ,', ~hi Pllnl!ll II ~nlor ~1n9Qnl Iro," Form 1040,lIn~ 32, Ill__.__l_ ~~ t:xI1Qn~IlQ " M~IIIIply IIl1n ~ nhoV" hy 7,11% (,076), , , , , , , " Slllllrnol 111111 3 Imlll 111111 1, It ~pm or loou, on or .0. II Sln\llonrl 100011noOl110 \nXllQ , , " , , , , , , II Ronlllolnln InxoQ (0110 pnoo A.2) , , , , , I , , 7 Olhor InXPfI, 1.IQ\-IIlPludo 8orl\onolllfopOfty loxun '" ,/).rIflll\ll..c(I,QJIr1f.~.lIrv,', ,..,C)(llf.fI,;ffli\:,.", ..."",.... o Add IInoo Ii hrollilhl ' , , , , , <- Oll 1I0lM mnltQag~ IIII~r~al IIml polllls ropollod 10 You 011 F~lIn 1000 II 110,"0 morjgngo InlorQolnol rnpor\od In YOII 011 1'011111000, II paid 10 1110 poraon Irolll whom,1011 hOlIOhllho homo, non pOOP A.3 ond ollllW Iho\ pmon's 110m 0, IdonllfylllO 110" ond oddrou '" In Iho omounl on I'orm 10'\0, IIno32, mora Ihol1 $100,.\50 (mora 11\011 $04,226 II 111orrlod 11I1I11l SOllOrololy)? · NO, Yout dudl/ellol1ls nolllmllod, AcId IInoo 4, Ob 12, 10, 17, 10, 24, Md 26 } , 011 d onlor tho lotlll 'Iorq, Alao olltor olll'orm 104 ,lIno 3, 4, Iho lotuor ollhl$, ,.. omounl or your slondord doducUol11 · vas, YOllr dodllcUllllmoy bo Ilrnllod, Son )0 0 A.5 lor tho amOll1l 10 ol1lot, , , For 1'I\~or'ilotk'n.dllollw~Aot NollOD, aDD Form 1040 InallllDlIono. C.', No, 11330x .' ,,( TIH(Qq YOII ,PIlII1 IBon pnao Ad ,) , 'nlaro!!l YOII PlI II IBoo poao A.~,) 'I ~otol 101001101 10 I1I0roo\l. nol cto(IUullhlo, , 11 - 12 ~IIIQ 10 'OhllrllV (Boa 111 poaD A-q,) 101 16 10 OpauRlly Rn~ Tholl ~QSSOB 17 Movlno lixponsol! 10 Job ExponSDS 10 Bn~ Most nthQr MlsDQllanaDlIs DD~uollollB RO (Boo POgo A.5 lor oxponoos 10 ctsctuot hPrD,) 21 22 211 24 Othor 26 MlsDOllllnOOlls Doduotlons Tolnl 26 lIomltod Doduollons , I.. ! ~Qhpftuh~ A"-Itollllitml PO~hIQt":ma IIlCllo!tlilp Illn on 11IlOI!1 '" "1111011 10 FUlnll1140, '" ,Sao hlall!lothlna for Ool\Ddul!!.!.A .11111.11 (f!!I!1ll().lo , .,,,,"'t"ll'..'..'.,l"t1I....P....."I.."t'..,,."'!'.II." Ot,IIlNo, \6''ln,007~ ----ii3~ Alln'htnQnt 00'11100'0 Nil, 07 VIlI" 1\..1.1 'Q""lIv n,,,,,bor ' III ,I ! .IN I Ii:l:l I .- ~"~-. , - ~~~"~ ~~~ -- ---- ~~ ~ ~ , ~ ,4", gij; i~ I 178, 00 I , lL --_J.!JL '10'10, !!1_I' Ii.. I I I I ,..- .1:15. 00 ~ I .. 0' -0- ''''!IIIft,''''''''!''''''''''''''''''''''''!'''''''''''''''''f! ""III'tt"""'lllfll'!'''''!ft!t''''''ltt."t.,..,,,,,,,.,,.,., Polntq not rllporlod 10 YOIl on Form 1000, Boo pooo A.a for spllolul ruloo , , , , , , , , . . , , , I InYllotmllnlll1tlltllsI, If roqulred, ollooh Form 405~, (Soo poco A..a,) I , I I , , , , I t t t I I , Add 1111110 Ilu Ihrou h 11 OoUllelRl " YOII modo n clwlln/Jlo oontr/bullon llnd (IlCO/voq n bonllflt /(1 mflirn, 800 pooo A.a, Oon\rl\1ullono hy onoh or choek'. , . . . , , , Olhor Ihon by conhor chook, If oyor $500, YOII MUST ollooh Form 0~03 , , I. , , , , , . , I , , OnlTYovor from prior Yllnr , , , I , , , , . , Adclllnoo 13 throullh 16 " , , , , " ' , . , - , " 335 00 OnuuollY or Ihollloos(on), Alloch Form 411114, (Soo PliO 0 A-4,) Movlnll expenoo'o; AlJ.llch I'ol'm 3003 or MOll.F, Soo POOD A'4, Unrlllmpuroed omployoD expenoos-Iob Irovol, 11111011 duno, job educullon, 010, II requlrod, YOIl MUS" ollnoh Form 2106, (800 PQ{JP A-4,) ... ,,,,,'.'1I.,4;...,,.,,......,, " ..' "lJ~ , , , , , t 1 ~ -0- .,..",.1..'..."11""...'1'..'.......,"...'1...'..,..'."1.... Othor oxponoos-hwoslmel1t, lox ptopnrullon, sulo dopoolI box, 010. Lis! typo nnd omolll1\ ~ ...."""...., I' It"....". ~....".., . ,.." I.. ft ,. . .,.,...... 10. t .. .....," i.. I' Add'lInoo100nd20, , , , " , . , , I , Enlot amount 110m Form 10,10, IIno 32, I 22 J . MUlllply line 22 obovo by 2% (,02) I , . , . , , Sublrool line 20 from line 21. II loro or 1000; onlor .0. , , ,.. i , -0- , , Olher-ll'Om 1I0t,011 pogo A.6, L1llt Iypo end omollnl '" .",....,,,......,,,.,,,,,,..., ~ ...,'...,.....,.""..11.1'..1..........1"1'1.......1....I'...'.".'II.I.jtt.lj'..'.....!II.~~ "0'" ',I Bol1odulb ^Wut,",1(40)1l193" " ~ ..., l' ~" 1'1 ,I, J . j., ~~ {~ f' n V '",1' ,,))' 'i uno b~~ql 'P~d "11111011011' 011 p~u~ I~,I !l!U \l1v 1I1Q Iv lvi, . Olhurwl\v, plpooo Pllll\ ur WPO' t'I~'I~~nll~1 ~ ~qllpl1 a~," ~IOI1 !!l 0 0 0 la, pllllhilH1DIll 111111' r'''\I'II!y'-I!\I''''\lIlll~'v911\.(1 UQIV\U1' jln\94L I s 0 )( Q l W lJ 11~ IIlll tit. o'\l~-n\lllnll'1'I' 01 '11111' 111 till 't::,. to'11Io ... J.II, I-P"", 31, IOU4;0, olh" I.. .or \lllllllll.11I ,IUH 0",1111 _,_~ ,Q.!:!llNo, 1~4a:J!!!1i. YOIII 111,111011'\1 41"11/111101 1'11"011'. YUI" 1\101'1 ".,IIIIY 1I\1"\~lr n I' " '-;'-"'**'~**"'<:AR'~r~f::~'ORT;*R;q!1~----'- iiji;iiiI'~.'II'III.llfltyn_ ~ _NX LHIHH3~~~~1 . pQIHjll~1A9? ~~8 10 i____....__ __ I I ~ JAC~lJ~~XN~ A ~ RICIlAI~P J POr~DA :1""11111, f'orPrlvnnVAolqn!l ..~;l P~~A~ANTON DR . 11i31 \----.-- pnroNrwnr~ Ro!lllollul1 ~ ,~~ll~IN PA L?;lll:1 n,....}.,o ollnn, aoo poQo 4, I tlI! 110101 fll",l(Il~ 'y,,1 .. - ~,I/ no ol'MVU I'llii' , '! -,._ _,L 14l or flt(Ju(:" ygl/r , , ~N/I. 1)0 Vail WOIII $a 10 ao \0 Ihlo 1111111'/, , " , , , , , , , II 0 0111 lolurn, IIn.. your IpnlIDO WOIII $.110 un 10 Ihlo IUIIII? .' BIIIUlo -K Mpltlo(IIIIIIIU lolnl rpl\1I11 (ovoII',1 ollly 01111 I1l1d IIIOOIt10) Mllrrllld 011110 IIIPPlqlO rvlUm, ~IIIQr Ipoolo'l 100111 l\Xl\lllIy 110, IIbovo 01111 ",lIlIlImllllOlll, I- 11001101 1101/lohold (Willi qlJplllyll1Q porool1l, (Boo PIIQO 10,) 111110 qllollfyllla porllol1lo Q chllrll>lIl nol YOllr doplI/1Clpn\, ulllllr 111111 olllld'o IIPlnP 1I0ro, ?- ft Quolll 111 Idow 01 wllh dOPOllllolI1 ol~or 0 101100 dlo,' '" II Boo 11 a la, 00.1:il You~.Ir, II VOllr porpnl (01 1011I00110 oln) CRl1.~ll\IlI\ YOII 00 II dllpOllllclI1 011 hlo or hor lox rOIUlII, dO nul ohook I>ox ~o, 1l1l11>1I 111I0 10 chook 1110 ~IIX 011 11111 aa~ all PPOO a , '"' . B aUln. t I . o POI'Ollllonlol .,. 0101111, IPlna,'11 I 0.0 monlhl II y""" uIPlnallllllo,I,IIi~ulIlV ,,11I10I'Ihlp I. Uvlll 1.\OUl '11 IlIml !fllll, 11111111, ,nd 1111 011ll11.Jiu.. numb.. vo!/--. hom,IU~ Rl'iun MJirml .JJUJ.../l.alZJJt'L llaUOht.a.L----U-_ Ji/Qhard..J.Jlnl'cln - .J1li1'J20fl ~1_ ....l2 -----, I ----r 1111 V.1I1 Chll" dldo'llIvl with Vall bill II olalmed 01 VOIII dlPlnd,nl uMel 0 pro,1088 aoreemenl, ~hlOk "0" '" 0 o Tololllllm~or 01 oxl1mpllol1o ololmorl , , , , , , , , ' . 7 WOUOI, lolorloo, lip I, 010, Allooh Forlll(l) W.a , , , , , , , , , , , , ...1.- --:....-.'UJ1Ji2. 00 Toxohlo 1III0lUoI I1I0ollle(000 puoo 18), Attuoll Boho<flllo lll'o~or $4,00 , 0 7.!L.. ~ Tox,oumpt Inlo,oll (100 pilau 1 II), PON'T IlIoloclo 01111110 8u o. I o Plvldolld IlIoomo, AlloolI Bohedule lllf ovor $,100 , , , , , , , , , , , 10 . ToxlI~lo lollllldo, orollllo, or oUoolo 01 olulo olld 100011110011I0 10xoI(00upIIUo 18) , . , 11 Alimony rOQulvocf ,. I , I I . I I , I , I , I, , , , I , , I 19 1lllllll0DB 111001110 ot (1000), Allooh Be hod ilia 001 Q,UZ, , , , , , , , , , 13 0111'1101 g011l or (Ionl, II roqlllrod, 1I1100h Sohodolo P (OOOpUOII 1P) , , , , , , 14 Olhor unlllo or (Ion 011, AtUOh Fnrtll 4707=:1'" """',' ,;, 1011 Tololll1A ,JIIlrl"lIt1ono, 1~u.I , _ ~I II TUJlohlO olllOUIII(1OO p'g~17) 10.. Tolal penllol1l alld IlInlllllll !J!lL! ...J I> Toxoblo omo\llll (100 pngo 17) 17 110111111 rool oOIUlo, roynlUIII, Pllll11010hlflo, !l oOlflolllllollO, IllIala, 010, Attuoh Bohollulo U 10 parm III0omo or (Ionl, Allool1' Boll0dlllo P. , , , , , , , , , , , , , 10 Ullomilloymolll OOml'ulla~lIon (~oo pOuo 101 , L ' , , , " , , , , , , 200 BoolollooUllty bOIlOlllo L.R!!n.1 ," ~J I> Tnxnblo omoonl (m pOQo 161 '11 Other lncbmo. ~1811Yflo and Plnount-soo pauo'10 ."....,.".".."..'..".OIIIO....,! _~ 22 Acf'llho IImOlllllO IlIlho 1M II0hl OOlllmll for 1111011 7 Ihrou h 21, Thlo I. all' totollnoor 0 ~ You, 1M 1I0lluelloll (000 pOgO 101 , , ,", , " 2011 SflOlllO'O 1M doduollol1 (100 flogo 10), , , , " 23" MoVlllg OXpOll01l1, Allooh Palm aooa or 3003.F " 24 Ollo.holl of 101l.omploymollllC\l(, , " " ! 28 Soll'omplllyod hoollh 111111101100 dodllOtlOI1 (aoo pogo an 20 I<oogh 1011/01110111 ploll 01111 aOll.omployod'SUI> doduollol1 _27 POII.lIv 011 onrly wllhllrllwol 01 IIIVIIIU8. , , , " 20. AllmOllV plld, 110011'10111'1 BSN ... I I _ 20 Alld 111101 230 1I,'ough 2Q, Thooe 1110 VOllr tolol o<ll1l8lmol11a , "... Sobllaclllne 30 ItolllllOl 22, Thll 'I VOUI Idlulled 0/011 Ineoma, 111011 Ihan 125,208 alld a child liVId WillI OU IlIIlhlll 10,000 II a ohlld <lIlia', ilvl WII" 0111, lie 'fa ned IlIcome 0""11' oil a e 27 ... 001, No, 11010n Flllno RIIlIIIR (Bonpllao 10,) QlWok only OliO II ox, 1 2 D 4 ~XQlnpllQnR (Boo POUII 1 D,) II moro Ihun ol~ dopondonlo, ,~00pouo14, I' lhOQme Altlloli COllY D 01 YOllr pllmll WoO, w.aQh"lld 11100' lioro, II YOII did 1101 Qol 0 w.a, 11111 I'lIgll 18, UllelolO, but do 1101 ollooh, OilY pOVIIIoll1 Willi yaur lolum, . . 'gao Ad\"st010Ilts h to 1100010 g4 CUll1lo1I1 Soa ilo 1II0001I01l0lla , , ... ,20 07 20 20 00 31 Ho, 1'1"'\ 1~:',1 'n, I -L.. 1101 011l~1 Ihl ~"n '0" whOI IIIYlIWIII1 ,,~ I! . ~lj,'III" ,llh . I1Ml~II,'~ lIPe'l" n (III PIlI 4 ~ Plp"lInl, 011" " 1101 IOI"Id II>9Y' _ Md'vmb", I1111"lo, --",- ~ ~ ~ ., 'ft>>I1\ IO~IIIIUU~1 TAX (:lpmtm. ~A~lpn (Buu P~IIII ~3,1 II,t'i~~f~'1 lallro YOIII Ull,loq poao ~4, Oredlts (Boo poUo 24,1 " Other' TAxes ~BOO pouo a,) " PlIymontR AIIooh W:w.o W.2, . 11011<1 Q O. 0/1 Iho Irolll, Rotund or Amollnt VOll OWo " Sign Here Koop 0 oopv of Ihlo lolo,h for YOIII 10001<11, raid Ptoparot's Usn only ~2 r'rnOIJ/lI limn 111111 31 (011111010<1 UlaUO !1100llW) " , ',', , , , , 0011 ohook III 1=1 Yall Wom Otlllr olllul, 1=1 Pllil1111=1 B"O\luo W!IO 00 01 ol,lor, AIlllllllll11111111111 01 1I11~IIU ollllokllll ~IIUVIlIlI1II ul11111 1110 101i\1 hOIIl, , , II II yn\!f purOl1llm 101l1UUllo ulIOIIlIl/1 01111111 Vlllllill 0 dup\lmlUI1I, ohuok holll o II VO\III'II 11'lltIlUlllIlIIIU IIUPII'lIluIV 01111 YOllr npulluo 11011111110 <lolh,ollollo 0' YOII mu II dl 01'01111110 0111111, IOU PIIIlU p.0 111111 olwIlk hIUO, , , \ " ... ~3o 1=1 lIoI1\IIu\I,Io\l\loIlIl110 Irol1l Bohulhilu r', 11110 au, 011 Bll1l11huti <II, 11111111011 ,haWII IloloW Inl vour IIIIIIU 01111110, BI,III/ YoII ohookull fil1V 1I11. ollllno B~q or 1, Q,O 10 pouo 2n 10111111 youI 010111111<1 dllllllOllol1, II you ohuoko\1 11110 ~OO, YOIII 1IIIIIIIIIIIIIIolhlOllul1111 lura, I Blllall-$O,OOo I liollll 01 hOllooholll~$8,UOO ' I Mmrlo<l 11I1110 101/1I1V 01 Qlllllllyloo Wlllow(oll-$U,OUO . I Murrllill fllluU IupO'"II1IV-$3,178 SqpHnp111no U'1 fromllntJ Q~ , I , , , 1 I I I , , I , _, , , t t ! 1111110 o~ III $80,6ao or 1000' mlllllplV $P.,400 IIY Iho 10101 olm'llor Of o~IIII1"lIol1o nlolrnoll 00 1100 ao, 111100 O~lo oYOI $On,U60, 1110 11'0 WOlklhool 011 pouo 24 for Iho omol(1I1 10 011101 i TpKnlilo IIIOOI1lP, 81111110011111006 frOl11l1l1o 36, IIlIno 06 10 moro "'"11 11110 06, olllor .n, , ToK, Ollook If 110111 0 l1'1 TOK Tlllllo, II 1=1 TOK Rolo Boholllll.a, "00111'11111 GIII!l TOK Wo,k. 111001, or d P FOlm 00lU (00'0 pllUO 2,11, Amoun\ from fOlmll) oa1ol '" 0 '...L.- 00 Alflllllollill lilKIIU, Ollonk IIlrom 0 1=1 FOlm 4070 h 1=1 FOlm 407P. . . , , , , , ~o " Add IInoQ 00 undOlL" I I I ; . I I ... ... ~1 Olodll lor 0111111 DOli IloPOo(j'"1 ooro o~pOllo'O, Alllloh FOlm ~441 .,jL ~~ Orollll lor Iho ol<lolly or Iho <lIIOblo(j, Allooh Bohodulo II , , :.J2 40 Fqrololl IOK orodll, AIIooh FOllll 1110 , . , , , , .. ~ 44 Olhor "'1I11110 (100 pOUII p.ol, ohonll IIlrom 0 1=1 Form 0000 II 1=1 fOlm BOUU 0 1=1 Form OUOI 110 1'01111 (apoolfy)_ 46 Add IIno,,~' 'hrough 4~, , , , I, , I , , , I , I , , , , , , , , ~O Bllblroolllno 40 Iroll1l1l1o 40, 111100 40 10 maiO Ihon 1111040 01110' .n. I> ~7 Bolf,omploymolll 10K, Allooh Bohodulo 8e, , , , , , , , , , '.' , , , ~O r'l\oll1ollvo mlolmllmlO1l, Mnoh forl1\ 0261 , 'd ' , , , , , , , , , , ~a RoooPI\"1 lo~o" Ollook II from 00 FOIlIl .1260 II Form U011 00 Form 00p.0 , , /lO Boolnl ooourlly ood MolllcOlo 1M 011111' locomo 1101 ropollO<1 10 omplovol, AltoPh FOlln 4137 61 TOK 011 qllollfloll 101110mool plnllD, IlIollllflllU IfWl, If roqlllrod, o\looh Form 6020, , , , 62 Advol1Oo oomo<l III0omo orodll pIIvmoolo from Fonn W.O ," , , , , , , , , , 63 'Add Iloon olD Ihrouuh 02, Thla I, YOllllololloa, " , l> 04 f,dlrallll.omo lax wlllllleld, II any II IIoln form(l) 1000,..lIeck I> Cl 3&12. ZB 00 1994 oellmolO<1IM povmolllo 0",101\100111 oppllod Irom IUOO rOlum , 00 Bomod IlIoom/l crolfll, II roqlllrod, nllooh 8chollUlo 010 (000 pnoo p.n, Nooloxolllo olllood IlIoom.1 '11\00111 ... I . I I and'(YPo ... 1'1., ~ Ill" II,H"!llI'" '11"'" """,...:.. If"" _60 67 AllIoIIIII pol<l willI Form 'IUOO 10~loonloll roqunol), , , , .J!L 60 OKoooa aOlllol 80011llly nnd RnTA 10K wllhliOld (000 pooo 32) J!JL _,~ 69 O(hof povmonlo, Ohook 1111011I0 Cl 101111 2460 Ii 0 FOIm4106 60 00 Add IIn08 fto\ Ihrouuh 60, Thoao oln your'lolol poymonll 61 IIlIno 60 Ie mOlo Ihnn 11110 a3, lollllnolllllo 63 11011\ 1111. ao, Thll II Iho omoulIl vall OVORMIO, 02 AlllolIlIl of 11110 01' you WOIII RBFUNDeO TO you, ' " '.'", 00 Amouol .11101 01 YOII waol mllEU T9 YBUn 1000 ESlIMATED m I> 03 " 00\ If 11110 60 In moro 111011 1100 00, oublrool 11110 00 from 11110 on, Thlo la Iho AMOUNT you OWe, for Ilolnlla 011 hoW 10 poV, IlIoludloo whol 10 wrllo 011 you, pnvmlilll, 100 pOD a 32 , , , 06 OlllmololJ'lox POllollY (OliO pngn 33), Alao IlIoludo 011 IIno M .1Jill.L UndO' penalllU 01 po'IIIIY, I tfnoltlfD lhqll hlWO ellamlned Ihlll 'Blum nntf accompanylnlllchodulea and Ilolo",onl" and 10 tho bo.! of my kl'lOW'edQe and btUolj tl10y tuD lIuo, cOI([K:l. ami complele, DeollllllUon 01 proparet (olhor 111Ulllaxpaye/l11 baaed 011 alllnlofrnatlon ql which pfopater has any ~noWlO<1Qol i ~ Your alonAlufq , DAlo Your occuplllton rAdrninistl'rtttve ,SpoIJIO'e QCoUP~\Ion , , , 1=11l11i\l1, ~ IIn" , ... DOh a~ ~.l\lor hli qrgor QI your I oP QO 07 Illl Spallin', IllJl1nlu,o, lIa jolnllolllfn, oaTH mUI' IIlgn. Pletlla/o,," ~ IIOflilhmt ,. rl'lfltll_ Mlno (or your~ 11 tell,employedl and nddrnaa DOlO ~ , "OUll ra 'i __a~l!1fJ. (W: I ~ . ~ I ~ " 71175 mL, 2</"7/ IJRIlO 141l" . 1""""_0' J!.!L ---.:- 220 I, _ 3D o 21101 2201 2201 1"tJflaror', BOOlal ucullIv.noo 1 , ,. , I I " , . IP~\"'ll~' ,o,:",:\~~,ury III N"IIt(,1 Ihuwn Oil FOil" 10lO Jnoqlwltl1\1 ,A, j!( Illolin'~I,1, /Jrm1!L ___ M~~I!l1l1 O~\Il1n", PO 1I01111C/(1(/0 OXpOlliOI rolmblllood pr paid by OIlIO'S, ~ 1I1111 1 ftloolnnl nn~ ~onl/ll oxponooo (000 pOQu A'1), , , , ~~ Oonllll II ~nl" 'moonl "om fOlm 1040, Iln, 31, l...L1 1__- ~ r:xpenQIlQ () M\llllply IIno r /lhnyu hy 7,8% (,076), , . , I ., , 4 SII111rnollll10 3 from 11110 1. If IIno 3 10 mora Il1l1n.!lll1. II Slolo ond loonllnoomo Inxoo , , , '; , , , , , .. Q Ronl onlnlo IlIlC/lo (non pno" A-a), , , , , , , 7 1'01001101 prnpot1y loxoo. , , , , , , , , , , Q Olhor toxoo, ~Ial Iypo nn~ nmO\1II1 ""..,."..,......,..., ""l/lll1\',wnl1l,~, .Q.Q.qllp.c,1,~(QIlI1I. 1~I~t.vIJIWQ. ,7:0,\', o Ado I 1I0a 6 111Iouol1 0, . , , , , 10 110m. mOl\oaO' Inllliil and polnla roporlod 10 YOII 00 fOlIO 1006, 11 H,omo /110110000 InlorOlI not ropor\1ll1 10yO\l on form 1000, If pol~ 10 Iho poroon 110m whom yOll bouOhl 1110 homo, 100 paoo A.3 on~ ohow Ihol pOlino', nomo. Idoolllylllg 110" and oddroll "" , I' ~OHr:PU~r:& A&~ (rorm 11>401 Th)(OQ Y!lll Plllll (Soo pogo M ,) Inloreal YIlII Pllltl (So~ fl090 A'P,,) Notll /'oloonol 1 n IlIloroot IB ' .. nol ' <<odIlO\I"lo, 1 () , " .....11.. HI allla 10 Olmrllv II you mollo 0 1Q gill olld gol 0 ~.n.m 16r ilL 17 BOO pogo A,a, 10 Op8\1pfly ftOlI J',ofll08aP8 10 Job e~pOI1SQB 110 Bl1d Mast OthBr MlscBIIBneolls lJoducllons 111 112 (Soo pUUI A.e for eKpUIIBOO 10 doduol 11010,) 110 24 116 _ 116 Other 111 MI8cellBllooUs 20 D6dllcllons Tolul lIuml~etl Oetluotlons !iPhlHhllo A.-'tf}m'~flJ' Pj)(fllllthmlt (BoltU\hIIo ilia on ~ll~kl J: Alluoh 10 FonnlP4P. ~SOD IIll\n.ollolll 0 Bo 10111110 II 1....,.,..."",.,..,.,.,...,.'.".11'...'..",.,..",""""1, 1''''OIf""""""",'''''''''''''''I''''''''''''''''''''''I' 1'1.1....'."10."'.1.'...',.,.,.....'...'1..'."0."'.."."", Polnlo nol ropot1ocl 10 YOlI on .Form1 Q~O. 800 pOQo A-o for ~poolQI rt~IOB, , , , , I , I , , to" , I Invoalmonl In\oroal, If roquhucl, n\111011 ~orm 4a62, (Soo paoo A.3,) , , , I.' , I I , , , I , , , Ad<< IInoo 10 Ihrou 113 01110 by 0001, or ohook. II any gill of $260 or mora, BOO pago A..3 I , I , I " I , I I I It' I , olhor 111 on by onoll or ohooll. If any olft of $260 or mora, BBO pogo A.3, If ovor $600, you MUST olloch Form 0263 Oonyovor froln prior yonr " , , . , ,', , , , Add II uo 16 111Iou h 17 , , , OnB\lolly or Ihell 1000(08)' Allnah form 4004, Soe Unrolmburoed omployoo oxpenooo'-Icb Imvol, ul1lon dUoo, loll ecluonlloll, 010, If roqulreel, yOU MUST nlloch Form 2100 or 2100'~Z. (Soo pogo A-6,) ~,..,......,.., ~, J\Q.. II~- . 112 ...011"".....",,,,,,,,.......,,...,,.,,,,....,........"'1... Add IInoo 20 Ihrough 22. , , , , . , . , , . 20 Eolel amountlrorn FOlm 1040; IIno 32, I 24 I I.~ Multiply IIno 24 nbovo by 2% (,02) , , , . , , , 116 Suhlrnol IIno 26 from IIno 23, If line 26 10 mora 11101111"0 23, ol1lor .0- Moving oxpel1eaa InCllrred before 1004, AIInch Form 3003 or 3003.F, (Soo pooo A.6,) , , Othor-from lIa\ 011 pogo A.6, Llel Iypo slid amounl "" ..................."..,....,. ,.,,,,,,,...''l.'..I....'.ll'H''.....''..,..H..........,,..... ."....0......"......,,,,,.,,,,,,,............,,..,.....,...,, TlIlC plepornlloll fooo , ' , . , , . , , , , , Olllor oxponaeB-lnvoelmnnl, 0010 e10pOBIt box, 010. Llo\ \ypo.nfld smaun\ ,. ..... .,..'...,.., ,."."""., ,.,.."..,. 110 Ie Porml040,IIno 02, over $111,000 (over $66,ilOO IImnrrlod f11lno oopnraloly)? No, Your <<oduollol1 IB nol 11I111tod, Add Iho omo\I!IIB 111 Iho far rlghl oolull1n } lor IIneo 4 through 20, Aleo, el1lor 011 form 1040, 11110 G4, the Inrger of ,,~ Ihla nmoul1l or your elell<<ord deQuollol1, . llB, Your doducllol1 mn bo IImlloel, See << e A.6 lor Iho amounl 10 ohlor . , ror Paperwork "oduollol1 Aol Nollol, IU Form 1040 IIIBtrtlollolll, OAI, No, '1n,30X' " --"':"'l"~ , -0- ~ BohedUla A (~O"" 10401 19M , . , . ach~UI..,I,I1I WOl1l110401 1001 ,,' _ "'""(1) 1"0\\11 Oil fOI1l111140, po 1101,11111 ",,,,. ,,,q 1000IQII\fIlill'Iy "UI1II>,1 If 11101'111 011 olhUl lidO, , t t . , t . , . . . , Ii , I . . . , , , , I , ; , . . . . I. f ~ I I , , . . . . , I , , . , , t , . , , , , . . ; , . ; . , , . . . . I . I I . . , , . . , I I . , . . . . . . . I AcIcI Iho omoul1lo On IIno 8, ",', " I Oopllol gain cllolrlbullono, ~I1lor horo 0l1c1 on Sol1oclulo pI , NOl1loxnblo dlalrlbullono, (600,lho Inol, for Form 1040, 111100,) 0 Adcl IInoo 7 ancl 0 , , ," " '" , , , Sublroot IIno 9 Irom IIno 0, antor the rooult horo oncl all /'olln 10,10, llno 9 , ... 0 . 'If you do no/nood Sohodulo 0 to ropoN any at/lor golns at lassos, entor your oopl/ol gain dls/t/bullons on Form /040, line /3, Wrlto "0130' 011 tllo dot od Ilno next to,/llIo l3i '. II you tlod ovo, r $-100 of Inloresl or dlvldondo OR hod II forolgl1 aocoulIl or woro' a grantor of, or a tronoloror Voo - 0, e 'orolgll It\lol, YOII mual compllllo Ihlo porl, ' 1111 At any limo during 1994, did you hove an Intorootln or 0 olgnolure or olhur eUlhorlly OVor e IInonolill oooollnt In 0 forolgn oountry, ouoh 00 0 bo~~ aocounl, oeourllleo oooounl, or, oll1or IInoholol oooollnl? Soe pogo B-2 for oxoopllorlo and fllI',g roqulr01110rllo for' Fotm TO I' 90.22,1 I , , , b If MYos," entor tho name of Iho foreign oountty II-- t.".'H.llllI.......'''''I.I'..'.''....''.ql.HIII.'' 111 Weto you Iho gronlor of, or tronefero, 101 0 foreign truol tl10t exleted during 1904, whether or nol You hovo OilY bon 0110 In! 11110 root In II? II 'Yea,' YOU may havo to rue Form 3620, 3620. ot 920 Pot POJltlrwotlc nllltfcrllot\04ot Nolloe, 101 form 1040 1lIllnlotiolll, sotun'ule b (porm 1(49) 10114 r~RI1I .. nl~rl!RI InppmR (Soo pOQOo 16 pn~ p, ,) Nnl" If you roaolvoq n form 10, DO.INT, I'onn OOQ,OIP, or .1I~lllIlllo .lllomonl Irom n ~rokornuo f1rm, lIullllo IInn'l 1I0mo aOJh' poyor 011 onlor Iho 101111nloro.1 Ihown on 11101 'arm, I.' PI1Ii II Plvll/unlt ' Inoul11l! (SIO pouoo 10 In~ s.q Nolo I II VOu rocolyod a fonll 10DD.PIVor uu~ollhllo ulolomonl from o IIrokorago f1rm,lIul tho fill" 0 lIomo ou Iho povor olld o"lor 1110 10101 ~Ivldondl . ulloWII on IIW lurm, Palilll ,. florolon Aooounlu und Ttusls (alo pig a a'2,) _ OMII No, 16'ia-0074 I'~ II ~I\lOlol I"'"l1ynUII'''u --L--1~_ Sollf:lQ\.1le I':l.-.Intere~t ~nd PIVldenc1 Inoome ~~~'I,'l~'~Q, llll 0" !'Ialom you Ilnelovor $,100 In '1lXllblo Inlarnul Inco/lla, YOllllllloI also oO/llplo/ll 1:1'111/, 1 ~'ol namu of payor, If nny Inlprnol 10 from n BUllur,Ilrmnopq mollpnoo nnel\llu ~uyur II00Q Iho propurlY ao n pllruonnl ronlt1unpo, Bun pa~u 13-1' nnll 1101 Ihlo InlPlUat Ilrql, AlBa 0110W Ihnl11\lypr'q ooplnl oOP\Jrlly nllmhor I1nd acldraoll ... ~ _-......hnl!\II11 'I""l'!I!IIIIO"",!"",'I'!"'I'I"""""!,"'".".,.I'."..'...,I.',.....",.'!"."I. I,tH1,",.tf",tll!Hl""",,,,.t'!"""""""II.ttt.,..,,.,,1O'"I'''''"''''I1''''''' ---., -- !"I"'I"""""'I"""""""""r't'!'t'!'!'!'"""'!"""""!"""""""""'" - "''''''''''''''''''''''''''''''''''''''''''111'''''1'''''1'''...,"""""'"''ItI''',I''' t"'lI"HI"'''''''''''''''''''''''t.H''H''tH''I,I''''''l'lI''''li!''t""''''''''t'I"''1 ---- - ,',,,tt""'t"'I"""I"""""'I',,,,,,,,,,,,,,,,,,,,,,,,,,,,,,""""""''''t'''''''' 1 _'f' ""'I'tt"""''''"'''''''''"''''''I''''''''''''''''''''I'''"","""'"''''''''''!!''' , " " 1',.., t 1 " " ,j",., , , "" " ". . ~ ". , " , , " , ,. I ., ... , , " ,., , , ,. " ,.. . . " ". ... . .. , .. " . , """"11'".'"..,,,,,,,..,.,,,',,.,,,,.,,,,,,.,,,,,,,,,.,,,,,,,,,,,,,,,,"''''''"'''''H,,, I,I"IIII1"l"",".tI.."""I",.,..",I"""""""'I"'",,,,,p..,...,.,,,,,,..,,,,, "'Il""""'!t,..".""...".t""""""""l""'t""""",.I"""""""I""'", , - "'"''''''''''''''''II''''''I'111'I'''''''''ft'''''''''II'','''''''''''""..."....,.".,. , ' '"''''''1''''"''111'''''''''''''''''''''''''''''''''''''''''''''''''''"ft,.",...,.",,,, ." "'1'" tit "1'""""", I' 1'.."...".".,., t I' .,.... ~" 1".".."" .,."""., ".", I ., 11 Acid Iho nmounls online 1 , , ".'" " -.l!_ II I'xnlllclnl1lo Intoroet on BnrloB g~ u,s, Bnvlnoo 110ndB 10Qupd nllnr 1000 from Form 0018, linn 14, YOII MUsT atlooh Form 111116 10 Form 10,10 , , , Cl 4 SI/blrool IIno 3 from IIno 2, Hnlpr 1I1e rOBl/1t horo and on Form 1040 0 8 Nolol " YOU linel "vor $400 III aross ellvldllrlels arid/or olllllr dlorrlbll/lorlo on stook, YOII mus . . I 6 I.lot nl1mo of pnysr, Inolude grose dlvldondo and/or 0111 or dlolrlbullono on elook horo, Any oapllnl ooln cUolrlb\llIono ancl nonloxablo dlolrlhullonB will ilu cJoduolod on IlnoQ 7 and O'~ I,.,.""tlt'.."",.,.,.",'".",.,...,.,."".,...,""'1"'""", -- "'I"II""""""""""t'I'I"'"""."",....,...,.,....,.t,,,.,,,.,.'I'.,...,,,..,.. "t""'I"""""""""""""""""'.""'I'""'t"""I""""""I.".',"""'" I' """'"'''''''"'''''''''''''''''1''''''''''''''0'''''''''''''''''''II...,."""".,,,,.., ", ....',.'I""'..I."...'."'I'."'t'I"."..".......,."",.'tl"'I","""""""""'" ."""'1"..."""'"'.,.".'..'"111..'..,.,..,,,.,.....,,,'1,...."",.....,.",......." ""'1"""""1"""'1"'1"1'1""""""""""""""'1.".,...1,......,1,....".,. o . , ,., I., ',.. , . ".,. 1.", t. . ..., .", .... ." . " ,. . ". , . . . . ,. . ..... ..,. . , ,. . ~ . . 'II .. t. .. . , , , . . I "1""""""""""""""""""'11""""'1"....t.'.t...I'.."...'..I,..I.......". """"""""""I""""""I,.,.".j",..,.,.,..'...i'......,..........,..,......I..'.. ,..,...".'I..".."""'....tf'.,,,.,.,,.....,.,,.,,..,.....,.,,.,,,.,,...,'.."..1........ '..'''''llt''.,,,q''..'''I''...',,..,.,..,...,,,......I..,,,,,,....",.,.........",....',1. ..,.""'I'.."......i.",""I"'H"....'.,..,.,..,..'...II.'''''''''''''''''''''''1..''." o 'I Q 9 111 po YOII Wmll $3 10 ~o 10 ihl~ tUII~?; , '" , , , , ; If 0 01111 tolulII, dooo our op"uoo WOIII $3 0 0 10 Ihlo IUIIII? , , _ Slnulo, ..2L MOll/oil fIIllla 101111 'alum (oV~1111 allly 0110 ho[111I00l1l0) , M,nlolllillnU lopo,olo 'OW'", ~^Ior IpoUIO'I<IocloIIO<Ju,lly 110, ohoyo 01111 lull noOlo halO, "', __ Ho"el of haillohold (wlll1 qllOlllvlna pOlO 011), (Soo PO(/O 12,) If 1110 qUlllllylll(/ pOlO 011 10 0 ohll<lllll! 1101 your (Iopol1elolll, "lIlor 11110 otlll(I'o 1I0mo hOlO, I> . . U Quolll In 1<10 01 wi h do londolll ohll(1 001 0 IOUBO dlod '" 1 0 ), 1500 PIl9.!!.J!:L an ttl Y',uroolf,11 YOUI P, 0'0111 (01 0011I00110 010,0) 0011 olohn VO!I B9 0 dopOlllliln1 Oil hlo or hu, lOX'} 110, 0,1 bOlIl 101ulIl, ~o 1101 ol1ock ~ox Uo, 1M ho ,ufo 10 ohook 11'0 hox Oil 11110 33h o~ pOUo ~, Ih!lk111 00 01 ~n, ,. . h ~ 81101100 , " 'l--L ' .L..-l 1-.1 II I o POpOnqolllol !11I'PIOOolI\'lIOClII -fjfo'ncIIO"!'\ I ,.01 menlni 11~lo~,~O~J 0' 111 filii nlmo 1111 oanll ~IICUII numb", II bOIn III,U,"IlIlp 10 INI~ I, 10"' ~II" I "Jl.lj!lnl,1J- 1ItL ~Wlli 2 (o:1'lon /lo/'cln -,/11 IIIOI7:12:r1Jn1Iql1t1i'i' 12 - IIIvoIIWllhl09 ~ _JiiQ}.\fll'd /l1)/'Cln....I.r.- OR I tJ JigQ,(L 80 L 12 :on~;IIIJII Willi .. I 1111011101 I, IIPIIQllon'lm 0 P.I'141 _ - I O"IOlIonl, on 10 0 . "I I OQIIOI"odl~9Vo~ (I II your chilli 1I11111'IIIyo Wllh VOo bolll .lllmoll 'I voor dlPonlllnl onllll a prod OS, ao'u;~oCk he Ie to- p ~~~re~m:~'I " Tolollltlmhor 01 oxoOlpllona ololl11on , , , 'bo I ~ 7 Wouoo, 80101/00, IlpQ, 010, Allooh POII11(O) W.~ , , , , , , , , , , , p. lillaJ2lllliL 80 To, xlI"lo IlIloroot' 1110011I0 (000 poOO 1 UI, Allooh Soholll'lo a I' oror, $'100, , , ',' 00 .; :1 ,5 II TOX'aXol11plllltOloot (100 pouo 16), PON'T IlIolodo 01111110 00 8 I ,~ 9 plyldond 111001110, AIInoh soho~"lo a If ovor $,100' , , , , , , , , , " 0 10 TOxahlo ,o'olldo, c'o~lIoi or ofloola 01 01010 ond loolllllloomo loxoo 1000 "ouo 16), , -1!L _. 11 Alimony tocolvo~ _ , I 1 , , I , , " t , I It' I,"" ...1L. 10 81'011l00n Inooll1o or (Ioao), Allooh Bohollulo 0 01 O.UZ , , , , , , ,', " 12 10 Onpllol 00111 0'11000), If roqulrorj, ollnoh,Qohorlulo P (000 pouo 16) , , " .,.J!L 14 Olhor oolno or 110Iooa), Allooh 1''''1114707, , 8' 1 , , , , , , , , ...ll... 1811 1'01a11f1A dlalrlhl'lIolla, IJ.1!!1.I h Tnxoblo omouol(GOo Rnoo 16) J.l!!!. 10a Total peollo", anll annullll8 11~ h Toxobl',alnollnl!'Qo'pago 16) J.l!!1. 17 11011101 rani oalolo, rovnllloa, pntlllolahl"B, B oorporollol1o, hllBlo, 010, Alloch ~oholl\Jln 0 .J.L 1S 1'01111 1110011I0 or (loon), Allooh Sohorltllo 1', , , , , , , , , , , . ' , -1.8 10 ,UllolllploYIII0l11 00IllP0I1111~" (aoo pngo 17) , I ' " , , . , , , , " 10 ROo 800101 oOOUllly l1..i'lIf11o On I 1-1 l1 Toxoblo alnounllGOo pooo 16) 20h R1 Olhor 1110011I0, ~Iallvpo 01111 omoulll-aoo flogo 111 ...."".....,,,,,,,,,,,,,,,,,..,,.. 2" 20 Adllll10 ntllOl'l1lo III Iho forrl hi olllllmll lor 111101 71hloll h 21, Thlo 10 ""t1 1111111001110 '" 2a 000 Your II1A dolluollon ('00 POgo 101 , , 1 , , , ,26n _ __ ,~ II 8pOlloo'III1A doduolllll1 10011 I'OgO 10), " ,,20h ~ 24,. Moving oXponooa, Allooh I'olm 0603 or 0000." 1 , , J!i... _ __,~ 2U Ollo.holl 01 ooll'omplovrnonllox, , " , , , , , J!!L ~ ' '26 Solf.omployod hoollh Inlulonoo 1I0llllollon' (00011000211 0 ~,~ 21, I(olluh 1\ noll.omplpyod S6P piMa, If SOP, ohllck I- 0 21 ,~ 28 POl1olly on oOllv wllhdrowol of oovlnuo I ' , , , , _08 '~ ~ 28 Allmonv paid, llaolplonl's,S6N to- '. d 29 ~,~ 60 A<ld 111100 230 'hlouUh 20, Thooo nlO Yllllr Inlol odlUblllllil\lo , , ' , , , , '" 60 BimfsTlld . 01 Bubllact IIl1e 30 Ironlllne 22, Thil Is your III/tilled glnulnleme, IIlau Ihan 126,9/3 aM a chlllllllell ~tl Wllh VOII (Ielllhao 10,230 II a chilli 11/lln'llIve Vlllh youl, see "tamlitlncolne C/Otllt" 011 .,1Ql 37 I- 0 " . '''",.- Onl, No, lIonon " ~I'lPf31 IU9G . ,,,"~olloni Oil p~Q~ 11,) ~'~ 11I~ Il1q oh~l, IlloiW/lo, pl\lnoQ 1'11111 or IVl'o, rr"I~~nllol ~1~~IIQI1 PolO Qlgn .500 1\ 0 l. Flllno alntllQ (Soo POuo 11,) Plloo~ ollly ono I'OX, axomptlollQ ISun paOn I?,) II 1'[10'" Ihon olX <<op~ndolllo, o~o pOO~ 13, InQoml3 Allool1 Oopy a of your Parmo W.~, W.~QL oml 100ll.t1 hoto, If VOU dill nol uol 0 W'2, euo pouo 10\, 6nelooo, hul do .nol o\looh, vo"r pOVlllonl 01111 p<<Vlllonl VOlloho" 800 pOon 33, " Ad\UsltnOllta to 11001110 . Pnp1ul!1\III\1 nlllHI tnll1~\HY-'I1I"fI\I11 nl1Vlmllll P"''Y\IlU U S p!.!lll!!..IillLRlltlfrn f'or Ill.. Ollt Jan,' 1-.()oa, 31. 10051 or'olh\lr till( yon, blJ\llnnfll\l ..",., 1'.1 .,.'. ,17 ~ I "'F In ~l !3 ~,:' ,)' U ;' 1 10 111 (. I II ~.~O'" -no """"""",,In'lll, """ , IOOfi,unulnll, In 0 11l1!o, 18"0'0071 VIIIII 'Olll\lt OOOlnllV IIl1l11hor ~--- n__J_..J 01'"'''''' 10nltllli0llrllY ""llIiIUi I L__ For PrlVllnV AnI nml ---- Pnl'lIlworl\ rip! 11011011 Ao\ Nollop oOP pnon 7, YOIl JlJ!... NolO! 0110011/10 ""0" -- i< IV/II nol ellllllgf yom I . 1 , I f _ -!L.. 4~ 0' IllcJuao YOllr , , . I X fQ(lIfld,; 1]@95 ~ ~ ~x 1~~~,~a-&3G1 aOtl-AA~1P97 aap1P a~OQP k ~~T~H~P~~9HARP ~ QPRPA ~ P~R X ~A 17tl1l! I , R Il~:-- S 'I ~ o 1 D :=J " "- !j(J1Gr,IJD S0166 IJIJ I""1n 1 040 1100&1 FurllllO'Illl1005J Tp~ Opmp~" tptlon . (B~o poUO ~O,I I YOI! wnlll '0 IRB 10 101110 your ax, &00 pouo On, Orec1lttl (BoO POOo n.", Other Tl=lxea (Boo pooo n6,) . Poymllnts Allool' r-ormo w.n, W.2G, 011<1 1000'1011 Ihe Ironl, Rohtnd or Amount You OWo Sign Here 1<000 0 oopy of Ihll roMII fat your tocordol ~ald rrOllarOr'.S USO only op AmouIllllOl1I 11110 01 (oc111151011 urooo 11101111\0) , , , , , , , , , 000 Ohllok III, P YOII 1'1010 DO or olllor, P IllIII<1I q 81101100 Woo 110 01 0111 or, A<l~ Iho mnll~or olllO~oo ohookod OllOVO 011<1 olllor Ihll 1111111 ,,,,Ill, , ' II If yow 1'1110111 (or 0011I00110 01, 0) 01111 01111111 VOIIIlO 111101',""1'"11, ohook hOIll , o II yoU 010 IIIorrlo~ III1I1U oOl'lIIOloly 111111 Yllllr upouoo 111111I11011 IlulluollollO or yoll 010 0 1I1101,0101uo 0111111, 0011 PIIUU a3 01111 ohook limo, , , , , , ,'" aau q 1"0111110<1 <1011110110110 Irolll Boho<lllln A,1I110 aU, 011 1 04 r:'II,or alOllllq r <1110 <1110\,101,1 allOW" 11010 1'1 for YOllr1i1i1l11 01111110,', PII,"!, yu \1 0 hookull ,0 onv 1101 all 11110 000 or 1', ao III pouo aa 10 1111 YOllr 01,"\1 ord dOd\lolioll, Maor II YOII ol",oko<lllol 000, yo "' 01011<1111<1 dodllolloll 10 lora, ~bull' . 61I1Ulo-$O,OOP . Mnrrlolj 11I1110 lolnlly or QlIolilylllO Wldow(01)-$0,660 . 1'100\1 nlllollooholrl-$O, 760 'Morrloll IIIIIIU ooporOloly-Sa,a70 8u!>tmo' IIna 31' from Uno 32 ,I I I , I , , 1 , , I I I I I , It, If 11110 aa 10 $66,026 or 1000, mulllply sa,500 hy Iho \0101 II\!IIIhor 01 O~OlllpllollO olOlll1Prl 011 11110 00, ,If 11110 a? 10 uVor $UM25, 000 Ihll wo,kohool 011 POUo 00 lor Iho omoul1llo ol1lor , TOll1l1lo Inoomo, Bul1\r1101 111111 00 Irumllllo 00, 1111110 00 10 1\10ra 1I1OI111no 36, olllor .0. , Tox, Ol1ook II Iroln 0 l[l Tllx Tohlo, \l 0 Tox nolo Bol'o<lllloo, 0 OOopll~1 Qoln TOI Work. ohool, or q 0 Form 0016 (000 poOo 2'1), AIIlIluIII Irom I'orllllol on 1 ,I .. 0 .J_ nO ,/IIllllllollolloxoo, Ohook II from 0 0 FOlm 4070 I' D r-01l1l 4072 , , , , 40 AII<lIIIloo 00 011<1 00 , , , , , , '- 41 Orodll lor 0111111 ol1d dopoll<lol1l 0010 UXpOIlOOO, AIlOOh Form 24011 ..1L 40, O'oqlt for Iho oldollV or 1110 111001'1011, Allooh Bohollulo 11, , jL 40 ForolOI1Il1l\ o'odll, Allooh Form 1116 , , , , , , , ...1!L. ,44 Olho, oro<lllo (000 poUo 26), Ohouk II Irorn 0 0 Fo'm 3000 110 1'0'111 036U 00 FOlm 0001 II q 1'01111 (opoollvl_ A'fd HnoQ 41 HHouoh 114 , , ".. , , I I , . I I '. t I , t , , 1 6uhlrnolllllo 46 Irom 11110 40, It IIno 46 10 111010 Ihol1 11110 40, onlor .0., , --'--l... I- BolI'omploymollllox, Altooh Ooh~q(lla 61l , , , , , , , , , , , , , , , Altoinollvo mllllmum Il1x, AlIl1ol1 I'llrnn 6251 ,', , , , , , . , , , , . , Rooopllllo loxo" OhOok II 110m 001'01111 4266 h I:J 1'0'111 0011 0 D l'orl\1 OO?O , , 800101 OOOll1lty 01111 MO<lIOo,o lox 011111"111001\10 nnl roporlod 10 omployor, AIIooh FOlm 4137 Tox 011 ouolllloll rollro!1lolll plono, 1I1011/Cllll0 U1.~o, If roqullolI, 01\0011 Fo,m 5300, , , , AClyol100 00111011 111001110 0101111 pOY!1lolllll 110111 FOlm w.a , , , , , . , , , , Houooholll 0I11ploV11l01l110xoo, Allool1 60hollUlo 1'1, . , , , , , , , , , , Acid III1M 40 Ihrou h 50, Tlllo I' our 0101101, . , , , , fo~orallncorno lal wllhllOl~, II aoV 10 110m FOlrnls) 1U99, chock'" 0 _06 W96 oollmolo<llol povmol1ls ond omoolll oppllod Irom 1990\ (olum , 00 OOll\ollllloomo orollll, Allooh Bohollulo EIO II VOII hovo 0 qonlllvll1U ~ ohllll, Nonlo'o!llo 0"'"0<1 IlIoomol omolllll 1-1 L...:J, ~ and typo ~ ..,....,.."..............."'.1.'''0.''.'''.,..''..' ..J!L Amolllll polll with Form 4000 (oxlonolqll roquool), , , , ..M... Exoooo ooolollouUllly onll RI1TA lox wllhholrl (000 1'0011 32) ,50 01110' povmol1l', t)hook II trom 110 Form 2430 h 0 Form 413U 00 A<llIlIlIoo 66 Ihlouuh 60, Thooe oro your 10101 "oymal1lo , , , 1111110011, maio Ihon IIn. 54, oubltoolllno Mllom IIno 61, Thlsla,lh' all1Dunl vou oVaRPAIO, , , Amoulll of 11110 UU yoll 1'10111 Rar-U"llJao rll VOU, " , , I ' , , , , , ,'" ^mollnl .11108 62 VOII wanl AI'PLIEU TO YOU" 1996 !9TIMAlEn TAX I- I 04 1 . If 11110 bolts !1loro Ihol111110 01, ouWoolllllo 011,011111110 64, Tl1lo 10 Iho AMOUNT you oWo, For 11010110 on how 10 pay olld uoo Form 1040.V, Poymolll Vouoho" 000 pouo 03 , ,I- no Eollll1010d lOX ponoltY (000 POUo 33), AIDa 1I10lu<looll 11110 06 1 00 I Undo' tlonnll~1& 01 po'luty, I doclatlJ Ihntl hnvo OlC6nlfnod Ihl. rolum Qnd aCCOfllIlQllylr'Q tchodulOl and Ildlomonl., otHllo tho bu' 01 my knowltdgD and bOIlOI'rh i '}Ollllo, COIlOOI, oml ,.0IOpl.,0, Oocl...llon ol,/,"p"" (olhor Ih.lllo,pOYOI/I. hnallll 011 .111,10"0'"0, 01 Whloh P"POI" has ~'Y knnwlodiJ., ~ Vur(unnllll~ '. f) 4' ,1 01110" VUl/raOUUlUlUen". ,. . 1. .(,(.LCi.!.[^(,.i_, IL' ~;~'t,..t{t'il........ 3/11/00 Clel'toal . ~ raI1UIIO" Ili~,MIWO' II a join, tUIUlnl oaTH mill' Illln. , ,. Onto 8pouto" aoel/pollon ,. ,/ '. 3/8/0/1 1'nwk IJ/'ive/', ""011410'" ~ Ottlo f-trOpI110r', loollll aOCl1fl1y no, .Iu'oluro....r I r-'''Tl'. nnmo (01 YOWl 1lIoll.omr,loYOIl) "flll i1ddlltllJ , , , 0\11111I1, '" ~aq '" aah IJ qo 00 '07 00 40 . 40 41 40 40 50 01 52 60 04 60 50 07 00 50 00 61 OR 03 04 . on .................... OR I I I I ,~ a '.' fii.uo a ,5/11/1/1 O~ -'- 10117:1117 05' tlfiIOll 72 - ---- ----., 06 10000 00 .JlL 3,S10llIL 00 52 II Q.!L o 527/1 J!.Q... " " r-- fi27l1QL. 85110/1./ 128 ,~ 128.,,'a;r- ~pHt:PlJ~131:1 A&~ ' &pheChlle A......lteml;z:e~ PefhJP~h:m1:1 (Fllrm 11>401 (l:1ohn~lllo ilia lln tlnnkl ~tPII~m'''loll~'TI''''ry' , . 1m ~ '"" B'~IC. , 111 A 100 0 om O?... Sna 111011110110110 lor SOhOllllloQ A olld IlIPorll 104n, . ,JlIl(II l/,oWII 011 Fo,m 10,10 . JooljllaJino A, ~ R/ol1orfl J. Uoreln Melllonl' . QO\lllnRl(Jo~olll1PlildOOKPOlIlOl(Olll1bilniodo(palrlbyo(llUrs, ~, nnll 1 Morjlnol "ncj <Ionlol oxponaon (nno (laQo A'11, . , , ~, Penln' ~ ~nlor omollnllroOl fOlm 10~o, 11110 ~~, 1....8.....1 I ~~ J:!lCpllnsea B Mlllllply linn ~ nhoyo py 7,6% (,076, , , , . " 3 4 SII11 roll 03 10m linn 1, 1111103 0 morlllhlln 11110 011 or .0. B Slolo onrJ lonallnnomo loxon , , , , , , , , , _JL B Rool onlolo loxon (aUo pooo A,~), , , , , , " 0 7 Poraonnl proporW IIIXOa, , ' " , , , , , , ~ o OJj~1[riuxoa,o~!ob~I;I ~1Cl81~o~~btr1'i'!iilrWrii"I\';( ~ "~"J'I,RLP...,..". . ~..,..tn~!l""HJ.L\"tr,.......lt v, a Ado InDo 6 Ihrol/oh , , , , , , , " , . 10 lIomo morlgnga Inloroll onll polnls ropnrloillo yo II 011 form 1006 ~ 11 HOlllo IlwnongO InloroBI 1101 loporlod In you on I'olm 100U, If pold ~ , 10 Ihn pal inn frnlll Whom you \loughl 1110 homo, soo PoD 0 A.3 ~ ol1d shnw 11101 parson's nOlllo, Idonllfylno 110'1 and nrldloss "" ~ ' .m ..tl""ofl"I""'"l1H.,p",..tI"!!""""'"11"""III" ~ ,~ . J.L " TIlXPa Ypu Pnlll (80n ., " pooo A-1,) Inlefaal YQIl PRill (80n pooo M,) Nolol i'oroonol 11110,os\ 10 1101 <loqlloll~ln, QIf\o III Ohmllv If VO\l mOdO 0 gilt olld gdl 0 011001 lor 11, 000 Pogo A.a, 1Q 17 10 08a~ft1lY and !J1!lft ~OS$Qq 10 Jab ~X~0I1S0S po ond MOIl. . Olhar Mlsoollal1aO\ls Ood~olluns . ,-. P1 . (800 P2 pooo M for OKpOlllOS 10 <lo<luol hore,) 23 24 PO PO Olhor 27 MlsDolIs\loalts OallllollollO TQllll Ilellll~Qtl beduallona 01.1\1 Nil, 1616.0074 ~@95 A\laohmonl .. SIl( uonCQ No. 0 VUIII Iuolol ,oollrllv nlill\hor 1M 12 Ii:lil~ II ~~ ~~ BIlIiO ~ 07:h1L~ I 201i,00 I o 1iIli2Z H-I ~, I I ~ .~ ,~ """111""'''''''''''''''''''''''"'101'''''''''''''''''''''' i""'!"".""""'I",..,."",t""""I""""'1,.11.,.." Polnl" nol ropartod 10 YOIj an !'plm 1000, Soo pooo A,o .for spoolnl I\llos, , , " , , , , , , , , ,j 10 Inyoo\monllnlorool, If ro~ulrorJ, nllooll Form 4062, (SOD pl\ge A-[q , , , I , I , , , , I , , , , 14 AdrJ IInoa 10 1111011 11 3 16 ellllo Py Qonh (1r ohook, II YOll m\ldo ony 0111 of $260 or mora, BOO pOgo A.~ ",t' I I I I I , , '; , , Oll1or Ihon py nosh or 01100k, II OilY gill 01 $260 or n)Ore, ooe pnoo A'3, II oyor $600, YOll MUBT allool1 Form 0200 OarlYoyor Irom prior yonr , , , , , , , , , , Add IIneo 16 111101101117, , , , , , ,', , , , 12 ...1!L , , , I , Onsually or Ihoft 1000(00), Alloot1 !'orm 4304, See 0 0 A.4,) , l:Jnrnl(T1\luraocj employee oxponsne-Iob Iroyol, union duooo.lob oduoolloll, 010, II reqlllre<l, you MUST alloet1 Form 2100 or 2100."Z, (Soe paoo A.6,) '" """"",,;., , , , , I , ,...."..,...,.,.......,.".,."..........".,.,.,..",',-,"""'11 JliL I ".".'"""""""""",,,,,,,,,,,,,,,,..,..,,,,,,,,,,.,.,,, 22 Adrlllllns 20 Ihrolloh 22, ,', , , , , , , , , ~ flnlor am6unllrom form 1040, IIno a2, LM.L__1 ~~, Mulllply lI~a 24 obovo by 2% (.02) , , , , , " 26 Sublrnol 11110 26 Irom IllIe 23, IIl1nu 26 10 more 111 on IIna 23, onlor ,0, , , , , Ollwr-Irom lIel on pago A-6, List typq ul1cl urnoulIl '" """..,,,..,..,..,,,,,....,, ""...".,.....'...""10"""....""..11."................. Tax prapamtlon fees , , I . I , t , , , , , , OlllOr eXp0l1000-llIvonlmenl, sufo depoolI \lox, ole, LlsI typo a'1d arnount It-, II.,...,. to. to..., "'0" I to" """., "" 2:J:IIl 00 "..t..."...!...'Il.""........"H".....;"........,....."''''..11.,,,,..,,............... . 20 Is room; 1040, IIno 32, oyor $1 1<1,700 (avor $57,360 If motrlod flllllg aopurnlely)? No, YOU, r dOdl/olloll Isnollll11l1ed, Adrllhe olnoul1le .In Iho lor rlOI,\1 00lUII111 ,} . tor 1I/10S 4 Ihrouoh 27, AlaQ, onler 011 Forln, 1040, IIno 30\, Ille IMonr of ,i>- Ihls olnoUlI1 .dr your alalldord ded\lo\lol1, Vlls, YOllr dorluoll II mo bo IImllod, Boe II 0 A-6 for 1110 smounl 10 nnler, . Pot I'oporwolk nodllollo'l Aol Nolloo, 100 "urIll1o~O IlIsltllollol1s, 0.1,110, 'il030X .........\t1-.... ., ,10//5 72 ---. " li002 EL. SPO 00 I ~ I I I 20 ~ 2366,00 "0 Sohodut. A (POtIl1104011OQe ,. " OI,lIlI/II,IU,IQ'OIl;,1 Pnllo Q Y.ur ,!IUlol IUUllrllv II\II"'IPI' L-l AUllnhmunl 1 Opql1unco to, 011 901l0dulol/"\&11 WOfm 10,11)) 11)U6 NQIlW(lI)',huwn 011 POlin '1)40, po nul9111llf 111111\\1 aml,ooltllutlowUy 11ll1ll11ur II ol\(Jwn ~ llltlu, Add Iho omounlo 01111110 6 , , , , , , , , , , , , COpllll1 Ol1ln dlslrlbllllolls, ~l1tor hOlo ollcl 011 Sohoclulo 0' , [..1. NOl1lo~oblo dlal/lbllllollB, (600 Iho 11101, 101 I'orm 1040, 11110 9,) 0 Add 111100 7 and 0 , , , , , , , , , , Sllhlraolllno'O Ira," 11110 0, gnlo! Iho rORltll hOlo opd on POrln 10'10, IIno 9 , ~ '1/ YOIl do (lot 1I00d SolladLl/o D to rop0l1 OilY olllor gO/lis or /oo~oil, BOO '110 IIlatmotlolls (or Form 10.10, IIlIa 13, 011 n a 16, PQti III I' you hod ovor $,100 6f 1I11slss1 or dlvldsllds IIr hod tllorolOI1 00001101 or woro 0 Oronlor aI, or 0 Ironsforor' Foreign ~oroIUllltllsl, you mual oomploln Ihlo porI, . . Aooounto '11 n AllIny limo dUlhl0 1906, did you hove nl1 111101001 111 01 n olOl1olUIO or othar oulhorlty oVor 0 flnnnolol IIn~ ooooul1l III 0 lorolon OOUI1It)', Ruoh na II bonll IIbDount, SOOlllllloo"oooollnl, or olhar IIn8nblol Trual8 00001l111? Boo poOn Il.Q for exooll\lOl1a nnd IIIlno raqulramonlo for Patin TO F 90-22,1 , , , '; (S'oo b If IIYoa/1 ulltor, tho nnlno bf tho fotolgn oOUl1Hy ~ .....H................".lt,,"'...'..H."..'...lil;; Ilnuo B.a,) 1a Woro you tho oranlor 01, or lrol1sloror la, 0 10101011 trllot \lllIt oxlslnd dllrlllO 10U61 whalhor or /101 _ YOII hnvo OIlY bonollolollnlerQst 111117 If ":r'oo," YOll r'nny hovo to fIIo Potln 3620 0620- or 020 Pol Pol>ofWofk RDdUollon Ao\ No\loa, lOa Palin 1040 Insllllotluno, Bbhol\lIlo b l~otm 1040110UD -'''-'':": -... I " r:~rt , nlo,roal nOlllne (000 poooo 10 o~" \1, ,) . 1'1010'11 you ruoolVHd 0 1'011" lOUO'INT, 1'011\1 10UO,OIP, or SllbolllU\o .lo\ol11a~1 Irol11 o ~rokorquo IIrm, 11',1111011101'0 ~01110 os Iho POVOI Olle) o~\or Iho lolnll~loIOol ol\Ow~ o~ 11\01 form, Pori II Plvl~oncl Inoomo (Boo pOQo.16' o~d 0,1,) 1'1010111 YOII rooolvoll 0 Form 1000.DIVor slI!Jstlllllo .Iolomonl from o blokorouo IIlml 1101 11'0 Olm 0 nomo no Iho poyor ond onlor Iho 10101 dlvlclondo" . IhoWII 011 Ihol 101m, aph~~\.lIl3 ~,.,..,Intar~at flnq Plvldlilnd lnpome Nololl! YO~ fillet ovor $,100 'n l~y,l>lo IliiP,u~t IlIoomD, Vall rn\!!L!!!'o ooill"Wln Plllt ll~ . 1 ~,Io\ nOfl1P 01 payor, If IIIlY 11110roo\ III from 0 oollor-flnllnoocl Il1pr\on\lo nncllhc Iluyor lIood Iho propolly nn II po[oonnl rooldllnoo, Bnn PIlOO p.l nflcl, 110\ \hlo 11110roo\ lIrol, Aloo, ollllW \11111 Illlyor'o 0001111 sOClllrl\y IwmllOr I1nti IIdclrlloo ~ Amounl. , ..,'!,ot,.,,,....,...,.,,,..,,...,....,,,.....,,..,".,".....,..."",..""'....".,"!." i ,,' ,. . ..,...It.,!...."...."..""....,.,,,.,,...,....,..,,.,.,......."..............".""".. ,. ---- 'H".....!,..,....,t"".'''...t.,'........!..,...'tf''............,...............i......" ,.."...".",.....,...".",.,..........,.......,.,..,."............,.,..........,..,.,... --'" .,.",.,.,..,.....,.'.."'1".'...........,..,.,.."...,.,...,.,.......;...,.,.........",.,. -~-~ .,...,..,.."..-.......".,...,..,...,.....,......,.,.,..".......,........,...,...."..,.,... 1 "...."..."....,.".,,,,,,.........,,,....,......,,,.,,.,......,.,......,..""...",,,,,. .....,,,.,.,,11"."'1''''''''....,.,,........,,....,,,,.,.....,..II,,,,...,...,.,ot...,,,,. ""....!.."'..,."'...""'.,,'...,...........,...,."...,....."".".."..,........,..... - ,.."""".",.10,,,,,,,,,.,,.....,,,,..,,,..,...""'"'.....,..,,,-,,,.,.......''''"''... ~ ...,.,......,,,.,......"'1".....,....,,..........,,,,,,,...,......",....,.....,.."....., .,..,..,..!'"".,.".,."."...,...,..".........,."..,.........."'.............."".,.., , ' " '..,....'."'..,......".""..,.......".........,...".,......,.,..",.",....",.....,.,.., ............""...,..,.,."",.".,."..,.......,."."."......,..",."...".,."',,.,.,., p. AcId Iho omounto on 111\&'1 , '" '" __2 l\' pxplllclotllo Intoroot nn sorloa ~~ U,S, anvlnoo pOlltla IOBlIod lifter 1900 from Form Q016, IIno 14. YOII MUsT llltnoh Form 0016 III Falin 1040 , , , , , , , 4 Suhlrnol 11110 3 Irom 11110 2, F.lllor \110 renUII horo onel on rorl1l 10. 0 0 0 Netol If YOll had ovOr $,100 /11 0'0" dlvld~llds olldlo, ollw dl.t'l~iitfollo 011 . auk, 011 mll.t glso oom 6 ~Ial nomO of payor, Inollldo orosa dlvldol1clo ond/or olhor cllslrl\Jullol1a on slook' horo, Any nopllol onlll clls\rlbll\lQIIO 011c1 110nloxohlo dlslrlllll\lolla will ho doclltolod on IIno~ 7 {lnd 0 ~ ,,,,..,'..,.,,,.....,.........,,,,.,...,.,.."I!'I'......,.....t!'''1. ~ 'I..',.'JI...."".....""."....,......,........."........,.,,,."".,..,.,.....,,,..,,.. .............,.,........,...,.......,..,...........,.,.,.,.....,.-......,...,........"..,.".. ........."....".1.,..'''""...,.......,........,....."....,..'''.,...................t., .'.'i.".'.,..,."'..,..."..,......."..,.....t...'"""""""''''''''''''''!'''''''."" . , ....,'...,..""'.....'...HII....."....,.....,...."'..........,.....,.,....'.i."'...'.,. ".......,..,,,.,..,.,.,,,,........,.,,...,....,......,,,.,..."".",..\.........."....... o ,..,..,.......,.....,..",.....,.............,........,........""...".........,.,.,..,..,. "........,{I!...".l.".,.'.......t..,.......,..,.....,.......r,,,,,'"''''''''''''''''II''' ...,.........."."....""".,..,..."..,.,.,.....''',',....................,.,..."....... , , , . . . . , t . . . . . , . . . . , , " , . . , , . . . . . . , . . ; , . . . . . . . 1 . . . . . . . , . . t ~ , . . . . . . . . , . . . . . . . . , . . , . , . . . . . . , , . .1'.'...,'1........,....."..".....""...,.,.......,.,.,......"...,..........,..""....., ,...........",.".."............,.,."...............".......,..................",...... ........,..............";0."'.....,,,,.....,,......,,+0........"..................,......" o 7 Q o 10 " Ii " l'orlll '2106 J:nwlpYl3o I=l\.lalneaa J:xpon~ea I" ~llll III1Pllllllo h,ulnIIlIlQl1u, Pop'l\fTI,nl Qll~, T'U'\lry Inlt,n" 11m'", DON'" (01 '" A 111011 \0 Porl11 040 or I'orn 1i14o.T, VOiJr MIM . Goulnl uPoIHlly nll/l1tHl1 lHahonl J, 110/'(10 1108 i 4,/ ! J IlfJ 7 .. All1rloYllo [:l\1QII1~lIo t:Xpol1l111ll Ill1d Roll11111lrOolllPnla --Pollll11l1-fi'----'---' .------(i~i\ini~-.--- Olho, 1'l1nn MIIIIIIl Monlu 011<1 ' nl1d 1:11\011111111110111 r;nIOl\nll1l1'Onl - --- ---"-- -----!~ !h~~'~:Z"~,~ ~~~ j~~~~~~1:~ ...L. ----,-- "'~~ '~1,."'~" ~~~~'%~ ~ """ ~,,"""'~~ ~~ ~~~~~~~~~~~~~ -1L -,._______ ____ ,,~~ '~''lli~,\~.''''~~~~~~ . ,~~ 'i.2~"~'l&~.~~ ~~~~~~~~~~*~~ _JL ~~~~1\'~. ...L~~~"'0~~ti",,,~' 11-- ~ 6 ~\~~~~~_~." ,1672 0 ~~ ~~; 6 ~~, ,1672 10 -~ anfl1 I=l1lpr Ylll1r t:xponllOQ " 1 VOlllolo QxponoO (rom 11110 ?? \lr 1I110?1l , , , , , , , , , iil Purklno (aoo, lolls, Ol1q Ir0l10pOllollon, Inolucllrla Ifllln, PlIS, 010" 111"1 Ilht no! Irwolvo ovamlolll \rl1yol , , , , , , , ,; ;. , . II Tr"vol oxponoa Wl1l1o nway froln homo ovornlulll, Inolllcllno lodolno, o!rplono,oor ronllll, 010, po 111111nollldo 11100111 IIn<I on\orlnlnlnonl 4 'B111I11100S oxponlloll nol Inolllqoq On IInos 1 II1!OllOll 3, po 1101 Inolll<10 1110nls ollq 01l101lnlnl1101l1 , , , , , " " .1 " 6 , Mools Ollq olllortnllll11onl OXpOIlSOS (soo Inslrllollollll), , , , . o Tolnl oXpol1aos,II1,Oollll1111 A, n(jQllllos 1 1I1rO\loh 4 oncl olllor 1110 rosull, In Ool\ll11n 13, ,olllor 1110 1I1I10lll11 Irol11 11110 6 , . , , , ...illd\!.~..!L_l!i~30'':''" ~n@95 AlllluhmlJlIl " ..!!IHIIIOI\Cil~L OCIJllpn\11I1l In WIl1uh uIlPOl\\iUII WVI~ IncUllut' 'I'I'llrlk /),,(\'0" Nolollf you wore nol re/mbllfaecl (or ony expoils0S In Step 1, skip IIno 7 end ontoI' tile el11011ll1 (/,om I/no 6 onllno 8, sTap II ~l1lor Amo\1nla YO\1r t:ll1ployor ClaYo YOll for aXpol1110a LlslllClln STap 1 7 ulllor amo\lI1ls your omployor ooYo YOII Ihol waro nol rop0l1ed 10' ynll In pox 1 01 Form W'~, Inoludo any omoun\ roporlod lillclor oodo "L" In box '1:J 01 our porm .2 000 Il1slrllo lono) , " 7 ,~~ ~ ~ -0-[ ~ STap Q FI{J~ro !:xpol1aoa To pod~llt 1111 Bnl1oc:t~llo A (Form 104p) or Form 10'10-T, soollol1 !3 . p In Oolllrnn /I, enlor 1110 omollnl IrOll1 IIno 0 (II zo,o or loso, ani or . ':0.), In c9illmn 13, 111llltlply Iho 0lnoUI11 on IIl1s e by 60% (,50), 0 10 Aqd the amollllls on 11110 0 01 bolh oolllmns olld olllor 1I1a 10lnlllmo, AIIIO, onlor thO lolnl on Bol1ocl\ilo A (Form 10'10),1111020, or Form 1040-T, 600\101113, I1no n,(QlIllllllod porformlno ohlsle Ollq IlIqlvlduols with dlsopllIUos, see Ule InslructlollS fa, 81'00101111100 on WllOIS 10 onlor tho total,) . It' , . , i , , , t. , , , . , , " -, "t ~ For Paporwork 1111<1110\1011 Aol Notlno; 100 ,1I1011\IOUoIiD, 0,,1. /j", "70011 o S\I\llrou\ 11110 7 (rom IIno 0 , , , , " ,."" Nolollf botll oolutnns of 11/18 e Bre zoro, sIal> 1101'0' If Co/llll1n A . Is less lllan zero, report 1110 amount 00 Incomo a/I Form 100/0, line ~, or Form 10,10. 1; line 1: . ..........'lol:a. " R~--- ~~ ..JL ~~ '/672, 00 ..11 . ....1 ~" ::..~~~ ,'~'"'' 2:!:l6, 0 10 2,136, 00 PII,m 21011l\o1lSI I'.,,,, aloo (IOOUI I',U' 11. o 0 0 ~ lo II Sou Ir 0 rllo Ions to flncL!llil...'1'i.!Jl!2 000 lono 0 oOl11lloto, - o ~Qpl1prnllll!!llmlltlE.1L___.______..__ ___ -1!tl~~ _{!Jl Vt1hlol~ 11 ~nlor Iho (Into vohlolo woo pllloou In on/vlclI, , " , , ,iL - I I '-'---L 'IP Tolal m\loo VOlllolo WllO drlvon [JlltlIlO 11106 " " "",..ilL ' , .JUllllJi___.iiiUiiii . 10 13\1olnooo mllllo IrIDI!Ju\HI 011 11110 1? , , , ,., , 0 mlloo ~ mllQQ 14 Pllrollnt of 11110lnooo 111I0, Plvluo 11110 13 11Y 11110 1(1 " , , ,..1!L ___---2i . 0< I in _<.Il 1~ Avornon qnlly rOllnrJ \rlp ooml11111 110 (1IntoIlO\I, " '" ---=-. -____mlloJl. __ mll'lU 1u 90111111\IIII1U I11l1no 1l1nllluo(1 on \l11I11? , , " " '" II 1]1111)U 17 Olho/ pornolllll mlloo, Aclu IInoo 10 und 111 1111(1 oll\llrnol \11\1 101111 flOI11 Ilno 1 Po . I , I , I , , I I I " I . , , , . I ;', ., , t milan Ion 1P Po Y~,l (or YOllr opouon) hovo nllo\llor vohlolo IIvl111011ln (or pnrullllol PWPOOOl1? , , , , , , , , , 0 Vall 0 No' 1u, l! YO\lr ol11ployor proVlclo<l YOII Willi 0 vohlolo, 10 poroolloluoo llilllllU olf,uuly 1!0!llO pOlll11110<l1 0 Voo rJ No papa you hllvo ovlclulloo 10 OIlPPOI\ YOllr duullllllon?, , , , , , , , , , , , , 21 If "YOII," 10 \1'0 ovlrlenoo wrllloll? , , , , , , , , , , , , . , , , , , " Soollol1 fI,.....Slllmhlrq Mlliillu.e Rille (Usn 11110 seotlon only Ifj!oll OW.llJI1U vohlolo, 2a MI@ply IIno 1(l py 30~ (,00), ~l1lor \1m /001111 I,ora' on(1 on \loa " IRllrnl mllll oorrloro, 000 Inatruotlono, ". ,. " ." 22 Sacllen Q,-Anlul1ll'l_l!oanaoa "L'((lhlolo 1 ~' ~lkVOhICIO a aoGlIoollllo,oll, ropulro, VOl11010 0 ~._... .. ..~.. . . 1/101ll1l/100,0Iu" , , , , , ...mL~~~. ~~ ~.~~;~~ . ~~~ Mil Vohlnlo ronlolo, , . , , , J!1JL ~\..~" _ ~ '.. 11 Inoluslo/1 omolllll (000 11I01(uolloI10) J!1.I1. " ~"-' ,~~"fffi_~ ~ , ' . ~ ~~ ~ ~ o fll,II),lmO\1I110~o\I)'r0I11I11102ll11 20 ~~ '......~_ aR' Vol~o o( olTlployor.provlQod '~'.~ ~...~ I VOhIOIIl(onPIIOO',onIYIl100%01 .~.~. .~..~ ~I ollnu, 01 10000 vn lun,wno InolilQ orl _.."~ ~11-~ on Form W.~-ano IlIolluollono) -IDL - ~~ ~ ~ _.~ m ~O Ad~ 111100 20, 240,lIncl25 " 20 ~._'~.~~ _ _m_ a7 Multiply IIno 26 by \ho . ~'W ~ ~ ~ ~ ~ ~ porcoolllOooo 111101<1 , " 2 ~~ , ~~ ~~_ 20 nO AQQllno027ao(120,~lIlnrlolnl ~._I _.~ ~~.~. loro 0/1/1 011 loa 20 ~~"'" a~ ~, Snellen p,,-Oaprocll1l1ol1 0lY!!h 0 oa Usa Il1ls seotlo/1 o!l~ If YOll own the vahlole,) n VOl11clo 1 -- -~'~.~~ ~ 00 ~~.~ ~ q -~,~ '~m~~~'" """-""=--~~~ m &..~.~.= ~". .~~.. ,. . _I _.. ~ ~. . .._. _III ~~ .'1 ~ _ ~.._I.. . _""I' _.'~ 00 ~~~\~~~~~~~ 2-1)..I"='~"-" ~ .. 'f.lP,11 ~\~,~~ ~~ ~~.-~ 00 ,~\~~~~~%~%~ . ~~'..iI " 00" anlor 0001 or otllor bnolo (000 IlIolruotlono) , , , . , , 111 ,.Onlor nmou/11 of 00011011 170 Qoduotlol1 (ooa Inolrllollollo) . 02 Multiply IIno 00 by lI/1e 1,1 (ooe IlIolruollonol( you eleolod tllo seotlol1 179 deductlol1), , . 00 Enlor cleproolalloll ITIOlll0<l al1d percelllllgo (oee 1110ltuollono) . 0>\ Mlllllply 11110 02 by 1110 poroonlngo on 11110 30 (000 Il1struotlono), , 00 Add 1I11UO 01 nncl 30\, , , , 06 unlt'lr Iho IIml1o\lon nrnounl from 1I1e 10blo 111 1110 line oa 1110111101l0no, , . , , , , 07 M(rllll)ty line 00 by 1110 porool1loge 011 IIno 10\ , . , 00 ~lIlar ilIa aml1l1ur ollll1e 05 or IIno 07. Also, ol1lor Ihlo ornolll11 ---'lJ1l1l1n. 20 abovo '.1,1 @ PIII1'.lfO/l,,,cy6I11l/(M,,lJf o Nol ~ppllooilla , 0 Voa 0 Nll o YaO 0 No 'U 11, OO'"1llml)(lj P"tliltl9 OHlci~,l(XlS , 3ft"3~1 " ~ t.,FlP@1 I~IIO !'nu" 11,1 k ~ ~ Flllnu ~llIh'" , 2 I' Q Ol,uok 011 IV 4 OIlUDo" 6 ~xllll1~lI11n" 6q I. 0 " If mOlolholl 01, 1I0pOpdolllD, ouo Iho IpoUuollol\o for 11110 00, .~ Income 7 6q A\1qoh II OOIIV P 01 VOllr .a Forml w.a, 10 W.AQh 01111 1000. 110ro, 11. II Vall <1111 1101 1P uOI 0 W.2, 10 Dqo 1110 14 111011110110110 160 fOI 11110 7, 10q nllolollO, hili <10 17 pol nlloo'" OI\V pnVl\lOl1l, AI.o, 10 ~IDA80 onolo&o 10 arm 1040.V ilOn 10001110 I1DUllollol\. 21 101 III\D 021, P\lpIUllnUI\\ ~)f tllll Tlllllll\lly-I!\\\Imol !\uYUtlllll nUIYlCU .8 I co ne Tille lletl1rn For Iho oar .Illn, Hloc, 31; 100~1 or olhor lOll o(lf buqlnnlnll Vnur IUel nnml,)IU$jlnl\llll" \.anl 1l111ll1J illID96 (1l Illll tJUOnly-D'll1olwlllllllf'\,ltlIOlnll\ltll1-lr.o 11000.ondlt1(1 Illljull\' ralurn. IPOlil\lll1 IlrQI IIQIl1U nnd hlllfnl ~l1ullll\rnQ Do Vall wnl1l $a 10 go 10 11110 IIIII~7, , , : i , , , , , , , If 0 OIIlIIDIIIII1, <1000 ollr 0 0\180 WOII $3 16 0 10 11110 1111\<I? .l-J 810ul0 -y C\- Morrlollllllng 101111 rul\II/\ (ovo/\ II olllv 0110 "~1I111001110) ftlO"loI' 1iI1oU ooplllolo 10111111, ~nlol OPOI180'1I lool,llIoOIIII\V no, ,!,nVII nn(lllIllnnlllD hlllD, ~ 1 \on<l 01 1101111111101(1 (wllh I1l1nlllVll1Q POIIIOI$, (800 IrloIIl101l0110,) II 1110 I1l1nlllvll1u pO,"OI1 III II ohlllllllll 1101 yo,!r <lnl'on<lOI1I, olllor 1I1to ohllll'o I1nmu 1'010, ~ ,,' 01111111111 I<low otl..\'illh 1I01'01\<l0111}hll<l (yoO' OPOI~ 1110<1 ~ 1 II ), (000 1111111\101101\0,) Dr VIlIIIDOIf, II YOllr jlO'OIlI (or 001111101111 0100) 0011 01011\, VOl; 110 0 Ihlfllll\llUl\lolI 1110 or 110r lOX}, 110," bon, roturn, qQ no' Ol109k hox 00 1 , I I I I I I , , I , t , , t ~hu~.11 0" 2 1I0"~I'0I1~b _~ ~ ,8 10U$0 . -l.- . . . Ilo,ol your Popollllonlol IIl,OlpendCII1'1I SOCia, 1310cpcnd.lIl's 141i. 0 mQnlh$ chlldro. 'n IIno UCII'I~, IIUlllbOL II bam ulatlOllshlp to IiH~ In YOUI 011 Who I 111 fil!l n.nll ".I."no III 000, IOU6 IC' in<l, "" ~~illL. liVId Wllh YOII' 2 1\/'(011 /lo/'rln 1f}11 60 17:J2:J /)ollf/Iltel' 12 . IlId"pIIIVI~IIII' I? tabflw---I1cu:dn I .ll.2J1i2JlfL ..sa 12 YOII dll' 10 dlvOIco . 1 I, OI'IPIIIII'" ('''1011111I111"11_ I __ p'rl"dlOI1G6IP' I nOl"IUldlb'v'_ i ADd ""mb III ....-.J.- lolllld 0" I nOllboVI ~ 1;0,:122 iiL ?2fJ,ClL ..i...."..'H".'.. .."........i'''''.. .,...,.....,...... ~....,,",.......... .........,. 2a Add Iho 0111011111.111 Iho rnr Ilohl 0011111111 lor 11110. 7 IhlOll 1121, Thill I' 0111 tohllllloomo ~ 200 Your 111/1 dodl/ollol1 (.'0 1110Il1101l011.) , , , , A AdlllRtod h 8pOllI0'.lf1/I <loduo\lon (bOO 111.11110110118), , " ao 1 GrDRS 24 Movll1U O'pnl1"l, Allool\ Fqtrn aooa 01 aOOG.I' " \l4 InOlllno 26 Ol1o.hol! 'of 801l'omplovmol1l10k, ~\loch 8chodlllll on a6 1111110 J I IA 11111101 26. ' 811il.omllloVntl hoollh 111.11l01100 (1lIdlw\lol1 ('"0 II1AI,) , , .1!L .. $28,.\05 (I'"do' 27 l<ooOh A .0il'ol1l1lloyod 8np plol1., II 8UP, ohoc~" 0 ..R- $0,500 II " ohll<1 26 l'ol1onV 011 o"!IV wnhll,owol 01 .ovI110" 20 <lId noUlvo \Villi ao AlIlI1oll" PAid, 11,,1010111'\ S$N .. I 20 VOII), \00 III. '" IIlBttuoUOnli. for ao Add 111108 231& thtough 20, . . . . , , , t , , , , !lno 501. 01 811hltAGlllllo ao ftomlil1o 2~, TI,I. IA Vow odlll.lod orooo IlIootT1o ror prlvnov ACt 011l1,1l0110~otk nldU.\loh Aot Notlool aD. pilgn 7, Honl9, II<ldIO'I 111","1", .ml .\fnoll, II YOII t'"YO 0 1',0, 0"" "0 IIIl~~~: I Apl.lln. Clly; town or po" oUiCI). alnll;t, and ZIP cotlg, \I YOLl llaVI1 1\10101011 "ddroaB, 'Oil paOli II. 'i, , , " --- TOloll\unlho, 01 oXlllnpllollo' i:lnlrnod . , ,. '" ..l-l..-.' WOUoo, on'~llolI, Ilpo, 010, Allool1 Forrn(o) W.2 " "" "" To'oblo InIOlQIII, Allooh 8cl,o<llll0 0 II ovnl $400, , , I 01" I' , , , , 'I ' Tox'oxolllflt Inlorool, DO NOT 1110/11110 011 IIl\n 00" .' . Dlvlclonlllnoolllo, Allnol1 8cl,ollulo 0 II avo' $'100 , , " " ToxoblD ,olunrlll, oro<lllo, 0' 0110018 of 81nlD nrr" looolll1qo/l10 in,oo (8110 11101'"0\101101 , Alimony roao!vD\1 I , " I I , 1 , I I' , I , \ I . , t 0\,,11100' IlIoomo 0' (lOBS), Allnoll ooho(hJlo 0 0' Q,UZ, " '" , Oopllnl uoln 0' (1000), II l0I111110d, olllioh 8c110(llIlo 0 , ",', ,,' ()ll1or uoln8 01 (1008001, AIIOO'] r~J 4707, , , " """" Tolol1l1l\ IIlnlllullllol1o, " ~ '-'-I h TR,aillo omollnl (60011111.1 TOlolpolllllon80n(1 nl\lIl1l1lo. 0 D h To..illD 0",0Ilnl(600 In61.1 Rnnlol 10010111010, rovnllloo, pnrll1olBl1lp., 8 OOll'o'olllllln, 1111810,010, Mnah Sohodlllo U r-UlIIl Illool1\o 01 (1000), Allnel, 80hollulD F, , , , , , , , , , , , Unomllloymonl cornponBnlloll", t '" t t I ' , , , , , ' I 800lnl oool/lllV bOl\01ll8 , lilliLl I II T..r.ulo oll1ollnl(88. III.\.I Oll1or III00tT10, Llol IVI'O omJ "lI\olml-oon 111.lwollollo ...... ,..............,........., . . , I I . i , ~ C,11. Ijll, 113200 (', 1 1 j" J' J ,~., \r~ "'1 11/1 'T"') "1 \11".. ',,),,,:j ,j ,10 . QM.I!.No, 1Ii,IO.OO/,1 y,,\tI' ,"clnl OQo'"I1Y nllllll181' I I OjlIlIIIU'IDooI!IID8olllllvnll. I , , , For hOII' Ilmlll1u 111111 Innlrtlo lalln, ODq PnUOo g 11I11 Q 11111!0 Ilollkla\, , , m..!:fu.. 110101 G/"";;;;V- X "\1<11' \ViI/ltol _ --'- (I/HIIIQI) ycw' tax 01 X ((/(!IICOYOIIf(g(W1cl, ..:L A o .JJL .J1.. ..it. .JJL .JL J.!llL J.!llL .JL .JJL .JJL 20h ~~ a 2 . I I II I o 01 7.2.5111l.1L ~ 9.!L:.' I FOIIII 1040 (1000} FOUII 1040110001 .TRlI Qpmpu. tRtlpn , YOIII WOIII 10 1810 01110 your "Xi 000 Iho no rllollollO or 11110 37, Oredlted Othar Tl1Xae PqvmontQ Attooh r-olmo W.2, W'2Q~ 01111 1000'H 011 Iho hOlll, Rofund Hovo II 00111 wroelli' 10 ~ b YOllr milk nooollllll Soo 11\01, ""<1 1111 In ~ <I 60b, 0, OI\( <I, ,01 Amount ,You OWl! ,Sign Here 1<0'" " ooPY 01 11\10 rolllm lor VaU' tOOQtds, Pqld , Propornr's Usn Onlv o I I I . "f" . ,~,;r i I,: \\'1 '.' PaQII a ~lJUQ, _t!L , AmO\llll from Iii'" 31 (1\<lllIoIQtl'ijrooo InoolllO) , " , , ,',;'" ,','., , ", Pl100k III P Yo\IWoIO ~6 01 oltlo" P !llllld! P ar~\'BO 1m U5 or plllor, P !llllld, A"d 1110 111l'1I~Or oll,oXOB ohookll(1 o\>ovo olld ol1lor 1110 \010111010, " '" Q~o ~ II YOII orn Il1orrlotl fIIIIIU oopo,"loly olld YOlJr OpOIlOO 1I01l1lzoo <<o(luol\ollo or ' ypll woro 0 <1110,"011\1110 011011, 000 111'1111011011' 011<1 ollook 11010 , , " '" DOl" P "omlla~ <10<1110110111110111 60hollll\0 A, 11110 2U, Pfl I r:"lor fI'o,I1.llor~d,a<l,IIO 11011, 0111>\,/11 \>010\,/ lor VOllr fIIIIIU 0101\10, 1M 000 "'0 ho 111011110110110 YOII OllOOkod ony I>ox 01111110 3:10 or I or 0011\00110 oraar o.n 01"11,, YOII 00 n 1I0pOtldolll, " ~~'III 0 OII1Ulo-$~,OOO . IMlllo<l 1II111U joll1l1V or Qllolllylnu wldo\'/(ol)-$O,'IOO . 1100(1 of Ilouoohold-$6,UOO . MOIllod 11I1110 oopornloly-$3,36o GII~lrno IIno 04 Irol"lIl1o~? " , , , , , , " ,', , .. , " , '. ; , 1111110 32 10 $UO,475 or \000, mlllllply $2,UUO PV Ihu 10101 nlll11~or 01 oXol1'pllono 01011110<1 on 11110 6d, 111111032 10 aVo.! $6~,475, 000 11'0 WOlkohool 111 "10 11101, lor "'0 ol1,ollnllo olllor Toxo\>lo Inool11o, 8uPI,"011l110 ao Iroll1llno 36, !I 11110 a6 10 moro Ihol1l1l1o 36, olllor ,0. , Tnxl-!loo ,ll\ollllOllol\o, Ohook If \0101 11101lldoo OilY lAx Irom ~ P FOlmlo) 00 i 4 " ,I U 01 92 ".,,' 09. Olodlt IpI phlld 011~ dopoml.nl OPlO o'ponooo, Allooh FOlm ~441. G9 40 . Protm (or 1110 oldorlY or Iho "100\>1011, Altnnh Soholllllo fl" , ~IL 41 ForolUII le~ 0101111, Allaoh FOlm 1116 , , , , , ,. , 42 Plhar, Ol,ook If Irom n 0 fOOll 30PO \> 0 Foo" 030G \ , cO Form Uo01 110 Form (epoolly) 2 i Aclt.lllnoEl 3D UUD\mh 4~ I t 1.' I I I.. I , It' , , I I I I I , , BIII>lrnollll1o 43 from 11110 aD, 11111\0 40 10 I1\orc 111111\ IIno 30, olllor .0. , ,~' , 801f'ornploymonllo~, Alto"h BOhoduln 8a i , I I , ,;., , , , , I , , , Allornotlvo mlll11l1t111110X, Allaoh Form 6001 " , , , ,',",' , , , I I , , , 000101 ooollllly Olld Modloolo la~ 011 tip 1I100mo 1101 lopolloll \0 ol11ployol, Allnoh r-O/m 4107 Tox 011 q\lollllo<l rollromolll plol1o, Inol!llllno IRAo, II roq!llrotl, nltooh FOlm 5329, , , ,..J!L Advolloo 0011I0<1 1110011I0 orodll pnymolllo Irol" Forrn(ol W'n '" , , , , , , . I ,'.J!L HOllooholq ornploymolll 10'00, Altooh Boho<llllo H, , , ','. I , '; , , , " eo 'Add IIl1o~~41'''01IOh 60, 1010 all' 0 I ax. ,'" 6 _ 5,61(1.L....._. Fodornlllloomo Inx withhold Irorn Forrno W.n alld 1009 ,," 5,1I1,'i, 6 L ~ 1006 oollmnlod 10, poVmoolo ond omollnl oppllod 1101111695 lolurn , m Bomllllnboml orodll, AlloQh OOhodlllo 010 II VO!l hovo a qll.lllylng e ohlld, NOlllo'ohlo oaroe" Inoomol omollol ~ L I ~ m 9~ OOn 04 05 36 07 00 40 44 45 40 47 40 4a eo 61 52 60 6.\ I ~ 60 1;.11.15,6 _ o 301 0 60 301 11 e Itll~(Li,<-(::-, ..1/+;,)1'1/ I ~ For 11010110 011 hoW 10 pav 011<1 1100 Form 1040.V, 000 Inolruotlono, , '.' I , ,'" 02 00, Eollrnololllax ponally, Aloo 1110111<10 011 11110 62, , I ' , I 63 1 Urulor nenallloll of porjury, I declaro thaI I havo OMnrl11nod IhlllolurrJ ,,'mJ Mcompanylnq IOIHltJ~lo. :and alpl.ment" and to tho bel' of my knowledgo plld boHof, lhoy fUO lrun, couon'. and cOInplolo. Declaral/on of pro pOUlt (olllollhan hucpayolllI baaed on aU Inlormallol1 of which pln"alGr hat n"y knowledgoi ~ ; Vour algnnlurn Onto Valli, ,OCQUIlBt_lon r ?'/28/D7 Clrl/'IOOI 8pauoo'a algl;~liltloJnlloIUln. OOTH mll'l slUn, Onto SPOUIO" occupation 2/28/07 LObrJl'l!I' 0.,0 ,,';, 65 50 67 B6 59 , 600 nnd typo ~ """.""tt,.,."".,."."..."..".".......", AII10llnl paid wllh Form 4uun (rcquosl for oXlonololll, , , . E~~o.1 onolol ooouIIIV nnll RRTA lox wlU'hold (000 11101,), , Olhor POVlllol1lo, Phonk II 110m 10 FOlm' ~4ao h 0 Fa'," ~130 A(ld 111100'02 Ihrouoh 57,11'000 oro your totalllnvmohll " .", ~ "11110 on 10 111010 11\01111110 51, oublrcolllllo 51 flam 11110 U6, T"lo 10 Iho omoulIl YOII oVPRPAIP AmoulIl of 11110 69 VOU WIIIII RllFUNOBO TO Ylill, , , ,,', , , , '.' ,~ RnullllU I\Ul11bOI ~ 0 Typol 0 Phookl"O ~ 8ovlllUO AoooulI\ lIiullbor { 'f .5' {I ',I , '( ,/ I( I 1/ 'I Amounl of I 50 ou a ~D 0 OU 00' 8 ~ Q "11110 Olio 1I10ro 111011 IIno 60, 811\>lrool ""0 591rom llrio 61, 'n,lo 10 Iho AMOUNT you owe, Q~ Propnto,'a ~ ~QMhilO r, r-Irm'a n0f110,(or VOW, H soH.employod) and IUld,nsa [. ..-.~'~..~ ..... " "IOPRIO,f, aaulnl aeowlly no, I 'I " , BQH!;P\J~t:B A,!I.~ (f'prm 1P101 OIIlI'I"'l!'1 01111, t"UI\fY 10 .1n111'~CIl1\l. StfvKlI. H ~ ,ho\'tll 011 fO'IlIIO,IO ,TnClC/llllltl111 A, &< /l(ohclI'Cl ,J,lIo/'rln MllfllaRI POllllo", po IJol /nellldo oXPoII$U$ ro/mlll/rsad or paId Ill' ollIPrs, ~' Rml 1 ty1adlool 01111 donlal oxpanooo (000 (lOQO A.l) , , , , J~ -- PlIn'RI ~ ~nlor ol111\III\IIrOIll fnllll \o~O, IIno 3?, l-ILJ " 1__ ~ IIMpllnlloo (I ty1111l1f1IY 11110 ~ alloy 0 11Y 7,p'lI, (,076), , , , 4 811\11100111110 (l from 11110 1. IIlIna 3 10 noro Ii I 6 ' slolo nnd looqllnoomo loxao , , , , , " o 'I~onl QololO laxoo(aaa POgo A.?), , , , , 7 Poroonnl propnr'\y loxon, , , , , , , , , , , II Olllor laxoo, 1.101 Iypo nnt1 amollnl I> ,UI(W.,~,I.f,1,I.f;l/.flo ." 1.'(\:).',q~/, ,(J,qn ,Qnn(tn ,(.!,.r;WmmQ,I.(Qlln I ,/!r',Ly, , , o Alld IInoo 6 11011 tl , 10 lIomo mnltoooo Inloroll 01\11 pOII1\6 roporlod \n YOII on form 1000 , 11 1101110 ",0110000 Intolull nnl ropollod 10 YOII 011 FOll11 1000, If paid . 10 Iho pOllOn Irolll Whom YOII /JoIIOh\ \ho l,ama, 000 pogo A.? .I.~ Ilnd ohow thol poroon'a nnl1lO, IlIol1\lfyl110 no" al1d nddrooo I> I II """'l"""""","""'!"I.",.""."'I"""I'",..t'. ~.~ ,~, ".q,.......".."""tlH"t'....'...'l"'..'",...,'i..,...... ~ .1L TI1Moo Voll PI1IIl 1800.. (IOUO A-1,) 1I1,IlIrllol Vall PRill (800 pouo A-?,) Notol PoloOII(,1 (',,111101001 1$ IPOI ' , 1I0<<IIOII~lo, , Glllo la alwllY If YOII Plollo 0 01" OI\!l 001 0 ~ollol1ll()r II, lOa nouo A.a, 17 10 O~al'~I\V ~lId, Jho I ~onea 10 Joh aXllel1aoa ~o Pl1d Moet Other Mleoellol1ooua Doduoti0l16 (~oo pooo A.4 for oXI'OIlBoO 10 1I01luql'horo,) , 20 24 20 20, Olhor 117 MISQOllaneous DedllotlollS Totlll 1\1I1l11zed boduat!tmll aghe~~le A.......'~eml7.e~ Pefl~ptl~m8 100I1U!l\llo fllll 011 hOok} om 10411, .. BOO 110 10110 10 for 60110<<11100 A '1111111 form 1040, "'".l"".'...,.,.""'''..,..,....."..'''''..,.''...,...,... Polnlo nol reporloll to YOII'on form 1000, Boo pogll A.O for apoolnl ruloD, t I , , I I , , It' , I 1(1 Inyootmonl Interoot, If rOIjl/lrod, o\loch form 4062, (Boo pno~ A"a,) , , , , , t , , , , " , , , I 14 Add 111100 10 Ihrouoh 10 , , , , , , ,,', , 16 01110 \1y Oooh or OllOOk, If youmndo nny gill of $260 or more, seo POgo A~Q ',I , I I , I I , I , I 1 (l Olhor \l10n IlY cnoh or 0110011; If any gift 01 $250 or moro, 000 Pogo f).3, II oyor $500, you MUST o\looh Form 0~03 Oonyovor from Pllor vonr . , , , . , , , , , Add IInoo 15 Ihrough 17, , , , , , J ' , , , 12 J!.. OnBllol\y or Iholt 1000(00), A\lnoh Porm 4004, IBeo 'pogo A.4, , , , , Unrolrl1~lurooel omplcyoo oX[lonooo-lo!J Iroyol, union . ~uoo, loll od,"oOIlOIl, 010, If rOljulrod, you MUST olluoh . ~',~~I,~. ~.1,~~..~:.~.1.~~:,~~', ~~.~~, ;,~~.; ,~:,~:), ,~.: ::::::::::::: . .M 1112400 i-c-~ m . , R 1..,.t.....t1;'...H'tt"'p.'..'..,..'..'H.......'"...j,.,,... Add IInoo 20 Ihrough 22. , , . , , , . , , , & Enlal ,)111011111110/11 FOlm IO~O, IIno 32, 124 I 57.11 Ig 00 ~ MUlllply 11110 24 ahoy 0 by 2% (,02) , , . , , , , .I 58 Bllillmcllll10 26 from II 0 ~(l, 111110 26 10 l11oro limn 1110 23 olHor -a. Olhor-lrcmllRt 011 pogo A.t\, 1.101 typo nllel nn10unl ~ ....'.......1"..".."......,. .0.,.I,""t"I""""'I"""'I.\,.,..,.....II"I'",.....t,.. 21 Tax propornllon fooo , , , , , , , , , , , . 22 Olhor oxpdhooo-hwoolmol1l, onfo dopoolt hcx, 010, L101 typo and mnount ~"",'''' ." "......'H "'" ".,.." Ii. ft. i 182,' )0 ....,....'''......t1........,."...,.'.~''''..'.''I..''..t..,....."'"ph.,.....,.,,..".'''il 20 10 l'or1111040, 1111032, oyor $11'1,\160 (oyor $60,0711llmorrlod IIIlng ooporotoly)? ., NO, Ycur doclucllonlo /101 11111110d, Add II10l'IIIOUI11B In 1110 lor t1ghlcoluml1 } lor IInoo 4 Ihtouoh 27, Aloo, onlor nil 1'0111I 1040, IIn034, tho IBrunt 01 ~ RO thlo Bmoullt or your oloildllrd dOducllolI, ' , VES, Your doduollol1l11oy bo 1llIIltod, Boo pOOo A.ll.lor 1110 011I01111110 ol1lor, ~or Paperwork no<lucllol1 ADt Nolloo,loo Potm1040 "lolr\lollol1o. OAI, No, 11330X " ._,.....,~...... -=-1L:- ,Qrln,1.UL. , " " " " Il<lllp~lIlo, MlllPUlIll In,1U1 \CUB mnWI.I.I'OI'lII un fUlfll 10'10, pu lIul pili., npn,u 11'111 .11.'111 ,uUlIIIIV 11\1111","11 'huwn 0/1 IIllIu, ,I!ip, .<!,......'''.i....'''H'....'...t..''''..fl'.''..!.......''.!......"""""!""I',\"", Add Ihe nlnollnln 011 IIno 6 , , , , , , " , , , , , Oopllnl 0011\ dlolllbll\loll9, filllo/ h% ond 011 SOhodlllo C' , tfJ Nonloxoblo dlnlllbllllollB, (Seo Iho Inol, fur form 1040, IIno 0,1 0 Add IIl1eo 7 and 0 , ,,'" "'" SlIblrnul IIno 0, from IIno 0, finlor Iho roollll horo ond oriforml040, IIno 0 , '" 'If you do lIo/Mad So//edlllo 0 /0 raport OilY ai/lOt oalns or lassos, sao II/a 1118/1110110118 lor Form '0'/0, IIno 13, . Vall 1111101 oomplolo Ihlo port II YOII (01 hod ovor $,10001 11)\0/001 or dlvldondsllb) 110d 0 Inro/gll 000011011 or VOl No (01 /ooolyod 0 dlslrlbllllon IIOIn, or Woro 0 grunlor of, or 0 110110 lara, 10, o lorolon 1/1101, 11n Al nny IIrnu dllllng 1000, dlcl YOII hnvo olllnlorool In orn 01011011110 orolhor olllhorlly oYor.o IInal10lnl ~. onoollnl In n forolon ObUI11ry, ol/oh 00 0 bonk 000011111, ooollrlllos ollooUnl, or othor IIlInl1nlol ~ \1 ooool/hl? Sao pogo 13-1 for oxoop\lono ond IIIll1g roqlllromol110 for form TP f 00-22,1 , , , , b I(HVo8," ontor tllo nnlno o'tl1o forolon oountry.... '..."'''H'''..I...ill'''..''.........H..oIti....,..., ~ ~ 12 Pu/lng lUOO, did YOII rooolvo 0 dlolllbll\lon from, or woruyolllho OIonlor of, or Irollal%r to, Q ~ ~ forolgl1lrllsl? If "Voo," 000 POliO 13.2 fat olhor formo YOll Inny hnvo 10 11I0 , , , I ~or rojtolWork Rudllolloll-l\!1l Nolloo, aDD Full" 1040 IlIalrl/ullollo, 8uhodlllb IJ (Po~rn 1040) 10lHl Pprll InlprpQI ltlpQmp IBuo pouo 13,1.) NolollI ynll looolvoel a 1'01111 1000.INT, Porm 1000.01p, or 0111101111110 ollllumolll Irom p IlInkolauu 111/11, 1I01lho 111/11'0 1101110 po 11111 PI\VO' 111111 onlor Iho 101Plllllo,001 ohoWII 01111101 101m, P~rllI Plvlrjan!l Inooma '" IBoo PPOII ~.I.) NolollI YOII 1000lvDtl n FOIITI lOOO.DIVor olliJolllulo ololomolll florn o iJrokolRou IIrrnl 1101 1110 111m 0 1101110 DO tho poyor Qml olllor Iho 10101 dlvllloncll '1110\'/11'011 Ihol forll1, Phrl III POrallll1 Aooounle Ilnd 'lruslQ IBoo pnoo 1J.1.) , OMn No, 1046,U014 !'Quu iii J=:: 'aalnl ".\lIlly Illllll~.r' ,-~ aph~~I-1'~ ~..,..ln113tq~t fln~ PIvI~f3n~ 'nppm~ ~~\~~~'i:l;'Nu, Oil NolollI YOII/mel ovor $,100 III !riXn/J/n IlItolUot l"ooll1n~.t'!!!.!!.!!,W 0/.0 OE!!!E!olo ParI /II, 1 I.lalllmno pf pnynr, Il ol1Y Inloro"flo 1[011\ 0 Bullor-tlllnnoncll\1orlOllgo on\l Iho 1)llyor \looclll\ll PIOpOI1y 110 0 poroollol 101lldol1ou, uuu paOli P-l 1111<11161 Ihlo ,Inlornst Ilmt, 1\100, Dhow 111111 1)lIyor's Donll1l ouol/lily IIIIInlJor IIlIrt IIrlrtruoo ~ AI110 I ..'I'..".,..'.""..........!..,..'.".".!",..,..,..'...,....'."'..!..!..,.!...,.!..,\... '1'..<I",.".,..,!f.,,,,,.,,,....,.,..,,,,,,,,..,,,,...,I1.,..,,,""""'''"'!'',,,,,.,.. 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JlmIQ t:!mplovoo f:I~IBll1oQ~ f:!XPO'IlQOQ Ollct Rolrl11HII'll01110111Q --_._--~--- OOI\ll111l A 0011111111 P aTt:lp 1 t:!nlor YOIII' t:!XpIlI1QOQ OUlOr Tlllll1 Mllllla Moulo ollcl ______ _. IIl1cJ ElIllIrllllnrnllnl _ Elllortllhlfllont < -~'_.J.. . 1 VOlllalo OXpolloll Irol11 IIno 22 or 111\0 20 , , , , , , ..J.- -0-.---- _ 'N~ @,.~~~. ~~ 2 f'mklno looa, lalla, IIlId Irlllloporlollon, IlIoludlng Iroln, lam, 010" 11101 ~~ .,~~~\~ ~~ ellll 1'0111''101'/0 ovornlol1l 1111'1.1 or aOll1f1lllUno 10 onll from work, , -L . ;.. , II 1'/lwol oxpllnoo wllllo away from hOlllo ovornlglll,lnollldlno lodging, ~ ~,.\~.~ 4 r.~~:::::ir.:i.~3;~~:i:;:;:;"::'~:~I',,;~~::,:'~'~:"::: : ",:~_ : ~i _. ~,(2'\~'~~~~'~ ' o /vIoqla and 01110nolll1110nl oxponooo (000 IlIolruollol1o) , , , , -L ~,\',:;'G~}~i'~~~~~' ~ ,16<18, 0 6 1'01111 oxponsos, In Oolul1111 A, odd 111100 11I1I01IOh " 0l1r1 ol1lor Ihu ~~---,,-. roallll, In Columll 13, onlqr 1110 111110111I\ from 11110 6 , , , i, 0 ;~~ Notollf YOIl woro 110t ro/m~lIrsact lor oilY axpal1sas 111 Slap 1, skip (/110 7 .1nd antor ilia 11111011/1( framl/l1a 60111/110 a, STt:lp;! t:!l1ler Amollnla YOllr !;l11plovar Q!Wo YOI.(for t:lxpa'iaaa ~Iataet 111 STj;P 1 . , 7 Enlor omolll1ls YOllr omployor govo you 11101 woro not ropollodlo 'lOll /11 pOX" of Form W.2, 1I101llclo OnY ornoll111 roponod IIndor ooelo "L" III POX l~lIr Forlll W.2 000 1I10lrllollo s , , , ~. ~~~~ - ,\~ , -oI -- 7 STt:!P:1 Flgllra t:!xpanaaa To paclllol 011 Sol1oclllla A (Form 10401 o Bllblrool 11110 7 from 11110 0 , , , , , , , , , , , , , ',~~~ 0' ~~I~~ " "" 1fu1l1 a.D- -..~'.[lI~-' . . ~~~~~~'~:::~~~$i..;,"" ';~~" ,,~~~, ~\~1'%~,~~~\~~~~ ~~{ ~~~ 'i~~~\t*~~~\~1' :,~~. ~~~, " ''',,'' ''''~'' .~~ o ' ~i: 182-1. 0 Nolo/II bolll 00111/11118 oil/no a 0'0 ~o'o, stop Iloro, II Colllml1 A Is loss IlIon ~oro, roport 1110 <1Inollnl as Inoomo on P,'rm , 0./0, I/no 7, o 111 Oolumn A, al1lor Iho OIllOUl1t frol11 111111 0, In oolumn 13, mulllply Iho ol11ounl on IIno 6 Py 69% (,60), If al1l10r oollllnn 10 loro or loso, -enler ~o.. In ",al column . . . . . t , , . . . . . , ill Add Iho omounls on IIno 0 01 holh aolul11ns and ontor Iho 10111/ horo, Aloo, 011101' Iho 10101 on Sohoetlllo A (I'onn 10401, (Ouolllloel flllllorl11tng ol1lola onellndlvldulIls with ellsohllllloll, 0001110 '1110111101101111 for sl1oc:1111 lulan 011 whoro 10 ol1lur 1110 101111, 0 , , , , ,', , , , , ~ 10 For P.IlOIwolk llodulIlIon AoI 11.110., D.. 1110Ilu.1I01111, 0,11, Nil. 1/70011 18201,00 Flit'" 2106119901 ..-~..,,~ ..... , . ' " rOlln ~Ioa 1100111 ' ' '1' " ~ __ - ROil,. . ,VoI1101p,Ji!po"uou (Bou /nlltruollonu 1<> find llIll Which 6nollon6 1<> oOll1plOlu,L , " fu!..!tlIe.n_A-Qol1.!!!!ll.ltJ1<llil1!l.l.illlL _____._,_' ___.,......, _.l!JU'rlli!8~~ _(\1) Vnhlolo a , 11 1:lIlor 1I1u dolo vol\lolu WilD pll1oocll" olllvlcn, " , , , , , , , , ,-11.. -_.......J._L-._ __L_L' ill 101011111100 vnhlolo Wlln clrlvolI ,111[1110 10U\1 , ' , _11L .,__.!IlUUU --,.JllUW 1 0 ~lIolllooo mlluu IlIpluclocl ol1l1nu 1 a , , , , , , , '" ...1JL mll08 mlloq 1<1 1'010011\ of 1>lIollWoo Uuu' Plvldo IInu Ia IlY linn \:1 , ...IA. --___........'Ji...... .'lli 16 Avurono rllllly rOIJl\cI Irlp 111)11111111\1110 cllololloo , _1.!L ~~ mlluu. .. mlllll\ 10 oOl11l11ullng mlloo IIICllucloCI 01111110 12 , , , , ",,!J lib mllo~ 17 O\l\or puroonol mlloo, Adcl 111100 13 01"1 Hi. oil" ollll\rnol \1\0 101(11 frolll Uno 12 , ~ t , , , I I , , It' , , . , , , , , , . 11\ ' Do YOll (or YO\II UpO\lRo) hovo nllolhor'vuhloln oVllllnl>/o fOl p1l1l101l1l1 PlIIPOOlllI? , , , , , , , , 10 II your olllployorprovlclocl you IVllh 0 vohlclo, III poroollol'uoo rhHlno olf'clUIY I\O\HO flO1l1l11t~c17 IJ Von 0 No .. , ' I, milan 11I!!.!l , 0 van IJ No CJ Nol upplloolllo , CJ Voo D No , tJ vao' D No :a0 po YOllhllVO ovlclolloo \0 OllPPOI" YOlllllllcluo\lol1?, , '.' , , , , , , ,,' , :a1 II "Voa," la Iho ovlclonoll wrlllon? "1' , , , , ' 1-1 ' , , , , .i..." 800tlan fl,-8lnndnrcl MlIllllijO Rnlo (\1.00 Ihlo ooollDI1 Dnll'Jf YOII DWI1 tho vohlolo, :a:a MlIl\lply line 13 I)y 31~ (,01), r:lllor \110 rOlllll\ Iwo ond on IIntl I. ([1llr(\1 1111111 oOlrloro, noo IIISlrllollonll,) , , , , , ,', , , , , , " ", , , , 22 80Dll011 O~AollmllExpol1aOQ 01 Vtlhlolo 1 lilohlOIO 2 ~~~~,~, ,,~ ~ ~~~~ ;1(\ On60llno, DII, rOfll\lrq,vohlolo .~~~~~~ .,___~~~ . ,. Insurllncot atoi .' , t , t , ~_ ~1L~~~~1~~ ~'fu~.. ~.. ~~~ __ ~ :a4n Vol1lolo ronlnlll, , ,.' ,', 2, n '. _11~~ . ~~ h Inclusion amDunl (1100 IIIsIIuollon61 '.Ml!. ~"'~ ' "" . ":ill!'!l~~"''i!, ~ ~'fu , ' ~ '1; 2nO ~~I~~oolol:r~o ::~I~I~;~~'I~I;~:I~~: ~1.~_~.._~..II_.-1 ' ...'..~.ll' vohlolo (opplloa only II \00% 01 ~.~~~ ..'.'~~ .. onlluollonsQ VO,IUO IV,I1S Inolllclecl ~,,~!Ii ,. ~~ I' :an ~~~~~,m'0~~~~:,~:,I~,~~llj;'~Ol:a), ~: _.~.._.'.I ~.a..~._1 :a7 /1h,lltlplY line. 20 by ,1110 .;;;_q . .~. porGonlogo Dn IIno 14 , " 2 . ~~, ~ . ~~_ 20 20 ~~~\:::~Oll ~~ I~~;~~o, cinl~r 1~loi .,.gjL ~.~"'. ." I 'horo oncl Dn IIno j ,20 ~~~" ~~ ~~ ~''" ~ 0.~ 8eDll011 -pe )reoln IDI1 DI Vo 1 DleB (Uoo' \1110 BeollDn Dnly If YDlI DWI1 tho vohlola, . 0 Vo 11010 1 ~ -----c _ ~,~~, 3 .~~lt . .,~ ~I' .~.~~ -..1 :: __ - _I _- %T.;~1\""~~"" ",~\ _~~~ ~~ 04 i'$'t,~~~k,~~~~~\ ~,'\~~ ~~~~~\~~~~~~ '. %~~~~~~~ - ;~~~~.'..\~~~'~'.::.. ~~ ~.' ~ ~~ ii1f~. "''".~ ~..~~.~._ -.___."1,. "! , .. _. "~''''''''''~'''''''''' . 11'''11&18 "~ ..QL~',&\'l~.~i ~,~~.~. ~~:~_".~..~&, "'~""'1i'~"',,"'~" "~. _""'~ ~~~ i.'@:.1 - "*%,~18.~"';'~ '\"'~ ,'" 'i'i..~~ ~~ ~~'~~ ~:~?~'~~'\~\~~ )~\~". ~~.~~ .~ :~,~~ 311 ~~~*~~~~~ St~% .'~~ ~'I 30 ~nler 0001 Dr olllor \lllala (SilO Inalrllo\lDn6) " . , , , 01 enlor OI11DIII1I Df 9001l0n 170 .. : lIeducllon (oeo InslllloIID'lB)' , (Ill Mulllply line 00 by IIno 1" (soo IIIalrucllons If you oloolocl 1110 1I0nllol\ \ 79 docluo\lon), , , 03 r,IItor cjoproclo\loll 11101l1ocl 01111 poroonloge (1100 jllBlt\lollansl , 34 Mulllply 11110 an by 1110 po,colllogB on 11110 33 (noo IlIallucllono) , , 06 Add 1111011 3 I 01111 34 ,", , , 30 elltel 1110 IIrnllnllon amounl from Iho loblo III tllO 11110 ~o lllslruollollo, , , , , , , 37 Mlllllply line 3U by 1110 peroolllogo on IIno 14 , , , 30 enler 1110 Bl11l1l1or Df 11110 35 or 1111037, AIIIO, olllor 11110 IIrnoulIl lllllllln 20 nl>Dvo , ' : .., 'U,9.0o""tvMnll'Muh9'Offtc.j'"1~ ~ol,~~ , , , ..-.. @ Ijlln'"I/<11lle~~fII.I"M/lfl' . 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'.", 9.6~~J"IUdl' P'VIII"I.lhll~li, 01 9 Piill'lJ1;dl ~IIIO\UI'i'oh'I\, ,'fd,,',:,":;' :~t rW~h: ~(;;;JI)qdi~~\Q!i~I~"lng~p\; no,) : ,,~;\ I '. " " i " ',,, ,,' ",' ,I,' <II",", HI Ihl""I:\I.':: ',i/ '1'~I~t;~n~~t,?~,'~',II!r' \', I~'.:! "i'iI.n iilftnl'_ :'~l 1~4'l'I~llpw l'l.u,l ~'I\IlI~g~I,. ". $, '" "n~Pllnll'orl"'I'~ "",_lnlll,lnpomll .' /. ~. ,Oily, ql_\., ~II',I ~II' olXlo . ,', ' III Olon In,uIllIlo~ l'!oOO,'d. 1161~IQ 11\00m,~ lo~ wllhhol<( , .In,~ r~~':rl : .!'Ti lllLlllaniosbU17I1, 60 $ ..,. $ 1lI~~lroll, I ,JIK '''''00111\1 nlllllhir (optlO!\~~ I~ QI.IIliP.vo,'. .lql~IIUlllh~' BiH PPpA~ OOn\:'I:AP\:' 1i.n\O~,~I\ii ~.17 ~~.t H~rkut strQLlt ' Vqrk, p~nnNy~v"niA 1740a., ~@9~'" M'!l(l~n~,n~q\H1 , '~P'Q\Ti.. , , fO/m 1000,MIBO ' "00po!IIIIonI9' Ihl T'09'qUl\,", 1I\I0lllql nlYlnU, aolYlo. , . ." ',,' ," , . I' " . ,;. , , , r '. ' . 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'i ii, ',',I,:,:"',"f' , " GEORGE UnDEGR^FF U31, PERRY DR, YORK, r^,11'1011 I TIII~ Inlolmqllo/ll. 11.1110 hl'nl.h~<( In '"n Inl.lnol n'vonll~ B~I'IICO, II VOlIl\l" 0'10 N 16'0000. 1911\l1lOd 10 1110 n lll~ 10 UfO, 11I1Pulloonc:o ppnllllY or tJllhar uneuon lIlay ~o , '1. ,0, 'I' U 111 OlOtlon 011 II 111 tlllCO"'O 1l'!ItllDblo dnd oUI.II 010 or\ II. 1 W09'I, lip., OlhOl oomp,n.ollon ~ FocJOlllllnoomo I... Wllhhold I' 1~1~~, ~n .1~fta, pp II Bool.1 ,.0",IIV 'l'iY?h , H ~ ~ 60cl.1 ,0~1I'IIY I... rN~'\O~\ o M.<(ionro I... wllhhl!<( 1ftH,U B MQdl~nro WOODS and \lP8 1a1aa III~ 7 60clOl ".uIIIV lip. 0 Advono. 010 p,vmonl 11 NoilqUlllUlod pions 10 000 In.II., fo' 110' 10 B Allooolollllp8 . Oonl,ol nil I.".. o Il'N~'~VBI;\ ~'~WIIIOIlIlOII I\lIlnhOi- D ~ll1ployor'o nomoi "tlllloao. P-l1d ~lr coda ,'. II '1P~~Y,fO'! 1r~i 80Clllily nl1l1lhnr I "'r~W~R'ft n6~~Jl'Xcl'0", ."d ZIP oodo nn P~E^S^NTON~'R, E^ST I1~R~IN, P^ 1?31~ 10 Doponlloll' OliO pllllnlo 1a 110/1.11181110111/10<1 In no. \ . '. " , .,' , 14 011'111" 0,00 I . .' ',. I" I " ,'7.' '..1-' ,. I'i 1ii^6'''' anH'NUI8ll'!i~~I'IO 1.Il, No, . . , . . . J.. . . . . . . . . . . . . .. . . . .. . . . ~ r . 1761"''.1117'8'5':''111 'tb'c~tv 'n~ a~I""rAo'b~ht~ ,~l \'lfII~W,IUI;' .. .... t,'; .. . .... ........!;,."... t,; .,. .". ", t .'..;,;, ~ .' j, ;>' ......,........... .............1'. " DOPIIIIIIOIII ollho T'Qn,u,y~lnllrnol nov.nllO .6IIYIC9 " " " J W.2 ~:~:mIlJ~1 TIIX 1996' Oopv 0 ror sMPLOYbB'B nOeonOQ (Boo Nollo!on bnok,) " .. " " " ,,~' .'i ,'" ... ":;:' .1 ., , ,. , . '.-.-r:-....... , \ lilll. w.,,,, e',or;:-- a40,00 If ~",.IIIVP'm. . n""llnOoiiiil.......-- ...'1.....r~,.._1"l;'!:l"rt!1"lr....,..,r."...~~r..fWl..".."f"!r""I-,..,..-...--..- 1 Wt9"t ~1p41 other oomp. .', ,,,' 'n~on" "JI wt\hli. ,--1!IA,5A ,8,!L- II 1~1.1..oIUII'.W'll.~'- 4 1000'1"'C1UIIIV'''wllhh'14 I 1111LDL..;... 1.L.!li.- '! ~l<ll.'" w. ia','\l~'p. iIfodiC." I" Wllh~'!~5 !, O'Rrf.m:. 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'" (01 1l0~.'\illll"l 0' !!D J,o,'~'"y--I!'lo'",o.1 nOVOI,II~ ~,.':!'" ',' .', """,JllllllllllmIUIIIIIIIIII.1II , :" ", ,,' ~ WA , ,\' 1, :', .' ,,: "'"1 ft W 2' .wIll:IO, !In. ~ TR1I1996 ;, i\! II! st!ltomllnt OOIIV 0 For PM"~O'rpp'o n~oonpa la.. N.II". on hO',k,1 ~_._____.._......__.-_____M"__.__.___'"'' -'''~-~'''''''''''-'''~''''1'~',"l~~''.''''\~'' I'.' , " , , ' " --_......----------_-----.~.....- .", ,.' .. . fJAVl\t\'l\ 11111n0, alrool ~~ldlOn, CIlYI alnto, and ZIP coclo Ot,11l ~o, lMa'011a (l:i"U' L;llll('I'\' ('JO\'lCl:'.!\Oc. 'i'.r:'LIC!,(j,I\" Ja17 i4~t M~~~~tatr~~t '(Q~"~ I" ,p,en,\ny 1 V~\i:~ /1 17 <1 ()~ il@96 ' MlaoellaneouQ Inol,lme " ,.. 'lwt'\m'B fodolulldonllhonllon numbor ;1~"~II'i.3 - naOIl'laNT'U o.mo " :lJ.C\'lHl,ll;; :lOJ:t:'l '\UO'f>m~T'a I,I.lll1lto.llolI 111111\/10' ~ I) t,... .l It ... 1 (1~.1 '1 FOII1I WOO.MISO ,,1'1.11,'0111' '" W I ft.hll1U 1>0"'"0,.",1. 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VUIII luolll' uaUllIy llUlnll\lr .. 1.....1____ nllllllnv'. ,otllllll\IOllrllv 1II1111hpr ___L_.I For "01/' 1111111'"11011110 III.'fIlo 10110, aoo \1110110 .' 2 IIl1cl 0 hI 'ho hllOklot, fl00 I No t,olPl Clloeki~ - -V- Vfl wlll/IOI , , _ _t'_. c:ll.1llVll YOUl Mv Of I t ((IduaQ YOllf /(I'lI/!d, ., - ~ ~ ~ ~I:>< I, ~id:~ '1,0 -llll(lI. e01il-4-1-'Hi8;'- tl110 ~o .JAOI'JU\::I- "tilE A !It -l;r';(-)H""~'~-tl.. "lnll~ll'- 1)13 :11_ ::(.IE-A 'Irotl IJ ~ lEAf",\, ~I;I~I- rtl I~(~ l:flll.(:Hl11lj'l' I A s Pll YOII WPIII $3 10 UO III 1111. hillcl?, , , , , , , ..., , I 0 01111 rOlllm, <1000 YOII' apllu.o WIIIlI $0 III 00 10 Ihlo fUllcI? , 8111010 Morllo(llIIll1l1lollll lolUlI110yol1II ol11V 0110 hl1<1 1110011101 MorllolllillllU OOPnlolo ,olum, r:lllo, 'P<lUIO'I ,oolnl ,ooullIV 00, ol>ovo oncllllll nmno ho,o, ~ X HOIIlI 0lholl80holcl (wllh ~lIollIVIIlO pOlaol1), 18011 I'"UO IO,)lIlho ~uolllyl110 1'010011 10 n ohllll 1>"11101 YOUI 1101'011<10111, ol1lor 1I,In ohll<l'o 1101\10 horo, " . 6 OllnlllylllO wlclowlor) wlll1 <Iopllllclolll 01111c1 (yoor ,pouan cJlocl ~ III I, (800 1'000 10,1 0" lXl YO\lIooll,1I vour PP'Ollllol 00/1111011" ol~ol ellll 0101111 VOU 00 0 clllpollclolll 011 hiD 0' hor IIIX} 1/0, tl ~Ol" rol\/lll. da no' ohook box On, " , I , I , t , '" I , I ,. l~':n~~o~n h t:J BnnuQo I , t ," I t I , , . ,_l ' I' , '..1-.l. tla 01 YOUI Cl PoPOllc101l101 ' I') O",n",ol'l 3j'o'PlnOlnl', 141 ,.. 0 monl~1 '~I'I'r,'n"' o. 'I "'Iy bl IIllllo"lhlp 10 "110 I,yoor "" 1'1 rlill 0'011 LOll 0""' lOe. 1I0Ul num I YOII ~oml" IIIL whOl 2 I I · 1IY!0 wllh yoo r-- lkio.o_Mar'ie Bordo -11IJ 60 732:1 _.lli:JurJlUe.c.. 12 _ I 010 "IllY! wllh lil12lull:d..J...1l.o1:cLa...J.r. ~J12JJJ.2..oJL anti . -rr:- IOU dUllo dlyo,OI I 'IIPllllloo '.. ,n Plil "I I I UIPI'dtnl, 011 0, ' , I I ''''''IIIO.l1ay._ Add .um~'" "11110 On "'" .bo I ~ , , 1 2 8 4 , . '[ , -L 00 .__1 ~~ .JL_ ..1Q... ...1L ,.IL ...1!L . ..J1- J!!!L J!!!L 2S28 IIlL :lR221~1 00 -0- 1/822.5. 110 ~ F,,,", 1040 IIn07l' ~ 1 -.-- j. " 1'01111 104011007) 'fR/< 00 QqI11P~'" (Hu hltlpl1 II O~ " I ~Ou ~~OI'1 aU , 11'1 10 a? 1~'fO your Q I Gnn all fl~Uo 10, 00 Qre~m~ ~o ~1 ~~ 40 ~'I 46 '10 OUler TaxeEl PlIvments il; Allooll flolmo W.2, . W'2G~ 011'1 1000'H 011 Iho Irolll, Refuml Havo II.. <lIIaolly I <lOflosllolll ..' Soo pogo 27 ~n'llIIlllI 02u," <I 020, Ollel 02<1, 00 Amount 04 VOU OWD 81gn Here 1\~lIp 0 oopy 01 Ihls IOIWII 101 you, "lnoolels, . Pnld ProlllHor's Use Only" POliO II I . Amolllll frollll!lIo II;! la<llllUlo,1 \lIOIS 1lIlIllmo) '-' , , , , . , , , , 'I ,~~l" ---1iB.iJ}Jlj JUt. . C1wok Iii !:l VOII WOI. 00 or 01<1." !:l 1311111111_1 SllO\"O wno 60 or Olellll, p IlIII\!',' f%$~ A,/el \hlll\l,m\lor 01 I>IIKlIO CIIlUlkll<l ollovu "lid 111101 \hlllllllll hlUu, , , ," Q'ln *~ If Y\l\IIIIO 1111111101111111111 IOPIII11\lIly .11111 V"llr IflulIon 1IU1111~1I0 elll<l\ICIlOI\II 01 ~~ YOII WUIO 0 111101'0\111110 11111111, OIlU flllll. 10 1111<1 IIhllnk hlllO , ' , , , ,.. IHh p, ~~' , lIo.ll1llnlllllllhlollollo "011I SIlllO'/lItO A, 11110 20, on " ') ~f@ r:1l101 Olullllorll1lO'lilolloll allll)VII Ilulow /UI VOl" IIIII1U olulllll, Pili olUI ~~~~ Iho P',IOO 10 I Vall ol,ooko< OIlV IIIlX 011111111 3'\n or 3"1> 01 somOOl\\1 00 027 ,'/7 loraor 0.\11 olnlll1 VOII "0 n <loflll\llol1l. l<!\'''' _ ~ - YOIII! '61I1Ulo-~",l00 . Molllod IIIIIIU jnllllly or QIIIIIIIVIIIU wl,IoWlor)'-:IO,ooq m . Hunel 01 hOllonhold-~O,OOo I MMIIIIIIIIIIIIU oOflmnloly-$:I"IOO ~~ 81lhlrno IIno 36 IrlUll Uno ail ! , I , , I I I I It! , , I . " ~~ --11lil!Le ~ If 11110 :13 10 $00,000 pr 1000, IIwlllfllv $II,UOO IIY 1110 lelol n\lIIlllor 01 OXolI'flllollo ollllll\oe/ 011 ~\;, .. IIr\U 0(/, 1111110 a:l 10 oV"' $00,000,1,01110 \Vorkallool on pl\Uo 1010' 1110 oll\oullllo nnh1l', JlL 7050,00 Toxo~lollloomo, 6uIIIII\nl IIno 3711011I IIno 3U, II 11110 07111 maIo Inll 11110 30, onllll .()., 110 11000,5, if:r' Tux, SilO 1'1100 10, Ohonk II nn Inx 10Il\ ::J flnllll a nn" h J 1'0111\ ,1lli-......1 ~ 00 .H -/Ill DO' Ornllll/ol ohllll olllllloflollllan\ 0010 o'ponsoo, Allllcl1 Form ~H l' ...1iI_ __ ~~ Orne/II lor Ihn oldorly 0111'0 '"001110'1, AIIl\cl1 60110111110 11 , , ...1L , . Mapllol\ oroc/II, Allnoh FOIII\ U0311, , , , , , , , , ,.11.8.- . I'ololgnln~ croe/II, Alluoh Form 1110 , , , , , ,', ~~ . 011101, Ohook If from 0 lJ 1'011I1 3UOII h !:l FOIIll OOOU m , . o!:1l'olmUOOl e/tlflolmlsPoolIvl__~_ ~ Adc.f Unuo 40 Ihro~lIJh 44 " , I I , , ,,_, ! I I . . , , '''. t , . -1liL 6111llrnolllno 40 from IIno 30, If IIno ,10 In rnoro 111011 11110 :10, 011101 ,0. . ~ _11L ~7 E\olf,oll\plovmolll lox, AlIl\oh 6nho""I. 611 , , , , , , , , , , , , " ..1L ,10 AI1o'llllllvn mlnlllllHII Inx, Allnoh 1'01111 0201 " , , , , , , , , , , , , ~ 40 600lnl aoollllly nnll MOljlclllo lox On III' IlIoomo nollopo'lne/ 10 OlllpIOVOI, Alllloh 110'11I 4107 , ~ 00 Tox on 'I\'Olllloe/ rolllnmolll plans (Inollle/lno, IRA'I nn" MOAo, Allnol1 1'01111 0300 II In'lullorl ....!ill.. 01 A,lvIII'OO onmnd Inoomo olne/II pnvlllonl. f,om FOIIII(a, W'2, " "'" .J!.L. 6e HOlloolllll11 omflloYlllonlloxoa, Allnoh Ool1oc",ln II, , , , , , , , , , " 0 no Add II110s 40 1111011 11 02, TI,la 10 ollr 101 1 tnx, , 00 04 Foc!urollnoOll1,O lox wllhllole/ Iroll1 FOIIIIs W-2 01ll1100U, , J1:L , " 06 1007 oallmnlolllO-'l fl,wmonla 011" omollnloppllollllom 10Qo lolull1 , nn I onn 0011\01111\00,"0 orOlIIl, AlIsoh 60hac/lllo ~IO II YOII hoVo ~ l1uolllvlno ' . ~ ohild h Nnnl01nhlo o.rno<l IncOIllol nmollnl .. I I I ~ ~ nnd typo ~ ,....,..,..,,;..,.,,..,,,...,.;........""..'IIIl. nn~n . 07 AmouIII pnl(/ Wllh flolm 4000 (rol1uosllo, OXI0l1'loII), , , ~ 00 r:.oooa 0/10101 ooollllly nnll RRTA In~ wllhllole/ 1000 flnoo ~7) ~n _. 00, Olho, povmonlo, Chook 11110," n (] FOlm 2,130 u q flolm ,1106 00 ~ DO Aeld II110s 0'1, 66,. .000, 07, 00, nll<l 00, TIl0no 010 nul olnl n monlo , " ~ 00 If 11110 Oll Is 11I010 \1101111110 03, ollullllclllno 63 from 11110 00, Thlo I.lho nll1ol",1 YOll oVn/lPAIP .J!L ArnolH'l of 1I~0 61 YOII wanl /lPFUNDnn TO VOU, , , , , , , , i , , ,~ OQn nmrrn"1mlT1TITTTTl,,~ ~ 11pllllnu IIIlInllo, 1-ZlI.:l.LL~1 ", 0 TVI'OI I<'l ChooklllU lJ Snvlnuo ~ AooouIII 1I11111UOr () ~ ^, 0" .' ~ . ^mnunl Ollloe 61 yoo wonWPllW TO YUUn 1900 ~STIMmll..IA.U-.U!.:L1 I I If 11110 O~ 10 /lIoro 111011 11110 00, slIhllnnlllno GO IIOn\ IIn. 63, This I. Iho AMOUNT VOU oWP, ~ Per dOlnllB on t,ow 10 Ill\Y, 800 pogo 27, I , I i. , . I ,I'" , , 'I ~ o.t 60 1l01111\010ellllx ponnlly, AIBO II'.!JllI"o on IIno Go! , , , , , I 00 1 _~~~,\~,,.~~~~"'~~ Undo, POI} UfOS of peflury, I dflollUO Ihall hnva It~MOII\O(llhll 'all,," nnd l\llco!111l0nylng ICIHtdulOI AM tll\lIHIIOfll'j nnd 10 Ilia bOil of mV knowlodgo (lnu bolla I, 9H(Y lUO \fuo, cOHoal, olld C0I11~1I110 OBof(lf~llQn of p~epllhH (nlllu, thon 1l\l(/lllYOfllt bileod on nllln'ofrnnHon 01 whlOh p/Op.1tot hilI Any knoWledgo, ~ lou $t~nnltllo I I) (,//1 ) UI\IO '(ow ol'laUp~\lo'l " lcc~~ ~V :' 'i'.:L, ~(, ~:;"(,L~((!L 2!25!OB CleNeol PfOlllO'".IIl,Jlll111UO, I CI jollll rOI(Jl/l. OOTH mil" SI!Jn. (lnlo SPOI'U', 000UP111101l' .' , PIIIP/'lIt,', IlgnnlUfo /:UII1'1 noml) fOf YOWl IlolI.ornJ)If)yocll.tlld 111!!IQU --.....'..:0::.-..- 01 OQn' l)nto " '"0"; ,1/1/6, ifO' ~ ---r- 4351 ,~" 1205,54 12005 05,/, ' -0- Chunk it &O"'lunf,loyod 0 PIOp/Hor', IOQinllltOlll!lY no, I I " UlN I 211' omJo - ;, , /:lQHt:lP\.l1,1l13 MP lPllrm 1 !l40) 0"'4/1111"'1 Qllh, !'''''IY 111 Inl tnlll1 ".....0 ICI am'(II '''0\,/11 01\ Por", 1040 JC1PqUO Una A, nO,.~tC1 MlI~lplll Oft~\Io", po 1101 Incll/(fp oxpql1$QS 10lmbuIllo{l or pold pY o(/lors, Iln~ 1 . Mpcjlnpl on(j (lpnlftl o~ponOOQ (ooP (JOQP M), , , PlInlnl ~ ~nlir ,m9~nl from form 1040, IIno 33, I_iLl I t:1l"~naoQ a MIlI\lply IInp ~ Opoyp py 1,6% (,0161' , , , I ' 4 Bulllrno\ III1P a 'rom IIno 1, If 11110 a a mora Ihon 1110 6Slnlp oncj 10Pallno0l11p loxpo , , , , , , , , , II ROlli oo\olp laxllo (000 [laQIl A-?) , , , , , ,", , 7 Pllfoonal proppny laxPQ, , , . , , , , , , , O'OlllOr laXIlQ, ~lsl Iypp ftnQ omO~nl '"' ."",,,,,,,,,,,,,,, ., ,l!,ql'l~ll,I.1nI. s\i, ,QrW,IJ/1f1Hmw.l. ,~'l:Iy.(II'.Qn, J:fI~.", o Aeld 11100 6 \llrolloh 0, , , , , , , , 10 Ifomo n!Pllg,Uo Inl%sl ,nd polnl.\ ropor1oillQ YOII on fOl1l1100n 11 Homo morloooo Inlorosl nOI ropol\od In YOII on FOlm 1000, II paid 10 Iho parson from whom YOII Ilouolillho homo, soo pOoo A-3 oncj ohow IIml parson's namoi Idonll~lno no" and addrooo '"' I' afJhf.l~hlla A,,....,Itaml1:f.lfl pefl\-lptlonEl IIlOI1Q(1\JIp Pill on pOok) 040, I' Soo n!!llilollolll lor SOhol'lIlol A olld II Worm 1040 , TIlXllS YPll . . Plll~ (Sop pogo M,) InlllfOlll YQ\l Plllq (Soo pooo A,~,) Ii ~ I ,~ """'''''''''''''''''''''''1'''''''"''1'''''''''''''''''''''' Nolol ~oroonol Inljros\ II no dO<1llolllllo, !""IIII!I!"H!'!"!'""""!!"l!ll!"I""'I""I'''''''''' 113 I" t"! t 11'111'1' tl""!,, I!'" 1 ~'" 1 lilt" , .." Of"It. j"" I. " Polnla nol roponpel 10 yo~ 011 Form 1000, Sao pooP A-a lor opaolol r~lpa , , , , , , , , , , , , , , Inyaolmonllnlorool, AlIaol1 Form 406~ If roq~lroQ, (Baa ppoa A~a,) , , , I ". , I I I . . 1 , I , (/el IInoo 0 I1rou 1110 Glfla Py oosh or 0110011, II yo~ maelo allY QIIl of $250 or mora, BOt;! paoo A..Q I I I , . I I , , , , I Olhor Il10npy 00011 or ol1aok, II ony ollt 01 $250 or mora, 000 pogo A.O, Yo~ MUST 0110011 Form 02sa II oypr $500 Oonyovor Irom prior yo or , , , , , , , , , , Aeld IInoo 16 111101101117 , , , , ., , , " , , , 1 . . (100 0 Glflslo Ohl1flly II yoU mOQo 0 ulll anQ 001 0 bon ani lor II, sOo paoo A.O, 10 (Son pogo A.a lor o~ponsos \0 Qolluol horo,) Coel/ollyor 1110 It loeo(oa), Altooll Form 4eS4, (Soo pooa A'4,) , ?% linrolmlllllaoel amployoo pxponooa-)oil Imval, IInlon ~ duoa; joil Pell/OOIlOIl, 010, YOl/ MUST allool1 Form 2100 ~ or 2100.EZ II roqulrod, (Soo poop A-4,) '"' ""....,,,,,,, ~" "''''''''"III.III'OIIII9,......t''''I''I..,..ttll\ttt'''''''I. /. % o 2 ~ 22 1..t.'I.II.I.II...I..';'I.......I..."".,....I....\II'......1.., Aelel IInoo 20 Il1rough 22, , , , , , , , , " 23 fnlor omouallrom form' 1040, IIno 33, I.M...L I @?p, Mulllply III1P 24 obovo Ily 2% (,02) , , , , , ,. 20 Sulllmclllllo 26 Iromlllla 20, 1111110 26 10 mora II1nr111no 20, alllar -0- 01l10r....from 1I0t oli POoo A-5, Llettypo ond amol/nt .. ,,,,'..,....,,,,,,..,,,,,..,,, " , II........."'I.."I"""""I'..'.".!.....'.,'...'..,."'..., TaX proparalloll 'oPo , , , , , , , , , , , I Oll1or oxponaao~hwoolmenl, eafo doposll box, 010, ~lol type ,and nrnount,~ ,.,."" ..." ;;"'1""'" .,.",.,......, 20 24 26 20 Other '27 Mlscell~neolls Deduotlons . Totnl 2S Ileml~oq Poduollone .1...'..11"'..'"..'1.".",.,...'.'''.1...........1.'...'..i.....""....,....II.IIi'..I...., , 10 I'orI111040, IIno 301 over $121,200 (ovor $00,000 IImolrlod IIlIng Bopaltllaly)? No, Your do<1 uollon B nol IIrnllod. AQel 1110 omol/llte III Iho lor rlghl columll } lor 111100 4 throuoh 27, Also, olllor 011 Forl11 10,10, 1111006, Iho laroor of .. Ihls amounl or YOllr elandnrd daell/nllun," , VIlS, Your doducllon may Ilo IImllo(j, Soo pago A.6 lor Iho ol11ountlo 0111 or, Par f'opolWark Roduollan Aot Nallo., teo Form 1040 In.lrllollono, 001, No, 11030X , -:~ro-.'1':'''", --2!!111 No, 10~a,0074 i)@97 Allooh,"orll a.qu.noo No, 07 y~ur 100101 "9111\11' nUIII\'9;"" -0- " 580 00 -0- I I I I I ~ 0 -0- ~' ,,-- 2 ...0.. ~ 601"""1,, ^'" rorm 10,IOIIU07 omo,II IhdWII ell riilni lo~O, po 1101 ,11101 ""11' O"~ 10"1\1 m\lfllv 11\111*"' IIlhoWII Oil o\h" II~" I' Soh~~\.ll~ 13,.......lnt~raat ~nq Plvlq~nq lnoome OMU No, 1046'00/01 Pooe $I Yollr '~dIOIIO'I'!IIV 1I~III~vr " -1-_ "11001""'"1 . B~q"Ollcn No, 011 ----., NolollI YOII hod ovor $-/00 III IlLvnblo /lI(uroollllO,0'1I0, yel/lIIl/S! also COlllllloto Port 11/,' " ,,, , - ~",11 nlllrPQI 1 ~lol nama 01 p"yor, If ony Inluraol lu fran, II oolior-f!!1l1nou~ morlonoo nl1q 1110 Amolll1t ' -- n\lon1p \l\!yor \IQPd 1110 propOIW 00 0 poroonnl roolcjonoo, oou roao 13-1 ol1d list 11110 (1300 JloaOo 'P 11110roolllrot, Alao, al10w 11111\ h\Jyor'lI aoolol OOO\lflty numpor ol1q oddrooo .. and .\.1 I , II . . . , , , . , , I . , .. .1 , I , , " I , . , " " I , . . I ~ , , . , , . . . . I , . . . . , , , I . . " , . I . , , . " . , . , I , , , . , " I"l . , I , , - ft 1"'111"" "lll'"",,"I'IH'''''''''!' '~!I'''!'''' ". ",,,,,,,,,,,,,,,,,,,"""""," - fl.tlll'II","III'I'\'I"""..I""'""""""""IIII'!II""..',I""'I"""',"'I'" - NolollI yoq """"IfI""'''Il'II,h,'tl''"'!I",..''''I''II''''''''''1"1"'"1,,'''11'''''1''''1''' -.,... rooolvoq 0 POlm 10uo.INT, 1'0lm .1.1'1"1"..'.1"""'''1.'1'''111'''''.'1111.....''.''.1.'111"1'''111..''''1''1''''''1''1 - 1000.01P, or ' , 11'1"'111"1"",,,,,,",111,''''''1'11,,.,.,111''1''''''''"I""""",,,,",.t'"I'.,,.. 1 - ollpsllllllo """"""'1''''''''1'1'''''1111111''''''''''\1''111''1''''''."""11"".".1."......" - ololomonlllom , rr Plokorouo 111m, . ,"1"""1'11'11'1''''''''1'1.''''11'1''''1..,''1'''1"..,,..nl"""""""1"""""" -- lo! 1110 flnn'o ,....,."" 1..'.''lI!!''''.....''''.'I'' 1f""'..'I.;~'.'...,'p..'l......II".".,.,"',... . - noma 00 lho ' " ~oyor om onlor ".j"...I"III'I""II.,.tl",II,II',""""""""'"""'"'''''''''''''''''''''''1''''' ~ 110 inllllllllrrool .""""""'""'Il'""'P""''''I.."",.,.,tt''""""",,,""'"Il'''''"I'I.".". - olioWII nn IMt ,"tl,.III""""'"'''''''','"I'',''I''''',,'I''','''''''"""'11"""""""1'01"'" -- form, ""11,.""...,1"""'''11.111''1'''''''''''''111'''''''1'".....11.1""...'......,...,.. - ..",.".,.,."..."."".1""1"."'..,....'..'1""""'!"';"I'I"""',"""""'lt... ---- - . . , , . . , . " . I . , , I , , . " 11 " 1 , , . , ~ . " , , . , , . , . . . . . , . , . , . . , . I . . , " , , , . . . , . 1 , , " 1 " . . . , j , , . " , , , . , ~ Add 1110 omounlo on IInu 1 ' , , , , , , , , , , , , , , , , , , .-L 0 I'xol\lclo\llo II11or061 on aorloo gl' U,S, oovlnoo pando loauocl oflor 1900 from Potrn " 0016,l1no 1'\, YOIl MUST 0\1001' Form 0016 10 Form 10.10, , , . , , , 0 , ~ Sublroolllllo tl from IIno 2, on!or tho roouit horo olld on Porm 10,10, 11110 On ~ .. .. " Ptll1l1 . NolollI you hod ovor $0100 In g'Oss'd/vlrlonds and/or olllor dlslrlbutlolls Oil slook Vall must o/so coma/ala Pari/II, ----r . Plvldpncl o Llal nomo of roror, Inoluclo oroaa dlvldonda and/or othor dlalrlp\lllono on alook Amount Inoomp horo, Any oqpito ooln dlalrlpullono ancl nonlaxoplo dlolrlpullol1o will po dOdlloluq . (600 lloooO 12 on IInDs 7 anct 0 JIIo '.I~".I';'I"'"..H.tftt,'I.'.'t!'...I....tt'''"''''.i.'.I'''",,,,, - Md ~.,,) """"""""11".."1111"""1""'.'1'1""""11"""""'11"""""""1"""'" , ,.'II"I""'ltl"lllltlll""'pl,',II'!IIII""'.",.,.!,.,.",.'t,.""..".,....."""", ~ , t . , , . , . . . . . f '. ~ . . I , . , I , , . , I . . . , . I . . , t , , . . . , , . , , I , t . , ; . . . , I , , I , I , , I I , t I . , . \ It' , . . , . . . , . . t . t , . . 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OO-OJ_OO L MO'M onlr.rl77mlRtQ 11001<1 ,00 ,00 ,00 ,00 1 is.sn lJ OiYTClnmn~EQ.IIOO\l1 ,00 COO t~O toilOO ,00 anI ,Ho"'l2..EUl~gE!l-1 ,a~ O I/OTlOII~L allY MORIUME co ~0071B 0.1IIU,69 &ibn[;bJ 1,3D5,01 l,a50,?? ~'l~ Y OS!if '~~l EREol-Pnlo 10 POD, ~:lH~iRU~_~ n_~:~c~nu ~-,'Of:/loRE_~~n~nhP'!cMMlli lePEr Y:Hu R-tY',IQ _ c .. ~~!E=n: ,. m ,~ .. n~mm - r~rT;~~- ~~r-. ,~oir~~sfi fil.5~fe^Rtn~n~_9~ m'd~~nn- ~ ~ ~~~!#~nm~. ~M~E~g'; ~i*b,~B~6\~~.- a~PfEgm- 6~~5~f~~~R~~kIGYm~f,~f~l.tR;'~rnr.:_ o p". 110 IOII-R 0: p- v Xii~AIOR'RtO~ Olil'-~OO IIhJ lu.REO.l!oll~-nov . , . E..lhlll SL...:..l' - . 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"Io-e~.oo LL 00 BlilC'oI0770 CilT'R'OgtnOnsm-oo 'So..M..I . nnle" ,nr!~ ' I~ 0iJ"""":O~-~-:-cr EJl.M1i.;o , , .' ,011_as_gGL" 3.60 n.a.. 00 D7iT9Jl7.trl:puoEEQ aooo'180 \ ' DIlICII 7.70 EuLf.sr.lLaQa~~ 61.00 05'110,00 1l~'~D311J,91J ,00 "aUlas ,00 100,01 IC~,Jr----jOO,J5 , 61,00 67,60 06aoa,00 .00 ,00 65aR7!l~,w-rnlIJl JOG,J5 t1P.66 51,00 0617~,JI ,00 ,00 ~IJ,OO *** g DB *** LOIll/IIlelOnY Y-T-O IIIV JOI Dill 001 lllV' 000016G715 1IJ latJl,9G PM, 75160 110iOU ,00 -- , I ,'-)( ...:.J~.J I L\ -c.\.:q;;\CI,~.( JUN oa IOO~ Q~ 1,,\ tJ P 1'1 A 1\ K flo 1\ 'I' n A 11" ill': IIV i (J I~ II ,I N () , ~nc': ',I,' :I;n ' '1 ~JI:<;l (,1,:1" :'1 .. lIpr.U",,,,..,..'-.....IMI'I': NN II \'I. VAN 1,1 GO It 1'111\ AT ION i" ' ,19\1? ;" ,: , ',:110 cl Adams Coumy , In !~O\),m,Il, "',; I, ':>. 623 . !'<lUU 1~~7,,I;[.ll.,~" 1'0' V I:r :IIUY :,' ',.,,: :,,:\,;11 ~:(I1 CIIG'llIYlbura 1'-t\f.llJllrl\l1: 1I,1V',"WIl A:iIlOCIA'I'ION ' " . " ,,'" ' 13 5 I' I (0' 'I' II A V I~ N lJ 1\ lI~dl;"I\r1Y~L1r~~Z 1'1'1"1'lIl1lJI\GII,I'A 152?2 .. _...! ~~_""RocorQQr ' D cr-t S ( l' (p ISI"WO I\I"!I" '11111 I,l!I'!'lIr,1l111lI"""1I1l1l11l1 -.----~.-7.-~. ~~ ffCftril)(y\ ,., f\~C\l.\;l\al 01'1lN-IlNl1 MORTGAGE '0 ';, ;"~\\~~lq1 . ~~ alll~ llln,oH j 'I '1'11111 1\1ol\TOI\OIJ ("lIuc\lrlly 1I\5\111\1IUI\I") I~ ~Ivun un !-If n ,10', ;,) IJ ," ",II' I '" 11100:' Sloln c:I ;'"nr\.\yIV\'II,lo, I~ (11'.1111\ C\'~lJ' ,"I, I S,S, '1'0 ' ,........ / .-...~ ) --- JAOQlJ~LINR A, 1l0RPA 'lfl/~q'2-, f'pl:il ;tj, 1992 fbr assig'Jlqlt l1110 I.arf.l\ll~ Slvil1J3 ~atkl1, En'3 m::Ol:t1 b:qL~.2. . nXR~_'1L. ~~..a.rl:fi~"'''4,\... Nlq...ss,~~.~.)"nr~11~ , Thu 11101101'001' I! ("Ilorrowcr"), This Suullrlw 1l1s11111\1UI\lls olvolllo LAN11HAI\K ~IOIl'!'OI\GI\alntVIot.;al lNO. whluh Is orOIlI1Iv.cd Ilnd oxl~lIl1o Illldur Ihu IIIWs of 1l11\lruss Is 335 Il[llTll AVI~NlJl\ I CON~\ONHI\Al!TIl O(ll't~NNSYJ,VI\NlA ,lIl1d whosu l'lT'!'13 PUIlGIl I'A 1. 522 2 , ('Lullller"), 1l0l'foWur owu~ LUlldor Ihu pl'inclp"1 S\ll1lof ' SIlV~NTY TIlOUI3AN~NtN~ IIUNPIlRO AND 00/1.00 '. l)ol\lIr~(lJ,S,$ 70,900,00 ), This. llohl Is oYldoncud hy llorTowor's 'l1olu Illllud Iho SRI\1U dolo os Ihl~ SuclIl'lty II1~tl1l111ul\l ("Notu"), which prnvhlus fill' l1Iul\lhly pRYl1\onls, wllh Iho flllt Ilohl, If 1101 pold eorllur, dl10 Rl1d pnyohlo 011 00 T 0 1\ r~ 1\ I 202 ~ ' Thl~ Secllrlly Il1sll\ll\1uI\I SeOllru~ 10 l.ellden (0) Ihu repnYl1lolllof Iho duhl uvhlollcud hy Iho NOlO, wllh II\luI'OSI, ol1d 01\ rul1owlIls, uxtullslons IInd 1\1n<lIncollolls of Iho NOIUI (h) lhu poynlUl1lof nil olher ~III1\S, wllh Il1tereM, 1l(11'llIwed 1111(101' plll'lIoroph 7 10 I'rutoct Ihu secllrlly of Ihls Secllrlty IIlSII\II1101l11 IInd (0) Iho purfol'l1\ollcO of 1I0rfowor's COVOl1onls IIlld IIll1'UOI1lUIlI~ IIndur Ihls socllrlly IIlSll1111\0111 1I11(llhu Note, 1'01' Ihls ptll'jlosu, Ilorrowur docs hurehy 11I0rlonoo, 01'1111\ IInd cOllvoy 10 I,ondur Ihll followlllg doscrlhed IlropOI1Y locotcd In '^OMlS COllnry, l'ul1l1~ylvnnllll 'llDilnl1n W1Ul all' b.llJdJl)'J EI..\:l.lLka anl:uildiI)'J Ilolm:Jllla wd all B:j.tillnont em oUl3l' p:!L1'q)31. 1:JJ.1:p3:Ly I:U:pitu::\ Qt' llEl jn Uu a:m\J;mtiQ13 of sa.icl 1:UiJdJI)'J3 Q1UU p:oniWl lmull\ d:B:lI:.ilxd \4)3U131: Q1 UU gro.n:l or jn El1Y of Un I:uiJdjl).J3 Q1 mid 101:. . 11 B a..~ ana of: nlnY OJJt~t.il'g Uu 1\.111 lIll:l.it of Un c;tbt axtlLu:l bJ lhia m:II:IlpJ3 am In In a:lVm:u:llJf Un M:n:b;):lJXl (1) Un M:n:U.J:g:n.'B j\1 c-m:u.tl'fT.!3 W.lUl Un LUlllE an, l'a:}.rlm1131111 of: 11 CEI:laiIl ll'.,)tlXllmt of e-.ul d~1n I13L~~.lUi l:ELwnl Un lIIrtiEE 1l3lulo m.' Uu btuul bJ Un M:u.i.lJ'l'JJL'B of El1Y ro.unlt, CJ;Jttmrmt or lIttn:atm:Urg Um1?Jll o:nlL"lirnl sln11 lXlntiluln a chfa11.t Irnatl..br. mJ Q\t:it:1a Un M:u.i:g:q;n haUl m.l ~tD;y ltm~' , Umttfur HW:kb,' fm- Imtlin. whh:hhllslhullddrussuf 33 I)J,I~ASAN'I'ON !lOAD gAS'!' 1I1i1\!,lN 1'011l1~ylvnl1ln 1'1 ' I I 1 7316 ("I'l'upully ^"dl'os~"li I, II (: ~lt 0 IS!lOCI, cllrl, "BNNSVLVANIA.Blnl/lo !'.!lllIy.rallnla MaIIF!a"lIlo Mno UNIFOnM INarnUMBNT nil n c:., \1\1'<1 '/\ oG 0 8 6 7 - .~nIMIIDIOII. , VMrMohlOAlIt rOll!'\8'II'mol'O'Oo ' looolb'I1'1\lAf.J ,:; u ~ *~ TillS I\DVANCg MONgy MOIlTGAGE SRCUIlES (lUTlJRIl " ^llVANOI\S UP 1'0 'l'\lg H^XtMUH OI\l\llI1' s1'A'!'IW 1l1~I\liIN PLUs ^CCIlUED AND UNPAID lNTgllRST Fo,rn 3030 0/00 Arn.n"." Blot ( ,...l f....ll"'i .;J ! I, II " " ,,, " A~~ THAT CmRTAIN lot oe 1an4 eituate in Rea~ing TownBhi~~ A~ame county, ~enneylvania, peing more particularly ~ee9ribe~ ae LOb No, 07~,on a Plan oe~otede Lake Mea~eSubdiviBion, duly entered and app~aring oerecor~ in the .flacdrder of peeds of A~amB CountYI ~ennsylvania, in Plat aook 1 at page 5, and being sUbject to all Jegal highwflYs I easements, rights of way fln~ reetriobions of recor~, uNPmR AND SUaJmCT TO the restriotions of record for Lake Meada SUbdivieion as found in Reoord aook 306 at page 704. " ,': },1\ II 04-~H2 11111 TItlf\ . ms ' WRIT TAX CHK 131523 7824 $27.00 $0.50 $27.5d IlECOROER OF oma ADAMS CO III OETTYS[IURtl, PO 17325 DETTY H. t-'lTm~ CflK m.50 04-~:H2 1111 mUA 7824 i,1 I'", I' ';, j'i BK 0 6 2 3 POD ~ 6 B TOQWl'lIllll IV,IT" \llIlhu IlIIpIIl\,UIlI~liI~ ",11\\' III 11\I1~IIf1VI ~I.U VI~IIIlIIIII\l PIOI'\lI'IY" 111111 \III V!I~IIII,WIII~, IIPI'IIIWIlIIIIVC~, 111111 n~llIrc~ 111\11' nr 11\I1\llIfI~,1' \I plIlI 11,1' III~ ,Pill/'iii'll" "II l\lpIIIVliIlIUIlI~ 1111\1 IIlIIIIIIIlII~, 8hllll IIlw Ii\l ~1l1'un,\1 I)' Ihls ~~vllrIlY III~IIIIIlI~III, M Ill' Ih\l rlllc~llllllll~ rufulWIll11 Illhls ~IIVIIIIIY 11I~11I11I1\l1II1I~ Ih\l' "I'rill'\lI'I)'," nOl!IIOIVI1H COVIlN"NT~ IlIill nlll'llllI'VII~ 11111'1\111)' s\llsllllllf 1111' \l~lliI\l h~r\lli)' 1!IlIIW)'~II 111111 hilS Ihv I'IVhllllll1lll'I~IIVC, Uf\1II1 \lIIIII!UIII'9~ Ihv I'rnpm)' 1111111\1\'1 Ihv I'rllpul'll' I~ IIIWIIl!lImlivI'I!II, u~"CPI 1\11 \l1Il!11I11"I';IIIl!\I~ Ill' 1l!l!IlI'\1. 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Nlllv, Ilnlllllw Nlllu lti plllll III filII, \I ~1l111 ("F\lllIh") 1'01'1 (II) YVIlI'I~ IM\lI, .. 1111\1 II~SC~slIl\ll1I~ whlclI 11111)' 111111111 prll1rli~ IlI'VI' Ihl~ ,'l~lJlil'lIy IIlsIIIIIIWIIIIl~ IllIulI nlllhv I'l'opUII)'1 (11) YVIII'I}' 1\lIIS\lholll plll'II1~III~ I1r UI'IlII1III rClIls olllh\l I'rl1p\lrl)', 1I'II11YI (c) ~vllrl~ III\~1I1'11 or l'I'OP\ll'l~ IIl~lIrllllcu prUIl1II1I11~1 @ YCIII'I)' OO\1\IIIISIIIIIIICC PI'Ull1hlll1~, If 1111)'1 (v) ~ollrly lI1orlUIIUI!' 11I~\lIIIIICV plull1l\III1S, If 1111)'111111 (() IIII}' ~\lII1S plI~II\'lu h~ UOlTOlI'ol' Iu I,Cllllcl', In IIccol'IlllllC\I with ' Ihv pl'Pl'l~lrllls of pllroUlIIl'h~, II) lIel! of Iho plIYII1VlI1 01' 1I10l1UIIUo 11I~lIrIlIlC(l prVll1hllllS: Thoti\lllvll1~ III'U cllllcll "I,scl'oll' IIcms," I,ellllel' lHll~, \II 1I11~ 1 II II I! , pollevl 111111 holll FIII1\I~ 1111111111110\1111 \101 III c~ccelllho 11111~III111m 111\1011111 \I 1\lIIIIor 1'01' II fcII\lrllll)' rollllv,1 ""OrlUllllV IPIII1 mll~ rOllllll'o fnr IInl'rnw\lI"~ cscrpWI1CcOll1l1 \ll1I1~r Ihu fC'\UlIIll\elll f'tilillC SolllvlllOl1I I'l'ol!ell\ll'c~ "CI of . 107,1 liS 1I1111!1I11vII fro III 1111I0 111\1111\1, p 11,11,(;, SIICHolI 26111 VI ~,,'1, ("11I111l"",'), 1I1110s~ II110lhcI IIIII' Ihlllllpl'II\l~ 10 HIP PIIIIII~' ~nl~ \I lo~s\lr 1111111\1111, If so, 1,01l(lnl' II1I1Y, \l11I1I~ 111110, colleClllnl\ hqlrll'\lIIIls 111 1111 11111011111 1101 10 c~cVl!II III! Ivssel' 11111011111, 1.\11111\11' 11111)' o~llmlllu IlIv 111111111111 of F\lI11\s 1111\1 IlIllhu 1111s1s of C\lrrCI1l 1111111 111I11 rClwolllll1lc C~lh1ll1Ie~ or cW\llllllllll'c~ of f\llllre I:scrow IIclI1~ or, olhcl'wls~ 111 IIcoonlllllcn wllh IIppllc\lhlo IIIII', ' The f'l\llIls ~hllll ho hvlrl III 1111 III~HI\lIIOII whns\l IloposlI~ nro In~IIroll by \I fnllol'lll IIUUIW)', 11I~ll1ll11on\lIlhy, 01' 011l11~ (IllChllllllU I.Cllllol', If I.omlrr Is slloh 1IIlII1sH\llIlon) or IIll1n)' pcllol'Ill HOllin I.Ollllllllllk, l.ol1ll\lr ~hllllllppl)' Iho Fllnlls III I'll)' Ihu ' Jj~CIOW lIillIIs, h\ll1\lvl' nwy 1101 chllruo norroll'or 1'01' holllll1u IInl\ IIpplyll1u.lho FIII111~, 111111111111)' 1I1l1l1)'?IIlU Ihu v~cro\\' IIcCOlll1l, pr l'erlf~IIlU 1110 \l~OI'l1\1' lIol11~, 1llllos~ hcml\ll' rll~s Ill1rrowor hllero~1 olllho FIIIll\fi 111111 IIppllcnblc IIII\' pOlll1hs 1.\111\1\11' 10 II1nko Mlah II chllrU\I, IlIlwOVCI', LOllllnr 11111)' rOllllll'o Ilorrowor 10 pll~ II 0110-111110 chllr~o for IIn hlllcpollllol1ll'Oll1 \lsllllo III~ l'~pol'lll111 ~\llvlco IIsvll h)' I.ollllvr III Comll!\lIIOI1 wllh Ihl~ 101111, 1\lllos~ IIppllcllhlo In\\' plovlllo~ olhml'lsc, Ulllcs~ 1111,III1I'V\l1]1\I1l1 Is 1]1111111 or IIppllcnhl~ III\\' I'C\I\lll'cS 1lll\lrosl'lo 110 ppl<l. h01l1l1!1' shlllll10l ho rClpllrcII 10 pllY \l11\Tow\lr 1I11~ 1I\I\lrC~1 01' 'ollrnll1us olllho PHillis, \lorrowcl' i11111 1.0111101 11111)' IIUl'ao III,wrllhw. holl'ol'ol', 111111 h\lol'o~1 sl1l111 b\l 1'11111 olllhv 1'1I1111s, hOllllnr shnll ulve 10 uorro\\'or, II'lIhol1l ChlllUC, IIl1l1nl111l1li\cCOIIIlIIIIU of Ihv plIl1Il~, showlllu cicIll\s IIl1d I\ohll~ 10 Ihc 1'\lI11\s 1I111111w pl1'l'O~C fl'r which ollch Ilohlllo Iho rllllll~ WIIS 11111110, Tho 1'1I1111~ 111'0 pl~lIuoll liS 111111111011111 ~oClIl'lIy 1'01' 1111 ~1I111~~oc\II'cII h}' Ihls SCCIII'II)' IIISII'Ul1lOlll, Ifllll! Fllnlls holll 11)' 1.0111101' c~coOlllho,111110\l1ll~ 1'0111111101' 10 b,c holll b)' 1I1'/',llcnblc IIIII', L\lnllol shllll IICCl'lIl1llo 1l0ITlI\\,'nl' 1'01' Iho \lXCoSS FIII1I1~ hllll!CIIlllllncu wllh IlIu rC(ll1lrcmonl~ of IIppllcllhlo IIlW, 11'110 11111\111111 of Iho FIIIIII~ hohl h)' l.clIII\l1' 1111111)' Ihllo I~ 11111 slll'Oclolll 10 pllY Iho Jl~clow IIcl11~ II' 101l11l!c, Lundol' 11111)' ~o lIutIr)' Illlrrnwol' 111 1\'1'111r1ll, 111111, 111 ~IICII CIISO UO!'roll'or sl)1I1I pllY 10 1.0111101' Ihu iilHl1l1nl. 1I0COSSIII')' 10 Illllko III' 1110 IloOclonc)', Ilnl'l'lllVol' ~hllll nlllkc lip Ilro IIoIMulIl!)' III 110 11101'0 Ihlln Iwolvo 1I1\1111111~ pIIYlI1onls, III 1,0Ildol"s solo dlscl'ollnll" , Upoll PIl)'1ll01l1 1II,I\IIInl' 1111 ~1I111~ socllro(1 b)' Ihl~ Sovllrll)' IlIsll'lImolll, 1.\llIdor ~hllll PI'llIl1PII)' rol'lIl1d 10 1111\'1'0\\'01' 1111)' , FIIIlII~ holllll)' honllol', II', IIl1dlll' pIIl'llulllph 21, I.onllol' shllll IICIIII I 1\1 111 ~olllllo I'IUPIII'I)', I.Cllllol', pllnr Inlhc IIC'illlfiHIOI1 01' ~1I10 nf IhcPl'iipOIl~, ~hllll oppl)' 1111)' rllllll~ hl!llI h~ 1.0111101' IIllho limo or IIC(IIII~lllolI 01' slllo II~ II cl'odllllFIIIII~1 Iho SIlIl1~ ~CClIl'cII h~ Ihl~ SCCIlrIl~ InSlnlll1ol1t." .. 3, ^IIIIHcnllllllllf Pn)'I1\Clllti, Ullless "l'pllCllhlo Inll' pl'nl'ldo~ oIIIOl'wl~o, 1111 pIIYlllonlfi I'ccclvod h)' 1.0111101' IIl1dol' plIl'lIFllmhs 1,111111.2 shllll bo I1ppllod: 111~1, 10 \IllY pIOplI)'mOnl ~hiltllos (1110 IIl1dor 1110 NOIUI ~ocol\ll, In llI11nlllllfi pII)'lIhlc 11111101' PIII'IIYI'IIpll 21 11I11'd, In111l0ro~1 dllUI fOllllh, 10 pl'lrwlplllllllollIlIlI 111M, 101111)' 11110 clllll'Uc~ dllo IIl1dor Ihc NOle, , '4. CIIII1'\lOSI 1,lulI~. Ilulrowor ~hllll I'll)' 1111 Inxos, 1I~~0~~1II011l~, ChIlIUOS, fillll~ 111111 IIllposlllnll~ IIl11'lhlllllhle In Iho 1'llllWII)' II'hll!h 11111)' 111111111 pl'lnrll~ OVCI' Ihl~ SOl!lIl'lIy 111,111111110111, 111111 ICII~ohold PII)'lil'OIlI~ 01' Ul'olllld rClIls, 11'1111)" Ilnl'l'oll'ul' shllll PII)' Iho~o ohllUllllolI~ 111 Ihe 1I111111\UI' plovlrlcd III plll'llUl'lIpll 2, 01 If IIUI pllld IlIlhlll 1I1l1l1l1cr, lhllTlhl'Ol' ~hllll pll)' Iholl11111 tllIle dlrecll)' II~ Iho pOI'~nll oll'od PIl)'llIunl. 1l0rro\\'CI' shllll I'!'lilllpll)' flll'l1lfih 10 I.ollder IIl1l1nllcos or 111110\11115 10 hc pllill IIl1dol' Ihl~ PIII'IIYl'llph, 1I1l01'I'IIwol' IIl11ko~ Iho~o 1'1I)'IIIU1l15 dll'ccll)', Ilnrrowur ~hllll proll1/nl)' flll'lIlsh 10 LOlldcl' rOl!clpl5 Cl'hll!IWlllg Iho PIl)'lIlOlll~, Ilonnw\lr ~hllll PlolIll'll)' dlsulllIl'ue 111\)' IIclI which hilS prlnrll)' llI'IlI' Ihls SOl!lIll1l' IIISll'IlIlICllllllllm Ilnno\I'ol'l (II) IIYI'CoS III 11'1111111110 Iho pll)'1I10nl or Ihc nhllYllllolI ~ccllrod h)' Iho HOIIIIIII 1IIIIIIIIcI' 1I0COplllhlo 10 l.olldl!1'I (hll'nlllcfill, II1yood 1'II1lh Iho HOII h)', 01 1I01'elld~ 'lIglllll~1 olll'olC\lI1IOIII or Iho 11011 Ill, 10YIII'pnwccdlllp~ which III Ihl' 1.0Illlvl''tinpIIlI01l OpCI'II1o ,10 prUI'UlI1 Iho ulI/ill'eollll!1I1 of Ilro lIun; nl (c) ~OClllOfi I'rnlH.lhc holdeI' of Ihe 11011 1111 "ureulHolIl ~lIllsl'lIl!lnty \n LUlldel ~lIhol'llllHlllllP Iho 1Il!1I III Ihlfi SCCIlIII)' IIISlnlll1ollt. II' I.olldol' dUlel'llllllc~ 1111111111)' ,1'111'1 nl'lhc I'I'II1'ell)' h ~lIh.lccl lOll l!ull. whldl 11111)' 111111111 1'1101'11)' UI'or lhls SUl!III'III' IrIS11'1I111011l, I.olldul' IlllIY Ull'o 1l11l'l'01lW IIl1nllcc IIlolltllYlllp IlIullclI" Ilonoll'cr ~hllll fillllfil')' Ihc 11011 or IlIko OliO 01' 1III1Ie of Ihn 1Il!llollfi ~ullilllh IIhl1l'c wllhlll 10 dll)'fi o(lhu Ulvlll[! nl' 1I01ku, P'U- ~ 01 (j Ol( 0 G 2 ~i PG U a 6 9 Falin a030 DIDO $, 1111/.11\'11111' 1'\'11 lIu 1'\)' 111111\'11111'1" 11111'111\1'1'1' ,Iwll ~UI'I' IlIu IIIII'IIII'UIIWIII' 1111\1' 11.\1>111111 111 II\'I'Ulll'iol UlwlI'1I "11 11Il! " 1'11111\'11)' 111,,111'11 111111111'1 \111> h} III"', 1111111111> IlIohllll!11 11'11111111111' 1\'1'11I ""'iClI\bl 1'11I'I'1'I111U" illI\llIlI~' 111111'1 lIilllIl 11\ , 111"1111111111 111'1\<1, 11111111,,11111" l'i1l' 1\1Ii<'1I 1.\'11\1<-1 ll'i1l1lll" 111'111I1111'1', Tllh 111'1111111<,\1 ,111111 h" illilllllilllli!llll1ll1l' iliIlIl'lill' 1I11i1 l'i1l' IIII' 1'1'111111\' 111\11 1,\'1111')1 ll'i1l1lll", Tllu 111\11111111'1' "11111\'1' 1'1'I1\1\1I11~ 1110 111'11111\1<'1' ,111111 \11' OIIII\UII hy 1II1II'1'\I'UI ",1\1.11'1'1111 1,'111111'1'\ iI 1'1'111 1 ill II IIkll ,111111111'1 \11' 1iIll"iI'"I1I1III}' 1\ 111I1II'ld, II' 11111'1111\'1'1' 1'1111, 111 11111111111111 1'11\'1'1'1111" 11"'I'IIIWIIIII'III'I', 1.,'11111'1 IIIIIY, III 1.,'1111,,1'" 111'111111, i1l'llIllIl'llIl'l'l\~1' 11I1'1I1I<"'II,Vlld"I'> I'lgIII, 11111111 1'1'1I1'VI'\)' 11111""111111111"1' 11'1111 1'IIIIIgl'II1'II 7, , \1\,11\11111111'1' 1'1111\'11', ,1111111'111'11'111, \111111 hI' II\Wl'llIhll' III 1,1'11\11'1' 111111 '11111111,,'1111111 II '111111111111 1111 'II II IlllU \'11111'1', 1,\'11111'1 ,llItlllIlIll' IIII' l'i~1I111I lIi1l1lll11' 1'"11c1I', 1111\1 I'I'IW\I'III\, If 1.1'1H1v1' 1I"i"II'''', 11111'1(1\\'1'1' ,111111 1II'IIIIII'IIy gll'I' 111 1'1'11111'1' 1111 1"'1'1'11'1' 111' I'lIhlpl'l'lIlllilll\IIIIIIII'lIl'lI'ltI 1I111il'I", 11111'1' 1'1'1'111111' 111'" 11111'11111'1'1' ,111111 gll''' 1'1'1I1111'111I1!!1'1' 1111111' 111111111111'1' \'111'111'1' 1111111""1,101, 1,1'111101' mil') 1I111~I' 1'1111'1' 111' II!II iflllllllll'\1\' pl'lIl11pll)' \IY 11111'11'11'1'1', , . \-'lIlvlh 1.01ldl'l' IIIIIIIIIIIIIII\'VI' 1I111l'IWlsI' II~IW 1111\111I1Ig, h\'III'IIII\'I' 1'1'1I\'I'ulIl \111111(,1' "pl'lI,," III 11'11111'11111111111' Ivpllll' 111'1111' I'I'IIPl'II}' 1111111111'1'11, If Ilw 1'1"1111111111111'1' 1'1'1'1111' I' 1"'1'111'11I1\'1111}' 1'011'1\111' 1111111,1'11111'1"1 'I'I'III'II}' 1\ 1111111'\\1'111'11, 11'1111' 1'I"lilllllllllllll' 1'1'1'1111' 1\ 111'1 I'\'lIl11l1l1l"1II\}' 1'1!II,I\llv III' I,olltlol\ ,I"'IIIII}' \11111111 \Iv II'ISI'III'II. Ilw 11I11I1lI1I~V I'l'm'l'l'1I1 ,1111111'1' ;lI'PIl~llllIllIv '"1"1 " '1'\'111011 i'y 1111, SV~lIrll)' 111'11'111110111, \l1I~IIWI' III 111'1 IIII'll rlllo, \11111 ;111>' 1'\\'1'\\ I'lIltl'lll 1I11'I'Il\l\,[, If 111111'11\11'1' 'lhlll1t1I1I1' Iltv 1'1't'I'I'iI}', III' dill" 111111111'\11'1 \lilllll1 .111 rill)" II 111111\'\'1'1'11111 1.l'lI\lvl' 1111111111' 111\111;1111'1' 1'1111'11',11111 i1lll'rvd III '.'111,' '11'1,11111. 1'11'11 1..01111\'1' lilliI' ':1I111'\'1 IlIv il1\111111100 plll,I'~lls, 1.1'1II11'r IIII1Y 11'1' IIII' prll\'l'I'111 III 1'1'1111' III 11"1111''' IIII' 1'1'111"'1'1) IIr Ii' 1'00,i '11111' "','\II'l'rI \I) Ihl< SVI'IIIII~ 111\11'111111'111, IIIWllwl' IIr 111111111'11 lillI', Till' .1Ihltl) 1',l'illrl \\III",'~11I \\It,'n Ih\' 111111\'1' I, III 11'11, 1'1110" l,vl1r1l'r ,11111 III1ITIl\II'I' 111.111'111'1'1' '!Vrl" III '11'1111111, ,III}' ,11'1'11\""11111 III' 1'111.:"",1\ III 1'1111,'11'011 'h,,1I 11111 "\1"1111 "I t""II""'I' Illv .hll' 011111' III' Ihl' ""'l1lhil 1"'111I1'111' 1111','1[1111111 III 1'i11IIVIIII'h' I ,11111 J III \'IIiIlI\IU lliu ,11111111111 III 1\," 1"'\ "..'"'' 1\ 1IIIIII'r I'"rllvrlll'h J I \III' I''''I'I'II}' I' II~IIIIIIVII h)' 1.~l1dur, III'rtll\\l'r\ l'iV \1111 'III}' 111"111111,0 IlIllI,'los ,111111'1111'1'\1,1\ 'I""III1IV 11'1111\ dlllHIIVV hi 1111' 1'11'1'1',11I I'rltll' 1111111' 111"1111>1111111 '1111111'11\\ III 1,1'11111'1' Illlhl' 1'\10111111' 1110 'lilli' '1'\'111'':11 h) 1111, SO\'IIIII) 111"1111111'111 IIIIIIlI'.lIlIlvl) I'l'lIIr Illlhl' 11\'11111>1111111, (II 1l1'1'\I I'll II\"\' , l'I'IlSUI'I'IIIII1I1, ,\IIIII1II'I1I1IWU 1llIlll'l'lIlu\'lIl1l1l1f Iho 1'1'lIllU\'Il'llIlIl'I'III\llr'S \,lIl1l1 ,\t1pll\'lIlhlllll,I'II,~hllllls, IIllrrllwor ,111I11 1I1'I'1I1')', 1',IIII,II\h, 111111 IN IIII' 1'1'111'1'1'1>' III 1II1!1'II\\'l'r!, 1'I'IIwll'II1 I~,"II'II~I' 11'1111111 ,I sl}' '1l1}'1 IInor IIII' I'sl"'IlIlIl". Ill' 11111 SpI'IIrllY IIISII'\IIIIOIII 1I11r1 ,111111 ,\,1111I111111' III ""\'III'Y Iho I'rlll'l'l'I}' II' nllITIIWl'r\ 1'111\1'11'111 1'1',11101\01' I'llr 11111'11'1 11111' }'I'III 11111'1' , 1111'111110 ill' I1\'Ollplll\l'>', 111110>1 1.l'lIdl'r 1l11ll'r\l'i~I' IIVII'I" 111 wrlllllg, \lhi\'II.>III\WIII '11111111I'1 1'1' IIml'll\lIIIIII'\}' wlllllloltl, III IIIIII'SS 1'.\II'IIIII1III1U \'!I'\,IIII\IIIIIWOI 0,,111 11'111011 lITo hl'>'1I1111 1I11!1'IlWI'I"s ~lllItrlll, Ili'rrllll'or ,111I11 11I'1 III'SIIIlY, dlll1111ll0 III' 111\1'1111' IlIu I'rIIl'l'rI}', IIIIIIIV IlIu P.l'('POl'ly III 110101'1111\111', Ilr. Oilllllllll 11'11111'1111 Iho Prlll'ul'l}', IIllrrtlll'Or '"1111 \Iv 111111'1'111111 If 1111}' r.1\'lulllll'l' 11.:111111111' I'I'IIOl'I'IIII1B, 1I'I\OIIII'r vlvllllr Qllllllllll, Ih hI'B"I\ Ihlllln I.vmll'r'i UI1I1\1 1'111111 )\IIIUIIIVI11 ol1l1hl rOSlllll11 I'lIl'fl'i1111'1' Ill' Ih~ I'roperlY Ill' IIlhul'wlsl' 111IIIvrllllly 111I1'1111' IlIu 11011 orulllcll hy 11111 SI'\'lIl'lIy 1IIIII'\IIIlUlllllr l.omltll"l ,oollrlly II1IVl'v~l, 1lllllllwI'I' II1I1Y \'lIto'~lI\'h II d"[lIl1i1l1l1d rolll'llllc, III Ilrlll'ltll'll ill plll'iIBrllpll Ifl, hy o;I1"ll1u IIII' IIl'lhll1l1r PI'III'''I'IIII1B III l'I'lllhllll~'I'<1 wllh 11 1111111" Ihllll 111 l'I'l1lll'r's ~11IJ\1 [111111 110101'11I111I1111111, preollllloi [1111'011111'0 III' Ihl' \lIlI'[IIWU(h 111101'1'11 In 1110 I'llIpl'ny Ill' 1I1111'r 1111I\1'1'1111 hl1pllll'lI1onlll[ IIII' 111'11 cl'ellll'\1 hy Ihl5 Secllrlly 1 11S11'1III11'nlIII' 1.l'lIdl'r'l ~,\'\lr\(Y IIIIVI'UII, \lllrrllwor Ihllllllllll he 1I1111'Iilllil If Ullrrllwvr, Ihlrll1B Ihu IlIlIn 111'1'111'11111111 prIWUIS, ~II\'U 1lI1111'rlillly I'lIlso ur hlllcollrllll' IlIflll'lllllll\ll1l1r SIIIII'II\01111 III 1.0lldof lul' filIII'll III plll\'lllv 1.1'11111'1'11'1111 III1Y II1l1lurhll In[II1111111h1ll1 In ~1I1111U\'llul1wlllI Ihu '"111\ ol'ldl'lwl'll hy Iho NUII',II11'hIlIlI1B, hili 1101 1111\110\1 i ,In. 1'0pl'Uson\llllIlIIs \'lIl1l'l'l'I1lnB 1llll'lIlll'l'r's IIC\'nPIlI1I'Y uf Ihl' Pn1pl'ny III II pl'll1l'lplll 1I'IIdVI1I'O, If Ihls SI'\'lIrlly 111,11'\111I1'111 il \l1111 II'llSI'II11111, UII!I'IIWl'r ,hllll olllllply wllh llll III" pnlVllllIl1S III' IIII' 11'1I1e, If \lIl!l'IIWl'r 1II'lll11rl's 1'1'0 11110 1Illlw Prllpl'l'IY, Iho Il'lIsollnld IIl1lilhl' [1'1' 11110 1II1l1l1l1l11l1OIue 1I1110s~ 1<0111101' 1I111'1'1'1 IlIlhl' I1\l'rBOI hIWIIIIIIU, ,. 7, I'l'lIlcolllll1l1f ""'1110\"5 JlI<<1I15 1I1111u I'rllpl'l'ly, If 1lll!l'IIwor rlllls III perfllrl1\lhl' I'IIVOIIIIIII~ 1\l\.IIIBIOOl1\el1\~ 1'\l11\\lh\O\\ \I, Ihl5 .'il'I'III'IIY 111111111110111, or 1111'1'0 Is II 101l1l1 pr\lool'lIl1'u 1I1I1I1I1IIY slBl1ll1ollll\ly 1I[[Uult.l'l1dor's rlyhls III Iho I't\lpeny (slloh II~ II , 1'1'0\''''''III1B III 1'"I1~rllplcy, pr\lh\llul [\11'1'0111101111111I1011 III' flllfolll1ro \lr In el1f\lr\:u 11111'5 01' I'VBIIIIII\OI1S), \hl'l1 LUl1lil'l' 11111}' t\1I ol1li \'IIY for WhlllOVOI' 15 1101'0ssllry 10 pl'\lll'ellllu Vllhlo of Iho I'rllpol'lY III\U I<ondur's I'IBIIls 1IIIIIu I'rnpl'rlY, l.ol1dllr'5 110110115 l\llly ,Iwhl<lo pllyll1B IIl1y Sll1ll5 sl'ellrell hy II 111'11 whlcll hilS pl'l\ll'lIy \lvor III Is .'iol'lIr1ly Il1slnllllOIlI, IIl'pollr/lIl! 111 oollrl, PIl,\'h1l! I'I'IIS\llHlhle 1I11\1l'\lUy5' fo06 1111<1 UII\Ol'llIBl1l1lho I'ropuny \(1 IIIII~II loplllrs, Allhullull '<l'lIl1or 1IIlIY IIl~U IWllul11111111'r Ihls I'lIrllBrlll'1I i, \_I'IIt1or t1\1U~ 1'\11 hllvl' 10110 '0, , , AllY \l11\\llIl1ls t11~hl1l'l'll hy 1.0mll'l 1111111'1' Ihls pllrllUlllpll ? ~hllll hec\l1I10 111111111011111 <ll'bl \If IIl>ITowo!' sO\'lIrl'tl I'y Ih/s Sl'l'lIllly 11I~11'1I11\1'1I\, Ul1lo\h IIl1rrull'or 1I11111_01l<lvr 1I~ll't' 10 \llhl'r 10rl1\s IIf PIlYI1\I'I1I, IholU 11I1111111115 ,hllll bl'ilr 11I11'rl'~1 I'IIlI1\ Ihv ,11111' III' ,ll\hllr\OIIlI'II\ III Ihl' NIIII' mlu ,11111 shllll hI' 11I'Yllhlo. willi IlIlcroll, Ilpun 11111101' frol1\ 1.1'11111'1' III Ullrrllwl'r rl'I/III'IIII1B . I'll) 11'1'111. ," ' H, .\1HtI~1I1\1' IlIsIIrrllwl', It' t,l'lIdl'r "'1111'1''' 1I111r1~IIII~ In,IIr'lIw~ ", II q,""lIlln III' IIll1kll'" Ihl' 111111\ \Oollrvll hI' Ihl, SUI'lIrlly 1II"fllI\l\'III, 1111(111\11'1 ,h,llIj'il}' Iho l"I'lIIhlllls 1I"IIIIIelilll 11111111111111 Ihl' III1'rlV"VI' IIISIIrlllll'1' III 1'11'1'\'1, If, I'ilr IIII}' "'i!Snll, Iho 1I'"t1~ilVI' 111'111'111"1' "O"'IIIP' II'IIIIIIv,1 h} 1,1'1\\101 III 1M, nr 1'1'''\0, Iii 1,1' III ,'lfv"I, 1ltlITnlll'f ,h'lll PII}' Ihl' 1'1I'1II11111!S 11'\111111'11 Iii 11111,111\ ,'II"'ll\plI \l11"I'IIIII'III~ "11'"1,111'11I111 Ih)! "'"rlpllpe 111'1111111<1' I'II'IIIIIIII}' III I'lfol'I, 'II '11'11\1 ,"1"11111111111)' \'111I1\'ill\'1I1 IlIlho ,',.,1 In IIIItrllll"I, nl Ih,' IIIn"~"vl' 111'"11111,'1' IHI'\ IIIII\I}' III 1'1f1'l:1, Irllll\ 1111 ,llll'rllilll' 1I\lIn!l'I~o 1III,Itot ,ll'ptl,\V,1 hI' "1'11I11'1':. If \l11"1,1I111"II~ I''1'"I"kll,IIII''PIIV' 111\111111111' """'IIIVI' 1\ 11111 ,'\1111111111:, nllllllWer ,11I11I1'"}'It'I,olklor I'...'IIIIII'lIlh II \11111 1''111111111 IIII\' 111,'11111 Jlllh,' ""III, 1I'"I1!l,IVc 111\111'11\\" 1\1"11111111I I"'III~ /,-1111 h~ 1""11111.' 1I1"'lIlho 111\1111111.... IIIIl'tllVC I"l''''' nt \\',1"'1' III 1,<' III .'1 It'< I I. ,...1,'1 ",II ,1\"'1'1, II'" ""I 1,'1"",111,,,, '''I llIellll.l1 .l In\\ 1""'/\ e III ".... IIr II."'p,IVtI 111\111111\\. 11111 /(''''11. OK 0 6 2 Ji'G U 8 7 0 ,...'" loa U 90, " ..... lit " , , \7, 'l'1'1I11~1\'I' III' Ih~ 1'1'1111\11'1)' III' II "~II~l1l'illlllil~I'II~IIIIIIIII'I'III1'~I" 1.1' 1111 Ill' 11I1l' nllll of Ih~ 1'101'1111>' 01' illIY IIIIIIIII~IIIIII I~ loll III' 11'I1I1~l'uITU,1 (01' 1111 1,IIWn"",11 1III1I'U\IIIIII<III'OIl'UI' 1\ I\lhl 01' Il'Iill\h1lTUlllilllllloll'01\'1I1' 1\ 111'1 II 1Ii11111'111 PUIIOII) II'lIl\ilill 1,111111111"\ plllll' II'I'IIIUII VIIII~~III, 1,1I1111~1' 11111)', III 11\ 111'11011, liltJlIlllI i1l1l1iUlI,IillU PiI)'1I1I111I III 1'1111 of 'ill 111111\ ~IICIII'OII, hl' Ihls HocIII'II)' 111\111111I11111, ,I 10 II'III'C I' , Ihl~ "plloll \11111111\1111\' CI,lIl'l'I\I'11 hl' I,'I,,,I~I' II u,~ulvlsu Is plolllhlloll h)' 10llill'ilIIIIII' 11\ !lllho dill~ of Ihls HIII1\IIIY 11I\II'III1IVIII, ,', , II' 1.~I1<11I1' 11.\IIICI\1I1 Ihll 01'11011, 1,1'1111111' \111111 ~11'0 11\lI'II'lI'olllollcu of IICClllcl'iIll\llI, Tholl\lllv~ 11I1I1I/11'01'lllc ilpllrloll of 1101 1~ls' 1\11111 ,111 1111)'1 I'l'lIql III~ 1I11\~ Ihll 1I\lllvlI Is 1111111'0\'1"1111 IIIilII,II11 II'llhlll whlvlI 11\111'011'111 11111\1 PiI)' ,ill '11Inl ICCIIICII I')' IIIIs HIII'1Ir Iy 111111'1111111111, 111\011'011'111' I'illls 10 Pll)' Ihlllll 11111\1 1'1101' 1\lIIIIIII~pililllllll \II' Ihls pUllo<l, 1.011l10r mill' 11I1'0~011llY 101l1\l<lIUI " PU\'IlIllIull hy 11111 HIIVIII'II)' 11111\'1111\11111 II'lIhlllll lilllhol 1\\lllcIIOI' dUlllilllllolllloITO\I'OI, , I>>, III11'1'mn'I"H HIHhl III 1\~IiIHIIIII1' 11'1I01T0\\w muulI 1'01'111111 \'0111111101\1' 1101'1'01\'01' Ihllll hlll'o 11111 IlllIII 10 hlll'u" II 1I1\ll'VII 11\, 111.11 ,01' 11111 Hllcmlly 111111'11111011I I \lOIIIIIIIIIIIIIIIII\!l1)' 1111I11 pl'lol' 1011\11 C,'1I1' IIII' of: (II) 5, (111)'1 (01 \lIVII, 1111111I' pOl'lo\11I1 'lIppllvllhlll III\\' II1I1Y Ipuvll'y IIII' 1IIIIIIIIIIUll101ll1lwl'01'1I 11\ II 01' Ihll I'I'0PIIl'ly plll'SIII1I1I 10 IIIlY PII\l'III"OI' Iillu cOIIIIIllIlIII 111 Ihls HlIlIlIl'lly I"SII'\III1I1III: 01 (hi 011\1')' 11/' II JIIIIUIIIIIIII ulll'olcllIU 111\1 HUOIII'II)' 111\1111111,11111, Tllo\1I 00I1r111101l1 111',0 111111 110I'I'01l'1Ir: (Ill pilY~ 1,1111\1111' III sllllll \\'lIloh 11101\ 1\'01111 ho IlIllIlIlI\luI 11111 S"OIlI' IY 111111'1111111111111111 I Ii II NOlo III 11'11111100111111'1111011111111 \1CCIII'I'IIII, (ill V\ll'lIj IIIIY 11111'11111101' IIl1y 1IIIIIf 001'1111111111 01' lIurOlllllOIllSI (cl PII\'I 1111 11.~pOIlIOI 11\11111'1'011 II IIl1fol'cllllllhll HIIOlIl'liy Iilsll'llllllllll, IIwllllllllU, 11\1111111 1111111111110, 1'11111011111>111111101'11111'1' 1'11011 111111111\ IlIklls III0h IICIIIII1111 1.111111111' IIIliY rUlIsolIlIl'ly Illlllllfll 101l1SIII'~ 11111111111,"011111' 11111 SIIC,'III'IIY 111111'111111111\, 1.lll1llur s 1'11I1I11 111 1111 i'1'I11'l1t'IY 1111I1 111111'011'111"1 IIhllUlIll1l1lo plIy Ihil 111II1s IIICIII'UII hy Ills Suullrlly 1lIlll'illlllll]1 sllllll 01111\111\111 IIlwllnIlUO\I, UPlll, 1'11111\ 111011\11111 hy 1111[1'011'111' IlIls HCII\IIII~ 111111'1111111111 111111 11111 phllUlIIlIIIIU HIIVIIl'oll 11111'0 'Y, 1111I11 11111111111 I'lIl1y IIITuOlll'u III 11'11011I11:01111'1I11011 hllllovOIII'I'U11. Ih111'1I1'0" IlIis Ilu 1\ 10 folllsllllo Ihllll 1101111'1'1)' II1/hI1 clIIIIOI' 1101111101'1I11011111111111' plll'lIUliIl'h 17, " U, 1111 ~ Ill' NIIIIII CllIlllHU of 1,,111111 11111"'11101" Tho NOIII 01' II 1"11'11111 111111rlll\ III 11111 NOlu (IOUlllllOI' 11'1111 IIIIH HoulllllY h,sll'lIl11l1l1l) II\IIY 1>11 11111 III1U 01' ",II,'I'U \IIIlIII \\'lllillllPI'IIII' 110110111011111'10\\'01" A 11I11I1I1I1y,\'IISIII1 11111 OIlIII1UII I1lho IInlll)' Ikl1oll'li liS IIIIl "1.01111 Sllfl'lcol'''III1111 o(IIIIICIS 1I101llhly pllYlIIlIll\l ,hlo 11111101' I IU N,'llllllllllhll Soolll IY 111111111111111\, Tholll 11110 111l1y 1>0 111111 ,01' 1I\01'01l1l1111UOI 111'111111,111111 SlIrl'lolIl' 11111'011111111111 1"Hlllllot' 11111 NOli', II' Ihol'lIls 1I0hllllUll01' 111111.01111 HlIl'l'lcol', lJlIll'l1l1'ol' \\'111 1>0 ulvolI II'fllllll' llOlIuo ot' 11111 OIlIlIlUIIIII 1I0110l'dllllOU \I' Ih 11111'IIUI'II1'II 14 1111111'11111111 IIPl'IIcIII>Io III\\', '1'111111111101111'111 111110 ,Ihll nlllllllllllll ",lIlfIlSS of 1111 IIO\\' 1.01111 slIl'l'lcllr 111111 IhllllllllfUIS 10 \\'1 oh I'"YIIIIIIIISlhollld hll 11111\111, Thll I\IIIIVII 1.1'111111111 OOtl\II1111111l' 1I1lillr 1111'111'1111111011 1'11111111'1111 hy IIppllvlIl>llIllI\\', .. " ~n, Ihl~IIl',IIIIIH SlIhHl!1l1VIIH, 1l01'I'till'01' \hllll'lllll 011I110 0,1' 11"1'11111 Ihll: PIOIOI]OIl, 11111, IIISPOSIII, S1111'iIUII. III' rOlulI,so 01' IIIIY Ihl1.lIl'llolIS S!lI'HllIllIIOH 1111 111' 111 11111 !'IOPlIl'ly, 11111'1'0\\'01' 1111111 1111\ dl1, IIl1r 1111011' III1Yl1no olslI 10 do, 1I11)'lhII1U 1II'I'IIollllU 110 I'ruplll'1Y 111111 H 111 1'11l11I111l1I Ill' III1Y IlI1Vlrnnl1lOllllI1 1.lIw, TIIII prucollltlU Iwo IOlllollCIIS ~1I1111 \1111 "/'\'ly III 11111 PI'OIUIIOU, \ISII, Il[ SII1I'IIUIIIlI1 III~ I'rll/,ony Ill' ~II1I1I1I,I\lIIIIiItIIlS Ill' 1111.I1r<lIl\lH SlIhlllllWIIH 1IIIIIIIrll UlIlIlIl'lIl1y 1'0cngllll,UI 0 h" IIppl'llpl'lillll ill IIlllmll rll~ 1101111111 \1m 11111 1Illl111111111111111cO of Ihu I'l'0pUny, " Illlrrll\Vol' sllllll \'\'!ll11pIlY Ull'u 1~1I1\11111' \\'11I1~lIl1ollco of IIl1y iIlI'IISIIUIIIIIIII, CIIlII1\, 1101111111", ,\"WSIIII "I' Illllor IlclIlll1 hr 1,lIy " UIlV~I'III1111111111 01' rllUlllllllry IIUOIICY 01' 1'1'11'1110 Pliny 1I11'II1vll1U \ho "I'opony IInlllll1Y IIIIZIII'I1I11I~ SII1111111cO 01' 1!11\'11'1l11l1l1l1li1l I.llw of whlllllllll'I'oWIII' III1IOCIIIIII kllowlo\ uO, If Ilorruwllr 10llrns, or IH nollllcll hl' Il1\y "01'111'1I11\111111I1 nl' rOUlllilllll'Y 1I11111111'lty, 111111 "l'y rUlI1ol'lI1 or Illhol' toll1011l1l1l0ll'nl' IlIIy t1I1ZII/'III1I1H SII11IIIIIWII IIl'ruolllIU 1110 1'I'01'1I1'IY Is 110COSSIII'YI IIlIrr01\'1I1' 1III'IIprull1plly II'~II I'II1UCO~HIIII' rIlI1II1II1I'IIIOIIIIII~ 1111100111'111'1100 II' III Illlvlro1l1l101111111.lIw, A~ IlSOlIII1 III Is 1'"I'IIUl'llpll 20, "IIIIZlIl'lIl1l1s Sl'hIIIlI1COH" 11111 IhllSo sII11IIIIIWUH 1101111011 liS In,~lc 01' hllzllldmls slIhllllllCIIS by 11111'11'01111111111111 1.111\' 111\11 1110 fnllnwltlU sllblllllluUHI U"IIIIIIIII, kU\'!lIOIlIl, 011101' 111111111\11hlo 01' 11I~10 pOlrolulI111 /'IIHIIICIHI 10~11I" IlllSIIIIII1I1H 111111 1I0l'hllllllos1 1'01111110 1011'01111, 1IIIII0IIIIIs,Ollllllllllll1U IIshollllS 01' I'nrll1l'llIlIl1ydll, I'IIiI rlllll01l01l1'1I1111110l' Ills, AI IIHIIIIIII Ills I'lImurn\11l 211, "Illlv I'nnll101l1ll1 1,,1111''' 1I101l1l~ I'cllcfllllll1\'5 IIII'I IlIwH of Iho JlIl'lsllIollolI wlloru Iho "Iopony Is IlIclIllI<I Ihlll lolllill 1011011111, HlIl'oly 01' 01l1'IrOIl1110\\l1I1 P1'1I1001101l, .. , NON-UNIFOllM COVUNAN' 'H, llol'l'owor IIlIlll.lIl\llol' 1'11I11101' cOYOlIlnl"lld "urllO 1III'II110wsI ' ~" Acoolul'lIl1l11l1ltollll1ll1oH, I,ollllll\, Hhllll Hll'o 11II1Ieu Inllll\TIII\'UI' II\' Ill' Illnl1culUI'IlIlolI rllllllll'ltlU Ilm'I'lll\'OI"H hl'ollOl1 Ill' 'lilY ellVOlllm, 01' ""\'uomolll 111 IlIls SOOlll'lIy hlHIt'lImOIlI (1m' 11111 11I'11I\' III IICUIIIII\'IHlolI 1111"01' 11I\I'IlH\'I1\lh '7 II111us5 111'11 \unhlllll1w 1II'IIVltloH olllol'lyIHo), 1.1I11110\' Hhllllllllllfy 1I1I1'I'IlWIII'III', 11I11ll1\H Illllul'Iltlll1l51 (II) tlto 11111'1\1111\,( 1) IlIu lIelllll1 1'111111 I'od III O\lI'U Ihu 1101'1\11111 (0) 1I'1I011IIlIl'lloflllllll1l\lSI ho U\lfullt IInll (Ill Ihlll I'lIlhll'o III unrll tho 1I01'1I111111H spoolnllllllllll' \,uHlIlIlllllouolo\,l1l1lllllll' IlIu Hl1\lIH suolIl'oll h)' III 5 SOCllI'IIl' IIIHtl'nmlll1t, I'Il\,CUIOS\II'U hy JlllllolIllllI'lluOOIIIIIIlI\I\l1 Hlllo Ill' 1111 I'l'llpo\'ll', I,omlo\' HIIIIII fn\'lhll\' 1I11'1l1'11\ 1l1l\'I'IlII'OI' 01' IlIu l'lollt 1III'uln511110 I\flo\, IIccolllrlllllln "1IlIlll11 I'lollt III IIHsol'lllI 11111 ' I'IlI'CC11I511\'0 11I'Iluuollhl0 tllo nil II-os HI0l1011 111'11 1I111'1Inllll\, nlll' Illhol' (IO[lInHO Ill' IIIII'I'II\\'II\, In ",CCU 01'1I11l1l1l1l11I'fll'01l1IlHll1'O, I' Ihu dul'lIl1l1 H nlll olll'od IIH Sllll011l0d1 Lomlol', III lis nllll"n, l\1I1Y \,011111'0 1I111110011111U 11IIl'l\1unllll fill nf 1111 Hnl\1H HOOI1I'OII hy , IIIIH 80Q111'lIl' IIIHII'IIl\1QI11 IV Ihllm fnrllllll' 11111111I1111 11l1d l\1l1l' fnl'oullIHO Ih H 110~l\1'lIy IIIH11'I111101\l hy Jllillchll 1I1'1I01l1lllh1H. ',ullllol' Hhnll hu ol1U1loll In 011111101 nl oNIIIIII~CH hwn\'l'od III /lnfHllhlU Iho, 1'1I11101ll0~ 11I'IIY dod III IhlH (1III'IIOI'1I11h 21, ' Inohlllnu, hnl nnllhnllod In, IIUIII'I1UYH'rOUH 111111 OIlHIH Ill' 11I10 III' dOllvu llllhu IINlolllllUi'tnllloll hl' IIIIIIII~lIhh' lilli', ' 22, ltlllollHO, Upllll PllYll101l1 of 1111 5111111 ~eclIl'e(1 by Ihls SOClIl'lIy 11I111\11I1UI1I, Ihl~ Seollrlty IllS 1111110111 IIl1d Ihll OSIIIIII cOllvoyod Hhlllllllnnllllllo IIl1d bucoll1o void, AOur slIoh 000111'1'01100, 1.01\IIuI' shllll dlschlllUO IllId S\llI~fy Ihls HoclIl'lIy 1111111111\0111 wlllltllll ehlll'go 10 Ilorro\l'ol', 1l01T0l\'uI' shllllpllY nlly 1'0001'111111011 oosls, ~3, WlIll'o,;s, 1101'1'011'01', lolho O~IOlllplll'l\1lilod hy IIpplicllhllllll\V, will 1'01 01\11 rololl~oH III1Y errol' or dOfoclH,ln f1toecodlllUs 10 011 force Ihls SIICllfliy (IlHll1l1nOI", IIl1d hOlohy w"IVOH 11111 hOllol11 of IIny III'0solll 01' 111I1It'0 III\VH prol'lIl1l1g 1'01' SillY 0 oxocnlloll, OXlulISlonllf 1111\0, exolllpllon I'rolll IIl1l1ehlllulIl, Iuvy IIl1d s\llo, IIl1d h0ll1olloll11 osol1\pllon, ~". 1~III1IHllllol\1l1l1ll'orh'd. 1l01t'01\'01"H 1111I11 10 10lnHllllopllll'Idcdln pllfllUl'lIl'1I IH shllll OXlolld 1001111 hOllr Inlol' 10 Ihu Imnl1\lOnCelllOnl 01' hlddlng 11111 Hhlll'll'l"s ~lIlnlll' olhur 11110 pllrHllllllllo Ihls soolllllY IllslnnnullI, " " , ~S, 1'1I1'ohIlHC MIlIloy Mn\'IOllllo. If ollr or Ihe dobl soclIrlld I>y IIIIH SUOlIl'lly ltl\lntlllOlll Is IUllllo 1l0lTol\'or 10 1I0,\lIll'e 11110 lolho 1'I'0l'0l1y, Ihls Soelll'lIy hlHlnllIIOll1 shill bo 1I1'lll'chIlHIIl\10I\OY 1II01'lg1lUo, 26, 11I10I'oHlltnte Arlu\' , IIdH1l11111t, 1l0rruwIII' IIgrooH Ihllllho 1lII0losI rlllo PIlYllhl1l IIflor II JlldUIIIOIlII\ 1Il110l'od ,* 1110 Nolo o~ In 1111 IIcllolI 01' InortUlIlIo l'orcQloSllfll shllll bo Iho fIIlO pllYllhlo [ml1\ limo 10 1111I0 III1t1or 11111 Nolo, Furlll 3030 0/00 F'ag6li 010 OK 0 6 2 3 PG 0 8 7 2 ? , ~ .. I) IJ........,I'" "I'''' .......H...i...q..-.\,...\'!l' IH~..,j.L^. , aqIl1P\lo~nU tllll _l.1.lll_._ clCIY of' ~dl 1 lO...R.., r,lQn:pwor wu~ 11~1\0 pmlf1\O\l\:ll of ,I nl:rll:OU~ nn,l,V 011 1,1\0 (.UIP\IIl\, of ~110 LOIlIl clil3b\u'u(:!(l, p\lr.uwm\: to tllp CO\latnlotioll !.Ol\f\ AlJr(IOlllO\l~ 01' uVoll cllllo Ilnrowl\:11 lJO\~~oon ~l1o par\:,IPfl 11(:l1:o~o lIl1el . ' .Em!Lllal1~a......rn!4 _I Con~r.{\a\:or., Ilroviele<l, howovor., ~l1a\: in '\:ho oYl-lnt I,Iw Il\lj,l,(:jjng or. \l\IHrUnua \:0 \)0 oonol:nlo\:(:.,<l 111:0 nol: (Jqlplrl~(:.'(l ~lY 1:110 lat_ (lilY of , " ~voll1brn' _, 1. O.-.!!.t...1 ill~ol:oa~ {lhn1.+ \10 OhC\l:gocl \lpOn \:110 tO~Al 1II1P\ln\: of tho ' 10tln whot\lIlr tho 10nnJ,!l :In Wholo or. in Plll:\: rj:\,clllllruecl, /lllrl l:!JU\lllll: Ilpn\:1l1y pnY111011~!l of pdl1oJ.pn.1., J\l\:oroa\: (.\l1el ol:hor ohllruoa 1\11 pmY,lclO(l .in tho Nc?to ullllU ~JO II\'Klo hYI:ho b.9rruwor, " >/ / 27, IIhl"I'H I'~ IhlH HUI'lI!.It)' 111Hlrnl1l\llll, If 111111 \lr 11111111 rldllls 111'1' ml'lIll'll II)' 1l11ITII\\'llr 1111I1 n'\'ml,~UClhcr wllh Ihls S~CIIlII)' Il1slnllll~l1l, Ih\ll'llI'\Inlllllh IlIIilllur"UlIIlll\\h uf IIIIIIh sllllh rlillll' hhllll lip 1lIl'lIlPllrllll'll 11I11I1I1l11,ih!\IHllllclIll 111.111 sllppl\llll\llll _ ' Iii" 1'1II'IIlllllllh 1I111111gr\lUlIlUI11h \If Ihls sl'\lllrll)' 11l~InIIHIII1IIIS If lhu I'lih'r{s) II'VIII II Pllilllf Ihlh SVl'lIll1y""sll'lllllll\l,/ 1C1l1'c~ IIpplIPIIIII" IllIx(lIsll ! ,,' I ~. A1UII~IIIIIIII 111110 IIlilllr~ -- COllilulI\llIhll1l Hl1ler /, E~ I'~I FlIlI\lIy 1(11)" qrll~lIl1ll'ill'lIrlllUl\IHhlur :& 1'11I1I1w1l Unll P~I'UlllI'IIWII' 1\1)1 r ..~ nilwII~h' I'I!,\IIIIIIIII 111111'r = lliiIl1ll1n Hl1lur ' - fllllll ItllprllvenlOlIl HI<lvr ' Sel'\lJ1I1Holiw 1ll11er ' y,A, Hlilor" _,_ Olhllr(h) /spllcll)'l I llYS1QNINQ IIl11.oW, UlllT,llWIII IIOI'Cl'lh 1I111111"rI'0; Illlhll lurl11. 1I11d <~Vl'nlllllh conllllnc<lllIlhls 5111'11[11)' Inhlnll\wnlllllll 1111111)' rhlllr(.) ~XI'Clllc<111Y llimoll'ol' IIl1d rOCJonlcd willi II, ~ I' " WIIIIII.SOhl " I ," I , ,,' _ ,.tLC<A,'-U.~'-1oJ_ .' fl..J-?('-t~ tL. (S~nl) .:..0!.:Lt.,...."r...,... 22.L\iI/;!;/'/~__ :noQuf.'i.lI'W A, 1I0HoA ' '11!'tlIlW" I, , ~___(SOIII) 'Illlrr<lwor 'P' ... ----rr--- (SuIII) .llnrrnwcr (51'111) 'lIotT\lw.t " CVl'lInl'lIl11 uf I\l'sl1lonl'c I, IIIP II'lthlll'nllll\I'1IMurlunuc\lIs , do hl'l'ch)' cOrllry 1111111111' corrcl'll1d1lr~ss or .3 .it.5' II fttt . 4vel 11 H"bi-( r.J It ,J~r,i (S Eo ;. "l- 1'1 Hj (111)' of )d f? /. I l " ,I f( f;" , I ' _,-.~.{)&,i..v)2z O~idu~ ' , ~nl of MOl1gnuoo COMMONWEAI:I'U OF 1'IiNNS\,,,,"ANIA, (~UI"'Li,~w-~/,".L., CUllnt)' sSI OU,ll1ls, 1111' ' /1/11, dll)' or " ~La Iff;. ,hufol~ 1110, Ihc llllderslglwd offlcol', 1'0rWIIIIII)' IIPI'~lIrcd -..) 6 all tA e 1,'(/ -e.. j. 11()1' d d " I, knoWlllo 1111' (or sllllsfllclotlly ployon) 10 ho 1110 " pctSCIII WhOhC nlll110 I;' Sllhherlhcd 10 Ihc within InslllllllclIllIlI<llIckllowll'dgcd 111111 S Iu- , I, , cxc<'lIlo1l Ihc hlllllC rnr Ihe plllpmCh hOl'clo COIIIIIIIICd, ' , ", IN WITNESS WHllIlHOF, 1 hcrolllllo hOIIll)' hlll11ll1l11lorncllll hCII!. " ,\ ,",';" , ' )1'7 .->-f~':"'I_ I L.. , 'M)' ConllnlhslollllxIlIPlU-_"':- _.:...._~"'-k0-L-ll.(v . r ~.. ~r , I ,r". ;,' .' . ~.!oI:'ljnl ~-:'i,! , ~ (~',~II'.I..lt. \'.,',) , ~:' ',,:,:;,; ,','.1,/;"1' ,_ . 01,:,',,'1 '_',~ "'.,:','_ "_'. ':.';' ,;'; Ii,' 1r1, t-f'o'III,-1 ~I ;,"!; ,: l " I,'! ' ;:/, ',1.:"" , _ ~"/;'i;, ,r,'"I:JV"'U1I~1 i'i~~'II:i(.\1 oll-iOtwoOO '1'111<' III CliO", " 1"'''.010 BK 0 6 2 J PG U 8 7 3' Fa;l" aOil9 9/90 \ WlIl1rsh 111)' hlllld Ihlh 0078196 (..J(..)pi..j r..l) ;:g( 1)(.1 r~ANNEI) UNrT DEV1~LOrMENT RIPER 'I'III~ 1'1.,\NNliP Iii'll'\' illiVlil.(JI'~I\IN'I' I\IPI!I\ Is 1I11111u Ihls 14 tl\' dlll'lIf Apr.i'\' , t 99~ .!II\\lls 11\~1I1'1'1I1'1110,111\11I 111\\1 \111111 ho ,lool\lI'd III IItl101\\1 111\\1 sIIpp1ol11111\I Ihp ~hlll~IIUo, Poo,llIl' 'I'I'IISI Ill' ~oolll'llY Poo,l Ilho "~ooIlI'IIY ItISll'\llIIol\l") of Ihu SIIII\o dllIO, gll'ol\ hy Ilw 1II\\Iol'sIuI\o,I ((ho "l1orrllwol''') III SOolll'O 1l01'1'oWol"s 1'11110 III ~^NPH^~K HOKT"AQK HftKyraRS, INO, Oho "I.ollllol"') of Iho SIII11U 1111I0 111111 ~01'0i'1I," Ihu 1'1'1>1'011)' ,losOi'II>oll IlIlho ~Oolli'lll' Il1sll'IlIl\ol1l 1I1HI' hWlIlOl1 1111 33 P~RAHANTON ROAP , I~ A A or 1\ 111\ 11 r N 11'101"11)',\,/111....1 Tho l'i'opol1Y 1I1O\l!llos, hili Is 1Il>1 111111111,1111, II plIl'Clllof 1lIlI'lll11pl'o\'U11 wllh "'111'01111111, 101l0ilWl' wllh 011\01' slIoh I'lIl'cols 111111 0111111111 oOll1ll1ol1l1l'Olls 1II1,lll'itOIIIIOS' liS II0sorlholll n DsY 3CJ (0 I'Cl 7 u - , (11\0 "POellll'{l\lol\"), Tho I'ropollY Is n plll'lof II pllll1l1o,llIlIlI 'ovulopll1ol1l klloWl111S 1,I\KR H!lADK 1'4\ 1 7 31 Ii IN'III1' of I'hlllll,tI iJnlllJ.vullll'lllClIll (tllo "1'\.lP"), 1'110 Prnpolly I1lso Inc\llllos 110l'rnwol"s Il1lol'osl 111 IlIe 1I011100W110i's IIsM>olllllol\ or Ollilll'lIloll\ o"llIy 011'11111001' 1I111111111111111ho OOllll1lonlll'UI1S 1I1I111\IOlllllos of 1110 pup (\lw "OWl1oi'S Ass\lollllloll") 1I11111ho IIsos, hOllO"lS nnd Pl'ocoolls of fllll'rowol"s 1I110rosl, , lUll CQVl>NAN'I'Ii, In 1111'11\1011 lil Iho cOI'Ollllllls 1111I1 lI~rooll1onls 11111110 III 1110 Soollrlly '"slnlll1onl, flOi'rllWor nmll-elldnr IIlrlllor ,eol'onllnlllmllllll'oO lis fullowSI , 1\, "Ul> OhIlIlIlIlIlIlS, 1l01'l\lWOr shllll porf,'rmllllof porrowor's obllllll\luns IIl1dor 1110 puP's COl1slllllonl POOIlI1\Ol\ls, TII~ "COlIsllI\IOnl POC\1111011IS" oro Ihol (i) puolll\,llIlol1l (Ill 1If1lolos of Incol1lOl'IlIlol1, Inlstll1sll'11l1\ol1i or OI\Y 011"lvolol11 \1001111\0111 wllleh croulos tho OWIIOI'S AssocII1IIol11 1111\1 dllllll1Y by'llIws 01' olhor flllos 1)1' i'o~lIll1lhillS of IlIu OWl1nrs Assoolullol1, llorrowqr shllll promptly PllY, whul1 dllO, 1111 dllos 111\11 nSSOSSl1\ollls Imposod P\II'S\1I11111Illho COl1slllllollt POCIII1\OlIls, , ' ,I, Ihm1l'll IIlsm'olleo,, So 101\11 OS 1110 OWllors Assoelllllllll 11\1I11110111s, wllh IllIcl10mlly l\Ceoploll InslIlIIl100 clli'rlo\'lu",II\1ISlor" O\' "hlonkot,',' polloy I I1SI1 1'1 1111 1110 I'ropollY whlell IssmlsfllcllIl)' l\l \'.011I101'11I\11 Which prol'hlos Il1sl11111100 COI'OrnllO 111 1110 Omolll1ls, for IlIu porlolls, ond 1I11111nsl Iho lIulul'lls I-ql1\ll1r rO'\lllros, IIICIIIIIII111 "ro 01111 IIl1znrds IIlchldod 11'11111111110 101'111 "OKtOlldod COyoi'lIgc," Ihol1l (i) I-olldol' woll'os Iho Ilr\lYlslol1 11\ Uniform COl'onlll\1 2 for Iho monthly pllYlllon(' 10 I.ollllol"'Rf)( ~\\CXI)!,RIRI~ of 1110 yourlr promlllm nSlllllmol1ls for hOlllnllnsllrnllco on Iho P\'OPerlYI oml ' <II> 110rrowor s ohllgotlol1 IlIldcl' linlform COI'Onnllt'~' III 1111111110111 hlllUl'd Il\sl\tIIl1co COYUrllgo 011 Iho flrllpony Is IIoOl1l0d sllllsnod 10 Iho OKI0l11 lIulI Iho roqulroll COl'orullo Is pl'ol'ldoll by Ihu OWl1ors AssoolllllolI polley, ' " ", ';', !lol'\,owor slloll glvo I.ol\dor prompl nollco of ol\Y 111pso In roqlllrod hUl.orlllllsllrunoo COl'orllllO prol'hlod by 1110 IIl1lSlor or, blunkot policy, ' 111 tho ovoll\of 0 dlsll'lblltlon of 11117.ord Il1slllllnoo proceods In 11011 of roslorollon or roplllr 1'011011'11111 q loss 10 Iho I'i'OllOrlY, or 10 cOllllllnl1 orolls ol1d foclllllos of Iho I'lJlJ, OilY prococds pO~lIble 10 1J0rrowor I1ru 1I01'0by OSSlll1101 olllt. sholl ho pllld 10 l-ol1dor, LOl\dol' shull opply Iho pi'ocouds 10 1110 slims Silcllrcll by Iho Soollrlly Il1slnllllol1l, willi OilY oXcm pullllo lhltrowor, C, I'"hlle Lll1hlflly l\lslll'l1l1co, !lUI'MYor slloll loke sllch ocllol1s liS II1I1Y bo rcusol1ohl~ In Insllrc 1111\1 1110 ()\I'I\OrS Assoclllllol\ tnllh1lolns II pllhllc lIuhlllly II\SIlI'lIlICO policy lIocoplllhlo 11\ 1'01'111, omoll11l, ond oxlonl of cOl'orogo III I.clldor, MUL TIIITATE PUO RIDEn. 61nolo r-omllV, r-ollll!o MQQIFlllhll~ Moo UNIFOnM INOTIIUMIIIIT "'ll~ , 01 ~ \G. .7191031 VMr MOnIUM! IlInMo .13'31203,6100, 1800'&21"101 Flltm 31 no 6(110 OK 0 6 2 3 PO 0 8 7 6 mNIl~!9\l7, !f1'~! FRP/1 pgw~1-fl qilW' ClJ(~'1SUt. TO 05fl8'16!'7~1~ ,1~,ml(J I~ , q~t' ,I~l' - ~'Pr. loATIPN I , " I ,', , \'IQRP~Qt~IR' MA (l180f' ,..( , ''11,~ p~1 ~ n~,~~nHlf~ '11~lrMI~ "mn~ rnOT~pnv~ T11~ pmnm~E VA, nl^,lil,~ ' 5'-~ ' 'I ~Q M O~,C ~\PANY ~ r~qNn\lnAN!l~ oOMPAnY, ANNUm III~lJ~~ Qn nnhlPA" '( , f1RL) , " (PRPI _ : If'RV~' ; , J3 Jlr 1, ~ i I ~ lItIIHI:.12 A I: : ! : '1 : : : : ,. I 11'~\I~'~~lt~~till~~~:~P~:t,:' ~ ,?(\" " : ~ IFI~,I:'Mldd, ',f\,IOIQ:11:f11; ,T lNI~1 I I^'I I ._I]Jl1<L. Pu I r II tala . \)J \ 4i 'f~l~o 00' I1lr'oo\ ' D~ !'Ionao!)t!!$. .l?.'/y." ; ~,pl H __ B,OQouPollnn 819to J::mplp~ou " ;, ' 'Ii~ " ," ., 610101--&1.1-_ ~Ip 1mB PlJ\loq" OY~/oo' Mnn~qo~" I ' " I , ~ P Ii 1, U T PN(~ .... I QIHhollzq PH\., P!PRP . PRY P III moko,lhu lollowlnu ro~\lC\loo(afol ~oM)lia: ' 'PIl r ) II, ,Ro\1uollol1(~)1 I , ' , , " IlllooIlVopalo(all" ;, \ 1-1.j~ '(i I ~IVV<L Jo:::;l::~M~~ .', "" I , Q 1/'1111.\ ihll, ,~lImlllt IH'Plain : t.n .liU/"J19 (U 7 h2~ ~11I""t.Il~~Y), Qff;llll~ho, ~02/97'1' , I I t ,II I ' , " ' :' ' , , , ' I '. " : ; ", I: ,,' II ()?' ' 'I:' 'I' tllal\U!.1/.1...l ,........., " , on' . (, 1 a ~ I , " 'AI. ~ USENo l'H~ ro~(cy TI1I: OM\; CFFU,l\; WlTlfAN,Y REQU~$TfOR A R~OlJOTIO i ' I P ~-r Il.IAP ITION(8) Qr INORl!Aaf!.~81 or R\looNaIPI1RATIQN(S)~' I roqvOql PR~ p p\~f' i:I f'RV 1:I1~ ~nko: ,111 MowlnQ 10Illly!chQnod(~)1 ;' , , I I I :dl1, : ! ,Cllapen(o)l ,I "!: '1, ' ";1'1:' ::f, r-j, '" I' ';1 I , 'I ,I'" , " ',I " " ' I, ,', I ' 'I" <:" 4 , " ' 't 1 I1lgll,a~d: ' ~1I11' ,"" loa r/l. i ,Inelloa 'liD pour\~!, '\ . Ih,~'Olbo: 01&' ~,'apPII~aIlQn ro, r Iho IpclIQ'((ar 10 bu Yoo No, Give lull \1elolla10r nny "Ybo" \!nnwd'4, " 110 la~ b II ,vI11Ih,.o Y~a~, hove YO~I ' ' i ; ,: 00 Iv~ 'QI~l!~llIiY, h~p1IDI m modldall>el1efllol Q,r a '.!.j : pun I~~ lor /lilY afoknbos or Inlwy? 1 ' ": p (;:( , ,i~la~III'~ dls~~IIIIY, orillosPllal,lndUTnce, rDl~d liP, p ~. 'i i ' , " mod lie rel~ciI,od, on~o,alled or nol rOnOWQd.1 '... 1 I ~.1 00 1'- nie'~ 'y'a pl:1ynlolunor pr lc;1II10I1011' 00011 ~ ! , \'''Illal, ad,or na"llI@nall~nd; orb II III or 111 urall? t:J !:ii' , i "', , , , ~pp a (oven) , ,'. "...,..'_,~,jj,..j~;,~;."I.i,.'ll.,."...".\~~ .,.' '0 " , I , , , I , , ' 'I , OOMI'LIA on poriM - PtiR MilT a OHANQI1(81,QNW I " I I I , i' ' TO! Qa tllVIlN PROPOS P INstJRIlD UPON THIl SIGNING Of' THE APPLIOATION I I I .111 I t I' Wn PP'O 101 yo~i f]1nklno applloollol1lo 110 PaUl !1ll\1oro Lllo Inaurnnoo COI, Tho Poull1ovoro Prolnollv~LUo t\'IuranooCQ.! pll lor'TII P III np~are Vorlnbla Al1nully nsuranob 00" WorooSlor. Maonoo 1Ulolle 011106 101lnoyrqi1Qo oovo 'de, We wlshl ' 10 It I~'m v~u'1I al an InveallgollYA ounoum I report may ba OrdorO\1 no 10 ynll"~8uloblllly, 'rill, toporl moy lnolllddtll appllnobln,: Inlo f1\alllln GO 10 vdur ohornolnl, gel1erol replJlallon, POllOllnl ohnroolorlolloo"ond moda of living 00 moybo Obln~oll UlIouohi 1"10 Vlowa ,will loollly Ihom~ora, frlonoo, MIUhborB ",,0 u800lolu,' If YOII \yOIlI~ lIko 10 know wl10111or eUolt ~repot1 Woo ord rod ~rldj 'leO"IOQOIVO addlllonollnlorr~ollon Da 10 110 "aluro nnd ooopo, Iholulllnglho llama, oddrBu olld nl l1a nllmbor' 0111 e reporlln aQ~,jOV, wo 'will bn ploooo~ 10 lurn(oh 11110 '"lorlTlol/on upon 'yolll wrll/oll tOnueot \0 0111 HOlllO Inno 011110 Bbo "edotoa , Yop mql'Jobolva a oopy 91 olloh roport by oOllleollng Ilia r~"olllno agonov, " ' :' , ',!' ,': , ;:':' ~ ' :.. I a!l~ ,I'RE.NoTlca ON RE~ERIle SlbE I.' ~Y 28'97 lGIOO 1 717 'm 93'/8" ~,OOl ,5\1S, I: I I I' I I 'I . , , I , I I co., , tYW-iI\l-\~1l'7 llllfl~ FllON PliWJX:lfl 1=111111' !=1ll~'lSI'I. TO allt)a'15\m~ I',fl~ " I\lPlmQIIO, i lfJ~ll\rtllf111 ~j, r lrW\lmblllly will 1,10 11\l!llolf ou COI1lldulIl~~, TI1\I1'0\ll f1owr,u I.<<a In&JlIII,'rw~,I.~!~LTI'/l 1', oUI RI"/Il, :,10 lOiClq\l~ I~, InllUrOl\Cll Co, IlI1'i/or ;TI\Q Polll t1P'l\1f!1 Vat1~\~o AI\II\JIIY IIIQuror\oo Co, moy, ll""1'UV1't, mollll 1\ Ilrl PPOrt Ihur onl(Q'N111l hie. 0 !lon,prOflI mumll'I8'\lp Of1lol\\~1 on 011110' MurllncO compOr/Oll, wliloll unat\llllY on Inl , l\il~ohl lUI~" fI on 6clllJr <11 1\11 rnuf1,IP<I Po,IV, II ~ ul1ply 10 OnO\tlpr Mill mumi'nr co,j,Po!'Y "pr 1110 or ~b~III1 InQlIrunqu rr.,1lrllWu, r II pIp1m/Qi-' Ixtnol1\lllu r~l].lmllll1<j \Q atlr.11 " oompullY, tr\113. UllOn roqllpnl, Will ullpply "',10'1 onmplllIV wllll Ijotnkiil)1 lion Jl'\llunip. , t: "', , , " : ' pan rjl<1o PI (lI~ i~\lQq( lrom ~I, Mill \\'III ~rl1lnQQ cjlnclouuro pI oIlY InlMma\lol1l1 may hll\'llln ~\lr ~IP.I~ V\lll'quuu\lon ' , : I~q ~r~ c4, a 1I'/01l110110n In II. fflu; ~ IOuy 00, n\ur.\ MIO onq nouk 0 cllIrllO\lQq ,In llCGon:fulloo 111111111/ 1OO0qllroa Gr.I, 111n ha 1\1lJ fel1rOr\ldll Rllpofllnll/'llt, Tllo oddrfl1lljol Mlll'q Ir(om'o\lollolllua/a fP. PO\( 105, llllu l~!l\lld 1, POU\l1n,llfA 1~~, ai, \'l.1(1l n~~.366o. , , ' , ' " '; ',,' , I 11110 lpll/i/lte mov 0111(1 rQlo~ Ipfonno!lpn In illalr Wuo \0 Ihalr I1llns\lrprn ~f1(V()r olllor IIro Inullmh<lo COlllpllnhll1 'l 'hom' III QPplv'lor lIio Pr ho:slillln!\lmhoe, or to whom 0 ulolrl1 (01 Punpnl!J may ho nll~mll\od, 'I ' 'illVlI PIf' qPRllo '16r '11(11 pr ';~ollh In~lIlanQaWil"'n You Nil ,O!va 'lUll ~oldil~lor any "Y~q 'iqnelY rG, fla'Pail 1\1~11I1~~--,;_,: ....,p 111' I 'i I! 'o'YCl~ 11 Q ~n~ pl\YQlnol or n1anlollnlpQlrmunl7 Aro ! ,Pi.! p 'm dloil,1lpn7 , ' I, I P (3" I , I \ : bn \Iel ar~lll (n'pom'b luon llUJIlna~u, pneon In $ fJ f' try,<..' ! ; , 11 ,oo\llP IIY(~II"d,.rn: UIII(ul ot InGlltanoa Irl!~lcQ G/rnllono Pclloy(olll,lno n1lnnoad, , I ! ; ,I! ;" (1r+-, ,,' , i I 'l~lI o~ lion' r Inoron~d oppllnd tor IIl0nQQd,l\l raPlllo,II or ol1onoa ony ~Ihel o~ldllnQ' InU\lfOnoo or onll I y?' I/q Pl' l!:l! !"'Yuo'\ a/vo dolallo, orwpro hoproprlolo rQplacernell1 lOlme, ,":: 1 ' ' , , , I ' , '., I ' "\ I' ;. , I " " I ' '" , , , , I \ , 1111 unda"to -h I OIll'tflid'~1 fOllowl, : ; ': _ , ; 1(11 I ~Qvd rei d IHe nlPlunfel1lo,pn!l anGWUro mpdu abovo, T1loY MO, 10 IIln bGG! nl my knowlpdiJe ond b~II>>I, I,uo andl ' c1omplolu an~:n rrbollt rocotdod, TIle Comi\llny will IDly Ollll1l1rn In InGuina "ny 1IIldlllollollneul'lnco" ' ! (~) 11W O'l~n 0(' ppllocl lor In Pall ~ 1'1111 nol 6uoorno olleollvu \lnllll ; , " ~l ~~~ ~nlp, 11~~n'~W~6~~~~:~JI):Jil~~e~~~I~hil:~~Y /10011I1 fOl1\l1ll1G OU sih'IOd uPOYO,' ~" 'I : ,(Bl ~hU orm 0 r' !!ll1ollzaQ In oPloln,":, IiW~J~~O ~OIlO\III1"rrIlPOI1 JII mll'~' , ' , I , :PI n~d,\I' 'I' t; 'lrcu..;.' A.., Dqle ~~k.0 l' J i 1D..Ez!, , ; I IlIiYI~I/~~ 'IrUlv q~ aacurataly leaOld<K110l1'lhll ' , " I , : ' ' ; : I : I I [1"ilIlOn, a IOlo rnqllon' QUPflIlO,cI 'by Il1u ,4.ppIlr,allli Tn , , k' ' I' ' ! Ih Il~e, 01 y ~n laclua, ruElnoomanl 01 e~lillno ,"10 l';I/"tl1'", I 111 111'1"'10 01 annl~ 100 Clio !:lIe nnl InYolvod, I I1nvu i ; , I ' 'i lie e~:'1 f"u ~I 0 a~: In ~'108I1un 7 IIb~u, ' , ! I ! ' , WI ~bqe, I " : " " , ' ,,/,; I I !! ", Aganl,ol Ilrok9r ! rom IX]1 avor, nl, 0 ropona 01, qr P ollli "~I !,: ~1;1 11'1:" 1~~:~::~'~'~lt:lopo~ed Il1oura<1:01 ':"IO'j'UQ 110\lroj, ,Ap lllll I :, 'I , , , ,00, :', : ~ : : , ',' ~?MP~I\ FOR PARTF OHANt "(II) o~!.y - AUTIiOr'ZAT10N FOR INFORM :noN I ' ..' i " I 'II' QI7tJ.~lith IIZ'~I:IIcUnlatlcl physlc/qu, mecllcnl, pl'lll;\l~anol, hoopllol, clinlo or oll1er modesl 01 rned/oaI~ ~lalocl foolllly, : ' Itnl2?v'l C P'~IP, no. or OIIL'er ~rOonllnJlbn, 1l1!llllullo/1 or peruon,:U101Ilao,ahy roool'ds or 1(11 Gd~e at me or; I II",,:, '1, g IQ l'I.!'PoUI AQVQro/(u '''''urUllCa 00" Tl1a Paul Rfl\'ero Plolnctlvu We Ineuranoe 041, 'If nul Rovaru, ' a ~blo',~n ny Ih~urunc:Od Co., MdlOf 1I)iJ/r lulnsvlora any auoh IlIlom1ll1101l, To locllllolo rapid Bubml$lllon nuch Infor. I m "On, "1I10rlZp,oll 101 BOiJIooo. ~ePl MID, Ii1().1 (0 tJlva uiJoh IGcOlOO 01 I<nCWIOdga 10 uqulhll('Sel)rl9lis, or oIlY co "Um~t ru rU~Q u~or1CV, ^ phol~tat;ot 11110 aUlho,lzlIlIon 8holl btl M Wild Mllla ollglllol, : . " . '! I' t I .' ,I ,_ . , I' " ,I , :1' DOlo I'; , ' , , , , 'I ' " :111,1.. -..J , I'rlV l'Ia '97 IGlOO , , " " x 1 , , , "! I' SIO""lure 01 "Ioponod InouIOII " ....' 't' ',. I, T'OTFil. 1',0:1 f'fal,1lo2 /, 1 '71'7 'Ia7 a:l?o ,. ,. ' , .- ". r ~ ~ ~ ~ ~ ~ ~ t. ~ ~ H ~ ,b ,b ~~ I~ J~ III II ~ ~ I 'I I I l I I ~ ~~~~r~rr~.ww~ww' I~ n n n ~ " i' ~ , l~ ~ ~ ,~ ;J; 'I 1;;" I;; ~ I U ~ ~ ~ ~, .!. I " g ~ g g~gg ~g g ~g~g g g i~ I l~ I " "I ,. I" I l I ~ ~~ ~ \; ~ .!. ,.j rl rl 111 , , '" I ~ ~ ;1 '" '" ~ ,. I W. QQggngnQQQQngQQQ g 6 . ~Q ~ ~Q~QQQ QQQ II ~ I. III I I I I . I I I'. I I , ~ I ij" ~ +3' +3' +3' \T, \f o:r't \T~..:r ~ " .. " l!; , I w lQ ~ ' , w I~ I:l' ~ ~ ,I '" ~ ~ ~~~~~~~~~~~~~~~~ b~ I III , ~ I ... Ill'" \n III U\ ,,, I~ I.Il +:,,\1' _-.t II' Q ~ .. !I m m~ ~ g Q Q Q ~ Q Q iii g ,,' Q g iii .. Q Q ~ ~ ~~ ClClQ ClQ1 09 1CtClQ \!l I I ,. I "11 I I , ',,, I I I Q I ~ ., .!. I ~ , I " I \a \a \a ,.~' ~ ~ , , ~ " III III ... H,. ... " ~ , n ~ I " " ~ I " "~~~~~~~~~~~~~~~~ , r " ~ .i I "~~"""";f""g'n'g'~g' ~ ~ ;~~nnU~~~I~i "~ ' ~ ~ ~ ", , I, , ~IPP '11i/'o RpV ~'io POMMONWllA~ TlI QI'I'PNNaY\.VI\NIA I)PPAHNU~T OI'~OOIl ,INllINPUatRY \\,PHI<ORUi cOMpo aAlloN AI'I'OAI. sOAHr " \111 a, CAMORP SmUUT, HOOM ~05 11^RRlaIlURl1, PA 11104'1511 - lliohunl nw:!~L.-________...____________._____., c\.AI~WIT JEi.WllhlW MillJ!ulk !loud .._.____.___.______...' , " APOlloas , M!!!:.~!J.!ill:!J'\lrn__.._.. , CITY I'A 17055 .-----Si'/ITO-..,----?lp.COOll YO, lilO \10 1l0hl~COI1'~IUtll!.(1 OOI'ONllANT 1',0, UO~ 1262 APOIloao- APPJ:AI, FROM JIJPf3J:'l:l FINPIN~a PF FAQT ANP CONOl-.U810NS OF I-.AW = 'Pulol Ilm'!..~.LL~.~~,_,.__._..._..__.__.____.'___.m._... ,Pullllul1 TyPlll l!~HI.!!'t!~~!l1l!\lJ!\:!ll'!.!lL____._____,-- OllO\llullOI1 pulUI .Mll~. 2(), I !I!l_~...__.---,..-.._.._..____ SqnlulsoollrllV Nllrnllllll 12~-44-IHlll_.__",__ Pulu of 111)llryl ~J.IltU.'!t 9, 1991 ._____ Slnle Worknro' Illslll'U1100 F\~lIl INau/lANCU cARnlOfl .lQP LookowulIlIo Drlvo_ APllRoao }Vllkeu.lJurro \1A IH7113 Soronlon lW 18503 CITY aTATU ~iji'ii'iiPii- CITY aTATu ~ln cOpu TO TH~ WORlmRs' OOMPIiNSATION APPIiAI. !:lOARD, HARRISI3URG, PIiNN!:'lY~VANIAI IIwrlllly oppoul from 1110 doolslon of JUdgo131i!!!l2Jl.l!deL___----.:_._-_ uncI ullage 1110 followlno findings of f!lol !Ira In arror uncj,oro not supported Ily supstantlol ovldonoo, or contain 01l1Or errors os speulfioally sol fortll' ,,' polow, A oopy of 1110 ')lIdgo's Qo~Islon Is mtaollllll. F'indin~f Foot N~L.,h_Ji/_.2L.8 an(;LJ,QL....'!hUforlillrnnti,oned, findinGs of fact mm. discl1as~on are not aupp:>rted by al1batant:i..:b_ competent: and credible eVidenoe,.. As I1l1oh, .the aforementioned fil1d!ngs of faetand discl1sl3:!2n..Ji<;LU9.t..mmmrt t:hILf.1.lliting...oLa....t'a~ occurrsnce of any cUI3E\biHty related to the Claimant's ill1gul3t 91 1991 wot.1t injury, (See -RGCjI.\Bst;-f1G!.'-SUP9t;sedeas-at>t;aaheq-hst;etG-and_inGGt'flGr-a t>ed-hel1ein-by.-bhis-l.'O€el.'enee-; . .. I horally appoal from Illa daolslon of JUdgs Ilrlltn O. Uoder . anel speolfy Iho fOllowing orrors of low oomrnll\oQ Ily 1110 8!11d JUdgo, anQ tile ressons Why tho doo/slon does not oonform 10 tho prOVisions of the Workers' COlTlponsallon Aot or tho Oooupatlonsl Dlsoose Aol, A oopy of the JUdge's doolslon Is allellhllll. ' r.analuaions of! UlW No_~..!..J.L.,g,'-~1 4, 5, and ~be Order. ----1 -..-<- Plsssa oillor my OllPOoronoo for appellont: MlehoclU, MoOrolh, Ilsl\lIlro ._ NAME 2,10 OtolldvlelY Avenue.. .. -- ...--~--_..._~---._--- ' ADDRESS COI1lP HIli I'A 1701,1 .----sTiiTif-l!1' cone CllY " ()ofond_olll NAMI! or PARTY TAiliNG 'APPUAL" -'---'-""---- (CLAIMAIIT on OUl'l;NOANn OOPV OF JUDGU'S DEOISION IS A11'Aof'faOI PROOF OF SI:RVIC13MUBT aa FII.l:eb OUT oN THe s13coND PAGEII ' Af>f>EAI.SHOULb Be ~ILEb IN AN ORIQINA~ANtl ' FOUR (4) dorlEsl1I , ,," '.!l!lL.H/1l8, WIlP ,IOil11 11M 717 1111.1 ~'Iua , UIVlIl!tJI.\1I11l 1I11 I f..t~q-~H (ll!,V, 10-071 GOI111PNWl>fI/'~'" OJ" l'l>tltl:>Y\,YMH/\ p~rARTH~N~ Of ~APOR AND INDU~TRY , llUI\l~AU or WOI\I<!'IHl' OOI1r'>N~NNON ~ 171 ROII!:h c"mllron ~\;.\1nl;I "oom 1pJ 'lrlrdnl311l:lJ, PA 1710~-2!101 Ii!lOIl~ ~OQ-~1da07 .Jon{PI1~ _~u1.fl-~~jJ APM113 COUNTY OS/20/90 PATE; or CIRCUf,.ATION ('1l7)7a~-~41~ W~l ~~"6 . , \)L\ RICHARO 130RPfI 194 WIf,.l,pW MI~H PM\ti lIP MI1CllANIGI3PURO P^ 17055 Vii IUe P Q Hor,PINOS OORI'OIV,TION 1'0 !lOX 1~6~ WrLKI113 !lARRE; I'A 10703 " /:lTATf1 Wom<MEtla II'H1UllfINCl'J , /.lTATf1 OFFICE; PLPa 100 LAcKllWI\NNA lWF. /.lC~ToN r/\ 101103 ' FUNO , TilE NJ.1T/\ellJ::P PEOIl3tON OF 'lillE t1UPClJ:: IS fINAL UNLl1sa I\N I\PPl'JI\L ra TA~J::N TO Till> WOHKE;RI3' COMPl1t/SM'ION AI'!'I1AL 130AI1P I\/.l !'ROVIPI>P PY LI\W. H' yoU PO NOT MRf1f1 W;J;TlI 'I'lIIS PECII3~ON AN AI'!'EJ\lt M11S'P PI1 FtJ.J;:O WITH 'I'UJ;1 WORK-,r , ERa' COM.f1l1N/.lI\TION ,ArpE;l\r.. 130lll\o WITIIIN " 20 PAYS Of' Tllm PI\'l'E or THIS NO'l'IC~, " ",,,,1 FORMS FOR AN APPI1I\r.. ~y PE ODT/\IN~P l"ROH Till') WORKERS I COMPE;NSI\TION I\PPf1l1L RODEm!' 1lJ\.MI f,.TON , f.SQ I llOARO r 901 NORTII IJJ;:VlilNTH STR~J;:T / ~RD ~~,~O 1~~NO'{,J;:S'I'OWN AD !/f.~o;~~~OU~I~/ ,Il,MRISllURO/ 11" 1571\~21-,I,l ~~2" Il^RRISllUna PA 17110 r~ d '\~ MIC;;^m~ MCGIt1\TH/ J;:SQ, ~, oJ, ~ t' , 2~O OIW-lDYII;:W I\VI;: , ' , J 1l^~n.I:nu7'J?1I!JjbOl" 'C ", ~ "\) "j,~f;f., ,;;rc)\~ ...... ... . .... '" ... . .' ';f:t] . Li '1S~ IV\I~ROAD AYI;;NtH1 ~ " '~ ' " SHIRfJMANSTOWN 11/\ 17011 1:\ IE @ f.ii1 U W Iii! lID _~ w... '0' MAY 22 1998 ' 11 ~ 7t~ ~ ~J .>&Q. '~ ~~~ tm INSUIt1\NC~ "- JUDOJ;: bRI~ G fJAOJ;:R, aa! " --,' illl/~Uy'6' \VIlP'~6100 FI\~ 717 9U,,. 31o~ ' U -On -.. .._...._-.~..,- ....,....~----_......__M_~~.._....._......._. .M..~. ,_. HI! IIl/Gl-l\ illS till !illQQ1 I,' I , , Rh;hnnl ,]"PQnlll YS, I!:IC PO l'lphllnlJs Cllrpnrnllnn H~lllstn to m~ n lI,]nll\dH 8,8,11206-44-1 all7 Pngo 3 ' FJNPlNGS OF FA.CT (CONT'P) 3, On JUn~ 25,1996 cllllmAnl fileQ II pelillon for rolnslnlel11Pl1! ofcnmpensnllon bOl1\lOts nlllllllnlllhnl nS of~eptembqr n 1993,lhrough no fOlllt of his own, clnlmnnt'~ cllsnbllll~' hAllllll~ln n~tvorsolY nfTootoc\ his eomlnll ppWllr, all July 17, 1 ll96 dcfendfllll tlI11cl n timely answer c\onylnll nil moterlnl elemonls oColl1lmnnl's plltfllon, On fJeplember 19, 1997 dofenc\l\nl filec\ n pellllon for Jolnclor l\lIelllnlllhnt 0Inlml\nl'6 symptoms, lfnny, hnr.l I rllcoqulTed whlto 0lnhnm1t WaH In lhool11pl,oy of 13cnQhly Hl\rely Seeds, /4. rn support orhls pellllon clalmanl lostlOod ho hilS unr.larllone t'll'O Cnrpl\IIUnnel surllqrles performer! \1y PI'. Floeler on September 29, 1993 and Anrll29, 1994," C1alml\lIt further testlfior! he continues to cxporlcnce numbnessnnd woak!1ess In his /ITlp strQ/I/Jlh, 'C1r1lmonl nlso sloteo he IIlso conlinues to experience probl~ms with hla neck, Clnlm!lnl I1lso lestltlec\ he Is fentrlclcd 10 II!Wenly five pound 1I1\1!1llllmft by Dr, Fldelar, ;;, ctnlmllnt lestltlod ~IOOll his Initial surgery, 00 September 27, 1993, he has experienced periods ofwl\go loss resullant from tolal and partial dlnablllty, Clalmllol further leslltled " he Is 110 Ion lieI' phYsleullY ollpllble of rClumlng 10 his pre-Injury Job !IS II CO/1stl1letlon , ,lllborer beCAuse of his work Injury, " ,.{ ,[/1 suppon of his pelhloll, Cllllmllnt Imroduged lho deposltlonlcsllmony of Rio hard W, Flelaler, M,D" Cllllmllot's neurosurgeon, Dr, Ftcielor tesllfied he first saw claimant 00 Sqplembor 18, 1991, on referral from Dr, Pavld Long, claimant's family ph>'slclal1l On lhot date, upon examination, PI', Pldcler dlagnosod olaltnant as hnvinllaleft C7 ," tlIdlclllopathy Wllh let\ oarpaltunnel syndrome and lel\ ulnar seosltl\'lt>' at the albow, Dr, " ", Flde!er, t\lflher ,teSllOed,,\m,P~\9P~r.45, \??I'.h,epcr.formeclllo alllerlor,dlsl~ rcmovnlllnd, ,.., fusion on olalmant lit C6,7, 17, Dr, Fldeler leslll1ed he ~erfonned two addll(~nal sllrgerles on clul~anl.' On September 27, 1993 he performed a len carpallunilel releaso anel 011 Apr1129. 1994. ulen ulnnr ' ,~erve transposition nt tho elbow. PI'. Pldelor IIlso testified to a ~easonnble degree of medical certainty all surgerles he perfomlcd 011 clnlmant wore reasonable nnd neoessnl)' alld cllusnlly relnted to clnhllnllt's work Injury of AU!lust 9, 1991, Dr. Fldlller then testlfied aftllf clnlmnnl's surgeries he would hllve becn reslricled trom evel')1hltlg bUllhc lightest work c\UIY for two 10 three months, " ", I., trlQ,Y "'1 lem tl'':''! 4 , ,'.Y,a/J?IU~, \i~P,~~,lgO, F".~ H7 uua 3'103 51\'11:/0'-<\1110 I!Il Ii!JQoq , , .,' Rlchllrrl .I, Jl!lnlll V~, glC pO nQI~ll1lJ~ Corporllnon Rill n~tl\ to men tN 0 In lieI' ~,S, 11108.4401"97 PIIBe 4 FJNPlNQS Qlr fACT (CQNTIP) la, PI', Fldflhlr tC~llfic~ to l\ reQsoIHlblo de~Tee ofmedlGf11 Qeli/llntr pll\lmmnls hAvlnll ' rcohluQI s)'mplom~ IIndl\lsnbllll)', 9, JI1 opposlllol1 10 clQhllf1Il1's petlllol1, defendAnt offen.'!d Ihe c.leposltlol1tllsllmol1)' of DlIvlQ C, 13Qker, M,P" bOllrQ celilfied In Qlihon~dlps, PI', 13Akllr testlllec.llt \l'ns his opll1lon cllllmnnt's cArpnltllnncl s)'nQromC coulQ nOt be rclateQ to his work Injury, PI', BAkllr Alsu teslltled he \Jelleved CIAlmrml \l'u~ reecvcr~d o-om his "lslon surgor)', Dr, Bilker I\mhar tastll1ec.llt lI'as his opinion clalmun\ ann work \i'lll1oul rostrlctlons. ~, Aftar P!l~Ofttl And thorollgh review Qfl\1I tho avldllncll p~eSllnllld thlu Judge finds clalmQl1llo bo crllQlbla TlllJ1lrdlnll his ClllTOn! s)'mptom~ !lnd the n!Top! on his Ahlll!)' to work. This JUQlle fwthar Onds lIw testlmon)' of Dr, Fldehlr to bll moro crecllblii thal1lhat orDr, alikeI' In thaI Dr, Fldeler flS alnlmflnt's surgeon and trel1tlng ph)'slclanls bel1er fillualcd to I\ssess the dlsl\blllty ofcllllml1nt thfln Is PI', Baker In thnt PI', Bilker hlls onlY Qxamlned clfllmllnl once, ' p 10, Clalmnnt's counsel has Inclln-ad IItlllfltlon coats IIssoclated with this Issue In the Amount of $~,161.1 0, ~~ . II, ClnlmllOl has a ~O% fee agreement with counsel thflt IS,seen as rensonnble, I~, Defendant has pmel\ted n reasonabla contesl of this mntt,er. , , , CONCLUSIONs OF LAW '''''I ....".." '."" " . ,.., ,., ,,' ,.., " II" II. Clnlmflnt has sustained his burden Ofproofthraullh no fault of his own, his aamlnll power hllsbolllln, once agntn adversely affected his earning power,' , , I Z. Defendflnl hfls not mal thaiI' burden of proof that claimant's rl10cCIllTence of his' \~ork InjUry WflS the rc:sult of his emplo)'l1\entwlth l3eachlY Hnrdy,Seeds, /;" ," ' 3, Clnhnanlls entitled to have his past, present, and f\Hure reasonable nhd necessary medlelll costs paid by derandlll1l, ,', .. ,. '., ,.. .,..,. ..' ,/ " , . .......,..,........ ,.., VIIIII' Smlhl' S\lIlIll'Hr 011 pn/IP A, IW ~~p\nllll11lll'~ 11\1111\\ ~I1WI'~11 ~nrlllnuw III1Ii HllOlill S~~lII'lly '~I\I'nhll:l~ 111111 ty ~\II~III'~ \IIX~N, I'h~ fllll~lWII1U 011111'\ NIIIlWN YIlIII' I'~plll'\\lll Olll'l1li\IlN' II ' "nllIY 1111\ HIIIlW NIlI1IP or 1\1 01 YIlIII' ollrnllll\N frllll1 IIIN\ Y~1I1' l~\lI\IIN~ 1 IllY Ilr~ 11111 Y~I 1'~~lll'lhl!l, ThiN YOIII"N olll'lIlnuN will 11 III 11\1 l'upon~\1 \11 1111 1111111 11~~1 r~III" " I YIl!ll' IlWI1 Iwpnlh lip 1I1l111U1W wilh 11111 11llrnll1UN 11111111111111 NllpWI1, pIUIIN~ ~PIIIII~IIIN I'lllh\ IIIVIIY, ' " Sn~iill~I'IIY -------. MI'Il!III1I'~ ,- , Y~I\I' M!"1!1I11111 T!,~!,hl~ Y"!11llol'tlIl,,1 IhllllllllcIIT"'o, MII'IIIII!II! T".III,lo Y""r 1101''''\011 1!,llrll",oII '\'11'" 11:\1111111' _~!!!ll' Y,," 1''' II ___ I!IIIIIIIIII' ___ IIIIIIIIIIII' Y"'II'"III 193?50 $3,()()O $ () $ 0 1951 3,60il 0 0 1952 3,(100 0 0 1953 3,600 0 0 195" 3,(,00 0 0 1955 ",200 0 0 IU56 ,l,200, 0 0 IV5? ",200 0 0 1958 ,1,200 0 0 M~lllclllO dIll [WI.IM\ 1959 ",1100 0 0 \lnlU 1I)M. 1960 ,1,1100 0 0 1961 ,\,1100 0 0 1962 ",1100 0 0 1963 ",,1100 0 0 19M ",1100 0 0 - 1965 ",1100 0 0 19M 6,600 0 0 $6,(1)0 $ 0 $ 0 1967 6,600 0 0 6,600 0 0 " 196R ?,1I00 0 0 ?,1I00 0 0 1969 7,ROO 0 0 7,ROO 0 0 1970 7,600 450 18 7,600 450 '2 19?1 ?,600 ~,950 135 7,600 2,950 17 1972 9,001) 2,825 129 9,000 2,625 16 1913 10,600 2,R% HO 10,800 ~,6% ~8 1974 13,~1!!...- 320 15 13,7.00 320 2 ' 1975 "',100 . 'Ill 6 "',100 I ,Ill I 1976 15,300 ' 1.892 93 15,300 1,892 17 1')7? 16,500 7,883 390 16,500 7,6i13. 70 , '1976 1'/,700 10,680 539 17,700 10,680 106 1979 22,900 12,664 643 22,900 12,664 132 1960 25,900 ',289 26R 25,900 ',289 , 5,5 19111 29,.700 6,461 345 2!),71)0 6,'161 83 1983 32,.\00 15,984 863' l3AOO 1',984 207 1983 35,?OO 6,367 3'13 35,?00 6,3(,7 82 1911" 37,800 69 3 3?,1I00 69 0 " .~ 1985 ,39,600 339 ,.. 19 39,600 339 4 19111, "2,OqIJ 235 13 "2,000 235 3 1987 ,13,III){) 4,752 270 '13,800 4,152 68 191111 '15,000 15,26 I 926 "5,000 15,211 1 221 19119 ,11I,1l1l0 21,859 \,324 "1I,1l1l1l 21,859 316 \991l 5\,31l1l 14,265 H85 5I,31l0 \,qIl5 207 1991 5.1,401l 5,13<1 3111 1 25,1l1l1l 5,13'1 74 1992 55,51l1l 0 0 1.10,200 0 0 1993 57,600 0 0 135,000 0 0 199" 60,600 0 0 Nn l~hllll 0 0 1995 61,21111 1'1,50" H99 No 1,111I11 14,504 210 199(, (,2,?OO 15,047 932 No 1.111I11 15,0'\7 218 1997 65,0\011 Nol y ot Ilocordotl Nn t.hnll Not Y Q\ llooolllod \,)1)11 611,0\00 16'I/j[;-, Nnl.lmlj " 'I'ulnl ;ollnllll,,1 Sud,1 SOCIIi'll, Inm I'nhl $ 9.516 'I'lllnTH'fllllultll ~ll'llll'lltu Ill\I!' Ilnlll $ 2,139 2 , , .. . '." .... .., ,. , VIII, I" '~~lI, IH'I'fJ" Sill! nl 1'l1l1!1'" Iy UfJIIllm!i " Hvlll'PIllPnl np"pnl~ PI~lIhl1lly nOl\v",~ Irlllll,n~' IlUl\unl~ fJlII'vh'UI' , nOl\onl~ MudlulIl'U ~- YUltl' WUl'k 11I1Iitll' Hllullll SOUIII'IIY 11Illp~ YIlII IluII YIlIII' 1'II11111y III 11\llIl1l'y l'ul' 1101lul'l\ 11IlYlllunl~, Tho klllll~ Ill' 11~lIunl~ Y!lIlI\1IUhlIJUIII!O lIu~ul'll1uII11~I\lw, 1'01' ulluh " 10liunl, YI1I1 1l0~1 11 UU 1'1111 11 1\11 111 hul' Ill' WOl'k ul'ulIl\~ (IIUU PIIUII 5), OIWU YO\I hllYU UIIIl,II\lh Ul'uIIII~, Y\llll' 11111111\11 lll\1lll1 11 I \llIpIIIlII~ Oil Y',IIII' IIVU\'lIUUullrnIIlU~ \lm YOIII' work lIullI'ulllllU, \Yo 1I~01 IlIu UIlI'i1I1U~ III IIlu ulH\1'I \lll J1IIUIl 2 10 nUII!1I Y\1111' Pl'ulIlI~ 111111 O~lhlllllu YPIII' 1101l~rllll, \Yo 1I111hlllllll IIIIY I \JI 7 111111 1 u\Ja unl'II11lUIi Ilnll IIIlY u~IIIHI\luII 1'111111'11 uIII'I1IIW~ YOII 10111 \I~ 11110111, '!'PIlU\ S\1ullIl suuIIl'llY rU11r1l111U1l1 hOllul1ll1, >'l1l1lluuII ,10 ul'u\1111I or \vork, Thill I~ I\I~(J ho\Y I1\lIny YOlll\Oul1 1'01' Mu<lIulI!u IIIIIUU Cl5, YOIII' ruuol'lI IIhllWII 11111\ yol\ 1111\'0 IlnPHuh uru\lII~, 011 plll!u 5, wu u~plllillllbolll Illrl'urclI\ IIUII~ \,'h~1I YUII UIII\ I'ulhu, If YOII \Yurkud III YOIII' pl'ulluill rnlu lip Iu olleh rllllrUIIIOIlI IIUU, YU\Ir 1\101llhly 111\1\1111\1 WOIIII' hu IIbuIII: AllIl!u Cl2 (rulllluud bUllul1l) , , , , , , , , ' , , , , , , , , ' , , , , , , , , ' , , , , , , , , , , , " $ 505 AIl\III'rulll'uI1101l1IlUU ((i(i yumll ur nuu) , , , , , , , , , , , , ' , , , , , , , . , , , , , , , ,,' $ HOO " A' nuu 70, I I '." , ., " t ,'"" " ,., \'" , ,t '" f ',' , , ,,'" t , ; '.J ""," :& 1.085 011 PIIUI' CI, WIl lull YO\l11illl11l <IIHlII11IIIy I1Ollul1ll1, II' YOII I1IlU\lIlW <lIl1l1bluII rllllll no\\', Y\lllllooll 22 ul'u<llI~ 10 111111111'>' \<11' 11I1I1I11I1h>' bUlIul1ll1, Y\llllwllo UII\1\ 20 oflhPlI1l uro<1I111ln Ihp Inlll 10 >'Ullrll, YoIII' ruuofl' IIh\lWlllllnl YI1I1 1I11\'u uumu<1 unnllull uruIllI1I Wllhllllhu 1'1>>111111110, 1{11!1I1110W, >'0\11' ""'nlhl~' <lllIlIbllllY 11111011111 wplihl bu 11110111 , , , , , , , , , , , ' ,,$ 710, , If YOII UUI rollrul11ol1l or <lIl1l1bllllY l1unol1ll1, YOllr spnllHU IIl1d YOllnu ohlldl'ol1l11l1Y 111110 ~lIl1l1ry for bUl1ul1ll1, Suu PII!!U 6 lill' 1110l'U Il1fonlWllnl1l1hO\11 11ll11l1y bUllol1ll1" " Il'yolI diu, oprlllll1l11Ul11burll ofyollr flHully I1II1Y <ll1l1l1ty 1'01' lIurl'll'ol' bUllol1l11 Oil >'ol\r I'uuorll, SUU pllgu CI for 1\11 U1\ph\lllllloll 01' wllo I11I1Y qllIlIlCy, , If YOII diu rll!hlllpw, YO\ll1uu<l22 orudllll fnr YOIII' 1I111'1'I\'PI'II10 gul bUI1UOIIl, YOllr l'uool'lllIlIoWII YOII 11111'0 ul1ol1ull, If Ihuy 111011111 plhur ruII"ll'ul11UIII1,IIIOl1ll1ly /lUl1util1lmPlIl1I1I wOIlld l1u IIboUI; For your child, , , , I . , , , I , , " ' , ; I , , , , , , I , , , , , , , t , , , , . . , , , , , , I , ,,$ 5.55 For YPIII' 9p0l111U who III ullrlllll thr YO\II' uhllll , , , , , , , , , .., , , , , , " , , , , ,,$ 555 Wllun YOIII' IIpOl1l1U rUI\UIlUII filll-rullrol11UI1II1Uu , ',' , , , \ ' , , , , , , , , , , , ;', ,,$ 7,15' For 1111 YOIII' 1'II11111y 11\01II11urll, II' 011101'11 111110 <l11I1II1Y (lIIol'U ulllldrul1, foroxntnplu) , , .., " '" "" " """ , """ j '" , "1,' I , . , "I, t, I I $ 1,,295 Wu IIIny IIll1n bu nhlu 10 PIlY YOllr IIpOl1l1U pr ulllldrul1l1 0110-1111\0 <lUlllh bUl1ol11 01'$255, < Mulllcllru ho~pltlllllllll mudlclIlllIlIlIl'l\llclll~ II IWO,pllrl hOllunl progl'lIl11lhm holplllll'olocl YOII 1'l'\l111 Ihu hluhuolIllI or molllulIl CIII'U, 1I0llplllll hlHllrllllco IWl1ul'Ils (1'111'1 A) 11011' Pllr 1110 CDIII wholl YOII 111'0 1IIIIIu hOllpllllllll1l1 1'01' OUI'I1I11I klnd~ 01' IhlllllY-llp CIII'U, Mu<lIulI II1SIlI'1I110" hunol1ls (1'111'1 Il) holp PIlY 1110 cosls or II0UIOI'S'IIUl'l'lcOII, If YOII 11111'0 ol1\lIlUh WOl'k Ul'olllt~, YUI1 I1WY '1"l1l1fy 1'01' Mudlolll'u lIospltlll 111~l1l'llllUU III huo CIS, OVUI1 II' YUI1I1I'U 111111 wUl'klllg, YOII I11ny 1IIIIIIII'y hul'ol'u IIUU Cl5 II' YOII III'U 1I11111hloll or hlll'o PUI'IIII1I1UIII kldl1eY 1'1111 II I'U , YUill' IIpOIlSU IIIIIY IIluo '1"11111')',1'01' hosplllll 1I1HIII'llIjCu nl CIS 011 )'DIII' 1'0uol'lI, " AII1l01l1 III1YOIIU who Is 65 or olllul' 01' who '1"1111 1'1 os 1'01' Modlolllu hosplllll 1IIIIIItI\lICO CIIII ulII'oll for l11edlclllllllllll'llIlUU, YOII II111s1 PIIY 11IH0111111y pl'Ollllll11l 1'01' It, Fill' MIlI'U 11If'U1'III1\lInl\ Ill' Tn Cnl'l'uul Y n\ll' UUCIlI',d Allul' YOII rUl\(llhlllllllllul1lulIl, plOllllU 'oull I-ROO-537- 7005.11' YOII hllYU III1Y <IIIUllllolIlI, If yOlllluud 10 tUporlllllY 1IlllIshl!! 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FOl'mIlS,\.711l15.SM.Olt (I.U8) , @llllhlttl'l;nm'~h,tlrlllltt , 4 PPMMPNWr.A~TII PI"P~NNaYI.V(lNIA STAT/:: I=MP\"PYl=a' RI=TIR~MI=NT IWQTJ:M ~o NPIITII Tlllllo aTn~~T 'I',p, nox 111'1 IIARI\lall~f1!l,I'PNNaY~VANIA 1710U,11011 1997 Sl~A TEMENT lJ.lACCOUNT/or " , J^CQU~~IN~ ^ PORDA 33 I'~~^SANTON DR ~^ST P~R~IN PA 17316 67,7~O Tlw SIIlIOEl1lplorOH' f{o\l1'01lW111 S)'Hlol1l (::II.\I\S) IH 1'1011>>0\110 pl'ovldo ro\ll' nnl1\llIl 8111101l1C11\ qf ' Aooollnt, Yom fllnlonWlIllIslH ollle\llllllol\s bl1Hed 011 Il\l'ol'lnll\lon I'oportcd to rolll' I'otll'ement neoolll\t thl'lIl1gh nooomhol' 31,1997, Thoso olllolllllllonH 111'0 9\1bJoo! 1011 Onllllllldll by sims In 1I0\l01'(11I1100 \Vilh IIpj1llcllhlolllW IIml rOlJIIIII!lon9, For \lw ill's! limo, rOlli' Stlllon1On! IIslH Iho bonollollll'y(los) roq"hllvu nlllllotlln )'0\11' MII'0111011\ 11000\.111\, YOII will On(1 Ihl9 Inlbl'l11l1llon In r01l1' SllllOnwl1t lindeI' Iho hOlldlnlJ I'I'hlllIJlIII IIcnonolnl')'(los), Plollso bo s\ll'O Ihls Inlbl'll1l1\1on 19 IIH rO\l Wl\Il1 II, 1111'01'11.11111011 01111 Nllllllnlltlon of, llonollollll'r(los) Ibl'ln Illod bo/bl'o 1993 01' sll100 Dooombol' 31, 191)7, mil)' nol lIppOlll', Explnnlllorr Inl'ol'mlltloli Is II10hl(10t! on YO\II' Sllllol11Ol1l \lndor Iho hondlngs 1l'~NEl'l'r lCS'I'IMA.l'IC CODES, 1l\'IJIOH'rAN'I' INJlOI{MA'I'ION ,l\llC.\ 'I'I!:HMS .~ DlWlNl'I'IONS, UIl 9ll1'o 10l'uvlow rom Slntol11onl Olll'ol\\lIy IInd rO(l\ll1lt thl' flumo 1'01'01'01100,1 I' yon I'oollhol'o n1l.\Y hn pl111H910ns 01' dlsol'opnnolos In YOIII' SllIlon1Ol1l, rOll I1lllrl , ' · 01\1\ YOlll' sIms Ihltirol11C111 Counsollng (:onlol' toll'Ii'oo lit l.fl(l(l,1i33,54Ci I, " , 01', II'You wrlto 10 \lSI, ' , · 111010 YOIII' spooltlo 001100\'I1(S) or (l"oHtlon(s), lint! · IIddrCHS yoIII' lolto\' 10 sims; Allnl Momhorshlp SOl'vloos IllvlHlnn " , JI,O, JInx 1147 ' ,llul'I'lshlll'H,I'A 17Hlfl.lIoI7 YOUR STATEMENT CONTAINS PERSONAL AND CONFIDENTIAL INFORMA TION ABOUT YOUR SE~S RETIREMENT ACCOUNT WE RECOMMEND YOU MAINTAIN THIS STA1EMENT WITH , , ' OTHER IMPORTANT FINANCIAL INFORMATION , " 1997 Sl'ATEMENT(~lACCOUN11 " , fll/',' \lM)Q\I~~INP A PPIIPA 1'01/1' slrlll!/l/r/ll (-,o/lWIIIS (!In!l! ,\,V(.'({(lIf.\,,' /.iN~TH}N 'I IIMile IMT,\ ~NCTlnN 1I1/~\')7'!Mtl1'fm HI~'I'I'U';l\llilN'I' IIICNI~FITS 1\1' OF 1l'~CNMU'LH ;ll, 1\197 . ~NcTJnN 1II1 !r~l'IM..mm HIi:'I'IHIt:I\'''':1'1'1' H1CN'~li'ITS l'IH),JICc'I'Iilll TO NOHMI\l, HWI'IIU:MICNT "'L --.., -- u ,-~~- _.... tJ"''''''''''..:'~~__:''''J''~'-. _ SliC'I'InN II lIMilC 1>1\'1'1\ -. -~I~""--Q\~~- ~"...,...., -+~~ ...-- 11Pl'HIlIllllPIIIIl Spulnl Soullrlly NlIl1Ihprl So~l 1l1r1h Phlo: CpvprnB~ WilPI _ COlllrlbllllll1l ~OIU: CIlIIIIHUIlIlIl CnlllPP Nl1nnnlllollrol1lonll)lIlol _ Flnlll A VUrPBO SIIIIII)': 1997llullrpI1IoIII Cuvurod ""mIIlUs: TUIIII SSI Nun,Cuvul'ollllllrnlnBsl lulnl CovorilUu ConvorsllllI A 111111111I 1 MOI1c1ol~rY'Pohl: flu uu Cl'UI I~ of Dou, ~ I I !I!I? ~ Yours of Survluu Closs _ "yullrs ~r Sorvluu 2e,OlBO 2e,OlUB 11l4,42,aaa, FPMAI,P , 11-IlAN-' a!l4 r!l~~ -6,oO%, HARRISPURA pa"ppa-aoQ7 $a7,,02, all $a~ ,'oa4, 41l' CloftS -aD a&l-eo 'TO AI, Sf:IWIC~: 28,0100 1'1'lnoll1nl llunonolnrYllu~) "" -, SI'ICCIAL CONlH'l'lONS DIll' 10 Ilro /i'l/oWIIlIl rU(1.!OIl(.I), ,I/,uollll oO/ldlllo/lS (1/,/,(1' 10 >'o/lr bOllujll uSIIIIIll/u,1 01' u,llIllwlN lra\'U /10/ baoll ot/lolIl'l/lld: .'1 1\~I"'\llIt IInlnnpj! Iloglllnl' Conll'l\llIlllllla $08 , a'lrl, 00 $ 1, o~a, 0 1 H~I ~."lllrll'"lll1la \)uo, 31, 1990, tJIV"IIIlU CUlIll'lbllll11ns 1,II111P Sll1111iilYlll01lla Arrullrs I'nYl1lollls Crodllud lillul'lIRI YTIl ^,UIISlllllll1ls,' \)lIe, 31. 1997, tJ1I11II1ll1I 'I'01'Al-Ill'PUCTIONH $1,~70,DO $ao, AIl_~ .$00 , AIlO..J!.!l - ^",'onl'~ -lll1ll1l1uU liS uf Iluu. 31, 1 !I!I? 1\011111111' . SS! ' 'I'n~nhlu Ill'pnllllu\\'lI uf \'0111' Acel1"""'" TII~olllc COl1lrll,I;lllll\S $a 1, 800,81 I'I'IIVlllllsl>' To~ui CIIlIll'lhllllllllR $4 000, DO Crullllcd IlIlurcsl'(Tllxn\llo) $ 2 008, ~o \)UU, 31, 1997, Bnllllluu SOB , 200, OB ; .1' 'I[ )'1111 (//'0 ulIUlhll' 1111'1/1'<'11/1.1(1 III'ur//(',blo .1'<11<' ,1111/101' '1<111' ,1111(0 ,111I1'(00, IIoIIIIIV( )'11111' (l1f(/I'Ulllellll COIIII.lIIIIII' [IJI' lItfc>rlllll/llIlI 0" 1'11I'.-1111,,'11111 .lVI'\'lou, till rOI(IIU,II,I' 1II/'"r"/III,\'a' ,IUrt'/c" //1//.\'1 /10 j/lod 11'11/10 )'1111 uro 11/1 IlCliI'o, 01111/1'1"11/11111 1II0mber, ., 1tif<J/'1II'1/10I1 flllirl VII II NOII/III,I/IIJIIII[ /Jullofl<'lm:I'(fe.l) fi)/,/II befiJ/'u 1993 II/' sl/lou Du<', 3(. 1997, ()/' 1111'1111'11111 .Ipeolnl vll'ollll/.llIlIIoo.l (.111<'" ns (/10 ,10.1/111101/011 o[ 'III c,flolo ()/, I/'I(,\( nS ,1'111/1' bU/Iliflvlo/'y) 11I(/,1' "01 "PPCi1/', tl 11I1<11/111/1/1 o[ 10 hUlluflv/o/'los /1111,1' bu .1"0\1'11 '1<'/,0,' I1I'\I'UI'O/" )'011 /11'11' 1Il1\'0 IIIOl'a htlll,!/kll/l'/o,1 /11 ,\'0111' I'U((I'U/IIUII/ l'IJVOI'd. l\ulIl' ,\lOI/l' hUllujlv/m~' 1111/11/111/111111 "/lI"'vlII, 1'/111 /11/1,1' <'IIIII/IIU )'n/lr I ""lIuj/vlll/')' lIellll/1I1111/111 III III/Y I/IIIU b,\' j//I1111 II Ilun' MIIIIII/IIIIIIII 0/ J/uIWlv/III')'(fe,l) //lrlll 11'1111 S/:'I1S, Fllrll/.\' Ilro 11I'11/1""'11 /1'011I )'11//1' IIl1ul/t~' 1~lIr,\'Illlllol O!JIcc '" .1'1111/' ralllol/l,1 o\'/IIIS IM/roll/Olll (:11/lII.\'u/lIIII~'olllur, 1'luI"IO VOII/IIUII/,II[ ,\'11/1 do 11,1/11'111I/ )'/I/lr 1101I0j/<'IIIr,\'(/a,l) l/.I(uII /III /II/lira SllIIolllellH.l, ,lIT/) (l'eli1/'.7'o./)I/IU) ,hUIIS/llIalll,1 "'if/uo/ OO/'I'Ut'I/Il/l.t III )'VI/,. 1I0<'1l1/1II /i,r \l'lI/eh .l'1l1/1I1,.uc/l(,' hll\'o /'ccull'lId /101(11<'11(/"'" II '-'8/;/18 /,1 " I/ujll1ud Il<'lIujll ,,11/11 l/IId",' III/c/'IIIII 1I"l'ul/I/II Sc/'l'lcu Cod" SUC'I/Il/l ,/01 (II), IMPORTANT INFORMATION . UPIIPlll ERt'IIllIlIPR nrp Ilruvlllpll furl Plsnbllhy l~olll'ol1\ent, , , MII~hlllll\l Slnllle I.lfe Annuli)' (1Ilso known liS FilII ' I.)elllh In SWlu Sel'vloc . I,. yon 111'0 Willed IInd die I\ellrenwnt AlloWllnOe) . Monthly Pension pllYl110nt whllo IIl1l1ellvu ol1\ployo, II will he IISSnl1\e<l yonl'etlroil 111 lido to YOI1 for IIful bonenolllry(lus) roeelve(s) IIl1del' Opllon I tho dllY buforo YO\lr dOlllh, Tho (1rosenl Aeollllllllllted Dodlletlol1S, loss Monthly (1nnslon Vnhlo Ill' YOIII' 1I11,I1111ty will ho pnYllhlo to yoilr pnYlllel\ls yOII reoelvod IIl1l\I\I1y IlIl1\p SIlIl1 YOII rocclvud hel1ollolllry(los), It yOIl lire 1101 wstod, your IIl1dor Opllon '1. Aocllll1l1ll1tod [)Odllcllol1s will ho pllynblu to YOllr , 01111011 1 - Monthly Pons Ion P"Y1110111 II1l1do In YOII benenclllly(loS), for 111'01 bOl1uflolllry(1os) recolvo(s) I'rosont YIIIIIO, less M0l11hly (1ol1slol1 pnYII10llls YO\I rocolvollllnd IIny IIII11P SIII11 YOII ruoolvod lindoI' Gpllon 4, , Optllltl 4, At Nllrol11onl, YOII I11I1Y, wlthdrnw IIn 1I111011l1t oll 1111 I 10 ~II or III\Y plll't of YOllr Aoolllllllllltod Dodllollons, YO\ll1l1ly 01001 10 rooelvu Ihls wlthdrnwlllln , lip 10 1'011I' Insllllltllonls, II' YO~I, oloot this opllon, YOII I1Il1st IIlso, olol:t II Mnnthly (1onsloll pllyl110nl pllln, , , 1llsIIblllly Iloth'omell,t, . YOII nllist hllvo lit 10llsll1vo YOllrs or crodltod SOI'Vloe (cxoopl SllIlo 1'01100 mid El1roroolllont Ofl1oor.clltegory omployos, whll ItIlVO 110 "l11lnll11l1l118el\/loe, 'tol\"lre,lI1enl) IInd ho ce/'llflud by SHI~S Modlolll EXllm nors liS phY8101llly Ill' II1cllllllly Inollpllblo or pel'rllr\l1ll1l! ollrrunl Joh dllllos, Only 1I0tlvo, oOl1ttlblltlng l11el11bors a/' Ihosu Oil 10llVo wltholll PIlY , IlIlIy IIpply rot DlsllbllllY 1~011ro11101l1, YIlII Ollnllllt wlthdrllw YOllr Aoolllllllllllod I)odllotlons If YOII Inko __ __s.. ~1~CTlqN III P81'!Mil 1'1..'/1 tH~'I'IHI~I\'II~NT rIJCNIWIT~ i\~ nt" IlI~CJCMIII~H 3' 1 19!J7 7//{,\'m'((011 1)1'(1\'IrI~,1 (l1'~,I/lIIIIII~ 01,\'01(1' MOlllhl.,' ('~fI.,'I!JI' (llll~' V~'ol/ II(II'~ f!( 1(/(1,11 1(},I'~rII',\' (.Ih'I'(!lllIl/iI,\'(II'\'/~~ (II' ,\'0(( IIal''' rwwIWII,I'OW NO/'II/(l1 ((~III'~III(J/I( OII!!1 (/11/111111'11 IlIl,la,\'{ (law,wl/lw 01 ~Ndllwl ,wI'I'IOf, _ MII~lnlll,l~llllr(MSI,^1 Mlllllhly f'ollslllll ' $002,77 Aoo\II1\1I11110ll pOll!lollolIS" $00, OOQ:J!!I Opllllll1 $004,70 $200,414,00 , Opllll1l4 (AIUII!I~II fill wl11111rnwIIIIlf Mlllllll1lll1l~<1 P~i1I1~IIIlII!) AiUII!lod MIiI,A MUlllhly flllllSlul1 $700,01 AIUIISIOIIO lIun I MUlllhly 1'111181011 $710,04 AdJlIsIllltl'rosoll1 VIIIIIO Ulldor 0111UII 1 $11111,100, '/1 $1,000,00 nU1I11t In SllIle SOl'vlco $200 414,00 -=(-=<&"'''11'''''''' ---- ._ ~JWI'I()N 11I1 N\T!ilf,mm HJ~II'IHI~"'"~NT III~NIWITS 'IrH),IJ~CTI~1l Tn NPHMI\I, IH~TIHICI\'II~NT Ilt\:rl~ ....1Ll--r- -. . -- --,..........-... _ 1'/11,\' ,IIII.'/lrlll IJI'ClI'ldl',ltlfollllll.l' 1'~I1,,'IClII 1,.\1(11I111\1,1, J!l'ojl'Fl~d {O' .1'01/1' N!JI'II/(IW(IIII'~/I/~III /.l(//~, 011(1' ({YO(( (/1'(/ \l'1IIr/II I(I,\'~(//',I O/,I'IJ/(f' N(JI'II,(/IIiII(II'~IIWIII /laM t:.HIII,(II~,\' (lI'l1lJ/'(lI'{iI~11 jill' /IIl1.\'11II1\1 "/1/1011'\' (/.\ (l,1!l1lllallll'l' '~'111'1I(l1' II, nl11~lmIl11l ~.1Iru Allnlillt,ThlSI,t\) , Ivh'llIh[Ll'ulI,lulI $2 ,270_J!!L AOIlIlI1\IIII1\od POIIIIOi!~II' $01 0 a aD Iv\lllllhl)' 1'011811111 I'leS1I1I1 VIIIIIO_ OpHu $ a, l!1!lUJL $440.041 ,4e ' " " GI BOllonl E~lhl1nlOH nH,~lIl1lol 'Your 1\11111'0 olll'llhll!R will bo IIlIl snl1lo I\S III 1997, , YOII conllnllo hI your prOSon! ClllSR of sorvloc ns II 1\111-1111\0 ul1\plpyu, . Retlrol1101l1 Inhlos nlld I\lclorR 1'011111111 tho 8111110 liS thoso II111S0 01\ Doo, 31, 11)1)7, . Any Arl'Olll'S 1llllllllcO will ho pllld (eXooplloll . thllso Inombors who nru clIrl'olllly vosleos 01' 111 n I\ltlollllh sllltllS)" " , YOllrolll'l1lngs, will not oxooed tho fodorlll soollll Soourlty tnxllblo wlIgu hllso IIl\et 191)7, , JollII COI'OI'II11e Is convertod tll FilII Cllvorngo prior 10 O/' III tho 1111I0 0/' rotll'ulllonl. ' CIIII'./,/Irwd ,!"I"/I.',k /1I11ll' , 1\11)' MlIllIhllllrr P~11I, willi IIpproprllllu II1IUI'OHI, hll!l \luYII IW\lIl1rlllll)' rUllIIOol1 1'1'011I IIw I'rOH\1111 YIlIII~ of )'0111' 1100111111\, NIIIPllf)'(111 IIIlYu 1ll'011lluII Kol'I'loo ilK II Mlllllplo' SurylllUI1lUl1lhul' (HUl'vlcu 1I1,I'olh SI\I~H 111l111ho I'llhllc ~oh\lol Illllplll)'US' l~ollrUlllol1l H)'HI0I11 IPHI~ltHll, )'0111' osllllll\lo Ilpull IIpl Iiwlll!lo )'0111' PHHlts col1\rl\l'IlIIlIlH, YOIll' Korylpo IIl11Y 110 OYUI'Kllllolllf III 1111)' 011101111111' )'0111' , )'011 11111'0 COllolIlTenl Horylou, 'OthPl' Mllnlhl~' POIINlnu pinus (nn1 oNlIlI1l1lel1 he I'll) 1\I'Ili ' , Opllllll 2 111111 11pllll11 3, whldl 111'0 hlllioll oil YOllr 1111111 of hll'llll\llIl Iho 1I!llo of hll'lh or )'0111' IIUKlllIllllel1 Hllrylypl', Thll .\'0/(11,1:0/' )'11111' Klll'ylyol', Ihu 10\1'11/' YOIII' MIll1ll1l)' PllllHlplI III11PIII1\. Folh1wlllll )'PIII' dUlllh, Upl11111 2 ppl\'hlu!i )'Illtf HIIl'ylyor Iho ,)'(/1111' IYhllllhl)' 1'0l1Kl01I )'011 l'oCIlIY411, whllu 0,,111111 ~ pI'PYldeK~olll' HlIl'ylyor PI/l'. hilI! Ihu MOllllll~ Pel1slol1 )'011 ruclllwll, C0l1111cl rOllr SH\tfi HOIIl'011l01l1 COllnKolol' Ihr pll)'II1UII\ osII111111os 111\1101' Dpliol1 ~ 1\1111 OpllplI 3, TlmMHISL Ul~FINITlON~ '" 1,'oI(O\l'II/!I (/1'0 rll'/Il/lllpl/.I Ilf IIII'll/.\' ,u,wrl III )'(1/(1' .1'1011111/1111/ (If l/oC(lIII/I, fi'pr /IIOrl' Il!/ilNllollr% n:fur 10 ,I'our SPR," MomhH 1I111111hllul\. ,\qollmllllllollllollllllllllllKI '1'01111 of' UPlllrlhll\lonK 11hlK Cl'udllod IiMroKI ellnwd Oil )'0111' 1'0111'0lllUnl !ICCPllnl, , ^ollvo MUl1lhuI'1 All umploYu Ihl' whom OPl1ll'lhl11 \lIlK IIru llOlnlllllnllu Illlh~ FlIlld or wh\1IK OIlIU\lI'U wllholll PII)', ^IlIIlIUrl Thu pUII~lollllllIIUnl pllilllll m\1lllhl)' h\~llIlImullls, , ' MI'ollr" 1\lIlllllUPI Tho hlllll110U owull 10 )'ll\ll' l'ullrOll\oll1 IIOCIlllllllhr which )'\111 III'U nlllkll111 PIIYl'l111 dodlloliollS, l\ulloOullll')'(lu")1 Tho pursol1(s) 01' lltllll"ll,lllioll(~) )'llll 1I1s1 <IO!illllllllUd III wl'ltll111 10 SHI{S tll I'ocull'u 11l1r l'ol1\lIlnlnll pllllKloll \lolWnl IIplln YOllr dUIIIII", " CmwllI'I'unl SOl'Ylco, SOl'vlou 111 SI:I~S 1I11111hu I'lIhllo Hohooll!mployoH' l{ulll'ul1\enl syslum (l'slll~S) f'01' whloh )'011 i, oOll\l'lhlltu 10 holh s)'s\ol11s IIllho slImo Ihnu Ilurlim !Ill)' YUllr 01' nlOmhurKhlp, " Cl'ofll!ull C1I1KK III' l3urvlool i\.(iU . NOl'lnllll~ullroll1ul1t AllU or 60, ^.5l1 , 1'101'111111 Rollrol1\enl AllO or 501 C. Norllllll l~ollrull1UlltAllu of' 50 IIH II Hlnlo'l'olloo amour or Oil1i1rcul11UIII pfl1ocl' whoso surl'loo hOYIIII prior 10 MlI1'oh I, 19711i , n.~. NOl'lnlllltolll'uIII0111 Aile or 50 liS 1\ mUll1hul' orlllu (IOllorol Assumhly whoao servloo hognll prior 10 MlIl'uh I, 1974, )~.1 . Normlll Rollrul\1ulll Allo 01' (10 Ihr 1ll0ll1hura of' Iho JlldlolllrYi 1';.2 . Norll1l1l golll'ol1lOlll All\l or (10 liS II PIKlrlol JlIsIIO\lII'SlmS' SUl'vloowlth Iho I'lIhllo S\lhooll;lIIphl~'US' I{utll'umolll Syslom, aSHlI. Nonnnlltolll'UIl1U111 Allu'ol' 601 sal.~lI .NlJr11\1I1 Rellrul\1oll\ AIlO or 50, II' rOil hllYo IIIlY ol'ullltllhlu SI!llo 01' 110llK\IIIu sUI'I'loo mil 11lOIIIIIu\l, oOlllllot rOllr SH\ts t~qllromullt COllllKelol' 1'01' Illlill'l11l1l1oll ol1l'lIl'chnslnll slloh ul'udlt, 111/ I'VIIUU,I/s (0 /Iurchasu sU/'I'lcll IIIIISI "uftlwl whllo )'011 rlru 11/ 11// (Icl/l'o Imy ,WI/liS, " Cl'olllloll (Ul' SIIIIIIIIlI'Y) IIllUl'osl1 MOll1hol' IICOOlllllll1tul'UHI sui h)' IlIw 111'1 pOl'cull\ per YUlir, oompolllldud 1I1111\llIlIy, Flnnl ^VOI'IIUO SIII"r)', Thu IlYOl'IlllU slIllIry of' Ihruu 11011'01'01'11Ippll1ll perlodK or f'Olll' oOI1SUClllll'O cnlulldlll' 11"lIl'luI'S, Trplollll)'. Ihls IK tho IIVel'lIgo of'lhu hllll!usl Ihl'oo )'\'lIra 01' 0011\pol1slIlIol1, FilII CnWl'lIl1o l\oIulllhol'l AllY 1I1011\hor Il1l1klhll rU~lIll1r 1110mhur eonlrlllllllol\s who JolncdSnltS on Of, llliUI'Jllly \, 1\)6,1. ,Iullll (:nvofllUO\,For, mombol's who Jolllod Hl',lts ho\woon Mny 2H, 11)57, IInd Jllllo 30, 1%'1, oluctod Socllll Sucllrll)' oovurllgo I1l1d pllld II rodlloull rOlll'UlllOI111'1\lO IlIto SIlI~H, Mnlldnlury nohll A dohl 10 ho snllsnoll IIllho 111110 of' I'olil'olllonllhl'ol,gh \lIlIlCllllIl'llIll'udllCllolllo tho I'l'uilullt YIIIIIO of' thu ,molnhur'K 1100011111, , NUI'mlll' Hoth'ulllolIl 1llll0/AllIII AlliO ellllud sllporlllllllllltloll II11U, 1I0l'mlll rUllromol11111W lill' l1l\lsl 11IOmhul'K Iyplolll\)' IK 'lIgo 60 wllh III IUllsl thl'uu YUIII'Ii of' oredltod sUl'vloo or 1111)' IIllu IIpnnllltllllllllll 35 )'CIII:S or crodlted sorvlco, Whlehol'ul' OoOIIl'snrst, Allo '0 Is lIormllll'ulll'omul1ll1110 1'01' IIl11umhur of' Ihu OOllu1'1I1 ASKomhly, IlII ol1l'orcol1lulll omour, II eorrccllon 'OrnOUI', II pK)'ohlllll'lc Hucllrlly IIldo,11 DollIWlIl'U Itlyor 1'01'1 Alllhol'ily polloell1lll1, 1111 ,ornour or tho l'onlls)'lvIIIIIII Stlllo Pollcu, or II l1Iombul' or III1Y othcr momherKhlp ~l'nlll1 sllpllllllell hy luglslllllvo rel'lslon or Ihe I~QIIl'umul1l Codu, " ' ')'I'osol1l Ynlllol Tho lotlll 1'111\10 or II mumhel"s l'ull'UlllOllt IIccollollhlll I\mlls 1111111111>: pll)'mollts oVer his 01' her lIf'olhl1ol this nlso hi Ih\!1I 1\1 1111 II I pllld lOll wHlud 1l1Clilbur'H hUl1ol1ollll')'(lus) who II II vosto\1 !lIumhul' dlcs III Stlllu sorvlco, 581 (Sudnl SuolH'lt~" III\UlIl'lIllulI) CUlltl'lhllllllllal For ullglhlo mOmhel'K who oleoted 581 cOl'ernllU, 11\0 \01111 OOllll'lhllllollS 011 ollrnhllls excuudlllu Iho fotlol'lIl Sllcllll SeclIl'lI)' tllX hllKU lill' 111\ YOllrs or S81 oovul'l\go slllco JIIII, I, 1956, Vosloo!Voslolli l:JIglhlu In ruooll'u II SllItS 1\101l1hll' pOliS 1011, ' Ij lioJ/l )'O/lr SI"/l!I/I~I" III II ,III{l1 (l11It't', .,.IIu'I'I,\' II $.1 dlll/IIII fot III/t'II IIIII'/lt'I/I" ,\'IIII"l/Iul", 'I, , COMI~ONWEAnIIOF PA '~ EMPLOYI STATEMENT " .. "-'.'. - ~VL1l~!"~UlI~l'lt~"I_ilAlfU~"1 Jltj~~..,!U. ~Q#1+- , Pllm !AlI~WPS " Hill"" " f.!~ 1I!~~l pHI"')U \,IPI,'O ~t~,PI~!ggol~~~~~1 01-1"-'& "11"1\1 p, IlI\OIII 011' I al ,0.1 ., _ 00 l'l! ill' I~ 00 IIPOOOl! la~;i& 'fIIP: ' r. I I~~'I 017~9l POSi' 017191 jlA' Ill-~1.oal~ S~1l 11l/~"1I TX l~oonl 3, 9 jlll I!a VII! n'l 0 ' ITlI' ,I '1,10 mn III IX ~A a ooo~ !:M II 1II01l1lliTt Pllol~r. II ,I h 0\' ,IIIH 1l0llllliH I~r. ~~ T -r '! 0\ 9111 00000' l:!~d t:l 'II [:0 tAn: 1111' , , oOoW o,aa r ~ Itr :nll' ',on I! OIlUS 1,00 IT IlIn iloilO AI' a,Oo , 1,00 , I' HAPrrlN~ n 1I0~IJ~ 3 I,!AATNPI~U HAB ' HR~'N flA I ,In " I, , V),II, , 1Ii'T IAlIIIIIIIISI l,m,lo mu PAlh_tll!lli.l1 "'" , , 1'1.IlS 1IIiltl01l0111llllTl --- -....---'---. ~r~11I t8~l~~~' IIIAPlI!lIll1loA .01l1l1lAI, PA ~ohi~~I~r.lI'lTY ~m milT 11m IIIPIOVII RH iVS \ I." "EliEPI1S USTEU !DoVE r.OlllllllJE AI FIJI,I, VAWL- n'~.,", 'PAlomVl,llAHlIllIT , mAl. ollllOT illl'om AIIOIIIIT ~ 1,0",70 , , , IEIIV\CI CII'II111 10 YII U PP " ;c'::,cc"II~VEUIAOO PEroRnn ,,' ...-- --::-Oaii'"~"""'" I1n ljiil .'!]ffi.i\PiiHiI oll01ili~iir -liiiiT~=- :""""ATE Oll~ pr 1110 ------- ON1-11 AIIHIJAI. \0,00 ol-IHO Rln III. 10,'00 It,ll \,106,10 , , TOIAl 110011 HAPHIHOI TillS rAy.." " ~ 1,10\"0' lma AoTlYlTY " AIIIIIlA.L ' DICK.. " PERllll/AI. , , 1~~RI1V II/FOlillATIolI ,'.,., " --- ~ t~~~U~k \~ll rATElliHT " 3'0, ~O 611,11 ,no ~'Lg 1,00 V I H Tl~IPP I~:og ,00 AnJ n I ,00 :00 ,no mAH lit I STilT 313,18 818,16 7,80 - , > ACr.RUAUATE\ AHHUA\, 10,0 % oler-Doll , H~~~~~Mf~~E~h li~M~~l TAX r.Olllllm~~l~l:hvl , !IlAIIS COIIlIIY 1I1!1l1l10 ll1P, " flIT \ AX Pllaas I l,lSl,ll '1,1 " " " " " , " ! ~ ~ , " " . ' CPMMPNl'leA~TII PI' peNNeY~VANIA , UTATO eMP~PYee' ReTIReMeNT uYunM . j. UTATffMeNT PI' AOCP!lNT AU PI' PeOeMQeR 31, 1 QQo '1\ ~nnu~llY lhl ~\'Io r~lar"l H,llro'lOlIl irl\.,~ IHlliI pI'avlII.. f'.h 10011'/>01" llil!!,ollrr.l1\ "'\I""",'~\ 0.'PI1l11 tnfar~lfal1 whloh Iholl\ll ~. 11010111 111 I'!\<loro onilll1u lho Ilall.rlt. "roy 11011 I'Y 111. 1'0\ r....nl I' "1 01", II 11011" (11\'"0 ~\ P't/"11I1U, '~\O I\il~~~ ~I proPlI',II lolllU 1"' 110 . 1'0001'11." 111 yallr 1'6111'."""11 000011111 JI,'nq'..P...ti1IJ'!1'nl1, TIOp9~1 JlI'~ I mil qpJ 10 Itn~\ 01" "y hl i ~ n .o.brllll,., Wit 1 o~p'l.q~l. low ,nd roulllo\ .11', ~1-"II"e R\.I'.R '11 Il~Y Keu DIPO r R M~P 1\ r ~NrallMATloN AQOUT YPUR DTATOMON~_ OJ) .s~n 1 ,~ I'lIrrlHrp Frill JAoqUel,lNB A elJIIIlA po P~BASANTON PR1VB BAST ueR~IN PA 17016 iUI 1D'1--1~'1I001 1'.10 of "11'\1\1 II-JAN- 1011,1 io" I' lI.ulol1 0",1.10'/ \. ^ 1I0r~III 'I.JlrOfTl.II\ n',I," !'l-nr,O'~007 /' J~ 01'0' 'YI \'l.rYI, eo II a i\ v1t..~ I" ~ 'A-~o ~~, lIr8 \., SSI-UO ~,1,011l6,... ')\' - .IllilWJL i.i1 CaYOrOUO hpo FIJI. I. COlllrlllll\l.'1 "'1. , FIII.I ^Ylr.uo i.lory , , t." 110\11'....111 Cov.rocl D.rnl"UI I iil 1I0n-Ooyor.II torl1ll1Uo " J.II1lII.y.r.uo convorofol1 M\olln\ I 1I.l\Ilo\ory P.~I ' I -----TA~API.e PReAKPOI'IN ar AOQOIJNT-.-_n , II,OOY. $O~,660,6a $~7,~ao,0? AQQOUNT PA~ANO~ a~l,"o, ~o of 1~-~\-9S .... ~lltYI\y Pln\rlbll\lallo ~\.". \1'" P,Yl1101I1\ Arr.lrl r.YMOlllo A<IJllotMO~I.' 01'0<11\0<1 In\ornl $1,040,00 a.I,~ol ~I of 1~-~1'96 $oQ,0~O,99 ~rrurl hl~l\o' II 01 1~-31-96 - " -AdlultmenU rellent carroctlonl to your nncount "haUl which )'(JudmvQ l}CIon notUlad, ' '. , . . ',S.II'lll u\I"",\.. "0 Pr,.Jlorod for /noIl'I>." .ho h.v. r..oh"t '101'1''''1 "'"1'_'/1 Ira 111<1 for merr/>.ro .ho h~Y. 'I I.u\ \0 y..'rl Of arId .11 nrvlo. lor "'uUI.r 1I01Ir_nl~1\I1 ~I I.nl S yan" a oraclll.'llorv 0" II' Ol..b II\y 11.111'_111 1i1~lo 1'01101 'nil Enf.rQ....III oflloo" h~vo nO mllll"'", l.rVloa r.~IIlr""nl fOI' IIlonbll Iy r. lr'MOIII , " II YO,' 10rmll1,l. prior 10 .11,lnlno .IlOI~llIIY, lor IOOIIIhlY b.nollll, Ih.1 II 01'101' 10 1101.",1110 v"hd, Ylu woul" ~. .nl,lllI>\1 III r.oilv. rIll I' .anoUnt ~'I'"ca mllll" .IIY <Iobll I. Iho O""""'"'..'Ih .. 01 YOllr ".1. I' hrmlMllolI, ' $OP,QOp, 1~ , $""O~,P7 To'-OI!lrr.d Conl"II"IlIolI' t rr.Ylo!I,ly T...d Conlrlllllllolll t Cr.dllacl 111111'..1 . loolllnl a.l~no. '" 01 13-31-96 $19,949,00 $~iaQo,Q9 $1,1 , ggll, 40 $00,040,00 neNEPIT ESTIM^TE~ PU~~' ROTlRHMeNJ - Till' aptloll proVldOl Ih. ""1'1..... IOOrlhly hon.fll' 10 you I.r Hfa,'U )IOU, JO beforo roealY 110 raUr"tohl l\CQumu atent dOfIUo, ani, "'D b. '"0' .111'1'. p~1 10 YO\ll' bln.1 a ory 1.11. OPTION 1 - Thlo 1"llon provl"ol r.'hlolcl m.n\hIY ~onoflll Ir Yllllllr 1110, All rnon\hh bou.rll' JNI JOUUQ6( trom "/0 Pr041'H1 V.\luu. Ah~ bot Am:u f'Ul1t~ lI111U ~ your doith wll110 p.1 10 your IlOlIof olorYllnl, " PRRUNT VA~Ue - PO'lh aon.fllllnd" Opllonl '1' . do.lh In .tol. 10rvl,., OPTION 4 - VoU m.y rO~'.lv. ,II or . "01'11011 01,'0111' ftQCU""I.tod doell/ltlolll 1001111'1"'"1011' .'-1 l~torOlI III. 111"1' ..In or III.t. 1m.nl "'Y".,1I11 .11<1 ron.ly. reduolK monthl)' bono I" under one or the Dlhar rettrDment Qpttonl, Optf6n 4 II ~y.llolll~ only.1 11.'llmo of 1'0111'0".111 .nd m.y nol ..oned rOIl!' .00,,,,,,I.I.d dedtlcttO"a, '" I, ~UI.~ ROTlReMeNT APJUSTEP UNOOR OPTION 4 apTIaN 1 AP~USTEP UNDER OPTION 4 AOJ'US'rEll PRESENT VA~iJll UNllER OPTION 1 \11TH Ol''rION 4 CII'i~~~\_'\ 0' - "roJ.ol." to liar..! 1l.llr....llf $700,61 ", $'/70, 10 $ III I ,007 ,17 " $~O, 040,00 ',I " , MAXIMuM (lISAOILITV - YoU mllal h. "'."Ia'''r I.rllll,d ~y SEilS If.dlo.1 h.mlll'rl to b. phy,'u'11y .1' '101I1.11y "'o.pohl. I plrformll1U yoor IIIrr.nl JolI dllll." OPTION 4 \lITHPRA\lA~ IS NOT AVAILAO~R WITH A PIBAnI~ITY ReTIREMENT,;, ' ;REFER TO OOPU II 'rHROUtlH R"ON THE IltVERSE SIO, or- THIS r-URM r-Oll AN EX/'LANATION Of: "HE /,OLLO\lINll,;OOIlU As THEY APP~Y TO YOUR BENEFIT ESTIMATES, 0 $000,9-1 $Og2,OB $1411,000,10 $I,4Q7,OB '" " t\OOITlONA~ RnTlREMONTOPTlONS ARE ^VAnAO~E. ,PLOASll 'rE~E"HoNe YOUR seRS RellloNA~ ReTIReMENT OOUNDllLOR TO~~-PREE (1-aOo-ooo.tl40~') rOR QUESTIONS coNoeRNINll YOUR OENePIT RIGHTS OR THIS STATRMENT ,01' ACCOUNT I ' . .. " i , . lMl'JUIIAIiL!til'.RI!I1I1Illltf.IIl!P..YI -'t nl!ILllI IIHI>.mNr ~~Y TO n<<N~pn <<,fiTlM,(l.TA CO!!l!fi - ("HI 10 OI1P pI' I~pro of 1,111' folloWllW I'PO\l1l110, "1'""1"1 Olll1rll\lol1~ UPPIY 10 VOIII' !lpnUflt OQf11\1Qtop pl\ ilip Puf(m\I\II11 11PV" 11"\ I,prlll OolOlllDlprlr A yay q40\ IIy PV loW to Ilnfl'oozP yO\lI' rl'OZPI1 ')I'PIIPI1\ VIIIIIlJ 011<.1 IlnVP II fl'lllll" p"IlIlPI11 VI1II111 <.1111>\, VOlII' potlm~top 11PVp PoPI1 0010111011111 oO"PI''1ll1llly, WU OOI1,IW\ p,'oVI<.I1I yUll Wllh P"lljIlO\ll<.l fjUII~'o\lIo nl 11110 limo, n YpUr~0004nl 111lP nol poon o\l"lloQ py 6f:llfi, " o VIl\l 110VO ~ frozon pl'paonl Vlllqo, 'p YO\l I,.vo Olp.p P qUI'Vlpo, , r: P\l1' rOOllrQo iMlo"lo VP\I Wol'o om~pUI1I1"IOl'l llll' II'UII \11011 l,nllO hOlll'lI 111 01 11111111 a of \llll 'ofol II YPDI'II, I' Tll0 FOP AI'I'\\rllltPI1 AW.I'<.I 10 1110111<10<1 111 VOlII' "lll'1'0111 Illl\llIll1\llU PIli III 11111 111011nJarJ 111 OI1V pI'oJolllarl ollllmol.a, q YollI' 1'''"01 I I oU t I mo 100 moy Po \lI1QUI'o 10 10'1 1'\100\1,,11 voq <.I I <j 1101 l'I'"nl VIl fqll - \ I mil OI'IHj 1\ "\II'lna nooh 01 Iho 10PI 6 yoorP, Ii V041' rOlll'amonl .n<.l QPothPuI11lll1 oollmoluo ol1oWI1 001l111ll0 VO\l wilt 011101 10 oOI1Vol'l \0 filii onvol'U{JQ, ,. Vp\lr ponor I I opt '",olou Inolll<.lo on odlll\ 101101 lJOl1uf I I dlll'IVod II'om YOlll' Pll1l1,I 0 HUIl\lI"I' AOOlllntilolo<j Po<l\lOllonp, 'J YOIII' pl'ojooloq oollm.loo moy po 10WPI' 11,,10 Yool' IIW' 10PI 1'0001,"11 VillII' 1I0\11'0IOPI1\ QOVUI'O<.l r:a"l1lnlla Wllra low"r \hlo YOal' Ih~n 1001, " ' K 'YOIJI' ol!rranl,pnnolij ullma,lon I~O('O ooloqlal"q WillI Iho Uao 01 Iho oarlv l'ulll'0IOUI11 "wlnrlow" rlAI1a In 01'001 Pooompar Oi, 000, Thla Wlmlow pOl'lo'1 Wlll0101l0 JLlly I, 1007, I. V04 haVo 1I104fflolol11 oOI'Vloo O('odlla 10 q'lallry Ipl' 0 1'0011101' l'OIH'omlll1\ punolll, M YpU,I1nvo Il1o\llflolonl "orVloo ol'oql\o 10 Qllollfy 101' 0 dlnolJIII\y 1'01I,I'ornoI11 pOl1nf 1\ , N VOl4 haVo IIIA\lfflo10111 ullrl1ll1llo qual'lo"p 101>0 L1pod 10 oololllolo ruIII'0100111 pol1ofl\ oallmaloa, o Moro \llan Ion yooro "omoll1 10 1101'1001 ruI,ll'umunl doto, " , P Yoq 11~VO oll'oA!JY I'ooohod 110rmo I 1'0 I Irarnanl oao, Q . Thla AlololOOnl 'n01\J~oa yoqr Ol'odllo~ OOI'VlOo Wllh PSEIISI 1'\11 o~e1\J~oA 01 I P6HII6 COI1\l'lp\Jllonal , ll,orntoro, Ino mOl1lhly onnllllY ponoflln nllor 011 OPII<1I1 , WII\1dnoWol o,'u ovol'alalud, In 0<.1<.1111011, 5\010 urv 100 maY po OVal'a 10 lad I I t 11 OilY 0.10,11<1.1" voor YOII hovo 00110111'1'0111 011I1', loymal11 (0011 I"'IPUI 1110 10 I'SHIlS Wl,ll,lo,pollvolY oonll'lI>\l11111l to SHIIS), IF slTlisA UTUATIoN APP~Ipa "0 YOU, OONTMT YOllR AsTXAPMsNT COUNs~~OR PRfOR TO RPTfR<<MsNT To RsOPIYP A MaRs AOOUAATP hsNsl'fT SSTfMATS, ' R - YOIJl' 04rl'anl M<.I/ol' PI'OjOqIO, q oollmOloo "1'0 \'ono<j 011 Alloao rolll'omol1l, olnoo YOII mll.1 11.VO ~o VO.I'O 01 orOQ I loq oorv I 00 op 0 001' 1\0 I Po II 00 Off 1001' or A I I'Pal' I Po II 00 PH 1001' 10 qu,," fV fOI' Alla 60 1'0111'0100111, /lQttreJll!!nL~l!fLh;,ntn!lg - 1I10ludOA all oalol'Y nnd WOOOO (oxoILl<.la. pOI1\Jooa and ,onah nWol'~n) 011 Whlel1 aonll'tb\JlfQiio Woro mooo 10 VOIII' ouooUI1I, l!lnllLA~nagILi1.1A~lMIU -Tllo Ilnu\ oVol'oga pOlory uOnurn""I 1) 'you oonlrlbLllod 01 10allt Ig q\Jnl'lol'aL olld g) VO\J 01'0 a lull'lImo ornploya. IF yoU PO NoT MssT POTH or THsBs OONPITIONS, YOUR CORRsoT rAs Wl~~ As OA CUl,ATPe WHsN You RSHRs, ", 'AI'l'aal'. h1a!lllJ! - Tha polonoo owlnll 10 yO\Jr ooooLlnl 101' whloh YOl4 01'0 m.'<l111l p.Yl'oll dodUollonn fpr tllO punollPQIl of nOI'V I 00, /lIJl1Ila1gl1Lfl.lllU. - Tho omollnt owll1o tp vO\Jr rat lI'amanl OOOOUI11 opolll whloh YO\J hovo POOI1 110t (I lad PraVIOllolY, Thlo ~o\ll" 10 to pO pollpIlo~ at tl'o' limo of your I'0111'amo111 111I'01l1l11 on 0011101'101 l'odllOllol1 ,10 VO\Jr PI'Ooonl VA \,\10 , '.&Il.LNl1n'OeVol'otf h~1l91l - Hol'nlnllo whloh aXOOO<.lo,1 11'0 faQal'ol 500101 60OLII'IIY IlUOU fol' all VooI'a 01 551 OOV~I'.llo alnoo 01-01-60, Tllaoa oorl1ll1ll" WOl'a uanet 10 <.Iotol'mlno VOUI' 551 bOl1ofl\ OI1Q 0,'0 Indl\ldoq 111 YO\JI' ,Panol I t oat Imoloa, i' Oredl ted c1 US'" of Berv I o'!I A.ao - NOI'1001 110 t Iromont Ago or ao I A.ao - Norma 1 110 II l'omul11 A'!lo 01 60 I 0 _ Norln~ 1 RollromanlAgo or 60 an a 61~~0 Polloa Orlloor or~nloroomul11 OHloor Wll0ao sorVloo POOOI1 PI'lol' 10 00-01.74, p.o. Normol 1I01lromonl Allo '01 60 00 0 1lI0mbal' of ~ho 001101'01 AaoernplY whoao a..rvloo pogOl1 Pl'lol' 1000-01'741 ~-1 - Norm~' 1I0llro,"onl Ago of 60 fol' malOboro 01 Iho J\JQlol.I'YI S-~ - NOl'm~1 1I0tll'om~I1IAllo 01 6000 a Qlolrlot J\lollool PSSRfi - fiOl'vloo Wllh tlla PUbllo 50hool Hmplovos' 1I0t 1I'01no111 6ysloIIII fiBI.aO . NOI'1001 RuIII'srnol1\ Ago 01 001 SSl,,~O . NOI'mAI RetlrelOant Allo 01 DO, ',' .. II VO\l h~v~ OIlY ol'odlloplo Slola 01" 1101101.\10 oOI'vlaa not IlIolUdocfj ,6liLy.gYll_AliURliMIlJiL.mUlli!l[I.11R fOI' l/1tol'm~llal1 on PUl'ohoolllll ouoh 01'0"11, A~L ,RSQUSfiTS TO PURCHASs fisRYIOp MUST 06 rI~I'-p WHnH IN ANAOTIVll PAY fiTATUB, .,., ' , , " tf9rJllal Rotll'oment Ago (NRA) - If YOll will oohlllVO Oll yo~ra 01 OI'OdllOd aal'vloo ""'I';I' 10 'tho Olla Ihdloolarl opov. \Jlldor OI.PO of 60l'V f 00, YOllr NIIA pooomoo YO\lr ~1l0 011 1110 clo 10 you ~0111 ovu 06 yoara 01 ol'aclllod aOI'V I 00, .H!!.tJnB.LIllU1r.iIJn!mLgall! . Tllo dolo at whlol1 YOll will oohlovo NIIA, bSIIIl.f*T ESTItM.ID . AooLlrnpl 10110 llood to proJ 001 0011 mo 100 I I) f\lllll'O oorl11110S W t 11 PO t 110 soma sa 19661 Q) YOI WiT1 oonlll1\1o III YOUI'I'rUnaI11 olooa an 0 It''I-llmo am/JloYOI O)I'ollromol1t loblso 0"'1 foolora will I'omoll1 \11< aamo oa \11000 III liDO 011 12'01-001 4) OI1V ol'"s."o bol0l100 Will Po paid (EXOSPT!ONI Iho.o Irlslnbaro who oN. oLII'rontlv Vunlooa or 111 0 Iurloullh 0(01110)1 D) YOUI' 001'11 I 11(1 a Will 1l1l1 a.ooad \110 rodol'~1 500101 5001l1'lly loxoblo W.IlU baoo ortol' 10061 0) YOLl 0('0 ~ I\JII coval'ollo marnpoI'1 Ol1d 7) YOUI' mandolory dobt, W1\h oPPI'oprlolG 11110roal, hoa POOI1 ootLlarlolly ra,lu"ad 11'010 YOLlr I,rouenl VO)llO, lll!lAlll.I I IiI - To bo ol'lglblo fOI' 0 Qlaablllly I'atll'omolll, YO\J mLIOI hovo 0110001 G YO"ra of orodllad 10l'Vloa 1010 '0 100 and Hllfol'aOllllll1t Off 1001'0 havo 110 mllllrnllmool'Vloa I'O'l1l11'omal1t) ""dbo lOa<.lloolly 001'tlll0' ,by SSlIfi Modloo HXOIOIIl~,'a to bo ,PllYaloolly 01' mal1tolly 11100"oplo of pO"for'lOlnll yo",' ourrolll Job dLltloa, Moolll1\1 thoDO oIlOIPIII\\, l'Oqlll,'alOlll,1la dooo nOI gUol'Olllao YOll 0 llal10f It , In ardor to O""ly, 101' 0 dlaoJ;lllty retlrolnllll\, You Inunl \lo 011 sollvo OUIlII'lblltlilll mombar 01 5Hll~ 01' bo 0 1001.bol' III "" fl1oottvalaavo WlthoUllloy 1\o\\Ja, Roo YOUI' 110111'.10011\ OO\ll18alor fOI' fLII'thol' <.Iot"'la, ",' Kaop thili .tatoment th e Bofo pln'eo, There tB e $0,00 ahorllo for tlu,,' tcate atotulOonh, ! ' 111 \ha avont'", YOllI' daoth, OilY balla/Ita dUo will bo "old to your' 1I01.lld ball0flalal'Y(la,,), If YOllr 01'0 UllbuI'O ~I wholO you ho.vo etoalllllotaet, yOLI ahould UI,doto Valli' bOl1Oflolnl'v(loll), 500 YOLII' 1I0ttl'01O""t COll11a" 101' fol' \ho F)ropot' fot'M, _'_..~..... Cj)''''''~'\''';'' ", , , " 'O~\'lIalll no~p\~\1 , Iln(\ 1I11!\lth ~ll\'Vllllla , , , Fftllpnl Flnrno\pl Qprvloop Popnllmol1l , PiN ~q,~1~'11Qq ~~Uf1ANoP oOM",".. .... ... I,I!O~IPY NO", '"., j, \IN~TAY, ~6~q6nl0l o POX 7~0 \MP HIL~ PA ~70010780 IUARANTol1 ;:1". GROUP NO, ,', 13961 r ,:, ;:'~ f.)!:'fAI~ IH A, T!:MI!N'f 00 IY15 (3IY9I :g~lg1 ~'9IfA~ QUgL'1 N'{"A; , 1,1;1, Pool 011100 Ilox 177 011111010j :pA 17013,0117 PIIOI1O \717) Q~u.ua7Q ............",- --- flATI~ T .NAMI! ..I.:H,:. ~ ".i...~; :.., ~..l.~.~. ,I, :,j~ ': ',. ..;.~t\,:.J; " on PHI C IIA RD J. " , AOOOUNT No", ",il /lPMIT PAT!!', P/lQ!; NO, :", ~1,6876"9 1~/09l96 1 PATI~NT ~OO, BgO, NO, P\SOHAAQ~ PATR P TFIO ,PI~ ~08~~(1"18n lall U96 6 46 0' MUPIOA~ Ruoo!ipa NO, !ll~~ o~m~ ,fill /loOT, Rfir;-' 7'n383 la1~J/96 AOOOUNT, AI, NO!! ~OI~OA, JACQUEI.INE A. 33 PLgA?ANTON PRIVg P.lH PEfl~ IN, f'A '" H 316 ,. Ttlla la NOT A !11~~1 TlI!! f!!NNaYI.vANIA II!!A~TIIOARI! OOBT oONTAINMI!NT oouNOII. IS NOW IlUQUIRING'HOBfITA~S TO fR!!SUNT 'THaIR PATlaNTfj WITII A BTATUMI!NT 01' oIIARClUB, II' INSURANC!! INFollMATloN WAS GIVI!N AT TIM!! OF RI!QISmATION YOUR iY.~~~,R b"'lla~f{fu~I~.~lt ()~lr~N~ ~~I~~I~ ~'y~~~aT I~ A~M^~~~~V~f~lf~ nl! PROM you, YOU WI~I. Ill! 1l1~~!!P, 16600 1U09/96 OOM"f\ED/6S 1 16600 1?110/96 JOI'HEO/5S 1 HSQO 1U11/96 ;)0I1..BEO/55 1 CH\.09 12/09/96 H~ORDIAlEPOXIPE C;APSUI..F. ~$MO 2 AC~02 1210?/9~ CETAMlNCPHEN TAfll.ET 650'~0 1 NICOl 12/01/96 ICOTIN~ PC\.ACR Ii-EX 2MG 1 cLoa1 12/09/96 LO"llDI ~IE TABLET ,lMG 2 CHI..09 12/10196 H\.OROI AZEPOXIDE CAPSU\.E 25/-',G 2 C\.OOl 12/10/96 LONIOl NE TAllLUT ,lMO 2 CH\.09 12110/96 HI..ORDI.lZEPOXIOE CAPSIJ\.l': 2$~\Cj 2 AC;E'02 1211?/96 ACETA~lIjCPHEN T Alll..ET P(,$O/',O ACED? 12110/9~ CETAiJIIlCPHEN TAlll..ET 6.50MO CHI..'09 ,,' 12110/96 :HI..OROl AZl':POX!DE CAPSUI..E 2$1010 ACEO? 12110/96 ACETA!-'IIlQPHOI TAlll..ET 650/10 c\.e02 ~U10/96 LONIOlNE TABLE T ,?MG, CHLO? 12/11/96 HI..OROIAZEPOXIOE CAPSULE 2$MO C;,H.$O lUU/96 Hl,ORPRD'~IAZINE INJECTIO~j $o/,,(j' Cfl1..O$ 12111/96 :HI..ORPR~MAZINft TABLET 50/10 CHL061Ul1/96 IIL,PRPROM'\ZINE TAlll.f.Tl00MO CH\.06, -, 12111./96 HI..ORPRDMAZINE HIlLET 1001-1(, CH\.06 12/11/96 41..0RPROM~ZIN~ TABLET 1001010 CHI.. 0 6 1 2/11/9 6 : 11 L ') Rp.i1 J '" All NE TAll LET 10 0 I~ 0 NEC','O 12111/96 nC1TIlAU~jEO~\yr.IN&POI..Yi'Hl PAKS NEC70 l2/11/96 'lACtTIlAC&"lEOII,YC1~i.~POLY~\M8 PAKS ~IEr.70 12/11/96 3AClifl.\C&NEOf\YC IN&POl..nHI r.IKS 'NEe70 l2l11196 ;I,ICl TRACr,'IE(),~ya IlnroLYI","1l PAKS ACEO? 12112/'/6 ICETA'I!'ICPHtN T/IGLET 6511110 $6'l66,,, 12/1JUH .ONFlqu,'\,T1CIi PEI1 ClfWG 56061," l2l01196 :')f!FJrI:I,^TIC'; PE:? DPUG 55291" 121CQ/91J )RUO SC<EEI'I U,I ~Sb'OO ~2/10/?6 'HLEB'JT:J'IY FEF. $5257 l2/10/(/6 ril((jLYC~lnD!,S $ s n 5 0 l21l 0/96 Ij P T ' ,55276 12/10/Q6 )Aflfl,\ nT , 6 521,/, 1 2/1 0/96 . Y E /H 5 T IlY I'll or. I L ~ -..... iiiilOIlAiiou IlMG lll~~ DATI! 20112/96 2/23/96 ~~5,OO 118 $,00 ~~5.00 10, 00 ' . 00 , 2.00 ~, 00 10, 00 4, 00 10. 00, .00 . 00 10'.00 .00. 2, 00 ~ 0.00 12. 0,1 1,,00 ~. 00 6.00 6,00 "4,00 2,00 I,. '0,1 I" 00 "2. (Jo ,00 /,0.00 /, ,g. 00 llB,OO 8.00 24.00 20.00 27.00 3 ~. Oll IJMj~ C T OE IB~O,oo" ~i-),PI\I'USIP lIusplM " "lIncl f/ol~th ~Ol'Vj008 " f'~U~nl Pln~noi"I S~fYIO~1 P~pm\Il1PIlI PIN ~~'~Hd 1 PU INa\JMNPs POMPANY ;,1'" ,,:0;,,1(,'-' '"" ,\ PP~ QY NP,\;Il.t\'......i~li~lHl.l-, QROlJf',No, , I,lfNSTAY ~444??3J101 13961 I P (lOX "80 :AMP flfU PA QllARANToR Pall Pllloo oo'~ 177 ' O~rlluIQ, PA 1701a'P177 Pl10llQ (717) ?4D,6U7P , P~TAI~ " ' ElTAT~M~NT , ' . ",1,..1,.., , Po 1911111911 P6~'3A ~fO~PX~ qUagt~~'~:i'"~~<Wi~e " H0010 ao 0\. , .,,' ~ \,' _:j fJ'~\,~ POllOA! JACQUE~ ~NI:: 1\, 33 PI.t:ASANTPN DR! Vg I::AST PERQN, PA l7~16 Tl11a la NOT A 1l1~~1 nil: pgNNSY~VANIA IiSA~Tt-IOARIl OOST PONTAINMgNT oqlJNOII. IS NOW REQlJllllNO IiOSPITA~S To PRElmNT TlWIR PATlllNTa WITt-I A STATllMgNT OF OIIARQIlS, IF INaURANolllNFoRMATION WAS (lIVllN AT TIMIl OF RIlGISTRATloN YOUR DEGfr?~RbSFIlIl~~'hW~'m o~,rRHIG ~~~~FpAFym!~~ ~ A~MA~IB~Vtft&~f~g FRoM you, YOU WI~~ Il,S IlI~LgD, 5'H1 1U10196 niYflOlD flROF 1~1:: 1 ~ 56 0 4 1 U 1 0/9 6 P R QUA l. 1 55035 12110196 Be 1 55112 IU09/96 R~NAl.YS ~s ROUT IN!: 1 \'l0055 lUll!96 'flEST RqUTfNf:; 2V 1 7B930 '12/09/96 IT SPHlI1EN,~1 DnSTREr\M 1 76001 12111/96 :/<o 1 ' , 10~. 00 24.00 2 B. 00 16.00 116,00 B,oo, B 1, 00 '.1 I --. j' ,!,I " -,..,.. )\ ," , , IUOIlI'I~P POR, PfI I " , PlIHntiff v, ~I\OQU~~INm naRPI'I, PeCQnt:!An1l I IN f~'IIj]1 OO\JW~l o!" oOMMoN N~1!J1\I3 , aUMnliJRLI\NP COUN~Y/ pmNN~YLVI\NII\ I , NO, aO~3uoa CIVIL ~I!JRM I , aIvn l\C'l'ION ~ LJ\N , }N PIVORom ~aaETB o~ PAn'l'rE~ Pel.'ent:lAntr ~Ao!:.l~leline I3Cll:'t:!A/ IOAt'lqil on the lil'lt below tho~e item. ApplioAble to the OAl'lo At bAt' Ant:! it@mi~e~ the ftl'lqQt~ on the following pAge~. If an item ha~ been APPl:'Aiset:!, A copy of the ApprAi~al l:'e~ort is Attacheq, xx XX XX ~xJ ! ! ~ '~ (XX) 10, 11, 12. 13, ,14, 15, 16. ) 17. 1, 11 . 3 , 4. 5, 6, ~eal In"operty , MotaI:' Vehiole~ ~todk~l bont:!s, securities Ant:! OPti~~e Certif oAteaof t:!epoait Cheoking AOOount~, Qa~h " aAving~ Aaoount~, money mArket ant:! ' savings oertifioates cont~nts of SAfe deposit boxes Trust~ ' Life insuranoe policies (int:!ioAte fAoe value, OAsh sUrrender value ant:! ' ourrent benefioiaries) J\nnu~ties Gifts Inhedtanoe , ~Atents, oOPYl:'ights, inventions/ royalties , Personal propel:'ty outsit:!e ths,home l3usinesaes (list all owners, inolUding peroent1\r;!e of ownership, and" offioerl t:!ireotor positions held by a p1\t'ty with the oompany) IiJIOployment termination benefits~~ .everanoe pay, workm1\n/s compensQtion olaim/1\Ward Profib sh1\ring plan~ 7. o , a. " " I; , " P13nl'l~9n P;J.Anl'! ('~ncHPl\\:1'l emp;t.oY131'l P9ntri~~\:lon ~n~ ~Ate P;J.An'Yeete) Ret~rement plAnet Jn~iyi~~A;J. , R13tirement ~cP94ntp P~eap~;J.~ty paym13nte ~itigatiqn olAime (mAtqre~ An~ \.InmAI:4t"eq) , ' " M~litArY/V,A, penefite ~dqqation beneCit~ Depte d~e, ino14d~ng loana, mortgagee he;J.d n04eeholcl CUrniehinge And pereOnA;J.\:y , (inclqde ae a tptal cAt1j3gory amI " attach itemi~ecl list if ~istripqtion 'of aUQh A13Setl'l ie in di13p4te) , , :l6, other ,(XX) ;l.U, ( ) 19, l I ~O, , :l~, Lx! ' :l~, 113 , I :l4, (XX) :lB, (XX) ',e! " ,; ,,' II " , ,. H f' p' Ifi " j';1 " " , " j, . , ;; ,. .' , " 111 Ul .. ol> w I'J 14 p~ I I I I t I nUl -lttJ ttJ 1'0 [~ ~W ~rn ' ~ ' I. IW i ttJ 0 ~l ~,~ U ~ ~~a~~ i l(j to ~, ~ ~ ~ Cl'\L I ' , ,~J ~"" i'l z'~' " \1l l(j l(j 0 .... I~ ,~ "l ():l,p, , II"~ Qftl Q \1l~ ~ 0 t , H1 ~' ~' , - . I~ - .fIl' ~fI 1!l' -lIl -lIl ~ ~~~ ol> 0 C71 111 C71 \0 ~~o , , , , 1I1 El W tl 0 C71 ,p, lJ1 0 ~~~ ():l C71 0 Ul C/ . . . . . I 0 ():l U1 0 0 0 0 lZiO 0 0 0 0 0 "1 " .fIl 'Ill -lIl -lIl -lIl 1!l o~ C71 14 "1 -1 , El "" 0 1I1 , III III \0 ~~' III , " , ():l.. t W tl 0 . UI ,p, t!l. 0 ():l Ul III Ul 0 0 . . I . Ci'l g -:'"1 \2: r IZi Izl i J~ ~ ~, 0 ~ \1l - ~ I IZi \2i i IZi I~ 0 ~ ~ .. ~ ~ \-.- , i I ~ r i g \g~ l; , \1l W 0111 t:l 1.~I(j ~,' ~II ~! ' j;t:~ .~r a A III rn I~J , ~~, 'I~ r ~, ~ ,~:g ~ , ~'ftl ,!ij ~:g,~ " ~~ , ~ ~.. ~.~ j;t~. I!jIJ. ~ ~. , ~~ tO~ ~! ~ '" ", ", ,'. .. OJ '-1 ~~ , , o ' , " " ~ ~ ~'i ~ ~m~~6i ~o , ~ , ~' ~,' I~ OOJOJ eJg~ o~,g , ~~el "" ~U~. ' , I r ' H 0 -l ., ottl ~ "'-of o~' "~ttl 0 .. ,HI '~, ~'i I1J 'I ' 0 HI " ~ 1 - ", , I~ - - - -lIl -lIl ~~~' H 0 w 0 N , , ~~~, 0 OJ 0 W ..0 "'- , , 0 0, 0 l;!lO 0 , 0 ITj -- - -- ~~I " ,~ ~~ N , , OJ ~~, ~ g-l I .. Iii ~ ~~ ~ ~ ~ ~~ ~ - -- --- -~ ~ .. ~~ " ~ "I:j ~, " , , , " , - N 14 p~ , , " - ItItIJ~ ~~, ~i ~,~: ~ ~~ I~~ ! t , ~J !i'l ~ " ~ ---..- - I " 2~ ;0 I1j ~ - t! .(J\ U'~~ w , , 0\ U1 ~~h OJ OJ \0 0\ , . OJ ~ ...1 o ....I;J '" , ... '~l2: ,~ - t! 't! Ii; , , 0\ U1 OJ OJ \0 0\ " , . OJ ~ oo~ '-l 12111j - " ~~ ~~ ~~ , ~ul ~ul , ~~ n , .. r " ~tIJ' ~I~ , , l~~ w~ ~~" ~ ~~, ~ ~~ ~ " ~ ~ g~ I~ W ,g [ , ~~ "{ ~ ' " " , , ~ ~~HI[ C~I~~ 1 J "~'P~I 1::' /j;~4 \:1 ~, tli ' 1-'0 ft~t1OC al~~ p(l , ' ~ ~ l~ ~ooll " i~it ~~~~ , B l:; ~I~ , '~[a . m B ~I Hig f~~~ I=tH~~ ~'lii l'.l \-J p,~ t ~'g~ ! II 8tJ ~~~ ~I II- ~~~~ re @ w W..-,lIl ~ ~ tr ' 9 ~ F." I 1 0 ~ III " " ~,~ , 00 ~Ill '~ - '~'~ tJ l , " ~,~ ~ - i~~a " ~h 'ftl - -<<II re 81 , ~ N ~!~ . 1O ' lO . 0\ I, I: I W , ~ I 0 '" ~,~ :1 r 10' ffi , a m ttl ~~ ~~ ~~ ~,~ ~ 1=11:: ~ ~~ ~ rn ~l ~ , ~ tr ", ~' I~ rn r , 0 " " t1 " . , ; .. :J:nvElntpr.y " ji, " 'i" II! " ii' PElCenq~nt ppnp"t.'e AM lIPprdf'lElment. I' le' .,' ' d; i! 11 " , " " , " " 'I' '\/ d' ElUIInI'l1a wit.h All eKhibit." of Pldntifc, Clleq in t.hl! 'i; , , " I' , " 1 " " ,; " , .. " , " " " " ,.' I' " " " 'ji " , , ;L I ~ '" ".' , " " I' " I' ,,' " , , ~ " " " " " RICII~np 1l0RPA r P1A~n\:H1! I IN 1~'l1m CO\Jl1'I' PI~ oOMMON 11/'<11:/\13 I o\JMlllilu<I\NP OOUI'/'I'Y, PI'JNNI3Yt<VI\NI/I I I NO~ ap~3090 OrVlL ~mRM I I CIVIL I\qTION ~ LI\W I V, J/\CQUI1:LINIl: 1l0RP/\, pafllnclqnt , .Q.JlliTIFIOll'l'IU OIr smHVIOI~ I, RiohArd 13, Friadmnn, maq~i~e, hara~y certiey thAt on MAY f1:" 1999, I J3arveQ A oopy Oe tha within Inven\:Ol'y AoQ /lrpraiaament of JAoq4alina UorQa, ~y dapDaltin~ aAma in tha unitaQ stataa Mailr firpt olaaa, poataga prepaiq, acldraaeeel ae followal " Lori K, l3arrAtelli, mequire l3erratelli, l3ohiffman, Prown & cnlhoon, V,o, ~ooo Lingleetow~ Rei" l3uite ~01 IIArrie~urg, VI\ 17110 " FRlmPMI\N & 1:0, V,o" / '1------- I IUohar.p a, Friedman / ml3qUira, 600 N. Seoond street Venthbui3e suite V, 0, DOK 004 lIarrieburg, VA 17100 (717) ~3Cl~OOOO " ~( " P'l'l!ElR :tNoo\1lll1 Intflr.flflt PiVidenclfi Penflion $ocit\l $ecuri ty RentQ RO:f!l,1\:1efl tlEJ.!lli ~ION'rl1 , YEAR .....-- $, $, $-- $ $ $, $, $ $ $, $ - $-':': $ $ $.- $ $ - PllctleMe Accoljnt $, 01, etn $ " I $ $ , ~ $ ,$ $ " Unemplo:fment: COm!?, $ " Wor.l\'Jnen I fl comp, $ ',l'OIJ.'M Nill~' 1\.tfflUM :t~OOf'lli1 ,$~,...... $ , ---... $ $ t , t t t t t , t I , , tIt It, , , t t ,$ , 118,140,411 "', n:XP!i:l\Isms Weekl~ Nonthl~ Yearl\( JtO!1El1 Nortgage/Rent: Maintenance /I, " $ $ 0:18.1I,~ ,$ $ '10.50,00 $ $ tJlJ.':tJ:.:tlJ.'rEl::lI, Electric Qa.1l Oil 'l'eleph'one Wat:et' $ $ 1-10,00 $ " ,1080,.2.0 " $ $ t $ L $, $ $ 1 DO, 00 $ 11100,00" " $ $ 15,00 $ 180.00 $, $, 15,00 $ 180,00 -- $ $ $--10.800, " Pngl.l 2 I; Sewer 13 t113 TO'l'M/3 ", li1PUO~IJ):rPN' l?/;'iyal:e Ilcl1qo1 ~, $ $ ...,--- l?arooh~a1 /3oh901 1$ $ $ Oolle\Je $ $ $ , f{e1 ~Q'io\.\,. $ , $ , ,$ , 1'!ilR/30NM, ' , OlQl:h~~\1 $.-- L..1.oo,oo $ 11100,00 Food $, 80.00 $ $ 4100,00 aar~er/Haiidreaaer $ $, 1!O,00 $ ~,,0,00 Cl;'l!lcUt l?aYmel'\t $ $ $ " ,.\ " <, '~a:( 'IN VAQEI \:. ion Oi~ts HegEll li'13es ch~~i\:.ap~e con\:.~ip Chi~d I3l\Ppo~\; Alimony PElymen\:.s " O\:.lla!;' (flpecHy) Trqah , aUl\TO'l'~/;1 L $- ,noo $ \H~,OO $ $ $ 11000,00 $ $ ---, $ , $- $ ~oo, 00 $ , Iwno,oo $..,.... $,........, ~ $ $ , $ , $ .. $ - $ $ J5,OO " J80,00 $ $ $- $ , $ ,$, $ $ , $ 455MO " ~M~~~_______~__~_~__~~_~_~~____________""________M"____ " TO'l'~ ~~ ~~pm~amal $ 1..J1 , 088, 0 t , I M~_H_M______M__________~__~_____H________________M____. J;l1\Ol'.Iil1\'l';( OlffllilD, "" Ohec)<;ing 1\ccoun\:.s, l3avings 1\ccoun\:.s Credi\:. llnion " l3\:.ocks/Sonds " ReEll J;:s \:.EI\:.e P~I3CRIPTION ~ALUE See Inven\:.ory and Appraisement !! l1 J - --~ .~--- ~-~ ~ ..-.- - , M__~________M_____________"_____H_______________M_____.._ I.", ~~~ TOll'AL ................."..'...', $ M________M___________________________~---~--,---------___ (H), .. HusbE\11d (W) .. Wife (J) .. Joint ('age 5 " 1 INI3\.J!tl\NC!li ~lua CrQIHl ,.. MU:P,ICM ~l\.\a Crolls )Uu~ I3h!el.d liealt:h/l\Oo'!c\ent P!llap!l!t:~ ~ncQme Pen tal Other , ' COMPANY COI{ElRMlil Health,Amer!ca Po!ta Pan ta I (1-1) " Hual:land " i ,. ,.. " " " (W) " Wi~e .' , " Ii i.! " " I'ngo (j , . 'f,' POLICY II ---..,.----., t-- ...--- (C) " Child '" .' , -" .. q , ' j:! tl c ,..., ..---. ...--. r-r-- ~ ...--. -- ..-- -- ....... , ~ ..- ......, x: x x I, ..-- -- ....... ..-- ...--. ."C ~ ~ ,."'.~ ---,....-. ......, - ,---., - I' " " " \, " , I' HHlllflBP lloBPA, P+f1~ n\:~fl,' HI 1I'1l1~ OOUB'~' Ol~ (JoMMClt-l rr,IW:l OlJ~HW'n,ANP qplJN'I'Y I Pl~NNPyrNflN:rfl NO, 00-3UUU o:rvr~ ~mBM OTvr~ AO~ION - LAW TN PIyoHom v, \TfloQ\lmr"rN~ l:lOnPA I . , ppf~n~nnt , QllItl'n~rOI\'J.'Ji Ol~ f:1lmvror; :r, R.iohl-Wr~ 11, ,~,~1f.lqmAn, mf3qu~l~o, hOI'al)~ oal.tif.~ \:hl-11: on Mll~ 20, :).000, r f3PI've~ 1-1 qoP~ of the wHhtn paf,enelllllt'l'! P'~13"'!l'l'i/.\l Iltl-1tpment:, b~ ~apoo.iting ~nme 1n the unlteel Stntes MA11, f!rat alnaa, pOI'!t:Qga prepn!~, nqelre~aeq A~ fo1!oWal Lor! K, aerrntalli, maqUire aervAte!li, aohifflOnn, arown & OA1hoon, 1',0, 2000 ~inglel'!town Hel" auito 201, Hnrv1pburg, PA 17fl0 !, " " F'IU ml)MAN & lq)'lG, 1', a, Z~---- " //; r, " c~-"l v, IN rl'lIl~ OO\JH'I' Oli oOMMoN N,ITIflfJ OtJMllIDBI"TII'lP OPtJN'I'Y, PIDNNI3vr.NIINH~ NO, OU~3U!lU OIVIl, 'l'I'lI~M OIVI~ flOTION - ~lIW IN pIvonolD HIOIII\IW 1l0RPlI, P:\.nintHI' iI 1I0QU\!lI,r Nlil flPBPlI, pol'enctl1nt ~~BWEn TO-RJ~~TJON Fon nUXM~~NOENTE ~ IINP NOW aomeo tho pefonctnnt, iInoquolino nO~dA, ~y nnd th~ough hOl~ Atto~nGYo, l~riGctmAn Ii< l<ing, 1',0" Anct AnI3WPl'l'I tho ,petition for Alimony Pendente ~ite no fol~oWGI 1, lIdmitted, a, lIdmitted, It il'l Also AVe~red thAt DefendAnt will be And hAG ~een put to ooneicterablo eNpenee in the p~epnration of her OAae, in the nppointment 01' oounoel and pAyment 01' aoota! :\, It il'l actmittect thnt Plaintj.f,f's .inoome .il'l ' ,dil'lproportionAtelY lower thAn the inoome ~f PefendAnt, MoreoVe~, it ioAvened that the reason fo~ thc;J dil'lHropo~tionnte inoome ~etWeen the pA~tiel'l is the drug nnct I'Iubotanoe Abuse, together wit~ nloohol a~use,by the plAintiff. It is Aloo AVer~ed thnt the plAintiff doeonot have an inoome oommenourAte with hio inaap~oity. It io denied thAt Plaintiff is withopt ndequate funds to pay oql'lts and expenses of lit.igntion, Mo~eoVer, it is averred that on or about lIuUUst au, 1000, the plAintiff reaeived oVer $50,000,00 from the StAte Wo~kmGns' InBU~Ahoe Fund fot aooumUlated benefite And inte~est, and those funds may be utili0ed for his oosto, Mo~eoVe~, it is averred that th~, ii' " 'I ( ) 20, ( ) n,. ( ) ~~, ( ) 23, (X ) ~4, (X ) ~5 " ~6, 'I ,; , ". " u I' " .u '~1' , . DiARbili~~ paYmO"~~ r~il:igR\:ion olaim~l (mn\:u!:(Jcl Anel unmat:l1raell Mi:t :Lt:t\!:Y IV ,1\ t .. banefi t:p IEel\Wi'\\:.\.on )Janej:il:a pelJ\:s cltle, i,l1c:tueUnIJ lomw I mOl:~gqgep halel u Houpehold furniphings Rncl re~~onAlt:Y (ino:tl1de as A t:o~al oa\:egory And At:t:aah it:ami~ecl li~~ if dis\:ribution of suoh asse~s is in disput:e) 'Ot:he~: u ,. " ". ,. ;1' ,>> \ I ~ .. "I <I' II J; 1-" ,. " ;/! " " "'1 Pililll ~ 01' H " 'I " , , " !' 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Ll1AILgnlll11lT. _._ JLQlIIUlnllLlllT. _~ll.,.Q.Oll 1',,\h,I'llIo,\II\~, l'ollCII & I'ATI D~CK ",000 PECK ",000 "ATIO ",000 .fllU1WIIIJ11~ lIQII& . 1Q1I&__ _~.._ J{QlfL-..'.__ ___lIl1l1L_ __ !lnuJm.tll.,- J((JlIE IQll&':""':'___ ___ IIQllL___...... lIQIIE .. ___ =(lW!l- ~TaM '. o~n'~;lL_l'ill,le{~ ~:;:r~[:~: lII\l!IAlfu:~lJItL-3I.M.o. MVI~4111..r~" . .1\~lj~I'!1g\,. Q!1.tiW"!3tO( i:l1i~ljtiISUi3 olcom.lIIllL- '!>JIw' Ijh,.OI:!li1 10!l,.QQQ. Ulif.i.IijJ/.lll__J.QIl,,QQ,Q. tJu.lli:tEJiaoi.llL-illll,.QQ.Q. Comm,nl. ..llln c,mPl'Io" Irn.I'dlnl'~' M/IL' p19p"I,'I ..mPllIllIlI, 10 Ihl ntll~\orh"j, II.. I' /H;LhTIMlIW..Jlnl1&lmUM..:. ..,.. - -, 1 --1IlM. _ ".1l!M COMMRAIIIE 110. I .. .. COMUMlll.l/ILL-- COMl'AMmUHLl DIII,p".t1njp"1 IiOiiE 10 1'111011 sn~~ oTlmll I/O 1'111011 Sn~E OTIIEIl 110 1'111011 SAI.E OTIIEII I",,,~'p'~,,,,,, HAil TllhT ~I~TED' THAll TllnT I.ISTED TIIAII TllnT I,I~TED ,\\llIJll'IWl1lMllll i!.Q'/f,. AIJ.QI'f.1- ADOVE, M1~11I 'I I'" Wll9nl Iw""nl "1111. opllon,,/llIlIn, ,I \IIII"I,,'I'IOP"~ In41""YIII olllf! plIO' "'" 01 I,b/III 1M ..""".1'11 I\1lNn ono YII' 01110 dll' 0' .pphlllt ~r.lllnQ...tlL1ntlltllll\ti.gn-n:;;r~t;)~V.-\llLl!mlt.Wlll.L1IRl'.l'J.gp.lLln . th lU.PBlQIt,.-\llLlIll!l.loot .lllilP.lltlY-1Il1Jl.JIllU!JlQttJJill lC../!IIl!LlillluluhLLnnl!LY.!lIc..: ' . . _ IIl00QAIEPVA~IlEbYSA~SsoOMmISOIlArl'nOAcn..... ......,.. ...".... ...... .... I IOQ...Q.Q.Q. )0 Ell U!!l!!UJ!!OMl!AI'I'no C I A U"~'IlE"'mll,dM"k.'l1Inll lllA/Iol>.,olO. "'nIM"" "" . . /Un 1M, ipplll,alll m.~. lXJ 'i. I" lutltello the !tPil", .1I"'Vonl,lnlpH~Qru (l1~oMiUonllllt.dbtll)W _ Illbjtcllo eompltUonptl plllll.nd .pulftuVon.. c.rnIUono 01 .1/,"1,,1, Ilil.1lTl'Al<U&lLAnl1&Il!ll!l{. flOl' "",",'U'"on:!&LhT1n!<lIE1LAl!II&tIIlJ1MI._ lh' ~\IIPO" 01 lhl. 'PPl&tUI It III Ulltnil'lh;mU~il\l';;; fllthe Itll proptlli thit I.th, Mi.CloIIM. 'tp41t butdbnlhe 'bo~Oh' 'rldtht t'.rtnwon, tonUn~tnl 1041'/Ounl ..n~uonl,IM'OIUIV.,," 4IIiNU"lIollll .Illtdlnlfo 11I"h!4r,,4d,' M.. r01l1l4101f1l,jl MUl'orm IOOlD("'~"d I!/Jl3_ I. IIW~I ESTIMATE tilE MAnnET VAUlt, All UmIlW, 01' II'" ilEAL l'n'>I'mtv TIIlI III Tlf! nln'JI'UI or 1111l/,ErUoI, ASlll' QQI9.n&/LlQ,...luUL IWlllcnls TIlE IE or 111111' TlUII A E EITfUTlVEUA1EUI' TlUQ/,i:I'llb!ITubn. lQU19,Q0 , ArrnAlQEnl T. or ' .IIIH'EIIVIQUIIY Ai'/'Ii '"i:IIIUtH.VlI' Itr.OUIIli:1111 II 'II". ~1I :"nl'''' _ 0 ~4 0 ~41I'1 .ml KtlAIL II.' In""II'''I''', . I'" 01 I Old QD&Il.J.2.cluon iiiiiliiji'UII'!!L... "c" /1110" a~fi.o:l.......... 11.1. rlL 11."C""I111lon' 0111.11 lIttnlll .-'111 _ I"" -- o/sii1iii"," I ,tH~ II .,.,0 IU '00 ) ''''I'.hl~'''lljo''t _. ".ll"""...'Ml....'I1Ill'tw1 Ii 11.,. . Ill'. IMII ".'.'~l 1+1 Hork lIeoklnoh Rool Cetota AI'I>roleol'Q , "" , ' " 1'11, iiI" 33I'I,f.A8A . Pllrltl\TICm pr MflnllPT Vf\~\lPI Tho IIlo,II'!O~,&lo plloo ~hloh' PIOPOIII I,hoold bll1l9 III' ,'oOlpoll\lyO 'lid 01'011 m'l~ol \ll\dO, ,1 oOlldllloll~ loqollllo 10, l,iI 1110, Iho &ololllld 101101, OIOh 'ollnl Pllldonlll, ~lIoYilodlllo&ll 'lid lIIonlln91ho 1"loollnol ",,,Iod bl ondoo.II,III\IIUI, 111I1'11011111 \hl, doll.ollloo 11 1110 001,,011I/0,\101101 11110 ,. 01, iPoolllod d'lo "Id. 1110 1',"111101 \1110 110m " 10110110 &uYOI Vildol ooorillloll. ~hOIO&11 (I) &\'101 'lid ,oilol '10 111'1,,111 IIIOII"lodl (2) I'olh 1',,1101 "u \wlllolollllod 01 Woll 'dlllOd, 'lid OICh ,ollllq III wh,l ho ooolldOll hi, oWII bYilllllOlO,h (3) '1001On,1I10 lhllO 1.,lIowod 101 o'poomo 10 Ihu 01'011 "'IM (~) 1'l1l11on\ 1,III'du 10 10110' 01 onh III P,U, dolllll Olio \Olml 01110'1101,1 '"'110011I0111, 00101'01'&10 111010101 ,nd (&) Ihu plluo luplmol. lho 1I0llnll ooll,ldOI,lIolI 101lho plOpOIll ,old 1I0lll0010rl bllpool,l OIII"lIvo 1111"101111 6i ,.101 \1000mIOOl' QI,nlorll'l onyoou 1I1001,lod willi Iho 1110, 'AYI,'lmlI1IY lo\hll O\1I1IP'"bIYi mllll bO /0,,10101'1'001" 01 OIU,IIVO, IIn,ool09 01 1,101 O\1ouol.lolI" ,NO ,djll,llIlllill '10 ooo""IY 101 'Iho,o 0011, \'Ililoh '10 110101,111 p,lrI &Y '01101' lI'IO,ull 01 Il,dllloll OIIIW In ~ lO,lkol 1I01llhOlO 00.1. 110 10,dlllldllllllllblu lIliO' lho 101101 P'Y' IhO,o oOlI' 10 ylllUllll III ,,101 11'011011011', OPOOlll 01 olO,l!vo IIn'oolrlo 'dllllllOunll 0111 ~O IOldo 10 \ho oomp,I,&lo PlopOlll b1 00101"111011110 f1111noloq 101/0, oflllod bY I Ihlld PlllllollllllllollllloodOl llr'l I, 1101 0110ld110Yolyoll III IhO plopOlll 01111111101100, AnI . 'lIjUllmollllhoold /iul ~o C'loolllOII, 011' mOlih'III01ll1oll'l 101 dOll II 0011 ollho f1111110101 01 ooooonloll bllllho 1101111'/00011101,101 'd ollmolll Ihould ,pplOll/Ollo Iho m'l~ol', 10101100 10 1110 IlollloloQ 01 oonmllool &md UII Iho I"IOIIOI',llIdl"IOII\, . 8TATIIMIltlT PF ~IMITINQ ootlPITIQNa ANP f\pnnAlaPll'a Pl3llTIFIPATloN ootlTltlQlltlT Atl!! ~IMITINQ opNPITlotlal 1110 'PlllllOl'I 0011111"011011 Ihlllll'O"I III Ihu 'PI'I~I,ollOp",II, 111&100110 lho followloo oOlldlllooll . .' i 'I, Tho ,pPI,IIO! will 1101 bO 1011'0011&10 101 mlllOll of 1 IUQllo,llI1O lhol,lIuol UllhOllhu PloPOlll bOlO! OPI'I,IIOII 01 lho 11110 10 II, 1ho 'PPIII"I 11I11/001 Ihlllho 11110 I' oOOd IlId m'l~ola&lo ,od, IholOlolO, Will 001 100dOl 001 OpllIllIOI 1&0'11 110 11I10' Thn propoilY I, 'PpI,1101I on IIr' bill. of II bOlllO olldOl lOlpooll~lo OWIIOllhl/l, ~, Tho IPlIII", hl'PloYldld olkoloh 1IIIho ,pp"11I1 IOpoll (0 .hoW OoPlollmolo dlmoollllolof Iho Imployolllonl. 10d Ihu ,koloh I. 1II0ludOd ollly 10 '"1111ho 10,1101 01 Iho lopolllII yl"allll1l9lho 1'10110111 alld undOlilaollloo Iho applIl,OI'O dololllllolllon 0111. olzo, 3, Tho 11'1'101'01 hI! mmlood Iho ,y'"01l10 flood /Olpllh'l 110 I'loVldod &Y 1110 I'odulal r:IOOIooooy Mlo'QOlllolI1 Aloooy (01 011101 11111 oouIOO,) ,od hI! oolod III Iho 1IP/llllllopoll wholhOllho 111111001 olio II 10011011111 0" 111001111011 8poololl'I0lld IImlll AIOI, 1I00lulO Iho ,pPIOI",I, 001'IUIV0101, ho Ollho /Oako. no QUIIIOloOl, 0'1'1011 OII/OI'lIod, 10011111110 Ihl. dololmlllllloll, ~, Tho II'Plol,Ol will 110\ Qlvo 1011110001 01 '1'1'011111 ooull &oomo ho Olli,O mldo ali oPPIOIIII of Iho plOpOIlll11 quo,lIoo, 1101011 oplOlIlo IIIIoQO/OolIl' 10 do 00 hlYn bOOn /Oodo &OIOlohllld, 6, Thl IppIOI"I hll OIIlIOIlod' Iho y,luo ollho lalld Iii Iho 000\ ,pploloh 'IllS hlohOlI ood bOIl 010 lod Iho IrnplOyomolllllllholl oOIlIlI&Ulol)' VlIIIO, ThOlO OOPIIO\O y,lUlllool 01 Iho Ilod IlId IIIIIIIIYOIIIOO\I mUll 1101 ~o ulOd III oonluoolloo Wllh ,ny olhol OPPlalll1 'od 110 IIIYllld II Ihol110 10 UOOII, 0, Tho ,ppI'lm hit 1I010d III Iho 'PPI.IIIIIOpOII OOy ollYOllo ooodllloo, (Iuoh II, ooodod lopalll, 1I0ploolalloo, Iho Pro'OIlOO of hlllldouI Wlllol,lollo Iub.laoo!o, alo,) O&lolVod dUlloo Iho 10110011011 oll~! IUblool PIOpOIll 0111'11 ho or oho boo,mo 0\'1110 01 dUlloO Iho oormll IOIOlloh IlIvolvoll III oo!lolmloo Iho '1'1'101111, Uolo" olhOlwllU al,lod III Iho IpPlalll1 IOpOII, Iho IPPlol,OI hll 00 kllUWlodQo 01 Ml hldrloll 01 ullappllolIl uoodllloos 01 Iho plopolly 01 Idv0110 oovllOolooolll ooodlllool (Iooludloo ,Iho PIOIOOUO 01 1IIl,IdoUl Will"" lodo , , IOb.I'"000, 010,) Ihal would mlko Iho plop"ll molO or 10" Vllu,&I" ,nd hll lI$umod Ihallh'lo Iro 00 lUuh oondllloo' 'lid mlkol 00 9'111I111001 01 wall loll", 011'10" 01 Impllod, 10111111110 Iho 001111111011 of lho PIOPOilY, Tho Ippl.IIOI Will 001 &01011'00,11110 lor 10Y luoh ooodlllooolhll do 011'1 or fOI Inl oOglooOllol 01 luallOQ Ihll mlQhl bo loqllllod 10 1I1,00yor wholhOl IllOh ooodllloo. odol, aOUIUlo Iho IPN,I,or I' 001111 olpollllI Iho flold 01 ,"vlloomoolll h/Wdl,lho 'ppl'llIllOpOll/OUllool bo oOlllldolod " '" Olivlloomuolal lIIoo'lIIonl I" "ollh! plopOIly, " 7, Tho IPPIlI\oI 0&11111011 Iho 111101/0'"00, O'"lOllo",nd oplolooolhal WOIO OiPlo'sod 10 Iho ,pplIllIl lOpOll"Iom IOUIOOV "'11 ho 01 oho oOolldolllo bo 1.II,blo 'od &ollovollholO 10 bo IIUU alld OOilool, Tho IpPllllOI doo. 1101 a"umo lO.poosl&1II11101 1110 'UOUIICY of luoh 1I0m,Ihll WO(O:rUlllllhod ~y olhOl palllOl, , 0, ThUlPPI,OllOl will 001 dllOlOIO I~o oOllluII\I oUho IpplIllIl topoll olOopl II pll'vlrlod. for III Iho Ullllol/O 81111daldl of 1'10101110011 A,,'llu! I'laolloo, 0, Tho Ipplllaol hll bllod hi, 01 1,"1 ,pplIllIllOpOII Olld YIIII,lIo11 oooolllsloo 101 00 'PPlllllllh,ll. aubloollo 1I11111010lY oomplollon, lOp' III, OlallOlalloll1 00 Iho II,umplloo Ihol oOlllplollolI 01/110 Implovomonll will bO pollollooll III ,wolkmaollko mlnnll, 10, Tho appllloor I1\UlI /llovlrlo hi. 011"1 P1101 Wlllloo 0011I0111 bololo Iho 10""011011001 IlIoolllod 10 Iho applIlIIIIOpol1 cao dlalllbulo Iho apPlollIllOPol1 \loolUdlllo eOllolUllolilabou\ IhopropOlll Vlluo, Iho IPPIlIIOI'allloollll alld plOlOIIlooII dOlIOo,"001, 'od 'olOlOoeOl 10. anI No1nl1101l1 IPPllllllolOlolzlllnol 01 Iho film wllh whloh Iho 'PPlIIIOIII aubolllod ) l6'loyooo 011101 111111 Iho bOIlOwolllho 11I011010'0 01 III '1100011010 and allllnlllho 11\0/10100 III,UIOllooo.ullaOlol Plololllooal'PPllllI1 0Iglnl!!I,loII"lnII1110 01 fudolllll 'PPIOVO~ Ilo'oolallollllulloOl 01 any dopllllnool, ogoooY, ollo.llu/Oonlallll 01 Iho Uollod 81alol olaoy alalo Ollho 01111101 of CUIIIIII&III . olooPI 11111 Iho 100dollolloOllo'y dlllllllulo I~o plOpOIll dOIOII,lIoo aoolloo ollho 10poII 001110 dlla 0011001100 ollOpullloo '01V100(1) Wllhoul hlvlog 10 oblllll Iho apPII[aol', pllol \'11111011 001l101l\. Tho appllllII'1 wllllon ooolOlll.IId apploy,llOuol 1110 &0 oblalood &01010 I~o oPPlIlIII oall bo oOllvoyod b1101011Q 10 Iho publlo IhlOUoh IdvollI.1no, pu&lIu Iulallo"', IIOWI, 1110', 0/ olhollOOdll, floddlo M,o Fqlm 430 8..93 "100 1 012 "aoolo MIO fOlm 10048 6-63 " '-", ''''. ! '''i'"....._-....-......,--~ .' '1 'f, ,F APPRl\I.IIf\~ PIIIITlflIPIlYlIli'li Tllo Apl'llliol 901\1110' o~~ '1100' ViI\' 1'1,. II". 331'!.f.ASn 1, I IIlV9lf1Ql/9hoj Iho 101'190\ Uill~o\ ,/o! 'I\~ hlVcllllvlo~ 0 mll\II,\l1I1 vi lhll'l "cllll 1'111 vf pMVIUV' IlIv,1 ,111111'1 '"~ plOllm!II 10 \1\cleVIOI PIPPllll fv/ OVlllldol'llv~ I~ 11\011111 OO/1lI"IIIVll 111011111 'lid hm /1I,do I ~01l'1 o,ljVllmolll 1'11101,1 ,pplop/IMo \0 I"Hool VI9 IIIII~O\ ",oUolllolholo 11011\' of ,IQlllllollIl V"lollplI. II I IIQlllllollI1 11011\ 1111 oumplllhlo 1'101'0111 II 1\/pVlloI 10 , 01 10010 IIYOI,hlo Ihl', Iho ,chlool 1'101'0111, I hlVo m,dl IIII9111VO adjUil"""llv ,,~!'''v 1110 adJ\lllld 11111 lilloI' 01 1110 OOlill'lllhlp alld, II I o19"1110,1111 110m III I vomp,I'hll PI9Plllll1ll1I91101 10, III IoU IlyullLII ,111111 lhl 10~lp911'101Illll, I h,VI rnldo a I'oIIIlVlldj\/I"'lullllv 11101011\' U,O ,dlollpd IIlp,pllco 01 Iho oomp'IIhlo, . 1i 'I hm II~oll IlIlu cOlllhIOllll'l/llho hoIMIIII.11 hlVo III 1/111'001011 V,IW Iii IUl doVolop/1IOlI1 vllho 0'1110,1001 /11.111101 Vllon I~ 1111 .. IPp, 111111 101'011. I hlVo 1101. t,lIoWIIlQll wllhhohlllll .19"11101"1 IlIlolllllllo~ 110m Iho 01'1'111111 IUpl"1 olld I I'ollovo, lolho hOllol 1111 ,~lIoWIOdQ9' Ihll III ,1'lomu~II I~~ I~Iolli\llloO III lhu IPPIlli,IIVpuIIIIU 1100 I~d cOllool. 3, I Illloj I~ Iho IpPIIIIIIIOI,olI o~ll 11I1 PWII 1'01101111, IlIihlllOd, IlIj 1'101011101111 InIIVlII, oplriIO~I, IlId 110110111111'111, Whloh 110 IO~IIOI only Ip Iho (lo~llnQolllln~ III" IIn9 oondlllolll ipoolllod III 11'11 101m, . ". 4, I hm no 1'1010111 OllllctpoOIlYC ,"IOIOIII~ lh, 1'101'0111 Ih,llo Ihq io~loollo Ihll 10pOII, I~d IIIIVO no IIIolu~1 01 PlolpoollVo pOllonl1 1~llloII 01 bill Wllh 1011'00\ \0 Iho p'lliOlpl~lll~ lhol'lntlOllon. I ~Id 001 hm, cllholl'llllllll 010011I1'101011, 1111 1~IIVlII IIldlol lho 011110,10 01 m'l~ol Vlluo 10 lhu /1'1'111111 10pol\ on Iho 1100, 00101, lollglon, IIi, hondlolp, I,mlllll 1111111, III nltlo~11 ollQln 01 0111101 Iho plolPoollvo OW~Oll 01 ooollplnll 01 lh, lUhjooll'rop'"1 0101 1110 prolonlownoll 01 000111'1111' 01 Ihu plopo/lloll~ 11111 vlol~lly 01 Iho iubllolpropolly, . , G, I hm 00 1'101011101 oonlompl,lod Mow InlOlol1 In Iho JllbjoolplOpOlll, Ind llOlIhol rnl COl/onl 01 fu\olU crnplpyrnun\ nOI ml oornpon!illoll /01 pOllOlmlnQ Ihll 11'1'1,1,,111 ccllllnlonl Ol! Iho Ill'PIIIIOd Ylluo 01 Iho I'lOl'ully. .. .. . 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I hlVo allo oomllllnlod Ihoullho oHaol ollho IdvolIO oo~dlllulIl o~ Iho mllkoll~1I111 01 Iho Iuhjoul proPOIlY, g, I pO/llnllllpllplIod all oOllolullonl I~d opl~lollllboul Iho 1011011110 Ihll \'1010101 lOllh I~ Ih.IPpIIIIII 101'011, II Ilollod o~ Ilonlllol~1 plololllonallilllll~Oo 110m Iny l~dlYldual91lndlyldolll In Iho po/IOIlllan'o 01 Iho appilllll Ollho I'lOpallllon of 1111 Ipprlll,ll . 10PoII,' havo IIlmod Iuuh IndlylduII(I) I~<I dllOlOIld Iho 11'001110 IlIkl pOllollOO~ ~y Ihomlo Iho lono~ollllllo~ 1001100 01 Ihll IPPIIIIII . 101'011. I ollllfy Ihlllny I~dlyldual 10 lI'niod II quallllod 10 1'011011" Iho '"kl,'1 havo nollolholl/od Inlo~n 10 IIIlko a ohanQo 10 Iny 11010 In lho ropollllhOlOIOlO, 11111 ulllulholllod OhlllQO I' mldo 10 Iho 11'1'111111101'011,1 Wlllllko nil 10lponllblllll lor II, ,. BUPI'lf\VIBOllY APPIlAIBa,,'B oallTIPlaATIONI II a lupolVIIOIY IPPIlIIOI IIQ~o" Iho IpPlIIIIIIUpu/l, ho ollho 011'111101 I~d IgloOI Ihllll dlluolly luporvllo Iho /1'1'111101 who PIOPllod Iho /1'1'111111101'01', hlVo IOvln\'lod lho Ippllllll 10pOII, IQIOO wllh 'Ihl 1IIIotoolllllhd oonelUllolII ollho IPPIIIIOI, IglOO 10 ho hound by 'ho /1'1'111101'0 'olllllolllo~, hlllohOlod ~ IhluoOh 7 Iboyo, IlId 1m liking lulllolpon.lblllll 101lhl Ipplllllllnd 1110 IppIlIIlIIOPOII, '. 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I\ICNIWI'I"<i (\I'l fW I1Ii1CICl\'IIHCH 31, I !I!I? T" j,:;ii',,:;;;;;;;~;;;~;-';";1,,;;;N;i';";;i," (1111)1 Vi'oll IIf11'Y I'I (~IH( 10 )WII'.r iV,'/'illlllil!! 'H"'vli.'" Ill' ,\'1111 I/(I\'u ,.~(/<'II~d.\'IlIll' HIlI'IIIII( /lu(II'~IIIWIf (Jill!' "'111 IIf11'~ III (ill/.[( Ihl'u!, .1'1'(/1'.1 of u,.~(iIMI ~wv(!,u, . ~..-- Mil1l.tll!Wl1lli~I!'U I,Ifl!.L\.1ulll!!Y {Mlh,t\l....--=-_. MOlllhly I'qll~lhn ~oP~, 7'/ 01'01111\111111011 PutllI~111I11~ . _-= . tI10,~110L!~ Mlllllhly POns 1011 Proionl Vnlllo ~ -2!11l011 I $11114 I 7~ ~~01114141I1tl ,.' Ollllnn'" . (^,Uo\lO<1 fllr wl!llllrnwnlllf ....CC\lIl1l1hl\o'lllo'IIICllllm) AllJmloll MSI.^ Monlhly I'l1n~11l1\ $'IIIO,gl~ AllJllilull OpllIIII I Mllnlhl)' l'un~lon . .' H111,Q1_ ,'AllJl\ilulll'ruioill VIIIIIU. Un~lol' Oplloll I $11111,100,71' $1, OUo, 1111 ----nollt" In Stolo SOl'vlou . ~____;~$20a,414,IIO .;" ift,;'! :'f"f)Nm 'i'i\~~"1:iTi;:j,1Wr; "~I~,9iiTi~Mi~~7i"''''] . 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(""JIlIIOII fill wllhllmwolllf "CCllllllllin.d p,\dIlClllllll) AII.I\lllu,1 MSI.A Mlllllhly I'onllllll MJII~lutI OPllolI I MlllllhlY l'ullslolI AIIJllilutll!ru~Unl Vnlllo Undur Opllon I $ 1.0 nUll. 00 $ l..TI.tL!?!L $OQ4,000 , 0 , IMPORTANT IN~~ORMATION . · llo\1ulll Eath\ll1los nl'o lll'ovldoll furl! Dlsnbllhy l~ollrol11olll, 'l\1I1~ll11ul11 SIIInl1l 1..11'0 ^""l1l1y (1Ilsn klloWIIIlS FIlII t !lullth III Stnt\! SOl'vleu - II' yOIl nru vQ~lotlnn\1 tllo ROllrol11onl Allowlllloo) . ,Mollthly Pon~lon pllyl11Ullt whllo 1111 Ilollvo ol11ployo, II will bo IIsSIIInotl )'011 r,olirlld' InIlQO 10 YOII I'or 111'01 bonoflolnrY{los) roulllvu(s) IIntlor oplloll llho tlllY bol'oro y01l1' dOlllh, Tho Prosonl . AOclll11ulnlod Dodllollona, loss Monlhl)' POllslon VIII\lO 01' YOllr nnllllhy will bo pnYllblu to YOllr pnYllIo/lls YO\I I'ooolvotl nndony IlIl11p ~lIm yOIl 1'060lvoll bonllfiolllry(ios), II' )'0\1 IIr6' nOI vosloll, YOIII' \H1t1or Opllon I\, ".' Aoo\l~IIl1ll1lod f)ud\lollolI~ will bo pIlYIII!IU \0 YOllr t Optloll I . MOlllhly I'ollslon pll)'l11onl mndo 10 )'011 hOlloflclnry(loo). , . 1'01' 111'01 bcnoflolnry(lcs) rlloolvo(s) /'I'osonl Vnl\lu, luss MlIlllhly /'oll~lon pnYl110llls YOII rocolvod l\I1dll'1Y hll11P $,11111 yOIl rocolvod \llIdor Opt 1011 4, t Oplloll " . AI 1'0111'01110111, )'on I11ny. wlthtlrllw 1111 11I110llnl oqlllll .\0 ~II 01' II11Y pllrl of )',0111' AOOlll11l1ll1lm! Dodllollons. YO\llnny 0100110 1'000lvUlhls wllhdrowlIlllI up Ill. 1'0111' Instlllllllollts, If YOIl clool 111I~ oPlloll, you musl olso oluol n Monlhl)' 1'0l1slon poymanl pllln, t I>I~nblllt)' Hulh'011l01l1 . YOIlI1lIlSI hllvu 1I1100S1 fivo yon(s ,or crodltod. sOl'vloo (oxoopl SlIIlo pollon nlld ~nl'otqcmonl ornooroOnlOlllJry olnplo>,os, who hnyu /10 mllihnllli1 sorvloo i'ollulromonl) nnd bo uOl'tlf1l1d by Slll~S MlHllonl 1;l<lIlnlnors liS physlcnlly 01' 1II0111111ly IlIollpllblo 01' pOI'lbnllln!! Cllrronl Job (hlllo~, Ollly ncllvo, cOlllrlblllln!! 1II01llbol'!1 or iho~u on ICIIYO whholll filly '1110t opply liH DlsllhllllyRollrollloll1. YOIl CllnnOI wlthdtlll\' YOllr 1\001l1111111110d Dodllolloll>l If >,011 Inl:o I ,. · BOllont J~~lhllntu~ 1l~~~\1t1l01 t YOllr flltlll'o Ollmllllls 11'111\)0 Iho SIIIIIII liS 1111997. t YOIl oOl\llnllo 111 YOI!r pl'osonl olnss ofson'loo 'os II I'lIlHlmo ol1llllo)'o, . t Itullrollwnl III bios 1\11(1 fllolors rOlllllln Iho 51\'11\0 II~ . Ihosu In IIS0 on Doo, 31','1997. . t ^ny AminI'S 131110llco will bo pllld (oxooplloll . Ihoso 1l1OIIIbol's who nj'o Cllrtolllly YOSloOS or In II fllrloUgh SllIliIs). . t Ylllll" 01l1'l1111115 will 1101 oxoood Ihu fodural Socllll Socllrlly lllMblo wllgo hl\so nl\orl9l)7, t Jollll CoYOrnllO IS COIlI'Ollud III Filii Covorngo prlOI' 10 '01' 1111110111110 of rOlll'OIllOll1. (.'OIl1lmwc!ml 'J,a.:,( PO,lll' " I' " ,.' " " ,,' ,I \, :i " ,. " " ji " I' .. ,\, " Ii t' I' , ,;1 ," ',',- " " " .I' ", ,I', '. " "" " I' I, t, , I ~ I' " I'" ,,'. " " . '-" , I' . " I' " " " " " U " " " " j; , " " " " ,. , " " " " ." , " " " /, ,. I. jl , " ..i .I. " ,I I' I' i' "i! , :i ~I EXHIBIT' 0 " (':'/Jr~ " .,' lffl"fil1 99 III F-9 FRPI'II FRWPI'II'\N 8. l~lH<'1 ,. " j, "1\ "1f.:iG8\'J8f.l , iliU ~ ; ~~"'i ~ ~ .. '.' ~ ~ ....er. I r; . i ~. .. ~ "'.... ~ '~~'~ S ---- TO i'1l'! !j~(~ 5~[J I ~ !h~i!1 ~ ~~~~h~ t~ft~~r!~~ ~ . ~~' ~1 in ~f I: i a~ . i ! lj ~ ~ ;:~ ; ~ g~~~ ~ ~~~~.~ I i~111 ~ ~~~l;~ ~ ;6d .' m ~ ~ . = ~lil III! d'! .' ~ mEIVED TIMBMA~, 24, I1:JOAM . .. li~ . ~Ie g\J~ '" '0 hi ~ ~~'Il~ " ~"" ,~ ~~t , , Pli.' ~~ ~ ~ ~ !~i ~L ~~~ r .1, .. ! II ~~' ~l ,,~ ,; , ~~~n il ffi...il~ ~~ P F~~!O jij~ I" II P j e ,. 'I " I III "tl ~.. ~n ~~ .ia 6 J..' , , , "IiiUll;G Ii ~ tl .... "f. ~':o "... " ..t\ I ., ..6bl.\> ICJcto.n~a 1 ~r .' ~~ . 'ij a ~ .. , I~ , ,,~~ .' I~l ui . ~ . .,'~; ~~I' ,i, ",(ill i f1:), ~'I'" . I,I"~' .. . 1. . 'v' " I " ' I' . (.~ ,~'..,. . 1- ,1'. ' " ,I JI.., r\1~H!~ Iltl Ill?\] FI~r,I"11 FI~ II:PI'lAH \l. I: I 1'1(,1 '(I'If?:lG13Pl1r1 " TO,'(1"( 5111'l \;1181 PR'GE,aS ' , ~ ~ !j [I f~~~~~~U~~~~~~~H II m ~ "I~ " ~ ~ ~,. ,'5 ~ I~ I 't ~ /.. ~ ~ ,~,~ ~, h~ ~ ,t ~ H ~ '1 ~ ~ ~ ~ ~ "1 - .. .. ~"1 V' I' ~ I V' V Ir'l ~ ~1~I~Y~~lg~~~~~~ " ~ ~ " ffl I ~ ,. ~ ~ I ~ " ~ ~ ~ ~. '~ , ~ t 1:1 ~ n !' I ~ ~ p .!, jl ~ ~ ~ " . . I -, -, I 6 "I 6 11 ~~~' g~~~~:~ :~~A ~ " J i:I ~ I q ~ , '~ ~ ,J .. .fl '" II ~ \rPll In\11 V'l U1""\f1.... .. ~ " ~ ij~ . ~~~:~~~~~~~~~~~~ . ; tJl , ,~ ~ I" ~ I ~ a II ~ I ~ i 7i! ~ ~ .fl~ 41~~. ~~ ~~.~ ~ ~ ~ , , bt I , , . I I I . . . I I '~ ~ " g Q ft ~ : g g :I g ~ ffg n g g $I 4( U .. ~ " .. It> m, ~B ~ ClI. I D I VI ~ ~ ~ m J ~ f.'l I' ,,- , "I I ~, ~ .. ....I. ""hI. ..I. "gg" RPQ aUto. Pt1 CD Q ~ ~ n I" . ~ '. ~ " ~. r ~ " ! ... I I" ; " m Il ~1 , '.. I Ii J J ~ ~~~~,,~..~~..,,~~...... ~ ~i' ~ ~~~t.~~~~~~~t.~~~~ ~ I I 1'1 " I I N~ " I~'FI\ 99 \IIF9 FR(JI'\ I FI' J 1'111'\flH Po I, r HC:l 717[236813(1\3 TD,'WI \i1\\'I ul181 PriG!; IBG i " , .~ W ~ ,. ~, ~ l " , iii ~ ~ F .~ ro " ~ ., e I ~ g p "~"~ ,. .,. \", \ '" ,. \ Co, iit ~ , ~ ,~. . .. ~ ~,. , " , !' ., ~',,"\ ,. ,.' , ~ ~~ ~ ~ " V1, ~ -..,~ t-' ~ d~ " '....:.:...J " l' ~ " . , ,. d, J' " 'i-, 1.1- " I. .' " ~ I ; ~ ~r I ~ I i I~ I! ~, ! ij; ~P! t :~ ~I ~i ~ ~! ~ ~ ~,.. ~ ~ ~ ~ ~ ~ ~ " ~. ~ IIi a " !it : I, m ~ '. ~ I ,\ III A!;1' :' , ~ ' ! ; I ... Ii ! , I I. " " .. , " I " f'\f\R~Ff1 99 1\lf.!9 FI<ql'III'RII1Pi'lf\H ~ 1(11"(,1' '!l"(1-~3G,9l'!8.~,:.... TOI'!1751\~ 51\8\ , PR<iig,~3 .- ,'(l'1'-~Il'IW'1 "(I"il\ 'I'~(~'I I>fiWIl(:tn rHII~l cOltfil:l... Tn 1151lU/5\fl?;\l~ ,~,1I1 f~ I~ , "Ii I at!. ~r,; ICATlpN I . I . \ ,'. . ,y/Qf'CPQtp,f1, t,1,\Q1Mr ' S.(-i.. , ,; t~~u~~ ~tW:U~~~ : mti~\~~~~"~JUm~lwfY~ 'l~MN~'I~~~~~~~~~t~{A"~ ' " 'I v" ,\1 i 1"'11.)1 , " (f'R"1 " ("'WI' : , .tJ (J"'I ,-+,- '---"-'E-~'--'-"'----'-'-"'---- ~, ~1f\l1a~\~ ,qlll! "p'"aai' ' 1, L_' ~ "i :..llJJ'~ 1W2.w1.l,1-1--!-1-.1-I.,,4.-I-1-~-l ' 'VI. t I . H 1* 10f/ l"~; ,,-( I Fll,lf' '.M~\d. .~I.GJ=' 1..11. \.l:I..t1!..t I 11'\tl_l- _1_1_ _~ I Pay, ,'(~ . ,.1 "10 ' \}J \ I " " rt' Suc:5' J' ' I 4,: Ip'fllphep Ulipn/ '~1R.lli!ln W.j--., "Pi H ~,Occup'q\lnn" \ (" " II~" F tf.tlnrlln \ ' ... Ulplll~M:-- Zlp....4lllL PlIlly,' ;...~f(a'Man~'l-\1r , ~:1,', -,..... . r "I ' ,......1\ P flV 1, Af! U T rJ;'Hll~-;:f;,-,ql"n~iqpAI- P!I'I\f1 (l:l rl\v 0 fn mnkn'lhn IQlIewi~g'Qdll<:llan\Pl:~1 \la~pili~\ I 'fin r )(dll . . AIld~olla~1 . I ~'. . _~ I unaOIlVaPQI~(.II; , ~'l~~~"(., ; ,A#lNV(" .jt~1l"~4-v I,' , ': I, "II'" i., .""..1 '''~' .on,." 11111." '''"'''!~' I. '''''~'''.' i"1" 'I I , I l' ,II I ',. a de j'" : \", ' , ' I ' iJJ "" '7 ' '::, I'. llIanv<l ~ (~.i,"'/)<J-., I, ,- ~ f.-, : '.,..., on. I. '1 . , I 1 a ~-'o ! 'A~ ^~G br.1!P W'ff flq~(PY ~wmt; (loMU OFIllot! WlTli'AN,'1' R~Quq$'t f~O~ ^ AfIPUOTloL ,: ~ I' r\ :l, IMI 'tfdH(~) ql fNCRIlAU,,*Q) Of R~QOtHHD~"^TION(Q)": f 'oqUO~\ "AI- P I'r,1' 0 rnv Clio mUka: '1IItaqQ\'jlnv, QI/C):IMun'/i(p)1 , ' ! I I' I : U(dll , ': IClllinuo(a)! , ' : '; 'I : ,- . , 1 " I ~~-..... , ': I I t ,I: '11:" ,. I ! I:. ",.' ~ I I ':'!:::'~'., :! ,,':i 1 1, ~I "tI9'I,lIid:~~nll; .lJ- tefti.~IMhO~t '/,ID pall~d" , 'i! L I '~-"'l' I VOl No, Glvo lUll dol 0110 ~o, nny "~1'" 'an,wol4, , . ,,:,~ ~a~Qg~o: ~~~;/11~~~P~1~~~~~~~ ~citll~(O!' 10 00 '\ : ,i f1QQ9Iv~ fd~Il~III/V, he~pllol PlIlIOdl~al QcnolllB, Of n ..... :., ; fIlI".I!)n '91 AnV II~knboB or Inlllry? ' ; r:l I<l ' , :! adllll~ alalllllUty nrillo.PltollnBllnw.eralj!d UP, : i ' ""/00,11 101,(<\ad, Qa~e~lIad llt'nl~I'elwV/Od1 0 lit' I : ,: 110 II' ei~'~ ',y'. pt1yololM or prlcllllanol\ IlLHln : ! .. \OSIII" od,dl ndlilIlUMQlilart;crh;,\"mlilqrlnlulad? r:l r.;r I' 'Aflfl ~ 1 " ' " I (QVem ' I '11'1" , . r . II , I ...J, J.. ,. I TQ!UIlI1IVIl~~~~~~iill~,~~n~,;p ~~~~~i~ aQlt~~~~J;)T~i~~XPI'~I~^TfONi i I Wo ;pproqlal yoJI /huklno applloaUon 10 thO Paul !1l1Vnre Lila Inpuranco 00:, '1'h. flolll /lOVOI. prOI~cllvd Lllal~UlenaQ 1:0.: on Ibl'r/lb I' ul npvore Villa pin AnnullV nluIsnab qo" WorqOIIOI, MaUschuloll1 01000 101lnluI a/lQa COVO BgOI Wo wiSh' ' 10" Iblln ~~liI 01 a~ InvaahgaUvo oonlul!1~' rapon may bo O/~oroa eR 10 vour 1~"1J"1111111Y Tnlp rcp.ll1' ,rial' Include, 1/ appiloablo,' 111I l1'ollon 01 Ie your ohalnclor, oanorol 10P4lallon, personol nha,eolnlI1Ilol'J,nd mOdo 01 IIl'Inll an may bo abrpfiDd lhraughi Inlo ~IIIW' '1'111/1 11('1)1/)1 mombornil,laoda, n~IOhborl ~nd suaolalo,,'1I vnu would Ilko Ie knew wMlhl!f au6ti trOflC" waa ord rod .,no, ilao.,laOOIVO a!ldlllonnllnloll~allon 0810 III nalU/. Dlld 00, 01'0, lholudlna II,. n nlnu, 0 ddlasa aM nl no nUh,h., all fO re"Mln QgallOy, ~ will 1>0 ploalV~ 10 IUIl1'$n Ihll Inlo,mollon upon 'youl wllllen loquaollCl our HU,ma Iflaa 01 illS qoo e addrOP , '1'011 mqVJaoolvo 000111' 91 ouoh 1."0/1 hI' eMlaollno Iho lorolllng agoncy, I ' ,., .,; ': , ,:::'. ~" \ sue Pl1Ij.NOTlott ON' ne+l1l1SliSltJli I .' ~fI'( 20 \97 161llS 1 717 7IJ7 ~;r;'O l'fV.ill,ool . ,. RECEIVED iIMEMAR,24, 11138AM, I I, I I , '1 . , , , I " . eo., I I 'I " I, ,., " I', 'iii " " " " 'I,' ,. '\; 'I; I! ,,'< q' " I', " ,. "Ii 'I' ,. .i "j, " ,. " I ~ ' " ,. " II ,. I' ,. " d' , "[, " " I, " Ii' " ,. " " ,. " "i',! " " If " " ;, " " " " " I, " I. ,. " " " " " Ii I, /"'1 "~I, I" ,... !.I " I' H ), ',I " " " " ,. ElXHlbIT, F , I ,;' II 'I II \' " . , yl fiTA Tr: Wnlll<t:!IW' I NSI1I1I\Nct: I:IJNP . ,,(.:nnllll0nWllnllh llf I'ullllwIY,l1lln ~ PI'Ilill'IIllllllt nf I,nhn!' 1II1111111hlHII'Y 1 (l(lI,^(:K^WAfo/N^ AVI'IM:, I',el, 11m 'i Illll, SCH^,~ ION, I'A 1I1S(l!i.!i Ill(l I'llilNP (7171 !l(,]..H.:!!i 1\11\1\1111:20, ,l.0Ql1 Ilppar1: IIllniU\lpn,' !il~q\.l~,r.p ~q,fIO( r,illq.1.estpwn IHI" /;l1:fl IIllrr.l~h\.lr.q( PI\, 17.1.10 201 nOI nlohar.d pprdll C1A~m HI 1127620 04 oaaf n1:1:orllay Hamilton, Plll1ElIH1nt 1;0 the at'dlu: handed down on MRY 20, 1990, PAyment; hAP bean A\.l1:hpri~edl " Paidl GOMr, 11/3/93 ~o 12/31/04 . '260;23 . 60 d/7wka. . '15,762.60 . 1 N'Nil HIE S '1' , '1,091,93 ,1/1/95 t:o 4/1/05 @,'120,34. 13 wka, a , 1,660,42 . : U!'I'IEnlE/;l'I' 1/1 603,44 4/2/96 to 7/1/95 @ ~:J.;:!O,ao . 13 . Wltp, . II' I, !i62, 60 . IN'l'lilHlUS'l' ql 525,12 Wits. '" 1/1 '16'1.26 . IN'I'mHlUS'l' " . 1/1 190,66 " ,I wlta, . III 2,237,136 . I N'I'mHlW 'I' I~ 4 6 4 , '/5 \~Jts', . IF 2,7.12,34 " IN'l'mrHW'l' , 344,90 \~I{fl , b :/I 7., :1 7. l> ,'/0 . IN'l'h;IUUH'[' :/I JOJ.OO Wkdl 7/2/95 to 12/31/95 1/1/96 to 3/31/96 @, 0,02. 13 WkdI4/1/96 to 6/30/06 7/1/96 to 9/<19/96 @ 1111.'12,12 . 13 ,Wild I 9/30/96 1:0'1;!'/:Jl/96 1/1/97 to 4/1/97 @ '1'10.10". 13 " 4/2/97 tp 7/1/9'1 @ 11117/3,90 '" 1:1 " \. , "QP13,~I: IlIlIllU l;nn, IEllf{ t 1\\I\JIHll: flO, ~!I!111 !lAIlP 1'I\111111u!: 'I'WP 7/~/D7 tn D/~O/q? @ IH!lZ,OCl " l.a wlm, l' W /l,I\DCi,'11l " IN'I'Ii1IlIilI3'i' >>1 ;,\li1 t 3a I I:n lN3l./!I? @ WIlOli,on " la. l./7wk~, " IV >>, 1l,?OO,41l " IN'I'I~nlilf.l'I' 2l.'1,'I'I ,. t:o A/l./!I11 @ W25fi,03 " 13 " II' 3,31D.na " IN'l'IURlUf.l'r ~ ,. ~,71i, 41l " ~o 1l/;1,7/llll @ I!lI!(iO,;!3 " III l/?wl,I> , " n, 502 ,01 " IN'l'JUmfl'I' 'V l.l7,16 *1\0 ,IHill, 60 $10,300,46 I NPJi1MN~TY /it IN'l'Imm13'I'pf\;I:P, IWl'lilllmf3T N\:tP,I 1\\1\;ornl1Y fQQI> have Il(lQn pAId at 201/; !1aYIllQnt: fOl: IlHl of oost: has 'besn'ail1:hodl'ieq" i.\l the aIllOL1n~ of 1!l7.,1(il,lO, l3inoer.aly, allM0'p ,J~C1nne Clai.lII1> I'D I \l\Q.rl Refi.oa l10vIewar JI1/jll 901 fUn Ilichllt:d IlOr.dol " " " " I' ,. 'I' !l;' " " " j',; ,,' , ,,~ " , , " , , 'I II' " ,. " 'I' ,. 'i. \ "" "0' " I' ;" " " " " ], " ;,i ".' eXHI13IT G 'il'" oJ. , . .' ~ " , ,j" l" ,./fflNSYWANIA srAfli. MPWY ~s . &~pfT UNIO~ , " , " , 'I 11'1 MAIN OFFIC~' 1 COWlrUl/lUN r'AC~ IiAllnISOUnQ, f'A 11110.iOOIl MAlLIN" AllIHl~QQI ",Il,'OOlln 013 IiAIIIlISUUIIII, f'A 111110, 111 13 ,IIIIN r Q\'II/~IIS "'!lCA M IlUlWA ,IAllqUPHIlP lIon"A aARNINGS ON CIlRTIFICATIl PlY PIlNP RATal. 6,35 ~ ANNI AI.. rllRqr:NTMlI: IlAl'l: VIIlI.1l1 6,(,11 "i ANNIA~ Pr:IlCIlNTAGIl YIIl~O IlARNnll1 5,Q9" IlARNINGS PN CIlRTlflCATIl 11,11 PlY DaNO RATa,. 5,3fi " ANN A~ PIlllaaNTAGIl RATa Ylgl..PI G,nu " ANN'A~ PIlRcr:HTAHg YIIl~P gAIlNIlO, 6,Q9" NIlW IIA~ANcIl (MATUllllS 051139?) G,35" 10133 ;lG71(t3 1171 ;lGll? I(t ;lGU?H, , ,. ljI~~am~I~~~~~'in~ll.TO~P^'T-r-:'--"""""I-'_n_"'I-; '~:;'~'-'I---"TOTAL FIN^NC~'~It^,lii~ YMiliot~~i~fsE ..--- ,,- ... P~t~3'11~r.rln,~,~.I~o~.~~:'!lt,i~\cb" -.-.----".-....--- ~....__. I~ tN. u1ond31 v.."~ NOTloUI Soo '.VOI" lid. 100Imp.l\.nl"'fb,moUOIl, .' . 'INOICATES ~mOTlVE OATE ll,llO " , .\, , 1lI.la. !! i' " I, I 1", i',' " " ,. " " " " " ,. " I' ,. " " " " I' " " ,. \', " " " ',p " I' j; " " " Ii' " " H'l " " '\. " Ii " ; " " 'if! I:XHIBIT H " d ,. " ii, I' i' " ", ",c... " ", " , It " 11 ,\,'. " .I', " " " IJ .1' H " q, II " " ,. I' ,. ,.." " " I, , ." "'."'-;.-1,' ;',k' <cO " ' ,,,.;:'., '"j.- /,\ /.t,l, '\,,; ~'." " ;\,. '.i:'-,:-<;i,c,\/\J"jJI't":~j' I ~I"" .,1....' "i 0,.1 '.' . '\'-"",' 'I ' , ; '0"" J'".- '.' .1/,1.,\ ",' '1"\1 ~I" . ',' :1'.'\, I' f ,'.' . ld')\,"'T MU"rlDT'A .,P,,', ",-""H~,''',,' 'i' H;'\"l'-.I "il-; I '::{Ii-, . ''.<I'"......~~ \~,~':: "-'\}":'~'-Io'l';"~\ "',,,.J';",i, ,'i'l',.!AK<i.Rr:TlJ fll'! ;:Jllta.U.tJF N'r ":' 1,,'-:'.'1,' "I'I?' "',.,,"'.'''..,.),...'I.'..'I"N "" ..,,~"',.".:.illPt'I,. ,..".1", . I" ,',.. CI n""" .' . 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" IlIVIPnNIl PIV PIlNP flATIl' 3,2&" ANNIAL r'nflCpNTAGIl RATE VIEI.DI 3.30" ANNIAL PliRCPNTAGPYlliLP IiAflNliP, 3,30" PAYRoLL TRANSFllfl 011\~~;!ll331' PAYRoLL TRANsFliR 016~~;!ll331 PIVIPIlNIl IlIV PPNil RATIl' 3,~S" ANNIAL PIlRCIlNTAGIi RATIl YIELIl, 3.30" ANN AL r'llflcPNTAGIi YIPI.llllAllNJlIl, ..3,30 Y, Nnw. IlAI.ANCIi .r:>tl!lP . P~NNSY~VANIA STAle ~M 'lNoms mDIT, ION l' I 'f ., '" f, \ I ," ThAIN OI:I:W~I I ell 'lllT UNIPN /' AC~ . "^"nlsP! /lO, PA 1111'0./0011 .. d MAlqNO Allnnm, ~,(J, pufO IPI3 IWll1ls0UIIII, I'A 1'/100,10 I ~ " 1111111111111111111111111111111111111111I11111111111111111,111 InPIIAlIP,~ IIPflPA ,JR '33 PLPAaAtHPN OR PAsT IIPflLIN PA 17316-93!l~ ,IIlINT (JWN~1l9 J~Q~\JIII.IIW n"II"~ I on 1 I 0 I ! 10;!!i 1031 o 11\(,(,a5331 o 1 1\(I(t;!533 I 10011 1000 117' 103;!(lP 1 (l(t;!!lO IUli;!O(l I (llil't1\7 I 1011 II ;!2 113 (l 1000 10o(l llli 1061'11\7. I (l Utll? " 10777P I;:lOI\ 1220 I ;!31 1000, 10110 01 1011772' 11197'72 (I 0 (J 73: i I;! ~ I r.1H:GK tNo - R (, I'OU j Plill..VIOIJS IIALANCr;, 1231 Nnw llALANcll Jll ::. G ROW T II .sll.A1lli lW,H.LlE.I C ATE' /, ' CI.1RTIFICATIl I 1001 f1RIlVIOIJS, llAJ"AJiC~ 1031 IlARNINGSON CIlRTIFICATE Il,3? IlI.v PIlNIl flATEI ll,;JIi" ANNI AL PIlRCENTAGB RATIl YlbLDI 6,411 It ANN ^I. PEIlCllNTAGIl VIr:I.P t:AIlNI>D, 1i',311 It I I 0 3 , ~ S Ii AIlll C 11 lIT I F I C T P M A TlJln TV 0 . '7 (, IlIV PIiND flATP, li,;JliY, ANi'll AI. PIlIlCI1NTMIi RATC YIIlLD,'li,311 It .' ANNI AI. .l'EflCIlNTAcll: Y'tl>l.11 I>AIINEIlI 1i,39 It UCllNTINU"llK~ 11:3? I' , H 7(1 , ' . - TOT^.L oiviiiENp Y,~:^i,'~ ;:-,1I.0^ Tll-......."/-....-....-...".--:.--....----"j.'-.-.ToTAL flNANCSCIlMOE y. ~An. TO.OAlnj (0' ,(""vingl u/opl filA, ..; , 10' IUI""I, ., OM",n", Ih'WIl, " 11001 ov" wlll~' _no._..___'........,..__......"..... , .... ~ ('rortbd In Ih, In ",", n'V'n'" h,1Y e, . . In 1/i11 col,""O, VOOI,. NOTICE I r,,, ,'OVO,,, ,Ido f,'lrnpoil'liI1nfollnalloli, " . " " "INOICAT~S mtcTIV~ om " " " " , . , . , \ I I I ",~ 1,I"orll~, ~PITnlpllI, l!s\llIlrl', \In Iwrllhy Ilpl'llfy Ihlll Oil Al1rll ~,I \lUU, sprvl\lp of lIw , forll~IlIIlU WIIS l11U\lP hy \1\lposlliIlU 11 \lOPY 11111l\l 1.111110\1 ~IIIIPs l11ull, pnslllgll prpplIl\I, m\lh'oss\l\llls . .. fplloWHI " 1~lohllnl ~, FrlPlhnllll, llsq, FIUlmMAN l~ IIIUlmMANI l'tC, (lllll Nlll'lh I'lPPoIHll'llr\lllt, Flnh FlopI' \1,0, !lox \l1l4 .1,.."""""" "~~.I OH l /. ~",J""~.Q (Je , I.orl K?;'l I"rutlllll, HS\11 SICHHA'I'ICI,I,I. SCIllFJi'MAN. nnOWN ,'I; ei\l,HOON, 1',C; 20HO L1llglllsloWI1 H(I" Sullo 2ll I Ilnrrlsbul'U, I'A 171 to (717) 540.\l170 " Allol'lloy 1'01'. \1lulnlll'l' Ii" " ., " !, il'. II '"I I' " " ' " ii' ,~ J;J. " I'I~: . -- . ).,1,' ...:1 L",')' (\J (Jfl'; '"1'1 ;', il,., n:.; /'/i'" 1'{.) P-) I' ...." i;',.' , i;~: l~ (.'I,;" lL, I..,~' m t~,:, . .'" ';j (') . ',' I:).'" ;'" 'I: j :'1";' .II} 1"" ,I'(lt"j ,fl{j~ "::.'i C) ~ ~ Ii 8 ~ L: 00 8 aj ~. ~ i 0 ~ '~~ . .-~ I i " ,. ,. ~ .~ W'; ft; , ' ~ ~riH PI I> =l co tI1 r: !ll I.. '" ~ - ~ ~~ L ~ '" '" I ,.. ,.. g ~~ f-1 '" J iii. ". rl 19. /i1 r-tl ,'i " ,. " " /, 'J oi ' " ,. " ,. ,. >Ii .. . t,. f~'.ln'AbUU. j lWo,oJ ;'iUf~ ~~~\\~~Ti.~~n I tv ~ . . J .t, ;,_" ,':' IUCIII\f\P ,1, 1l0\\D/\, SH" l'lllintiff, 1)1\ ~O, lH3 IN '1'1 I ill call 1\'1' OE' COMMON PI,f:l/\S CIlMlllillU.JINU CO\Jl'l'l'Y, PIONNSYINTlNIII v, , I I I pOMHSTIC RIilLI\TIONS smcTIoN , CIVIL I\CTION - SIlPP9RT " NO, 31190 OtVIl, 'l'IilI\M 1990 , al\cglllilLINID II, BORPII, Defenc\ant: Q.IW.Jm-Q P CQIlI1'I IINP NOW, this 13th dllY of IIUGust, }999, in t:he 1I0t:10n of RiohArd J, Borc\lI, Sr, agllinst: JAoqueline 1\, Bordll for alimony pendent:e lit:e, the olllim of Riohllrd J, Borda, ar, for IIHmciny pendent:e Ht:e is denieel, Pursullnt: t:o an IIgreement: of oounsel, Pefendllnt: Jlloqueline II, porda shllll maint:llin Plaintiff Richllrc\ J, Borda, Sr, on her emplo~~rls mec\iolll inSurllnOe coverllge pending furt:her Order of Court: so long as suoh ooverage is aVllilabl~ at: no eNpense to defendllnt:, By t:he Court:, Lori K, Serratelli, Iilsquire counsel for pfllin~iff ~J.o Iii.. ;/0 J'(!"".yt~,,, ! ~; " "I, Vi " 'I " ,. Riohard S, rriedmlln, IDsquire Counsel for Defendllnt: Illf " " " O'll'l,OB mil tlotl 1I-26-99 'I " d' ,. " lUOlIl\RP "J, 130lWI\, sg" ~P1A:lnt:iff, "", IN 'l'ml COUI~ll.' O~' cOMMoN l'['NI\~ cUM13NR~nNP COUNTY, pmNNsYLVI\NJI\ NO, 3090 CIVIL TmRM I9pp YfI, Jl\oguNLINm 1\, 130RPI\, ,IJofenclant: , ... - ... ... - - - ... Jl\cgUIQl,INm 1\, 130RPI\, , l'la.i.ntifl:, I "" I Vi!, I ..I RIOIIMP J, 130RIJI\ , SR, , I Dofendllnt:, I IN Tllm COURT, or COMMON l'Lml\~ CUMBmRLI\NP OOUNTY, pruNN~YLVI\NII\ NO, 633 st)l'POR'l' 1998 ORIGINAL Ptqaeed.i.~~s held before Tllm HONORI\BLm J, wmSLmy OLmR,JR" JUOGm Courtroom No, 2, Oumberland County Courthouse, Carl..i.sle, Pennsylvania I\ugust: 13, 1999, aom~enoing at 10115 a,m, " " l\[lpml\RI\NcmSI SmRRI\TmLLI, SOHI"MI\N, BROWN 1 OI\LIIOON P,C, 13YI LORI K, SmRRI\TmLLI, mSQUIRm 'OR - Jl\cQOmJ,INm 1\, 130RDI\ 'RimDMAN & 'RlmDMI\N P,C, 13YI RICHI\RD St .RIIOMI\N, mSQUIRI POR - IUCIII\RD J, IJOIUJI\ 1. \ 'I'.: 11.,~~\':'ru 11,1,1.,',1:" I " ':' ,'''1''1) " "",'-',"/', ' " I' " " fl.:: 11 t:d G I ",UIl G:;i, I )\;,J'r-' !"il I.' _:,: 'I ,t:) \J }.1." ,I, ",Ji l., ",I, I' .~. .._ '1"11'" I 'j'l'l : :.j. ~;U \,,: ,: " \'1 r 1: liP (ll X '1' 0 W, + 'f li IQ Iil Iil wog '~'IIli1 1'1,/llN'1'H'~1 1l1lUOC '~' a\~Ollfl mOIJ I l\lil 0 '1' r~lnrJl\oSfl Hi ol1l1!:Ct lJonlA, (Jr, 4 1'1 ~(j ~Q u'og '1'1110 Illil11'lnN 1J/lN'I' None ,. I' q' " I. " " ,. " '" " " " "j, ., ,1' " II II " I' " I' '" " ,. " " d "Ii ," ,. I' " ,. " , ,. " " I' " " ", I" "II 'I, " 2 , " d' " I' " ,'" iI " ., 1 2 3 ~ 5 (i .7 0 9 10 '11 12 13 H 1" ,!) 16 17 10 "l 19 20 21 22 23 24 25 " " ,. ,JI, I~d(J1I IlOrell\, fJopl:oml)er 5th, 19'1\)/ 1'\1(111<11:(\ IJor(\<I, I\llgll~t \91;1\, 1900, ., I" 'J'1I1n COlJl~'l'l 1 '111 sorry, 1'11\ (JottlnlJ .10131: on these " n,'\mes, Wh<l\: \1<\1l I:ho U rst ni11110? 1>11:10<1 Mi1d.o Ilorclll, 80(1tollllJor 5th, OKi1Y, Ilncl'l:he noxt ohllc\? R1chard Jamoll BordA, Jr" I\UgUllt ,. OKElY, 1\, ,'Well, ShO'1l off' for Slllnmer vaoat1on, but1 belj,ove she's startJ.ng aga1n In Hepte11lber, ]' haven't t,aly,ed to her'for i1 whIle, lias she 9 raclua ted ld,gh /Johool? Yes, she hao, I\nd she's I3ti1l:ted oollege? I' She's already flnlshea ono semester, What collogo7 YorK COl.1.ogll1 W:l.th' whomdoofl she reulde? My'w1l:o, when sho I fj not goll1g to ifahool, I', I" .) . , :I 2 3 4 r u 6 '/ 0 9 10 11 1? 13 14 11' .U 16 17 10 19 20 21 22 23 24 21' .U .. 9, ^nd your nOli, 1\.1011111'<1, .In l6 yoilJ:/; old',' ^ , Yo:; , 110 1:;, Q, ^"d 1,)"hIJ ,ill hl\lh' nohool'l.. ^, YOI!, I III l n, Q, Whol'o do~u ho l'onldQ7 ^, 110 l:ol1.1do:; Clt: :\ 1'10":;I'IIt:OIl Pdvo in 11i\:;t: 110 I' J.1n , 'Q, WJ.t:h Ids "11\0 t: ho 1-:',' ^, Yos, Q, MI', pordo, wh"t: is your ourl'oll1: oooupo~ioll7 ^, 1'111 \lnoll1p.loyod I'lgh1: 1101'1, I'm reo01ving \~CJt'kOJ:sl 00I1\PoIIS1l1:ion, Q, Would you oxpl11in for the jllrlgO, ploose, whot. I Illjllry 0,.1\\130(1 YOIl to bo on \~OrkOr8' 00ll1pol1811t,lon'l ^, I' vo hml corp1l1 1:111'11l01 .i n my 10ftwri81:, ul1111r l1orvotr1lllSposition In lilY 10f1: olbow, diso fusion in my 1100k, Thot's about: it right now, Q, WhAt yoar d1d tha1: injuiy pecut', thoso injuries , . 000\11."1 A, 1992, I be.1..ieve, 'D!, Q, And who \~.as YO\1l' on\ployor at tho l:J.lI1e7 . A, mlCO Incorporation, Q, And what typo of work wero you <l01n9 at: tho 1:111\01 A, It \~as constr,llctJ.OI1 wod\! 1'10 woro p.lp1ng I Q, Woro you aWArdod Workors' componsation fairlY soon aftor tho inj\lry1 (i 1"1 t' ~ ~,'~ I iI,. '(on, ? ~, An~ how lona ~l~ you ~omQln on wo~kor81 oomp1 n, 1 n~ proHontly on It atl11, 3 4 q, WAll t:llCH'<1 avo),' n torllllnnt:lon oj' tho \~(Hkol:SI !i ()ol\\P'? 6 A, YI)fJ, thoro \1 ,Ill , 7 Q, Whnt yonr ~l~ thntooour? " o !) A, It wns Noyolllbol: I!)~, 9, J;'rolll the Injury in, 1991 I.lnt,ll Novom~)el' of I !)~I ,. 10 " wore ~QI.\ <\blo to do any otl1or type of wol:l\'l A, No, not with that oOlnp\lIW 11nymoro, It \,/,lS 11 If. 13 1.4 15 16 17 10 19 ,20 21 " ?? 23 24 25 I' C9nBtr\\otlon work, Tiley ha~ no lIght-duty, Q, Old you go t:I1J:ough Any ,type of 'vooaldonnl, . trainIng during thnt timo? 11, '{es, 1 did, Q, And for what occupQtion? .- 11, At first 1 was going for reBpirator~ tl1er~piet, and they moveel the classes to Yorll, So 1 deoided to, go'to school and drive a truok beoaUlle I noDded to g~t a job soon, ~, Do you rooall what years y~1.\ drove a truck? A, .June of 19!i approximatety untIl mid J~ly 196, Q, 'l'hnt \~aB clud,n9 the till10 when your worke'rs' oo~~~nsation had boen terminated? A, Yos, Q, Did you appeal that ter~inDtion7 'J ,'''-'' I. .\ 1 . 2 l\,' Y(i~]1 1 <(.\II, Weru 1'01\ OVO!\t\\il),ly l'llil\1i1r<lnd tlW WOldiol:Ui (WillI' 'I 0,' l\" YCJu/ 1 V{IIIJ, I\nd wl1l1t YIlIII: \~IIU tl\1I1:'1 3 ~ 0, [) 6 ,(\ , Q,' ,:' II /\, Q., () l\, 10 11 1090, fJllptoml.>llr, Pldyol\ clloolvD iI I:lltroilotlvo IIWilrd'l YOB,!' c\ld, ,. po 'loll 1:00<11.1 .how 11\\\oh tllill: Wilu'/ ~pproximiltoly ~%oo, .. " ' '1'.1\1': COUI<'I', ~O,OOO'l '1'1IH: Wl'l'Nl~fJiJ' Yo.:\h, 12 WI' MB, BI"I"~l\II'l,:llllll 13 Q, 14 ll1 Was thero intorasl: paid on.that award? /\, ,. YOB, 10,000 of it was ihtoroat, " , Q, l\nd thatwaB roportod to tho Dbmostib Rolation's 16 Offioe at the initial s\\pport conferonoe'l 17 1 B . l\, Yes, Q, Now, YOll indJ.Clltec\yoll dpove a trLlcK l1nti.l" 1 19 belJ.oVo 1'0\\ said, mJ.c\ 1996'1 20 Yeah, 1 bellove It \~nfl ,JulY ,\~hen hurd,cilno .l\ , 21 sellson oamo in, Why did.YOII stop cldv.l.n9, tho tr\\ok'l 22 23 H 25 Q, l\, 'I'ho, felio\~ 1 was dr.lvin';J, for wonl:l)An}U:Upt', Q, Do 'lOll rocall tho name of the cOlilpany'I 1\, Geor90 updograff Truckin9 Company, .. Ii (\ 1 ') ,~ 3 A, you, I <11<1, ,. , <;), p.1 <I YOII f t 1\'1 <IIW'I I 1'0111\<1 ,'I l'od:l.\ [.t: OP'H'ilt.ill') :1(1) thro\l<)11 I\olly A, 'I fJrJI:yl()(HI ill. Buol: of t:lll) MOl\th 1';1.1110, 5 G " 8 .11, \.1, 1I1HI whllt: typo 01: work did YOI! du thoro? A, ~orkllft oporlltor, \.1, Woro YOI\ 111010 to porform thilt job duty? Yall, '[ll1l1t \111111\' t 1:00 111\'1:cl boollulJo 1 hlld 1\0 9 1Ht:ing to do. 1\; \1111'1 jUfll: pill.lothocl nhJ:.tnk-wriii}pOd books, 10 11 12 13 14 15 16 1'1 18 19 20 21 22 23 24 25 \.1, lInd hO\1 dicl you COIllO 1:0 bo no longor wJt:h "oak of tho Month Club? fl. 'I'ho job thil t wo l1i'\d, t:l1o c:ontraot oalllo \lp on .it. , " Q, P.l.d you"look for ol:hor worl: thon? 11. ,1 e\.lel \10rk i'\t Book 01' the Montl1 Clllb for abollt I:wo weokfl, Q,,, And 1111Y dicl YOll lCli'\Yo? {\, Q, fl. Q, fI, Q, 11, Q, 11, 1 couldn't cia ropotil:lous'Work, Yo~ woro no longer on tho forklift? No, Whllt typo of work i8 thal:? It: was a1lsembly l.l.no, putt',Lng batiks in' tho boxes, lInd whAt YOill: would thin havo boon? 'Still 199'17 ThaI: would hilva boon 1998, Ilava you helcl olllploYlllonl: ,9inoo that job? " No, Ihav,on I 1:, 10 ,~ 3 ~ " ,I 6 '/ B 9' 10 11 12 13 14 15 16 1'/ 10 19 20 I,) 21 22 23 '" 24 25 1\, Q, .tilllu'/ 1\, 9" 1\, Q, .1\, Q, 1\. 9" 1\, Q, 1\, Not by 11111.1, no, Now, Whill: ol:h(d ,t(lUtor .I B troilUnlJ \,Oll Ill'. 1:1111) PI', slI',. ncol: tB, ,. 1\n~ Wllilt typo of dootor IB pr. Bllilrrottu? A IH1\,ol1li1tdfJt, 11/111 110 proBudbDd ilnyII\OLt.lu<ltlon'/ IIO'S (Jlvln<J IIII' 'I'hori\?ono (I?honetlu), i\ne! ..,- Is thi\t Tri\?oclono? YOi\II, 'J'ri\?o~ono, And whi\t 18 th<lt lIIodication for? It's to holp ilia sloop. Any othol'lIIed,lci\Uons'l Nellront1n, It I B <I IIIOO~ still:d,l.t.'zer I, Q, Do YOll expod,el1co ilny Ili.clo effllollll frolll thi\t: mec\J.cilt.ltln? 1\, Yos, Both lIIoC\1oBt.lons are ov~nly equal to clroWlllnoBs I tho\, l11i\ke mo feel i\ lot 1II01'e clro\~sIor, I'm tAkinu thene thingu I~hen I lJet Ill' in the morning ilne! before I ~Jo to bed, rivo cl1fforont pIll 1'1, or fOllr . cI.1: J't' 0 rent p,l.J.ls, 1\nd thoI' '/\11 haVll tho U<lI1lO \~i\rn1ngll on thell\, Q, Do \,ou oxporionce Bny By~)tOI1lS <IS a reslllt of, 1'0111;. pr.lor worl;ol:U I uOmpOl1lliltio,! 1njut:\,'1 1\, YeB/ 1 do, Q, 1\1)(1 I~hilt i\ro thoso 141'1111'1'.011I8'1 .. 13 I 2 3 4 5 6 '/ 0" ~ 10 II 12 13 H 15 l.6 17 10 19 20 21 " 22 23 24 25 II, 1111I '\ookin<:J'to I:ry. \',() ',IDI: 'In\.\) I:ho CJ\llll1i1ry i\l:tll 1'1:0(11"11\\, Q., WO\I.1r\ t:lwl: be II IOCill f1Dlloo1'l II, II: oOldd bo pOSfJlI:J.1.y I'hlliHlel.phlu, '1'111" COUR'l', ))0 YOII E11:1ll 11iIVO Iwpat..ltl;J'1 '1'1I1!: WT'I'NI~::H1, you, I elo, 'I'II"~ COUH'1'1 WOllld YOIl bo '1bIo to war!; 111 t:hi\t:'" Hold .wlth \:)1I1t 11ll1ofls'l '1'111" WT'I'NI!:SS, 1 Clxplalnocl I:ha I: to the WOIlIl\11 at OVRI and 13111') hillln' r, COllie Ill' wl th an anfJWI)l: yet, Sho 8<11(1 she has to dlsml8s It wIth BOllleono, 11' not, 1'1.1. look Into d j , 8ollle~hll1g dlfforel1t, I'm jllst waltll1g to 800, Till COURTI Okay, BY ~s, sffiRRATIDLLII Q, Mr, Borda, 'how much are YOII \:eccd,vIng curr.enUy on workers' COlllpenfJatIon? A, $402 overy two weeks, Q, And il!:(~' you rontlnCj an apartment: at tl1is 't:Imo? 1\, I'm rentil10n room, Q, I\nd hO\1 muoh doos that rLln you every mOl1th? II, 325, Q, And YOllr utIlItIes rUI1 how much? A, 'I'ho phol1o bIll 18 ,about $,/0, 'l'hat's about" It:, LIght and hoat andthlngs lIke that are ull Inoluded; Q, '))0 you have medIcal Insurance, medlaal cOVerage? 15 " .," ' 11 f' 1 2 3 4 l' :l 6 7 0 9 10 11 l~ 13 14 15 16 17 10 19 20 ,. 21 22 23 24 25 1\, ~13Il, 9, I\nd arc; yon <lWiHO :I.f tllore .j.u i\ IH'otr:i-<ll ,ho<ldng' sclw>llllo'cl7 (I, ~es, 9, Is tl1'\t (lU<JIlS\: 30tlll 1 l)ol.i,ovo'l ^, I cll(ln ,\: kno\{ tha t, ~0tJ , 9, I bollovo .j.t Is, (I, I do nO\~, Q, Nr, Borda, YOIl hav13 boon 'separated for oyer two <lncl i\ half ,yeilrs, and you hi\ve not reqLlostocl s\lpport Ot' alImony pendente lIte provlo\lsly, Why dl>1 You requost It now? 1\, nooaLllle with tho sllpport beIng taken 0\11: of: my" " check, I \~asn 't able to milke iI J:ent payment, Ny one check: didn't even coyerth13 rent, MS, SffiRR(lTffiLLII I havo no further q\lestions, 'I aRoaa-mX~MIN~TION .." BY MR, FRIIDDM(lN, Q, Nr, BOl:ds, ~ho supports ffirloa? (I, She works her own jcib, froM What I gather, Q, She paya hel: own way thl:o~gh ooll~ge? 1\, I gav~ her $3,000 last: year.for half of. t:he semaster, Q, And Ml:s, Borda pays all t:he rest: of the expenses? ';' II!,' I would assume -.- no, My daughter works when she 17 I I "., 1 2 3 ~ I' ., (i 7 0 9 10 11 12 13 1~ 15 16 17 10 19 20 21 22 23 2~ 2" .:1 1]0011 \:0 11011001, 9,,' Now, .1111',111 t.'llk <lboll\,: 1'.1\0110 :lOI'lB YO\l 1\1\<1, .. ~O\I \~oro elrlv.! nIl, \~lJron I \: YO\l, II l:I:\lCI); e1l'l.vllr'l l\, YO!l,:r \'111/1, 9, D.lel YO\l uvor 1'.\\lnl; <1 IIr.lnillynlll ilnd 10fiO yonr :)01)'1 fI". No, 1 ct.!el not louu II1Y :lob, 1 :l\lue flllnkod 1\ l\dn/l1yuis, Q, 1I0w 1I1,1ny l:imI'lEl? fI, ono tl\l1t .J ');now ot, Q, po YO\l l:oll1ombor iln .inolden\: In cil.l.!t:orn,Ii1 where thoy tl\rew you off tl1e lot anct -- fI, 'J'hi1t's tho ono, Q, find \:hoy nevor flrodyo\l? f\, No I I did not work to!.' HPS, ]: workocl I:or UpdogrA[t Truoklng, I' ' Q, You 111so had a drinkIng problem, dIdn't you? fI, I ,\ld In the pillll:, yas, Q, 'j'wo \)U I s 'I fI, Yas,ovar 20 yeilrs, ',1 Q, When \~ere I:hoy? 1\, .Ono l~ilS .in 1997/ or 1997 r gol', sentenoed, '1'he ., .other WilS .in 1977, Q, 1\nd did t~ilt affact your ~mployabll.it:y? 1\, No, 1 I;lIS lillel off ill: the tImo, 'l'ho compilny I 10 10 11 12 13 14 15 16 17 10 , 'I ':"I~i\lJ vi(~,l'kI119 fol' 'wont: \Jill\l;rlll'\., ;>. ,1\ 1'0 y(ii, lIlodl Oil \.utl 1'1 '.111 \: 1101'1'1' YUfl, :( lilli, 1\nrl YOlllwcl I'll 1'0[') Ollill'l.JOi<l)lo motc)). vul\101o 9\ " 3 1\, 4 \), r '-' i\ooldonts 1,\ ID!JCi IdonG',' " 6 'I'lll'uo cllill''.!Oi\\J t u'l <lon't rocilLl l:llron fI, 7 OIWrl,]Oid111l Inc:ldolltfJ In 1')%, o ,Q; D1 (I YOII 1111 VO tllrllll ,'[uoIdonl:fJ 1:1111 t \'/01'0 yoqr f 1\11lt in 1\)%'/ " " fI, Not tlli\t :[ .rool\11, q, llol~ .llIlIny did YOII "hAVo'/ fI, ono" 'tl~o , Q, Wel'o YOII hlll't In those? 1\, No, I \'/i\fJn' I., Q, Ilol~ dId you get hepII\:.i,Us .C'/ fI, I reA ll.y dan'\: ):no\,/, Q, Wel'o YOI! llslng needles' IInd 81'10I,t'drugs,! fI, I've illso lllld blood worf;, blood givon to ,me, And , 9 20 19 I WIIS lIPlng needles ilncl (lrugs, ilnd my Idfe f:no\'/s this, Q, FInd ilS il mll\:\:or of fllot, fOl: milny, many yeill'S you' 21 ,I~ero \~aat:ing your w'.He' fJ 1II0ney wltll dl:UgS? 22 23 24 25 FI, I nover wa~ted none of my wife1fJ 1II0ney, Q, Oh, you FJpen\: your llIonoy on drugs? I spent what I kept out of my oho~k on What r FI, \~anted, , ' 1\) 1 ~ 3 ~ 5 6 ., 8 9 10 11 12 13 H 15 16 17 18 19 20 " 21 22 23 24 ',' 25 t;)j Coord 110'( 1\, No, 1\ 9, 110 ro:l. 1\ '( " i' I' " 1\, MI\yl:J(J , " 9, No\: lIIi1ybo, 'tOil 01: 1)0, "" II, 'tanh, ", Q, WI",t: 01 so'l 1\, Mo t 11I\llIpho I: 11111:1.110, " Q, " Wlw \: 01130'1 1\, Mil I:I:)Uill1ilI Q, fJl::lll \ll11ok:ll\g pol:'l 1\, Onoe :In iI l~hIlo r hilVo to 1:0 help l1\e e"I:/ I've. " 101l1: Elll1\ODI: 100 pOllndB over 'tllo 1nsl: yeal: I Q, 1)0 you rOl1\ol1\bol: beIng III fron\: of 11'"l1\ill:r,i.Ago 00\ll1s0101' Elnd YOllr w:J.fe was I:rY:l.ng to koep I:hIs milrt:.l.llge togel:her ilnd Bil:ld'~ll you hElve to do Is give' up drInking and s~oking pol: and YOll tofused to give ~) smoking 1'01:7 1\, I told I1\Y wHo, I promI/wd -- \:hIs WElsmore of a contrAct thllY wanl:ed mo 1:0 do, Q, 1'0 stop sll\okIng ul)d ,Ij, 1\, 'tos " 1'1\11(\ I sa td 1:0 my wIfe, 1 salel, my tonguo would havo 1:0 fllll off Hs r0110ro .i.f I sa.i.d that: beaaL1Se I don'l: know If I'd be lyIng/ I Olll1not,gllarEinl:eo noth.i.ng lIke. t." " thal:l I allnno\: gllill:lll1t:oo I~hat '1 Ivould do 1:0II\orro\v, 'Q , , I Ilow muah IEI,llIl1rI:luanrl I:heso days'l 2() .\ 2 3. ~ 9, 1\, Q, 1\, _1.'1" I Yoii pill<l hol' (lbIOOD '0111; of 1:1\011,"(11<11\'\: YOII'? You, . '1'0 clo il IIII1UI:OI:' II l1oilrlWJ'" 1 told 1\01: 1:0 do wl\i1\'.nVlll" ,'110 1\ Il!)clml tp, '1' PIlI: it; in .. .. IIl\fl uho lIuo,t I I: uhu et \'., ,. i1n '(,SOI'OW i\o(JolIl\l:, itU II1IW ,. Sheld .l.nrj\lIl'e \:0 1110 ilnrl l:oll 11\11, "nd J 'c\ !lilY you, 'If l: h.1 t: , II I' .) 6 7 whnl: .yoll nood, do It, o 9, po YO\l IIllCtlll:u\'.ilncl tl1n\: tllo l)(Info lUA\lDS bof'oro 9 l:ho lIIi1fJl:Or",n'ro only cllssipi.il:.l.on of'. ilfJIHJ\:U i1nd i1lfmony i1f1 \:0 la' Whet,1HH 'Yo\ll to on\; Il:.\ocl 1:0 illimony? 11 12 1\, Q, IIX'O\l80 1110 'I Sttiko \:h01: q\lostion, . Thon you did spond $5,000 13' to pAY for YOIl!: oost and oxpOnU08 of' 1:110 cl.l.votco, .cl.l.cln'\: H YOII? I 15 16 1\, Q, Y(~s , 'I' I cl.l.d, " " I\\: th0\:illlo YO\l 1'0fl0ivod' the $~O, 000, whal: kJ:nel 17 of ~ vehiolo 1'101'0 YQ\I driving? 10 19 20 21 22 23 2~ " " 25 1\, Q, 1\, Q, 1\, 1900 IJ.l.naol.n, Ho\'! many mUos cl.l.c\ It hilVo' on' It? 90,000, I\nc\ \:hon did you b\lY anol:l1o~ oar? You, I c1.l.d I Q, What \:ypo of oar? 1\,' 1993 BoVlllo, Q. Ii Cac\.l.llao? 22 !'-, ] '1 (. 3 ~ !i 6 ., 1\, Yuu, 91 I\nd l10w 111\1011 ellel ,1:111\ t 00111: yon'l 1\, ',1'111 rl:I!UII nino, Q, $13, DOD 'I 1\, Yos, Q, And ill: t 11111: t 11110, I:hi\l; WilH IIIO!'C) thi1n YOII \~oro , '1 gel:l:Jn<J 011 OOIllP (1 yonr, 11'lBI1'1: Iq o 9 .10 1\, No, ))001.1111101 t~rl1c1odjn II IJ:lnooln wi,l:h It, "hoy gave I11ll $6,000 on I:ho I:r.ldo-jn, Q,. 'I'ho V'lIIlO of tho oilr wall mora than YOll mi\e)e ,tn A 12 11 YOi\r on oomp, Wil1ln't It? 1\, Yo~, It 11IIS, " Q, l\nd YOIl felt YOLl noedec) a CJclcl.l.llac worth $13, 9007 1\, Well, 1 .Wi1S clrIvIng a 1994 ],j,no01n dght before thi\t, so I WilS <JotUn<J SOllie thIng sIIIIl1ar 1:0 whAt I 1111c1, 13 1'1 15 16 1.7 10 Qt " Do YOIl havothe. dOoLlmenl:iltIon on thepurOl1ase of thilt vehlcle~ , 1\,. 19" Qi 20 hoadng? 21 ,1\, 22 Qt' 23 1\, 24 Q, 25 fI, " Yes, I ~\o, but It's at home, Do YOlt rl~qi\ll ~ ilskod .for \:11IIt' elt tho SUpPOI:\: " No, 1 don't I And thon what happened to the '93 Cildll1ao? The front a~le went bi\~,on 11:, How BOon <lftar you bougl11: .Il:? I Oh, ~~out olght weeks, 23 , ,. 1 "QI (.J 1\, :I \2, 1 1\, [i Q, G 1\, '7 I). 0 1\, 9 III 10 1\, 11.: $0,500, 12, I' Q" 13 1\. f1 Q, l" 1,lncoln7 .0 16 1\, 17 Q, 1.0 1\, " 19 Q, IHel Yol! Iiilvo i\ \~ilrrilnty Oil tho voldelo'l N(l, :it', ~lilH ,1 30,,;,clc'y \~ilrrillll'YI And (I.lel yO\!. hilVo. tllill: vold.clo l'opnlrf)(I'i No, 1 (I,\rln I I: , I t 1'i1e1nel 11; .\ 11,' I\nel wl1at diet ye,\! bllY tl1on7 1\ 199!.i J.Jncoln, U'Pl.' 1101> 1I1\lOh'l SOV(~ntoen ,nInl1, $17/9007 lie gclYO 11\8 H,500 (JII tl10 I,J.nooln, on tho c<\clcly, 130 Tl10y gi\VB you B,!.iOO anel you ppellt seventeen nIne7 Thoy gave 11\0 B,500 on the trade...in, yos, I So you spont $9,100 out of your funds nn' 1:110 195 Yes,/ I eliel, And yO\! I3pont, $7, 900 on tl)0"'93 CallUlac7, Yos, " ,. So In the past year sinco you got yo\!r $10,000, 20 you ,spent $i'l,300, plus a trado,;,In on yoUl.' LI~coln, on " 21 vehJ.clos7 22 A, Yos, I h<\d problolllB wI th a t:(l\~ of t:h(~Ill, tt poat: 23 too Illuch to fIX, ThrOB oatalytic convertorB are over a " 25 21 thousand dollars, Q, Where did the rost of thO monoy go?, 21 II, , '1'110 rHllt 01' thll II\Cll10y,I Cl\1~](\ ,11011, I,,)!:t <Jot 3 I' i VIJ, My Iltopmol;hlll' (II. tl\o.. \:.1111(1 IHld .1 OilnlJr! 11I0 '/ , Q, li'or whlll.'1 II, '/,O(l(J to IlIlY tho 1.1n",o.ln, .- <;1, Whon did YOII !lilY till] 1..1 nuo.l 11'1 II, ,J\ll Y 01' 19"1 .. '\)0, or Q, IInothor 1..1 no0111'1 II, 1~.I<Jht hel'oro J 9i.\Vo lilY wHo tho, otho1: 0110, tho , 2 ~ r ,) 6 '/ Il 9 '9~ j,,i,l1001111' wh.lch \1i.\B 8tol.1on flllppOf.lfJctly, 10 11 0, IInd whol'o 0180 diet tho' monoy go'l II, I paid off ctohtll to fUlllily 1II0mhors that had' 12 loanoel mo mOnoy, I d.lcln I t havo no inooloo for it pori ad .13 thoro, :~ en.d havo to J.j,VO on Ilomothing, My f:i,\l1d1y cloos 14 holp 'l11e I 15 0, So if I 1111c1orstanclyolI oorroctly, YOII want your " 16 wife to pay you a.1lmony to help support you \111011 you spent. 17 $1'1,300 ill o(18h on vehla10s \1.i.thin a cOIIPlo months'l III 19 20 II, \1hat cU:O YOll IIsld.ll<;J me? Q, You aro hore ~odi1Y auld n(/ I:he CalirI: to have your wUo, \11\0 supports YOllr children -- " 21 II, One ohJ.ld, 22 0, 01'10 o!l,Ud, and \1)10 hlls a chi lei in collegel YOU'ro 23 ilsk.ln<;1 tho COlll:t to 'orelor YOllr ~Ilfo to pay you support when 24 YOll spent $17,300 in eilsh .In voldcleu'l 25 II, Yo B / 1 do I Yo fl./ '1: do, 2" . ~ 1 2 ~m, 1"l\n1pr~^H, 11iIVll 1101'\11'\'.11\11' '1\llllll',iUll<II, '1'1Ii'1 COUI\'I', 1~11, ~IOI1'i\I:\l11 1'1 J RmpIRmO~ m~ftHINA'IO" 4. PY MP, pmi\l\nTWLLII 5 RlohArd, Mr, Wrledmnn WAS Aokin~ you what yoU di~ Q, 6 with t:he 40,000, Pld you give alwthin(j t:o your ~on out of 7 t:hat money7 o I did huy a 1904~oy~t:a Celioa whioh I got into n. 9 An. accident with right prior to whon I WAS going ~o give it: ,. 10 t:o him, The int:ent:ion WAS t:o (jiye it to him, hut I got in' 11 An aooident: And t:he OAr would not: hAVO pAs8ed inspection, 12 It oost: t:oo mUQh to till 1t, 80 I oouldn'l: see'giving it to 13 him, 14 15 16 17 10 Q, \)0 you reoA,1..l, how m\HJh you had spent for that: OAr? I 1\, 1,700, Q, Do you owe any money to I:ho m/3? 1\, I owod a thousand do),lars to t:ho IHS 19 APproximately, I WAS milking $50 A month pllyment:s prior t:o 20 21 t:his, ,. Q, ! belieye you t:estified alrriady t:hAt: you gaye 22 your daughter some money for oollego? . 23 24 1\, ~,3, 000, Did you purohase any furniture or items for I' Q, 25 yourself? 26 ," " " \. 'j .. 1 ,. 'II, hl\c1 illl On!:ul't,l.!1l1ll01ll: nilbinfJ!:, oj 11 \:OI'[H) , 11 nl11nil ,3 2 pIO!l~II: I\IHI"I\ phonu dou);, 01: i-i phono ti\blo, ~, Plcl 'yo\\ IUHl tho l'Olllldnel()I f9.r Ilv.ln<l exvpnlHHl III' ~ \1111:.1..1 tho ,\:.111I0 YO\\ fLioc! 1:1l.iI.l pol:! t:lon. fnl' 111'1,'1' ,. ::> II, You, ~ eilel, With tho S\\PPOl.'\'./ I \~11I3 ollly 6 I:llcoIvIn(] f,129B every I:Wo 11001;11, I l1ooclo[.1 ill: 1~1'lUt: 0110 ohe~lk o 7 to OOVOI' lilY ronl:, ~, Yo\\r s\\pport oreler prIor to lIug\\st 1999 is basecl 10 ..9 on YO\I!:: \~ol:koJ:'s I 0011I11 plLls Interest, Is that 001'reot.7 11 12 II, 13 beHeve, 130, ,~131, yes, 11 15 16 17 .10 Q, II, Q, 1\, Q, II, Yos, Q," Do YO\\ knol~ H ,that: 'orelor hilS been inodH1.eel7 Yes/ it: has, On 1\Ug\\8t 4th, it goos eioWn to, I I , POl' month',' " Per" mont:h, I\nd th'i\l: I s for tho Sllpport of yql\r 'son? Ye's, 19 "dr\\g or alcohol probJ.am'l' Mr, Borda, have you eVor sOllgh t tl:Oa tinen t for',,1I 20 1\, 21 22 C1, 1\, 2,1 Q, 24 ,A. 25 Yos/ I have, " Have YOlI IJeen' in-pa Uon t fOI:. tha t ttea ~lOen t 'I' Yeo,' I l~illJ, What's tho IIIost recent treatmont? po'L!embor of '96, " MS. Sh1HHII'l'lnI,II, 1 have no furthel.' questiolls, 27 i' ,,"" YOUI' llanoI', RmORO~~ MKftMIHftWIQU UYMR, 'RIruPMnNI Q, MI:, Bordfl, you J.nelioil\:OrJ -- And (.lon'oat: me 1f: :r'm Wrong, YOU gat: on top $40~ overy two woeks? n, Wi\:hout: tho support now, 'lOB, q, Oh, Il'han Aot\lally your groBS, YO\1'ra ge\:~lng $~60, 23 a woak [Incl support: .i.e ta.ken off:, Is' thaI: rIght? A, And also 20 poroent for the lawyer who represents me, yes, lIa r,eoeil'es 20 rJal'Oen~ of any workers' oomp I r.!;lqei V~l, Q, /lnd you bought: a oar. for your /Jon ,and t:hen wr.aokecl it: bef6re you hacl A ohanoe ~o gIve it to him? n, Yes, I ti,tcl, I hac.j it 'for four days, and I got into an aocident:, Q, You sought drug anel aloohol counseling? n, Yes, I d.td" q, Didn't: work, d.td .tt? 1\, .. It: did work, I got few things yell, a " st:raight:ened oGt:, I haven't: had a drink sinoe thls t.tme, M~, 'R:rillDMANI I havo no~h.tng furt:her, Il'lIill cOURlrl.. Ms, 80r.rato1.117 MS, SillRRM'illLI,I I Nothing furt:her, '{our lIol1or, " Tllm ~OURTI I\re you in agreement: that your not: monthly income from \~brkors I oompensation ls $1,610? 20 ",i' I 2 'l'lll!) NI'l'NliJIJIJ I No, B J}'.\ ] [',In 1100, /Inri -~. J (/0\: $~()7. b,1-I1(0);ly, ,. 'J1lttn COU1\lj'l Nilol'o 1:-1 I'lio cl.isl'"rIty 1'1'011\ w\w t tho 3 ~ pOlnost.lo 1\olf1I:Ionlll Off'.jeo l!socl'l 5 , 1~8, fJI!)1\1\fI'!'Hll.1.11 YOllr 1I0nor, ] thIn); thi1t [:19\11'0 .. 6 Ivl10 llsIng l:ho '110,000 Jnl:ol.'ont, '/ o '1'I11~ (:OlJ1\'l' I I nOG, MS, f;l1!)11l\fI'j'IilLI,11 line! tj]Gn i,1S of I\l19\181,: 5\:h, It'll 9 bC\80cl jl1llt on t.he workersl oomP, 10 , Mil, 1!'1\npl~I\NI 1110 petItIol" Y01.1l: 1101101'( prepC\red Jl by 1'18, seri:flte.1.H, ,it 811'18 .it oall\o to 260,23 11 weok on top, 12 'l'llUl N I 'J'NliJSS I Y08, 'l' il 11 I: '8 whil I: I Ivolllel 1'0 co I ve 13 .if'1 WC\89ottIng \Vorkors'. cOII\P, 1111, My lilWyo):fJ 'llncl 14 rapraoentQtIve, Hobert 1I1\11111ton, 11ho repreoentor.\ me In thIs 15 Oi1se, roceIvecl 7.0 pernent of \:I111t, 16 1'/ " " 'l'lllil COU1\'I'1 YO\l 811'1 '10\1 \lot. (1402 every t\Vo \Voeks? 1'Im WI,'l'NlnSSl Yos, sIr, :[ owe 11bollt $115 In 18 arrears on my support, Theylre t11klng $.1.3,62 out bIweekly, 19 'rllm COUl\'J'1 Ok11Y, Well, pLlttJ.n9 the SUPP01:t b11ck 20 In -- \Vol1, the s,Llpport oreler .i.n s\lspenc\eel 11t tilo moment, so 21 what 111'0 'lOll -- 22 , 'l'Hm WI'I'NI\SS I $~O2 evory two Ivook!l, 'rum COUl\'I', I\nd thn t. hQs no oUrpo!:t tC\kon out? 'r II In WI'rNmss I Yos, $13,62, , IrHIn COUI\'l'l I'm oOllfusocl, 23 21 25 29 1 Ml\, !i'lnmIlMANI (i'or ;Hl'(Jarn, (- .3 4 'j'Il"I,CCHJWJ', 011, for ;11.'>1'(1;11:11'1 ~lS, fJhIHHA'I'I,n,(,I, YOIl, '1'11": COlJH'i', So if' \10 il(lel tllill', biw!; 111, YOll Ire 5. gott1n9 whnt ovary ~Wo WDnko? G , 'Illl)!: W:r'I'NI!)f3H I $Q02, !)O HOIIH:Jt:IlJlllJ Clonts 1 "/ 'J'lIm COlJH'l'l 1.01: 11)0 try to got: n sl;.lplIIAtJol1 froll1 o 00Ul1801, tl1on, as to whnt tho notllil.1 not II'JP0Il10 WOll.l<:1 bo ,\ f g. tho BlIPport afronrago dOduotlon Wore nddod ~aok In, 10 Mt>, fll,JHHA'J'''Jlll,11 1 thlnf; the ()Onlol3tlo HelatIon' B 11 offioo had oQloulntod It, Just lol mo look at tho notos 12 horo, 13 MH, h'IUJ!IDMANI 0111:'llndorstand1ng, '{our llanoI.', .ts 14 that J/: thore 1 B no 1I)0cllfIoat:lon, that tho 'OHler \~0\.11d 90" " 15 down to $92 this month, 16 '1'1Im COUH'J'I It mIght, nut I Ilqod tohnve a 17 fIgure on whIch to baoe an order, I have to put: that figure 1 0 into theordo I.' I 19 ',1 Wo'11 j\.1st take a flvb~lI)inute recoilS and try t:o 20 got a stipulation on the Indomes of the parties, 21 ,,' 22 (Whereupon, a brief rlloeaa was taken',) Tllm DOUHTI We Will let: tho rocord indicat:e that 23' th\3 Court is Ogl'lil1' in session, 24 Md, Serratel.H? 25 . M8 \ SIDIUU\'J'WI,LI I YOll'r lIonor, I beHeve we hilVO a 30 7- :1 4 B 6 I' '7 0 9 10 11 12 13 14 15 16' 1 " 10 19 20 21 22 23 24 25 " I' " 1j1:11'\\.\q\'.lnn on 1:\10 not 1II0l1th.ly 1nonll\0 Df tlio l'ilrl:joll bi\IHlI! 011 10110 rJnl1l'nrn!1c!J U\I1I\II\i1ry bY I~u, flllq!:\r\i'lY, On I:ho ohl1ct u11l'port 1,;f.\\IO, I~r, Borcli1,alJ of: l\11(JllUI: 4th, 1999, lii.1IJ il !lot blwoo};ly 1l1oOl\lIJ or 1)116,3", I bo.l.Iovo I:lli'll: oOl\lns 0\11'. to 90:?',14 1I\o.nthly, 'l'IIF: COUg'l'l OkilY, Mil, nH:l\HII'I'ml'!,11 IInct Mrll, Borcla1s \t\ol1l:hlYl1o\: .i\100mO \~0\11cl bo \~hat tlio oOI11'oro\1ool1ol:as In(I:loaI:8 at ti2, Hr." , 93, '1'1IH: COUH'1'1 Mr, F'd.aell11il!l, Is 'that tho sUpqlaUo!1 wl.tll rOCjal:C\ 1:0 t:.he not monthly InOoII\OS' of tho partIos? MH, 1!'JUJ,IlW\NI 'I'hatls oorroot, Your 1I0nor, ii' '1'111, COUg'I'1 Oki\y, 'Ms I Se \: 1:a te III 'I MS, $mgHIITH:LL11 ourraqU8sl: Is thilt Mr, Borelil bo awareleel allmonype~elonto lite wIth tho o1'esot of what h.is obl.iCjcltJ.on woule\ be for tho ohllcl support, whioh, I believel as of lIugusl: 4{ 1999 \~0111el ))0 ;.130 pOl: month, Werro also 1:equest.ing that:. Mr8, Barela main\:ain , M1:, Borda on the modlcal covorage she has with tlie ,. " qonnnonweaHh, Wh:l.()h, I baLi.ove, 18 at 110 cost to' het: I 11'1ll""C,?UH'j'l Okay, Mr, H'rl(H\man? " MH, !"IUI,IlMlINI Ii tha court. pleaso, ,wIth J:Clgilrd to thfl medIcal covet:ilge, Mrs, !lorda wIll mi.1Inta.in Mr,' Borda 1I11t:.,11 the dIVorce .is 1'fn/.11I~,od, 'l'he qlles!:lon, YOllr 110\\01', Is why Mr, Borda.,needs I 31 "" "o. 1 monoY, Ni:, no!:e1l1 .I.IJ .'llIf;III(.!, "<jilln, illl.llin(J '{unr Iloilo!: to 2 lI1i]ko hill wHo, Ivlth WllOliI hi fJ ohl lelron l:uIIIl\o, l'ilY 1)11\\ AI'I, .3 whOIl ho, h.ill1fJo1f, O!:Oiltoel tho 1d.I:l\i1tlon \~hOrll ho r.\()(JfJn' \: 4 hilvo onou(lh 1I101l0Y to 1\ vo, 110 knovl 110 WIIU on 1~()rkouJ I cOIl1P ,. :J \~hon IHl (Jot tho i,;4o,000, 110 know ho l~illJ on workcHI3' comp 6 whon ho bought iI $.1.4,000 vohlulo, whloh .1.0 mo!:o thnn ho '! II1<1K<HJ <I YOi\!; on 001111>, 110 Know thilt Iw had to !:oly 011 hlB , 8 OOlnp whon he thon bought i1 $17,900 vohlole whiuh l,fj one f.\nd il hill.f Ull10B \~I1i\ t hO.l\\ilkeu iI yo"r, ,,'" 110 oreated hill probloll1, '{ollr lianaI.' , I)Y " aim 9 10 11 WAsting hls aSBots, and tho~ oOll1os Jnt~ court after a 12 his~ciry 0hore ho adll11ts ho still smokos pot ocoasionally, 'lsking his wifo and tho mother of hls childron to suppor\: p 14 hill1, 1,' . ,:J Your'lIonor, Mr, Borda has sufficient assots to i' 16 liquidate in ardor to suppaI.'\: hlll1HOlf. 1 ,ubll1it 17 respectfully thot for i1 Court to aWDrd D man AI'L or 'lny form , 10 of' Dsslstanoo when ho's'ddving an rilO,ooo vel'i'iGle is 19 ludiarouu,' 20 Lot Mr. Borda trade his $10,000 vohiole in on D 5 21 or $6,000 'vehicle, and he won't havo to come to th,1,s WOmDn 22 for support, 1 om respoGtful1y roquest1ng t:hat his request 23 for APL be turned down. " 251'11 entor an order. 24 TlI~ COURTI Wo'll take a brief roc08s, Inct t:hen 'I; 32 " 1 2 MI\Y ! 000 00\ll16u1 .ill ohul\\bortl? '(Whllrll\\POI1, 1\ bripf rlloPQQ WAn \:AlIlln.) 'l'.III~ 001Jl\'l'l l,o\: 1:110 rooorel IndloAte tl1t\1: t:he " Ii, 3 ~ aourt: hils reoonvenod ln opon s060Ion, We'll on tel' these \:1'10' 5 ortlers, 6 Wlrsl: at NUl\\ber 30~0 Clvl1 TOrl\\ 1990 in \:he OI\Be 7 of Rlahard J, Borda, Senlor versos Jaaquollne n, Borda o request:1ng allmony pendente 111:e, the olall\\ of ~iahard J, 9 Qorda, Senior for alimony pundente 1itl is denIed, 10 nnd at: Nl1n~er 633 support 1990 in whioh 11 JAaq\leline TI, Borda .l.s l:eqllostiWI oh1,le\ !luppo.rt:, weill ent:er 12 this order! Tlnd, nO\~, t:his 13th ctay 01: TlU9ust, 1999, upon ", 13. oonsicteration of .Plaintiffls olaim of ahild support: and 1~ following A hearlng and UPQI1 oonsiderAtion of Plalnt:lff's 15 a~pea1 fram the Ord~r of OOllrt heretofore ent:ered and t:he 16 Court: finding that: tho net: monthly lnoome'of Riahard J, 17 BOrda, Senior, the obligor, is 0902,l~ and that: the,net 10 mont:hly inoome of Jaoqueline TI. B01:cjA, the obligee, 10 19 '2,527,93, t:~e appeal is sustained to the ext:ent t:hat: the 20 obligor's ahL1.ct suppa1:t: obligat:ion 'up unUl 1\ugust: ~, 1999. 21 io det:ermined t:o bo '260 por month and thereafter to be '130 " 22 per month" 23 Tlnd in "t:hat first aase, \~e 'll ent:el: that: l:uling 2~ t:hat I made in the form of an ordor as well, " 25 TIny q~estions by oounsol? " , I ('I III ~~~ 33 "