HomeMy WebLinkAbout98-04218
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lbis Agreement shall not be considered to affect or bar the right of Husband or Wife to a
divorce if such grounds now exist or shall hercaftcr cxist. It is further spccifieally understood
and agrced that the provisions of this Agrecmcnt relating to equitable distribution of property and
alimony arc accepted by each party as a final settlement for all purposes whatsoever. '111C parties
intend to secure a mutual consent, no-fault divorce pursuant to the provisions of Section 3301(e)
of the Pennsylvania Divorce Code of 19&0, as amended, and agree to execute all pleadings,
affidavits, and other documents necessary to effectuate the entry of a decree in divorce.
2, EFFECT OF DIVORCE DECREE
The parties agree that unless otherwise specifically provided herein, this Agreement shall
continue in full force and effect after such time as a final decree in divorce may be entered with
respect to the parties.
3. AGREEMENT NOT TO BE INCORPORATED IN DIVORCE DECREE
It is agreed that a copy of this Agreement may be incorporated by reference into a divorce
judgment or decree. This incorporation shall not be regarded as a merger, it being the intent of
the parties to pennit this Agreement to survive any such judgment.
4. DATE OF EXECUTION
The "date of execution" or "execution date" of this Agreement shall be defined as the
upon which it is executed by the parties, if they have each executed the Agreement on the same. .
date. Otherwise, the "date of execution" or "execution date" of this Agreement shall be
as the date of execution by the party last executing this Agreement.
5. REPRESENTATION
The provisions ofthis Agreement and their legal effect have been fully explained to
parties by their respective counsel, Steven M. Montresor, Esquire for Wife and John 1. Connelly,
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5644]
Jr., Esquire for Husband. The parties acknowledge that eaeh has received independent legal
advice from Counsel of their selection and that they have been fully informed as to their legal
rights and obligations, including all rights available to them under the Pennsylvania Divorce
Code of 1980, as amended, and other applicable laws. Each party confirms tlmt he or she fully
understands the terms, conditions and provisions of this Agreement and believes them to be fair,
just and reasonable under the circumstances. The parties further confirm that each is entering
into this Agreement freely and voluntarily and that the execution of this Agreement is not the
result of any duress or undue influence.
6. PERSONAL RIGHTS
Wife and Husband may and shall, at all times hereafter, live separate and apart. They
shall be free from and contact, restraint, interference or authority, direct or indirect, by the other
in all respects as fully as if unmarried. Each may, for his or her sepnrate use or benefit, conduct,
carry on and engage in any business, occupation, profession or employment which may seem
advisable. Wife and Husband shall not molest, hnrass, disturb or malign each other or the
respective families of each other nor compel or attempt to compel the other to cohabit or dwell
by any means whatsoever with him or her.
7. FUTURE PERSONAL OBLIGATIONS
Wife and Husband each covenant, warrant, represent and agree that neither has heretofore
contracted for any liability or obligation for which the other or the estate of the other may be
liable except as specifically provided for by the terms of this Agreement. The parties further
covenant, warrant, represent and agree that each will now and at all times hereafter hold harmless
and indemnify the other and the estate of the other from all debts, chnrges, and liabilities incurred
after the execution date hereof, except as may be otherwise specifically provided herein.
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II. MUTUAL RELEASES
Husband and Wife each do hereby mutually remise. release. quitclaim and forever
discharge the other and the estate of such olher. for all time to come. for all purposes whatsoever,
of and from any and all righls. litle and interests or claims in or against the property (including
income and gain from propcrly hereafter accming) of the other or against the cstate of such other,
of whatever nature and whercsoever situate, which he or she now has or at any time hercafter
may have against the other, the estate of such other or any part thereof, whether arising out of
any fonner acts, contracts, engagements or liabilities of sueh other or by way of dower or
curtesy, or claims in the nature of dower or curtesy or widow's or widower's rights, family
exemption or similar allowance, or under the intestate laws, or the right to take against the
spouse's will; or the right to treat a lifetime conveyance as testamentary, or all other rights ofa
surviving spouse 10 participate in a deceased spouse's estate whether arising under the laws of (a)
Pennsylvania, (b) any State, Commonwealth or territory of the United States, or (c) any other
country; or any rights whieh either party may have or at any time hcreafter shall have for past,
present or future support or maintenance, alimony, alimony pendente lite, counsel fees, property
division, costs or expenses, whether arising as a result of the marital relation or otherwise, except
all rights and obligations which may arise under this Agreement. It is the intention of the Wife
and the Husband to give each other by the execution of the Agreement a full, complete and
general release with respect to any and all property of any kind or nature, real, personal or mixed,
which the other now owns or may hereafter acquire, except and only except all rights,
agreements and obligations arising or which may arise under this Agreement or for the breach of
any thereof, subject, however, to the implementation and satisfaction of the conditions precedent
as set forth hereinabovc.
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9. WAIVER OF FORMAL FINANCIAL I)fSCLOSIJRE
Each of the parties has oeen indcpcndcntly adviscd of and is fully cognizant of his or her
respective rights to a full and Iilir formal disc\osurl' of the cxtent of thc asscts. incomc.
expectancies and liabilities ofthc othcr prior to thc cxceution of this Agreemcnt. The parties
both reprcsent and confirm that they are each awarc of thc extcnt of the othcr's income, assets,
liabilities, holdings and cstatc, and caeh ofthcm knowingly waivcs his or hcr rights to such a
formal disclosure.
10. WAIVER OR MODIFICATION TO BE IN WRITING
No modification or waiver of any of the terms of this Agreement shall be valid unless in
writing and signed by both parties. No waiver or any breach hereof or default hereunder shall be
deemed a waiver of any subsequent default of the samc or similar nature.
II. LAW OF PENNSYLVANIA APPLICABLE
This Agreement shall be construed in accordance with thc laws of the Commonwealth of
Pennsylvania.
12. AGREEMENT BINDING ON HEIRS
Except as otherwise provided, this Agreement shall be binding and shall inure to the
benefit of the parties hereto and their respective heirs, executors, administrators and assigns.
13. OTHER DOCUMENTATION
Wife and Husband covenant and agree that they will upon demand (or within at most ten
(10) days after demand therefor) execute and deliver all written instruments, assignments,
releases, satisfactions, or other such writings as may be necessary for the proper effectuation of
this Agreement and/or the transfer of ~my property hereunder.
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56441
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14. NO WAIVEI{ OF DEFAULT
This Agreement shall remain in full force and effectllnless and untilterminaled under
and pursuant to the terms of this Agreemcnt. The failure of either party to insist upon strict
perfonnanec of any of the provisions of this Agreement shall in no way affect the right of such
party to enforce the same. nor shallthc waiver of any breach of any provision hereof be
construed as a waiver of <Iny subsequenl default of the same or similar nature, nor shall the
waiver of any breach of any provision hereof be construed as a waiver of strict perfonmmce of
any other obligations herein.
15. SEVERABILITY
The parties agree that each separate obligation contained in this Agreement shall be
deemed to be a separate and independent covenant and agreement. If any tenn. condition, clause
or provision of this Agreement shall be detennined or declared to be void or invalid, then only
that tenn, condition, clause or provision shall be stricken from this Agrecment and in all other
respects this Agreement shall be valid and continue in full force, effect and operation. Likewise,
the failure of any party to meet her or his obligations under anyone or more of the paragraphs
herein, with the exception of the satisfaction of any conditions precedent, shall in no way void or
alter the remaining obligations of the parties.
16. HEADINGS NOT PART OF AGREEMENT
Any headings preceding the text of the several paragraphs and subparagraphs hereof arc
inserted solely for convenience of reference and shall not constitute a part of this Agreement nor
shall they affect its meaning, construction or effect.
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\'\WI'ERTY DISTRIBUTION \'\WVISIONSI'IWI'ERT\' DISTRIBUTION
I'IWVISIONS
I. TANGIBLE l'\mSONAL I'\UWF;RTY
Husband and Wife do hereby acknowledge that the)' have previously divided their
tangible personal property including. but not limited to, motor vehicles, jewelry, clothes,
furniture, furnishings, rugs. carpets. household !loods and appliances. pictures, books and other
personal property; and hereafter Wire agrees that all of the property in the possession of Husband
shall be the sole and separate property of Husband; and Husband agrees that all of the properly in
the possession or Wife shall he the sole and separate properl)' of Wife. The parties do hereby
specifically waive, release, renounce and forever abandon any claims whieh either may have with
respect to the above items, which shall be the sole ,md exclusive property of the other.
2. REAL PROPERTY
Parties agree that the residence at 40 Bear School Lane, Carlisle, Pennsylvania and the
rental property at 156 Adams Street, Stcelton, Pennsylvania are both non-marital properties.
Husband hereby waives any claim of contribution toward the purchase of either property, any
increase in value of either property, and any other claim with respect to said properties from the
date of marriage to the date of separation. Wife agrees to continue as her sole obligation any and
all the mortgage payments and real estate taxes in connection with said premises.
3. DIVISION OF OTHER MAIUT AL DEBTS AND ASSETS
The parties hereby agree that the following personal liabilities, debts and obligations
which had been incurred prior to date of separation shall be paid in a timely fashion by Wife:
(a) Obligation to PNC Bank for a home equity loan, and (b) any and all credit card accounts
eurrentIy held by Wife for balances related to purchases between the time of marriage and time
of separation, including MBNA MasterCard, Montgomery Ward, Members First Visa, and Omni
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EACII OF TIlE PARTIES has carefully read and fully considered this Agreement and all
of the statements, terms, and conditions and provisions thereof prior to signing below.
IN WITNESS WHEREOF. intending 10 be legally bound hereby, the parties hereto have
set their hands and seals the day and year first written above.
Gl\~. d~'~~~~
., ~ ORE ~Y ASK ITCH
\ GJ~ 'ORY Y ASKOVITCH
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
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On the 7 day of.M"y, 2ClClO;-Yolanta S. Troy appeared before me in due form oflaw,
acknowledged the above Agreement to be her act and deed and desired that same be recorded as
such.
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Notarial Seal
Frederick W. Spease. Notary Public
South Middleton Twp., Cumberland County
My Commission Expires Dec. 06, 2003
Member, Pennsylvania Association of Notaries
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
On the d.3Ju/...day of~~OO, Gregory Yaskoviteh appeared before me in due form of
law, acknowledged the above Agreement to be his act and deed and desired that same be
recorded as such.
~j;JM.J0IJi..w
9
NOTARIAL SEAL
Jean L. Kosier, Notary Public
City of Hummelslown,County of Dauphin
My Commission Expires Feb. 9, 2004
56441
4. Plaintiff lInd Delendant were married on September 20, 1997, in ClIrlisle,
Cumberland County, I'ennsylvanill.
5. There hllve been no prior actions of divorcc or lInnulment bctwccn thc pllrtics.
6. The mllrrillgc is irretrievllbly brokcn.
7. I'laintiffhas becn advised of her rights to the availability ofmarrillge counscling
and that she may bave the right to request that thc Court require the partics to participate in
counseling.
8. The Defendant is not engagcd in the military service of the Untied Stlltes as
defined in the Soldier's and Sailor's Civil Relief Act, and its supplements and amendments.
9. Plaintiff requests the Court to enter a decree of divorce.
COUNT I - DIVORCE - IRRETRIEVABLE BREAKDOWN
10. Paragraphs one (I) through nine (9) of this Complaint arc incorporated by
reference as if fully set forth herein.
II. Plaintiff avers that the marriage is irretrievably broken within the meaning of
Section 3301(c) and Section 3301(d) of the Divorce Code oftbe Commonwealth of
Pennsylvania.
WHEREFORE, Plaintiff respectfully requests this Honorable Court to enter a Decree in
Divorce divorcing Plaintiff and Defendant on the grounds of Section 3301(e) or Section 3301(d)
of Pennsylvania's Divorce Code.
COUNT" - EOUlTABLE DISTRIBUTION
12. Paragrapbs one (I) through eleven (II) of this Complaint are incorporated by
reference as if fully set forth herein.
. 36174
,
LA TSHA DAVIS & YOHE, P.C.
By: Glenn R. Davis
Attorney I.D. No.: 31040
Steven M. Montresor
Attorney I.D. No.: 74244
Post Office Box 825
Harrisburg, PA 17108-0825
(717) 761-188/J
Attorneys for Plaintiff,
Jol:mta S. Troy
JOLANTA S. TROY,
40 Bears School Lane
Carlisle, PA 17013
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY
v.
CIVIL ACTION - LAW
GREGORY S. Y ASKOVITCH
3220 Brookfield Road
Harrisburg, Pennsylvania 17109
Defendant.
IN DIVORCE
NO. 98-
NOTICE OF A V AILABILlTY OF COUNSELING
Plaintiff hereby acknowledges and Defendant is hereby notified that counseling is
available to Plaintiff or Defendant if a request is made for same either by letter to the
Prothonotary of Cumberland County or through their lawyer. If requested, the Court will require
up to a maximum of three (3) counseling sessions. A list of qualified professionals who provide
such counseling services may be obtained either from the Domestic Relations Office of
Cumberland County or the Prothonotary of Cumberland County.
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36174
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.JOLANTA S. TROY - Y ASKOVITCH,
l'lninliff
: IN THE COURT OF COMMON PLEAS
: CUMBERLANI> COUNTY, I'ENNSYLV ANIA
v.
: NO. 98 4218 CIVIL
GREGORY R Y ASKOVITCH,
Dcfcndnnt
: CIVIL ACTION - LAW
: IN DIVORCE
DEFENDANT'S AFFII>A VIT OF CONSENT
AND WAIVER OF COUNSELING
1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on
July 23,1998, and served on Julv 31. 1998
2. The marriage of the Plaintiff and Defendant is irretrievably broken, and ninety days
have elapsed from the date of both the filing and service of the Complaint.
3. I consent to the entry of a final decree of divorce after service of Notice oflntention
to request entry of the Decree.
4. I have been advised of the availability of marriage counseling, and understand that I
may request that the Court require that my spouse and I participate in counseling. I further
understand that the Court maintains a list of marriage counselors in the Prothonotary's Office,
which list is available to me upon request. Being so advised, I do not request that the Court require
that my spouse and r participate in counseling prior to a divorce decree being handed down by the
Court.
I verify that the statements made in this Affidavit are true and correct. I understand that
false statements herein are made subject to the penalties of 18 Pa. C.S.A. Section 4904, relating to
unsworn falsification to authorities.
Date:October 19, 2001
b) A~",'/(? tj-"J.,,::i;/.
Grego R1 Yaskovitch, Defendant
(/
JOLANTA S. TROY,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
v.
98-4218 CIVIL TERM
CIVIL ACTION - LAW
GREGORY S. YASKOVITCH,
Defendant IN DIVORCE
RE: Pre-Hearing Conference Memorandum
DATE: Monday, March IS, 1999
Present for the Plaintiff, Jolanta S. Troy was
attorney Steven M. Montresor, and present for the Defendant,
Gregory S. Yaskovitch was attorney John J. Connelly, Jr.
A divorce complaint was filed on July 23, 1998,
raising grounds for divorce of irretrievable breakdown of the
marriage. Counsel have advised that the parties will sign and
file affidavits of consent and waivers of notice of intention to
request entry of divorce decree prior to the hearing to be
scheduled. The complaint also raised the economic claim of
equitable distribution. No other economic claims have been
raised in the action.
The parties were married on September 20, 1997,
and separated May 3, 1998. There were no children of this
marriage. wife has two daughters of a prior marriage.
Wife is in her forties and resides at 40 Bears
School Road, Carlisle, Pennsylvania, where she lives with her
two daughters. She has a Master's Degree and is a behavior
specialist. She currently is a consultant and is self-employed,
and for 1997 she showed income of $27,650.00. There is some
question whether wife is working full time or part time; she is
directed to provide a copy of her 1998 income tax return to
opposing counsel. Mr. Connelly has also requested that wife
provide copies of her 1995 and 1996 income tax returns. Wife
maintains her own health insurance.
Husband is 33 years of age and resides at 3027
Guinevere Lane, Harrisburg, Pennsylvania, 17110, where he lives
alone. He has an Associate's Degree from ITT and is currently a
field service technician with Trak Engineering. His net income
is approximately $2,000.00 per month. He is directed to provide
opposing counsel a copy of his 1998 income tax return. Husband
has not raised any health issues.
,.
The parties lived together prior to their
marriage. On January 12, 1997, wife purchased in her name a
property at 40 Bears School Road, Carlisle, Pennsylvania, where
she is currently residing, for $144,000.00. The mortgage payoff
as of October 14, 1998, was $128,204.28. The increase in value
from the date of marriage to the date of separation would be the
value that would be distributed under the current status of the
law, and Mr. Connelly can provide evidence as to whether or not
the house appreciated from the date of the marriage to the date
of separation. Mr. Connelly also raised a question about wife's
ability to borrow the monies used to purchase the property based
on her reported income in 1997. Therefore, wife is directed to
provide a copy of the financial statement that she used when she
applied for the mortgage and a copy of the settlement sheet.
Wife also borrowed money against the property on
a home equity loan from PNC. On February 11, 1998, the balance
on that loan, including interest, was $17,385.00.
In February 1997, wife purchased a property at
156 Adams Street, Steelton, Pennsylvania. Husband claims that
he contributed $8,000.00 toward the purchase of that property.
Mr. Connelly is going to attempt to provide verification of
husband's contribution. Mr. Connelly has likewise requested a
copy of the settlement sheet on that property.
Pre-trial statements deal with certain savings
and checking accounts at PNC and Members 1st. There is a
question as to the date-of-separation balances on the accounts
and how the monies were distributed. There is an issue as to
the distribution of a total amount of money of $1,700.00 between
the parties.
The parties have essentially distributed the
marital personal property and have retained the nonmarital
property which each brought into the marriage. However, there
are some issues as to property that wife and husband claim was
damaged apparently by the other party, and, also, husband claims
that certain property that he had which was nonmarital has
disappeared. The parties are going to attempt to place a value
on the damaged and missing property and are directed to provide
a stCitement at the time of the hearing showing the particular
items damaged or missing and the value placed on those items.
Husband also indicated on his pre-trial statement
that there were seven items of property that were jointly
purchased and that those items he has valued and they need to be
distributed or values need to be applied in the equitable
distribution computation. The items on the list start with a
Fisher gazebo and end with a rototiller.
Husband is upset about the fact that wife gave
his cat away; however, unless he can place some value on the cat
in terms of dollars and cents we are not able to distribute the
cat otherwise in the case since neither of the parties have
possession. Wife also has a dog which is a marital dog, and
counselor the parties will need to suggest to the Master how we
should distribute the dog.
With respect to marital debt, there were certain
credit card debts which counsel need to have their clients
verify. With respect to the home equity loan which was
previously mentioned and which is in wife's name only,
apparently, wife claims that she used those funds to pay marital
debts. If she is making any claim that husband should be
responsible for a portion of that debt she needs to show what
marital debts were paid out of those funds.
Wife believes that husband, prior to the
marriage, was discharged in bankruptcy from various debts.
There is a question as to when this bankruptcy action occurred,
because the date of this bankruptcy proceeding may affect
husband's credibility with respect to his claim that he
contributed $8,000.00 to the marital estate.
A hearing is scheduled for Tuesday, November 9,
1999, at 9:00 a.m. Notices will be sent to counsel and the
parties.
E. Robert Elicker, II
Divorce Master
cc: Steven M. Montresor
Attorney for Plaintiff
John J. Connelly, Jr., Esquire
Attorney for Defendant
JOLANTA S. TROY,
Plaintiff
vs.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 98 - 4 2 18
GREGORY S. YASKOVITCH,
Defendant
CIVIL ACTION - LAW
IN DIVORCE
ORDER AND NOTICE SETTING HEARING
'1'0: Jolanta S. Troy , Plaintiff
Steven M. Montresor , Counsel for Plaintiff
Gregory S. Yaskovitch , Defendant
John J. Connelly, Jr. , Counsel for Defendant
You are directed to appear for a hearing to take
testimony on the outstanding issues in the above captioned
divorce proceedings at the Office of the Divorce Master, 9 North
Hanover Street, Carlisle, Pennsylvania on the 9th __ day
of November ,1999, at 9:00 a.m., at which
place and time you will be given the opportunity to present
witnesses and exhibits in support of your case.
. B y. t .1 ~~. . rt,
~l~J'tJr. 're,ideM ,"dge
Date of Order and
Notice: 1-1 'i-qq
By:
Divorce Master
IF YOU DO NOT HAVE A LA\'IYER OR CANNOT AFFORD ONE, GO TO OR
TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN
GET LEGAL HELP.
CUMBEflLAND COUNTY BAR ASSOCIATION
2 LIBERTY AVENUE
CARLISLE, PA 17013
TELEPIIONE (717) 249-3166
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ARE JlEAEOV NOTIFIED TO PLt:AIl TO
THE ENCLOSED WlnUN
TWENTY 1201 DAYS 01" 8I!:RVICE HEREOr OR
A OIl"AULT JUDGMENT MAY DE ENTlRDO
AGAINST YOU.
LAW Ol'I'I('1i
JAMES, SMITH, DURKIN & CONNELLY
BY
fI, n, BOX MO
""'ISIIEY. PIiNNSYI.VANIA 17()JJ.()MO
WE tIERED'" CERTIFY THAT TUE WITHlfj 15
A TRUE AND CORlfECT COpy OF THE
:;'0'",' fILED 'N TN'S ACTION. 0"
JUL"2"81998 it
"nOllNIY
JOLANTA S. TROY-YASKOVITCH,
Plaintiff/Petitioner
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO. 98 - 4218 CIVIL
GREGORY R. Y ASKOVITCH,
Defendant/Respondent
CIVIL ACTION - LAW
IN DIVORCE
ORDER OF COURT
AND NOW, this Jr~ day of --h ' 1998, upon reviewing the
attached Petition for Special Relief, it is hereby ORDERED AND DECREED that a
hearing is scheduled for the 31st day of July, 1998, at 8:30 o'clock a.m. in Court
Room No, 5 of the Cumberland County Courthouse, One Courthouse Square, Carlisle,
Pennsylvania.
EDWARD E. GUIDO. JUDGE
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I verify that the statements made in this Pleading are true and correct. I
understand that false statements herein are made subject to the penalties of 18 Pa.
C.S. Section 4904, relating to unsworn falsification to authorities.
Date: 7- i~.l- 9g'
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v.
NO. 98 - 4218 CIVIL
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JOLANTA S. TROY-YASKOVITCH,
Plaintiff/Petitioner
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
GREGORY R. Y ASKOVITCH,
Defendant/Respondent
CIVIL ACTION - LAW
IN DIVORCE
CERTIFICATE OF SERVICE
I, John J. Connelly, Jr" Esquire, of James, Smith, Durkin & Connelly, attorney
for the Plaintiff, Lisabeth E. Capozzi, hereby certify that I have served a copy of the
foregoing Pre-Trial Statement on the following on the date and in the manner indicated
below:
U.S MAIL. FIRST CLASS. PRE-PAID
Glenn R. Davis, Esquire
4720 Old Gettysburg Road
Mechanicsburg, PA 17055
JAMES, SMITH, DURKIN & CONNELLY
DATE: 1- {Ag...cl>!
1 MR. CONNELLY: Good morning, Your Honor.
2 Your Honor, Mr. Davis and I have consulted on the petition
3 and we've reached an agreement that we can place on the
4 record.
5 THE COURT: Okay.
6 MR. CONNELLY: There are two lists of
7 property, Your Honor, one list that is attached to the
8 petition and a list that was provided to Mr. Davis yesterday
9 which he's reviewed with his client this morning. I'll have
10 that second list marked as Petitioner's Exhibit 1.
11 (Whereupon, Petitioner's Exhibit No. 1 was
12 marked for identification.)
13 MR. CONNELLY: Attached to my petition for
14 special relief is a list of property that involves
15 checkmarks and certain comments. All of the items on the
16 list of personal property attached to the petition will be
17 removed by my client with the exception of the following:
18 There's identified two circular saws. He will
19 remove one. There's a red tool box with hand tools. He
20 will remove his hand tools and leave the red tool box.
21 There are two hand saws. He will remove the one with the
22 black handle. Heavy duty extension cord, he will remove the
23 yellow one.
24 THE COURT: okay. Am I going to dictate an
25 order? If so, go slowly.
2
1 MR. CONNELLY: No, I think what we can do is
2 we could get the list transcribed so that I think you could
3 indicate at the end of the order that this forms the order
4 permitting him to remove -- I think that's probably the
5 easiest way to do it.
6 THE COURT: Good enough.
7 MR. CONNELLY: The yellow extension cord he
8 will remove. There are several outdoor tools, a pitchfork,
9 pickaxe, and they will remain at the house. There are boxes
10 of aftershave, soap, shampoos. He will remove what's left
11 of those.
12 A one gallon sun tea jug with dispenser will
13 remain. Crystal glasses, a gift from my client's mother,
14 will remain. The parties will have reviewed the CD's and
15 computer software, and he will remove what are his.
16 The reference to the 12 gauge pump shotgun and 22
17 bolt-action rifle, they're in the possession of the Sheriff
18 under the PFA order, and that will be worked out with Joan
19 Carey through the final order or the Court will address it
20 in October, so those items are not there. There are two
21 boxes of Christmas figurines and Christmas lights which are
22 going to remain at the house.
23 Now, the remaining items as well as several other
24 issues the parties have addressed through correspondence are
25 going to be addressed by the divorce master in order to
3
1 resolve, so those items on the list attached that I
2 specified will either -- all items except those specifically
3 referred to will remain or one or another will be removed as
4 specified.
5 THE COURT: And do I understand that the
6 additional items marked as Plaintiff's Exhibit 1 will also
7 be removed?
8 MR. CONNELLY: with the exception of --
9 there's two items in the left-hand column, one flintlock
10 type replica pistol and an outdoor smokey type grill. They
11 were items to be addressed later by the Master. All other
12 items on that list are to be removed.
13 THE COURT: Mr. Davis, does the agreement as
14 related to me by Mr. Connelly correspond with what your
15 client agrees to?
16 MR. DAVIS: Yes, it does, Your Honor, with
17 the exception that I thought our agreement, John, was that
18 the smokey grill was hers, but I mean that's again something
19 we can resolve later.
20 MR. CONNELLY: It does stay. My client was
21 not in the position to say whether it's hers or how it was
22 acquired, but I think we can resolve --
23 MR. DAVIS: Then what's been represented is
24 accurate.
25 THE COURT: It would seem to me what you've
4
1 just spent fighting over a smokey grill, you could each buy
2 two brand new smokey grills, so I would encourage both of
3 you to use a little common sense in negotiating over this
4 stuff.
5 MR. CONNELLY: Your Honor, in addition my
6 client will secure a constable to accompany him to the
7 residence to remove the items. He will be doing it on
8 Monday, this coming Monday, at 1 p.m. That would be August
9 3rd, and he will have movers there and several friends to
10 assist him in boxing, not family members, and a constable to
11 supervise, and we expect this to take approximately four
12 hours.
13 THE COURT: Okay.
14 ORDER OF COURT
15 AND NOW, this 31st day of July, 1998, the
16 parties have reached an agreement in connection with the
17 petition for special relief, it is hereby ordered and
18 directed as follows:
19 1. All issues except for the possession of
20 certain property hereinafter shall be submitted to the
21 Master for resolution.
22 2. Husband shall be entitled to remove all items
23 of personal property listed on the exhibit in the petition
24 for special relief from the marital home on Monday, August
25 3, 1998, commencing at 1:00 p.m. except those items as
5
1 placed on the record by counsel for the parties. Husband
2 will, at his own expense, hire a constable to attend and
3 supervise the moving.
4 3. In addition, husband will be entitled to
5 remove all of the items listed on Petitioner's Exhibit No.
G 1 except for the flintlock replica pistol and the outdoor
7 smokey grill.
8 By the Court,
9 Isl Edward E. Guido
10 J.
11 THE COURT: Anything else, gentlemen?
12 MR. CONNELLY: I believe that's it, Your
13 Honor.
14 THE COURT: Anything else, Mr. Davis?
15 MR. DAVIS: Your Honor, your order is
16 accurate. I would just like to point out, however, before
17 we're off the record some of the items we had indicated to
18 Mr. Connelly that Ms. Troy isn't aware of on Exhibit 1 at
19 the household.
20 I didn't want to leave the Court today with the
21 misunderstanding that because he couldn't find those items
22 she had removed them or that they were to be located
23 somewhere else, and we had identified those particular items
24 to Attorney Connelly prior to walking in the door.
25 MR. CONNELLY: He did mention them to me. If
6
1 we can narrow it down to the few, then the others we presume
2 will be there.
3 THE COURT: What I'm going to put in the
4 order -- just add this. There are certain items disclosed
5 by Plaintiff's counsel to defense counsel that Plaintiff is
6 not aware of. Defendant may remove those items if they are
7 in the marital residence. otherwise, the Master will
8 address those issues of missing items. Is that sufficient,
9 gentlemen?
10 MR. CONNELLY: The only thing I need to know
11 is what they were. I know one reference.
12 THE COURT: We will place them on the record
13 then.
14 MR. DAVIS: Yes, Your Honor. On the record
15 the items we had indicated, Your Honor, we weren't sure of a
16 two shelf bookcase. We weren't aware of a VCR, a farm
17 country scene picture, one small metal hatchet, one outdoor
18 broom, two bed pillows, one 30 foot telephone extension
19 cord.
20 MR. CONNELLY: Your Honor, as to the
21 bookshelf, we have now identified what it was. That will be
22 an issue that will be addressed by the Master since it's a
23 question of whether it was premarital property or not.
24 THE COURT: I'm not going to have Laura
25 transcribe any of this information. If you guys get into a
7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
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18
19
20
21
22
23
24
25
,
spitting contest over what was said here -- you're both good
lawyers. You should know what was said, and you're
professional enough that you shouldn't have to do this.
MR. CONNELLY: Your Honor, that will be an
issue for the Master.
THE COURT: okay. Anything else, gentlemen?
MR. CONNELLY: No. That's it, Your Honor.
THE COURT: I would expect that this move
will go smoothly on Monday. If you take something that's
not on the list, I'm going to hold you in contempt. If you
take -- if you keep him from taking something that's on the
list, I'm going to hold you in contempt. You've got the
order that you agreed to. I don't want to see you back here
again.
MR. CONNELLY: Thank you, Your Honor.
(Whereupon, the above proceedings concluded.)
8
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PEiV,'ySYU :"N/I\
GARY L. JAMES
MAX J. SMITII. JR.
KAREN DUIIKIN
JOliN J. CONNELLY. JR,
STUART J. MAGDUI.E
FRANK I', CIAIIK
SUSAN E, LEIJElIER
STEVEN A. STINE
JOliN J. MCNALLY. III
GREGORV K, RICIIAIUlS
scon A, IJmnERICK
LAW OFFICES
Jemss, Smith. Durkin & Connelly UP
P,O. BOX 650
HERSHEY, PENNSYLVANIA 17033
SlIcel nddrcss:
IJ4 SIPE A VENUE
IIUMMELSTOWN. PENNSYLVANIA 1703(,
E-mAil address: info@jsdlegal,ton1
(717) 533-3280
(717) 238.9780
FAX (717) 533.2795
lIarrlsburg omcc:
108-112 Welnul Slreel
lI.rrisburg.I'A 17101
(717) 238-1776
FAX (717) 238-1793
January 15, 1999
Traci Coyler
Cumberland County Divorce Master's Office
13 North Hanover Street
Carlisle, P A 17013
Re: Troy v. Yaskovitch
Dear T raci:
Enclosed please find a copy of the Defendant's Pre-Trial Statement. The original has
been forwarded to the Prothonotary. Thanks for your patience. Thank you.
<~verY fur yours,
L~
J~!,l . Connelly, Jr.
JJC/jlk
Enclosure
..' .~TO __,______'~.,_~_,_
---"-OU AAE IIIAEa... NOTlI'II:OTO t'LCAO TO
THE t;NClO"ID ,WII...N
TWENTY UOI DA'fS 0" 6[RVICl: ItErl[O' (l'f
II DE'AULT JUDOMt'NT MAY nt: [Nt["UJ
AOA.NfiT 'fOU
L^w OI'l'ICE
JAMES. SMITH. DURKIN & CONNELLY. LLI'
. .
WL ItClU:DY CEIITII'Y -rtMf' f'Hf: WITHIN l~
A. TAUE AND CQffffECT COPY OF nil:.
.Offl(ldrtJlt.l I'llEO Ifj TIm. ACTION
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111~I{SJfEY, I'I:.NNSYI.V^NI^ 17().1l()(I~()
JOLANTA S. TROY,
Plaintiff
IN THE COURT OF COlV~roN PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 98-4218
I"
v.
:
GREGORY S. Y ASKOVITCH,
Defendant
CIVIL ACTION - LAW
IN DIVORCE
DEFENDANT'S PRE-TRIAL STATEMENT
Date of Marriage:
Date of Separation:
Divorce Complaint filing date:
September 20, 1997
May 5, 1998
July 23, 1998
1. ASSETS
A. Marital Property
I. Monies contributed by Defendant to the residence of the Plaintiff
located at 40 Bears School Lane, Carlisle, Pennsylvania, purchased
when the parties were living together, but prior to their marriage.
The purchase price was approximately $144,000.00. The present
mortgage balance is unknown (See Plaintiffs Pre-Trial Statement).
2. Monies contributed by Defendant, including down payment
(approximately $8,000.00), on property located 156 Adams Street,
Steelton, Pennsylvania purchased for approximately $34,900.00.
The present mortgage balance is unknown (See Plaintiffs Pre-Trial
Statement). The marital funds in the said residence include not
only Defendant's contribution to the down payment, but rental
income, insurance claim, and property appreciation.
3. PNC Bank Savings, Account No. 50-0113-1334, with an
approximate balance as of April 1998 of $700.00. Husband
withdrew the $700.00 and gave Wife $500.00, using the remaining
monies ($200.00) to purchase an invisible fence installed at 40
Bears School Lane property.
4. PNC Bank Checking, Account No. 50-0097-0296. with an
approximate balance as of April 1998 of $1,000.00. Wife
withdrew all funds.
Missina Items of Defendant's
Personal Prooertv Continued
14. Cookware 100.00
15. Silverware 50.00
16. Tupperware 75.00
17. Toiletries 150.00
18. Sports Videos 15.00
19. Three Stooges Video 15.00
20. Dinner Plates 15.00
21. Souvenir Coffee Mugs 30.00
22. Drinking Glasses 15.00
23. Towels, Washcloths, Sheets 75.00
24. Telescope 100.00
Joint Purchases
1. Fisher Gazebo $1.400.00
2. Carpet and Padding for 800.00
Upstairs living room
and stairs
3. Outdoor Furniture 100.00
4. Formal Dishware 100.00
5. Lawn Tractor 1,250.00
6. Wagon for Tractor 400.00
7. Roto Tiller 600.00
"
TO
YOU ARE HEREBY NOTIFIED TO PLEAD TO
"'~:'~,TtlE:_ENCL09!D ,WITHIN
TWENTY 1::101 DAYS OF SERVICE HEREOF OR
A OEFAULT JUDGMENT IdAY BE ENTERED
AGAINST YOU.
LAW OFFICE
JAMES. SMITH, DURKIN & CONNELLY, LLP
BY
AnOFlNf:Y
1'. 0. BOX 650
HERSHEY, PENNSYLVANIA 17OJ3,(K,511
WE HEREO't CERTIFY THAT THE WITHIN IS
A TRUt: AND CORRt:CT COPY OF rUE
ORIOINAl. I'H.EO lU Till::; ACTlorl , " ',- .
B: __ IAN':UJ99~~
,o,nOR...1: J~
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JOLANTA S. TROY,
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO. 98-4218
GREGORY S. Y ASKOVITCH,
Defendant
CIVIL ACTION - LAW
IN DIVORCE
DEFENDANT'S PRE-TRIAL STATEMENT
Date of Marriage:
Date of Separation:
Divorce Complaint filing date:
September 20, 1997
May 5, 1998
July 23, 1998
1. ASSETS
A. Marital Property
1. Monies contributed by Defendant to the residence of the Plaintiff
located at 40 Bears School Lane, Carlisle, Pennsylvania, purchased
when the parties were living together, but prior to their marriage.
The purchase price was approximately $144,000.00. The present
mortgage balance is unknown (See Plaintiff' s Pre-Trial Statement).
2. Monies contributed by Defendant, including down payment
(approximately $8,000.00), on property located 156 Adams Street,
Steelton, Pennsylvania purchased for approximately $34,900.00.
The present mortgage balance is unknown (See Plaintiff' s Pre-Trial
Statement). The marital funds in the said residence include not
only Defendant's contribution to the down payment, but rental
income, insurance claim, and property appreciation.
3. PNC Bank Savings, Account No. 50-0113-1334, with an
approximate balance as of April 1998 of $700.00. Husband
withdrew the $700.00 and gave Wife $500.00, using the remaining
monies ($200.00) to purchase an invisible fence installed at 40
Bears School Lane property.
4. PNC Bank Checking, Account No. 50-0097-0296, with an
approximate balance as of April 1998 of $1,000.00. Wife
withdrew all funds.
5. NET INCOME
A. Plaintiff - See Income and Expense Statement. (Exhibit "B").
B. Plaintiff - See Plaintiff's Pre-Trial Memorandum.
6. EXPENSES
A. Defendant - See Income and Expense Statement. (Exhibit "B").
B. Plaintiff - See Plaintiff's Pre-Trial Memorandum.
7. PENSIONS/RETIREMENT
A. Defendant - Defendant has no pensions/retirement benefits.
B. Plaintiff - See Plaintiff' Pre-Trial Memorandum.
8. COUNSEL FEES
Defendant is not making a claim for counsel fees at this time.
9. PERSONAL PROPERTY IN DISPUTE
1. Documents relating to taxes, bills and real estate which are
currently in the possession of the Plaintiff.
2. Satellite access card and receiver.
3. Wedding band.
4. Defendant's dog and cat.
5. Contribution to the property located at 40 Bears School Lane, Carlisle, PA.
6. Contribution to the property located at 156 Adams Street, Steelton, PA.
7. Various items of personal property, household furnishings,
rototiller, and lawn mower.
,.
Misslna Items of Defendant's
Personal ProDertv Continued
14. Cookware
15. Silverware
16. Tupperware
17. Toiletries
18. Sports Videos
19. Three Stooges Video
20. Dinner Plates
21. Souvenir Coffee Mugs
22. Drinking Glasses
23. Towels, Washcloths, Sheets
24. Telescope
100.00
50.00
75.00
150.00
15.00
15.00
15.00
30.00
15.00
75.00
100.00
Joint Purchases
1. Fisher Gazebo $1,400.00
2. Carpet and Padding for 800.00
Upstairs living room
and stairs
3. Outdoor Furniture 100.00
4. Formal Dishware 100.00
5. Lawn Tractor 1,250.00
6. Wagon for Tractor 400.00
7. Roto Tiller 600.00
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INSURANCE:
Comoanv
Policy No.
Coveraqe*
l:! tl b
Hospital
Blue Cross
Other
Medical
Blue Shield
Other
Health/Accident Employer Coverage
Disabil. Inc.
Dental, vision Employer Coverage
Other
* (H=Husband; W=Wife; J=Joint; C=Child)
x
x
JOLANTA S. TROY,
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO. 98 - 4218
GREGORY S. YASKOVITCH,
Defendant
CIVIL ACTION - LAW
IN DIVORCE
CERTIFICATE OF SERVICE
I, John J. Connelly, Jr., Esquire, of James, Smith, Durkin & Connelly, attorney
for the Defendant, Gregory S. Yaskovitch, hereby certify that I have served a copy of
the foregoing Pre-Trial Statement on the following on the date and in the manner
indicated below:
U.S MAIL FIRST CLASS. PRE-PAID
Glenn R. Davis, Esquire
Latsha, Davis & Yohe, P.C.
Post Office Box 825
Harrisburg, PA 17108-0825
JAMES, SMITH, DURKIN & CONNELLY
DATE: / - /5- qq
UIKC(;I Ih~II\LLMChl LVllh IKUln-lh-LC,IU'h" Ul>vLV~VnC~
lender.
I
PNC Bank, National Association
Dale:
Fc:b. 11, 1998
OLNACS Number 6966871
late Charge: I I Nol Applicable. I X I U a paymenlll not matle
within 15 days of ils due date, Borrower may be charged Ihe grealer
of $10.00 or 5% of Ihe total amounf of fhe paymenl wlllch was nol
paid in full.
Prepayment: If Borrower pays oU early, Borrower will 1101 hm 10
. paya penally.
In addition, collateral (other than Borrower's principal residence) Required Deposit Balance: IX I Nol Apl;Ii"hle, I ' I I he
securing other obligations 10 lender may also secure this Nole. Annual Percentage Rate docs not lake illlo accoulIl.ny re1luired
S'curi~ Interist Charges: '.-' deposil balance.
, . Assumption: If this loan is sccmd by a dwelllllg, someone
~ I None. I] Filing Fees $ ". purchasing Ihat dwelling cannot assume Ihe remainder of Ihe lOIn
Variable Rate:IX ] Not Applicable,' . . _" , on Ihe originallerms. .
I ] The Annuaf Percentage Rale may increase if the Prime Rale pUblished in The Wall Slreet Journal increases. The rafe will 1101 illcrease
, more alien Ihan once a monlh, The rale willnol increase more Ihan one percentage poinnn anyone monlh ,nd will 1101 illcr",e more
. than five percentage points during the lerm of the loan. The rate will never increase beyond IB%. Any Increase Inlhe rale as. relull of (gila
an increase in Ihe Index may cause the number of payments 10 increase, andlor. . . . . .L-
. .'.' . I Ilhe amount of the final payment to change. The final payment will never be ipmased 10 more Ihan 150% ollhe regnlar (hi 10
payment For example, if your loan' were foi$lO,OOO.OO al an inilial rale of 131/2%, repayabiein 4BI"onlhly payments 01 $170.76, alld $
. Ihe rale increased to 14112% after 12 paymenls,)ncreased to 151/2% after Ihe nexl12 paymenls, and IllCn remained Ihe Slme for the
tenn of the loan, you woufd be required to pay one additional paymenl of $254,BB, , (1110
I ] the amounl 01 the paymenls to change. The amount of the paymenls may increase every lour years, lhe flll,I,"ymenl Will $
never be increased 10 more Ihan 150% of the reguiar payment For example, if your ioan were lor $10,000.00 al an hntial rate 01131/1%,
repayable in 72 monthly payments of $203,39, and the rale increased to 141/2% after 12 payments, increas~d 10 15"2% ,Iter Ihe nexl I'rollaid Financo Charge
, 12 payments, 'and tlien remained'lhe same lor the term 01 thi loan, Ihe paymenl amounl would increase 10 $227.12 lor Ihe 4~th Ihrough $
the 72nd payments: ,.' .' '. Itemizalion 01 Amounts paid by Borrower
I ] It Borrower's participation in the aulomatic payment plan is disconfinued for any reas,on, Ihe Aulomatic l'aymenll'lan Discoullt of ,llhe timo Ihe loan is made:
," . 'c.".... C c' percentagepoinls wlllterminale arid may cause the rale 10 increase. Any increase in the rate will cause Ihe 'moulIl of (II 3e! settleient Stlteaent
the payme~IS 10 iricreasr: Fore,ample, if your loan were for $10,000,00' at an initial rale of 131/2%, repayabie in 4B monlhly paymenls 01 $
$270.76, and the Discount lenninated after 12 payments,the paymenl amounl woufd increase 10 $ . lor Ihe ,"mahlll" 01 (21
the term of the Nole/' ,'" '. " . '" ,.',',.
, See you'r contiact documenls for any additionai'informalion aboul nonpayment, delaull, any required paymenl in lull helore'lhe $(3)
. sclieduled dale and prepaymenl refunds and penalties." ",
$ , ,.. ., ,. . .
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.. CREDIT INSURANCE )S NOI REQUIRED: Credj~,Lile insuranc; and Credil Disabilily Insurance are not required 10 oblaill credll, and will 1101 bo (Hovldeit unless 1I0Howor(S) sign below.and
agree to pay Ihe addlllOnal cost(sl. Insurance .may be purchased'on the hfe of one or Iwo Bor.ro~ers. Credll DlSahlhly IlIsurancc may be purchased on ollly 0110 lIorrower, If oblamed
.. through lender the. cosl 01 the insurance for t~o originaltelil] of Ihe credit is slaled beiow. A portionol Ihe coslmay he relalried by or plld 10.lh~ lellder, . 'lIorrower' who is lrisured may
'notbeaCo.Maker.;" ','~.'.;",:._."...'~.>..~I' :",,~~;,," '''..,' ,. . '1, "," ',' .,,', "".11.' '. -,.I';',,:!,I;.,
IwantSingleCreditLifelnsurance~hichcosts$243.46"':;"" '.,!;.I..~ 1:..',.. ," ", ,. ""","'c....".;
,;' '.,'... . ..; c, '-:,;,..:' ~..l ;..' j',,;;,"::'; . . '. " 'Signature 01 Person 10 be insured lor Single Credit We Insurance " l~ "~: <?!:
-"', ,.," ,:~~..'" :"'" :'lt~':"'.!:":':,~' :.!- -r"'" . . 1';
I wanlSingle Credit Disability Insurance which costs $'754,54 "'''''''''' " " " . ,,, .,
":. .~., :~. '~. . :','~ ~:; ~: ;':":;;~~ ;~,: :.~: ~:~'.~: ~ -;:'~ ':?;;'~;"~ .:~:.., . Signature '01 ~_ers~.~~ ~e .in.~~~~.I~.r~~~r.l.I.I!~.~~::~~~I..'~i~~h~hl! 1~~I~lJ.: ~:~~~:.. .'1',.1;'..... l'" t_....: ~~.;.....~_...._.
ANNUAL
PERCENTAGE
RATE
The cosl of the Borrower's
credil as a yearfy rale.
8.404 .%
FINANCE
CHARGE
The dollar amounllhe credil
will cost the Borrower.
Amount Financed
The amount 01 credit
provided to the Borrower or
on the Borrower's behall,
Total of paymenls
The amount Ihe Borrower Will have
paid aller lIorrower has made all
paymenls as scheduled,
$ 3387.60
$ 13998.00
$ 17385.60
lhe Borrower's Payment Schedule will be:
Number of Payments Amount 01 Paymenfs
$
e means an cslimate
When Payments Are Due
Monthly, beginlliog o.y
Security: lender is getting a security inlerest in deposits or
. prOperty held by lender, and: ..
. , .. " , . .
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I Goods or property being purchased.
J
l.-)None. .
t I Real Estale.
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PLAINTIFF'S
EXHIBIT
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Ilemlzatlon 0 mounl malice
Amounl Financed
Sle Settleleet Stltellet
(\) Amount given directly Ie lIorrower
SO! mtlemt Stltmnt
(2) Amounl pard on lIorrower's .ccounl
$
-(31 Amount refained by lender for
$ .-
(4) Amount p.id to olh." on Borrower's
behall:
('110 lIublic ollici.ls
S~e 30lllelent Stllellet
(b) lorcredillnsu"nce
$ See Scttlmnt Slltmnt
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I want Single Credil Disabillly Insuran~e which cosls $ 754.54
h;"- . .. ". "';. '" .,;t:. ;: .;i.; '.:: ':' ';- ~;, ..: ,;':':!J ....: ~ ,0<,:,
. We ~ant"ioinlCredil iiie Insurance which cosls $" , .
"; ", ""', .
.;,- '", ".
~i2nature 01 Pl!rs:on 10 be insu~e~ fO~ Sin,lll~ Cro~it .~j~~.bj.lit~.IO!:ur;;.nce
I: " .....' ' ". .". '~2'" -,' .."..
Signalures of Persons 10 be insured lor Joint Credit life Insurance'
'"
. Borrower does not desire or is nol eligible for credil insurance:
, "." ' .. " . Signature of Borrower
Notice 10 'Borrower(s}: The maximum' amounl of coverage which insti';d B;;rowerlsj will roceive is set forth in Ihe certilicate or policy, as applicable,
'L.nd;r;; Sing'l. Interest Insura;~;:lI . I' Not Applicable, I 1 l~nder'sSin~e Inlerest Insurance is required as a condition of Ihis ~rediL Borrow~r can ob!ain the insurance from a~yone
accepiable'lo tender. If obtained from lender, the cost will be $ ..'. . " :, . ..
;,DIRECTJNSTALLMENTlOANNOTE.:'>'.. :, ' . "::.,'" lATE CHARGE: I J Not Applicable, k, J Borroweragrees Ih;tLender may aSsess a fale
DHlNITlONS:.ln Ihis Note;lhe woid 'Borrower' means each and ali of those who sign below Charge lor any paymenl.nol paid in fu!l'within 15 days of ils due dale. The lale charge will
: and each and all of Ihose' who endorse the check which dishurs" Ihe 'Amounl given directly be the greater of $10,00 or 5% of Ihe fotal amount of Ihe payment which was not paid in
to Borrower." . ., .. '. , ".... ,.', .' .' ., ", " full. No late Charge witl be due, however, d Ihe reason that Ihe payment is late is either. (a)
The word 'lende~ means 'PNC" Bank . Nati~n~l' Assb~iatio~ atlribulable to a late Charge assessed on a prior payment; or (b) because. after default by
or any person to whom this Nolenas Deen tra~sferrea, . Borrower, the entire outslanding balance on Ihis Nole is due. No more than one lale charge
:',., , ",' ..., -' willbeimposedforanysingiescheduledpaymenl. .. c',,',";,. "
BORROWER'S. PROMISE TO PAY: To repay this loan, Borrower promises to pay to lender MONTHLY PAYMENT,CHANGES: " .' . . ,'" ," i' ",,' ",.' ":;,
$.t3998.00 ,wit.hi,nle!,,! o~ !h~ ~~p~id,baiance from thedate fu~~s are l! 1 The payment a.mounts wiiinolchange over the lerm of Ihe loan except as slated in the
. advanced un!il ~~id infull. Interest shall ~e paid.aqh(r~te. per a,nnum or . 8 40 .. ., ~.6, Payment SC.hedUI~. . ... .f ':.. '.; ," ~l: ~~';";' " '..? .;. "~~~[." l.~~':' ;:;' ~'~,~ ':' .:~ .I
B~rro.er promISes to ma~e paymenls In accordance wll~Jhepayme~t S/h!au~e slal,ed III [ 'J The payment'amounts may increase d'Borrower ie,inin,les participaiion'in ihe automatic
IhlS Note. Borrower p!omlSes ,10 pa~ to lender all olher amounts which may become due paymenl plan. lender wiiL.determine Ihe amount of equal monthlY'payriie~ts' thaI' would be
under Ihe lerms of thIS Note, Illcludlllg, If apphcab!e, Lale Charges and Costsof CoilectlOn, sufficienllo)epay iri lull, 6y the Malurity Oale,the unpaid principaf bafance tlians expected Ii> be
Borr~wer agrees 10 make payment~ at the place deSignated by lender.. Bo~rower may also be due on the' payment chang,"dal., al the inlerest'rate in effect'al the time the calCulatiori ~ being
reqUired to pay 10 lender,cert"n olher charges before len.der wlil gIVe any money 10 made, lender wiil nolify Borrowerolthe new amounl of the payment which is due. .. '.
Borrower. These charges, If any, are staled above III ~itemlZallOn of Amounts p3id by "
Borrower al the lime the loan is made' and/or.in the SeWement Stalemen!:"''-'" . . [ '.' J ~hange~ Ill-'he Illterest ralmay .cause the number 01 payments tochange and/or!he. ,
". ,. :,' . \. . " 'amount of the flllal payment to change, One month before the Maturity Oate, if necessary,'
. PAYMENT SCHEDULE: Borrower.agrees 10 pay,to lender the amounts due under Ihis Note:',:> the number of payments due will.increase so,tha) thetinal payment will not be Iliore than
.1 " ., I I d . thf . t'. .. 't 'j .''''.., ,;"'...: .. ,., 150%ofthe previously scheduled monlhly paymen!:,. 1'.', '"c ,:.S.'-..,..::". ..rr!
K' Illunlllerrupemon ypaymensS9' paymenso'iS'976" . .:....;.. ,""'.",,'. .'..... .,..~.",',.. "."
. . .. . . ',' " ,', : ... , ." . ': :' " '. :. .' ....", . . ".!;" . ' . 0' .' ; . ~, . . ;,. .. .. I' , . . '. . ~ I . ,. :' ~ .. I ':. . '. ' . ',,'. ,,;. .
'and; final 'payment, which"will be billed by lender, 01 all remaining uripaid amounts, I JCliangesinthe'interesj.r,~\~.IJ!aycauseth. ~um~erof~ayme.nlstoi:har.ge'and/orthe,
, , amount of the paymenls 10 Illcrease; the first change III the payment amounl may occurori
..P~YlI!ents,~11I be dueon \he, sa,meday ?f,eac.h ~~nth startlllg,onHay' 6, 1998 ,-: . "a date 4B,monthsafter the due date'ofthe first monthfy payment 'subsequent changes, if
,Payments,wiil conlinue until ali.am~unts due,are paid." , , ;",' ',,''c. '" ".;.,. " : >,applicable, will.9ccurevery 4~ monlhs jhereaftcr. Not more,l~a.nA5;d!ys. bu\~ot.less than '
I. J in. unin.terr"p'l.ed monlhly p' ymen'. exce'p'l for the months shown'. ,paymenls 25 da.ys. before the date 01 eaq~. par!,,~~l change, L~nder wl!I,c;~I~ulal~,\~e n,,!. pay. m.ent
. . a", .. . '. amount. The payment amount'maY'lllerease bul Will not decreaseiexcepPYor.lhe flllal
of $ ,. - and a linal paymenl, which will be billed by the lender, of all, payment. Lender-wi!/-defermine-lhc amo,untof'equal'mont~IY1l!yl(lents1hah'lould~~e"
remaining unpaid amounts Payments will be due on the same day of each month starting on suffiCient to repay In full, by the MatUrity Date, the. unpaid pn~clpal)lalan~e..tbat IS
' expecled to be due on the payment change date, at the Illlerest rale III effect at the time the
,PROVIDED, HOWEVER, that no paymenls shali be due during the caiculation is being made, lender wili nolify Borrower of the new amount of the payment
which is due. One month before the Maturity Date, if necessary. the,number. of payments
due will increase so that the final payment will not be more Ihan 150% of the previously
or each year. ~ni~~ti~~~W~lrt:ar,~~~~ is more than one Borro~;;:each;grees to bi r~sp~nsibie to
I J in a singlepaymeni 01 $ . " plus accrued interest and all other lender, Individually and together, for payment in full of this loan. Borrowers agree that
amounts due on payment of all or part of the proceeds of this Note 10 any Borrower or to anyone eise at the
I J In addition, prior 10 the month of the firsl scheduled payment as slated above, inlerest ~~~;llf~1 ~\;'~trr~~;~~er wili be the equivalent of payment to each Borro~~r and for the
shall Ire payable monthly on the unpaid balance and shali be due on the same day 01 the THE ADDITIONAL PROVISIONS ON THE REVERSE StOE ARE PART OF THIS NOTE.
month as the laler paymenls, '. BORROWER ACKNOWLEDGES RECElfT OF A COMPLETELY FILLED.IN COPY OF. THIS,
The date thai the linal paymenl is scheduied in this paragraph to be due is called the NOTE. BY SIGNING BELOW. BORROWER AGREES TO BE lEGAlLY BOUND BY ALL THE
"Maturity Dale' of this Nole. TERMS ANO CONOfTION.S OF T,HIS NOTE. Each, of the Borrowers guarantees that the
sIgnature of any Borrower IS genuine.> ,. . ... '., ,..
VARIABLE RATE: k ) Not Applicable, I ] The interest rate on this Note may Change ' ! i' I, .r' ---rc '., ?'
based on changes III Ihe Interest Rate Index, See the 'Changes In Inlerest Rate' section on > .' , c , ,\-.. ,. 10';, " , 11.(, ~
thereverseside 01 this Nole, . ,,' .......,'-. '-,,'. .' -'~i Borrower' Date
,. . JOLllNTA' S TROY ,I . .
AUTOMATIC PAYMENT PLAN: + I Not Applicable, I J Borrower authorizes lender ' V
to deduct the payments on"1his loan from Borrower's deposit account number
on each scheduled paymenl due 'date, The inlerest rale on Ii;is ioan
may increase by , percentage points I"Automalic Payment Plan Discount') if
participalion in the aulomatic paymenl plan is discontinued for any reason, inclUding: (a) if
any Borrower chooses 10 terminate participation; (b) the deposit account iden.lified above is
closed; or (cl if there are not sufficient funds in Ihe account to make Ihe lull monlhiy
payment on three payment dales,
months of
Borrower.
Date
CO. MAKERS-SEE NOTICE TO CO.SIGNER ONTHE REVERSE SIDE: Any B~rrowerwhoi;",
designated as.a Co.Makecagrees to be.equally responsible w.ith 'all other Borrowers. foi tli.;\,;,
, payment oflhis loan and perlormanee of all promises in this Noie:.:', . '. ',)';::~;".i'
":'<'-;:,."
NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION
PA
00000000128 (Rev. 10/96)
Co.Maker
- ',., ~
':,,' ,
~. .>~':~:
BORROWER'S COPY
., Co.Maker
AOOIllONAL PROVISIONS
CHANGES IN INTEREST RATE: If Ihe inleresl rate on W;N~I,'J;ich,'nge'base~ Oit'ci,ini:ei' , " "A iii'.uli i,Y'(jo;;o~H 'o,,'lfi,i Hale i;' .~Ie,iUll on e",y olher nole, loan or agreemenl c
in Ihe Interest Rate Index rlndex'), Ihe rale will be delermined by adding a 'Margi,,' 10 Ihe 1I0rtower wllh lender, , ,
,', Index, The Index may change from time 10 lime, Ihe M"gin Will remain lire sarno lor Ihe GENERAL WAIVER PROVISIONS: 1I0rtower' waives presenln;enl for paimenl, demand
term of the loan. The interest. rale staled in :Borrower's Promise to Pay. is Ihe "Base rtalc." p,olcsl, lIoltee 01 protesl. dl\!lonor Jnd aU other lIohees or demands in connection wilh (tit
The Base Rale was computed by adding the Margin 10 the original Index, and therl, if dlJ!lvc,y, accepl.lnce, pIHlormancl!. del au It or elllorcemenl of this Nole. Borrower further
'40rroWfLjs,participatinginJI1e ,aulomaliii,'p'arrii;'nl'pfjh'-sublfacling'lhe~mollnl Ollhe '. 'w,llves anyrlr,hllo',NIUhe d"d,hgP.ncc Incolleetion byl.mJel7-~'-' ,.~..~,',_"";
,,' :Autoniatic;Paymenl,PlanOlsCounL~lnleresi rale"'l!juslffienls "re"(ompuled by 3dding II,~'" DElAY, IN ENfORCEMENT: Lender e,n del,y enforting any'righls-under IhisNole,w/'lhOU'
;,""MarginIOlhe-currenl'liioex' arthifllme~of Ihe adjullmenl (subjecllo Ihe 'fin,ilallOn" losing lIiy'righls, rendir's I"lulO 10 .nlorce:~ni',iigh,1 ~nder Ihis K~I~ s~.!'.nol !C, as:,
'!' described befow) and Iheri.i(B9iiOwer i,l partlcipaling'in' the automalic'paymenl pl.n, waivor ollhal righl or plOclude Ihe ."rcise 01 Ihal"'Rhljn Ihe event of a,(ulure occ~rrenf'
t- subtracting,the.amount ofJlre:Automalic Paimenl Plari'DisCounL The Inleresl rale 'au IIli, of Ihe same'dvent len<ler can also 'elleud Ihe lime allowed for making payments,'anc! sucl
, :; loan may bndjusled monthly.on,lhe tifslcalendar day 01 each '"linda'r ",onlh, beginning , ..lenSlou ""II n61 alleellhe obhg.tlOns 01 any 1I0rrower, 'whelher or not thai Borrower,i:
':j: 'in,lhe mon.lh afterithe funds'are,~dvanced,'Jhe Index is Ihe highest Prime Rale published in gIVen nolICe ollhe exlenslOn, I . " , " '-. ' ", i " : t.
,;-the"Money Rales"seelion'oHhe~1I Street Journai lor the iasl day of Ihe preceding R[l[ASE Of SOME BORROWERS DR SOME SECURITY: II Ihere is more Ihan one Borrower
i' caiendir'nlo'Mh-',hich ~rripci~ed,'lf'th'e )n?ex,O! Ih.e, in!olll!,alian,on wh!chJI!~ ~ase~! ~h~lI.. ", each aglOe'~o,"main ~'!.~1.~Y lhi~ ~o!~, .aIlMug~, ~~~d,~r l~aY,!~I~!!e a~y ol~cr ~or\o~el
: cease to be avalfable, lender shall sel..1 a new Index wlite', m lender's sole opllllon, UllOn a or reluase or suli'lllule allY plOperly which IS secunly far lhe repayiue~rof thlS"Note
';-Teaso~!br(fi~;i~~1S c9~pariim(llflhirrndj,x, Thi'~'hn\irinler1i;rrale will nol increase or lIorrnwer waives all delenses based on surelyship aud impalrm,nl'ol coilaleral ors;curily:;
.f decrease moretha. one perce'nlaf, 'poinl i.niny:onecalendiif'n10nlh;1fnd \vIII nOllnerease"" ~ECURITY IN.r~RE~TCIIARGES: Uarrpwer,agrees:\o'pap~y:refPnJin~; ,fili,n,g;,'salisf~cli~r
~'~ o~ decrease more than five percentage points dunng-Ihe lerm or the loa II, due-Io changes 111 .. ".' and encumlJwlCH ioes wluch may be ,chargod. Tho charges arc fo.rcpay,lender.for the fOj!~
; the Index, (~hange e~~.'ed. by ler~inallo~.oLBQ(r~,w~J,parlieipalion in Ih~,aulo[TIal'~ ,.p,lid.lopublicoflicl~'UOPIOI'~!, ,Qnli!!.u.e, or ,,-~I~'ie ,anJ,~ecyrUt!!"lcre~_t.giy~n, i,n (Ill
, !,p;y.ment,PJaJ1"I!i,R!l!ml~cl to,lhfU,m,!faUoOs,set lorth In Ihe prevIOus senlence,! The allnual secullly agreement or lIIorlgaee, : , j
i' mleresl rale Will nol exceed 18%:", ~ I ~ 1--'- -------", .-", '.' PREPAYMENT:'Uorrowcr mayprepay,'lnlull or In part, Ihnmounl'owed on Ihi~ Nol..1 anI
'f-COMPUlING'TNTE~ESTHnteres~i~~arg"'doii'a"daili'b'isrs,acc"ordiiig"lolhooulsl;nlliiij:' ,--Iulle wllhoull,,"ally, II Bortower prepays Ih.loan in parI; Borrower agrees loconlin'ue,!c
,oj;' balance 'subject to~n(eiesl Qh1~icht Uay-bF..lhe'/oan term, The daily interest rate is equal to make regularly scheduled llaymcnls until all amounts.due under.thls:Nole,are paid,,:),.,: !
I, theanlll!;1 inlerest'rat. in,effect on Ihll ~a~ divided bylh! pUl!lber aT ,days'in Ihal e>lqlldar:' If LE~OER,O,OfAlNS A SECURITY INTEREST TO SECURE UORROW, Eft'S; PA,YMENTJO,~' TH)S
i:Y~ar.llofro'\W""a]l~tMlW:CJlPlf.ipter~sf is calClllaledon,a daily.,basis, lale paymellls will . ", ,NOTEt B?,RROWER MAKES II,IE fOLLOWING ADDITIONAl ~ROMISES TO LENDER. (a) II
, :, r~ull in addilional'inltfes!'yanij,'ir applieible; a laie c~arie)t early paymenls will resull in ,,!, properly,u,lSurance Is requlled by a morlgage, and/~rcsee"'ly agreqment s,curlllg t,he
' Liess inlMgll bein'g chaa:~!UUD'!.J~.leje~t rale on Ihis 1I0le will not Change Uecause 01 wpaym,lll ol,lhis Nole alld/or 1III00d msurallce IS reqUired ~y lederallaw. ~RRROWE~ M~Y
, i changes in Ihe Index (see the 'Variable Rate' seelion), e"ly ond/or lal, pay",enls wdl eau~q , OBfAlN TIlE IN,SUIlANCE FROM ANYONE Of BORROWER S CHOICE subleello L,nder, s
. i the amouril of th, final paymenllo ehange:'lllh,"inleresl'ralc'ori Ihis'Nole 'cari chang, ,::"'reasollahl,'alfllrovat 1I1100d Insurance IS reqUired, Borrower has been separalely nOIIII~,d.
,1~-beeause,of,~hanges,in,lhe-lnde,~_(~e~ t~e:Variabie Rale' se,e,lionl" early, and/or lalo " Th" pro~crlY Insur,1nce lIlusl cower I~ss 01 ~r dam,age 10 Ihe eollaleral and musl be ,m an
-'" payments Wlf! cause th, number ot,paYlIJenlSdue; Ihe .mounl 01 the paymenls (1llhe ,,) am9~"1"ulfl~lOnllo plOleclLender s tnle,l~sl, flood 'nsuran" musl be 01 ,lhe)ype andm I~e
c i'," am,ounl 01 the paymentS is subjecllocha~gri eveiYc48 monlhs)'and/or Ihe amounl ollhe ' ,. alllounl re(IUllcd hy IcdClallaw;,I~) Bor,rower ~gtees to proVlde,.l'nder,eY!de,',Fse of [e,qul(!d
F.'finatpaymentto~hange------'-'c ,\' Insurance, AII,IIOIIC"S musl name lender as a loss payee/se,yuted'party,and}jw~lprov!de
! ;"'- " . 'Jl '..~ : :. ,'~'" .~, '.,t' .... ' , ~ "., .. ,'.' ',," ,lar)atlcasIIO,davs wtillen notice to lender 01 reduction in'cov'iiiagi(or cance"IJation;'(crif
i._APPLICATION Of PAYMENTS: Lender:w)II,!pp~ paymenl,s,!~c'~,e:fQllow",r, .order a! prroply,:, ',':' Borrowe; 'Iails )0 keep in lorce Ihe requited insurance, and/or lails 10 provid~ evidenee:ol
,J,,, "'1~teSI,:fale.ehargeS,,'ee~andlh':":,Plln~lpat.^" r~gular paymenls Will be apphed 10 Ihe "such ins~rance 10 Lender, Lender may nolily Borrower ,Ihal BOrrower sh.o,~ld 'pu,reha~e, I~e
,.,! . sallSfacllon of scheduled paymenls '" Ihe order rn whICh Ihey become due, , r"lulled IIlsurance al Borrower's expense, II Borrower fads 10 purchase the IIlsurance wllh",
' , ;~_W~IY,E,R_WtiE)jjJE,R:J! Borr~~eJ.has,~mad;' or'inakesin'lhc'fulure anolher ioan agriemelll', Ih, lime slaled in Ihe nolice andlor lails ;0' provide evidence 01 such'iniiiiance tOlender,
" wilh Lender, Lende(mighl oblain a's~curi~ inleresl iri'lheprinclpal,dwel!ing of Borrower or.' Lender inay pureh,;e insuratice 10 pruleclLender's inier,sl:lothe eil,nt p,ermi~'d py
i" someone else to secure Ihal other foanagreemenl Thai seeutily ar,reemenllllay proVide Ihal appiicable law, and charge Uorrower Ihe cosl of Ihe premiums ;nd anyolher'amounls
'" the principal dwelling 'secures nOlonfYlhat olher loan agteemenl bul also af! 01 her loan lender incurs in purchasing Ihe insllranee, THE INSURANCE LENDER PURCHASES WILL BE
;: ~greeme~ls of Uorrower wilh Lendederider ~iivis Igivesupl a~Y.righllo ciaim'a securily SIGNlflCANll YMORE EXP,ENSIVUND ,MAY PROVIDE LESS,CDVERAGElHAN)NSU,RAN,CE
',..!nleresl,mlhe, pllnClp,af dwelling of ,any person .to seeUte Ihis, Nole 'unless;!','. securily BORROWE~ COUl~, PURCHASE OTHERWISE" Upo,~ demand, B.orrOlverpromises '10 p~y
, ",tetesllS spee,f,callyglVen to secu,~~ Ihis ~ole. .. Lender,lhe cosl of )nsurance p~rcha,sed,and o,lher amounls incurred by Len~~r: ~orro~er
. ~ INTEREST AfTER MATURITY AND JUOGMENT:,Unless prohlbiled by applICable law, inleresl agrees Ihaltender ,may," permllte,d by applicable la~, add Ihe ,casl ollhe insurance 10 ~~e
,-.at Ihe rale provided in Ihis_ Nole sl'~lI.f.onli~ue 10 a,ccrue o~ Ih, unpaid balallee IInlil paid ill , atllounls on'whICh ",letesll.5 charged,allhe ~ale proVided 111 ,lhlS Nole: L~nder may r~e~lye
:' ,full, even after (whelher by accelerallOn ,o"otherwlsc! malullly and/or if Uorrower UCCOllles rem.aUle compensall?n lor the !ervlCes which Lender p~ovrde~ lII,oblallllng ,anY,requ,l~ed
, a deblor in an aelion liled under Ihe B,ankruplcy Code and/or il judr,menl is onlered againsl"in,sur,ance ~n Borrower s b,hall" In certain slales, Ihe,requlled IIIsuranc~ l1)ay, be 'oblOln,d
',_ ~~~ro,werfor, the:a~ounls due:/t at any li",'e inleresl as plcvided for in Ihis paragraph is nol' IIrroul:h a licensedmsu.ance agency afhhaled wllh Lender, ThIS agency w,'1I recCtve a"fee for
perm!lIed by la~, IIIleresl shall, in Ihal evenl an~ allhallime, accrue a\.lhe highesl ral, provlllrng Ihe req~IIed IIIsurance,ln addllron, a~ a/trhale maybe responSlbl,. for som~ or ~"
_.!I.I~:!t_eotby ~ppJLcable law, If the 101eresl!ralc on this Hole can change, Ihe interest rale ollh~ und~rlyrng 1~5u~ance r!sks and ma~ rC~e1ve compensation .I~r assuffilOgsuch risks. If
: ~hich will !pply beginriing on"iiiii.'d;le a I,wsuil ~ liIed bltender shall 110 Ih, inleresl rale addlllOnal IIIforlllallOn IS reqUlredconccrnlllg IIIsurance,Ol our allllrale arrangemenls, please
III effecl on Ihe dale or Ihe inleresl rale slal.d in Ihe 'Bonow",'s Promise 10 Pay,'whrchever conlacl Cenlralrled ,Cuslomer AsslSlance, ,2730 Llberly.Avenue, P!,llsburgh, ,PA 15222;.Idl,to
",~ less, .. -.-- -" ,,',,_ .___ .'.. ' pay alllaxes duc on Ihe collaleral,lI Borrower does nol pay Ihe laxes, Lender has Ihe oplion
DEfAULT: (As d' h' c'," " ' , ';' 10 pay Ihe Iales, Upon demand,Borrower promises promplly 10 repay 10 Lender any
Gua f' US~ 10 I IS paragraph, Ihe term B.orr~wel In.eludes ~orrowcrs, Co,Makcrs, amounls pilid by lender lor taxes; (e) jf lender eets a security inlercst in stock or securilh~s,
,ranlo y, su!e!~es, and any owner ai, pro~"ly whICh IS secunly lor IhlS Nole,! Uurtower will Ihe valuo 01 Ih, eolialeral may becollle insullicienl 10 plOlecl Lender, II Ihal happens
be III default .: : '; Borrower aglOes 10 delrver 10 lender addilional collaler" whkli Lender believes will b~
(al if Borrower doesnol makeany paymenllrefom or on lliedale il i, dne; or" i, ,noul:1r 10 prolecl{ender; 1I)la;lIow Lender Iherighllo insp,cllhe eollalerai'al any
, ' '(b) I! Borrow!! lail~ 10 keep any promise lIladein II", 1101, or delaulis on any olher nole, lOasonable lime, and 10 lIIainl.rin Ihe collaleral in good condilion and repair; reasonable wear
'.' 10,an ~r 19reemenl,wlth Lender, or :,' " and lear exceple9; W) il,amounls are adyanced by Lenijer 'under Ihis Nole for laxes and/or
',' ,(e) I,tanyone ~ho signs,lhe ~eeurilyagreelllenl 01 a morlr,ar,o seeutint: IIlis Nole breaks any insurance, lender may, ~Uls ,OpliOll, II p,'rmilled by applicable iaw: add the ,a moun Is so
" prom!se made III Ihe, secullly agreemenl or morlgage; Includinr, bul nol lillliled 10 lire atlmeed 10 lire oul,landlllg balance anti require repaymenl wllh Inlercsl,~yjnc)easlng Ihe
{'... ~-~: ~!~~~~~:~N: ~~,:~~II',. ~!.vf:~~~.~.?~, l!~.~~!~r .~i!I.~.I~ y~c. _~~~('C.r!~, ~.h!~I~.!~ }!I?, ~~!~j~;,l.~~ }~l~ t . . , .i!!~~:l,!!n)~~I! ,,~a,~,IJ~,:.~\I~.~?,. !.I~~~. gl~; ~:u.l~,l}.~~.i.~~. .~.~~ ~f.iA~I. .~~.l.~rfP: ,i~ ,r.:.~~!9}~ .J~,!r.:!r,
. ': ,",. . "..., . ." '.' . _,' .'"....", '.' ..,.'. 0, .,' . . "".".' .' ,.', ..". " " . ,". " :..."." _', .' , .~, " . _ ~ . "','. "', " ,". '...' ",' " '" . . ....'.. _', . ,.:.:" '.' .: '. '.... '_.. ,:: "
'\;.'
proin". in,d. ,. 'h. ..,."" ,,,,..".,., .w,....""'od'.' ." ",110m,,," ,. "" ..,,,.,," I. Ih"oll""",\I.' ."'.'."'"""<1.". "p'i,i"nrw'lh 'In""il~1:li"ii.'.i.. ilh
promise nollo sell, giv~ away or I"nsler t,t1e to Ihe prope.ty which IS Ihe subjecl ollhe inslallmenl paymenls so ,Ihat the, outslanding Pfincipal b~lan~e, is repaid jn..l~1I ir
niortgage or security interest; or ' ' , , , "",:.:, ,,:r lOW",.. ""', ":' ," /"';' , " subslanlially equal inslallmen1s'on Ihe due dale slaled in lhe payment schedufe; and (h'
(d] if any property in which lender has oblained a securily ihlerest 10 secure this Nole is Borrower's p.omises made and lender's righls set lorth in this seclion shall nol morge will'
los~ stolen land not recovered wilhin a ,oasonable lime) 0' destroyed; or, , any judgmenl in any legal aclion',nd shall apply unlil all amounls owed are paid in lull,
(e) il Borrower has made any untruei$latemen~(l","lsleplesenlalion in Ihe credit ,', "LENDER MAY SIGN BORROWER'S NAME 10 INSURANCE CHECKS: Borrower gives Lender
applicalion or any olher certilicale or document given or m.de for Ihis loan; or Ihe richllo sign Borrower's n.me on any check or draft lrom an insurance company, This, is
(f) upon the dealh of Borrower or .ny one ollhem; illhore is more lh.none; o. , " limlled ,10 . check or dran in paymenl 01 relurncd piemiums or benefits under credillil.
l&l if Borrower provides Lender wilh lalse information or foiged signatUres at any lime; or' insurance or credil disabilily insurance, insurance covering properly which is securily lor
(h) if a court wilh proper jurisdiclion 10 do so finds thaI ~orlower, or anyone of Ihem, is lliis loan or Hood insur~~ce.,1his means lhat Borrower appoints lender as allorney-in,fact lor
incapacitaled; or " ,Borrower w,lh Ihe full power to endorse checks or dralls, :
Ii) illender in good failh belioves Ihat the pros peel 01, Borrower's paying Ihis Nole is , COSTS OF COLLEC1ION: II Borrower is in delaull,under Ihis Nole and,len,d~r hies suit. 0'
impaired, ' ,,', ' , , I.kes olher aclion 10 collecllhis loan or prolect any collal.ral. Borrower agrees to pay cost!
II ,Bonower is ip,delault lhe ,nlire ~ulstanding balance an this, ~ole shall be 1m00ed13leiy, 11,01 suit and. iI permilled by law, realOnabloallorneys: le~s,and expenses.." ,':",,: : ".:,'
due. at Ihe opllOn of the lender, ThiS Will happen wlthoul any pllor notice 10 Borrow", or SECURITY INtERES1IN DEPOSI1S; The.Lender mai ,,1'011 any amaunls due and unpaid
right to cure, except as may be required by law. under Ihis loan againsl any'oi Borrow,,;;s'nioiiei on #,iWsit wilh lender. This Iniludefp,'ny
'; Borrower will also be in def~ull: ," , ' . ~::. 'c"', money whi~h i~,now o,r maY,i~,lhe 1~I~re,~o depo,sil~~'~!I~Leii.d!\ byJ~f,ro!li~pi,wi\h a'ny
" 01. tl BOrr~~~r~;c~~e.s'"n~o~,,~nt, ~nd/?r ca~no~pa; Barrow:" debls " Ihey become "fo;dep,os!,.~rdncl~~,lng B,orraw.r's ,sp,ause.}his,also clOclu~~s any prape!ly,:credils,
due, or " ' , " " ,,.,, "', " -" securities, or money ollhe BorrOWer, which may arany time, be' delivered' to or in the
'lh~l~n~7r~I~~:s;~~1;~~d~"! ~y}eg:! ~r~~~ t~ la~~ any money or property 01 Bor~o~:r In possession 01 the len,der,lhis maybe,don. ~ilho~' any prior natice.la,Bor'o~e;:':,~,:::,;,",
, :'" III if Borrower hies a' bankruplcy petition or if anyone (iles an involuntary bankruplcy ASSIGNMEN1: Borrower may nal a,sSlgn or olherw!se ,tra~sfer Borrowers, ngh.ls,~nde! t~IS
againsl Borrower, or ' ", ' , , ' Nole 10 anyone else, Lende~ may sell, Ir'n~ler, o~ asSign '.hIS ~Ol,:, and any s:c~nty
" (m)iI Borrower makes an assignment for the benelit o(credit'a;s;'o!'any insolven'cy,' agreeme~t andlor mortgage given taseeure IhlS Nole, and Borrowel s nghtslind obhga!'ons
; reorganization,arrangement, debt adiuslmenl"receivership: Irusleeship,.liquidalianOi olher ' ,under thIS Nale w,lI continue Ullchang.d, ' ':" ,",," ' ;, " ,',,:',::
legal or equilable proceedings are insliluled by or against Borrower, 0;' .',' , HEIRS AND PERSONAL REPRESEN1~lJVES ,BOUND: lhe: provisi,.ns ~f l~is,,~o.le, sh,~il,be
, (n) if any judgmenl, I!I lien, municipal charge or lax levy is Illed or wril 01 execulion IS bmdlng upon Ihe Borrower, and the 'relrs .nd personal representallves of the Borrower, '",
isSued againsl Barrower:' ..' ',c' " :" " , c..' '" '::':, ' :," GOVERNING LAW PRDV!SION:lhis Nole and ,ils validily, CODstr~,tion-in{en!orcea'bility
, 'If any evenl described in 01, Ik); (II, (m) or (n) happens, the entire outslanding balance an ' sh.1I be governed by Ihe laws 01 Pennsylvania, exceplto Ihe extenl thai sUCh laws have been
."lhis'Noldhall be'immedialelY,due without ani prior, nolice 10 Borrower; orrighllo cure. ,!' preempled or superseded by federal law,..," " :' "": " ,',,, ,(",""" ",/".:':'
""excepta,inayberequired'bylaw:'" ,," "":'~:''''''c' ",J,",,,, ",'." ,',; "',.. ",' "" """c.,'",,,,-,;c'''',~''''''':''''
_ .' .<':...j,;::~_ y: ~~l ;.~'!;~ ..'..~';:I;~~ ,,:;;,~r ".' '. ..~~1'::;. (Jil.: ,;' .~.'::-. ".' '
,.:....... .,;"'; 'c . _,;, ,~;>~:.:l~ ~'r .Ii:'" ,: ,,~~:}-:~~'l'!-:";'~"";"!'J'-;~'~Y:'~
". ,. , " NOTICE,TO CO-SIGNER'"''
Yau are being, asked to guarantee this debt. Think carefully befareyau do.. If the Barrawer daesn't pay the debt, you will hav'e to.
Be sure yau can affard to. pay if you hav'c to;and thafyau 'want to. acceplthis,resp~nsibility.,,,: ' r.' ,:" ,,:, ',"";' ",,"':: ,j,,' , ,,' :
Yo~ '!)ay have t? ~at~~)'! th~ f~1I am~!1~t;,~~ t.~~,~ebt ifthe ,!orro,,:e~ d.~"s pat pay, you !,!illy, ~I~~ have ,topay)ate,feesor
collechan casts wluch increase this 'amount:" ''':.,,':'' ,.,.. :: :,: " ,,, ..:..," ' "- ,'" .' ",. (, l. ""," "", "JI''''''"' "" <,"'" , ""
Tlie:~"nd'r' ca~cC\Jllect 'ihisdebf cCrom y~~':;ioio~t fir'.ttrying to. ,collect fram' the:Bo;roiv~'r:th'c'lt~:~~1::fb'aii \J~~':tiih'~silnie
~?lIect,ion lJl~thodsagainst yO\! !h~Uar.Je:.us~~:igi,inst th~~?rrnwer, such as suing yau, etc; If this'dcbtis ever'indefault~\;t1laff;Cl
m,!,Y ,be~al1le ,apart of ypur credIt record.",:, " .. c '.' ' ". ' """"" .. ".. ""," ,',,,,,n"', .'cJ,:' O),""',;",,"h'",'; "
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. SEP 0 2 -e9a
South Mountain Plumbing and Heating
1157 GreenSpring Rd.
NewvillePA 17013
August 26, 1998
To Whom itl'vIay Concern:
I was called to provide service to the home of Y olanta Troy on 8/7/98 because of
a leak and no hot water.
I repaired a leaking PYC sink drain line in the basement. In my opinion the pipe
could have only leaked because someone pulled on it, breaking the seal at a tee joint.
There was no hot water because the timer on the hot water heater had been
switched to the off position.
Total cost of service call and repair was $119.00.
Sincerely,
r"l, J;t~ ~~
M,M. Smyser
Registered Master Plumber
PLAiNTIFF'S
t;~pIBIT.
~
I
n040
)
label
ISH L
InIUue1ion. ~
on p.tg. la,' E
L
)
U.. the Ins
laboL
]
O1hlrwB',
pi.... print
o'fy~.
1
1
Check only
one box.
1
Exemptions
1
1
IfmotlJfhansix
dependents.
SCHI page 10.
1
Income
1
Attach
Copy 8 01 your
Forms. W-2.
W.2G;.nd
, 099-R here.
If you did not
getaW.2.
see page 12.
Enclose. but do
nOl .lInach. any
payment. Also.
please use
Form 104o.V.
j
Adjusted
Gross
Income
, .
o.PM1n~nt of th, T.0it5UIV . Inflrnal R....lHlue SfNic.
U.S. Individuallncomo Tllx Roturn
For hfl "/H Jnn 1 to 3 t HHl1 nt n,tu', IIII' flnr tlf' innln
Your first name .nd inidm L..t on"
(!HIt IRS Un Onl'.l'Oo nol writ. 0' .t.pl. in lhis SpIC.,
HUH "",Iin 10 I OM8 No, 1545-0074
You, IOCla' security numb.,
JOLANTA S
If .I julnl '.Iurn, spolln', first n.m. Ind Inll!.:ll
TROY
tall nlml
22 Add the amounts in the far ri ht column for lines 7 throu h 21. This is our total incomo. . ~
23 IRA deduction (seepage 16) .............. 23
24 Medical savings account deduction. Anach Form 8853 . 24
25 Moving expenses. Attach Form 3903 or 3903-F. . . . . 25
26 One-half of self-employment tax. Anach Schedule SE . . 26
tf line 32 is under 27 Self-employed health insurance deduction (see page 17) 27
$29.290 (under 28 Keogh and self-employed SEP and SIMPLE, plans 28
$9.770 H' a child
)', did not live with 29 Penalty on early withdrawal of savings . . . . . . . . . . 29
you). see EIC inn 30011 Alimony paid b Recipienfs SSN 30011
onpa,.22. 31 Addlin,.s23through30a.. . PLAINTIFF'S"
j Forpriva':Act3:nd~~~:::~~~:~~:;i~n:~~~ fYi,;IBIT ,.., ......
CARL ISLE PA
P,..sljdentiel . ~ Do you want $3 to go 10 lhis fund? . . . . . . . . . . . . .
Elect on Campolgn ..
S... a II 10. If a . int roturn. doos ur s ouso want $3 10 0 to this fund?
1 Sinole
Filing Status 2 Married filing joint return (ovon if only ono had income)
3 X Marriod 1iIing npariJro return. ~~~~5f,f3f~;rnSaO~'h~~~~jry no..... GREGORY R Y ASKOV r TCH
4 Head of household (INith qualifying ptYson). (See page 10.1 If tho qualifying porson ts a chik:l but not your dependent.
enler this child's name hero. ~
Oualifying widow{orl with dependent child (year spouse died ~ 19 I. (Sce 0 10.1
Yourself. If your parent (or someone olso) can claim you as a dependont on his or her tax
return. do not chock box 6a ...................
UOrTMI address lrunber ltnd SUMO. If '(011 h8V. I P.O. LIl.. Id. p~ 10.
^III. no,
H
E
R City. lown or pasl olfieo. Slata..nd ZIP rod_, II '(011 h"v, II foreign .oddr1fU. 108 PlI(,1o 10.
E
40 BEARS SCHOOL LANE
17013
5
6. lXJ
b Souse
c Oopondents:
1 First name
MELISSA TROY
ALLAN PROBERT
......... .
....... .
(3J Dopondent's
rolalionship10
you
CHI LD
CHI LD
I
I
I
last name
(21 Dependent's
social securhy numbor
41 No. of_
.........
.......lnltt'
12
12
d Total number of exemotions claimed. . . . .
7 Wages. salaries. tips. ete. Attach Form(s) W.2 7
8011 Taxable interest. Attach Schedule B if required 80
b Tax-exempt interest DO NOT include on line 8a 8b
9 Dividend income. Attach Schedule 8 if required .
10 Taxable refunds. credits. or offsets of state and local income taxes (see page 12)
11 Alimony received . . . . . . . . . . . . . . . . . . . . . .
12 Business income or (loss). Anach Schedule C or CEZ
13 Capital gain or (loss). Attach Schedule D ..
14 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . .
15 a Total IRA distributions ~ . . . ~ 'b Taxable amount/soo page 13)
168 Total pensions and annuities ~ b Taxable amount (see pago 13)
17 Rental real estate, royalties. partnerships. S corporations. trusts. etc. Attach Schedule E
18 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . . . . .
19 Unemployment cOfl1pensation . . . . . . . . . . . . . . . . . . . . . . . . .
20a Social security benefits ...~ . ibTaxableamount(Seopage14)
21 Other income. List type and amount-seo page 15
1.955.
1,325.
....
31
32
136-80-6536
spau.... &OC~I Mcurlty numb.r
172-58- 1960
For help finding lin.
Instruction::, S88 pogo::
2 nnd 3 In the booklet.
Yos No
Not.: Checking
X -r.s.wi'"ot
cJyn~ your Wi Of
-,.duee 'faur rofund.
No. ot bons
checked on
6a end 6b
No. of your
children on
6cwho:
. lived with you -L
. did n01: live with
you due 'to divorce
or $epar~ion
(soe page 111
DependClnts on 6e
not emend above
Add numbol"$
entClred on
linn abov,," 3
60.
27 676.
NONE
27,725.
STMT 1
3.280.
24 445.
Fo,m 1040 (19971
-L
Fonn t040 1997
Tax
Compu-
tation
If you WIt"t
th.IRS to
(igure your
tax. ICe
page 18.
Credits
Other
Taxes
Payments
Attach
Forms W-2.
W.2G. and
1099-A on
thcflont.
Refund
~ Have tt
directJy
deposited!
See page 27
and fiB in 62b.....
62e. and 62d. 63
64
Amount
You Owe
Sign
Here
Keep a copy
of this return
for your
records.
'JOLANTA S TROY
33
Amount from line 32 (ad~lsted gross incomel ., ,....,...,..,..
Check il: 0 You wore 05 or older. 0 Blind: 0 Spouse was 65 or older,
Add tho numbor of boxes checkod above and ontor tho tOfal horo, , . . ,
b If you aro malTiod filing soparately and your spouse itomizos doductions or
you wore a dual-.tatus alien, sao pago 18 alld chock horo ,.'"". ~ 34b 0
{ Itemlz.d deductions from Schedule A. lino 20. OR }
Enler Standard deduction shown bolow lor your filing stalus. But suo tho
tho pagn 10 if you checked any box on Ii no 348 or 34b or IOlTlllOnO
hltO.r can claim you as II dependenl.
of e Sin Old . $4, 160 . Marriod filing jointly or Qualifying widow(orl. $6.900
your: ,Heod of housohold. $0.050 . Married filing loparaloly. $3,450
Subtract lino 36 from lino 33 . . . , . . . . , , , , , . , . . . . . . . . . . . . , , , .
IIlino 33 is S90,900 or lOIS, mulliply $2.050 by tho lotal number of exemption. claimod on
lino Cd. If lino 33 ill ovor $90.900, soe tho works';:ot on pago 19 for the amount to ontor
TaxlIblelncome. Subtract lino 37 from lino 36. II lind 37 is moro than lino 30, entor.().
Tax.Soe a a 19.Checkifan tnx(rom a form(slBB14 b Form 4972 #
Crodit lor child and dopendent ~ro expensos. Attach Farm 2441 , 40
Credit far the eldorly or tho disabled. Al1ach Schodulo R 41
Adoption credit. Attach Form 6839 ,....,.,. 42
Foreign tax credit. Attach Form 1110 ...,.,....... 43
Other. Check if from 1.1 8 Form 3800 b 0 Form 6396
o 0 Form 8801 d Form (specify) 44
Add lines 40 through 44 . . . . . . . , . . . . . . . . . , . .
Subtract line 45 from line 39.11 line 45 is more than lino 39. enter.(). .
Self-employment tax. Attach Schedule SE . . . . . . . . . , . , . . . . , . . , .
Alternative minimum tax. Attach Form 6251 ...............,...
Social security and Medicaro tax on tip income not reported 10 employer. Attach Form 4137
Tax on qualified retirement plans (including lRAs) and MSAs. Attach Form 5329 if required
Advance earned income credit payments from Form(s} W-2 ...
Household employment taxes. Attach Schedule H . . .
Add lines 46 throu h 52. This is your total tax
Federal income tax withheld from Forms W-2 and 1099 .,.
1997 estimated tax payments and amount applied from 1996 return .
Earned income credit. Anach Schedule EIC if you have a qualifying
child b Nontaxable earned income: amount ~
~-~ ~
Amount paid with Form 4868 (request far extension) ........ 57
Excess social security and RRTA tax withheld (see page 27) . . . .. 58
Other payments. Check if from II D Form 2439 b 0 Form 4136 59
Add Hnes 54. 55. 56a. 57. 58. and 59. These are our total 8 manu . . . . . . . . . . . . . ....
If line 60 is more than lino 53. subtract line 53 from line 60. This is the amount you OVERPAID .
Amount of line 61 YOU want REFUNDED TO YOU . , . . . . . . . . , . , , . . . . . . ....
Routing number I c Typo: 0 Checking 0 Savings
'136-60-5535 p".2
33 24 446.
9 680.
36
14 766.
34.
'd~li'n~.'
~ 34.
35
36
37
38
39
40
41
42
43
44
.~
NON
37
38
39
7 960.
6 816.
1 024.
45
46
47
48
49
50
51
52
53
54
55
54
55
56.
57
58
59
60
61
62.
~ b
a Account number
Amount of line 61 ou want APPLIED TO YOUR 1998 ESTIMATED TAX....
If fine 53 is more than line 60. subtract line 60 from line 53. This is the AMOUNT YOU OWE.
For details on how to pay, see page 27 .,... , . . . . . . . . . . . . . . . . . . . .
Estimatedtax en",1 .Also include an line 64 . . . . . . . . . . .. 65
.. ~
266.
~
45
46
47
48
49
50
61
52
53
NONE
1 024.
3 910.
NONE
65
SELF-EMPLOYED
Spouse's occupation
Date
Checkif
self~m loved
I>-
4.934.
Preparer"s.....
Paid signature ".
. Pre parer's Firm's name (or yours
Use Only (f self-employed) and ~
address
.....'"
Under penahies of perjury. I declare that I have examined this return Olnd accomP'lny;ng schedulas and statements. and to the best of my knowledge and
belief. they are 1rue. correct. and complete. Declaration of prepnrer (other than tllXpayerl is based on all information of which preparer has any knowledge.
Your signature Your occupation
~
~
JSA
BROWN SCHULTZ
1011 MUMMA ROAD
WORMLEYSBURG
P ZIP code
EIN
Preparer's social security no.
202-38-8776
25-1644159
17043
ill
1]
Note: In most cases. you do not flood to fila Fann 2210. Tho IRS will figuro Bny ponlltry you owo Imd 30nd you D bill. FiJo Form
2210 only if ono 01' mOlD boxos in Parr I apply to you. If you do not flood to filo Form 2210. you still may uso it (0 figuro your ponn/ey.
Entor rho amount from line 20 or line 32 on rho tJOnatrv lino o!vourroClrn. bur do not ottach Form 2210.
Part I Reasons for Filing .. If la. b. or c below applios to you, you may be ablo to lowor or eliminato your penalty.
But you MUST chock tho boxes that apply and filo Form 2210 with your tax return. II ld below applio. to you,
check that box and file Form 2210 with your tllX lotura,
1 Check whichever boxes apply (if none apply. see the Note above):
a D You roquost OJ waiver. In certain circumstnnc8s. tho IRS will waivD all or part of tho ponalty. Sea WtWver of Penalty on
p.ge 1 of the instructions.
b 0 You use tho annualized income installment method. If your income v~riDd during the year. this method mflY reduce
the amount of one or more required installments. See page 4 of tho instructions.
cO You had Faderal incoma tex withheld from wages and. for astimated tex purposes. you treet the withheld tax as paid on
the dates it was actually withheld. instead of in aqual amounts on tho payment due datas. Sea tha instructions for
line 22 on pago 3.
dO Your roquirod annual payment (line 13 below) is based on your 1996 tex 'and you filed or aro filing a joint rat urn for aithor
1996 or 1997 but not for both veers.
Part II Raquirad Annual Payment
Form
2210
Underpaymont of
Estimated Tax by Individuals. Estates. and Trusts
.... s.. sepllrllt_ Inttructlons.
.... Attach to Form 1040 1040A 1040NR 1040Nn.EZ or 1041.
Oep.lnmenl oflhe Tteuury
Inlemlll Revenue Service
Name(s) shown on tax fllMn
JOLANTA S TROY
lID
il
111
J]
~
lU
2 Enter your 1997 tex attar crodits (sae page 2 of the instructions), Caution: Also so. pag. 2 for
a special rule if claiming the reseorch credit. ...... .................
3 Other texas (seo page 2 of the instructions) ..... . . . . . . . . . . . . . .
4 Add lines 2 and 3 .........
5 Earned income credit . . . . . . . . . . . . 5
6 Credit for Fedoral tex paid on fuels . . . . . . . . . .. 6
7 Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 Currant year tex. Subtract line 7 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . .
9 Multiply line 8 by 90% (.90) . . . . . . . . . . . . . . . . . . . . . . . . . I 9 I 4 , 441
10 Withholding taxas. Do not include any astimated tax payments on this lino (soe page 2 of the
instructions) ................................................. 10
11 Subtract line 10 from line 8. (f loss than S500. stop here; do not complete or file this form. You
do not owe the penalty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12 Enter the tax shown on your 1996tax return (110% of that amount if the adjusted gross income
shown on that return is moro than 5150.000, or if married filing separately for 1997. mora than
575.000). Caution: S.. pag. 2 of th. instructions ..........................
13 Required annual paymant. Enter the smaller of Ii no 9 or line 12 . . . . . . . . . . . . . . . . . .
Note: If lin. 10 is .qual to or mora than /in. 13. stop here: you do not owe the panalty. Do nor
fil. Form 22 10 unl.ss you checked box 1 d above.
Part III Short Method (Caution: See psg. 2 of the instrUctions to find out if you can use rho short mathod. If
you checked box 1 b or c in Part I. skip this part and go to Part N.)
14 Entet the amount if any. from line 10 above. . . . . . . . . . . . . .. 14
15 Enter the total amount if any. of estimated tex payments you made. 15
16 Add linas 14 and 15
17 Total underpayment f~r'y~~r: Suj,~;c; I;n~ '16 'f;~';"Ii~; i3. 'If'z~r~'o; less. st~p' he;o; ~du'd~'
not owa the penalty. Do not file Form 2210 unless you checked box ld above. . . .. ., .
1 B Multiply line 17 by .05986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19. (f the amount on lina 17 was paid on or after 4/15/9S. anter .0..
. If tho amount on lina 17 was paid boforo 4/15/98, make tha following computation to find the
amount to enter on line 19.
Amount on Number of days paid
line 17 X before 4/15/98
!ill
B1
m
}1
.;JJ
m
m
]
..
t1
X .00025........... 19
~
20 PENALTY. Subtractlina 19 from line 18. Enter the rasult hera and on Form 1040, line 65; Form
1040A,lina34;Form 1040NR.line 65: Form 1040NR-EZ, line 26: or Form 1041. line 27 ...~ 20
For Paperwork Reduction Act Notice. sea page 1 of separate instructions.
~
OMB No. 1545-0140
~~7
An.ehmenl
SeQu.nu No. 06
Id.nttfylng number
136-80-5535
2
3
4
1 024.
3 910.
4 934.
7
8
4 934.
11
4 934.
12
13
5 880,
4 441.
4.441.
266.
266.
Form 2210 119971
m
11
.-.
~
,~
fl
2210
Underpayment of
Estimated Tax by Individuals, Estates, and Trusts
OMS No. 1545-0140
Form
1]
~~7
Oepolnmenr of the T,usury Ii-- S.. upante lnstruotlomll. Attachment
In'ernlllRevenueService ... Att"ch to Form 1040 1040A 1040NR 1040NR.EZ. or 1041. Sequence No. 06
N.1me(sl shown on llUl 'alum j'dentifying numb.,
JOLANTA 5 TROY " 136-80-5535
Note: In most CIISBS, you do not noOfl (0 filo Fonn 2210. Tho IRS will fi{Juro any ponatry you owo and 30nd you a bill. File Form
2210 only if ano or mora boxo$ in Part I apply to you. If you do not nood (0 mo Form 2210. you still may uso it to figuro your ponalty.
Enter tho BmoU!It from lillo 20 or lino 32 on tho nB I1ilo 01 ur roturn. but do not attach Form 2210.
Part I Reasons for Filing . If 1a, b. or c below applies to you, you may be ablo 10 lowor or eliminate your penalty.
But you MUST check lho boxes thai apply and file Form 2210 with your tax return. If 1d below applies to you,
chock that box and filo Form 2210 Wi1h your tax ro1urQ.
1 Check whichnvor boxes apply lif none apply. see the Note above):
aD You requost il waiver. In cert..in circumst..nces, tho IRS Vlill w..ive <Ill or ptlrt of tho penalty. S09 Waiver of Penalty on
page 1 of the instructions,
b 0 You uso tho annualized Income installment method. If your income v;lriod during tho year, this method may reduce
tho amount 01 ono or mororoquired installments. Soo pago 4 of tho instructions.
cO Vou had Federal incomo I'X withheld from wages and, for estimated tax purposes. you treat the withheld tax as paid on
the dates it was actually withheld, instead of in equal amounts on the payment due dates, See the instructions for
line 22 on page 3.
dO Vour required annual paym.nt (line 13 below) is based on your 1996 tax 'and you filed or are filing a joint return for either
1996 or 1997 but not for both years.
lID
f]
1]
Hl
~
~
Part" Required Annual Paym.nt
2 Enter your 1 S97 tax after credi~ (se. page 2 of the instructions). Caution: Also see page 2 for
aspecialru/91,c1aimingtheresearchcredit. . . . . . , . . . , . . . '" " . . .. . . .
3 Other taxes (see page 2 of the instructions) ...................
4 Add lines 2 and 3 .......... . . . . . . .
5 Earned income credit . . . . .. . . . 5
6 Credit for Federal tax paid on fuels . . . . . " 6
7 Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 Current year tax. Subtract Iin, 7 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9 Multiply line 8 by 90% (.90) .. . . . . . . . . . . . . . . . . . . . . . .. 9 4 441.
10 Withhoiding taxos. Do not include any estimated tax payments on this line (see page 2 of the
instructions! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 10
11 Subtract line 10 from line 8. 111.ss than 5500. s:op here; do not complete or file this form. Vou
do not OWe the penalty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11
12 Enter the tax shown on your 1996 tax return (110% of that amount if the adjusted gross income
shown on that return is mar. than $150,000. or if married filing separately for 1997. more than
575.000). Caution: See page 2 of the instructions .......................... 12
13 Required annual payment. Enter the smaller of line 9 or line 12 . . . . . . . . . . . . . . . . . " 13
Note: If line 10 is equal to or more than line 13, stop here: you do not owe the penalty. Do not
file Form 2210 unless you checked box Id above.
Part III Short Method (Caution: See page 2 of the instnJctions to finci out if you can use the short method. If
you checked box 1 b or c in Part I. skip this part and go to Parr N.)
14 Enter the amoun~ if any. from line 10 obove. . . . . . . . . . . . . " 14
15 Enter the total amoun~ if any. 01 estimated tax payments you made " 15
16 Add lines 14 and 15
.... ......................................
17 Total underpeyment for year. Subtract line 16 from line 13. If zero or less, stop here; you do
not owe the penalty. Do not fiI, Form 2210 unless you checked box ld above
18 Multiply line 17 by .059S6 . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19. If the amount on line 17 was paid on or after 4/15/98, enter-O-.
. If the amount on line 17 was paid befora 4/15/98. make the following computation to find the
amount to enter on fine 19.
Amount on Number of days paid
line 17 X before 4/15/98 X .00025........... 19
4,441.
266.
H1
1 024.
3 910.
4 934.
@
4 934.
m
J]
4 934.
w
5 880.
4 441.
~
20 PENALTY. Subtract line 19 from Ii" 18, Enter the result here and on Form 1040. line 65; Form
1040A,line 34; Form 1040NR. lin. 65; Form 1040NR-EZ, line 26; or Form 1041.lin927 ...~ 20
For Paperwork Reduction Act Notice/seB pago 1 of separate instructions.
266.
Form 221 0 11997}
..,
111
SCHEDULES'A&B
(Form 10401
Schedule A - Itemized Deductions
(Schedule B i. on back)
~~7
OMB No. 1545-0074
IJ1
Otpanmonl of lh. T'DUUry
Inl.m'l R.venu. s.l\tic. 1991 ~ Attach to Form 1 040. ~ S88 rn~ruction:; for Schoduro~ A and B
Name(.) shown on Form 1040
JOLANTA S TROY
Modical
and
Dental
Expenses
j]
IJ
f!l
Taxes You
Paid
C.ution:Do nor includo lJXpotltQJ roimbUl3od Of P.W by otllors.
1 Modical anddcml.1J UXponsol (uo paga A'l) . . . . . . .
2 Enl.,anlOllnlllomForm 12" I 24 445
1040.~n.33. . . . . .~ "
3 Muhiplylino2 abovo by 7.5% (.075) . . . . . . . . . .. 3
4 Sub1fDellinG 3 from lino 1. If line 3 is moro than lino 1. onlor.o. .
5 51310 and IOCilI income laxol . . 5
5 Real e.tate laxe. (.ee page A.21 . . s'rMf: 2. 5
7 Porsonal proporty taxes . . . . . . 7
8 Other talCos.list type and amount ....
SEE STATEMENT 2
9 Add lines 5 throu h B . . . . . . . . . . . . .
10 Home mongagll inlerOSI and points repor1ed to you on Form 1098 10
11 Home mortgage inlerest n01 reponed 10 you an Form 10gB. If peid
10 tho person from wham you bought lhe harne, see p..1ge A-3
and show lh.u parson's name, identifying no" and address ~
Add lines 20 through 22
Enlor amount from Form 24
1040.lina33. . . . . .
Mulliplyline24aboveby2%(.02) . . . . . . . . . . .. 25
Subtract line 25 from line 23./1 line 25 is more than line 23. enler-o-
01her ~ from list on page A-5. List type and amount ~
12 Points not reported to you on Form 1098. Seo page A-3
for special rules . . . . . . . . . . . . . . . . . . .
13 Investment interest. Anach Form 4952. if required (See
page A.3.) .....................
Add lines 10 lhrou h 13 . . . . . . . . . . . . . . .
Gifts by cash or check. If you made any gift of $250 or
more.seepageA.3 . SEE. S.TATEMENJ. 2.
Other than by cash or check. If any gift of $250 or more,
see page A.3. You MUST anach Form B2B3 if over ssaa
Carryover from prior year
Add lines 15 throu h 17 . . . . . . . . . . . . . .
Casual or theft loss es . Attach Form 4684. See aoe A4.)
Unreimbursed employee expenses - job travel, union
dues. job education, etc. You MUST attach Form 2106
2106-EZ if required. (See page A-4.) ....
21 Tax prepdration fees. . . . . . . . . . . . . . . . .
22 Other expenses - investment, safe deposit box, etc. List
type and amount ~
........... .
136-80-5535
2 717.
1 833.
....... .
4
884.
(50S
page A.2.)
Q1
Interest
You Paid
1 211.
1 602.
8
300.
ID
(See
page A-2.)
....... .
3 113.
STMT 2
~
Nate:
Personal
interest is
not
deductible.
5 583.
11
12/
13/
........ .
14
5,583.
]
n
14
Gifts to 15
Charity
If you made a 16
gift and got a
benefit for it. 17
see page A.3. 15
15/
15/
Hi
100.
J
1
Casualty and
Theft Losse. 19
Job Expenses20
and Most
Other
Miscellaneous
Deduction.
....... .
................ .
18
19/
1
(S..
page A.5 for
expenses to
deduct here.)
23
24
25
25
Other 27
Miscellaneous
Deduction.
100.
20
2.'
'''/
"..:.:0.,':
22
231
27
Total 28 Is Fonn 1040,Iine 33. over $121.200 (ovor $60.600 if married filing separately)?
Itemized NO. Your deduction is not limited. Add the amounts in the far right column
Deductions for lines 4 through 27. Also, enter on Form 1040,Iino 35. the larger of . ,; . . .... 28
t!lis amount or your standard deduction.
YES. Your deduction ma be limited. See a e A.5 for the amount to enter.
For Peperwork Reduction Aot Notice, .ee Form 1040 ins:ruotion.. Schedule A (Form 194O1 1997
JSA
1400 2.000
d nv 1 ~ I
v.,..,,,
fil
SCHEDULE C
(Form 1040)
Profit or Loss From Business
(Sole Proprietonhipl
~Partn.~hjps.joint Venturn. etc., must fiI. Fonn 1005.
"'Attllch to Form 1040 or Form 1041. III-S.. Instructions for Schttdul. C
Ql
Oap.lr1manl of the T,.uury
Inlftnal Ravanl>> Service 99
N../N of prop,ielor
JOLANTA S TROY
A Principal business or profossion, including product or service (soe page C.l)
BEHAVIOR SPECIALIST
C Ou.ineu nomo. II no soparate businou name, leave blank.
~
m
JOLANTA TROY
E Bu.in....ddr.ss (including.ui..orroom no,) ~ 40 BEARS SCHOOL LANE
City. lown 0' post offic.. ,IB'c. .nd ZIP code CAR L I SL E P A 17013
F Accoun'ing mc1hod: (1)[15] Cash (2)0 Accrual (3) O,hc, (specify) ~
G Did you .matorialty participato. in tho operation of this businoss during 19971 If -No,- 108 pago C-2 for limit on lossos.
H If you startod or acquired this businou during 1997. chock hero. . . . . . . . . . . . . . . . . . . . . . . . . .
ill
Part I
Income
~-,
.'
'.,
, Gross recoipts or sales. Caution: II this income was reponed to you on Form W.2 and tho .StatUTory
omp/oyos" box on that form was checkod. seD pagG C.2 and chock horD SJMJ. 3. ... 0
2 Returns and allowances . . . , , . , , , ,
3 Subtract line 2 from line 1 . , . . , , . , . . ,
4 Cost of goods sold (from line 42 on page 2) ..,...
5 Gro33 profit. Subtract line 4 from line 3 .".,..,
6 Other income, inclUding Federal and stato gasoline or fuel tax credit or refund (see page C.2) . .
7 Gross income. Add lines 5 and 6. . , , , . . , . , , . . . , , , . , . , , . . , . . . . . . ,
Part If Ex enses. Enter ex enses for business use of our home ani on line 30.
8 Advertising . , , , . , , . , . 8 19 Pension and profit-sharing plans
9 Bad debts from sales or services 20 Rent or lease (see page C-4): .
(seo page C-3) , . , , , ,9 a Vehicles. machinery, and equipment
10 Car and truck expenses b Other business property
(see page C-3) .8.TMT. .3. 10 4 . 914. 21 Repairs and maintenance, , . ,
11 Commissions and fees 11 22 Supplies (not included in Part HI)
12 Depletion .,.,. 12 23 Taxes and licenses . , . . , . .
13 Depreciation and section 179 expense 24 Travel. meals. and entertainment:
deduction (not included in Part III) a Travel .. . . . . , . . . , . .
(see page C.3) . . . . , . . 13 b Meals and
14 Employee benefit programs entertainment
(other than on line 19). , . 14 0 EnlerSO%Or
15 Insurance (other than health) 15 216 lino 24b sub;ee1
, tolimitalions
16 Interest: {seepageC-41 '
a Mortgage (paid to banks, etc.) 16a d Subtract line 24c from line 24b
bOther . . , . , . . , , , . , , ., 16b 25 Utilities ..,...".....
17 Legalc:nd professional 26 Wages (less employment credits)
services. , . , . . . , , . . , .. 17 27 Other expenses {from line 48 on
18 Office ex nsa,....,..", 18 a e 2 .....
28 Total eXpensos before expenses for business use of home. Add lines 8 1hrough 27 in columns
29 Tentative profit (loss). Subtract line 28 from line 7. , . . , ,
30 Expenses for business use of your home. Attach Fonn 8829 ........,.,.....
31 Net profit or (lossl. Subtract line 30 from line 29.
. If a profit. enter on Form 1040. line 12. and ALSO on Schedule SE,tine 2 (statutory employees,
see page C-S). Estates and trusts, entor on Form 1041,/ine 3.
. If a loss, you MUST go on to line 32.
32 If you have <II loss, check the box that describes your investment in 1his activity (see page C-S).
. If you checked 32a, enter the loss on Fonn 1040, line 12, and ALSO on Schedule SE.line 2
(statutory employees, see page C-SI. Estates and trusts, enter on Form 104 1,Iine 3.
. If YOU checked 32b. YOU MUST attach Fonn 6198.
For Paperwork Ro~uction Act Notice, 500 Form 1040 instructions.
ID
E
~
II
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]
]
]
]
J
]
SA
OM!) No. 1545-0074
~@97
AUnchmon1
Fo"" 1040 , Sa unnco No. 09
Soclalucurhy numb., fSSNI
BEnt., principal bus In... ood.
Is.. , .C./l ~ 9886
o Employ., 10 number fEINt, It any
No
...
~
1 36 914.
2
3 36 914.
4
5 36 914.
6
7 36 914.
19
20.
20b
21
22
23
24.
24d
25
26
~
27
28
29
30
3
8
28
460,
590.
324.
649.
}
}
31
27 6750.
..I":,
32111 ~ ~I in, vestmu-"1 ",..ai'",_",:
, nsk., ,_ ,'_,_,,' ">
32b Some I{\VBS1ment Is,
not at nsk. , ',' """:,"
(,
"
,,',"" '"
Sch.dulc C IFonn 1040) laS7,
;:,/'
;<.!
,".,:'
<'<:",:-,\j:];
"_e,' "<':,;:::'~;:"~':;-::-:,::
] Part III
33
J 34
] 35
30
] 37
] 39
1 40
41
136-80-5535 p,..2
Molhod(sl used 10 vl1luo closing invontory: CoSI b Lo'Na( 01 cosl or markot c
WiJI thoro any ch.1l'l(Jo in dotolmining quantitios, costs, or valualloru oolWoon OflllrMng and dosina inventoryllt
.Vo.,- anaeh (lxpl.nalion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other (anl1ch axplanation)
. .. Dves [XjNo
Invontory 01 ooginning 01 yoar. If difforent from 1.1S1 yoar's closing lovantcry, altach oxplanation
35
Purchalos leu cost of Itoms withdrawn for porsonal uso
36
Colt of lobor. 00 nol includo salary paid ~Q yoursolf
37
38
Materials and supplios
38
Other costs
........................................ eo.
39
Add Ii nos 35 through 39
40
Inventory al end of yo:!r . . . . . . . . . . . . . . . . . . . . . . . . . . .
41
42 Cost of oods sold. Subtract lino 41 from line 40. Enter the result here and on aoe 1 line 4 . . . . . . 42
Part IV Information on Your Vehicle. Complete this part ONLY if you are claiming car or truck expenses on
line 10 and are not required to file Form 4562 for this business. See the instructions for line 13 on page
C-3 to find out if you must file.
43 When did you pL1ce your vehicle in service for business purposes? (month, day. year) ...
04/01/96.
44 Of the total number of miles you drove your vehicle during 1997. enter the number of. miles you used your vehK:l'e for:
8 Business
15,600.
c Other
4 ,400.
b Commuting
45
[K] Vos D No
[R] Ves D No
B Ves ~ No
Ves No
Do you (or y.our spouse) have another vehicle available for personal use?
46 Was your vehicle available for use during off-duty hours? .
478 Do you have evidence to support your deduction? . . .
b If .Ves" is the ovidence written? . . . . . . . . . . . .
Part V Other Ex enses. List below business ex enses not included on lines 8-26 or line 30.
BOOKS 200.
CELLULAR PHONE
960.
TELEPHONE
1 800.
DUES
500.
48 Total other ex enses.Enlerhere and on aoe 1.lino27............................ 48
.
J
SCHEDULE E
(Form 1040)
Supplemental Income and Loss
(From rental real 8st81e, royalties, partner.ohipto.
5 corpor81ion$, O$tlltO$. tru::ts, REMICs, etc.)
.. Att"chto Form 1040 or Form 1041, ~S.. Instructions for Sch.dulo E
OMS No, 154&{)074
~@97
]
Olp.lnm.nl of thl T,usury
Intomo' R"vlnul ServicI 99
Name(s) shown on folurn
Anachment
Form 1040 . So uen 0 No 13
Your aoclll ..curity numb.r
]
JOLANTA S TROY 136-80-5535
Part I Income or Loss From Rentel Real Estate and Royalties Note:Roporr inconlO o/ld oxpomos (rom your busiflO>3 o(rollling
]
nnl30nal DfDOOrtv on Schedul.. C or eEZ I!oo DlJaO E-1 J. RSf.XJrr farm 1oms/lncomo or Ion from Form 4835 on nnno 2./ino 39.
1 Show tho kind ond locotion 01 ooch 'onlo1 rool o.tBlo D'ODOnv: 2 For ooch ,on",1 roo I 051010 propo,ty Yes No
A RES I DENT! AL RENTAL lislod on lino 1. did you 0' your lomily
156 ADAMS STREET STEELTON PA usa it during the tax yonr for porsonill A X
B ~ purposos for more than thQ groilt2..r of: -
0 14 doys. or
0 10% 01 tho 10101 doys ronlod 01 B
C foi, 'onlol valuo]
(Soo pogo E.1.) C
Income: Prooortios T otol.
A B C (Add columns A. B. and C,)
3 Rents recoived ........ . 3 6 023, 3 6 023.
4 Ro=lties received 4 4
Expenses: <<
5 Advertising .. . ........ . 5 '.,.."....
6 Auto and travel (see page E-2) . . 6 fr
7 Cleaning and maintenance. . . 7 i
8 Commissions .......... . 8
9 Insuranc6 ........... . 9 520. 'i
10 Legal and other professional fees. . 10 1 > i
11 Management fees . . . . . . . . . 11 I I
12 Mortgage interest paid to banks, 121
etc. (see page E-2) . . . . 1 782. 12 1,782.
13 Other interest . . . . 13 I I I
14 Repairs .... . . . 14 I 1 220. I ,.."
15 Supplies '" . . . ... . . . 15 I 1 ,.,)
16 Taxes. . . . . . 16 500. I't
17 Utilities .. . . . . . 17 710.1
18 Other (list) ~ I?'
SEE EXPENSE STMT. 586. ;
18
c::';
II
19 Add lines 5 through 18 ..... . 19 1 5 318. 1S 5 318.
20 Depreciation expense or depletion
(see page E-2) ......... . 20 1 034. 20 1 034.
21 Total expenses. Add lines 19 and 20 21 6 352.
22 Income or (loss) from rental real
estate or royalty properties.
Subtract line 21 from line 3 (rents)
or line 4 (royalties). If the result 'is ..
a (loss), see page E-2 to find out
if you must file Form619B. .... 22 -329.
23 Deductible rental reat estate loss.
Caution: Your rental real estate
loss on line 22 may be limited. See
IH!ge E.s to find out if you must
file Form 8582. Real estate
fJ!!)fessionals must complete line 23 ( NONS ( ) ( )
42onpage2 . . . . . . . . . . . ,
24 Incomu. Add positive llmounts shown on line 22. Do not indude any losses ...... . .. . ....... . 24
25 Losses. Add royalty losses from line 22 and rental real estate losses from line 23. Enter the total losses here 25 ( NONE
. .
26 Total rental real estate and royalty income or (loss). Combine lines 24 and 25. Enter the result here.
If Parts II. III. IV, and line 39 on page 2 do not apply to you. also onter this amount on Form 1040. -
.,
, NONE
line 17. Otherwise. include this amount in the total on line 40 on page 2 . . . . . . . . . . . . . . . . ..... . 26
]
J
'j
For Paperwork Reduction Act Notice. seo Form 1040 in:ttructions.
Schodul. E IForm 10401 19,57
'1
"
>C1300 2,000
dI;V1~ ,
1(''171
\I "7 nl'l
Pl.lI-?1178?
11
SCHEDULE SE
(Form 1040)
Self-Employment Tax
OMB No. 1545-0074
~ S..lnltn.lctlons for Sch.dul. SE IFann 1040).
~@S7
Attachment
S. ullnce No. 17
o
O.".nrlMlnt of th, r,...ury
Inllmal R....~u. S.Me. 1991 II- Athch to Fo"" 1040.
Name of parlon with ulf..mplo'lment income (liS .hown on Form 1040)
Soc:i:lI sealrny number of plinian
wnh u.....m 10 m incomlt ..
136-80-5535
~
JOlANTA S RO
Who Must File Schedule SE
You musl filo Schedule SE it
· Vou h.d nol e.mings from sell...mploymonl from olhor than church employeo income (Iino 4 of Short Schedulo SE or lino 4c of
Long Schedulo SE) of $400 or more. OR
· You h.d church employeo incomo of $108.28 or moro. Incomo from servicos you performod .s . minislor or . membor of .
religious order Is not church employoe income. Seo p.ge~E-1.
Noto: Evon if you hod a loss or a small amount of incomo from solf-emp/oymont it may ba 10 your banolit ro lilo Schodulo SE and
uso oirhor 'optioflBl molhod' in Part /I of Long Schodulo SE. Sos p:1gO SE-3.
Exception. ff your Dnry self-employment incomo was from 9&lrnings as a minister. member of a religious order. or Christian Science
pr.ctilioner and you filed Form 4361 .nd roceilllld IRS approval nollo be wed on those earnings. do not fila Schadula SE. Inslead.
wrile 'Exampl.Form 4361' on Form 1040. line 47.
m
~
~
May I Use Short Schedule SE or MUST I Use Long Schedule SE7
fi
OlD VOU RECEIVE WAGES OR TIPS IN t9977
No
Ve.
m
Are you a mini:ner. member of a religious order. or Chmtian
Scionctt practnkmer who recei....ed IRS appro....;]1 not 10 be taxed Y 8S
on earnings from these sources. bU1 you owe sel(-(lmp/oyment
tax on olhor earnings1
Ve.
~
Was the tauII o( your wages and lips subjec11a social security
or railroad relirement lax plus your net earnings from
setf.employment more than $65.4001
No
TI
Are YOU using one of the optional methods 10 figure your net
earnings (see page SE-311
Ve.
No
1
No Did you receive tips subject to social security or MediC4re tax
that you did not repon to your emplo~r1
Ve.
No
Did you receive church employee income reponed on Form
W.2 of $ 1 08.28 or more1
Ve.
1
No
VOU MAV USE SHORT SCHEDULE SE BELOW
~ VOU MUST USE LONG SCHEDULE SE ON THE BACK
Section A - Short Schedule SE. Caution: Read above to see if you can use Short Schedule SE.
1 Net farm profit or (loss) from Schedule F. line 36. and farm partnarships. Schadula K- 1 (Form
1065). line 15a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Nal profilor (loss) from Schadula C, line 31; Schadule C-EZ,lina 3; and Schadule K-1 (Form
1065). line 150 (other than farming). Ministers and mambars of religious ordars. see page SE-1
for amounts to raport on this Iina. See paga SE-2 for other income to report ........... 2 27
,
3 Combine lines 1 and 2 ....................... S.EE. .S.T A T.EMENJ. .5. . . . 3
4 Nota.mings from .elf-employmant. Multiply line 3 by 92.35% (.9235).lIless than $400,
do not file this schedula: you do nol OWo sall-employmenltax . . . . . . . . . . .. ~ 4
5 Salf...mploymont tax. If the amount on lin. 4 is:
. $65,400 or less, multiply Iina 4 by 15.3% (.153). Enter the rasull haro and on }
Form 1 040, line 47. ~.. .. .. .. .
· Mora than $65,400. multiply lina 4 by 2.9% (.029). Then. a " $8.109.60 to the
rasult Enler thatolal her. and on Form 1040, line 47. -<
27
25
6 Daduction for oniHlall of salf-employmenttax. Multiply Iina 5 by
50% .5 . Enler tha rasull hera and on Form 1040. line 26 . . . . . . . . . . I 6
For Paporwork Reduction Act Not/co, S88 Form 1040 instructions.
1
,.
Attachment
So ulnco Na. 32
I Your ooci", socurity numbor
136-80-5535
~ F..m
6251
Alternative Minimum Tax -Individuals
~ Sae separate in~tructjon:o.
J Oep.tnmen1 at the T,u,ury
Inl'fNI R.venuI SIlo.vic.
... Attach to Form 1040 or Form 1040NR.
Nomo(s) shown on Form 1040
_. JOLANTA S TROY
:jlPart I Adjustments and Preferences
lIt 1 II you homized deductions on Schedule A (Form 1040). go to line 2. Othorwise, ontor YOUf standard deduction
from Form 1040,lina 35. hore and 00 to line 6 ..............................
ii 2 Medical and dental. Enter the .mallar of Schedule A (Form 1040). line 4 or 2 1/2% of Form 1040. line 33 . . .
IJ 3 Tues. Enter the amount from Schedule A (Form 1040), lino 9
4 COrlnin intorost on a homo mortgago not usod to buy, build. ~,. i';'pr~;o y~u~ h~";o' : : : : : : . . . . . . . .
ii 5 Miscollanoous itomizod deductions. Ent.r tho amount from ~hodulo A (Form 1040). lino 26 . . . .
JJ 6 Rofund of taxos. Entor any tax rolund from Form 1040. lino 10 or lino 21. . . . . . . . . . . . . . .
7 Inv..rmont intorest Enter difference lwlWeen regular tax and AMT deduction . . . .
8 Post.1986 depreci.tion. Enter differonc. bolWoon rogul.r tax and AMT doprociation
'j1 9 Adjustod gain or loss. Entor difforonc. b.twoon AMT and rogular tax gain or loss . .
.:!I,o Incentive stock options. Enter excess of AMT income over regular tax income . . . .
" Passive activities. Enter differe'nee batmen AMT and regular tax income or loss . . . . . .
ii 12 Bonoficiarios of ostatos and trusts. Ent.r tho amount Irom Schodulo K-l (Form 104 1), lino 9 . . . . .
!I13 Tax..xompt intor..t Irom privato activity bonds issuod aftor 8/7/86 . . . . . . . . . . . . . . . . . .
14 Othor. Entor tho amount if any. lor ooch itom bolow and ontor tho total on lino 14.
B Charitable contributions . h loss limitations
b Circulation expenditures . i Mining costs . . . . .. .
c Depletion. . . . . . . . J Patron's adjustment ....
d Depredation (pr~19B71 . k Pollution control facilities
e Installment sales I Research and oxperimental
f Intangible drilling COS1S . mTax shelter farm activities.
9 Long-term contracts . . . n Related adjustments
:-15 Total Adjustments and Proforencos. Combino linos 1 through 14 . . . . . .
Part II Alternative Minimum Taxable Income
16 Entor tho amount Irom Form 1040, lin. 36. If loss than zoro. ontor as a (loss) . . . . . . . . . . . . . . . .... 16
'. ,17 Not oporating loss doduction. if any. from Form 1040. lino 21. Entor as a positivo .mount ........ 17
~ '8 If Form 1040. line. 33. is aver .$121.200 (over $60.600 if married filing separntety~. and you itemized deduC'tions.
, enter the amount, lfany, from Ime 9 oftheworksheetforScheduleA( Form 10401.lIn028 ........ . . . . ... '8
19 Combino linos 15 through 18 . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... 19
-11120 Alternative tax net operClting loss deduction. See page 5 of the instructions .. . . . . . . . . . . . . . .. 20
_!21 AItomativo Minimum Taxablo Income. Subtract lino 20 from lino 19. (II marriod filing soparatoly and lino
21 is morothan $165.000.soo a 050lthoinstructions. .... . . .... ..... . ......... .~ 21
;..Part III Exem tion Amount and Alternative Minimum Tax
[i22 Exomption Amount. (If this lorm is for a child undor ago 14. soo pago 6 01 tho instructions,) ,
_I .. AND lino 21 is lliEN entor on
IF your filmg statUs IS... not over.. . lino 22.. .
$ 33.750 }
45.000 .
22.500
~
]
NON
. ....
II
$112.500
, 50.000
75.000
Single or head of household ........
Married filing jointly or qualifying widow(er) .
Married filing separately .. . . . . . . . .
]'1' If lino 21 is ovor tho amount shown obovo for your filing status. soo pago 6 01 tho instructions.
23 Subtract lino 22 Irom lino 21. If zoro or loss. ontor -0- hore and on linos 26 and 28 . . . . . . . . . . . . .... 23
24 If you complotod Schedulo D (Form 1040). and had an amount on Iino 25 or lino 27 (as rofigurod lor tho
AMT. il nocossary). go to Part IV 01 Form 6251 to figurolino 24. All othors: If lino 23 is $175.000 or loss
($87.500 or less il marriod filing soporotolyl, multiply lino 23 by 26% (.26). OtholWiso. multiply lino 23
by 28% (.28) and subtract $3.500 ($1.750 if marriod filing soparotoly) from tho rosult . . . . . . . . . . ....
25 Alternative minimum tax foreign tax credit See page 7 of the instructions. . . . . . . . . . . . . . . . . . .
ij 26 Tont.tivo minimum tax. Subtract lin. 25 from lino 24 . . . . . . . . . . . . . . . . . . . . . . . . . .. . . ....
.., 27 Enter your tax from Fonn 1040, line 39 (minus any tax from Form 4972 and any foreign tax crecflt from Form 1040.
Iine431 .. . . .. . .. . . . . ..... ... . . .'.... . . . . . . . . . . . . . .. . . . . .. . . . ... 27
rl28 A1temative Minimum Tux. (If this form is for a child under age 14. see page 7 of the instructions.) Subtract line 27 from
t line 26. Ifzero or less. ontor..o-. Enter hOfcand on Form 1040. line 48 . . . . . . . . . . . . . . . . . . . . . . ..~ 28
For Paperwork Reduction Act Notice. sea separate instructions.
II
ib.
'j !X4700 2.000
V708
PHI-24732
40Y1AI
K371
i-.~%>>..,<
t~*~\::;-;.,
W.~\'l~~
'.%.&
~1~:
~,k#l'
>'%W
:~..
II
*~:A
11;1:
14
15
'"Ie'",
.o,,'l ~.~
W. .
"I''''
m.'\,:;
~.. .
.$~:;.; ..
" ).
22
Ut.lD t~o. 1!.J4~.v;;2:
~~7
1
2
3
4
5
6
7
8
9
10
11
12
13
611.
3.113.
NONE
NONE
NONE
3 724.
14 765.
)
18 489.
18489.
22 500.
24
25
26
J
136-80-5535
r,,,,,ft75tt19971 JOL.ANTA S TROY
Part IV Uno 24 Computation Using Maximum Capital Gains Ratos
Pall" 2
J
]
29 Ento, tho amounl from lino 23 . . . . . . . . . . . . . . . . . . . . . . . . . . .
30 Ento, tho amounl from Schodulo D (Form 104U),lino 27 (as rofigu,od fo, tho
AMT. if nocossary). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
31 Enlo' tho amounl from Schodulo D (Fo,m 1040).lino 25 (as rofigu,od fa, tho
AMT. If nocossaryl. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
32 Add Ii nos 30 and 3 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
33 EnIDr tho amounl f,om Schodulo D (Form 1040). lino 22 (as rofigu,od for tho
AMT. if nocossary). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
34 Enlor tho smallor of lino 32 or lino 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
35 Subuacllino 34 from lino 29. If lO'O or loss. onlor'o- . . ':' . . . . . . . . . . . . . . . . . . . . . . . . . . 35
36 If lino 35 is $175.000 or loss ($87.5000' loss if marriod filing soparalaly). multiply lino 35 by 26% (.26).
Othorwi,o. multiply lino 35 by 28% (.28) and subtracI S3.500 ($1.750 if marriad filing soparatoly) f,om
tho rosult. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . .. I> 36
37 Enlo' tho amount from Schadulo D (Fo,m 1040).lino 36 (as figurod for tho ,ogula, tax). . . . . . . . 37
38 Enlor tho smollo51 oflina 29. lina 30, or lino 37 . . . . . . . . . . . . . . . . . . . . . . . 38
29
39 Multiply lino 38 by 10% (.10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
40 Ento, tho smallor of lina 29 or lina 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
41 Enlor tho amounl from lino 38 . . . . . . . . . . . . . . . . . . . . . . . . . .
42 SUbuacllino 41 from lino 40. If lO'O or loss. onlo"o- . . . . . . . . . . . . . . . . . . . . . . . . . . .
I> 39
40
41
42
43 Multiply lin. 42 by 20% (.20) . .. I> 43
44 EnlO' tho amounl from lino 29 .. 44
45 Add linos 35. 38. and 42 . . 45
46 SUbUaCllino 45 from lino 44 .. 46
47 Multiply lino 46 by 25% (.25) . . . . . . . . . . . . . . . . . . . . . . . . . . .. ........
48 Add lino, 36, 39. 43. and 47 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
49 If lino 29 i, $175.000 0' loss ($87.500 or loss if marriod filing sopa'alaly). multiply lino 29 by 26% (.26).
Otharwisa. multiply lina 29 by 28% (.28) and subUacI S3.500 ($ 1.750 if marriod filing sapa'alaly) from
tho rasult. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I>- 47
48
49
50 Enter the smaller of line 48 or line 49 here and on line 24 .
50
ISA
~4701 1,000
40Y1AI
K371
V7()A
PHI-2473?
II
II
II
II
H
~
]
I
]1
]i
Ii
Ii
'I
'~'
form
8829
Expenses for Business Use of Your Home
~ Fil. only with Schedule C (Fo"" 10401. U... uparate Form 0829 (or..ch
home you us.d for business during the yenr.
... S.. sa aret. instructions.
Oepartment of lh. Yr..sury
Inletn.1 Rev.nue S.rvict1991
Name(sl of proprielor(s)
JOLANTA S TROY
Part I Part of Your Homo Used for Business
1 Ar.a used regularly ll/ld exclusivoly for businoss, rogulorly for day care. or for storago of inventory
or product samples. See instructions. . . . . . . . . . . . . . . . . .
Total area 01 home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DMOO line 1 by line 2. EnlBr the result as a parccnt:lgo . . . . . . . . . . . .
. For day-car. facilities not used oxclu:sively for bu=inu3. also complete lines 4-0.
. AJI other.s. skip linn 4-6 and ent.r the amount from lino 3 con line 7.
Multiply days used lor day care during year by hours usectper day . . . . I 4
Total hours availllble for use: during tho yoar (365 days )( 24 hours). See instructions 5
Divide line 4 by Iino 5. Enter the result as a decima' amount. . . . . . . I 6
Business percentage. For day-care facilities not used exclusively for business. multiply line 6 by
line 3 (enter tho rusult as a percentage). All others. enter tho amount from line 3 ......
Part II Fi ure Your Allowable Deduction
8 Enter the amount from Schedule C. line 29. plus any net gain or (Joss) derived from the business use of ,~ll
your home and shown on Schedule 0 or Form 4797 ,If more than one place of business, see instructions 8
s.. Inn~~ns for columns (.) and (bl before ~~(~~; I.) Oireet expenses {b} lndirllc1l1xpenses Hlli~i,
completJl~ Imes 9.20. ,~~>:,," k%ft
CII S' ti 9:1.'\&
asua t:t{ osses. eo Instr,uc ons ........ :%'miti
Doductible mortgage interest Se9 instructions. '0 5 856. J~R'$t
Real 9state taxes. Sea instructions ... l' 1 681. ili~tl~
Add lines 9. 10. and 11 ....... 12 7 537 Jt\IM
Mulb'ply I',ne '12. column (b) by I',ne 7 . . ,.. ',"' ,~"' ", 3 5 2 . ',',~>>.',,,.',,,',c,,;,l,,.".:;,",:,.,,,,,::,,
~~~: %'%1U\~\MtThh~~'W 13 .,J'~~"
Add line 12. column (a) and line 13 . . . t\1~~\i~ f4itW~RWID.%.~i~%ffi1iM KiWgKi#J@~*~W#iitWh 14
Subtract line 14 from line 8.lf zero or less. enter.o. . R%W@ ~l@#~~rnW~W$t~mtWlm :~@A1@tWt#Dt.Nj.jM~~fjm '5
Excess mortgage interest See instructions . '6
Insurance ........ 17
Repairs and maintenance ......... 18
Utilities. . . . . . . . . . . . . . . . . . . 19
Other expensos. See instructions STMT. .7. 20
Add lines 16 through 20. . . . . . . . . . . .. 21
Multiply Ii no 21. column (b) by line 7 . . . . . . . . . . . . . . . . .
Carryover 01 operating expenses from 1996 Form 8829. line 41 ..
Add line 21 in column (a). line 22. and line 23 . . . . . . . . . . . .
Allowable operating expenses, Enter the smeller 01 line 15 or line 24. . . . .
Umit on excess casualty losses and depreciation. Subtract line 25 from line 15
Excess casualt:t{ loss9s. SeB instructions ................. 27
Depreciation of your home Irom Part III below . . . . . . . . . . . . ., 28
Carryover of excess casualty losses and depreciation from 1996 Form 8829. line 42 29
Add lines 27 through 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Allowable excess casualty losses and c1apreciation, EnlBr the smallerol line 26 or line 30
Add lines 14, 25. and 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Casualty loss portion. if any. from r",as 14 and 31. Cony amount to Form 4684. Section B
Allowable Gxpansos lor business usa 01 your home, Subtract fine 33 from line 32. Entar here
and on Schedule C. line 30. If our home was used for mora than one business. see instructions
Part III Depreciation of Your Home
35 Enter the smaller of your home's adjusted basis or its fair market value. See instructions
36 Value 01 land included on line 35 . . . . . . . . . .
37 Basis of building. Subtract line 36 from line 35 . . .
38 Businoss basis 01 building, Multiply line 37 by line 7 . . . . .
39 Depreciation percentage. See instructions ........ '. .
40 Depreciation allowable. Multiplv line 38 bv line 39. Enter hero and on line 28 above. See instructions
Part IV Carryover of Unallowed Expenses to 1998
41 Operating expanses. Subtract line 25 from line 24. If less than Zero. enter ..(). ............
4 Excess casual losses ll/ld de reciation. Subtract line 31 from line 30. If less than zero. ento, ..().
For Paperwork Reduction Act Notice, see page 3 of separate instructions.
2
3
4
5
6
7
hr.
8.760 hr.
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
t~ilil~~;
23 9'..4[1
2
2
22
23
:I~*t
158 \,),$
'liJ1~
~A
'A63361.000 AnV1 ~ I
V':l"1"
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ou, _" If"'''''
11tH}
. ...
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:~~,W~~; -
:m~m
'11
7
24
26
26
30
31
32
33
&tt~;
... 34
35
36
37
38
39
40
41
4
C\1B U. 1545-1266
~~7
AUachm.n1 66
S& u.nc. No.
Your loc...1 .."'my number
36-80-5535
1
2
3
168.
3 600.
4.67%
4.67%
28 324.
352.
27 972.
139.
139.
27 833.
158.
158.
649.
649.
146 000,
21 900.
124 100,
5 795.
0.0273%
158.
Form 8829 11997}
Form 4562'
Depreciation and Amortization
(Including Information on Listod Property)
OMR ND 154&.017
O'p.lr1m.nl of ,h. Tr.asury
InT.,n,1 R'V,,"I>> SIlVie. 99
NlrM{s) shown on r.Mn
~~7
~ S.. SII tlrllte instructions.
~ Attl!lch this form to ur r.tum.
AtlachnMnl
S. olnc. No. 67
hMnttfying numb.,
JO ANTA S T OY
Busn... or ICINilV 10 which IhlS lorm ,.lo1l.s
RESIDENTIAL RENTAL - SCHEDULE E
Part I Election To Expen.e Certain Tangible Property lSection 179) (Note: lfyoul1oveony'listedpropony.'
complete Port V before you comp/ete Port I.)
36-80-5635
1 Maximum dollar limitation. If an nntorprise zone businc'5. :100 pllga 2 of tho instructions
2 TOlal cost ol.ection 179 proporty placed in sorvico. Soo page 2 of the instruclions
3 Throshold cost of section 179 proporty bofore roduction in /imitation ..........
4 Aeduction in Jimilalion. Subtr.i1ct lino 3 from Iino 2.lf zoro or loss. ~tor.(). . . . . . . . .
5 Dollar limitation for lax year. Sublraclline 4 from line 1.1f lero or less. onler -0.. If married
filin so ralol. see a 0 2 of Iho instructions . . . . . . . . . . . . . . . . . . . . .
I-I Oeseriplion of '0 Dnv
Ibl Cost lbusiness use onr
1 9 000.
2
3 100 000.
4
5
ie, ffeeted cos1
6
7 Ustcd property. Enter amount from lino 27 . . . . . . . . . . . . . . . . . . . . . " 7
8 Total elected cosl of seclion 179 property. Add amounts in column (C), lines 0 and 7 . . . . 8
9 Tentative deduction. Enter the smaller of line 5 or line 8 ................... 9
10 Carryovor of disalJowod deduction from 1996. See page 3 of the instructions ......... 10
11 Business income limitation. Enter tho smaller of business income (not less than zoro) or line 5 (soe instnJctions) 11
12 Section 179 eXp8ruo deduction. Add lines 9 and 10. but do not onter more than line 11 . . . . . . . . . . . 12
13 Car over of disallowed deduction to 1998. Add linos 9 and 10.resslino 12.. .. . ~ 13
Note: Do not use Part II or Part III below lor listed proparry (automobiles. certain othBl' vehiclos. cellular to/ephones.
certain comourefS. or prcoorrv used for entertainment. recroation. or amusementJ. Insread. use Part V for listed prooenv.
Part II MACRS Depreciation For Assets Placed in Service ONLY During Your 1997 Tax Year (Do Not Include
Usted Property.)
Section A . Genortlll Asset Account Election
14 If you ara making the election under section 168[1J(4)10 group any assets placed in service during the tax year into one or more
general asset aCcounts. check this box. See page 3 of the instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....~
see DET A I L Section B - General De reciation S stom (GDSllSoe .!I 03 of the instructions.1
lb) Month :Jnd lei B:Jsis for doproeilllion Ild' R
I d. lb' r. eeovory
fa} CJ3ssiftclllion of property yo...r p :lce In usrness,rnvestmenl use . d (Ill Convention If) Melhod (gJ Depreeiation deduction
. serviee only. see instructionsl perlo
15. 3-year propertY
b ear pro e I
c 7 ear ro e 200.1 7.00 HY 200D8 29.
d 10 ear ro e I
. 15 ear ro e
f 20 ear ro e
25 eaf ro e 25 s. SIL
h Residential rental 03/15/9 34 900. 27.5 IS, MM SIL 1 005.
ro 27.5 IS. MM SIL
Nonresidential teal 39 s, MM SIL
ro MM SIL
1 Go, Class life
b 12 ear 12 s.
c 4 eat 40 s. MM
Part III Other Depreciation (Do Not Include Usted Property.) (See page 6 oft"e instruction..
17 GDS and ADS deductions for assots placed in service in tax yeats beginning before 1997 ...
18 Property subject to section 168(f)(1) election. . . . . . . . . .
19 ACRS and other de reciation ........... . . . . . .
Part IV Summa (See e 7 of the instructions.)
20 Usted property. Enter amount from line 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21 Total. Add deductions on line 12.linos 15 and 16 in column (g). and lines 17 through 20.Entorhere
and on the appropriate lines of your return. Partnerships and S corporations. see instructions
22 For assets shown ~bove and placed in sorvice during the current year. onter
the portion of the basis attributable to section 263A costs. . . . .. . . . . . . . 22
:A
(2300 3,000 For ?aporwork Reduction Act Notico, see the sep.!lrato instructions.
MW161 1('071 \l7no OUI-?d7::l?
Section C. Altem.!ltive De reciation S stem (ADS) (See
e 6 of the instnlctions.
17
18
19
20
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8582
Passive Activity Loss Limitations
Form
III
Ollpanm.nl of the T,usury
Inte,na' R.vllnOll S.rvic. 1991
Nam.(sJ shawn on rlMn
.... Seo ~op8ra1B im::tructions.
~ Attoch to Farm 1040 or Farm 1041.
fl1
,
"
I
JOlANTA S TROY
Part I 1997 Passive Activity loss
Coution: Sos tho instructions for Work:;hoors 1 soo 2 on pago 700(0," camploting Pan I.
Rontol Roo' Eototo Activit;.. With Activo Porticipotion (Far 1110 dofinition at octivo p.rticipotion
soo Activo Participation in 0 Ront.' Rool Estoto Activrty an pogo 3 of 1110 instructions.)
fl1
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1. Activitios wi1l1 not incomo (ontor 1110 omoUnt from WorkshAot 1.
column (0)) . . . . . , . . . . . . . . . . . . . . . . . . . . .
b Activitios wi1l1 not loss lomor tho omount from Workshoot 1.
column (b)) . . . . . , . . . . . . . . . . . . . . . . . . . . .
c Prior yaar unallowed loss9s (onter tho amount from Worksheet 1.
column (c)) . . . . . , . . . . . . . . . .
d Combinolinos 10, lb, .nd 1c . . . . . .
All Othor Passivo Activitios
........ .
"'" .
10
-)'I
11
lb
lc
ID
n
2a Activities with net income {enter tho amount from Worksheet 2.
column (0)) . . . . . . , . . . . . . . . . . . . . . . . . . . .
b Activitios with not lass (ontor 1110 omount from Works hoot 2.
column (b)) . '. . . . . , . . . . . . . . . . . . . . . . . . . .
c Prior year unallowed lassos {antor the llmount from WorksheDt
2. column (c)). . . . . . . . .
d Combino linos 20, 2b. .nd 2c . . . . . . . . , . . . . . . . . .
2c
..... .
2a
...... .
2b
n
..... .
II
3 Combino linos 1 d ond 2d, fr tho rosult is not incomo or zoro. oil lassos .ro .IIowod. inClUding ony
prior year unallowed losses entered on line lc or 2c. Do not complete Form 8582. Take the losses
tathe form or scheudle you normally report them on.
If this line and line 1 d are losses. a ta line 4. Otherwise. enter -0- an line 9 and 00 to line 10 . . . 3
Part II Special Allowance for Rental Real Estate With Active Participation
Note: Enter all numbers in Parr II as positive amounts. See page 7 of the instructions for examples.
J
1
4 Emar 1110 smallor of tho loss on lino 1 d or 1110 loss on lino 3
..0..00. 0.0..0.0...
]
5 Entor $150.000. It m.rriod filing sopor.toly. soo p.ga 7 of 1110
instructions . . 0 . . . . . . 0 . . . 0 0 0 0 0 0 . . 0 0 . . 0 0 . 5
6 Enter modified adjusted gross income. but not less than zero (see
p.go 7 of 1110 instructions,. . . . . . . . . . . . . . . . . . . . . 6
Nato: If lina 6 is equal to or groater than line 5. skip lines 7 and
8. enter -0. on line 9. and then go to line to. OthelWise. go to
line 7.
7 Subtract lino 6 from lino 5 .......................... 7
8 Multiply lino 7 by 50% (.51, Do not antor mor01l1.n 525.000. It m.rriod filing sopar.toly, soo
p.go 9 of 1110 instructions
i/
I
...0.. .
9 Entor tho smallor of lino 4 or lino 8
Part '" Total losses Allowed
..0.. 00
10 Addthoincomo,if.ny,onlinos 1..nd2..ndontor1l10tol.,.........'..........
..00.
11 Totallossas allowodfrom oil possivo activitios for 1997. Add linos 9 ond 10, Soo p.gos 9 of
the instructions to find out how to report the losses on your t:lx return 0 . 0 . . . . . . . . 0_. . 11
For Paperwork Reduction Act Notice, see separate instructions.
lA
1(5500 ~OClO ,_......
329.)
OMB No. 1545-1008
~~7
Al1achmenl
88
Idtlntffylnll number
136-80-5535
2d
-329.
4.
8
9
10
E/OLANTA S TROY
136-80-5535
ill SUPPLEMENT TO FORM 1040
niSELF-EMPLOYED HEALTH_'NSURANCE ADJUSTMENT
~SCHEDULE C ACTIVITY
-. JOLANTA TROY
I]
1. HEALTH INSURANCE PREMIUMS PAID IN CURRENT YEAR
2. PERCENT ALLOWABLE AS AN ADJUSTMENT
o 3. LINE 1 MULTIPLIED BY LINE 2
EARNED INCOME FROM THIS ACTIVITY
TOTAL EARNED INCOME
PERCENT OF EARNED INCOME ALLOCATED TO THIS ACTIVITY
TOTAL SELF-EMPLOYMENT TAX, KEOGH & SEP DEDUCTION
SE TAX, KEOGH AND SEP ALLOCABLE TO THIS ACTIVITY
EARNED INCOME LIMITATION (LINE 4 LESS LINE 8)
4.
m 5.
6.
7.
m 8.
9.
._ 10.
ill
~
~:
m
';;.1
]
U
U
.~
ij
m
D
-------------------
~
3,312.
40%
1.325.
27,675.
27,675.
100.0000
1.955.
1,955.
25,720.
SELF-EMPLOYED HEALTH INSURANCE ADJUSTMENT FOR CURRENT YEAR
1,325.
TOTAL TO 1040, LINE 27
------------
1.325.
J:
}
1;
J!
lllVOLANTA S TROY
136-80-5535
'':f.'
J SUPPLEMENT TO SCHEDULE A
---=:=--== '=----
-- -= - - -=--
fir
t1J
~..
~ REAL ESTATE TAXES
-----------------
u
PERSONAL PORTION OF REAL ESTATE TAXES FROM OFFICE-IN-HOME,
VACATION HOME, OR OTHER PERSONAL/BUSINESS PROPERTY.
1,602.
~
J
TOTAL TO SCHEDULE A, LINE 6
------------
1,602.
OTHER TAXES
-~-
H
-----------
PER CAPITA
TOTAL TO SCHEDULE A, LINE 8
------------
300.
Ri
300.
]'i
"
"
HOME MORTGAGE INTEREST REPORTED ON FORM 1098
--------------------------------------------
PERSONAL PORTION OF MORTGAGE INTEREST FROM OFFICE-IN-HOME,
VACATION HOME, OR OTHER PERSONAL/BUSINESS PROPERTY.
JI
5,583.
TOTAL TO SCHEDULE A, LINE 10
------------
5,583.
CASH CONTRIBUTIONS
=-- - -=
------------------
OTHER CASH CONTRIBUTIONS
------------------------
50% ORGANIZATION(S)
MISCEllANEOUS
TOTAL CASH CONTRIBUTIONS BEFORE LIMITATION
CASH CONTRIBUTION LIMITATION
TOTAL TO SCHEDULE A, LINE 15
100.
------------
100.
-------
..
I1I
roJ
1/
In
U
IJ
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,~
~
.
~
r
136-80-5535
SUPPLEMENT TO SCHEDULE E
OTHER EXPENSES. SCHEDULE E - PAGE 1, LINE 18
-
- -
KIND OF PROPERTY: RESIDENTIAL RENTAL
LOCATION OF PROPERTY: 156 ADAMS STREET. STEELTON. PA
YARD MAINTENANCE
MISCELLANEOUS
TOTAL OTHER EXPENSES
500.
86.
------------
586.
INCOME OR DEDUCTIBLE LOSS, SCHEDULE E - PAGE 1
KIND OF PROPERTY: RESIDENTIAL RENTAL
LOCATION OF PROPERTY: 156 ADAMS STREET. STEELTON, PA
GROSS INCOME
TOTAL DEDUCTIONS
INCOME/LOSS BEFORE AT-RISK ADJUSTMENT
PLUS: AT-RISK ADJUSTMENT
INCOME/LOSS AFTER AT-RISK ADJUSTMENT TO SCH. E, LINE 22
LESS: PRIOR YEAR UNALLOWED LOSS
INCOME/LOSS AFTER PRIOR YEAR UNALLOWED LOSS
PLUS: DISALLOWED LOSS FROM FORM 8582
DEDUCTIBLE RENTAL LOSS TO SCHEDULE E, LINE 23
6,023.
6.352.
------------
-329,
------------
-329.
------------
-329.
329.
------------
NONE-
-~-
I""". ., 1''''_"