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HomeMy WebLinkAbout98-04821 0\')' " " ,.;- ~ " ~ I',' b ~ .... ~' II" " I;, "Ii , 0;" I' il'" ", ii " '! ,,' " ,. ,,' " " " " (i " " " "" i. " ';; "Ii " '\ " 'L Hi " ,. P" it" "',d, " " , " I,J' " ,. dll ," " " " ~ ~. 'J ", Ii 'Ii " I' 'Ii 01 " " ~ \ I " if ;\ , '1'1' ,. ,. -"., " I'" ,I. " " " " - <"'6, ~. " " " " " " Ii " " " 'I, ,I, .' ,. " .' Ii '" f'fNl'"> '') I" ') ",;> , r- (l " " , " i" , " , " " ; " , " I' , , " " 1! " Ii ,,;, :' I, , . " " , rr"l c?$'?". tf('1\(J~ 'r; ~;;;d )1~(l(~';J,r;' 1-;),,:1 ,/1 .:(" 1 1/ /"k...:I..:" O:'{;~!l:' IW(t'i,1;,;1 <(<I (i" ,". 't . I " ,. " " 'I. " " Ii' " ,. L; " " ., ,',I H " " I' ,. " "" "j' I. 1 L, " , " d' /I , .. " ,. " " I' " " " i\ 'I' ;-1 " " " '" lIt " .. , ,,, ,. " ,. " 'i'; " I' " , " ,. " " " \1 ~. r<' '':JJ ~ ~ ~ "J ',- ~ ,~ '0 ~'1" (... t'o po: Il~ " 0 il. l! :"i)..r ,I, t'.! ( 1.:, '-1. G I' (. "j ~'.' ~ '" I j', ., " .,.-j 'I,':! 1l I" " ~ '. 1.1, rq " / {~ ~ ,Ill I' " , Q . , lIP, ! '~ :;tj'i:1 t;: iJ. (li(l, . .; ;,,' ; I.... (,) I " CJ 1 ) 0', I,., .1 1<",1 " II " " I' ,I' " , , " i; " " " , " " " , , ., ,. " " ';I 01 " , ., I, d' It" 'i, " " ,. " " " I. .,' " " " " 1\1,1\1'1 p, RXCHTlil\\ / !?J.llin\:iff XW 'l'lllil COUIV~' OF COMMON PT.11D1\13 CUMPIDRj'.JI\WD COUN'l'':{ / l?lilWNI3':{LNFlW11\ " y, No, 90-~0;n civH Tel:m Ml\R':{ J, lUoI1TlilR I pe~enc\'l\lt C1V1~ I\CT10W - ~l\W I 11'1 P1VORClil' bEElPAV1T OF alilRV1Cfi COMMONWIDI\J.m1 OF PlilWHI3':{LVlINI1\ i I 13131 qO\JN'l,'':{ OF D1\Ul?llIW I I, JiJ,l J", Hoover, l,egaJ, l3eotetury in the Y.1UW Offioe of. . lilc\Warl:l a, FinlteJ,[Jtein, lil[Jquire, who being duly [Jworn atloorc\ing to ljl.W/ depo[Je and slIY tha\: on Auguat ;l4, 19PO I [Jent a oertif;\.ec\ oopy of. the Rul. '0 I3how CaliSe in the above-tef.ere~oed ma\:ter to " L the pefel1clant / Mary J, Riohter a\: 69 Litt:J,e RIm llo<\d / camp U!],l, , " Pel1n[Jylvania 17011/ by oertified mail, ]:e\:Utl1 receip~ req~e[Jt~d, Certified Mail No, P-196 904 146, l3aid tetUtn reoeipt oard waa r~turned aigned by Defend<\nt on l\U9uat ;l13, 1990 a~ evidenoed \:ly lillthibil: "A" attaohedhereto and made a part hereof, .. " aworn to and subacribed bel:ol;e 1I1e this 26th day of-AU9ili, " 1990, N~l'WI'~~O,~O\nlY 1'111>110 Kn\\I\'~\11~~Il\l' (?nlllll11l\.f~lIW P'OO\ MY Qol11ml81llOl\ "'\111111 C' , J1iidl.~ ~1<<~ rd..~~1- Kathleen amee Hiraoh NotarY l?Ublio My c.ommisaion eltphea I i, p-' I, ':'1 I , " " , " \l : \. I" , \ 'I " 1,1; {I' I j, ," , I' 1\ ! ,I I ;, .. I " I I' I' I' " I. ,. " " - -...-...... ----..-.., -1"'......._...-"':'- ~ ~ ~ ~ . i ,I ill ta ~ UI m IJ., ui I g .~ . ':, " ~ ~ 'I, m _I ., -. .1 .. .. " " II ,. " I' ". ,. " " .,. " " ,I ,.. I, , '/1 I' " , , IN Tlln .~ouln 01'- C()~lMnN IH,HAH OF CUtv1nHI~I<ANP CQUNTY, PI~NN~YIN ANIA AI;AN p, HICIITI\H, . 1'111111111'1' v, ) ) ) , ) NO, lJR. 4U;! I CIVIL TI\IHvl ) ) CIVil, ACTION. I,A W ) IN PIVOHc!l ",1 , " " ., , ~VAIVlm OF N!ITICI~ OIllN'mN'I'ION '1'0 ImOlJl~S'I' I~N'I"W o It' ^ IlIVOHCI') ImcmClC IJNnl~l~ !lilillil(.llLOIt' Tim IlIVOIWI') COIlE I, I 901111911110 Ih9 ol)ll'Y M 11 1111111 docl'oo Oflllvol'oo wllhollll1ollco, 2, 11I11110rllllll1l1lhlllll1111Y loso l'lllhts oOl1ool'l1hm IIlhllol1Y, dlvlslol1l]fl1ropcrly, IIIWyol"1I roos or OXl1011110S 11'1110110101111111 Ihol11 horol'o II 1111'01'00 Is gl'lIl1lcd, ~, , \lndcrllllll1d Ihllll 11'1111101 IIc dlvol'cod 111111111 lllvorco dccl'cc Is onloro(1 by Ihc CO\lI'IIII111 Ihlll II cllPY orthc (iccrco will ho sont I~ 1110 Itlll11odlllloly IIftOI' It 1III110d with Iho . prolhonollll'Y, I vorlly Ihlll tho stl\\l1l11Ql1ll1llllldo 111 Ihls IIf'f1dllvll 111'0 11'110 1ll1d OOITOO\, I IIndorsllll111 Ihlll rlllSOillllllOIllOl1ls horoll1l1l'o Illlldo IIlIbJoollo Ih.o p.ol1l1l1los or 181'\I,C,8, *4904 1'01lltll1g 10 IInsworn f11111111111\t1nnlo mllhol'lIlos, " DII1.o:_9):~;?? /?Y' ...-,--::~.::::.:::::..')~'-''''-'.'-_._---''--,,,,,,,,,,~ " ~. ~'" "'J -) ." -" " y.- / " ... /" /-" / /,~?;" //:. /:...( 7.""~<;'" ...-- . /' C_...e.~ '- ........ ~._ ~'..r.(....,.t.r,C~ c__.- AI\lnlJ, RloI1tol'. Pllllntlr( /X lIP fJenl: '\:0 11\13 1-11111\mlinl:c,dy nt:l:r~r n: ilJ f:ilml wHI1 1:\113 proCl1onO\:f.\l:Y, " ?, x hijvp been nclv1-Qucl ot: tho nvn.ilEl)JJ1j,\:y at: mfm:if\ge OO\.I1\I3BHng tlncl l-\\1clenltElncl l:l1qt I I\1fclY !:eCj\H'll3t 1:11111: C)1e Coqr~ reCjuire OO\H1[lBling, . I clo 1101: rli'CJ\\e~lt t\1<1\: the COIIJ:\: l:ec~qiro oounaelinrJ, I verify Chat tho otatomentD made in thil3 ^t:t:ida~1-C are trqe f.\ncl aorreot, X und8J:ptancl that falsD I3tEltemol1ts horein EIre mElclo subjeat to. the penaItiop of 18 PEl, a,S, Seation 4904 relEltinQ to , IInl3WOrn f<1Il3ifioEltion ta Elutharitiog, 'I': " 'J \ \ Mil 1.:\_ ii:r-J2u,A(i' '( " Mi'lvy IT, Ri'Shtljll1, Defenclant' sslf \ '\ '\:';,,:J. (\ n L\ I Df\tedl In:, ,(. ''1tl. 2861 " " " " ,. " " " ,/I , ,. .' " '; " " " " " I I,' I'; '; 'I H II il! '" " l~: (1') ,~ 1:1', I'. V; 1'1., jt: II':! .,:' ...r , 1" (' . \ .[ ~ :\:: C) ;~t~ (I: ~, '-'''II n.. ,,': ~i;' (:1< 11.;:' I' \~) ".,(/) 1.( ',1:.;-:'. I'd'," \ " " ( i": ';'~' 1;,1' c": i,l.lu:l " l"' 1:1. l;l,!(:\.; ":1. \1':5 II, C'T' l..l i6', ,r:; ,il \\ ". " " 'i " , " .1' ii, 'j; i' " I' " " " 'I I' " I' '\ Ii " ji II If .. " " " " I, ,. r, ",I' " ., " " l' ,." " I' " I' " ;. 'L Ii " " ;.-, I" ,. " I, " ,. " ,. H 1\ " " " ,. I" ;! " 11' '~... " l\lNl p, I',IcIITE:r\, , ' IN '1'1l1'J GOlJl'~' eiF' CO~l~lON P 1,ILI\8 OU' P.\"IIlQU , CUMI,E:I\j,MjIJ COUN'I'Y, I'ILNNflY1N^NT ^ I vat I NO, 90 - 11021 CIVIl, I Ml\IW J, IUCII'I'lm, , pefencli1nt I IN IlII/O!,(;m '1'1) , nill~c((i~'~(,!trr ",e~-f.l, 1l'ilik",lll..eill , ^tton\QY 1:01: pluintJ.ff Carl u, W~ss Attorney for pefenclnnt , Pl\'l'RoI U'dclilY, October 22, 1999 cmWrI IfIC^'rION I certify ~hnt discovery is complete as to the claims for which the Milster hus been appoInted, ': OH IF DIscovmllY IS NO'l'COMPIAL.'l'ml (al outline whi1t info~mution is required thut is not pomplete In order to prepare the case for. trial al)'d 1ndlcatewhether there are any outstanding interr.ogatories or discovery mot10ns, " " J, ~ : , " " " ,. , .; "" ,. , .. .,., 1,"'Wlllllll\UI \InWlq'T,I~llilill'lm:n \'Il(!(lNl.l':Y, l',(~, pll W^I,NIII' Hlluq!l 1'11111'1111'11'1\1111)( HIli 11"'111111,,,, !'I "!III I v,,'" 1'I11IH .1\lIIN\'.IIII\\'I!I'LJIl. pIIN.lilll'. ~\HHINlllill l'INI1Y H.\'11NI,II\' P,\ll II IiN J, IIlI\.HI' 1l1i1l11"M'"IIIMI' I.~ \III "111.\11111 " (111l~H,2r"(1 I'''X(11?llH.5'1I11 .. )11110 ~(l, ~()()O . " " TI'IIIlI ,In Colyol'l ornoo MlIl1l1gol' .. Ornqo nr\lw PII'IlIW MIIH\U\, I) Nnnh 111I11n1'UI' S\l'oo\ CII\'IIHlo, P/,170Il f'.; I{ol 11I('/111'/' I', 11/1'11/('/' ,Nn.JJ~. 4821 H , I,'i POII\'TI'IIUI: .. HlwloHolI plollwli\1ll \wolloplos llf'lhc plll'liuH' l\illY.\lXUU\llol1 tvllIl'lIl1\ Solllol1lOl1\ Agrcoll10111, We wOllld Ilkolll hlll'u MI', nllolwl"H lI\1pOII1\1110111 I'OVOI,\llllllll\1I 10 ponnll OI1\l'y 01'11 11\11111111'111'0011001'00, Thlllll, yO\\ Ibl' YO\lI' 1I11~IIIIIII1CO wllh \hlH 111111101', SI\uol'u\y,. "~f '. ( [L:~)):c) PO\~l'Ii M, shimp \, ) I i, " '1. .' 1l110\OHIII'OH 001 CIII'I a,WIIHB, ll~q\\II'U AIIIIl D, Rlohlul' iF, ,. II " " " .... " ii' " 111 '1'\11\ OllIJl\'1' IW OOHNoN l'I"~AS \JlI i:PHIl\mLANll OOIll1'I'Y, 1'I\NNHYI.vAl'llA AI.AN ll, l(:\oll'I'I':H .I l'ln:l.\1I~i.l'f va, NAHY' ,I, HTOII'I'lm (Hj - Mm 1.9.,_ I ". , NO, !'. HO'I'Tlll'l FOR Al'l'OU1'I'fllili.T...OF HAS'I'lm , (1'1nl\1~1rl'\ ~"ti8&<<".~t), fol1p\~1nll u!c\i.lna I 1I1Pval\ (ilia UIlI\1:C Co nppoinc Alnn p, l\1r:h\ol' f1, 1I1l\Buar wJ.Cl1'~BBpel1t~ UP chp (X) 1l:l.,Vbl:UU . ( ..) Alll1\11man~ (X) ,\li1l10ny (X) Al:lmony l'a\1lla\1Uo I' (X ) ( ) (Xl (X ) lllBCri~"~Jon of l'roparcy }lUPPIH'C .' OOlIl1Bol I,'oafl CoeCfl nnd R~l'j\1BOe I,He AmI 1n fln\1\lOrc of cha mocion BUl\caal" (1) lliaopvery ia 110tnp1.e~0 liB AppO:l.\1c11\anc of l\ mAflCer i~. reqUOB\iUl\, It ' (2) 'l'h(l l\afendnnC (h/lB) (hy tyi/$ nctomey,_ Cnd Cl, WnHIl (3) 'fha aCllcnrory ~o \~ha u1/11mB (a) for l~hi.l1h ~ho " (\Vlf~X~lm /lppel\rerl '1n Clle Ac,c:lOl1 (\~<4~!y~I~~U$') .. , I RS'1uiro), . [lrounrl (a )l'ot'rl:l.vorc,a (Ui )' (Aro) ~3301( c) folloldngo1n1111B I 0;t.n:l1l1BI (I,) P\j1ece\ihe innppliuollle pOl:ollrl1ph (8) , .. (0) The 1I0cipn :La noc oontlestod, (b) An agreemunc hllB boun rU/lohad \~itll l'ellpea c ~o tho dlvol'Cll, c'lllHllhlll l\'Isll'.II'llIJnn, nl:lllpny, ^1~" co\lnrol ('0('..'1, crl.'l\:s nnd OXllOllSf'..'! (0) 'l'he aoc:lun iB uoncesCuc\ wich rUBpeoC co ,che fol.lOW:l.111l II; The naCion (1nvolvuB) (rlooll not: Jnvolve) 'ooml1loll iaBUBB of law or fnoc, ". Data' 1 0/'1 /91.) RBquii'a, ., ~..--,"- i' , ,. " J I'll! ", " /J!' ., I/,~ lY ~)~.lnr'r II ,,' '),'(;1', on_, \.. ('11'" ,1' ", "}"!'I'" .i 101,,1, ii,,' 1,I'i' (I I I: I:NI'!'.;YI.V/N"\ " " " I, I' I' " " " 1! " " ,. ,. " " I' " I' " ~q , , " (,I", 1;"'" 11: ",;'.' " '''"),:1 \ (l,'J I 1.11- .,ll.:) , , ~,~: f~) i""C \l...., "1' l'r'i': C(I " O~n , I 'I';" '.1 , ':iii', I " r , !to.. L:...I" '" + 1,\ 1'1', ""'1 ,) !J), \..J .' " " ,." ,I I. I, ,. r'_, ,I' ,," " " I, " "'" ,I' " " " " "," I. " " " " " t, " I" .11 " ii " ,. " j; ,. " ,. " ,! ;' II " " " -I' 'I. " .' ,.., " ..~" tn I': 'i-\' C.' li'l .. 111.' . ~ 1'1 ; !"oc 'I: '1'., ' L", / ~ ( , C~\ , Fi [ ('-.1 1,1. \.I, e i"jj " I IU. , c: " [ , ( " () " ,. !i\. , " " . " " " " Ii " ,. " .. 'I; J; ,. , .. , " ,. [, Ji " ,. " " I, " ;' " j. " \, "1< " " " " i; 'i; '! ,. , n' " , . i , ~ I " " ;,'f I: " " " ,. " 1'1 ,I; " 'r' " ~: VI' I~" ,,,,\') '- )'1..: \'.f;',..' \"11 t\t -:., ,j' fr:\'" ll:J!I.I I'T [.: 'II t,) ". ~p ..:1 (,0 ," tl';U (,Cl N" ?l.' ".1 ") c~, c::....J , , >,;: \;r\ ,.,d I.. \p (,. tl' ..,~~ Li'\~ " .t/~ l'~ I~-;J. .1.I~rh. . , I~"n. ~' b Hi" " \I, ,'. ,. " ,. " " " !' "'ii' (! " " " "" .,. " " 'II " " " " "'I " " Ii, " " .1' I; " " " .. " I, ,\:,., ..... '1.,1.) ,..,' I ' ,. " .." .., I. I , .:: " .. ..._,f 'i! " I' ; ,I ., ;\1' '\' ',I I, ,. .. " , H ., " Ii i' " ,. " " ',; " , ,. I' ;\, " "," " ,. ,. II, " " i. I , . " neoellslolry lp omry Dljl tIle provisions of t/lltl Aorool11enl, Nollhorpmly 11llfllll11olosl tile plhsr or fI\tel11pt to enqet'tVor 10 molest 1110 Qther,nor oOlllpal the plher to pollE1Plt with the ,. r' '. other, or In flny WtlY 11E1rt1SS or mallqn tho ot/ler, nnr In any WP.Y IntPrfere wllh the peflPaful ' exlslenoe, sapamle anq I:1pml frpm Ihe olher, a, W1EW DEBTS, Wife represenlll QI1el Wl'lrrl:1l1ta to HUllln1l1d t/mt Slnofllhe separE1\1on she has nol and In the fulme she will not oonlmol or Ino\.lrany debl or IIl1plllly ;, I' for which H\.lsPt1l1d or hlfl esttlle' mlghl pe rasppnslble flnel Sllt111 Indflmnlfy tll1d llE1Vfl harmless H~lspand from "my and ElII clEllme or demanela m\1de agalnslhllll Py reallOn of de pIa E1nd ollllga\lonll Inourred by t/le Wlf13 prior to t/w dE1le of Ihe clellvery of this . " Agreemenl, Elncl ~II furtller debts Inoun'edllY Ihe Wife from E1nd afler the elale of elellvery hereof ShE1l1, be \I1e yVlfe'a Individual rellponslblllty,' " 4. J:jLJSBAND'S DEBTS, H\.lsband rElprasents and warrants to Wife Ihal since .. the separatIon he has nol and In lIw future he will not conlraot 01' Inour any debl or liability , for whloh Wife or her estale mlghl be responlllble and shall Indemnify E1nd save harmless Wife from any and all olalms or demands made agFJlnst her by reason of debts or obllgallohs InOl,lffed him, Husband aol~nowledges anel aoreos Ihat all debls find obllg",\Ions .. lIicurred by the Husband prior to the dale of the delivery OfUlls Agreement, and all further i debts Incurred by the HU!l.panel from and after Ihe dale of delivery hereof shall be ,the HUsband's Individual responsibility, I. " , A, Those Items of Indebteelness which were Incurred for the purpose of providing an eduoallon for the daughler of Husband are aolmoWledged to be the " 2 , I I' I I ,. " !!ole Wlrj exchjlllVa lIalJllI\lOs of HtllllJ<1I1c1, E1ncl Hllsllflnd E1oraoa Ihtlt he slmlllJe solely responsllJle for \1113 pflymenl of t/l0!!e oiJllOflllons. . 5, JQjNT DEBTS, The par\les aclcnowledoe thAI, E1llhe \Ime oflhalrsepara\lon~ Ihey hE1cl only two (~) Items of Jolnl IndeIJteclness, to wit: (1) a martgtlge obligation upon 11113 , mflrlltll hpme of tile pnrt/13s, 11eld I)y l3ank of Amerloa, upon Ihe marital homll of the parties lapE1ted al Gfl I..ltlle RIH1I~oacl, Hampden Township, Oljmlll'Hlancl Oounty, pennsylvania, and (;;!)a mortgaoeolJllgatlon, held by First Oltlzena Banl~ of Norlh Oarollna, upon 1I1e jQlntly ownecl reE11 estate of Ihe parlles I~nown as "Free Spirit", and IDoated E11 i:rnerf.lld Isle, North Oarollna, BDth of Ihese Items Df mortgage Indebtedness will be sepE1rately troaled In a sLlbsequent paragraph enllllecl "REAl.. PROPERTY," G, . MUTUAl.. RELEASE;., SUbject 10 Ihe provisions oflhls Agreement, eao.h party has releasecl E1ncl dlsohflrged, nnd by this Agre'~ment does for himself or herself, ancl his or her heirs, legal representallves, executors, aclmlnlstrE1lors, and Elsslgns, release E1nd 'iJ, c1lsohE1rge the other of and' from E111 causes of E1ollon, blE1lms, rights, or c1emands, whalsoever In law or equity, whloh either of the parties ever hacl or now has against Ihe other, except any or E111 oause or oauses of aotlon for dlvoroe and exoepl for any or all oauseS of acllon for breaoh of any provision of this Agreement. , 7, QISCI..OSUBE OF PROpgm, Husband and wife aol~nowleclge and agree that Ihey have made a full E1nd oDmplete c1lsolosure tD the other of alllnformnllon pertaining tD the parlles' separata Ell1d marital property own,ed, possessed and/or controlled by the 'Dther althe lima of the separallon of the parties, , , 3 " " 0, QeLl!llilll'pi= p!;BaQNl\I~l:BQj:.l;BIY., Thu PArtlUS nolll1oWlodgu and n(lree . Illa\' At IIle lime uf thaiI' sepnm\lul1, on ur tllJOllt April. 1, 1000, thay dlvl~led between 'thehlIlUlv(:lB all of the artloles of persunul propurty prevlol-Jsly owned or Lltlll?;ed by t1wm within their marltalhol11t:l tlt 611 ~lttle R~lfl Road nnd, axoept tiS harelnafler spaolfloally set for\Il,I3f.1oI1 agreaa IhQt tile tlrtloles of pflraonal property rel110vecl from 1I1ll mmltalhol11e by Wife E1nd presently In Wife's possasslon ahalllJe and remain the sola Qnel exoll-Jslve i , ,.. , propurty of Wife, ancl thallhe E1rtloles of personal property presentlY 10ot1ted In tile ll1E1rltal , home anclln the possession of Husband, Sllt111 pe.allcl rell1alnlhe sole and aeparale property of 11usbancl, A. The single excepllon to tllB foregoing division af personal property from the l11t1rltalllome Is a Renoir print of two girls In hElta, whish print, Husbancl " . I' Elgr~es 10 c1ellver to Wife within len (10) c1ElYs follOWing the dElle of the exeoullon of Ihls Agreement, o. '. OASH,.BANI<ING AOOOUNTS ANP INVESTMEN;rn., EElch of the parties Ilf.\S, subsaq~lent to their separallol1' tranaferrerj to, or oonllllLle 10 rnalntE1ln In his or her " solo name, Qartaln banl~lng C:1otlounts ancllrwestml.'lnls, Tile parlles agree that those banlclng accounts and Investmrmts presently In the nf1me of Wife (fol' her own acoouni. or for the aocount of ElI1Y of her grandchildren) shall be ~ncl rell1f1ln the sole ancl separElte property of Wlfej ancl, that nil banl\lng aooounts and Investment ~1Coounts presently In the name ~f Husband shall be and remain the sole and SOptlrate proparty,af H~sband, For purposes of olarlty, Ills agreed that the followlngshall be the sole and separate propeliy " " , of WIfe, to wll: !-Imrls Snvlnos f3t1l11~ ol1f:lolclng nnrj flElvln0f111cool-lnls, PennsylVAnlEl ~Iw) Shield Retirement Inveslmnnl Acoount, mulual f~lmls IT1Plnlplned In Iha sole name of Wife py Anohor Flnanollll GrOllp, and tl10se \I1ree sppnrala mLllufll funcl ousloc\lpl accounls malntEllned In the nflme of Wife, ps OLllltodlAn for 11f'lr \I11'l3e grtlndohlldren, py Anchor Flnanolal Group, Wife llhElII Elisa be deemed Iho sole owner of Ihe l)anl~lng aooount .. herelofore ~ltlll~ed by Ihe pElrtlaa with reOElrd to their GLimmer Inve!!tmenlhorne ("Free Splrll"). . All othel' bElnl~lng accOllllts and InVeslmenlaooo~inls, wlletllel' or nol previouslY owned Jointly py the parlles or IndividuallY by l-lusbEmd, shall be cleemed Ihe . sole and sepE1rale property of Husbtll1d, 10, RETlli[;MENT ACOOUNTS, I31'10h of the pnrtles maintains retirement aooounts. The 401(1~) ratlrement aocount ofHusPimd shall be and remain his aole and . separale property; Wife rallnqulslleS any fulllfe Interests thareln: and, If a separale document Is required to be signed by Wife IndlcaUng her release of E1nylrllersslln sflld retirement aooount of Husband, Wife aorees slle ~1I1 exac,uta suoh doo~lmenl. T11e' Pennsylvania Blue Shield Investment aocount and,the deflnecl benefll pension of Wife shall " hereElftor be and remflln her separale acoounts; Husband herebY releases and ," relinquishes any future Interesl therein, exoept as set forth hereinafter, The parties aoknowledge thaI Husband Ie and shall remain an 'Irrevocable survivor atlnultant with respeot 10 said defined benefit pension, If. some further c100ument Is required 10 be eXaouleic! by Husbanc1 for the pbrpose of evldenolng his releaSe. of any Inlerost In the !3 j. ;, l. I , " ra\ll'oment aqoP(lI1t8 01 Wlfo, flxnopl el8 BOt lorlll Iwroln, (lpOI1 mf!\lo8t, l'hll:1lmncl will eXeoute suoh dpmHlwnt, 11, . A!JIQMQlliJJ;.s., Wife Is tllo owner of a '1 OO~ Toyota Camry BE mllomolJlle, HUfll}anclls the oWllllr of fl '1004 OlleVl'olo\ 13lm~ar, SUV, gf.lch party flQmes lhatlhe owner nnd possessor ofaaoll of tho flforellalcll11o\or vel,lloles 81Ul111wreafler IJe and l'emE1lnllla llole ownar tl1ereof, 19, WI. PI'WPERTY, Tile pmtles E1l'a 11113 Joint ownms of wllAt WAil fprmerly their marllal home looated at 69 I..ltlla RIIIl R/iod, Hal11pdon Township, Cumberlancl County, Pennsylvanla,Snld real eslale Is subJeotto a mortgage IndolJtedness l1eldDY " , 13anlc ofAmerloQ, Tile PQrtles ara tl1~ Joint owners of real e!l\ate Imownas "Frea Spirit" and looatl3d In gmerflld Isle, North Cmollnf.1, Said real estate 18 sUIJ]eol 10 a mortgtlge t' ' enoumbranoe held by Flrsl, Citizens 'l3anlc of North Oarollnfl, A, Wife a\)rees that slle shall Join Wltll Husband In exeoutlng a deecl to Husband for the purpose of transferring sola ownership of 69 I..ltlle Run Road to Husband, subjept to tile tarms andoondlllons set fortl1ln Item 0 ofll1ls parf.lgrapl1, " 13" Husbf.lnd agrees 111 at he sllall' Join with Wife In exeoullng E1 deeQ to Wife for tl1.e purpose of transferring sole ownership of "Free Spirit" to Wife, subject to the lerms ond condlllons set forth In Ital11 C of tills parflgrapl1, , , 0, Each of the parties receiVing a deeclto'eltl1er of Ihe parcels of retll aslate set forth In lI(3ms A and B of this pmagrpP!l shell assume In his or her sole name tile ongoing responsibility forthepaymenl of the mortgage enoumbranoe , , 6 ljpnn Iho pmool qf ronl ostptfJ rf)()fJlvael; nml ahf111, 11Y 1I11ti AOrelllnfJnl, and 11Y rfjforenpe In \3Qph of tllO c1eeds of tmnsfel', <lgrao W Imlelnnlfy nnd holtlhl-1rmlesa Iho ImnsfElITlng pelrty from any hllllre IItll11llty or obligation with reptlrc~ 10 U1D mortgnOI'! !:1SSllmllt( hy \he p!:1rty rooelvlng sole title 10 ench paroel of rOal13slato, Notwllllsll-1neHng \110 foregoing, and wllllln slXly (GO) el!:1Ys followlnplho exeolltlOn of this Agreement, the pmty reoelvlng a cleod for sola ownership of one of the P!:1rOelll of real eslate shall mal\o a fnriTml request 10 tile hnl1k or mortgl-1ge lender holding tile mortgage 10 release the otl18rpnrty from any further liability upon Ihe respeotlve , " mortgl-1ges py assumption or olller equivalent prooaclllre, The Inl-1blllty of ellller parly 19 be able 10 seOllre E1 releat1e of the other pl-1rty from the mortgl-1ge ,Inclabtaclness shall not Invalidate the transferor ownerslllp of tile two. pl-1l'oels of real eslate prOVided In 1I11a paragraph, the respeotlve agroem~nts of IndemnlfloE1t1on by either of Ihe parties receiving a def/c1lo one of the pnroels of real estat~ sill I being In exlslenoe for the benefit of Ihe Inclemnlfled party, , " ,'\ II D, Tho parlles agree thatel-1oh shall exeollle the c1eedaprovlded herein simultaneously with the exeoutlon of this Agreem13nl. 13, SPOUSAL SUPP~ FEES~, B'oth parties hereby waive and rollnqulsh any right which eaoh of them may have 10 seel~ or 10 reoelve from Ihl:> other party Ihe paymenl of any slims of I\loney as spousnl support or of1.aooount , ' of the expenditure of oounselfees and expenses by elthal' of them, Husband aoknowleclges Ihathe has oaused to be Inslltuted lI1e presently.pencllng action 111 dlvoroe 7 " " , " Inlhe Ooqrl pf common Plans of Clllnl1erlnml OOllllly, PonnsylVAnla, at Np, 00-40?1 civil , Term, nl1d,norpflll Ihnt he, nlone, ShAIII)e responfllhle fqr all of his al\prlley's fpes ancj court oollls ASlloolnled with Qalcl dlvoroo aotlon, 14, l\blM.Q~.E.lililliiliIlllITE AND t\lJ.MQHY, Tlw parlles Elolmowledoalh<\1 IhaY 11I:lve flxeoutecll1n Inlarlm Agraement clnled Allpusl17, 1000, wherepy liufllJand , agreecllo pay 10 Wife tlleawm of Six HundroQ Fifty ($6(50,00) pollars per monlh <Is alimony p"'llclanle IIle, , SE1lellntal'lm Agreement has peen mt"lela a pE1rt oftl18 recorcl In thp pencllng , aollollln dlvoroe E1lld has rssulted In t"ln Oreler fpr the paymant of alimony penelenle ilIa pelno enlerecl by Ihe Court of Common pleas of Cumberlancl Oounty al No, 06-4621 Civil Term, The parties agree Ihnt the obligation pf HUllbancl to pny alimony pendente lite pursuanlto the .aforementlonecl Orcler shall be lermlnated, r~troElollvely, as of Maroh1, ' 2000, Huspancl c1oes, however, agree tl1at Il1e aforementioned Order of the Court of Gammon Pleasef Cumberland County fortl1s payment of alimony pendente lite sl1all be amended 10 provlcle for tile p"'yment of alimony to Wife, Ihrough Il1e Court pf common Pleas of Cumberland County, as follows: Husbancl agrees to pay to Wife alimony, oommenolng Maroh, 2000, In the sumof Foul' HunclreQ Elgl11Y ($400,00) Dollars per month, suol1 payment of alimony to colitlnue tllroughtl1e monlh of Ootober, 2004, eluting whloh month Wife sl1all attain the age of ,62, Alimony sl1all terminate upon tile death of either party, Wife's remarriage or Wife's oohabltatlon, " , o " " In flrlcll\lpn to the for(~(Jolng perlodlo pflynlOnt of flllmony, Hpal1And flgreOS thElI he sllflll pFly 10 Wife, flS I.1rldlllplltll r.ll1rllPI1Y, f,\ lump SIIIll PElyment of Two ThO~lsancJ ($g,oOO,OO) Dollma within ten (10) daya following the el1try of fl DaClree InDlvoroe upon , the Oomplalnlln Plvoroe heretofore InsllMecl by Husblll1tj, ., . ~' yY\f:.~' AnI' PAymenl of I.1l1mony panden;e lite Iwrelofore lTlade by Husp~ncl (1fter UA ;t(((tfh ' ~ 'I, gooo, whloh shtlll PI'! In exoess of IIle S~lm of alimony herein provlcled I'll1tlll pe ' oredlted to Il"ie aooo~lI1tof Huspancl,f.lnd suoh oreclll ahalllJe raoelvecl by Husband In \110 form of E1 deduotlon from any final pE1ymant. or paymenls, of permanent E1l1mony provlclecl herein during the flntllmonth, or final two monlha, herelp proVlcl13d for 11113 payment of permanenl tlllmony, 15, IMPL~MENTATION OF AGflli(;MENT, The pElrtles tlgrel'!1I1ElI, upol1lhe I exeoullol1of this Agreemenl, eElOll of Ihem will sign all dooumenls, oonlemplall'!d py the lerllls of this Agreemenl and neoessary to provide for the tmnsfer of any asset Inlended 10 be transferrecl to one or th.e other of Ihe pnrtles under the terms of Ihls Agreement ancl , shall OE1use suoh execuled doouments to be delivered to e",ch otll13r upon the enlry of E1 final, deoree In divorce, ' , 16, J3REACI-[, If either party breaches any provision of this Agreement, the 'other parlyahall have the right, alhls or her eleotlon, to sue for damages forauoh breaoh, and , , Iha P/.1r1Y bro/.1ohlng this oontraot shall be responsible for paymenl of legal fees and ooata Inourred by the other In enforolng hla or her rights under Ihls Agreement, or may seek suoh , other remedies or relief aa may be available to him or 11er. 9 " '. 23, eNTRY AS PART OF THE DEeR!;!;;, Huslmnd hna Inlllatedan 1:1o\lon In cllvoroe under Sac\lon 3301 (0) of the Pennsylvnnla Pom~s\lc Relallona Cocle, flied In OumlJerland CO~lI1ty to No, 9tJ.41l210Ivll Term, Ills Ihe Intention of the parties thallhe within Agraement shall surviVe the aforementioned Ellltloll for cllvoroe, and tllE1t no order, JUclgment pr c1eoree, temporE1ry, Inlerlooulory, final or pel'manenl shall affect or moulfy the flnanQlal terms of Ihls Agreement, Both partlell Iilgree to exeoule Affidavits of Consenl for the purpose of entry ofa Dlvoroe peoree under Section 3301(0) of IIla Pennsylvania Domestic RelE1t1ons Dade, This Agreement shall be maele part of any such ,1udgmBnl or decree of final dlvoroe, put shall not be merged therein, Husband agrees to provide to Wlf~, E1lhls expense, a oertlfl!3d copy' of the final Daoreo In Divorce, 24, VOLUNTARY EXECUTION, Husband has been reprosentecl by pan aid T,. 1<lsslnger, r::squlre, In connection with the negollatlon of this Mnrrlage Settlement Agreement, ancl Wife has be~n represenled by Carl G, Wass, Esquire, In Ihe neoollallon , of this Marriage setUemenl Agreemenl, Both parties cia acknowledge Ihl:1l their respeollve " , allorneys have expll:1lned 10 them the rig hIs and obllgallons which eaoh of Ihem has ancl may have under the Domestlo Relallons Code of Pennsylvania, partloularly with regard to the equltablecllatrlbutlon of marital property, the right of ollher party to reoelve alimony or 10 reoelve alimony pendente lIle or to reoelvethe payment of their respeotlve oounsel fees and court costs, Both parties do acknowledge ancl declaro that eaoh c10es understahd the 11 " v PRI~I;I\/N011~~~ TO WlTltltmp INrnMl' I'nR ~1l1'llo'n Sl~lp,CUI\IIllIlI1\VPAllh.\ll-l!\UIl'tiv.lvilllln. \)1('1', !Ill 1it12\ Olvll c",/Clly/pisl, n( cIlM1mlU'I\lill.-___ \'NJUI':U 'mHXlurl\ Pi\\lI o( Clnl!lI'1Np\lrn 0'111'1/00 1>21152"/ CPIHllCilll1 NIIIl1\1l1r (Sill! !\Ill/pIIIIIIIII (IIr \',1-\11 ~III""WI') OI)IlltllI!'ll)lIh"II~IIII1'" @ ^'III'II'"IIIIIIIIII/NlltI'" O\""I1I11,'I""llh'I/NIIIIIII 1"111'\11\'11111\'111111,,101"1'> r,'d""llwiN\iiiiI.'r ------ IlliQQ..JJ&l!fll1l1 N 9 CON.!iT.lillITllili-----.-- 11111'11'\"',111'1'111,11,,11,11,11" N,III11' (j35 l,lJCKNOW liP 1111111"\,II,IIVIII\II"IIIIII'. A'"hl'" 1I111\l1I911UlW I'll 17ll.0-1635 IlIlil\.H!J!:r!m.L..JI1JlJU.!.L-----...----,---,----- I 1"11'11'\""'11111\111'"" N,'II11' II ,,,1,1'1'\1, Mil ' I " l-i.Il.:.;l~,IlP.llL,____._.__.__.,__~~___._ I , 1'11'1'1"1'11,'/111>1111'""Sill 1,,1 SII,,"II1'NIIIIII"', ' I 330al00~5n I '1.1111'1"WI'IIII1I1I111'.'!',,.IIldlllli1il"l----.------ , I (.\1'1' """('/111'11I1 1('!J!1,'11I'~~1J!f!J!!!.!!!:11!!'11 11'1/11 [!!!!1!!!L!!!I,lllimrIlIJ I C:"'IlIdl"II""I'"I" N"IIIIIII,"I,III.I,h\11 I --, SI'll/\IIelpllllmll (,i, elpIWfI[lllllt II,I"'II~ ,1/Ie( II/rIll el,llll,\' ,lHllrI,lIllelwl/lr l'IlW,i (1(1 ,It/.lr/m,,,,rl, ()1~(Jm INfOg/y/l\ nONI This Is im (lnhlr/Nollrulo Wllhhnld Ille:nll1l1 for ~lIl1ll1lllllillllllllpnll ,Ill ord!'r (PI' slIpporl (fOIll aUMllllfl"fIlolP CmIllIY, cOllllllonwolllth nf 1\:11"'\':Yi\llli1, lIy lilW, YIlII'mn rnqlllrud 10 rlnrl\lc\ \11I11n ml1ll1l11\i (1"1lllllho ilI10yu,nlll11nrl olllploynu's/o\lllnor's Inr:nllllll,ln\1I (1II11111r 1Ill\lc:onvllll I( Ihn Orrlur/Nn\lc:nls no\ IISIIOrl hI' YOllr ~IIIIU, ' $ 400 , 00 pur 111011\11 In Clll'folll slIpporl $ 50.00 pur 1I1P1I\h III pnsHltlo SlIpport Arllwsl~! wuukl or nrunlnrl OYOl ~ nO $ __~.!l..Q.pur l110nlh 11\ l11orllc:nl 'liPIHlIl $.. o,..llJl.pm lIH1nlh for 1l011ll1lc: 10'\ c:m\, $.-. pur 111011111 11\ 0111l1r (fiPllc:lfyl for II Inlnl nf $ 53~~ pOl' 1l10nth In hn furwnnlolllu pnyou 111110w, YIlII rlo no\ hllYII lu vIlIY,VOIlr 1'111' cyclulu \10111 c:oll1pllilllCn with Ihu IlIpporlUrrlm, If I'ollr pllY C:Yf.lu rloos nolllllllcl1 tllllufllnrnd slIppllll pllYll10nl cycll1', IISIIIhn followlnnln rlnlonl1lnu how II1I1c:h 10 withhold, $ 122....11pur wonkly pny pmllllli $ _--A1..1....6.2.IHH hlwonkly IHI\' purlorl (OVUIY \wo wnnks), $ 261i,.Jl.Q.por ,nl11ll11on\hly Pill' Plll;lorlllWIc:O il IlIonlh), $ 530,00 pm 1I11111\hly Ilny pnrlorl, /{I'MlrrANCI' IN/'D/(MAlIONl YOIlIl1I1SI honln wl\hhollllnll nollllor Ihillllhn flrs\ IlIlY pUrlll(1 oCC:lIrrlnn 1(ln (10l worklnn rlnys lIf10r \IHI rllI\O of Ihls Ordm/Nollco, ~ond pIlYIl1QI\1 Wltlllll suvnn(71 wmklnn dnys of Ihu pnyrlnlu/dn\u o( wlthholdlnll, 1'011 mn nntlllndlo dmlllcl n foo 10 dufmy \hu cosl o( wlthholdliln, Ilufor 10 Ihulhwl novumlnn1h(1 work slnlo of Y[lm ol11ployoo for tl1n IIHI nllownblollll1ll1l1ll, Thololnl Wllhhnld 111l1ll11111, nnd yom fun, c:nnnol OX((lllll 55"1" of Iho olllplOYllll'sl o\lllnor's ilnufOllOln dlspOSilhhl wnukly ullrnlnns, I'm Ihllpllrposuof 111Ullll1ltllllon un wlll1holdlnn,lhu (ollowl,nnlnlmllln!lQllls " lHwllml (500 /19 011 pn, 2l, If 1'1lInllllnu hI' l;n/I;IJI, plllllSO cnll i'llnl1lylvnnln ~\n\o Colloc!lul1S ill1r1I)lshllrSUl11onl Unll (SClJUI 1:1I11110vor ClIslol1lor Snlvlco n\ ,.077.C,7C,.!151111 (or 11lS\1Ilc:tlnns, Mnl(llltumlllnl1cU PnYilblu 111111" SCDU suml chuck tn! I'lll1l1Rylvnl1lil SCPU,I',O, IInx li!l112,HnrrlHIllIl'lI,I'il '1710(,.!l112 IN ADDITION, I'A YMfNTS MUST INcLU/J/! Wt; OU/!N/JANT'S NAMII ANIJ T/-II: I'ACSI'S MfM/lfR /D fsllrl\WI .1buvU,IS 1110 /!I/I/lluYllu!Oblluur's c,lSd t"lllllU/or) 011 SOCIA/. s/!cIJH/TY NIJMllfl1 IN O/lDfll TO /III I'IIOCfSS/IP, DO Nor stNo CAStl /lY MAl/., J>H1l1 1\.1 S1lL\ckluy MAILED llel dofoll:hl\\l: . ,?/../.I(i(/ , l~) IJn\!lof CJr~lnr.' ,Jill y Ill, 2000 nn"'~~ Fdlv<lld g, GUido ,1Il1xm !'Drm EN.b21l WDrknr II) $IlIT'I' Slllvlen Tyllll M OMlINu,:lIlml'/JI.\4 ,wllh.llrltIO"lfl:l'JlJj/no _ APPITIONAf.INI'O~MATlON TO ~M'II.OnKS ANP OTIIf:1I WITIHtpl.P~KS IJ If IlIiHlj"" 1'0\1 ,nllll"IIIIrI"llo 1'101'1"" " 101'1' o( III!> (011\110 YOlli ill\1plol"Hl, 1, 1'11111111'1 Wlllllu'lilll1l1ll1ulnr 1111\ O"IIlI/Nollrl' II,,~ 1'1101111' OVIII ,lilY 01111'1 IIlIIHI I'I0n'\\ IllUlol SI"IIII,lIv ,,".,III\IIIHl s,ullllliui'l\1ll, 1'11"1111'1 "IX 11I\'IiIIII1I1HIIII'"flllll "11'1111'1 o( 11111 ollli" lI'iYIlPllollly, If 111,,," ,ulIll""I,i1IHX Ii'VIIII III "'(llllpllloIMI 10111,111 1110 "1I11I11~1I1111 ,'11"1111' 111111" 1I1l10w, ~, C0I\1I'II1II111 I'!11'11I""1~1 1'0\11,"1 101l11>11111\\,IIIIIII1I!1.lIli1II1I1IS (IOIl1I1UIII, 111,11' ol1l1l1l111'II1Yllll/ol>lI11I1I's 11111111111111 ,I \111111" 1"'1'1\111111 10 "'11 II .1111'111)' Illljllllblll1l1 11'11111101"11111, 1'011 11111\1, 11"11'11\,"" "'llo1i,IIIlII' 1I1111111h' 111111''''11011 o( 11111 sll1l1lll 1',11'11111111111.,1 Is '111111>'11,11'111 III IlHIII Illl1ploYIlIl/"I,lhl"l, ],' 11"1'"1111111 1IIIlI"IY"!lIIl/!>!lII' ,,( Wllhhol"llllI; YOIiIIlIl~1 "'1'011 i1ill I'HI'''.IIIli<I;,I" "f 11'11111101"11111 whlll1 11111"11111 Iho P'IYI1HlI11. 'lIl1l l'iIY"iIlIl/IlHI" of Wllhholrlll1l1l' III" rlillll Oli whil"h ,11I101i1l1 w,,, 11'111111\11" (1011111111111\1,,1[11""'" S\'IIII"I, Y"II 1I1'lsl r 01"1'11' wllh Ihlll,"\' or 11\1\ ,1,1111 o( Ihl1llll1plo\'Il,,'l/ollllllol', 1'11111'11"11 pl'll'll o( Ill\1pIOY!l1I1I1I willi Illllllllllo 11111 1111111 pOllod' wlihll1 whlrh l'llli 1\111'111111'11'111111111111' willlllol"llIlI 0111111 ,11111 f'"WoIIIIIIIIl 1111'1'011 1"11'1\\1\111', ' ,I,' l'I\1"lo\'I",/()hllllol Willi MIIIIII'I" Slipporll'lllldlllllll I( Ihllilll, 1I101l! IIIHI1 01111 OlllurMollrl1l" WllllllOl" 1111 011111 (01 Snl'"oll ,111I!1i1'llhl\ 1l",,,loYll%l>lIl1or "'HI YOli Mil \1il<,I>II, I" IIOl1or "II 'lip,,"11 oldlll/NolII III lIlil1lo rlldll',11 01 Si,II" wlllllll1l"II1I1,III11Il', YOIi I1l1,sl folio\\' Ihl! 11iI\' of IIIIl 11,11110fl1l1lploYI'I1',/ohIlIl01" 1'1111"1',11 pl'lfn of I1l1lpIOI'IIlI1I1l. Y';1f IlIl1sl 1101101.111 OlflI11,/Nollil1' lollll'lUI"'11111 I1XII',111 pO'llhll1, (S'U' //9 I>l1low) , , 5, Tollllllll1l1ol1 Nollflr'llIol11 YOIf 1Il1l11 p,ol11plly 11011h' Ihl1 Ill"IIII1'lhlll Alluill I' II'hollllll1l1l11l'irl\'l1l1ilil>lIl1oll' 110101111"' \\'o11H1I1I (111 YOII, Pll1il'" plovldll I I III Il1f'''III,1I11l11 "''Ilfl1'll1d ,lIlflll1ll1l1l ,I mpy o( Ihll Oldl1l/Nolir 111011111 AlIl1llfl' irlol1i1f11111 ""111\\" U""'I.OYI'I"S/OlllICiOll'S NAMI'I 1'M1'IO"I'I"S CASI' IPI'N11I'1I:111 I.AST KNOWN IIOMI: APPlll'SSI NI'W 1'Is-\I'I.DYI'II'S APPlll'SSI " PAll' O!' srI'AIlA liON I _, , rl, \,lflllP SIiIlI l'ilYIIIllIII'1 YlllllllilY IIll II1'1llhl1'IIOll1pOII ,lIlfl wllhhold (rolll 11I1I1P 111m 1',11'11101111 '"1'11 ill 1>111111"'"' rtIl11l11lssloll', III '"VII,""1l 1"'1', I( YOI1I",vl1 ,IIII' '1111"11011' ,11>111111111111' 11I11111l1)'lIlfllll', rllIlIMIIIII1IIllI"'" 01 ,llIllIlIrlly 11Il10w, 7, I.lill>lIl1\'1 I( 1'011 (,11110 wltlllloldlllml11h ,I' IIIIl O,dl111Noilrl1 ,IIIlHII, YOllllll1l1ill>l11 (or "olh Iho '1f"C11I1\lIlillml "11\011111 1'"11 ,1I01l1d I",vu wllllllllld flfll11lhul1ll1ployuu/ol>lI11ol" 11I('(II11U ,lIlfl oillflt 1"'I",1111lI ,ul "I' PUIlI1'I'll'il11l,1 SI'III1I,I\\', 1'I111111ylvillllil SlillulilW 1l0VUIII' 1111111" II," 0""1101 II IIlllploYl1d III ,II1OlhI1ISI,lll1, III wlllrll ril"'lhll lilW of illl1 SI,1111 111 whi<:h hl101 'lilli, I1l11i,loyml 1l0VIlIIII, ' " 0, 1\1I1f.lllsrrhlllll'lllolIl YIlII illll Sill >/111 I 10 ,,111111 dl1lull1lll1ll1f IIllflul SI,llu IliIv fOI dl""'loIIIIlIlll ,Ill Illllp11lY'lIl/01l1l1101 flOIll Ul11pIOYIIIIIIII, II1(lIslllll'lo ulllploy, 01 1,lkhllldll"llllllilIY ilrlloll ,111<1111'1 ,lilY ulllployuo/ohllllol I>llr,1I111l of 'I '"ppoll wlllllloldll1l1, 1'l1ll1\lylwlIl,1 SI,lIU I"w lIovm'\, 111111111 Ihll obllll"l I, 1IIllploy",111I ,"\olllm Slillo, 111 wlllrh r,I,,'IIIIlI,\1I' of 11111 Slillu 11\ Wlllrh hu 01 ,11111' "lllploYIlt!llo\'OIII" 9,' Wllhlloldllllll.ll11l1'l YOIIIIMY 1101 wlihhold lIIoll1lhillllhulu""1 0(1 1llhl1 ,II1HIIIIII' "lIowl1d hI' 11111 !',,,lm,11 C0I1II1I1H'1 Cinelli 1'10111r!101I AI I (1 S 1I,S,C, ~ 1 (,7:1 (hii 10(2) \hl1 ,11110111111 ,11I0WI,,1 hI' 11111 SI"II1 o( illl1l1lllp!oyull',/ohllllor', prll1r1pill "Iilen o( IllllploYlIlnlll, TIII1/'lldm,111I1Il1t '11'1'11111 10 11I111\11I\lllllill" 11I'1"",lhll1 Wl1llkly '''11II111lI' (APWI'). ,IPWI' II Ihllllllllllrollll1ll1fl ilfl"l 111,lldllllllh1lldill0lY t!mhlllloll' llrrh ,IS, SI,II", /'1,,1111,\\, II,r,III,IXI1\i So".11 Sl1rllllly I,IX"', ,lIld Mmllr,lfl1l.IXIlI, 10, '" 'NOlll I( 1'011 {}f" 1'0111' 1l9olll'mllsllIvnd with 0 COllY of IIIIs nrdllr 11111111 slo\n IholllSlilldthl1 orcinI', 1'011 o iii 10 (olioII' tho low of Iho sln\olhilllsSlIlIlllIIII mdor with flllpllCllo IhIllOlllllllS, !\1lC\lIoslIng Anoncl'l I( 1'011 or your oll1plpl'OIl/ohllg!Jr lIilVO,OIlI' qlloslIlll1S, ])OMI'5TIC IlHATIONSSECTlON' cOlllnc\ WAm ATTACHMI:NT LJI~I" I!.Q, 1l0X 320 hl'lolophollllOI (717) 240.6225 or CAIII.151.1' "A 17013 hI' FAX 01 17171 24.ll:.U2.11L., (JI by Inlornol @ pilgO 2 of 2 , I'mlll EN.021l Worknr If) O!J\1'T SOIVlco TI'PIl M (',~lll 'JIl.!(III1/t.1tlS" hpllatl41flllllf':lJIHIOII \li'\\:rKl l~lrlf.l ,~.?~. <lilY of: ~~,... 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AclclolIllI I III Form EN.02!1 Workor II) $11\'1''1' 5tHvlco Typo M tlMAN/I,:Oi'l1IH'J!H I IldMIfCl/lI Mt/1: Uf.1l/un .. APPITIPNAI. INI:ORMATION TO P'yW~nY':RS ;,NP OTIWR WllllIlPl.JlI:RS "P If rh!lr~I,!1 1'"\1 illll [l1!llllllld III I'lllvllh,1 ,I "'PI' IIf Ihl; ("1m I" \'11\11 "'lIpl"\'IIII, 1, 'P(IIIIIIY: Wllhl1i>hlll1l1'WI"1 Ihl5 OldllI/NIIllr" h,IS prlllrlly 111'111 ,,"\' illl\lll 11111,,1 1'111111'; IlI\d"l 51.11" 1,\11' '1IIilll1~llh" ;,1111" 1111'1111\11. I'IlIh!r;" I,IX 1111'1,,; 111111(,,<:\ 1>"(111" '''1',,11'1 Ilf Ihll IIl1hl! h,IV" PII"IIIY, I( Ih"I" ,11\1 !'i1l1l'iI,II,IX 1"1'1". III "(("1'1 pi"",,, 111111,11 Ilh" '''!I"II'1i111' ,111'1111'1' 11111111 b"III\\', 2. 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'\011" pf Ihll "Il1I'IO\'II,,'s/ol>llI\o(" 1'1111c1l'illl,I,"" II( 111111'1111'11\""1 wllh I"'P"I 11111111; 1111111 I'"rllld; Wllhll1whlrh YOlIlI\lIsII1111'1""\11111 11\11 wllhhollHnll Iml"lilllIl (0111'11I1111\11 '111'1'''11 1',11'111111''', '1,' , 1:1111'101'",,/01>111101 wllh /rIIIIIII'h1 511l'porll'lpl<lIlIIlSI I( Ih"I" I' 1\1'"'' 111.11\ 0'\11 Or<l"I/Nolh:" I" WI'hhold 111('(111\11 ("15111'1"'11 !lII,III1S1 Ihls "1I11'10\,,,,,/III,l1Ilol ilI\l1 1'011 ;mllll1ilblolo hOl1l1r illl 1111'1'"1\ Olllnr/NIIII...,s Ihl" 10 1'1'<1111,11 01 ~1,lltI wllllholdll1/l11111l1s, 1'011111\111 fllllo\\' Ihol,l\\, of 1110 Slillo of oll1plo\,,,"'./ohIlIlOl'S prll\dp'III'I.llo o( IIl11plo\,II\IlIII, \'11\ll!IlIlllIoIIIII "II Or<l""/Nollctls III 1110 1I111,lIosl Ilxlillll po!'lhlo, (Sun IIQ holow) 5, TOlll1ll1ilt/OIl Not/f1nlllolll 1'01111111'1 pIOII!l'lly 1\IlIVY Ih" 1\0'111111111111 AIIi'Il(:Y WII0l1lholll11pllivoll/ohllllll1 II 110 101\11111 1I'0rl;11\1I fOI .. ,Villi, 1'10'1'0 ploVllloll\llll\(oll11,lllolI 1"'1110'1,,<1 illI<I rllllllll ,I ropyof Ihls Ordlll/Nolll:lllo Ih" AIIOI1!'\' 11101\11(10<1 I'olo\\', 1'fy\I'I,OYf;I"S/OII\.IGO\\'S N,\MI', I'MI'I:OYI:!C'S CAS!; IPI'NTII'II:I{I , lAST KNOWN HOMl' AP\1IlI,5SI NI'W I'MI'I.OYIR'S AIlPIlI'SSI PMI' OF SI'I'AI{A TIONI 6, 1.lll11p S'lInPilYI11I1I1IS! 1'011 OlilY bo loq\lllod 10 101""1 '"1<1 wllhllol<l (,OI11II1I11P SIIII11lilYI1101ll' 511(:11 ,IS h0l111S0S, wl11l11l,slolI" 01 SOVOI!\IIW p'ly, ,I( YOIII"II'O 'IIII' !I"II'llolII ,11>01l111l1l1P '"I!1IMYII""'I!, 1:0111"(:1,11101""'011 01 ,IIIIIIIlIIIV holol\', " 7, 1.lil\1I1I1Y: I( 1'1111 (,11110 wllllhol<l 11I!Ol!Iu,!, rho Or<loI/Not/(:o <I frill I', 1'011 ,1I01l"hlo (olbolh Ihll iI(:CIIIIII(I,III1<1 '"no"llt 1'011 ,hollld IlilYo wllllllold hOIl1 Iholll11pIIIYllo/ohllllor', 111('(11110,111<1 olhnr pOllillllllS \01 hI' 1'01lllsylv,\IIlil Slilloln\\', 1'01111'1'11"\111,1 Slillol"w 1I01'0m' llI1lO'Slhoohllllor Is ol!lploYII<I 111 '\IIolhol Slnlo, 111 which l"solllolilW 0(11105\'110111 \\'hleh 110 01 ,hol; 111111'101"1<1 1I0VOlhl, 0, AIlt/,dl'crhnlllilll\l111. VOII ,111I sllhjoellP " flllo dolollnll1o<l 1111<101 Slillo liIIV (or l!lscl\illllll1l1 ,\II o!lll'loYllo/ohllllol (roll1 oll1ploYl!lol1l, lefllslolI 10 ol11ploy, 01,lil111l1/l 1!I,dplll1"'Y ,11111111 illl;IIIIsl i\ll\, ol!lplllyoo!lIhllllol IIllC,l'ISO o( il ;IIPPllllwllhhlll<lfr'", 1'0l\llsVlVi1l\Iil SI,lll1l,,\\' 1I0l'fIrl1' \11110" Iho 01>111101 I' ol1\plllVlld 111 ,1I\01hol 51"",, III which e,lslIlhol,l\\' of Iho 51.110111 which ho or sholl oll1pIIIY!HIIIOVOII!" 9,' Wllhholdlllll 1.lhllls: YII\lI1!il\, 111.1 \\'lIhllol<l 1!I001IIh""' Ilmlo,sof 11(11) Ihll iIIl\IlllIlI' illlo\\'od by 11\11 !,o<lotill CIII1S'"110rClmlll I'rolOlllllll Arlll 5 l),S,C, ~ 167:1 (b)ll 01 2) Iho '1\11011111' illlll\\,o<l liy IhnSI.llo iJf Iholll!lployoo',/ohlllllll" pllllclp,ll pl,\!:o of IIl!1ploYI!IOI1I, Tho 1'01101<11 1111111 ilppllos 10 Iho .IIIIIIOllillo iII'p'''ilhlo wooklv '\ilIIIIIIII' (t\I)WI'I" APWI' II Iho IIollll!Ol!Iolo(1 il(11lI 111i11111111111<1111IOlloIY <lo<llll:t/ol1' ,"(:11 ilS: 51.1,111, 1'0<101,11, ""'.III,IXO" SOdOlI 51l1"lIl1y lilxoS! Olml Iv\mllnllli I"xo" 10, , 'NOTEI If YOIl or yOllr 1\1\1111\ mo sOlvod willi 0 copy of Ihls ardor IlIlho 511\10 IhllllsSllP.d Iho ordor, yOlll\fO \0 follow Iho Il\w of Iho 511\10 thllll'~lIllCllhls ordor wllh 10splJ(:llo IhosollllCl1s, ' . ' , 1\llqlloslIl1l\ Auol1cYI If yOIl or YUill' Olllployoo!oblll\OI' hl\vol\lIY qllosllull5, JJOMI:SDJ.:JiEI.ATIONS SECTION conll\cl , WAGI' ATTACHMI:NTUNIT' ' 1',0, 1l0X 320 by 1010phuI1o ill 1717l 240.&UL or WilllJsu: I'A 17013 by I'AX iI\ (7171 24U:Ji2!llL- 01 b\,ll1lmllol @ \l I'ngo 2 of 2 1'0I'1I11:N.021l Workm II) $I1\'r'r Service WllO ' M !' llMIl Ni"IIIVlll.ol~~ Illllt.lkm ll~ll': 1lIJ111111 ',r" - 11\ '1'\10 npl1 r\; (J r COIIHl\PfI II I 01111 PI (J1I1II!lllrllll\ll \)(l\lll\',y Prp\.hpno\;lIry' fI OJ'llnp ,'1 r:Jlvll 1\lJ1;I,nll Nn" .\UD\l.'ll4n~1 '" III (JII'I'\!:H MlIlIY .1 f1 D 1',1'1"111,1'1 H\lN Hnllll nllMP 1111,\1 I'll 171111 Jl..LWJ:!'liHLl\J!I\I'LJl.,.._.. ..,.,..-,..-----' , ." , I'l(11ntl1'I ** Vl'IIIfi1lfl ** 11 T CJllTl'lIL.MI\.l\Y,..L.,__.......______._ I. 1)('1 t:O I\dll 1\ I: ,;, " YOII IHO horol)y nol:lf'le~j \:lIn~,n \leOl:eo In 11,Ivoroo WMl ' pn\;(ll:od ,I n \;110 nl10Yo anl1",lono(\ C1/IAO on ll~IJY._nrl./.__E.QQ!!.L_- 'l'hlH ,lotto\: nhol\ld 1\o\:)() IIHOlI In pl(loo of: \:110 ndtllll1' pOOl:On, ll' yOII dOfll \:0 II der.\;lI' .lod (lOllY 0 I' \:hlfl p001:00, you Olin obtllln tho ~nmo by aomlng Into our. offLoe, PIOIIAobrlng \;h,I,f\ 10\;\;01: wHh YOII, 'l'1\a 1'00 113 ...l2...J1Q..- olllOh or. monoy n\:dl1l.' , II' \:OqUflAI: .1 H mll(IO hy mllll, p10(lAO onoloao ,-"~JLL\HL far. t.ho ol1\:t,11'.I oct oopV p f: Iluor.ee I fllBP, t\o na\, I:Ol:gO\:' to Inll.lol\\;o CIvil flcU,nn NOI on your. r.oC]uont, Hln/i..1YSjJP. I'r(~~J/AO'"r- , 1,1' ,. " " .' " " "t. '-' '-~-I . .j.1x\'I'1>1'N1"N'11'1'1'l'I-\'N+N"111-N'I-\'!'!'I'I'I-lxl'" H -1'l'I"""'I+l'\-\'\'\-1'1'I'I-I'I-I-1-'-1-11-\-I+ \"I-I'\-hl-1'~ :~ IN TH g C~I;~~~:ll~~~)~c.~J~.~N P~~AS l ( rt, :: ~\ .l~~,~, ,; BTATI:: OF~ l'i'!;.,.I', F'I.':NNA, " I,~ "l~ll'u(; r ~'l: : ; :/"r,;h,;,~,';".' _ ,., " ".t .. " , r> " p .. - I:' " p " , AI.AN Il, 11ICII'I'I':\! 1'11\ 1111,11' f No, ..,. .()~I::!!!!2..U:LYJ.~_'rt~!~1 VI'H!iIJ!i , , ~IAHY,I, HH111'1'lm 1)111'(1111111111 D~CRF-~ IN DIYORcg ANIJ NOW,. ..-:::r-~ (" , o:r I(,'D~~'~' , )O()()" IT I!; OIWI'.HI"U Mill ilr::CIH'.I,.n FIIAT .. AI.AN 1l,IUCII'I'lm NAllY ,I, HI CII'I'I':H ..,I'I.AINT'FF, , , ANP ........... , nllFI;:NP^,~T,' ^,11;: PIYOIICI'.il FllOM Till,: 1I0~II.l!; ()F MATlllhIONY, Tllli COUll'\' /~I'.TAINI, .JUIllliDICTION OF Till': FOI.I..oWING CLAIMS WI'IIcH HAYI'. Ill'.I'.N Il^16Eil OF f11'.COIW IN TillS ACTION 1'011 WHICII ^ FIN^L Ollpl'.rl H^S NOT II:'T UI'.r;:'-I ('.IHlm/;:I); II llll 0 , .. 1\ IH 1\ll'lhol' OIWERED. ^ n,ll.1lKII!P 1I1lt! nneR Imp \hlll Iho 101'111H, 1I1'01'IHI0llH IIlld oOlldlthlllH orll i"ui;iiihi'MiIi'liill~utilullililil ^mool\1olll huili'oUlllhOPlll'lloH lllllod ,1l1llo,~,20nn,'III'U .... IIICnl'pnl'll\od IIllhlH Peol'oo III Dll'ol'l'e hy I'ol'ul'ollco IIH 1\111)' IIH 11'1110 HII1110 IWI'O Hollill'lh hOl'olllll1 ICllglh;"Hnld'1\gl'cc11I01l1Ilhllllllq\ 1Ill'l'gl! wllh 11\II'HIIIIII HlIl''' "lhiH \)UCI'CO 11I1)lvl1l'co~'" 13\' '1111' , .. - . ,. . " - , , ^'ITlc!;I': ..,~.. WHIONOT^IlY , I j. +1><l+1+1'Vl'I'I'I'I'I.I'1>1-H,N-HI.I'!'!.I'I+1:'Y"'>1'vl'f-l'I.t+l>N#H+l.t+l>1+1 " " . ., ,. , ., . , , " . . " , o , . " , " - , .(}o " " " , " , , , " " ,. . .I, , . , ,.! ,(/(fl\)/Jl~4 'l0tVt::(e. PIIPI:IIINPTln Tn WITltllnl.IlIN(:UMr rnll ~~J'll'qlll ~totp J:JJIHll1!1I1W!lollh-llIJ!UlllliVlvOlllo. r.o'/clly/PI~I' Il( ()\lMIl1~llI,II!i!L-_____ P"lnllf Prdl1r/NlIlln' lll/lti/1l4 rrll\illHiIlCiltill NIIIl,11111[ (~pp tllllll"'III/I/I fur 1'!1$\1 ~1I/11l1i,ll'/') " f/77-A/, ' Olllllll'wll),III"INlIilll' o 1\l1wndlll! { )1I!ill/NlI\hll @ 1I'""hlillllpllln,/I'"lln' 1II'f'h'\'I"i\Viiiiiilllll)l,',TI~i1""IIIIN N!lIIII'I" HI'.IlICH'I'lm, 1Il!!\!'Llh- ____ 111lf'IIIYI'I'/Ohllllll'" N,III1I1(\ ,Ill, Ih'i, Mil li!l.J:lli,;,!lll1i____ 111lIilllYI"l/Olilf,IIII'i, S",I,II SIII'IIIlh' NI1IIII,,,, 3302100256 i'iiif'h'I'III'/Ohllil!l/" C,IIl1 1111"11111111 (Sill' Mill'lIIll11!1 (1/1/I/,lIl!tI((i"lIl1l'! ,lllIwl,l/I'rl 11'//11 r,llI'lill! ,111,11'/11111'1111 CIIII\IIII,1I1',,,",,I', N,1I""(\illl, 1'11'1, Mil, I'H,oo II1\U~MIINfJ CONfJ'I'IlU()'l'TON ,G3li l,tJOICl'lO\'/ 1m 1I111l11I~lltJllq 1'1\ 1 'I!lll-l fi 31; i)l!/ F/I/~j'.. ,IS-,')! (,7/(1,'{ 1'J).;i;K:~ r; '7) 7/ {'(l(lt!/ I, '" ~I'O 1'1111I1'1/111/111 (nr Ilfl/WIIIIIlIIII/l1mfl~t1Ilrl /l/rlllll,llps ,mllrlMIIII \vllll (,,15I'S Oil ,111111'1//111'111, ON/lf/~ INt'CJNt\'ll\lICJN: TI11s I; 1111 Ordnr/Nutlrn III WllhhllhllllClllllll fur Sllppllrl!>iltillllllPOIl "l1ordnr fm lillpPCllI fml11 OUMllblHl\IINP CUllll\Y, CUI111l1UllWOilllh of I'nllllsylvilnl.l, Ilv lilW, YOllllrl1 rl1qlllrml 10 dC\lhlCllhoso 11nlPllnl~ frOllllhl1 ill111vo'ni1l11mlol11plpyoo's!ohllnor's Il1conlllllnlll (11I11101' noli co nvon If Iho ordor/No\lwls no\ I"tlod hy yom SI\llo, ' $ _ 0 ,00 PO! l11unlh In Cllrronl ~lIppnr\ $ 0 ,Oll pilI' n1l1nlh In pilsHllIO sllpporl $ 1I, 1I11 por l110lllh In 1110dlcill sllppnrl $ 0, Oll pOl' n1l1lllh (or llonullc los\ [\IS\S $ ~ _ por 1110lllh In u\l1Or (spoclfy) , , ' fur" tnl~llif$ 1I ,00 pur 111\ll1lh In hu rnrwOfclud 10 P~Yllu hlllow, VOII do nol hilVo \0 VIIIY YOllr PilY C'yclolo holn cOlllpllnoco wllh Iho sllPllllll (lrdl1r, If yom Pi1Y ('yr.lo doos nolm.llcl, 111\1 ordorml SllpptJr\ PI1Ymlllll cyclu, IlsO \ho followlnl\ \0 du\orl11ll1u how I11llCh 10 wllhholch $ 0,00 pur wookly PilY porlod, ' $ 0 o_OJl.Por hlwookly \lilY porlod (ovnlY \wo wooks), $ ll, 00 pot somlnlonllly PIIY purlnd lIwlw 1\ monlhl, $ 0, Oll pol' l110nlhly p"y pnrl(l(1, 1~1;IvII1TI\NCI; INI'ONMiIlICJN: VOlln"lsI hOl\ln wllhholdlnl\ nn lilloI' \111\11 Iho flrsl PilY 'purl(l(1 oCl:llITlnn 11111 (10) wmklnl\ dilYs 'Iflnr 1110 dillo of lllis Ordor/No\h:o, Sond pl1Yl11onl wllhln sown (7) worklnll dilYs of Ihn pi1Ydlllll/d,l\npf wllhholdlnl\, VOII mUl1n\lIll1d 10 dodllr.1 ~'foolo do(my Iho c:oslof wllhholdlnn, IMol' 10 Ihn Imvs l\ovornlnn \ho \York SI"lu of YOllr 11I11ployon for thn illlowilbln ill110unL Tholl1lill wllhhold ilI11011ll\, "'111 you!' (oo,nll1no\ OXClIlIl155"1n.o( Iho omploynn'sl nblll\m's ill\l!tOl\illn dlspllS.lllln'wool<lyoilrnlnl\s, For 1110 purpnsn of Ihllllmllil\lnn nil wllhhnldllll\, \ho followllll\ Il1forlllilllol1ls 1l0(1(lod (Soo 1/10 on Pll, 2), " If r01ll11l11l1l I\~ I:I'T/I:DI, ploilso ~:i1" l'ollnsylvillllil Slilll\ Colhlcllolls lIlld Dlshllrsollltllll LlIlII (SC()UI I:l1lploYllr ClIslol11W SOlvlcn ilI1-I177.Cl7Cl.95110 (01' Inrlrllc:llolls, Mnl((! llomlllilnco I'nYilhlo tot I'ASCDU Sond chocl< tot I'011l1sylvilnln SC,DU, 1',0, lJox 69112, Uill'rlshurl!, Pn 171()(,.9112 IN t1DDITION"I'A YMt:N.TS MUST INCWDE THE DEFt:NDtlNT'S NtlME t1N/l THf/'ACSES MEM/lER (t) (stroWII ~bllVIl.l$ 1/10 Em/lloYI'Il/obllyur's e,l$ll Ir/lll/lIl/orlOR SOCII'lL st:eUR/TI' NUM/lER IN OHDEH TO /IE I'HoassE/), DO NOT SfNI) CA.~HIIY MAIL, ' . ,., ,\rrom; 12 wooks or Ilrnnlorl 0 yos <Xl l1u1 Solvlcn Tv"ll1 M lIMn Nu,) (fll'll-Ill~1 "'.'......"....'.....".) IIY nu: COUIlTI r: .. .,."..,_....:"....;, " .,,;,.:,::;#~~~, ".c;-~'1.I" L h- , 1I.~"..~".tl 0'1(1."'/1" () I: {", I.' ,('/)t;-+ ,'Il..7Y(l;; " l'ol'ml'N.0211 Worknj'llJ 21205 p(\I(I of Ord(ln.J)Cll U 1UUI, .,,1 'I I APfllTlnNAllNrnllMATIPN Tn I:MI'I.PYI:llfi ANP PTltm WlTltllOI,Pf;IIS q 1II'IlIII'kl'III'oll IIIU'l'ljllhl"\ 10 \"IIYIIIII II 1'lIpy' uf 1111' (0111'110 \'UIII'IIIl/lloI'l!U, If !'0\III"1Iplu\,llI!fWOlkl" 1111'1 'IIIlll IllwI I' I ' II (I'I",il 10111111(1 H,'II 111,\1 I,II!(, 1111' 011 UI, ,I roP\ lilli' 'I' piliI'll "I 101'111110111' OI'I'U UVIIII 1111' HI~ 'l1ul I' 1I'1'~11I , I, WII,IPIIII1I'I,IIIIIIII1 1'0111111<111' 1'01ll111lill.II',11 o( ':111111I,,111' 111\'01111111111 Il1l1hlllirllll1f, irll"llIy,u\\'llIIlI 11I1,II1I1SfllS, ,11111 1111111111'0\\,,1(111 IIII,IIII"Ii" 101',1\1'11 1111,1 I\lbUIY,IIIIIIIIIIII dlllliblllo \\'1111110111111 ,IITlHdIlI1I'U \\'1111 1111\ 110111'11, ~,' 1'1'1111'111'1 Wllllllolllll1111111111n Ihl, ClIIIIII/I~uIII'U 1Ii11 prlulIlY OVUI ill II' 0111(1,11111111 PIII('I16' 1111111'1 SIIIWI,I\\, III111hwllhu ,,111111 h1ll1111U, 1'1'111'1;11 hl~ 11'1'11'1 1I1I'(ftll'\ IW(OIIIIUl'ull'l o( Ihl, olllln hlll'I' IlIluIIIY, If IIII'IU!IIII hldul,lllil~ 1III'Iub 1111'((111'1 plllllSu \,0111.11'111\11 1'(1111111'111111 ilIIIII1l'1' 11'11111 1II,lu\\" ], (:"lIIhII1111" I"WIIWIII'I 1'011 rill' <'(IIIlIlIIlI' \\'111111(1111 IIlI1UIIIIII (rolll 1110lUlllilll UIIU '"111'IuYIl0/0hIlIl01'b 11I1'01l1i1 III II '1IlIIIIII'iI\'II1UI1II0 IIilI'h 111111111'1' fIlII\II11111111 wlIlIlIolllll1l1' 1'11111\111'1, hOIl'IIVIII, Sill'iII'llllh' Idllllllfy 11\11 P'111101111( 111i' Sllllllll Pil\'IIII'I1II1IilII\ illI,lI1\11.11I1I1 \ol"l('h 1'lIIploYllI'/olllhm[, ' , ,I. "llllpUlI1111l11l1l1'11\'111Itll/!J1I11l o( 1'1'1111110111111111 1'011111\11\ [1'1'01\ 1II\I11IIVlhilll/lllllll (If wllhhllhllllll 11'111111 'lIll1ll'1l1 111\111111'11\11111, TIIlI ' PIWli!III'IIIIIII' (If wllhlloldll1l1ls IlIulhllll Oil wh rh 1111101111\ 11'11' 11'111111\1 d fIOl1llhllllllllllol"'"" 1I'1I1111', 1'1111 11111'1 l'llllll'ly wllh 1II011lw of IIIll ,\.,10 o( 111\1 Pl1IpII1YI'II'I/ollllllof', IlIlm:lp,,1 I'lill'lI of IIIIIPII'YIIIIIIII \\'1111 lObi IIII'I III 111\11 III II pllrlllll, 11'1111111 wlllrll \'IIIIIl1111111l11'llllllllnllhll wl\lIhllhllllii mlll'f '1IIIUIIIWiHli 11\11 '"pp"11 1',11'11\111111, ' 5, I ~l11llllvllll/Ohll""r Wllh MIIII"*' SIII'llInllllllllll1>>II I( Ihllllll, mOl II IIIIIIIIlIIIl O'lhlllNolIPIIII Wllhhllld IIIClJllId fill S\IIlPIII\ IIII"IIISI 11111 UllIlIII'Yllll/olllltllll 11111 1'1111 i\tllllllllhllllu hlllllll 1111 '1IpP"1\ O[liUf/NIIIII'II' 1I111l101'1IIIIH,11 II,. SlillI' wllhlllllllllllllllllll', 1'011 111\161 IIl1l1w IlIulilw III IIIIl ,IIIIl' of 1I1l11'IIl\'UII',/olllhlol" pllllrll'111 1'1,1(:11 o( 1l1l1.IIII'YI11\lI1I, 1'1111 I1Il1sl 1I111111r 1111 OldlH,/NollcII' 101Ilullrlll\IIlII.I'~II'"1 I'ossllllll, ISIlIl II11l11llIllW), " (" Turl11ll1l1l1lll1 Nllllflrlllllllll YIIII 1111111/'1111111'111' 111111(1' II\!J Illl"lIll'lInll AIIIlIII'Y WIWI1111\111'nl'101'1III/ollllllol 'I 110 1111111111 w"rklllll fOI Villi, I'IUil6i1 pIIII'I,II' 1111' III(III1I1i1l1ol1 1I11111\16lm ,11111 rO\lll11,1 I'II1'V II( Ihls (lnllH/NIIlIl'o 10111\1 AIIOI1l'Y I1I0rlllfl11l111ll10w, ' , WITIHIOI.IUII'S Ill, 23111033210 ' ~MI'~OYWs/OI1~lrIOlllS NAM~I IUCII'I'lm, III,IIN f) , ' , ~MI'I,OYWs CAS~ m~NTlmnl 330210Q2BB . PAn Or SWAIIATIONI ~AST KNoWN ItOM~ APpnr:ssl N~W ~MI'~OY~n's N^M~/APpn~ssl " ~, 1,1111111 SIIIH I'IIVlllulIl'l 1'01111111\' hl! I"III,lllllllo lopoll illIlI wllhholll fll1111111111P '1IlII pilYIlIl'nl' '"l'h ,is hlllll1lll', rOlnllllS6lol1s, 01 SIlVll1,ln1'1l PilI', If VOIII,1i1YU IInv 11'lllSlIof1S illlIllllllllllP ""n p"yn"'nls, C11111,1r\ 11\11 pNlnl1 or illllllnrlll' hlllllW, 1\, t.I,lhllllvl I( VOII (,11110 wlllllluld IIICIlIllU ii' Ihll Onllll/NIlII"" 1111111'1', 1'011 iI'" 1Ii1l1lu (Ill hllth Iho ilcrllllllllnllld IlInnlllll YUII ,holllll III1VIl wllhllullI (10111 1110 Ol11ploV\lo/ollllllor', hlcoll1ll11l1l1 olllor pOlllllllol '01 hI' l'ollll.ylvlIl1ll\ SllIlolilll', 1'0111111'1\'111\11\ SllIloll\W 1\01'011I6 1I1110,s IlIli ohllllor 16 oinpl\lyml 111011011'01 Slolo, Ii\ whlrh CillO 1110 1m\' of il1u Slolulll whlcl1 110 or ,1101, ul11ploVlI1I I\OVI1111', ll, AI1I1'IIIIcrllnll1l1l1l1l11 1'0ll 1U0 ,"hlllcl 10 11 (1110 lIuloll11ll11111 lInllor SllIlul,IW (or 1I1,cllllrnlllll 1111 ol11ploYllU/ohllllor (111111 11lI1ploVIIHll1l, Infllsllll\lo 11111ploy, 01 Il\kll1l1 dl,rlplhll\lY ilrllol1!iil,lll1'\ <lilY IIn\ployun/ollllllllllll"'III1'U o( 11'SIIPllOII wlillhold 11111, 1""'l1syll',1I110 Slnllllmv IIOVU1I1' 1I1110,s IlIu olllluor Is ull1ploYl,1I 11111111111101 Stillu, 111 wlllrh rl\'o 1I1\11i1w IIf Ihp SllIlullI wlllch IWllr ,11111' ul11ploymll\ov01l1" \0,' Wlthl\lllllll1l\l.ImltsI You 111111' 1101 wlihllolll 1I1010lhllll 11",10""1 n(1 Illho mnolllll' illlowollhl' Ihlll'llllor.11 COI1'lIII1IIIClmlll "rolurlloll Arl (IS U,S,C, ~ 1 C:7:l (h)ll ot 2) Iho <1Inlllll1ls II110wml hI' 1110 SllIlolI( 1110 ull1ploYllo'6/0hlluor" prll1r1Il<11 plncu o( 1lII1ploVIIl\1111, Tllo I'mlllmllhnli IIppllllS lb tllo illIlIl\Il\lIlu "llpllsilbll~ WOllkly Oi1ll1ll1l1' (AOWn" APWI' Is Iho nul 1111:01110 lofl 11(101 1110ldl11\II11\I111111olY Il.ollllc\lOI1S sucll 111.1 ~Iillo, I'ndoml, locllllnxo\! SocllIl Suclllliy 11I~1lS1111111 fvlmllc,lI1lIIlXm, 11, Alllllllolllllll1f\ll 'NOT!:I If I'nll or ynqr <lIIOllt MO 51l1vod with <I coilY of \h15 ordor Il1lho 51<11111hl\I I""ncl tho ordor, 1'011 lito 1\1 follnw IIw IlIw of thl! '11\\0 Ihil\ l"lIocl Ihls nrdur wllh rusJluc\ 10 \husu lIom5, " , SlIhlnlllcd 111'1 If 1'011 or VOllr ol1lploVou/nhllllor hl\vII nilI' qllu5110115, lli2MJ~lEI.ATIONS SECTION ClJl1ll\rlWAGE ATTACHMI:N'r UNIT 1:1 N,HANOVlH ST ' hy 111111phollo nl (~17) 2'Hl'[,225 Ill' ~IOX no hI' I'AX 1\1 171~) 2,i(),r.2.111 or CARI.ISI.I: "A 1101 J hI' II1\OtlHl\ www.chllclsllJlJlol\.blnto.l~ ~ulvko TVpu M' 1'1\1102 of 2 ()I.\IINu,:IJfj'llfll~'1 1''' I'nrJllI:N.021l Wnrkor ID 21205 ,QIIIlI:tIINPTlf:nn WIHtlIQI.P INml\W mil ~UI'I'n1n.. . ~','I" ..coJlln\UI1Wll~Uh.uLI!llIlIl~v,lv~nl~. Cn'/Cl\y/Plh\, of CJ\lMl\Iml.IIl'll!____ Pdlnllf Pldnr/Noilrn ..1lL~,lL..!!.1.. TIlllllndl/Cilhp N\llI\lwl' fliPIl/ulrl"IIr1U/II (fir r,ml ~lImllhll'yJ Olllllllil"I(ll,II!'iNIIIIlII () AIIII'"""" 1 lllllOllNoI.III' (fl.lllllllllh'h'(l,","INoIIlII l~l,CO 1I1\UflMlItHl CONfI'I'IlUC'I'lON G 3 U J.,UC1<Now IlIJ , 1Il1HllTfll\1JlW I'll J'1l10-:lti3U , '4~! 101~ .J/~P-I (1'(/ m(i[;'C""~;-7ICtJ 94>/ 11l:IlWlI'I'lm,I\I,IIN..!!..t-_ , '1'1111'1111"1'/111>1111111" N,'"III1",I, 11"1, ~III li..!L:l[:oOOlli__ 11111'111\"'1'101>11110'" sll''',1 S",,"II\' NIIIIII>II' 3) 0 ill.!lJlJiJL , 1'11'1'.111\'1'1'101>1111101'1 (""11 1I""IIIIII'r' (,\"1' 1\1I111'11I1,1111 ("I' ,JI,1I11U(('h1111V1 ,1IllJd,1h'III\'IIII r,lIl'1 (II",l1ol1/II!lVIII! ('11'10<11,,11',"""1', N,IIIIII II ,1>1, 1'1"1, Mil 1II1I'IIIYI',Nlllhhlllllll"\ I"'IIIII!,IIIN NIIIllI>II' , Iico I'1rlrlolli/flllI fdt rlopomloll' 'hlmp~ 11/11'1 h/rlll rl,l/1l~ .mnd.1/crl willi r,mi~,(I" tlIl!1r/mll'lIt, ()HP~N INI'OHMI\ HONi TI1I>Is 1111 Ordnr/Notlmlo Wllhhllld Il1coll1n for 511PPPII h'ihlHIIII!lH1 1111 olllnr for sllppml fml1l ClIMlllmhllNP COllllty, Clll1lll1llllwnnl\h of I'nl1l1hyIVill1li1, Ily IIIIV, YOII mil rl1qlllllHllo d(!dlll'llhllm IH11p11I11s frPl1llhn nhllvn-I1,II1lIHI 11ll1pIIlYOll'S/llhllllor's Il1co11111'llIltll fllrlhnr no\!t:nnVlln If Ihll Drdlll/Notlrnls 1101 lfisllnd IIY yom 51111n, $ _, 0,00 'pllr l1lonlh In I'lIrrnl1l hllpporl $ , 0 ,00 pnr 1110111h 111 p.1sH11I1l support $ 0, OQ, pili mOl1lh 111 I1Wtllcill fillpporl $ 0, .ll..ll.llllr 1I10111h for 1111110\11' \llsl rosls " $ _ pilI' mOl1lh 1110\hllr (spl1clfy) for i1111lillnf $ 0.00 Ilor 1l111l1lhln ho forwnl'lloll In Pi1Yoo holnw, YOII dOl1nl hilvolo Vilty Yollr PIIY cyclo 10 1111111 coll1pllill1cl1 wllh Ihl1 suppmlordllr, If YOIllPi1Y cydll dOllS 1101 l11illch \hll or(!tlf'(!(1 sllpporl PiIYl1ll1l11 cyelll, lIBlllhll (ollowll1lllo dollllll1ll1o how II1llCh 10 wlihholdl $ 0 .Jl.Jlllllr WOllkly Imy pllrlml, ' , $ _ 0 ,lUl.pl1r IJIWllllkly \'i1Y pllrlml (I1VlIIY Iwo WOllksl, $ '0,00 pOl' Bllll1ll1lol1llly Pil\' pllrlpd (lwlcu i1 1111,'l1lh), $ ~__-.lL....Q.l!.por lI1ol1\hly Pi1Y porlod, ' IWMIT1I\NC/: INN lHA/I\ /'ION: YOllIl1I1S\ h01l111 wllhholdll1ll 1101i1lorlhill1 \ho flrs\ Pi1Y porlmloccurrll11111111 (10) Wnikl'i\IlII,iYs .1fll1r Ihl1 dnlnof IhlB Olllur/Nn\lrn, Suml PilYl11nl11 wllhll1 snWi\ (7) WOlk1111l dlIY" I1f Ihl1 pl1ydillo/c1nlnof wit!1!1ollilpll, YOll ilto (lI\litlllcllo d\II!1lctn fllll to dofmy 11m cllhlof wlthholdli\ll, IMl1r to \hl1li1WB 1l0Vllrnll111 thl1 work h\n\l'lIf your ull1plOYlln fm thn illloWilhl1l ill1lll\II1\, Thl1lol;ll wl\hhllltllHlIlllll1t, tll1c1 youl' fOil, cnI1I101I1xcl!lHI.55% o( \hl1l1ll1llloyoo's/ ohllllor's illlIlrnllil\IlIIlBpOSilhlll wookly l1iltl1ll111S, 1'01' \ho purposl1of \hnllmltil\lOI1 Oil wlthholdll111, Ihn followll111ll1forl11nlloi\ Is l10llllnd (51111//10 Oil Pll, 2), If Il1mlllll1l1 hy HT/WI, p!tlllBI1 ci1I1I'ul1l1sylvilt11i1 51i1lu coII\'ctlol1s ill1d IJlshlll'slHlIllill U'll1 (sc!JU) i:ll1llloynr Cuslnl11ut.Snlvh:11 ill \.1\77-67r,.U5I\O fvl' Il1hlnJrlllll1s, " ' Milkllltomlltill1co l'ilYilhlo tal I'A SCIlU ,Solid check IOlllelll1sylVlIlllil SCOU, P.o, Uox (19112, Hilt'l'lshurH, Pil171116.9112 IN ADDITION, 1'1'1 YMENTS MUST INCWI.lli mE DIiFt:NDtlN1"S NAMI! AND TIll! I'I'1CSCS MI!MIlt:/11/l (SllOIYII i\bnVo <1$1//0 /!/IIIJ/nyon/obl/gor'.1 C,lSnlclnllllflnrJ OR soclAt ~fCUR/TY NUMlnH IN oH/JfH TO /Iii I'ROCESS/!O, DO Nors/!NI) CA,~H OY MAlt" " , , ., 1 -1\ 1:'"~'"':1 1;1",1 fl-" I' ", kJL,,~) i,~;/, IIVJ.IU: cOUltTI !Jilin of ordl1l'!~OV ~ 2004 ,..--/.( 'o?.::.,. r.......-. 17/)(V !<fIelJ Arrl!Ms 12 wooks or lllU,lllll1 o yos Q(l 110 ') Slllvlnl Tyi'\' M (JMn NU,l lI'i/{llll\1 :. _:..t. ~:: ;; :~~ft ;1/ ' ," If: li~;~~'''I.'' .::n/J'!t:t(f \., ". 'I'nnn rN.ll21l , Wntknr I!J $ 111'1"1' I' "1' , t\PPITIONt\I. INI'PIIMI\TlPN Tn (,i\WHWI'l\s I\NP onlf!lI. WIl'I"towl'ns ' IJ 1I1'llIlIkl'JlI'III1 ,"11 111(1"111"\ 11I\1I11~lIhl '1I'III'y'lIf Ihll, (1111/1111 1'1111I1111'111111'1'1" II 1'11\" 1'lIll'lIll'lllI \\'lIIk~ iii iI .1,lllIlhillli 11111IWI1\ 1111111 11111 ~lilll 111 ill \~III( 1111\ 1111 1'1, ,I P'I'I' IIll1h \III !l11l1'1I I" III ylllllllllll'lIl"'IIIII'IIIII( 1I111111'~ 1\ 1II1II'I1''''~Il,I, I, WII ill'lI,l\lrlnllllll\l1'01l"'lllIl'i'PlllllllilIII'1I0( 1'1',hllllll\' "'\,III1I1I(,'III'IIII,IIIIIII'"~, 1111",11\"011'111'11 h".IIIII;;I'~' ,11111 1II1II,!I1'P\\"III11 hllih1\li~I'i hll'illllllol1" 1"'"I1'.IIIIIIIII,1I1'1I01Iil1 III \\'111111\1111111 ilnoll!,IIIl'I' II'lIh Ihl\ 1111111'1" ~. !'llflIIIV! WllllllfllIIII111111111111 1111; I lllhll/Nolll'1I IlIlh 1',111111\' 111'111 illI\' IIlhl" hlll'IIIIIIII'I'hi "'"1111 SI,'lllliIIl' illlilll1\1111II ~,1111\111H'III11\1, ",llIhl[,lllil~ 11I1'1I'i 11111((1"'11111(1111' 111\'1111'1 II( \hlh 11111111 hill'l' 11'111'111', I( 1111"" ,III' 1'11111'101 liI~ 1111'111\ 11I1I(f!'l'llIllIilhll nlllllll'\ 11111 "'11111'1111111 ill\lllllY lIill'cllllllfI\\', , , ' " ], (:lIIl1hlllh," 1',WIIII'IlIi! 1'1111 l'illl I'1III1hll1l1 \\'11111\11111 illl1Pllfllh (1'111111111111 IlIilll III1I1I1I11I1I11)'I'I'/IIIIIIIIIII'i IlInllllll 111 ,I ~llIlIlIl 1'111'11111111111 ' I!,wll nlllllll'y 1111111111111111 \\'lIlIIIIIlIlilill' 1'11111111111, hll\\'I'I'I'I, Sl'IIi\f,11I1IV 1lllIlillh' 11111 I'II!1I11IiO Ihll .1111111' l'ill'lIIl1l1lthilllh illIllI'"Ii1IIII'IIIIIII'h 111II1I1I!\'III'/IIIIIIIIIII, " ,. 'I.' 1l1111111111i1lIhl'I'III'<II1I1./I1III1' of Wllhlllllllllllll YOIIIIIII~I f1'IIIIrl 1:1I1/I'Wlhllll/<lIlIl'"( II'lthlloldlllll 11'1\1111 81111dlnl\ Ihll 1'111'11\11111, TlIII ' I'IIYlllllll/dlll1l o( 1I'1I111101dllll' Ih Ihlllllllll Oil wlllrll illlIlIllIIl WII~ wllhllll d (rollllhu 1'11111101'1'/"8 WIIIIII/., YIIIIIIIII~I rOlliI'll' II'lIh 111111,111' III 11111 slnlll o( Ihll OIllI'III\'I'U'8/0"II\III's 1IIIIIrll'nl 1'11\l'1' o( 1'111111111'1111I111 willi rllhpllrllu Ihl'l 11111 I'lIrlllll~ II'lIhlll wllldl 1'01l11l11h11i1l1'1I11111111111111 \\'lihhllldll1l1 onltn 111111 (OIwnllllhll hl'I'III'11 I'''yllllllll~, ' , fJ,' VIl111Inv~~/Phllllnl' wllh MIIIIII'h' HII1111l1l1lllllllhlllSI I( 1111111111. 1I11!111 IIIHII 111111 Pllltll/NolI(,lIto Wllhhold IlImlllll (ur SIII'I'Oll '(llilIIISI III Is, olllllloYIII'!ohlll\or i1Illl YoII nll'IIIIHhllllu lIonor nil 1111'1'011 DIIIIII/Null(,lIs Ilt,u lu rlll!IIr,,1 Of ~Iillu Wllllholdllmlllll1l5, yOIlIlIlI~1 III IIII' 1111110111' IIf 11111 hlnlll o( l'IIIIIIOYIIU'~/ol'liilOl'~ I'rlll\,lI'nl I'lnnl II( 111111'101'"11'"/, YIIIIIIIII~I hllllor nli (1Idllr5/NIIII('IIS 1i11l1ll1\1I'Hlllslll~II'"1 1'00slhll', (SilO N 111 hl.ln\\, , , , 1'" T~II"llIlIlInl1 Nnllfh:l1l1nm Y,OIlIllIlSII"OIl11'IIV 11l11l(y Ihll IIl1qllllslll111 AI\III1IY wlllln Ihll 1I1111'IIIYllll/ohlll\Of Is IInlOlll\lIr \\'olklllll (II' VOII, I'IIIHslI IIfIlI'IIIII 1I1111nfornlilll01llllllillllllll ill1d 111\\1111 iI ml'Y II( Ihls DlIlIII/NolII'o 10 Ihll AI\III1C:Y 11I1I1111(hlll,llIIlo\\', WITIH!OI.Il~II'H IIlI a31U1I33a1 (1 " ~MI'I.Ovr:WH/()IlI.ICH)II'S NAMr! IHUII'I'lm ,-AI,IIt>! IJ '--_ rMl'~oYWH CASI: 11l1:NTII'IVlh 3302100205 PAT I' ell' ~WAnATIONI_ ~AST KNOWN IIfJMV APfJnrsH, Nf;W f.MI'I,()Y~1l'6 NAMI!/AllfJllrSH!__ ?, 1.1I1lI1I SIIII1I"WIII~ntsl YOllllh1Y hll rnqlllfl.d 10 11I1'011 Hlld 11'11111101\1 (,olllllllill' SIIIII I"lylllllllls ~1I('h I" hOIlIlIOI, ('Olllllllsslolis, or SIlI'III,II1('O I'ny, I( YIII' hllVll ,1111' (1IInsllulI~ nllllllllllll11' 51111I I'nYIIIIIIII~, (,(lIlliKllhu I'III~1I11 II/' lII!1hollly holo\\', /I, ,PllhllllVI I( VOII (nil 10 wlllll\llld Inmlllll nS II'" Oldllr/NolIll1 dlrorls, 1'011 nlO IInhli. 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