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IN THE COURT OF COMMON
PLEAS
OF
CUMBERLAND
COUNTY
STATE OF
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PENNA,
DEBORAH WHlTCmlll,
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98 - 6742 CIVIL I~
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DOUGLAS K, WlIITCO)1B,
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DECREE IN
DIVORCE
AND NOW,. .v.'1.V'\9J ~rl 19 yt.y.. it is ordered and
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decreed that ...
Deborah Whitcomb
. . . . . . . . . . . . , . . . '. plaintiff,
. . . . . . . . . . . . . '. defendant,
and.. . . . . . . . D?u~Ias. K... Whlt~o:nb . . . . . . . . . .
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are divorced from the bonds of matrimony.
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The court retains jurisdiction of the following claims which have
been raised of record in this action for which a final order has not yet
been entered; None
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...... .The. at.ta.ch.e.d .Prope.rty. .S.ettl.e,me.nt. .Agr:eeme"t.i~ .her:eby' .~,,~o~p'~~q~~4,.. .
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Attest:
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PROPF.RTY SF.TILF.;\IENT AGRF.EMF.NT
THIS AGREEMENT, made this.J'f..tL day of ~Jf ' 1999. by and
between DOUGLAS K, \VHITCOMB, hereinafter called "H~band' ,and DEBORAH
WHITCOMB. hereinafter called "Wife",
WITNESSETH:
WHEREAS, Husband and Wife were legally married on June II. 1983;
WHEREAS. two children, Matthew D, Whitcomb, date of birth October 29, 1990, and Erin
L, Whitcomb, date of birth May 6, 1987, were born of this marriage;
WHEREAS, differences have arisen between Husband and Wife in consequence of which
they desire to live separate and apart from each other; and
WHEREAS, Husband and Wife desire to settle and detennine their rights and obligations.
NOW THEREFORE, in consideration of the premises and covenants contained herein, it is
agreed by and between the parties hereto that:
1. SEPARATION,
It shall be lawful for each party al all times hereafter to live separate and apart from each
other at such place as he or she from time to time shall choose or deem fit, The foregoing provision
shall not be taken as an admission on the part of either party of the lawfulness or unlawfulness of
the causes leading to their living apart,
2, INTERFERENCES.
Each party shall be free from interference. authority and control by the other, as fully as ifhe
or she were single and unmarried, except as may be necessary to carty out the provisions of this
Agreement. Neither party shall molest or attempt to endeavor to molcst the other, or in any way
harass or malign the other, nor in any other way interfere with the peaceful existence, separate and
apart from the other, Each of the panies hereto completely understands and agrees that neither shall
do or say anything to the children of the parties at any time which might in any way influence the
child/children adversely against the other party,
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3, IlIVISION OF REAl. PROPERTY.
lIu.sband agrc:es to trnnsfer all his right, title and interest in and to the real esUte situated at
23 Winebeny Drive, Mechaniesburg, Cumberland County, Pennsylvania. now titled in the name of
Husband and Wife and agrees to immediately execute now or in the future any and all deeds,
documents or papers necessary to effect such transfer of title upon request, Husband further
acknowledges thaI he has no claim, right, interest, or title whatsoever in said propeny and further
agrees never to assert any claim to said property in the future. Said transfer shall be effective
immediately and shall be binding regardless of the marital SUlUS of the parties,
Wife agrees that within sL'<ly days of the date of this Agreement, to complete a refinancing
of the first mot1gage and home equity loan thereby releasing obligations Husband may have on the
said real eSUle,
4. EQUITABLE DISTRIBUTION.
In addition to the transfers of monies from Wife's 401(k) account. more particularly set
forth in Paragraph 8 hereof, Wife shall pay to Husband in the form of equitable distribution, the sum
of$19,089,23, The said amount shall be paid at the time of Wife refinances the marital residence,
5, DMSION OF PERSONAL PROPERTY.
The parties have divided between them to their mutual satisfaction, personal effects,
household goods and furnishings and all other articles of personal property which have heretofore
been used in conunon by them, and neither party will make any claim to any such items which are
now in the possession or under the control of the other, Should it become necessary, each party
agrees to sign any title or documents necessary to give effect to this paragraph, upon request,
6, ADVANCED EDUCATION.
The parties agree that they shall be responsible for the college education expenses of their
children including, but not limited to, room, board, tuition, fees and books in the proportion that
their incomes bear to each other at the time the expense is generated on an annual bases, The
contribution of the parties shall be established after deducting all grants, loans or scholarships
secured by the individual child.
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7, ASSUMPTION OF OEnTS,
Wife shallllSSume sole responsibility for the Americhoice IBM Visa with an approximate
balance of S3,8oo,OO and the Traveler.; Visa with an approximate balance ofS330.oo, Wife shall
indemnity and hoid Husband harmless on the said debts,
8. PENSION/40HKlllRA PLANS.
Husband has an IRA with Salomon Smith Bamey and a 401(k) Plan with Morrison
Knudsen Corporation and Wife has a 401(k) Plan with GIa."(oWellcome. As an additional payment
on equiUlble distribution, Wife agrees that she will trnnsfer from her GaxzoWeJlcome 401(k)
account to Husband's Morrison Knudsen Corporation 401(k) retirement savings plan, the swn of
S25,173.33, After the said transfer, which shall be accomplished by a Qualified Domestic Relations
Order, each party shall retain as their sole and separate property, the retirement type plans
previously mentioned herein.
9. MOTOR VEHICLES,
Wife shall continue to retain use of the leased 1998 Ford Taurus (her company vehicle) and
Husband will retain as his sole and separate property, the leasehold interest in the 1997 Honda
Passport.
10, LIFE INSURANCE.
Each of the parties shall name their minor children, Matthew D, Whitcomb and Erin L.
Whitcomb, as equal beneficiaries on life insurance, Wife shall cany a life insurance policy on her
life with a death benefit balance of at least $100,000,00, Husband shall cany a life insurance policy
on his life with a death benefit balance of at least $50,000,00. In the event of the death of either
party, should either of the children be under the age 01'21 at the time of the parent's death, Wife's
sister, Marion Fedor.;hak, shall be named as trustee of the funds designated to the minor children.
The designation of Marion Fedorshak as trustee shall be reflected in any insurance beneficiary
designation on either party's policy, The beneficiary designation for the children shall be
irrevocable, Husband and Wife cannot cancel the said policies nor borrow against the cash value if
any, Each pany shall provide the other with evidence of compliance with this paragraph within
sixty (60) days of the date of this Agreement.
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11, BANK ACCOUNTS,
Either pany shall relnin as their sole and separate propcny, bank accounts in their individual
names, The panies shall take steps necessary to close any joint accounts and divide any funds
retained in said accounts equally,
12, TAX ON PROPERTY DIVISION,
Husband hereby agrees to pay all ineome taxes assessed against him, if any, as a result of
the division of the property of the panies hereunder. Wife hereby agrees to pay all income taxes
assessed against her. if any, as a result of the division of the property of the parties hereunder.
13, BREACH.
If either pany breaches any provision of this Agreement, the other party shall have the right,
at his or her election, to sue for damages for such breach, The pany breaching this contract shall be
responsible for the payment of legal fees and costs incurred by the other in enforcing his or her
rights under this Agreement, or seeking such other remedy or relief as may be available to him or
her.
14. FULL DISCLOSURE,
Husband and Wife each represent and warrant to the other that he or she has made a full and
complete disclosure to the other of all assets of any nature whatsoever in which such pany has an
interest of every type whatsoever. It is further warranted and represented that each of the parties
have made a full and fair disclosure to the other of all relevant facts relating to the subject matter of
this Agreement
15, ADDITIONAL INSTRUMENT.
Each of the parties shall on demand execute and deliver to the other any deeds, bills of sale,
assignment, consents to change of beneficiary on insurance policies, tax returns and other
documents and do or caused to be done any other act or thing that may be necessary or desirable to
the provisions and purposes of this Agreement. If either pany fails on demand to comply with this
provision, that pany shall pay to the other all attorneys' fees, costs and other expenses reasonable
incurred as a result of such failure,
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16,
WIFE'S DF.nTS,
Wife represents and Wafr.ll1ts to Husband that since the panics' separation she has not and in
the future she will not contract or incur any debt or liability for which Husband or his estate might
be responsible and shall indemnify and save Husband harmless from any and all claims or demands
made against him by reason of debts or obligations incurred by her,
17. HUSBAND'S DEBTS.
Husband represents and warrants to Wife that since the parties' separation he has not and in
the future he will not contract or incur any debt or liability for which Wife or her estate might be
responsible and shall indemnify and save Wife harmless from any and all claims or demands made
against her by reason of debts or obligations incurred by him,
18. WAIVERS OF CLAIMS AGAINST ESTATES.
Except as herein otherwise provided, each party may dispose of his or her property in any
way, and each party hereby waives and relinquishes any and all rights he or she may now have or
hereafter acquire, under the present or future laws of any jurisdiction, to share in the property or the
estate of the other as a result of the marital relationship, including without limitation, dower, curtsy,
statutory allowance, widow's allowance, right to take in intestacy, right to take against the Will of
the other, and right to act as administrator or executor of the other's estate, and each will, to the
request of the other, execute, acknowledge, and deliver any and all instruments which may be
necessary or advisable to carry into effect this mutual waiver and relinquishment of all such
interests, rights and claims,
19. REPRESENTATION,
It is recognized by the parties hereto that Deborah Whitcomb is represented by John J.
Connelly, Jr" Esquire, and Douglas K. Whitcomb is unrepresented by counsel and has the right to
have this Agreement reviewed by an attorney of his choosing, It is fully understood and agreed that
by the signing of this Agreement, each party understands the legal impact of this Agreement and
further acknowledges that the Agreement is fair and reasonable and each party intends to be legally
bound by the terms hereof.
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20, VOLVNT Any EXEClrrJON.
The provisions of this Agreement are fully understood oy bOlh plllties and each party
acknowledges that this Agreement is fair and equiUlble, that it is being entered into voluntarily and
that it is not the result of any duress or undue influence,
21. ENTIRE AGREEMENT.
This Agreement contains the entire understanding of the panies and there are no
represenUltions, wlUTalltics, Covenants or undertakings other than those expressly set forth herein,
22, PRIOR AGREEMENT,
It is undcrstood and agreed that any and all property settlement agreements which mayor
have been executed prior to the date and time of this Agreement are null and void and of no effect.
23. MODIFICATION AND WAIVER.
Any modification or waiver of any provision of this Agreement shall be effective only if
made in writing and executed with the same formality as this Agreement. The failure of either party
to insist Upon strict performance of any of the provisions of this Agreement shall not be construed as
a waiver of any subsequent default of the same or similar nature,
24. GOVERNING LAW.
TItis Agreement shall be govemed by and shall be construed in accordance with the laws of
the Commonwealth of Pennsylvania.
25. INDEPENDENT SEPARATE COVENANTS,
It is specifiCally understood and agreed by and between the parties hereto that each
paragraph hereof shall be deemed to be a separate and independent covenant and agreement.
26. VOID CLAUSES.
If any term, condition, clause, or provision of this Agreement shall be determined or
declared to be void or invalid in law or otherwise, then only that term, condition, clause or provision
shall be stricken from this Agreement and in all other respects this Agreement shall be valid and
continue in full force, effect and operation.
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27, ENTRY AS PART OF DECREE.
It is the intention of the parties that this Agreement shall survive any action for divorce
which may be instiluted or prosecuted by either party and no order, judgement or decree of divorce,
temporary, final or pennanenl, shall affect or modify the linancialterms of this Agreement, This
Agreement shall be made a part of, but shall not merge with, any such judgment or decree of final
divorce,
28. DIVORCE ACTION.
The parties shall, at the time of the execution of the Agreement, execute documents
necessary to finalize the divorce action including, but not limited to, the withdrawal of any claims
pending under said action, indexed to number 98.6742 Civil, in the Coun of Common Pleas,
Cumberland County, Pennsylvania. as well as Affidavits of Consent and Waivers of Counseling and
Waivers of Notice of Intention to Request Entry of a Divorce Decree, Counsel for Wife shall
promptly transmit the Praecipe and secure a final Decree in Divorce fonhwith,
29, DOMESTIC RELATIONS CODE OF THE COMMONWEALTH OF
PENNSYLVANIA.
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Except as specifically provided in this Agreement, each party waives any claim they may
have against the other under the Domestic Relations Code of the Commonwealth of Pennsylvania
including, but not limited to, alimony, alimony pendente lite, counsel fees, costs and equitable
distribution of marital property.
IN WITNESS WHEREOF, the parties hereto, intending to be legally bound hereby, have
hereunto set their hands and seals the day and year first above written,
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Douglas K;~whitcomb
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Deborah Whitcomb
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COMMONWEAL111 OF PENNSYLVANIA
55,
COUNTY OF DAUPHIN
On this, the f.lic day of ~ J ; I J.. , 1999, before me, a Notary Public,
personally appeared Douglas K. Whitcom ,kno\v6 to me to be the person whose name is
subscribed to the within Property Settlement Agreement and acknowledged that he executed the
same for the pwposes therein contained,
IN WITNESS WHEREOF, I hereunto set my hand and official seal,
SfA/Ui&' ~ll ,~)
I. NOTM PUB IC
COMMONWEALTH OF PENNSYL VANIA
NOTARIAL SEAL I
~EAN L KOSIER. Nor,ro,r/ Public
CIty 0' H&rn~:ulg. o.'tlj),~ln C~unry
I.-ty Ccm~ru"::.;Jn E;tCiI:'.~'l tlO'l. 29. 1999
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COUNTY OF DAUPHIN
On this, the.EL day of 'Q I .ll.ff ' 1999, before me, a Notary Public,
personally appeared Deborah Whitco~~, knoJh to me to be the person whose name is subscribed
to the within Property Settlement Agreement and acknowledged that she executed the same for the
pwposes therein contained,
IN WITNESS WHEREOF, I hereunto set my hand and official seal,
01 f} /luJ..R" d' lI'~ h J
ONOTAR~
NOTARIAL SEAL
JEAN L, KOSIER, NOI"'Y Pub/'",
Ciry of Ham~burg. Dauphin County
MyCOmmi,:::;on E:o:::rr,:, ~lov. 29.1999
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IN TilE COllin OF COMMON I'LEAS
ClJl\1JlEI~LANJ) COlINTY.I'ENNSYl.V ANIA
v,
NO, 9H 6742 CIVIL
nOUGLAS J{, WIIITCOMII.
J)efendant
CIVIL ACfION - LA W
IN U1VOIKE
I'I~AECII'E TO TI~ANSMIT IU:COIU>
To the Prothonotary:
Transmil the record, togcther with the following infonnation, to the Court for entry of a
Divorce Decrec:
I, Ground for divorce: irrelrievable breakdm\n under Section (XX) 3301(c) ()
3301(d) of the Divorce Code,
2, Date und manner of service of the Complaint: December II, 1998 by certified mail
no, 1'461 910449,
Complete either paragraph (a) or (b),
(a) Date of execution of the Affidavit of Consent and Waiver of Counseling
required by Section 3301(c) of the Divorce Code: by Plaintiff: July 18, 1999; by Defendant: July
18,1999
(b) (I) Date of execution of the Plaintiffs Affidavit required by Section 3301(d) of
the Divorce Code:
(2) Date of service of the PlaintifPs Affidavit upon the Defendant:
4, Related claims pending: All claims of record have been resolved and settled pursuant to
a Property Settlement Agreemenl dated July 8, 1999,
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DEBORAH WHITCOMB,
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO, 'it- t, 7 fJ-
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DOUGLAS K. WHITCOMB,
Defendant
CIVIL ACTION. LAW
IN DIVORCE
NOTICE
You have been sued in Court, If you wish to defend against the claims set forth
in the fol/owing papers, you must take prompt action, You are warned that if you fail
to do so, the case may proceed without you and a Decree in Divorce or annulment
may be entered against you by the Court, A jUdgment may also be entered against
you for any other claim or relief requested in these papers by the Plaintiff, You may
lose money or property or other rights important to you, including custody or visitation
of your children.
When the ground for the divorce is indignities or irretrievable breakdown of the
marriage, you may request marriage counseling, A list of marriage Counselors is
available in the Office of the Prothonotary at the Cumberland County Court House,
One Courthouse Square, Carlisle, Pennsylvania,
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY,
LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED,
YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE, IF YOU DO
NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, Pennsylvania 17013
Phone: (717) 249-3 1,66 G.' G'.~
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John \), Con Jlll/y, Jr" Esquire
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WHEREFORE, the Plaintiff roquests tho COllrt to on tor a Decree:
a. dissolving the marriage between the Plaintiff and Defendant;
b. equitably distributing all property owned by the parties herete; and
c. for such further relief as tho Court may determine equitable and just.
JAMES, SMITH, DURKIN & CONNEllY
Date: (\\'.I'(I'i'~:
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By:
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Attorney" for PI~intiff ) J
Post Office-Box 650 ,____
Hershey, PA 17033
(717) 533-3280
PA I.D, No, 15615
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O~I~I"'AL. "LID IN 'HII ACTION
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DEBORAH WHITCOMB.
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v,
NO. 98-6742 CIVIL
DOUGLAS K, WHITCOMB,
Defendant
CIVIL ACTION. LAW
IN DIVORCE
AFFIDAVIT OF SERVICE
COMMONWEALTH OF PENNSYLVANIA
: ss,
COUNTY OF DAUPHIN
AND NOW, thi$Jlf /. day o~UW.J)t{k"~)
, 1998, personally appeared
before me, a Notary Public in and for the State and County aforementioned, John J,
Connelly, Jr" Esquire, who, being duly sworn according to law, deposes and says that
a copy of the Complaint in Divorce was served on the Defendant. Douglas K,
Whitcomb, on December 11,1998 by certified mail number P 461910449,
addressee only, return receipt requested, as evidenced by the return receipt card
attached hereto and made a part hereof,
Sworn to and subscribed
before me this ,~ q it.;
day OfYJUIP./fJt~~.1998'
, , ,-'P.I50U Ju
I Notary Public \
r'JOT Ar~IAL SEAL
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UEIIOItAII WIIITCOMIJ,
1'laintiiT
IN TilE couln OF COMMON PLEAS
CUMUEI{LAND COUNTY, PENNSYL VANIA
v.
NO.6IHiI1l9!l, (/;' ~,'!'/~
DOUGLAS K. WHlTCOM/J,
Defendant
CIVIL ACTION - LAW
IN I)IVORCE
PLAINTIFF'S AFFIDAVIT Of CONSENT ANI> WAIVEI{ OF COUNSELING
I. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on
November 30, 1998, and served on December II, 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 ofIntention
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 Prolhonotary'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 I
participate in counseling prior to u divorce decree being handed down by the Court,
I verify that the statements made in this Affidavit arc 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:
1'/ -lY - qq
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Deborah Whitcomb, Plaintiff
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DEBORA II WII/TCOMIl.
!'Iainliff
v.
IN TilE COIJ/rr 0,.. COMMON I'LEAS
ClJl\fIIEHLAND COUNTY, I'ENNSYL VANIA
NO,612S1999 (/J"t,.'/'f),
DOUGLAS K, WHITCOMB.
Defendant
: CIVIL ACTION. LA W
: IN I>JVOI~CE
WAIVER OF NOTICE OF INTENTION TO RE UEST ENTRY
OF A f)JVORCE DECREE UNDER' 3301 c OF TilE f)JVonCE CODE
/, I consent to the entry of a final Deeree ofDivoree without notice,
lawyer's fees or expenses if I do not claim them before a divoree is granted,
2, / understand that / may lose righlS conceming alimony, division of property,
3. / understand that I will not be divorced until a Divorce Decree is entered by the
Court and that a copy of the Decree will be sent to me immediately after it is filed with the
ProthonotaJy.
/ verity that the statements made in this Allidavit are true and correct. / understand that
false statements herein are made subject to the penalties of 18 Pa. C,S,A. Section 4904, relating to
unsWom falsification to authorities.
Date: 1-jJ - 19
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Plalntirr
IN TilE COlJlU OF COMMON I'LEAS
ClJl\lIlEI{LAND COUNTY, I'ENNSYL VANIA
NO.~f~-S-1999 9 (' . I:. 1'/).,
v.
DOUGLAS K. WHlTCOMII,
Defendant
CIVIL ACTION - LAW
: IN DIVORCE
WAIVER OF NOTICE OF INTENTION TO REOUEST ENTRY
OF A DIVORCE DECREE UNDER' 330/(e) OF THE DIVORCE CODE
I. I consent to the entl)' of a final Decree of Divorce without notice,
2, I understand that I may lose rights concerning alimony, division of property,
lawyer's fees or expenses if I do not claim them before a divorce is granted,
3. I understand that I will not be divorced until a Divorce Decree is entered by the
Court and that a copy of the Decree will be sent to me immediately after it is filed with the
Prothonotary.
I verifY that the statements made in this Affidavit are true and correct. I understand that
false statements herein are made subject to the penalties of 18 Pa, C.S,A. Section 4904, relating to
unsworn falsification to authorities,
Date: IJ -18-99
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l'lalntlff
IN TilE COlJlU OF COMMON I'LEAS
CllMIlERLANI> COUNTY. I'ENNSYL VANIA
v,
NO. 98 6742 CIVIL
DOUGLAS K. WIIITCOMII.
Uefendant
CIVil, ACTION - LAW
IN J}IVORCE
PJ{AF.CIPF. TO WITlII>RA W CLAIM
TO THE PROTHONOTARY:
Please withdraw the claim for Equitable Distribution in the above-captioned divorce action,
Date: '1-1 g - 9'7
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STATE OF PEmlSYLVANI.-I.
SS:
IN THE: CUMBERLAND COUNTY COURT
OF COMMON PLEAS
COUNTY OF CllMBERLAND
IN RE: THE M21.RR!.ll.GE OF
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DEBORAH WHITCOMB.
Petitioner.
DOUGLAS K. WHITCOMB,
Respondent,
QUALIFIED DOMESTIC RELATIONS ORDER
CONCERNING BENEF!TS ONDER
~~~O WELLCOME 401(k) ?~~~
Upon consideration of the oarties' Motion for Encrv
of a Qualified Domescic Relations Order Concerning Benefits -
Under the Glaxo Wellcome 401 (k) E'lan, the Common Pleas ,
Court for Cumberland County, Pennsylvanu hereby
orders as follows:
E'Jl.RT I - FINDINGS OF FACT
The Court makes the fOllowing findings of fact:
A. Definitions.
For purposes of this Order, the folLowing terms
shall have ~\e respective meanings set forth below, unless a
different meaning is plainly required by the context:
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1.
Alternate Payee shall mean the spouse, former
sPOuse, cnl"d or other dependent of the Participant
who ~s recogni~ed by this Order as having the right
speci~ied in this Order to receive all, or a portion
of, the bene~its payable under the Plan with respect
to the Participant pursuant to section 414 (p) (8) of
the Internal Revenue Code of 1986, as amended (the
"Code") and section 206(d) (3) (K) of the Employee
Retirement Income Security Act of 1974, as amended
("ERISA"). The Alternate Payee named in this Order
shall be considered a beneficiary under the Plan for
purposes of any prOVision of ERISA,
The only Alternate Payee recognized by this Order is
Dou~Ias K, Whitcomb
Date of Birth: November 22, 1956
;
Social Security N'wnber; 202-46-6551
;
Mailing Address: 2902 Chesterbrook Ct. Apt, 211
Camp Hill, PA 17011
;
Relationship to PartiCipant: Former Spouse
2, Alternate PaYee's Account(s) shall mean the Tax-
Deferred Account, Matching ACcount, Voluntary
Account (if any), and Rollover Account (if any)
established and maintained on behalf of the
Alternate Payee pursuant to the terms of this Order
to which shall be transferred (respectively) the
cortion of the Particioant's Tax-Deferred Account,
MatChing Account, VOluntary Account (if any), and
ROllover Account (if any) specified in this Order.
3, Alternate PaYee's Benefit or Benefit shall mean the
portion of the PartiCipant's benefit under the Plan
that is assigned to the Alternate Payee pursuant to
Part rr,A.l., below,
4,
PartiCipant shall mean Deborah WhItcomb
Date of Birth: October 10, 1954
Social Security N'wnber:
;
188-46-0561
;
Mailing Address: 23 Wineberry Drive
MechanIcsburg, PA 17055
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5. ~ shall ~ean the Glaxo ~ellcome 40l(K) Plan.
6,
All Other Caoitali:ed Ter~s, Any other capitalized
tar~ used l~ thlS Order shall have the meaninq
asslqned to the capltali:ed term by the Plan,
tInder the Plan.
,
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a,
The following information is current as of September 30, 1998.
(Consult parties for date to be used here,)
1. rnformation Regarding the particioant:
The Participant (check one and provide the
appropriate information):
[xl (a) has been a participant in the Plan since
, and was actively
employed by the Employer on the date
specified above; or
(b) was a participant in the Plan from
to , and
was not participating in the Plan on the
date specified above.
2, The ?articioant's aenefit tInder the Plan:
As of the date specified above, the Participant's
total Account balance under the plan was
S 65,470,00 (The total Account balance is
determined as of the Plan Valuation Date preceding
the above date (unless that date is a Plan Valuation
Date, in which case the Account balance is
determined as of that date) and does not include
contributions after the Valuation Date.)
3. The Participant (check one and provide the
appropriate information)
had taken a loan from the Plan and
outstanding balance of S
of the date specified above; or
[ X] (b) had no outstanding loan from the Plan as
of the date specified above.
[ J
owed an
as
(a)
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Par: II - DiscOsition o~ Participant's Benerit Under the Plan
Based on the above rindings or fact, the Court
approves the Participant's assignment of a portion or his/her
~q~' -~=QRt benefits to the Alternate Payee and hereby orders
tho Plan to pay the Alternate Payee as follows:
A. Division of the Participant's Benefit Under the Plan.
1. Amount of the Particioant's Benefits Assigned to the
Alternate Pavee:
The Participant hereby assigns to the Alternate
Payee $25.l73,33 ~x'llltxm~~t~ of the
Participant's Accounts under the Plan as of
Seotember 30, 19q~ (specify date); prOVided that the
amount assigne to the Alternate Payee shall not
exceed the value of the Participant's Accounts as of
the date the Alternate Payee's Benefit is trans-
ferred to the Alternate Payee's Accounts, This
amount shall be withdrawn on a pro rata basis from
each of the Participant's Accounts and pro rata from
each Investment Fund in which each Account rs--
invested, other than the Loan Fund, as of the date
specified above, and shall be disposed of as
specified below.
2, Investment Rights of the Alternate Payee:
(a) The amount assigned to the .~ternate Payee
pursuant to Part II,A.l, of this Order shall be
held in the Alternate Payee's Accounts.
(b) Until the Committee determines, pursuant to the
Plan, that this Order is a Qualified Domestic
Relations Order, the amounts held in the
Alternate Payee r s Accounts shall remain.
invested in the Investment Funds in which such
amounts were invested immediately before the
transfer to the Alternate Payee, After the
Committee determines that this Order is a
Qualified Domestic Relations Order, the
Alternate Payee shall have the same investment
rights as are provided to the Participant under
the terms of the Plan.
(cl The value of the Alternate Payee's Accounts
shall reflect the current fair market value and
the gains, losses, income, and expenses of the
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!nve~tmon~ Funds to which such Accounts are
allocated.
3. Form and ':i.mlna of Dist::i.bution to Alternate Pavee.
(a)
The Alternate Payee shall be eligible to
receive hts/her Benefit in any form that is
available to the Participant under the terms of
the Plan at the time the Alternate Payee elects
to receive his/her Benefit.
(b)
The Alternate Pavee mav elect to receive the
balance i.n his/her Accounts on or after the
date on which the Participant attains "earliest
retirement age" as defined in section
4l4(p) (4) (B) of the Code, A Participant's
"earliest retirement age" under the Plan is the
first to occur of the following two dates: (i)
the Participant's termination of employment or
(ii) the Participant's attainment of age 50.
In no event may the Alternate Payee elect to
receive the balance in his/her Accounts later
than the first to occur of the following two
dates: (y) the date on which the Participant
attains age 65 or (z) the date on which the
Committee receives written notification of the
Participant I s death together with any other .
information or documents that the Committee may
deem necessary or appropriate.
(c) Alternatively, the Alternate Payee may elect to
receive a single lump-sum distribution of
his/her Benefit immediately following the date
as of which the determination that this Order '
is a Qualified Domestic Relations Order becomes
final, during the period and pursuant to the
terms set forth in Section 9,7(c) of the Plan
or any successor provision thereto.
(d) If, as of the date the determination that this
Order is a Qualified Domestic Relations Order
becomes final, the value of the Alternate
Payee's Benefit is not more than $3,500, such
payment shall be made as soon thereafter as
practicable,
(e) The Committee shall distribute the Alternate
pavee's Benefit, determined as of the
Date that next follows the Alternate Payee's
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elected or r~quired payment date, within 90
days a!ter the applicable Valuation Date,
4, Pa'r.nent of Benefits Aft~r Alternate pavee's Death.
(al The Alternate Pay~e may designate a beneficiary
to receive any portion of his/her Benefit that
remain~ unpaid at the time of the Alternate
Payee's death.
The Alternate pavee's designation of a
beneficiary shall not be effective unless it is
made in writing, in a form and manner that is
acceotable to the Committee, and shall not be
effective until and unless received by the
Committee during the Alternate Payee's life.
(b)
(c)
(d)
The Alternate Payee's beneficiary shall be
entitled to a lumo sum distribution of the
Alternate Payee's' Benefit determined as of the
Valuation Date coincident with or next
following the date upon which the Committee
receives written notification of the Alternate
Payee's death together with any other
information or documentation that the Committee
determines to be necessary or appropriate. The
Committee shall distribute the Alternate
Payee's Benefit to his/her beneficiary within
90 days of the foregoing Valuation Date.
If the Alte~ate Payee dies before receiving
his/her benefit and without having designated a
beneficiary, or if no person or entity so
designated survives the Alternate Payee, the
Alternate Payee's Benefit shall be paid to
his/her estate,
5, Pavment of Benefit After Particioant's Death.
The Alternate Payee's right to receive his/her
Benefit pursuant to the terms of the Plan and Part
II,A, of this Order shall not be altered in any way
(neither increased, decreased, amended, nor
terminated) as a result of the Participant'S death,
PART III - Understandings and Conditions.
The assignment of a portion of the Participant's
benefits to the Alternate Payee and the payment of benefits to
- 6 -
the Alternate Payee pursuant to this Order shall be subject to
the following understandings and conditions:
A, Remarriage, The subsequent remarriage of either party
shall not affect the disposition of benefits described in
Part II of this Order,
B, Death Benefits, Except as otherwise provided in this
Order, death benefits shall be awarded in accordance with
the terms of the Plan.
C.
Name and Address, The Participant and the Alternate
Payee, respect~vely, shall advise the Committee in
writing of any changes in his/her mailing address or
legal name as set forth in Part I.A" above.
D,
Qualified Domestic Relations Order. Nothing contained
herein shall be construed to require the Plan or the
Committee:
(1) To provide any type or form of benefit, or any
option, not othe~Nise provided under the Plan;
(2) To provide increased benefits determined on the
basis of actuarial value; or
(3) To provide benefits to the Alternate Payee that are
required to be paid to another alternate payee under
another order previously determined to be a
qualified domestic rela~ions order.
E,
copy of this Order shall be
as soon as practicable after
Coo v to Committee, A true
delivered to the Committee
the Order is enter~~
IT IS SO ORDERED this~ day of
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Alternate Payee
of the Cumbe and co,Court
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('lVII, M""llIN LAW
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VB.
IN /lIVORC~:
Dill,') it).;' k
lA/III Ii', 1/ \.S
lie lelldilnt.
~.9TIC~_...:!:O 1lr;5UHE -"JllO!~_ 5UIINAHE
Notice is hereby given lhill the Plainlifff/lefendanl in the
above matter, having been grant.ed a ~'inaI Decree in Divorce on the
.JJ___ day of__,-.iJ~:'i:!:_c: I: _ ' 19 ?!..,' hereby elects to resume the
prior surname of ______ [)L~{:>I:.4dL_ li-[)(c?:::.fiAf<:-._________, and gives
this written nolice pursuilnl lo the provisions of 54 1'.5. S 704,
DM'E:
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/~./-+-t,0J.JLuf~~____u
Signature
A{'-&,~_:J-~~t..~~_
Signature of flame be.ing resumed
COMMONWEALTH OF PENNSYI,vANIA:
COUNTY OF CUMBERl.AND
On the .,M_ day of __()_~ ' ~~OOI, before me, iI
Nol.ury Public, personal.ly ilPPCiJ-;((~d the id)()vc ilffIiJnt' known to me to
he the person whose flalTle i~ subscribed to the within document and
ilcknowledged that he/she executed I.he foregoing for the purpose
therein contained.
55,
scal..
1n WilrH~!;S When~or.
fldve II(~ret.Jnt:o ~;cl my fwnd and offieial
(J1aM)Jf~R,~b-~
Notary Public
NOTARIAL SEAL
ClAUOIA A. BREWBAKER, NOTARY PUBLIC
Carlisle BolO, Cumberland Counly
My Commission Expires April 4, 2005
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