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IN THE COURT OF COMMON PLEAS
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OF CUMBERLAND COUNTY
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GORDON DEAN OSBOURN, Plaintiff
STATE OF
PENNA.
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404 Allendale Way; Camp Hill, PA 17011
No.
00 - 6562
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VERSUS
PATRICIA JEANNE OSBOURN, Defendant
362 Woodland Road; Madison, NJ 07940
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DECREE IN
DIVORCE
AND NOW,
<Iud; u r , Z4'61 , IT IS ORDERED AND
GORDON DEAN OSBOURN
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DECREED THAT
, PLAINTIFF,
PATRICIA JEANNE OSBOURN
AND
, DEFENDANT,
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ARE DIVORCED FROM THE BONDS OF MATRIMONY.
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;
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PaNt
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PROTHONOTARY
BY THE COURT: i
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IN THE COURT OF COMMON PLEAS OF THE JUDICIAL DISTRICT
OF PENNSYLVANIA COUNTY CUMBERLAND
GORDON DEAN OSBOURN
Plaintiff
vs.
PATRICIA JEANNE OSBOURN
Defendant
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CIVIL ACTION - LAW
CASE NO. 00 - b~ b"2.
IN DIVORCE
MARITAL SETI'LEMENT AGREEMENT
TIllS AGREEMENT made and entered into this the..!l.. day of \let.{ "1 ~E-rt-, 1.. 0 00 ,
between GORDON DEAN OSBOURN residing at 404 AlIendaIe Way; Camp Hill, Pennsylvania
1701 I and PATRICIA JEANNE OSBOURN who resides at 362 Woodland Road; Madison, New
Jersey 07940.
WHEREAS we were married to each other at Medaryville, Indiana on December 24,
1980 and lived as husband and wife until such time as we separated on June 1, 1998; and
WHEREAS a pennanent breakdown of the marriage has arisen between us and we are
now living separate and apart from each other; and
WHEREAS there are no wunarried children under the age of eighteen years born to or
adopted by the parties and none is expected.
WHEREAS we now intend, by this agreement, to make a final and complete settlement
of all of our rights and obligations concerning spousal support, division of property and debts, the
care, custody, control, access to and support of our minor children; and
WHEREAS the parties hereto warrant and declare under penalty of peJjury that the assets
and liabilities divided in this agreement constitute all their marital assets and liabilities, and
further that in the event that the division of their assets and debts is unequal, the parties do hereby
declare that they knowingly and intelligently waive an equal division of their marital estate; and
WHEREAS in consideration of the premises and mutual promises and oodertalcings
herein contained, and for other good and valuable consideration, the parties agree to the
following:
I. THE PARTIES AGREE to live separate and apart from the other ~, free from any .
control, restraint or interference, direct or indirect by the other party, and In all respects to hve as
if he or she were sole and wunarried. .
II. DIVISION OF PROPERTY: We agree to divide the property of our mantal estate as
follows:
l. PATRICIA JEANNE OSBOURN T....n.fers to GORDON DEAN OSBOURN as
A. -- --.-. d PATRICIA JEANNE OSBOURN is divested of aU ri~t.
ole and senarate oropenv an. .
mIe. and interest in and to the follow/D9 oropertv.
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Household Furniture, ete. All household furniture, furnishings, fixtures, goods,
appliances, and equipment in the possession of or subject to the sole control of
GORDON DEAN OSBOURN.
Clothing, ete. All clothing, jewelry, and other personal effects in the possession
of or subject to the sole control of GORDON DEAN OSBOURN.
Cash. All cash in the possession of or subject to the sole control of GORDON
DEAN OSBOURN.
Cheeking Aeeounts. All checking accounts at all banks or other financial
institutions which stand in GORDON DEAN OSBOURN's sole name or from
which GORDON DEAN OSBOURN has the sole right to withdraw funds.
Credit Union Aeemmts. All credit union accounts at all credit unions which
stand in the sole name of GORDON DEAN OSBOURN or from which GORDON
DEAN OSBOURN has the sole right to withdraw funds:
Certifieates of Deposit. All certificates of deposit at all banks or other financial
institutions which stand in the sole name of GORDON DEAN OSBOURN or
from which GORDON DEAN OSBOURN has the sole right to withdraw funds.
Life Insurance. All policies of life insurance insuring the life of GORDON
DEAN OSBOURN.
Employment Benefits. All swns and all rights related to any profit sharing plan,
retirement plan, pension plan, or like benefit program existing by reason of
GORDON DEAN OSBOURN's past, present, or future employment and not
otherwise awarded to P A TRIClA JEANNE OSBOURN in this agreement.
2. GORDON DEAN OSBOURN Transfers to PATRICIA JEANNE OSBOURN as
sole and separate property, and GORDON DEAN OSBOURN is divesteci of aU right, title,
and interest in and to the following property:
Household Furniture, etc. All household furniture, furnishings, fixtures, goods,
appliances, and equipment in the possession of or subject to the control of
PATRICIA JEANNE OSBOURN.
Clothing, etc. All clothing, jewelry, and other personal effects in the possession
of or subject to the control of PATRICIA JEANNE OSBOURN.
Cash. All cash in the possession of or subject to the sole control of PATRICIA
JEANNE OSBOURN.
Cheeking Aeeounts. All checking accounts at all banks or other financial
institutions which stand in the sole name of PATRICIA JEANNE OSBOURN or
from which PATRICIA JEANNE OSBOURN has the sole right to withdraw
funds.
Credit Union Aeeounts. All credit union accounts at all credit unions which
stand in the sole name ofP A TRICIA JEANNE OSBOURN or from which
PATRICIA JEANNE OSBOURN has the sole right to withdraw funds:
Certificates of Deposit. All certificates of deposit at all banks or other financial
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institutions which stand in the sole name ofPATRIClA JEANNE OSBOURN or
from which P A TRIClA JEANNE OSBOURN has the sole right to withdraw
funds.
Vehicle. The vehicle described as a 1998 Honda Accord with vehicle
identification number lHGCG1659W A064799 including all prepaid insurance,
keys, and title documents. The property has a lien against it payable to Essex
County Teachers Federal Credit Union on loan number 3~" , 1 with a balance
of$ 1~.~"'J".t.(.
Life IDsuranee. All policies of life insurance insuring the life of PATRICIA
JEANNE OSBOURN.
Employment Benefits. All sums and all rights related to any profit sharing plan,
retirement plan, pension plan, or like benefit program existing by reason of
P A TRIClA JEANNE OSBOURN's past, present, or future employment and not
otherwise awarded to GORDON DEAN OSBOURN in this agreement.
401k. The parties agree that the total value of all401k accounts will be divided equally
between the parties. The division will take place on a mutually agreeable day after the entry of
fina1 decree of divorce.
DEBTS TO BE p"m BY GORDON DEAN OSBOURN
GORDON DEAN OSBOURN shall pay, as a part of the division of the estate of the
parties. the following and shall indemniJy and hold P A TRlClA JEANNE OSBOURN and
P A TRIClA JEANNE OSBOURN's property barmless from any failure to so discharge these
items:
Any and all debts, charges. liabilities, and other obligations incurred solely by GORDON
DEAN OSBOURN from and after June 1, 1998 unless express provision is made in this
agreement to the contrary.
All debt associated with any property awarded to GORDON DEAN OSBOURN.
DEBTS TO BE PAm BY PATRICIA JEANNE OSBOURN:
PATRIClA JEANNE OSBOURN shall pay, as a part of the division of the estate of the
parties. the following and shall indemniJy and hold GORDON DEAN OSBOURN and
GORDON DEAN OSBOURN's property hannless from any failure to so discharge these items:
SECURED DEBTS
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Vebiele. One promissory note payable to the order of Essex County Teachers Federal
Credit Union with loan number 3~" ! , . The note is secured by a lien against vehicle
described as a 1998 Honda Accord with vehicle identification number
lHGCG 1 659W A064799 and valued at . A lien is recorded by financing
statement in the proper office in the county and state.
Any and all debts, charges, liabilities, and other obligations incurred solely by PATRICIA
JEANNE OSBOURN from and after June I, 1998 unless express provision is made in
this agreement to the contrary.
All debt associated with any property awarded to PATRIClA JEANNE OSBOURN.
HI. NOTICE
Each party shall send to the other party, within three days of its receipt, a copy of any
correspondence from creditor or taxing authority concerning any potential liability of the other
party.
IV. ALIMONY - MAINTENANCE:
Both parties agree to waive any rights or claims that either may now have or in the future
to receive alimony, maintenance, or spousal support from each other. Both parties understand the
full import of this provision.
V. NECESSARY DOCUMENTS:
THE PARTIES AGREE TO EXECUTE AND DELIVER TO the other party any documents that
may be reasonably required to accomplish the intention of this instrument and shall do all other
necessary things to this end.
VI. AGREEMENT DESIGNED TO FACIUTATE A DIVORCE OR DISSOLUTION OF
THE PARTIES' MARRIAGE:
Tbis Agreement is entered into with the express intent to facilitate eneourage, aid, and in
any other manner lead to a divoree aDd or dissolntion of the marriage between the parties
hereto.
vn. SUBSEQUENT DISSOLUTION OF MARRIAGE:
herein, acknowledges receipt of a copy of the to be filed herein with this agreement of the
parties attached as Exhibit" A", and states that he/she has read and understands the same. It is
agreed that this Agreement shall be offered into evidence by either party in any dissolution of
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marriage proceeding, and if acceptable to the Court, this Agreement shall be incorporated by
reference in any Final Judgment that may be rendered, and the parties shall be ordered to comply
with all its provisions, and all warranties and remedies provided in this agreement shall be
preserved. However, notwithstanding incorporation in the Final Judgment, this Agreement shall
not be merged in but shall survive the Final Judgement and be binding on the parties for all
times.
VIII. REPRESENTATION:
The parties represent to each other:
(a) Each had the right to independent counsel. Each party fully understands their legal rights and
each is signing this Agreement freely and voluntarily, intending to be bound by it.
(b) Each has made a full disclosure to the other of his or her current financial condition.
(c) Each understands and agrees that this Agreement is intended to be the full and entire contract
of the parties.
(d) Each agrees that this Agreement and each provision of it is expressly made binding upon the
heirs, assigns, executors, administrators, successors in interest and representatives of each party.
IX. WAIVER OF BREACH:
No waiver of any breach by any party of the terms of this Agreement shall be deemed a waiver of
any subsequent breach.
X. ENFORCEMENT OF THE AGREEMENT:
Both parties agree that the Court granting the divorce, at the request of either party, insert in the
Final Judgment a reservation of jurisdiction for the purpose of compelling either party to perform
this Agreement, or any part thereof. The prevailing party shall be entitled to attorney's fees in
connection with such proceeding.
XL GOVERNING LAW:
This Agreement shall be interpreted and governed by the laws of the state of Pennsylvania.
XIII. WAIVER OF SERVICE OF PROCESS AND FILING AN ANSWER:
herein, acknowledges receipt of a copy of the to be filed herein, and states that he/she has read
and understands the same, hereby waives the issuance, service, and return of process upon
himlher in this action enters a voluntary appearance in this cause, waiving all time and right to
plead, answer or appear in this action, and consents that the same may be set down for trial and
heard by the court at any time hereafter without notice to, and in the absence of, this .
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XIV. WAIVER OF EMPLOYEE AND/OR MILITARY RETAINER OR RETIREMENT
BENEFITS:
Both parties agree to waive any rights, interests, or claims, that either may now have or in
the future to receive employee and/or military retainer or retirement benefits resulting from the
past, present or future employment and/or service of the other party in the Armed Forces of the
United States. Both parties understand the full import of this provision.
~~(;;f
GORDON DEAN OSBOU~
STATE OF Pennsylvania~
COUNTY OF Cumberland~ss.
Before me, the undersigned, a Notary Public within and for the State of Pennsylvania on
this l day of ~ ,'- 00 ( , personally appeared the above named GORDON
DEAN OSBOURN to me known to be the identical person who executed the above and
foregoing marital settlement agreement and personally acknowledged to me that he/she read,
understood and signed the same; and that he/she executed the same as his/her free and voluntary
act and deed for the uses and purposes therein set forth.
IN WI1NESS WHEREOF, I have hereunto affixed my signature and official seal the day
and date heretofore state . NOTARIAL SEAL
BElTY K. HOOVJ:lN,.Notary Public
Lemoyne Boro, Cumberland County
~CommiSsion expires: . ~ ' cmmi si n x Ires Ma 27 2001
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SIGNED ON THIS THE .2L day of fl r.~
Notary Public
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P!\TRICIA JE OSBOURN
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STATE OF New Jersey)
COUNTY OF Morris) ss.
Before me, the undersigned, a Notary Public within and for the State of New Jersey, on
this .:u day of~ ,,flo-tn) ,personally appeared the above named to me known to
be the identical person who executed the above and foregoing marital settlement agreement and
personally acknowledged to me that he/she read, understood and signed the same; and that he/she
executed the same as hislher free and voluntary act and deed for the uses and purposes therein set
forth.
IN WITNESS WHEREOF, I have hereunto affixed my signature and official seal the day
and date heretofore stated.
My commission expires:
~ a~, 6lc-o.3
JOYCE K. CUSHMAN
MY COMMISSION EXPIRES AUGUST 31, 2003
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Notary Public
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IN THE COURT OF COMMON PLEAS OF THE JUDICIAL DISTRICT
OF PENNSYLVANIA COUNTY CUMBERLAND
GORDON DEAN OSBOURN
Plaintiff
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CIVIL ACTION - LAW
CASE NO. () (J - ,,)' &. ~
vs.
PATRICIA JEANNE OSBOURN
Defendant
IN DIVORCE
PRAECIPE TO TRANSMIT RECORD
To the Prothonotmy:
Transmit the record, together with the following infonnation, the Court for entry of a
divorce decree:
1. Ground for divorce: Irretrievable breakdown under Section 3301 (c) of the Divorce
Code.
2. Date and manner of service of Complaint: the "2..7 day of S crr ~"1 (J~~,
'LooO
by Acceptance of Service
3. Complete either paragraph (a) or (b)
(a) Date of execution of the Affidavit of Consent required by Section 330 I ( c) of the
Divorce Code;
By Plaintiff: A 'P r:t I l.. 1-
, '1.IIQ I By Defendant: D~ C<~"7~~1t 1. \?,
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(b)(l) Date of execution of the Plaintiffs affidavit required by Section 201(d) of the
Divorce Code:
4. Related claims pending:
(a) Related Claims Pending: Incorporation of attached agreement.
(b) Claims withdrawn
(c) Claims settled by agreement of the parties: Division of property, custody,
visitation, child support.
(d) State whether any written agreement is to be incorporated into the Divorce Decree.
If yes, attach a true and correct copy of the fully executed agreement to the proposed
Decree that is submitted herewith: YES.
5. I certifY that the Notice of Intent to File Praecipe to Transmit as required by Rule
1 920.42(c) or (d) was mailed on ~!. , '2..Dd"I,andacopy
thereof is attached. I further certify that all other documents required by Rule I 920.42( e)
are enclosed herewith.
Dated: ~
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GORDON DEAN OSBOURN
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IN THE COURT OF C.OMMON PLEAS OF THE JUDICIAL DISTRICT
OF PENNSYLVANIA COUNTY CUMBERLAND
GORDON DEAN OSBOURN
Plaintiff
vs.
PATRICIA JEANNE OSBOURN
Defendant
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CIVIL ACTION - LAW
TERM
CASE NO. 00 ~ l" I, f).
IN DIVORCE
NOTICE TO DEFEND AND CLAIM RIGHl'S
You have been sued in court for:
IllI Divorce
o Support
B Division of Property
o Temporary Alimony
o Costs
o Annulment of Marriage
o Custody and visitation
o Alimony
o Attorney
You have been sued in Court. If you wish to defend against the claims set forth on the
other side of this page. youmiiSt.take prompt action. You areww:ned that if you fail to do so, the
case may proceed without you and Ii depree of divorce or annulment may be entered against you
by the court. Ajudgmentmay ~$O be entered against you for any other claim or relief requested
in this paper by thePlaintifL You may lose money or property or other rights important to you,
including custody or visitation ofyouchilC;lol\ clnldren. .
When the grounqfordivorce is indignities or irretrievable breakdown of the marriage,
you may request ~eooililseling. A list of maniagecounselors is available in the Office of
the Prothonotary at the CUMBERLAND county Courthouse, in , P A.
IF YOU DO NOTf1Ll3ACLAlM FOR ALIMONY, DMSIONOF PROPERTY,
LAWYER'S FEES OR EXPENsES BEFORE DIVORCE OF ANNULMENT IS GRANTED,
YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM.
YOU SHOULD TAKE nnSPAPERTO YOUR LAWYER AT ONCE. IF YOU DO
NOT HAVE A LA WYERORCANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
AOVERTENCIA
13}'lR. 4%0(/64:-I(ON
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IN THE COURT OF COMMON PLEAS OF THE JUDICIAL DISTRICT
OF PENNSYLVANIA COUNTY CUMBERLAND
GORDON DEAN OSBOURN
Plaintiff
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CIVIL ACtiON - LAW
CASE NO. '
TERM
PATRICIA JEANNE OSBOURN
Defendant
IN DIVORCE
COMPLAINT UNDER SECTION 330Hc) OR 330Hd) OF THE DIVORCE CODE
I. Plaintiff is GORDON DEAN OSBOURN who resides at; 404 Allendale Way; Camp Hill,
Pennsylvania 17011.
2. Defendant is PATRICIA JEANNE OSBOURN who resides at: 362 Woodland Road;
Madison, New Jersey 07940.
3. I8l Plaintiff and/or 0 Defendant have been a bona fide resident(s) of the Commonwealth of
Pennsylvania for at least six months immediately prior to commencement of this action.
4. Plaintiff married Defendant on December 24; 1980 at Medaryville, In~ana. Attached hereto
and marked as Exhibit n An is the certificate of marriage evidencing said lnarriage.
5. Neither plaintiff nor defendant is in the military or naval service of tile Unites States or its
allies within the provisions of the Soldier's and Sailor's Civil Relief Act of Congress 1940 and
its amendments.
6. There has been no prior action of divorce or for annulment between ~e parties.
7.The marriage is irretrievably broken.
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8. After 90 days have elapsed from the date of filing of this Complaint, Plaintiff intends to file an
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affidavit consenting to a <ijvorce. Plaintiff believes that Defendant may also file such an affidavit.
Complaint for Divorce; Page I
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9. Plaintiff has been advised that marriage counseling is available and that Plaintiff may have the
right to request that the Court require the parties to participate in marriage counseling.
10. There are no unmarried children under the age of eighteen years born to or adopted by the
parties t<l this marriage.
WHEREFORE, ifboth parties me affidavits consenting to a divorce after 90 days have
elapsed form the date offiling of this Complaint, Plaintiff respectfully requests that a decree of
divorce be entered pursuant to Section 3301 (c) of the Divorce Code dissolving the marriage
between the Plaintiff and Defendant.
COUNT II
REQUEST FOR INCORPORATION OF MARITAL SEITLEMENT AGREEMENT
PURSUANT TO SECTIONS 3104(A)(I) AND (3) AND 3323(B) OF THE DIVORCE CODE.
11. Paragraphs 1-10 are incorporated herein and made a part hereof by reference as though fully
set forth.
WHEREFORE, Plaintiff respectfully requests that this Court approve and incorporate the
agreement reached between the parties into the final divorce decree, pursuant to Sections
3104(a)(1)and (3) and 3323(b) of the Divorce Code.
GORDON DEAN OSBOURN
I verify that the statements made in this Complaint are true and correct. I understand that
false statements herein are made subject to penalties of the 18 Pa.C.S. Section 4904 relating to
unsworn falsification to authorities.
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Date:
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GORDON DEAN OSBOURN, Pro Per
Complaint for Divorce; Page 2
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NOTICE TO DEFEND AND CLAIM RIGHTS
You have been sued in Court. If you wish to defend against the claims set forth on the
other side of this page, you must take prompt action. You are warned that if you fail to do so, the
case may proceed without you and a decree of 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 this paper by the Plaintiff. You may lose money or property or other rights important to you,
including custody or visitation of you child or children.
When the ground for 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 Courthouse, in , P A.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY,
LAWYER'S FEES OR EXPENSES BEFORE DIVORCE OF 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.
Office of the Prothon()tary
CUMBERLAND County Courthouse
,PA.
Telephone( )
READ OTHER S~DE
Complaint for Divorce; Page 3
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Camp HiU Boro.. Cumbedand County
Myaxnmission expires Feb.!', 2004'
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IN THE COURT OF COMMON PLEAS OF THE mDICIAL DISTRICT
OF PENNSYLV ANlA COUNTY CUMBERLAND
GORDON DEAN OSBOURN
Plaintiff
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CIVIL ACTION - LAW
TERM
CASE NO,
PATRICIA ~E OSBOURN
Defendant
IN DNORCE
COUNSELING NOTICE
The DivOrce Code of Pennsylvania requires that you be notified of the availability of
counseling where a divorce is sought under any of the following grounds:
Section 3301 (aX6)
Section 3301 (c)
Section 3301 (d)
Indignities
Irretrievable breakdown Mutual Consent
Irretrievable breakdown TwolThree year separation
A list of qualified professions i~ available for inspection in the
Office of the Prothonotary
CUMBERLAND CountY Courthouse
,PA.
Telephone( )
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OF PENNSYLVANIA COUNTY CUMBERL4'D
GORDON DEAN OSBOURN ~ CIVIL AC'$ON - LAW
Plaintiff ~
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TERM
CASE NO. i
PA TRIClA JEANNE OSBOURN
Defendant '
IN DIVORCE
,
AFFIDAVIT OF NON-MILITARY SERVICE
,
GORDON DEAN OSBOURN, being duly sworn according to Law, deposes and says that
he/she knows by hislher own personal knowledge and therefore avers that the defendant,
P A TRlClA JEANNE OSBOURN, is 53 years of age and that he/she is not in the military service
of the United States or its allies, or otherwise within the provision of the Soldier's and Sailor's
Civil Relief Act of Congress 1940 and its amendments and that the defendant is employed by
Date: '1/"l.7/00 ~~C9~
I I GORDON DE~N OSBOURN, Plaintiff
Sworn to and subsCribed before me this the~ 7 ~~y of SJp {" d-I-d
NOTARIAL S!Ml
Pay I. BiCirlwt, NoW'}' l'\Il!lle
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OF PENNSYLVANIA COUNTY CUMBERLAND
GORDON DEAN OSBOURN
Plaintiff
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CIVIL ACTION - LAW
vs.
PATRICIA JEANNE OSBOURN
Defendant
CASE NO. 00 ~ &, 5' b "L
IN DIVORCE
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under Section 3301 (c) of the Divorce Code was filed on the 27 day
of 7cP"tE-iVl \l G/C... , '2/JdO.
2. The marriage between the parties hereto is irretrievably broken. Ninety days have elapsed
since the filing of the Complaint.
2. I am aware that marriage counseling is available and do not desire said counseling.
3. I state thatI have read copies ofthe Complaintfor Divorce Under Section 330l(c) of the
Divorce Code, and I understand said Complaint. I waive any pleading periods and notices there
may be.
4. I hereby enter my consent to the entry of a final decree of divorce.
5. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or
expenses if! do not claim them before a divorce is granted.
6. 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. Section 4904 relating to
unsworn falsification to authorities.
Dated:
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GORDON DEAN OSBOURN, Plaintiff
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IN THE COURT OF COMMON PLEAS OF THE _ JUDICIAL DISTRICT
OF PENNSYL VANIA COUNTY CUMBERLAND
GORDON DEAN OSBOURN
Plaintiff
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CIVIL ACTION - LAW
CASE NO. 00.., ~S"b2-
vs.
PATRICIA JEANNE OSBOURN
Defendant
IN DIVORCE
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under Section 3301 (c) of the Divorce Code was filed on the '27 day
of 5e-PTt!3/l1 RGR.. , '2,,000 .
2. The marriage between the parties hereto is irretrievably broken. Ninety days have elapsed
since the filing of the Complaint.
2. I am aware that marriage counseling is available and do not desire said counseling.
3. I state that I have read copies ofthe Complaint for Divorce Under Section 330l(c) of the
Divorce Code, and I understand said Complaint. I waive any pleading periods and notices there
may be.
4. I hereby enter my consent to the entry of a final decree of divorce.
5. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or
expenses ifI do not claim them before a divorce is granted.
6. 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. Section 4904 relating to
unsworn falsification to authorities.
Dated: J;lEc6N1 ~E'~
2"i? 2.o/JO
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OF PENNSYL VANIA COUNTY CUMBERLAND
9
9
9
9
9
PATRICIA JEANNE OSBOURN, Defendant 9
362 Woodland Road 9
Madison, NJ 07940 9
973-410-1414
GORDON DEAN OSBOURN, Plaintiff
404 AIlendale Way
Camp Hill, PA 17011
717-761-1215
CIVIL ACTION - LAW
CASE NO. ()r) - 6S" 1....
IN DIVORCE
WAIVER OF NOTICE OF INTENTION TO REQUEST
ENTRY OF A DIVORCE DECREE UNDER
~3301 (c) OF THE DIVORCE CODE
1. I consent to the entry 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 in 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 inthis Affidavit are true and correct. I understand that
false statements herein are made subject to the penalties of 18 Pa. C. s. 9 4904 relating to
unsworn falsification to authorities.
Dated: 1.-/ /1/01
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GORDON DEAN OSBOURN, Plaintiff
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IN TIlE COURT OF COMMON PLEAS OF THE JUDICIAL DISTRICT
OF PENNSYLVANIA COUNTY CUMBERLAND
GORDON DEAN OSBOURN, Plaintiff
404 AIlendale Way
CampHill, PA 17011
717-761-1215
9
9
9
9
9
PATRICIA JEANNE OSBOURN, Defendant 9
362 Woodland Road 9
Madison, NJ 07940 9
973-410-1414
CIVIL ACTION - LAW
CASE NO. 00 ~ bi"6<...
IN DIVORCE
WAIVER OF NOTICE OF INTENTION TO REQUEST
ENTRY OF A DIVORCE DECREE UNDER
~3301 (c) OF THE DIVORCE CODE
I, I consent to the entry 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'eJq>enses in do not claim them before a divorce is granted.
3. I understllll.d that I will not be divorced until a divorce decree is entered by the
court and that a'copy ofthe 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 IS Pa, C. S. 94904 relating to
unsworn falsification to authorities,
Dated:
#/,/01
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PATRICIA JEANNE
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IN THE COURT OF COMMON PLEAS OF TIIE JUDICIAL DISTRICT
OF PENNSYLVANIA COUNTY CUMBERLAND
GORDON DEAN OSBOURN
Plaintiff
PATRICIA JEANNE OSBOURN
Defendant
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CML ACTION - LAW
TERM
CASENO. 60- h S-6"L.
IN DIVORCE
ACCEPTANCE OF SERVICE
I hereby accept service of the Complaint in Divorce filed in the above-captioned matter.
rv.
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IN THE COURT OF COMMON PLEAS OF THE JUDICIAL DISTRICT
OF PENNSYLVANIA COUNTY CUMBERLAND
GORDON DEAN OSBOURN, Plaintiff
404 Allendale Way
Camp Hill, P A 17011
717-761-1215
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PATRICIA JEANNE OSBOURN, Defendant ~
362 Wood1andRoad ~
Madison, NJ 07940 ~
973-410-1414
CIVIL ACTION - LAW
CASE NO. 00-6562
IN DIVORCE
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under Section 3301 (c) of the Divorce Code was filed on the
27 day of September, 2000.
2. The marriage between the parties hereto is irretrievably broken. Ninety days have
elapsed since the filing ofthe complaint.
3. I am aware that marriage counseling is available and do not desire said counseling.
4. I state that I have read the copies ofthe Complaint for Divorce under Section
3301 (c) of the Divorce Code, and that I understand said Complaint. I waive any
pleading periods and notices there may be.
5. I hereby enter my consent to the entry of a final decree of divorce.
6. I understand that I may lose rights concerning alimony, division of property, lawyer's
fees or expenses ifl do not claim them before a divorce is granted.
7. I verifY that the statements made in this Affidavit are true and correct. I understand
that fulse statements herein are made subject to the penalties of 18 Pa. C. S. ~ 4904
relating to unsworn fulsification to authorities.
n.tro:l/'f'r5' 1':;0171
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PATRI~~
R-~ a~
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OF PENNSYL V ANlA COUNTY CUMBERLAND
GORDON DEAN OSBOURN
Plaintiff
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CML ACTION - LAW
CASE NO. () C ~ Co)" 'l.
vs.
PATRICIA JEANNE QSBOURN
Defendant
IN DIVORCE
PRAECIPE TO TRANSMIT RECORD
To the Prothonotary:
Transmit the record, together with the following information, the Court for entry of a
divorce decree:
I. Ground for divorce: Irretrievable breakdown under Section 3301 (c) of the Divorce
Code.
2. Date and manner of service of Complaint: the "2.. -, day of S € ""t """ (J ~ It..,
'l-()OO
by Acceptance of Service
3. Complete either paragraph (a) or (b)
(a) Date of execution of the Affidavit of Consent required by Section 3301 (c) of the
Divorce Code;
By Plaintiff: Apfl.\(. 1- . "tD/l1 ByDefendant: MAY-t..5"'
VliJ(
(b)(l) Date of execution of the Plaintiffs affidavit required by Section 201 (d) of the
Divorce Code:
4. Related claims pending:
(a) Related Claims Pending: Incorporation of attached agreement.
(b) Claims withdrawn
(c) Claims settled by agreement of the parties: Division of property, CQstody,
visitation, child support.
(d) State whether any written agreement is to be incorporated into the Divorce Decree.
If yes, attach a true and correct copy of the fully executed agreement to the proposed
Decree that is submitted herewith: YES.
5. I certifY that the Notice of Intent to File Praecipe to Transmit as required by Rule
I 920.42(c) or (d) was mailed on .~ 1) , V)4'I,andacopy
thereofis attached. I further certifY that all other documents required by Rule 1920.42(e)
are enclosed herewith.
Dated:~/. 1..C5
2.. C1" ,
~.x!}~cP~
GORDON DEAN OSBOURN
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IN THE COURT OF COMMON PLEAS OF THE JUDICIAL DISTRICT
OF PENNSYLVANIA COUNTY CUMBERLAND
GORDON DEAN OSBOURN. Plaintiff
404 Allendale Way
Camp Hill. Pennsylvania 17011
717-761-1215
~
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PATRICIA JEANNE OSBOURN, Defendant ~
362 Woodland Road ~
Madison, New Jersey 07940
973-410-1414
CIVIL ACTION - LAW
TERM
CASE NO. rJ. - bS" b 'L.
INCOME AND EXPENSE STATEMENT
OF
. G6RD9N DE-~ QSBeuRN, Pl:.MNTIF'F
Vefe:IlID,qIll'r f~{"q\c 114 TEAtVlVE OSf3e111/1Il1V, f>f:1"6rJDI'tNT
,Ph.;"lifffiles the following Income and Expense Statement setting forth hislher income
lIDd expenses as of the date set forth below.
\) f?f'I2I111>14117T
PlaiBHft"-..erifies that the statements made in the Income and Expense Statement are true
D E'Fe^' Jlr'!-Al;-
lIDd correct. Plai~tI understands that false statements herein are subject to the penaIties" 1 8
fa. C.S. Section 4904 relating to unsworn falsification to authorities.
Dated: ~. 2(P J 2000
(J..~ ~ ---- M~
6ORf>(>>1 DEAN OSBOURN
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INCOME AND EXPENSE STATEMENT OF
G9RDeN DEAN 6SBotIftN, PLAINTIFF
PA-T!ZIC{A- 'J"EA'-Ali/14T"f/.\t.lk re-A-NN'E., osgPII/,e#J 9E~C'N1)I'tNT
NAME: {JORDeN DEAN OSBOURN
GORDON DEAN OSBOURN VS. PATRICIA JEANNE OSBOURN
INCOME:
. .
Employer: "- I U 1 d- S -t-O ,J
Address: -/tvi &1f RJ
Type of Work: E 1:1 vel<>. ~
~b. 1 Eo
.I,J'7th..... I fl1 014 ~4
Payroll No.: '10 - II 3 t
Social Security No.: 541568335 11 (; - l{"b- ,.f~ ~
Gross pay per pay period: $ 3?" I, 'fD 2 Pay period 0 weekly 0 biweekly 0 monthly
#.O~f'^ --r........ t.ll~/".c, JI""()........fI.~)
~2"1'-{1 5"0 X1.O~ t79g30,OO lYFItf?
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ITEMIZED PAYROLL DEDUCTIONS:
Federal Withholding $ ~tI S" . 1."] Local Wage Tax $
Retirement $ 111.37 Credit Union $
C""f. i41'S $ ~t/'5. ~3
Health Insurance 11''''' $ 15".77 Social Security
Savings $ State Inc. Tax $ ~q.~J
Life Insurance $ Other
-1Avk <4oV JIA4 $ 57, 3g
h..- $ I{o'$ ~
U. We; $ .:s..-o
NET PAY per pay period: $ .2 c.. (7, { (p
~ ~2131/()
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DATE: ~ .~b,2.-(XJO
INCOME AND EXPENSE STATEMENT OF
"'69RBGN BEAN G8BetJRN, PLMNllFF
fATI<,\Lt,4 TC?,If;l/,</t;- r'l'flj(,\C-It<! :;-~,qvll/f; OSfitJV/~~ PE ~EN'{)I1N'f"
NAME: OOItDON BEAN OSBOURN
GORDON DEAN OSBOURN VS. PATRICIA JEANNE OSBOURN
OTHER INCOME Weekly
Monthly
Yearly
mtere&~ $
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Dividends" $
Pension >( $
Annuity X $
Rents ~ $
Royalties I( $
Social Securityk $
$
Expense Account" $
$
Gifts $
$
$ ;)00 -
Unemployment ><' $
$
$
$
$
$
$
$
Workers' Compensation -< $
Other $
Other $
$
Total All lneome: $ b~ l '51/0
Per I:J Week I:J Month
~Year
,',"
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:
DATE: ~c.. 110 \ '-000
INCOME AND EXPENSE STATEMENT OF
'-GORIK:JN Hl.N 98BQGRN, Pl...\H'mW
fftT~JC.IA TeJ'\N,.,IE; PI't"'~\C.114 ueA,oVA/E CJSi'3b/.1~A/) 'DE.I'CA.lP'"i1VT'
NAME: 6ORDON OCAN OSBOURN
GORDON DEAN OSBOURN VS. PATRICIA JEANNE OSBOURN
PROPERTY OWNED
J}eseriptiOIl Value Husband Wife Child
Checking Account $a.,...,..v 0 ~ 0
Savings Account $ 0 Jill 0
, .
Credit Union /'t\l~4~ '5"2. . (, .( 0 11 0
Stocks/Bonds $ .,- )xl
0 0
Real Estate $ 0 t:t 0
Automobile 'H ~Jo- Quo..) . $ 0 ~ 0
Other $ 0 ~ 0
INSURANCE COm"DY Poley ## Husband Wife Cbild
Hospitalization HOR.17 ON ~ll( Cro~ # C)O ~fS''Io 7 0 k 0
!61.AA. S~;.IJ 1M
I, II
Medical # 0 .e 0
Health/Accident II #. /. 0 jl; 0
Disability - # 0 )1 0
Dental Hoi.,2:u,V ~e"'1-ill('AU # y~Lt07 -on 0 ~ 0
J'.
-.. .- ", -.
."
DATE: bl.lt Ilo D-u
INCOME AND EXPENSE STATEMENT OF
GORDaN DEMil OSBOl:JRN, Fl.MNTIR
P.4'rA.\C.I.4 ";)-C't'/,r/AlE 'f'1l-\fZ\C.d\ Tel'tN'NG' 07BO~~ De-rE'NJ>I't-NT
NAME: GORDeN BE:\N OSBOURN
GORDON DEAN OSBOURN VS. PATRICIA JEANNE OSBOURN
EXPENSES ALLOCATIONS
rH~ME .... ...... - ----.--- - -. ------....- .. ._-~.- .'.. ,. -....._,
W~ Monthly Yearly Self Cbildren
I Mortgagel<l $ $ $ $ $
Rent $ $ II./.i.. ~-- $ 17, /,"0 $ \'7 toO $ ~
/
MaintenanC94 $ $ $ $ $
lOss $ $ 70 $ 1'1(0 $ <6<{o $
,
I Electric $ $ fO $ l/g-1) $ l..{'-i?o $
i Telephone $ $ OjO $ / (? 'in) $ 1.(f~O $
$ $ 2.0 $ i./f'D $ '19& $
I Water
$ $ - $ - $ $
IS~"':'er .....
-,,-'..-.,-,_.' .- ... ._....-.~-_...._. -...._.._~-~,._._-_... ....---..----.--..,..-.,.-
EMPLOYMENT Weekly Monthly Yearly
Transportation $ '10 $ /lJ,() $ J{Ooo
Lunch $ ~S- $ /00 $ /.:1 ",0
Maintenance $ $ $
51.\~A.-L "
. ,
~ , ' , , ,
"
DATE: /l.. ){, I t-liJ
INCOME AND EXPENSE STATEMENT OF
. G9ROON DEAN Q8BQlIR..'Il, YLAfN'ffFF 1) f; F'" E- ~ /) J'f/UT
PA-rRICtf! 'J"'E,qPII/E fl\-.,..f{ICI A- ::re"lNN6 oS'~oV\~,
NAME: GOftl)ON DEAN OSBOURN
GORDON DEAN OSBOURN VS. PATRICIA JEANNE OSBOURN
EXPENSES ALLOCATIONS
TAXES Weekly Monthly Yearly Self ChDdren
Real Estate $ $ $ - $ $
Personal Property $ $ $ - $ $
Income $ $ $ - $ $
INSURANCE Weekly Monthly Yearly Self Children
Homeowners $ $ $ ,-- $ $
Auto $ $ $ I ~.3g $ \1. ,~ $ -.
.
Life $ $ $ - $ $
Accident $ $ $ - $ $
Other $ $ $ $ $
co v l?J(€ I<\NV~ C~ <<VII 1A.,vIM L-<1f1-1.i
CAR Weekly ~~~~ ,{:~ ~~If _ . Children
Payments $ $ -'
Fuel/Oil $-- $ 100 $ I ;tOO $ I 'l,l'>o $
.'
Repairs $ $ $--- $ $
MEDICAL Weekly Monthly Yearly Self Children
Doctor $ $ $ '3Ci,j $- 30"__ $
Dental $ $ $ jOO $ ICl tJ $
Hospital $ $ $ - $ $
Medicine $ $ $ ,",00 $ 400 $
Special $ $ $ $ $
7' VI. ~'1rrI'1-L ~ ;(: '3 'Z..."3?'
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DATE: I-I~~
INCOME AND EXPENSE STATEMENT OF
-GORDON DE-AN ggg.VRN, Pl.AlNTIFF
PJn"~iC.(A 'J"EAd.....C' fItTl(tC./I'l ~e~N;l/e (JST)Ol.{,e.N/ D~PeN1>l'ttvl"
NAME: EJORDON D[,~OSBOURN
GORDON DEAN OSBOURN VS. PATRICIA JEANNE OSBOURN
EXPENSES ALLOCATIONS
SCHOOL Wee Self Children
Private School $ $ $
Parochial School $ $ $
College $ $ $
Religious $ $ $ $ $
PERSONAL Wjlekly Monthly Yearly Self Children
Clothes $ , . $ /5"0 $ . I . 'P'OO $ I. 'loo $ -
---r"- ;n
Food $ ,2.00 $ r01J ~ _1(,,0;) $ q ?tlO $ -
,
Hairdresser $ $ $ 1f<ID $ i-f9tJ $ -
-
Barber $ $ - $ $ - $
-
Credit Payment $ $ $ r-- $ - $
Credit Cards $ $ $ - $ ---- $
$ $ $ - $ - $
Charge Accounts
Dues $ $ 90 $ ~ $ "601) $ -
CHILD CARE
DaYl,:are
Babysitter
Other
$
Self
$
$
$
Wee
$
$
$
-
5 '^ ~ rCi'Tltc ~'
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DATE: ~~b?Oc;)
INCOME AND EXPE SE STATEMENT OF
. -GORDON DEAN OSBOORN,.N.AJN'fIFF
PA(R~CII'{ TEI/II/Ne:: fAT~\C.IA ';Je/!-A/jVe 05G'.1/(,<:?~ DEPENPI4IV{-
NAME: OOIIDON DEAN OSBOURN
GORDON DEAN OSBOURN VS. PATRICIA JEANNE OSBOURN
EXPENSES ALLOCATIONS
LOANS Wee Self Children
Credit Union $ 3 $ ~ bq:3 $
Other $ $ $
Other $ $ $
Other $ $ $
MISC. Weekly Mon~1y Yearly Self Children
Papers $ $ $ ..... $ - $
Magazines $ $ $ .;!..ell' $ 1--00 $ -
Entertainment $ $ $ J, if 010 $ I 'T 170 $ -
, .I
Pay T.V $ $ $ (,CJfJ $ t,oo $ -
Vacation $ $ $ 1,:FoO $ I, f)oo $ -
Gifts $ $ $ 'coO $ J "06 $ -
- ) -)
Legal Fees $ $ $ - $ $
Contributions $ $ $ ,300 $ ~oo $ ~
Other Child Support $ $ $ - $ $
Alimony $ $ $ -./ $ $
Other is f . $~qO $ 240 $
$ $ -
Other~ $ $ $~ $ Q&O $ -
Other $ $ $ $ $
TOTAL
EXPENSES
Weekly
Monthly
Yearly
Self
ChildreD
$
$ 4'W1,2..)$ ,-r, g:3/ $ ,I, 'PO / $
,
"7 (,{ &lvr A- ( ,
1(2-- 7))
,
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IN THE COURT OF COMMON PLEAS OF THE _ JUDICIAL DISTRICT
OF PENNSYLVANIA COUNTY CUMBERLAND
PHILADELPIllA
GORDON DEAN OSBOURN
Plaintiff
~
~
~
~
~
CIVIL ACTION - LAW
CASE NO. 00 - " S- 61..-
vs.
PATRICIA JEANNE OSBOURN
Defendant
IN DIVORCE
NOTICE OF INTENT TO FILE PRAECIPE TO TRANSMIT
You are hereby given notice that five days following mailing of this notice, a Praecipe to
Transmit Record, together with a proposed Final Decre!' of Divorce, will be filed in this matt!'r
with the Appointment Clerk's Office, Room at
in Philadelphia, Pennsylvania 19107. Exact copies of the Praecipe and the proposed Final Decree
in Divorce are enclosed herewith.
After the praecipe and proposed Final Decree in Divorce are filed, you will have a period of ten
days during which you may file objections to the entry of the Final Decree based upon this
Praecipe. If you dispute any of the information on the Praecipe or Final Decree you must act
within that ten-day period. Any objections must be filed in writing with the Appointment Clerk's
Office, Room B-16, 34 S. 11th Street, Philadelphia, Pennsylvania 19107. Ifno objections are
filed before the expiration of the ten-day period, this case will be submitted to the Court for entry
of the Final Decree.
Dated:
~L
2-00 r
~~ (Jl~
Plaintiff, GORDON DEAN OSBOURN
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IN THE COURT OF COMMON PLEAS OF THE JUDICIAL DISTRICT
OF PENNSYLVANIA COuNTY CUMBERLAND
GORDON DEAN OSBOURN
Plaintiff
~
~
~
~
~
~
CIVIL ACTION - LAW
TERM
CASE NO. oj - fJ5 (g d.
PATRICIA JEANNE OSBOURN
Defendant
IN DIVORCE
AFFIDA VIr AS TO SIGNATURE
GORDON DEAN OSBOURN, being duly sworn according to law, deposes and says that
helshe is the Plaintiff in the above-captioned divorce action; that he/she is familiar with the
signature of the Defendant; and that the signature on the Acceptance of Service attached hereto
as Exhibit " A" is the signature of the Defendant.
.~.ff~a~
~ GORDON DEAN OSBOURN, Plaintiff
Sworn to and subscribed before me this the 7./'(\ day of -r f/ b..rl / (,i 'jV W7J I
fJ5 k-~
NOTARIAL SEAL
SETTY K. HOOVEN, Notary PUblic
~emoyne Boro, Cumberland County
M Commission Ex ires Ma 27, 2001
'2/~/o I
,
Date:
I
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INVENTORY AND APPRAISEMENT COVER SHEET
IN THE COURT OF COMMON PLEAS OF THE JUDICIAL DISTRICT
OF PENNSYLVANIA COUNTY CUMBERLAND
GORDON DEAN OSBOURN, Plaintiff
404 Allendale Way
Camp Hill, Pennsylvania 17011
717-761-1215
~
~
~
~
vs. ~
PATRICIA JEANNE OSBOURN, Defendant S
362 Woodland Road ~
Madison, New Jersey 07940
973-410-1414
plf{~\C.IA ~GilAlNE'
GORDON DEAN{)SBOURN files the following inventory and appraisement of all
CIVIL ACTION - LAW
TERM
CASE NO. do - b 5"'6-z.
property owned or possessed by either party at the time this action was commenced and all
property transferred within the preceding year.
f4TIl.\c.rl4 'Tt-AVAlG
GORDON DEAN OSBOURN verifies that the statements made in this inventory and
appraisement are true and correct.
f'A-T,(tC'.rA \l-e-,qAlAlG
-eORDON DEAN-OSBOURN understands that false statements herein are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Dated:
Du. 2. f I ~oo >0
fl.;. ~ f1..-
D:EAN OSBOURN
fATt?\CrA 7eMNE
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INVENTORY AND APPRAISEMENT COVER SHEET
IN THE COURT OF COMMON PLEAS OF THE _ JUDICIAL DISTRICT
OF PENNSYLVANIA COUNTY CUMBERLAND
GORDON DEAN OSBOURN, Plaintiff
404 Allendale Way
Camp Hill, Pennsylvania 17011
717-761-1215
~
~
~
~
- ~
PA mCIA JEANNE OSBOURN, Defendant ~
362 Woodland Road ~
Madison, New Jersey 07940
973-410-1414
CIVIL ACTION - LAW
TERM
CASE NO. CJ 0 ~ b 5" {;,1-
GORDON DEAN OSBOURN tiles the following inventory and appraisement of all
property owned or possessed by either party at the time this action was commenced and all
property transferred within the preceding year.
GORDON DEAN OSBOURN verifies that the statements made in this inventory and
appraisement are true and correct.
GORDON DEAN OSBOURN understands that false statements herein are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Dated:
'I/r/Of
r (
~~&~
GORDON DEAN OSBOURN
,
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IN THE COURT OF COMMON PLEAS OF THE JUDICIAL DISTRICT
OF PENNSYLVANIA COUNTY CUMBERLAND
GORDON DEAN OSBOURN, Plaintiff
404 Allendale Way
Camp Hill, Pennsylvania 17011
717-761-1215
~
S
S
~
vs. S
PATRICIA JEANNE OSBOURN, Defendant S
362 Woodland Road S
Madison, New Jersey 07940
973-410-1414
CIVIL ACTION - LAW
TERM
CASE NO. 00 - 65"1-.
INVENTORY AND APPRAISEMENT
OF
GORDON DEAN OSBOURN
GORDON DEAN OSBOURN files the following inventory and appraisement of all
property owned or possessed by either party at the time this action was commenced and all
property transferred within the preceding year.
GORDON DEAN OSBOURN verifies that the statements made in this inventory and
appraisement are true and correct.
GORDON DEAN OSBOURN understands that false statements herein are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Dated: '3-1- 0/
~ (Jl~ ~
GORDON DEAN OSBOURN
- ,.~~~~'~
,,'k,_
.~ -- ""
o' ,", ~~
Plaintiff marks on the list below those items applicable to the case at bar and itemizes the
assets on the following pages. IF an item has been appraised, a copy of the appraisal report
is attached.
o 1. Real Property
02. Motor Vehicles
o 3. Stocks, bonds, securities and options
o 4. Certificates of deposit
05. Checking accounts, cash
o 6. Savings accounts; money market and savings certificates
o 7. Contents of safe deposit boxes
o 8. Trusts
o 9. Life insurance policies (indicate face value, cash surrender value and current beneficiaries)
o 10. Annuities
o 11. Gifts
o 12. Inheritance
o 13. Patents, copyrights, inventions, royalties
o 14. Personal property outside the home
o 15. Business (list all owners, including percentage of ownership, and officer/director positions
held by a party with the company.
D 16. Employment termination benefits - severance pay, workman's compensation claim/award
D 17. Profit sharing plan
D 18. Pension plans (indicate employee contribution and date plan vests)
D 19. Retirement plans; Individual Retirement Accounts
D 20. Disability payments
o 21. Litigation claims (matured and unmatured)
D 22. MilitaryN.A. benefits
D 23. Educational benefits
D 24. Debts due, including loans, mortgages held
D 25. Household furnishings and personalty (including as a total category and attach itemized list
if distribution of assets is in dispute.
D 26. Other
"
;,._' - 0_ _'" '.:. _' _n~ ,'_ ;- -^'-,"~""- ",' ,',o, '., . '<'.__ \:.1" ~!
MARITAL PROPERTY
Plaintiff lists all marital property in wbicheither or both spouses have a legal or equitable
interest individually or with any other person as ofthe date this action was commenced:
Use a separate sheet for each property item.
Item
Number
Item
Number
1.
Item
Number
1.
Item
Number
Description
of Property
Names of all
Owners
Date of
Acquisition
Cost or Value as of
Date of Acquisition
$
Value as of Date
Action Commenced
$ $
Amount of
Any Lien
Nature of
Any Lien
Mortgage
Effective Date
of Lien
Holder of Lien
Reason for Exclusion from Marital Property
,...~-,' ,,,,,,-
-
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MARITAL PROPERTY
Plaintiff lists all marital property in which either or both spouses have a legal or equitable
interest individually or with any other person as of the date this action was commenced:
Use a separate sheet ior each property item.
Item
Number
1.
Item
Number
1.
Item
Number
1.
Item
Number
Description
of Property
Names of all
Owners
Date of
Acquisition
Cost or Value as of
Date of Acquisition
$
Value as of Date
Action Commenced
$ $
Amount of
Any Lien
Nature of
Any Lien
Mortgage
Effective Date
of Lien
Holder of Lien
Reason for Exclusion from Marital Property
,,' ,
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MARITAL PROPERTY
Plaintiff lists all marital property in which either or both spouses have a legal or equitable
interest individually or with any other person as of the date this action was commenced:
Use a separate sheet for each property item.
Item
Number
Item
Number
I.
Item
Number
I.
Item
Number
Description
of Property
Names of all
Owners
Date of
Acquisition
Cost or Value as of
Date of Acquisition
$
Value as of Date
Action Commenced
$
Amount of
Any Lien
$
Nature of
Any Lien
Secured Purchase
Money
Effective Date
of Lien
Holder of Lien
Reason for Exclusion from Marital Property
"
MARITAL PROPERTY
Plaintiff lists all marital property in which either or both spouses have a legal or equitable
interest individually or with any other person as of the date this action was commenced:
Use a separate sheet for each property item.
Item
Number
1.
Item
Number
1.
Item
Number
1.
Item
Number
Description
of Property
Names of all
Owners
Date of
Acquisition
Cost or Value as of
Date of Acquisition
$
Value as of Date
Action Commenced
$
Amount of
Any Lien
$
Nature of
Any Lien
Secured Purchase
Effective Date
of Lien
Holder of Lien
Essex County
Teachers Federal
Credit Union
Money
Reason for Exclusion from Marital Property
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MARITAL PROPERTY
Plaintiff lists all marital property in which either or both spouses have a legal or equitable
interest individuany or with any other person as of the date this action was commenced:
Use a separate sheet for each property item.
Item Description Names of all Date of
Number of Property Owners Acquisition
Nof\J~ (
(
Item Cost or Value as of Value as of Date Amount of
Number Date of Acquisition Action Commenced Any Lien
Item
Number
Nature of
Any Lien
Effective Date
of Lien
Holder of Lien
Item
Number
Reason for Exclusion from Marital Property
~~."~'-
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. :
LIABILITIES
Plaintiff lists all liabilities of either or both spouses alone or with any other person as of the
date this action was commenced.
Item
Number
Description of
Liability
Names of All
Creditors
Debtors
Nove
r
<
Item
Number
Date Liability
Was Incurred
Amounts of Liability on Date Incurred and
Date Action Commenced
Item
Number
Date Balance
is Due
Periodic Payment
and Amount
.
,
. .
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.
PROPERTY TRANSFERRED
Plaintiff lists all marital property in which either or both spouses have a legal or equitable
interest individually or with any other person and which has been transferred within the
preceding three years.
..-7'" __
Use a separate sheet for each property item.
Item
Number
II
Item
Number,
If
Item
Number
/t
Item
Number
{,
OFF
Description
of Property
rt~.., G
Names of all
Owners
~ VA-Otto} P, l' f*T~\C.\A ir,
t'J~ &1>,,~1V
Cost or Value as of
Date of Acquisition
t 'Z,"", <I ~O
:,/
Value as of Date
Action Commenced
t 2..'1'3 5"()tJ
/
Nature of
Any Lien
Nt .. """j I't~e
Effective Date
of Lien
f/-"t (1'Z~
Date of
Acquisition
A "i / 1.,<6 ~
Amount of
Any Lien
1/'11 (700
/
Holder of Lien
Wop.'-'D ~"VI#f
Reason for Exclusion from Marital Property
H(lII/,e 5....:/> ;:)....~y) UO(). f~.c-6E1JS L{,G, ,,,
LIeN AIV]) "yGBTS flet..p :J::"u c.A1MI11Il1.
ftty
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LIABILITIES OF PARTIES
" ,~
Plaintlffmarks on the list below those items appUcable to the case at bar and itemizes the
Uabilities on the following page.
Secured
o 1. Mortgages
o 2. Judgements
03. Liens
o 4. Other Secured Liabilities
Unsecured
~
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j) P€,,>(JII';'19t.e tp;f-
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ON c.1t....'\lS
f-o "e.,C6N
!(S. Credit card balances
06. Purchases
o 7. Loan Payments
o 8. Notes payable
o 9. Other unsecured liabilities
Continl!:ent or Deferred
o 10. Contracts or agreements
o 11. Promissory notes
o 12. Lawsuits
o 13. Options
o 14. Taxes
o IS. Other contingent or deferred liabilities
;Jotlt:
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IN THE COURT OF COMMON PLEAS OF THE JUDICIAL DISTRICT
OF PENNSYLVANIA COUNTY CUMBERLAND
~
~
~
~
vs. ~
PATRICIA JEANNE OSBOURN, Defendant ~
362 Woodland Road ~
Madison, New Jersey 07940
973-410-1414
GORDON DEAN OSBOURN, Plaintiff
404 Allendale Way
Camp Hill, Pennsylvania 17011
717-761-1215
CIVIL ACTION - LAW
TERM
CASE NO. 0 () ~ b!"' 7....
INCOME AND EXPENSE STATEMENT
OF
GORDON DEAN OSBOURN, PLAINTIFF
Plaintiff files the following Income and Expense Statement setting forth hislher income
and expenses as of the date set forth below.
Plaintiff verifies that the statements made in the Income and Expense Statement are true
and correct. Plaintiff understands that false statements herein are subject to the penalties of 18
Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Dated: ,7 -I-~I
~..f)~{JJ~
GORDON DEAN OSBOURN
>
-:;"'^)t!,:>'
, .
DATE: 1 - {- 0 I
INCOME AND EXPENSE STATEMENT OF
GORDON DEAN OSBOURN, PLAINTIFF
NAME: GORDON DEAN OSBOURN
GORDON DEAN OSBOURN VS. PATRICIA JEANNE OSBOURN
INCOME:
Employer: PI/...01 Ctf8VI U:.A L. C-oA1.jJ~y
Address: \ II S'" BIA./tKE S"~ / )MTI Pe: 51',(,11\/7 ~ c;:; CJ"" 7(}
Type of Work: ~ fi1/D,vA-l. 'f' -9- ury. M &-vlt7 lEt<. - U/.eI4LC/fL :J:"''V~rr,e'l
Payroll No.:
--,
Social Security No.: 541-56-8335
Gross pay per pay period: $ '.1 0 '2. ~. o~ Pay period 0 weekly ,. biweekly 0 monthly
ITEMIZED PAYROLL DEDUCTIONS:
Federal Withholding $ ,'ttt, V> Local Wage Tax $ '30.2.3
$ - Credit Union $ -
Retirement
Health lnsurance $ 'Z.."1 ,o~ Social Security $ ! <g,.t3 0
Savings $ - State lnc. Tax $ q, 'i .OU
--
Life lnsurance $ Other
Me'ftc-JI1.<.G $ c..t1.S0
$
$
NETPAYperpayperiod:$ \/"~"~'2- ')(..1.1> ~ ..... 'b"l ~77.)?'-
,
-~
>__ 0_
, '
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" "~ - ' ,
lrit,
DATE: 3 - t... () l
INCOME AND EXPENSE STATEMENT OF
GORDON DEAN OSBOURN, PLAINTIFF
NAME: GORDON DEAN OSBOURN
GORDON DEAN OSBOURN VS. PATRICIA JEANNE OSBOURN
OTHER INCOME Weekly Monthly Yearly
Interest $ $ $
Dividends $ $ $
Pension $ $
Annuity $ $
Rents $ $
Royalties $ $ $
Social Security $ $ $
Expense Account $
Gifts $
Unemployment $ $ $
Workers' Compensation $ $ $
Other $ $ $
Other $ $ $
Total All Income: $
0,00
Per 0 Week 0 Month
){ Year
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DATE: "? - ? ~ {) (
INCOME AND EXPENSE STATEMENT OF
GORDON DEAN OSBOURN, PLAINTIFF
NAME: GORDON DEAN OSBOURN
GORDON DEAN OSBOURN VS. PATRICIA JEANNE OSBOURN
PROPERTY OWNED
Description Value Husband Wife Child
Checking Account $ > 20.:1. () tI ~ 0 0
Savings Account $ 0 0 0
Credit Union $ - 0 0 0
StocksfBonds $ 0 0 0
Real Estate $ 0 0 0
Automobile $ - 0 0 D
$ -- D
Other D D
INSURANCE Company Policy # Husband Wife Child
Hospitalization C~~~ )'QUS,~e9 # X 0 0
Medical " I / # ? 0 0
Health! Accident '/ t ( # ? D D
Disability " ., # ;L- D D
Dental I' , { # ~ 0 0
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DATE: J- (- 0 1
INCOME AND EXPENSE STATEMENT OF
GORDON DEAN OSBOURN, PLAINTIFF
NAME: GORDON DEAN OSBOURN
GORDON DEAN OSBOURN VS. P ATRlCIA JEANNE OSBOURN
EXPENSES
ALLOCATIONS
HOME Weekly Monthly Yearly Self Children
Mortgage $ $ $ $ $
Rent $ $ 5" 'bo.o!] $ ~'bO.OO $ $
Maintenance $ $ $ $ $
~OIL.. HeAT $ $ f', \ 0 0 $ &,aD, ~ 0 $ $
Electric $ $ -'t. t() $ )(P','I) $ $
Telephone $ $ " I. 0, $ 7~f. f P $ $
Water $ $ 1 f".o ~ $ $ $
Sewer $ $ - $ $ $
EMPLOYMENT Weekly Monthly Yearly Self Children
Transportation $ $ - $ $ $
Lunch $ $ \1.0.00 $ tqD, 0(1 $ $
Maintenance $ $ - $ $ $
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DATE: ,.......( ~ 01
INCOME AND EXPENSE STATEMENT OF
GORDON DEAN OSBOURN, PLAINTIFF
NAME: GORDON DEAN OSBOURN
GORDON DEAN OSBOURN VS. P ATRIClA JEANNE OSBOURN
EXPENSES
ALLOCATIONS
TAXES Weekly Monthly Yearly Self Children
Real Estate $ $ ,-- $ $ $
Personal Property $ $ - $ $ $
Income $ $ ---- $ $ $
INSURANCE Weekly Monthly Yearly Self Children
Homeowners $ $ -- $ $ $
Auto $ $ -- $ $ $
Life $ $ --- $ $ $
Accident $ $ -- $ $ $
Other $ $ - $ $ $
CAR Weekly Monthly Yearly Self Children
Payments $ $ .--- $ $ $
Fuel/Oil $ $ - $ $ $
Repairs $ $ - $ $ $
MEDICAL Weekly Monthly Yearly Self Children
Doctor $ $ - $ $ $
Dental $ $ --- $ $ $
$ $ r $ $ $
Hospital
- $ $
Medicine $ $ $
$ --- $ $ $
Special $
-
"-_wM~,.
..
DATE: ?~ \ -D\
INCOME AND EXPENSE STATEMENT OF
GORDON DEAN OSBOURN, PLAINTIFF
NAME: GORDON DEAN OSBOURN
GORDON DEAN OSBOURN VS. PATRICIA JEANNE OSBOURN
EXPENSES
ALLOCATIONS
SCHOOL Weekly Monthly Yearly Self Children
Private School $ $ .... $ $ $
Parochial School $ $ - $ $ $
College $ $ --" $ $ $
Religious $ $ r $ $ $
PERSONAL Weekly Monthly Yearly Self Children
Clothes $ $ I(I",(}~ $ '''''''-17.120 $ $
#
Food $ $ 6 ~",OO $"7'L..OO,QC7 $ $
I
Hairdresser $ $ - $ $ $
Barber $ $ to,Of} $ \'1.(/, '" $ $
Credit Payment $ $ - $ $ $
Credit Cards $ $ 1..0q,OfJ $ '1, <.10P.I1P $ $
I
Charge Accounts $ $ .,... $ $ $
Dues $ $ - $ $ $
CHILD CARE Weekly Monthly Yearly Self Children
Daycare $ $ - $ ~ $ $
$ $ -. $ ... $ $
Babysitter
Other $ $ ~ $ $ $
"'tIt"j.4-t... ~ ~ \Of~ 1P,fJO
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..
DATE: :>-1- 0 \
INCOME AND EXPENSE STATEMENT OF
GORDON DEAN OSBOURN, PLAINTIFF
NAME: GORDON DEAN OSBOURN
GORDON DEAN OSBOURN VS. PATRICIA JEANNE OSBOURN
EXPENSES
ALLOCATIONS
LOANS Weekly Monthly Yearly Self Children
Credit Union $ $ .... $ $ $
Other $ $ ""' $ $ $
Other $ $ - $ $ $
Other $ $ - $ $ $
MISC. Weekly Monthly Yearly Self Children
Papers $ $ ... $ $ $
Magazines $ $ 'Z....IIV $ 'Z.t(o.~ P $ $
Entertainment $ $ I (,.IJ.OQ $J4:1'1.', -00 $ $
,
Pay T.V $ $ J,tI,O() $ 3 ~(I, 00 $ $
Vacation $ $ 'too, 00 $ '2., l.{'"o& $ $
Gifts $ $ 71/,00 $ 'i,!11 ,ob $ $
Legal Fees $ $ - $ - $ $
Contributions $ $ \11', "0 $ 1.1,.10.'0 $ $
.
Other Child Support $ $ - $ - $ $
Alimony $ $ -' $ - $ $
Oth sl4fl'R;r.,1= $ $ (,~o.Oo $ 7 '1.,q.oo $ $
er ;J\Q.,..It..~ I
Other $ $ $ $ $
Other $ $ $ $ $
TOTAL Weekly Monthly Yearly Self Children
EXPENSES
'l, ~'tf.' /) 'I), '!/)O
$ $ 7l ~","Cl $WI'~O OQ-- $ $
/
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NOV 2 0 2003 \)
IN THE COURT OF COMMON PLEAS
OF
CUMBERLAND COUNTY, PENNSYLVANIA
GORDON DEAN OSBOURN,
Plaintiff
'f-
CIVIL ACTION - LAW
VS.
PATRICIA JEANNE OSBOURN,
Defendant
CASE NO. 00-6562
IN DIVORCE
QUALIFIED DOMESTIC RELATIONS ORDER
Under this Domestic Relations Order ("Order"), as defined in Sections 414(P) of
the Internal Revenue Code, the Alternate Payee named below shall be entitled to receive
a distribution of the amount hereinafter set forth from the BASF Corporation Employee
Savings Plan ("the Plan") at such time and in such a manner as hereinafter provided.
1. Parties.
a. Plaintiff Gordon Dean Osbonrn ("Participant") is a Participant in
the Plan. The Participant's Social Security Number, date of birth,
and current mailing address are as follows.
Social Security Number: 541-56-8335
Date of birth : February 2, 1948
Mailing address : 404 Allendale Way; Camp Hill, P A 17011
b. Defendant Patricia Jeanne Osbourn ("Alternate Payee") is the
Alternate Payee under this order. The Alternate Payee's Social
Security Number, date of birth, and current mailing address are as
follows.
Social Security Number : 316-48-5888
Date of birth : March 17, 1947
Mailing address : 39 Sandpiper Drive; Hackettsown, NJ 07840
2. Amount of Distribution. The amount to be distributed from Participant's
vested Account under the Plan to Alternate Payee pursuant to this Order shall
equal 34.0 percent of the Participant's account balance as of November I,
2003, determined in accordance with the applicable terms of the Plan at the
time distribution is to be made. (Any loans outstanding by the Participant
against the Plan as of the date of assignment of a portion of the Participant's
benefit to the Alternate Payee will not be included within the segregation or
allocation of benefit to the Alternate Payee.)
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3. Distribution Date. Distribution shall be made as soon as practicable following
a determination by QPG that this Order is a Qualified Domestic Relations
Order and as soon as practicable following receipt by the QPG of the
applicable election forms properly completed by the Alternate Payee.
4. Form of Distribution. Distribution of the amount to which Alternate Payee is
entitled pursuant to this Order shall be made as a direct rollover to an
Individual Retirement Account or another qualified plan.
5. Death of Alternate Payee. In the event of the death of Alternate Payee after
the date this order becomes final and before distribution commences pursuant
to the Order, the Plan shall, to the extent permitted in accordance with the
applicable provisions of the Plan and any applicable law governing survivor
benefits, distribute to Alternate Payee's estate the amount set forth above in
the form of a lump cash payment as soon as practicable following the date of
Alternate Payee's death.
6. Death of Participant. In the event of the death of the Participant at any time,
payment of the Participant's interest in the Plan shall be made in accordance
with Participant's election on file with the Plan and shall not affect or increase
any payments from the Plan due to the Alternate Payee.
7. Plan Administrator. The QDRO Analyst shall take all such actions as are
necessary in accordance with the terms ofthe Plan and any applicable law to
enable the Plan to comply with Order.
8. Miscellaneous. This Order is intended to comply with the provisions of Code
Section 414(P) of the Internal Revenue Code of 1986 and ERISA Section
206( d) of the Employee Retirement Income Security Act of 1974, as
amended. To the extent that any part of the Order is found to be invalid by a
Court if competent jurisdiction, such finding shall not affect the validity of the
rest of the Order.
Accepted and ordered this ;?I!: day of ,v. vr-lrV
,2003.
By the Court: . / /
--;/ . 4 JL
Judge
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