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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
.
PENNA.
STATE OF
.
.
JEFFREY N. POrTER,
.
Plaintiff
No.
2000-8512
VERSUS
.
HOPE L. POrTER,
.
.
Defendant
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.
.
DECREE IN
DIVORCE
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G.. I.{: S3 ,.M .
,2001 ,IT IS ORDERED AND
AND
NOW,~'')'
DECREED THAT
Jeffr~ L. Potter
, PLAINTIFF,
AND
Hope L. Potter
, DEFENDANT,
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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All claims resolved by Marital Settlement Agreement dated August 28,
.
.
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2001, the terms of which are hereby
Decree for purposes of enforcement only
By TH
but not merged, into this
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PROTHONOTARY
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JEFFREY N. POTTER,
Plaintiff
: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO. 2000-8512
Civil Term
HOPE C. POTTER,
Defendant
IN DIVORCE
MARITAL SETTLEMENT AGREEMENT
THIS MARITAL SETTLEMENT AGREEMENT is made this.lk1;y of August, 2001, by
and between HOPE C. POTTER, ("Wife"), and JEFFREY N. POTTER, ("Husband").
WHEREAS, the parties were married on June 26,1976, and have remained married since
that time; and
WHEREAS, certain differences have arisen between the parties and, as a consequence,
they are living separate and apart from each other; and
WHEREAS the parties wish to set forth certain covenants and understandings regarding
their separation and their respective property rights;
NOW THEREFORE, in consideration of the mutual promises and undertakings contained
herein, the parties hereto, intending to be legally bound, covenant and agree as follows:
1. VOLUNTARY AGREEMENT: The parties agree that this Marital Settlement Agreement is
entered into voluntarily and after due deliberation by each of them. The execution of the
Agreement is not the result of any duress or undue influence, and it is not the result of any
collusion or improper illegal agreement or agreements. The parties acknowledge that each has
been fully informed of, or is familiar with, the wealth, property, state, and income of the other, and
each party is hereby satisfied that such information is true and correct.
2. LEGAL ADVICE: The parties acknowledge that Husband has been represented by Dawn
S. Sunday, Esquire, as counsel in this matter, and that Wife has been represented by Andrea C.
Jacobsen, Esquire, in this matter. Wife and Husband each acknowledge that they have received,
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or have had the opportunity to receive independent legal advice from counsel of her or his
selection prior to the execution of this Agreement. Each party agrees that she or he each fully
understands the facts surrounding this divorce, and each has had the opportunity to be fully
informed as to her or his legal rights and obligations. Each party acknowledges and accepts that
this Agreement is, under the circumstances, fair and equitable, and that it is being entered into
freely and voluntarily after Wife's consultation with her attorney and Husband's consultation with his
attorney.
3. SEPARATION AND NON-INTERFERENCE: It shall be lawful for Wife and Husband at all
times hereafter to live separate and apart from each other and to reside from time to time at such
place or places as they shall respectively deem fit, free from any control, restraint, harassment or
interference, indirect or direct, from each other. The foregoing provisions shall not be taken to be
an admission on the part of either party of the lawfulness or unlawfulness of the causes leading
them to live apart.
4. DIVORCE ACTION: An action for divorce between the parties has been filed by Husband
in the Court of Common Pleas of Cumberland County, Pennsylvania, to the caption, Potter v.
Potter, No. 2000-8512 Civil Term. The parties hereby acknowledge their intention and agreement
to proceed in said action to obtain a final decree in divorce by mutual consent under Section
3301 (c) of the Pennsylvania Divorce Code on the grounds that their marriage is irretrievably
broken, and to settle, amicably and fully hereby, all claims which might be raised by either party in
the divorce action. The parties acknowledge that they are executing, simultaneous with the signing
of this Marital Settlement Agreement, the necessary Affidavits of Consent and Waivers of Notice of
Intention to Request Entry of a Divorce Decree in the pending action and to deliver them within ten
(10) days to Husband's counsel whq will file them with the Court and finalize the divorce.
5. PERSONAL PROPERTY: The parties acknowledge that there has been distribution of
their items of personal, tangible and intangible property, between them since their separation,
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and, except as otherwise provided for herein, or as may be mutually agreed upon by the parties,
each agrees that the division of such property is to their mutual satisfaction, subject to the
further terms of this Marital Settlement Agreement. Except as otherwise provided for within this
Marital Settlement Agreement, each of the parties shall hereafter own and enjoy, independently
of any claim or right of the other party, all items of personal, tangible and intangible property
now or hereafter owned or held by her or him with full power to dispose of the same effectively
and for all purposes as if she or he were unmarried.
6. MARITAL REAL PROPERTY: The parties acknowledge that the marital home has been
sold and the proceeds have been applied to debts of the parties and/or have been distributed
between them. The parties certify that, except as set forth herein, they own no other real property,
individually, or jointly with each other or any other party, which constitutes marital property.
7. NON MARITAL REAL PROPERTY: The parties acknowledge that Wife has purchased
certain real property at 1166 Heron Court, Mechanicsburg, Pennsylvania, which she holds in her
individual name and title. Husband agrees that such real property is non-marital property and he
waives and releases any and all claim, interest or title in such property. Wife acknowledges her
responsibility for any debts or obligations stemming from her ownership of the property and
indemnifies and holds Husband harmless with regard to any such expenses or obligations.
8. CREDIT CARD DEBT: The parties acknowledge that there is currently an outstanding
credit card debt in the amount of $3,948.82 due as of August 23, 2001, on the Capital One Visa
Account, Account No. 43057217 18486363, held in the name of Wife. Wife warrants that she has
not used the account since August 1, 2001, and shall not hereafter use the card until the current
balance is fully paid off. Wife further warrants that there are not and shall not be any new or
additional charges on the account, other than finance charges, incurred since the charges reflected
in the above balance. The parties agree that they shall be jointly responsible for the debt on such
credit card account, and shall jointly make equal payments each month on the account until the
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debt is retired. The amount of such payments shall be TWO HUNDRED AND FIFTY DOLLARS
($250.00) per month or such other amount as the parties may mutually agree.
9. ALIMONY:
a. The parties agree that Husband shall pay Wife as alimony or spousal support the
sum of ONE THOUSAND DOLLARS ($1,000.00) each month, beginning as of
September 2001, and continuing each month until and including the month of
December 2013.
b. The parties agree that such payment is intended to supplement Wife's income to
permit her to maintain the approximate life style enjoyed during the marriage of the
parties. The parties acknowledge their intent that the monthly payment shall be
considered, for federal tax purposes, as taxable income to Wife and as a deductible
expense to Husband.
c. The parties agree that the amount of the monthly payment to Wife shall not be
modified, and shall terminate only in the event of death of either party or remarriage
of Wife.
d. The parties agree that such payments shall be made directly by Husband to Wife
and not through any Court unless Husband shall fail to comply with such obligation,
in which case, upon application of Wife, such payments shall be payable through the
Domestic Relations Section of the Court of Common Pleas of Cumberland County.
The parties hereby agree to execute any necessary documents or to otherwise
cooperate to effectuate the intent of this paragraph.
10. RETIREMENT ACCOUNTS:
a. The parties are the owners of various retirement accounts including IRAs and 401(k)
funds, which were acquired during their marriage and constitute marital property. The
parties warrant that the accounts set forth on Exhibit A, hereto, is a full and complete
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listing of all such accounts held by either party, and their value, as of June 30, 2001.
The parties agree to the equal division between them of the total combined balances of
all the listed accounts as of June 30, 2001, which the parties stipulate equals
approximately $264,249, as set forth on Exhibit A. Such distribution shall be through
the equitable distribution and assignment of all or part of two of Husband's accounts to
Wife by entry of Qualified Domestic Relations Orders, in the divorce action between
them, or by such other means as the parties may agree, with the distribution to Wife of
the following assets held in Husband's name:
1. Coventry Health Care Inc Retirement Savings Plan - Total balance of fund on
date of transfer.
2. T. Rowe Price qualified investment accounts - 30 % of balance on date of
transfer.
b. Husband shall retain all other accounts held in his name, and Wife shall retain all
accounts held in her name.
c. The parties agree that upon the transfer of the above account and share of account,
they shall each be the sole owner of any and all such retirement, 401 (k), pension, or
other similar benefits held in his or her name or on his or her behalf. Each party
hereby waives and releases any and all claim or interest in the accounts of the other
party. Each party hereby agrees to execute any necessary documents or to
otherwise cooperate to effectuate the intent of this paragraph.
11. INVESTMENT ACCOUNTS:
a. The parties hereby agree that they are the owners of two joint investment accounts
that were acquired during their marriage and constitute marital property. As of June
30, 2001, those accounts included:
1. Strong Investments, Inc. - Strong Funds Account No. 035-3500450779; and
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2. T. Rowe Price Prime Reserve Account no. 521085768-2.
b. The parties agree that the total balance of both joint accounts identified above shall
be transferred to the individual title of Wife and that she shall thereafter be the sole
owner of such assets. Husband hereby waives and releases to Wife any and all
claim or interest in the said accounts.
c. The parties hereby agree to execute any necessary documents or to otherwise
cooperate to effectuate the intent of this paragraph.
12. VEHICLES: The parties acknowledge that as of their separation they owned three (3)
vehicles which constituted marital property, including a 1993 Mercury Villager, a 1997 Saturn, and
a 1996 Toyota Camry. The parties agree that they have distributed the vehicles between them and
that the current title and possession of the vehicles is to their mutual satisfaction and that
hereinafter each shall retain full title, right and interest in the vehicle or vehicles presently titled in
his or her name, without interest or claim of any right of the other party.
13. POTENTIAL LIABILITY: The parties acknowledge the existence of a potential claim by
Promedco, or its agents, against Husband relating to an employment contract dispute which
arose during the parties' marriage. The parties acknowledge that Husband disputes such claim.
Wife agrees that in the event that Husband is found to be liable for any damages stemming from
the claim against him by Promedco, by Court Order or settlement, she shall reimburse Husband for
one third (1/3) of the net post-tax consequence cost of such damages to Husband.
14. EXECUTION OF DOCUMENTS: Each of the parties shall, from time to time at the request
of each other, execute, acknowledge and deliver to the other party any and all further instruments
that may reasonably be required in order to give full force and effect to the provisions of this
Agreement.
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15. TAXES:
a, Wife and Husband warrant that they have paid all taxes on prior jointly filed returns
including the calendar year ending December 31, 2000; that they do not owe any
interest or penalties; and that no tax deficiency proceeding or audit is pending or
notice thereof received. Husband shall give Wife notice of any deficiency
assessment and Wife shall give Husband notice of any deficiency assessment of
which they individually or collectively become aware. The parties agree that should it
ultimately be determined that any deficiency and/or penalty exists with respect to any
jointly filed returns, the party responsible for the erroneous preparation and/or, non-
disclosure or erroneous disclosure of information which has resulted in the deficiency
and/or penalty, shall be solely responsible for the payment of the amount ultimately
determined to be due, together with interest, as well as expenses that may be
incurred to contest the assessment
b. The parties acknowledge that Husband has been responsible for the undergraduate
education expenses of the children of the parties. So long as Husband continues to
undertake this responsibility, Wife releases any claim to take the children as
dependents for federal tax purposes and shall sign any waivers or documents
necessary to carry out the intent of this paragraph.
1.6. MUTUAL RELEASE AND COUNSEL FEES: Except as provided for in this Agreement,
the parties hereby remise, release, quit-claim and forever discharge each other and the estate of
each other, for all time to come, and for all purposes whatsoever, from any and every claim,
including alimony, alimony pendente lite, spousal support, equitable distribution of marital property,
counsel fees or costs under the Divorce Reform Act, or otherwise, that they make or hereafter
make in and to or against each other's estates or any parts thereof, whether by way or dower or
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courtesy, or under the intestate laws, or the right to take or elect against the other's will, except only
such rights as accrue pursuant to this Agreement.
17. ENTIRE AGREEMENT: The parties acknowledge and agree that this Agreement
contains the entire understanding of the parties and supersedes any prior agreement between
them. There are no other representations, warranties, promises, covenants or understandings
between the parties other than those expressly set forth herein.
18. AGREEMENT BINDING ON HEIRS: This Agreement constitutes the final agreement of
the parties and is binding upon their heirs, assigns and successors in interest.
19. 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 provisionshall be stricken from this Agreement, and in all other respects this Agreement
shall be valid and continue in full force, effect and operation.
20. APPLICABLE LAW: This Agreement shall be construed under the laws of the
Commonwealth of Pennsylvania.
21. BREACH OF AGREEMENT: In the event that either party breaches any provision of this
Agreement or fails to timely perform his or her obligation under this Agreement, she or he shall be
responsible for any and all costs incurred to enforce the Agreement, including, but not limited to,
court costs and counsel fees of the other party. In the event of breach, the other party shall have
the right, at her or his election, to sue for damages for such breach or to seek such other and
additional remedies as may be available to her or him.
IN WITNESS WHEREOF, the parties hereto have set their hands and seals as of the day
and year first above written.
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HOP C. POTTER
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JEFF Y . P ER
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Value
Retirement Assets 06/30/01 To Wife To Husband
Coventry 401(K)
Account No. 4-32508 87,944 87,944
Coventry Supplemental Annuity
Contract No. 4-35724F/4-35724V 7,307 7,307
Beacon - formerly ProMedco
200406 or 03725-001 26,622
Belvedere Medical Corooration 23,594 23,594
T. Rowe Price Acct No.
Prime Reserve - 521085768-2
Equity Income - 400388907-5
European Stock - 70092028-8
International Stock - 200833355-7
Media & Telecomm. - 2785106535-8
Media & Tellcomm. - 2785106536-1
, New America - 207081407-5
Science & Technology - 207081403-3
Value - 521976973-9 64,050 30% 70%
Strong Investments, Inc. IRA
International Stock - 035-3500450779
Money Market - 023-2302108358
Advisor Common - 032-3200678255 19,847 19,847
Columbia Funds IRA
Account 1-38499 9,881 9,881
Vanguard IRA
Account No. - 9885488013 8,988 8,988
PA League of Cities
Entitv: 3863 16,016 16,016
Total 264,249
EXHIBIT A
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JEFFREY N. POTTER,
Plaintiff
: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
vs.
2000-8512 CIVIL TERM
HOPE L. POTTER,
Defendant
: IN DIVORCE
PRAECIPE TO TRANSMIT RECORD
To the Prothonotary:
Please transmit the record, together with the following information, to the Court for entry of a
Divorce Decree:
1. Ground for divorce: Irretrievable breakdown under Section 3301 (c) ofthe Divorce Code.
2. Date and manner of service of the Complaint:
Acceptance of Service signed bvDefendant's counsel. Andrea C. Jacobsen on 12/14/00.
3. Dates of execution and filing of the Affidavits of Consent and Waivers of Notice required
by Section 3301 ( c) of the Divorce Code:
By Plaintiff: Signed August 28, 2001. attached for filing.
By Defendant: Signed August 28, 2001, attached for filing.
4. Related claims pending: None. All claims resolved bv Marital Settlement Agreement dated
August 28, 2001 which is to be incorporated into Divorce Decree.
Jb81ud- ,30) /J-co/
Date
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Dawn S. Sunday, Esquire
Attorney for Plaintiff
ill #41954
39 W. Main Street- Ste. #1
Mechanicsburg, P A 17055-6230
(717) 766-9622
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JEFFREY N. POrTER, : IN THE COURT OF COMMON PLEAS OF
plaintiff . CUMBERLAND COUNTY, PENNSYLVANIA
.
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vs. : 2000- <;51.2. CIVIL TERM
.
.
HOPE L. POrTER, .
.
Defendant : IN DIVORCE
NOTICE TO DEFEND AND CLAIM RIGB'l'S
You have been sued in Court. If you wish to defend against the claims
set forth in the following pages, 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 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:
CllMBERLAND COUNTY CXXJRT HOOSE, CARLISLE, PENNSYLVANIA 17013.
IF YOU IX) Not FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER I 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 IX) Nor HAVE
A LAWYER OR CANNot AFFORD ONE GO TO OR TELEPHONE THE OFFICE SET FORTH BELCW
TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
CUMBERLAND COUNTY BAR ASSOCIATION
2 LIBERTY AVENUE
CARLISLE, PENNSYLVANIA 17013
TELEPHONE: (717) 249-3166
TOLL FREE: 1-800-990-9108
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JEFFREY N. POrTER, : IN THE OOURT OF COMMON PLEAS OF
Plaintiff . CUMBERLAND COUNTY, PENNSYLVANIA
.
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vs. . 2000- 'i5)2...J CIVIL TERM
.
.
.
HOPE L. POrTER, :
Defendant . IN DIVORCE
.
<n4PLAINT
Plaintiff, Jeffrey N. Potter, by his attorney, Dawn S. Sunday
files this Complaint for Divorce, and in support thereof states the
following:
1. Plaintiff is Jeffrey N. Potter, M.D., who currently resides
at 103B Forge Road, Boiling Springs, CUmberland County, Pennsylvania.
2. Defendant is Hope L. Potter, who currently resides at 3808
Pamay Drive, Mechanicsburg, Cumberland County, Pennsylvania.
3. Plaintiff and Defendant have been bona fide residents of the
Commonwealth for at least six months immediately preceding the filing of
this Complaint.
4. Plaintiff and Defendant were married on June 26, 1976 in
philadelphia, Pennsylvania.
5. There have been no prior actions for divorce or for annulment
between the parties.
6. Plaintiff avers, as the grounds upon which this action is
based, that the marriage between the parties is irretrievably broken.
7. Plaintiff has been advised that counseling is available and
that Plaintiff may have the right to request that the Court require the
parties to participate in counseling.
8. Plaintiff requests that the Court enter a Decree of Divorce
under Section 3301(c) or 3301(d) of the Pa. Divorce Code.
Respectfully Submitted,
CL.~,~~
Dawn S. Sunday, Esquire
Attorney for Plaintiff
ID # 41954
39 West Main Street
Mechanicsburg, PA 17055
(717) 766-9622
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VERIFICATlOO
I verify that the statements made in the foregoing Complaint are
true and correct. I understand that false statements herein are subject to
the penalties of 18 Pa.C.S. ~4904, relating to unsworn falsification to
authorities.
plaintiff
Jeff
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JEFFREY N. POTTER,
Plaintiff
: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
vs.
2000-8512
CIVIL TERM
HOPE L. POTTER,
Defendant
: IN DIVORCE
ACCEPTANCE OF SERVICE
I, Andrea C. Jacobsen, Esquire, hereby accept service of the Divorce
Complaint on behalf of Hope L. Potter, and certify that I am authorized to do
so.
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AndreaC. obsen, Esquire
52 East High Street
Carlisle, P A 17013
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JEFFREY N. POTTER,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
vs.
: NO.2000-85l2 CIVIL TERM
HOPE L. POTTER,
Defendant
CIVIL ACTION - LAW
IN DIVORCE
AFFIDAVIT OF CONSENT TO DIVORCE
(I) A Complaint in Divorce under Section 3301 ( c ) of the Divorce Code was filed on
December 8, 2000.
(2) Defendant accepted service of the Complaint, through Acceptance of Service signed by
Defendant's counsel on December 14,2000.
(3) The marriage of Plaintiff and Defendant is irretrievably broken and ninety days have
elapsed from the date of filing the Complaint.
(4) I understand that I may lose rights concerning alimony, division of property, lawyers fees
or expenses if! do not claim them before a Divorce is granted.
(5) I consent to the entry of a final Decree of Divorce.
(6) 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. Being so advised, I do
not request that the Court require that my spouse and I participate in counseling prior to a Divorce
Decree being handed down by the Court.
I verify that the statements made in this Affidavit are true and correct. I understand that false
statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn
falsification to authorities.
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JEFFREY N. POTTER,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL V ANlA
vs.
NO. 2000-8512 CIVIL TERM
HOPE L. POTTER,
Defendant
CIVIL ACTION - LAW
IN DIVORCE
WAIVER OF NOTICE OF INTENTION TO REOUEST
ENTRY OF A DIVORCE DECREE UNDER
SECTION 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 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. Section 4904 relating to unsworn
falsification to authorities.
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JEFFREY N. POTIER,
Plaintiff
v.
: IN THE COURT OF COMMON PLEAS OF
: aJMBERIAND COUNlY, PENNSYLV ANlA
: NO. 2000-8512 Civil Term
HOPE C. POTTER,
Defendant
: IN DNORCE
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under the Divorce code was filed December 8,
2000, on the grounds that the marriage of the parties is irretrievably
broken.
2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety
days have elapsed from the date of filing the Complaint.
3. I consent to the entry of a final decree of divorce.
4. 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.
I vertfy that the statements made in the Affidavit are true and correct. I
understand that false statements herein are made subject to the penalties of 18
Pa.C.S. S4904 relating to unsworn falsification to authorities.
Date: 3}agIa.oo,
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Ho e C. Potter
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JEFFREY N. POTTER,
Plaintiff
v.
IN THE COURT OF COMMON PLEAS OF
aJMBERIAND COUNTY, PENNSYLV ANlA
: NO. 2000-8512 Civil Term
HOPE C. POTTER,
Defendant
: IN DIVORCE
WANER OF NOTICE OF INTENTION TO REQUEST
ENTRY OF A DNORCE DECREE
UNDER 3301(c) OF THE DNORCE 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 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. S4904 relating to unsworn falsification to authorities
Date: 2" ):;g!:JOD I
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Hop C. Potter
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JEFFREY N. POTTER,
Plaintiff
. IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL V ANlA
vs.
NO. 2000-8512
CIVIL TERM
HOPE L. POTTER, (alk/a Hope C. Potter)
Defendant
CIVIL ACTION - LAW
IN DIVORCE
OUALIFIED DOMESTIC RELATIONS ORDER
AND NOW, this li~ day of J ~ , 2002, upon
consideration of the attached Stipulation of the parties, it i rdered and directed as follows:
This Order is intended to be a qualified domestic relations order ("QDRO"), as that
term is defined in section 206(d) of the Employee Retirement Income Security Act of 1974 ("ERISA')
and section 414(P) of the Internal Revenue Code of 1986 (the "Code"). This QDRO is granted in
accordance with Chapter 23 of the Pennsylvania Divorce Code, which relates to marital property
rights, child support, and/or spousal support between spouses and former spouses in matrimonial
actions.
SECTION 1.
IDENTIFICATION OF PLAN
This Order applies to benefits under the Coventry Health Care, Inc. Retirement Savings
Plan (the "Plan").
SECTION 2.
IDENTIFICATION OF PARTIES
a. Jeffrey N. Potter is hereafter referred to as the "Participant." The
Participant's address is 2126 Canterbury Dr., Mechanicsburg, PA 17055. The
Participant's Social Security Number is 171-46-0003.
b. . Hope C. Potter is hereafter referred to as the "Alternate Payee." The
Alternate Payee's address is 1166 Heron Court, Mechanicsburg, PA 17050. The
Alternate Payee's Social Security Number is 192-44-1577. The Alternate Payee
is the former spouse of the Participant.
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SECTION 3.
AMOUNT OF ASSIGNMENT
The Plan is hereby Ordered to assign 100% of the Participant's vested account as of the
date of transfer pursuant to this Order to an account to be separately established in the name of the
Alternate Payee.
SECTION 4.
FORM OF DISTRIBUTION
The Alternate Payee may elect to receive payment from the Plan of the benefits
assigned to the Alternate Payee under this Order in any form in which such benefits may be paid under
the Plan to the Participant (other than in the form of a joint and survivor annuity with respect to the
Alternate Payee and his or her subsequent spouse), but only if the form elected complies with the
minirnum distribution requirements of Code section 401(a)(9).
SECTION 5.
TIMING OF DISTRIBUTION
Payments to the Alternate Payee pursuant to this Order shall commence on any date
elected by the Alternate Payee (and such election shall be made in accordance with the terms of the
Plan), but not ~arlier than the Participant's earliest retirement age (or such earlier date as allowed under
the terms of the Plan), and not later than the earlier of: (a) the date the Participant would be required to
commence benefits under the terms of the Plan; or (b) the latest date permitted by Code section
401(a)(9).
For purposes of this Order, the Participant's earliest retirement age shall be the earlier
of: (i) the date on which the Participant is entitled to a distribution under the Plan, or (ii) the later of (a)
the date the Participant attains age 50, or (b) the earliest date on which the Participant could begin
receiving benefits under the Plan if the Participant separated from service.
SECTION 6.
DEATH OF PARTICIPANT
Payments of the Alternate Payee's separate interest shall not be affected by the
Participant's death.
SECTION 7.
DEATH OF ALTERNATE PAYEE
Ifthe Alternate Payee dies before commencing benefits and Section 2 ofthe Order does
not provide for a contingent Alternate Payee on the Alternate Payee's death, the Alternate Payee's
separate interest shall revert to the Participant.
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SECTION 8.
COMPLIANCE WITH APPLICABLE LAWS
The parties to this Order intend that it comply with applicable provisions of ERISA and
the Code. Nothing in this Order shall require the Plan:
a. To pay any benefits not permitted under the Code or ERISA;
b. To provide any type of form or benefit or any option not provided by the
Plan; or
c. To pay benefits to the Alternate Payee that are required to be paid to another
alternate payee under another QDRO that is in effect prior to this Order.
SECTION 9.
RESERVATION OF JURISDICTION
This Court reserves jurisdiction to amend this Order to establish or maintain its status as
a QDRO under ERISA and the Code.
Judge
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JEFFREY N. POTTER,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
vs.
NO. 2000-8512
CIVIL TERM
HOPE" POTTER,
C Defendant
H
CIVIL ACTION - LAW
IN DIVORCE
STIPULATION FOR THE ENTRY OF
OUALIFlED. DOMESTIC RELATIONS ORDER
c.H
Plaintiff, Jeffrey N. Potter, and Defendant, Hop~ Potter, hereby agree to entry by the Court
ofthe attached Qualified Domestic Relations Order transferring Plaintiffs Coventry Health Care, Inc.
Retirement Savings Plan to Defendant.
IN WITNESS WHEREOF, the parties, intending to be legally bound hereby, have voluntarily
executed this Stipulation on the dates indicated below.
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er, M.D., Plaintiff
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