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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
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STATE OF
PENNA.
Tammy Suzanne Ambrose
Plaintiff
No.
961
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VERSUS
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Rodney Lee Ambrose
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Defendant
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DECREE IN
DIVORCE
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AND NOW,
, IT IS ORDERED AND
DECREED THAT
Tammy Suzanne Ambrose
, PLAINTIFF,
AND
Rodney Lee Ambrose
, 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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By TH
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TAMMY SUZANNE AMBROSE
Plaintiff
: IN THE COURT OF COMMON
: PLEAS OF CUMBERLAND COUNTY,
: PENNSYL VANIA
and
RODNEY LEE AMBROSE
Defendant
: CIVIL ACTION - LAW
: NO. ()J - 9(,,1_ CIVIL TERM
: IN DIVORCE
NOTICE
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 in divorce or annulment may be entered
against you by the court. A judgement 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 divorce is indignities or irretrievable breakdown ofthe marriage,
you may request marriage counseling, A list marriage counselors is available in the
Office of Prothonotary, Cumberland County Courthouse, Carlisle, Pennsylvania 17013,
IF YOU DO NOT FILE CLAIM FOR ALIMONY, DIVISION OF PROPERTY,
LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS
GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU
DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR
TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU
CAN GET LEGAL HELP.
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, Pennsylvania 17013
(717) 249-3166
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In the Court of Common Pleas, Cumberland County, State of Pennsylvania
In re: The Marriage of:
TAMMY SUZANNE AMBROSE
Plaintiff
and
RODNEY LEE AMBROSE
Defendant
And in the interest of:
TAMMY SUZANNE AMBROSE and
RODNEY LEE AMBROSE
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Case#: 6/- '1(.l 6:u:J ~
COMPLIANT FOR DIVORCE
This action is brought by TAMMY SUZANNE AMBROSE, Plaintiff, age 37, who
resides at 5199 Laurel Lane, in the City of Harrisburg, County of Dauphin, State of
Pennsylvania, whose Social Security # is 168-58-1824, and who is employed as a
Electronic Banking Utility Clerk, at Commerce Bank, located at 3 Crossgate Drive, Town
of Mechanics burg, State of Pennsylvania,
The Defendant in this action is RODNEY LEE AMBROSE, age 39, who resides at 1350
Asper Drive, in the Town of Boiling Springs, County of Cumberland, State of
Pennsylvania, whose Social Security # is 208-50-5713, and who is employed as a
Computer Programmer at Electronic Data Systems, located at 225 Grandview Avenue,
Town of Camp Hill, State of Pennsylvania.
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The undersigned Plaintiff states, under oath, the following:
1. RESIDENCY, Plaintiff has been a resident of and domiciled in the State of
Pennsylvania for the proceeding 37 years and the County of Cumberland for the
preceding 10 years,
2. SERVICE OF PROCESS, The Defendant has agreed to file a Wavier of Service
of Process in this cause and, therefore, no service of process is necessary at this
time.
3. JURISDICTION, The court has proper jurisdiction to hear this cause. The
Defendant has agreed to file a Consent in this cause, Neither party has ever been
involved in any other domestic relations proceeding involving the other party in this
or any other jurisdiction, Neither party is currently an active member of any branch
ofthe Armed Forces of the United States,
4, MARRIAGE. The Plaintiff and Defendant were married on the 19 day of April,
1986, in the State of Pennsylvania and lived together as husband and wife until on
or about the 16th day of February, 2001, at which time they separated and ceased to
live together and they have lived separate and apart without cohabitation ever since.
5. CHILDREN, There were (2) children born to the marriage and their names and
dates of birth are as follows:
Cody Ryan Ambrose, born April 9, 1992
Tristan James Ambrose, born October 12,1995
6, GROUNDS, The Plaintiff and Defendant, after (8) marriage counseling sessions
over a period of (5 112) months, agree the marriage is irretrievably broken and there
is no possible chance for reconciliation,
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7. AGREEMENT, This proceeding is uncontested, The Plaintiff and Defendant both
signed a Marital Settlement Agreement, dated the 16th day of February, 2001,
which is attached and incorporated by reference, By the terms of this Martial
Settlement Agreement they have settled all of the issues relating to their marriage,
including the division of all of their property, the disposition of all oftheir bills and
obligations, the need for any alimony, maintenance or spousal support, and the
custody, visitation, care, and support of their children, A Financial Statement has
been prepared by each ofthe parties listing their respective income, expenses,
assets, and liabilities and the individual Financial Statements are attached and
incorporated by reference, The Marital Settlement Agreement and Financial
Statements were signed under no duress or force and without collusion,
8. CONSTENT. The Defendant has agreed to file Consent to the incorporation and
merger of said Martial Settlement Agreement into a Final Decree of Divorce in this
cause,
9. WAVIER. The Plaintiff hereby waives any rights to findings of fact and
conclusions of law, a record of testimony, motion for a new trial, notice of entry of
final judgement or decree, and the right to appeal, but does not waive any rights to
the future modification of any judgement or decree in this cause,
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The Plaintiff respectfully requests and prays:
1. That a Divorce be granted by the court dissolving and terminating forever the
marriage between the parties,
2, That all of the terms and conditions of the party's Martial Settlement Agreement,
which is attached, be approved and be incorporated, merged into, and made part of a
Final Decree of Divorce, and that the parties be ordered to comply with all terms and
conditions of the Martial Settlement Agreement, but that the Martial Settlement
Agreement survive.
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Dated this ~ day of ~\.IM~
,2001
J: ~. ilL
(~ture o[Plaintiff)
State of Pennsylvania
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SS.
County of Cumberland
On this ~day of ~~~
,2001, TAMMY SUZANNE AMBROSE
personally came before me and, being duly sworn, did state that she is the person
described in the above document and that she signed the above document in my presence
and verified that the information contained in the foregoing document is tme and correct
on personal knowledge and acknowledged that the document was signed as a free and
voluntary act for the purposes stated,
Notary Public, for County of Cumberland
State of Pennsylvania
My Commission Expires Dee J 3 ::? .....:2
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Notariu! Seal ~
Judrih A. SiimmeJi, Notary PUbi.iC I'
Hampden Twp., Cumberland County
My CommissIon Expires Dec. 23, 2002 J
Member, Pennsylvania Assoc!ation of Notaries
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State of Pennsylvania
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SS,
County of Cumberland
Onthis~dayof ~
,2001, RODNEY LEE AMBROSE
personally came before me and, being duly sworn, did state that he is the person
described in the above document and that he signed the above document in my presence
and verified that the information contained in the foregoing document is true and correct
on personal knowledge and acknowledged that the: document was signed as a free and
voluntary act for the purposes stated,
0....-
(Signature ofN
Notary Public, for County of Cumberland
State of Pennsylvania
My Commission Expires D e(c. 23 d 0-0.2
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Notarial Seal
Judith A. Stimmel!, N0tary Pubiic
Hampden Twp., Cumbc;iarld County !
My Commission Expires Dec. 23, 2002 I
Member, Pennsylvania Association of Notaries
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In the Court of Common Pleas, Cumberland County, State of Pennsylvania
In re: The Marriage of:
TAMMY SUZANNE AMBROSE
Plaintiff
and
RODNEY LEE AMBROSE
Defendant
And in the interest of:
TAMMY SUZANNE AMBROSE and
RODNEY LEE AMBROSE
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Case # : CJl - 91.,. (
MARITAL SETTLEMENT AGREEMENT
This is an Agreement made the 16th day of February, 2001 by and between TAMMY
SUZANNE AMBROSE, who lives at 5199 Laurel Lane, in the City of Harrisburg,
County of Dauphin, State of Pennsylvania; hereinafter referred to as "Wife", and
RODNEY LEE AMBROSE who lives at 1350 Asper Drive, in the Town of Boiling
Springs, County of Cumberland, State of Pennsylvania; hereinafter referred to as
"Husband",
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WITNESSETH
WHEREAS, Husband and Wife were married on April 19,1986 at the
Mercersburg Academy Chapel in the Town of Mercersburg, County of Franklin, State of
Pennsylvania; and
WHEREAS, the parties have two (2) minor children, to wit: Cody Ryan Ambrose,
Social Security No, 161-74-7272, date of birth April 9, 1992; Tristan James Ambrose,
social Security No, 180-76-6414, date of birth October 12, 1995; and
WHEREAS, we both agree, after (8) marriage counseling sessions over a period
of (5 1/2) months, our marriage is irretrievably broken and that there is no possible chance
for reconciliation; and
WHEREAS, we both desire to settle by agreement all of our martial affairs,
including the division of all of our property and bills, spousal support or maintenance,
and all issues relating to our children, including custody, visitation, and child support;
NOW THEREFORE, in consideration of our mutual promises, and other good
and valuable consideration, we agree as follows:
1) SEPARATION - It shall be lawful for each party at all times hereafter to live
separate and apart from the other party at such place as he or she may live from time
to time choose or deem fit. The foregoing provisions shall not be taken as admission
on part of either party of the lawfulness or unlawfulness of the causes leading to their
living apart,
2) INTERFERENCE - Each party shall be free from interference, authority, and
contact by the other; as fully as if he or she were single and umnarried except as may
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be necessary to carry out provisions of this Agreement. Neither party shall molest the
other or attempt to endeavor to molest the other, nor compel the other to cohabit with
the other, or in any way harass or malign the other, nor in any way interfere with the
peaceful existence, separate and apart from the other, and each ofthe parties hereto
completely understand and agree that neither shall do or say anything to the children
of the parties at anytime which might in any way influence the children adversely
against the other party.
3) WIFE'S DEBTS - Wife represents and warrants to the Husband that since the date
of this Agreement, she has not, and in the future she will not, contract or incur any
debt or liability for which the Husband or his estate might be responsible and shall
indemnify and save harmless Husband from any and all claims or demands made
against him by reason of debts or obligations incurred by her.
4) HUSBAND DEBTS - Husband represents and warrants to Wife that since the date of
this Agreement, he has not, and in the future he will not, be responsible and shall
indemnify and save harmless Wife from any and all claims or demands made against
her by reason of debts or obligations incurred by him,
5) OUTSTANDING JOINT DEBTS - We agree any joint debt not specifically
addressed in this Agreement shall be the responsibility of the party who incurred the
debt.
We agree that the Wife shall pay and indemnify and hold the Husband harmless from
the following debt:
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Auto loan currently held with Allfirst Bank, Account Number 20-0000-0009-
6273, on the 2001 ToyotaRAV4, VINNumber: JTEHH20V410039514, PA
License: RRl177,
We agree that the Husband shall pay and indemnify and hold the Wife harmless from
the following debt:
Home mortgage currently held by Mellon Bank, Account Number: 419-4013809
and Household Financial Services, Account Number: 3319944, on the family
home located at 1350 Asper Drive, Boiling Springs, Pa 17007.
6) DIVISION OF PERSONAL PROPERTY - The parties have divided between them
to their mutual satisfaction personal effects, household furniture and furnishings and
other articles of personal property which now have hereto been used by them in
common, and neither party will make any claim to any such items which are now in
the possession or control of the other. In addition to personal property now in the
control of the parties, the parties hereby divide other personal property including but
not limited to household goods and furnishings, personal property including but not
limited to household goods and furnishings, personal effects and other items formerly
used by them in common as follows:
a) Wife shall become the sole owner and Husband shall waive any claim to:
i) All stocks, bonds, bank accounts, investment accounts, certificates of
deposit, mutual funds, investment plans, pension plans or the like titled solely
in Wife's name regardless of whether it was so titled before or during the
marriage or after the time of separation,
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ii) A "95% distribution" of the EDS 401(K) deferred compensation plan
provided through the Husband's place of employment so titled before or
during the marriage,
iii) "50% equal distribution" of the EDS Stock Purchase Plan, and EDS
Retirement pension plan provided through the Husband's place of
employment so titled before or during the marriage.
iv) "50% equal distribution" of all bank accounts and certificates of deposit so
titled before or during the marriage,
b) Husband shall become the sole owner and Wife shall waive any claim to:
i) A "5% distribution" of the EDS 401(K) deferred compensation plan
provided through the Husband's place of employment so titled before or
during the marriage.
ii) "50% equal distribution" ofthe EDS Stock Purchase Plan, and EDS
Retirement pension plan provided through the Husband's place of
employment so titled before or during the marriage,
iii) "50% equal distribution" of all bank accounts and certificates of deposit so
titled before or during the marriage,
7) DIVISION OF REAL PROPERTY - The parties hereby agree that the marital
residence at 1350 Asper Drive Boiling Springs, Cumberland County, Pennsylvania
17007 will be the sole and separate property ofthe Husband, and the Wife transfers
and quitclaims any interest that she may have in this property to the Husband.
8) ALIMONY, ALIMONY PENDENTE LITE AND COUNSEL FEES - Wife
agrees that she shall not make any claim against Husband for spousal support,
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alimony, alimony pendente lite or counsel fees on her own behalf and waives all
rights to assert such claims after the date ofthis Agreement. Husband agrees that he
shall not make any claim against Wife for spousal support, alimony, alimony
pendente lite or counsel fees on his own behalf and waives all rights to assert such
claims after the date ofthis Agreement.
9) CUSTODY AND CHILD SUPPORT
a) CUSTODY
i) We both agree that iUs in the best interests of our children that we both
have joint legal and physical custody of our children, We also agree that the
actual physical residence of our children will change alternating weeks unless
otherwise mutually agreed between the parties..
ii) All decisions pertaining to the place of residence, discipline, education,
health, extracurricular and summer activities, vacations, religious training,
medical and dental care, and welfare of our children will decided by both of
us after reasonable and adequate discussion. We also agree that the parent
with physical custody shall have control over minor day-to-day decisions
affecting the child, including any medical or dental emergencies, We agree if,
after reasonable attempts, we are unable to reach an agreement on any of the
decisions affecting our children, we jointly seek professional mediation to
resolve our differences,
iii) We also agree that each of us has the right to know of any circumstances
or decisions that affect our children and that each of us has the right to any
medical, dental, or school records of our children, Neither of us will do
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anything to hamper or interfere with the natural and continuing relationship
between our children and the other parent.
iv) We both agree that our Children will be known by the last name of
Ambrose,
v) We both agree that frequent and continuing contact with both parents is
vital to our children, and therefore we both agree that neither of us will
permanently remove our children from the state of Pennsylvania, the county
of Cumberland, and the school district of Cumberland County, without
express written permission of the other parent.
vi) We both realize that the well-being of our children is of paramount
importance and, therefore, we agree that our children should have as much
contact as possible with the parent that does not have physical custody for a
given alternating week and that our children may visit that parent as often as
may be agreed upon.
(1) Although contact may be scheduled more often, the parent that does not
have physical custody for a given alternating week will have the right to
be with our children at least as follows:
(a) On Wednesday evening from 05:30 PM until the children's bedtime
unless otherwise mutually agreed between the parties.
(2) Holidays with date and times shall be mutually agreed upon between the
parties,
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vii) We additionally agree to use our very best efforts to insure that our
children receive the most care, love, and affection possible from both parents
throughout their entire childhood.
b) SUPPORT
i) We both agree that the Husband will pay to the Wife, for child support, the
amount of $500,00 per child per month, for a total monthly payment of
$1,000.00. The payments will begin 16th day of February, 2001 and will
continue for each child until that child has reached the age of 18, died, become
self-supporting, or married. We both agree that this obligation is subject to
modification by a court at any time.
ii) We agree that the required child support payments should be made
directly to the parent to whom they are due and should not be required to be
paid through any court or state agency or official. The parent receiving the
payments, however, does not waive the right to request, at any time and in his
or her sole discretion, that such payments be made directly through a court or
state agency or official in the future, We both further agree that we will
cooperate in obtaining any necessary income withholding orders or income
assignments ifrequired to guarantee this obligation.
iii) As additional child support, we both agree that as long as support
payments are due the Husband will carry and maintain life insurance in the
minimum amount of $100,000, naming our children as sole irrevocable
beneficiaries, The parent obligated to provide such insurance will provide the
other parent with annual proof of such coverage.
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iv) As additional child support, we both agree that as long as support
payments are due the Husband will carry and maintain adequate health,
dental, hospitalization insurance for the children's benefit. The Wife will pay
the first $250,00 of the yearly required deductibles. The Husband will pay all
subsequent required deductib1es after the first $250,00 required by payment of
the Wife. All other medical or dental expenses ofthe children that are not
covered by such insurance will be divided according to the fractional or
percentage share of the total child support, The parent obligated to provide
such insurance will provide the other parent with annual proof of such
coverage,
v) We agree the Husband may claim the federal dependency tax exemption
for Tristan James Ambrose and the Wife may claim the federal dependency
tax exemption for Cody Ryan Ambrose,
10) AGREEEMENT - We both desire that, in the event of divorce or dissolution of
marriage, this martial settlement agreement be approved and merged and incorporated
into any subsequent decree or judgement for divorce or dissolution of marriage and
that, by the terms of the judgement or decree, we both be ordered to comply with the
terms of this agreement, but that this agreement shall survive.
We have prepared this agreement cooperatively and each of us has fully and honestly
disclosed to the other the extent or our assets, income, and financial situation, We
have each completed Financial Statements which are attached and incorporated by
reference,
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We each understand that we have the right to representation by independent counsel.
We each fully understand our rights and we each consider the terms ofthis agreement
to be fair and reasonable, Both of us agree to execute and deliver any documents,
make any endorsements, and do any and all acts that may be necessary or convenient
to carry out all ofthe terms of this agreement.
We agree that this document is intended to be the full and entire settlement and
agreement between us regarding our marital rights and obligations and that this
agreement should be interpreted and governed by the laws of the State of
Pennsylvania.
We also agree that every provision of this agreement is expressly made binding upon
the heirs, assigns, executors, administrators, successors in interest, and representatives
of each of us,
11) BREACH - If either party breaches any provision of this Agreement, the other party
shall have the right, at the party breaching this contract should be responsible for
payment of legal fees and costs incurred by the other in enforcing their rights under
this Agreement, or seek such other remedies or relief as may be available to him or to
her.
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Signed and dated this k day of ~
,2001.
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(Sign r of Wife .
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(Signature of Witness)
Y~MtJ~o--J
(Signature 0 ltness)
State of Pennsylvania
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County of Cumberland
On this k day of ~~.\IAi ,2001, TAMMY SUZANNE AMBROSE
and RODNEY LEE AMBROSE p rsonally came before me and, being duly sworn, did
state that they are the persons described in the above document and that they signed the
above document in my presence as a free and voluntary act for the purposes stated,
Notary Public, for County of Cumberland
State of Pennsylvania
My Commission Expires fJe;L,J 3 d <:re;)
c.~'m'_-_--------_.-~~-'l
l Notarial Seal
. Judith A. Stimme;i, Notal)' Public
Hi:lmpden Twp., Cumberland County
My Commission Ex-prres Dec. 23, 2002
Member, Pennsylvania Association ot Notaries
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FINANCIAL STATEMENT OF TAMMY S. AMBROSE
EMPLOYMENT:
Occupation: Electronic Banking Utility Clerk
Employed by: Commerce Bank
Address of Employer: 3 Crossgate Drive
Mechanicsburg, Pa 17050
Every (2) Weeks
02/15/2001
Gross: 640.00/ Every (2) Weeks
Pay Period:
Next pay day:
Rate of Pay:
AVERAGE MONTHLY INCOME:
Gross monthly salary or wages...,.......................,...,...,
Minus Social Security...,............,..,.....,.....,......
Minus Medicare.. ................,........................
Minus Federal Income Tax ....,........,.............,.,
Minus State Income Tax........... ....... ................
Minus Local Income Tax .....................,..........
Other deductions from paycheck on monthly basis:
Other"" ",. "., ""., .,. "" ,. "".,. "..',., ""'" ,. ",."
Net Monthly salary, wages, .....,......... ......... .....,...,...,
Monthly income from other sources
Commissions, bonuses, etc. ..................,..........,
Unemployment, welfare, etc, .............................
Dividends, interest, etc. .................................
Business income .""" .",., .." ." ,. "" ." ,. ""., .,.. ,.
Rents, royalties ,.""".,.",.,.,."".....'",."",.,.",..
Other monthly income (list)
Child Support (50% Custody) . ".,.,. ..,.,. ",., "".
TOTAL AVERAGE MONTHLY INCOME..................,.......
AVERAGE MONTHLY EXPENSES
Mortgage or rental payment ".,. ,...,. ,. "".,. ,.".." ""., ".
Property taxes""",."",..".",.",.".....,.,."".".,....",.
Occupational taxes ., ,. ""., .",.,. ,.."." "".,. ,. ,.".. """"
Homeowner's insurance..................,..............,.......,
$ 1386.67
$ 90,00
$ 21.03
$ 68.57
$ 40.64
$ 14.51
$ 0,00
$ 1151.92
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 1000,00
$ 2151.92
$ 430,00
$ 100,00
$ 20.00
$ 23,04
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Electricity,........,...,..............,.....,.....,........,....., ..
Water, garbage, sewer............,.....,......,..............,....
Cable television.... ...,...........,.....,..........................
Telephone............,............,.....,.......,................ ...
Fuel oil and natural gas............................... ............,
Cleaning and laundry.... ...,.......,.....,....................."
Repairs and maintenance ,,'. "".,. ,.,.,. ,. "".,. ,. ",... ,..... ,.
Pest Control,. '" ,. """ ""., """. ,. '.'. " .,.,.,. ,. ""., .",.."
Housewares ,'...".,.",..."".,.",.,.,.,.,.,...,....,.",...",.,
Food and grocery items..........,.................................
Meals outside home,. ,. """ "" ,. "....... .,., ,. .",.,. ,.,.,. ,.,.,
Medical, dental, prescriptions ............,.......................
Education ..., ."", """ """ "".,. ,.,..... ......... .",.. "".."
Day care I baby sitter, , , , , . , , , , , . , . , . , , , , . . . , , , . , . , . , , , , . , . , , , , , . ,.
Entertainment................ .....................................,
Gifts or donations,. ",,', ,.""., "".,. ,., .".. """. ,. "" ,. "" ,.,.,
Vacation expenses ,.",.,.,.,.".....,...,."".",.",."""..",.,.,.
Public transportation,....... ....,...........................,.....,.....
Automobile:
Gasoline and oil,..................,..........,.....,.....,...,..
Repairs "., ""., ".,., .,.,.,... ."... .,.,.,... .,..., .,.,... ,., .,.
License. .... ,. .,.... ....... ........ ....... ........ ...... .,.... ....
Insurance.,.....,......................,......,.......,...,... ..
Payments "., """. ,.,.,. ,. "".. "".,. ,. .",.,. ,.,.,. ,.,.,. ,.
Insurance:
Health ",. ",. ,. "".. ,..,., ...,... ,. ,." ,. ".,.,. ,. "".. ",.,
Disability.,.....,.....,.....,............ ..........,... ...,....
Life .",.,.,.,.,.,.,.,."".."".,.,.,.".....""...,....,.,.,.
Other ,. ,. '.' "".,. ,. "" ,. "".,. ,.,.,. ,. "".,. ,. "".. ".....
Any other expenses (list):
Orthodontia...................,.................... ...,..........
Fixed debts on a monthly basis:
Creditor ,. """ ,. """ """. ,. """" Monthly payment
Creditor.. .................. ............. Monthly payment
Creditor"",."""",.""."",.,.,." Monthly payment
Any other debts:
Creditor, "" ,. "".,. ,.,.,. ,. ".. ,. "". Monthly payment
Creditor. ."... ",. ,. "".,. ,.,.,. ,. ".,. Monthly payment
Creditor .",. ."". ,. ""., "".,. ,.,.,.. Monthly payment
TOT AL AVERAGE MONTHLY EXPENSES,.........,.,.,.,.,
ASSETS:
Cash ".."""".",.,.,.,.,."".."",.,.",...,.,.,...,",.,.,.,..",..,
Stocks ..........,..............,....,.....,............,.............,....
2
, J.~I
$ 120.00
$ 34.20
$ 36.10
$ 54.23
$ 0.00
$ 0.00
$ 25,24
$ 0.00
$ 0,00
$ 300,00
$ 80.00
$ 20.00
$ 0,00
$ 0,00
$ 100.00
$ 25,00
$ 0,00
$ 0,00
$ 144,00
$ 0.00
$ 3,00
$ 57.33
$ 346,20
$ 0,00
$ 0,00
$ 0,00
$ 0,00
$ 0,00
$ 0,00
$ 0,00
$ 0,00
$ 0,00
$ 0,00
$ 0,00
$ 1918.34
$ 7500.00
$ 0,00
.'> ,,'-
"' '-5.:
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Bonds ",.,.,. ,,'., ""., "".,. ,,'..,., "".,. ",.,. ,. .,.,.,. ",.,. ",...
Real estate, ...,.........................,..............,.................
Automobiles ".,.",.,.",.,..."..,.""............,.,.,.,.,.,........
Contents of home or apartment.,..............,........,.....,......
Jewelry..........,....................,........... ...,.....,.............
Other (list)
40 1 (K) Plan (95% Division - $7500.00 Cash) ...........
EDS Retirement Plan (pP A) (50% Division) .",.,.",...
TOTAL ASSESTS ...,.............................................,..
, II
$ 0.00
$ 0.00
$ 21065,00
$ 5000,00
$ 2500.00
$ 41,202,69
$ 19,145.09
$ 96412.78
LIABILITIES:
Automobile ................................................ Balance Due $16650.00
TOTAL LIABILITIES ................................................. $16650.00
SUMMARY OF INCOME AND EXPENSES:
Average Monthly Income...............................,...........,
Average Monthly Expenses,............,......................,. ,..
$ 2151.92
$ 1918.34
AVERAGE NET MONTHLy......................................,... $ 233.58
SUMMARY OF ASSESTS AND LIABILITIES:
Total Assets....................... ....,.....................,.....,...,
Total Liabilities,...,.............,............,..........,.....,...,...
TOTAL NET WORTH ,.............................................
3
$ 96412.78
$ 16650.00
$ 79762.78
L" ,-"
"~,.~-
-
1,..1
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Dated this ----\k day of '\sYN?~~
, 2001
~e<- ~ /). /J.l '-
(Signa~{Spouse) -
State of Pennsylvania
)
)
)
)
)
SS,
County of Cumberland
On this day, before me, the undersigned authority, in and for and residing in the above
county and state, personally appeared TAMMY SUZANNE AMBROSE who is
personally known to me to be the same person whose name is subscribed to the foregoing
document, and, being duly sworn, verified that the information contained in the foregoing
document is tme and correct on personal knowledge and acknowledged that said
document was signed as a free and voluntary act.
Subscribed and sworn to before me this ~day of ~~\I,.~~
,2001.
~
(Signature of Notary Public)
Notary Public, for County of Cumberland
State of Pennsylvania
My Commission Expires OE~,93 c2 ;-OJ.
~-" -
r~o~':"dt-,-i Ses!
~:'ddi:h A. r;;timmB:J, i\otary F'ul1i;c ~
j Hsmpden Twp., Cumb0~j8.nd C0uni.y ~
l_~~~~~~~~~~cnis:::_~~es ~:::l3, 20Q:._J
~\i;":;iii!.;8~, Pe;'H1SYIVfiilitl ASSO:!E\tion of NO'larios
4
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FINANCIAL STATEMENT OF RODNEY L. AMBROSE
EMPLOYMENT:
Occupation: Computer Programmer
Employed by: Electronic Data Systems (EDS)
Address of Employer: 225 Grandview Ave.
Camp Hill, Pa 17011
Bi-month1y
02/28/2001
Gross: 3785.42/ Bi-month1y
Pay Period:
Next pay day:
Rate of Pay:
AVERAGE MONTHLY INCOME:
Gross monthly salary or wages,......... .,.,.. ......... ...,.......
Minus Social Security,. "",... "".,. ,.""" ."",. ,. "..
Minus Medicare ...... .....,. ...... ,. ....... ,......,.... .,.
Minus Federal Income Tax ..........,.,. ,..... .........,
Minus State Income Tax.......... ........... .............
Minus Local Income Tax ................................
Other deductions from paycheck on monthly basis:
Insurance (HMO Admin) ....,...........................
Insurance (Flex HMO) .. ........ ......... ................
Insurance (Flex Dental) "., .,...,... ...,... ,.,..... .,.. ....
Insurance (Flex Accident) "",.,.,."".,.,."",.""..
Insurance (Life Cash) ....................................
Insurance (Flex OPT LTD) ,. ,...........................
Insurance (Post GUL) ...,... .........,..............,...,
401(K) Plan (6% Min. for Match) .........,.....,.,.....
Stock Purchase (1 %).......,........,............,.....,...,
Credit Union (Cody Ryan Ambrose) ,.... ,.,.,. ,...'..
Credit Union (Tristan James Ambrose) ..",.,.,.......,
Union dues ..... ,....... ....... ..,..,............... ,.......
Other............ ............... ,....,.......... ,..... ,.......
Net Monthly salary, wages, ......, ,....... .....,... ...,... ....,.,
Monthly income from other sources
Commissions, bonuses, etc, .... ... ...........,...........
Unemployment, welfare, etc, ......,......................
Dividends, interest, etc. ..,..............................
Business income "., "".,. ,.",. ...... ,. "".,. ,.,.,. ,...
Rents, royalties, .. .. .. . .. , .. . .. , . , . , . .. .. .. .. .. . . , .. , . , . ..
1
$ 7570,84
$ 431.92
$ 101.02
$ 1105,20
$ 206.70
$ 75,70
$ 2.00
$ 45,90
$ 42,76
$ .30
$ 11.52
$ 8.92
$ 48.40
$ 454.25
$ 75.70
$ 10,00
$ 10.00
$ 0.00
$ 0.00
$ 4940,55
$ 0,00
$ 0,00
$ 0,00
$ 0,00
$ 0,00
-
,
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Other monthly income.............,.......,... ...,.. ,..,
TOTAL AVERAGE MONTHLY INCOME.... ...,..............,...
A VERAGE MONTHLY EXPENSES
Mortgage orrental payment,....... ....................... ......
Property taxes"""."",."".,.",....."".,.""",."".....,.
Occupational taxes """".,...',...,.",.,.,.,.".,...",.,.,.,.,
Homeowner's insurance.......,.............................,...,
Electricity. . . , , , . , . , . , , , . . . , , , . , . , . , . , . . . . , . . . . . , , , . , . , . , , , , . , , , , . ..
Water, garbage, sewer...,......,.....,..........................,.
Cable television......,..................,.....,........,...........
Telephone,...,.....,...........,..... ...,.....,........,.....,......
Fuel oil and natural gas..........,.......................,.....,...
Cleaning and laundry, ."",." ""., "".,. ,. "".,. '. ,..... .,...
Repairs and maintenance, .",.,. ,.,.,." "".,. ,. "".,. ,.,.,. ,.,.
Pest Control"" ",. '. ",. ,. ."... ...".,.. "".,. ,. "".,. ,.,.,. ,.,.
Housewares, , , , . , . , . , . , . , , , , , . , , , , . , . , . , . , . , . . . . . . , . . . , , . , . , . , . , . . . ,
Food and grocery items.............,.............................,
Meals outside home.... ...,.......,.................................
Medical, dental, prescriptions ...................................,
Education "'" ,.,.,. ,.,.,. ,.""" ""., .,., .".. "" ." ,. "".. ",.,
Day care I baby sitter.. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. .. .. .. ..
Entertaimnent ..... ....,. ............... ....................... ...,.
Gifts or donations.......... ....... ........ .....,........................
Vacation expenses ".. "".. ".,..... ",... ...,.,... ...,... ....' .......,
Public transportation,. ",.,." "".,. ",.,. ,. "".,. ,. ",." "" ,. ",..,
Automobile:
Gasoline and oil,....................................,...........
Repairs ",. ""., "".,. ,. ",... "".,. ,. "".,. ..,.,... ..........
License. ",. ,. ",. ,. "".,. ",.,. ,. ""... ,. "".,. ,.,., .,.... ....
Insurance.......,.......,..............,........,... ...,....,...
Payments ".,.",.,.,.,.,.,."".,.",.,.,."".,.,.",.,.,.,.,.
Insurance:
Health ",.,.,. ...... '. ""., "".,. ,. ",.... ,. "".. .",.. .,.,.
Disability".,.,.,.,.."""".,.,.,.,....,.,.,..",.....".... ,
Life "."..".'".,."".,.,.""..".,.,.,....,.,.........,.,...
Other,.....................,........... ..............,...,......
Any other expenses (list):
Child Support (50% Custody) ............. .................'
Fixed debts on a monthly basis:
Creditor "" "."" ,. ""., "".,. ,. "'" Monthly payment
Creditor "" """ .,.".... ,."" """., Monthly payment
Creditor "" """ """. ,.".. ,."""" Monthly payment
Any other debts:
2
,,),
.-t'i110.-'-'
$ 0.00
$ 4940.55
$ 1544.49
$ 157.92
$ 37.16
$ 35.67
$ 130,00
$ 118.39
$ 36.10
$ 54.23
$ 70.00
$ 0.00
$ 79,13
$ 51.50
$ 0.00
$ 300.00
$ 80,00
$ 75,00
$ 0.00
$ 596,00
$ 100,00
$ 112,00
$ 0.00
$ 0.00
$ 154,00
$ 50.00
$ 4.87
$ 57,33
$ 0.00
$ 0.00
$ 0,00
$ 0,00
$ 0,00
$ 1000,00
$ 0,00
$ 0,00
$ 0,00
.;1-~'
,
"
Creditor,...,.....,....................,. Monthly payment
Creditor., ,. "" ,., .,. ,. ...,.,. ,.,.,. ,." Monthly payment
Creditor ",. "" ,. "".,. ,.,.,. ,. ,,'... ,. Monthly payment
TOTAL AVERAGE MONTHLY EXPENSES .",... "".. ",...
ASSETS:
Cash ,.................,..................,.....,.................,....,...
Stocks ."""",..."""""."",."",......",.,.,.,.",.""..,.,..,.
Bonds. .",., """ """ ""., ,....,. ,.",... "".,. ,. ",... ...,., .", ".
Real estate,.......... .......................,......................,...,.
Automobiles "., """ """ "".,. ,.",. ,. .."., ."",." """ ",. ,. ,.
Contents of home or apartment......................................
Jewelry,. ",., ""., ""., "".,. ,. '.'... .",.,. ,.,.,... ".,., .,.,.,. ",.
Other (list)
401(K) Plan (95% Division) .. .............. ......... ........
EDS Retirement Plan (PP A) (50% Division) ..............
TOTAL ASSESTS ,...............,.........................,...,.....
LIABILITIES:
Real estate.............. ........ ..,.... ............... Balance Due
I I_I
-",
" ..~~~-
$ 0,00
$ 0,00
$ 0,00
$ 4843,79
$ 500,00
$ 0.00
$ 0.00
$ 165500.00
$ 4550,00
$ 4500,00
$ 650.00
$ 2563.30
$ 19,145.09
$ 197408.39
$ 177000,00
TOTAL LIABILITIES........... ..................... ..... ............... $ 177000.00
SUMMARY OF INCOME AND EXPENSES:
Average Monthly Income,.....,......... ......... ...........,.......
Average Monthly Expenses, ............... ............... ..........
AVERAGE NET MONTHLy.".,.,.",.,.,."".,.,.,.".........
SUMMARY OF ASSESTS AND LIABILITIES:
Total Assets.",.....,.,.,.,.,."".,.,.,.,.,..,.,.........,.",.,.",..
Total Liabilities...................,.......................,........,..,
TOTAL NET WORTH.......................... ........ ........,...
3
$ 4940.55
$ 4843,79
$ 96,76
$ 197908.39
$ 177000.00
$ 20908.39
,--~
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II
,
.
DmedthiS~daYOf~
,2001
State of Pennsylvania
)
)
)
)
)
SS,
County of Cumberland
On this day, before me, the undersigned authority, in and for and residing in the above
county and state, personally appeared RODNEY LEE AMBROSE who is personally
known to me to be the same person whose name is subscribed to the foregoing document,
and, being duly sworn, verified that the information contained in the foregoing document
is true and correct on personal knowledge and acknowledged that said document was
signed as a free and voluntary act.
Subscribed and sworn to before me this ~ day of ~~
,2001.
Notary Public, for County of Cumberland
State of Pennsylvania
My Commission Expires Dee., ~3 cJrr-r;J.
Judil~ A. b~~~~~;~~'i;;~~!'~"W ~.~~).::I\~ h
t...lclnlpden TWP" Cllm\)<.::.o.i1G .:-:,:'.~'~
",';,"ortlmissi-c.n Exp:r'35 D\.~c. ~,l, ,~,)02
1'1 -' ""
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4
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.
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.
FtB 27 20~
In the Court of Common Pleas, Cumberland County, State of Pennsylvania
)
)
TAMMY SUZANNE AMBROSE )
Petitioner )
)
vs, )
)
RODNEY LEE AMBROSE )
Respondent )
)
NO. : 01-961 CIVIL TERM
QUALIFIED DOMESTIC
RELATIONS ORDER
WHEREAS, this Court has jurisdiction over petitioner and respondent and the subj ect matter of this
Order;
WHEREAS, petitioner, respondent, and the Court intend that this Order shall be a Qualified
Domestic Relations Order ("QDRO") as that term is used in Section 206(d)(3) of the Employee
Retirement Income Security Act of 1974, as amended ("ERISA"); and Section 414(P) of the Internal
Revenue Code of 1986, as amended ("Code"); and
WHEREAS, petitioner and respondent have stipulated that the Court shall enter this Order.
SECTION 1. DEFINITIONS AND INTERPRETATIONS
Terms used, and not otherwise defined herein shall have the same meaning given like terms defined
in the EDS Retirement Plan, unless the context clearly indicates a different meaning. The Plan
Administrator or its designee is authorized and empowered to interpret provisions ofthis Order, and
its determination shall be deemed final and binding on the parties, As used in the Order, the
following terms shall apply:
(a) "Accrued Benefit" for any Participant who terminated employment with the Company, retired
from the Company prior to July 1, 1998, or whose assigned benefit is effective prior to July
1, 1998, shall mean the Participant's Accrued Benefit under the Prior Plan calculated as of
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.
a specific date and expressed as a single life annuity, and for a Participant who has a Personal
Pension Account ("PP A") under the Plan, "Accrued Benefit" shall mean the greater of
Participant's Grandfathered Benefit, Prior Plan Benefit, or the PP A calculated as of a specific
date and expressed as a single life annuity with a cost-of-living adjustment using the interest
rate and actuarial rnortality assumptions set forth in the Plan's definition of Actuarial
Equivalent. The Accrued Benefit is the amount payable at the Participant's Normal
Retirement Date.
(b) "Alternate Payee" is Tammy Suzanne Ambrose, whose address is 5199 Laurel Lane,
Harrisburg, PA 17109, who was born on December 20, 1962, and whose Social Security
Number is 168-58-1824. The Alternate Payee is the spouse of the Participant
(c) "Normal Retirement Date" shall mean the Participant's age sixty-five (65) (or as otherwise
defined in the Plan),
(d) "Participant" is Rodney Lee Ambrose, whose address is 1350 Asper Drive Boiling Springs,
PA 17007, who was born on May 15,1961, and whose Social Security Number is 208-50-
5713.
(e) "Plan" shall mean the EDS Retirement Plan, as amended from time-to-time or its successor
plan.
(f) "Plan Administrator" shall mean the EDS Benefits Administration Committee,
SECTION 2. PERIOD OF MARRIAGE
Participant and Alternate Payee were married on April 19, 1986, and were separated/divorced on
February 16, 2001.
SECTION 3. PORTION OF BENEFIT TO BE ASSIGNED TO ALTERNATE PAYEE
The Alternate Payee is awarded the following property as her sole and separate property:
Alternate Payee's interest in the Plan shall be 50% of the PPA balance as of February 16, 2001.
2
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-
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SECTION 4. EARLY RETIREMENT SUBSIDY
If Participant elects to retire from the Plan before his Normal Retirement Date and ifby reason of
that early retirement the Plan provides an early retirement subsidy, then Alternate Payee shall be
assigned a portion of such Participant's subsidy attributable to the portion of Participant's benefits
assigned to Alternate Payee hereunder.
SECTION 5. FORM AND TIMING OF BENEFIT PAYMENT
The Plan is hereby ordered to pay directly to the Alternate Payee the benefit set forth in Section 3
aod Section 4, if applicable, above commencing on any date elected by the Alternate Payee (aod such
election shall be made in accordance with the terms of the Plan) occurring on or after the date the
Participant attains his early retirement date under the Plan, The Alternate Payee shall have the right
to elect any form of benefit, excluding an annuity with a joint and survivor feature, permitted by the
Plan as ofthe date the Alternate Payee elects to begin receiving benefits under the Plan,
SECTION 6. ADJUSTMENT OF PARTICIPANT'S BENEFIT
The Participant's Accrued Benefit under the Plan shall be actuarially reduced by the equivalent of
the amount required to be paid to the Alternate Payee,
SECTION 7. DEATH OF ALTERNATE PAYEE
Upon the death of the Alternate Payee prior to the commencement of benefits pursuant to Section 5,
the Alternate Payee's interest shall be paid to the beneficiary on file with the Plan Administrator or
if no beneficiary on file, then in accordance with the terms of the Plan, The Alternate Payee is not
permitted to have a survivor benefit ifher death occurs after commencement of benefits pursuaot to
Section 5, but was permitted to elect any other form of benefit payment offered under the Plan, on
the annuity starting date, which shall determine whether aod to whom any post-commencement date
death benefits shall be payable,
SECTION 8. TREATMENT AS SURVIVING SPOUSE
Upon the death of the Participant before retirement and before the commencement of benefits to the
Alternate Payee, the Alternate Payee shall not be treated as the Participant's spouse for purposes of
the pre-retirement survivor annuity with respect to the portion ofthe Participant's Accrued Benefit
3
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assigned to the Alternate Payee, The benefits assigned to the Alternate Payee shall not be payable
pursuant to Section 3 of the Order if the Alternate Payee is treated as the Participant's spouse for
purposes of the pre-retirement survivor annuity,
SECTION9. MISCELLANEOUS
(a) The Participant shall cause a copy of this Order to be delivered to the Plan Administrator.
This Order shall remain in effect until a further order of this Court or until all payments
assigned hereunder are paid in full. Nothing contained in this Order shall be construed to
require the Plan, Plan Administrator, Trustee, Plan sponsor or its officials, agents or
employees:
(i) To provide to the Alternate Payee any type or form of benefit or any option not
otherwise available to the Participant under the Plan;
(ii) To pay to the Participant and the Alternate Payee in the aggregate, more than the
Participant's Accrued Benefit;
(iii) To pay any benefits to the Alternate Payee that are required to be paid to another
alternate payee under an order qualified by the Plan Administrator at any time prior
to the qualification of this Order.
(b) In the event the Plan Administrator does not qualify this Order, then the Participant and
Alternate Payee shall cooperate and do all things reasonably necessary to devise a form of
order acceptable to the Plan Administrator.
(c) This Court retains jurisdiction to enforce, revise, modify, or amend this Order insofar as
necessary to establish or maintain its qualification as a QDRO, provided, however, neither
this Order nor any subsequent revision, modification, or amendment shall require the Plan
to provide any form of benefits not otherwise provided by the Plan, or any amount of benefits
which in the aggregate exceeds the Participant's Accrued Benefit.
(d) In the case of conflict between the terms of this QDRO and the terms of the Plan, the terms
ofthe Plan shall prevail.
4
(e) The Alternate Payee and the Participant shall hold the Plan, its sponsor and fiduciaries
hannless from any liabilities that arise from following this QDRO, including all attorney fees
that may be incurred in connection with any claims that are asserted because the Plan, Plan
Administrator, Trustee, Plan sponsor and officials comply with the terms and provisions of
this Order.
(f) To the extent that the Plan pays to the Participant any benefits that are payable to the Alternate
Payee under the QDRO, the Participant shall be deemed to be a constructive trustee holding
the amount of such benefits in a constructive trust for the benefit of the Alternate Payee. The
Participant is ordered to pay such amonnt to the Alternate Payee within thirty (30) days after
the Plan notifies the Participant that the Participant has received amounts that are payable to
the Alternate Payee. To the extent that the Plan pays to the Alternate Payee any benefits that
are payable to the Participant under this QDRO, the Alternate Payee shall be deemed to be a
constructive trustee holding the amount of such benefits in a constructive trust for the benefit
of the Participant. The Alternate Payee is ordered to pay such amount to the Participant within
thirty (30) days after the Plan notifies the Alternate Payee that the Alternate Payee has received
amounts that are payable to the Participant.
(g) When the Plan has made full payment to Alternate Payee of the benefits assigned to Alternate
Payee pursuant to this QDRO, the Plan, Plan Administrator, Trustee, Plan sponsor and
officials shall be discharged oftheir respective obligations to Alternate Payee.
(h) All of Participant's benefits payable under the Plan, other than those payable hereby to
Alternate Payee, shall be payable to Participant in such manner and form as Participant may
elect in his sole and undivided discretion, subject only to the Plan requirements.
(i) Alternate Payee is ORDERED AND DECREED to report any payments received from the
Plan on any applicable income tax return.
(j) If the Plan from which benefits are assigned under the Order terminates with an unfunded
liability and the Pension Benefit Guaranty Corporation ("PBGC") makes benefit payments
in connection with such Plan, and if the amount of the total benefit payment to be paid to
both the Participant and Alternate Payee is thus decreased, then the Participant's benefit
payments and the Alternate Payee's benefit payments each will be reduced by the same
percentage.
5
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Date: fv1 U(.
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FEB 2 7 200,tJ
-"\'
In the Court of Common Pleas, Cumberland County, State of Pennsylvania
)
TAMMY SUZANNE AMBROSE)
Petitioner )
)
)
)
)
)
)
)
)
)
NO.: 01-961 CIVIL TERM
vs.
QUALIFIED DOMESTIC
RELATIONS ORDER
RODNEY LEE AMBROSE
Respondent
WHEREAS, this Court has jurisdiction over petitioner and respondent and the subject matter of
this Order;
WHEREAS, petitioner, respondent, and the Court intend that this Order shall be a Qualified
Domestic Relations Order (hereinafter referred to as a AQDRO=) as that term is used under the
Employee Retirement Income Security Act of 1974, as amended by the Retirement Equity Act of 1984
(ERISA); and
WHEREAS, petitioner and respondent have stipulated that the Court shall enter this Order.
SECTION 1. DEFINITIONS.
As used in the Order, the following terms shall apply:
(a) "Participant" shall mean Rodney Lee Ambrose, whose current address is 1350 Asper Drive,
Boiling Springs, PA 17007, who was born on May 15,1961, and whose Social Security number is 208-50-
5713.
(b) "Alternate Payee" shall mean Tammy Suzanne Ambrose, whose current address is 5199
Laurel Lane, Harrisburg, PA 17109, who was born on December 20, 1962, and whose Social Security
number is 168-58-1824. The Alternate Payee is the former spouse of the Participant.
(c) "Plan" shall mean the EDS 401(k) Plan.
(d) "Plan Administrator" shall mean the Benefits Administration Committee for the Plan.
SECTION 2. DATE OF MARRIAGE
1
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II
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Participant and Alternate Payee were married on April 19, 1986, and were separated/divorced on
February 16, 2001.
SECTION 3. AMOUNT OF BENEFIT TO BE PAID TO ALTERNATE PAYEE
The Alternate Payee is awarded the following interest in the Plan as her sole and separate
property:
Alternate Payee interest in the Plan shall be 95% of the Participant vested account balance as of
February 16, 2001, subject to earnings and losses subsequent to February 16, 2001.
SECTION 4. TIMING AND FORM OF PAYMENT TO ALTERNATE PAYEE
Benefits payable to the Alternate Payee as set forth in Section 3 above may commence as soon
as practicable after the Order is qualified.
The form of benefits available under the Plan are as follows: (1) lump sum distribution, 2) periodic
payments, 3) in kind distribution for stock, or 4) annuity payment. The Alternate Payee must commence
benefits upon the Participant's attainments of age 70).1.,. If the benefit awarded to the Alternate Payee is
equal to or less than $5,000 the Alternate Payee may receive a lump sum involuntary cash-out.
SECTION 5. DEATH OF ALTERNATE PAYEE
Upon the death of the Alternate Payee prior to the receipt of distribution to the Alternate Payee,
such benefits shall be distributed to the Alternate Payee~s beneficiary on record or, if none, to the estate
of the Alternate Payee per Plan.
SECTION 6. DEATH OF PARTICIPANT
In the event of the death of the Participant after qualification, but prior to the receipt of a
distribution to the Alternate Payee, the Alternate Payee shall be entitled to a distribution only to the extent
provided under the Order.
SECTION 7. MISCELLANEOUS
(a) The Participant shall cause a copy of this Order to be served on the Plan Administrator(s).
This Order shall remain in effect until a further order of this Court. Nothing contained in this Order shall be
construed to require the Plan or Plan Administrator:
(i) To provide to the Alternate Payee any type or form of benefit not otherwise available
to the Participant under the Plan;
(ii) To provide to the Alternate Payee increased benefits not available to the Participant;
or
2
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(iii) To pay any benefits to the Alternate Payee that are required to be paid to another
Alternate Payee under another order determined by the Plan Administrator to be a QDRO before this
Order is determined by the Plan Administrator to be a QDRO.
(b) The Participant~s account balance shall be reduced to reflect any payment pursuant to this
QDRO and any subsequent payment to the Participant or to an Alternate Payee under a subsequent
QDRO, shall reflect said reduction in the Participant~s account.
(c) A separate account will be established for Alternate Payee to whom payments are due.
(d) In the event the Plan Administrator or its Agent does not approve the form of this Order,
then each party shall cooperate and do all things reasonably necessary to devise a form of Order
acceptable to the Plan Administrator.
(e) This Court retains jurisdiction to enforce, revise, modify, or amend this Order insofar as
necessary to establish or maintain its qualification as a QDRO, provided, however, neither this Order nor
any subsequent revision, modification, or amendment shall require the Plan to provide any form or amount
of benefits not otherwise provided by the Plan.
(f) In the case of conflict between the terms of this QDRO and the terms of the Plan, the terms
of the Plan shall prevail. The QDRO shall not be interpreted to provide anything otherwise impermissible
under the terms of the Plan.
(g) The Alternate Payee and the Participant shall hold the Plan (and its sponsor and fiduciaries)
harmless from any liabilities that arise from following this QDRO, including all attorney fees that may be
incurred in connection with any claims that are asserted because the Plan honors this QDRO.
(h) To the extent that the Plan pays to the Participant any benefits that are payable to the
Alternate Payee under the QDRO, the Participant shall be deemed to be a constructive trustee holding the
amount of such benefits in a constructive trust for the benefit of the Alternate Payee. The Participant is
ordered to pay such amount to the Alternate Payee within thirty (30) days after the Plan notifies the
Participant that the Participant has received amounts that are payable to the Alternate Payee. To the
extent that the Plan pays to the Alternate Payee any benefits that are payable to the Participant under this
QDRO, the Alternate Payee shall be deemed to be a constructive trustee holding the amount of such
benefits in a constructive trust for the benefit of the Participant. The Alternate Payee is ordered to pay
such amount to the Participant within thirty (30) days after the Plan notifies the Alternate Payee that the
Alternate Payee has received amounts that are payable to the Participant.
(i) The benefits hereby assigned to Alternate Payee shall paid to Alternate Payee not
withstanding Participant's anticipated continued employment with EDS.
3
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U) All benefits payable under the EDS 401 (k) Plan, other than those payable to Alternate
Payee shall be payable to Participant in such manner and form as Participant may elect in his/her sole and
undivided discretion, subject only to the Plan requirements.
(k) Plan Administrator is relieved of allliability/responsibility hereunder once all payments are
made.
(I) Alternate Payee is ORDERED AND DECREED to report any payments received under the
Plan on any applicable income tax return.
4
.
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IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
VS.
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CIVIL DIVISION
NO. 0\-'\0\ CIVIL TERM
PRAECIPE TO TRANSMIT RECORD
To the Prothonotary:
Transmit the record, together with the following information to the court for entry of a divorce decree:
1. Ground for divorce:
Irretrievable breakdown under !l3301 (c)
3301 (d)(1) of the Divorce Code.
(Strike out inapplicable section).
2. Date and manner of service of the complaint: ~ \~ I ~\
3. Complete either paragraph (a) or (b).
(a) Date of execution of the affidavit of consent required bY!l3301 (c) of the Divorce Code:
by plaintiff ~ \l \~\ ; by defendant ~I \l'I~
(b) (1) Date of execution of the affidavit required bY!l3301(d)
of the Divorce Code:
(2) Date of filing and service of the plaintiff's affidavit upon the respondent:
4. Related claims pending: ~t..
5. Complete either (a) or (b).
(a) Date and manner of service of the notice of intention to file praecipe to transmit record, a
copy of which is attached:
(b) Date of plaintiff's Waiver of Notice in !l3301 (c) Divorce was filed with
the Prothonotary: ~y \11 ~\
Date defendant's Waiver of Notice in !l33
the Prothonotary:
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In the Court of Common Pleas, Cumberland County, State of Pennsylvania
In re: The Marriage of:
TAMMY SUZANNE AMBROSE
Plaintiff
vs.
RODNEY LEE AMBROSE
Defendant
And in the interest of:
TAMMY SUZANNE AMBROSE and
RODNEY LEE AMBROSE
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NO. : 01-961 CIVIL TERM
CIVIL ACTION - DIVORCE
ACCEPTANCE OF SERVICE
The undersigned Defendant states on oath, that:
1. RESIDENCY. I have been a resident of and domiciled in the State Pennsylvania
for the proceeding 39 years and the County of Cumberland for the preceding 10
years.
2. ACCEPTANCE. I have hereby depose and say that I personally received and
accepted service of a true and correct copy of the Complaint For Divorce which was
filed in this cause and I have read and understand it and admit all of the allegations
contained in it on the date written below.
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.
1
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Dated this ~\ day of ~\\
\
,2001
State of Pennsylvania
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SS.
County of Cumberland
On this ~\ day of ~
personally came before me and, being duly sworn, did state that he is the person
,2001, RODNEY LEE AMBROSE
described in the above document and that he signed the above document in my presence
and verified that the information contained in the foregoing document is true and correct
on personal knowledge and acknowledged that the document was signed as a free and
voluntary act for the purposes stated and that a copy of the Compliant has been received.
~j{~Mt
(Signature of Notary Public)
Notarial Seal
Oanls9 S. Kocotl. Notary Public
East Pennsboro Twp., Cumbsrland County
My Commission Explr9. May 29, 2003"
M€'!I~Bl1nSYlvai1ia A;;;~;:-i;:;noti'Jo~a(TBS'~
Notary Public, for County of Cumberland
State of Pennsylvania
My Commission Expires
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In the Court of Common Pleas, Cumberland County, State of Pennsylvania
In re: The Marriage of:
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CIVIL ACTION - DIVORCE
TAMMY SUZANNE AMBROSE
Plaintiff
NO. : 01-961 CIVIL TERM
vs.
RODNEY LEE AMBROSE
Defendant
And in the interest of:
TAMMY SUZANNE AMBROSE and
RODNEY LEE AMBROSE
CONSENT AND WAVIER OF COUNSELING
The undersigned Plaintiff states on oath, that:
1. SERVICE OF PROCESS. A Compliant For Divorce under Section 3301(c) of the
Divorce Compliant was filed on the 16th day of February, 2001.
2. MARRIAGE. The Plaintiff and Defendant were married on the 19 day of April,
1986, in the State of Pennsylvania and lived together as husband and wife until on
or about the 16th day of February, 2001, at which time they separated and ceased to
live together and they have lived separate and apart without cohabitation ever since.
The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days
have elapsed from the date of filing and service of the compliant.
3. WAIVER OF COUNSELING. I consent to the entry of a final decree in divorce
after service of Notice ofIntention to Request Entry of the Decree.
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4. WAIVER. 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 my spouse and I participate in
counseling prior to a Decree in Divorce being handed down by the Court.
2
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Dated this n day of ~
,2001
ry~, tLL
(Signa 0 Plaml1ff)
State of Pennsylvania )
)
)
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County of Cumberland )
SS.
On this ----1l day of ~y
personally came before me and, being duly sworn, did state that he is the person
,2001, TAMMY SUZANNE AMBROSE
described in the above document and that he signed the above document in my presence
and verified that the information contained in the foregoing document is true and correct
on personal knowledge and acknowledged that the document was signed as a free and
voluntary act for the purposes stated.
Notary Public, for County of Cumberland
State of Pennsylvania
My Commission Expires J/13r..,j 3 ~ IJ().J,
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Ha~d~~~T Stimmell, Nctary PUbiic f
My CommiSS:'E~~i:~e2~~~ 2~~~~~2 ,f
Member, Pennsyfvania AssoC;:--"i-J"-,,;-;~~M.::,~J
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In the Court of Common Pleas, Cumberland County, State of Pennsylvania
In re: The Marriage of:
TAMMY SUZANNE AMBROSE
Plaintiff
vs.
RODNEY LEE AMBROSE
Defendant
And in the interest of:
TAMMY SUZANNE AMBROSE and
RODNEY LEE AMBROSE
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NO. : 01-961 CIVIL TERM
CIVIL ACTION - DIVORCE
WAVIER OF NOTICE OF INTENTION TO REQUEST
ENTRY OF A DIVORCE DECREE
The undersigned Plaintiff states on oath, that:
1. CONSENT. I consent to the entry of a final decree of divorce without notice.
2. WAIVER. 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.
3. DIVORCE DECREE. 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.
1
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Dated this ~ day of
\Y\d
,2001
l'-( ~'^. ilL
(Signa e o[Plaintiff)
State of Pennsylvania )
)
)
)
County of Cumberland )
SS.
On this \l day of ~y
,2001, TAMMY SUZANNE AMBROSE
personally came before me and, being duly sworn, did state that he is the person
described in the above document and that he signed the above document in my presence
and verified that the information contained in the foregoing document is true and correct
on personal knowledge and acknowledged that the document was signed as a free and
voluntary act for the purposes stated.
Notary Public, for County of Cumberland
State of Pennsylvania
My Commission Expires PEe.. ':?/ =r .,(00 :J..
Notarial Seal
Judith A. Stimmefl, Notary Public
Hampden Twp.. Cumberland County
My Commission Expires Dec. 23, 2002
Member, Pennsylvania Association of Not3riBS
3
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In the Court of Common Pleas, Cumberland County, State of Pennsylvania
In re: The Marriage of:
TAMMY SUZANNE AMBROSE
Plaintiff
vs.
RODNEY LEE AMBROSE
Defendant
And in the interest of:
TAMMY SUZANNE AMBROSE and
RODNEY LEE AMBROSE
)
)
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NO. : 01-961 CIVIL TERM
CIVIL ACTION - DIVORCE
CONSENT AND WAVIER OF COUNSELING
The undersigned Plaintiff states on oath, that:
1. SERVICE OF PROCESS. A Compliant For Divorce under Section 3301(c) of the
Divorce Compliant was filed on the 16th day of February, 2001.
2. MARRIAGE. The Plaintiff and Defendant were married on the 19 day of April,
1986, in the State of Pennsylvania and lived together as husband and wife until on
or about the 16th day of February, 2001, at which time they separated and ceased to
live together and they have lived separate and apart without cohabitation ever since.
The marriage of Plaintiff and Defendant is' irretrievably broken and ninety (90) days
have elapsed from the date offiling and service of the compliant.
3. WAIVER OF COUNSELING. I consent to the entry ofa final decree in divorce
after service of Notice of Intention to Request Entry of the Decree.
1
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4. WAIVER. 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 my spouse and I participate in
counseling prior to a Decree in Divorce being handed down by the Court.
2
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Dated this \1 day of ~y
,2001
State of Pennsylvania
)
)
)
)
)
SS.
County of Cumberland
Onthis~dayof ~y
,2001, RODNEY LEE AMBROSE
personally came before me and, being du~y sworn, did state that he is the person
described in the above document and that he signed the above document in my presence
and verified that the information contained in the foregoing document is true and correct
on personal knowledge and acknowledged that the document was signed as a free and
voluntary act for the purposes stated.
GL
(Signature of No ary Public)
Notary Public, for County of Cumberland
State of Pennsylvania
My Commission Expires
PEe
d 3 :(1101.0
.
Notarial Seal
Judith A. Stimmell, Notary Public
Hampden Twp., Cumberland County
My Commission Expires Dec. 23, 2002
Member, PennsylvanIa AssociatIon of Nota~ies
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In the Court of Common Pleas, Cumberland County, State of Pennsylvania
In re: The Marriage of:
TAMMY SUZANNE AMBROSE
Plaintiff
vs.
RODNEY LEE AMBROSE
Defendant
And in the interest of:
TAMMY SUZANNE AMBROSE and
RODNEY LEE AMBROSE
)
)
)
)
)
)
)
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NO. : 01-961 CIVIL TERM
CIVIL ACTION - DIVORCE
WAVIER OF NOTICE OF INTENTION TO REQUEST
ENTRY OF A DIVORCE DECREE
The undersigned Plaintiff states on oath, that:
1. CONSENT. I consent to the entry ofa fmal decree of divorce without notice.
2. WAIVER. 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.
3. DIVORCE DECREE. 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.
1
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,2001
State of Pennsylvania )
)
)
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County of Cumberland )
SS.
On this ~ day of w..y
,2001, RODNEY LEE AMBROSE
personally came before me and, being duly sworn, did state that he is the person
described in the above document and that he signed the above document in my presence
and verified that the information contained in the foregoing document is true and correct
on personal knowledge and acknowledged that the document was signed as a free and
voluntary act for the putposes stated.
Notary Public, for County of Cumberland
State of Pennsylvania
My Commission Expires De c.. :1:3 :?! 0 ::).
L' '". , JUdi.th. A. ~=::!_~.7~~:,~" "\'.~);,\;
Hampde~TW0 r, ,".:12IloGounty
~~Cl')""'-n'("; " I;Xplres Dec. 23, 2002
~' ''c ;1 ;;iyj.;'ailia Association at Notaries
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