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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
STATE OF
ADELAIDA CASTANEDA WILLIAMS
Plaintiff
VERSUS
GORDON STANLEY WILLIAMS
Defendant
PEN NA.
No.
2001-1617
DECREE IN
DIVORCE
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AND
DECREED THAT
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~, IT IS ORDERED AND
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AND
Gordon Stanley Williams
, DEFENDANT,
ARE DIVORCED FROM THE BONDS OF MATRIMONY.
THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE
YET BEEN ENTERED;
BEEN RAISED OF RECORD IN THIS ACTION FOR WHICH A FINAL ORDER HAS NOT
None:
The terms of the marital settlement agreement. dated March 30, 2004
are incorporated but not merged into the Decree in Divorce.
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By THtOURT:
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PROTHONOTARY
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SHUFF, FLOWER
& LINDSAY
ATIORNEYS'AT'LAW
26 W. High Street
Carlisle, PA
Adelaida Castaneda Williams, : IN THE COURT OF COMMON PLEAS OF
Plaintiff, : CUMBERLAND COUNTY, PENNSYLVANIA
vs.
: NO. 2001 -1617
CIVIL TERM
Gordon Stanley Williams,
Defendant.
: IN DIVORCE
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 Section 3301 (c) 3301 (cl)(1)
of the Divorce Code. (Strike out inapplicable section).
2. Date and manner of service of the complaint: Acceptance of Service on
March 25, 2001 signed by Andrew C. Spears, Attorney for the Defendant and filed with
Protho,notary on July 10, 2004. (copy enclosed)
3. (Complete either paragraph (a) or (b)).
(a) Date of execution of the affidavit of consent required by Section
3301 (c) of the Divorce Code: by the Plaintiff March 30, 2004; by
the Defendant July 16, 2004.
4. Related claims pending: None' Resolverl hy Marital Property
Settlement anrl Separation Agreement rlaterl Marr.h 30 ?004
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 Plaintiff's Waiver of Notice in 3301(c) Divorce was filed
with the Prothonotary: April 29, 2004.
Date Defendant's Waiver of Notice in 3301(c) Divorce was filed with
the Prothonotary: July 21,
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ADELAIDA CASTANEDA WILLIAMS,: THE COURT OF COMMON PLEAS OF
Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA
vs.
NO. 01 - 1617 CIVIL
GORDON STANLEY WILLIAMS,
Defendant
IN DIVORCE
ORDER OF COURT
AND NOW, this
c:Jo 77t.- day of .1. y-
2004, the economic claims raised in the proceedings having been
resolved in accordance with a marital settlement agreement
dated March 30, 2004, the appointment of the Master is vacated
and counsel can file a praecipe transmitting the record to the
Court requesting a final decree in divorce.
BY THE COURT,
Ge
cc:
~rol J. Lindsay
Attorney for Plaintiff
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vAndrew C. Spears
Attorney for Defendant
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01- I&./7 G()i.lT~
NUUUTALSETTLEMENTAGREEMENT
THIS AGREEMENT, made this ~ day Of~2004' by and between
Gordon Stanley Williams (hereinafter "Husband") of Kentucky, and Adelaida Castaneda Williams
(hereinafter "Wife") of Arizona.
WITNESSETH:
WHEREAS, the parties are Husband and Wife, married on June 27, 1998, in Buffalo, NY;
WHEREAS, no children were born of the marriage;
WHEREAS, unhappy differences and difficulties have arisen between the parties, in
consequence ofwmth theparties intend to live separate and apart forthe rest of their natural lives;
WHEREAS, Wife filed for divorce on March 20, 2001 which action is docketed to
Cumberland County Docket No. 01-1617;
WHEREAS, notwithstanding the filing of said divorce complaint, Husband and Wife have
been living separate and apart effectively since December 11, 1999;
WHEREAS, the parties desire to settle fully and finally their respective financial and
property rights and obligations as between each other, including, but not limited to, the ownership
and equitable distribution of real and personal property; past, present and future support, alimony
and/or maintenance; and any and all claims which either party has, or may have, against the other or
the other's estate; and
Document #: 243327
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NOW, THEREFORE, in consideration of the mutual promises, covenants, and undertakings
hereinafter set forth and for other good and valuable consideration, receipt of which the parties
acknowledge, Husband and Wife, each intending to be legally bound, hereby covenant and agree as
follows:
1. SEPARATION
Each party shall have the right to live separate and apart from the other party, free from the
other party's interference, authority, and control. Neither party shall interfere with the other or
attempt to interfere with the other, nor compel the parties' cohabitation.
2. HUSBAND'S AND WIFE'S DEBTS
Except as otherwise set forth in this Agreement, the parties represent and warrant to each
other that they have not incurred and will not contract or incur any debt or liability for which the
other or the other's estate might be responsible. Each party shall indemnifY and save hannless the
other party from any and all claims or demands made against the other by reason of debts or
obligations incurred by that party.
3. WANER OF RIGHTS AND MUTUAL RELEASES
Except as provided in this Agreement, both parties absolutely and unconditionally release
and forever discharge each other and their heirs, executors, administrators, assigns, property, and
estate from any and all rights, claims, demands, or obligations arising out of or by virtue of the
marital relationship, whether such claims exist now or arise in the future. This release shall be
effective regardless of whether such claims arise out of former or future acts contracts
, ,
engagements, or liabilities of the parties or by way of dower, curtesy, widow's rights, family
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exemption or similar allowance, or under the intestate laws, or the right to take against the spouse's
will, or the right to treat a lifetime conveyance by the other as testamentary, or all other rights of a
surviving spouse to participate in a deceased spouse's estate, whether arising under the laws of
Pennsylvania, any state, commonwealth, or territory of the United States, or other country.
Except for any cause of action for divorce which either party may have or claim to have, and
except for the obligations of the parties contained in this Agreement, each party gives to the other an
absolute and unconditional release and discharge from all causes of action, claims, rights, or
demands whatsoever, in law ,or in equity, which either party ever had or now has against the other,
including, but not limited to, alimony, alimony pendente lite, spousal support, equitable distribution
of marital property, counsel fees or expenses.
4. DIVISION OF PERSONAL PROPERTY
All personal property currently in Husband's possession shall be the sole and separate
property of Husband. All personal property currently in Wife's possession shall be the sole and
separate property of Wife. It is acknowledged that Husband has been keeping Wife's furniture and
personal items in storage at his home located at 9345 Joyce Lane, Hummelstown, Dauphin County,
Pennsylvania. Wife has ninety (90) days from the date of this Agreement to remove the furniture
from said home. Attached as Exhibit "A" and incorporated by reference is a list of personal
property of Wife which Husband has been storing. Husband has not seen all of the items that are
listed, but to the best of his ability warrants that the property is in the same condition as it was when
removed from a private storage facility. The only items known to be damaged are the wicker
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furniture which due to space constraints had to be placed on the front porch and has been
deteriorated by the weather. Provided Wife gives Husband 5 days notice, Husband will make the
personal property on Exhibit "A" available to wife or her designated agent for pick up.
5. JOINT DEBTS
The parties acknowledge that they have no debts which were jointly incurred during their
marriage with the exception of the following:
Approximate
Account Balance Due
(a) Student loans to Direct Loans
(Amount consolidated on March 22, 1999) $ 21,105.98
Amount owed after repayment by 9/21//23: $ 36,232.02
Amount paid so far: $ 4,844.50
Balance owed; $ 31,387.52
Husband shall be solely responsible for 54% or $16,949.26 of the student loans. Wife shall
be solely responsible for 46% or $14,438.26 of the Direct Loan account. Commencing February
2004, the monthly payment due on the Direct Loans will be $145.31. Husband will be responsible
for 54% of this payment or the amount of $78.47. Wife will be responsible for 46% of this
payment in the amount of $66.84. Wife shall make the monthly payment directly to Husband. In
the event, Wife can pay off her balance owed in a lump sum prior to 9/21/23, she will be discharged
from paying the monthly amount to Husband.
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For the purposes of this paragraph only, Husband and Wife agree to keep each other aware
of their respective addresses so payment of this debt can be made. Wife's current address is 260
South Laveen Drive, Chandler, Arizona 85226. Husband's current address is Box 2134, 2825
Lexington Road, Louisville, Kentucky 40280.
Any debts or obligations incurred by either party in hislher individual name, other than those
specified herein, whether incurred before or after separation, are the sole responsibility of the party
in whose name the debt or obligation was incurred.
6. RETIREMENT BENEFITS
During the marriage Husband had a savings stock purchase plan with General Motors
Corporation through his prior employment with General Motors. Husband agrees to pay Wife the
sum of Seven Thousand Five Hundred Dollars ($7,500.00) in settlement of Wife's claims for the
marital portion of the savings stock purchase plan. Husband agrees to pay this amount within thirty
(30) days of the date of signing of this agreement.
Husband also owns 75 shares of General Motors stock. Wife specifically waives, releases,
renounces and forever abandons all of her right, title, interest or claim, whatever it may be, in any
stocks, whether acquired through Husband's employment or otherwise, and hereinafter said shares
of stock shall become the sole and separate property of Husband.
7. DNISION OF BANK ACCOUNTS
Husband and Wife acknowledge that all joint bank accounts have been closed or divided to
their mutual satisfaction prior to the execution of this Agreement.
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8. AFTER-ACQUIRED PROPERTY
Each of the parties shall own and enjoy, independently of any claims or rights of the other,
all real property and all items of personal property, tangible or intangible, hereafter acquired, with
full power to dispose of the same as fully and effectively as though he or she were unmanied. Any
property so acquired shall be owned solely by that party and the other party shall have no claim to
that property.
9. SPOUSAL SUPPORT, ALIMQNY PENDENTE LITE, AND ALIMONY
Husband and Wife waive and relinquish all rights, if any, to spousal support, alimony
pendente lite, and alimony. Any transfer of monies between the parties pursuant to any term of
this Agreement shall not constitute alimony, but is made as part of the parties' equitable
distribution.
10. TAX MATTERS
The parties have negotiated this Agreement with the understanding and intention to divide
their marital property. The parties have determined that such division conforms to a right and just
standard with regard to the rights of each party. The division of existing marital property is not,
except as may be otherwise expressly provided herein, intended by the parties to constitute in any
way a sale or exchange of assets. It is understood that the property transfers described in this
Agreement fall within the provisions of Section 1041 of the Internal Revenue Code, and as such
will not result in the recognition of any gain or loss upon the transfer by the transferor or transferee.
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11. COUNSEL FEES AND EXPENSES
Except as otherwise specified herein, each party shall be responsible for payment of hislher
own counsel fees and expenses.
12. ADVICE OF COUNSEL
The parties acknowledge that each has received or has had the opportunity to receive
independent legal advice from counsel of their selection and that they have been informed fully as
to their legal rights and obligations, including all rights available to them under the Pennsylvania
Divorce Code of 1980, as amended, and other applicable laws.
Each party confirms that he/she understands fully the terms, conditions, and provisions of
this Agreement and believes them to be fair, just, adequate, and reasonable under the existing
circumstances. The parties further confirm that each is entering into this Agreement freely and
voluntarily and that the execution of this Agreement is not the result of any duress, undue influence,
collusion, or improper or illegal agreement.
13. AFFIDAVITS OF CONSENT
Each party agrees to execute an Affidavit of Consent for the obtaining of a no-fault divorce
under the provisions of the Divorce Code of 1980, as amended.
14. EFFECT OF DNORCE DECREE ON AGREEMENT
Either party may enforce this Agreement as provided in Section 3105(a) of the Divorce
Code, as amended.
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As provided in Section 3105(c), provisions of this Agreement regarding equitable
distribution, alimony, alimony pendente lite, counsel fees or expenses shall not be subject to
modification by the court.
15. DATE OF EXECUTION
The "date of execution", "date of this agreement", or "execution date" ofthis Agreement is
the date upon which it is signed by the parties if they sign the Agreement on the same date.
Otherwise, the "date of execution", "date of this agreement", or "execution date" shall be the date
on which the last party signed this Agreement.
16. HEADlNGS NOT PART OF AGREEMENT
The descriptive headings preceding the paragraphs are for convenience and shall not affect
the meaning, construction, or effect of this Agreement.
17. SEVERABILITY AND INDEPENDENT AND SEPARATE COVENANTS
Each separate obligation shall be deemed to be a separate and independent covenant and
agreement. If any term, condition, clause, or provision of this Agreement shall be detennined or
declared to be void or invalid in law or otherwise, then only that term, condition, clause, or
provision shall be stricken from this Agreement and in all other respects this Agreement shall be
valid and continue in full force, effect, and operation.
18. AGREEMENT BINDlNG ON HEIRS
This Agreement shall be binding on and shall enure to the benefit of the parties and their
respective heirs, executors, administrators, successors, and assigns.
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19. INTEGRATION
This Agreement constitutes the entire understanding of the parties and supersedes any and
all prior agreements and negotiations between them. There are no representations, warranties,
covenants, or promises other than those expressly set forth in this Agreement.
20. MODIFICATION OR WAIVER TO BE IN WRlTING
No modification or waiver of any term of this Agreement shall be valid unless in writing
and signed by both parties.
21. NO WAIVER OF DEFAULT
The failure of either party to insist upon strict performance of any t= of this Agreement
shall in no way affect the right of such party hereafter to enforce the term.
22. VOLUNTARY EXECUTION
The parties acknowledge that this Agreement is fair and equitable, and that they have
reached this Agreement freely and voluntarily, without any duress, undue influence, collusion, or
improper or illegal agreements.
23. APPLICABLE LAW
This Agreement shall be construed under the laws of the Commonwealth of Pennsylvania
and more specifically under the Divorce Code of 1980, as amended.
24. ATTORNEYS' FEES FOR ENFORCEMENT
If either party breaches any provision of this Agreement, the breaching party shall pay all
reasonable legal fees and costs incurred by the other in enforcing this Agreement, providing that the
enforcing party is successful in establishing that a breach has occurred.
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IN WITNESS WHEREOF, the parties have set their hands and seals the day and year first
written above.
WITNESS;
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Carlisle. PA
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ADELAIDA CASTANEDA WILLIAMS, : IN THE COURT OF COMMON PLEAS OF
Plaintiff, : CUMBERLAND COUNTY, PENNSYLVANIA
vs.
: NO. 2001 - )I,!/
CIVIL TERM
GORDON STANLEY WILLIAMS,
Defendant.
: 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 wamed
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 the Cumberland County Court House,
Carlisle, Pennsylvania, 17013.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF
PROPERTY, LAWYERS FEES OR EXPENSES BEFORE A DECREE OF 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
SAIDIS, SHUFF, FLOWER & LINDSAY
Attorneys for the Plaintiff
B
James D. Flower, J
ID # 27742
26 West High ,Street
Carlisle, PA 17013
(717) 243-6222
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ADELAIDA CASTANEDA WILLIAMS, : IN THE COURT OF COMMON PLEAS OF
Plaintiff, : CUMBERLAND COUNTY, PENNSYLVANIA
vs.
: NO. 2001 - /(.,/7
CIVIL TERM
GORDON STANLEY WILLIAMS,
Defendant.
: IN DIVORCE
COMPLAINT
COUNT I-IN DIVORCE
ADELAIDA CASTANEDA WILLIAMS, Plaintiff, by her attorneys, SAIDIS,
SHUFF, FLOWER & LINDSAY, respectfully represents:
1. The Plaintiff is ADELAIDA CASTANEDA WILLIAMS, who currently
resides at 380 East Yale Loop, Irvine, California 92614.
2. The Defendant is GORDON STANLEY WILLIAMS, who currently
resides at 6991 Linglestown Road, Artemas, Dauphin County, Pennsylvania 17211.
3. The Defendant has been a bona fide resident in the Commonwealth of
Pennsylvania for at least six months immediately prior to the filing of this Complaint. The
parties lived together in Pennsylvania as a married couple for a period in excess of six
months, in Cumberland County, Pennsylvania.
4. The Plaintiff and Defendant were married on June 27, 1998, in Amherst,
New York.
5. There have been no prior actions of divorce or for annulment between
the parties in this or in any other jurisdiction.
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6. The Plaintiff avers that she is entitled to a divorce on the ground that the
marriage is irretrievably broken and Plaintiff is proceeding under Sections 3301 (c) and/or
(d) of the Divorce Code.
7. Plaintiff has been advised of the availability of marriage counseling and
of the right to request that the Court require the parties to participate in marriage
counseling, and does not request counseling.
WHEREFORE, Plaintiff requests the Court to enter a decree of divorce.
COUNT 11- EQUITABLE DISTRIBUTION
8. The averments of Paragraph 1-7 are incorporated herein by reference
as though set out in full.
9. In the course of their marriage, the parties have acquired certain
property, both personal and real.
WHEREFORE, Plaintiff prays this Honorable Court to equitably divide said
property.
COUNT III - ALIMONY. ALIMONY PENDENT-E LITE
AND ATTORNEYS' FEES AND COSTS
10. The averments of Paragraph 1-11 are incorporated herein by
reference as though set out in full.
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Carlisle, PA
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11. Plaintiff is without property and assets sufficient to provide for her
reasonable needs presently and after the entry of a Decree in Divorce, and to pay
attorney's fees and court costs.
WHEREFORE, Plaintiff prays this Honorable Court to order alimony, and
alimony pendente lite, in an amount sufficient to provide for Plaintiff's reasonable needs
and to pay for reasonable attorney's fees and costs.
SAlOIS, SHUFF, FLOWER & LINDSAY
Attorneys for the Plaintiff
Date: ~-t1- D I
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James D. Flower, Jr., E
10 # 27742
26 West High Street
Carlisle, PA 17013
(717) 243-6222
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I. ADELAIDA CASTAN~DA WILl.IAMS, Plaintiff herein, hereby verify that
the statements made in this Complaint/;lTe true and correct to the best of my knowledge,
information and belief 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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ADELAIDA CASTANEDA WILLIAMS,
Plaintiff
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY,
PENNSYLVANIA
v.
NO. 2001-1617 CNIL TERM
GORDON STANLEY WILLIAMS,
Defendant
IN DNORCE
ACCEPTANCE OF SERVICE
I, Andrew C. Spears, Esquire, accepted service of the Complaint in Divorce on behalf of
Defendant Gordan Stanley Williams on March 25,2001, and certify that I was authorized to do
so in accordance with Pa. R.C.P. 402.
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Andrew ."Spears
Dated; July 2, 2004
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SHUFF, FLOWER
& LINDSAY
ATIORNEYS.AT.LAW
26 W. High Street
Carlisle. P A
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Adelaida Castaneda Williams,
Plaintiff,
PENNSYLVANIA
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY,
vs.
: NO. 2001 -1617
CIVIL TERM
Gordon Stanley Williams,
Defendant.
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A Complaint in Divorce under 93301 (c) of the Divorce Code was filed March 2!fr-OO~ i
The marriage of plaintiff and defendant is irretrievably broken and ninety days have ~psed'
from the date of filing and service of the Complaint.
: IN DIVORCE
PLAINTIFF'S AFFIDAVIT OF CONSENT
UNDER 63301(c) OF THE DIVORCE CODE
AND WAIVER OF COUNSELING
2.
3. I consent to the entry of a final Decree in Divorce after service of notice of intention to
request entry of the Decree.
I verify that the statements made in this Affidavit are true and correct to the best of my
knowledge, information and belief. I understand that false statements herein are made subject to the
penalties of 18 Pa.C.S. 4904 relating to unsworn falsifica' n to authorities.
Date:
3/..30//J4
/ /
PLAINTIFF'SWAIVER OF NOTICE OF INTENTION TO REQUEST
ENTRY OF A DIVORCE DECREE UNDER
!i 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 to the
best of my knowledge, information and belief. I understand that false statement herein are made
subject to the penalties of 18 Pa.C.S. 4904 relating to u 0 f sification to aut rities
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ADELAIDA CASTANEDA WILLIAMS,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO. 2001-1617 CIVIL TERM
GORDON STANLEY WILLIAMS,
Defendant
IN DIVORCE
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under S 3301(c) of the Divorce Code was filed on March
21,2001 and served upon Defendant on March 25, 2001.
2. The marriage of Plaintiff and Defendant is irretrievably broken, and ninety (90) days
have elapsed from the date of filing and service of the Complaint.
3. I consent to the entry of a Final Decree of Divorce after service of Notice of
Intention to Request Entry of the Decree.
I verify that the statements made in this Affidavit are true and correct. I understand that any
false statements herein are made subject to the penalties of 18 Pa.C.S., S 4904, relating to unsworn
falsification to authorities.
Dated: -dill ( el-
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Drr4 4~ OJ fL,
I Gordon Stanley Williams
280208-1
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ADELAIDA CASTANEDA WILLIAMS,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL V ANlA
v.
NO. 2001-1617 CIVIL TERM
GORDON STANLEY WILLIAMS,
Defendant
IN DIVORCE
WAIVER OF NOTICE OF INTENTION TO REQUEST
ENTRY OF A DIVORCE UNDER & 3301(c) OF THE DIVORCE CODE
1. I consent to the entry of a final decree of divorce without notice.
2. I understand that I may lose rights concerning alimony, division of property,
lawyer's fees or expenses in do not claim them before a divorce is granted.
3. I understand that I will not be divorced until a divorce decree is entered by the Court
and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary.
I verify that the statements made in this Affidavit are true and correct. I understand that
false statements herein are made subject to the penalties of 18 Pa.C.S. g 4904 relating to unsworn
falsification to authorities.
Dated;
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rdon tanley Williams
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April I 0, 2003
SINCE 1888
3211 North Front Street
P.O. Box 5300
Harrisburg, PA 17110-0300
717-238-8187
Fax: 717-234-9478
E. Robert Elicker, Esquire
Divorce Master
9 North Hanover Street
Carlisle, P A 17013
Other OfficeR
Colonial Park Mechanicsburg
717-652-7020 717-691-5577
Millersburg Sbippensburg
717-692-5810 717-530-7515
Re: Adelaida C. Williams v. Gordon S. Williams
No. 2001-1617
Dear Mr. Elicker:
Melissa 1. VanEck, Esquire, the previous attorney for Defendant, Gordon S. Williams, had
previously filed for a Divorce Master in 2002. On June 20,2002, Plaintiffs attorney, Carol J.
Lindsay, Esquire, filed her certification of discovery and asked for additional discovery from
Defendant. At this time, I believe that all outstanding discovery requests have been complied
with and it looks like the parties will not be able to settle their case without your intervention.
Therefore, I am requesting you to send a directive for pretrial statements so that we can proceed
further with this case.
.If you have any questions or concerns, please do not hesitate to contact me. Thank you for your
cooperation in this matter.
Very truly yours,
METZGER, WICKERSHAM, KNAUSS & ERB, P_C_
~
Andrew C. Spears
ACS:c1
cc: Carol J. Lindsay, Esquire
Document #: 266784.1
J';;';:~1: c;;,,~----
Edward,E,;_Knauss, IV*
Jered L. BoCk
Steven P. Mirier.
Clark DeVere
Milton' Bernstein
Bruce J. Warshawsky
Francis J. Lafferty, N
David H. Martineau
Andrew W. Norfleet
Andrew C. Spears
Young-Suh KOD
* Board Certified in civil
trial law and advocacy
by the National Board
afTrial Advocacy
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SINCE 1888
3211 North Front Street
P.O. Box 5300
Harrisburg, PA 17110-0300
717-238-8187
Fax: 717-234-9478
May 23, 2002
Other Offices
Colonial Park Mechanicsburg
717-652-7020 717-691-5577
Millersburg Smppensburg
717-692-5810 717-530-7515
E. Robert Elicker, II, Esquire
13 North Hanover Street
Carlisle, PA 17013
Re: Adelaida Castaneda Williams v. Gordan Stanley Williams
Docket No. 01-1617 Civil, In Divorce
Our File No. 86-41
Dear Mr. Elicker;
Enclosed please find Defendant's Certification that discovery is complete in the above
referenced matter.
If further information is needed, please do not hesitate to contact me.
Very truly yours,
METZGER, WICKERSHAM, KNAUSS & ERB, P.C.
~ ~ lb.k 2Qk
Melissa 1. Van Eck
MLV:sae
c: Carol J. Lindsay, Esquire (w/encl.)
Prothonotary, Cumberland County (w/encl.)
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James F. Carl
Edward E. Knauss, IV'
Jered L. Hock
Karl R. Hildabrand*
'-Steven P. Miner
Oark DeVere
E. Ralph Godfrey
Steven C. Courtney
Francis J. Lafferty. IV
David H. Martineau
Andrew W. Norfleet
Melissa L. Van Eel<
Andrew C. Spears
Young-Sub Koo
* Board Certified in civil
trial law and advocacy
by the National Board
of Thai Advocacy
Document #: 235053.1
,.
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OFFICE OF DIVORCE MASTER
CUMBERLAND COUNTY
COURT OF COMMON PLEAS
9 North Hanover Street
Carlisle. PA 17013
(717) 240-6535
E. Robert Elic:ker. II
Divorce Master
Trllc:i Jo Colyer
Office Manager/Reporter
West Shore
697-0371 Ext. 6535
April 15,2003
Carol J. Lindsay
Attorney at Law
SAlOIS, SHUFF, FLOWER & LINDSAY
26 West High Street
Carlisle, PA 17013
Andrew C. Spears
Attorney at Law
METZGER & WICKERSHAM
3211 North Front Street
P.O. Box 5300
Harrisburg, PA 17110-0300
RE: Adelaida Castaneda Williams vs. Gordan Stanley Williams
No. 01 - 1617 Civil
In Divorce
Dear Ms. Lindsay and Mr. Spears:
Counsel have indicated that there are no outstanding discovery
issues. We can now proceed with a directive for pretrial statements.
A complaint in divorce was filed on March 20,2001, raising
grounds for divorce of irretrievable breakdown of the marriage and the
economic claims of equitable distribution, alimony, alimony pendent
elite, and counsel fees and costs.
Attorney James Flower, Jr. filed the complaint; however, I assume
that Ms. Lindsay has now taken over the Plaintiffs representation.
I am also assuming that grounds for divorce are not an issue and
that the parties will either sign affidavits of consent or have been
separated for a period in excess of two years.
In accordance with P.R.C.P. 1920.33(b) I am directing each counsel
to file a pretrial statement on or before Friday, May 9,2003. Upon
receipt of the pretrial statements, I will immediately schedule a pre-
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Ms. Lindsay and Mr. Spears, Attorneys at Law
15 April 2003
Page 2
hearing conference with counsel to discuss the issues and, if necessary,
schedule a hearing.
Very truly yours,
E. Robert Elicker, II
Divorce Master
NOTE:
Sanctions for failure to file the pretrial statements are set
forth in subdivision (c) and (d) of Rule 1920.33.
THE ORIGINAL PRETRIAL STATEMENT SHOULD BE FILED
IN THE MASTER'S OFFICE AND A COPY SENT DIRECTLY
TO OPPOSING COUNSEL.
FAILURE TO FILE PRETRIAL STATEMENTS AS DIRECTED
BY THE MASTER MAY RESULT IN THE MASTER'S
APPOINTMENT BEING VACATED.
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ADELAIDA CASTANEDA WILLIAMS,: IN THE COURT OF COMMON PLEAS OF
Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA
VS.
CIVIL ACTION - LAW
,NO. 01 - 1617 CIVIL
GORDON STANLEY WILLIAMS,
Defendant
IN DIVORCE
NOTICE OF PRE-HEARING CONFERENCE
TO: Carol J. Lindsay
, Attorney for Plaintiff
Andrew C. Spears
, Attorney for Defendant
A pre-hearing conference has been scheduled at the
Office of the Divorce Master, 9 North Hanover Street, Carlisle,
Pennsylvania, on the 9th day of January 2004, at 9:00 a.m., at
which time we will review the pre-trial statements previously
filed by counsel, define issues, identify witnesses, explore
the possibility of settlement and, if necessary, schedule a
hearing.
Very truly yours,
Date of Notice: 12/8/03
E. Robert Elicker, II
Divorce Master
, " -T. _ /lI.Ji~
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10/14/2003 17:22 FAX 7172349478
MWK&E HGB PA
~002
Oct~er 14, 2003
SINCE 1888
~211 NO>i~ Front Str.et
P.O. Box 5300
Horri$bllrg, PA 17110-0300
717-238-8187
F.":717-23~-~~78
YIA'iF ACSIMILE: 240-1890
Olhl"r OH;r("~
Colonial flark Me..:hMI.ksburg
717-(,;2-7020 717-691.5577
Miller"bu,,& ShiJ'pel\sburg
717-692-5810 7l70530-7515
E. Robert Elicker, II, Esquire
Divqrce Master
9 Nol1h Hanover Street
Carl~le, PA 17013
Re:' Adelaida C. Williams v. Gordon S. Williams
No. 2001-1617
Dear:.Mr. Elicker:
This 'letter is to inform you of recent developments in this case. Unfortunately, I have been
advicied that I must be available for trial in Dauphin County for the week of October 20, 2003.
TheTI~fore, it is impossible fOT me to attend the hearing scheduled in this matter on Wednesday,
October 22, 2003. I have consulted with Carol Lindsay, Esquire, and she informed me that
ordiri,arily she would not have a problem with continuing the hearing to another date; but she
belie~es that her client may have already purclJased a plane ticket. You may recall that neither of
our ~lients lives in Pennsylvania; rather Plaintiff lives in Arizona, and my client lives in
Kentllcky.
I ant ~SOlTY for any inconvenience this is causing. The scheduling of the trial in Dauphin County
was ~eyond my control. Your cooperation and help in this matter is greatly appreciated.
Very'!truly yours,
,
MEtzGER, WICKERSHAM, KNAUSS & ERB, P.C.
\,~
Andrj:w C. Spears
ACSiseh
ee: Carol J. Lindsay, Esquire
Jamp..,F.C~I'l
Edward E. Knau...,., IV'"
)f!rf,d I.. Hocl<
Stew!, P. Miner
CI.ltk DeVere
Milton Bernstein
Bruc.e,1. WiloIShaws.ky
Prilnoli J. Lafferty. rv
DllVid J-I. Martineilu
Andrl.'w W Nortleet
Andrew C. SpEilf6
Yuune;-S1.1h .l<oc
'ltlltlnfuwti/ir.dfllr.iT.i/
lrillll'/W'I~(I",h'II~\y
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October 14, 2003
SINCE 1888
3211 North Front Street
PO, Box 5300
Harrisburg, PA 17110-0300
717-238-8187
Fax: 717-234-9478
VIA FACSIMILE: 240-7890
Other Offices
Colonial Park Mechanicsburg
717-652-7020 717-691-5577
Millersburg Smppensburg
717-692-5810 717-530-7515
K Robert Elicker, II, Esquire
Divorce Master
9 North Hanover Street
Carlisle, P A 17013
Re: Adelaida C. Williams v. Gordon S. Williams
No. 2001-1617
Dear Mr. Elicker;
This letter is to inform you of recent developments in this case. Unfortunately, I have been
advised that I must be available for trial in Dauphin County for the week of October 20, 2003.
Therefore, it is impossible for me to attend the hearing scheduled in this matter on Wednesday,
October 22, 2003. I have consulted with Carol Lindsay, Esquire, and she informed me that
ordinarily she would not have a problem with continuing the hearing to another date; but she
believes that her client mayhave already purchased a plane ticket. You may recall that neither of
our clients liv~s in Perinsylvania; rather Plaintiff lives in Arizona, and my client lives in
Kentucky.
I am sorry for any inconvenience this is causing. The scheduling of the trial in Dauphin County
was beyond my control. Your cooperation and help in this matter is greatly appreciated.
Very truly yours,
METZGER, WICKERSHAM,KNAUSS & ERB, P.C.
~
Andrew C. Spears
ACS/seh
cc; Caron Lindsay, Esquire
James F. Carl
Ed~,van:J..E ~auss, IV*
Jenid (:Hock
Steven P.:Mirier..
. Park beYe~
Milton Berrtsteih
J3ruce J. Warshawsky
FranCis J. L~fferty, IV
David"H. Martineau
Andrew W. Norfleet
Andrew C. Spears
Young-Suh KOD
* Board Certified in civil
trial law and advocacy
by the National Board
afTrial Advocacy
290563-1
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SHUFF, FLOWER
& LINDSAY
ATIORNEYS'AT'LAW
26 W. High Street
Carlisle, PA
"
.
ADELAIDA CASTANEDA WilLIAMS,
Plaintiff
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: CIVil ACTION - LAW
: No. 2001 - 1617 CIVil TERM
VS.
GORDON STANLEY WilLIAMS,
Defendant
: IN DIVORCE
PLAINTIFFIWIFE'S PRE-HEARING
MEMORANDUM
The parties to this action are Adelaida Castaneda Williams, of 1283 West
Parklane Blvd., Apt. 203, Chandler, Arizona, hereinafter Wife; and Gordon Stanley
Williams, of 9145 Joyce lane, Hummelstown, Pennsylvania, hereinafter Husband.
The parties were married on June 27, 1998. The parties separated on
December 11, 1999.
Husband owns property and receives a pension that allows him to live
comfortably and securely. After retirement, he has been able to continue his education
and improve his chances of obtaining additional employment.
I. MARITAL ASSETS
The marital assets are summarized on the attached Inventory.
II. NON-MARITAL ASSETS
The non-marital assets are summarized on the attached Inventory.
III. EXPERT WITNESSES
None anticipated.
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SHUFF, FLOWER
& LINDSAY
ATIORNEYS.AT.LAW
26 W. High Street
Carlisle. P A
~w
II
IV. LAY WITNESSES
Wife will testify for herself.
V. EXHIBITS
Attached hereto is an asset list which Wife intends to introduce at the hearing.
. Wife reserves the right to introduce additional exhibits and provide them to counsel for
Husband prior to the hearing.
VI. WIFE'S INCOME
Wife's tax return for 2002 will be provided at pre-hearing conference. The
Support Office determined her earning capacity to be $1863.00 per month net.
VII. EXPENSES
A copy of Wife's expense statement is attached hereto.
VIII. RETIREMENT BENEFITS
Wife has no retirement benefits.
IX.
ATTORNEYS' FEES
At this point, there is no claim for Attorney's fees.
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SHUFF, FLOWER
& LINDSAY
A'ITORNEYS'AT'LAW
26 W. High Street
Carlisle, P A
-~ ,~
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X. TANGIBLE PERSONAL PROPERTY
The Plaintiff has some pre-marital furniture currently in the possession of the
Defendant.
XI. MARITAL DEBT
During the course of the marriage the parties consolidated student loans for their
children into a single loan in the Husband's name.
XII. PROPOSED RESOLUTION
Wife requests that Husband pay $7500.00. Also, she requests alimony
payments of $375.00 for 6 months after the divorce. Wife would agree to separate out
the student loans and be responsible for payment of those she brought to the marriage.
Respectfully submitted,
By:
. [Indsay Esquire
693
26 esl High reel
lisle, PA 17013
(717) 243-6222
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SHUFF, FLOWER
& LINDSAY
ATIORNEYS-AT-LAW
26 W. High Street
Carlisle, P A
!I
CERTIFICATE OF SERVICE
~7+-
I certify that on the J- ;;Z day ~H003, I served a true and
correct copy of the within PlaintifflWife's Pre-Hearing Memorandum upon counsel for
Defendant, Gordon Stanley Williams, in this matter by depositing same in the United
States mail, first class, postage prepaid, addressed as follows:
Andrew C. Spears
Metzger Wickersham
3211 North Front Street
PO Box 5300
Harrisburg, PA 17110-0300
SAlOIS, SHUFF, FLOWER & LINDSAY
Attorneys for Plaintiff
By:
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CASE:
CIVIL ACTION - DIVORCE
No. 01 . 1617 CIVIL TERM
Date; 8/22/03
INCOME AND ExPENSE STA TEMENT
THIS FORM MUST BE FILLED OUT
ADELAIDA WILLIAMS
INCOME STATEMENT OF:
I VERIFY THAT THE STATEMENTS MADIS IN THIS INCOME AND EXPENSE STATEMENT ARE TRUE AND CORRECT. I UNDERSTAND THAT FALSE STATEMENTS
HEREIN ARE SUBJECTTOTHE CRIMINAl PENALTIES OF 18 PA.C.S.!i4904, RELATING TO UNSWORN FALSIFICATION TO AUTHORITY.
8/22/03
ADELAIDA C. WILLIAMS,
DATE
PLAINTIFF/DEFENDANT
INCOME:
EMPLOYER: THE CLINIC MASSAGE INSTITUTE-SELF EMPLOYED
ADDRESS: 1283 W PARKLANE BLVD. #203
TYPE OF WORK: MASSAGE THERAPIST/MASSAGE THERAPIST INSTRUCTOR
PAYROLL NO. GROSS PAY PER PAY PERIOD $
PAY PERIOD (WKL Y, BI-WKL Y., ETC.)
ITEMIZED PAYROLL DEDUCTIONS
FEDERAL WITHHOLDING SOCIAL SECURITY LOCAL WAGE TN<
STATE INCOME TN< RETIREMENT SAVINGS BONDS
CREDIT UNION liFE INSURANCE HEALTH INSURANCE
OTHER DEDUCTIONS UNION DUES OPTI-WAGETN<
(SPECIFY)
TOTALS
NET PAY PER PAY PERIOD $
Service Type
Page 1 of 5
Form IN - 008
Worker ID
l,,"'W.r.~jl
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Income and Expense Statement
PACSES Case Number;
Other (Fill in Appropriate Column)
Income WEEK MONTH YEAR
INTEREST
Dividends
Pension
Annuity US Treas. 330.00 3960.00
Social Security
Rents
Royalties
Expense Account
Gifts
Unemployment Compo
Workmen's Compensation
IRS Refund
Other
Other
TOTAL INCOME 330.00 3960.00
EXPENSES (Fill in AppropYiate Column)
WEEK MONTH YEAR
HOME
Mort9age/Rent 735.00 , 8820.00
Maintenance
Utilities
Electric 200.00 2400.00
Gas
Oil
Telephone 100.00 1200.00
Service Type
Page 2 of 5
Form IN - 008
Worker 10
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Income and Expense Statement
PACSES Case Number;
EXPENSES (Fill in Appropriate Column)
continued WEEK MONTH YEAR
Water
Sewer
EMPLOYMENT
Public Transportation
Lunch 100.00 1200.00
TAXES
Real Estate
Personal Property
Income
INSURANCE
Homeowners
Automobile 52.00 624.00
Life 70.00 840.00
Accident
Health
Other
AUTOMOBILE
Payments , 382.00 4584.00
Fuel 100.00 1200.00
Repairs 125.00 1500.00
,
MEDICAL
Doctor 170.00 2040.00
Dentist 25.00 300.00
Orthodontist
Service Type
Page 3 of 5
Form IN - 008
Worker 10
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Income and Expense Statement
PACSES Case Number;
EXPENSES (Fill in Appropriate Column)
continued WEEK MONTH YEAR
Hospital
Medicine 150.00 1800.00
Special Needs (alasses.
braces, orthopedic devices)
EDUCATION
Private School
Parochial School
College
Religious 25.00 300.00
PERSONAL
Clothing 100.00 1200.00
Food 150.00 1800.00
Barber/Hairdresser 50.00 600.00
Credit payments; 50.00 2064.00
Credit Card 122.00
Charae Account
Memberships Lie. Renewal 41.66 500.00
(Massage Therapist License)
LOANS
Credit Union
MISCELLANEOUS
Household help
Child Care
Papers/BooksiMagazines 35.00 420.00
Entertainment
Pay TV 50.00 600.00
Vacation
Service Type
Page 4 of 5
Form IN - 008
Worker ID
<'-_'-'iI,- ._.~'!~
Income and Expense Statement
PACSES Case Number:
EXPENSES (Fill in Appropriate Column)
Continued WEEK MONTH YEAR
Gifts
Legal Fees
Charitable Contributions
Other: Child Support
Alimony Payments
OTHER;
Total Expenses
Service Type
Page 5 of 5
Form IN - 008
Worker ID
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April 22, 2003
3211 North Front Street
PO. Box 5300
Harrisburg, PA 17110-0300
717-238-8187
Fax: 717-234-9478
Carol J. Lindsay, Esquire
Saidis, Shuff, Flower & Lindsay
26 West High Street
Carlisle, PAl 70 I3
Other Offices
Colonial Park Mechanicsburg
717-652-7020 717-691-5577
Millersburg Shippensburg
717-692-5810 717-530-7515
Re: Gordon Williams v. Adelaida Williams
Dear Ms. Lindsay:
This letter is in response to your April 16, 2003, letter. After reviewing the file, 1 found the
Savings-Stock Purchase Program statement for June 26, 1998, through June 27, 1998, which
would cover the day of the marriage being June 27, 1998. I do not know why this was not
provided to you before and I apologize for any inconvenience this caused you or your client. I
believe this satisfies all your requests for discovery.
If you have any questions or concerns, please,do not hesitate to contact me.
Very truly yours,
V METZGER, WICKERSHAM, KNAUSS & ERB, P.C.
~e,~ -
'~', ~ - ,
Andrew C. Spears
ACS:cl
Enclosure
cc: E. Robert Elicker, II, Divorce Master, (no enclosure)
,'I:
James F. Carl
Edward E. Knauss, IV*
Jere<! L.ctiock ,
Steven P. ~r
: ClarkDeVe~ ..-~
'Milton Bemste~
BrUce (Warshawsky
Francis J. Lafferty, IV
David H. Martineau
Andrew W. Norfleet
Andrew C. Spears
Young-Suh Koo
* Board Certified in civil
trial law and advocacy
by the Natumal Board
afTrial Advocacy
Document #: 267517.1
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LAW OFFICES
JAMES D, FLOWER
JOHN E. SLIKE
ROBERT C. SAIDIS
GEOFFREY S, SHUFF
JAMES D, FLOWER, jR.
CAROLj. LINDSAY
KIRK S. SOHONAGE
THOMAS E, FLOWER
LINDSAY GINGRICH MACLAY
jACLYN M. SMITH
SAIDIS, SHUFF, FLOWER & LINDSAY
A PROFESSIONAL CORPORATION
26 WEST HIGH STREET
CARLISLE, PENNSYLVANIA 17013
TELEPHONE: (717) 243-6222 - FACSIMILE: (717) 243-6510
EMAIL: cIindsay@ssfI-Iaw.com
www.ssfl-law.com
WEST SHORE OFFICE:
2109 MARKET STREET
CAMP HILL, P A 17011
TELEPHONE: (717)737-3405
FACSIMILE: (717)737-3407
REPLY TO CARLISLE
April 16, 2003
E. Robert Elicker, II, Esquire
Office of the Divorce Master
9 North Hanover Street
Carlisle, PA 17013
Re: Adelaida C. Williams v. Gordon S. Williams
NO. 2001 -1617 CIVIL TERM
Dear Mr. Elicker:
On June 20, 2002, I requested discovery and I think most of it has been provided. The
only item that has not been provided, so far as I can see, is the value of the savings
stock purchase program on the date of the parties' marriage. I expect counsel will be
able to obtain that in short order.
Thank you very much for your assistance.
Very truly yours,
SAlOIS, SHUFF, FLOWER & LINDSAY
C,mIJ.U", ~
CJUtjb
cc: Adelaida Williams
Andrew Spears, Esquire
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: IN THE COURT OF COMMON PLEAS OF
ADELAIDA CASTANEDA WILLIAMS CUMBERLAND COUNTY, PENNSYLVANIA
: CIVIL ACTION - LAW
v.
GORDON STANLEY WILLIAMS
: NO.
01-1617
; IN DIVORCE
ORDER AND NOTICKSETTING HEARING
Adelaida Castaneda Williams
TO:
Carol J. Lindsay
, Plaintiff
, Counsel for Plaintiff
Gordon Stanley Williams
Andrew C. Spears
, Defendant
, Counsel for Defendant
You are directed to appear for a hearing to take testimony on the outstanding
issues in the above captioned divorce proceedings at the Office of the Divorce Master, 9
22nd
North Hanover Street, Carlisle, Pennsylvania, on the
October 2003 9:00
at a.m., at which place
and time you will be given the opportunity to present witnesses and exhibits in support
day of
of your case.
George E. Hoffer, President Judge
Dat~ of Orde?im83
NotIce;
By;
Divorce Master
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, P A 17013
TELEPHONE (717) 249-3166
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ADELAIDA CASTANEDA WILLIAMS,: IN THE COURT OF COMMON PLEAS OF
Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA
VS.
CIVIL ACTION - LAW
NO. 01 - 1617 CIVIL
GORDON STANLEY WILLIAMS,
Defendant
IN DIVORCE
CONFERENCE WITH
COUNSEL AND PARTIES
TO: Carol J. Lindsay , Counsel for Plaintiff
Adelaida Castaneda Williams , Plaintiff
Andrew C. Spears
Gordon Stanley Williams
, Counsel for Defendant
, Defendant
A conference has been scheduled at the Office of
the Divorce Master, 9 North Hanover Street, Carlisle,
Pennsylvania, on the 4th day of December 2003, at 9:00 a.m.,
with counsel and the parties to discuss the outstanding
economic issues to determine if there is a basis of settlement
of claims. If issues remain after the conference, a hearing
will be scheduled at another date.
Very truly yours,
Date of Notice: 10/27/03
E. Robert Elicker, II
Divorce Master
I,
"
ADELAIDA CASTANEDA WILLIAMS,;IN THE COURT OF COMMON PLEAS OF
Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA
Vs.
:NO. 01 - 1617 CIVIL
GORDON STANLEY WILLIAMS,
Defendant
;IN DIVORCE
RE: Pre-Hearing Conference Memorandum
DATE: Monday, September 8, 2003
Present for the Plaintiff, Adelaida Castaneda
Williams, is attorney Carol J. Lindsay, and present for the
Defendant, Gordon Stanley Williams, is attorney Andrew C.
Spears.
This action was commenced by the filing of a
complaint in divorce on March 20, 2001, raising grounds for
divorce of irretrievable breakdown of the marriage and the
economic claims of equitable distribution, alimony, alimony
pendente lite, and counsel fees and costs.
The complaint states the address of the
Plaintiff as 380 East Yale Loop, Irvine, California and the
address of the Defendant 6991 Linglestown Road, Artemas,
Dauphin County, Pennsylvania.
The Master has made reference to the pretrial
statement that was filed also does not list an address in
Cumberland County for either of the parties. The Master
indicated to counsel that he and the Court have the
discretion as to whether or not they will accept venue of
this case in Cumberland County; however, the Master has
advised counsel that rather than have them go through the
refiling or an order to have the case transferred to another
county, he will at least initially give the parties and
counsel an opportunity to settle the case here in Cumberland
County. He has advised counsel, however, that he will
further determine, depending on how matters go, whether or
not he will ultimately ask counsel to move the case to
another jurisdiction.
Consequently, the Master is going to schedule
a hearing on this case and give counsel an opportunity to
indicate on the record what needs to be accomplished in
order to move the case forward and to engage in negotiations
which may be helpful in getting the matter resolved.
1
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.
I,
The parties were married on June 27, 1998.
The parties have indicated in their pleadings two different
dates of separation; however, counsel have indicated that
the date of the separation, whether it be November or
December of 1999 is not particularly relevant with respect
to valuation of assets.
Attorney Lindsay has provided today a spread
sheet showing the marital estate values and listing assets
that she has determined are subject to equitable
distribution. There are some questions that she needs to
have answered in order to refine her statement, in
particular, the GM savings stock purchase program value.
She will address that matter in her comments as well as the
proposal to settle the case. Mr. Spears will also raise
some issues that he feels are relevant to credits which his
client may be entitled to regarding payment of debt for the
wife and the assumption of a storage fee for property which
wife had remaining in Pennsylvania after she moved to
California.
wife is currently living in Arizona and
husband in Kentucky. The Master is going to give the
parties and counsel an opportunity to get through the issues
here in Cumberland County as previously noted and to that
end will try to move this case forward by scheduling a
hearing. A hearing is scheduled for Wednesday, October 22,
2003, at 9:00 a.m. Notices will be sent to counsel and the
parties.
Attorney Lindsay has also indicated she has
not yet determined whether she will offer testimony on
marital misconduct but when she makes her comments on the
record, the Master requests she give some statement with
respect to the nature of her marital misconduct testimony.
Ms. Lindsay.
MS. LINDSAY: To begin with, with regard to
the issue of marital misconduct, the testimony would include
those allegations of marital misconduct contained in a
petition for protection from abuse filed by wife in
Cumberland County to No. 2000 - 7602, and she would also
present a photograph taken on December 15, 1999, by the
2
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staff of the Carlisle Domestic Shelter Home.
With regard to additional information needed
to settle this case, wife has provided to husband by letter
of August 20, 2003, a request to determine whether the
valuation on December 10, 1999 -- the valuation date which
we have been using includes $21,577.00 taken from that
account by husband a few weeks prior to separation and used
to purchase a home in his name only. If it appears that the
date of separation value of the stock savings program should
include the additional loan value of $21,577.00 -- in other
words, if the date of separation value is reduced by that
loan amount, then wife would need to reconsider her offer of
settlement. If, however, the balance in the account on the
date of separation of $51,392.77, if that amount is the full
value of the account, including the loan, then wife has
offered to settle the case for payment to her of $7,500.00
and alimony for a brief period of time; that is six months
as set out in the pretrial statement, in the amount of
$375.00.
THE MASTER: Ms. Lindsay, the number that you
are using with regard to that plan, is that the total value
of the account or is that the increase in value, do you want
to clarify, please?
MS. LINDSAY: On the asset list, which has
been attached to the pre-hearing memorandum as well,
3
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$26,829.24 is our calculation for the marital portion of the
GM savings stock purchase program. The question that I have
raised here is whether that should be increased by another
$21,577.00 because unlike some programs where the value of
the plan is not reduced by any loan taken out because the
plan is considered to continue to have that money in the
plan; just subject to a loan, this particular plan may have,
and I believe may have, reduced the value of the plan by the
loan amount in which case since Mr. Williams took that money
and used it for his own purpose, that would be part of the
marital portion in our view. So we need to clarify that
issue and the offer of settlement is really dependent upon
the answer to that question. If the answer is that there is
only $26,829.24 of marital value in that plan, then the
offer of $7,500.00 to settle the case with the alimony as
set out before is our offer.
THE MASTER: Mr. Spears.
MR. SPEARS: In terms of the marital
misconduct, husband will, of course, offer his response to
those allegations.
In terms of the stock purchase program, I
will provide as much information, including statements and
the phone numbers for Ms. Lindsay so she can obtain that
information. If it is deemed that there was the increase in
value due to a loan decreasing the amount, we will would
4
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like to provide information regarding what the present day
valuation of the GM stock is, not just the valuation on the
date of separation.
MS. LINDSAY: And I would agree that the
present value of the number of shares that were marital
would be relevant. I would just ask you to either get me an
answer to my question documented, a letter would be great,
or in the alternative get me a release and a phone number
for a human being so that I can make the inquiry myself.
THE MASTER: Do you want to address the
alleged credits that he is asking for?
MR. SPEARS: Husband is asking for a credit,
$4,000.00 which he will provide documentation prior to the
hearing regarding taking wife's furniture out of storage.
Also a $2,900.00 credit for paying off a personal debt which
wife owed as well as determining credits he would receive
for payments of student loans for each party, which were
consolidated during the marriage which he has been paying on
since the time of separation.
THE MASTER: You are going to get the
receipts from the storage company?
MR. SPEARS: Yes.
THE MASTER: And you are also going to get
evidence about this loan that he paid off for her. Was it a
car loan or what kind of a loan was it, do you know?
5
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MR. SPEARS: I believe in wife's statement
that she provided today, they refer to it as a personal loan
to her.
MS. LINDSAY: A $2,900.00 personal loan to
wife paid off by husband is what we put on there.
THE MASTER: What was the loan for and who
was the payee.
(A discussion was held off the record)
MS. LINDSAY: Counsel has provided a document
that indicates that Adelaida Williams asked Ernest Deetz for
a loan for help with tuition for her child in the amount of
$3,500.00 in 1997 which would have been prior to the
parties' marriage, and I expect that what Mr. Williams is
claiming is that he paid some or all of that money back.
MR. SPEARS: If I could further clarify too
-- can we go off the record again?
(A discussion was held off the record.)
THE MASTER: Ms. Lindsay, would you state for
the record how your is client employed?
MS. LINDSAY: Adelaida Williams at this time
is employed so far as I know, the last time I spoke to her,
as a massage therapy instructor where she teaches others to
become a massage therapist. I think she probably also does
some on her own.
THE MASTER: And your client, what is he
6
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doing?
MR. SPEARS: He is currently retired from GM
and receiving a pension annuity from them and he is
attending a seminary in Kentucky.
THE MASTER: What school?
MR. SPEARS: I am not positive. He is
studying to become a minister.
THE MASTER: Counsel and the parties are
directed to file income statements prior to the hearing to
be scheduled in these proceedings on or before Wednesday,
October 15, 2003.
MS. LINDSAY: Can I just suggest one other
thing to help with a resolution and that is, can we get an
indication of whether he can access that stock purchase
program to pay her off if need be.
cc: Carol J. Lindsay, Attorney for Plaintiff
Ade1aida Castaneda Williams, Plaintiff
Andrew C. Spears, Attorney for Defendant
Gordon Stanley Williams, Defendant
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ADELAIDA CASTANEDA WILLIAMS,
Plaintiff
6/q,o~
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL V ANlA
v.
NO. 2001-1617 CIVIL TERM
GORDON STANLEY WILLIAMS,
Defendant
IN DIVORCE
DEFENDANT'S PRETRIAL STATEMENT
Defendant, Gordon Stanley Williams, files the following Pretrial Statement.
1. List of Marital Assets:
At this point, Defendant lacks sufficient knowledge of all of the parties' marital
assets. However, the assets that he is aware of, though the amounts are not known, are;
(a)
Savings Bonds
Value
$150.00
(b)
75 Shares ofGM Stock
January 12, 1998 - $56.00 per share
January 11, 1999 - $85.97 per share
(c)
Saving Stock Purchase
Program from GM
Market value
June 27, 1998 - $24,525.96
Market value
December 11, 1999 - $29,722.61
2. Expert Witnesses:
Defendant does not intend to call expert witnesses at this time. However,
Defendant reserves the right to call an expert from GM Stock Program who would be able to
explain the value of Mr. Williams' Stock Purchase Program.
280208-1
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3. Other Witnesses;
Gordon Williams
Adelaida Williams
4. Exhibits of Defendant;
(a) Records from General Motors indicating Mr. Williams' Stock Options.
(b) Records from Statements from General Motors regarding Mr. Williams'
Savings Stock Program valued on June 27, 1998.
(c) Statement from General Motors regarding Mr. Williams' Savings Stock
Purchase Program dated December 11, 1999.
(d) Information regarding the separate student loans which were consolidated
into one loan.
5. Defendant's Income;
See income and expense statement of Defendant Gordon Stanley Williams.
6. Defendant's Expenses;
See income and expense statement of Defendant Gordon Stanley Williams.
7. Valuation of Defendant's Pension;
Not applicable.
8. Counsel Fees:
Defendant proposes that both parties be responsible for his/her own counsel fees.
9. Personal Property:
The only personal property left to be split up is furniture of Plaintiff Adelaida
Castaneda Williams. Defendant is currently storing them at his home in Harrisburg and he will be
280208-1
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more than happy to turn them over to Plaintiff. Defendant did have to borrow approximately
$8,000.00 from his Savings Stock Program to pay for storage costs of this furniture.
10. Marital Debts:
Student loans which were consolidated.
II. Proposed Resolution of Economic Issues;
Assets to Wife;
$1,000.00 to represent her share of Mr. Williams' savings stock purchase program
for the time in which they were married.
Alimony to Plaintiff Wife:
Due to length of their marriage and the fact that Plaintiff is able to procure
employment for herself, Defendant proposes an award of no alimony.
Student Loans
Student loans will be unconsolidated and each will party will pay their respective
loans.
METZGER, WICKERSHAM, KNAUSS & ERB, P.C.
By ~ ~~
Andrew C. Spears, Esquire
Attorney J.D. No. 87737
P.O. Box 5300
Harrisburg, PA 17110-0300
(717) 238-8187
Attorneys for Plaintiff
Dated:
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280208-1
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CERTIFICATE OF SERVICE
I, Andrew C. Spears, Esquire, of the law firm of Metzger, Wickersham, Knauss & Erb, P.C.,
hereby certify that I served a true and exact copy of the Plaintiff's Pretrial Statement with reference
to the foregoing action by First Class Mail, postage prepaid, this q ~ day of
0\~
,2003, on the following;
Carol 1. Lindsay, Esquire
Saidis, Shuff, Flower & Lindsay
26 West High Street
Carlisle, PA 17013
~'
Andrew C. Spears, Esquire
280208-/
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ADELAIDA CASTANEDA WIUlAMS
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO, 2001-1617 CML TERM
GORDON STANLEY WIU..IAMS,
Defendant
IN DNORCE
TO: Adelaida Casteneda Williams
clo James D. Flower, Jr., Esquire
Saidis, Shuff, Flower & Lindsay
26 W. High Street
Carlisle, PA 17013
Weare enclosing herewith Interrogatories propounded by Defendant, Gordon Stanley Williams,
to be answered by Adelaida Castaneda Williams within thirty (30) from the date of service hereof with a
request that a copy of the Answers be served upon counsel for Adelaida Castaneda Williams.
Each Interrogatory hereinafter set forth not only calls for the knowledge of Adelaida Castaneda
Williams but also for all information that is available to her by reasonable inquiry including inquiry of her
representatives and attorneys,
These Interrogatories shall be deemed to be continuing Interrogatories. If, between the time of
your answers to said Interrogatories and the time of the trial of this case, you, or anyone acting on your
behalf, learns of or discovers any further information not contained in your answers, any such additional
information shall be promptly furnished to the undersigned by Supplemental Answers. Please attach
written materials to any answer for which written materials are available. If there are none available state
the number of the Interrogatory to which it pertains. If there are no written materials relevant to the
question. please state.
METZGER, WICKERSHAM, KNAUSS & ERB, P,C.
By:
v~ cY rltzu/I
Melissa L. Stickel, Esquire
Attorney 1.D. No. 85869
3211 North Front Street
P,O. Box 5300
Harrisburg, PA 17110-0300
(717) 238-8187
Attorneys for Defendant
Dated: !l.dj (3/ J ;}Oo/
DEfENDANT'S
EXH1Sn
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Document #: 207274.1
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6. State the names of all employers for the last five years to the present and for each
employer, state:
a) The dates of such employment.
b) The position held.
c) A description of the duties performed.
d) Reason for termination.
e) Salary .
ANSWER:
q. S[Lf;Ell1f/..DtjE~ S/Nce I?r'l
~. &tSIN~S &/JAfa:./OPtlG!fTOi<.
c. f)jYS/cALj;f}~IfG& il/844I'/ eJ../AlIC-7lIfM!I.>r/~
q, Nt/A Neck IN:JU/<'Y /997
e. GI<~~5 k;.!Aflllru...y '$'/~ tJ()~.d)
Document #: 207274,]
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23. List the sources of your income and amounts for each of the years since the date of
final separation.
ANSWER:
tiS 1(utbl1.fy csA ""'''tArrY -$33.S:i?O rPer mul.l+A.
DOCJIJfNnt #: 207274./
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DEFENDANT'S
EXHIBIT
2tfH
34. For each of the last two years state the amount expended by you monthly for the
following;
a) Pleasure.
b) Travel and transportation. '
c) Food.
d) Clothing.
e) Housing.
f) Medical.
g) Education.
h) Contribution to retirement or disability plans, social security, and
premiums paid on any insurance plan (please specify 1he type of insurance
and the amount for each type).
ANSWER: 'if <"l eo . o'C)
ct. A(
b. iI!j$()w 00
e. <iliPt50. 00
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Document #: 207274.1
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42. With respect to your education, training and experience, state:
a) The name and address of each high school, vocational school, college or
other post-graduate training, the last year completed and dates of
attendance.
b) The major course of study or training received at each.
c) Any other training, experience or skill you have obtained, received or
developed.
ANSWER:
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DEFENDANT'S
EXHIBIT
Document #: 207274./
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My trip to the LA Concours
By Bev Giffln-Frohm Orange Coast Region
The day before the Concours was June 2nd and the morning was cold and rainy
in Los Angeles. It looked as if June weather had arrived on schedule and was
going to chaHenge the event masters of the PCAlLA Concours. The weather
gods had the event masters in a dilemma. Would the rain stop in time? Will the
rain stop in the morning? How many people would show up if it rained?
However, by late afternoon the rain stopped, at least in LA. It was still damp in
the air but this was like the normal June gloom. The event masters sighed with
relief and the show was ready to roll the next morning.
The morning started out Hke your typical June non-sunny morning, so I made
sure I was dressed in layers, I knew we would be at the beach and who knew
what the weather would be like in Marina del Rey verses IMne. I rolled into the
designated parking area at Burton Chase Park around 7:30am. I thought I was
on time, but there ware 8 other cars in front of me - this is the sign of a good
show. I pulled in behind Marty Stewart and we had a chance to catch up with
each other. Soon they were placing the ears in the park and we started last
minute preparation to get the ears ready to be judged.
I always enjoy attending Concours events, as you get to see people from around
the Zone and socialize a bit. It is amazing to see us earry on a conversation with
someone while cleaning a car. As long as they don't mind speaking to some of
your "other" body parts while doing so. It is amazing our ears are so clean, yet
we continue to find these tenacious bits of dirt that have taken up residence since
the last Concours. Someone joked that they didn't think I could get inside the ear
any further than I was already, they are probably right, but I was in hot pursuit
and ready to evict dirt. I am glad no one took a picture, or at least I hope to heck
no one did.
In my immediate area we had Marty Stewart, Doc Pryor & Linda Cobbarubias,
Darnell Bennet, Mark & Tina Trewartha, Bill & Barb Enke and . '
Jl ',..These are great folks and we proceeded to swap stories, trade supplies,
and set up our blankets and chairs.
As I was working on my ear Fred Stewart, the event's Head Judge, asked if I
would help with judging. I was selected to help judge the Wash and Shine class
together with Richard Price. The largest classes in the Zone Concours are the
Street and Wash and Shine c1asS9S. With 22 ears to be judged, three were Full
Concours, one U.,.RestOled, eight Street and ten Wash and shine. You get a
work out, but it is a great way to meet people and promote the Concours. By the
time we were half way through judging, the sun started to peek out and the ears
gleamed like jewels in the park.
DEFENDANT'S
EXHIBIT
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In Wash and Shine, we had ten terrific cars; seventy percent of those had come
out for the first time and did very well. The scores ranged from 128.1 to 129.8
that is close competition for this class. One first timer, Darnell Bennett took Best
of Wash and Shine with his beautiful white 1999 Boxster. I think this guy is ready
to move up into Street - don't you? Richard and I enjoyed talking to each owner
and giving them helpful hints on car preparation. I hope they come out again,
because each of their cars were great!
Here are the results from the show.
!class
C2
~
C9
83
84
84
S5
S6
S6
87
89
89
UR2L
W82
WS2
W82
WS2
WS3
WS3
W83
WS4
WS4
WS4
IName IRegion
Patrick, James LAR
~an, Guy &......
Giffin-Frohm, Beverly OCR
Enke, Bill & Barbara 8GV
Picchio, Julio AZR
Sell, Lawrence LAR
8cott, Michael LAR
Trewartha, Mark OCR
DeCocker, Dean 8GV
Ewbank, Bud & Carolyn 8BR
Kunban, Scott LAR
Mansolino, Mike OCR
Aeming, Jack LAR
Guerin, Jim SGV
Pyeatte, Charlie LAR
Stewart, Marti GPX
COban'Ubias, Linda GPX
Szielenski, Ziggy SOR
Widom, Keith LAR
Bennett, Damell GPX
Cottam, Tyler LAR
PierSel, Frank LAR
lear I
58 Speedster
86 9288
70 911E
77 9118 Targa
74 Carrera
93 Carrera 4
97 993
97 993 Turbo
00 Boxster
78 924
91 944
89 Carrera
82911SC
87911
82911SC
97 993
89 92884
82 928
99 Boxster
99 Boxster
01 Boxster
Points I
318.0
"
322.5
238.4
237.3
238.1
238.5
237.5
239.0
239.6
239.4
238.6
238.3
128.7
128.1
128.6
128.9
129.3
128.9
128.7
129.8
128.3
129.5
A big thank you goes to the Los Angeles Region for hosting a great event. We
had a great day with terrific people.
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Beverlv Frohm : LA Concours 2001 : View PhQto
. Photo 24 of 25 ".
richard and mercy putting the final
touches on before judging
, ~ Visit Albums .
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SAIDIS,SHUFF,FLOWER+LINDSAY FAX NO. : 2436510
DEPARTMENT 01" TilE TREASURY
l<'INANCIAI. MANAC:ICMENT SERVICE
P.O. BOX 1686
BIRMINGHAM, ALABAMA 3!lJOI-1686
THIS IS NOT A BILL. PLEASE RETAIN FOR YOUR ltECORDS
Dec. 21 2001
!Ii .. -
DEFENDANT'S
EXHIBIT
1LFft
FROM :
10101101
ADELAID C HALEN
380 B YALE LOOP
IRVINE CA ~614
Dear ADELAID C UALEN:
As authorized by Federal law, We applied all or part of your Federal payment to a debt you owe. The
government agellCy (or ag"lIOies) collecting your debt is listed below.
U.S. DEPARTMENT OF EDUCATION TIN Num: 537-62-2134
C/O ILLINOIS STUDENT ASSISTCOMM TOP Trace N1D1I: 810551743
1755 LAKE COOK ROAD Acet Num; ILS37622134
DEBRFIELD IL 60015 Amount This Creditor; $109.68
Creditor: 05 Site: IL
800-9"'.3512 (80\)) 934-3Sn
PURPOSB: Non- Tu Federal Debt
The Agency bas previously JeIlt notic" to you at the last addn....s known to tbe Agency. That notice,
explained the lIIt10unt and type of debt you owe, the rights available to you, and that the Agency intended
to collect the debt by intercepting any Federal payments mad.. to you, including lax refunds. If you
bellew your payment was ndueed In error or If you have questions about this debt, YOII must
eolltac:t 4he Agency at the address and telephone numbeJo shown above. The U. S. DepaI1mentof
.. the'.Treasury's' Fi:lllllcw MltfJagemenl Service calUlot re.oh-. issue. regaluing debts with o~r "sc.hcies.
We will forward the money taken from YOUl' Federal payment to the Agency to be applied to your ,lebt
balance; however, the Agency may not receive the funds fur several weeks after the payment date. If you
int:eod to coutact the Agency, please have this notice available.
C\~
Charles A, Wilsoll
Department of the Treasll1}', FillJlucial Management Service
(800) 304-3107
PAYMENT SUMMARY
PA YEn NAME: ADELAID C HALEN
PA YMBNT BEFORE REDUCTION: 5438.7S
TOTAL AMOUNT OF THIS REDUCTION: 5109.68
PA YlNG FEDERAL AGENCY: Office of Personnel Management
~:#PC/~ ~ ~14--:tf~ Ir
PAYMENT DATE; 10/01/01
PA YMBNT TYPE: EFT
POk. OPFICIAL OS.E ONLY~ ooroool.1781os.s1'14m'7622134C8669mOO1ALTR~P01At>ELOOlI1'
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ADELAIDA CASTANEDA WILLIAMS : IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiff
VS.
CIVIL ACTION - LAW
01 - 1617
NO. CIVIL
19
GORDIN STANLEY WILLIAMS
IN DIVORCE
Defendant
STATUS SHEET
DATE:
/ to"'11
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ADELAIDA CASTANEDA WILLIAMS, :IN THE COURT OF COMMON PLEAS OF
Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA
vs.
NO. 01 - 1617 CIVIL
GORDAN STANLEY WILLIAMS,
Defendant
IN DIVORCE
TO: Carol J. Lindsay
Attorney for Plaintiff
Melissa L. Van Eck Attorney for Defendant
DATE: Friday, May 17, 2002
CERTIFICATION
I certify that discovery is complete as to the claims
for which the Master has been appointed.
OR IF DISCOVERY IS NOT COMPLETE:
(a) Outline what information is required that is not
complete in order to prepare the case for trial
and indicate whether there are any outstanding
interrogatories or discovery motions.
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(b) Provide approximate date when discovery will be
complete and indicate what action is being taken
to complete discovery.
DATE
COUNSEL FOR PLAINTIFF
COUNSEL FOR DEFENDANT
NOTE:
PRETRIAL DIRECTIVES WILL NOT BE ISSUED FOR THE
FILING OF PRETRIAL STATEMENTS UNTIL COUNSEL HAVE
CERTIFIED THAT DISCOVERY IS COMPLETE, OR OTHERWISE
AT THE MASTER'S DISCRETION.
AFTER RECEIVING THIS DOCUMENT FROM BOTH COUNSEL
OR A PARTY TO THE ACTION, IF NOT REPRESENTED BY
COUNSEL, INDICATING THAT DISCOVERY IS NOT
COMPLETE, THE DIRECTIVE FOR FILING OF PRETRIAL
STATEMENTS WILL BE ISSUED AT THE MASTER'S
DISCRETION. HOWEVER, IF BOTH COUNSEL, OR A
PARTY NOT REPRESENTED, CERTIFY THAT DISCOVERY
IS COMPLETE, A DIRECTIVE TO FILE PRETRIAL
STATEMENTS WILL BE ISSUED IMMEDIATELY.
THE CERTIFICATION DOCUMENT SHOULD BE RETURNED
TO THE MASTER'S OFFICE WITHIN TWO (2) WEEKS OF
THE DATE SHOWN ON THE DOCUMENT.
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ADELAIDA CASTANEDA WILLIAMS,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
VS.
CIVIL ACTION - LAW
NO. 01 - 1617 CIVIL
GORDON STANLEY WILLIAMS,
Defendant
IN DIVORCE
NOTICE OF PRE-HEARING CONFERENCE
TO: Carol J. Lindsay
, Attorney for Plaintiff
Andrew C. Spears
, Attorney for Defendant
A pre-hearing conference has been scheduled at the
Office of the Divorce Master, 9 North Hanover Street, Carlisle,
Pennsylvania, on the 8th day of September 2003, at 9:30 a.m.,
at which time we will review the pre-trial statements
previously filed by counsel, define issues, identify witnesses,
explore the possibility of settlement and, if necessary,
schedule a hearing.
Very truly yours,
Date of Notice: 7/21/03
E. Robert Elicker, II
Divorce Master
Carol J. Lindsay, Attorney for Plaintiff, has not filed a
pretrial statement as of the date of this notice.
Andrew C. Spears, Attorney for Defendant, filed a pretrial
statement on May 9, 2003.
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ADELAIDA CASTANEDA WILLIAMS, ; COURT OF COMMON PLEAS OF
Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA
v.
; NO. 01 - 1617 CIVIL
GORDAN STANLEY WILLIAMS,
Defendant
: IN DIVORCE
TO:
Carol 1. Lindsay
Melissa L. Van Eck
Attorney for Plaintiff
Attorney for Defendant
DATE;
Friday, May 17, 2002
CERTIFICATION
I certify that discovery is complete as to the claims for which the Master has been
appointed.
May d.!:L 2002
lfYll ~ .!W ~. Va L< pp j
COUNSEL FOR DEFENDANT ---
NOTE: PRETRIAL DIRECTIVES WILL NOT BE ISSUED FOR THE
FILING OF PRETRIAL STATEMENTS UNTIL COUNSEL HAVE
CERTIFIED THAT DISCOVERY IS COMPLETE, OR OTHERWISE
AT TIm MASTER'S DISCRETION.
AFTER RECEIVING THIS DOCUMENT FROM BOTH COUNSEL
OR A PARTY TO TIm ACTION, IF NOT REPRESENTED BY
COUNSEL, INDICATING THAT DISCOVERY IS NOT
COMPLETE, TIm DIRECTIVE FOR FILING OF PRETRIAL
STATEMENTS WILL BE ISSUED AT THE MASTER'S
DISCRETION. HOWEVER, IF BOTH COUNSEL, OR A
PARTY NOT REPRESENTED, CERTIFY THAT DISCOVERY
IS COMPLETE, A DIRECTIVE TO FILE PRETRIAL
STATEMENTS WILL BE ISSUED IMMEDIATELY.
THE CERTIFICATION DOCUMENT SHOULD BE RETURNED
TO TIm MASTER'S OFFICE WITHIN TWO (2) WEEKS OF
THE DATE SHOWN ON THE DOCUMENT.
Document #: 235044.1
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ADELAlDA CASTANEDA WlLLIAMS,
Plaintiff
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
vs.
NO.2001-1617 CIVIL TERM
GORDON STANLEY WlLLIAMS,
Defendant
IN DIVORCE
MOnON FOR APPOINTMENT OF MASTER
AND NOW, Gordon Stanley Williams, Defendant, moves the court to appoint a master
with respect to the following claims;
( ) Divorce
( ) Annulment
(X) Alimony
(X ) Alimony Pendente Lite
(X) Distribution of Property
( ) Support
(X) Counsel Fees
(X) Costs and Expenses
and in support of the motion states:
(1) Discovery is complete as to the claim(s) for which the appointment of a master is
requested.
(2) The Defendant has appeared in the action by his attorney, Melissa 1. VanEck,
Esquire.
(3) The statutory ground for divorce is 3301(c) and/or (d) of the Pennsylvania
Divorce Code.
(4) The action is contested with respect to the following claim;
(i) Equitable Distribution.
(ii) Alimony, Alimony Pendente Lite and Attorneys Fees and Costs.
Document #: 219683.1
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(6) The hearing is expected to take one (1) day.
(7) Additional information, if any, relevant to the motion: None.
METZGER, WICKERSHAM, KNAUSS & ERB, P.C.
(~ cV. lbJn eU.;
Melissa L. VanEck, Esquire
I. D. No. 85869
3211 North Front Street
P. O. Box 5300
Harrisburg, P A 17110-0300
Attorneys for Defendant
Date; 5-'1-0d-
Docu~nt#:)1968~1
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I, Melissa L. Van Eck, Esquire, of the law firm of Metzger, Wickersham, Knauss & Erb,
P.C, hereby certifY that I served a true and correct copy of the Motion for Appointment of Divorce
Master of Defendant with reference to the foregoing action by first class mail, postage prepaid, this
N~'\
, \ day of
rrtLur
, 2002, on the following:
Carol Lindsay, Esquire
Saidis, Shuff, Flower & Lindsay
26 W. High Street
Carlisle, P A 17013
METZGER, WICKERSHAM, KNAUSS & ERB, P.C.
~ 0J. \JeLLfoJ
Melissa 1. VanEck, Esquire ~
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ADELAlDA CASTANEDA WILLIAMS,
Plaintiff
vs.
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
NO.2001-1617 CIVIL TERM
GORDON STANLEY WILLIAMS,
Defendant
IN DIVORCE
ORDER APPOINTING MASTER
AND NOW, this 8 ~ay of ~ 2002, E: ~Wlj" Esquire, is
appointed master with respect to the following claims:
Equitable Distribution.
Alimony, Alimony Pendente Lite and Attorneys Fees and Costs.
By the Court:
~
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In
Document #: 219683.1
j'7"""1"'1ilWi\;~~ ""
vs.
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
NO.200l-l6l7 CIVIL TERM
ADELAIDA CASTANEDA WILLIAMS,
Plaintiff
GORDON STANLEY WILLIAMS,
Defendant
IN DIVORCE
DEFENDANT'S ANSWER TO PLAINTIFF'S
PETITION FOR ALIMONY PENDENTE LITE
AND NOW COMES the Defendant, Gordon Stanley Williams, by and through his
attorney, Melissa L. Stickel, Esquire, and files the following Answer to Plaintiff's Petition for
Alimony Pendente Lite.
1. Admitted.
2. Denied. The date of separation was November 11, 1999.
3. Denied. Defendant denies that Plaintiff lacks the ability to earn income
sufficient to meet her reasonable needs and to pay attorney's fees.
WHEREFORE, Defendant, Gordon Stanley Williams, prays this Honorable Court deny
Plaintiff's Petition for Alimony Pendente Lite.
METZ
Melissa 1. Stickel, Esqu e
Attorney J.D. No. 85869
3211 North Front Street
P.O. Box 5300
Harrisburg, P A 17110-0300
(717) 238-8187
By
Dated; J/(fl
Attorneys for Defendant
Document #: 213410.1
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CERT~CATEOFSERVICE
I, Melissa L. Stickel, Esquire, do hereby certify that on the date set forth below,
I did serve a true and correct copy of the foregoing Defendant's Answers to Plaintiff's Petition
for Alimony Pendente Lite upon the following person at the following addresses indicated
below by sending same in the United States Mail, first-class, postage prepaid;
Adelaida Castaneda Williams
c/o James D. Flower, Jr., Esquire
Saidis, Shuff, Flower & Lindsay
26 West High Street
Carlisle, PA 17013
METZGER, WICKERSHAM, KNAU
By
Date: M
l)ocument#:21341~1
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ADELAIDA CASTANEDA WILLIAMS,
Plaintiff/Petitioner
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
vs.
GORDON STANLEY WILLIAMS,
Defendant/Respondent
CIVIL ACTION - DIVORCE
NO.2001-1617 CIVIL TERM
DR# 30930
Pacses# 924103734
DEMAND FOR HEARING
DATE OF ORDER:
October 16, 2001
AMOUNT:
$966.00 per month plus $134.00 per month on arrears
FOR:
Alimony Pendente Lite
REASONS(S):
Plaintiffs income was imprope;ly calculated in that she admitted during support
conference that she was working in exchange for rent. This is income which should have been
taken into consideration in the calculations. Also Plaintiff contends that she is disabled from a
motor vehicle accident in 1997, however, the documents that she provided to the Conference
Officer did not state that she did not have the ability to work.
PARTY FILING DEMAND FOR HEARING.
Gordon S. Williams, Defendant/Respondent
METZGER, WICKERSHAM, KNAUSS & ERB
By;
tiYJ 1 ~i1lIJC1 ct~ValY1lkt
Melissa L. Van Eck, Esquire
Attorney J.D. No. 85869
3211 North Front Street
P.O. Box 5300
Harrisburg, P A 17110-0300
(717) 238.8187
Attorneys for Defendant/Respondent
lolQ.~\Ol
Date:
Document #: 218924.1
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SAlOIS
SHUFF, FLOWER
& LINDSAY
A'ITORNEYSeAT'LAW
26 W. High Street
Carlisle, PA
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"
ADELAIDA CASTANEDA WilLIAMS, : IN THE COURT OF COMMON PLEAS OF
Plaintiff, : CUMBERLAND COUNTY, PENNSYLVANIA
: NO. 2001 - 1617 CIVil TERM
vs.
GORDON STANLEY WilLIAMS,
Defendant.
: IN DIVORCE
PETITION FOR ALIMONY PENDENTE LITE
Now comes ADELAIDA CASTANEDA WILLIAMS, by and through her counsel,
JAMES D. FLOWER, JR., of SAIDIS, SHUFF, FLOWER & LINDSAY, and petitions this
Honorable Court as follows:
1. The parties hereto are husband and wife, having been joined in marriage
on June 27,1998.
2. The parties separated on or about December 11, 1989.
3. Petitioner is without the ability to earn income sufficient to meet her
reasonable needs and to pay attomey's fees.
WHEREFORE, Petitioner prays this Honorable Court to order alimony pendente
lite in an amount equal to the Pennsylvania State Support Guidelines and reasonable
attorney's fees.
SAlOIS, SHUFF, FLOWER & LINDSAY
Attorneys for Plaintiff
B
ames D. Flower, Jr.
I.D. #27742
26 West High Street
Carlisle, PA 17013
(717) 243-6222
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SHUFF, FLOWER
& LINDSAY
ATIURNEYS.AT-LAW
26 w. High Street
Carlisle. P A
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VERIFICATION
The undersigned, JAMES D. FLOWER, JR., avers that the facts set forth
in the within instrument, based upon information and belief, were developed from
conversations with Plaintiff and information gained in the investigation of this file, and
this verification is made for the reason that Plaintiff is outside of the jurisdiction of the
Court, and that her verification could not be obtained within the time allowed for the filing
of this pleading, and this verification is made subject to the penalties of 18 Pa.C.S.
Section 4904, relating to unsworn falsification to authorities.
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DRS ATTACHMENT FOR APL PROCEEDINGS
~
PETITIONER;
ADELAIDA CASTANEDA WILLIAMS
DaB: MAY 10, 1953 SSN: 537-62-2134
ADDRESS: 380 EAST YALE Loop, IRVINE, CA 92614
PHONE: 949-559-1800
ATTORNEY: JAMES D. FLOWER, JR., ESQUIRE
PETITIONER'S EMPLOYMENT; NONE
How LONG?
NET PAY: N/A PER
JOB TITLE: HOME MAKER
OTHER INCOME; (INCLUDE AMOUNT AND SOURCE)
RESPONDENT: GORDON STANLEY WILLIAMS
DaB: JULY 1,1943 SSN: 366-40-0477
ADDRESS: 9145 JOYCE LANE, HUMMELSTOWN, PA 17036
PHONE: UNKNOWN
ATTORNEY: MELISSA L. STICKEL, ESQUIRE
RESPONDENT'S EMPLOYMENT: GENERAL MOTORS
NET PAY:
JOB TITLE:
How LONG?
$$5,000.00
UNKNOWN
UNKNOWN
PER
MONTH
OTHER INCOME: (INCLUDE AMOUNT AND SOURCE)
WHEN MARRIED:
DATE SEPARATED:
JUNE 27, 1998
DECEMBER 15, 1999
WHERE: AMEHURST, NEW YORK
WHERE LAST LIVED TOGETHER;
FOR DRS INFORMATION ONLY
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ADELAIDA C. WILLIAMS,
Plaintiflj'petitioner
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
VS.
CIVIL ACTION - DIVORCE
GORDON S. WILLIAMS,
Defendant/Respondent
NO. 2001-1617 CIVILTERM
IN DIVORCE
DR# 30930
PacseS# 924103734
ORDER OF COURT
AND NOW, this 28th day of August, 2001, upon consideration of the attached Petition for
Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel
appear before RJ. Shaddav on October 1. 2001 at 1:30 P.M. for a conference, at 13 N. Hanover St.,
Carlisle, P A 17013, after which the conference officer may recommend that an Order for Alimony
Pendente Lite be entered.
YOU are further ordered to bring to the conference:
(1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed
(2) your pay stubs for the preceding six (6) months
(3) the Income and Expense Statement attached to this order, completed as required by Rule
191O.11<[)
(4) verification of child care expenses
(5) proof of medical coverage which you may have, or may have available to you
IF you fail to appear for the confereuce or bring the required documents, the Court may issue a
warrant for your arrest.
BY THE COURT,
George E. Hoffer, President Judge
Mail copies on
8-28-0 I to:
Petitioner
< Respondent
James Flower, Jr., Esquire
Melissa Stickel, Esquire
Date of Order: August 28, 200 I
~.J.
YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND
REPRESENT YOU. 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 MAY GET
LEGAL HELP.
CUMBERLAND COUNTY BAR ASSOCIATION
2 LIBERTY AVE.
CARLISLE, PENNSYLVANIA 17013
(717) 249-3166
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DR 30930
PACSES ill 924103734
vs.
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
DOMESTIC RELATIONS SECTION
CIVIL ACTION - LAW
ADELAIDA C. WILLIAMS,
Plaintiff/Petitioner
GORDON S. WILLIAMS,
Defendant/Respondent
NO. 2001-1617 CIVIL TERM
ORDER OF COURT
AND NOW, this 161n day of October, 2001, based upon the Court's determination that
Petitioner's monthly net income/earning capacity is $333.00 and Respondent's monthly net
income/earning capacity is $4,118.81, it is hereby Ordered that the Respondent pay to the
Pennsylvania State Collection and Disbursement Unit, $1,100.00 per month payable monthly as
follows; $966.00 per month for alimony pendente lite and $134.00 per month on arrears. First
payment due with next pay date. Arrears set at $2,898.00 as of October 16,2001. The effective date
of the order is August 9, 2001.
This Order considers that husband is making payment on a vehicle that was in wife's
possession upon separation and isnot in husband's possession. Should the vehicle be returned to
husband's possession or a sales transaction is completed the APL Order may be reviewed.
Consideration is given for the medical insurance costs paid by husband.
Failure to make each payment on time and in full will cause all arrears to become subject to
immediate collection by all of the means as provided by 23 Pa.C.S.~ 3703. Further, if the Court
finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare
the Respondent in civil contempt of Court and its discretion make an appropriate Order, including,
but not limited to, commitment of the Respondent to prison for a period not to exceed six months.
Said money to be turned over by the P A SCDU to: Adelaida Williams. Payments must be
made by check or money order. All checks and money orders must be made payable to P A SCDU
and mailed to:
P A SCDU
P.O. Box 69110
Harrisburg, PA 17106-9110
Payments must include the defendant's P ACSES Member Number or Social Security Number in
order to be processed. Do not send cash by mail.
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Unreimbursed medical expenses that exceed $250.00 annually are to be paid 0% by the
respondent and 100% by petitioner. The petitioner is responsible to pay the first $250.00 annually in
unreimbursed medical expenses. Respondent to provide medical insurance coverage. Within thirty
(30) days after the entry of this order, the Respondent shall submit written proof that medical
insurance coverage has been obtained or that application for coverage has been made. Proof of
coverage shall consist, at a minimum, of: I) the name of the health care coverage provider(s); 2) any
applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims
should be made; 5) a description of any restrictions on usage, such as prior approval for hospital
admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage
contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms.
This Order shall become final ten days after the mailing ofthe notice ofthe entry of the Order
to the parties unless either party files a written demand with the Prothonotary for a hearing de novo
before the Court.
DRO: R. 1. Snadday
Mailed copies on
10-17-01 to: <
BY THE COURT,
Petitioner
Respondent
James Flower, Jr., Esquire
Melissa Stickel,quire
Edgar
J.
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ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
):,,.u Ol-/U'l {lrNL
State Commonwealth of Pennsvlvania fll:J(!.}:t5' tj;;; Cff0373fC
Co./City/Dist. of CUMBERLAND ~/C.- 30936
Date of Order/Notice 10/16/01
Court/Case Number (See Addendum for case summary)
@ Original Order/Notice
o Amended Order/Notice
o Terminate Order/Notice
) RE: WILLIAMS, GORDON S.
) Employee/Obligor's Name (last, First, MI)
) 366-40-0477
) Employee/Obligor's Social Security Number
) 0322100482
) Employee/Obligor's Case Identifier
) (See Addendum for plaintiff names associated with cases on attachmenV
) Custodial Parent's Name (Last, First, MI)
)
EmployerlWithholder's Federal EIN Number
GENERAL MOTORS CORP*
EmployerlWithholder's Name
C/O ARTHUR ANDERSON BPS CENTR
Empioyer/Withholder's Address
PAYROLL SERVICES
PO BOX 62650
PHOENIX AZ 85082-2650
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER INFORMA TlON: This is an Order/Notice to Withhold Income for Support based upon an order for support
from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these
amounts from the above-named employee's/obligor's income untii further notice even if the Order/Notice is not
issued by your State.
$ 966.00 per month in current support
$ 134.00 per month in past-due support Arrears 12 weeks or greater? Q9yes 0 no
$ 0.00 per month in medical support
$ 0.00 per month for genetic test costs
$ per month in other (specify)
for a total of $ 1,100.00 per month to be forwarded to payee below.
You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match
the ordered support payment cycle, use the following to determine how much to withhold:
$ 253 85 per weekly pay period.
$ 507.69 per biweekly pay period (every two weeks).
$ 550.00 per semimonthly pay period (twice a month).
$ 1.100.00 per monthly pay period.
REMITTANCE INFORMA TlON:
You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this
Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to
deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the
the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's
aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is
needed (See #9 on pg. 2).
If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer
Customer Service at 1-877-676-9580 for instructions.
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown
above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSf,D.
DO NOT SEND CASH BY MAIL. .
BY THE COURT:
C
Form EN- 28
Worker ID $IATT
Date of Order: OCT 1 7 Z001
Service Type M
M~~
. , , MB No.: 0970-0154
/0 r;7 Expiration Date: 12131100
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ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
o II checked you are required to provide a copy 01 this lorm to your employee.
,1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income.
Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting
agency listed below.
2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment
to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to
each employee/obligor.
3. * Rc.polth.g tile PClydatel[)att vC'JJ;tl.l.oklh.g. 'tv.... 1I1(15t le..pOlt tile fJQyJatddare of n;ll,l,vIJil'8 nllel. se11J;11Ei UIL payh,el,t. Tile
pAydateJdcdt vf nitl,l,oldillg;;:I tile dAte. 011 vvl,id, .:ullvtlllt vvas nitLI,elJ f16111 tLe elll""lvyce/s nages. You must comply with the law ofthe
state of the employee's/obiigor's principal place 01 employment with respect to the time periods within which you must implement the
withholding order and lorward the support payments.
4. * Employee/Obligor with Multiple Support Holdings: II there is more than one Order/Notice to Withhold Income lor Support
against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding iimits, you must
follow the law of the state 01 employee's/obligor's principal place 01 employment. You must honor all Orders/Notices to the greatest
extent possible. (See #9 below)
5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working lor
you. Please provide the information requested and return a copy olthis Order/Notice to the Agency identified below.
WITHHOLDER'S ID: 3805725150
EMPLOYEE'S/OBLlGOR'S NAME: WILLIAMS, GORDON S.
EMPLOYEE'S CASE IDENTIFIER: 0322100482 DATE OF SEPARATION:
LAST KNOWN HOME ADDRESS:
NEW EMPLOYER'S NAME/ADDRESS:
6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have any questions about lump sum payments, contact the person or authority below.
7. Liability: II you lail to withhold income as the Order/Notice directs, you are liable lor both the accumulated amount you should
have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs
unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
8. Anti-discrimination: You are subject to a fine determined under State law lor discharging an employee/obligor from
employment, refusing to employ, or taking disciplinary action against any employee/obligor because 01 a support withholding.
Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is
employed governs.
9. * Withholding Limits: You may not withhold more than the lesser 01: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (15 U.S.c. 91673 (b)1; or 2) the amounts allowed by the State olthe employee's/obligor's principal place 01 employment.
The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory
deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes.
10.
*NOTE: II you or your agent are served with a copy 01 this order in the state that issued the order, you are to lollow the
law 01 the state that issued this order with respect to these items.
Requesting Agency:
DOMESTIC RELATIONS SECTION
13 N. HANOVER ST
P.O. BOX 320
CARliSLE PA 17013
II you or your employee/obligor have any questions,
contact WAGE ATTACHMENT UNIT
by telephone at (717) 240-6225 or
by FAX at (7171 240-6248 or
by Internet @
Page 2 01 2
Form EN-028
Worker ID $IATT
Service Type M
OMB No.: 0970-0154
Expiration Date: 12131/00
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ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor:
PACSES Case Number 924103734 /3/Xl; 3D
Plaintiff Name I
ADELAIDA C. WILLIAMS
Docket Attachment Amount
01:::t617 CIVIL$ 1,100.00
Child(ren)'s Name(s):
WILLIAMS, GORDON S.
DOB
O_lf checked, you are required to enroll the child(ren)
identified above in any health insurance coverage available
through the employee's/obligor's employment.
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
o If checked, you are required to enroll the child(ren)
identified above in any health insurance coverage available
through the employee's/obligor's employment.
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
:,
:'
o If checked, you are required to enroll the child(ren)
identified above in any health insurance coverage available
through the employee's/obligor's employment.
Service Type M
OMB No.: 0970-0154
Expiration Date: 12/31/00
"2;:>'1'1 P"'~"_~~
.,
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
tJl;~~~~J~~:~~~~r~;~~:[;~~;~;~;~II;~~~~ild(ren) . :. < :..i . '.' .
identified above in any health insurance coverage available
through the employee's/obligor's employment.
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
o If checked, you are required to enroll the child(ren)
identified above in any health insurance coverage available
through the employee's/obligor's employment.
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
[j;/~~;~J~~;;~~~;~ required to enr~ln~~~~il~;;~~; .........
identified above in any health insurance coverage available
through the employee's/obligor's employment.
Addendum
Form EN-028
Worker ID $IATT
In the Court of Common Pleas of CUMBERLAND County, Pennsylvania
DOMESTIC RELATIONS SECTION
VS.
) Docket Numbe~-ci6f_ LiJ; 11(\ ~L.::ILr.rv..-;
) '-.~,
) PACSESCaseNumber qd410~ 184-
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) Other Stale ID Number 30'1 ~o
f\-~ Qo.,s+o.l'\l1.d.a LDll \ KiM-D
, Plaintiff
~DrdO(\ S--\-Qnte..L( Defendant
W. \1\CLmS
Praecine
To the Clerk of Courts/Prothonotary:
Pleahe I!Y/;WL my ~ on. ~ 06 .the ~~ ydn r1 t,
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Title p.
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Date I
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Attorney ID Number
Service Type
Form OE-516
Worker ID
In the Court of Common Pleas of CUMBERLAND County, Pennsylvania
DOMESTIC RELATIONS SECTION
Defendant
) Docket Number V-t').@"IL- -r, 7"~
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) P ACSES Case Number c; ~ 1- I tJ"3 I '"3 Cj-
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) Other State ID Number
"l>R.;:fF- 36'130
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(J-.o-r~ S, UJI~ UlCU/..u<-
Praecipe
To the Clerk of Courts/Prothonotary:
P&u.e en;Wr. my ~ on Wza.e.6 06:the ?Ia..----ht'/f~,,-L
1~-;21-0l
Date
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Title
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CUMBERLAND
County, Pennsylvania
Phone: (717) 240-6225
DOMESTIC RELATIONS SECTION
13 :-<. HANOVER ST, P.O. BOX 320, CARLISLE. PA. 17013
AUGUST 28, 2001
Plaintiff Name: ADELAIDA C. WILLIAMS
Defendant Name: GORDON S. WILLIAMS
Docket Number: 01-1617 CIVIL
PACSES Case Number: 92410373~-I?0930
Other State ID Number: I .
Fax: (717) 240-6248
.
Please Dote: All correspondence must include the P ACSES Case Number.
Income and Exoense Statement
THIS FORM MUST BE FILLED OUT
(If you are self-employed or if you are salaried by a business of which you are owner in whole or pan, you must
also fill out the Supplememal Income Statement which appears on page two of this income and expense
statemem. )
INCOME STATEMENT OF A:PEJ..-!f-IJ)/J {!., WI Lit /1111~
Section I: Income and Insurance
INCOME:
Employer fA, S .
Address
Type ofWnrk C "NUl '
Payroll No. liJ//+ Gross Pay per Pay Period S
,
VUON TIH- '.I
Itemized Payroll Deductions:
Federal Withholding S Social Security S r= Local Wa2"e Tax s ('.;
Stale {ncome Tax S Retirement S n Savin2s Bonds S ('l
Credit Union S Lite InSllrdoce S .... Health Insurance S r.
Other Deductions (specify) S t': S ('
0 s r:: S r'
Net Pay per Pay Period S
OTHER (Fill in Appropriate Column)
INCOME WEEK ' MONTH i YEAR
Interest S f) S ;:) S 0
Dividends /') 0 U
Pension t' ,) 0 V
Annuitv -<- r.
Social Securitv t') i"
Rents 0 (-)
Royalties r. /' I J
Expense Account t":: ('. (
Gifts r: t" :....
lJnemplovmenr r> If'. f)
Workmen's 0 0
ComnensatillD 0
Other " n
Other r': ,y
TOTAL S S G s U
TOTAL INCOME $ 0 'Z~ nD 3QQl '"
PROPf::RTY Ownership *
OWNED DESCRIPTION VALUE H W J
Checking Accounts IL:17 fo~7, S !:'oft X
Savings Accounts
Credit Union
Stocks/Bonds
Real Estale
Other
TOTAL IS 50,00
. H = Husband; W = Wife: J =Joint
Service Type M
PLAINTIFF'S
EXHIBiT
bFH
'"-
.
.
Income and Expense Statement
PACSES Case Number 924103734
Coverage *
INSURANCE
COMPANY POLICY # H W C
Hosoital tJtJ( /rPPU" ~-' ~
Blue Cross
Other /J/./l
Medical Jo,llJr I'rfflLi,.44J'L
B}ue Shield
Other tJ/A
Healthl Accident JJ / A-'
Disability Income ~/A-
Dental ,.JIlt
Other tJ!1r
* H=Husband; W=Wife; C=Child
Section IT: SUDDlemental Income Statement
a. This form is to be filled out by a person
o (I) who operates a business or practices a protession. or N J /1r
o (2) who is a member of a pannership or joint venture, or AJ/k
o (3) who is a shareholder in and is salaried hy a closed corporation or similar entity. p / It-
b. Attach to this statement a copy of the tl11l0Wing documents relating to the pannership. joint venture. business. profession. ~/ II-
corporation l1r similar emity:
(1) the most recent Federal Income Tax Return, and A..""-"" ~ (!..()P,/ of /Qig
(2) the most recent Protit and Loss Statement rr I f'n'-rl6.V I
c.
Name of business:
Address and telephone number:
/"J77T ~ ('.H.I R
d. Nature of husiness (check one)
B ;~~ ~:i:;::~~re ~
o (3) prolession JV71r
o (4) closed cOfl'oration rJ/1\'
o (5) .,ther /'V/A-
e. Name of accountant. controlier or other person in charge of fmancial records:
/'IPT ~Uf1!>t.-8
f. Annuallncome from business:
Ndl ,+ff>Ltc.~/;:r
(I) How often is income received'!
,,; / A-
.
(2) Gross income per pay period:
"YA
.
(3)
Net income per pay period:
tJ/A
(4)
Specified deductions. if any:
,0/ A-
.
Page 2 of3
Form IN-008
Worker 10 21205
Service Type M
'.-'W\t~?_~
.
-
c
-
~--
.... ""
.
Income and Expense Statement
Section ill: EXDenses
PACSES Case Number 924103734
Instruclions: Only show extraordinary expenses in this section unless you tilled out Section II on page two. The categories
in BOLD FONT are especially important for calculating child support. If you are requesling Spousal SupportlAPL or if
you assert your case cannot be determined according to the guideline grids OT formula, this section must be fully completed.
(Fill in Appropriate Column)
EXPENSES
WEEK MONTH YEAR
Home
Mortcran~e~ S S --;;;~- S
. .
Maintenance "/\ 0 ()
Utilities
Electric S S~OD S
Gas ,
Oil ,., ;., /')
T dephone 1LA: m\
Warer n A --;;:J
Sewer ,..., t'I ,')
Emnlovrnem
Puhlic Transport. S --:;;) S -,.., S 0
LUnch r, r'l n
Taxes
Real estate S ----;;; S 0 S ~
Personal Property ,.....,- ".., 0
Insurance
Homeowner's S C7 S 0 S ,.,
AUlomohile I ^ r") t<'\
Lile T --;c:::., 00
Accident i .... 0 0
H...IIth I , J/'.OO
Other I n <C-. C>
Auromohile
Paymems S S J/AA""" S
Fuel ,;... -^,,-
Repairs I "2~"'. Oi')
Medic.ll
Doctor S S sO,."., I'>r
Dentist ':!tY'l.N
Orthodontist
Ho'pital :7Sa.'l,OO
Medicine '!rV;: an
Special needs / Db, 00
(g~~~~~races,
onbn 'c devir~'
EXPENSES (Fill in Appropriare Column)
(continued) WEEK MONTH YEAR
Educa.tion
Private School S 0 S t') S 0
Parochial Scbool (') 0 0
College 0 '" r.
Religious /"'0,00
Per~onal
Clothing S S?N\ . Or S
Food .":ll:f\,OI;J
Barberi IOO.OD
T-Ja;"dresser
Credit Payments
Credit Card /Fl/!. ()n
Charge rl "., 0
Memberships :J "'-'. ^r>
Loans
Credit Union S 0 S 0 S 0
5 loO...1 /",>JI.ao
Miscellaneous
Household Help S S /:2/1, D() S
Child care t> '" i"'\
Papers/books tmwelAl'f 46T.,
Maoa'7ines
Entenainment -/~: ^^
Pay TV /) ,..., C>
Vacation "A ~ Il^
Gifts ,<::7\ J......
Legal tee~ 0 n t'\
Charitable
r~~ntrihur;ons lOO. DO
Other Child 0 0 C>
S"M'-
Alimony 0 0 to
Pa........:.tc;;
Other n r'1 ""'l
S S S
I i~~~nses: I s WEEK S MONTH S YEAR
I verify that the statements made in this Income and Expense Statement are true and correct. I understand that false
statements herein are suhjecr to the criminal penalties of 18 Pa. C.S., 4: 04. lati to unswo
9-y~,
Dale I
Service Type M
v~,.."..~,.. ..
~,~-
,
-
Page 3 of3
Form IN-008
VVorkerID 21205
"
,~ r. ,-~
Employer: /JOAJ€
H
{,IJJ G'#/Pt.oye1>'/ Sl/IIcE /9"'~
Check if address ~;upplied is: ( ) Employmem Location (
Please supply your Federal Employer Identification Number:
) P'aytoil Address ( ) Employment and Payroll lOC'cltions are the same.
L!d-/3?'-,n.,
PACSES Case No.:
?))tj;o3734
3rYl3()
.
Re: c2~ !U~
SSN:S37-tf.2' ,;)/3'1 DOB: S"-IO-53
EARNINGS REPORT
Furnish Earnings information for the above-named employee for each pay period during the last six (6) months.
It is preferred that you attach a photocopy of your records containing the earnings information requested. Attach
a copy of the employee's most recent W-2 Form.
Payroll lId Number:
Employee Address:
N//t
I
Nature of Employment:
101ft
,
NIl!-
/
Date of Hire: ~/Jj-- , Lastdayworkedlterminated: SEj>, ~6 197'7
Reason::r CONr//VuG ~ A~ ?f!SI'rP.J&:" -h"E 71!) ~ /ltU$cJJ~-<;'I'~ ?J;.rw:i4l
!>1vA IN Iff7 A,v]) '1+1 7)1 ene.
Call back date: o/A Full-ome: 1"/1 Part-time: Al/-+ Gross hourly rate: $ Njf
fiJ} ~
7)~tJ -m
Pay cycle: 4) Monthly VI1~ Semi-Monthly (1f.4 Bi-Weekly ~). Weekly
Payroll Period Ending tJllr
Date of Pay 0
Gross Pay 0
,
Deductions
Federal Withholding ()
Social Security 0
Local Wage Tax I 0
State Income Tax t7
Retirement 0
Savings Bonds (3
Credit Union C> I
Life Insurance 0
Health Insurance 0
Other (Specify) 0
Other C>
Net Pay 0
Hours Worked 0
I verify that the statements made in this Earnings Report are true and correct. I wlderstand that false statements
herein are subject 10 the criminal penalties of 18 Pa. C.S. ~ 4, Ian to unsworn ills' cation to authorities.
"
Signed by:
Position:
Date: 1-5""- 20()j
Service Type
Page 2 of 4
Form IN-OI5
Worker ID
i*~W~' ,~~
r--r 1
-
.
II Il 'I
Employer: lJ.,Jt:t11r'LOYeJJ I StAle$: /ctr7
Re: A])t::J_fhDfl- C. ~.JJLL./AM5
SSN: .(-, ,I DOB: r- 10 r...,
./::> 7- ~].-:V3"'t ::J - -~.;.
PACSES Case No.: 1~</(03'73ft()T
HEALTH INSURANCE COVERAGE REPORT
This form must be completed and returned within ten (10) days. Failure to comply may result
in issuance of a subpoena or other appropriate sanctions.
Does the employer make medical, dental, eye care, prescription or other insurance coverage
available to the employee? Yes tfPr No r::> / It
Name the dependents covered under the employee's insurance, and indicate which types of
coverage they have through your company.
trl'T kfl/.../~g
I
Tvue of Coverav:e
Hosnital- Medical Dental ~ PrescriD- Other
11.3000 !!!!!!
( ) ( ) ( ) ( ) ( ) ( )
( ) ( ) ( ) ( ) ( ) ( )
( ) ( ) ( ) ( ) ( ) ( )
( ) ( ) ( ) ( ) ( ) ( )
( ) ( ) ( ) ( ) ( ) ( )
( ) ( ) ( ) ( ) ( ) ( )
SSN
Full :\lame
'\!I
Provide the information indicated for each type of insurance which is available to the employee
whether or not any of the above-named dependents are covered at this time:
Insurance company (provider): . }1/ A
Claims address: f!./ II-
Group #: tJ /.4 Plan #: jV/ A- Policy #:
. #' /
EffectIve coverage date: If A- Type of Coverage:
Cost of coverage for dependents: ,tJ/A
'"
I'-VA-
0/.4
Insurance company (provider):
Claims address:
Group #: AJI A
Effective coverage date:
Cost of coverage for dependents:
tJ/A
jJ/A
,
Plan#:
,vIA-
"
J-l/,4 Policy #:
.
Type of Coverage:
^VA-
I
AI/A-
.
N/A-
Service Type
page3 of 4
Form IN-Ol5
Worker ill
~~~
1"=
;+JJa-IrID~ c. W/U/AmS 'PtA-IIJ17FP
Insurance company (provider):
Claims address:
Group #: 7 fr Plan #:
Effecrive coverage date: J)1 A-
Cost of coverage for dependents:
PACSES Case Number: '1;21//1)3737':6./10
])~ '/...;v/~~
/0/A-
I
10/4-
,
t.4- Policy #:
ype of Coverage:
,J/A
I
v.
G01Z.7>otJ S. 01/.L..1/ftt1S
tJ,/A
1\..1/ A
/
Insurance company (provider):
Claims address:
Group #: IS/JJr
Effective coverage date:
Cost of coverage for dependents:
.N/A
tJ/ A-
,
Plan #:
fI)/ It- Policy #:
Type of Coverage:
N/A-
I
/'fA-
^f))-
If the above-named dependents are not currently covered by insurance, please state the earliest
date coverage could be provided tJ/ A-
,
PLEASE PROVIDE FORMS NECESSARY TO ADD DEPENDENTS, AS THE
EMPLOYEE MAYBE ORDERED TO PROVIDE COVERAGE FOR THEM.
I verify that the statements made on this Health Insurance Coverage Information form
are true and correct. I understand that false statements herein are made subject to the penalties
of 18 Pa. C.S. ~ 4904 relating to unsworn falsification to authorities.
Date: q - S-~ 2ot:J7
/fJ/U ~ itJ:1!~-
!;ignature !
Z!~~-Ittl
Ti e
Please return the completed documenrs to:
DOMESTIC RELATIONS SECTION
13 N. HANOVER ST
P.O. BOX 320
CARLISLE PA 17013
Phone: (717) 24(}-(;225
Fax: (717) 240-6248
Service Type
Page 4 of 4
Form IN-Ol5
Worker ID
"','**<:1._
. "
.
< .
. 'F~"" ,,640
).abel
,,..
~
onp-oe12.)
l/M1IIe .-
-.
~....
p-P/inl
or..
Pl'I,ltrntial
EIeclIon~n
(s"p e12.)
.. DcnOlw"leorllltClleinthi,. ac.
.' 9 OMS No. '54> 0074
Your &ocLaI security number
537-62-2134
Spou.... ~....urtty number
344-40-0477
III ANT !
Voumust..1Ir .
urS N
V.. No Nola: Checking
X "Yes"wlllnot
ch.ngeyourWeor
reduceyourrafuna..
.~ v ,-
Department oftl lOUry' In"",,"1 RevenuI S4rvice
US. IndlvL..allncome Tax Return
F'.. J, ~ 31 ,'98, or other tax erb"'innlti.9
oru,eyear an. ~"""""". .
1998
1.,,9)
IRS u.e 0"1
~ 998_ enO:l"'g
ADE~rPA c KALEN
.. 0 BOX 178
GENESEO, IL 61254
!
Co you wlntS3 to go to this fund?
tf8 iointreturn. does ur soouse want S3to 0 to this fund?
Single
Married fiUngjoint return (even if anty one had income)
X Married filing separata I1ttum. Enl.'IPoU..'.SSH.bo"'.andfullnlrl'l.".'..... GORDON WILLIAMS
HtIlld ot houaehold (with quaUfying person). (See 101100 ,2.) litho qualifying person is a child bul nol yourdependen~
entat thia chikf', name here. ...
Qualifylngwidow(er)wilhdependlntchlld(yeerspouaedied "'9 ). (SeepIge12.)
Youl'Mlf. It your parent (or someone else) can a.lm you as a dependent on nls or ner tax
retum, do not cheek boxlla
Filing Statua 1
2
3
CIleck only 4
on. box..
S
exemptions lie
22 Add the amounts in the far ri ht column for lines 7 through 21. This is your totallncorne
23 IRA deduction (see page 25) . 23
24 Studentloan intereSldeductlon (see plge 27) . 24
25 Medicolsavings lceounl deduction. Allach Form 8853 25
26 Moving expenses. Attach Form 3903 28
27 On... half 01 seW. employmlnt lex. Attach Schedule SE. 27
%I SeIf- employed he.tttllnsur.nce deduction (see page 2e) 28
29 Keogh and seW- employed SEP and SIMPLE pllns. 29
30 Penalty on eartywithdrawal of savings 30
31 Alimonyplid bRecipienfsSSN ~ 31a
32 Add linea 23 through 310 . . .
33 Subtract line 32 from line 22. This is your ad usted rosa Income
For _ICY Act and Papoorworit Reduction Act NOllce.... page 52.
K ......
than aile
d~"'"
_ page 13.
Income
AUach
Copy 8 ot Jour
Forme W. 2.
W.2G,_
I_RIleN.
It you did nOl
geU \Yo 2.
_pegl'4.
EncJoee buldo
not alIach any
paymenl Also.
p--
Fonn 1lWC). V.
Adjusted
Grou
Income
If line 33 is under
S30.095 (uncll<
S10.030Wechiid
did notivewith
you). _EIC
inSl. on pego 30.
KSA
b S
c Dependents:
1 FItsl nome
Last name
(2) Dependlnrs
soclalaecu. numbe
(3) pendenr.
relabOnsnlp to
ou
d Tolalnumberolexemptionsclained
7 Wages. salaries. tips, ole Attach Fo""(s) W. 2
%
7 I
8.
:-:
9
10
11
12
13
14
ISb
16b
17
18
19
20b
lie
b
9
10
11
12
13
14
llla
ll1a
17
18
19
20a
21
Taxabll interesl Attach Schedull B WAlquired
Tax- eump! 'ntlrell. 00 NOT Include on Une Ila
Ordinlrydividends.Attach Schedule B WAlquired
Texable refunds. credits. orotlsetsolstatelnd Iocol income laxes (see page 21) .
AJimony received
au...... income or (loss). Attach Schedule C or c.. EZ
CepilaJ glln or (loss). Altlch SChedule 0 .
Othergeinsor(Io_I. Attach Form 47g7. ........
TotallRAdislnbutions ~ I b Taxable amnl
Tot8IpensionsandannU~ie.: 1&a, .3, 996. bTaxab&eamnt:
Rental r8al estate. rOYillties, partnerships, S corporations. trusts, etc. AAactl Sctle~u~ E .
Farm income or (50sa). Attach Schedu)e F .
Unemployment compensation
Socleleecur.yben_ . . (~J
Other income. List type and amount. Me page 24
8b I
f b T~ab~a~nt.
GAMBLING
2,400
..
..
"'~
.'It~./~';
,~~_.
f.-1Oc01'....'. FD104o.1V1.24
Onftw.....f"i;i;;nn'" ,.... ,QlNtH&A Block t. S.Nte.. lnc
"''<''5''''"''"''lf'~'II!,~~",..,
lIiIRi!lllp'''''i''1~
} .. ., .....
Ct'I.c,Jl1oCl 0"
. a,lnd6b _
No., of your
cnltclrenon6c
.4) !! 1;I.I&I.who:
cnllel fOf . lived with
Cl\ildt... Ct. yOU
.- dlCl nolliv. witI'!
yOIol QloIelO di'tolc.
Of.IIP.,..~n
(... P. 13)
C.pen4ent. on
SCnol em'"
Ibov.
Aael numD,'1 .
~~~~'::O~~ ~ 1i
(H7.)
o.
2,400.
1,603.
1,603.
Form 10.t0{19ge
,c .,0'
"' ,~
.Form 1(\l1O{1998)
TaA and
.Credits
StancIanI
DocI_
lorM..-t
Peoplo
Single:
$4,250
Hoad 01
household:
$6.250
Mamed filing
jointly or
Qualifying
widow(er):
$7,100
Married
filing
separately:
$3.550
Other
Taxes
Payments
Altach
Forms IN- 2
and IN- 2G
on pagel.
Also _ch
Form 109&- R
~taxw..
withheld.
Refund
Have it
directly
deposited!
See l1!'!le 37
and fill In 66b
Amount
You Owe
Sign
Here
ADELAID~ HALEN
34 Amountfromli...o.>3(adjustedgrossincome). . " .. .....
358 Check if: 0 You were 65 or older, 0 Blind: 0 Sp0i.i88was65 or older,
Add the number of boxes checked above and enter the total nere
b tfyou are married filing separately and your spouse ilemtzeadeductions or
youareadual-statusalien,aeepage23andCheCkhere. . . . .
36 En1erlne larger of your Itemized doductfono from Schedule A lino 26. OR. standard
deductlon shown on lne left. But see pago 23 to find your standard ~edu~lon IIyou
checked any boxon line 35aor 3Sb or if someone can claim you as a dependent.
37 Subtract line 36 from line 34
36 II lino 34 is $93.400 or less. multiply 52.700 by tho total number 01 exemptions claimed on
line 6d. If line 34 is over$9:!,400, see the worksheet on page 30 forthe amount to enter
39 Taxable Income. Subtract line 38 from line 37. I!line 38 IS more than iine 37, enter. 0-
40 Tax. See page 30. Check hnYlaXlrom aD Form(s) 8814 b 0 ~orm4972
41 Credit for dliki and dependent care expenses, Attach Form 2441 . 41'
42 Cllldrtforlneeiderlyorthedisabled.AllachSCheduieR 42
43 Childtaxcllldrt(_page31). i 43
oW Educationcredits.AlIach Form 8863 oW
4 Adoption credl~ Attach Form 8839 45
4 Foreign tax cllld It. Attach Form 11161froquired . . .. 46
47 Other. Checi< ff from a B Form 3800 b 0 Form 8396 ,%
c 0 Form 8801 d Form (specjfy) 47
46 Add lines 41 through 47 .
49 Subtrac1 line 46 from line 40. l!line46 Is more than line 40. enter- Q. ·
50 Se~-employmentlaX.Atlach Schedule SE
51 Altemati\le minimum tax. AlIach Form 6251
52 Social security and Medicaretax on tip income not reported to employer. Attach Form 4137 .
53 Taxon IRAs. other retirement plans. and MSAs.Attach Form 532911 reQulled .
54 Advance earned income credi payments from Form(s) W- 2
65 Househokf employment taxes. Attach Scnedule H
537-62-2134 P e2
34 1,603.
OSlind.
..350
o.
O.
.35b 0
3,550.
(1,947. )
2,700.
o .
O.
o.
o .
.
56 Addlines49through55. This is ourtotaltax
~ Federal income tax withhekj from Forms W- 2 and 1099
58 1998 estimated' tax payments & amount applied from 1997 ret...m <
59a Earned Income credit. Attach Sch EIC if you have aQualifying
chikf b Nontaxable eamea income: amt. .... I
and type .
60 Additional child tax eredrt. Attach Form 8812 .
61 Amount paid with Form 4868 (roquesttormension) .
62 Excess social security and RRTAtax wrthheld (_ page 43)
63 Otherpayments.Checkiffrom aOForm2439 bOForm4136 :
64 Add lines 57thrcu h63. These are 'ourtotDl ments
65 Ifline64 is more than line 56. subtract line 56 from line 64. This is the arr:ount ycu OVERPAID
66a ,Amount of line 65 you want REFUNDED TO YOU
.... b Routing number I I. c TyP~
. d Account number ,
87 Am~ofline65 uwantAPPUEDTOl999ESTIMATEDTAX. 67
sa If line 56 is more than line 64. subtract line 64 from line 56. This is the AMOUNT YOU OWE, ~
Fordetailsonhowtopay.seepage38. . . . ~ r/~;/
89 Estimated tax penaJty. Also includeon.ne68 I~ . ~~
Und.r pen.Ute. 0/ p11rlury. I (leerarlll thaI I h ....III1:1Ir1'nea 11'115 rElll.rn ,!nO acccmpaflY'l"!O J':I".eCll,lhu ana stalements. i'r>a 10 Ihe be.t of my knowledge and
bell.'. they are ('l,Ie. e'oneel. lInd ~omplllle. Oe-clarellon 01 prepar", {o:n"r !nan l.jIlpa~ erl's baaed on Bllmfotma',o,. o. ...." ,::11 prep.t.r has any lI,.ow'."""
57
sa
::%
59a
60
61
62
63
~
.
~h~Ckin9
o Savi~g;
l\eep a copy ~ Your signature Date I Your occupalion Daytime telephone
of this retum ~ Spouse's signature. If a joint return, BOTH must sign. SELF number (oplional)
for your Date Spouse's occupation
records.
Paid Pnlpare(s ~ I Date I Check ff Prepare,s social security no.
Preparer's signature 1/26/99 se~-employed n 484-42-0265
Use Only Firm's name (or yours ~ H AND R BLOCK EIN 42-0951072
heft- employed) and DAVENPORT, IA
KBA ZIP code 52807-0000
Fo'ml040(19981
r;'''D-1A,..,",~~
fonn1040(1998) FD104Q.2V124
orm SOf1w..CopyrlQttt 1996- 1998 H&R Bloek Ta. SentlQ.a.lnc.
I I"
""""'~
..
"~ .
Nafne of proprietor
ADELAIDA C KALEN
A Principal business or profession, including produd or service (see page C~ 1)
SERVICE INSTRUCTION
C Business name. Ifno separate business name, leave blank.
HIS N HER BEAUTY CLINIC
E Bulineoa add..... ~
City. town or post olllce. state. and ZIP cade
Aa:ounting m.thod' (1) Cash
Profit or Loss From Bu:
(SOle Proprietorship) 1998
~ PaJtnershl~,JoIntventu..., etc..ITt\JlltflJe Fonn 1065 or Form 1066- B. _ment
~ Attach to Form 1040orFonn 1041. .. See InstructJons forScheduJe C 'Form 1040). Sequence No. 09
Social security number(SSN)
537-62-2134
B Enter NEW code lrom page. C. 8 & 9 1
~ 561210
o EmployerIOnumber(E1N),lfany
42-1336567
ess
OMBNO.1545-0074
SCHEDULE C
'(Fonn 1(40)
f,.~:r~m~;~:~:;::':::UrytQQl
F
POBOX
GENESEO
(2) Accrue'
178
IL
(3)
61254
Other (specify) ~
G Did you "materially participate" in Ihe operation olthisbusine.. during 19987 II"No: see page C- 2 for limit on losses . ~ y~ Wo
H If you started or acquiAld thi.businossdurlno 1998, check he..
I Part I I Income
1 Gross receipts or sales. Caution: Ifthis income was reported to you on Form W- 2 and the "Statutory D
employee"boxon that ftlrm wa. checked. see page C- 3 and check here . ~ 1 41 403.
2 Returns and alSowancn 2
3 SubllaClline 21rom lin. 1 3 41.403_
4 Coil ot good. sold (!lorn line 42 on page 2) 4
8 G...... proftt. Subtract ine 4 !lorn line 3 5 41,403.
8 Other income. incilldlng Federal and state gasoline or tuel tax credit or retund (see page C- 3) 6
7 G......lncome. Add lines 5 and 6 ~ I 7 41,403.
i Part III Exnenses. Enter """enses lor busineoa useolyourhome onlv on line 30.
8 Advertising . I 8 3 034. 19 Pension and profit~ sharing plans j~
9 Bad debts !lorn sales or 20 Renl or lease (see page C. 5):
S8lVices (see page C-3) 9 a Vehicles, machinery, and equipment 20.
10 Car and truc:l< """enses b Other business property . 20b 16,553.
(_pageC-31. 10 21 Repairs and maintenance 21
11 Convnissfons and fees 11 516. 22 Supplies (not inCluded In Pa~ III) 22 6 007.
12 Depletion 12 23 Taxes and licenses ~
13 Oeprecialion Il1d sectlon 179 24 Travel, meals. and entertainment
"""en.. deduction (not induded . Travel 248 1,322.
inPatllllll_pageC-4) . 13 b Meals and en- I
14 Employee benefit programs tertainment
(other than on Une 19). . 14 c Enter 50% of
15 Insurance (other than health) . 16 1 400. Une 24b subject
18 Interest to limitations
(see page C- 6)
a Mortgage (;>aid to banks. etc.) 168 d Subtract line 24(: from line 24b 24d
b Other 18b 25 Utilities 25 2,134.
17 Legal and professional 26 Wages (less employment credits) 26 7,400.
services 17 650. Other expenses (from line 48 on
18 Otllce_ense 27
16 paga 2) X7 3,184.
28 Total eXP8naem before expenses for business use othome. Add lines 8 through 27 in columns ~ 28 I 42,200.
29 Tentative profit (loss). Subtract line 28 !lorn line 7 29 (797. )
30 Expenses lor bulineoa u.. olyour home. Altacn Fo;'" 8629 30
31 Net profit or (I....). Subtract line 30 !lorn lina 29.
. We profit. enter on Form 1040, line 12. and AlSO on SChedule SE.llne 2 (statutory emp loyees. 1
see page C- 6). Estates and trusts. enter on Form 1041. line 3. 31 (797. )
. lfa loss. you MUST go on 10 bne 32.
32 It you hall.. loss. check the box thatdeacribes your investment in this Dctivity (see pageC- 6).
e It you checked 32a.enlerthalosson Form 1040, line 12, and AlSO on Schedule SE, line 2
(statutoryemployees._pagaC_ 6). Estates and trusts. enteron Form 1041. line 3.
e "you ched<ed 32b. you MUSTatl8ch Form 81!N1.
KBA For Paperwork Reduction Act Notice. see Fonn 1040 Instructions.
J
}
32a
32b
~ All investment is at risk.
o Some investment is. not
at risk.
Schedule C (Form 1040) 1998
I
!
,
!I SchC-1040119981 FDC-1V19
f"orm SOflw..'topyrflJht 1996. 1996 H&R Bloel tax Servic... Inc.
I
,
i -"'''''~;'fm_Rl ,__, _.,.~ ~,. mllll~
~~.,.,
.
ScheduleC (Form 10.10) 1998 At' "IDA C HALEN
'If!!i1!!.C Cost of Goods Sold ,_.....page C. n
537-62-2134
Page 2
'33.
Method(s) uoed to 0 .
valuedolinginventttry: a Deost b 0 L.ower of cost or market c Other(att8enexplan.tion)
Was thent any chanoe in determining quantities, costs, or valuations between opening and closing inventory? If 0 0
"Yes -aaachexplan,llon . Yes No
:u
35 Inventory at beginning ofyear.lfdifferentfrom fast year's closing inventory, attachexplanaUon. 3li
36 Purchases.. COlt Of items wtthdrawn for personal use 3li
37 Cost oflabor. Do not include any amounts paid to yourseW . 37
38 Materialund aupp""" . 38
38 Other costs 38
40 .Add lines 35lhrough 39. 40
41 Inventory at end olyear. 41
42 Cost ofllOOdilaold. Suolractline41 from Iino 40. Enlerthe reouft hore and on pago 1. line 4 42
IPart IVI Infonnatiorl on Your Vehicle, Complelethispar10NLYWyou are claiming carorlNcI< expenses on
line 10 iiIInd are not reqUired to tUe Form 4562 for thIS busmess. See the InstructIons for line 13 on page
C-4toftnd outWyoumuSlfile.
43 VIn1en did you place yourvehicle in service for oUllinesspurp""",,? (month. daY.l"'ar) ~
44 Of the total number of miles you drove your vehicle during 1998. enter the number of miles you used your vehicN! for:
a Business
b Commuting
c Other
45 Do you (or your spouse) have anothBrvehicle availaole for personal use?
Dyos oNO
Dvos oNO
DYe.oNo
46 WasyourvehideavailaOleloruseduring o/f.dulyhoura?
47. Do you havoevidence to suppor1yourdeduction? .
0 It"Yes,- is the evidenatwrib:en? nYe. nNo
I Part V I Other EX0811Ses. List oelow business expenses not included on lines 8- 26 or line 30.
PHONE 3,184.
.
.
48 Total olhoreXl>lnse.. Enter here and on page 1. line 27 146 3,184.
KBA
Schedule C (Form 1040) 1998
SehC.1040f11881 FDC-2V1.1
~om; IoU...,.'CODy!iDht '996. 1998 H&.R Brock Tu: S.rvic... Inc
"je:~',!II:""- .,_ I I 1,
~
IUl"""'.~ntofReY...
1998Fol'!11 I L- 1040
Indlviduallncorne Tax Retum
Step 1
Complete
your taxpayer
Intonnatlon
A
T
T
~ Step 2
H Figure your
A income
c
o
p
Y
o
F Step 3
W Figure your
2, base Income
W
2
G
&
Attaeh copies
of any required
1 federal or illinois
o
9 to..... and
9 schedule..
R S..lnatructiona.
F
o
R
M Step 4
S
Figure your
exemption
allowance
Step 5
Figure your
net income
ortorflscel
year ending'
Do not ..rit.IlbD\f'.lhi.ll~
@ Chod< the box 1I10t indentities
the filing status that you
checked on your federal
return. Check only one box.
1999
@
PrInt ortypeyour personal information below, Iffilingjointty. be sure your
Social Security numbers are in the orderl"ey appear on your federal retum.
537- 62 -2134
344-40-0477
Your Social Secunty number
spou..', Sect" SecUl.ty numD8l'
ADELAIDA C
HALEN
o Single or
head of household
~ Married filing jointly
Married fifong separately
Widowed
Your t irat n...... tnCI inillal
Your I..t name
spou..'. fir.t name and initial
Spou..',lasl n.me (II difl.re"l)
Ii' 0 BOX 178
..elllno .adr...
GENESEO
City
61254
ZIP
IL
$laI.
@ Ched<thebox ifotleasttwo.thirdsofyourtotalfederolgrossincomecemefromfarmlng. ~D
@ Were any nfyourwageaearned in Wisconsin while an Illinois resident during 19987 0 Yea 2!1 No
Wyaa. write the Wisconsin wage. you received $ and your spouse received $
1 WrIte your federal adjusted gross income from either your U.S. 1040. Line 33;
U.S. 1040A, Line 18: U.S. 1040EZ. Line 4: or TeleFiIe worksheet. Line H.
2 Write your federally tax. exempt interest and dividend Income from either
your U.S. 10400r1040A, Line8b. 2
3 Write any other additions to your income that are taxable in Illinois. See the
instructions for details, Specifyyouradditions. .. 3
-4 Add Woes 1 through 3. Thisisyourincome. 4
1,603
1,603
5 Write your federally taxed Social Security and federally taxed
retirement income from either your U.S. 1040 or 1040A
6 Write any active- duty military pay you earned if you incJuded
thispayin Line 1.
7 WrIte your lIIinoi.'ncome Tax refund if you included this refund on
U.S. 1040. Line 10. If you flied a U.S. 1 O4OA or 1040EZ. wrile"O."
8 WrIte the U.S. govarnment obligationsand U.S. agency income
from ertheryourU.S. 1040, ScheduleS. or U,S. 104OA. Scheduia 1.
9 Write any other subtractions to your income. See the instructions
and our Publication 101 fordetc'ils. Specify your subtractions. Do
not i"etude our* of- state income. ..
10 /Jtdd Lines 5 through 9. This is your total subtractions.
11 Subtract Line 10 from Line 4. This is your base income.
5
6
7
8
9
10
11
1,603
12 CompMtte the calculation below to figure your Illinois exemption allowance.
a Write the number of number Identlfled In the
exemptions from Instructions If you were claimed
your federal return. on someone else's return.
W . 0 .~X $1.300
a
1,300
~
b Check if you were
65 or legally
olcler blind
o . 0 . 0.0-
Add Linesaandb. llus $ your total exemption allowance.
R.fJsidents only.. nonresidents and part- year residents, skip Step 5 and go to Step 6.
13 Subtrad Line 12from Line 11. This is your net income.
Write the amount here and on Line 15.
Residants, ski Ste 6aod otoSle 7.
spouse was
65 or legally
older blind
~
b
X $1,000
1,300
12
13
303
TJ"Ii.lorm is aUlhorind a. ouW"eC' by UummOlllncame T&;Il: Act Dlsclasure al '''I' m'ormation II REQUIRED Failure 10
fl. 10.0 p~ I (R. 12'98) (ovtda '"'ormation could reSUllln a anall ThIS form nas o.en roved b 11'19 Form!" Mana el'f'lenl Center Il. 492. 0055
"onn1040/1998) IL1040-1V1.13
form SOftwn Copyrigl'll 1996. 1!i96 ,","A B laek Ta.. Servu:... Inc.
"-'''''''''''''fr
,
Nextpage...
. ,,'-'. ,~ " ~I -.
? ~, .
"'''~",. .~.,
ADB~IDA
'Step 6 .
. Norireslde nta
part. year
. residents
C HALEN
Nonrellldents _.~ part- ye.. ...ldento only - ..sldento. skip Step e ..... 010 to St,!!' 7. .
14 Check lI>e box that applies to you during 1998. U NonreSident
Complete Schedule NR, and write your Illinois income from
Step 5, Une45. Attach a copy of you. completed Schedule NR. 14
537-62-2134
o Part- year resident
Step 7
Figure you lax
15 Rasldanlll, write your net income from Line 13.
18 Rasldenlll. muttlplyLine 15 by 3% (.03). and wrttethe resutton Line 16. Thlsi. your tax.
Nonresldentli and part- year re.fanta, write your tax amount from
Schedule NR. Slop 5. Line 51.
15
303
18
9
Step 8 17 Wrile the tatal amount of Illinois Income Tax I/latwas withheld from
FIgure your
payments you. pay as shown on your W- 2 forms. generally Box 18. 17
and credits 18 Write any estimated payments you made will> FormslL. 1 Q4G- ES
and IL- 505- L Includeany credit from your 1997 overpayment. 16
19 W you paid incoma tax to anoll>... state. complete lII..ots
A_you. Schedule CR Write the amount from Schedule CR, Line B. 19
W-2sto_1. 20 tf you paid Illinois Property Tax, compMtte the Homeowner's Property
Tax CredttWor1<sheet in thalnsUUClJons, and write the amount from
AttacIl any Une3 . and the amount from Line 6. . 20
requlNdaclledUlu
andollle._' 21 If you completed Schedule129&- C, write the amount from
relllmllo pogo 2- Section II. PartVlII.Une41. 21
22 Add Unes17through 21. This is your total payments and credits. 22 0
Step 9 23 If Line 22 is greater than Line 16, sub-tract Line 16 from Line 22.
Figure your
overpayment This is your oyerpayme-nt. 23
or your lax due 24 IfUns 16 isgreaterth.an Une22. subtract Wne 22 from Line 16.
This is your tax due. 24 9
Step 10 25 Writeyourpenaity amount from Form IL- 2210. Step 3. Une 16. 25
Figure your
penalty Check the box ~you completed Form IL- 221 0, Step 5, or ~ you 0
checked the boxon Form IL- 2210. Slep 1. Line 4. .
Step 11 26 If you wish to donate to one or more oftha following VOluntary contribution funds, write the amount.
Figure your
donatlons \Mldlile Preservation a Homeless Assistance d
Child Abuse Prevention b Breast Cancer Research a
Any donation wil Atzheime<'s Resea,ch c
reduce your refund Add Unes a through s. This is your total voluntary contributions. 26
or increase the 27 Wyouwishtodonate to your school district. complete the
\ amount ou owe. worksheet in the instruct>>ons. and write the amount from Une 4. 27
28 Add Unes 25 through 27. This is your total penalty and donations. 2B 0
Step 12 29 tfyou have an overpayment on Une 23 and this amount is greaterthan
Figure your Line 28, subtract Line 26 from Line 23. 29
refund or the 30 Write the amount of Line 29that you want to be applted to your
amount you 1999 estimated tax. 30
owe 31 Subtrad line 30 from Line 29. This is your refund. 31
32 Wyou have lax due on Line 24. add Unes 24 and 28. e If you have
an overpayment on Line 23 and this amount is less than Line 28.
subtrad Une 23 from Line 28. This is the amount you owe. 32 9
Step 13
Sign and date
your return
Under penalties of perjury. I state that I have examined this return and. to the besl of my knowledge, it is true, correct,
and complete.
(309)944-5370
Your signature Date Daytime phone number Spouse's signature Dale
H AND R BLOCK 01/26/99 42-0951072 (319) 326-3539
Paid preparers signature Date Preparer's FEIN or SSN Preparer's phone number
... IfYlXl use a taxpreparer and do not wish to rec.Jyea booklet next year. check here. 0 4
Mall this return to: Illinois Department of Reyenue. Springfield.IL62119- 0001
IL-10.0pIlO'l2{R:_'2/981 AP DR
Fonn 1(1olO/19981 IL1114b- 2V1.13
~O"" $0".." Copyrignt 1996. 1998 MIR Bloc'" taa: S.rvic... Inc
ME ZZ SE WA RX NS DC 10
~lIIlI
...---
.",
-
199& IA. 1040
. ."1 .
or flIcal,year beginning
"
Iowa Individual Income Tax Long For,...
1998 an, ding 0 Ch.cklffl..t-llmelowafll.r '
FOR OFFICE USE ONL V
,
STEJ>1: Place your laba~ or nil In lha blanks Ifvou do not have a label.
Las!n.me Your first name/middle initial Soci.1 Security Number .
A. IiALEN ADELAIDA C 537-62-2134
spouse's last name Spouse's first name/middle initial Social Security Number .
B. Are your name, Your Occupation .
CurrentmaUing address (number and street. apartment. lot or suite number) or PO Box your spouse's SELF
name, ifapplicable.
p 0 !lOX 178 and your address Spouse's Occ::upanon .
City. State. ZIP the same as on last
GENESEO IL 61254 year's return? Residence on 12131/9&'~
STEP 2 Flllna Slatus: Mark one box onlv. n Ve. Iii! No County No. . !SCh. Dist No. .
1 Sinale: Werevou claimed as a dependent on another person's Iowa return?r-j Yes I f NO.A. . 00 0000
2 Married Mno a ioint rolum. School Distric:l Name
3 Married tIlIno separately on this combined rolurn. Spouse use column B. NONRESIDENT
4 M.rried tBing separalo rotum.. Spouse'. name: GORDON WILLIAMS SSN: 344-40-0477 . Incom.: S 0
5 rt.-i of t\o..-nold WIltl. ~u.nfying p",or\, If qualify,"; plM".on 'a nol claImed... dep.ndent on Ihll feh.fr'l, enla( Ine person's nems end SCClal S.~rny Number n.r.
6 QualifYing widow(er) with dop.ndenl child. I Namo: SSN:
I. ""..onal Credit: Enter 1 or Enter 2 ~filing joint or h.ad 01 housenold. . . 1 x S 40 = S 40
YOU ..
STEP 3 (lI'ld ~ou.. IF b. Enter 1 for each spouse whO is65oroJderand/or 1 for each spousewhois blind,. 0 x S 20 = S
ExIlmptlons til1noioinlly) Co Depandanla:EnterHoreechdependent...................... . . 0 x S 40 = S
...,..' -
d. Enlerft,.namosofdop.ndonlshere: .. TOTALS
;'-",,-;;';";icreditEn;;-;..~......~.... ..~. ~.~. ~..-=-=x S 40 = T
b. Enlllr1 if65or oldarandJor1 ifbllnd.. .... ........ .... .... .. .. .. .. . ...... _, S ~ . S
Co Oopandanta: Enter 1 lor eac:hdopenden\ . .. .. .. . .. .. . .. . .. .. .. . .. . .. ... ,S 40 . S
d. Enterfi,.namosold.pendontsh.re: .. TOTALS
a Spouse/Status 3 A. You or Joint a. Spouse/Status 3 A. You or Joint
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
STEP 4 1. w.g.....I.rios.tip..etc. .......................
2, Tax..I' InI.....1 in.c:om.. It more th., $400, compl.'e Scrtedule B.
FIll......
s your 3. Ordin..-y diYld.nd incom.. 11 more Ih atI $0400. complete' Sch. B . .
~ groaa 4. Alimonyreceived . . .. . . .. . ,.. . . . . . .'. ..' . . . . . . .
~ Income 5. Businosslncomel(loss) from Federal Soh. C or C- EZ. . .
E 6. Capilalgain/(Ioss) from Federal Schedule D. See page 6
w 7. Olh.rgains/(Io....) from Federal form 4797. See page 6
, 8. T...ble IRAdistrlbulion. . . . . . . . . . . . . . . . . . . . . . . .
s
p 9. Taxable pension. and .nnuities. See page 6 . . . . . . . . .
~ 10. Rents. royalties. partn.rshlp.. estate.. ele. See page 7. .
.. 11. F.rm incomel(loss) from Federal Schedule F . .
E
" 12. Unomploymenlco"1'onlation
T .............
A 13. TuabIeSOcialSocuritybon.tils.Seepag.7.........
~ 14. 0lh.rmcome.s..pag.8 ......................
v 15. GROSS INCOME. ADD .nes 1 - 14
8 STEP 516. Payments to .nlRA, KEOGH or SEP . . . . . . . . . 16.
~ Figure 17. One-h.ifolseif-omploymenllax .... 17.
~ your 18. Heatth insurance deduction. Seepage 8 .... 18.
'" adjust.. 19. Pen.ityonear1yw;thdrswalofsavings .. .. _.... 19.
~ :-nta 20. Alimony paid.. .. . . . . .. .. . . . . .. . . . . . . . . . . . . ... 20.
E Income 21. Pensionlretirementincomeexdusjon. See page 9 . . . .. 21.
22. MOYlng ..pel'll. deduction from Feder.' fo,,,, 3903 or 3903F. . .. 22.
23. low~Clpilalglin.deduction.Seepag.9 ........... 23.
24. Oth.radju.tmenls.s..Pago10.................. 24.
25. Total adjustmonts. ADO lines 16-24 .. LOW INCOME EXEMPTION
26. NET INCOME. SUB'l'RACT lin. 25 from lin. 15.s..; ~~~~ ii k,;~~~bl~~x~;';~t;;n ~~';"I~~ . . .
STEP 627. Feoeralincometa,rofund received in 199B.. 27. .
Flgurw 28. Sen~ emptoymentlhouMhold employmenttaxe$. . 28. ..
~:ra1 29. Addition for Fed.rallaxos. ADO line. 27 and 28 . . . . . . . . . . . . .
Tax 30. T01lll.ADOlines26;ond29 .........................................
Id:lllon 31. Fed.raIl11lCwithh.1d .. .... . . . . . . . . . .. . . .. . ... .. 31.
::dUCll.",32. Fedotal_atedtaxp~yrnentsmadein 1998 32.
33. Additional Federal tax pilid in 1998 tor 1991& prioryears 33.
34. DedudlOnforFederallal<es.ADOUnes31, 32. and 33
35. BALANCE. SUB'TRACT lin. 34 from line 30. Enter her~ ~~d '~n'lin~':iS, 'p~~' i . . . . . . . . . .
Fomt1040(1918) IA104<J..1 Form Softwer. Cop)'righI1996 H & R Block 1&;1 S.r"tcel Inc
SPOUSE
~FflU..
,t_ua3j
i'~W.~~~~
-~~~
-
~~
-~I"""""'I
.JO
(797)
2,400
15.
.
1.603
.
.
25.
26.
.
.
1,603
29.
30.
.
.
.
34.
35.
I'!
4'.001./10/98.
^ ~ - -_.~
. '. AI' AIDA C HALEN 537-62-2134
; 9-98: fA 1'040, page 2 B. Spouse/Slatus 3 .. You or Joint B. Spouse/Status 3 A. You or Joint
STEP 7 36. IIAl.ANCE. From side 1. line 35. . . . . . . . . . . . . . . . . . . . . . ; . . . . . . . . . . . . . . . . . . . . . . . . . . . .36.
37. Tot.lIemud Ilhduclion. trom F.o.r. Schedule A . .. 37.
38. lowaincometaxifincludedinUne3~...... 38.
39. BALANCE SUIl'TRACTline 38 from line 37 .... 39.
40. Olherdeductions. Seepago 13 40.
41. Deduction. Ched< one box 0 Item;z"0;i.Add'Ii'n~~'39'and 40. 0 Standard. Seo poge 14
42. TAXABlE1NCOME.SUBTRACTline41 trom line 36
STEP 8 43. Tu: !'.ol.. tf.g,"onp~22)or all.rnllteliIX ,.... page 14). 43.
44. Iowa lump- ....m lax. 25% ofFedoraltax from form 4972. 44.
45. Iowa minimum lax. Altach 1A6251. Seepage 15 ..... 45.
46. Totaltax.AODlines43,44and45.....................................
47. Total exemption cred~ amount(s) from Step 3. pago 1 . . 47.
46. Iowa eamed incomo cred~: 6.5% of Federal credit 48. ...
49. Tuition and _ook credtt .. . .. . . .. . . . . . . . . . ... 49. ...
50. Totalcredltf.AOOllnea47.46and4g ............................ 50.
51. IIAl.ANCESUB1RACTline50fromiine46.lfiesslhanzero.enterzero .................... .5'.
52. Cl1lClttlor nonresid..,llIor pan- year resident See page 15. Attach IA 126 and Federal return. . . . . .52.
53. IIAl.ANCE.SUBTRACTline52fromline51......................................... .53.
$4. Olher Iowa credltf. Seepage 15. ............................................... ..$4.
55. IIAl.ANCE.5UB1RACTine64tromline53 ........................................ .55.
58. SchooldistriolSIJrtaxlEMS....rtax. Seepage 16. Tables begin on page 26 ..... ... .56.
57. TotaITax.AODlines55and56 ............................. ........ .57.
56. Total laxboforecontributions. AOOColumnsA and Bonline57and..,terhere. .. ................. .58.
59. Contributions. See page 16. Conrributions will reduce your refund or add to the amount you owe. Amounts must be in whole dollars.
FlShI'Mldlile 598:... _ StatoFair59b:... _ DomeSlicAbuse59c:... ADD Enlerlotal 59.
60. TOTAL TAX AND CONTRlBUTlOHS. ADD Unes 58 and 59 60.
STEP 9 51. Iowa income lax withheld from Box 1BolyourW-2(s). . 51. ... 120
62. Estimate ancl voucher payments made for 'tax year 1998 62. ...
53. Out-ol-sta"'lax credit Altach IA 130 . . . .. .. . . 53. ...
64. Motorvehiclefuellaxcred~.Attach 1A4135 ........ 64. ...
65. Child and dependent care credit. See pago17 .. 55. ...
56. Olherrelundablecredits. See page 17. ............ 66. A
(;T. TOTALADDUnea61-56 ...................... 57. 120
58. TOTAL CREDITS. ADOcolumnsA and Bon nne 57 and enter here 58.
STEP 1059. IfUne 68 is more than line 50. SUBTRACT line 60 from line 58. This is the amount you overpaid.. .59. A
70. Amount of line 59 to be REFUNDED to you ............................... ........ 70.
71. Amount at Ilnae&to be IDPUecl to your 199ge.limlled Iu; ... 71." ...
72. If line 58 is .....than line 60, SUBTRACTline 58 from line 60. This is the AMOUNT OFTAX YOU OWE . 72. A
73. Pena/tyfor underpayment of estimated lax. FromIA22100rIA2210F................ ..........73. ...
74. Pena/tyand interest Seepage 18. 74a. Penalty ... 74b. Interest ... ADD Entertotal 74.
75. TOTALAMOUNT DUE. ADD lines 72.73 and 74. and enter here ........... . . . . .. . . . .PAYTHISAMOUNT75. ...
Make check payable to: TREASURER, STATE OF IOWA. Attach pavmentto pav voucher IA 1040V- 1998.
STEP 12 STEP 13
cow- CALF REFUNDAltach IA 132.
Do NOTuse the.. amounts to increase your
refund (line 69) or reduce the amount you owe
(line 72). See page 18.
Spouse: S
""""-.-,--, ~.
Figuow
yoiIt
..,Ie
-
Fill'"
your
tax,
CNdIls
and
chec:kofl
contrlbu-
Ilona
Flllura
your
CNdIls
Fill'"
your
rafund
'"
amount
you owe
} Complete linea 37 - 40
ONLY If you itemize.
. .41.
42.
...
...
...
...
. .. ..45.
o
o
...
A
o
...
o
o
o
o
...
...
o
o
120
120
120
o
o
STEP 11
POUTICAL CHECKOFF. See page 1 B. This checkoff does not
increase the amount 'of tax yOlJ owe or decrease your refund. NEXT YEAR. I would like to receive:
SPOUSE ... YOURSELF (check one) ...
51.50te Republican Party ~ ~ $1.50to Republican Party 0 O. a booklet with preprinted label
$1.50te Reform Party $1.5010 Reform Party ~ 2. a postcard with a preprinted label only
51.50to Democratic Party $1.50 to Democratic Party (not avai)ab~ to electroniC filers)
51.5010 Campaign Fund 51.50te Campaign Fund 0 1. neither a bookiet nor alabel You. 5
I ('w'Vel. the I.Jno.rslgneCI. declare under penllly 01 pequry thai I (we) nlve oJlI:am'ned It'! IS re,urn, Includmg allsccomosny,ng scheCules
11'10 sIal.m""ls. a"d. 10 It'> III tUttt 01 m~ !our)knOwIiJd98 and behef. If I" a Hue. carrect. and cornelole 'elurn DeclaratIon of ~r.parer
jOiner than taxpayetj,s based on all ,ntarm.llon ot whIch me prepare, has IIny kno.....l.dg.
...
SIGN HERE
SIGNHERE
.Ver"'y your Soci.
Secr.anly NurnlNf(a)
.Recheck rour m.h
.AtlKh.llU
W.2s
01/26/1999
0...
Your S.gnaure
0...
Pr.p.,....'.. Signalure
DAVENPORT IA 52807
Addr.u
spou...... Signelur.
DOl.
(309)
944-5370
(319) 326-3539 42-0951072
08yllme Telepl\one No Emplo~er Idenllfic8tion ar Soci.al Securily Numt:c'
MAIL TO: 10WAINCOMETAXPROCESSING
DEPARTMENT OF REVENUE ANO FINANCE This relum is due Aprll30. 1991>.
HOOVER STATE OFFICE BUILDING
OES MOINES, IOWA 60319- 0120
OaylFm. T.l~ho". Numb.'
Fonn1040(1J98) IA104o.2
Form S~H".e Copyrignl 1996 H & R a IOC:k Tax Sery,ces. Inc
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949 260-4465
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01\ TE: 07103101
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DOSE: TABLET PRVO.: 06UU47& N/R: N
10': 388400477 a...M M.F: I'IICC1NHC
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011765 227003
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HOI 'fAU LOCI' ,.lnNI.Co\'Z6.4
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949 250-4485
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WILLIAMS. ADELAIDA
YOUR PHARMACIST RECOMMENDS
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YOUR PHARMACIST RECOMMENDS
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YOUR PHARMACIST RECOMMENDS
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PAW: 0 DAYS: 034 R~FILll TIME
949 2504465
OEA, 6T5249962
DATE: 03/21101
WILLIAMS, ADELAIOA
).Itu I VALl L~ IIVIMl, CA '161"
QlY.UNDE 6HAB IMICI .
NDC: 66953-. .
DR. GROSSM ,MARSHAll. MD.
"100 SAND CANTDN;4V1 m lOOP "VIII" (A .Hlt
PAID PRESCRIP11llN1 0..
DOlE: TAIIlET PAVC.; 068'476 N/R; N
I~~ 3118400411 eLM REf~ upnOLF
GRI-: GYDOOOO PLAN:
aTY: 58.00
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WILLIAMS. ADELAIDA
llDl 'ALl LOOP .aVjNi. CA91614
949-559-1800
PAY: . 11.00
949 2150-44811
DEA:BT6249962
DATE: 03/21101
949-559-1800
GlUCcmtllQ..~... ,.' Q TABLiT
NDC:l!IIQl~' . II
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WILLIAMS. ADELAIDA
:1.0 I YAll LOOI' Il.VINi, CA 'ill> I"
PAY:. 111.00
949 210-44811
DEA: 1116249962
DAT~: 03/21101
949.559.1 aoo
zt!STlUL IOM~'ABLET
NDC, 003.10-... 11-10
OR. GROSSMA .MARSHALL . MO.
1'.'IIoND q.rt~AVC "'loot ll..-.NI..CA 9BI.
PAID PRESCAIP'I'tPN5 aM
DOlliE: TAR-IT PRVD.: 0118476 N/A= N
IDtt: 358400477 CLM MEf; MPF1'LA)(
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aTY: 34.00
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D~SCOUNT<OUT~~TS
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WILLIAMS. ADELAIDA
R8commended OTC Product8:
ill
WilLIAMS. ADELAIDA
R8commended OTe Products:
.
WilLIAMS. ADELAIDA
Recommend8d OTC Product8:
10/02/2001 03:05 01
~ ?1IIi!1~~Ml::l,
~ IlViw..,c:nI,
06766226919
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WIl.lIAMS, ADELAIDA
llKl r. 'f^~1 ~~ laVIN.. CA~.l.I"
ACTDS 4I1MB'.....T
NDC: 64711'- ',24
DR. GROSSMA . MARSHALL . MD.
16JooiAH 1N'!O"l ~"'ITI_ IIVIHI,r;/<. 9~!1
PAID PRESCRIPTI"& 0..
00'61;: T....L.Er
948 260....6
DEA:BH2499ti2
DATE: 09/24/01
949-559-1800
GRP: GMOOOOO
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aTY: 30.00
RPH: OJH
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PAY:' 211.00
949 210......11
DEA: BT6249962
DATE: 09/24/01
WILLIAMS. ADELAIDA
lllOIYALll* 11\fINI,O.91611 949.569-1800
BL~'U_RID 14".. . . TAl. (MICl
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DR. GROS ';~RSHALL. MD.
I._'AH '-A:~' .:.""1'. I.VlIlI. CA 'I.fll
PAID PRES RII'_8 0'"'
nO'8E: TA ,ET PRYO.; OIiIl141ti N,A~ R
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3., I YALll.OC>> IIVlN... CA U614
PAY:' 11.00
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DATE: 09/24101
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I'JOflL\ND~)Il'o.AYI IIVINI.CA "',.
PAID PRESCRII'11llN8 OM
DOlE, TABLET PRVD': 0&80476 "/~: R
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aTY: 80.00
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D1 SCOUNT <OL.!TL~TS
~.
WILLIAMS, ADELAIOA
YOUR PHARMACIST RECOMMENDS
III
WilLIAMS, ADEl.AIDA
YOUR PHARMACIST RECOMMENDS
SUNSCREEN
III
WILLIAMS, ADELAIDA
YOUR PHARMACIST RECOMMENDS
PAGE 0g
10/02/2001 03:05 01
.. 'AY~m DIl~~S "!Io7.~
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WILLIAMS. ADELAIOA
JIlll (V"U LOO" Il\rlNl. [A, ~J614
949 250-4486
OEA:BT5249962
DATE: 09/19101
949~569~ 1800
VIOJO( 21lMG T,n
NOC: 00006-(11 68
OR. CLEEREWI S. IlRUCE 6. IN~
ItJOO'ANO o.N'fOf'll "WI JTI 601 IlvlNi, C^ .Z611l
PAID PRI!SCRIP11Ot1S aM
DOSE: TABlET P'RvO': 069941& t11/R: R
elM "EF: NNEUW7E
GR;P: GMOOOOO PLAN"
UTY: 30.00
RPH: OJH
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PAY:' 18.15
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DISCOUNT<OUTLETS
.
WILLIAMS, ADELAIDA
YOUR PHAAMACIST RECOMMENDS
PAGE l~
c~!~2!2~~l ~3:~5
01
DISCOUNT<OUTL'CTS
PAGE 11
'\TEv'EN K WILLIAMS MD
16300 ~AND CANYON AVE
SUITE 506
IRVINE CA -92618
1108#152
Return serVice Requested
1221010-33235
E'
ADELAIDA
......~uMlltIl
819*8190000463
WILLIAMS
. , "....lM!lIIeNt WI~
0]-0]-01
Pl.~c Qf S.~vlcel IRVINE MEDICAL CTR CPOP
500C81.819.8190000463 1108#152
(
~~4.~~0 "[A~UNf ~Alb J
11.1....1.1.11,..,.11.1"11...11.1..11..,,.1.11..1.11.....1.11
ADELAIDA WILLIAMS
380 E YALE LOOP
IRVINE CA 92614-7902
STEVEN K WILLIAMS MD
16300 SAND CANYON AVE
SU ITE 506
IRVINE CA 92618
15103412700000081900004635800001340020
PLEASE DETACH AND RETURN TOP PORTION WITH PAYMENT
"'~
DATE
02-15-01
02-15-01
05-22-01
'f
I
,," ,"~.
,.,0"""
DESCRIPTION
CONSULT, OFC/OTHR OUPT;MOD CO
INJ SINGLE SHOT LUMB/SACRAL E
UNITED HEALTHCARE PKT
""'J , ' ,
AMOUNT
150.00
520.00
-536.00
DOCTOR
CODE
9924425
62311
3501
PLEASE cALlIH:f\.irOiTIlT !.fOURS Or 9:00 ARTUlt:-oOl'''--
Billing questions? Call: 949/753-]421
........-""NUU-.
8190000"1Ii3
"'"'~~~~AI'~'~~L~~MS
MAkE CHECkS PAYABLE TO.
~TEVEN K WILLIAMS MD
I'
Ii
DArt "" 5fAftMI!1IIT
PA~~.,y ~.;,b.' ~;;~
OATE WILl. APPEAR ON
YOUR NEXT STATEMENT
YOUR ACCOUNT IS PAST
COLLECTION ACTIVITY,
- TODAYII
, "I' .',. '8ALA~If!" ", I', '
. " "., "'I AIIIIOllNT"OllI
0]-0]-01
1 34.00
OUEII TO AVOID FURTHER
PLEASE MAIL PAYMENT IN FULL
:
'i
II,
5,
n'
~
Tax Id 448646298
PIece of .ervlce. I~VINE MEDICAl CT~ CPOP
Referring Ooctor, B~UCE CLEERMANS MO
DlaUno.'.. 723.10
STEVEN K WILLIAMS NO
16'00 SAND CANYON AVE
SU IT!: 506
IRVINE CA 92618
'''''753-7''21
OL6.1~Jr;Ft" :.
EXH1Bl,'
3 J..-FH
'<1,," . ^, ~ "_ ,_,. . """!!I"'_.
10/02/2081 03:05
01
D I SCOU~T <OUTLETS
PAGE 12
(818) .508-0107
The Collection Connection
..--~-~--- ~-
September 14, 200 I
645() lJelltngh(Jm AVf:nue', Suil~ C
Nwlh Hollywood, CA. 9/606-/429
PeTSonllI & Confidential
RETURN SERVICE AEQUESTED
Ref8rence: Emergency Phy:.icians Billing
Account II: 306760-7
[Total Due: $91.20 ---'~-l
AMOUNT ENCLOSt:D, $
IICCN91lKA001471II 306760-7005
11.1.."1,1,11",,,11,1..11,,,11,1.,11,,,,,1,11,,11,11,,..,I,ll
WILlIAMS.GORDON
380. YALE LOOP
IRVINE CA 92614-7902
RBHIT TO:
THE: COLLE:CTION CONNECTION
6450 BELLINGHAM AVENUE, SUITE C
NORTH HOLLYWOOD, CA 91606-1429
11,1"",11.11"11""11,.,,,11,1,,1,,\,11,1,,1,1,,1,1,,.1,,11
- -. - - - . . - - - - - -
A Det3ch Upper portion And Return With Payment A
Reference:
Aecount:
Arnolllnt Due:
Emergency Physicians Billing
306760-7
$91.20
If you have any questions call 1818)-508-0107
Our previous demands for payment In full have bellO Ignored. Your failure to cooperate can only
make matters worse. If YOU intend to pay thiS account, do it nowl
"Protect your Credit Rating"
Visa, MasterCard. Discover. and American Express accepted Call for details.
This is a communication from a Debt Collector. This is an attempt to collect a debt. Any
information obtained will be used for that purpose.
....c..;:! .'IT :E.
I..".A",'" . -,'....'. . '.
. ,9, .-"",,"
· (818) 508-0107'
The Collection Connection
,''""''~ _ m'i!l_~
. n" ,''''.n '" '"\f'""'.
C.'
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-"
, ~
10/02/2001 03:05
m
DISCOUNT<OUTLETS
PAGE '_3
PERSONA&. AND
CONFlOEirnAL
57I3F
ReTURN setVlCE
REQUEStED
AMERISHIELD
CORPORATION
CrodllDr: Hilla PhyaJ.,.1 Th...py
Relerence No: WILAOOOO-18
Am...."1 Due, ,82IUB
9/612001
FO BOX 26100 /'COLUMBUS, OIiIO /43226-0100
WILLIAMS, ADELAIDA C
380 E YALE LOOP
IRVINIl, CA 92614~7902
11,1.,.,ld.II..,..II.I;.II...II.I..II".,.I,II.,I.II..,..1.11
SEND TO:
Hills Physical Therapy
4330 Barranca Pkwy_. #240
Irvine. CA 92604
Rcturn Top Pottion With YOU{ PftYUl.~t
Re: Hills Phy.ical Therapy
Phone: 949--157-6558
Referencell: WILADOOO-J8
Amount Due:
$829.29
AMERISHIELD CORPORATION is a collection agency.
This ill an attempt to collect a debt. Any information obtained will be used for that purpose.
Our client has asked us to contact you about the past due amount shown above.
Send YOUT check OT money ordeT. payable to our client for the full amount due.
We have pre-addressed the upper, tear-off portion of this letter and have included a return envelope for your
oonvenience_
When your obligation has been resolved, we witI clear this record from our active collection files.
Unless you notify this office within 30 days after receiving this notice that you dispute the validity of this debt. or
any portion thereof, this office will assume this dcbt is valid. If you notify this nffice m writing within 30 days fmm
receiving this notice lhat the dehe or any portion thereof, is disputed, this officc will obt:lln vorifio3lJon of the debt
or a copy of ajudgmcnl and mail you a copy of such judgment or verification. If you reque:-;t in writing within 30
days after receiving this notice. this office will provide you with the name and address of the Qriginal creditor. if
differelllt from the CUrrent credItor
Thank you.
AMERISHIELD
PO Box 26180 I Columbus. OH 43226-0160
OIC-1970
.;', ~
~,--",,,' - .- "',,"'" ~-;
"' ,~< .' -. ~-
Central Financial Control
PO BOX 14050
Orange, CA 92863
Pat1entName
ADELAIDA WILLIAMS
Patlentf
006090195
Acco1lllU
00177848431
llnltl
01 140
Mes,agejl
01
September 29, 2001
AccountB<ihnce
692.70
Principal
692.70
Intel'llst
.00
t B W N H D L V 11111111111111111'111111111111111111111111111111111111111111111111111111111111111
tDD177848431GDD1Di
ADELA IDA WILLIAMS
380 E YALE LOOP
IRVINE, CA 92614-7902
AooltDate
03/27/2001
Fac1llty
Irvine Medical Center(PBAR)
Guarantor
ADELAIDA WILLIAMS
PAY NOW OR CALL
(800)300-7192
(714)431-7113
To pay l5y creclif card, please complete this section
lEI VISA [] MASTERCARD
[] AMEX lEI DISCOVER
CARD NUMBER (ALL DIGITS PLEASE)
EXPIRATION DATE
MONTH YEAR
Ell Ell
Print cardholder's name:
Cardholder's signature:
Please include your account number on your check or money order, payable to:
Account Number..... 00177848431
Responsible Party... AOELAIDA WILLIAMS
Patient Name.......... ADELAIDA WILLIAMS
Account Balance..... 692.70
Central Flnancial Control
Check here for change of address. []
Please note change of address on the reverse side.
MECFR01
Please make sure the return address on the back of this form shows in the window of the envelope provided.
01
".
:i'liiW~_""l'-"""""
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n ~, ,",,,-,.~,,> ,." e'~,~'.'-"'''"'' >,,',''"~' -~. .-" ," ~_' ~~i,-'" __ ~ ,
''"~IJWu nun
Unless you notify this office of your dispute within 30 days after receiving this
notice, we will assume this debt is valid.
If you notify this office in writing within 30 days from receiving this notice we
will: obtain verification of the debt or obtain a copy of a judgment and mail you a
copy of such judgment or verification. Upon receipt of your written f!lquest
during this time period, we will provide you with verification and the name and
address of the original creditor, if different from the current creditor.
De no notificar e esta oficina su desacueroo, dentro de 30 dias de haber recibido
este aviso, asumiremos que esta deuda es wilida. Si notifica a esta oficina por
escrito antes de los antedichos 30 dias, esta oficina: obtendra el comprobante de
la deuda y Ie enviara por correo una copia del mismo. Al recibo de su peticion
escrita dentro de dicho plazo, Ie proveeremos el comprobante y el nombre y
direccion del acreedor original, si fuese distinto del acreeoor actual.
street Address
City, State and lIP Code
Telephone Number
Central Financial Control
PO BOX 14050
Orange, CA 92863
Please make sure this address
appears in the window of the envelope.
MECBK06
0910140 006090195 000069270 0
01
'"
ft.
...~,lL:J~,._,lJ
.. ~ijj!!lI;mr@1ll~~~M~(iTl'Mi'~J.J;!"~"'>"'~~!<;~~~~"-)'"ifu~1>.:m>;"""""o... ~ ~ .._~".... 1l!!!!\'fW1'~m"'t;iii'-~~ ^'-~-- ,'c'\ -'-' - -," '---'.'~';~F""'";'!'f,_-~:""""!J.$>JWf,_\V}1li"Fi'0i:>:1!0i"'!t';iR!C~~~1~~1
10/02/2001 03:05 01
DISCOUNT<OUTLETS PAGE 15
IF PAVING BY MA:!l; I r::r'll..:^t<u _r..:~- VI;"A, riLL VV' ""'='::''':___~_. -------1
- - -----CHECK GARO USING f:':OR pA,YMENT
14111i'--''=l 1-0
~~ MASTERCARD ':I~I \i.SA _
CARD ~UMBi:"R---- . ---~...--_.- AMOUNT
-SANTA ANA-TUSTIN RAD MED GROUP
1450 N TUSTIN AVE 1/132
SANTA ANA. CA 92705-8641
FORWARDING SERVICE REQUESTED
-------- -~- -- -------
EXP DATE
7530
SIONN"URl;;
--STAT-~M[NT DATE
pAY THIS AMOUNT
--ACCT_ff
9/05/01
27_60
96093801
PHONE: 714 835-3709
TAX 10; 95-2316954
PAGE: 1
SHOW AMOUNT $
PAID HERE
ADDRESSEE:
REMIT TO:
11,1""1,1,11..",11,1"11",11,1,,11..,,,1,11,,1.11,,,..I,ll
(;ORDON WILLIAMS
360 E YALE LOOP
I~VINE, (A 92614-7902
11,1.."1,11,..111,..,1,1,1..1"11,,,1,,1..,11..11,,,1,1,,11,1
SANTA ANA-TUSTIN RAD MED GROUP
1450 N TUSTIN AVE 1/132
SANT A ANA. CA 92705-8641
n Plea". chct;k bOle if .ddro$$ is; im::Dnl'lr:;t. or l"u!ll.Jrllll'\<:08
U i,..,fol"Mstion ha.'l chanOlld. and indicate changol,,' on ",ven"'1 ~Ide
I
iHII..IIIIIIIIIIIIIII!IIIIUIIIIIIIIII
STATEMENT PlEASE DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT
~,~,,);x);>
-
DATE PIi EXAM CODE SERVICE DESCRIPTION DIAGNOSIS AMOUNT
PREVIOUS BALANCE:
03/29/01 1 93880/26 NI CAROTID IMAGING 785.9 100.00
03/29/01 1 11020/26 CHEST 2 VIEWS 786.50 38.00
OS/29/01 973 CONTRACT PAYMENT 110_~0
OS/29/01 F=OR SERVICE OAT S 03/29/01 - 03/29/01
:
i
,.
I
I
J """, ...-"'" -. -- -- - .m -----_..--- ~-- --,-,---., .,----.-
.
PS - PLACE ~ S~RVICE CURRflllT OVfR 3D DAYS OVER 150 DA. Y5 OVER 90 DAYS IIALANCf DUf
1. INPATIENT HOSP... 3. DOCTORS OFFICE _m ~..
2. OUTPATIENT HO . 4. EMERGENCY ROOM 00 .00 00 110.40 27.60
--
PLACE DF DATE OF IIIRTH LAST PAYMENT
SERVICE , SnO/53 5/19/01
IRVINE MEOICAL CENTER EMPLOYER . GENERAL MOTORS
..&......a...TAKE ACTION NOW*******.4.a..~. PRIMARY
YOUR INS_CARRIER CAN NOT IDENTIFY YOU AS INSURANCE. UNITED HEALTH CARE
A MEMBER OF 'rHEIR PLAN. PLEASE PAY SECONDARY
BALANCE DUE ON THIS ACCOUNT IMMEDIATELY. INSURANCE.
ATTENDING
PHYSICIAN . STEIN, MARK G M.D.
-". --
ACCOUNT NUMBI!lII STATEMENT DATE REfERRING PHYsiCIAN DATE INJURED DATE ADMITTED DATE DISCHARGED
. ..-..
96093801 09/05/01 AHDOOT, JAcoB J M_D_ 03/29/01
--- -..--
;<~Jl!;!!Ii!II_!\.;_.,...,,'
".. ,r_, "'_~"'_ , "'~~ P.'~" _ 'c' ,_ __~
p~
DISCOUN!<OUTLETS
10/02/2001 03:05
01
PAGE ,~ 5
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TJISCOUNT<fJUTLl.::::TS
PAGE 1.7
GRANT & WEBER
P.o. Box 8669 -
Calabllllllll..CA 91372-8669
ADDRESS SERVICE REQUESTED
September 11 0 200 I
"A Professional Collection Coq>oration" (818)-871-7736
(800) 400-1240
For: SANTAANA-TUSTINRADMEPGRP
Acct No.: FDSOO\/066096-\/108
Call: R. CHANCE
AmolU1t: $7000
Interest: $4.15
Total: $74.\5
IIBWNFTZF
IIOWI066Q961016#
PPSOOl 1066096-1 1 J08 - R02
ADELAlDA WILLIAMS
380E YALEI..OOP
IRVINE CA 92614-7902
11.1....1.1.11.....11.1..11...11.1..11.....1.11..1.11.....1.11
Sond To:
Grfllll & Weber
PO. BOX 8669
CALABASAS. CA 91372-8669
11.1",..11..11.1...1..1.11..1..11...11..1.1...11..1.1...1..11
..",...,.......,.....,...
....... . ....,. "i<'" Q;tO;'.p;.w~.u.;;..il~Wiih.y~r;..r:.:.t.:><.. ",.......... ........ ,....,..... ..,,,,.,,
YOU HAVE APPARENTLY IGNORED OUR PREVIOUS NOTICES
TIm CLAIM IN QUESTION MAYBE ON YOUR CREDIT RECORD FOR A
NUMBER OF YEARS YOU SHOULD PAY IN FULL NOW AND CLEAR YOUR
CREDIT RECORD WITH THIS OFFICE.
THIS IS AN ATTEMPT TO COLLECT A DEBT. ANY INFORMATION
OBTAINED WILL BE USED FOR THAT PURPOSE.
r~ ......lI\Y. 0 VISA 0 MASTERCARD 0 DISCOVER 0 CARTE BLANCE 0 DINERS CLUB
For the Amount of $
Can! N....'-
If you choo.e to pey by credit card. fold
on the line above and return entire letter
So.........
FD800)/066096-1 1 101
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Exp. Dalo
Grant & Weber .26575 W. Agoura Road .CalabasBs, CA 91302.(818)-811-7736
Member of Ex peri an (Formerly TRW Credit Data)
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PAGE 18
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--MARK E. ANDERSON, M.D.
NEUROSURGEON
II ,.""O..-"..5-lQ....~ cO....O.....TIO..
16300 SAND CANYON AVE.NUE, SUITE 1005
IRvINE, CALl"'ORNIA 926.119
T~LEPHONC(e49)7~3-0303
FAX (949) 753-696e
DIP",O..ATI; ^"'E~I~AN ..o....n 0'-
NEU..OLOGlCAL :!l.u..a"FlV
Mr./Mrs./Ms.~~
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2.
1. Make sure yoU are scheduled with the American Red Cross for your blood
donation (800-696-1757).
On ~~/ at ~'f:':.. a.m., you are scheduled with
~.f2. _ _~ _~. at ./~ S~ c41'.t~ .A~-
pre-admitting. You will complete your admission forms at this time. Once these
are complete. you will be sent to the preop clinic for all lab work-up.
"H"Private patients and work camp. patients:......
You are scheduled with..9r. Marshall Grossman for a history and physical
/.,:J. ~CJ-<I-t!)I6il.- /. 'fIC& Av . The appointment card is enclosed.
No food or drinks after midnight on /",:;-~.c;/.
3 Surgery is scheduled for /d--t:)?-~/ at /L}:c;;o~. You must arrive
at the hospital no later than '7.'/Y.:I ~
on
If you should have any questions regarding this schedule, please contact me at the
above number.
Kate
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IRVINE UEDlCAL GROUP, INC.
.....SICIA_ Of'FICE BulLDltIoC
CAHYON AW.. SuITt! loot. IRVINE. ~I\ 82818
(8181 727-(1744
M.
DR. MARSHALL K. GROSSMAN, M.D.
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NEUROSURGEON
A,..o.-r._..A\,<:QlltPO....l',g..
16300 SANO CANyON AVE:NUE, SUITE 1005
IRVINE'. CAI.JF'ORNIA 9Z618
TELEPHONE (949) 753.0303
F"AX (949) 753.8982
DI"L.O,.....,TC ...1Ot~RICAN 80ARO 0"
NI!:UJlOl.OGICAL S\JRGE.A....
June 15,2001
Bruce Cleeremans, M.D.
16300 Sand Canyon Avenue, Suite 608
Irvine, CA 92618
RE: WilLIAMS, ADELAIDA
Dear Dr. Cleeremans:
Adelaida Williams pa to my office today in neurosurgical follow-up visit
accompanied by her . The patient has undergone MRI of the cervical spine of
June 7, 2001.
The findings are somewhat surprising. There is a prominent central disc protrusion at
C4-5 compromising the spinal cord. The patient has. in addition, advanced degenerative
changes at C5-6. There are changes to a lesser extent at C3-4. The most striking
finding is that of central spinal cord impingement at C4-5 and broad based disc bulge
at C5-6. On the T1 image cuts, #5 of #10, this is best seen.
The patient relates the positionality of her complaint. She states that it is a functional
impairment to her. As soon as she does repetitive neck motion or bending, she gets her
arm complaint and has ongoing symptomatology.
I have told her that I was looking for a nerve root compression at the C6-7 level as the
patient has left C8 versus ulnar numbness and tingling, which is persistent. Of course,
the patient has EMG evidence of mild slowing of the ulnar nerve across the elbow on the
left. There simply is not a neurological compromise at C6-? The findings are consistent
with a disc protrusion C4-5 and C5-6. I do not feel that the C3-4 disc protrusion is
surgical.
On clinical examination, she is unchanged.
IMPRESSION:
1. CERVICAL PAIN AND LEFT UPPER EXTREMITY COMPLAINT.
2. POSITIVE EMG OF THE LEFT ULNAR NERVE AT THE LEVEL OF THE NOTCH.
3. HNP C4-5 AND C5-6 CENTRAL WITH CERVICAL DEGENERATIVE DISEASE
C3-4.
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RE: WilLIAMS, ADElAIDA
June 15, 2001 - Page Two
PLAN: I have advised the patient that in my opinion, she is a surgical candidate. I have
described to her the risks, benefits and techniques inherent in the procedure of anterior
cervical discectomy and fusion C4-5 and C5-6 with donor bone graft and anterior spinal
instrumentation.
With the use of anatomical models as well as radiographs, charts and surgical
brochure's, I have advised the patient of the risks, benefits and techniques of anterior
cervical discectomy and fusion. I have described to the patient that this involves the
risks inherent in general anesthetic and the probability of a sore throat from the breathing
tube postoperatively. I have described to the patient that this involves an incision on the
anterior surface of the cervical spine which therefore leaves a visible pencil mark type
scar. Subsequent to this surgical approach requires displacement of the breathing tube
and esophagus, as well as great vessels and nerves of the neck. This provides access
to the cervical spine.
The principles of microdissection are conducted in such a manner as to remove all
accessible disc material, including the posterior ligament encapsulating the disc In such
a manner as to decompress the nerve roots to the arm, as well as the spinal cord. This
requires the use of meticulous technique. Thereafter, a bone graft is utilized to replace
the removed disc.
I have described the alternative of further conservative management including bed rest,
immobilization and use of medication.
Implicit in any surgical procedure, Including this procedure. are the inherent risks which
include, but are not limited to infection, blood clot or neurological injury, This :ncomplete
list includes paralysIs of the nerve to the vocal cord with subsequently hoarse voice and
difficulty singing, injury to the gr~at vessels of the neck with stroke or sudden blood loss,
injury to the airway or chest breathing system, which would need further surgical
attention. There is the chance of rupture of the esophagus with subsequent need for
repeat procedure and chance of infection or serious life threatening complication. There
is the chance of nonfusion, graft rejection or graft extrusion, The possibility of acute
airway compression exists. as well as the unavoidable risk of infection to the skin or
wound or bone graft or spine itself.
Infection of the covering around the spinal cord - meningitis - can occur. There is the
chance of penetration of the dura or water filled sac with subsequent spinal leak and
need for repeat surgical procedure, although this is considered remote. Upon review of
the neurosurgical professional literature, there exists a statistical incidence of 1 in 700
of nerve root injury resulting in monoplegia, paraplegia, triplegia, quadriplegia, spinal
cord injury or death. Statistically unpredictable events such as anesthetic reaction.
adverse medical reaction, blood clot formation with embolism to the lung. or heart attack
cannot be discounted and are threats felt to be real in any surgical hospitalization.
.~
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RE: WILLIAMS, ADELAIDA
June 15, 2001 - Page Three
The chance of complication occurring is 2% for injury not resolving in 30 days; 3% for
injury resolving in 30 days and 10% for chance of no resolution of symptomatology; Le"
chronic cervical pain or persistent arm pain. This includes the possibility of the need for
repeat surgery for inaccessible or recurrent disorder and approximately B5% chance of
resolution of arm and shoulder symptomatology and decrease of neck pain, although
there is no complete cure for neck pain. Approximately 10% of the patients are not
helped. This is believed to be related to scarring or permanent nerve injury having
already occurred prior to the surgical procedure. This would not be benefitted by repeat .
surgical procedure. There are rare instances when an additional posterior surgical
procedure is required to further enlarge the canal for the nerve root. It is possible for a
recurrent fragment to occur; additionally, it is possible for a nonfusion to occur.
Persistent chronic spinal pain can result even with a good fusion from an associated
musculo1igamentous disorder. Therefore, one can see that no promises of good result
or outcome can be verbally offered, tendered, intimated, written or assured, and none
are given to this patient.
I have discussed with the patient the necessity for obtaining blood on a stand-by basis
as a requirement for operative intervention. Since more blood may be necessary in an
emergency.for transfusion than the patient can donate in advance without compromising
their medical status at the time of surgery, Blood Bank blood is required. The risks of
blood banking, including non-detectable viral illnesses, or unforeseeable, untoward
reactions have been discussed, although, in my opinion, these are uncommon and the
benefits of Blood Bank blood utilization exceed its risks dramatically. The patient has
been informed that surgical measures to limit blood loss will be attended by the operative
team and that the patient will only receiv~ transfusion in the event of reasonable medical
need if a greater than expected blood loss occurs. However, in the outstanding majority
of cases, transfusion is not required. Risks including death and debility, liver disease,
and prolonged chronic illness can occur as an inherent risk in blood transfusion and the
patient is knowledgeable in layman's terms that risk still exists, as does the need for
blood transfusion on an unforeseeable basis.
lUaccrest bone graft may be required which additionally requires an incision resulting in
pain, delayed wound healing, possibility of infection or blood clot as well as numbness
and tingling in the skin area around the right iliac crest temporarily. This bone will be
utilized for replacement of the resected cervical disc and immobilization of the
interspace. Donor bone graft may be substituted.
I have advised the patient that at one level, range of motion of the cervical spine is not
restricted: however, at two or more levels, restriction does occur. However, the patient
is able to functionally accommodate these by movement at other levels and movement
of the eyes.
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< RE: WilLIAMS, ADElAIDA
June 15, 2001 - Page Four
Videotape Instructional information from Ludann and Acromed and patient handout
literature has been provided and the patient has had their questions answered.
I have encouraged the patient to obtain a Physician's Desk Reference (PDR) for review
of their medication and familiarization with associated risks as well as benefits and to
h_ave__?IV.~ill;ibllll for fl,lture_ ref~rencE1 when given prescription medication.
The patient has been advised to predonate one unit of autologous blood with preparatfon
of split products for use at the time of surgery to stop bleeding and to undergo general
physical examination by an internist. Variances in the videotape and handout
information and the patient's individual case have been described.
Risks of spinal instrumentation including breakage, displacement, neurological, vascular
or visceral compromise requiring removal, replacement, or revision have been discussed.
In my experience, the benefits of instrumentation, i.e. increased fusion rate and
prevention of anterior graft extrusion, outweighs its risks.
I have recommended that she predon ate one unit of blood with preparation of split
products and undergo internist admission history and physical and have her diabetes
followed closely by Dr. Grossman during the course of her hospitalization at Irvine.
I have told her that at a later date, she may require address to C3-4, however I do not
feel that this is appropriate to address at this time.
She states that she will consider the recommendation and contact my office regarding
scheduling. I will keep you advised as the patient's care plan evolves. Once again,
thank you for your neurosurgical consultation request.
Yours truly,
Mark E. Anderson, M.D.
MEA:mak
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.lINE REG HOS~ MED CTR
PATIEm' .,..,.....6207607 WILLIAMS. ADELAIDA
MErr REC NUMBER. 236026
FAXED TO PH'i ANDERSON. MARK
ORDERING PH'i ... ANDERSON. MARK
ORDER NU~BER ... 0524946 SP CERV W/O CM $
PRIORITy.,..." TODAY
PERFORM ........ 6/07/0113:06
RESL~T DATE/TIME 6/09/01 13:31
LOCATION "
SEX...... .
AGE .......
BIRTHDATE .
RA
F
046'1
5/10/53
MRI OF THE CERVICAL SPINE - 6/7/01:
HISTORY:
Severe neck pain. Symptoms of disc disease at C6-7. Left
shoulder 'and left upper extremity radiculopathy,
TECHNIQUE:
The examination Was performed on GE Signa 1,5 Tesla magnet
utilizing the following pulse sequences:
1, Sagittal T1-weighted.
2. Sagittal fast spin echo T2.
3. AxialT2-weighted Gradient echo,
FINDINGS:
At C3-4 there is a 3 mm posterior broad based disc protrusion,
At C4-5 there is a 4 mm posterior disc extrusion. This lesion
extends above and below the level of the C4-5 annulus and
indents Slightly at the anterior surface of the cervical spinal
cord,
At CS-6 there is a 3 mm central posterior disc protrusion that
is large enough to touch the anterior surface of the spinal
cord.
At eG-7 there is a 1-2 mm posterior annulus bulge,
The C7-Tl and C2-3 discs are normal.
No fractures or destructive bone lesions are visible. The
cervical spinal cord is normal,
( CONTINUED)
PLAINTIFF'S
EXHIBIT
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__.vINE REG HOSP MED CTR
PATIENT .,.,,'.. 6207807 WILLIAMS, ADELAIDA
MED REC NUMBER. 236026
!':AXED TO PH'! '.' ANDERSON, MARK
aRDERING PH'! ... ANDERSON, MARK
ORDER NUMBER ... 0524948 SP CERV W/O eM $
PRIORITy,...... TODAY
PERFORM ....., " 6/07/01 13:06
RESULT DATE/TIME 6/09/01 13:31
LOCATION ..
SEX...... .
AGE .......
BIRTHDATE .
RA
F
048Y
5/10/53
This patient has a relatively small central spinal canal. This
central AP canal diameter is estimated at 9 mm at the level of
the C4-Sdisc extrusion.
At CS-6 there is a mild right foraminal stenosis and the
foramina at other levels are normal,
IMPRESSION:
1. C4-5, 4 MM CENTRAL POSTERIOR DISC EXTRUSION IN A PATIENT
WITH A CONGENITALLY SMALL SPINAL CANAL AND AI' DIAMETER OF
ESTIMATED ~ MM,
2. C5-6, 3 MM POSTERIOR DISC PROTRUSION AND A MILO RIGHT
FORAMINAL STENOSIS.
3, C3-4 BROAD SASED 3 MM POSTERIOR DISC PROTRUSION.
4. C6-7, 1-2 MM POSTERIOR ANNULUS BULGE. THE REMAINING
CERVICAL SPINE MRI IS NORMAL.
.. END OF REPORT ..
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ADELAIDA C. WILLIAMS,
Plaintiff
IN THE COURT OF COJVlMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL VANIA
V.
DOMESTIC RELATIONS SECTION
GORDON S. WILLIAMS,
Defendant
: PACSES NO. ~qF34,
:tJtO~Ohl.6J7 C TE"RM ';
INTERIM ORDER OF COURT
AND NOW, this 3rd day of January, 2002, upon consideration of the
Support Master's Report and Recommendation, a copy of which is attached hereto as
Exhibit "A", it is ordered and decreed as follows:
A. The Defendant, Gordon S. Williams, shall pay alimony pendente lite to the
Plaintiff, Adelaida C. Williams, as follows:
I. During the period of August 9, 200 I, through December 5,
2001, the sum of$892.00 per month.
2. During the period of December 6, 2001, through February 13,
2002, the sum of$1,647.00 per month.
3. Commencing February 14, 2002, the sum of $892,00 per
month.
B. The Defendant shall be given a credit towards outstanding arrearages of
$1,464.00.
C. The Defendant shall pay the sum of$50.00 per month towards outstanding
arrearages.
D. All administrative provisions of our prior order of court dated October 16,
2001, shall remain in full force and effect.
The parties are hereby advised that they may file written exceptions to the
Support Master's Report and Recommendation within ten (10) days of this order.
Exceptions shall conform with the requirements of Rule 1910. 12(f), Pa. R.C.P. Ifwritten
exceptions are filed by any party, the other party may file exceptions within ten (IO) days
ofthe date of service of the original exceptions. Ifno exceptions are filed within ten (10)
days of this interim order, this order shall then constitute a final order.
~~~~1~
Edgar B. Bayley, J.
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cc: Adelaida C. Williams
Gordon S. Williams
James D. Flower, Jr., Esquire
Melissa 1. Van Eck, Esquire
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ADELAIDA C. WILLIAMS,
Plaintiff
: IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
V.
DOMESTIC RELATIONS SECTION
GORDON S. WILLIAMS,
Defendant
PACSES NO. 924103734
: NO. 01-1617 CIVIL TERM
SUPPORT MASTER'S REPORT AND RECOMMENDATION
Following a hearing held before the undersigned Support Master on December 21,
2001, the following report and recommendation are made:
FINDINGS OF FACT
1. The Plaintiff is Ade1aida C. Williams, who resides at 380 East Yale Loop,
Irvine, California.
2. The Defendant is Gordon S. Williams, who resides at 9145 Joyce Lane,
Hummelstown, Pennsylvania.
3. The parties were married on June 27, 1998.
4. At the time of the marriage, the Defendant resided in the State of New York.
5. At the time of the marriage, the Plaintiff operated a business in the State of
Illinois, which she continued to operate after the marriage.
6. The Plaintiff is a licensed cosmetologist and also performs massage therapy.
7. The Plaintiff was involved in an automobile accident in July, 1997, and
suffered a serious neck injury.
8. In May, 1999, the Defendant was transferred to Pennsylvania.
9. The parties resided together in the marital residence at 5C Richland Lane,
Camp Hill, Pennsylvania, from May, 1999 through December, 1999.
10. Because of an incident involving a physical assault upon her by the
Defendant, the Plaintiff left the marital residence in December, 1999 and
moved to a women's shelter.
11. In January, 2000 the Plaintiff moved to Arizona.
12. While in Arizona the Plaintiff was hired by Richard Baron as a district
manager to oversee the operation of several stores which he owned.
Exhibit !lA.1I
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13. The Plaintiffs annual salary as district manager was $40,000.00.
14. The Plaintiff left the position as district manager after one month because, in
her opinion, she lacked the physical stamina to perform the duties of the
position.
15. In December, 2000 the Plaintiff moved to a home owned by Richard Baron in
California in which his elderly mother also resided.
16. The Plaintiff performed services as a caretaker for Mr. Baron's elderly mother
in exchange for room and board.
17. Rent and utilities for a one-bedroom apartment would cost the Plaintiff
approximately $1,425.00 per month should she leave the Baron home.
18. On December 6,2001, the Plaintiff underwent surgery for a cervical
discectomy and fusion. She will be disabled for eight to twelve weeks as a
result of the surgery.
19. The Plaintiff receives a monthly annuity of$438.75 as the result of the death
of a former husband.
20. In addition to the medical problems involving her neck, the Plaintiff also
suffers from diabetes.
21. The Plaintiff has not filed a federal income tax return since 1998, the last year
in which she had income from her self-employment.
22. The Defendant is employed as a sales representative for General Motors.
23. The Defendant has a gross monthly income of $6, 161.15.
24. The Defendant pays $60.67 for medical insurance on himself and the Plaintiff.
25. When the Plaintiff left Pennsylvania in January, 2000, she took a 1996
Oldsmobile Bravada titled in the Defendant's name for which he was making
loan payments of$488.00 per month.
26. The Bravada was used primarily by the Plaintiff's son until late October,
2001, when it was returned to the Defendant.
27. The Plaintiff filed her petition for alimony pendente lite on August 9, 2001.
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DISCUSSION
Before a spouse is entitled to an award of alimony pendente lite, she must show
entitlement. Clouse v. Clouse. 50 Cumbo 1. J. 167 (2001) The party claiming alimony
pendente lite must show that the award is required to adequately preserve his or her rights
in the divorce litigation. Sutliffv. Sutliff, 326 Pa. Super. 496, 474 A.2d. 599 (1984),
overruled on other grounds Rosen V. Rosen, 520 Pa. 19,549 A.2d. 561 (1988)
Factors to be considered in determining entitlement to an award of alimony
pendente lite are the ability of the other party to pay, the separate estate and income of the
party petitioning for the award, and the character, situation, and surroundings of the
parties. Litmans v. Litmans, 449 Pa. Super. 209, 673 A.2d. 382 (1996) If an award of
alimony pendente lite is warranted, the support guidelines as set forth in the Pennsylvania
Rules of Civil Procedure are utilized to calculate the amount of the award in a similar
manner as spousal support. Little v. Little, 47 Cumberland 1.J. 131 (1998)
Under the facts ofthe present case, the Plaintiff is entitled to an award of alimony
pendente lite. Her medical condition clearly prevents her from earning a sufficient
amount to support herself and preserve her rights in the divorce litigation. Consequently,
the support obligation of the Defendant is to be calculated pursuant to the support
guidelines as contained in the Rules.
The Plaintiff obtained employment after the separation in December, 2000, where
she had an annual salary of$40,000.00. The Defendant contends that this income should
be utilized in determining his support obligation. However, the Plaintiff argues that
because of her medical condition as a result of the auto accident and injury to her neck,
she was unable to fulfill the responsibilities of that employment. Plaintiff s Exhibit 5 and
6, the report from the neurosurgeon and the MRI results respectively, both of which
predate the filing of the petition for alimony pendente lite, support the Plaintiff s position
that the $40,000.00 salary should not be utilized as her earning capacity. In determining
a person's earning capacity, a Court cannot estimate what an individual might
theoretically earn, but rather what that person could "realistically earn under the
circumstances, considering his or her age, health, mental and physical condition and
training." Goodman V. Goodman, 544 A.2d. 1033 (pa. Super. 1988); Strawn vs. Strawn,
664 A.2d. 129 (pa. Super. 1995) In computing the Defendant's support obligation, the
Plaintiff s earning capacity will be the value of the in-kind compensation paid to her for
services provided as a caretaker to Richard Baron's mother, determined to be $1,425.00
as shown on her Income and Expense Statement (plaintiff s Exhibit No. I), plus the
monthly annuity of$438.75. This results in a gross monthly income of$I,863.75.
Inasmuch as the Plaintiff has no tax liability for this income, this figure will also be
utilized as her net monthly income.
The parties stipulated that the Defendant's gross monthly income was $6,161.15
and that the Defendant paid a medical insurance premium of$60.67 per month for
insurance covering himself and the Plaintiff.
Utilizing the incomes as set forth above and making the adjustment for the health
insurance premium paid by the Defendant, his obligation for alimony pendente lite is
$892.00 per month as set forth on Exhibit A.
The effective date of the order will be August 9, 200 I.
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The Defendant will be given a credit towards arrearages for automobile payments
made on the 1996 Bravada for the months of August through October, 2001, for a total
credit of $1 ,464.00.
On December 6, 2001, the Plaintiff became totally disabled as a result of the
surgery performed on her neck. Consequently the Defendant's obligation for alimony
pendente lite will be $1,647.00 per month for a period often weeks, the anticipated
convalescent period for the Plaintiff following her surgery, and will revert to $892.00 per
month thereafter.
RECOMMENDATION
A. The Defendant, Gordon S. Williams, shall pay alimony pendente lite to the
Plaintiff, Adelaida C. Williams, as follows:
1. During the period of August 9, 2001, through December 5,
2001, the sum of $892.00 per month.
2. During the period of December 6,2001, through February 13,
2002, the sum of$I,647.00 per month.
3. Commencing February 14,2002, the sum of $892.00 per
month.
B. The Defendant shall be given a credit towards outstanding arrearages of
$1,464.00.
C. The Defendant shall pay the sum of$50.00 per month towards outstanding
arrearages.
D. All administrative provisions of our prior order of court dated October 16,
200 I, shall remain in full force and effect.
~,~\~
Michael R. Rundle
Support Master
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In the Court of Common Pleas of Cumberland County, Pennsylvania
--. -'-,- Support Guideline WorKsheet
. Rule 1910.16-1. elsea.
Defendant Name: Gordon S. Williams Docket Number: 01-1617 Civil
PACSES Case Number: 924103734
Plaintiff Name: Adelaida C. Williams Other Case ID Number:
Defendant - . . pj~lintiff'-
1. Number of Dependents in this Case
2. Total Gross Monthly Income $6,161.15 $1,863.75
3. Less Monthlv Deductions -~--- - --- $2,025.65
-
4. Monthly Net Income $4,135.50 $1,863.75
Line 2 minus Line 3
5 a. Combined Total Monthly Net Income $5,999.25
Amounts on Line 4 Combined ---- ..-,.
5 b. Derivative Soc. Sec. Benefits Paid to Child(renl -
5 c. Adjusted Combined Total Monthlv Net Income -
6 a. Child Suooort Obliaation based on Adiusted Income (Line 5cl -
- ..'
6 b. Less Derivative Soc. Sec. Benefits (Line 5bl (-I .. ..
- .
6 c. Basic Child Support Obligation -
From Rule 1910.16-3 Basic Child Support Schedule
7. Net Income as a Percenta!le of Combined Amount 68.93 31.07
8. Each Parent's Monthly Share of the Child Support Obliaation - -
9. Adjustment for Shared Custody Rule 1910.113-4 (c) (# of OyerniQhts: - ) -
10. Adjustment for Child Care Expenses Rule 1910.16-6 (a) -
11. Adiustment for Health Insurance Premiums Rule 1910.16-6 (bJ -$18.85
12. Adiustment for Un reimbursed Medical EXDEmses Rule 1910.16-6 (el -
13. Adiustment for Additional EXDenses Rule 1910.16-6idJ -
14. Total Obliaation with Adiustments Line 8 minus Line 9, alus Lines 10,11,12,13 -$18.85
15. Less Solit Custody Counterclaim Rule 1910.16-4 (d) -
16. Obligor's Support Obligation Line 14 minus Line 15 ~$18.85
Prepared by: mrr I Date: 1/ 2/2002
.....
- --. Summary Reoort
I
51. PACSES Multillle Familv Adiustment -
52. Sllousal SUllllort Award $891.97
53. Adiustment for Excess Mortaa!le Payments (If Applicable) -
54. Final Calculated Support Obligation Monthly: Weekly:
Line 16 (orS1, if applicable) plus Line S2 and S3, if applicable $873.12 $200.95
TAX INFORMATION Tax Method FiJina Status Exemptions
55. Defendant 1040 ES Married Filin!l Separately 1
56. Plaintiff 1040 ES Married Filin!l Separately 1
57. Total Support Amount if Deviating from Guidelines Calculation Monthly: Weekly:
- -
58. Justification for Deyiatina from Guidelines Calculation and/or Other Case Comments:
SupportCalc 2001
Exhibit 1Il\"
ADELAIDA C. WilLIAMS,
Plaintiff
V.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
DOMESTIC RELATIONS SECTION
GORDON S. WilLIAMS,
Defendant
. PASCES NO. 924103734
: )/I(Q:::mz'1Q'l7. cldJ:.E.....RM3
AMENDED ORDER OF COURT
AND NOW, this 4th day of January, 2002, the Court being
advised that our prior order of court entered January 3, 2002 contains a clerical
error, said order is amended as follows:
A. The figure of $892.00 in paragraph A (1) is amended to read
$873.00;
B. The figure of $892.00 in paragraph A (3) is amended to read
$873.00;
C. In all other respects our prior order of January 3, 2002 remains
in full force and effect.
BY~'1~
Edgar B. Bayley, J.
CC: Adelaida C. Williams
Gordon S. Williams
James. D. Flower, Jr., Esquire
Melissa L. Van Eck, Esquire
DRO
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. ,
'State Commonwealth of Pennsvlvania
Co./City/Dist. of CUMBERLAND
Date of Order/Notice 01/14/02
Court/Case Number (See Addendum for case summary)
ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
]),1(( 01-/&/7 (1ft//(..
;Jfk5f> 9:J.t( 103 75Sr
])Ie 3tJ130
o Original Order/Notice
@ Amended Order/Notice
o Terminate Order/Notice
) RE: WILLIAMS, GORDON S.
) Employee/Obligor's Name (last, First, MI)
) 366-40-0477
) Employee/Obligors Social Security Number
) 0322100482
) Employee/Obligor's Case Identifier
) (See Addendum for plaintiff names associated with cases on attachment)
) Custodial Parent's Name (Last, First, MI)
)
EmployerlWithholder's Federal EIN Number
GENERAL MOTORS CORP*
EmployerlWithholder's Name
C/O ARTHUR ANDERSON BPS CENTR
EmployerlWithholder's Address
PAYROLL SERVICES
PO BOX 62650
PHOENIX AZ 85082-2650
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER INFORMA TlON: This is an Order/Notice to Withhold Income for Support based upon an order for support
from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these
amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not
issued by your State.
$ 1, 6<i7. 00 per month in current support
$ 134.00 per month in past-due support Arrears 12 weeks or greater? Oyes @ no
$ 0.00 per month in medical support
$ 0.00 per month for genetic test costs
$ per month in other (specify)
for a total of $ 1,781. 00 per month to be forwarded to payee below,
You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match
the ordered support payment cycle, use the following to determine how much to withhold:
$ 4J 1. 00 per weekly pay period.
$ 822.00 per biweekly pay period (every two weeks).
$ 890.50 per semimonthly pay period (twice a month).
$ 1. 7Rl. 00 per monthly pay period.
REMITTANCE INFORMA TlON:
You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this
Order/Noti<:e. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to
deduct a fel! to defray the cost of withholding. Refer to the laws governing the work state of your employel! for the
the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's
aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is
needed (Sel! #9 on pg. 2).
If remitting by EFT/EDI, please cali Pennsylvania State Collections and Disbursement Unit (SCDU) Employer
Customer Service at 1-877-676-9580 for instructions.
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER 1D (shown
above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED,
DO NOT SEND CASH BY MAIL.
Servi ce Type M
B No.: 0970-0154
/ ..../t;"" -0", Expiration Date: 12/31/00
mH'~
<CUM- 8, &I;r-p.'1~gw;
Form EN-028
Worker ID $IATT
Date of Order:
JAN 1 5 2002
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ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
D If checked you are required to provide a copy of this form to your employee.
1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income.
Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting
agency listed below.
2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment
to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to
each employee/obligor.
3.* Repoltillg tl,e; P<<ydatdDdtt v{'NitLI,Oldil,O_ '/vtllllust le....v,t t[,(. paydab'J.atG of vvitl.l.oIJil,g vvl,eh ;)l:;IIJ;I'5 ti,e pay I IIc;lIt. Ti,e
l-'Q.yJatddatL of yy;tl,I,oldh,g;;) U,,;; dati. 011 yyl,;~I, cilllOUht VVg" nitl,l,dd (IVIl. t1,~ ('llIpIOyC;\:>/~ vvagts. You must comply with the law of the
state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the
withholding order and forward the support payments.
4. * Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support
against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must
follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest
extent possible. (See 119 below)
5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for
you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below.
WITHHOLDER'S ID: 3805725150
EMPLOYEE'S/OBLIGOR'S NAME: WILLIAMS, GORDON S.
EMPLOYEE'S CASE IDENTIFIER: 0322100482 DATE OF SEPARATION:
LAST KNOWN HOME ADDRESS:
NEW EMPLOYER'S NAME/ADDRESS:
6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have any questions about lump sum payments, contact the person or authority below.
7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should
have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs
unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from
employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding.
Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is
employed governs.
9. * Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (15 U.S.c. 91673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment.
The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory
deductions such as: State, Federal, local taxes; Sodal Security taxes; and Medicare taxes.
10.
'NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the
law of the state that issued this order with respect to these items.
Requesting Agency:
DOMESTIC RELATIONS SECTION
13 N. HANOVER ST
P.O. BOX 320
CARLISLE PA 17013
If you or your employee/obligor have any questions,
contact WAGE ATTACHMENT UNIT
by telephone at (717) 240-6225 or
by FAX at (717) 240-6248 or
by Internet @
Page 2 of 2
Form EN-028
Worker ID $IATT
Servi ce Type M
OMB No.: 0970-0154
Expiration Date: 12131/00
'-~~IIII!!iI;lIl!ll"'~IIl$c._,_
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ADDENDUM
Summarv of Cases on Attachment
Defendant/Obligor: WILLIAMS, GORDON S.
PAC5ES Case Number 924103734/30980
Plaintiff Name
ADELAIDA C. WILLIAMS
Docket Attachment Amount
01=1617 CIVIL$ 1,781. 00
Child(ren)'s Name(s):
PACSES Case Number
Plaintiff Name
DOB
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
dli~~~~~;~:;~~;;~;~~~\;~~;~"~~;~II;~~'~~:I~(ren)
identified above in any health insurance coverage available
through the employee's/obligor's employment.
".dl;C~:~~:~;;~~~;~;~~~i;:~;~:~;~:I;~~~~il~t;~~;///.....
identified above in any health insurance coverage available
through the employee's/obligor's employment.
PACSES Case Number
Plaintiff Name
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
o If checked, you are required to enroll the child(ren)
identified above in any health insurance coverage available
through the employee's/obligor's employment.
o If checked, you are required to enroll the child(ren)
identified above in any health insurance coverage available
through the employee's/obligor's employment.
PACSES Case Number
Plaintiff Name
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s}:
DOB
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
.'t5I;~~:~~:~:;~~.;;:';~~~i;~~;~~~;~II;~:~~;id;;:'~;'.'..................... ... .
identified above in any health insurance coverage available
through the employee's/obligor's employment.
BI;~~~~~:~:;~~;;:;~~~i;~d;~:~;~'II;~:~~;ld:;:~;
identified above in any health insurance coverage available
through the employee's/obligor's employment.
Addendum
Form EN-028
Worker ID $IATT
Service Type M
OMB No.: 0970-0154
Expiration Date: 12/31/00
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ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
11:'/ dO(')!-!w/7 (l If//L
State Commonw..alth of pennsylvania fJl1c<;r" t(,:J / 1103731/
Co.lCity/Dist. of CUMBERLAND ) "\ 't >'-
D~teofOrder/Notice 02/14/02 J5;:: .JD93u
Court/Case Number (See Addendum for case summary)
o Original Order/Notice
o Amended Order/Notice
o Terminate Order/Notice
) RE: WILLIAMS, GORDON S.
) Employee/Obligor's Name (Last, First, Mil
) 366-40-0477
) Employee/Obligor's Social Security Number
) 0322100482
) Employee/Obligor's Case Identifier
) (See Addendum for plaintiff names associated with cases on attachment)
) Custodial Parent's Name (last, First, MI)
)
EmployerMlithholder's Federal EIN Number
GENERAL MOTORS CORP'
EmployerM'ithholder's Name
C/O ARTHUR ANDERSON BPS CENTR
EmployerMtithholder's Address
PAYROLL SERVICES
PO BOX 62650
PHOENIX AZ 85082-2650
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER INFORMA TlON: This is an Order/Notice to Withhold Income for Support based upon an order for support
from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these
amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not
issued by your State.
$ 873.00 per month in current support
$ 134.00 per month in past-due support Arrears 12 weeks or greater? Q()yes 0 no
$ 0.00 per month in medical support
$ 0.00 per month for genetic test costs
$ per month in other (specify)
for a total of $ 1,007.00 per month to be forwarded to payee below.
You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match
the ordered support payment cycle, use the following to determine how much to withhold:
$ 232.38 per weekly pay period.
$ 464.77 per biweekly pay period (every two weeks).
$ 503.50 per semimonthly pay period (twice a month).
$ 1.007.00 per monthly pay period.
REMITTANCE INFORMATION:
You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this
Order/Notice. Send payment within seven (7) working days of the paydate!date of withholding. You are entitled to
deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the
the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's
aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is
needed (See #9 on pg. 2).
If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer
Customer Service at 1-877-676-9580 for instructions.
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN A~DlTION, I'A YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE I'ACSES MEMBER ID (shown
above as.' the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BY MAIl.
Service Type M
COfL,pf,(
MAILED OMBNo.,09>()-Ql54
Expiration Date: 12/31/00
6
Form EN-028
Worker ID $IATT
Date of Order:
FEB 1 5 2002
J.'.'=_<ffl<"'~:II'~, m ~n no'!;" _~,~
,--,
Jl(
~
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
o If checked you are required to provide a copy of this form to your employee.
1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income.
Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting
agency listed below.
2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment
to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to
each employee/obligor.
3. * Repoltiltg tile PaydAK/Date of 'N;U.I.oldihg. YOu IlItI!lt lepolt the pAydateldd~ of vvitLl15ldil,g nl.en selldillg tLe paylllel.t. Tile
pa,d.te/date of "ithholdi',g i. t1,e date "" "I,iel, a'M)U',! ,,", "itl,l,eld Ii"", tl,~ e'"pl",e.'. "age.. You must comply with the law of the
state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the
withholding order and forward the support payments.
4. * Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support
against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must
follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest
extent possible. (See #9 below)
5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for
you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below.
WITHHOlDER'sID: 3805725150
EMPlOYEE's/OBLlGOR's NAME: WILLIAMS, GORDON S.
EMPLOYEE'S CASE IDENTIFIER: 0322100482 DATE OF SEPARATION:
lAST KNOWN HOME ADDRESS:
NEW EMPLOYER'S NAME/ADDRESS:
6. lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have any questions about lump sum payments, contact the person or authority below.
7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should
have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs
unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from
employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding.
Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is
employed governs.
9. * Withholding limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (15 U.S.C. 91673 (b)l; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment.
The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory
deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes.
10.
* NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the
law of the state that issued this order with respect to these items.
Requesting Agency:
DOMESTIC RELATIONS SECTION
13 N. HANOVER ST
P.O. BOX 320
CARLISLE PA 17013
If you or your employee/obligor have any questions,
contact WAGE ATTACHMENT UNIT
by telephone at (717) 240-6225 or
by FAX at (717) 240-6248 or
by Internet @
Page 2 of 2
Form EN-028
Worker ID $IATT
Service Type M
OMBNo.;097CJ..0154
Expiration Date: 12/31/00
_'.""{!,?!i'11'J';'L " ~~..
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ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: WILLIAMS, GORDON S.
PACSES Case Number 924103734 009.30 PACSES Case Number
Plaintiff Name ! Q Plaintiff Name
ADELAIDA C. WILLIAMS
Docket Attachment Amount
01=1617 CIVIL $ 1,007.00
Child(ren)'s Name(s):
DOB
If you are required to enroll the child(ren)
in any health insurance coverage available
through the employee's1obligor's employment.
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
you are required to enroll the child(ren)
in any health insurance coverage available
employee's/obligor's employment.
P ACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
If you are required to enroll the child(ren)
above in any health insurance coverage available
through the employee's/obligor's employment.
Attachment Amount
$ 0.00
Child(ren)'s Name(s):
Docket
DOB
If you are required to enroll the child(ren)
above in any health insurance coverage available
the employee's/obligor's employment.
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
If checked, you are required to enroll the child(ren)
in any health insurance coverage available
employee's1obligor's employment.
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
If checked, you are required to enroll the child(ren)
above in any health insurance coverage available
through the employee's/obligor's employment.
Service Type M
Addendum
Form EN-028
Worker ID $IATT
OMB No.: 0970-0154
Expiration Date: 12/31/00
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In the Court of Common Pleas of CUMBERLAND County, Pennsylvania
DOMESTIC RELATIONS SECTION
ADELAIDA C. WILLIAMS ) Docket Number 01-1617 CIVIL
Plaintiff )
VS. ) PACSES Case Number 92410373yS'o?30
GORDON S. WILLIAMS )
Defendant ) Other State ID Nwnber
PETITION FOR MODIFICATION
OF AN EXISTING SUPPORT ORDER
I. The petition of
GORDON STANLEY WILLIAMS
respectfully
represents that on OCTOBER 12, 2001
, an Order of Court was entered for the
support of
ADELAIDA CASTANEDA WILLIAMS
A true and correct copy of the order is attached to this petition.
Service Type M
Form OM-501
Worker ID 21205
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WILLIAMS
V. WILLIAMS
PACSES Case Number: 924103734
2. Petitioner is entitled to 0 increase (i) decrease 0 termination 0 reinstatement
o other of this Order because of the following material and substantial change(s) in
circumstance:
(Please complete this section by listing the reasons for your request.)
Defendant. Gordon Williams. reaueRtR a decreaRP- (hIP- to R.
a change in circumstances. Defendant's income has decreased due to
being forced into early retirement by his emplmyer, beginning
ApT; 1 1. ?OI1?
WHEREFORE, Petitioner requests that the Court modify the existing order for support.
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Peti . oner
LV mAt [ftL
Attorney for Petitioner
_ oR
I verify that the statements made in this complaint are true and orre<:l3~ undtUliand
that false statements herein are made subject to the penalties of 18 Pa. C.S. ~';!t904 r~ing to
unsworn falsification to authorities. ',..
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Date
jJJ6-ry A, fD(~
/Petitioner /
Service Type M
Page 2 of2
Form OM-50l
Worker ill 21205
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ADELAlDA CASTANEDA WILLIAMS,
Plaintiff
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
vs.
NO.2001-1617 CIVIL TERM
GORDON STANLEY WILLIAMS,
Defendant
IN DIVORCE
MOTION FOR APPOINTMENT OF MASTER
AND NOW, Gordon Stanley Williams, Defendant, moves the court to appoint a master
with respect to the following claims:
( ) Divorce
( ) Annulment
(X) Alimony
(X ) Alimony Pendente Lite
(X) Distribution of Property
( ) Support
(X) Counsel Fees
(X) Costs and Expenses
and in support of the motion states:
(I) Discovery is complete as to the claim( s) for which the appointment of a master is
requested.
(2) The Defendant has appeared in the action by his attorney, Melissa 1. Van Eck,
Esquire.
(3) The statutory ground for divorce is 3301(c) and/or (d) of the Pennsylvania
Divorce Code.
(4) The action is contested with respect to the following claim:
(i) Equitable Distribution.
(ii) Alimony, Alimony Pendente Lite and Attorneys Fees and Costs.
Document #: 219683.1
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(5) The action does not involve complex issues oflaw or fact.
(6) The hearing is expected to take one (I) day.
(7) Additional information, if any, relevant to the motion: None.
METZGER, WICKERSHAM, KNAUSS & ERB, P.C.
(~c\J. lbJn &1.) ,
Melissa 1. VanEck, Esquire
I. D. No. 85869
3211 North Front Street
P. O. Box 5300
Harrisburg, P A 17110-0300
Attorneys for Defendant
Date: 5-'1-0d-
Document #: 2/9683./
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CERTIFICATE OF SERVICE
I, Melissa L. Van Eck, Esquire, of the law firm of Metzger, Wickersham, Knauss & Erb,
P.C., hereby certify that I served a true and correct copy of the Motion for Appointment of Divorce
Master of Defendant with reference to the foregoing action by first class mail, postage prepaid, this
I\~ day of
~
, 2002, on the following:
Carol Lindsay, Esquire
Saidis, Shuff, Flower & Lindsay
26 W. High Street
Carlisle, P A 17013
METZGER, WICKERSHAM, KNAUSS & ERB, P.C.
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Melissa L. VanEck, Esquire ~
Document #; 219683.1
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ADELAIDA CASTANEDA WILLIAMS,
Plaintiff
vs.
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYL V ANlA
NO.2001-1617 CIVIL TERM
GORDON STANLEY WILLIAMS,
Defendant
IN DIVORCE
ORDER APPOINTING MASTER
AND NOW, this 8 ~ay of ~2002, f:. ~ {kj~, Esquire, is
appointed master with respect to the following claims:
Equitable Distribution.
Alimony, Alimony Pendente Lite and Attorneys Fees and Costs.
By the Court:
In
Document #: 219683.1
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State Commonwealth of Pennsylvania
Co.lCity/Dis!. of CUMBERLAND
Date of Order/Notice 05/07/02
Court/Case Number (See Addendum for case summary)
ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
'OK!, 02.tPtYl-/{p/7 (!li/lL.
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@OriginaIOrder/Notice
o Amended Order/Notice
o Terminate Order/Notice
) RE: WILLIAMS, GORDON S.
) Employee/Obligor's Name (Last, First, MI)
) 366-40-0477
) Employee/Obligor's Social Security Number
) 0322100482
) Employee/Obligor's Case Identifier
) (See Addendum for plaintiff names associated with cases on attachment)
) Custodial Parent's Name (Last, First, MI)
)
EmployetM'ithholder's Federal EIN Number
PENSION ADMINISTRATION CENTER
EmployerMiithholder's Name
PO BOX 5014
Employer,w"ithholder's Address
SOUTHFIELD MI 48086-5014
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support
from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these
amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not
issued by your State.
$ 873.00 per month in current support
$ 50.00 per month in past-due support Arrears 12 weeks or greater? Oyes @ no
$ 0 . 00 per month in medical support
$ 0 . DOper month for genetic test costs
$ per month in other (specify)
for a total of $ 923.00 per month to be forwarded to payee below.
You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match
the ordered support payment cycle, use the following to determine how much to withhold:
$ 213.00 per weekly pay period.
$ 426.00 per biweekly pay period (every two weeks).
$ 461.50 per semimonthly pay period (twice a month).
$ 923.00 per monthly pay period.
REMITTANCE INFORMATION:
You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this
Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to
deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the
the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's
aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is
needed (See #9 on'pg. 2).
If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer
Customer Service at 1-877-676-9580 for instructions.
Make Remittance Payable to: PA SCOU
Send check to: Pennsylvania SCOU, P.O, Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown
above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BY MAIL.
Service Type M
BY THE COURT:
HAY 8 "" _(2;p~\
~ Form EN-028
. OM' No.' 0970.0154 Worker I D $OINC
- .s- -Y'-O:y xpirationDate:12J31/00
Date of Order:
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ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
o If checked you are required to provide a copy of this form to your employee.
11. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income.
Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting
agency listed below.
2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment
to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to
each employee/obligor.
3. * RePO.l;I,g tl,~ PaydatelDAti. ofWitLLold;lIg. You IIIU3ll~polt tLe f:J3.ydatc/date of vvitl.l.oldL Ig vvl,eh selldillg tI,G paY'II~J It. Ti,e
poydAl;c/date of vv:LI,I,oldihg is the ciA&. 01. nl,id, dll.OtJht vvas vvitl.held flOlll the elllployee'.5 m!l.gl;;S. You must comply with the law of the
state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the
withholding order and forward the support payments.
4.' Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support
against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must
follow the law of the state of employee'sJobligor's principal place of employment. You must honor all Orders/Notices to the greatest
extent possible. (See #9 below)
5. Termination Notification: You must promptly notify the Requesting Agency. when the employee/obligor is no longer working for
you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below.
WITHHOLDER'S ID: 3146100172
EMPLOYEE'S/OBLlGOR'S NAME: WILLIAMS. GORDON S.
EMPLOYEE'S CASE IDENTIFIER: 0322100482 DATE OF SEPARATION:
LAST KNOWN HOME ADDRESS:
NEW EMPLOYER'S NAME/ADDRESS:
6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have any questions about lump sum payments, contact the person or authority below.
7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should
have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs
unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from
employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding.
Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is
employed governs.
9.' Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (15 U.s.c. 91673 (b)l; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment.
The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory
deductions such as: State, Federal, local taxeSi Social Security taxesi and Medicare taxes.
10.
'NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the
law of the state that issued this order with respect to these items.
Requesting Agency:
DOMESTIC RELATIONS SECTION
13 N. HANOVER ST
P.O. BOX 320
CARLISLE PA 17013
If you or your employee/obligor have any questions;
contact WAGE ATTACHMENT UNIT
by telephone at (717) 240-6225 or
by FAX at (7171 240-6248 or
by Internet @
Page 2 of 2
Form EN-028
Worker ID $OINC
Service Type M
OMB No.: 0970,0154
Expiration Date: 12/31/00
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Defendant/Obligor:
PACSES Case Number 924103734 ~q3JJ
Plaintiff Name I e2
ADELAIDA C. WILLIAMS
Docket Attachment Amount
01-1617 CIVIL$ 923.00
Child(ren)'s Name(s):
ADDENDUM
Summarv of Cases on Attachment
WILLIAMS, GORDON S.
PACSES Case Number
Plaintiff Name
DOB
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
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identified above in any health insurance coverage available
through the employee's/obligor's employment.
o If checked, you are required to enroll the child(ren)
identified above in any health insurance coverage available
through the employee'slobligor's employment.
PACSES Case Number
Plaintiff Name
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
o If checked, you are required to enroll the child(ren)
identified above in any health insurance coverage available
through the employee'slobligor's employment.
o If checked, you are required to enroll the child(ren)
identified above in any health insurance coverage available
through the employee's/obligor's employment.
PACSES Case Number
Plaintiff Name
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
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identified above in any health insurance coverage available
through the employee'slobligor's employment.
o If checked, you are required to enroll the child(ren)
identified above in any health insurance coverage available
through the employee's/obligor's employment.
Addendum
Form EN-028
Worker ID $OINe
Service Type M
OMB No.: 0970-0154
Expiration Date: 12/31/00
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ADELAIDA CASTANEDA WILLIAMS,
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYL V AN1A
v.
NO. 2001-1617
GORDON STANLEY WILLIAMS,
Defendant
CIVIL ACTION - LAW
IN DIVORCE
INCOME AND EXPENSE STATEMENT
OF DEFENDANT, GORDON STANLEY WILLIAMS
METZGER, WICKERSHAM, KNAUSS & ERB, P.C.
By: ~ &1 \JCUl. fcJ
Melissa 1. VanEck, Esquire -
Attorney J.D. No. 85869
3211 North Front Street
P.O. Box 5300
Harrisburg, PA 17110-0300
(717) 238-8187
Attorneys for Defundant
Document #: 233223.1
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05/01/2002
INCOME AND EXPENSE STATEMENT OF
GORDON STANLEY WILLIAMS
Employer: Retired
Address:
Type of Work:
Payroll Number:
Pay Period (weekly, biweekly, etc.): Monthly
GROSS PAY PER PERIOD: $3,136.36
Itemized Payroll Deductions:
Federal Withholding: $311.47
Social Security:
Medicare:
Local Wage Tax:
State Income Tax:
Unemployment Tax:
Retirement:
Savings Bonds:
Credit Union:
Life Insurance:
Health Insurance:
Other: (specify)
NET PAY PER PAY PERIOD: $2,824.89
Document#: 176291.1
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OTHER INCOME: WEEK MONTH YEAR
Interest
Dividends
Pension
Annuity
Social Security
Rents
Royalties
Expense Account
Unemployment Compo
Workmen's Compo
TOTAL OTHER INCOME:
TOTAL MONTHLY NET INCOME: $2,824.89
Document #: /76291.1
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WEEKLY MONTHLY YEARLY
HOME:
Mortgage/rent $919.00
Maintenance $50.00
Repairs $25.00
UTILITIES:
Electric $60.00
Gas
Oil
Telephone $70.00
Water $20.00
Sewer/Garbage $30.00
EMPLOYMENT:
Public Transportation
Lunch
TAXES:
Real Estate
Personal Property
Income
INSlJRANCE:
Homeowners
Automobile $72.00
Life
Accident
Health $67.00
Other
Document #: 176291.1
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AUTOMOBILE:
Payments
Fuel . $90.00
Repairs $25.00
Maintenance $20.00
Licenses $12.00
Registration $8.00
Auto Club $5.00
MEDICAL:
Doctor $30.00
Dentist $40.00
Orthodontist
Hospital
Medicine
Special needs $20.00
(glasses, braces,
orthopedic
devices)
EDUCATION:
Private school
Parochial school
College $150.00
Religious
School lunches
Books/misc. $10.00
PERSONAL:
Clothing $30.00
Document#: 176291./
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Food $300.00
Barber/hairdresser $26.00
Personal care $15.00
Laundry/dry cleaning $10.00
Hobbies
Memberships
CREDIT PAYMENTS:
Credit card $150.00
Charge account $75.00
LOANS OR DEBTS:
Credit Union $288.00
MISCELLANEOUS:
Household help
Child care
Camp
Pet expense
Papers/books/
magazines
Entertainment $20.00
Pay TV $35.00
Vacation
Gifts $50.00
. Legal fees $50.00
Charitable
Contributions
Religious
Memberships (Tithing) $200.00
Children's
D . 7
ocumen! #. J 6291.1
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Allowances
Other Child
Support
Alimony $1,007.00
payments
Lessons for
Children
OTHER:
SSPP Loans $289.00
TOTAL EXPENSES $4,248.00 $20.00
Document #: 176291.1
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CERTIFICATE OF SERVICE
I, Melissa 1. Van Eck, Esquire, ofthe law firm of Metzger, Wickersham, Knauss & Erb,
P.C., hereby certifY that I served a true and exact copy of Income and Expense Statement of
Defendant with reference to the foregoing action by first class mail, postage prepaid, this 1 th
day of <Y\Clj-' 2002 upon the following:
Carol Lindsay, Esquire
Saidis, Shuff, Flower & Lindsay
26 W. High Street
Carlisle, PAl 70 13
METZGER, WICKERSHAM, KNAUSS & ERB, P.C.
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Melissa 1. Van Eck, Esquire
Document #: 233223.1
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VERIFICATION
I, Gordon Stanley Williams, do hereby verify that the facts set forth in Income and Expense
Statement of Defendant, Gordon Stanley Williams, are true and correct to the best of my personal
knowledge or information and belief. I understand that false statements herein are made subject to
the penalties of 18 Pa.C.S. ~4904, relating to unsworn falsification to authorities.
Date: 5 -{ 0 -D~
/0~ J iVJL
'Gordon Stanley Williams
Document #: 232373.1
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ADELAIDA CASTANEDA WILLIAMS
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
NO. 2001-1617 CIVIL TERM
GORDON STANLEY WILLIAMS,
Defendant
IN DIVORCE
INVENTORY OF DEFENDANT
Defendant files the following inventory of all property owned or possessed by either party at
the time this action was commenced and all property transferred within the preceding three years.
Defendant verifies that the statements made in this inventory are true and correct.
Defendant understands that false statements herein are'made subject to the penalties of 18 Pa. C.S.
~4904 relating to unsworn falsification to authorities.
Q~ ~,i)&L
G RDON S AN y' WILLIAMS
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ASSETS OF PARTIES
Defendant marks on the list below those items applicable to the case at bar and itemizes the
assets in the following pages.
(X) 1.
(X) 2.
(X) 3.
( ) 4.
(X) 5.
(X) 6.
( ) 7.
( ) 8.
(X) 9.
( ) 10.
( ) 11.
( ) 12.
( ) 13.
( ) 14.
( ) 15.
( ) 16.
(X) 17.
( ) 18.
(X) 19.
(X) 20.
( ) 21.
( ) 22.
( ) 23.
(X) 24.
(X) 25.
( ) 26.
Document #: 230082.1
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.
Real property
Motor vehicles
Stocks, bonds, securities and options
Certificates of deposit
Checking accounts, cash
Savings accounts, money market and savings certificates
Contents of safe deposit boxes
Trusts
Life insurance policies (indicate face value, cash surrender value and current
beneficiaries)
Annuities
Gifts
Inheritances
Patents, copyrights, inventions, royalties
Personal property outside the home
Business (list all owners, including percentage of ownership, and officer/director
positions held by a party with company)
Employment termination benefits-severance pay, workmen's compensation
claim/award
Profit sharing plans
Pension plans (indicate employee contribution and date plan vests)
Retirement plans, Individual Retirement Accounts
Disability payments
Litigation claims (matured and uIUllatured)
MilitaryN.A. benefits
Education benefits
Debts due, including loans, mortgages held
Household furnishings and personality (include as a total category and attach
itemized list of distribution of such assets in dispute
Other
"-_r', I~, "'" r
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MARITAL PROPERTY
Defendant lists all marital property in which either or both spouses have legal or equitable
interest individually or with any other person as of the date this action was commenced.
Item
No.
Description
of Property
Names
of All
Owners
1.
3
Savings Bonds ($150.00)
Husband
2.
3
75 Shares ofGM (stock option)
Husband
3.
19
Retirement from GM
Husband
Document #: 230082.1
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NON-MARITAL PROPERTY
Defendant lists all property in which a spouse has a legal or equitable interest which is claimed to be
excluded from marital property.
Item
No.
Description
of Property
Names
of All
Owners
Reason for
Exclusion
1.
I
9145 Joyce Lane
Husband
post-separation
2.
2
1996 Bravada
Husband
pre-marital
3.
3
Household Furnishings
Husband
pre-marital
4.
3
Household Furnishings
Wife
pre-marital
Document #: 230082.1
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Description
of Property
None
Document #: 230082. J
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PROPERTY TRANSFERRED
Date of
Transfer
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"I
Consideration
Person
to Whom
Transferred
LIABILITIES
Names Names
Item Description of All of All
No. of Property Creditors Debtors
1. 1 9145 Joyce Lane GMAC Husband
2. 24 Credit card Discover Card Husband
3. 24 Student loans US Dept. of Education Joint
4. 24 Credit card The Bon Ton Husband
5. 24 School School of Theology Husband
6. 24 Consolidation loan Automakers Credit Union Husband
7. 24 401(k) loan SSPP Husband
8. 24 Credit card Hecht's Joint
Document #: 230082.1
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.
CERTIFICATE OF SERVICE
I, Melissa 1. Van Eck, Esquire, of the law firm of Metzger, Wickersham, Knauss & Erb, P.C.,
hereby certifY that I served a true and correct copy of the Inventory of Defendant with reference to the
foregoing action by fIrst class mail, postage prepaid, this r[4Y\ day of
mOL{
,2002,
on the following:
Carol Lindsay, Esquire
Saidis, Shuff, Flower & Lindsay
26 W. High Street
Carlisle, P A 17013
METZGER, WICKERSHAM, KNAUSS & ERB
~6f\bDtrL
Melissa 1. VanEck, Esquire
i\ttorneyId.85869
32 11 North Front Street
PO Box 5300
Harrisburg, P A 1711 0-0300
(717) 238-8187
Attorney for Defendant
Gordon Stanley Williams
Date: May l, 2002
Document #: 228599.1
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In the Court of Common Pleas of CUMBERLAND County, Pennsylvania
-DOMESTIC RELATIONS SECTION
ADELAIDA C. WILLIAMS ) Docket Number 01-1617 CIVIL
Plaintiff ) 9241037300930
vs. ) PACSES Case Number
GORDON S. WILLIAMS )
Defendant ) Other State lD Number
ORDER OF COURT - APPEAR AT A MODIFICATION CONFERENCE
@ Initial Conference
o Rescheduled Conference
You,
ADELAIDA CASTANEDA WILLIAMS
, Respondent have been sued
in Court to modify an existing ApL order. You,
ADELAIDA CASTANEDA WILLIAMS Respondent, and You,
GORDON STANLEY WILLIAMS Petitioner, are ordered to appear in person
at CllMBERLAND co DRS
13 NORTH HANOVER STREET, CARLISLE, PA. 17013
on the
12TH DAY OF JUNE, 2002
at 10: 3 OAM for a conference and remain until
dismissed by the Court. If the Petitioner of this action fails to appear as provided in this
Order, this petition may be dismissed. If the Respondent of this action fails to appear as
provided in this Order, an Order for Modification may be entered against the Respondent.
You are further required to bring to the conference:
I. a true copy of your most recent Federallncome Tax Return, including W-2s, as fIled,
2. your pay stubs for the preceding six (6) months,
3. the Income and Expense Statement attached to this order as required by Rule 1910.11 (c).
4. verification of child care expenses, and
5. proof of medical coverage which you may have, or may have available to you,
Service Type M
Form OM-503
Worker lD 21205
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WILLIAMS
V. WILLIAMS
PACSES Case Number: 924103734
THE EXISTING ORDER MAY BE MODIFIED OR TERMINATED IN ANY APPROPRIATE
MANNER BASED UPON THE EVIDENCE PRESENTED.
If you fail to appear for the conference/hearing or to bring the required documents, the
court may issue a warrant for your arrest or enter an order in your absence. If paternity is an
issue, the court may enter an order establishing paternity.
An appropriate order may be entered against either party based upon the evidence
presented without regard to which party initiated the liP L action.
BY THE COURT:
Date of Order:
S-ts -o-;}.
YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE
AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT
AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELO TO
FIND OUT WHERE YOU MAY GET LEGAL HELP:
CllMBERLAND co BAR ASSOCIATION
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AMERICANS WITH DISABILITIES ACT OF 199~ ~
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The Court of Common Pleas of CllMBERLAND County it' requir~ by law to
comply with the Anlericans with Disabilities Act of 1990. For information about accessible
facilities and reasonable accommodations available to disabled individuals having business
before the court, please contact our office at: (717) 240-6225. All arrangements must be
made at least 72 hours prior to any hearing or business before the court. You must attend the
scheduled conference.
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2 LIBERTY AVE
CARLISLE PA 17013-3308-02
(717) 249-3166
Service Type M
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Form OM-503
Worker ID 21205
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ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
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o Ori'ginal' Order/Notice
@ Amended Order/Notice
o Terminate Order/Notice
5,tate Commonwealth of Pennsvlvania
Co./City/Dist. of CllMBERLAND
Date of Order/Notice 06/13/02
Court/Case Number (See Addendum for case summary)
) RE: WILLIAMS, GORDON S.
) Employee/Obligor's Name (Last, First, MI)
) 366-40-0477
) Employee/Obligor's Social Security Number
) 0322100482
) Employee/Obligor's Case Identifier
) (See Addendum for plaintiff names associated with cases on attachment)
) Custodial Parent's Name (Last, First, MI)
)
EmployerlWithholder's Federal EIN Number
PENSION ADMINISTRATION CENTER
EmployerNlithholder's Name
PO BOX 5014
EmployerMtithholder's Address
SOUTHFIELD MI 48086-5014
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER INFORMA TlON:. This is an Order/Notice to Withhold Income for Support based upon an order for support
from CllMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these
amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not
issued by your State.
$ 375.00 per month in current support
$ 0 . 00 per month in past-due support Arrears 12 weeks or greater? 0 yes @ no
$ 0.00 per month in medical support
$ 0.00 per month for genetic test costs
$ per month in other (specify)
for a total of $375.00 per month to be forwarded to payee below.
You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match
the ordered support payment cycle, use the following to determine how much to withhold:
$ 86.54 per weekly pay period.
$ 173.08 per biweekly pay period (every two weeks).
$ 187.50 per semimonthly pay period (twice a month).
$ 375.00 per monthly pay period,
REMITTANCE INFORMATION:
You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this
Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to
deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the
the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee'sl obligor's
aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is
needed (See #9 on pg. 2).
If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer
Customer Service at 1-877-676-9580 for instructions.
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER fD (shown
above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BY MAil.
Date of Order:
JUN 1 4ZOll2.
LJ6~
Form EN-028
Worker ID $OINC
Service Type M
_:JR.. ,RI~BNO.:0970-0154
_;rationDate:12/31/00
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j . ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
o If checked you are required to provide a copy of this form to your employee.
1. , Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income.
Federal tax ievies in effect before receipt of this order have priority. If there are Federal tax levies in effect piease contact the requesting
agency listed below,
2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment
to each agency requesting withholding. You must, however, separately identify the portion of the singie payment that is attributable to
each employee/obligor.
3. * Reporlir.g 11,( Pa,darelDdte ofWitl,l,oldir.g.. You ,ousl,.p",t tl" pa,datc/d.te of "ill,l,oldi',g ,,1,"0 ,,,r.dir.g tl,e 1'.,'".01. TI,e
paydateldate of y~HLLoldillg L~ t1.e-ddtG 01; vvl.;d I anlOJllt vvc1S yy;ll,lleld (.61.1 tile G!I,pI5yC:e'S vvagGS. You must comply with the law of the
state ofthe employee's/obligor's principal place of employment with respect to the time periods within which you must implement the
withholding order and forward the support payments.
4. * Employee/OO/igor with .Multiple Support Holdings: Ilthere is more than one O,der/Notice to Withhold Income for Support
against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding. limits, you must
follow the law of the state of employee's/obligor's principal place of employment. You must honor all OrderstNotices to the greatest
extent possible. (See #9 below)
5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for
you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below.
WITHHOLDER'S ID: 3146100172
EMPLOYEE'S/OBLlGOR'S NAME: WILLIAMS, GORDON S.
EMPLOYEE'S CASE IDENTIFIER: 0322100482 DATE OF SEPARATION:
LAST KNOWN HOME ADDRESS:
NEW EMPLOYER'S NAME/ADDRESS:
6. lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have any questions about lump sum payments, contact the person or authority be'low. .
7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should
have withheld from the employee/obligor's income and other penalties set by pennsylvania State law. Pennsylvania State law governs
unless theobligor is employed in another State, in which case the law of the State in which he or she is employed governs,
8, Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from
employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding.
Pennsylvania State law governs unless the obligor is employed in another State, in which case the iaw of the State in which he or she is
employed governs.
9. * Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed bithe Federal Consumer C/'edit
Protection Act (15 U.s.c. 91673 (b)l; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment.
The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory
deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes.
10.
*NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the
law of the state that issued this order with respect to these items.
Requesting Agency:
DOMESTIC RELATIONS SECTION
13 N. HANOVER ST
P.O. BOX 320
CARLISLE PA 17013
If you or your employee/obligor have any questions,
contact WAGE ATTACHMENT UNIT
by telephone at (717) 240-6225 or
by FAX at (7171 740-6248 or
by Internet @
Page 2 of 2
Form E N-028
Worker ID $OINC
Service Type M
OMBNo::097Q-0154
Expiration Date; 12/31/00
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ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: WILLIAMS, GORDON S.
PACSES Case Number 924103734/2>6'930
Plaintiff Name
ADELAIDA C. WILLIAMS
Docket Attachment Amount
01=16i7 CIVIL $ 375.00
Child(ren)'s Name(s):
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DOB
o If checked, you are required to enroll the child(ren)
identified above in any health insurance coverage available
through the employee's/obligor's employment.
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
-,;,;.-;.
o If checked, you are required to enroll the child(ren)
identified above in any health insurance coverage available
through the employee's/obligor's employment.
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
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identified above in any health insurance coverage available
through the employee's/obligor's employment.
Service Type M
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
o If checked, you are required to enroll the child(ren)
identified above in any health insurance coverage available
through the employee's/obligor's employment.
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
o If checked, you are required to enroll the child(ren)
identified above in any health insurance coverage available
through the employee's/obligor's employment.
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
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identified above in any health insurance coverage available
through the employee's/obligor's employment.
Addendum
Form EN-028
Worker ID $OINC
OMB No.: 0970.0154
Expiration Date: 12/31/00
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ADELAIDA WILLIAMS,
Plaintifl7Petitioner
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
VS.
CIVIL ACTION - DIVORCE
GORDON S. WILLIAMS,
DefendanVRespondent :
NO. 2001-1617 CIVIL TERM
IN DIVORCE
DR# 30930
Pacses# 924103734
ORDER OF COURT
AND NOW, this 13th day ofJune, 2002, based upon the Court's determination that Petitioner's
monthly net income/earning capacity is $1,863.75 and Respondent's monthly net income/earning
capacity'is $2,941.3 9, it is hereby Ordered that the Respondent pay to the Pennsylvania State
Collection and Disbursement Unit, $375.00 per month payable monthly as follows; $375.00 for
alimony pendente lite and $0.00 on arrears. First payment due ono or before the 5th day of each
month, commencing in July, 2002. Arrears set at $695.67 as of June 13, 2002. The effective date of
the order is April 1, 2002.
This Order is based upon the fact that Defendant has retired, effective April 1 , 2002. Consideration is
given for the medical insurance costs paid by Husband, The balance of$695.67 is to be paid in full
within ten days upon receipt ofthis Order.
Failure to make each payment on time and in full will cause all arrears to become subject to immediate
collection by all of the means as provided by 23 Pa.C.S.~ 3703. Further, if the Court finds, after
hearing, that the Respondent has willfully failed to comply with this Order, it may declare the
Respondent in civil contempt of Court and its discretion make an appropriate Order, including, but not
limited to, commitment of the Respondent to prison for a period not to exceed six months.
Said money to be turned over by the P A SCDU to: Adelaida Williams. Payments must be made by
check or money order. All checks and money orders must be made payable to P A SCDU and mailed
to:
PASCDU
P.O. Box 69110
Harrisburg, PA 17106-9110
Payments must include the defendant's P ACSES Member Number or Social Security Number in order
to be processed. Do not send cash by mail.
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Unreimbursed medical expenses that exceed $250,00 annually are to be paid 0% by the respondent
and 100% by petitioner. The petitioner is responsible to pay the first $250.00 annually in
unreimbursed medical expenses. Respondent to provide medical insurance coverage. Within thirty
(30) days after the entry of this order, the Respondent shall submit written proof that medical
insurance coverage has been obtained or that application for coverage has been made, Proof of
coverage shall consist, at a minimum, of: 1) the name of the health care coverage provider(s); 2) any
applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims
should be made; 5) a description of any restrictions on usage, such as prior approval for hospital
admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage
contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms.
This Order shall become final ten days after the mailing of the notice of the entry of the Order to the
parties unless either party files a written demand with the Prothonotary for a hearing de novo before
the Court.
DRO: R. 1. Shadday
Mailed copies on
6-14-02 to:
BY THE COURT,
Petitioner
Responsent
Carol Lindsay, Esquire
Melissa Van Eck, Esquire
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ADELAIDA WILLIAMS,
Plaintiff/Petitioner
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
VS.
CIVIL ACTION - DIVORCE
GORDON S. WILLIAMS,
DefendantlRespondent
NO. 2001-1617 CIVIL TERM
IN DIVORCE
DR# 30930
PacseS# 924103734
NOTICE OF RIGHT TO REOUEST A HEARING
The parties are hereby advised that they have until June 24. 2002 to request a hearing do novo
before the Court. File request in person or mail to:
Office of the Prothonotary
1 Courthouse Square
Carlisle, PA 17013
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ADELAIDA WILLIAMS,
PlaintifflPetitioner
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
VS.
CIVIL ACTION - DIVORCE
GORDON S. WILLIAMS.
Defendant/Respondent
NO. 2001-1617 CIVIL TERM
IN DIVORCE
DR# 30930
PacseS# 924103734
DEMAND FOR HEARING
DATE OF ORDER: June 13, 2002
AMOUNT: 375.00 per month
FOR: Alimony Pendente Lite
REASON(S): .
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ADELAlDA WILLIAMS,
Plaintifli'Petitioner
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - DIVORCE
VS.
GORDON S. WILLIAMS,
Defendant/Respondent
NO. 2001-1617 CIVIL TERM
IN DIVORCE
DR# 30930
PacseS# 924103734
NOTICE OF RIGHT TO REQUEST A HEARING
The parties are hereby advised that they have until June 24. 2002 to request a hearing do novo
before the Court. File request in person or mail to:
Office of the Prothonotary
1 Courthouse Square
Carlisle, PA 17013
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IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY,PENNSYLVANIA
CIVIL ACTION - DIVORCE
ADELAIDA WILLIAMS,
PlaintiIDPetitioner
GORDON S. WILLIAMS,
Defendant/Respondent
NO. 2001-1617 CIVIL TERM
IN DIVORCE
DR# 30930
PacseS# 924103734
DEMAND FOR HEARING
DATE OF ORDER: June 13,2002
AMOUNT: 375.00 per month
FOR: Alimony Pendente Lite
REASON(S): .
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In the Court of Common Pleas of CUMBERLAND County, Pennsylvania
DOMESTIC RELATIONS SECTION
ADELAIDA C. WILLIAMS ) Docket Number 01-1617 CIVIL
Plaintiff )
vs. ) PACSES Case Number 924103734
GORDON S. WILLIAMS )
Defendant ) Other State ID Number
ORDER OF COURT
You,
ADELAIDA CASTANEDA WILLIAMS
plaintiff/defendant of
260 S LAVEEN DR, CHANDLER, AZ. 85226-3883-60
are ordered to appear at DOMESTIC RELATIONS HEARING RM
DOMESTIC RELATIONS OFC, 13 N HANOVER ST, CARLISLE, PA. 17013-3014-13
before a hearing officer of the Domestic Relations Section, on the
NOVEMBER 7, 2002
at 1: 30PM for a hearing.
You are further required to bring to the hearing:
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C")-7J
1. a true copy of your most recent Federallncome Tax Return, including W -2s, liS<filed,
'.0
2. your pay stubs for the preceding six (6) months, $ ;:;:;2:'
3. verification of child care expenses, and I . r
4. proof of medical coverage which you may have, or may have available to you.:;;: 0
5. information relating to professional licenses ",;:;:;::;:J
or",
6. other: ~:=;r<1 ..
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Service Type M
Form CM-509
WorkerID 21302
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WILLIAMS
V. WILLIAMS
PACSES Case Number: 924103734
If you fail to appear for the conference/hearing or to bring the required documents, the
court may issue a warrant for your arrest or enter an order in your absence. If paternity is an
issue, the court may enter an order establishing paternity.
The appropriate court officer may enter an order against either party based upon the
evidence presented without regard to which party initiated the support action.
BY THE COURT:
Date of Order: 10 (..If 02
YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE HEARING AND
REPRESENT YOU. 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 MAY GET LEGAL HELP:
CUMBERLAND CO BAR ASSOCIATION
2 LIBERTY AVE
CARLISLE PA 17013-3308-02
(717) 249-3166
AMERICANS WITH DISABILITIES ACT OF 1990
The Court of Common Pleas of CllMBERLAND County is required by law to
comply with the Americans with Disabilities Act of 1990. For information about accessible
facilities and reasonable accommodations available to disabled individuals having business
before the court, please contact our office at: (717) 240-6225. All arrangements must be
made at least 72 hours prior to any hearing or business before the court. You must attend the
scheduled hearing.
Service Type M
Page 2 of2
Form CM-509
Worker ID 21302
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In the Court of Common Pleas of CUMBERLAND County, Pennsylvania
DOMESTIC RELATIONS SECTION
ADELAIDA C. WILLIAMS ) Docket Number 01-1617 CIVIL
Plaintiff )
vs. ) PACSES Case Number 924103734
GORDON S. WILLIAMS )
Defendant ) Other State ID Number
ORDER OF COURT
You,
GORDON STANLEY WILLIAMS
plaintiff/defendant of
9145 JOYCE LN, HUMMELSTOWN, PA. 17036-8629-45
are ordered to appear at DOMESTIC RELATIONS HEARING RM
DOMESTIC RELATIONS OFC, 13 N HANOVER ST, CARLISLE, PA. 17013-3014-13
before a hearing officer of the Domestic Relations Section, on the
NOVEMBER 7, 2002
at 1: 30PM for a hearing.
You are further required to bring to the hearing: n~
S;=o
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1. a true copy of your most recent Federallncome Tax Return, including W-2s, .
2. your pay stubs for the preceding six (6) months, ?]~o
3. verification of child care expenses, and ;;:n
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4. proof of medical coverage which you may have, or may have available to you .- ~
5. information relating to professional licenses .2 ~,..,
6. other: -j ~
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Service Type M
Form CM-509
Worker ID 21302
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WILLIAMS
V. WILLIAMS
PACSES Case Number: 924103734
If you fail to appear for the conference/hearing or to bring the required documents, the
court may issue a warrant for your arrest or enter an order in your absence. If paternity is an
issue, the court may enter an order establishing paternity.
The appropriate court officer may enter an order against either party based upon the
evidence presented without regard to which party initiated the support action.
Date of Order: I 0 ~l 02
BY THE COURT:
QlJj~E
YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE HEARING AND
REPRESENT YOU. 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 MAY GET LEGAL HELP:
CUMBERLAND co BAR ASSOCIATION
2 LIBERTY AVE
CARLISLE PA 17013-3308-02
(717) 249-3166
AMERICANS WITH DISABILITIES ACT OF 1990
The Court of Common Pleas of CllMBERLAND County is required by law to
comply with the Americans with Disabilities Act of 1990. For information about accessible
facilities and reasonable accommodations available to disabled individuals having business
before the court, please contact our office at: (717) 240-6225. All arrangements must be
made at least 72 hours prior to any hearing or business before the court. You must attend the
scheduled hearing.
Page 2 of2
FormCM-509
Worker ID 21302
Service Type M
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ADELAIDA CASTANEDA WILLIAMS, : COURT OF COMMON PLEAS OF
Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA
v.
: NO. 01 - 1617 CIVIL
GORDAN STANLEY WILLIAMS,
Defendant
: IN DIVORCE
/
PRAECIPE TO WITHDRAW APPEARANCE
/
Kindly withdraw the appearance of Melissa L. VanEck, Esquire, on behalf of Defendant,
Gordon Stanley Williams.
METZGER, WICKERSHAM, KNAUSS & ERB, P.C.
Dated: O~ 3\ -ad
By~,d;M) ~- \&ft&L
Melissa L. Van Eck, Esquire
Attorney J.D. No. 85869
P.O. Box 5300
3 211 North Front Street
Harrisburg, PA 17110-0300
(717) 238-8187
PRAECIPE TO ENTER APPEARANCE
Kindly enter the appearance of Andrew Spears, Esquire, on behalf of Defendant, Gordon
Stanley Williams.
METZGER, WICKERSHAM, KNAUSS & ERB, P.C
Dated: ~ _~ ' \j'y'
By C~- ('~
Andi'ew Spears, Esquire
P.O. Box 5300
Harrisburg, P A 1711 0
(717) 238-8187
Document #: 247794.1
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ADELAIDA CASTANEDA WILLIAMS, :IN THE COURT OF COMMON PLEAS OF
Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA
vs.
NO. 01 - 1617 CIVIL
GORDAN STANLEY WILLIAMS,
Defendant
IN DIVORCE
TO: Carol J. Lindsay
Attorney for plaintiff
Melissa L. Van Eck Attorney for Defendant
DATE: Friday, May 17, 2002
CERTIFICATION
I certify that discovery is complete as to the claims
for which the Master has been appointed.
OR IF DISCOVERY IS NOT COMPLETE:
(a) Outline what information is required that is not
complete in order to prepare the case for trial
and indicate whether there are any outstanding
interrogatories or discovery motions.
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(b) Provide approximate date when discovery will be
complete and indicate what action is being taken
to complete discovery.
<::::::::.s.~Q.
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DATE
NOTE:
PRETRIAL DIRECTIVES WILL NOT BE ISSUED FOR THE
FILING OF PRETRIAL STATEMENTS UNTIL COUNSEL HAVE
CERTIFIED THAT DISCOVERY IS COMPLETE, OR OTHERWISE
AT THE MASTER'S DISCRETION.
AFTER RECEIVING THIS DOCUMENT FROM BOTH COUNSEL
OR A PARTY TO THE ACTION, IF NOT REPRESENTED BY
COUNSEL, INDICATING THAT DISCOVERY IS NOT
COMPLETE, THE DIRECTIVE FOR FILING OF PRETRIAL
STATEMENTS WILL BE ISSUED AT THE MASTER'S
DISCRETION. HOWEVER, IF BOTH COUNSEL, OR A
PARTY NOT REPRESENTED, CERTIFY THAT DISCOVERY
IS COMPLETE, A DIRECTIVE TO FILE PRETRIAL
STATEMENTS WILL BE ISSUED IMMEDIATELY.
THE CERTIFICATION DOCUMENT SHOULD BE RETURNED
TO THE MASTER'S OFFICE WITHIN TWO (2) WEEKS OF
THE DATE SHOWN ON THE DOCUMENT.
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ADELAIDA CASTANEDA WilLIAMS, : IN THE COURT OF COMMON PLEAS OF
Plaintiff, : CUMBERLAND COUNTY, PENNSYLVANIA
vs.
: NO. 2001 - 1617 CIVil TERM
GORDON STANLEY WilLIAMS,
Defendant.
: IN DIVORCE
CERTlFICA TlON OF DISCOVERY
(a) See attached letter to counsel.
(b) As soon as counsel responds to our 6/20102 letter.
, >
,
..,
JAMES D. FLOWER
JOHN E. SUKE
ROBERT C. SAlDIS
GEOFFREY S: SHUFF.
JAMES D.. FLOWER, JR;
CAROLj, LINDSAY
jOHNNA j, KOPECKY
KARL M. LEDEBOHM
JOSEPH L. HITCHINGS
THOMAS E. FLOWER
FORREST N. TROUTMAN. IT
LAW OFFICES
SAIDIS, SHUFF, FLOWER & LINDSAY
A PROFESSIONAL CORPORATION
- 26 WEST HIGH STREET
CARLISLE, PENNSYLVANIA 17013
TELEPHONE: (717) 243-6222. FACSIMILE: (717) 243-6510
EMAlL: attorney@ssfl-law,com
WEST SHORE OFFICE:
2109 MARKET STREET
CAMP HILL. PA 17011
TELEPHONE: (717)737-3405
FACSIMILE: (717)737.3407
REPLY TO CARLISLE
June 20, 2002
Melissa L. Van Eck, Esquire
Metzger, Wickersham, Knauss & Erb
3211 North Front Street
Harrisburg, PA 17109
t(Q)~1f
RE: WILLIAMS v. WILLIAMS
YOUR FILE NO. 86-41
Dear Melissa:
I am enclosing a copy of my Certification of Discovery to the Court. I have had
an opportunity to review all of the discovery provided, and it is deficient in the following
manners:
1. There are seven bank accounts for Mr. Williams, but none of the statements
provided for December 11, 1999, or for the date of the marriage, June 27, 1998.
We need those statements so that we can determine the marital value of those
accounts.
2. There is no information in the file regarding the General Motors salaried
retirement program; only information regarding the stock option/savings program.
Can you provide me a plan booklet so I can have the pension valued?
3. In discovery, you reveal that Mr. Williams has the option to purchase 75 shares
of GM stock. I enclose the May 14, 1999 letter that you provided. The check
marks in the left hand column indicate documents which would help us value that
option. For instance, I do not know how long the option period is. Would you
please provide the special edition of the Total Compensation Bulletin, the 1999
GM stock option prospectus and plain language version, and the additional stock
option information that Mr. Williams was to have received in the Fall of 1999 with
specifics on how to exercise the option.
,..<i'-MU"',,"~~
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June 20,2002
Page 2 of2
4. With regard to the savings stock purchase program, we need the value of that
program on the date of the parties' marriage. I note that all of the loans against
the program have been taken subsequent to separation and possibly impair the
ability of that entitlement to be alienated. Apparently Mr. Williams, post-
separation, borrowed nearly the entire value of the savings stock option plan.
5. Please provide the cash value of the State Farm Life Insurance policy, both as of
the date of the marriage and as of the date of separation.
6. Please advise whether Mr. Williams has retained his GM Life Insurance policy
and whether it, too, has a cash value or is term life.
Not until we receive this information will we be in a position to negotiate or litigate
this case. I look forward to your soonest response.
Very truly yours,
SAlOIS, SHUFF, FLOWER & LINDSAY, P,C.
Ctuit-
Carol J. Lindsay
CJUtjb
Enclosure
cc: Adelaida C, Williams
E Robert Elicker, iI. Esquire (Div Mast)
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SC Ricbland Ln Apt T12
Camp Hill, PA 17011-2476
1,,,111,,,111,,,,,.11,,.11,,1,1.1,,11,,,1,11,,11,,,,.1,11,1,,1
May 14, 1999
Dear Salaried Employee:
Congratulations!
Based on General Motors' business performance in 1998, we are pleased to provide stock options once again to eligible U.S. and
Canadian classified employees. Stock options, combined with your direct pay, variable pay cash, and benefits, remforce GM's
commitment to provide a total compensation package that is aligned with business success and contInues to be competitive
with premier industrial companies of the Fortune SO, GM remains the only automotive manufacturer to offer broad based stock
options to its salaried workforce.
Stock options provide you with the opportunity to purchase GM's $1-2/3 par value common stock at a pre-established price over
a defined period of time. GM provides stock options so you and your family can directly share in the success you help create.
Provided below is a history of the stock option grants you received as part of the 1998 and 1999 Variable Pay ProgTaIns.
Gl'lIl1t Date
January 11, 1999
January 12, 1998
Number of Stock Optioos
75
75
Stock Option Price
$85.97 US
$56,00 U.S.
J
Please note that in connection with the complete separation of Delphi Automotive Systems, the number of shares and the stock
option price, associated with both grants, will be adJusted to reflect GM's lower stock price. Although the stock price is expected
to be lower, the value of your options will be preserved when a formula, prescribed by the Generally Accepted Accounting
Ptinciples, is used to adjust both the number of shares covered by outstanding options and the exercise prices. This information
will be communicated, following the separation date of May 28,1999, in a special edition of the Total Compensation Bulletin.
,.; Enclosed is the 1999 GM Stock Option Prospectus and Plan Language which have been re-written in a style that is easy to read.
Refer to these documents for complete information concerning your stock option grant. Also included in your packet is a
Beneficiary Designation Form. If you have not completed this form or wish to change your beneficiary designation, please
complete and return the form as. soon as possible, If you completed a beneficiary form last year and the beneficiary designation
remains the same, you do not need to complete another fonn.
I This Fall you 'Yill receive additional stock option information, including specifics on how to exercise your options. If you have any
questions on the Stock Option Plan, your individual grant or designation of your beneficiaries, please call the following numbers
based on your country assignment
--
u.s. Employees
Canadian Employees
1-800-489-GMGM (4646)
1-800-945-GMGM (4646)
GM Investment Service Center
Fidelity Emplo~ Service Centre
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Remember, when your actions support GM meeting its business objectives, you influence the long-term success of GM-an
important element in determining the ultimate value of your stock options. You can hell' GM meet its business objectives by
improving the quality of your daily work, exceeding customer expectations, speeding delivery, cutting scrap, working safely and
controlling expenses while achievmg the same or better results, This year, GM is introducing The Enhanced Variable Pay ProgTam
for salaried employees. You will be hearing more about this initiative and how your future payout opportunities, in the form of
cash and/or stock options, can be enhanced when you help GM achieve greater business success.
Sincerel);,
~~4~
Vice President, Global Human Resources
74541.001
L.GM-STOCK-599
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SHUFF, FLOWER
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26 W. High Street
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Adelaida Castaneda Williams,
Plaintiff,
PENNSYLVANIA
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY,
vs.
: NO. 2001 -1617
CIVIL TERM
Gordon Stanley Williams,
Defendant.
: IN DIVORCE
PLAINTIFF'S AFFIDAVIT OF CONSENT
UNDER 113301/el OF THE DIVORCE CODE
AND WAIVER OF COUNSELING
1, A Complaint in Divorce under 93301 (c) of the Divorce Code was filed March 21, 2001
2. The marriage of plaintiff and defendant is irretrievably broken and ninety days have elapsed
from the date of filing and service of the Complaint.
3. I consent to the entry of a final Decree in Divorce after service of notice of intention to
request entry of the Decree.
I verify that the statements made in this Affidavit are true and correct to the best of my
knowledge, information and belief. I understand that false statements herein are made subject to the
penalties of 18 Pa.C.S. 4904 relating to unsworn falsifica' n to authorities.
Date:
3J3{)/~4
/ /
PLAINTIFF'S WAIVER OF NOTICE OF INTENTION TO REQUEST
ENTRY OF A DIVORCE DECREE UNDER
II 3301 leI 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, lawye~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 to the
best of my knowledge, information and belief. I understand that false statement herein are made
subject to the penalties of 18 Pa,C,S, 4904 relating to u 0 f sification to aut rities
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IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - DIVORCE
PACSES NO. 924103734
NO. 01-1617 CIVIL TERM
ADELAIDA C. WILLIAMS,
Plaintiff/Petitioner
GORDON S. WILLIAMS,
Defendant/Respondent
ORDER OF COURT
AND NOW, this 8th day of November, 2002, the Court being
advised that the Plaintiff has withdrawn her request for a hearing de novo to our
order of June 13, 2002, and that the Defendant consents to the withdrawal, said
order of June 13, 2002, is affirmed as a final order.
CC: Adelaida C. Williams
Carol J. Lindsay, Esquire
For the Plaintiff
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Gordon S. Williams
Andrew C. Spears, Esquire
For the Defendant
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In the Court of Common Pleas of CUMBERLAND County, Pennsylvania
DOMESTIC RELATIONS SECTION
ADELAIDA C. WILLIAMS ) Docket Nwnber 01-1617 CIVIL
Plaintiff )
vs. ) PACSES Case Number 924103734
GORDON S. WILLIAMS )
Defendant ) Other State ID Number
ORDER
AND NOW, to wit, on this
9TH DAY OF JUNE, 2004
IT IS HEREBY
ORDERED that the support order in this case be 0 Vacated or OSuspended or
<i> Terminated without prejudice or 0 Terminated and Vacated,
effective JANUARY 1, 2004 , due to:
AN AGREEMENT OF THE PARTIES. THERE IS NO BALANCE DUE THE PLAINTIFF.
DRO: RJ Shadday
xc: plaintiff
defendant
Carol Lindsay, Esquire
Andrew Spears, Esquire
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JUDGE
Service Type M
Form OE-504
Worker ID 21005
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ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
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State Commonwealth of Pennsvlvania
Co.lCity/Dist. of CllMBERLAND
Date of Order/Notice 06/09/04
Tribunal/Case Number (See Addendum for case summary)
o Original Order/Notice
o Amended Order/Notice
@ Terminate Order/Notice
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9~YI0373V:
RE, WILLIAMS, GORDON S.
Employee/Obligor's Name (Last, First, MI)
366-40-0477
Employee/Obligor's Social Security Number
0322100482
Employee/Obligor's Case Identifier
(See Addendum for plaintiff names
associated with cases on attachment)
Custodial Parent's Name (Last, First, MI)
EmployerM'ithholder's Federal EIN Number
PENSION ADMINISTRATION CENTER
PO BOX 5014
SOUTHFIELD MI 48086-5014
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support
from CllMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these
amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not
issued by your State.
$ 0.00 per month in current support
$ 0.00 per month in past-due support Arrears 12 weeks or greater? Oyes <Xl no
$ 0.00 per month in medical support
$ 0.00 per month for genetic test costs
$ per month in other (specify)
for a total of $ 0.00 per month to be forwarded to payee below.
You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match
the ordered support payment cycle, use the following to determine how much to withhold:
$ 0 . 00 per weekly pay period.
$ 0.00 per biweekly pay period (every two weeks).
$ 0.00 per semimonthly pay period (twice a month).
$ 0.00 per monthly pay period.
REMITTANCE INFORMATION:
You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this
Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to
deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the
allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's! obligor's
aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is
needed (See #10 on pg. 2),
If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer
Customer Service at 1-877-676.9580 for instructions.
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown
above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BY MAIL.
Date of Order:
JUN 1 0 2n04
Servi ce Type M
OMB No.: 0970-0154
Form EN-028
Worker ID $OINC
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ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
LJ If !;hecked you are required to provide a copy of this fomi to you, employee. If your employe~ works in.a state that is
ditterent from the state that issued this order, a copy must be prov,ded to your empioyee even lithe box 15 not checked.
1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned
businesses located on a reservation that choose to withhold in accordance with this notice.
2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income,
Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting
agency listed below.
3, Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to
each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each
employee/obligor.
4.' Repoltil,g t1,c Pa,datelDate of W;t1,I,,,ldil ,g. You ",u,t '.po,l 11,. p",dateld",., of ..iti ,I ,oldir.g ..I,." ,,,,dir.g the fl",l"er,t. Tl.e
pa,date;'d"tt, of ..itl,l,oidir.g is the date 0" ..I,id, a,,,ou,,t ..as ..ithl.eld ['0'" t1,e en,pl",,,,', .."ges. You must comply with the law of the
state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the
withholding order and forward the support payments.
5.' Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against
this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow
the law of the state of employee's/obligor's principal piace of employment. You must honor all Orders/Notices to the greatest extent
possible. (See #10 below)
6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you,
Please provide the Information requested and return a copy of this Order/Notice to the Agency identified below.
WITHHOLDER'S ID: 3146100172
EMPLOYEE'S/OBLlGOR'S NAME:
EMPLOYEE'S CASE IDENTIFIER:
LAST KNOWN HOME ADDRESS:
NEW EMPLOYER'S NAME/ADDRESS:
WILLIAMS. GORDON S.
0322100482 DATE OF SEPARATION:
7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have any questions about lump sum payments, contact the person or authority below.
8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have
withheld from the employee/obligor's income and other penalties set by Pennsylvania State law, Pennsylvania State law governs unless
the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment,
refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law
governs unless the obligor is employed in another State, in which case the law of the State in which he or s,he is employed governs.
10.' Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (15 U.s.c. ~1673 (b)l; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment.
The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory
deductions such as: State, Federal, local taxesi Social Security taxes; and Medicare taxes.
11. Additional Info:
'NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the
law of the state that issued this order with respect to these items.
Submitted 8y: If you or your employee/obligor have any questions,
DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT
13 N, HANOVER ST by telephone at (717) 240-6225 or
P.O, BOX 320 by FAX at (717) 240-6248 or
CARLISLE PA 17013 by internet www.childsupport.state.pa.us
Page 2 of 2
Form EN-028
Worker ID $OINC
Service Type M
OMB No.: 0970-0154
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