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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
.
JASON M. CARRUTHERS,
PENNA,
STATE OF
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No. 01-3833 civil Term
Plaintiff
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VERSUS
KELLIE S. CARRUTHERS,
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Defendant
IN DIVORCE
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DECREE IN
DIVORCE
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D eL-C- vz.., 10 cV {9
, 2.00 I , IT IS ORDERED AND
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AND NOW,
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JASON M. CARRUTHERS
DECREED THAT
, PLAINTIFF,
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KELLIE S. CARRUTHERS
, DEFENDANT,
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ARE DIVORCED F'ROM THE BONDS OF MATRIMONY,
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THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE
BEEN RAISED of RECORD IN THIS ACTION FOR WHICH A FINAL ORDER HAS NOT
YET BEEN ENTERED;
NONE.
The terms of the Marital Settlement Agreement dated
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May 25, 2001, are incorporated but not merged into this Decree
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in Divorce.
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AT
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PROTHONOTARY
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SAIDIS
SHUFF, FLOWER
& UNDSAY
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26 W. High Slreet
Carlisle. PA
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JASON M. CARRUTHERS,
Plaintiff
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: CIVIL ACTION - LAW
: NO. 01- 3833 CIVIL TERM
VS.
KELLlE S. CARRUTHERS,
Defendant
: IN DIVORCE,
PROPERTY SETTLEMENT AND SEPARATION AGREEMENT
THIS AGREEMENT made this c?~ay of ./??~
2001,
between JASON M. CARRUTHERS, of 507 Sarah Court, Mechanicsburg, Cumberland
County, Pennsylvania, hereinafter referred to as Husband,
A
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KELLlE S. CARRUTHERS, of 5815 Spring Tree Court, Enola, Cumberland County,
Pennsylvania, hereinafter referred to as Wife,
RECITALS:
R.1: The parties hereto are husband and wife, having been joined in marriage on
August 14,1993 in Holyoke, Colorado; and
R.2: A Complaint for Divorce has been filed in the Court of Common Pleas of
Cumberland Commonwealth of Pennsylvania, to Number 01 - 3833 Civil Term; and
R.3: The parties' hereto desire to settle fully and finally their respective financial
and property rights and obligations including, but not limited, of all matters between
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SHUFF. FLOWER
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them relating to the ownership of real and personal property, claims for spousal support,
alimony, alimony pendente lite,
NOW THEREFORE, in consideration of the covenants and promises hereinafter
to be mutually kept and performed by each party, as well as for other good and valuable
consideration and intending to be legally bound, it is agreed as follows:
(1) SEPARATION: It shall be lawful for each party at all times hereafter to live
separate and apart from the other party at such place or places as he or she from time
to time may choose or deem fit, free from any control, restraint or interference from the
other. Neither party will molest the other or endeavor to compel the other to cohabit or
dwell with him or her by any legal or other proceeding. Each party shall be free of the
interference, authority or contact by the other as if he or she was single and unmarried
except as maybe necessary to carry out the terms of this agreement.
(2) DIVORCE: The parties acknowledge that the marriage is irretrievably broken
and that they will secure a mutual consent no-fault divorce decree in the above-
captioned divorce action, and will execute and file the necessary documents to finalize
the divorce after the expiration of ninety (90) days of the service of the Complaint and
the moving party shall move for the entry of the divorce decree at that time,
(3) REAL PROPERTY: The parties are the owners of certain real estate with
improvements thereon erected and known and numbered as 507 Sarah Court,
Mechanicsburg, Cumberland County, Pennsylvania, The marital home shall be listed
for sale with a real estate agent satisfactory to both parties, Upon the sale of the marital
home, the parties will equally divide the proceeds after payment of the usual costs of
sale, Pending the sale, HUSBAND will reside in the marital home, and the parties will
contribute to the mortgage in the same proportion as they have heretofore,
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SHUFF, FLOWER
& LINDSAY
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26 W. High Street
CarU.le. PA
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(4) DEBT:
A, MARTIAL DEBT: The parties have no marital debt of any substance. Any
o igations which are jOint obligations or which the parties consider to be marital obligations
s II be paid from a joint account before being divided as set out hereafter.
B: Post Separation Debt: In the event that either party contracted or incurred
any debt since the date of separation on February 28. 2001. the party who incurred said
debt shall be responsible for the payment thereof regardless of the name in which the
debt may have been incurred.
C: Future Debt: From the date of this agreement neither party shall contract or
incur any debt or liability for which the other party or his or her property or estate might
be responsible and shall indemnify and save the other party harmless from any and all
claims or demands made against him or her by reason of debts or obligations incurred
by the other party
(5) MOTOR VEHICLES: Each party relinquishes any right, title and interest he
or she may have to any and all motor vehicles currently in possession of the other party.
Within ten (10) days of the date of this agreement each party shall execute any
documents necessary to have said vehicles property registered in the other party's
name with the Pennsylvania Department of Transportation, Each party shall assume
full responsibility of any encumbrance on the motor vehicle received by said party, and
shall hold harmless and indemnify the other party from any loss thereon. HUSBAND
will retain the 1993 Chevrolet Truck, and WIFE will retain the 1998 Grand Prix. WIFE
will be solely and exclusively responsible for the payment of the loan to Intrust Bank and
shall indemnify and hold HUSBAND harmless on account of any loss thereon,
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SHUFF, FLOWER
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26 W. High Sireet
CarUsI.. PA
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(6) TANGIBLE PERSONAL PROPERTY: The parties hereto mutually agree
that they have effected a satisfactory division of the fumiture, household fumishings,
appliances, tools and other household personal property between them, and they have
attached hereto as Exhibit "A" all tangible personal property which shall be WIFE's.
WIFE will remove the property on Exhibit "A" from the marital home at least ten (10)
days prior to its sale,
.
(7) INTANGIBLE PERSONAL PROPERTY: Each party hereby relinquishes any
right, title or interest he or she may have in or to any intangible personal property
currently titled in the name of or in the possession of the other party, including, but not
limited to, stocks, bonds, insurance, bank accounts, individual retirement accounts,
employment benefits including retirement accounts, savings plans, pension plans, stock .
plans, 401 K plans and the like. Notwithstanding the above paragraph, the parties will
pay from their joint checking account at Commerce Bank in the approximate amount of
$8,000.00 such bills as they shall agree prior to the sale of the marital home. From the
joint savings account at Commerce Bank, HUSBAND will receive three-quarters of the
balance of that account in the approximate amount of $24,700,00 after payment of any
bills upon which the parties can agree. The parties shall not remove any funds from the
Commerce accounts without the express agreement of the other. WIFE will retain her
savings account at Community First National Bank in the approximate amount of
$18,200,00,
Further, the parties will equally divide the approximately 115 shares of
Purina Stock within ten (10) days of the date of this Agreement. The parties will
execute any and all documents required to affect the division. The AIM, Putnam and
Franklin Templeton Mutual Funds in the approximate amounts of $12,880,00,
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SHUFF, FLOWER
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26 W. !Ugh Street
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$4,780,00 and $5,720.00 respectively. Within ten (10) days of the date of this
Agreement, the parties will execute whatever documents are required by the mutual
funds to effect the transfer, The division shall be without tax consequence to either
party. By Qualified Domestic Relations Order WIFE will transfer to HUSBAND one-half
of her 401(k) plan with Purina Foods, Within ten (10) days of the date of this
Agreement, WIFE will provide to HUSBAND's counsel the requirements for the
preparation of a Qualified Domestic Relations Order with the Plan administrator for the
401 (k) plan. WIFE will cooperate in the signing of a Qualified Domestic Relations Order
equally dividing the plan within five (5) days of its presentation to her by Husband's
counsel.
HUSBAND waives any and all interest which he may have in WIFE's stock
options.
(8) ALIMONY: WAIVER OF ALIMONY: The parties acknowledge that each
has income and assets satisfactory to his and her own reasonable needs, Each
party waives any claim he or she may have one against the other for alimony,
spousal support or alimony and alimony pendente lite,
(9) ADVICE OF COUNSEL: The parties hereto acknowledge that each has
been notified of his or her right to consult with counsel of his or her choice, and have
been provided a copy of this agreement with which to consult with counsel. HUSBAND
is represented by Carol J, Lindsay, Esquire, and WIFE has been advised that she may
be represented by counsel of her choice. Each party acknowledges and accepts that
this agreement is, under the circumstances, fair and equitable, and that it is being
entered into freely and voluntarily after having received such advice and with such
knowledge as each has sought from counsel, and the execution of this agreement is not
.
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SHUFF, FLOWER
& UNDSAY
'.'\, .ATJ'OIlNBYSIIAT-LAW
26 W. High Street
Carlisle, PA
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the result of any duress or undue influence, and that it is not the result of any improper
or illegal agreement or agreements. Each party shall pay his or her own attomey for all
legal serviGes rendered or to be rendered on his or her behalf,
(10) ADDITIONAL INSTRUMENTS: Each of the parties shall from time to time,
at the request of the other, execute, acknowledge and deliver to the other party any and
all further instruments that may be reasonably required to give full force and effect to
the provisions of this Agreement.
(11) INCOME TAX: The parties have heretofore filed joint Federal and State
Tax retums. Both parties agree that in the event any deficiency in Federal, state or local
income tax is proposed, or assessment of any such tax is made against either of them,
each will indemnify and hold harmless the other from and against any loss or liability for
any such tax deficiency or assessment and any interest, penalty and expense incurred
in connection therewith, Such tax, interest, penalty or expense shall be paid solely and
entirely by the individual who is finally determined to be the cause of the
misrepresentations or failures to disclose the nature and extent of his or her separate
income on the aforesaid joint returns,
(12) ATTORNEYS FEES: WIFE will pay to HUSBAND one-half of his
attomey's fees and the cost of filing a Complaint in Divorce, WIFE will make payment
of this obligation within ten (10) days of presentation of a statement to her by
HUSBAND for attomey's fees and costs.
(13) BANKRUPTCY: The parties hereby agree that the provisions of this
Agreement shall not be dischargeable in Bankruptcy and expressly agree to reaffirm
any and all obligations contained herein. In the event a party files such bankruptcy and
pursuant thereto obtains a discharge of any obligations assumed hereunder, the other
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SHUFF, FLOWER
& LINDSAY
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Z6 W. High Street
Carllsle, PA
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party shall have the right to declare this Agreement to be null and void and to terminate
this Agreement in which event the division of the parties' martial assets and all other
rights determined by this Agreement including alimony shall be subject to court
determination the same as if this Agreement had never been entered into.
(14) COMPLETE DISCLOSURE: The parties do hereby warrant, represent,
acknowledge and agree that each is fully and completely informed of, and is familiar
with, the wealth, real and personal property, estate and assets, eamings and income of
the other and has made any inquiry he or she desires into the income or estate of the
other and received any such information requested. Each has made a full and complete
disclosure to the other of his and her entire assets, liabilities, income and expenses and
any further enumeration or statement thereof in this Agreement is specifically waived.
(15) RIGHTS AND RESPONSIBILITIES: Husband and Wife acknowledge that
each of them has read and understand his and her rights and responsibilities under this
Agreement and that they have executed this Agreement under no compulsion to do so
but as a voluntary act.
(16) FULL SETTLEMENT: Except as herein otherwise provided, each party
hereby releases the other from any and all claims, or demands up to the date of
execution hereof. It is further specifically understood and agreed by and between the
parties hereto that each party accepts the provisions herein made in lieu of and in full
settlement and satisfaction of any and all of said party's rights against the other for past,
present and future claims on account of support, maintenance, alimony, alimony
pendente lite, counsel fees, costs and expenses, equitable distribution of marital
property and any other claims of the party, including all claims which have been raised
or may be raised in an action for divorce,
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SAIDIS
SHUFF, FLOWER
& LINDSAY
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26 W. High Street
Carll,le. PA
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(17) RELEASE OF ALL CLAIMS: Except as may be otherwise specifically
provided in this Agreement, Husband and Wife, for themselves, their heirs,
representatives and assigns, each hereby forever releases, remises, discharges and
quitclaims the other, and such other's heirs, representatives, assigns and estate, from
and with respect to the following:
A. All liability, claims, causes of action, damages, costs, contributions
and expenses or demands whatsoever in law or in equity;
B, All rights, title, interest or claims in or to any property of the other,
whether real, personal or mixed and whether now owned or hereafter acquired;
C, All rights of courtesy and dower and all claims or rights in the
nature of courtesy and dower;
D. All widow or widower's rights;
E, All right, title, interest or claim in or to the other's estate, whether
now owned or hereafter acquired, including but not limited to all rights or claims:
(1) to take against the other's will;
(2) under the laws of intestacy;
(3) to a family exemption or similar allowance;
and
(4) all other rights or authority to participate or intervene in a
deceased spouse's estate in any way, whether arising under the laws of Pennsylvania
or any other country, territory, state or political subdivision,
F. All rights or claims to any accounting;
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SHUFF, FLOWER
& UNDSAY
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26 W. High Street
Carlisle, PA
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G, All rights, claims, demands, liabilities and obligations arising out of
or in connection with the marital relationship or the joint ownership of property, whether
real, personal or mixed;
H. All rights, claims, demands, liabilities and obligations arising under
the provisions of the Pennsylvania Divorce Code, as the same may be amended from
time to time, and under the provisions of any similar statute enacted by any other
country, state, territory or political subdivision;
I. All rights, claims, demands, liabilities and obligations each party now
has, or may hereafter have, against or with respect to the other.
(18) GOVERNING LAW: This Agreement shall be construed under the law of
the Commonwealth of Pennsylvania. If any provision of this Agreement is determined
to be invalid or unenforceable, all other provisions shall continue in full force and effect.
(19) INCORPORATION INTO DECREE: In the event that either of the parties
shall recover a final judgment or decree of absolute divorce against the other in a court
of competent jurisdiction, the provisions of this Agreement may be incorporated by
reference or in substance but shall not be merged into such judgment or decree and
this Agreement shall survive any such final judgment or decree of absolute divorce and
shall be entirely independent thereof.
(20) BREACH: In the event that either party breaches any provision of this
Agreement, he or she shall be responsible for any and all costs incurred to enforce the
Agreement, including, but not limited to, court cost and counsel fees of the other party.
In the event of breach, the other party shall have the right, at his or her election; to sue
for damages for such breach or to seek such other and additional remedies as may bi:t
available to him or her,
SAlOIS
SHUFF, FLOWER
& LINDSAY
_ ':-."~AN.AW
26 W. 1I1gb Street
Carlisle. PA
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(21) ENTIRE UNDERSTANDING: This Agreement constitutes the entire
understanding between the parties and there are no covenants, conditions,
representations, or agreements, oral or written, of any nature whatsoever, other than
those herein contained.
(22) AGREEMENT BINDING ON PARTIES AND HEIRS: This Agreement shall
bind the parties hereto, their respective heirs, executors and assigns.
IN WITNESS WHEREOF, the parties hereto intending to be legally bound have
hereunto set their hands and seals the day and year first written above,
WITNESS:
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JASON M. CARRUTHERS,
Plaintiff
vs.
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: CIVIL ACTION - LAW
: NO. 01- 3833 CIVIL TERM
KELLlE S, CARRUTHERS,
Defendant
: IN DIVORCE
PRAECIPE TO TRANSMIT RECORD
To the Prothonotary:
Transmit the record, together with the following information, to the court for entry of a
divorce decree:
1. Ground for divorce: irretrievable breakdown under Section 3301(c) 3301(el)(1) of
the Divorce Code. (Strike out inapplicable section).
2. Date and manner of service of the complaint: Acceptance of Service signed by
Defendant, Kellie S. Carruthers, dated July 28, 2001 and filed July 5, 2001.
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 December 10, 2001;
by the Defendant December 1, 2001.
(b) (1) Date of execution of the Plaintiffs affidavit required by Section
3301 (d) of the Divorce Code:
(2) Date of service of the Plaintiffs affidavit upon the Defendant: _
4. Related claims pending: None
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 Plaintiffs Waiver of Notice in 3301(c) Divorce was filed with
the Prothonotary: December 18, 2001.
Date Defendant's Waiver of Notice in 3301(c) Divorce was filed with the
Prothonotary: December 18, 2001.
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SAlOIS
SHUFF, FLOWER
& LINDSAY
ATI'ORNEYS-AT-LAW
26 W. High Street
Carlisle. PA
JASON M. CARRUTHERS,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. 01- 4[>03.3 CIVIL TERM
IN DIVORCE
vs,
KELLlE S. CARRUTHERS,
Defendant
NOTICE
YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set
forth in the following pages, you must take prompt action. You are warned that if you
fail to do so, the case may proceed without you and a decree 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, P.C.
Attorneys for Plaintiff
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By:
C r J. Lindsay, Esquire
I D 44693
26 West High Street
Carlisle, PA 17013
(717) 243-6222
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SHUFF, FLOWER
& LINDSAY
ATIORNEYSIATIUW
26 W. High Street
Carlisle, P A
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JASON M. CARRUTHERS,
Plaintiff
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: CIVIL ACTION . LAW
: NO. 01- 3 11 3.3 CIVIL TERM
V5.
KELLlE S. CARRUTHERS,
Defendant
: IN DIVORCE
COMPLAINT
JASON M. CARRUTHERS, Plaintiff, by his attomeys, SAlOIS, SHUFF,
FLOWER & LINDSAY, respectfully represents:
1. The Plaintiff is Jason M. Carruthers, who currently resides at 507 Sarah
Court, Mechanicsburg, Cumberland County, Pennsylvania, where he has resided since
1999.
2. The Defendant is Kellie S. Carruthers, who currently resides at 5812 Spring
Tree Court, Enola, Cumberland County, Pennsylvania, where she has resided since
February, 2001.
3. The Plaintiff and Defendant both have been bona fide residents in the
Commonwealth of Pennsylvania for at least six months immediately prior to the filing of
this Complaint.
4. The Plaintiff and Defendant were married on August 14, 1993 in Colorado.
5. That there have been no prior actions of divorce or for annulment between
the parties in this or in any other jurisdiction.
6. The Plaintiff avers that she/he 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.
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SHUFF, FLO~
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ATI'ORNEYS'AT'LAW
26 W. High Street
Carlisle. PA
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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.
Date:
II
WHEREFORE, Plaintiff requests the Court to enter a decree of divorce.
SAlOIS, SHUFF, FLOWER & LINDSAY, P.C.
Attorneys for Plaintiff
By:
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SAlOIS
SHUFF, FLOWER
& LINDSAY
ATIORNEYSIATlLAW
26 W. High Street
Carlisle, PA
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VERIFICATION
I, the undersigned, hereby verify that the statements made herein are true and
correct. I understand that false statements herein are made subject to the penalties of
18 Pa. C.S. S 4904, relating to unsworn falsification to authorities.
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Date:
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SAIDIS
SHUFF, FLOWER
& LINDSAY
ATIORNEYS-AT-LAW
26 W. High Street
Carlisle, PA
JASON M. CARRUTHERS,
Plaintiff
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: CIVIL ACTION - LAW
: NO. 01- 3833 CIVIL TERM
VS.
KELLlE S. CARRUTHERS,
Defendant
: IN DIVORCE
ACCEPTANCE OF SERVICE
I accept service of the Complaint in Divorce in the above captioned matter
o/;A3/ Ol
Date
Kelli S. Carruthers, Defendant
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SHUFF, FLOWER
& LINDSAY
ATIORNEYS-AT'LAW
26 W. High Street
Carlisle, P A
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DEe 1 3 2001
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JASON M. CARRUTHERS,
Plaintiff
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: CIVIL ACTION - LAW
: NO. 01- 3833 CIVIL TERM
VS.
KELLlE S. CARRUTHERS,
Defendant
: IN DIVORCE
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under !!l3301 (c) of the Divorce Code was filed on
June 22, 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 falsification to
authorities.
:Jason M. Carruthers,
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JASON M. CARRUTHERS,
Plaintiff
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: CIVIL ACTION - LAW
: NO. 01- 3833 CIVIL TERM
vs.
KELLlE S. CARRUTHERS,
Defendant
: IN DIVORCE
WAIVER OF NOTICE OF INTENTION TO REQUEST
ENTRY OF A DIVORCE DECREE UNDER
s3301{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 statements herein are
made subject to the penalties of 18 Pa.C.S. 4904 rating to unsworn falsification to
authorities.
son M. Carruthers, Plaintiff
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JASON M. CARRUTHERS,
Plaintiff
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: CIVIL ACTION - LAW
: NO. 01- 3833 CIVIL TERM
vs.
KELLIE S. CARRUTHERS,
Defendant
: IN DIVORCE
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under ~3301 (c) of the Divorce Code was filed on
June 22, 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 unswom falsification to
authorities.
IlIe S. Carruthers, Defendant
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JASON M. CARRUTHERS, : IN THE COURT OF COMMON PLEAS OF
Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA
vs. : CIVIL ACTION - LAW
: NO. 01- 3833 CIVIL TERM
KELLlE S. CARRUTHERS,
Defendant : IN DIVORCE
WAIVER OF NOTICE OF INTENTION TO REQUEST
ENTRY OF A DIVORCE DECREE UNDER
!i3301lcl 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 statements herein are
made subject to the penalties of 18 Pa.C.S. 4904 relating to unsworn falsification to
authorities.
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Kelle S. Carruthers, efendant
Date: CL.t \ \ ~ (
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MAR 1 2 2002)
JASON M. CARRUTHERS,
Plaintiff
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: CIVIL ACTION . LAW
: NO. 01- 3833 CIVIL TERM
vs.
KELLlE S. CARRUTHERS,
Defendant
: IN DIVORCE
NOW, this
QUALIFIED DOMESTIC RELA TIONS ORDER
PURINA MILLS RETIREMENT SA VINGS PLAN
r3}4
, 2002, upon
fVI ?J ,::.L,
day of
the Agreement of the parties, it is hereby ordered and directed as follows:
A. Definition ofTerms.
1. The term "Domestic Relations Order" means a Judgment, Decree, or
Order (including approval of a property settlement agreement) which:
(a) Relates to the provision of child support, alimony/maintenance
payments, or marital property rights to a spouse, former spouse,
child or other dependant of a Participant; and
(b) Is made pursuant to a state domestic relations law.
2. The term "Qualified Domestic Relations Order" means a Domestic
Relations Order which:
(a) Creates or recognizes the existence of an Alternate Payee's right
to, or assigns to an Alternate Payee the right to, receive all or a
portion of the benefits payable with respect to a Participant under
a qualified retirement plan;
(b) Clearly specifies certain facts, as set forth in Paragraph B,
herein;
(c) Does not alter the amount or form of benefits under a plan, as
set forth in Paragraph C herein.
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SHUFF, FLOWER
& LINDSAY
A'ITORNEYS-AT-LAW
26 W. High Street
Carlisle. PA
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3. The term "Participant" means the employee. The Participant's name,
Social Security Number, date of birth, and last know mailing address are
as follows:
NAME:
SS#:
D/O/S:
MAILING ADDRESS:
Kellie S. Carruthers
508-84-6723
December 11, 1972
4106 Nantucket Drive
Mechanicsburg, PA 17050
4. The term "Alternate Payee" means a spouse, former spouse, child, or
other dependent of a Participant who is recognized by a Qualified
Domestic Relations Order as having a right to receive all, or a portion of,
the benefits payable under a plan with respect to such Participant, and,
for purposes of the Employee Retirement Income Security Act of 1974
(herein called 'ERISA"), shall be considered a beneficiary under the plan.
The Alternate Payee's name, Social Security Number, date of birth, and
last know mailing address are as follows:
NAME:
SS#:
D/O/S:
MAILING ADDRESS:
Jason M. Carruthers
507-94-0723
September 1, 1971
80 Sali Hai Road
Mechanicsburg, Pennsylvania 17050
S.
Factual recitals required and provisions regarding the certain andlor assignment
of retirement benefits.
The following facts are relevant to the creation andlor assignment of retirement
benefits provided herein and are required by Section 414(p)(2) of the Code.
1. Name of the plan to which this Order applies: Purina Mills Retirement
Savings Plan (hereinafter the "Plan").
:
SAlOIS
SHUFF, FLOWER
& LINDSAY
ATTORNEYS'AT'LAW
26 W. High Street
Carlisle, PA
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2. The Alternate Payee shall receive fifty (50%) percent of the Participant's
vested Account balance in the Plan determined as of February 15, 2001,
payable ratably from each of the Participant's vested Plan Accounts, other
than a loan account. Such amount shall be adjusted for investment gains
and losses from the determination date until the date of distribution to the
Alternate Payee.
3. Number of payments or period to which this Order applies: Until all sums
due the Altemate Payee are paid.
C. Covenants regarding nonalteration of benefits. Pursuant to Section 414(p)(3) of
the Code. The Order:
1. Does not require the Plan to provide any type or form of benefit, or any
option, not otherwise provided under the Plan;
2. Does not require the Plan to provide increased benefits (determined on
the basis of actuarial value); and
3. Does not require the payment of benefits to an Alternate Payee which are
required to be paid to another Alternate Payee under another Order
previously determined to be a Qualified Domestic Relations Order.
D.
Payment of retirement benefits as provided herein shall be made to the Alternate
Payee in the form of a lump sum rollover into an IRA designated by the Alternate
Payee and shall be paid as soon as permissible under the terms of the Plan.
E.
Miscellaneous provisions.
1. It is intended that this Order will qualify as a Qualified Domestic Relations
Order and that the provisions herein shall be administered and interpreted
in conformity with the law.
. .
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SAlOIS
SHUFF, FLOWER
& LINDSAY
ATIORNEYS'Al"LAW
26 W. High Street
Carlisle. P A
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2. This Order is issued pursuant to Pennsylvania law relating to the
provision of child support, alimony payments, or marital property rights of
a spouse, former spouse, child, or other dependent of the Participant.
3. The Court retains jurisdiction to amend this Order, but only for the
purpose of establishing or maintaining its qualification as a Qualified
Domestic Relations Order; orovided. that. no such amendment shall
require the Plan to provide any type or form of benefit or any option not
otherwise provided under this Plan; orovided. further, that no such
amendment or the right of the Court to so amend will invalidate this Order
as "qualified".
4. A certified copy of this Order shall be served upon the Plan Administrator
forthwith. Said Order shall take effect immediately and remain in effect
until further Order of Court.
IT IS THEREFORE, BY THE COURT CONSIDERED, ORDERED, ADJUDGED
AND DECREED that the above and foregoing constitute and are incorporated herein as
the Order of this Court.
IT IS BY THE COURT SO ORDERED.
J.
J n ~.~ Plaintiff
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