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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
PENNA.
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STATE OF
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STEPHEN ZIMMERMAN
No. 01-5925 CIVIL TiRM
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VERSUS
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KIM ZIMMERMAN
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DECREE IN
DIVORCE
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,2006 , IT IS ORDERED AND
AND NOW,
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DECREED THAT Stephen Zimmerman.
AND
Kim Zimmerman
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ARE DIVORCED FROM THE BONDS OF MATRIMONY.
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, PLAINTIFF,
, DEFENDANT,
THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE
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YET BEEN ENTERED;
BEEN RAISED OF RECORD IN THIS ACTION FOR WHICH A FINAL ORDER HAS NOT
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PROTHONOTARY
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STEPHEN ZIMMERMAN,
Plaintiff
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
v.
: CIVIL ACTION
: IN DIVORCE
KIM ZIMMERMAN,
NO. S - 2001-5925
Defendant
MARITAL SETTLEMENT AGREEMENT
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THIS AGREEMENT is made this ~day of
tfI..,/
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, 2006, between Plaintiff, Stephen
Zimmerman ("Husband"), and Defendant, Kim Zimmerman ("Wife").
WHEREAS, Husband and Wife desire to enter into an agreement as to all economic
issues between the parties, except child support which is docketed at Zimmerman v.
Zimmerman, Docket No. 01186-DR-05, PACSES Case Number 022102256, and to have this
agreement made an Order of Court;
NOW, THEREFORE, Wife and Husband, each intending to be legally bound hereby,
agree as follows:
DIVORCE
I. The parties have lived separate .and apart since June of 1999.
2. Upon fulfillment of the provisions contained herein, both parties shall promptly file all
necessary papers to finalize the divorce pursuant to Section 3301(c) or 3301(d) of23 Pa.
C.S.
PERSONAL PROPERTY
3. Upon signing this Agreement, Husband shall grant Ryan Zimmerman access to the
marital residence at 15 Wayne Road, Camp Hill, Pennsylvania 170 II, and shall allow Ryan
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Zimmerman to take the dresser which Wife believes to be located in the bedroom of the marilal
residence and deliver the dresser to Wife as her sole property.
4. Wife hereby assigns to Husband all of her rights in any other furniture, furnishings, rugs,
household equipment and appliances, pictures, books, works of art, and any other items of
tangible property of whatever nature which are presently located in the marital residence other
than the dresser specified in Paragraph 3. These items shall constitute the sole property of
Husband.
REAL PROPERTY
5. The parties jointly own real estate, the marital residence"located at 15 Wayne Road,
Camp Hill, Pennsylvania 170 II.
6. The parties agree that Husband shall pay $20,000 to Wife in exchange for Wife releasing
and renouncing any further legal or equilable interest in said real estate upon receipt of payment
in full. Husband shall refinance and retitle said real eslate in his own name. Husband shall
assume sole responsibility for any mortgages and any other debt associated with said real estate
upon refinancing and retitling it in his own name. The parties shall cooperate in executing any
legal papers to allow Husband to refinance the real eslate in his own name and retitle it in his
own name. The parties agree that they shall fulfill~.Of~. -5:1!?ns specified in this
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paragraph by no later than ~1, 2006. Time sha I be 0 the essence.
RETIREMENT PLAN
7. Wife shall be entitled to one half of the fixedarmuity of Husband's IBM Retirement Plan.
Wife's counsel, the Family Law Clinic, shall assume primary re~ponsibi1ity for drafting a
Qualified Domestic Relations Order to submit to the court for its approval, and to submit to
Husband's employer's pension plan administrator.
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8. Wife shall bear sole responsibility for paying any costs or expenses that may be incurred
in drafting, preparing, or filing said Qualified Domestic Relations Order.
MEDICAL INSURANCE COVERAGE
9. Husband shall continue to provide medical coverage for Wife until the entry of the
divorce decree.
AIMONY. ALIMONY PENDENTE LITE. SPOUSAlL SUPPORT
10. Husband and Wife do hereby waive, release, discharge and give up any rights which
either may have against the other to receive alimony, alimony pendent elite, spousal support, or
other post-divorce maintenance or support. From the date of entry of the divorce decree, it shall
be the sole responsibility of each party to sustain himself or herself without seeking support from
the other, except this shall not affect child support which is docketed at Zimmerman v.
Zimmerman, Docket No. 01 I 86-DR-05, P ACSES Case Number 022102256.
REMEDIES
II. If either party breaches any provision of this agreement, the other party shall have the
right, at his or her election, to sue for damages for such breach, and seek any other remedy
allowed under Pennsylvania law.
BINDING ON PARTIES AND OTHERS
12. This agreement shall be binding on the parties and their respective heirs, executors,
administrators and assigns.
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INCORPORATION
13. The parties intend this agreement to be incorporated, but not merged, into the divorce
decree. This agreement shall continue in full force and effect after such time as a final decree in
divorce may be entered with respect to the parties.
MODIFICATION TO BE IN WRITING
14. No modification or waiver of any of the terms hereof shall be valid unless in writing and
signed by both parties.
LA WOF PENNSYLVANIA APPLICABLE
15. This Agreement shall be construed in accordance with the laws of the Commonwealth of
Pennsylvania.
INTEGRATION
16. This Agreement constitutes the entire understanding of the parties and supersedes any
and all prior agreements and negotiations between them. There areno representations or
warranties other than those expressly set forth herein.
NO WAIVER OF DEFAULT
17. This Agreement shall remain in full force and effect. The failure of either party to insist
upon strict performance of any of the provisions of this Agreement shall in no way affect the
right of such party thereafter to enforce the same, nor shall the waiver of any breach of any
provision hereof be construed as a waiver of any subsequent default of the same or similar
nature, nor shall it be construed as a waiver of strict performance of any other obligations herein.
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ADDRESSES OF PARTIES
18. As long as any obligations remain to be performed pursuant to the provisions of this
Agreement, each party shall have the affirmative obligation to keep the other informed of his or
her residence address, and shall promptly notify the other in writing of any change of address by
giving the new residence address.
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19. Each of the parties has carefully read and fully considered this Agreement and all
of the statements, terms, conditions, and provisions thereof, and has consulted with
counsel prior to signing below.
S~RMAN
Plaintiff
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Defendant
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GAIL GUIDA-SOUDERS, ESQ.
Guida Law Offices, P.C.
111 Locust Street
Harrisburg, P A 1710 1
(717) 236-6440
Attorney for Plaintiff
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ROBERT LASCHER
Certified Legal Intern
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ROBERT E. RAINS
THOMAS M. PLACE
LUCYJOHNSTON- WALSH
ANNE MACDONALD-FOX
Supervising Attorneys
FAMILY LAW CLINIC
45 North Pitt Street
Carlis1~, P A 17013
717-243-2968
Attorneys for Defendant
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IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 01-5925 CIVIL TERM
STEPHEN ZIMMERMAN
Plaintiff
KIM ZIMMERMAN
Defendant
CIVIL ACTION - 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. Grounds for divorce: irretrievable breakdown under Section 0 3301 c (X) 3301 d ofthe
Divorce Code (Check applicable code)
2. Date and manner of service of the complaint: October 18, 2001 by Registered Mail.
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: Plaintiff-July 13, 2006, Defendant-July 25, 2006.
(B) (1) Date of execution of the plaintiffs affidavit required by Section 3301 (d)
of the Divorce Code: July 13,2006
(2) Date of filing and service of the plaintiff s affidavit upon the respondent
filed: Filed plaintiff s affidavit on July 20, 2006;
Related claims pending: settled by written agreement on: May 30, 2006
4. (Complete eith@r (B).)
(A) Date and manner of service of the notice of intention to file praecipe to
transmit record, a copy of which is attached: Service made to attorney on July
25,2006
(B) (1) Date plaintiffs Waiver of Notice in ~ 3301 (c) Divorce was filed with the
Prothonotary:
(2) Date defendant's Waiver of Notice in ~ 3301 (c) Divorce was filed with
the Prothonotary:
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STEPHEN ZIMMERMAN
PLAINTIFFIRESPNODENT
VS
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUN'll'Y, PENNSYLVANIA
: CIVIL ACTION - CUSTODY
KIM ZIMMERMAN
DEFENDANTIPETITIONER
: NO. 01-5925 CIVIL TERM
I, Gillian Woodward, Legal Intern, on behalf of my client, Kim Zimmerman, accept
service of the Notice of Intention to Request Entry of a Divorce Decree and Mfidavit Under
Section 3301 (d) of the Divorce Code I certify that I am authorized to do so.
Datell2,.;"'51b'o
G' lian Woodward, Legal Intern
Dickenson Family Law Clinic
45 North Pitt Street
Carlisle, P A 17013
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STEPHEN ZIMMERMAN
PLAINTIFF
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY PENNSYLVANIA
VS
CIVIL ACTION - DIVORCE
KIM ZIMMERMAN
DEFENDANT
NO.
. 2001- fY1 ~~
NOTICE TO DEFEND
You have been sued in court. If you wish to defend against the claims set forth
in the foDowing pages, you must take action within twenty (20) days after this complaint and
notice are served, by entering a written appearance personally or by attorney lIlI1d filing in
writing with the court your defenses or objections to the claims set forth against you. You are
warned that if you fail t.o do so the case may proceed without you and a decree of divorce or
annuhnent 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 around for divorce is indignities or irretrievable breakdown of the
marriage, you may request marriage counseling. A list of marriage counselors is available in
the Office of the Prothonotary at the first floor in the Dauphin Court Courthouse, Front and
Market Streets, Harrisburg, Pennsylvania.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DMSION OF
PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE
OR ANNULMENT IS GRANTED, YOU MAY LOSE TIlE RIGHT TO
CLAIM ANY OF THEM.
YOU SHOULD TAKE THIS PAPER TO YOUR ~AWYER AT ONCE. IF
YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO
OR TELEPHONE THE OFFlCE SET FORm BELOW TO FIND OUT
WHERE YOU CAN GET LEGAL HELP.
Dauphin County Lawyer Referral Service
213 North Frout Street
Harrisburg, P A 17101
(717) 232-7536
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STEPHEN ZIMMERMAN
PLAINTIFF
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY PENNSYLVANIA
VS
KIM ZIMMERMAN
DEFENDANT
CIVIL ACTION - DIVORCE
12001 ..SQd6
NO.
COMPLAINT IN DIVORCE
AND NOW, comes the Plaintiff, Stephen Zimmerman, by his attorney, Gail Guida
Souders, Esquire, and pursuant to Section 3301 (d) of the Pennsylvania Divorce Code, seeks to
obtain a Decree in Divorce from the Defendant, Kim Zimmerman, upon the grounds set forth:
COUNT I
DIVORCE
1. 'The Plaintiff, Stephen Zimmerman, is an adult individual residing at 15 Wayne
Road, Camp Hill, Pennsylvania, 17011.
2. The Defendant, Kim Zimmerman, is an adult individual residing at 6303 Brandy
Lane, Mechaniesburg, Pennsylvania 17050.
3. Plaintiff has been bona fide resident of the Commonwealth of Pennsylvania for at
least six (6) months immediately previous to the filing olf this Complaint.
4. The Plaintiff and Defendant were married on October 20, 1979 in
Mechanicsburg, Pennsylvania.
5, Plaintiff has been advised of the availability of counseling and that Plaintiff may
have the right to request that the Court require the parties to participate in
counseling and does not request the same.
6, There have been no prior actions of divorce or annulment between the parties in
this or any other jurisdiction.
7. The Plaintiff and Defendant are both citizens of the Uuited States of America.
8, The Defendant is not an active member ofthe Armed Services of the United
States.
9. The parties have two children Kristen D.O.B. 4/24/87 and Shawn D.O.B. 1/23/89.
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10. The Plaintiff avers that the grounds on which the action is hased are:
(b) That the marriage is irretrievably broken under 23 Pa. Const. Stat. ~ 3301(d).
(b) The parties have been separated since June 10, 1999.
11. The plaintiff requests this Honorable Court to enter a Decree of Divorce.
WHEREFORE, Plaintiff requests your Honorable Court enter a Decree as
follows dissolving the marriage between the parties.
Respectfully submitted
.11Lt{ ~
Gail Guida Souders
Attorney for Plaintiff
Guida Law Offices
503 North Front Street
Harrisburg, PA 17101
Supreme Court ID # 68740
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I verify that the statements made in this Complaint are true llnd 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.
DATEI~i
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ATTORNEY FOR PLAINTIFF
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STEPHEN ZIMMERMAN
PLAINTIFF
: IN THE COURT OF COMMON PLEAS
: CUMBERLANDCOUNTY,PENNSYLVANIA
VS
: CIVIL ACTION - DIVORCE
KIM ZIMMERMAN
DEFENDANT
: NO. 01-5925 CIVIL TERM
CERTIFICATE OF SERVICE
I hereby certify that on October 18, 2001, I served a copy
of the Divorce Complaint upon Kim Zimmerman and in the manner
indicated below, which service satisfies the requirements of
Pennsylvania Rule of Civil Procedure. 403.
Service by U.S. Certified Mail to:
Gai Guida Souders, Esquire
Guida Law Offices, P.C.
111 Locust Street
Harrisburg, PA 17101
717-236-6440
Dated: August 18, 2006
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U'l MECHAHICSBURG PA 17050
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0 Restricted Delivery Fee $0.00
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I::l Total Pos,tage & Fees $ H.17
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.- Attac;h this card to the back of the mailpiece,
0l" on the front if space permits.
1. Article Addressed to:
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D. Is delivery address dltferen Item 1?
If YES, enter delivery address below:
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3. Service Type
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4. Restricted Delivery? (Extra Fee)
2. Article Number (Copy from service label)
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PS Form 38~ 1, July 1999 Domestic Return Receipt
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STEPHEN ZIMMERMAN
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
VS
CIVIL ACTION - DIVORCE
KIM ZIMMERMAN
Defendant
NO. 01-5925 CIVIL TERM
NOTICE
If you wish to deny any of the statements set forth in this
affidavit, you must file a counter-affidavit with in twenty days
after this affidavit has been served on you or the statements will
be admitted.
AFFIDAVIT UNDER
SECTION 3301 Cd) OF THE
DIVORCE CODE
1. The parties to this action separated on June 10, 1999 and
have continued to live separate and apart for a period of at least
two years.
2. The marriage of plaintiff and defendant is irretrievably
broken.
3. I understand that I may lose rights concerning alimony,
division of property, lawyer's fees or expenses if I do not claim
them before a divorce is granted.
I 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. ~ 4904 relating to unsworn
falsification to authorities.
DATE ~ I~l-I'l 2r/J;6(
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STEPHEN ZIMMERMAN
PLAINTIFFIRESPNODENT
VS
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
: CIVIL ACTION - CUSTODY
KIM ZIMMERMAN
DEFENDANTIPETITIONER
: NO. 01-5925 CML TERM
I, Gillian Woodward, Legal Intern, on behalf of my client, Kim Zimmerman, accept
service of the Notice of Intention to Request Entry of a Divorce Decree and Affidavit Under
Section 3301 (d) of the Divorce Code I certify that I am authorized to do so.
Datet / 2}5ltN)
G' ian Woodward, Legal Intern
Dickenson Family Law Clinic
45 North Pitt Street
Carlisle, PA 17013
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STEPHEN ZIMMERMAN
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
v.
CIVU, ACTION - DIVORCE
KIM ZIMMERMAN
Defendant
NO. 01 - 5925
PRAECIPE TO ENTER APPEARANCE
To the Prothonotary:
Please enter the appearance of the Family Law Clinic on behalf of Kim Zimmerman, the
Defendant, in the above-captioned matter,
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Date: 10 IMP 101
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GINA M. CARNES
Certified Legal Intern
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THOMAS M. PLACE
ROBERT E. RAINS
Supervising Attorneys
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STEPHEN ZIMMERMAN
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
v.
CIVIL ACTION - DNORCE
KIM ZIMMERMAN
Defendant
NO. 01 - 5925
CERTIFICATE OF SERVICE
I, Gina M. Cames, certified legal intern at the Family Law Clinic, hereby certify that I am
serving a true and correct copy of the Praecipe to Enter Appearance on Gail Guida Souders,
Esq., at Guida Law Offices, 503 North Street, Harrisburg, PA 17101, by depositing a copy
of the same in the United States mail, this 2{i'h day of October, 2001.
ci) VvliA / 1Jn. Cavne,)
Gina M. Cames
Certified Legal Intern
THE FAMILY LAW CLINIC
45 North Pitt Street
Carlisle, PA 17013
(717) 243-2968
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STEPHEN ZIMMERMAN
Plaintift7Respondent
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
v.
CIVIL ACTION - DIVORCE
KIM ZIMMERMAN
DefendantIPetitioner
NO. 01 - 5925
PETITION FOR ALIMONY AND EOUlTABLE DISTRIBUTION
AND NOW comes Kim Zimmerman ("Wife"), the defendant/petitioner in the above-
captioned divorce action, by and through her attorneys, the Family Law Clinic, and sets forth the
following petition for alimony and equitable distribution, pursuant to PaRe.P. No, 1920.15 (b):
ALIMONY
1. On or about October 16, 2001, the respondent Stephen Zimmerman,
("Husband") filed a complaint in divorce.
2. Wife and Husband were married on October 20, 1979,
3. Wife currently lives with her mother.
4. Wife is 44 years old and suffers from severe clinical depression which interferes
with her ability to work.
5. Wife is employed part-time at Weis Markets in Mechanicsburg, Pennsylvania.
6. Wife receives no medical or retirement benefits as a result of her employment
with Weis Markets.
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7. Wife did not have a regular income during the parties' marriage. She worked
sporadically, and spent most of the marriage as a homemaker, in accordance with Husband's
wishes.
8. Wife does not have a college education or any other post-high school training.
9. Husband is employed and is fmancially able to provide for the reasonable needs
of the petitioner.
10. Wife requires reasonable support to adequately maintain herself in accordance
with the standards of living established during the marriage.
11. Wife lacks sufficient property to provide for her reasonable needs and is
unable to support herself through full-time employment.
WHEREFORE, Wife requests the court to enter an award of reasonable alimony, and
such other relief as the Court deems just.
EQUITABLE DISTRIBUTION
12. Wife hereby incorporates by reference paragraphs 1 through 11.
13. The parties have acquired marital assets and debts subject to equitable
distribution under the Divorce Code, including, but not limited to the following:
a) Husband's pension, 401k accounts, retirement accounts, bank accounts;
b) Various items of personal property;
c) Various home furnishings; and
d) A marital home at 15 Wayne Road, Camp Hill, Pennsylvania 17011.
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WHEREFORE, Wife requests that this court equitably divide the marital property and
debts between the parties and grant such other relief as the Court deems just.
Respectfully submitted,
Date
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Gina M. Carnes
Certified Legal Intern
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TH S M. PLACE
ROBERT E. RAINS
TERI L. HENNING
Supervising Attorneys
F AMIL Y LAW CLINIC
45 North Pitt Street
Carlisle, PA 17013
(717) 243-2968
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VERIFICATION
I verify that the statements made in this Petition for Alimony and Equitable
Distribution are true and correct to the best of my personal 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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Date: .11 ;JJ,-61
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Kim Ann Zimme ,
Defendant/Petitioner
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CERTIFICATE OF SERVICE
I, Gina M. Carnes, Certified Legal Intern, Family Law Clinic, hereby certify that I served
a true and correct copy of Petition for Alimony and Equitable Distribution on Gail Guida Souders,
Esq., at Guida Law Offices, 503 North Street, Harrisburg, PA 17101, by depositing a copy of
the same in the United States mail, this 291h day of November, 2001.
J1~ 11l CJtIVYUD
Gina M, Carnes
Certified Legal Intern
THE FAMILY LAW CLINIC
45 North Pitt Street
Carlisle, PA 17013
(717) 243-2968
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STEPHEN ZIMMERMAN,
PlaintifflRespondent
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY,
: PENNSYLVANIA
v.
: CML ACTION - LAW
: IN DIVORCE
KIM ANN ZIMMERMAN
Defendant/Petitioner
: NO. 01-5925 CIVIL TERM
PRAECIPE TO PROCEED
IN FORMA PAUPERIS
To the Prothonotary:
Kindly allow Kim Ann Zimmerman, Defendant, to proceed in forma pauperis.
I, Gina M. Carnes, Certified Legal Intern in the Family Law Clinic, for the party
proceeding in forma pauperis, certify that I believe the party is unable to pay the costs and that I
arn providing freelegal service to the party.
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Date
Gina M. Carnes
Certified Legal Intern J
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TE 1. HENNING
THOMAS M. PLACE
ROBERT E. RAINS
Supervising Attorneys
THE FAMILY LAW CLINIC
45 North Pitt Street
Carlisle, PA 17013
(717) 243-2968
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STEPHEN ZIMMERMAN,
Plaintiff/Respondent
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY,
: PENNSYLVANIA
v.
: CIVIL ACTION - LAW
: IN DIVORCE
KIM ANN ZIMMERMAN
Defendant/Petitioner
: NO. 01-5925 CIVIL TERM
PRAECIPE TO PROCEED
IN FORMA PAUPERIS
To the Prothonotary:
Kindly allow Kim Ann Zimmerman, Defendant, to proceed in forma pauperis.
I, Gina M. Carnes, Certified Legal Intern in the Family Law Clinic, for the party
proceeding in forma pauperis, certify that I believe the party is unable to pay the costs and that I
am providing free legal service to the party.
\ \ I'd-q I 01
Date
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~arnes
Certi1i~~egal Inte~
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THOMAS M. PLACE
ROBERT E. RAINS
Supervising Attorneys
THE FAMILY LAW CLINIC
45 North Pitt Street
Carlisle, PA 17013
(717) 243-2968
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In the Court of Common Pleas of Cumberland
County, Pennsylvania
Phone:
Fax:
Plaintiff Name: fZtephen Zimmerman
DerendantName:Kim Zimmerman
Docket Number: 01 - 5925
PACSES Case Number:
Other State ID Number:
Please Dote: AD correspoDdence most inclDde tile PACSES 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 Supplemental Income Statement which appears on page twO of this income and expense
statement.)
INCOME STATEMENT OF _k"M Z\ VV\\'Y1e{rY\tln 1 De"\--lj\oan+ I Pe'h'..j,'CVlif
Section I: Income and Insurance .
INCOME:
Employer Wel'S ~V"~e.-\-s
Address <;;:iMfS"OVl ~-ef(1j ~t\~, f-.\'t'(~OU\iGc\o/M""~ I f'A 1"1-0Sci
Type of Work Cc<s!.\\ y
Pay toll No.'l;S1.\'ltL GtOSS Pay per Pay Period S II ~. "14. Pay Period (wkly., bi-wldy., ele.) w-<.e..~'f
/'
Itemized Payroll Deductions: A\JeV"PllA(!.. wee\Ll.J ~v'OvY\ l61"2.I/OI +0 1\ 1"1 (02-
Federal Withholding S 0 Social Security $ -:J-.DI1l Local Wage Tax S I. '60
Slate Income Tax s:3, I'! Retirement $ Savings Bonds s
Credit Union S Ufe Insurance s Hcallb iosomIce $
Other Deductions (specify) ,W<G- S 1.lnt:; $
S S
Ne. Pay pet Pay Period S \ 00 . (p \
OTHER (fill in Appropriate Column)
INCOME WEEK MONTH YEAR
mteresl $ S $
Dividends
Pension
Annuitv
Social Security
Rents
Royalties
Expense Account
Gifts
Unemflloyment
Workmen's
Comoensation
Other
Other
TOTAL S S S
TOTAL INCOME S (')
PROPERTY Ownership *
OWNED DESCRIPTION VALUE H W J
Checking Accounts S
Savings Accounts
Credit UDioD
SlockslBoDds
Real Estate ,
Other
TOTAL IS 0
* H~Husband; W~Wife; J~Joint
Service Type
Fonn IN-008
Worker ID
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Income and Expense Statemeot
PACSES Case Number
Coverage *
INSURANCE H W C
COMPANY POLICY #
Hospital A-e~ (hM.s:\P~'~") V V V-
Blue Cross
Other ,
Medical A-e-.-t-V\t1-...- C~us.\:>tlM'l: ') V </ (./
Blue Shield
Other
Health/Accident
Disability Income
Demal }Itt.-\Y'A.. (\1 R~\.?tl'vv1l~ ') V V V
Other
. H=Husband; W=Wife; C=Child
Section II: Sunplernental Income Statement
a. This form is to be fdied out by a person
o (J) who operates: a business or practices a profession, or
o (2) who is It member of a partnership or joint venture, or
o (3) who is a shareholder in and is salaried by a closed corporation or similar entity.
b. Anach 10 this statement a copy of the fOllowing documents relating to the partnership. joint venture. business, profession.
corporation or similar entity:
(I) lire IDOSl recenl Federal Income Tax RelUm. and
(2) the most recent Profit and Loss Statement
c. Name of business:
Address and telephone number:
d. Nature of bus..... (chf<k oDe)
o (l) panoership
o (2) joiot venture
o (3) professioD
o (4) closed corporation
o (5) other
e. Name of accountant, controller or other person in charge of [manciai records;
f. Annual income from business:
(1) How often is income received?
(2) Gross income per pay period:
(3) Net income per pay pctiod:
(4) Specifed deductions. ifany:
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Page 2 of3
FOnD IN-C08
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Income and Expense Statcmclll
Section III: Expenses
PACSES Case Numher
Inslru~tions: Only show eXlr..wrdinary expenses in this section unless you HUed oU( Section II on pag'-' 1\\\'. The categories
iD 1I0LD fONT are especially important for calculating child suppon, If you ate requesting Spousal SupportlAPL or if
you assert your case cannot be determined according to the guideline grids or formula. this section must be fuliy completed.
(Fill in Appropriare Column)
EXPENSES
WEEK MONTH YEAR
Home
Mongage/Rcnt $ - $ - $ -,
Maintenance - - -
Utilities -^ -
Electric $ .-- $ -' $ -
Gas -^ - -
Oil ~--, -,-- -
Telephone -- - --
Waler - - --
Sewer -_.- -- -"
Emnlovment
Public Transpon. $ $ .. $
Lunch ~ -..
Taxes
Real estate $ " $ .. $ --
Personal Propeny --' -
'lnsurance
Homeowner's $ - $ -,- $
Automobile -- ..
Life - -
Accident - ..
Health ..' ..
Othet ..
Automobile
Payments $ - $ $ -
Fuel IE
Repairs .. ..
Medical
Doctor $ $ -^ $ 46
Dentist 15
Orthodontist -, - -
Hospital -- -'
Medicine IS
special 0_
(g~:::.~~~~, .. - -
O-;"hD c, fVlCes
EXPENSES (FiU in A.ppropriale Column)
(continued) WEEK MONTH YEAR
EducatiOD
Ptivate School $ $ - $ -
Parochial School - - -"
College - -- -
Religious -
Personal
Clothing $ -- S - $ -rS
Food 230
Batherl - 15
H.irdre'~r -
Credit Payments
Credit Card - -- ~
Charge - -
Memberships - -' -
Loans
Credit Union $ S - $ -
Miscellaneous
Household Help S S $ -"
Cbiltlcare --"--
Papers!books -' -
M~'87ines -
Entenainmem -
Pay TV -
Vacalion ,
Gifts 5 -
LegaJ fees -
Charitable - -,
~lltio"" -
er t;bild -
AlimODY - -
P'~~ts -
Other
$ - $ $
I~~~nses: 1$ WEEK s3~Y~<{, $_ YEAR _
I verify that the, statement,s made in th!S ~ncome and Expense Statement are troe and correct. I understand that false
statem~nts herem are subject to the cnmmal penalties ~f 18 Pa. C.S. ~ 4904, relating to unsworn falsifica~on to authorities.
f-:~-{U .Y(~ ff1~
Date Plaintiff or DefendaDl
Page 3 of3
Service Type
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Worker lD
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WEIS MARKETS, INC. - PAYROll
EMPlOYEE LOCATION & NAME
00;8 1
KIM A ZIMMERMAN
- EMPLOYEE NO,
80;424
SOCIAL SEC, NO.
184 48 880;4
CONTROL # 010647
EXPlANATION OF EARNINGS/T ES/DEDUCTIONS
HRS/RATE/EARNINGS
TAXES
DEDUCTIONS
22,00
9.00
6.50
7.50
TOTAL EARNINGS
FICA
MEDICARE
FED WITHHOLDING
PA STATE TAX
LOCAL TAX
DCC PRIVILEGE
TOTAL TAXES
TOTAL DEDUCTIONS
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NET PAY
WK. END
07/07/01 3208736
CURRENT YEAR TO DATE
143.00 .00
67.50 .00
210.0;0 4733.14
13.05 293.46
3.05 68.62
4.61 47.14
5.89 132.52
2.11 47.35
.00 10.00
28.71 .00
.00 .00
181.79
4134.00;
.
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EIS MARKETS, INC. - PAYROLL
EMPLOYEE LOCATION & NAME
058 1
KIM A ZIMMERMAN
EMPLOYEE NO.
85424
SOCIAL SEC. NO.
184 48 8854
CONTROL # 010688
E PLANATION OF EARNINGS/TAXES/DEDUCT! NS
HRS/RATE/EARNINGS
6.50
7.50
TAXES
D_~DUCTIONS
21.75
5.00
TOTAL EARNINGS
FICA
MEOICARE
FEO WITHHOLDING
PA STATE TAX
LOCAL TAX
ecc PRIVILEGE
TOTAL TAXES
iOTAL O~LljCTXO;.'_.~
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WK. END
07/14/01 3225566
CURRENT YEAR TO DATE
141. 38 .00
37.50 .00
178.88 4~12.02
11.09 304.55
2.59 71.21
.00 47.14
5.01 137.53
i .79 49.14
.00 10.00
20.48 .00
.00 .00
158.40
4Z;2.4:;
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WEll:; MARKETS, INC. - PAYROLL
EMPLOYEE LOCATION'S. NAME
0';8 1
KIM A ZlMMERMloN
EMPLOYEE NO.
8.';424
.1 SOCIAL SEC. NO.
I
I 184 48 8854
I
EVPLANATIONOF EARNINGS/TAXES/DEDUCTIONS
HRS/RATE/EARNINGS
I
b"
,"Jf','!;l:,1
CONTROL # 010740
TAXES
;;EOUCT.IONS
1
i':'"'
. ~
17.50
5.25
6.50
7.50
TOTAL EARNINGS
FICA
MEDICARE
FEll WITHHOLDING
PA STATE TAX
LOCAL TAX
acc PRIVILEGE
TOTAL TAX~~
TOTAL DEDUCTlO~S
."..,...-
WK. END
08/04/0j
CURF'I;NT
113.75
39.38
153.1J
9.49
2.22
.00
4.29
1.53
.be
17.'.iJ
-
,..'"
.L
I
I
:1
I
I
3275794
YEAR TO D''''';=-=-1
I
I
.00
.00
'::J67.78
332.81
77.82
4~L:;7
150.29
5:".70
'H),OO
i
I
I
i
I
i r
I
I
i
.00
.00
''''1ri''<''''''''' ~",'.,~
".ov' ,_. .,.~.,">
. WEIS MARKETS, INC. - PAYROLL
EMPLOYEE LOCArlON & NAME
0')8 1
KIM A ZIMMERfo1AN
EMPLOYEE ~JO.
8')424
SOCIAL SEC. NO.
184 48 88')4
E PLANATION OF EARNIN S/TAXES/DEDUCTIONS
HRS/RATE/EARNINGS
CONTROL # 010588
TAXES
DEDUCTIDNS
WEIS "FAMILY PICNIC - SEPTEMBER 2), 2001
PICNIC SLIPS MUST BE RETUltHED IMMEDIATELY
401(K) CHANGES DUE BY ~/14/01
<:W:'T.~""""'. ..
TJF"" .....~-
~~,,!I"''''C
A'1".t,' ~,_
".." <,
,. ,
22.75
5.25
6.50
7.50
TDTAL EARNINGS
FICA
MEDICARE
FED WITHHOLDING
PA STATE TAX
LOCAL TAX
OCC PRIVILEGE
TOTAL TAXES
TOTAL DEDUCTIONS
NET PAY
I 1 ~
n
WK. END
08/2')/01
CURRENT
147.88
39.38
187.2&
11. 61
2.72
1.12
5.24
1.87
.00
22.')&
.00
1&4.70
\
\
\
3327001\
YEAR TO DATE
.00
.00
')8')2.42
362.85
84.85
51.09
163.86
58.54
10.00
7)1.1~
.00
')121. 2)
~ ~"~e--
i
/
l
;ARKETS, iNC. - PAYROLL
,N1PlOYEE lOCATION & NAME.
00;8 1
KIM A ZIMMERMAN
EMPlOYEE NO.
80;424
SOCIAl SEC. NO.
184 48 880;4
CONT~OL # 010558
EXPLANATION OF EARNINGS/TAXES/DEDUCTIONS
HRS/RATE/EARNINGS
6.50
7,50
TAXES
DEDUCTIONS
WEIS FAMILY PICNIC - SEPTEMBER 23. 2001
PICNIC SLIPS MUST BE RETURNED IMMEDIATELY
401(K) CHANGES DUE BY 9/14/01
11.25
5.00
TOTAL EARNINGS
FICA
MEDICARE
FED WITHHOLDING
PA STATE TAX
LOCAL TAX
OCC PRIVILEGE
TOTAL ,'TAXES
TOTAL ~EOUCTIONS
.;~:. [~t~1MN~"" ;~~m~ . ~",',~~~.M:". ~.~r..,~ A.. . "f,
m~~"{%~i*~'^ _
. "'~----'"
WK. END
09/01/01 3343340
CURRENT YE R TO DATE
73.13 .00
37.50 .00
110.1.3 0;91.3.00;
6.86 369.71
1.60 86.45
.00 51.09
.3.10 166.96
1. 11 59.65
.00 10.00
12.1.7 743.81.
.00 .00
~., ::1;
._. I
:;~J9.19
WEIS MARKETS, INC. - PAYROLL
I
I
I
I
~50-1
., .50 I
I
EMPLOYEE LOCATION & NAME : EMPLOYEE NO. SOCIAL SEC. NO.
L ~1~ A ZiMMERMAN 85424 184 48 8854
EXPLANATION OF EARNIN S/TAXES/DEDUCTIONS
HRS/RATE/EARNINGS
CONTROL # 010661
14.00
4.25
TOTAL EARNH;;;S
TAXES
FICA
MEDICARE
FED WITHHOLDING
PA STATE TAX
LOCAL TAX
OCC PRIVILEGE
TOTAL TAXES
DEDUCTIONS
lTOTAL. D5J)UCTIO.~-$
"--<'EI.; \I . ~ ~ ,_ ,".
..,.,...<;"!~ f '
....I!III
WK. END
09/22/01 3392627
CURRENT YEAR TO DATE 1
'1
91.00 .00 I
31.88 .00
122.88 6334.94 I
,
7.62 392.77 ,
1. 78 91.84 I
.00 51.09 ,
3.44 177.37 I
1. 23 63.37 I
.00 10.00
14.07 786.44
I
I
. vi) ,
.00 I
I
I
I
I
I
I
I
!
i
I
I
,
I
108.81
5548.50
, ~'--~
.,.~".,.~^ .
~
WE IS MARKETS, INC. - PAYROLL
EMPLOYEE LOCATION & NAME
0';8 1
KIM A ZIMMERMAN
EMPLOYEE NO.
8';424
SOCIAL SEC. NO.
184 48 88';4
EXPLANATION OF EARNINGS/TAXES/DEDUCTIONS
HRS/RATE/EARNINqS
CONTROL # 010759
14.25
5.00
6.50
7.50
,
TOTAL EARNINGS
TAXES
FICA
MEDICARE
FED WITHHOLDING
PA STATE TAX
LOCAL TAX
OCC PRIVILEGE
TOTAL TAr:.;
DEDUCTIONS
TOTAL DEDUCTIONS
DIREC: DEPOSIT IS AVAILABLE NOW. SEE SUPERVISOR.
\
,",!;:-r,!"
,. --,
NET PAY
r - ~
WK. END
10/06/01 3426375
URRENT YEAR TO DATE
92.63 .00
37.50 .00
1)0.1;3 6662 . 0'/
8.07 413.05
1. 89 96.59
.00 53.67
3.~4 186.53
1.,0 66.64
.00 10.00
14.'~0 826.48
.00 .00
11';.2;3
';8;3';.';~
.,.- ...
, In_"
"'"r
.~. <
lEIS MARKETS, INC. - PAYROLL
I -{ .
EMPLOYEE LOCATION & NAME
058 1
KIM A ZIMMERMAN
EMPLOYEE NO.
85424
EXPLANATION OF EARNINGS/TAXES/OED CTIONS
HRS/RATE/EARNINGS
CONTROL # 010748
TAXES
DEDUCTIONS
SOCIAL SEC. NO.
184 48 8854
17.75
6.50
tOTAL EARNINGS
FICA
MEOICARE
FED WITHHOLOING
PA STATE TAX
LOCAL TAX
OCC PRIVILEGE
TOTAL TAXES
~IRECT DEPOSIT IS AVAILABLE NOW. SEE SUPERVISOR.
TC:r AL:JEilUCTtONS
..-
;; ~ ~ " .
:: %S!*!... '. . . ".,
, .
V7~,~ -r- .,c
NET PAY
WK. END
10/1:3/01
3442943
CURRENT
YEAR TO DATE
115.38
.00
6777. 45
115,:38
7.15
1. 67
.00
3.23
1. 15
.00
1:3.20
420.20
98.26
53.67
189.76
67.79
10.00
8:39.68
.00
.00
102.18
5937 . 77 \
-~
!
I
I
I
I
I
I
I
I
I
i
I
,
i
I
I
1-/
,
\
_v~
WEIS MARKETS, INC. - PAYROLL
EMPLOYEE LOCATION & NAME
0';8 1
KIM A ZIMMERMAN
EMPLOYEE NO.
8';424
SOCIAL SEC. NO.
184 48 88';4
EXPLANATION OF EARNINGS/TAXE IDEDUCTIONS
HRS/RATE/EARNINGS
CONTROL # 010607
TAXES
DEDUCTIONS
6.50
7.50
13.50
5.00
TOTAL EARNINGS
FICA
MEDICARE
FED WITHHOLDING
PA STATE TAX
LOCAL TAX
OCC PRIVILEGE
TOTAL TAXES
TOTAL DEDUCTIO~S
DIRECT DEPOSIT IS AVAILAB~E NOW. SEE SUPERVISOR.
,- ;'FU<lC1'il!\, ,.<, ,., . _.~, ','. ...,
~- .p'"
NET PAY
WK. END
10/20/01 3459377
CURRENT YEAR TO DATE
87.75 .00
37.50 .00
12';.2'; &902.70
7.77 427.97
1. 82 100.08
.00 53.67
3.51 193.27
1.25 69.04
.00 10.00
14.)'; 8';4.0)
.00 .00
110.'10
&048.&7
~ "'" v ,__
",~."".". "''', '.'" =~ ,-~ ,
WEIS MARKETS, INC. - PAYROll
EMP~OYEE LDCATION & NAME
0';8 1
KIM A ZIMMERMAN
EMPLOYEE NO.
8';424
SOCIAL SEC. NO.
184 48 8854
EXPLANATION OF EARNINGS/TAXES/DEDUCTIONS
HRS/RATE/EARNtNGS
CONTROL # 009885
TAXES
DEDUCTIONS
17.50
5.25
6.50
7.50
TOTAL EAf(NINGS
FICA
MEOICARe
FED WIT~,HOLDING
PA STATF TAX
LOCAL T!<X
DCC PRIVILEGE
TOTAL 1,MES
TOTAL DEDUCTIONS
<-'o-'-","",~.
. ,-,
"' ,
; NET PAY
-.-,.,
WK. END
11/03/01 3490830
CURRENT YEAR TO DATE
113.75 .00
39.38 .00
153.13 7193.84
9.49 446.02
2.22 104.30
.00 53.67
4.29 201.42
1.53 71.95
.00 10.00
17.53 887.3& ,
.00 .00
135.&0
&30&.48
_.~
,
~'"+,.- '",,,....
....'""
, WE IS MARKETS, INC. - PAYROLL
EMPLOYEE LOCATION & NAME
0';8 1
KIM A ZIMMERMAN
EMPLOYEE NO.
8';424
SOCIAL SEC. NO.
184 48 88';4
EXPLANATION OF EARNINGS/TAXES/DEDUCTIONS
HRS/RATE/EARNINGS
CONTROL # 009545
TAXES
DEDUCTIONS
6,50
7.50
16.50
2.25
TOTAL EARNINGS
FICA
MEDICARE
FED WITHHOLDING
PA STATE TAX
LOCAL TAX
OCC PRIVILEGE
TOTAL TAXES
TOTAL DEDUCTIONS
",!II;"''-
'i-'C""'~-""'j{,., -J
,'~", ". .- -" "'" . "
NET PAY
I'
WK. END
12/22/01 3601034
CURRENT YEAR TO DATE
107.25 .00
16.88 .00
124,1) 70;04,2';
7,70 490,07
1,80 114.59
.00 53.67
3.48 221, 32
1, 24 79.06
.00 10.00
14.22 0;68.71
.00 .00
100;.0;1
&0;3';.';4
-.."'......=
~""-'0"'<''"'~~
WE1S MARKETS, INC. - PAYROLL
EN!PLpYEE, LOCATION & NAME
0';8 1
KIM A ZIMMERMAN
EMPLOYEE NO.
8';424
SOCIAL SEC. NO.
18448.88';4
EXPLANATION F EARNINGS/TAXES/DEDUCTIONS
HRS/RATE/EARNINGS
CONTROL # 009372
TAXES
DEDUCTIONS
13.25
5.00
4.00
6.50
7.50
6.50
TOTAL EARNINGS
FICA
MEDICARE
FED WITHHOLDING
PA STATE TAX
LOCAL TAX
TOTAL TAXES
UNITED FUND
TOTAL DEDUCTIONS
PART-TIME OPEN ENROLLMENT DEADLINE IS 1/18/02.
NET PAY
WI<. END
01/0';/02
CURRENT
86.13
37.50
26.00
14').0)
9.28
2.17
.00
4.19
1. 50
17.14
,50
.';0
1)1.')')
~
3630424
YEAR ,TO DATE
.00
.00
.00
)2).)')
20.05
4.69
.00
9.06
3.24
)7.04
1.00
1.00
28';.)';
~
WEIS MARKETS, INC. - PAYROLL
, , .
"
EMPLOYEE LOCATION & NAME
0';8 1
KIM A ZIMMERMAN
EMPLOYEE NO.
8';424
SOCIAL SEC. NO.
184 48 88';4
EXPLANATION OF EARNINGS/TAXES/DEDUCTIONS
HRS/RATE/EARNINGS
CONTROL # 009295
TAXES
DEDUCTIONS
12.50
6.50
TOTAL EARNINGS
FICA
MEDICARE
FED WITHHOLDING
PA STATE TAX
LOCAL TAX
TOT At. TAXES
UNITED FUND
TOTAL DEDUCTIONS
PART-TIME OPEN ENROLLMENT DEADLINE IS 1/18/02.
,!~
~:",-'m"\'l1f
I\IETPAY
WK. END
01/12/02 3644730
CURRENT YEA TO DATE
81.25 .00
81.2'; 404.64
5.04 25.09
1. 18 5.87
.00 .00
2.28 11.34
.81 4.05
9.31 46.3';
.50 1.50
.';0 1. ';0
71. 44
3';&.79
iT"
WEIS-MARKETS, INC. - PAYROll
EMPLPY~E U:>CATION & NAME
058 1
KIM \ ZIMMERMAN
EMPLOYEE NO.
85424
SOCIAL SEC. NO.
184 48 8854
CONTROL # 009182
EXPLANATION OF EARNINGS/TAXES/DEDUCTIONS
HRS/RATE/EARNINGS
TAXES
DEDUCTIONS
11. 25
5.50
TOTAL EARNINGS
FICA
MEDICARE
FED WITHHOLDING
PA STATE TAX
LOCAL TAX
TOTAL TAXES
UNIJEo FUND
TOTAL DEDUCTIONS
'f'A~'. ,~__!tt,,_
-~-, ' -~,~
NET PAY
",1
WK. END
01/19/02 3658958
CURRENT YEAR TO DATE
73.13 .00
7).1) 477.77
4.53 29.62
1.06 6.93
.00 .00
2.05 13.39
.73 4.78
8.)7 54.72
.50 2.00
.90 2.00
64.21>
421.<:15,
~
~
'P"~
.~u, .~-, ,.,,__,- _"pr. - ._-..-. ...-..... ..- ...........
7,904.25 53.67
3 Social s"curity w3911" . So~i31 So~urity tax withhllld
- 7,904.25 490.07
. ""<"!.,cOT,,...,1)9,,,,"ond\;p,," ,6 Modic""" tax withhold
'71,S'$4.~ 114.59
. Controi numbllr I .Copt. Corp. I EmploYQr use only
08808
, Employer's namo, addras", ... ZIP code
WEIS MARKETS INC.
1000 S. SECOND ST.. P.O. BOX 471
SUNBURY, PA 17801
b Employer's FED 10 number . Empl~yee.s SSA numbor
24-0755415 184-48-8854
7 Social security tips 8 Allocated tips
9 Advance EIC payment 10 Dspendent ~are be"ofits
" Non'luallflodplans ", Soe instru~1ion" for box "
13 ~'''"''~I ~1~'i"m'"'I:~"d'P"~ " Other
IImployg pia" sick pay
)~m;~YQ~S first nomll and initiall ZI~~~;~~
6303 BRANDY LANE
MECHANICSBURG PA 17050
f Employee's addross and ZIP cod..
~A SlatoIE~~~C;7554 ~D5 1t:iSlale wagQ., tips, lite..
7 904. 25
1 St~~!l; inco!,"e ~? 1 . 32 I = Lo~al in~ome tax 79 . ns
11:1 Lo~al wa7., gl()4, :t25 - WESTty SHORE TAX
Employee Reference Copy
W 2 Wage and Tax 2001
- Statement
Copy C for llmploYilQ's rgcords. OMB No. 1545.000B
2001 W-2
058-01-85424
KIM A ZIMMERMAN
6303 BRANDY LANE
MECHANICSBURG PA
y.'a.9os,. tips, ol~o.r compo 2 federal incomo tal< wlthhgld
7,904.25 S3.67
3 So~ial socurity ~-,-:'911" . Soci"t SIlCUTity t..x wilhhilld
7,904.25 490.07
5 Modicillrll wagu and tip. 6 MlldicarQ t<lX wilhlillld
7;904.25 114.59
. Conlrol number Dept. COTp. EmplcYQr uso only !
08808
-. c_._ . .
1 Waglls, lips, othllr ccmp. 2 Fllderal income lax w[thheld I
7,904.25 53.67 .
i3 Social ~ecurity w,3ges . Social Sllcurity tax wilhheld ,
7,904.25 490.07 i
5 Mqdicll.rQ wa911s and tips 6 Medicare tllX withhglcl
7,904.25 114.59
, Control number " 1 Depl. Corp. ! EmploYllf lJse only
08808
, Employer'~ namo, addrllss, and ZIP COdll
WEIS MARKETS INC.
1000 S. SECOND ST., P.O, BOX 471
SUNBURY, PA 17801
b Employer's FED 10 numb.r d Employoo's SSA number
24-0755415 184-48-8854
7 So~ial socurily tlp~ 8 AffoClltod tips
, Advanco EIC paymenl 10 Dependent carll bllnefils
11 Nonqualiiied plans 12, Soe instruction. for bolO; 12
13S"'"""'1 r";,,m'"T;l.."rty ,. Other
IImploYlle plan SIC pey
e~7~oye~~ lirst nam", and initiaIIZI~;~;~
6303 BRANDY LANE
MECHANICSBURG PA 17050
fErn 10 qll'" addr<lu and ZIP code
lS Stat<lIEmploYllr's state lu.. 10;:,t..tll Wa91l? llgSb.at:'25
PA 24-0755415
17 Stale incomo tax 1= Local incomll lax
221.32 79.06
I Q ~Ocal wa97s, 9'04 ~12S Locallly namo
WEST SHORE TAX
State Filing Copy
W -2 W~:t:~~~:X ~QQJ
Copy 2 to bll Wod with emploYoo's STATE Incomo Tax Roturn
c . Employor's mime, .i.ddre~s; ...nd ZIP code
WEIS MARKETS INC.
1000 S. SECOND ST., P.O. BDX 471
SUNBURY, PA 17801
b Employer's fED 10 number
24-0755415
Employoo's SSA number
184-48-8854
7 Soci",1 sllcurity tips
S Afloc.alod tips
9 Ad
EIe
10 D
b f
vance paymlln llponentcaro gnOII.
11 Nonqcalified plan~ 12. S."inslructions for box 12
13St"luto~1 ~Olirgm"nllI-hird-party 14 Olher
llmployo plan SIck pay
I~;;ye~~ first name and iniliall ZI~;~;;lN
6303 BRANDY LANE
MECHANICSBURG PA 17050
f Emolovee's address and ZIP ccdo
15 StalelEmPloyer's Slale to 16 Stale wa911s. tips, elC,
PA 24-0755415 7 904.25
17 St..le incomo tal< 19 Loca) income tax
221. 32 79.06
'" w.age~. tIpS, et~. ..~ocaity name
7 904.25 WEST SHORE TAX
, Federal Filing Copy:
W-2 W'S~:t:~~J:X ~QQJ
Copy B to be flllld with employee's FEDERAL Incomg Tax Return
17050
-.-.- -"--
1 Wages. tips, other compo 2 Fodora! Incom", tax withheld
7,904.25 53.67
3 Soc;al security wages . Social 'Sgcuriiy tax withhold
7,904.25 490.07
, Medicare wagll~ and lip:; 6 Medicnro tax withheld
7,904.25 114.59
, Control number I Dept.. Corp. I EmploYllr usa only
08808
, Employor's nllmll, IIcldross. IInd ZIP code
WEIS MARKETS INC.
1000 S. SECOND ST., P.D. BDX 471
SUNBURY, PA 17801
b Employer's FED 10 number d Employee"s SSA numbllr
24-0755415 184-48-8854
7 Soci..1 SllCUrity tip~ 8 Allocaled tips
9 Advallcll EIC payment 10 Dopendllnt caro benofits
11 Nonqualiliedplans 12, Seeinstruclionsfor b" 12
1sStatutort~1 Rotirgmentl;.hird-party 14 Other
emploYlle plan SIck pay
Q~;~ye~s litsl namQ and ;nltiaIIZIM~~~;~
6303 BRANDY LANE
MECHANICSBURG PA 17050
I Em 10 DIl.S addrllss and ZIP code
p~ Slalel E2~~()755t4 4Ds 16 Slate wage, li9sb4t~.25
17 State inoome lax 19 Local incomll tax
221.32 79.06
'" wa90~, tIPS, otc. 'WESTty SHORE
7 904.25 TAX
City or Local Filing Copy
W-2 W~:t:~~~:X ~QQl
CoCy :! to b. 'il<><l wIth employ..'. CITY of LOCAL Incom. hl< R.wm
:1""-
~ -.. .
STEPHEN ZIMMERMAN
PlaintifflRespondent
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
v.
CIVIL ACTION - DIVORCE
KIM ZIMMERMAN
DefendantlPetitioner
NO. 01 - 5925
CERTIFICATE OF SERVICE
I, Jennifer Heverly, Certified Legal Intern, Family Law Clinic, hereby certify that I
served a true and correct copy of the Income and Expense Statement, with attached Payroll and
W2 Statements, upon Gail Guida Souders, Esq., at Guida Law Offices, 503 North Street,
Harrisburg, Pennsylvania 17101, by depositing a copy of the same in the United States mail this
[,t day of February, 2002.
~
Date
~
Cert led Legal Intern
F AMlL Y LAW CLINIC
45 N. Pitt St.
Carlisle, PA 17013
717-243-2968
<,,'q'v~~r_ 17-- ~ r
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_~j~.~f<l'm~"~~~:illb'ilIW'i';'tf1-;;~r<""',"'''!--:~'--~--o''!;.~:,,"~~"'l,,'r"i_BrW:'_-'''''''-~-''''''';!''')!i'~''l-.'''i:'$p>e:!"liFjmw'~,,*_~l''!l~ff",I"il~''1']~~~~~~Y'_;_"_?<'1:;I;
STEPHEN ZIMMERMAN,
Plaintiffi'Respondent
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLV ANlA
v.
: CIVIL ACTION - DIVORCE
KIM ZIMMERMAN,
Defendant/Petitioner
: NO. 01 - 5925
INVENTORY
OF
KIM ZIMMERMAN
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, to the
best of her knowledge, information, and belief. Defendant understands that false statements
herein are made subject to the penalties of 18 Pa.C.S. 94904 relating to unsworn falsification to
authorities.
%~ t1k~~
Defendant, . ZImmerman
ASSETS OF PARTIES
Defendant marks on the list below those items applicable to the case at bar and itemizes
the assets on the following pages.
(X) 1. Real Property
(X) 2. Motor Vehicles
( ) 3. Stocks, bonds, securities and options
( ) 4. Certificates of deposit
(X) 5. Checking accounts, cash
(X) 6. Savings accounts, money market and savings certificates
(X) 7. Contents of safe deposit boxes
( ) 8. Trusts
(X) 9. Life insurance policies (indicate face value, cash surrender value and current
beneficiaries)
( ) 10. Annuities
( ) 11. Gifts
1
"f~~1>, ~. . ~r,_,__"
"",,,!",?,. ,"<.
~ --
,.,
".
( ) 12. Inheritances
( ) 13 Patents, copyrights, inventories, royalties
( ) 14. Personal property outside the home
( ) 15. Business (list all owners, including percentage of ownership, and officer/director
positions held by a party with company)
( ) 16. Employment termination benefits - severance pay, worker's compensation claim/award
( ) 17. Profit sharing plans
(X) 18. Pension plans (indicate employee contribution and date plan vests)
(X) 19. Retirement plans, Individual Retirement Accounts
( ) 20. Disability payments
( ) 21. Litigation claims (matured and unmatured)
( ) 22. MilitaryN.A. benefits
( ) 23. Education benefits
(X) 24. Debts due, including loans, mortgages held
(X) 25. Household furnishings and personalty (include as a total category and attach itemized list
if distribution of such assets is in dispute)
( ) 26. Other
MARITAL PROPERTY
Defendant lists all marital property in which either or both spouses have a legal or
equitable interest individually or with any other person as of the date this action was
commenced:
Item
Number
Description
Of Propertv
Names of
All Owners
1
Home at 15 Wayne Road,
Camp Hill, PA 17011
Stephen and Kim
Zimmerman
2
1996 4-door sedan
Stephen Zimmerman
5
Checking Account at
Commerce Bank
Kim Zimmerman
5
Checking Account at
at a local credit union
Stephen Zimmerman
6
Savings Account
at a local credit union
Stephen Zimmerman
7
Unknown contents of safe deposit box
Stephen Zimmerman
2
,i:t".';'~~!\!W,,'5" ~~"" .__, ;'_ '>~ ,,^).>,(r. ,oj - r'
I ,
-
, ..
9 Life Insurance Policy Stephen Zimmerman
18 Pension Plan with employer, Stephen Zimmerman
Washington International
19 Retirement Account with employer, Stephen Zimmerman
Washington International
25 Household Furnishings Stephen and Kim
See attached itemized list Zimmerman
Item
Number
PROPERTY TRANSFERRED
Description Date of Consid-
of Pro~erty Transfer eration
2
VW car
2001
Item
Number
Description
of Property
LIABlLITmS
Names of
All Creditors
24
Home Mortgage
Person to whom
Transferred
Names of
All Debtors
Stephen and Kim
Zimmerman
Defendant reserves the right to correct and/or supplement this Inventory to the extent that
she acquires additional information regarding assets and/or liabilities.
3
'l'l"-'0'''''4'O;^Jf!ff"
,< r.~' - ~F
-,1- ,'I'
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Home Furnishings still in residence:
A. Master Bedroom:
1. Queen Bed with Headboard
2. Dresser
3, Dresser with Mirror
4. Nightstand
5. Lamp
6. 2 pair of green draperies
B. Children's Bedrooms:
1. Single Bed with Drawers
2. Red, Car-shaped Bed with Drawers
3. Dresser with mirror
4. Red and White Dresser
5. Wooden Toybox
6. Desk and Chair
C. Living Room:
1. Draperies on Bay Window
2. Computer
3. Love Seat
4. Couch
5. Recliner
6. 2 Hexagon-shaped End Tables
7. Lamp
8. Large scenery Picture (mauve and blue)
9. Scenery Picture (canyon)
10. Television
11. VCR and video tapes
12. Stereo and compact discs
D. Dining Room:
1. Tailored Blinds on two windows
2. Gold-framed Scenery Picture
3. 2 Animal Pictures
4. Television
5. Dining Room Table and Four Chairs
E. Kitchen:
1. Stove
2. Microwave
3. Refrigerator
4
'I "oj,; '~""-ii;;_~_", _ r _,,_,~, ~o ." '" _,_ "," ..
~-
~. l"l"__
4. Dishes
5. Eating and Cooking Utensils
6. Pots and Pans
7. Crystal - A Flask and 3 Glasses
8. Wok
9. Under-cupboard Can Opener
10. Crock Pot
11. Toaster
12. Glasses
13. Beer Stein from Germany
Miscellaneous:
1. Washing Machine
2. Dryer
3. Gas Grill
4. Patio Table with Umbrella and Four Chairs
5. Picnic Table
Home Furnishinl!:s no lonl!:er in Residence:
1. VCR and video tapes
2. Lamp
3. Books
5
'^ct:><!"-"'i'V~'__Cf"_~,.T... ..,,' 1_.
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.
STEPHEN ZIMMERMAN,
Plaintiff/Respondent
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
v.
: CIVIL ACTION - DIVORCE
KIM ZIMMERMAN,
Defendant/Petitioner
: NO. 01 - 5925
CERTIFICATE OF SERVICE
I, Jennifer Heverly, Certified Legal Intern, Family Law Clinic, hereby certify that I
served a true and correct copy of the Defendant's Inventory upon Gail Guida Souders, Esq., at
Guida Law Offices, 503 North Street, Harrisburg, Pennsylvania 17101, by depositing a copy of
the same in the United States mail this 25th day of February, 2002.
(~'
- \ I ,.:-<i
J ennifef'
Certifie
FAMILY LAW CLINIC
45 North Pitt Street
Carlisle, PA 17013
717-243-2968
6
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^'''-)f,<"-'q,,,~
STEPHEN ZIMMERMAN
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiff
v.
NO. 01-5925
KIM ZIMMERMAN
Defendant
CIVIL ACTION - LAW
IN DIVORCE
INCOME AND EXPENSE STATEMENT
Attached hereto is the Income and Expense Statement of Defendant submitted
pursuant to Pa. R.C.P. No. 1920.31.
m/1~
Gail Guida Souders
Attorney for Plaintiff
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 in part, you must also fill out the Supplemental
Income Statement which appears on pages 8 and 9 of this Income and Expense
Statement. )
INCOME AND EXPENSE STATEMENT OF STEPHEN ZIMMERMAN
payroll Number:
pay Period (Weekly,~weekl~etc.):
I 12b.tf5
Gross Pay per Pay Period:
$
Itemized Payroll Deductions:
Federal Withholding
~p. S6'
'1 ~ .s 2-
II.~~
$
Social Security
Local Wage Tax
_ ',r~ .
-t' ,
~-~
"
~ ,'IIl!l
~ - ..
'."
State Income Tax
'0'2. .'l5
RetireInent
Savings Bonds
Credit Union
Life Insurance
Health Insurance
S6.t) ~
I (;.Qb
l"\~Ctf\Rt. Other (specify)
Net Pay per Pay Period:
B:t. ~W'ifC.,KL/
$ QSES/L6
Other
Income:
Week Month<X~a~
(Fill in Appr priate Column)
Interest
$
$
$ua-I ~)
Dividends
Pension
Annuity
Social Security
Rents
Royalties
Expense Account
Gifts
Unemployment Compo
Workmen's Compo
Total $
~1~1
\$ QSS.-a6' ..B~-Wt~KLiJ
$
$
TOTAL INCOME
EXPENSES
"'^"~-""_"'~l' _.
,^"""'- "'-t
I 1
Weekly . Monthly Yearly
(Fill in Appropriate Column)
Home
Mortgage/rent
Maintenance
$
$ 5(;LJ-.~5 $ ... M~
359>~~
CI) - ~
\d-~"~
ltS-~
'36"- ~
bl),S~"~ 3 ~
Utilities
Electric
Gas
Oil
Telephone
Water
Sewer >
'R f\<;~
Employment
Public
$
$
$
Lunch
Real Estate $
Personal
GeG -r}>lX
Income
$
$
I 'L 5~'~b.~ - ~
I 3 ~.f ~~A:A~'tJ
I fJbjIJ, - 1.K.AIVV''''ff
Taxes
Insurance
Homeowners
?3~~~o..
l+6rl>.... 'tJlAJ WIf}
Automobile
Weekly Monthly Yearly
(Fill in Appropriate Column)
Life
$
$
$
I \P ~ 3. ~
~-~
Accident
Health
S(;/)cP -
Other
Automobile
'-'-"4""'.:'C.j"1[:I!ilt1= "
~"
^ -. " 'r.-. F_~--
, '
Fuel
16
$ $
~~
?>if,- ~ :J
bb-~
~
Payments $
.
~~
Medical
Doctor
$
$
$ . \J_,
9.<1~ _~d\... ~
Dentist
Orthodontist
Hospital
Medicine
r;,~.~
Special needs rrglass~s>~
braces, orthopedic
~~
Education
~99i ~
\Pp ~ ~
Private school $ $ $
Parochial school
College
Religious
Weekly Monthly Yearly
(Fill in Appropriate Column)
Personal \)_ ._
no,"'", $ $ ,12.l'Sj!i- 'LWu ~
::::e'/Mh"'~~$~ !'.;; ~ 3 ~ ~ M- ;t.
Credit payments ~ ~ ~
Credit card ~YM - ~6'f
Charge account - J-lf j5f6 - ~ _ ~
C'"M M,ww",," ~ Cw.\>+~ ~ I ~ -,}t'Mv
Credit Union
$
$
$
-\"-"-~_<;-,d:._U_ "g,~.,~__""",!, .. '__~_"'
Miscellaneous
Household help
$
$
$
Child care
Papers/books/magazines
"J. SJ ~
Entertainment
Pay TV(~J
3lf 6w ~
i d.,y5~~
Vacation
Gifts
Weekly Monthly Yearly
(Fill in Appropriate Column)
Legal fees $
$
$
Charitable contributions
Other child support
Alimony payments
Other
TOTAL EXPENSES
$
$
$
PROPERTY OWNED
Description
Ownership* J ~
Value H W J ,A ec=t 11
~ ~ ~ ~ l,03't,q-l~ )q;/I/
~ _ 'Jj3~;t ~ # a..S tf68q -PI
~~~Q!~ ~~3Sl)q;~~ ,$1to,-'l;t
Checking accounts
Savings accounts
Credit Union
"-"~~, ".
~ H -- 'C" -~ ~ ,
r"
_ ~~_ ~~. M _~'''''''''''''''''
Stocks/bonds
_..
Real estate
Other
TOTAL
$
*H~Husband; W~Wife; J~Joint
INSURANCE
Policy
Company No.
Coverage*
H W C
Hospital
Blue Cross
Other
Medical
....
i1-W -c - ~ tit S~,J2) _ ftn,-'-c>, #:
~.$ ~~2..6bf) - 'f~S- J5ji521'!61
~~/) -lfLj--QSf)6-951
Blue Shield
Other
Health/Accident
Dental
... t+W-C-.
~ IAS ~ ,.Po~<y.ltl~)_*4--qSl)b
~Jt: ?>lJi.6bf) -3b" -;6(; I
Disability Income
Other
H~Husband; W~Wife; C~Child
SUPPLEMENTAL INCOME STATEMENT
(al This form is to be filled out by a person (check one) : rJlA
(1 ) who operates a business or practices a profession, or
(2 ) who is a member of a partnership or joint venture, or
(3) who is a shareholder in and is salaried by a closed corporation or
similar entity.
(b) Attach to this statement a copy of the following documents relating to the
partnership, joint venture, business, professionl corporation or similar entity:
t",;,-,=",,;," -,,", ,< ''"'"" "
-,.
F
ri'
e,
-
(1 ) the most recent Federal Income Tax Return, and
(2 ) the most recent Profit and Loss Statement.
(c) Name of business:
Address and Telephone Number:
(d) Nature of business (check one) :
(1 ) partnership
(2) joint venture
(3) profession
(4 ) closed corporation
(5) other
(e) Name of accountant, controller or other person in charge of financial
records:
(f) Annual income from business:
(1) How often is income received?
(2) Gross income per pay period:
(3) Net income per pay period:
(4) Specified deductions, if any:
I understand that the statements made herein are subject to the penalties
of 18 Pa.C.S. 54904 related to unsworn alsification to authorities.
r'f"5j~,*"?." "'.' ._, ,. _", .' ~; ,_
.
I verify that I have reviewed this
my knowledge the answers herein are true
form with my client a~to the~est
and corrmJ4 ~
Gail Guida S uders
Attorney for Plaintiff
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GROUP UNIVERSAL LIFE FOR THE EMPLOYEES AND FAMILIES OF IBM
GROUP POLICY NUMBER: A28064-G
GROUP UNIVERSAL LIFE STATEMENT OF CASH VALUE
CERTIFICATE OWNER:
ZIMMERMAN, STEPHEN
15 WAYNE ROAD
CAMPHILL PA 17011
OWNER NUMBER: 187-44-9576
STATEMENT PERIOD:
12/01/00 - 11/30/01
Employee
Spouse'':
Insured I S Name
KIM ANN
STEPHEN
Certific~te Number
0021526
0421497
Basic Life Amount
72,000.00
60,000.00
Cash Value
Employee
Spouse"
Cash V~lue
as of 12/01/00
67.80
50.20
Premium Received**
168.39
125.10
Total Expenses
224.52-
166.80-
Subtou1
56.13-
41. 70-
Interest Credited
2.72
2.00
Cash Value Balance
as of 11/30/01
14.39
10.50
Certific~te Loan Activity
NONE
NONE
Death Be~efit Amount
as of 11/30/01***
72,014.39
60,010.50
Spouse/Domestic Partner
,'~,'~
"Premium Received" includes the Cash Accumulation contributions and
the Cost Of Insurance premium.
,'do~
Death Benefit Amount is the sum of the "Basic Life Amount" and
curre~t "Cash Value Balance" as of the date of death.
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GROUP UNIVERSAL LIFE FOR THE EMPLOYEES AND FAMILIES OF IBM
GROUP POLICY NUMBER: A28064-G
STATEMENT OF ACCOUNT AS OF 11/30/01
CERTIFICATE OWNER:
ZIMMERMAN, STEPHEN
15 WAYNE ROAD
CAMPHILL PA 17011
OWNER NUMBER: 187-44-9576
STATEMENT PERIOD:
12/01/00 - 11/30/01
Employee
Spouse;'
KIM ANN
12/01/87
0421497
60,000.00
Yes
None
\
S ~-
pause"
Smoker
1l.10
l.00
l.80
0.00
13.90
Spouse''c
133.20
12.00
2l. 60
0.00
166.80
I. BENEFIT SUMMARY
Insured I S Name
Original Effective Date
Certificate Number
Basic Life Amount
Accidental Death and Dismemberment Rider
Child Rider
( $10,000 per eligible child)
STEPHEN
12/01/87
0021526
72,000.00
Yes
Yes
II.
MONTHLY COST SUMMARY
Employee
Rating Class
Term Insuran~e Cost
Administrative Expense Charge
Accidental Death and Dismemberment
Child Term Insurance Cost
Non-Smoker
14.91
l.00
Rider Cost 1.80
l.00
Total Monthly Expense
18.71
III. ANNUAL COST SUMMARY
Employee
Term Insurance Cost
Administrative Expense Charge
Accidental Death and Dismemberment Rider Cost
Child Term Insurance Cost
178.92
12.00
2l. 60
12.00
TOTAL ANNUAL EXPENSE
224.52
PREMIUM RECEIVED
DURING STATEMENT PERIOD OF
12/01/00 to 11/30/01**
168.39
125.10
id If you are participating in the Cash Accumulation Option the "Premium
Received" includes your Cash Accumulation contributions and Cost Of
Insurance premium noted above.
THE GROUP UNIVERSAL LIFE PROGRAM IS OFFERED AND ADMINISTERED BY SEABURY &
SMITH, INC., AND UNDERWRITTEN BY METROPOLITAN LIFE INSURANCE COMPANY.
FOR UPDATED INFORMATION CALL OUR TOLL-FREE NUMBER 1-800-247-5628.
Spouse/Domestic Partner
see reverse side
JV101Z
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.-- - . -
NOTICE OF DEFERRED VESTED BENEFIT
INTERNATIONAL BUSINESS MACHINES CORPORATION
Social Security Number: 187449576
IBM Serial Number: 795854
A deferred vested benefit is payable to you under the tenns of the IBM Retirement Plan. $458.00 is
payable to you on a Single Life Basis commencing the first day of the calendar month coincident
with or following your 65th birthday (i.e., the first of the month following your 65th birthday unless
your birthday is on the first day of the month in which case payments begin on that day) and
continuing thereafter for your lifetime.
You may elect to have the monthly vested rights benefit commence any month after attaining age
**62**. The vested rights benefit described above .will be reduced if you elect to receive payment
earlier than age 65 or if you receive a joint and survivor annuity under the terms of the Plan. If you
are married, a 50% joint and survivor annuity will be automatically applied unless you complete the
Election of Retirement Date and Income Basis form choosing an alternate form of payment and you
obtain your spouse's approval, where necessary.
All payments are subject to the terms and conditions of the Plan to the extent allowed by law. The
vested rights benefits payable to you, or on your behalf, are obligations of the IBM Retirement Plan.
Date Issued: Sep 21 2001
~--------~--~------------------------~------------------------~--~--------------------------------------------------.-
INTERNATIONAL BUSINESS MACHINES CORPORATION
RETIREMENT PLAN DEFERRED VESTED BENEFIT NOTICE
IBM SERIAL NUMBER: 795854
Age 65 Benefit: $ 458.00
I hereby certify that this notice was issued to me as a fonner IBM employee and that I will attain
age _ on as evidenced by the attached or previously supplied proof
of age. Payments of my vested rights income should commence on (Month) I,
(Year) and are to be sent to me at the address shown below until further notice.
My marital status is (check one): _ Married _ Single
Spouse Date of Birth
Signature
Address
THIS DEFERRED VESTED BENEFIT NOTICE SUPERSEDES ALL PRIOR DEFERRED
VESTED RIGHTS CERTIFICATES OR NOTICES.
.
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STEPHEN ZIMMERMAN
PLAINTIFF
vs
KIM ZIMMERMAN
DEFENDANT
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY PENNSYLVANIA
: CIVIL ACTION - DIVORCE
: NO. 01-5925
CERTIFICATE OF SERVICE
l, Gaii Guida Souders, Esquire, Guida Law Offices, hereby certify that 1 served a true and
correct copy ofthe Plaintiffs Inventory upon Jennifer Heverly, Certified Legal Intern, 45
North Pitt Street, Carlisle, Pennsylvania 17013, by depositing a copy of the same in the
United States mail.
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Guida Law Offices, P.C.
503 N. Front St.
Harrisburg, PA l7IOl
(7 1 7) 236-6440
Supreme Court ID #68740
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STEPHEN ZIMMERMAN
PLAINTIFF
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY PENNSYLVANIA
VS
: CIVIL ACTION - DIVORCE
KIM ZIMMERMAN
DEFENDANT
: NO. 01-5925
INVENTORY
OF
STEPHEN ZIMMERMAN
Plaintiff 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.
Plaintiff verifies that the statements made in this inventory are true and correct, to the best of his
knowledge, information, and belief. Plaintiff understands that false statements herein are made
wbjoc' '" <h, p.","~ of" PaC.S. '4904 rel"m~","o",;~.
~nZimmennan
ASSETS OF PARTIES
Plaintiff marks on the list below those items applicable to the case at bar and itemizes the assets on
the following pages.
(X) I. Real Property
(X) 2. Motor Vehicles
( ) 3. Stocks, bonds, securities and options
( ) 4. Certificates of deposit
(X) 5. Checking accounts, cash
(X) 6. Savings accounts, money market and savings certificates
(X) 7. Contents of safe deposit boxes
( ) 8. Trusts
(X) 9. Life insurance policies (indicate face value, cash surrender value and current
beneficiaries)
( ) 10. Annuities
( ) II. Gifts
( ) 12. Inheritances
( ) 13. Patents, copyrights, inventories, royalties
( ) 14. Personal property outside the home
( ) 15. Business (list all owners, including percentage of ownership, and officer/director
positions held by a party with company)
( ) 16. Employmenttennination benefits-severance pay, worker's compensation claim/award
( ) 17. Profit sharing plans
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(X) 18. Pension plans (indicate employee contribution and date plan vests)
(X) 19. Retirement plans, Individual Retirement Accounts
( ) 20. Disability payments
( ) 21. Litigation claims (matured and unmatured)
( ) 22. MilitaryN.A. benefits
( ) 23. Education benefits
(X) 24. Debts due, including loans, mortgages held
(X) 25. Household furnishings and personalty (include as a total category and attach
itemized list of distribution of such assets is in dispute)
( ) 26. Other
MARITAL PROPERTY
Plaintiff lists all marital property in which wither or both spouses have a legal equitable
interest individually or with any other person as of the date this action was commenced:
Item
Number
1
Description
of Properlv
House at 15 Wayne Road
Names of
All Owners
Stephen & Kim
Zimmerman
2
1996 Buick Skylark
(Purchased in October 2001)
Stephen
Zimmerman
5
Checking Account
Americhoice Credit Union
$0.00
Stephen
Zimmerman
6
Savings Account
Americhoice Credit Union
$1,989.00
Stephen
Zimmerman
7
Safe Deposit Box With
No Items of Value Exist In It
Stephen & Kim
Zimmerman
9
Life Insurance Policies
Stephen
Zimmerman
a) Stephen-$72,OOO, Cash Value $14.39
Beneficiary-Earnest Zimmerman
b) Kim-$60,000, Cash Value $10.50
Beneficiary-Stephen Zimmerman
18
Pension Plan From IBM
Can Vest at 62 NO Value Until Then
Stephen
Zimmerman
19
IRA With Americhoice Credit Union
Stephen
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Value $3,579.22
Zimmerman
25
Household Furnishings
See Attached List
Stephen & Kim
Zimmerman
Item
Number
2
Description
of Propertv
1988 VW Fox
PROPERTY TRANSFERRED
Date of Consideration
Transfer
October 2001 Given Free
For Parts
Person to whom
Transferred
James S latt
Item
Number
24
Description
of Propertv
Home Mortgage
$25,002.71
LIABILITIES
Names of
All Creditors
Names of
All Debtors
Stephen & Kim
Zimmerman
24
Pinnacle Health
$477.00
Stephen & Kim
Zimmerman
24
Holy Spirit
$221. 00
Stephen
Zimmerman
24
Visa
$3,132.72
Stephen
Zimmerman
24
Mastercard
$8,129.16
Stephen
Zimmerman
24
Holy Spirit
$150.00
Stephen
Zimmerman
24
Boscovs
$63.58
Sears
$23.95
Stephen
Zimmerman
Stephen
Zimmerman
24
Plaintiff reserves the right to correct and/or supplement this Inventory to the extent that he
acquires additional information regarding assets and/or liabilities.
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Home Furnishings Still In Residence
A. Master Bedroom:
1. Queen Bead With Headboard
2. Dresser
3. Dresser With Mirror
4. Nightstand
5. Lamp
6. Two Pair Of Green Drapes
7. Stereo and Compact Discs
B. Children's' Bedrooms:
1. Single Bed With Drawers
2. Desk and Chair
3. Dresser With Mirror
4. Car Bed With Drawers
5. Dresser
6. Desk With Chair
7. Stereo
8. Stereo
C. Living Room:
I. Drapes On Bay Window
2. Sofa
3. Love Seat
4. Recliner
5. End Table
6. Computer (Children's)
7. Computer Desk (Children's)
8.Television
9. VCR
10. Large Scenery Picture
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11. 3 Lamps
12. Surround Sound Receiver With Speakers
D. Dining Room:
1. Blinds On Two Windows
2. Table & Six Chairs
3. Large Gold Framed Scenery Picture
4. Two Animal Pictures
5. Television
E. Kitchen:
1. Stove
2. Microwave
3. Refrigerator
4. Dishes
5. Eating & Cooking Utensils
6. Pots & Pans
7. Radio/Cassette Player
8. Flask & Glasses-Crystal
9. Can Opener
10. Crock Pot
II. Toaster
12. Glasses
F. Miscellaneous:
I. Lawn Mower
2. Dryer
3. Washing machine
4. Vacuum Cleaner
G. Items Removed Form Residence:
1. Lamp
2. Books
3. VCR
4. 100 To 200 Video Cassette Movies
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STEPHEN ZIMMERMAN
PLAINTIFF
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY PENNSYLVANIA
VS
: CIVIL ACTiON - DIVORCE
KIM ZIMMERMAN
DEFENDANT
: NO. 01-5925
CERTIFICATE OF SERVICE
1, Gail Guida Souders, Esquire, Guida Law Offices, hereby certify that 1 served a true and
correct copy of the Plaintiff's Inventory upon Jennifer Heverly, Certified Legal Intern, 45
North Pitt Street, Carlisle, Pennsylvania 17013, by depositing a copy of the same in the
United States mail.
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Gail Guida Souders
Guida Law Offices, P.C.
503 N. Front St.
Harrisburg, P A 1710 1
(717) 236-6440
Supreme Court lD #68740
Date:
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21 yY)'fY\O..( fV)M)
Statement of Intention to Proceed
To the Court:
s ~N Vl Z 1fYJrf'M fl'1 cd)
intends to proceed with the above captioned matter.
PrintName ~AI'-'hlA'M S:-o,-<l>m!5'
Sign Name
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Attorney for ~-h 1+
Explanatory Comment
The Supreme Court of Pennsylvania has promulgated new Rule of Civil Procedure 230.2 governing the termination of
inactive cases and amended Rule of Judicial Administration 1901. Two aspects of the recommendation merit
comment.
I. Rule of civil Procedure
New Rule of Civil Procedure 230.2 has been promulgated to govern the termination of inactive cases within the
scope of the Pennsylvania Rules of Civil Procedure. The termination of these cases for inactivity was previously
governed by Rule of Judicial Administration 1901 and local rules promulgated pursuant to it. New Rule 230.2 is
tailored to the needs of civil actions. It provides a complete procedure and a uniform statewide practice, preempting
local rules.
This rule was promulgated in response to the decision of the Supreme Court in Shop v. Eagle, 551 Pa. 360,710 A.2d
11 04 (1998) in which the court held that "ptejudice to the defendant as a result of delay in prosecution is tequired
before a case may be dismissed pursuant to local rules implementing Rule of Judicial Administration 1901."
Rule of Judicial Administration 1901 (b) has been amended to accommodate the new rule of civil procedure. The
general policy of the prompt disposition of matters set forth in subdivision (a) of that rule continues to be applicable.
II Inactive Cases
The purpose of Rule 230.2 is to eliminate inactive cases from the judicial system. The process is initiated by the
court. After giving notice of intent to terminate an action for inactivity, the course of the procedure is with the parties.
If the parties do not wish to pursue the case, they will take no action and "the Prothonotary shall enter an order as of
course terminating the matter with prejudice for failure to prosecute." If a party wishes to pursue the matter, he or she
will file a notice of intention to proceed and the action shall continue.
a. Where the action has been terminated
If the action is terminated when a party believes that it should not have been terminated, that party may proceed
under Rule230( d) for relief from the order of termination. An example of such an occurrence might be the termination
of a viable action when the aggrieved party did not receive the notice of intent to tenninate and thus did not timely file
the notice of intention to proceed.
The timing of the filing of the petition to reinstate the action is importaDt. If the petition is filed within thirty days of
the entry of the order of termination on the docket, subdivision (d)(2) provides that the court must grant the petition and
reinstate the action. If the petition is filed latet than the thirty-day period, subdivision (d)(3) tequires that the plaintiff
must make a show in to the court that the petition was promptly filed and that there is a reasonable explanation or
legitimate excuse both for the failure to file the notice of intention to proceed prior to the entry of the order of
tennination on the docket and for the failure to file the petition within the thirty-day period under subdivision (d)(2).
B. Where the action has not been terminated
An action which has not been terminated but which continues upon the filing of a notice of intention to proceed may
have been the subject of inordinate delay. In such an instance, the aggrieved party may pursue the remedy of a
common law non pros which exits independently of termination under Rule 230.2.
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Office of the Prothonotary
Cumberland County
Curtis R. Long
Prothonotary
Case # 01-5925 02-2154
NOTICE OF PROPOSED
TERMINATION OF COURT CASE
To: GAIL GUIDA SOUDERS ESQ
The court intends to terminate this case without further notice because
the docket shows no activity in the case for at least two years.
You may stop the court from terminating the case by filing a Statement
of Intention to Proceed. The Statement of intention to Proceed should be
filed with the Prothonotary ofthe Court at:
CUMBERLAND COUNTY PROTHONOTARY
ONE COURTHOUSE SQUARE
CARLISLE, P A 17013
717-240-6195
on or before October 25. 2005.
Date
IF YOU FAIL TO FILE THE REQUIRED
STATEMENT OF INTENTION TO PROCEED, THE
CASE WILL BE TERMINATED
Seutember 16. 2005
Date of this Notice
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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
STATE OF
PEN NA.
STEPm:N ZIMMERMAN
No. 01-5925 CIVIL TERM
VERSUS
KIM ZIMMERMAN
DECREE IN
DIVORCE
AND NOW,
2006
, IT IS ORDERED AND
DECREED THAT
Stephen Zimmerman
, PLAINTIFF,
AND
Kim Zimmerman
, DEFENDANT,
ARE DIVORCED FROM THE BONDS OF MATRIMONY.
THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE
BEEN RAISED OF RECORD IN THIS ACTION FOR WHICH A FINAL ORDER HAS NOT
YET BEEN ENTERED;
By THE COURT:
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PROTWONOTARY .
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STEPIlEN ZIMMERMAN : IN THE COURT OF COMMON PLEAS
PLAINTIFF : CUMBERLAND COUNTY, PENNSYLVANIA
VS
: CIVIL ACTION - DIVORCE
KIM ZIMMERMAN
DEFENDANT
: NO. 01-5925 CIVIL TERM
NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE
TO KIM ZIMMERMAN, Defendant
You bave been sued in ail actiOn fOI divorce. You have failed to answel' tbe
complaint or me a counter affidavit to the plaintiff's affidavit. Therefore, on or after
August 1, 2006, the plaintiff can request the court to enter a final decree in divorce.
If you do not file with the Prothonotary of the court an answer with your
signature notarized or verified or a counter affidavit by the above date, the court can
enter a final decree in divorce. Unless you have already filed with the court a written
claim for economic relief, you must do so by the above date 011' the court may grant
the divorce and you will lose forever the right to ask for econOmic relief. A
COVNTERAF,FIDAVIT THAT YOU MAY FILE WITH THE PROTHONOTARY
OF THE COURT IS ATTACHED TO THIS NOTICE.
UNLESS YOU HAVE ALREADY FILED WITH THE COURT A WRITTEN
CLAIM FOR ECONOMIC RELIEF, YOU MUST DO SO BY THE ABOVE DATE
OR THE COURT MAY GRANT THE DIVORCE AND YOU WILL LOSE
FOREVER THE RIGHT TO ASK FOR ECONOMIC RELIEF. THE FILING OF
THE FORM COUNTER-AFFIDAVIT ALONE DOES NOT PROTECT YOUR
ECONOMIC CLAIMS.
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 LEGL HELP.
CUMBERLAND COUNTY LAWYER REFERRAL SERVICE
32 SOUTH BEDFORD STREET
CARLISLE, PA 17013
(717) 249-3166
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STEPHEN ZIMMERMAN
PLAINTIFF
: IN THE COURT OF COMMON PLEAS
: CUMBERLANDCOUNTY,PENNSYLVANIA
VS
KIM ZIMMERMAN
DEFENDANT
: CIVIL ACTION - DIVORCE
: NO. 01-5925 CIVIL TERM
Counter-Affidavit under & 3301 (d) of the divorce code
1. Ch.e6'k either (a) or (b):
if (a) I do not oppose the entry of a divorce decree.
D (b) I oppose the entry of a divorce decree because (theck (i),.(ii) -or both):
o (i) The parties to this action have not lived separate and apart for a
period of at least two years. '
o (ii) The marriage is not irretrievably broken.
2. Check either (a) or (b):
o (a) I do not wish to make any claims for economic relief. I understand that I
may lose rights concerning alimony, division of property, lawyer's fees or expenses
ifI do not claim them before a divorce is granted.
o (b) I wish to claim economic reJiefwhich may include alimony, division of
property, lawyer's fees or expenses or other important rights.
I understand that in addition to checking (b) above, I must also file all of my
economic claims with the prothonotary in writing and serve them on the other
party. IfI fail to do so before the date set forth on the Notice ofIntention To
Request Divorce Decree, the divorce decree may be entered without further delay.
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. 9 4904 relating to
unsworn falsification to authorities.
DATE JJ..-.fl.5-.2tJb.6
~. .
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Kim Zi erman
NOTICE: IF YOU DO NOT WISH TO OPPOSE THE ENTRY OF A DIVORCE
DECREE AND YOU DO NOT WISH TO MAKE ANY CLAIM FOR ECONOMIC
RELIEF, YOU SHOULD NOT FILE THIS COUNTER-AFFIDAVIT.
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