HomeMy WebLinkAbout99-07506
I
KELLIE A. LAMBERT,
i
Plaintiff
OF CUMBERLAND COUNTY
s
STATE OF tko;? PENNA.
1 ?'
IN THE COURT OF COMMON PLEAS
1
msu;
MICHAEL ERIC LAMBERT
Defendant
N, t) 99-7506 Civil T....... 19
DECREE IN
DI VORCE
AND NOM..... l?! ...2:F 1-9 . ..... it is ordered and
decreed that .. KELLIE, .,,LA?7?ERT• ,........ • • • • plaintiff,
is
and ....MICHAEL. ERIC. LAMBERT .............................. 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; 'k)c7K.Q- °
IT is ORDERED and DECREED that the Agreement entered into between
the. p.??ties..40. June..?4.. 2499,. ett??hed..h?x?to.as..>axhxb.?t. "A" .¢e and
hereby is incorporated into this Decree for pur oses of enforcement
•t•hereof; • brut • said- Agreement • s•s not. -merged • with this • Decree• •and
retai s its status as a separate contract/ a een the parties.
o
By The ou
1
\ f e
Attest: ..... j.
w
( •othonotary
s • :e: :e• :c• :?:• •:e:• -:ei <e. W. W. e:• •%• cey •:e:• •:e <e • W. •:e:• .:e: •:o:• -.*1
:e..e:•. •:e:•:
r"54
i -,a
06
i
IN THE COURT OF COMMON
KELLIE A. LAMBERT, PLEAS OF CUM13EW .Awn COUNTY,
PENNSYLVANIA
PLAINTIFF
versus NO. 99-7506 Civil Term
MICHAEL ERIC LAMBERT,
DEFENDANT
CIVIL ACTION - LAW - IN DIVORCE
Qualified Domestic Relations Order
THIS ORDER is entered pursuant to the terms of the property settlement
provisions of a decree of divorce entered in this case on a
2000, and the terms of the property settlement agreement executed between the
parties on June 14. 2000 , which was incorporated into the divorce decree so as to
survive and not merge into it. The parties having provided in the property settlement
agreement that a Qualified Domestic Relations Order will be signed and entered by
this court in order to provide for the allocation and distribution of the 401-K
Retirement Plan (the "Plan") assets, funds and benefits of the defendant as described
fully in that agreement, and in accordance with Section 414(p) of the Internal Revenue
Code of 1986 (IRC), as amended. This order is intended to serve as a qualified domestic
relations order (QDRO) by which the defendant, Michael E. Lambert, assigns a portion
of his retirement benefits under the retirement benefit plan specified below, to the
plaintiff, Kellie A. Lambert.
1. The retirement benefit plan subject to this order is as follows: Progress
Lighting, Inc. USI RSIP Retirement Account No. 609659-00880.002, in the
name of Michael E. Lambert.
2. The participant is the defendant, Michael E. Lambert, Social Security No.
235-78.5356, date of birth May 1, 1953, whose last known address is: 4196 Nantucket
Drive, Mechanicsburg, Pennsylvania, 17055.
3. The alternate payee is the plaintiff, Kellie A. Lambert, Social Security No.
236-94-7032, date of birth July 20, 1958, whose last known address is: 4196 Nantucket
Drive, Mechanicsburg, Pennsylvania, 17055.
1. F'•
4. Kellie A. Lambert, plaintiff and alternate payee, is the former wife of the
defendant and Plan participant, Michael E. Lambert.
IT IS ORDERED:
5. That $100,000.00 of the vested balance credited to the account of Michael E.
Lambert, defendant and Participant in the Plan, net of any loan outstanding on the
Assignment Date or consented to by Kellie A. Lambert, plaintiff and Alternate Payee
between the Assignment Date and the date of the distribution to Alternate Payee (the
"Assigned Benefit"), be assigned to and become the property of Alternate Payee
effective as at (the "Assignment Date").
6. The Assigned Benefit shall be adjusted for experience gains or losses of the
Plan trust from the Assignment Date to the date hereof.
7. From the date hereof to the date of distribution to Alternated Payee the Plan
shall separately account for the Assigned Benefit.
8. If the Plan so provides the Assigned Benefit shall be disbursed in one sum to
Alternate Payee as soon as practicable. If the Plan does not provide for an immediate
lump sum payment, Alternate Payee may hereafter elect to receive any form of benefit
then offered by the Plan payable at the earliest date permitted by law.
9. If Alternate Payee dies before the full amount of the Assigned Benefit has
been disbursed to Alternate Payee the balance of the Assigned Benefit shall be paid to
Michael E. Lambert, Social Security No. 235-78-5356, date of birth May 1, 1953, 4196
Nantucket Drive, Mechanicsburg, Pennsylvania, 17055, unless such beneficiary shall
predecease Alternate Payee in which case the Assigned Benefit shall be paid to
Alternate Payee's estate.
Date: zY w
J.-X/????tt
O,j jrf
KELLIE A. LAMBERT,
PLAINTIFF
versus
MICHAEL ERIC LAMBERT,
DEFENDANT
IN THE COURT OF COMMON
PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
NO. 99-7506 Civil Term
Cl[VILACTION-LAW-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 of marriage and consent of both
parties which was obtained more than ninety (90) days after service of the complaint
under Section 3301(c) of the Divorce Code.
2. Date and manner of service of the complaint: Service was made on the
Defendant by depositing a copy of the complaint in the United States mail, certified,
return receipt, postage prepaid, on December 15.1999 , and received by the Defendant
on December 20. 1999. Proof of service has been filed with the Court.
3. Date of execution of the affidavit of consent (defendant's affidavit) required
by Section 3301(c) of the Divorce Code: June 14, 2000, the original of which has been
filed with the Court.
4. Date of execution of the affidavit of consent (plaintiffs affidavit) required by
Section 3301(c) of the Divorce Code: June 14, 2000, the original of which has been filed
with the Court.
5. Defendant waived marital counseling by document dated December 20. 1999
and filed with the Court.
6. Plaintiff and Defendant executed a Separation and Divorce Settlement
Agreement, dated June 14, 2000, which has been filed with the Court and will be
incorporated and made a part of the divorce decree.
7
7. As part of the divorce agreement, the parties agreed to split defendant's
Section 401-k retirement account and agreed to the terms of a Qualified Domestic
Relations Order to implement the parties agreement.
8. There are no claims pending.
NOW THEREFORE,
Plaintiff requests this Honorable Court to:
1. Enter a Decree of Divorce under Section 3301(c) of the Divorce Code,
incorporating by reference the Divorce Settlement Agreement; and
2. Enter a Qualified Domestic Relations Order to implement the parties
agreement.
Date: L /2-D/ °"
tto for Plaintiff #16216
Gary L. Martin, Esq.
234 State St.
Harrisburg, Pa. 17101
'r
N
r{_
IN THE COURT OF COMMON
KELLIG A. LAMBERT, PLEAS OF CUMBERLAND COUNTY,
PLAINTIFF PENNSYLVANIA.
versus NO. 99-7506 Civil Term
MICHAEL ERIC LAMBERT,
DEFENDANT
CIVIL ACTION-LAW-IN DIVORCE
SEPARATION AND DIVORCE SETTLEMENT AGREEMENT
The parties have entered into a final, binding Separation and Divorce
Settlement Agreement which is attached Naereto. It is a true, complete, correct and
originally signed agreement.
vary Jp- aarcln, 1? sq.
ID # I V16
234 State Street
Harrisburg, Pa. 17101
(717) 238-4000
AGREEMENT
SEPARATION AND DIVORCE SETTLEMENT
This agreement is made on 2000, by and
between Kellie A. Lambert, presently residing at 419Nantucket Drive,
Mechanicsburg, Cumberland County, Pennsylvania, hereinafter referred to as "Wife";
and, Michael E. Lambert, presently residing at 4196 Nantucket Drive, Mechanicsburg,
Cumberland County, Pennsylvania, hereinafter referred to as "Husband".
THE PARTIES STIPULATE AND RECITE THAT:
A. They are husband and wife, having been married in Cabell County, West
Virginia, on March 27, 1981.
B. The parties have no children.
C. Tile parties have lived separate and apart since November 15, 1999.
D. The parties have resided in Pennsylvania for at least six months prior to the
date of this agreement.
E. The parties agree that their marriage is irretrievably broken. As a
consequence, the parties have separated and are now living separate and apart. The
parties desire to fully and finally settle their respective financial and property rights
and obligations as between each other, including without limitation by specification:
the settling of all matter between them relating to the ownership and equitable
distribution of real and personal property; settling of all matters between them
relating to the past, present and future support, and alimony; and in general, the
settling of any and all claims by one against the other or against their respective
estates. This separation agreement shall form the basis of the parties' divorce.
NOW THEREFORE, in consideration of the mutual promises, covenants and
undertakings hereinafter set forth and for other good and valuable consideration
receipt of which is hereby acknowledged by each of the parties hereto, each intending
to be legally bound hereby, covenant and agree as follows:
Page 1 of 16
SECTION ONE
DIVORCE
A. Kellie A. Lambert has filed a Complaint in Divorce in Cumberland County,
Pennsylvania, No. 99.7506 Civil Term, claiming that the marriage is irretrievably
broken under the no-fault provision of Section 3301(c) of the Pennsylvania Divorce
Code. Michael E. Lambert and Kellie A. Lambert hereby express their agreement that
the marriage is irretrievably broken and express their intent to execute any and all
affidavits or other documents necessary for the parties to obtain an absolute divorce
at the same time as they execute this agreement. It is further specifically understood
and agreed by the parties that the provisions of this Agreement relating to equitable
distribution of property of the parties and alimony (both permanent and pendente lite),
and support, are accepted by each party as a final settlement for all purposes
whatsoever, as contemplated by the Pennsylvania Divorce Code.
B. Should a decree, judgment or other order of separation or divorce be obtained
by either of the parties in this or any other state, or country, each of the parties hereby
consents and agrees that this Agreement and all of its covenants shall not be affected
in any way by any such separation or divorce; and that nothing in any such decree,
judgment, order or further modification or revision thereof shall alter, amend or vary
any term of this Agreement, whether or not either or both of the parties shall remarry.
It is specifically agreed, that a copy of this Agreement or the substance of the
provisions thereof, may be incorporated by reference into any divorce judgment or
decree. It is the specific intent of the parties to permit this Agreement to survive any
judgment and to be forever binding and conclusive upon the parties.
SECTION TWO
LIVING SEPARATE
A. It is agreed that both parties, at all times hereafter, will live separate and
apart at such residences as they each may choose, wholly free from marital control,
authority, advice, and influence, as if they were each sole and unmarried.
B. Each party shall be free from interference, authority, and contact by the
other, as fully as if he or she were single and unmarried, except as may be necessary
to carry out the provisions of this Agreement. Neither party will in any manner molest
or annoy the other, endeavor to compel the other to cohabitate or dwell with him or
her, by any legal proceedings for the restoration of conjugal rights, or otherwise.
Neither party will call upon or visit the other without the full consent and approval of
Page 2 of 16
the other. Neither party will in any way harass or malign the other, nor in any way
interfere with the peaceful existence, separate and apart from the other.
C. Both parties may continue in their respective occupation, or engage in such
other different occupations as they may each desire, free from the control or
interference of the other. Except as provided herein, each party will receive and retain
their respective income from their occupations.
D. The foregoing provisions shall not be taken as an admission on the part of
either party of the lawfulness of the causes leading to their living apart.
SECTION THREE
PROPERTY DIVISION
A. The parties hereto entered inn agreement for the separation of marital,
tangible, personal property dated L?45- ZDDV , which is
incorporated herein. Each of the parties shall take tie items of personal property as
indicated in the aforesaid agreement, which is and shall be their solely owned
property. The parties waive any further claims for such property other than as agreed
in that contract.
B. The parties agree that the aforesaid agreement on personal property is full
and complete and that the possession, title and interest indicated on the inventory
represents the full, final and informed agreement of the parties on equitable
distribution of marital property and non-marital property. It is agreed that wife shall
have the right to enter the marital residence and retrieve such items at the time of
signature of this agreement, or at any time thereafter.
C. Neither party shall make any claim to any such items of marital property, or
the separate personal property of either party, which are now in the possession and/or
under the control of the other, except as provided herein. Should it become necessary,
the parties each agree to sign, upon request, any titles or documents necessary, to give
effect to this section.
D. Prior to the date of this agreement, the parties, in anticipation of their
divorce and settlement agreement, agreed to separate their ownership interest in their
joint residence at 4196 Nantucket Drive, Mechanicsburg, Pennsylvania. The parties
agreed that the husband shall be the sole owner of the aforesaid residence, and shall
be solely liable for all debt against such property and all taxes, utility charges,
maintenance expenses and any other costs of ownership. To implement this agreement,
Page 3 of 16
the parties signed and recorded a deed dated November 19, 1999, transferring
ownership of the aforesaid property from their joint ownership to the sole and
exclusive ownership of Michael E. Lambert. As part of this transaction, Michael E.
Lambert obtained a mortgage in his name alone against the aforesaid property and
used the proceeds to pay off and extinguish the previous joint mortgage(s) against the
aforesaid property. Further, a surplus of $34,000.00 was generated by the
remortgaging of the property, and the parties equally split the surplus. Each party to
this agreement acknowledges receipt of their portion of the surplus. Each party
agreement confirms that these terms of agreement are to be made part of this
agreement, by incorporation by reference, that the disposition reached regarding this
property is fair, equitable and a part of the overall settlement agreement. If any
additional documents to implement this agreement are necessary, each party agrees
to sign such documents.
SECTION FOUR
SPOUSAL SUPPORT AND ALIMONY
A. The husband will pay to the wife, Rellie A. Lambert, as nonmodifrable
alimony the sum of One Thousand ($1,000.00) Dollars a month, each and every month
beginning with the month following the date of this agreement, payable in the amount
of Five Hundred ($500.00) Dollars on the first day of the month, Two Hundred and
Fifty ($250.00) Dollars on the tenth day of the month, and Two Hundred and Fifty
($250.00) Dollars on the twentieth day of the month, for 120 consecutive months, at
which time all payments shall cease if they have notpreviously terminated as provided
herein. Time is of the essence. If payments are not made within three (3) days of the
day they are due, payment shall be late and the Husband shall be obligated to pay the
wife an addition late fee of Fifty ($50.00) Dollars, for each and every occurrence of late
payment. The Husband's obligation to pay under this paragraph will end and he will
be released from the obligation of payment upon the death, cohabitation or remarriage
of the wife, or upon expiration of the term of payment provided herein, whichever
occurs first. The Wife's estate, successors, or heirs shall have no right to payments
scheduled to be made subsequent to the wife's death.
B. For the purposes of this agreement, cohabitation shall be defined as financial,
social, and sexual interdependence where the wife and the person with whom she is
living, actually reside together, for a period of at least sixty (60) days, in the manner
of spouses, assuming the rights and duties generally associated with a marriage
relationship. This definition is derived from the case of Miller v. Miller, 352 Pa. Super.
432, 508 A.2d 550 (1986) and shall be controlling upon the parties regardless of
changes in the statutory or case law of Pennsylvania.
Page 4 of 16
C. Husband, so long as he is obligated to pay alimony as provided in this
paragraph, shall pay, or reimburse Wife, for fifty (50%) percent of her actual costs to
obtain full Blue Cross/Blue Shield medical insurance, prescription plan coverage and
dental insurance.
D. The monthly alimony payments payable under this paragraph will be
annually adjusted for inflation as of January 1, of each year, in the following manner:
a. For each calendar year subsequent to the initial year of this agreement, an
additional amount of alimony will be added to the base monthly alimony, provided
above; either the greater of TWO (2%) PERCENT per annum, or, the actual increase
in the Consumer Price Index to account for any increase in the cost-of-living index
published by the Bureau of Labor Statistics of the United States Departmentof Labor,
using the period 1982.1984 =100 as the base period (or such other period generally
used as the base period). The alimony for years subsequent to the initial year of this
agreement, shall be computed by dividing the sum of TWELVE THOUSAND
DOLLARS, ($12,000.00), which is the amount of alimony for the initial year of this
agreement, by the index number for the month of March 2000 and then multiplying
that amount by the index number for the month of March immediately preceding the
initial month of each subsequent year of this agreement. This new annual alimony will
then be divided by twelve (12) to arrive at the new monthly alimony for the next year
of this agreement which will be payable thereafter as if it had been specified in the
previous paragraph as the original monthly alimony, provided however that the new
monthly alimony shall not be less than the base monthly alimony provided above, plus
a minimum increase annually of 2 percent.
b. The Wife will send written notice to the Husband of the monthly alimony as
revised by the cost-of-living standard before the start of the next year.
c. Subsequent years of this agreement and the term of the alimony obligation
hereunder, shall be subject to the same method of calculation of the increase in
alimony, based on the previous years adjusted alimony as the new base alimony.
E. Except as specified herein, each party hereby waives, releases and gives up
any rights they may respectively have against the other for alimony, alimony pendente
lite, spousal support or maintenance.
Page 5 of 16
SECTION FIVE
RETIREMENT BENEFITS
It is acknowledged that a portion of the marital property of the parties consists
of USI RSIP Retirement Account, No. 609659-00880-002, in the name of Michael E.
Lambert from his employer, Progress Lighting, Inc. The full, net cash value of the
retirement accoumt, all of which is marital, was $115,565.97 as of November 22, 1999.
The parties agree that the sum of One Hundred Thousand ($100,000.00) Dollars shall
be assigned to wife pursuant to a Qualified Domestic Relations Order which shall be
entered within thirty (30) days of the grant of a final decree of divorce, in substantially
the same form as attached hereto as an Exhibit. Husband, as participant, shall be
awarded the remainder of the 401-K account balance together with all interest and
dividends earned thereon.
SECTION SIX
LIFE INSURANCE
Husband agrees to name wife as irrevocable beneficiary on a policy or policies
(hereinafter policies) of life insurance on his life, totaling One Hundred Thousand
($100, 000.00) in coverage, and to pay the premiums and maintains said policies so long
as he is obligated to pay any alimony pursuant to this Agreement, after which time he
may designate any one he desires as beneficiary. In performance of his obligations
under this paragraph, the Husband shall do the following:
a. Simultaneously with the execution of this Agreement, the Husband
shall designate the Wife as the primary irrevocable beneficiary of the
entire proceeds of a policy or policies in the amount of $100,000.00.
b. The Husband shall at all times keep the aforementioned policies in full
force and effect and shall promptly pay any and all dues, premiums and
assessments thereon. Husband, further, shall not convert, borrow
against, pledge or encumber said policies.
c. Within 30 days of the execution of this Agreement, Husband shall
provide proof satisfactory to the Wife that he has taken all steps
necessary to cause the insurance company issuing the aforementioned
insurance policies to forward duplicate premium receipts to the wife.
d. To secure due performance of his obligations under this paragraph, the
Husband, within 30 days of the execution of this Agreement, shall deliver
Page 6 of 16
the original of the aforementioned policies to the wife.
e. If the Husband defaults in the payment of dues, premiums or
assessments on the aforementioned policies, the Wife shall have the
option, but not the obligation, to pay the same. In the event that the Wife
elects to make such payments, the Husband shall forthwith become liable
to the Wife for the aggregate of such payments made by the Wife.
f. If the aforementioned life insurance policies are not in full force and
effect at the time of the Husband's death, or, if for any reason the Wife
does not receive the proceeds thereof that the Wife is entitled to under
this paragraph, then the Wife shall have a creditor's claim against the
Husband's estate in an amount equal to the insurance proceeds Wife
should have received under the provisions of this paragraph.
g. Notwithstanding any other provision of this Agreement, it is
understood and agreed by and between the parties that any insurance
proceeds payable in the event of the Husband's death in excess of
$100,000.00 shall be payable to such beneficiary or beneficiaries as the
Husband might select.
SECTION SEVEN
AUTOMOBILE
A. The Wife has entered into a sixty (60) month lease for a 1999 VW Passat
automobile. Husband agrees to pay the full amount of lease payments, costs, charges
and overages, for this vehicle for the full term of the lease. In addition, Husband shall
pay the full amount of automobile insurance required to insure the vehicle for the full
term of the lease. Husband shall not be liable for the cost of repairing or maintaining
the vehicle during the term of the lease.
B. At the end of the aforesaid lease, Husband shall pay Wife the amount
necessary to purchase the aforesaid vehicle, which is indicated on the lease documents
to be the sum of $12,745.00, plus the cost of taxes, tags and title necessary to complete
the purchase; PROVIDED HOWEVER, that Wife has not remarried or entered into a
cohabitation with another person as contemplated in the paragraph aforesaid
regarding the payment of alimony. Such payment may consist, at the option of
Husband, tobe a cashpurchase down paymentand monthly financing payments, until
the vehicle has been fully paid off. If Wife has remarried or is cohabitating, Husband
shall pay Wife Twenty (20%) Percent of the aforesaid pay off purchase price, in cash,
Page 7 of 16
r
for the aforesaid vehicle. If the wife wishes to obtain a different vehicle, she may apply
the aforesaid pay off sum to the lease or purchase of another vehicle as she may choose.
Husband shall not be liable for the payment of insurance on the aforesaid vehicle or
any other vehicle of the Wife's after the expiration of the aforesaid 60 month lease.
SECTION EIGHT
RELEASE OF PROPERTY AND ESTATE RIGHTS
Each party hereby waives, relinquishes, and releases:
A. All right and claim in or to the property of the other, including all rights of
dower, curtesy, and marital share;
B. All right to share in the estate of the other under the laws of succession of the
Commonwealth of Pennsylvania or any other state, wherein eitherparty may hereafter
be domiciled or own property;
C. All right to object to or interfere with the last will and testament of either
Party, except as otherwise provided herein, and the right to serve as executor or
administrator of the estate of the other party, or to take under the last will and
testament of the other party, except by will, or codicil to a will, hereafter made.
SECTION NINE
DEBTS AND OBLIGATIONS
A. The parties agree that debts in the name of the husband, as shown on the
attached Exhibit, shall be paid by husband. If creditors maintain any claim for
payment against wife for such debts, husband shall obtain from creditors a signed,
written release of wife's liability for such debts.
B. The parties agree that debts in the name of the wife, as shown on the
attached Exhibit, shall be paid by wife. If creditors maintain any claim for payment
against husband for such debts, wife shall obtain from creditors a signed, written
release of husband's liability for such debts.
C. The parties agree that joint debts in the name of both the husband and the
wife, as shown on the attached Exhibit, shall be paid by husband. If creditors maintain
any claim forpayment against wife for such debts, husband shall obtain from creditors
a signed, written release of wife's liability for such debts.
Page 8 of 16
ut:
D. Each party shall indemnify and hold harmless the other party for and against
any and all debts, charges and liabilities incurred by the other from debts which exist
on the date of execution of this agreement, as shown on the aforesaid Exhibits, and all
other debts of like kind not shown on the Exhibits, except as may be otherwise
specifically provided for by the terms herein.
E. Each party represents that they have not heretofore incurred or contracted
for any other debt or liability or obligation for which the estate of the other party may
be responsible or liable except as may be provided for in this Agreement. Each party
agrees to indemnify and hold the other party harmless for and against any and all
such debts, liabilities of every kind which may have heretofore been incurred by them,
including those for necessities, except for the obligation arising out of this Agreement.
F. The parties covenant, warrant, represent and agree that with the exception
of obligations set forth in this Agreement, neither of them shall hereafter incur any
liability whatsoever for which the estate of the other may be liable. Each party shall
indemnify and hold harmless the other party for and against any and all debts,
charges and liabilities incurred by the other after the execution date of this Agreement,
except as may be otherwise specifically provided for by the terms herein.
SECTION TEN
TAX ISSUES
A. The payments required by paragraph Four above shall be treated as alimony
for tax purposes, only if made during the year when due. Payments made in advance
or in arrears shall not be taxable to the Wife nor deductible by the Husband.
B. The parties agree that they will file a joint income tax return, federal and
state, for the 1999 tax year. Husband shall prepare and pay the cost of preparation of
such returns. Wife shall have the right to review the returns with her accountant or
attorney prior to her signature on the tax return forms and shall have the right to
object to any entry. The parties agree that the Wife shall receive 30% of any tax refund
from such tax returns, and that Wife shall not be liable to pay any portion of any
additional taxes as may be due on such returns.
C. The parties shall file separate tax returns for all tax years after 1999, and
each shall )e solely responsible for any taxes due.
D. Throughout the parties marriage, they have filed joint tax returns. The
parties acknowledge and agree that Husband was responsible for the preparation and
Page 9 of 16
filing of such tax returns and was responsible for payment of all tax due. If the taxing
agencies, by audit orotherwise, determine that additional tax, interest or penalties are
due for any and all returns filed jointly by the parties, Husband agrees that he shall
be solely liable for payment of such claims, and to that end Husband, on his behalf and
on behalf of his estate, agrees to defend, indemnify and hold Wife harmless from any
and all such claims. Husband stipulates and agrees that Wife shall be considered, for
purposes of the Internal Revenue Code and state tax law, an "innocent spouse".
SECTION ELEVEN
VERIFICATION OF MARITAL PROPERTY
The parties hereto, individually and jointly and to the best of their knowledge,
information and belief, represent, stipulate and verify that the attached Inventory and
Exhibits correctly and completely itemizes all items of marital property and non-
marital property which existed on November 15, 1999, the date of the parties
separation.
SECTION TWELVE
DEATH OR BANKRUPTCY
All financial obligations undertaken by the Husband in this Agreement, shall
be binding upon his heirs, executors, administrators, successors and assigns, and shall
constitute a charge against the Husband's estate. It is further acknowledged and
agreed that the aforesaid alimony payments and such other payments as specified
herein shall be deemed to be support payments as contemplated by the Bankruptcy
Code, both as a matter of fact and as a matter of law, and are not intended by the
parties to be debts which may be discharged in bankruptcy.
SECTION THIRTEEN
DISCLOSURE
Each party asserts that at the time of this agreement, each of them has made
a full and fair disclosure, to the best of their knowledge, information and belief, of the
real and personal property of whatsoever nature and wheresoever located belonging
in any way to each of them, of all debts and encumbrances incurred in any manner
whatsoever by each of them, of all sources and amounts of income received or
receivable by each party, and of other facts relating in any way to the subject matter
of this Agreement. Both parties acknowledge that some valuations and descriptions of
property may be incomplete or incorrect. Each of the parties, upon their own judgment
and against advice of counsel, has accepted as part of the consideration for entering
Page 10 of 16
into this Agreement, the incomplete disclosure of these facts and mutually waives any
further claim for full disclosure or additional consideration based upon such full
disclosure.
SECTION FOURTEEN
ATTORNEY'S FEES AND COSTS
The parties shall pay the costs of their own attorneys and their other costs
associated with this matter and for any fees or expenses which occur subsequent to the
execution of this agreement. The husband agrees to reimburse wife for all of her legal
fees, costs and expenses incurred in connection with the parties divorce, marital
settlement agreement, and subsequent enforcement of such agreement.
SECTION FIFTEEN
DATE OF EXECUTION
The "date of execution" or" execution date" of this agreement shall be defined as
the date upon which it is executed by the parties if they have each executed the
agreement on the same date. Otherwise the "date of execution" or "execution date" of
this agreement shall be defined as the date of execution by the party last executing
this agreement.
SECTION SIXTEEN
DISTRIBUTION DATE
The transfer of property, funds and/or documents provided for herein, shall only
take place on the "distribution date" which shall be defined as the date of execution of
this agreement or as otherwise specified herein.
SECTION SEVENTEEN
MUTUAL RELEASE
The parties hereto each do hereby mutually remise, release, quitclaim and
forever discharge the other and the estate of such other, for all time to come, and for
all purposes whatsoever, of and from any and all rights, title and interests, or claims
in or against the property (including income and gain from property hereafter
accruing) of the other or against the estate of such other, of whatever nature and
wheresoever situation, which he or she now has or at any time hereafter may have
against the other, the estate of such other or any part thereof, whether arising out of
any former acts, contracts, engagements or liabilities of such other or by way of dower
Page 11 of 16
V--.
or curtesy, or claims in the nature of dower or curtesy or widow's or widower's rights,
family exemption or similar allowance, or under the intestate laws, or the right to take
against the spouse's will; or the right to treat a lifetime conveyance by the other as
testamentary, or all other rights of a surviving spouse to participate in a deceased
spouse's estate, whether arising under the laws of (a) Pennsylvania, (b) any State,
Commonwealth or territory of the United States, or (c) any country, or any rights
which either party may have or at anytime hereafter shall have for past, present or
future support or maintenance, alimony, alimony pendente lite, counsel fees, property
division, costs or expenses, whether arising as a result of the marital relations or
otherwise, except, all rights and agreement and obligations of whatsoever nature
arising or which may arise under this Agreement or for the breach of any provisions
thereof. It is the intention of the parties hereto to give to each other by the execution
of this Agreement a full, complete and general release with respect to any and all
property of any kind or nature, real, personal or mixed, which the other now owns or
may hereafter acquire, except and only except all rightand agreements and obligations
of whatsoever nature arising or which may arise under this Agreement or for the
breach of any provision thereof. It is further agreed that this Agreement shall be and
constitute a full and final resolution of any and all claims which each of the parties
may have against the other for equitable division of property, alimony, counsel fees
and expenses, alimony pendente lite or any other claims pursuant to the Pennsylvania
Divorce Code or the divorce laws of any other jurisdiction.
SECTION EIGHTEEN
ADVICE OF COUNSEL
The provisions of this Agreement and their legal effect have been fully explained
to Kellie A_ Lambert by Gary L. Martin, Esquire, attorney for Kellie A. Lambert.
Michael E_ Lambert has knowingly and intentionally chosen to proceed with this
agreement and the parties divorce without legal counsel. Michael E. Lambert waives
and releases any and all claims that he was denied legal counsel, or that he entered
into this Agreement without knowledge of its terms, without understanding its terms,
or without the benefit of legal advice.
The parties hereto, for themselves, with full knowledge of the terms hereunder
and irrespective of any advice by any other person including their legal counsel, accept
that this Agreement is, in the circumstances, fair and equitable and that it is being
entered into freely and voluntarily and that execution of this Agreement is not the
result of any duress or undue influence and that it is not the result of any collusion or
improper or illegal agreement or agreements. The parties further acknowledge that
they have each made to the other substantial disclosure of their respective assets,
Page 12 of 16
estate, liabilities, and sources of income and that they waive any specific enumeration
thereof for the purpose of this Agreement. Each party agrees that he and she shall not
at any future time raise a defense or otherwise the lack of such disclosure in any legal
proceeding involving this Agreement, with the exception of disclosure that may have
been fraudulently withheld. Each party, for themselves, assumes full responsibility
for the acceptability of the terms of this agreement.
SECTION NINETEEN
EQUITABLE DISTRIBUTION
Each party hereby agrees and represents that this post-nuptial Agreement
constitutes an equitable distribution of property, both real and personal, which was
legally and beneficially acquired by the parties, either jointly or separately, during
their marriage, or previous to their marriage, as contemplated by the Divorce Code of
Pennsylvania, 23 Pa. C. S. 3301 et seq.
SECTION TWENTY
EXECUTION OF SUBSEQUENT DOCUMENTS
The parties will execute and deliver any other instruments or documents that
may be necessary or convenient to carry into effect the provisions of this agreement.
SECTION TWENTY-ONE
WRITTEN MODIFICATIONS
No modification or waiver of any of the terms hereof shall be valid unless in
writing and sigi:jd by both parties and no waiver of any breach hereof or default
hereunder shall be deemed a waiver of any subsequent default of a similar nature.
SECTION TWENTY-TWO
MUTUAL COOPERATION
Each party shall, at any time and from time to time hereafter, take any and all
steps and execute, acknowledge and deliver to the other party any and all further
instruments and/or documents that the other party may reasonably require for the
purpose of giving full force and effect to the provisions of this Agreement.
Page 13 of 16
SECTION TWENTY-THREE
APPLICABLE LAW
This Agreement shall be construed in accordance with the laws of the
Commonwealth of Pennsylvania which are in effect as of the date of execution of this
Agreement.
SECTION TWENTY-FOUR
BINDING AGREEMENT
This Agreement shall be binding and shall inure to the benefits of the parties
hereto and their respective heirs, executors, administrators, successors and assigns.
SECTION TWENTY-FIVE
INTEGRATION
This agreement constitutes the entire understanding of the parties and
supersedes any and all prior agreements and negotiations between them. There are
no representations or warranties other than those expressly set forth herein.
SECTION TWENTY-SIX
NO WAIVER OF DEFAULT
This Agreement shall remain in full force and effect unless and until terminated
under and pursuant to the terms of this Agreement. 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 hereafter to enforce the same, nor shall the waiver
of any default or breach of any provisions hereof be construed as a waiver of any
subsequent default or breach of the same or similar nature, nor shall it be construed
as a waiver of strict performance of any other obligations herein.
SECTION TWENTY-SEVEN
SEVERABILITY
If any term, condition, clause or provisions of this Agreement shall be
determined or declared to be void or invalid in law or otherwise, then only that term,
condition, clause or provision shall be stricken from this Agreement and in all other
respects this Agreement shall be valid and continue in full force, effect and operation.
Likewise, the failure of any party to meet her or his obligation under any one or more
Page 14 of 16
of the paragraphs herein, with the exception of the satisfaction of the conditions
precedent, shall in no way avoid or alter the remaining obligations of the parties.
SECTION TWENTY-EIGHT
BREACH
WITNESS:
If either party breaches any provisions of this Agreement, the other party shall
have the right, at his or her election, to sue for damages for such breach or seek such
other remedies or relief as may be available to him or her, and the party breaching this
contract shall be responsible for payment of reasonable legal fees and costs incurred
by the other in enforcing their rights under this agreement.
SECTION TWENTY-NINE
HEADINGS NOT PART OF AGREEMENT
Any heading preceding the text of the several paragraphs and subparagraphs
hereof are inserted solely for convenience of reference and shall not constitute a part
of this Agreement nor shall they affect its meaning, construction or effect.
THIS AGREEMENT SHALL BE BINDING ON THE RESPECTIVE HEIRS,
EXECUTORS, ADMINISTRATORS, AND ASSIGNS OF THE PARTIES.
IN WITNESS WHEREOF, WE HAVE HEREUNTO SIGNED OUR NAMES,
THE DAYAND YEAR PROVIDED ABOVE, INTENDING TO BE LEGALLY BOUND
HEREBY.
/' "/) W. , , " 'r-
_ BY:
chael E. Lambert
Wa4 BY: 'Ale
Ke lie A. Lambert
Page 15 of 16
COMMONWEALTH OF PENNSYLVANIA :
//11
COUNTY OF fir .cam i ll SS.
On the da- of 'J(-'-11C,
20 UD before me, a
Notary Public, personally appeared Michael E. Lambert known to me to be the person
whose name is subscribed to the within document, and acknowledged that he executed
the foregoing for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and Notarial Seal.
COMMONWEALTH OF PENNSYLVANIA
nn
COUNTY OF A-Lt4 T'1 SS.
On the / Pl. day of J ?
2000 , before me, a
Notary Public, personally appeared Kellie A. Lambert known to me to be the person
whose name is subscribed to the within document, and acknowledged that she
executed the foregoing for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and Notarial Seal.
NOTARY 1 L SEAL
Y.mh R Martin, Notary Public
Page 16 of 16 ? ZC001 uricbwg, Dauphin
;,? ? 6.2004
.
NOTARY PU E,(N SEAL
tin, Notary Pub lic
ur& Dauphin County
n ice Mar. 6, 7004
KELLIE A. LAMBERT,
PLAINTIFF
versus
MICHAEL ERIC LAMBERT,
DEFENDANT
IN THE COURT OF COMMON
PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
NO. 99-7506 Civil Term
CIVIL ACTION - LAW - IN DIVORCE
Qualified Domestic Relations Order
THIS ORDER is entered pursuant to the terms of the property settlement
provisions of a decree of divorce entered in this case on ,
2000, and the terms of the property settlement agreement executed between the
parties on June 14. 2000 , which was incorporated into the divorce decree so as to
survive and not merge into it. The parties having provided in the property settlement
agreement that a Qualified Domestic Relations Order will be signed and entered by
this court in order to provide for the allocation and distribution of the 401-K
Retirement Plan (the "Plan") assets, funds and benefits of the defendant as described
fully in that agreement, and in accordance with Section 414(p) of the Internal Revenue
Code of 1986 (IRC), as amended. This order is intended to serve as a qualified domestic
relations order (QDRO) by which the defendant, Michael E. Lambert, assigns a portion
of his retirement benefits under the retirement benefit plan specified below, to the
plaintiff, Kellie A. Lambert.
1. The retirement benefit plan subject to this order is as follows: Progress
name of Michael E. Lambert.
2. The participant is the defendant, Michael E. Lambert, Social Security No.
235.78-5356, date of birth May 1, 1953, whose last known address is: 4196 Nantucket
Drive, Mechanicsburg, Pennsylvania, 17055.
3. The alternate payee is the plaintiff, Kellie A. Lambert, Social Security No.
236-94-7032, date of birth July 20,1958, whose last known address is: 4196 Nantucket
Drive, Mechanicsburg, Pennsylvania, 17055.
E%
PHIBIT
4. Kellie A. Lambert, plaintiff and alternate payee, is the former wife of the
defendant and Plan participant, Michael P. Lambert.
IT IS ORDERED:
5. That $100,000.00 of the vested balance credited to the account of Michael E.
Lambert, defendant and Participant in the Plan, net of any loan outstanding on the
Assignment Date or consented to by Kellie A. Lambert, plaintiff and Alternate Payee
between the Assignment Date and the date of the distribution to Alternate Payee (the
"Assigned Benefit"), be assigned to and become the property of Alternate Payee
effective as at (the "Assignment Date").
6. The Assigned Benefit shall be adjusted for experience gains or losses of the
Plan trust from the Assignment Date to the date hereof.
7. From the date hereof to the date of distribution to Alternated Payee the Plan
shall separately account for the Assigned Benefit.
8. If the Plan so provides the Assigned Benefit shall be disbursed in one sum to
Alternate Payee as soon as practicable. If the Plan does not provide for an immediate
lump sum payment, Alternate Payee may hereafter elect to receive any form of benefit
then offered by the Plan payable at the earliest date permitted by law.
9. If Alternate Payee dies before the full amount of the Assigned Benefit has
been disbursed to Alternate Payee the balance of the Assigned Benefit shall be paid to
Michael E. Lambert, Social Security No. 235-78-5356, date of birth May 1, 1953, 4196
Nantucket Drive, Mechanicsburg, Pennsylvania, 17055, unless such beneficiary shall
predecease Alternate Payee in which case the Assigned Benefit shall be paid to
Alternate Payee's estate.
Date:
J.
[Signature]
EXHIBIT
r ??
?
.
`- t.: '
"'' S
?.. '
i
`
; ,:
;.?,-
KELLIE A. LAMBERT,
PLAINTIFF
versus
MICHAEL ERIC LAMBERT,
DEFENDANT
IN THE COURT OF COMMON
PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
?i v? ?rc2h?
NO. 94 - '790L
CIVIL ACTION - LAW - IN DIVORCE
NOTICE TO DEFEND AND CLAIM RIGHTS
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 ff: y 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 of children 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,
1 Courthouse Square, Carlisle, Pennsylvania.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S
FEES OR EXPENSES BEFOREA DIV()RCE ORANNULMENT 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.
IF YOU DO NOT HAVE A LAWYER, CQNTAC.
Referral Serd
lx?
ministr r taU
ounty Courthouse
.17013
>Carli
o2
ficx?
-2
02 ?
` ?
eb' c_[-(s.fl
C4 -b !L`
/7-??
CONT CT
IF YOU CANNOT AFFORD A LAWYE :
Legal Services, Inc.
8 Irvine Row
Carlisle, Pa. 17013
717-243-9400
Sr.-.._
IN THE COURT OF COMMON
KELLIE A. LAMBERT, PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
PLAINTIFF
versus NO.
MICHAEL ERIC LAMBERT,
DEFENDANT cpgL ACTION - LAW - IN DIVORCE
T
COMPLAIN
1. The plaintiff is KELLIE A. LAMBERT who resides at 4196 Nantucket Drive,
Mechanicsburg, Cumberland County, Pennsylvania.
2. The defendant is MICHAEL ERIC LAMBERT, who resides at 4196 Nantucket
Drive, Mechanicsburg, Cumberland County;" Pennsylvania.
8. The plaintiff and the defendant have been a bonifide residents of the
Commonwealth of Pennsylvania for at least six months immediately previous to the
filing of this Complaint.
4. The plaintiff and defendant were married on the 27th day of March, 1981, in
West Virginia.
5. No other divorce proceedings by either of the parties herein has been filed in
this or any other jurisdiction.
6. Neither the plaintiff nor the defendant in this action are presently a member
of the United States Armed Forces.
7. The plaintiff and the defendant have been separated since November 15, 1999.
8. The plaintiff has been advised of the availability of counseling and that she
may have the right to request the Court to require both plaintiff and defendant to
participate in counseling in accordance with the provisions of Rule 1920.45. Being so
advised, plaintiff does not request that the Court require the parties to participate in
counseling prior to a Divorce Decree being handed down by the Court.
9. Plaintiff avers that the marriage is irretrievably broken. The plaintiff will
submit an Affidavit of Consent from both the plaintiff and the defendant as required
under Section 3301(c) of The Divorce Code.
WHEREOF, plaintiff request this Honorable Court to:
A. Enter an Order dissolving the marriage between plaintiff and defendant.
Date: (Z c ci4 z?.r.?.?l , "
Attnrn fnr Plninfiff
Gary L.Wartin, Esq.
# 16216
234 State Street
Harrisburg, Pa. 17101
717-238-4000
IN THE COURT OF COMMON
KELLIE A. LAMBERT, PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
PLAINTIFF
versus NO.
MICHAEL ERIC LAMBERT,
DEFENDANT
CIVIL ACTION - LAW - IN DIVORCE
VERIFICATION
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
SS.
KELLIE A. LAMBERT, being duly sworn according to law, deposes and says
that she is the Plaintiff in the foregoing Complaint in Divorce and that the facts set
forth are true and correct to the best of her knowledge, information and belief.
f90„ Q.Lyt?
(Pl 'ntiff's signature)
SWORN TO AND SUBSCRIBED
BEFORE ME THIS 9*h DAY
OF Pecepyt bee- 19 q I .
NOTARY PUBLIC
NOTARIAL SEAL
LEAH R. MARTIN, Notary Public
City of Harrisburg, Dauphin County
My Commission Expin+* v. "ri' 8, 2000
m
KELLIEA. LAMBERT,
PLAINTIFF
versus
MICHAEL ERIC LAMBERT,
DEFENDANT
IN THE COURT OF COMMON
PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
NO. 99-7506 Civil Term
CIVILACTION -LAW-IN DIVORCE
DEFENDANT'S WAIVER OF NOTICE OF INTENTION
TO REQUEST ENTRY OF DIVORCE DECREE
AND NOW this Z? day of T uN4 2000,
Defendant, Michael Eric Lambert, hereby waives notice from the plaintiff, that
plaintiff is filing documents with the Court requesting entry of a divorce decree in the
above captioned matter. Defendant, Michael Eric Lambert understands that entry of
a decree of divorce will be made without further notice to him, that it will be final, and
that all divorce related issues, such as property settlement, alimony, and support will
be waived to the extent not otherwise decided by the parties and/or the Court.
ir:
IN THE COURT OF COMMON
KELLIE A. LAMBERT, PLEAS OF CUM 3ERI.AND COUNTY,
PENNSYLVANIA
PLAINTIFF
versus NO. ?yso? G4 2/t'l
MICHAEL ERIC LAMBERT,
DEFENDA.'iT
CIVIL ACTION - LAW - IN DIVORCE
AFFIDAVIT
AVAILABILITY OF COUNSELING
Defendant, MICHAEL ERIC LAMBERT, being duly sworn according to law,
deposes and says:
1. I have been advised of the availability of marriage counseling and understand
that I may request that the Court require that my spouse and I participate in
counseling.
2. I understand that the Court maintains a list of marriage counselors in the
Domestic Relations Office, which list is available to me upon request.
3. Being so advised, I do not request that the Court require that my spouse and
I participate in counseling prior to a divorce decree being handed down by the court.
I understand that false statements herein are made subject to the penalties of
18 Pa. C. S. §4904 relating to unsworn falsifi
DATE: /Z - 20 - /Pty
?. _
•- O 1,
77.
KELLIE A. LAMBERT,
PLAINTIFF
versus
MICHAEL ERIC LAMBERT,
DEFENDANT
IN THE COURT OF COMMON
PLEAS OF CUMBERLANID COUNTY,
PENNSYLVANIA
NO. 99-7506 Civil Term
CIVILACTION-LAW-IN DIVORCE
AFFIDAVIT OF CONSENT
1. A Complaint in divorce under Section 3301(c) of the Divorce Code was filed
on December 15. 1909.
2. The marriage of plaintiff and defendant is irretrievably broken and ninety
(90) days have elapsed from the date of filing the Complaint.
3. I consent to the entry of a final decree of divorce.
4. I understand that I may lose rights concerning alimony, division of property,
lawyer's fees or expenses if I do not claim them before a divorce is granted.
I 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: G /! o x// Z .^ ?2 `6?
Plaintiffs signatuge
>_ C)
A-
-J
!?
_?-
_??;
._. ?J
--? " :n
_j.,.
iw
_ '=
, ?
;•?
:? _?
J
IN THE COURT OF COMMON
KELLIE A. LAMBERT, PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
PLAINTIFF
versus NO. 99-7506 Civil Term
MICHAEL ERIC LAMBERT,
DEFENDANT
CIVILACTION-LAW-IN DIVORCE
AFFIDAVIT OF CONSENT
1. A Complaint in divorce under Section 3301 (c) of the Divorce Code was filed
on December 15, 1999 .
2. The marriage of plaintiff and defendant is irretrievably broken and ninety
(90) days have elapsed from the date of filing the Complaint.
3. I consent to the entry of a final decree of divorce.
4. I understand that I may lose rights concerning alimony, division of property,
lawyer's fees or expenses if I do not claim them before a divorce is granted.
I 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.
Z?z ?Z'l
DATE: (416
Def danes signature
IN THE COURT OF COMMON
KELLIE A. LAMBERT, PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
PLAINTIFF
versus NO. 99-7506 Civil Term
MICHAEL ERIC LAMBERT,
DEFENDANT
CIVIL ACTION - LAW- IN DI VORCE
AFFIDAVIT OF SERVICE
MICHAEL ERIC LAMBERT, Defendant herein, acknowledges that he received
service of the following documents under 3301 (c) of the Divorce Code, on or around
December 20, 1999, by certified mail:
1. Plaintiffs complaint under §3301 (c) of the Divorce Code;
2. Notice to defend;
3. Waiver of marital counseling; and
4. Acknowledgment of receipt of service of these documents.
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: ?Y ca
Defendant's signature
SENDER:
•? 'Complete Ilerns I strutter Z for additional services.
d 4b I also wish to receive the
following services (for an
h ,
:Complate Items 3,43, an
Pdrn your name end address on the reverse of this loan to that we can return this
d extra (go):
car
to yyoou.
'Mach thlaform to the front of the mailplece, or onthe beck if space does not
1. ? Addressee's Address
z
u ppaast.
'The Saturn it I. to below the Mlclo
'The Receipt ecd xlA I. ewo whom the the enlde was e delivered and the data
dale
?
p,?Residcled Delivery
1%
§ delivered. ered. Consult postmaster for fee.
3. Article Addressed to: 4a. y P Number
t'' I ?'i` 7
c
E
$
?T ??•
q(C l? 4b. Service Type
? Registered XCenlged
c
m
M / ?a a 70 s? p Express Mall ? Insured 3
? RelumReceipt for Merdwndse ? COD
7. Date of Delivery
0
5. ad QyrNerye) t kit's
as (Onlyll requested
d
a!
Y7 . p
z ,:1
PS Fopf3311,
i
!r i
J
I
.? ?;
_i ?;
1,
1?. -. .. _1'=
' •-' 1~J
(._, .
i 7l ?
?`= ! 1
- h.a
?:
I.;_ (_?
r_ 1 ;_) la